Mitch Joel WARNING... LONG RANT! It takes a lot for me to both get angry and publish about it. Canada’s…
Health & Healthcare
New Alzheimer’s treatment fully restores memory function
Of the mice that received the treatment, 75 percent got their memory function back
Australian researchers have come up with a non-invasive ultrasound technology that clears the brain of neurotoxic amyloid plaques – structures that are responsible for memory loss and a decline in cognitive function in Alzheimer’s patients.
If a person has Alzheimer’s disease, it’s usually the result of a build-up of two types of lesions – amyloid plaques, and neurofibrillary tangles. Amyloid plaques sit between the neurons and end up as dense clusters of beta-amyloid molecules, a sticky type of protein that clumps together and forms plaques. (18 March 2015)
Everything You Know About Martin Shkreli Is Wrong—or Is It?
(Vanity Fair, December) Even before his arrest this week on securities fraud allegations, Wall Street’s most visible villain was infamous for gouging AIDS patients and pregnant women.
In the spring of 2012, MSMB announced that it was investing $4 million in a new biotech company called Retrophin, and Shkreli said that he was going to wind down MSMB to devote all of his time to the new company.
Shkreli says his initial idea for Retrophin was to purchase two drugs from Valeant, Cuprimine and Syprine, which are used to treat Wilson disease, an inherited disorder that causes severe liver and nerve damage. His plan, he says, was to jack up the prices. But the deal fell apart.In late 2012, Shkreli took Retrophin public’ Over the next two years, the company raised an additional $100 million from investors … At least some of the investors wanted in based on the promise that Retrophin was going to develop new drugs for rare diseases, but the company started to buy existing drugs—including Thiola, which helps prevent a rare form of kidney stone—and hike the prices.
September 30, 2014, Shkreli had been replaced by Stephen Aselage. Shkreli immediately started a new company Turing. which a year later announced the $55 million acquisition of Daraprim from Impax Labs.
Hot Startup Theranos Has Struggled With Its Blood-Test Technology
Silicon Valley lab, led by Elizabeth Holmes, is valued at $9 billion but isn’t using its technology for all the tests it offers
(WSJ) Theranos has struggled behind the scenes to turn the excitement over its technology into reality. At the end of 2014, the lab instrument developed as the linchpin of its strategy handled just a small fraction of the tests then sold to consumers, according to four former employees.
In a complaint to regulators, one Theranos employee accused the company of failing to report test results that raised questions about the precision of the Edison system. Such a failure could be a violation of federal rules for laboratories, the former employee said.
Theranos also hasn’t disclosed publicly that it does the vast majority of its tests with traditional machines bought from companies like Siemens AG .
Cure for Type 1 Diabetes Imminent After Harvard Stem Cell Breakthrough
(Yahoo! News) Scientists say they have made a “giant leap forward” in finding a cure for Type 1 diabetes following a breakthrough in stem-cell related research.
Researchers at Harvard University claim a cure for the disease could be imminent after they were able to create insulin-producing cells, which are almost identical to those found in the human body using embryonic stem cells.
Described as a “major medical breakthrough”, scientists have recreated human beta cells in such quantity that cell transplantation is now possible, signalling an end to the daily insulin injections and health complications linked to Type 1 diabetes.
(Nick’s Gleanings) A blow struck for Chinese traditional medicine – Tu Youyou is one of the three co-winners of the 2015 Nobel Prize in Medicine (she got half, while the other two shared the other half since theirs was a joint effort) for discovering anti-malaria-, & anti-roundworm parasite-, drugs respectively. She is an 84 year-old pharmaceutical researcher long associated with the Academy of Chinese Traditional Medicine who during the Mao Tse Tung era developed an anti-malaria drug, artemsinin, from the sweet wormwood plant after having learnt from her study of ancient traditional medicine books that an extract from the plant had been used as far back as 400 AD to treat fevers. The Nobel Prize in Physiology or Medicine 2015
Scientists are working on an “exercise pill” so you never have to work out again
(Quartz) It took three years to create the exercise blueprint, and it will be many more before a pill could conceivably be available—“at least a decade,” says Hoffman. But the researchers are “actively working on” that end goal, he says.
Don’t like the idea of yet more drugs poured into the body but
“An exercise drug could have major benefits for the elderly, as well as people who have obesity, type-2 diabetes, and cardiovascular disease. Though it sounds like a gift to the lazy, such a treatment could transform the lives of many who cannot exercise.”
‘Pharma bro’ Martin Shkreli and the very American debate over maximizing profit
(WaPost) Prescription pricing is a strange thing to stir such rage, however. After all, Daraprim, the drug in question, is not widely used. It treats a potentially deadly condition called toxoplasmosis that primarily affects people with compromised immune systems, such as newborns and HIV patients.
Moreover, “Pharma bro,” as Shkreli quickly became known, is not the first person to corner the market on a drug and then hike its price — although he is a frequent offender.
So, how did Shkreli become the Internet’s latest villain?
Much of the reason lies with the former hedge fund manager’s unabashed pursuit of profit.
(CBS & CBC) The news of the 5,000 percent overnight increase in the price of Daraprim caused such outrage that CEO Martin Shkreli (a nasty piece of work according to media accounts) of Turing Pharmaceuticals has backed down, although he seems unchastened. The outcry over Daraprim has also caused Rodelis Therapeutics to reverse its decision to introduce a 2000% increase in the price of Cycloserine, a critical drug used to treat a rare and dangerous form of multidrug-resistant tuberculosis. Rodelis is returning the rights to Cycloserine to the non-profit Chao Center from which they were purchased in August.
Jimmy Carter to get radiation, new immune therapy for skin cancer that spread to liver, brain
(AP) Carter said he will get two types of treatment — focused radiation to the tumors in his brain and a drug aimed at boosting his immune system. On Wednesday, he received the first dose of pembrolizumab, or Keytruda — a Merck & Co. drug recently approved for treating melanoma. It removes a sort of cloaking mechanism that cancer cells use to evade attack by the immune system. Three additional doses are planned at three-week intervals.
“It’s a wonderful drug,” with relatively few side effects, as opposed to older, traditional chemotherapy drugs that cause hair loss and other symptoms, said Dr. Patrick Hwu, a melanoma expert at the University of Texas MD Anderson Cancer Center who helped test it and other immunotherapies.
Carter also received a stereotactic radiation treatment on Thursday afternoon. It focuses beams precisely on tumors and avoids other areas of the brain and causes far fewer side effects than the whole-brain radiation common in the past. He was fitted with a customized mask to hold his head perfectly still to help make sure the radiation goes only where it is intended. More radiation treatment could be scheduled if needed.
Fetal Tissue Gives Hope for One of the Worst Diseases
Planned Parenthood is right to supply it.
(Slate) Stem cells hold terrific promise for the treatment—and, eventually, the defeat—of ALS. The most useful stem cells are found in fertilized embryos and fetuses, where they haven’t yet developed into specialized cells. (Scientists can also reprogram adult cells to act like embryonic stem cells, but these reprogrammed cells, while useful for research, have not been shown to be therapeutically safe.)
(Quartz) New hope in the fight against Alzheimer’s? Eli Lilly and Biogen present new data on the degenerative brain disease at a conference in Washington. Biogen will unveil results of a trial using a smaller, safer dose of a proven drug; Lilly will announce whether it has found a way to make its drug, solanezumab, slow down the progression the disease.
Will Trial Results for Lilly and Biogen Alzheimer’s Drugs be Hard to Forget?
(WSJ/Pharmalot) Two efforts from Eli Lilly and Biogen, in particular, are drawing considerable attention. Lilly will unveil results of a clinical trial of a medicine that will help signal whether the drug cannot only overcome earlier, negative studies, but become the first marketed treatment to slow the worsening of the underlying disease, The Wall Street Journal notes.
A leading theory is that the buildup of a sticky protein known as beta amyloid in the brain contributes to the disease. The Lilly drug, which is called solanezumab and is infused intravenously, is designed to bind to amyloid and clear it from the brain, the Journal writes. But the project is risky because like most other drugs targeting amyloid, results in earlier trials were mostly negative.
Canadian-Led Ebola Vaccine Hugely Successful, Provides 100% Protection: Study
An Ebola vaccine provided 100 per cent protection in a field trial in hard-hit Guinea, researchers and officials said Friday, marking “the beginning of the end” of the killer West African outbreak.
The world is “on the verge of an effective Ebola vaccine,” the World Health Organization (WHO) said, hailing the results from the first efficacy test of the VSV-ZEBOV vaccine among people living in a high-danger zone.
“This is an extremely promising development,” added WHO chief Margaret Chan. “An effective vaccine will be another very important tool for both current and future Ebola outbreaks.” …
The test, backed by drug firm Merck, the WHO and the governments of Canada, Norway and Guinea, saw 4,123 high-risk people vaccinated immediately after someone close to them fell ill with the deadly haemorrhagic fever.
None of the vaccinated group caught the virus, according to study results published in The Lancet medical journal.
Ahead of Alzheimer’s meeting, researchers seize on signs of progress
(Reuters) After decades of Alzheimer’s research that led to dead ends, including 123 drugs that failed, top researchers in the field say they are far more confident now of producing an effective treatment.
Their optimism has been building ahead of the Alzheimer’s Association International Conference (AAIC), which starts on Saturday in Washington, DC. … the field has gained a major understanding of how the brain changes with Alzheimer’s and better insight on how and when to intervene medically.
Alzheimer’s May Begin 20 Years Before Symptoms Appear
(TIME) … in the most recent report published Wednesday in the journal Neurology, experts say that the disease may actually begin even earlier — 18 years earlier, in fact — than they expected. … the results only link cognitive testing scores on broad, group-level risk, and can’t be used to predict an individual’s risk of developing the disease. For one, more research will be needed to find the range of decline that signals potential Alzheimer’s dementia. But the findings do set the stage for studying whether such a non-invasive, easily administered test can, or should be, part of a regular assessment of people’s risk beginning in middle-age. That way, he says, people may have a longer time period in which to hopefully intervene to slow down the disease process. Rajan plans to study whether brain-stimulating activities like crossword puzzles or learning a new language and social interactions can improve the test scores, and in turn slow the time to diagnosis of Alzheimer’s. At the very least, he says, the current data shows that there is a longer window of time in which people might be able to intervene in these ways and potentially delay Alzheimer’s most debilitating effects. [Cognitive impairment 18 years before clinical diagnosis of Alzheimer disease dementia]
A challenge for new doctors: Focus on the patient, not just the symptoms
André Picard’s commencement address to graduating class of medical doctors at the University of Manitoba.
“In this, the Internet age, we are drowning in information, but starving for wisdom. I urge you, as you forge long, successful and prosperous careers, to not just be smart, but be wise.
In every interaction you have, embrace the ancient wisdom of Hippocrates: “Whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient.”
Alzheimer’s study finds possible cause of disease
(The Guardian) The findings published in the Journal of Neuroscience contradict current thinking on Alzheimer’s and offer hope of finding new treatments
The [Duke University] research suggests that in mice with Alzheimer’s disease certain immune cells that normally protect the brain begin abnormally to consume an important nutrient called arginine.
By blocking this process using the drug difluoromethylornithine (DFMO), memory loss and a buildup of sticky proteins known as brain plaques were prevented.
Alzheimer’s: New hope for research after years of gloom and dead ends
Findings from the US bring us closer to understanding what causes this disease, but ‘Alzheimer’s mice’ are not a perfect parallel for what happens in human brains
Is Myopia The New Rickets? Are Schools To Blame?
(Science 2.0) A new study compares the history of school myopia with the bone disease rickets. During the 17th century, rickets was common among children in England and then reached epidemic levels through northern Europe and North America. In some cities, 80 percent of children were affected.
The remedy proved elusive until the 1920s, when scientists discovered that a lack of sunlight, resulting in vitamin D deficiency, was the cause of rickets.
Over the last 30 years, short sight, or myopia, has become a global health problem. The most dramatic rise has been in Singapore, Taiwan, China’s cities and elsewhere in East Asia, where rates can be as high as 80-90 percent among children leaving secondary schools in the region. As many as a fifth of them have severe myopia and so are at high risk of eye problems in later life.
In Western countries rates are increasing; although not as rapidly as in East Asia. Myopia, like rickets, is a seasonal condition which seems to get worse in the winter, according to a new paper. Recent papers on myopia have revived an old hypothesis from the 1890s, that school children who spend more time outdoors have lower levels of myopia. However, unlike rickets, low ambient light levels rather than low vitamin D levels seem to be the deciding factor in myopia.
New Alzheimer’s treatment fully restores memory function
Of the mice that received the treatment, 75 percent got their memory function back.
Australian researchers have come up with a non-invasive ultrasound technology that clears the brain of neurotoxic amyloid plaques – structures that are responsible for memory loss and a decline in cognitive function in Alzheimer’s patients. … As we don’t have any kind of vaccine or preventative measure for Alzheimer’s – a disease that affects 343,000 people in Australia, and 50 million worldwide – it’s been a race to figure out how best to treat it, starting with how to clear the build-up of defective beta-amyloid and tau proteins from a patient’s brain. Now a team from the Queensland Brain Institute (QBI) at the University of Queensland have come up with a pretty promising solution for removing the former. Publishing in Science Translational Medicine, the team describes the technique as using a particular type of ultrasound called a focused therapeutic ultrasound, which non-invasively beams sound waves into the brain tissue.
Maria Shriver: Help Me Wipe Out Alzheimer’s Now
(HuffPost) Alzheimer’s still carries a stigma of the unknown — even though today, more than 5 million Americans have it. That’s right. Every 67 seconds, another one of us develops Alzheimer’s. Women in their 60s are about twice as likely to develop Alzheimer’s as breast cancer. With 10,000 baby boomers turning 65 every day, there will be 13.5 million of us with Alzheimer’s by 2050. And many people don’t understand that Alzheimer’s isn’t a natural part of aging. Alzheimer’s is a disease that kills.
The truth is, we’re right in the middle of an epidemic, but we as a nation are in denial. An Oscar for “Still Alice” is shining the brightest light yet on Alzheimer’s, but light isn’t enough anymore. Attention isn’t enough. It’s time to get serious. Alzheimer’s is exerting a powerful impact on American families — on our health, our finances, and our futures. And women are disproportionately impacted.
Why women? Back in 2010, when we published “The Shriver Report: A Woman’s Nation Takes on Alzheimer’s,” we broke the news that women were more than half the individuals diagnosed with Alzheimer’s and nearly two-thirds of the unpaid caregivers of those who had it. Now those numbers are far worse. Today nearly two-thirds of those with Alzheimer’s are women — that’s more than 3.2 million women. And women are more than 70 percent of Alzheimer’s caregivers, having to reduce their own workload or even drop out of the workforce altogether to care for loved ones.
I Am Still Sandy
Sandy Oltz, Mom, former nurse and Alzheimer’s Association advocate who was diagnosed with the disease at 46 years old.
(HuffPost) The facts about Alzheimer’s are alarming: Alzheimer’s is the sixth leading cause of death in the U.S. and it is the only cause in the top 10 without a treatment to cure, prevent or slow its progression. Almost two-thirds of Americans with Alzheimer’s are women, and more than 60 percent of Alzheimer’s and dementia caregivers are women. I have learned death rates for other serious diseases, such as heart disease, prostate cancer and HIV/AIDS, are actually declining. That is not the case for Alzheimer’s. As baby boomers age, the number of people with Alzheimer’s is projected to triple to 13.5 million by 2050, or 11 percent of the U.S. senior population.
WHO: Climate change will increase threat of neglected tropical diseases
Neglected tropical diseases such as yaws, guinea worm and dengue fever are likely to spread beyond their traditional habitats due to climate change, says a report by the World Health Organization. “The potential for spread provides yet another strong argument for making the needed investments” in curbing NTDs, says Dirk Engels of WHO. Responding to Climate Change (U.K.) (2/20), Reuters (2/19)
John Oliver Takes Down Big Pharma in his Return to Last Week Tonight
He rolled a clip profiling corporate reps who hound doctors for prescribing too many of their competitors’ brands. He compared an over-the-top sales meeting for an asthma medication to an “NBA pre-game show.” His revelations may not be new to anyone who’s paid attention to news stories on these subjects in recent years, but as usual, Oliver managed to crystallize some appalling facts about the way the U.S. works. Stay through the end for a biting take on prescription drug ads. (9 February 2015)
Experts raise hope of end to Ebola outbreak
Infection rates have slowed significantly say the World Health Organisation, while a new vaccine is now being trialled in Liberia. But the devastation will cast a long shadow, writes Simon Allison
Reading between the lines of the dry, technical language, it’s possible to detect a hint of optimism in the latest Ebola situation report from the World Health Organisation (WHO).
“For the first time since [late June 2014], there have been fewer than 100 new confirmed cases reported in a week in the three most-affected countries,” said the report. This is a significant milestone, and is pretty convincing proof that the effort to slow the spread of Ebola has worked.
In the week ending on 25 January 2015 (the most recent data available), there were just 99 cases in West Africa – 65 in Sierra Leone, 30 in Guinea, and only four in Liberia, which is the country closest to eradicating the disease entirely.
Ebola vaccine trials begin on volunteers in Liberia
Two experimental vaccines are being tested on 600 volunteers in the first phase of trials that authorities hope will eventually include 27,000 people
(The Guardian) A large-scale human trial of two potential Ebola vaccines has started in Liberia’s capital, part of a global effort to prevent a repeat of the epidemic that has now claimed nearly 9,000 lives in west Africa.
The trials in Liberia are taking place after smaller studies determined that the vaccines were safe for human use. By comparing them now with a placebo shot, scientists hope to learn whether they can prevent people from contracting the deadly virus that has killed 60% of those admitted to hospital with the disease.
The World Health Organisation says the Ebola epidemic has infected more than 22,000 people and claimed more than 8,800 lives over the past year. Without a vaccine, officials have fought the outbreak with old-fashioned public health measures, including isolating the sick, tracking and quarantining those who had contact with them, and setting up teams to safely bury bodies.
Post-Ebola, AU plans pan-African CDC
(Devex) The African Union will announce the launch of its Ebola Solidarity Fund on Friday during the AU summit in Addis Ababa, a first step toward its goal of establishing an African center for disease control by mid-2015.
On the heels of criticism from Oxfam that African leaders aren’t doing enough to contain the Ebola outbreak, AU Commissioner for Social Affairs Mustapha Sidiki Kaloko said that the first phase would focus on “an early warning system” for the detection of epidemics. 5 most promising innovations for Ebola response
UN’s Nabarro: Efforts against Ebola are working
Ebola in Liberia, Guinea and Sierra Leone is waning, according to Dr. David Nabarro, the United Nations special envoy for Ebola. “The change in behavior that we’ve been hoping for, working for, anticipating, is now happening everywhere,” he says. Reuters (1/15), ABC News/The Associated Press (1/15), Voice of America (1/15)
Bad luck, not genes or the environment, cause for many cancers, researchers find
(PBS Newshour) Sometimes there just isn’t a good explanation for a cancer diagnosis other than random bad luck.
That’s what researchers at Johns Hopkins have found. In a study published Thursday in the journal Science, oncologist Dr. Bert Vogelstein and biomathematician Cristian Tomasetti link more cancers than previously thought to random DNA mutations, and not to heredity or environmental factors.
Their analysis reveals a strong correlation between the total number of divisions that naturally occur in a tissue over its lifetime and the risk of getting cancer in this tissue. So, the greater number of divisions, the higher the risk of developing cancer in that tissue.
The two looked at rates of cell division among 31 types of tissue. They found that 22 of the types, including pancreatic, bone, ovarian and brain cancer, are often affected by these random divisions.
But the researchers warn that this new analysis does not mean that people should ignore other factors that could contribute to developing cancer. Tomasetti said, for instance, it is well known that smoking carries a huge risk for lung cancer, so it depends on the tissue.
PBS Newshour: This is how you get Ebola, as explained by science (30 September 2014)
Hell in the Hot Zone
As the Ebola epidemic rages, two questions have emerged: How did the deadly virus escape detection for three months? And why has a massive international effort failed to contain it? Traveling to Meliandou, a remote Guinean village and the likely home of Patient Zero, Jeffrey E. Stern tracks the virus’s path—and the psychological contagion that is still feeding the worst Ebola outbreak in history. (Vanity Fair, October 2014)
Epidemics Expert Jeremy Farrar: ‘The Most Dangerous Emerging Disease Is Drug Resistance’
Farrar: We do not live in the 19th century. We live in the 21st century. We have to use all the resources available to us, including those of modern science, to stop this epidemic. I think it is possible that this epidemic will continue well into the second half of 2015. If we had a safe and effective vaccine, this could play a major role. Not to mention in future epidemics.
SPIEGEL: You think there will be more outbreaks in the future?
Farrar: Yes, future epidemics are inevitable. There remains a big reservoir of the Ebola virus in animals, probably in primates and forest-living bats. Occasionally, when humans come into contact with those animals, they will get infected. The biggest worry I would have is that, as the virus spreads more widely, it could become established in domesticated animals in rats or in bats that live very close to lots of people in huge cities. So there could be more outbreaks of Ebola in in these big urban centers. To have a vaccine then would be crucial.
SPIEGEL: Is it possible to completely eradicate such an infectious disease?
Farrar: It is possible for some infectious diseases, such as smallpox, but not in an infection that has an animal reservoir like Ebola. Moreover, eradication is only possible with a vaccine. With other interventions — drugs or behavior change, for example — this is impossible.
Ebola response too slow: Doctors Without Borders
(AP) The number of people infected with Ebola has passed, 17,000, according to data published Tuesday by the World Health Organization. Of those, more than 6,000 have died. Emphasizing the severity of the outbreak, Sierra Leone announced that another doctor, its 10th, has tested positive for Ebola.
The vast majority of Ebola infections are in Guinea, Liberia and Sierra Leone, poor countries that have been left to handle the crisis without sufficient help, said Doctors Without Borders. It said foreign donors had concentrated on building clinics but did not provide medics to staff the centers. The group repeated its call for countries to deploy biological-disaster response teams.
WHO’s Chan: An informed public can stem Ebola’s disruption
Governmental efforts to better inform the public about Ebola are a “good defense strategy” and will help curb the economic costs of the disease, says Margaret Chan, director-general of the World Health Organization. The United Nations envoy on Ebola, David Nabarro, hopes the outbreak can be contained during the coming three months. The Associated Press (10/13), BBC (10/11), Voice of America (10/13)
Canadian Ebola vaccine to start clinical trials
Early clinical trials of a Canadian Ebola vaccine are being launched at an American research institute, research that Health Minister Rona Ambrose hopes could one day stop the spread of the virus.
The tests on a small number of healthy people will, however, take at least two months, and if successful would require further trials – making it unclear when, if ever, the vaccine could be deployed to front-line health care workers or others.
Ebola: If the outbreak of Ebola in West Africa is not quickly brought under control, the number of infected will pass 20,000 by Nov. 2, raising the possibility that the disease will become endemic, remaining a constant presence, according to a new report by the World Health Organization. The estimate is significantly more dire than previous assessments, which posited that the region might pass 20,000 cases in nine months. more (NYT via Foreign Policy)
Black and Hispanic Kids Have a 50 Percent Chance of Developing Diabetes
A major new study finds diabetes risks skyrocketing for all Americans, but especially among certain racial and ethnic groups.
(Mother Jones) The good news: According to a study published Wednesday in the Lancet, American children diagnosed with diabetes can now expect to live more than 70 years with the disease. The bad news: Black and Hispanic individuals have about a 50 percent chance of developing diabetes over the course of their lifetimes, and Americans overall have a 40 percent chance.
(HuffPost) BURIAL TRADITIONS SPREADING EBOLA “The harder phone calls that the Dead Body Management Team receives, and the more dangerous burials they perform, take place in the communities themselves. Here, they must walk a delicate line between allowing the family to perform goodbye rituals and safeguarding the living from infecting themselves. The washing, touching, and kissing of these bodies—typical in many West African burials—can be deadly. But prohibiting communities from properly honoring their dead ones—and thereby worsening their distrust in medical professionals—can be deadly, too.” The latest tactic West African countries are using to limit the spread of the disease — Using a Tactic Unseen in a Century, Countries Cordon Off Ebola-Racked Areas
(CBC The Current) Are drugs the best way to curb the Ebola outbreak? The World Health Organization has ruled that experimental drugs should be made available to countries dealing with the outbreak. We look at the science and ethics of using an unproven Ebola treatment, and if focusing on drugs is the best way to curb the outbreak.
Ebola outbreak is a public health emergency, WHO says
World Health Organization says extraordinary response needed to stop virus’s spread
It is the largest and longest outbreak ever recorded of Ebola, which has a death rate of about 50 per cent and has killed at least 961 people as of Aug. 6. WHO declared similar emergencies for the swine flu pandemic in 2009 and for polio in May.
The WHO chief, Dr. Margaret Chan, said the announcement is “a clear call for international solidarity” although she acknowledged that many countries would probably not have any Ebola cases.
The Center for Disease and Control has classified Ebola as a level one threat, highlighting concerns about the virus’s spread into Nigeria. Medical experts continue to call for greater access to the experimental drugs two infected American missionaries received. The death toll of the deadly virus is fast approaching 1,000, and health workers are frantically looking to track down 70 people who may have had contact with the virus. And here’s how Ebola kills its victims. [NBC] World Health Organization calls on medical ethicists to weigh in on the use of experimental treatments for Ebola outbreak
How Terrifying Is the New Ebola Outbreak?
Where the epidemic is spreading and what can be done to stop it.
On March 25, 2014, the Centers for Disease Control and Prevention (CDC) announced that 86 suspected cases of Ebola had been reported to the World Health Organization across four southeastern districts in Guinea. At that time, cases were also being investigated in Liberia and Sierra Leone. By April 1, Liberia was reporting eight suspected cases and two deaths. On May 26, a case of Ebola was confirmed in Sierra Leone. Since then, the disease has continued to spread across the region. Guinea has had the highest suspected death toll so far, with 314 fatal cases as of July 20.
Have there been Ebola outbreaks of this size before?
No, health workers are reporting that this is the deadliest. According to data compiled by the BBC and the World Health Organization, the outbreak that comes closest occurred in 1976, when over 400 people died. Many of those cases occurred in then-Zaire (now Democratic Republic of Congo) cropping up near the Ebola river (for which the disease is named). Since then, there have been several outbreaks across Africa, but none of this scale.
Malaysia Airlines Flight MH17: Joep Lange, AIDS fighter, feared killed
The United Nations AIDS program, UNAIDS, said it feared “some of the finest academics, health-care workers and activists in the AIDS response may have perished” on the plane.
(CBC) … Among them was Lange, the former president of the International AIDS Society who researched the condition for more than 30 years and was considered a giant in the field. Lange was also admired for his tireless advocacy for access to affordable AIDS drugs for HIV positive patients living in poor countries.
Antibiotics are losing effectiveness in every country, says WHO
World Health Organisation warns of ‘devastating’ consequences and says once-beaten diseases could re-emerge
(The Guardian) Antibiotics are losing their power to fight infections in every country in the world, according to new data from the World Health Organisation – a situation that could have “devastating” consequences for public health. It raises the possibility that once-beaten diseases will re-emerge as global killers.
Antibiotic resistance is a major threat to public health, says the WHO. It is no longer something to worry about in the future, but is happening now and could affect anybody, anywhere, of whatever age.
“Without urgent, co-ordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill,” said Dr Keiji Fukuda, the WHO’s assistant director general for health security.
“Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine. Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public-health goods and the implications will be devastating.”
The new report is the first to gather comprehensive data from the WHO on antibiotic resistance and has information from 114 countries. Although the data is more complete in some regions than in others, it is clear that drug-resistant strains of bacteria and viruses are common and that trying to preserve the efficacy of the antibiotics we have is a losing battle.
25 April 2014 — Immunization prevents an estimated 2-3 million deaths every year. Yet 1 in 5 children still misses out. As working parents, there is often so much to juggle at home and professionally that it is all too easy for vaccinations to fall off of the ‘to do’ list. WHO has helped develop a new app that contains information on vaccines, the diseases they prevent and the immunization schedule of the country. Feature story about the immunization app
World Immunization Week 2014: Know, Check, Protect
( WHO)Immunize for a healthy future: Know, Check, Protect. This is the message of this year’s World Immunization Week, on 24-30 April. This short video encourages you to ask your local health clinic which vaccines you need, check whether your vaccinations are up-to-date, and to get the vaccines you need, when you need them.
Vaccines Work. These 8 Charts Prove It.
More kids die of vaccine-preventable diseases every year than the entire population of Philadelphia—but that’s a lot less than just 30 years ago.
How to tell when your memory loss is normal – and when it’s dementia
(Globe & Mail) Most people think of memory as short term or long term. That it is one system that remembers what you had for dinner last night and what you wore at your prom night 40 years ago. Memory researchers now see a much more complex interconnected system that can be oversimplified into four key types of memories: episodic (personal experiences), semantic (knowledge), procedural (physical memory such as playing an instrument or hitting a golf ball), and finally, working memory.
Dr. Mike Evans is a staff physician at St. Michael’s Hospital, an Associate Professor of Family Medicine and Public Health at the University of Toronto, and a scientist at the Li Ka Shing Knowledge Institute
Margaret Lock: The real challenge of aging and dementia
(Policy Options) The acclaimed cultural anthropologist asks whether our obsession with finding a “cure” for Alzheimer’s disease distracts from the need for a broader public health engagement with aging populations and with the multiple causes of dementia.
In order to assess why and how so many individuals remain healthy and active even in old age, a move must be made away from AD causation conceptualized as in the brain alone, to include variables mediated by the boundary-traversing mind, such as education, traumatic social and familial events, social isolation, deprivation, and so on, and, in addition, variables that affect neurodevelopment directly, including exposure to toxins, prions, other disease-causing entities, inadequate diet, and others. If the AD “epidemic” is to be confronted, a public health approach orchestrated at global and local levels is called for, one that targets variables than can readily be manipulated without resort to expensive technologies, high-powered facilities, and highly trained personnel. This, surely, is the most humanitarian and effective way to approach the problem, one that does not, of course, rule out support of a well-funded research program designed to tackle the molecular puzzles that are so challenging.
Although those who work to increase funding for AD wish to sustain a frightening image of the global future ravaged by an unstoppable AD epidemic, the reality is that there will be no silver bullet for Alzheimer disease — the heterogeneity of the condition that so many researchers surely recognize ensures that this will be so. The challenge presented by an aging brain exceeds that posed by all other organs of the body. (January 2014)
Alzheimer’s treatment breakthrough: British scientists pave way for simple pill to cure disease
Historic ‘turning point’ hailed as UK researchers discover how to halt death of brain cells, opening new pathway for future drug treatments
Obamacare week two – Administration admits to website design problems – ACA ground war won or lost in Texas
(Politico) More than 8 million visitors have visited Healthcare.gov, with one-third accessing educational information and two-thirds accessing the marketplace to begin their application and shop for plans, according to an HHS release late Friday. The agency also said it assigned more technicians to work on the system around the clock and added additional servers. … The Obamacare ground war will be won and lost in places like Texas, our colleague Jennifer Haberkorn reports from Houston. If a significant number of the 6.1 million uninsured Texans don’t enroll, then the White House could miss its national enrollment targets, the exchanges could falter and insurance rates could spike. That’s exactly what leading Texas politicians like Gov. Rick Perry and Sen. Ted Cruz would like to see happen. But advocates are banking on a grass-roots push in more liberal, urban areas of the state, plus the demand among the uninsured to get health coverage. http://politi.co/18JLccJ
Cellular Breakthrough Earns Trio Nobel For Medicine
James Rothman and Randy Schekman of the United States and Thomas Suedhof of Germany won the Nobel Prize for Medicine on Monday for groundbreaking work on how the cell organises its transport system.
Their discoveries have unlocked insights into diseases ranging from diabetes to immune-system disorders, the Nobel Committee said.
They learned how molecules that are key to the functioning of the cell are shunted around in an internal freight system, packaged in tiny bubbles called vesicles.(7 October)
Slow Ideas — Some innovations spread fast. How do you speed the ones that don’t?
by Atul Gawande
We yearn for frictionless, technological solutions. But people talking to people is still the way that norms and standards change.
(The New Yorker) … This has been the pattern of many important but stalled ideas. They attack problems that are big but, to most people, invisible; and making them work can be tedious, if not outright painful. The global destruction wrought by a warming climate, the health damage from our over-sugared modern diet, the economic and social disaster of our trillion dollars in unpaid student debt—these things worsen imperceptibly every day. Meanwhile, the carbolic-acid remedies to them, all requiring individual sacrifice of one kind or another, struggle to get anywhere. (29 July 2013)
“Why We Care” paints intimate portraits of why global leaders support access to reproductive health
To coincide with London Summit on Family Planning, Aspen global health and development and the United Nations Foundation unveil a groundbreaking book titled, “Why We Care.” The book provides a platform through which Global Leaders on Reproductive Health will focus international attention on the world’s hardest to reach women, who want access to voluntary contraception to build on the momentum set by the London Summit’s goals and commitments. Read more. (11 July 2012)
Bill Maher And Congressman Give Tea Partier Lesson In Obamacare
… within that batch of people who do not like Obamacare are those who think it did not go far enough. They wanted a single payer system. … 16% of that 54% want it to be more Left. They want single payer. … Based on early results those that get access to the real options in Obamacare are happy with the results. As such it is likely Obamacare will poll much higher as time goes by.
Some Americans Say They Support the Affordable Care Act but Not Obamacare
(The Atlantic) The idea that ignorance is the root of much disagreement—that if Americans understood the healthcare law, more would support it—seems condescending, but not invalid.
Countries unprepared for larger share of elderly, UN study says
Most countries are ill-prepared to handle the increasing number of senior citizens, a United Nations report finds. Lack of data has contributed to the absence of planning, the report argues. “Unless you measure something, it doesn’t really exist in the minds of decision-makers,” says John Beard of the World Health Organization. ABC News/The Associated Press (10/1), The Guardian (London) (9/30)
Hi, It’s Your Doctor
By EZEKIEL J. EMANUEL
Health care is headed back to the future. House calls are a sign that we will all see our health care going back to the “old days” when, like my father, the doctor came to our homes, giving us real personalized medicine — and saving money at the same time.
(NYT) In 1930, house calls accounted for 40 percent of physician interactions. By 1980, that number had dropped to 1 percent.
But after a half-century, the house call is making a comeback. The available data on house calls are spotty at best. But one study estimated that in 2010, about 4,000 physicians conducted more than two million house calls. (5 September)
Bring on the Foreign Doctors
They’re just as good as the homegrown variety. So why don’t we let them practice here?
(Slate) If President Obama’s health care reform plan is implemented in its current form, the United States will face an estimated shortfall of 130,000 doctors by 2025. To put that into perspective, consider that the current shortage—which inspires much handwringing—is less than one-half that amount, according to projections from the Association of American Medical Colleges.
There’s a simple solution to this problem: Import more physicians from abroad. And yet, it takes years for foreign trained doctors to earn a U.S. license. Some of the safeguards are sensible, like verification of foreign credentials and proving English language fluency. Some are not. Even if a doctor has practiced for years in her home country, she must pass the same exams as graduates of American medical schools, then repeat three or more years of residency and fellowship training.
A recent New York Times article explored the bewilderment among some health care policy advocates as to why we’ve been slow to liberalize the importation of doctors from abroad. After all, we’re importing more farmhands and nurses to alleviate our shortages in those fields.
The deteriorating health of the working poor
(Broadbent Institute) Last year the Metcalf Foundation released a report on working poverty in Toronto. It found that 113,000 people were living in working poverty in the Toronto region in 2005, a 42% increase from 2000. The report’s findings indicate that people living in working poverty most commonly work in sales and service occupations; work comparable hours and weeks as the rest of the working population; are over-represented by immigrants; and are only slightly less-educated than the rest of the working age population.That report raised questions for us on the impact that working and living in poverty has on health. How healthy are people who are working but still can’t make ends meet? How does their health compare to those who are working and have sufficient incomes? How do both of those health outcomes compare to those who are poor and not working?
In our report Rising Inequality, Declining Health, we used data from the Survey of Labour and Income Dynamics, and the Metcalf definition of working poverty to answer these questions. These data show that those who are working but still live in poverty have worse health than those who are working and make sufficient incomes.
Esther Dyson: The HICCup Manifesto
(Project Syndicate) It is hard to find anyone in health care who does not believe that spending $100 now on healthy behavior – exercise and proper nutrition, counseling for pre-diabetics, risk monitoring, and so on – could yield more than $200 in reduced costs and improved outcomes later. The numbers are fuzzy, of course, and there are plenty of methodological caveats, but there is little dispute about the desirability of such an approach.
Instead of just complaining, I recently decided to create HICCup, the Health Intervention Coordinating Council, a self-appointed counseling service aimed at persuading local institutions to embrace a long-term perspective and launch a full-scale intervention in their communities. For practical reasons, there are a few guidelines – but anyone who wants to do this without following our rules is welcome to do so.
The U.S. health-care gouge
Two-thirds of personal bankruptcies are caused by huge medical bills, writes WILLIAM MARSDEN
(Canada.com) If you need a new hip or knee joint in the United States, it’s probably best not to hobble over to Monterey Park Hospital in California. They’ll try to skin you for at least $223,000 US. In fact, stay out of California altogether. Just over in Inglewood at the Centinela Hospital Medical Center the charge isn’t any better: a mere $220,800.
The best bet is to head for tiny Ada, Okla. There, the Chickasaw Nation Medical Center will fix you up for only $5,300.
This huge disparity is the same story for pretty well every medical procedure everywhere in the United States. Sticker prices are shockingly inflated and the differences are in many cases astronomical, according to a database of hospital medical charges made public by the White House this week.
Laura Tyson: America’s Healthy Path to Fiscal Health
Trends in the US budget reflect an inconvenient truth: If the growth of spending on health-care programs cannot be slowed, stabilizing the federal debt at a sustainable level will require deep cuts in spending on other priorities and increases in taxes on the middle class. The recent slowdown in the growth of health-care spending is a promising sign that America’s budgetary tradeoffs may turn out to be less difficult than expected.
(Project Syndicate) Over the last five years, the growth of health-care spending in the United States has slowed dramatically – to the lowest rate in the past 50 years. The slowdown is not a surprise. It is a predictable result of the recession and slow recovery that have left millions of Americans without health insurance and dampened household spending. …
As a result of the recession and lagging recovery, health-care spending has also slowed significantly since 2009 throughout the OECD. Indeed, for the first time on record, real health-care spending stalled on average in the OECD in 2010, as developed countries, reeling from budgetary constraints, clamped down on health programs. Growth in health-care spending was slower in every OECD country in that year, with the exception of Germany.
Canada loses out on drug pricing: UBC study
(Eureka) Health systems worldwide are increasingly negotiating secret price rebates from pharmaceutical companies and Canadians risk losing out on the deal.
“The pricing of medicines is now a game of negotiation, similar to buying a car at a dealership,” says Steve Morgan, an expert in health policy at the University of British Columbia. “There’s a list price equivalent to a manufacturer’s suggested retail price; and then there’s secret deals that everyone negotiates from there.”
In a study published today in the April issue of the journal Health Affairs, researchers interviewed policymakers from nine developed countries and analyzed practices for securing confidential manufacturers’ rebates.
They confirmed that almost all countries are now routinely negotiating rebates from drug companies as a condition of coverage under their health care systems. Manufacturers are promoting these rebates because the associated confidentiality clause ensures deals struck in one country don’t set precedent in others.
(NYT) The most rigorous study to date of how much it costs to care for Americans with dementia found that the financial burden is at least as high as that for either heart disease or cancer, and is probably higher
Estimating the Soaring Price Tag and Other Costs of Dementia Care
(PBS Newshour) A new study by the RAND Corporation estimates the cost of dementia care as $41,000 to $56,000 anually per patient. Jeffrey Brown examines the findings and implications with Dr. Ronald Petersen, director of the Mayo Alzheimer’s Disease Research Center, and Dr. Richard Hodes, director of the National Institute of Aging.
Novartis loses landmark India patent case on Glivec, govt hails ‘historic’ SC verdict
India’s top court dismissed Swiss drugmaker Novartis AG’s attempt to win patent protection for its cancer drug Glivec, a blow to Western pharmaceutical firms targeting India to drive sales and a victory for local makers of cheap generics.
The decision sets a benchmark for intellectual property cases in India, where many patented drugs are unaffordable for most of its 1.2 billion people, and does not bode well for foreign firms engaged in ongoing disputes in India, including Pfizer Inc and Roche Holding AG, analysts said.
[Editor’s Note: At least one Wednesday Nighter suggests that as many patents for the most popular prescription drugs from the major pharmaceutical companies either recently expired or are set to expire there could be a 15% reduction in drug costs in Canada over the next decade, but that the real potential for these drugs lies in the soaring diabetes, hypertension, obesity and related health problems in populous emerging economies resulting from their rising middle classes adapting Western diets/habits, e.g. Just about all of Egypt’s middle class has high blood pressure and diabetes. New biopharmaceuticals, even if they are more effective, will likely not see significant uptake in emerging markets in the presence of viable, much more cost-effective traditional pharmaceuticals – especially when they are available at a fraction of the cost as generics. and that decisions against large pharmaceuticals trying to update their popular drugs to extend their patents in emerging markets matter. Decisions such as those in India will set a precedent for other populous, emerging economies.]
Dr Eric Topol on NBC News’ Rock Center: iPhone is the future of medicine
In a recent video on NBC News’ Rock Center, cardiologist Dr Eric Topol has revealed that the iPhone may well be the future of modern medicine.
In his interview, Topol appeared convinced that smartphone-enabled medical devices will bring down costs and revolutionise modern medicine, making it more efficient and more effective than ever before. He showcased a handheld ultrasound machine, and an iPhone-compatible EKG machine. It is devices like this that he believes will enable doctors to carry out procedures in primary care, or even at the home of patients.
Could polio soon meet the same end as smallpox?
Despite the recent murders of 16 health workers associated with anti-polio efforts in Pakistan, eradication of the disease appears “tantalizingly close,” writes Jeffrey Kluger. “Just 25 years ago, polio was endemic to 125 countries and would paralyze or kill up to 350,000 people — the overwhelming majority of them children — each year. Now the disease has been run to ground in just three countries: Afghanistan, Pakistan and Nigeria, and in 2012, it struck only 215 people worldwide,” Kluger writes. Time.com (1/3), Time.com/LightBox (1/3)
Germany ‘exporting’ old and sick to foreign care homes
Pensioners are being sent to care homes in eastern Europe and Asia in an austerity move dismissed as ‘inhumane deportation’
(The Guardian) Growing numbers of elderly and sick Germans are being sent overseas for long-term care in retirement and rehabilitation centres because of rising costs and falling standards in Germany.
The move, which has seen thousands of retired Germans rehoused in homes in eastern Europe and Asia, has been severely criticised by social welfare organisations who have called it “inhumane deportation”.
But with increasing numbers of Germans unable to afford the growing costs of retirement homes, and an ageing and shrinking population, the number expected to be sent abroad in the next few years is only likely to rise. Experts describe it as a “time bomb”.
Germany’s chronic care crisis – the care industry suffers from lack of workers and soaring costs – has for years been mitigated by eastern Europeans migrating to Germany in growing numbers to care for the country’s elderly.
Increased life expectancy brings wellness concerns
People the world over are living longer, yet more young and middle-aged adults are suffering from diseases and conditions typically associated with wealthy nations — notably cancer, heart disease, diabetes and depression. The results of a five-year survey reveal that “[w]e are in transition to a world where disability is the dominant concern as opposed to premature death,” said Christopher J.L. Murray, who directed the study published Thursday in The Lancet. The New York Times (tiered subscription model) (12/13), The Washington Post (12/13), PRI’s The World (Boston) (12/13)
Universal health care now benchmark for global development
Universal health coverage was endorsed Wednesday by the United Nations General Assembly. “There have been lots of discussions of what health goals should be, for example on non-communicable diseases. This resolution gives weight to health systems as a whole and questions of equity. It ensures that universal health care stays on the agenda as one of the post-MDG goals,” said Ceri Averill of Oxfam. The Guardian (London) (12/13), The Guardian (London) (12/12)
A New Imperative for Healthier Cities
(The Atlantic) Collaboration among business, academic, and government leaders is oftentimes the key factor in making cities better places to live. And while local leaders often come together to discuss growth or infrastructure, shouldn’t they consider health care and social programs too?
By asking, how can we keep our citizens well, or how can we make our city a healthier place to live, communities can make dramatic strides working together. Some cities are starting to do this by creating new programs and services to improve the health of citizens. Others are focusing on the overall population, making their community a more desirable place to live and work. Either way, by providing ways to improve citizen health, smarter cities can attract new businesses and enhance quality of life for everyone.
Staunch Conservative J.D. Kleinke Makes Conservative Case For Obamacare
IF Mitt Romney’s pivots on President’s Obama’s health care reform act have accelerated to a blur — from repealing on Day 1, to preserving this or that piece, to punting the decision to the states — it is for an odd reason buried beneath two and a half years of Republican political condemnations: the architecture of the Affordable Care Act is based on conservative, not liberal, ideas about individual responsibility and the power of market forces.
Paul Krugman Medicaid on the Ballot
By any reasonable standard, this is a program that should be expanded, not slashed — and a major expansion of Medicaid is part of the Affordable Care Act.
Why, then, are Republicans so determined to do the reverse, and kill this success story? You know the answers. Partly it’s their general hostility to anything that helps the 47 percent — those Americans whom they consider moochers who need to be taught self-reliance. Partly it’s the fact that Medicaid’s success is a reproach to their antigovernment ideology
Paul Krugman: Romney’s Sick Joke
(Other News) … the fact is that everything Obama said was basically true, while much of what Romney said was either outright false or so misleading as to be the moral equivalent of a lie.
Above all, there’s this:
MR. ROMNEY: Let — well, actually — actually it’s — it’s — it’s a lengthy description, but number one, pre-existing conditions are covered under my plan.
No, they aren’t. Romney’s advisers have conceded as much in the past; last night they did it again.
I guess you could say that Romney’s claim wasn’t exactly a lie, since some people with preexisting conditions would retain coverage. But as I said, it’s the moral equivalent of a lie; if you think he promised something real, you’re the butt of a sick joke.
Arianna Huffington: Just last week, a study was published by researchers at Rensselaer Polytechnic Institute which showed that the light from computer screens interfered with the body’s melatonin production, which helps govern our internal body clock and regulates our sleep cycle.
And, as I’ve pointed out before, sleep plays a vital role in decision-making. According to the Harvard Medical School’s Division of Sleep Medicine, lack of sleep was a “significant factor” or played a “critical role” in the nuclear accidents at Three Mile Island and Chernobyl, the wrecking of the Exxon Valdez, and the explosion of the Challenger space shuttle.
“Sleep deprivation negatively impacts our mood, our ability to focus, and our ability to access higher-level cognitive functions,” Harvard’s sleep doctors say. “The combination of these factors is what we generally refer to as mental performance.” More
Cancer, diabetes must be among development goals
It’s a vicious cycle: Poverty contributes to noncommunicable diseases, and their effects worsen poverty, threatening sustainable development, write Johanna Ralston and Ann Keeling. NCDs were left out of the original Millennium Development Goals, but the four most prevalent NCDs — cancer, cardiovascular disease, chronic respiratory disease and diabetes — must be included among the sustainable development goals being debated, they write. The Guardian (London)/Poverty Matters blog (9/11)
Paul Krugman: The Medicare Killers
Paul Ryan’s speech Wednesday night may have accomplished one good thing: It finally may have dispelled the myth that he is a Serious, Honest Conservative. Indeed, Mr. Ryan’s brazen dishonesty left even his critics breathless. … The Republican Party is now firmly committed to replacing Medicare with what we might call Vouchercare. The government would no longer pay your major medical bills; instead, it would give you a voucher that could be applied to the purchase of private insurance. And, if the voucher proved insufficient to buy decent coverage, hey, that would be your problem.
Adverse Effects of Mining Industry Provoke Hard Questions for Medical Humanitarian Organizations
(ScienceDaily) — Increasingly humanitarian organizations will find themselves responding to health emergencies provoked by the adverse effects of mining and other extractive industries, setting up a potential clash to do with the core principles and values at the heart of humanitarian medicine, writes Philippe Calain from the humanitarian medical organization, Médecins Sans Frontières (MSF), in this week’s PLoS Medicine.
Hacking Health: Bottom-up Innovation for Healthcare
By Jeeshan Chowdhury, Sauvé Scholar 2011-2012
Technology Innovation Management Review
Healthcare is not sustainable and still functions with outdated technology (e.g., pagers, paper records). Top-down approaches by governments and corporations have failed to deliver digital technologies to modernize healthcare. Disruptive innovation must come from the ground up by bridging the gap between front-line health experts and innovators in the latest web and mobile technology. Hacking Health is a hackathon that is focused on social innovation more than technical innovation. Our approach to improve healthcare is to pair technological innovators with healthcare experts to build realistic, human-centric solutions to front-line healthcare problems.
David (Kilgour): Despite its faults, Canada’s health care system remains better than America’s
David (T. Jones): At its best, U.S. health care is exceptional — but the battle isn’t over yet
London Summit offers crucial opportunities for women, health
The London Summit on Family Planning opened today and aims to prioritize and fund family planning globally, giving women “the tools to make critical decisions about the size of their families and the spacing of their pregnancies,” writes Nafis Sadik, whose United Nations roles include being a United Nations Foundation board of directors member. Also today, the U.K. pledged to double family-planning aid to about $280 million annually for eight years. Read more from the UN Foundation on supporting the Every Woman Every Child movement. Diplomatic Courier online (7/11), The Independent (London) (7/11), The Huffington Post (7/10), The New York Times (tiered subscription model) (7/9)
Then and now, GAVI reducing unnecessary deaths
The board chairman of the GAVI Alliance, Dagfinn Høybråten, discusses the potential for ending by 2035 deaths of children due to preventable diseases and conditions. The alliance has helped prevent more than 5.5 million unnecessary deaths, he said, and a program to vaccinate 250 million children through 2015 could save an additional 4 million lives. GlobalPost.com/Global Pulse blog (6/25)
Malaysian prince promotes protein pill to fight dengue fever
[the pill] starves mosquito larvae and could revolutionise the global dengue fight.
It is a fight that is intensifying: more than 2.5 billion people – about 40 per cent of Earth’s population – live in areas susceptible to the mosquito-borne virus, with up to 100 million infected annually, according to the World Health Organisation. Dengue kills 20,000 people worldwide every year, and its complexity – and what health advocates say is a lack of priority given the race to find cures for higher profile viruses such as AIDS – means a vaccine has proved elusive.
Global anti-polio effort is declared an emergency
The Global Polio Eradication Initiative has launched an emergency action plan to boost immunization against polio in Nigeria, Pakistan and Afghanistan, where the disease is endemic. … some vaccination campaigns have been halted because of funding shortfalls. BBC (5/24)
Gates Foundation funds a dozen unusual disease treatment ideas
The Bill & Melinda Gates Foundation has awarded a dozen scientists $1 million each in funding over the next five years to further explore unusual approaches to combating malaria and other global public health concerns. Adapting a microwave to identify and target the presence of iron in a bid to wipe out the malaria parasite is one of the ideas selected to receive a grant from more than 500 that initially received a smaller amount of funding. Bloomberg Businessweek/The Associated Press (7/13)
UN Foundation partners to transform mHealth
In an interview, the chief executive officer and co-founder of DataDyne, which creates Web and mobile software for the global health and international development community, cites the partnership between the United Nations Foundation and Vodafone Foundation — which provided funding and communications support — as essential to the success of the social startup. “Obviously, the funding was important, and we wouldn’t have been able to do anything without that, but almost as important was their help in getting the word out about what we were creating,” said Joel Selanikio. The Guardian (London) (5/27)
Medicare has a lemons problem
(The Economist) THERE are many problems with Paul Ryan’s budget and his plans for Medicare, but for Democrats, one is paramount: it is unpopular. His proposal initially put Democrats on the back foot, but within days they took heart as press commentary and polls turned negative.
Both parties have, somewhere inside them, a serious proposal to reform Medicare. If they thought they could be elected by offering such a plan, they would do so. But any serious attempt to reform Medicare is going to be unpopular because it will cost the elderly something, and the elderly are on the way to becoming 30% of the voting population. Thus, the opposing party is inevitably going to use such a proposal to kill the other at the next election without advancing an alternative. And since both parties know this, the only Medicare plans they offer voters will be lemons.
The Need for Greed
In the Republican budget plan proposed by Representative Paul Ryan, it’s the I’ve Got Mines vs. The Left Behinds.
(NYT) … in order for the Republican plan to turn Medicare, one of most popular government programs in history, into a much-diminished voucher system, the greed card had to work.
The plan’s architect, Representative Paul Ryan of Wisconsin, drew a line in the actuarial sand: Anyone born before 1957 would not be affected. They could enjoy the single-payer, socialized medical care program that has allowed millions of people to live extended lives of dignity and decent health care.
And their kids and grandkids? Sorry, they would have to take their little voucher and pay some private insurer nearly twice as much as a senior pays for basic government coverage today. In essence, Republicans would break up the population between an I’ve Got Mine segment and The Left Behinds.
George Monbiot writes (blisteringly) on the transformation of Britain’s NHS
A Death Foretold
Why have successive governments been waging war on one of the world’s best health systems?
This programme [proposed by PM David Cameron] seeks to model one of the most efficient and cost-effective health services in the world – the NHS – on one of the least: the US system. The OECD’s figures show that healthcare in the US costs $7,500 per person per year. The OECD average is $4,500. In the UK it costs $3,500. Yet while the US system is plagued with fraud and lawyers, while it overtreats the rich and dumps the poor in the street, the NHS came out top of the countries surveyed in the journal Health Affairs on most measures of public confidence and public access. The US came bottom. As Major did with the railways, Cameron wants to take a functioning system and smash it into chaotic fragments.
Chan: Time to reform WHO
The World Health Organization is instituting cost-saving and efficiency measures as a reflection of global economic realities that caused a significant drop in voluntary contributions by United Nations member states. WHO Director-General Margaret Chan says the cutbacks present an opportunity for the organization to undertake reform to better represent a mandate that as changed significantly over the past decade. Google/Agence France-Presse (5/16)
Health Care Showdown: Obama Administration Calls Out GOP Governors
The Obama administration is showing political tough love with Republican governors who criticized both the constitutionality and funding of the president’s signature health care legislation.
On Monday, Press Secretary Robert Gibbs called out GOP leaders who were bemoaning the law — and threatening to ignore its provisions — while still taking the funds needed for implementation.
House votes to repeal health-care reform: What happens now?
(CSM) Though the House has repealed health-care reform, it won’t be repealed by the Senate, meaning the effort is virtually dead. But House Republicans can still try to dismantle the law by other means.
26 December 2010
Obama Returns to End-of-Life Plan That Caused Stir
Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.
Congressional supporters of the new policy, though pleased, have kept quiet. They fear provoking another furor like the one in 2009 when Republicans seized on the idea of end-of-life counseling to argue that the Democrats’ bill would allow the government to cut off care for the critically ill.
Senate Passes 9/11 Health Bill as Republicans Back Down
Legislation providing $4.3 billion received unexpected support 12 days after Republicans had blocked a more expensive version from coming to a vote.
After years of fierce lobbying and debate, Congress approved a bill on Wednesday to cover the cost of medical care for rescue workers and others who became sick from toxic fumes, dust and smoke after the 2001 attack on the World Trade Center.
Sharing of Data Leads to Progress on Alzheimer’s
(NYT) In 2003, a group of scientists and executives from the National Institutes of Health, the Food and Drug Administration, the drug and medical-imaging industries, universities and nonprofit groups joined in a project that experts say had no precedent: a collaborative effort to find the biological markers that show the progression of Alzheimer’s disease in the human brain.
Now, the effort is bearing fruit with a wealth of recent scientific papers on the early diagnosis of Alzheimer’s using methods like PET scans and tests of spinal fluid. More than 100 studies are under way to test drugs that might slow or stop the disease.
Insurers Push Plans That Limit Choice of Doctor
As the Obama administration begins to enact the new national health care law, the country’s biggest insurers are promoting affordable plans with reduced premiums that require participants to use a narrower selection of doctors or hospitals. The last time health insurers and employers sought to sharply limit patients’ choice was back in the early 1990s, when insurers tried to reinvent themselves by embracing managed care. Instead of just paying doctor and hospital bills, insurers also assumed a greater role in their customers’ medical care by restricting what specialists they could see or which hospitals they could go to.
The concept was largely abandoned after the consumer backlash persuaded both employers and health plans that Americans were simply not willing to sacrifice choice.
This remarkable documentary “Obama’s Deal” from PBS’ Frontline stands out for the scope of the awfulness of virtually all who were involved in the multiple scuttling of the Obama health reform legislation.
“On March 23, 2010, after a bruising year of debate, negotiation and backlash, President Barack Obama finally signed the health reform bill that he had promised more than a year before. But at what cost to his popularity and to the ideals of bipartisanship and open government that he’d campaigned on?
In Obama’s Deal, veteran FRONTLINE producer Michael Kirk takes viewers behind the headlines to reveal the political maneuvering behind Barack Obama’s effort to remake the American health system and transform the way Washington works. Through interviews with administration officials, senators and Washington lobbyists, Obama’s Deal reveals the dramatic details of how an idealistic president pursued the health care fight — despite the warnings of many of his closest advisers — and how he ended up making deals with many of the powerful special interests he had campaigned against.”
Mark B. McClellan, Director, Engelberg Center for Health Care Reform: Better Health Care at Lower Costs: Real Health Care Reform
(Brookings Institute) The passage of comprehensive health care reform legislation presents tremendous opportunities to improve the way that America’s health care system works. Reforms to expand coverage hold the potential to help millions of Americans. But in order to sustain this coverage and assure it provides access to innovative care, we need to focus on helping all Americans get the best care, not just better coverage.
Baffled by Health Plan? So Are Some Lawmakers
(NYT) The confusion raises the inevitable question: If they did not know exactly what they were doing to themselves, did lawmakers who wrote and passed the bill fully grasp the details of how it would influence the lives of other Americans?
The law promises that people can keep coverage they like, largely unchanged. For members of Congress and their aides, the federal employees health program offers much to like. But, the report says, the men and women who wrote the law may find that the guarantee of stability does not apply to them.
Under Fire for Abortion Deal, Stupak to Retire
Mr. Stupak, a nine-term incumbent, has been under intense pressure from anti-abortion groups and others since the health care bill passed last month. At his request, President Obama signed an executive order outlining the prohibitions against the use of federal funds for abortion. But anti-abortion groups dismissed the executive order and pledged to defeat Mr. Stupak, whom they had once championed.
We were not alone in our bewilderment regarding what the President had signed when. The intrepid Tony Deutsch queried his friend Professor Hal Waller of McGill: “A few days ago there was a much-publicized signing ceremony of the health-care bill at the White House. Now I discover that yesterday Congress passed another piece of what seems to be the same legislation, and sent it to the President. My, obviously mistaken, impression was that the legislation had to be complete before the President could act on it. (Under the British system Royal Assent has the effect of proclaiming the legislation as law of the land.) Could you possibly enlighten me as to what appears to be the U.S.practice?”
The prompt answer was – and is –
“Normally a bill is taken up separately by the two houses of Congress. In the course of its route through each house there are many changes made (basically amendments). The result is that for any consequential bill the two houses produce two somewhat different versions. In order for a bill to become law it must be signed by the president. But he can only sign a bill that has been passed in identical versions by the two houses. So the usual practice is to set up a conference committee for each such bill. The committee consists of representatives from both parties in each house and reflects the majority party’s weight. This committee has broad powers to combine the two versions into one bill. It can add or delete anything, compromise between the two versions, etc. Eventually the representatives of the two houses on the committee have to concur on a joint version (the conference report). This joint version is then sent back to each house for an up or down vote (i.e., no amendments on the floor). If it passes both houses then it has passed in identical form and can be sent to the president for signature. That’s the normal procedure.
What happened with the health care bill was a sharp departure from the normal procedure. In November and December the two houses had passed different versions of the bill. But once Scott Brown won in Massachusetts, the Democrats no longer had the votes to shut down a Senate filibuster. The Republicans would have filibustered any conference report because they were opposed to any bill. So the Democrats had to go around this obstacle and not set up a conference committee. Instead they sent the Senate version to the House, where it was passed last Sunday night without any changes. That was the bill (passed in identical form by both houses) that the president signed on Tuesday. However, the House Democrats had insisted that there were changes needed in the Senate bill. In exchange for the House’s willingness to pass the Senate bill, the Senate agreed to accept some amendments, in the form of a separate bill. This separate bill was officially handled as a budget reconciliation measure. Under Senate rules such bills are not subject to filibuster. So the House passed the reconciliation bill on Sunday night and sent it to the Senate. The Senate finally passed it on Wednesday, albeit with a couple of small amendments. So it went back to the House, which passed the amended version. That was then sent to the president [to sign]. That completes the legislative process on this matter!
The Last Piece in Place
In Alexandria, Va., President Obama on Tuesday signed into law the final piece of the Democrats’ health care overhaul.
Insurers to Comply With New Rules for Children
Under pressure from the White House, health insurance companies said on Tuesday that they would cover children with pre-existing conditions.
At last: Final health care measure heads to Obama
Yearlong struggle to pass health care overhaul ends as Democrats send final piece to Obama
(Yahoo! Finance)The last legislative chapter in the wrenching debate came Thursday night when the Democratic-controlled House passed, for the second time, a package of fixes to the bill that Obama had signed two days earlier. The measure includes better benefits for older people and low-income and middle-class families.
Taken together, the two bills extend coverage to 32 million uninsured Americans and aim to crack down on unpopular insurance industry practices, such as denying coverage for people with medical conditions, and to reduce federal deficits by an estimated $143 billion over a decade.
Most Americans would be required to buy insurance for the first time or face penalties if they refuse.
The second of the two bills also presented Obama with another victory, stripping banks and other private lenders of their ability to originate student loans in favor of a system of direct government lending.
Obama was expected to sign the measure early next week.
But, wait a minute! Senate Passes Set of Changes to Health Care Overhaul
After running through an obstacle course of Republican amendments and procedural objections, the Senate on Thursday afternoon approved of a package of changes to the Democrats’ sweeping health care overhaul, capping a bitter partisan battle over the most far-reaching social legislation in nearly half a century.
After Health Vote, Threats on Democrats
Democratic lawmakers have received death threats and been the victims of vandalism because of their votes in favor of the health care bill, lawmakers and law enforcement officials said Wednesday, as the Congressional debate over the issue headed toward a bitter and divisive conclusion.
Bill Boyarsky: A Healthy Start … With Loopholes —
Now that President Barack Obama has signed health reform into law, insurance industry lobbyists will turn their attention to trying to cripple it. This will be done under the pretense of improving the reform proposal—or, as they say in the lobbying business, loving the law to death.
Obama Signs Health Care Overhaul Bill, With a Flourish
With the strokes of 20 pens, President Obama signed his health care overhaul — the most sweeping social legislation enacted in decades — into law on Tuesday during a festive, at times raucous, White House ceremony.
Despite the president’s signature, the legislative work on the measure is not over, nor is the intense partisan fight over it. Republicans are already vowing to repeal the bill. And the legislative battle will flare anew in the Senate on Tuesday, where lawmakers are set to take up a package of changes to the measure under the parliamentary procedure known as reconciliation.
Obama on Health care – Presidential campaign 2008
Obama believes that the federal government should provide health care for everyone. He also feels that we need to increase competition in the insurance and pharmaceutical markets and advocates better funding for AIDS research and prevention. “Too many hard-working Americans cannot afford their medical bills, and health-related issues are the number one cause for personal bankruptcy. Promoting affordable, accessible, and high-quality health care is a priority.”
We have arrived, I think, at a difficult point in human history. For millennia, before this moment in time, we had little knowledge of what to do to improve and sustain the health of human beings. We lived in ignorance. The average longevity of a person was under 40 years. The body, and how it failed, was largely a mystery.
The 20th century, however, brought an age of remarkable discovery. In the last century, scientists have come to recognize more than 60,000 different diseases and disorders that can afflict the human body — 60,000 different ways the human body can fail. And they have discovered methods of prevention and treatment for nearly all of them — if not to cure them, then at least to alleviate their worst harm and misery.
That knowledge has ranged from how to construct sewage systems well, to how to provide intensive care technologies. And that knowledge is continuing to grow. But having discovered so much, we have hit, in this new century, a new problem — how to actually deliver on all that has been learned.
Legal and Political Fights Loom
President Obama plans to open a new campaign this week to persuade skeptical Americans that the bill holds immediate benefits for them and addresses the nation’s shaky fiscal condition. Republicans said they would seek to repeal the measure, challenge its constitutionality and coordinate efforts in statehouses to block its implementation.
“The Moderate Republican: An Endangered Species” — Boy, the Republicans know how to make Barack Obama look good. What are they going to do now, threaten to repeal a law that forces insurance companies to cover the sick? Or block the provision that allows you to keep your out-of-work kids on your policy until they are 26?
Times Topics: Health care reform:
Mr. Obama and the Democratic leaders of Congress have appeared to be on the verge of victory before. On Nov. 7 2009, handing Mr. Obama a hard-fought victory, the House approved a sweeping overhaul of the nation’s health care system by a vote of 220 to 215. The Senate passed an $871 billion bill on Dec. 24.
But even as the House and Senate worked to merge their bills, their fate was put in jeopardy on Jan. 19, 2010, by an upset Republican victory in a special election to fill the Senate seat in Massachusetts held for decades by the late Senator Edward M. Kennedy. That outcome deprived the Democrats of the 60th vote needed to block a Republican filibuster, and threatened to change the political calculus for wavering supporters in both houses.
After weeks of strategizing and a one-day bipartisan “summit” organized by the White House, on March 3 President Obama began a final push for passage, making clear that he favored using a procedural maneuver called budget reconciliation to avoid a Republican filibuster in the Senate and allow passage of revisions to the original bill with a simple majority.
The House’s March 21 passage of the bill that was adopted by the Senate on Christmas Eve marks the first step of the Democrats’ plan. Mr. Obama is expected to sign that underlying measure quickly. But the House also approved a set of changes in a separate reconciliation bill, which Senate leaders have promised to pass. The reconciliation package would effectively smooth out some of the differences between the House and Senate versions. Mr. Obama would then sign that package, and he has also promised to issue an executive order “to ensure that federal funds are not used for abortion services.”
Marc Ambinder: Republicans in Disarray
A week ago, Republicans were united and on the verge of completely commanding the political narrative between now and November. Now, with their entire strategy having been upended by the Democratic health care victory, the party is in disarray.
There is no fallback on health care — none — except to call for repeal, as conservative House lawmakers and congressional candidates have already begun to do. But what to repeal? The “bad” stuff — tax increases and such — kick in later. Most everyone who will feel reform’s touch within the next year or so will get benefits, be it in the form of not having their coverage rescinded, or be it a $250 rebate check from the government. Today, Senate Majority Leader Mitch McConnell acknowledged as much by refusing to say whether Republicans actually would move to repeal legislation, or parts of it, if they manage to take control of the Senate.
New health care bill pros and cons: Will it cut costs?
(CSM) The Congressional Budget Office says the new health care bill will be deficit neutral. But economists aren’t sure. What are the financial pros and cons of the bill?
Hammering home reform
Barack Obama’s health reforms cross the most important threshold
(The Economist)The heart of the new reform is a restructuring of America’s deeply flawed insurance market. Insurers would face tough new regulations forbidding such practices as dropping customers with “pre-existing conditions” (real or trumped up), lifetime coverage caps and other cruel practices. In return, though, they would enjoy a vast expansion of the country’s private insurance market. Some 32m of the country’s 49m or so uninsured would be required to get insurance, starting in 2014; and the poorer ones will be given subsidies for doing so.
Paul Krugman: Fear Strikes Out
In the debate leading up to the victory for health care reform, President Obama urged lawmakers to do what is right, while opponents relied on fear and cynicism.
US House approves healthcare overhaul
(The Independent) In a late-night 219-212 vote, House Democrats approved the most dramatic US health policy changes in four decades.
U.S. House passes health care reform bill
The House of Representatives voted 219-212 to pass the a bill to reform the U.S. health insurance system. The reforms, which include income-based subsidies for the purchase of health insurance and an expansion of Medicaid, are expected to provide near-universal health coverage. The New York Times (free registration) (3/22) , The Wall Street Journal (3/22)
House Approves Health Overhaul, Sending Landmark Bill to Obama
Congress gave final approval to legislation that would provide medical coverage to tens of millions of Americans and remake the U.S. health care system along the lines proposed by President Obama.
Why this moment matters
James Fallows (The Atlantic) For now, the significance of the vote is moving the United States FROM a system in which people can assume they will have health coverage IF they are old enough (Medicare), poor enough (Medicaid), fortunate enough (working for an employer that offers coverage, or able themselves to bear expenses), or in some other way specially positioned (veterans; elected officials)… TOWARD a system in which people can assume they will have health-care coverage. Period.
That is how the entire rest of the developed world operates, as noted yesterday. It is the way the United States operates in most realms other than health coverage.
Obama Delays Trip as Report Aids Final Push on Health Care
As House Democrats geared up for a possible vote on Sunday to pass health care legislation, the Congressional Budget Office issued an analysis allowing them to point to significant cost savings in the decades ahead, and President Obama postponed a planned trip to the Pacific to keep pressing for approval.
Paul Krugman: Health Reform Myths
… reform still has to run a gantlet of misinformation and outright lies. So let me address three big myths about the proposed reform, myths that are believed by many people who consider themselves well-informed, but who have actually fallen for deceptive spin.
Frank Rich: The Up-or-Down Vote on Obama’s Presidency
Now that we have finally arrived at the do-or-die moment for Obama’s signature issue, we face the alarming prospect that his presidency could be toast if he doesn’t make good on a year’s worth of false starts. And it won’t even be the opposition’s fault. If too many Democrats in the House defect, health care will be dead. The G.O.P. would be able to argue this fall, not without reason, that the party holding the White House and both houses of Congress cannot govern. .
Obama dominates the room at healthcare summit
(Reuters) – It was a unique insight into President Barack Obama’s management style.
Obama dominated the debate during Thursday’s nearly seven hour cross-party summit on healthcare, always in command not only of the room but also of the most intricate policy details, as he personally rebutted every point he disagreed with.
His tone was at times professorial, occasionally combative and at one point even dismissive of his 2008 rival for the presidency, Republican Senator John McCain.
It remains to be seen if the American public was more convinced by Obama’s detailed exposition of policy or the Republicans’ more visceral argument against an expansion of Washington’s powers.
What is certain is that there was little progress toward generating a greater bipartisan consensus around a reform of the mammoth healthcare industry.
9 November 2009
U.S. health care reform ‘two steps away’
… U.S. health care reform ‘two steps away’. Obama ‘confident’ Senate will pass legislation.
US Healthcare Reform Myths and Realities
(Conference Board of Canada) The debate raging over healthcare reform in the United States has taken a number of bizarre twists and turns that has [sic] come as a shock to many Canadians observing the unfolding drama. The Canadian healthcare system has been dragged into the debate as critics of government-run healthcare point to the deficiencies in our system as evidence concerning the damage that the public option brings with it. Apparently a publicly run system like ours can lead to the creation of death panels that can determine who lives and dies, according to Sarah Palin and other Republicans. Little is said about the fact that Canada has a higher life expectancy than the United States.
Health care reform clears a Senate hurdle
(MSNBC) Nearly nine months after the president pledged in his Inaugural Address to tackle health care, legislation to expand coverage to millions who lack it has now advanced further than President Bill Clinton’s ill-fated effort more than a decade ago — or any other attempt in more than a generation.
CBO: Health care bill to cost $829 billion
(MSNBC) Budget experts say proposal would cover 94 percent of Americans
The Congressional Budget Office added that the measure would reduce federal deficits by $81 billion over a decade and probably lead to “continued reductions in federal budget deficits” in the years beyond.
Max Baucus releases health care bill
(Politico) Introducing a health care reform bill without the bipartisan support he had sought, Senate Finance Committee Chairman Max Baucus on Wednesday defended a series of concessions to Republicans in the $856 billion plan that have drawn sharp criticism from Democrats.
The bill forces insurance companies to change the way they do business, such as prohibiting them from dropping or denying coverage based on preexisting conditions. To force competition with private insurers, the Montana Democrat chose creating nonprofit consumer-owned cooperatives over the public insurance option, which most Democrats prefer.
13 August 2009
Palin doubles down on ‘death panels’
(Politico) Former Alaska GOP Gov. Sarah Palin defended her claim that the Democratic health care proposal would create “death panels” in a statement Wednesday night slamming President Barack Obama.
“Yesterday President Obama responded to my statement that Democratic health care proposals would lead to rationed care; that the sick, the elderly and the disabled would suffer the most under such rationing; and that under such a system, these ‘unproductive’ members of society could face the prospect of government bureaucrats determining whether they deserve health care”.
26 March 2009
(TIME) Max Baucus Is Mr. Health Care
Baucus has been surprising almost everyone, most notably by the zeal with which he is tackling what could be the toughest challenge of all: overhauling the health-care system to provide coverage for the more than 45 million Americans who lack it and to bring soaring costs under control. Indeed, Baucus’ proposal, unveiled in an 89-page white paper eight days after the election, was even more ambitious than Obama’s, adding a requirement that individuals who are not covered by their employers purchase their own health insurance, much as car owners must carry auto insurance. Max Baucus Health Reform White Paper
Presidential campaign 2008 – Barack Obama on the issues
(Washington Post) Do you have a plan to make health care more accessible to Americans? If so, how would you do it?
(Barack Obama) Every American has the right to affordable, comprehensive and portable health coverage. My plan will ensure that all Americans have health care coverage through their employers, private health plans, the federal government, or the states. My plan builds on and improves our current insurance system, which most Americans continue to rely upon, and creates a new public health plan for those currently without coverage. Under my plan, Americans will be able to choose to maintain their current coverage if they choose to. For those without health insurance I will establish a new public insurance program, and provide subsides to afford care for those who need them. My plan includes a mandate that all children have health care coverage and I will expand eligibility for the Medicaid and SCHIP programs to help ensure we cover all kids. My plan requires all employers to contribute towards health coverage for their employees or towards the cost of the public plan. Under my plan a typical family will save $2,500 each year. We will realize tremendous savings within the health care system from improving efficiency and quality and reducing wasted expenditures system-wide. Specifically, these savings will result from investments in health information technology, improvements in prevention and management of chronic conditions, increased insurance industry competition and reduced industry overhead, the p