August 2009

By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) – The new H1N1 swine flu is estimated to have infected about 800,000 people in New York City in the spring, a top U.S. health official said on Sunday, citing a study due to be released later this week.

Dr. Thomas Frieden, who heads the U.S. Centers for Disease Control and Prevention, said surveys suggested the virus was widely spread around the city. Frieden was New York City’s health commissioner before taking the top CDC job in June.

“In New York City where we had a lot of H1N1 this last spring the estimate is about 800,000 people, about 10 percent of New York City residents, got infected with the flu,” Frieden said in an interview with C-SPAN television aired on Sunday.

“That’s a lot of people.”

New York City health department officials say the full study is being finished and will be released within days.

Frieden said there had been a twenty-fold variation in influenza infections around the country. “We expect that some places will have more flu. Some places will have less,” he said.

Swine flu has infected well over 1 million people in the United States, and is now the CDC’s No. 1 priority. Other research also shows that older children and young adults are by far the most likely to be infected with the new virus.

The World Health Organization predicts a third of the world’s population will eventually be infected.

The virus is still circulating and most health experts expect a resurgence in the northern hemisphere’s autumn as temperatures cool and schools, traditional breeding grounds for infection, reopen after summer holidays.

Detailed reports on outbreaks can help health officials prepare for epidemics in their communities.

Every year, seasonal flu infects between 5 percent and 20 percent of a given population and kills between 250,000 and 500,000 people globally. Because hardly anyone has immunity to the new H1N1 virus, experts believe it will infect far more people than usual, as much as a third of the population.

It also disproportionately affects younger people, unlike seasonal flu which mainly burdens the elderly, and as a result may cause more severe illness and deaths among young adults and children than seasonal flu.

Chicago health authorities said last week that the pandemic H1N1 flu infected 14 times as many children as adults over 60 there, and also disproportionately affected blacks and Hispanics.

WHO said pregnant women and people with asthma, diabetes and heart diseases are at special risk of severe complications of death from H1N1 flu.

Some countries are reporting that as many as 15 percent of patients hospitalized with the new H1N1 pandemic virus have needed intensive care, further straining already overburdened healthcare systems, WHO said on Friday.

Companies are preparing vaccines against H1N1, which will be given in addition to the regular seasonal influenza immunization.

(Editing by Paul Simao)

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Reuters provides an in-depth look at the issues facing Americans as the Obama administration wrestles with healthcare policy.  Full Coverage 

WASHINGTON (Reuters) – Fewer Americans are afraid that they will be unable to pay for healthcare services and fewer expect to postpone medical treatments due to costs, according to a Thomson Reuters survey published on Monday.

Researchers found a steady increase in people’s confidence about their ability to pay for healthcare services — it rose 12 percent between March and July this year.

The survey of 3,000 households showed, unsurprisingly, that people who made more money were more confident they could pay for medical care, and people who had insurance were far more confident about paying than those who lacked insurance.

“These findings are consistent with data we’ve been seeing for everything from hospital discharge trends to opinions about healthcare reform,” said Gary Pickens, chief research officer for the Healthcare & Science business of Thomson Reuters.

“There is growing optimism among many healthcare consumers, but (there) also is a clear disparity in outlook between those with higher income levels who have insurance coverage and those who are uninsured. This gap needs to be an area of focus for healthcare professionals and policymakers,” Pickens added in a statement.

Healthcare reform is the signature policy goal of President Barack Obama, and Congress is working on several bills, most concentrating on changes in the health insurance industry.

Thomson Reuters, the parent company of Reuters News, telephoned 3,000 people to ask whether they expected to have difficulty paying for healthcare services, delay or cancel a routine doctor’s visit, diagnostic test, elective surgery, a visit for a minor illness or injury or therapy over the next three months.

“Consumers in the lowest income groups are approximately 20 percent less confident than average, while those in the highest income group are approximately 40 percent more confident than average,” according to the report, published online here

“In July 2009 those consumers with college degrees or more education had confidence levels 25 percent greater than average, while those with high school education or less were approximately 10 percent less confident than average at the same point in time,” it adds.

“Those with insurance have overall confidence levels approximately 10 percent higher than average, while those with no insurance have overall confidence levels more than 80 percent lower than average. Improvements in confidence occurred in both groups.”

(Editing by Paul Simao)

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By Ben Hirschler

BARCELONA (Reuters) – AstraZeneca’s new pill Brilinta for preventing heart attacks works better than Plavix, the world’s second biggest selling drug, without increasing the amount of life-threatening bleeding, researchers said on Sunday.

The positive clinical trial result should ensure the blood thinner wins a slice of the Plavix market, worth $9 billion last year, and is likely to trigger upgrades in analyst forecasts for the drug, which AstraZeneca hopes to launch in 2010.

Some analysts believe it could be a $2 billion-plus seller.

Plavix is sold by Sanofi-Aventis and Bristol-Myers Squibb’s. It already faces one rival in Eli Lilly and Daiichi Sankyo’s recently launch Effient, which has also outperformed Plavix in tests.

But Effient, also known as prasugrel, is hampered by a strict warning on bleeding risks.

“This drug appears to be even better than prasugrel,” said Douglas Weaver of the Henry Ford Heart and Vascular Institute in Detroit, who was not involved in the study.

AstraZeneca believes its medicine has an edge in part because its action can be reversed. This means that heart patients who take Brilinta can be prepared for any necessary surgery much sooner, without excessive bleeding risk.

On the downside, it must taken twice a day, while Plavix and Effient are once-daily.

AstraZeneca said in May that Brilinta, or ticagrelor, had proved superior to Plavix in a head-to-head Phase III trial. But doctors and investors were only given details of the study at the European Society of Cardiology annual meeting in Barcelona.

These showed that patients with acute coronary syndrome (ACS) who took Brilinta were 16 percent less likely than those on Plavix to die from cardiovascular causes or suffer a heart attack or stroke.

That was a slightly weaker showing than for Effient, which showed a 19 percent advantage over Plavix in a different trial that analysts said was less onerous in design.

Brilinta also showed a 22 percent relative risk reduction in rates of death from any cause in the latest study.

“The fact that ticagrelor was able to lower death rates is very powerful. We didn’t see that with prasugrel,” said Kirk Garratt, a cardiologist at Lenox Hill Hospital in New York.

While there was no significant difference in major bleeding risk, patients on Brilinta were more likely than those on Plavix to have spontaneous bleeding unrelated to heart bypass surgery, including intracranial and gastrointestinal bleeds.

Brilinta was also linked with shortness of breath, though less than 1 percent of patients discontinued treatment because of this, and there were more cases of slowing of heart rhythms, though this rarely caused any symptoms.

Lars Wallentin of the Uppsala Clinical Research Center in Sweden and colleagues, who carried out the one-year study involving more than 18,000 patients with ACS, also reported their results online in the New England Journal of Medicine.

ACS describes a range of conditions, including unstable angina, or acute chest pain, and heart attack.

AstraZeneca is relying on Brilinta and a clutch of other drugs in its pipeline to help offset a looming loss of patent protection on existing blockbusters such as Nexium and Seroquel.

Current consensus risk-adjusted forecasts for 2014 Brilinta sales are just $686 million, according to industry consultancy Evaluate Pharma. But some analysts think sales could reach $2.5 billion or more.

While Brilinta could dampen prospects for Effient, it will probably not have a significant impact on Sanofi or Bristol, since Plavix is expected to face U.S. generic competition in 2012. Generic copies of the drug are already on sale in Europe.

(Editing by Mike Peacock)

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NEW YORK (Reuters Health) – People who are heavily in debt are more likely to be heavy themselves, too, according to new research from Germany.

“Overindebted” people – defined as those who would find it impossible to pay off debts in a reasonable time frame — were about twice as likely to be overweight as the general population. They were more than 2.5 times as likely to be obese, Eva Muenster of the University of Mainz and her colleagues found.

European countries, as well as the United States, have seen a sharp rise in the percentage of people who are overindebted, Muenster and her team say. Estimates are that 3 million households – 7.6 percent – of German households fit into the “over-indebted” criteria.

Socioeconomic status is clearly linked to health, the researchers add, but techniques now used to measure it don’t take debt into account. To investigate how debt might affect health, they surveyed 949 people who were receiving counseling for debt and insolvency at centers in two German states, comparing them to 8,318 people who participated in a 2003 telephone health survey and were considered to represent a slice of the general population that was not indebted.

The indebted individuals were younger, less educated, and less wealthy, and were also more likely to be depressed, overweight, or obese, the researchers found. About 11 percent of the general population was obese, compared to 25 percent of the indebted group. The indebted individuals were also more likely to smoke every day.

After taking these factors into account, Muenster and her colleagues found that being overindebted was associated with a 1.97-fold greater likelihood of being overweight, and a 2.56-fold greater risk of obesity.

Psychological factors could contribute to the greater risk of being overweight or obese among indebted people, Muenster and her team note, who may eat to cope with stress and depression. Healthy foods may be less affordable for them, the researchers add, while “energy-dense food such as sweets or fatty snacks are often less expensive compared to food with lower energy density such as fruit or vegetables.”

The findings don’t rule out the possibility that overweight or obese people are more likely to get into debt because they have a tougher time finding a job or make less money than slimmer people, the researchers note.

Muenster and her colleagues conclude by calling for investigators looking at socioeconomic status and health to include indebtedness in their analyses, along with standard measures like income and education.

SOURCE: BMC Public Health, online August 7, 2009.

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By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) – Doctors are reporting a severe form of swine flu that goes straight to the lungs, causing severe illness in otherwise healthy young people and requiring expensive hospital treatment, the World Health Organization said on Friday.

Some countries are reporting that as many as 15 percent of patients infected with the new H1N1 pandemic virus need hospital care, further straining already overburdened healthcare systems, WHO said in an update on the pandemic.

“During the winter season in the southern hemisphere, several countries have viewed the need for intensive care as the greatest burden on health services,” it said.

“Preparedness measures need to anticipate this increased demand on intensive care units, which could be overwhelmed by a sudden surge in the number of severe cases.”

Earlier, WHO reported that H1N1 had reached epidemic levels in Japan, signaling an early start to what may be a long influenza season this year, and that it was also worsening in tropical regions.

“Perhaps most significantly, clinicians from around the world are reporting a very severe form of disease, also in young and otherwise healthy people, which is rarely seen during seasonal influenza infections,” WHO said.

“In these patients, the virus directly infects the lung, causing severe respiratory failure. Saving these lives depends on highly specialized and demanding care in intensive care units, usually with long and costly stays.”

MINORITIES AT RISK

Minority groups and indigenous populations may also have a higher risk of being severely ill with H1N1.

“In some studies, the risk in these groups is four to five times higher than in the general population,” WHO said.

“Although the reasons are not fully understood, possible explanations include lower standards of living and poor overall health status, including a high prevalence of conditions such as asthma, diabetes and hypertension.”

WHO said it was advising countries in the Northern Hemisphere to prepare for a second wave of pandemic spread. “Countries with tropical climates, where the pandemic virus arrived later than elsewhere, also need to prepare for an increasing number of cases,” it said.

Every year, seasonal flu infects between 5 percent and 20 percent of a given population and kills between 250,000 and 500,000 people globally. Because hardly anyone has immunity to the new H1N1 virus, experts believe it will infect far more people than usual, as much as a third of the population.

It also disproportionately affects younger people, unlike seasonal flu which mainly burdens the elderly, and thus may cause more severe illness and deaths among young adults and children than seasonal flu does.

“Data continue to show that certain medical conditions increase the risk of severe and fatal illness. These include respiratory disease, notably asthma, cardiovascular disease, diabetes and immunosuppression,” WHO said.

“When anticipating the impact of the pandemic as more people become infected, health officials need to be aware that many of these predisposing conditions have become much more widespread in recent decades, thus increasing the pool of vulnerable people.”

WHO estimates that more than 230 million people globally have asthma, and more than 220 million have diabetes. Obesity may also worsen the risk of severe infection, WHO said.

The good news — people infected with AIDS virus do not seem to be at special risk from H1N1, WHO said.

(Editing by Mohammad Zargham)

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Reuters provides an in-depth look at the issues facing Americans as the Obama administration wrestles with healthcare policy.  Full Coverage 

By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) – Researchers searching for a cure for obesity said on Thursday they have developed a drug that not only makes mice lose weight, but reverses diabetes and lowers their cholesterol, too.

The drug, which they have dubbed fatostatin, stops the body from making fat, instead releasing the energy from food. They hope it may lead to a pill that would fight obesity, diabetes and cholesterol, all at once.

Writing in the journal Chemistry and Biology, Salih Wakil of Baylor College of Medicine in Texas, Motonari Uesugi of Kyoto University in Japan and colleagues said the drug interferes with a suite of genes turned on by overeating.

“Here, we are tackling the basics,” Wakil said in a telephone interview. “I think that is what excited us.”

Scientists are painfully aware that drugs that can make mice thin do nothing of the sort in humans. A hormone called leptin can make rats and mice drop weight almost miraculously but does little or nothing for an obese person, for instance.

But Wakil, whose team has patented the drug and is looking for a drug company to partner with, hopes this drug may be different. “I am very, very optimistic,” he said.

Fatostatin is a small molecule, meaning it has the potential to be absorbed in pill form.

It works on so-called sterol regulatory element binding proteins or SREBPs, which are transcription factors that activate genes involved in making cholesterol and fatty acids.

“Fatostatin blocked increases in body weight, blood glucose, and hepatic (liver) fat accumulation in (genetically) obese mice, even under uncontrolled food intake,” the researchers wrote.

Genetic tests showed the drug affected 63 different genes.

The idea of interfering with SREBP is not new. GlaxSmithKline has been working on a new-generation cholesterol drug that uses this pathway.

After four weeks, mice injected with fatostatin weighed 12 percent less and had 70 percent lower blood sugar levels, the researchers wrote.

Now they plan to test rats and rabbits, Wakil said.

The drug also had effects on prostate cancer cells they said — something that may help explain links between prostate cancer and obesity.

© Thomson Reuters 2009 All rights reserved

Reuters provides an in-depth look at the issues facing Americans as the Obama administration wrestles with healthcare policy.  Full Coverage 

By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) – Scientific advisers to President Barack Obama may have asked the government to speed up the availability of swine flu vaccines, but they are unlikely to be ready before October, the new head of the U.S. Centers for Disease Control and Prevention said on Wednesday.

And imperfect tests for the pandemic H1N1 virus means it will be impossible to get precise numbers on how many people are infected, said Dr. Thomas Frieden.

Nonetheless, swine flu is the No. 1 priority for the CDC, Frieden said in an interview.

“We have literally mobilized more than 1,000 people at CDC who work on H1N1,” Frieden said in the interview, conducted by Reuters and Associated Press to be aired on the C-SPAN television network on Sunday.

On Monday, the President’s Council of Advisors on Science and Technology said the government should speed up the supply of swine flu drugs and vaccines, making at least some shots available by mid-September.

The group also said the government should take advantage of the pandemic to improve flu surveillance.

Frieden said it was unlikely vaccines against H1N1 could get out to the public sooner than mid-October, when mass vaccination is scheduled to start.

“We wish we had new vaccine technology that would allow us to turn on a dime and make new vaccine in terms of weeks or months. It’s not possible with today’s technology to do that,” he said.

Five companies are making swine flu vaccine for the U.S. market — AstraZeneca’s MedImmune unit, CSL Ltd, GlaxoSmithKline Plc, Novartis AG and Sanofi-Aventis SA. Tests have begun to determine if people will need one or two doses to be protected.

WORST CASE PREDICTIONS

Frieden also distanced himself from some of the worst-case predictions outlined in the council’s report, which included a “plausible” estimate that between 30,000 and 90,000 people might die and up to 1.8 million might clog hospitals.

“Unfortunately, the media coverage of it was not nearly as balanced as the report itself,” Frieden said.

“Everything we have seen in the U.S. and everything we have seen around the world to date suggests that we won’t see that kind of number if the virus doesn’t change.”

Because this virus is new, more people are susceptible to it and the World Health Organization has been predicting for months now that 2 billion people will likely become infected.

“We will do everything in our power to reduce the number of people who die,” Frieden said.

But officials fear H1N1 could worsen as U.S. schools start their fall terms. Frieden fears there could be a rush of demand for vaccine if that happens.

“As people become sick or severely ill or die from flu we’ll get an increased demand for the flu vaccine and that is one of the challenges we have,” he said.

The Health and Human Services department estimates only 45 million doses will be available by mid-October, with 20 million a week coming after that.

Asked about surveillance, Frieden said that will be difficult, too. The new flu does not always show up on standard, on-the-spot flu tests given in doctor’s offices.

Special tests to differentiate pandemic H1N1 from seasonal flu have been sent to every state health department but it will be impossible to test everyone with symptoms, the tests are not 100 percent reliable, and there is not much point in testing everyone anyway, Frieden said.

“Once flu is in the community most people with flu don’t need to be treated,” he said. People at high risk of death or severe symptoms, such as pregnant women or people with asthma, need to be treated right away anyhow and it is not worth waiting to test them, he added.

(Editing by Mohammad Zargham)

© Thomson Reuters 2009 All rights reserved

Reuters provides an in-depth look at the issues facing Americans as the Obama administration wrestles with healthcare policy.  Full Coverage 

By Thomas Ferraro

WASHINGTON (Reuters) – Senator Edward Kennedy’s death comes as a political struggle appears to be chipping away at the Democratic power-broker’s vision for what he called “the cause of my life,” providing affordable healthcare coverage to all Americans.

After decades of laying the groundwork to overhaul the U.S. healthcare system, Kennedy, who died late on Tuesday at age 77, was forced into a limited role in the fight to enact such legislation since being diagnosed in May 2008 with brain cancer.

Yet despite being away from Congress most of the year, Kennedy, one of the most effective lawmakers in U.S. history, managed to help draft a preliminary bill to overhaul the $2.5 trillion U.S. healthcare system.

Between chemotherapy treatments, the ailing liberal lion stayed in contact, the best he could, with colleagues and President Barack Obama, who at Kennedy’s urging made healthcare reform his top domestic priority.

But Kennedy’s physical absence on Capitol Hill created a void felt by those seeking a deal.

“If the country ends up without healthcare reform, I think divine misfortune will be to blame,” said Paul Light of New York University’s Center for the Study of Congress.

“Kennedy was a powerhouse in face-to-face negotiations who was sensitive to the need for bipartisanship,” Light said. “The debate is now stalled and getting vicious. Kennedy wouldn’t have allowed it.”

But Kennedy’s death, with the extensive news coverage and outpouring of affection for him, could actually jump-start the effort for legislation that would be seen as a tribute to his lifetime of work.

‘MOST EFFECTIVE’

Republican Senator John McCain has called Kennedy “the most effective member of the Senate if you want to get results.”

In a June interview with Reuters, McCain noted the difficulties in reaching a healthcare deal without him.

“The absence of Ted Kennedy is a very big factor,” McCain said. “What Ted Kennedy usually does … is that he sits down and negotiates and then you come to some kind of agreement.”

Still, because of competing political and economic pressures, many congressional analysts figure a healthcare bill will be signed into law this year. But they say it is certain to fall far short of Kennedy’s goal of covering all of the estimated 46 million Americans without health insurance.

“Whatever passes, Kennedy deserves credit because he’s been the guiding light on this issue for decades,” said Ethan Siegal of The Washington Exchange, which tracks Congress for institutional investors.

Born to privilege and wealth, Kennedy became a voice for the young and old, poor and disabled, minorities and labor during his nearly half century in the Senate.

Over the years, he led successful efforts to upgrade schools, bolster civil rights, raise the minimum wage, outlaw discrimination and expand healthcare.

“There’s a lot to do,” Kennedy told Reuters in a 2006 interview when asked explain what even critics called his relentless efforts on behalf of the downtrodden.

“Most of all it’s the injustice that I continue to see and the opportunity to have some impact on it,” Kennedy added.

Kennedy reached out to Democrats and Republicans, but also took on members of both parties when he saw fit.

After a dispute with Democratic President Jimmy Carter over healthcare, Kennedy challenged Carter for their party’s 1980 presidential nomination. Carter won but was damaged and lost in the general election to Republican Ronald Reagan.

Kennedy worked with Republican President George W. Bush in 2001 to pass legislation, “No Child Left Behind,” to bolster schools and make them more accountable. But Kennedy later accused Bush of inadequately funding the program.

SON BATTLED CANCER

Kennedy got much of his passion to expand health insurance to all Americans in 1973 when his then-12-year-old son, Teddy, battled cancer. He survived, but lost a leg to the illness.

“My dad would spend the night in the hospital with my brother,” recalled Patrick Kennedy, who now serves in Congress as a member of the House of Representatives.

“He met other families and heard their financial struggles,” Patrick Kennedy said. “He couldn’t imagine not being able to pay the bills for my brother. He believed all should have affordable and quality health care.”

“Over the years there are countless stories of my dad paying for health insurance for people who didn’t have the money,” Patrick Kennedy said. “My dad didn’t tell me. Other people told me and thanked me.”

Kennedy was a popular yet polarizing figure and frequent target of conservatives.

In recent months, with Kennedy’s condition deteriorating, the drive to revamp healthcare ran into increased delays and opposition. Yet Kennedy remained upbeat. At least he tried.

In the July 27th edition of Newsweek magazine, Kennedy wrote: “We will end the disgrace of America as the only major industrialized nation in the world that doesn’t guarantee health care for all of its people.”

On July 30, Obama named Kennedy as a recipient of the 2009 Presidential Medal of Freedom Award, the nation’s highest civilian honor for lifetime achievement.

Obama called Kennedy “one of the greatest lawmakers — and leaders — of our time.” and said the senator had “dedicated his career to fighting for equal opportunity, fairness and justice for all Americans.”

(Editing by Phil Stewart and Vicki Allen)

© Thomson Reuters 2009 All rights reserved

Juggling while jogging requires a hand as sure as a foot is fleet. But for some well-coordinated multitaskers, there’s nothing quite like it.  Full Article 

By Julie Steenhuysen

CHICAGO (Reuters) – Younger Americans are being exposed to worrisome amounts of radiation from medical scans that increase their risk of cancer, U.S. researchers said on Wednesday.

They said the cumulative risk of repeated exposure to radiation from medical scans is a public health threat that needs to be addressed.

“Even though the individual risk for any patient exposed to these kinds of doses may be small, when you add that up over millions of people, that can be a concerning population risk,” Dr. Reza Fazel of Emory University in Atlanta and colleagues wrote in the New England Journal of Medicine.

Their three-year study of nearly 1 million Americans aged 18 to 64 suggests that as many as 4 million Americans a year are exposed to what they viewed as high doses of radiation.

The findings heap new pressure on imaging equipment makers such as General Electric Co, Siemens AG and Philips Electronics NV, already facing efforts in Congress to cut payments for imaging procedures as a way to find money to expand U.S. health insurance coverage.

While diagnostic scans can give doctors valuable information, studies suggest too much radiation exposure can cause cancer, especially in younger people.

A report in March by the National Council on Radiation Protection and Measurement found that Americans are exposed to seven times more radiation from diagnostic scans than in 1980.

The new study looks at different ranges of dose and individual procedures that contribute to that exposure. The team used medical claims data from people insured by UnitedHealth Group Inc in five U.S. markets between January 2005 and December 2007.

CAT SCANS

The two biggest contributors to radiation exposure were an advanced kind of X-ray called a computed tomography or CT scan and nuclear medicine scans — in which a small amount of radioactive material is injected into the bloodstream and read by special cameras.

“Those two accounted for about three-quarters of all the radiation exposure from these studies,” Fazel said.

One of the nuclear medicine procedures, an advanced heart stress test called a myocardial perfusion scan, was the single-biggest contributor. “It was easily the procedure that accounted for the greatest proportion of the overall radiation exposure,” Fazel said.

Women were more at risk than men, and while mammograms accounted for some of that, they did not account for all, Fazel said. Most procedures — nearly 82 percent — were done in outpatient settings such as doctor’s offices instead of a hospital, which Fazel said offered some indication of how sick people were.

Dr. Harlan Krumholz of Yale University in Connecticut, who worked on the study, said many people who are insured look at imaging as a “freebie” because they often do not have to pay a lot out of pocket for them. “The truth is it is not a freebie. It’s exposing you to some risk,” he said.

Dr. Michael Lauer of the National Heart, Lung, and Blood Institute, one of the National Institutes of Health, said imaging equipment makers are working on new products to reduce radiation risks. But he said the biggest problem is that there is often no evidence that many of the scans save lives.

“We may know the costs and we may have a good guess at the risk, but we don’t know the value,” said Lauer, who wrote a commentary calling for clinical trials that prove the scans are worth the risk.

(Editing by Maggie Fox and Eric Walsh)

© Thomson Reuters 2009 All rights reserved

Reuters provides an in-depth look at the issues facing Americans as the Obama administration wrestles with healthcare policy.  Full Coverage