Health Headlines - October 15

Patients Complain About Medicare Changes

Officially, former tug boat captain Lawrence Michalski died of cardio-respiratory disease last month at his Seminole, Fla., home. Unofficially, his wife and some doctors say the 67-year-old man died in part because changes in Medicare funding left him scrambling to find a particular drug treatment that many health care providers say they can no longer afford to give needy patients.

The case has become a flashpoint in an argument over thousands of Medicare patients suffering from rare immune disorders and other illnesses that can be treated with intravenous immune globulin, or IVIG.

Immune globulin is a mixture of antibodies, infection-fighting proteins that healthy people normally have in their bloodstreams. Given intravenously, it is used mainly by the 50,000 Americans who suffer primary immunodeficiency, 7,000 of whom receive Medicare.

IVIG has also been given to multiple sclerosis or nerve damage patients for whom other treatments have been unsuccessful. It has recently been studied as a possible treatment for Alzheimer's disease.

Until recently, most patients could get monthly IVIG treatments at their doctors' offices. IVIG restores the strength of patients whose immune systems are so weak they would otherwise be vulnerable to many infections or illnesses.

At the start of the year, after Medicare cut the IVIG reimbursements for doctors from $66 per gram to $39 a gram for powdered brands, many stopped providing the treatment. Michalski and his wife Angelina scrambled to get IVIG from local hospitals, who are slated to get a similar cut next year.

Angelina Michalski said a four-week delay in her husband's IVIG treatment is partly responsible for his death.

"I had to fight every month to get the medicine, and everyone was saying they can't afford to get it for us," said Angelina. "It started with a scratch on his hand, and then he had a fever, and then he needed surgery."

Michalski died Sept. 15.

Now, doctors who treat such patients are warning that another scheduled cut in IVIG reimbursements, one that would apply to hospitals starting in January, will result in even fewer Medicare patients receiving effective treatment.

"If that happens, a lot of patients aren't going to be able to get IVIG at all, and that will essentially kill some patients," said Dr. Mark Davis-Lorton, director of Clinical Immunology at Winthrop-University Hospital in Mineola, N.Y.

Health advocates first raised alarms in the spring when doctors stopped offering the treatments, arguing they were seeing dangerous shortages.

The Department of Health and Human Services investigated the complaints, and declared in August that there was no shortage. Medicare officials still insist the payment changes have not led to a lack of treatment or scarcity of the drug.

"There are a variety of factors going on in the marketplace, so I don't think you can say the Medicare change in pricing is in itself creating a single reason why individuals say they are not getting their treatment," said Herb Kuhn, director of the Center for Medicare Management.

Part of the problem, Kuhn said, is that IVIG is being used to treat all sorts of health disorders, and that may be siphoning supply away from those who need it most.

Kuhn also said hospitals would not stop offering IVIG treatment once the reduced reimbursement rate goes into effect.

"Manufacturers are working very hard to make sure they're getting the product into the hands of suppliers," said Kuhn, adding that the recent problems with IVIG were a matter of "the market being out of equilibrium," and adding that equilibrium is now being restored.

Rep. Steve Israel, D-N.Y., blamed "an absolutely appalling lack of priorities" in government.

"If we don't stop cutting these Medicare reimbursements, the only people who will be able to afford these treatments will be wealthy people," said Israel, who is trying to rally support in Congress for IVIG patients.

Shirley Peters, a 71-year-old in Palm Beach Gardens, Fla., receives regular IVIG treatments at a hospital for her immunodeficiency, but fears fewer hospitals will offer the treatment next year.

"It's disgusting. What do they expect us to do?" she said. "Are we supposed to just get sicker and sicker until we pass away?"

Health Official Warns of Bird Flu Pandemic

Health and Human Services Secretary Mike Leavitt finished up a four-country tour of Southeast Asia a week after officials from 80 countries met in Washington to discuss how to prevent and contain a potential global health threat.

After watching chickens and ducks being gutted and cleaned on the sidewalk, Leavitt said it would be difficult to change behavior that is a regular part of people's lives.

"It's evident to me that part of the dilemma here is the cultural momentum because it's happened for hundreds of years, and the chances of changing it anytime soon are very low," he said while walking through the open-air market. "It adds obviously to the equation and to the possibility that you will see an outbreak at some point."

During Leavitt's Southeast Asian trip, which also included stops in Thailand, Cambodia and Laos, he has repeatedly warned of a potential flu pandemic and the importance of all countries rallying together to quickly come up with preparedness plans. The deadly H5N1 bird flu virus was confirmed in birds in Turkey this week.

The disease has hit Vietnam harder than any other country, killing 43 people and 45 million birds, decimating the flocks of poor farmers.

Health experts have warned that the world is due for the next pandemic and fear that the H5N1 virus could mutate into a form that is easily passed among people.

Leavitt on Saturday compared the spread of a pandemic to a brush fire, and said the "chances are not good" of being able to monitor the "spark" when a virus mutates and then quickly contain it.

"There is a spark where every fire starts, and if you're able to be there at the moment it occurs it's possible to simply stamp it out," he said. "If you allow it to burn for an hour, often it will gain enough momentum that it's uncontainable and begins to start other fires."

The U.S. has committed $25 million to address the threat in Asia, and Vietnam will receive more than $6 million for preparedness.

Leavitt was traveling with U.S. Centers for Disease Control and Prevention Director Dr. Julie Gerberding, U.S. National Institute of Allergy and Infectious Diseases Director Dr. Anthony S. Fauci, and Margaret Chan, the World Health Organization's top official in charge of monitoring avian influenza.

Fauci said the potential severity of a bird flu pandemic remains "extraordinarily variable."

"We as public health officials ... must assume the worst-case scenario, and H5N1 now is giving us a lot of signs that it is becoming a little bit more worrisome, if not a lot more worrisome, because of the events that are going on," he said.

Two of the last three global pandemics, all in the 20th century, originated in Asia.

The Asian flu of 1957-58 and the Hong Kong flu of 1968-69 each killed more than 1 million people. Neither compared to the Spanish flu of 1918-19, which killed up to 40 million people and sickened an estimated 20 percent to 40 percent of the world's population.

So far, most human cases have been linked to contact with birds. More than 60 people have died from the virus in Southeast Asia since the disease began ravaging poultry stocks in the region two years ago.

Adult Obesity May Trace to Infancy

Big babies who grow quickly in the first two years of life risk being obese in childhood and adulthood, British researchers report.

As obesity reaches epidemic proportions in the United States -- 30 percent of adults are obese and 65 percent are obese or overweight -- researchers are looking for keys to prevent it. Those efforts may need to begin in childhood, the researchers said.

"Levels of obesity are increasing in the population, and halting the rising prevalence of obesity is a public health priority," said study lead author Dr. Janis Baird, a research fellow at the MRC Epidemiology Resource Centre at the University of Southampton.

"It is not clear how early prevention can begin," she added.

To determine whether obesity may begin in infancy, Baird and her colleagues looked at 24 studies that found a relationship between infant size or growth during the first two years of life and obesity later in life.

They found that the heaviest infants and those who gained weight rapidly during the first and second year of life faced a nine-fold greater risk of obesity in childhood, adolescence, and adulthood.

"These findings suggest that factors in infant growth are probably influencing the risk of later obesity," Baird said. "There are many factors that do influence infant growth. What's needed now are much more detailed studies to look at how infants grow and what the predictors of their growth are."

The study findings appear in the Oct. 14 online edition of the British Medical Journal.

One expert believes that nurture, more than nature, is responsible for the rise in obesity among children.

"If people take this too seriously, people may start calorie-restricting their infants, which is a bad thing," said Dr. Dennis Woo, chairman of the pediatrics department at Santa Monica-UCLA Medical Center, in California.

According to Woo, children regulate their own calorie intake.

"A lot of kids eat what they want to eat, and they do a pretty good job of regulating their weight and height balance. There are some kids who grow rapidly in the first year, but then they go through a phase where they become picky as far as their eating goes," added Woo, who's also an assistant clinical professor of pediatrics at the University of California, Los Angeles David Geffen School of Medicine.

Woo advises parents to let infants eat what they want to eat and not force them to eat during the time they are picky about eating. "We are fighting the cultural belief that fat babies are healthy babies," Woo said. "So people like to fatten their kids up."

Many parents also believe fat babies are fine because they slim down when they are older, Woo said. "That doesn't always happen. People use that as a rationale for really stuffing their kids."

"There is nothing wrong with a baby being heavy as an infant as long as he's regulating his own eating," Woo said. "There will come a time when he will not be growing and he will cut down on his eating. Most of the time, those are the big babies who then slim down."

Woo believes healthy eating habits begin in infancy.

"We want to teach all kids healthy eating habits right from the very beginning," he said. "We need to shape how people look at eating. Because infants don't have the psychological cues that adults have, they respond to their biological needs. We could actually learn from infants about how to eat."

Interferon-Linked Protein Key to HIV Vaccine

Scientists say a newly discovered cellular pathway could pave the way for a new type of vaccine against HIV, the virus that causes AIDS.

According to background information, disease progression after HIV infection is associated with the decreased presence of plasmacytoid dendritic cells (pDCs), major producers of an immune protein called type 1 interferon. According to researchers at New York University (NYU), high numbers of pDCs are related to successful control of HIV, the virus that causes AIDS.

The new study, published in the Oct. 13 online issue of the Journal of Clinical Investigation, outlines the mechanisms by which HIV-1 activates human pDCs. This activation requires at least two interactions between the HIV and pDCs, the NYU team explains.

The study noted that a decrease of blood pDC is frequently observed in chronic infections suffered by people with HIV. This decrease of blood pDC correlates with high viral load, reduced CD4 counts and susceptibility to opportunistic infections.

By identifying the active component of HIV-1 that stimulates pDC function, the researchers believe they have pinpointed an important pathway that may prove a useful target in the development of HIV vaccines or immunotherapies.

Food Fact:
Fish: Good fat vs. bad.

In seafood, it's key to know which fat can help your heart -- and which can hurt it. The fat in seafood is the kind you want to eat -- even in a low-fat diet. A "fatty" fish still has less fat than the "leanest" red meat. Better yet, the fat in fish helps prevent heart attacks. For maximum benefit, resist the urge to cook your seafood in butter, or ordering it fried out -- almost all oils used for commercial frying contain artery-clogging fats. Cook seafood at home with small amounts of canola or olive oil -- or no added fat.

Fitness Tip of the day:
Make a cardio-commute.

You're going to work anyway -- be creative, and you can squeeze in a little effortless exercise on the way. In the morning, walk or ride your bike to the train station or bus stop, or hop off the bus a few blocks from your normal stop and walk the rest of the way. At work, try talking the talk as you walk the walk. Suggest to your boss that you take your brainstorming sessions outside for a walk around the block or a stroll through the halls.

FAQ of the day:
Are fish-oil pills better for me than eating fish?

While fish-oil pills contain the same heart-healthy omega-3 fatty acids as seafood, they also add fat and calories to your diet, which may defeat the purpose. When you eat fish or shellfish, it often means you're not eating high-fat foods, such as burgers, you might otherwise have chosen at that meal. If you can't stand fish and want to explore taking a fish-oil supplement, check with your doctor first.