Wild Things

What was most powerful about the movie was the accuracy with which it portrayed the angry powerlessness of youth. Where it missed was in thinking that young adults (which was definitely what it was aimed at) would still think "Don't be selfish" is a profound lesson. Yeah, we know already. We're Catherine Keener, not Max Records.

Dorelan is the best!!

I have the sweetest roomie EVER!!

There must always be a reason

Unless there is a direct cost to US taxpayers from elective cosmetic surgery paid for out of pocket, I don't agree with a tax on plastic surgery.

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WASHINGTON (AFP) – Americans opting to have surgery to suck out fat, grow or shrink breasts, shape their nose or banish wrinkles may pay for a health care overhaul that was unveiled by US Senate Democrats.

The White House-backed plan would impose a five-percent tax on elective cosmetic surgery that is estimated to raise an estimated 5.8 billion dollars over 10 years towards the 849-billion-dollar plan.

The measure exempts plastic surgery done to remedy a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or disfiguring disease.

Individuals who seek purely elective procedures, which are typically paid for directly out of patients' pockets, would have to pay the new tax starting in January 2010.

The global economic recession has not dented US demand for cosmetic surgery procedures, which were up three percent in 2008 to 12.1 million procedures, according to the American Society of Plastic Surgeons.

But breast augmentations were down 12 percent from 2007, to 307,230, while wrinkle-banishing Botox injections were up eight percent to just over five million procedures.

The legislation does not exempt US lawmakers.

Today in the life....

Today, the Obama administration reports that over $98 million dollars of taxpayer dollars was improperly used in 2009. In particular, it notes improper payment rates of 7.8 percent and 15.4 percent in the Medicare fee for service and Advantage programs, respectively. While no one contests that Medicare and Medicaid has poor mechanisms in place for filtering out waste and fraud, I think it's important to point out that a lot of these "improper" payments is defined as such by lack of proper documentation. Anyone who works in healthcare can give testimonial as to how burdensome and confusing government documentation is, and I have to wonder how much of this money was truly improperly spent, or merely appears to be because busy healthcare workers don't have the time to fill out the reams of government paperwork required for simple indicated procedures.

Also, the Augusta Chronicle reports that applications to the Medical College of Georgia are 4 percent higher than last year, outpacing the 0.1-percent national increase. Not surprising considering that, despite astronomical tuition increases from 2006 to present, MCG still remains a competitively priced medical school with decent residency admit numbers. Alumni truly cast a wide net, as evidenced by the Chair of my residency interview today graduating from MCG.

Finally, I am finally back in GA after an exhausting and eventful two months! Here is the song that's been getting me through the past few days...

From the Healthcare Economist

Health Reform Bill Passes in the House: Who wins and who loses?

November 9, 2009

A Health Reform Bill passed in the House despite declining support among the American people. The Kaiser Family Foundation has a nice summary of what is included in the bill. Today, I will review who wins and who loses from different aspects of the bill.

Individual Mandate.

• Winners: High cost individuals. Premiums (may) decline if younger, healthier individuals are forced to buy insurance and the insurance companies. This will only decrease premiums, however, if insurance companies can’t charge lower rates to these healthier individuals.
• Losers: Those who don’t want health insurance or can’t afford it. All individuals will have to pay a penalty if they do not buy “acceptable health coverage.” Low-income families are exempt from this requirement.

Employer funding requirements.

• Winners: Requiring employers to pay for health insurance simply means that individuals will see lower wages in the long run. The big winner here is big business. They already provide health insurance for their employees. Small company competitors however
• Losers: Health insurance is more expensive for small companies. Making them pay for health insurance will drive up their costs and force them to cut wages more than big businesses will. This may make working at a small firm less attractive, especially for younger employees. However, the smallest companies are exempt from this requirement and the government will provide subsidies to cover some health insurance cost initially.

Expand Medicaid to all individuals with incomes below 150% of the Federal Poverty line (FPL).

• Winners: Lower middle class individuals who are now covered by Medicaid who were not in the past.
• Losers: Taxpayers.

Require CHIP enrollees with incomes above 150% FPL to obtain coverage through the Health Insurance Exchange.

• This depends on how well the Health Insurance Exchange works. If it is an efficient system, poor children could get better coverage and the taxpayer bill could decrease. Or poor children could get worse coverage and the taxpayer bill could increase.

Subsidies to individuals with incomes below 400% of the FPL to to obtain coverage through the Health Insurance Exchange.

• Winners: Middle class families not eligible for Medicaid who now will received subsidized insurance.
• Losers: Taxpayers not eligible for the subsidy.

Reinsurance program for individuals aged 55-64.

• Winners: Employees of this age bracket. They will be more attractive to employ since their health care costs will be capped.
• Losers: Taxpayers not aged 55-64.

Tax of 5.4% on individuals with modified adjusted gross income exceeding $500,000 ($1m for families).

• Winners: Individuals getting subsidies, expanded public programs, etc.
• Losers: The Rich.

The Public Option and the Health Insurance Exchange.

• Here, the devil is in the details. If the Public Option provides superior health care at lower cost, everyone wins (except private insurance companies). If the public option provides superior health care but runs a deficit every year, consumers will win while taxpayers and private insurance companies will lose. If the public option loses money and provides low quality care, everyone loses except for government employees now hired to run the public option. Similarly, the health insurance exchange may provide more choice to consumers, a standardized benefit package so the consumers can price shop, or it may reduce insurance choice by limiting the products insurers can offer.

Savings from Medicare and Medicaid

• Winners: If the savings come from reduced waste, Medicare enrollees will benefit (fewer unnecessary procedures will increase their health) as will the taxpayers. However, if the savings come from cuts to necessary services, Medicare enrollees will be harmed.
• Losers: Doctors and hospitals. Cuts to Medicare mean that doctors and hospitals will get less money. If the cuts are from waste, only inefficient doctors will see their earnings hurt. If the cuts come from necessary care, then good and bad doctors will see their incomes fall.

Fascinating!

but also reminds me a bit of the beginning of I Am Legend :-)

New gene therapy halts 2 boys' rare brain disease

By LAURAN NEERGAARD, AP Medical Writer Lauran Neergaard, Ap Medical Writer – Thu Nov 5, 5:12 pm ET

WASHINGTON – French scientists mixed gene therapy and bone marrow transplants in two boys to seemingly halt a brain disease that can kill by adolescence. The surprise ingredient: They disabled the HIV virus so it couldn't cause AIDS, and then used it to carry in the healthy new gene.

The experiment marks the first time researchers have tried that long-contemplated step in people — and the first effective gene therapy against a severe brain disease, said lead researcher Dr. Patrick Aubourg of the University Paris-Descartes.

Although it's a small, first-step study, it has "exciting implications" for other blood and immune disorders that had been feared beyond gene therapy's reach, said Dr. Kenneth Cornetta, president of the American Society of Gene and Cell Therapy.

"This study shows the power of combining gene therapy and cell therapy," added Cornetta, whose own lab at Indiana University has long researched how to safely develop gene delivery using lentiviruses, HIV's family.

The research was published in Friday's edition of the journal Science.

In 20 years of gene therapy research, there have been few home runs and some headline-making setbacks — including a risk of leukemia caused by otherwise successful gene therapy for another rare disorder, "bubble boy disease." That's a risk that specialists hope a lentivirus-based gene therapy will eliminate.

Best known from the movie "Lorenzo's Oil", adrenoleukodystrophy, or ALD, is a rare genetic disease that, in its most devastating form, destroys the coating of nerve fibers in boys' brains. Without that coating, called myelin, the neurological system breaks down. The disease typically strikes between the ages of four and 10, leading to blindness, deafness, dementia and loss of muscle control, and killing them within a few years.

Bone marrow transplants can halt ALD by letting new myelin-forming stem cells take root. But it's difficult to find a matching marrow donor, and the transplant itself is very risky.

So what if stem cells from the boys' own bone marrow could be genetically corrected, eliminating the ALD mutation? To do that, Aubourg's team had to overcome a technical hurdle: Gene therapy works when scientists harness deliver a healthy new gene by attaching to a virus that can harmlessly infect cells. But none of today's so-called gene therapy "vectors" could penetrate enough of the stem cells needed for an ALD treatment to work.

Unlike most viruses, HIV can penetrate stem cells, and it sticks permanently. So Aubourg's team removed the genetic parts of HIV that make it dangerous, leaving basically a scaffolding to carry the new therapeutic gene.

Then they culled stem cells from two 7-year-old boys in the early stages of ALD, and mixed in the healthy gene. The boys underwent bone marrow-destroying chemotherapy and then had their genetically corrected stem cells reinserted.

Two years later, the boys have shown no sign of worsening brain damage and are functioning well with 15 percent of their blood cells producing the healthy protein, said Aubourg, who plans to test the experimental procedure in more patients. An advocacy group, the Stop ALD Foundation, is working to raise money for a similar U.S. study.