Get Thee To A Screening

Recent news reports have called for changes in how frequently people should go for cancer screenings and that's raised all kinds of debate over what's truly appropriate and how the screenings affect health care costs, effectiveness, and life-expectancy.

Having a healthy debate over the issues is all well and good, but early detection is a major factor in getting good outcomes in any number of forms of cancer. That means regular screenings. You should absolutely talk with your doctors about screenings and how frequently you should go by looking at your family history, risk factors, and environmental factors.

Without a doubt, that means if you're a woman, that means going for regular mammograms.
For men, it means prostate and testicular cancer screenings (a federal panel of doctors found that regular screening for prostate cancer may not be worth the risks). It also means that if you find your body changing - are more fatigued or notice other physical changes that aren't easily explained to go see a doctor.

For everyone, that means regularly checking for skin cancer (which is the most common cancer there is with more than 2 million cases diagnosed annually but which has very high cure/remission rate). Skin cancer cases exceed the number of pretty much every other form of cancer combined.

Skin cancer screening is fairly simple - if you see something on your skin that doesn't look right (a mole that changes color, size, bleeds, etc.) you should go get it checked out.

It's a pain in the ass to go for regular screenings, but you know what's a bigger pain in the ass - waiting too long and finding out that you not only have a cancer, but that the docs have limited or no options. Early diagnoses can vastly increase chances of remission. The treatments might suck - and those are much improved from just a few years ago - but they're better than being dead (and leaving friends and families without their loved one).

New Study Finds Tremendous Disparity In Appendectomy Costs

Appendectomies are a relatively common medical procedure, which means that there are plenty of them done around the country. It therefore makes a great study to see just how much they cost.

The results of that study are eye-opening.

The costs range by tens of thousands of dollars.

In fact, the cheapest appendectomies were under $2,000 while the most expensive were over $100,000. The median cost was $33,000.

What do hospitals charge to remove an appendix? The startling answer is that it could be the same as the price of a refrigerator — or a house.

It's a common, straightforward operation, so you might expect charges to be similar no matter where the surgery takes place. Yet a California study found huge disparities in patients' bills — $1,500 to $180,000, with an average of $33,000.

The researchers and other experts say the results aren't unique to California and illustrate a broken system.

"There's no method to the madness," said lead author Dr. Renee Hsia, an emergency room physician and researcher at the University of California, San Francisco. "There's no system at all to determine what is a rational price for this condition or this procedure."

The disparities are partly explained by differences among patients and where they were treated. For example, some had more costly procedures, including multiple imaging scans, or longer hospital stays. A very small number were treated without surgery, though most had appendectomies. Some were sicker and needed more intensive care.

But the researchers could find no explanation for about one-third of the cost differences.

The researchers took uncomplicated cases, which involved patients aged 18-59, and examined what the patients were billed. It didn't look at the negotiated payments that the insurance companies made on behalf of patients.

Many patients have no idea how much procedures are going to cost before doctors go and perform them. There's little transparency on costs, though some insurers are beginning to provide that data to their customers.

It's cost-roulette. The differences can be significant within geographical areas, and even between hospitals in the same city.

The NY Times indicated that one instance found a patient hit with charges for his appendectomy that were six times the median for his geographical area.

In all, Mr. Hong was charged $59,283, including $5,264 for the doctors. According to the Healthcare Blue Book, that amount is six times the fair price for an appendectomy in Northern California, which is $8,309 (including a four-day admission) for the hospital and an additional $1,325 for the doctor. Even after Mr. Hong’s insurer paid the hospital $31,409 and Mr. Hong paid the doctors $4,034, the bills kept coming.

Even when balancing for complexity of cases, the disparity shows that the billing isn't necessarily reflective of the costs for cases and that there is tremendous room for improvement in reducing health care costs.

Some hospitals and medical groups are starting to provide relative costs for procedures, but it's not sufficiently widespread.

One area of regulation that might help increase transparency and reduce health care costs is requiring hospitals to provide easily accessible pricing for procedures so patients can understand the costs involved and potentially shop around and/or negotiate a better price.

Billing should provide more information - including a clear description of charges and itemized accounting for expenses and billing codes.

Common Sense Prevails As Doctors' Group Calls Upon Profession To Stop Over-Ordering Tests; Procedures

The MSNBC headline is misleading. Doctors aren't calling for an end to 45 procedures, including PAP tests in certain circumstances, or chemotherapy for those suffering from terminal cancer. They're calling for doctors to utilize procedures and drug regimes when the circumstances call for it - based on the science.

Nine medical societies, including the American Society of Clinical Oncology and the American College of Cardiology, representing nearly 375,000 physicians are challenging the widely held perception that more health care is better, releasing lists Wednesday of tests and treatments their members should no longer automatically order.
The 45 tests and procedures considered to be overused include:

• Repeat colonoscopies within 10 years of a first test
• Early imaging for most back pain
• Brain scans for patients who fainted but didn't have seizures
• Antibiotics for mild- to-moderate sinusitis unless symptoms last for seven or more days or worsen
• Stress cardiac imaging or advanced non-invasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present
• PAP smears on women younger than 21 or who have had a hysterectomy for a non-cancer disease
• Advanced imaging or bone scans in patients with early-stage breast or low-grade prostate cancer
• Bone scan screening for osteoporosis in women younger than 65 or men younger than 70 with no risk factors
• Routine cancer screening on dialysis patients with limited life expectancies
• Chemotherapy for sickest cancer patients

Dr. Christine Cassel, president of the American Board of Internal Medicine, said the goal is to reduce wasteful spending without harming patients. She suggested some may benefit by avoiding known risks associated with medical tests, such as exposure to radiation.

Doctors may be prescribing these procedures or ordering tests because they're practicing defensive medicine - ordering tests so that if they miss something they can point to the test (and the ordered test) to show that they didn't commit medical malpractice. That's something that the article doesn't address.

The article does tangentially address the fact that some doctors and medical groups may benefit economically from ordering tests and procedures, such as EKGs, even though they aren't always necessary. It notes that insurance companies would have a hard time filtering out unnecessary tests from those that are prudent and necessary:

Insurers will certainly take a close look at the recommendations, but what they do may be limited. That's because most of the questionable tests and treatments in the lists don't particularly stand out in the avalanche of bills processed daily by insurance companies.

Take a recommendation for no annual EKGs for low-risk patients with no heart symptoms. Dr. John Santa, director of the Consumer Reports Health Ratings Center, said he used to routinely order EKG's when he was a general adult medicine practitioner. EKGs cost $50 to $60. A medical assistant would do the tests, and it would take Santa just a couple of minutes to read them. Yet 2 percent to 3 percent of his income came from EKGs, enough to make a difference in a tight year.

"It's very difficult for an insurance company to tell the difference when an EKG is being used as a diagnostic tool and when it is being used as a screening test," said Santa. "It would probably cause more trouble for insurance companies."

However, doctors and patients need to understand that not everyone benefits from a one-size fits all approach.

Computerized Pathology May Lead To Cancer Diagnosis/Treatment Breakthroughs

Scientists have been working to create computer programs that can help identify and catalog cancers, which involve abnormalities in various kinds of cells in the human body. After researchers taught the program how to identify cancer cells among the slides, they found that the program not only correctly identified cancer cells, but that characteristics of the cancer cells and those of surrounding cells were important to identifying prognosis for recovery.

Once it was trained, Beck et al. used C-Path to evaluate tissues of cancer patients it had not examined before. Again, the researchers already knew the outcome, so they were able to check C-Path’s success rate. Its results were a statistically significant improvement over human-based examination, the authors say.

C-Path even figured out something pathologists haven’t — that the characteristics of the cancer cells and the surrounding cells were both important in determining a patient’s outcome. “Through machine learning, we are coming to think of cancer more holistically, as a complex system rather than as a bunch of bad cells in a tumor,” said Dr. Matt van de Rijn, a professor of pathology and co-author of the study, in a statement. “The computers are pointing us to what is significant, not the other way around.”

This is an impressive result, as Rimm explains it, because existing pathological analysis is a very subjective science. Experts make judgments about tissue metastasis and a patient’s overall chances of survival by simply looking at tissue, and their own diagnoses can vary widely, as a 2008 study showed. But a computer model using thousands of times more criteria could be much more consistent.

Despite this success, C-Path is still a long way from clinical use, the authors say.

Faster please.

Guru of Sports Medicine Finds MRIs Vastly Overused

If you want to find a reason for the high costs for health care, look no further than the overuse of MRIs, says Dr. James Andrews, the doctor who revolutionized sports medicine.

He did a study where he looked at MRI scans of healthy athletes, and found that the scans picked up abnormalities nearly all the time.

“An M.R.I. is unlike any other imaging tool we use,” Dr. Sangeorzan said. “It is a very sensitive tool, but it is not very specific. That’s the problem.” And scans almost always find something abnormal, although most abnormalities are of no consequence.

“It is very rare for an M.R.I. to come back with the words ‘normal study,’ “ said Dr. Christopher DiGiovanni, a professor of orthopedics and a sports medicine specialist at Brown University. “I can’t tell you the last time I’ve seen it.”

In sports medicine, where injuries are typically torn muscles or tendons or narrow cracks in bones, specialists like Dr. Andrews and Dr. DiGiovanni say M.R.I.’s often are not needed — they usually can figure out what is wrong with just a careful medical history, a physical exam and, sometimes, a simple X-ray.

M.R.I.’s are not the only scans that are overused in medicine but, in sports medicine, where many injuries involve soft tissues like muscles and tendons, they rise to the fore.

In fact, one prominent orthopedist, Dr. Sigvard T. Hansen, Jr., a professor of orthopedics and sports medicine at the University of Washington, says he pretty much spurns such scans altogether because they so rarely provide useful information about the patients he sees — those with injuries to the foot and ankle.

“I see 300 or 400 new patients a year,” Dr. Hansen says. “Out of them, there might be one that has something confusing and might need a scan.”

The price, which medical facilities are reluctant to reveal, depends on where the scan is done and what is being scanned. One academic medical center charges $1,721 for an M.R.I. of the knee to look for a torn ligament. The doctor who interprets the scan gets $244. Doctors who own their own M.R.I. machines — and many do — can pocket both fees. Insurers pay less than the charges — an average of $150 to the doctor and $960 to the facility.

MRI machines are a profit center for doctors and those operating the scanners. The machines, which can cost upwards of $250,000 a piece, have utility for certain kinds of illnesses and injuries, but are being overused. When an individual scan can cost $1,000 or more - these costs add up over time.

Indeed, the news report highlights the need for doctors to take a careful and detailed personal history and physical examination rather than relying on scans alone. In one instance, several doctors claimed that a patient had a torn ACL, but if they took a detailed history, they would have known that the patient continued skiing after the apparent injury, which is something that would not have been possible had the ACL truly been torn. It turns out that the patient had a broken bone in his leg.

And patients and defensive medicine plays a significant role in why these MRI scans are being ordered:

Dr. DiGiovanni did a similar study with foot and ankle patients, looking back at 221 consecutive patients over a three-month period, 201 of whom did not have fractures. More than 15 percent arrived with M.R.I.’s obtained by doctors they had seen before coming to Dr. DiGiovanni. Nearly 90 percent of those scans were unnecessary and half had interpretations that either made no difference to the patient’s diagnosis or were at odds with the diagnosis.

“Patients often feel like they are getting better care if people are ordering fancy tests, and there are some patients who come in demanding an M.R.I. — that’s part of the problem,” he said.

Some doctors might also feel they are providing better care if they order the scans, Dr. DiGiovanni said, and doctors often feel that they risk malpractice charges if they fail to scan a patient and then miss a diagnosis.

This is exhibit A as to why health costs are soaring.

Light The Night Kickoff

This weekend, I had the honor to attend the 2011 Light The Night Walk kickoff event for Red Bank, New Jersey. The Red Bank walk in the newest location in New Jersey to host a Light the Night Walk -- this is the third year for this location. As I explained in an earlier post, Light the Night is the oldest walk to raise money for cancer research.

At the kickoff event, we heard some additional information regarding the new treatment breakthrough for chronic lymphocytic leukemia, or CLL. Lawhawk posted about this last week. This new therapy essentially takes cancer T-Cells, infuses them with a new protein and reintroduces them into the body. The new infused cells begin to attack the cancer cells, and most excitedly, get the bodies existing cells to fight the cancer as well. Currently, two patients are more than 1 year cancer free, with a third approaching 1 year. When they get 12 patients cancer free for 1 year, the procedure will be considered for approval.

The reason for the discussion at the kickoff was that the Leukemia and Lymphoma Society has donated more than $50 million to this research over the years. Over that past several years, the FDA has approved 19 new drugs and therapies for blood cancer -- all with the assistance of the LLS. Of the 19, 12 have been approved or are being studied for the treatment of other forms of cancer as well. That is remarkable.

I was watching a baseball game the other day and a commercial for the MLB's involvement with Stand Up 2 Cancer came on (anyone who saw the All Star Game, the Stand up 2 cancer half inning display was chilling.) They splashed two stats on the screen that shook me. 1 in 3 women and 1 in 2 men will get cancer. The numbers are staggering. With respect to blood cancer:
• Every 5 Minutes: Someone in the United States learns that he or she has leukemia, lymphoma, Hodgkin’s disease or myeloma.
• Every 10 Minutes: Another child or adult is expected to die from a blood cancer.

This is why I renew my plea to all our readers and donations to the Light the Night Walk can be made through the link on the top left of the page, or by going to my team page . Any amount of support is greatly appreciated. By donating, you are not only helping to cure blood cancers, support caregivers, assist patients with purchasing drugs they could not otherwise afford, but you are indirectly supporting research that is going to treat and cure other cancers as well.

Cautious Optimism On Novel Gene Therapy Cure For Leukemia

A very small study involving three patients receiving a novel gene therapy treatment appeared to cure two patients completely of a common form of leukemia. The third patient showed significant improvement.

I'm stressing the small size of the study, because such results might not be found when applied to a larger group and that many additional studies will be needed to confirm the early findings.

"It worked great. We were surprised it worked as well as it did," said Dr. Carl June, a gene therapy expert at the University of Pennsylvania. "We're just a year out now. We need to find out how long these remissions last."

He led the study, published Wednesday by two journals, New England Journal of Medicine and Science Translational Medicine.

It involved three men with very advanced cases of chronic lymphocytic leukemia, or CLL. The only hope for a cure now is bone marrow or stem cell transplants, which don't always work and carry a high risk of death.

Scientists have been working for years to find ways to boost the immune system's ability to fight cancer. Earlier attempts at genetically modifying bloodstream soldiers called T-cells have had limited success; the modified cells didn't reproduce well and quickly disappeared.

June and his colleagues made changes to the technique, using a novel carrier to deliver the new genes into the T-cells and a signaling mechanism telling the cells to kill and multiply.

That resulted in armies of "serial killer" cells that targeted cancer cells, destroyed them, and went on to kill new cancer as it emerged. It was known that T-cells attack viruses that way, but this is the first time it's been done against cancer, June said.

For the experiment, blood was taken from each patient and T-cells removed. After they were altered in a lab, millions of the cells were returned to the patient in three infusions.

The researchers described the experience of one 64-year-old patient in detail. There was no change for two weeks, but then he became ill with chills, nausea and fever. He and the other two patients were hit with a condition that occurs when a large number of cancer cells die at the same time — a sign that the gene therapy is working.

"It was like the worse flu of their life," June said. "But after that, it's over. They're well."

The main complication seems to be that this technique also destroys some other infection-fighting blood cells; so far the patients have been getting monthly treatments for that.

Penn researchers want to test the gene therapy technique in leukemia-related cancers, as well as pancreatic and ovarian cancer, he said. Other institutions are looking at prostate and brain cancer.

This study should spur investment and research at utilizing similar treatments for other common cancers.

While the imminent side effect of a bad flu lasting a week or so would be a vast improvement over the kinds of side effects from current treatment options, that include everything from prolonged weakness, hair loss, organ failure, auto-immune disorders, among others, that other immune cells are affected might have long-term consequences that need to be studied as well.

These patients will need to be studied over the next couple of years to see if their cancer remains in remission or if there are thus-far undiscovered side-effects such as other forms of cancer or illnesses that result from the gene therapy.

Still, that this development is going to spur investment and research on this technique is a major breakthrough and here's hoping that the results hold up.

Astronomers' Discovery May Lead To Improved Cancer Treatments; Another Argument In Favor of Basic Science Research

For many people who suffer from any number of cancers, radiation treatments are a vital part of the regime along with chemotherapy.

A discovery by astronomers studying black holes may make that radiation treatment far more effective and safer.

Pradhan conducted computer simulations to calculate how individual atoms would react to every wavelength of energy -- no small feat. They logged many hours at the Ohio Supercomputer Center to complete the analysis.

But the effort was worth it. Pradhan found that some of the prior measurements of chemical abundances inside stars might be off by as much as 50 percent. They were also intrigued by how certain heavy metal atoms absorb radiation: they emit low-energy electrons when exposed to x-rays at specific energies. For example, bombarding iron, gold and platinum with a small dose of x-rays tuned to a narrow frequency range results in a burst of low-energy electrons.

Both x-rays and heavy metals like gold and platinum are routinely used in medical imaging and cancer treatment, hinting at more practical applications. It's the fine-tuning of the x-ray source that seems to be key.

The scientists are now examining how to take advantage of this observation and the assembly of a device that would take advantage of the fact that gold or platinum nanoparticles amass naturally in cancerous tumors in the body, and could then be zapped with the focused x-ray beam. The beam wouldn't require the levels of radiation utilized at present and could be even more focused than existing technologies. It would allow cancer cells to be killed without damaging nearby health tissue. The goal is to combine radiation therapy with chemotherapy, using platinum as the active agent.

It would also be able to target cancers that are previously considered to be inoperable or resistant to current medical treatment.

Once again, this is the result of basic science research and a multidisciplinary view on basic science. Projects like the follow-up to the Hubble Telescope are under fire for being over cost and may be cut by the current Congress. That would be a huge mistake considering the vast amount of knowledge gleaned about the universe from the Hubble and other similar technologies. Canceling the Webb telescope would hinder further discoveries that may have spinoff applications in other fields, including medicine.

It's yet another reason to donate to the Leukemia & Lymphoma Society's Light the Night campaign, which is fighting for a cure for a wide range of blood cancers, including the kind that Legalbgl wrote of that struck his wife, Non-Hodgkin’s disease called Primary Mediastinum B-Cell Lymphoma.

Will Zadroga Act Cover Cancer?

That's the multibillion dollar question being asked after a report released by Dr. John Howard, the director of the National Institute for Occupational Safety and Health, found no connection between exposures at Ground Zero and any multitude of cancers that Ground Zero responders believe to be caused by that exposure.

But the report, released by Dr. John Howard, the director of the National Institute for Occupational Safety and Health, said that there was very little evidence to go on, as there have only been 18 published research studies on the attack that even mentioned cancer, and only five of those were peer-reviewed. The results of the peer-reviewed studies were mixed.

Even if it appeared that the events of 9/11 caused cancer in certain people, it would be hard to prove because cancer is widespread in the general population. In the United States, the probability that a person will develop cancer over a lifetime is one in two for men and one in three for women, the report said.

“Drawing causal inferences about exposures resulting from the Sept. 11, 2001, terrorist attacks and the observation of cancer cases in responders and survivors is especially challenging since cancer is not a rare disease,” the report said.

The report was required by the James Zadroga 9/11 Health and Compensation Act, which took effect on Jan. 2; it provides $4.3 billion over the next five years to monitor, treat and compensate people who were exposed to the fumes and dust.

The act provides treatment and compensation for a specific list of illnesses, mainly asthma and other respiratory diseases. As part of a political compromise needed to pass the bill, cancer was not included. A provision of the law, however, specified that the administrator of the National Institute for Occupational Safety and Health would periodically review the evidence to determine whether cancer, which could be one of the most expensive illnesses to treat and compensate for, should be added to the list.

This goes to basic epidemiology. Scientists have to look at the specific incidence of a given disease and determine whether there is an increased rate. Then, they have to see whether there's more than a casual connection with exposure at Ground Zero.

The NIOSH will periodically review the findings, but it will take further studies to show that there's an actual cancer link between 9/11 and the responders' incidence of cancer. So, while a link hasn't been shown to date, this doesn't mean that within the next several years that the link wont be proven.

All this is cold comfort to those who are suffering from cancers they believe were the result of service at Ground Zero following the 9/11 attacks, and who believed that they would be covered by the Zadroga Act.

Dr. Howard may be the official responsible for not including cancers among the compensated illnesses, but that doesn't mean that other doctors treating Ground Zero responders aren't finding a connection.

Dr. Philip J. Landrigan, head of a 9/11 treatment, monitoring and research program at Mount Sinai Medical Center, said Tuesday that the possibility of cancer in the responders increases as time goes by. Mount Sinai, he said, is tracking the rates of 60 different cancers, and will be feeding that information to the federal government.

Dr. Landrigan said his researchers were looking especially hard at multiple myeloma, because they had already found eight cases — an unusually high number — in responders younger than 45. Usually, he said, myeloma is found in people who are older.

Landrigan and his fellow doctors have to publish their findings and get others to confirm those findings, before it can be added.

Unraveling the Causes of Autism - A SSRI Link?

Forget about vaccines. One of the culprits behind the rise in autism may be the use of SSRI (anti depressants) taken by women while they are pregnant.

Children whose mothers take Zoloft, Prozac, or similar antidepressants during pregnancy are twice as likely as other children to have a diagnosis of autism or a related disorder, according to a small new study, the first to examine the relationship between antidepressants and autism risk.

This class of antidepressants, known as selective serotonin reuptake inhibitors (SSRIs), may be especially risky early on in a pregnancy, the study suggests. Children who were exposed to the drugs during the first trimester were nearly four times as likely to develop an autism spectrum disorder (ASD) compared with unexposed children, according to the study, which appears in the Archives of General Psychiatry.

The study included fewer than 300 children with a diagnosed ASD and does not prove that taking SSRIs during pregnancy directly causes ASDs, which affect approximately 1 percent of children in the U.S. The findings will need to be confirmed in larger studies, and should not dissuade women from starting or continuing to take SSRIs, experts on prenatal drug exposure and mental health say.

One study by itself doesn't give an explanation, but it does raise serious questions over if and how these medications should be dispensed during pregnancy.

Andrew Wakefield Still Peddles His Anti-Vaccine Pablum To Willing Parents in US

Andrew Wakefield, whose fraudulent study and report led to a generation of parents to withhold critical vaccinations over what Wakefield claimed was links between the MMR vaccine and autism, is still peddling his nonsense to crowds of American parents despite being banned from the practice of medicine in the United Kingdom where the fraudulent study was conducted and published in the Lancet.

Andrew Wakefield has become one of the most reviled doctors of his generation, blamed directly and indirectly, depending on the accuser, for irresponsibly starting a panic with tragic repercussions: vaccination rates so low that childhood diseases once all but eradicated here — whooping cough and measles, among them — have re-emerged, endangering young lives.

And yet here he was in Texas, post-career-apocalypse, calmly discussing his work, and a crowd of around 250 people showed up to listen. As people walked into the lobby of the church in Tomball, they passed by a whiteboard with a message that asked attendees to express their thoughts to Wakefield. Many complied with lavish thanks: “We stand by you!” and “Thank you for the many sacrifices you have made for the cause!” When he finally took the podium, the audience members, mostly parents of autistic children, stood and applauded wildly.

In his presentation, Wakefield sounded impatient but righteous. He used enough scientific terms — “ataxic,” “histopathological review” and “vaccine excipients” — that those parents who did not feel cowed might have been flattered by his assumption of their scientific fluency. He also tried to defend himself against a few of the charges laid out in The British Medical Journal — offering defenses that did not hold up before the journal’s panel of editors but were perhaps enough to assure an audience of his fans that he did, in fact, have defenses. Some part of Wakefield’s cult status is surely because of his personal charisma, and he spoke with great rhetorical flair. He took off his glasses and put them back on like a gifted actor maximizing a prop. “What happens to me doesn’t matter,” he said at one point. “What happens to these children does matter.”

After the talk, a line of visitors snaked down the length of the lobby, his followers waiting to have Wakefield sign a book he wrote about his experience and convictions, “Callous Disregard.” “All right, love?” he said, handing the book back to one mother. “Of course,” he said when asked for a photo. A pregnant woman in the lobby told me she was there trying to educate herself. Another woman, with tears in her eyes, blamed herself for not working harder to obtain a separate measles vaccine for her possibly autistic child.

Michelle Guppy, the coordinator of the Houston Autism Disability Network and the organizer of the Tomball event, said she believed her own autistic son benefited greatly from one aspect of Wakefield’s work: his conviction that untreated gastrointestinal problems could be behind some of autism’s symptoms. It was Guppy, it turned out, who thought to hire the armed guards “to make the statement,” she said, “that this is neutral ground, and it’s going to be civil.” Guppy, a mother of two who was elegantly dressed for the occasion, made no pretense of neutrality herself. She narrowed her eyes when she learned that a writer from The New York Times was there to write about Wakefield.

None of Wakefields claims could stand up to scrutiny and hundreds of studies carried out since Wakefield's original claims found no link between autism and vaccinations. None could repeat his results, and closer scrutiny of the original study found widespread fraud and misleading information to the point that the Lancet retracted the story - albeit far too late for the damage to have been undone.

Vaccination rates are now much lower than they were before Wakefield's study was published - and that has a direct effect on medical costs, hospitalizations, deaths, and severe injury resulting from infection with easily preventable communicable diseases like measles, mumps, or rubella.

Regardless of the science, Wakefield still holds to the belief that the MMR vaccine causes autism - and parents of kids who are of an age who should be getting vaccinations are still listening to the likes of Wakefield and he's receiving support from Generation Rescue, which further peddles the anti-vaccination tripe despite no evidence supporting any link between vaccination and autism.

Indeed, one of the reasons that Wakefield's study was retracted was because a closer look at the patients in his study found that several of the severely limited sample size were already displaying developmental disabilities well before they were vaccinated with the MMR - suggesting that something else was at work - not vaccinations. Many studies note that there are likely genetic and environmental factors at work, but vaccinations are not one of them.

Rep. Giffords Making Significant Progress In Recovering From Attempted Assassination

Rep. Gabrielle Giffords is making tremendous progress in recovering from the gunshot wound sustained when Jared Loughner attempted to assassinate the Congresswoman at an event in a Tucson supermarket.

Doctors have been reducing the sedatives being given and while swelling remains a concern, they are seeing hopeful signs for a positive outcome.

Yesterday, President Obama, in the midst of his speech about the civil discourse and the need for unity, announced that Rep. Giffords had opened her eyes for the first time since surgery.

Today, doctors announced that she's sitting up and moving all her limbs.

The Arizona congresswoman has been sitting up, dangling her legs on the edge of the hospital bed and moving her limbs in response to commands. That's after she spontaneously opened her eyes during visits with her colleagues Wednesday night. She is able to lift both of her legs on command and is yawning and starting to rub her eyes, doctors said.

"She's becoming more aware of her surroundings," trauma chief Dr. Peter Rhee said during a news conference at the University Medical Center in Tucson, Ariz., Thursday.

The next milestone will be removing her breathing tube, and perhaps have her sit in a chair on Friday, said Rhee, who has treated soldiers in Iraq and Afghanistan. Doctors want to make sure Giffords doesn't regress and are watching for pneumonia and blood clots.

One of the keys to her survival and seemingly miraculous recovery to date is the prompt medical attention, including by her intern, Daniel Hernandez, whose actions helped save her life.

Blood Test May Revolutionize Cancer Treatment and Diagnosis

Scientists are looking at a blood test that could discover a single cancer cell floating amid billions of normal blood cells.

In 2007, researchers at Massachusetts General Hospital, developed a "microfluidic chip," called CellSearch, which could count the number of stray cancer cells, but that test didn't allow scientists to trap whole cells and analyze them.

But on Monday, Mass General announced an agreement with Veridex LLC, part of Johnson & Johnson, to study a newer version of the test. According to the Associated Press, the updated test requires only a couple of teaspoons of blood.

The microchip is dotted with tens of thousands of tiny posts covered with antibodies designed to stick to tumor cells. As blood passes over the chip, tumor cells separate from the pack and adhere to the posts.

Scientists are wagering that this type of test, if successful, might also detect cancer early in its course, predict the odds for a recurrence, and assess a patient's general prognosis.

"There has been speculation that these [stray] cells are the ones that are responsible for the spreading of the disease," noted one expert, Dr. Massimo Cristofanilli, professor and chairman of medical oncology at Fox Chase Cancer Center in Philadelphia. "Simple enumeration tells us that this patient has a worse prognosis . . . Now the question is, what other information we can gather, if we are able to capture these cells? For example, could we do gene analysis profiling and can we get information for the best treatment?"

As it stands today, biopsy -- an invasive and sometimes even hazardous procedure -- is one of the few ways doctors can get key information about a cancer's size and characteristics.

"Many people consider [the new blood test to be] a 'liquid biopsy,' so that eventually we can access cancer cells that are representative of the tumor without performing an invasive biopsy," said Cristofanilli, who is not involved in developing the test.

Experts stressed that the new type of test, if it ever arises, may still be years away, and researchers still aren't sure what these circulating tumor cells (CTCs) actually mean.

Identifying cancers at an early stage increases survivability and increases the range of treatment options.

Indeed, this has the potential to revolutionize pancreatic cancer and other difficult cancers. For now, the test is not being used in clinical situations, but several major cancer centers around the country are studying the test.

Overselling Stem Cell Treatment Cure For HIV

German doctors claim that they have cured a patient of HIV using stem cell treatments carried out in conjunction with chemotherapy and a bone marrow transplant.

Timothy Brown, an American living in Berlin, was given stem-cell therapy and chemotherapy in 2007 to treat leukemia, a condition that developed after he was infected with the AIDS virus.

Three years later, doctors believe the 42-year-old has been cured of both cancer and HIV.

"Our results strongly suggest that cure of HIV has been achieved in this patient," wrote study author Kristina Allers in this month's issue of the medical journal Blood.

Doctors say they treated Brown with stem cells and bone marrow from a healthy individual with a genetic predisposition to resist HIV.

Doctors believe Brown is the first person ever to be cured of HIV and say the treatment could pave the way for a new approach in fighting the virus.

The treatment was not without side effects. Brown developed neurological problems that caused temporary blindness and memory problems as well as difficulty with coordination and speech.

Dr. Gero Hutter, the lead doctor overseeing Brown's treatment, told the German magazine Stern his team has "overthrown the dogma that HIV can never be cured".

I don't think anyone thought that HIV could never be cured. This particular treatment isn't going to be the cure although it might lead to new treatment paths. The doctors had essentially killed the patients existing immune system and rebooted it with the bone marrow transplant and stem cell treatment, but that's not a feasible method of curing the disease as it is dangerous, tremendously costly and time consuming.

Doctors, including noted AIDS research Anthony Fauci, say that this particular treatment is costly and dangerous, but that it could lead to other treatment paths. Moreover, the patient is now trading one set of expensive medications for another equally expensive and dangerous set of medications - retrovirals are replaced by immuno-suppressants to prevent rejection of the donated tissues.

Headlines blaring a possible cure here are overselling the circumstances of the treatment. Headlines touting the stem cell treatment aspect are likewise overselling the nature of the treatment. It gives false hope to millions living with the disease.

Yet Another Unintended Consequence of Health Care Reform

Childrens' hospitals wont be able to deliver certain low cost medications to patients in need because the 2010 health care reform package eliminates orphan drug status eligibility for those hospitals. Drug manufacturers were required to provide orphan drug discounts to hospitals, including childrens' hospitals. Orphan drugs, which are categorized by the FDA, are for treatments that affect 200,000 or fewer people a year, and while some of the drugs might have other uses, the use for these conditions could be quite expensive. It's yet another unintended consequence of the health care reform package signed into law earlier this year. As the Times reports:

In an unintended consequence of the new health care law, drug companies have begun notifying children’s hospitals around the country that they no longer qualify for large discounts on drugs used to treat rare medical conditions.

As a result, prices are going up for these specialized “orphan drugs,” some of which are also used to treat more common conditions.

Over the last 18 years, Congress has required drug manufacturers to provide discounts to a variety of health care providers, including community health centers, AIDS clinics and hospitals that care for large numbers of low-income people.

Several years ago, Congress broadened the program to include children’s hospitals. But this year Congress, in revising the drug discount program as part of the new health care law, blocked these hospitals from continuing to receive price cuts on orphan drugs intended for treatment of diseases affecting fewer than 200,000 people in the United States.

The reason behind the change is murky, though some drug makers had opposed expansion of the drug discount program. The discounts typically range from 30 percent to 50 percent, and children’s hospitals say the change is costing them hundreds of millions of dollars.

Under the new law, hundreds of rural hospitals became eligible for discounts for the first time, but the discounts are not available on orphan drugs, which account for a surprisingly large share of their outpatient pharmacy costs. At the same time, children’s hospitals lost access to discounts on the drugs.

Once again, the cost for medications will rise as a result of the health care legislation. The orphan drug discounts were anywhere from 30-50% of the cost of the medication normally. Drug companies have gone along with this because they receive tax credits to conduct research on these diseases.

This follows a move to all but eliminate OTC drug purchases with flexible spending accounts, which allow consumers to buy their OTC drug needs with pre-tax income. Requiring a doctor's prescription/note to become eligible for the FSA reimbursement adds time and cost, but which also is meant to deter people from using FSAs and diverting income to pre-tax accounts (reducing taxable income). That move is essentially an accounting trick, but one that makes the cost of medication more expensive.

Here, the rationale for the switch isn't apparent. No one quite knows why the law was drafted that way, and an unidentified House Democrat staffer says that it was an honest drafting error.

I'm not totally buying that because the drug manufacturers benefit on their bottom line by eliminating one reduced revenue source (they will now expect full compensation on those drugs). Some drug companies may take an altruistic approach and continue the orphan drug status to curry favor, but others, like Allergan and Genentech said that they would stop providing certain medications under the program as the new law is currently construed.

In the end, this hurts the kids who are suffering from diseases that were formerly treated with drugs on the orphan drug list. It can significantly increase the health care costs - and potentially complicate treatment options for children suffering from diseases that fall into this classification.

Here's hoping that the new Congress can get together to fix this particular mess. Far from improving health care, this particular issue is a big step backwards.

A Major Breakthrough in Stem Cell Research

For the first time, researchers have injected embryonic stem cells into the spinal column of a person who was paralyzed. The researchers wont know for several months if the treatment will work to restore some movement and feeling in the extremities.

The pioneering but controversial treatment was done Friday on a volunteer at the the Shepherd Center spinal cord and brain injury rehabilitation hospital in Atlanta.

Doctors hope the manufactured nerve cells will prompt damaged spinal column nerves to regrow — and enable the patient to eventually recover feeling and movement.

"When we started working with human embryonic stem cells in 1999, many predicted that would be a number of decades before a cell therapy would be approved for human clinical trials," said Dr. Thomas Okarma, president of Geron, a biotech company that has already spent $170 million developing a stem cell treatment for spinal cord injuries.

It will be months before doctors know whether that gamble pays off.

In animal trials, paralyzed rats regained some movement after they were injected with nerve cells made from stem cells. But it remains to be seen if this kind of treatment works on humans.

Little is known about the brave volunteer beyond the fact that he or she was injured within the last two weeks.

Previous studies had involved injecting embryonic stem cells into mice with some success. One of the keys to this treatment is an early intervention to introduce the stem cells within two weeks of the incident causing paralysis.

Scientists will not only be looking for signs of success, but of abnormal growths including cancers, and other side effects. One of the hurdles to overcome in stem cell therapies, regardless of the source of the stem cells is their propensity to turn into cells that aren't wanted for a given application.

French Scientists Working on Dental Gel To End Fillings

If you've ever had to endure the dentist's drill for fillings, this is news that can't come quickly enough. A team of scientists in France are working on a gel that would allow teeth to regenerate and fill in cavities without the drill.

The new treatment is painless. And although fillings halt decay, they can come loose and sometimes need refilling.

Experts believe new tooth cells would be stronger and a permanent solution.

The French team mixed MSH with a chemical called poly-L-glutamic acid. This is a substance often used to transport drugs inside the body because it can survive the harsh environments, such as the stomach, that might destroy medicines before they get a chance to work.

The mixture was then turned into a gel and rubbed on to cells, called dental pulp fibroblasts, taken from extracted human teeth. These cells are the kind that help new tooth tissue to grow.

But until now there has been no way of 'switching' them back on once they have been destroyed by dental decay. The researchers found the gel triggered the growth of new cells and also helped with adhesion - the process by which new dental cells 'lock' together.

Faster Please! Cancer Treatments Improving And May Appear To Be Even More Impressive Than First Thought

The advances in cancer treatment continue to be encouraging for a wide range of cancers, but they can't come fast enough.

The key to the most recent advances, new drug regimes, combination therapies, and tailored treatments that benefit subsets of cancers based on specific subtypes.

But some of the victories reported this week against breast and prostate cancer, leukemia and the deadly skin cancer called melanoma may be larger than they appear. These trends offer reason for optimism:

• Newer drugs seem to be making a bigger difference for small, specific groups of patients, as companies develop treatments that more precisely target genes behind subtypes of cancer.

Pfizer Inc. rushed into late-stage testing one such drug: crizotinib, which is aimed at only 4 percent of lung cancer patients. More than 90 percent of them responded to the drug in initial tests. High response rates also have been reported for other novel drugs for melanoma and breast cancer driven by certain genes.

The hope: Develop enough of these specialized treatments that eventually every cancer patient will have something that works.

• Quicker answers from smaller, focused studies. Pfizer's test of crizotinib will need only 318 patients and will be finished early next year. It also will test the drug earlier in the course of illness rather than as a last-ditch option.

"You don't really need big trials if it works so well," and the group of patients who stand to benefit can be identified in advance, said Dr. Roy Herbst, lung cancer chief at the University of Texas M.D. Anderson Cancer Center in Houston.

• Big gains from novel combinations. All 66 patients testing a drug combo for the blood disease multiple myeloma saw a reduction in the amount of cancer they had by at least half. A 100 percent response rate is unheard of for any cancer and would not have occurred if two drugmakers had not teamed up to test their treatments together instead of against each other, said Dr. Paul Richardson of Boston's Dana-Farber Cancer Institute, who led the research.

The combo of Takeda Pharmaceutical Co.'s Velcade, Celgene Corp.'s Revlimid and the chemotherapy mainstay dexamethasone allowed more than half of patients to delay and perhaps avoid a bone marrow transplant — a harsh and risky treatment for the disease.

• Comparison tests of long-used treatments. For decades, men with cancer that has spread beyond the prostate have been given hormone treatments with or without radiation, yet only a few studies have tested these against each other or together. A Canadian study found that combo treatment extended survival an average of six months in high-risk cases, and the oncology society said it could become a new standard of care.

One thing that isn't improving is the cost.

These kinds of treatments remain expensive and aren't going to get any cheaper as treatments become even more tailored and specific.

Meanwhile, if you're interested in donating to cancer research, my choice is Memorial Sloan Kettering Cancer Center in New York City, which is one of the global leaders in cancer research.

Time Gives Too Much Credit (and Credence) To Anti-Vaxxer McCarthy

The studies that have long underpinned the anti-vaccine campaign as a fight against autism have been discredited and repudiated. That has done nothing to stop Jenny McCarthy and others from continuing to spread their nonsense that vaccines have caused autism.

When is she and her supporters going to be held responsible for the public health crises that have erupted around the world based on those individuals not giving their children vaccines to communicable diseases that are easily prevented and wholly avoidable like mumps and rubella? Outbreaks of measles, mumps, and whooping cough have occurred all around the world, including in my own backyard in the New York metro area all because one child was exposed to one of these diseases on a trip to Britain where vaccination rates are much lower and the resulting outbreak has infected more than 1,500 people.

Yet, Time is continuing to give credence and space to McCarthy to spread her noxious views.

McCarthy's way, however, is one that flies in the face of all credible research on what does and does not cause autism and whether it can be treated. McCarthy claims Evan was healed through a range of experimental and unproved biomedical treatments; even more controversially, she blames the MMR (measles, mumps and rubella) vaccine for giving her son autism. And yet research conclusively shows that vaccines are safe for children; just last month, the U.K. scientist who had published a study linking the MMR shot to autism was found by a British medical panel to have acted unethically. McCarthy says she does not believe all vaccines are bad — though she swears she will never allow Evan to receive another — nor is she saying you shouldn't vaccinate your child. Her position is more slippery but just as heretical to prevailing medical wisdom: do everything necessary to cure your child, no matter what the doctors tell you.

This message has won her a wide audience, based on her three best-selling books on autism. She has just completed shooting the pilot for a daytime talk show for Oprah Winfrey's TV network to begin airing later this year — which will be, she promises, yet another platform for her message. But her profile has also made her, among pediatricians, other doctors and many parents, a deeply polarizing figure. Though close to 80% of American children receive the standard battery of vaccinations, skepticism about their safety remains widespread, in part because of the antiscientific clamor of the McCarthy camp. Enough parents are refusing to vaccinate that some long-dormant maladies, like measles and meningitis, have re-emerged. Nonvaccination rates among kindergartners in some California counties have been reported at 10%. To McCarthy's opponents, from the public-health officials at the Centers for Disease Control and Prevention (CDC) to the pediatricians of the American Academy of Pediatrics, this makes McCarthy much worse than a crank: she's a menace to public health.

But she can't be ignored.

Yes, she can be ignored. She should be shunned all because she is a menace to the public health. On that, there can be no other way to describe her position. The publicity surrounding her situation and press coverage - including on the Oprah Winfrey show - have been met with a decline in the vaccination rates in the US - and an increase in outbreaks of communicable diseases.

And that's despite the fact that there are no links between vaccinations and autism and that the supposed chemicals responsible for autism haven't been in those vaccines in years. Even McCarthy's son's health situation isn't nearly as clear cut as she'd like people to believe.

Her son began having seizures in 2005, after which he began exhibiting signs of autism, and she made the connection between the vaccines and her son's ailment, even though there's no way to identify whether the seizures were brought on by the vaccinations or whether her son suffered from some other malady, which some doctors believe was actually Landau-Kleffner syndrome, which is marked by seizures that can be brought under control with medication.

But that hasn't stopped her from yammering on about the connection despite having no medical background and no idea what causes autism.

That's why she's so dangerous to the public health - she has know understanding of the ailment and yet manages to get her opinions delivered all across the media making it all the more difficult for public health officials and doctors to deal with.

Canadian CYA Over Newfoundland Premier Seeking Surgery In USA

Canadian health officials are trying to CYA claiming that Newfoundland Premier Danny Williams could have received the heart surgery in Canada and that he didn't have to go to the US for the procedure.

The surgery Newfoundland and Labrador Premier Danny Williams required may not be available in his home province, but chances are it's available in his home country, experts say.

Williams — an outspoken proponent of public health care — went to the U.S. Monday morning for a heart procedure his office said couldn't be done in Newfoundland and Labrador.

Williams' office has been tight-lipped about the situation, refusing to disclose what type of procedure he's undergoing, or where. Canadian medical experts insist that when it comes to heart procedures, there's nothing you can get in the U.S. that you can't get here. You just have to wait a bit longer, and the accommodations aren't as nice.

Dr. Arvind Koshal, a prominent Alberta cardiac surgeon, told the Globe and Mail Williams is sending the message that if you have money, you can forgo the hassles of public health care and pay for quicker service south of the border.

“The optics are very poor, especially for people who are proponents of the Canadian health-care system,” said Koshal.

Dr. Wilbert Keon, a heart surgery pioneer in Ottawa and a Conservative senator, told the Globe there is “no question” Williams could have chosen to remain in Canada.

Meanwhile, U.S. opponents of President Barack Obama's proposed health-care reform have made Williams their poster child. Obama aims to extend health care to the country's uninsured — a move critics say will extend wait times, turning America's health-care system into the Canadian model.

Patients First, an American organization against Obama's health-care reform plan, cited Williams' decision as proof the Canadian system is flawed.

Note the part I set off in bold. You have to wait longer and the accommodations aren't nearly as nice. For someone who needs heart surgery, delays can add to the costs and reduces quality of life. That's not a good thing. Neither is the fact that the Canadian officials admit that the accommodations aren't as nice. There is something to spending lots of money on health care infrastructure - you more often than not get what you pay for.