November 2009

By Donna Smith

WASHINGTON (Reuters) – Leading Democrats on Sunday said they expect Congress to pass a major healthcare reform backed by President Barack Obama, but supporters may have to accept legislation that falls short on some issues.

The U.S. Senate on Monday is set to begin debate on the sweeping overhaul of the $2.5 trillion U.S. healthcare system amid growing concerns about the cost of the legislation that aims to provide medical coverage for millions of the uninsured.

“We want to cover the uninsured, yes, but we don’t want to do it in a way that’s going to drive up the costs for folks who currently have it,” said Senator Evan Bayh, one of a number of centrist Democrats whose support will be crucial to pass the overhaul in the face of solid Republican opposition.

In an interview with “Fox News Sunday,” Bayh said he would push to make sure the legislation is cost effective but acknowledged that not every senator will get what he wants.

“I don’t think we can afford to do nothing with costs going up 10, 15 percent a year,” Bayh said. “My objective is to try and make that alternative of doing something as positive as we possibly can, realizing that — at the end of the day it may be just imperfect.”

Howard Dean, a physician and former governor from Vermont who has been critical of some of his fellow Democrats who do not back a public health insurance option, predicted on the same news show that Obama would succeed on healthcare reform.

“We’re going to pass a decent health care bill that really is going to start reform,” Dean said.

The U.S. House of Representatives passed its version on November 7. The Senate is set to begin debate on Monday after the legislation passed a crucial procedural vote before the week-long Thanksgiving holiday break.

Senate Majority Leader Harry Reid has no margin for error as he tries to accommodate competing views among his fellow Democrats on issues like abortion, a new government-run insurance plan and efforts to rein in costs. Democrats control 60 votes in the 100-member chamber, and Reid needs every one of them to overcome solid Republican opposition.

REPUBLICAN OPPOSITION

The stakes are high for Obama. His political standing and legislative agenda are on the line. A number of moderate Democrats oppose the proposed new government health insurance plan that would compete with private insurers. But some liberals, including independent Senator Bernie Sanders, insist the bill include a public plan, arguing that it would help contain insurance costs.

“I would be very reluctant to support legislation that did not have a strong public option,” Sanders said in an interview with ABC’s “This Week” news show. “I’m speaking for other senators, I’m speaking for many members of the House; we’re going to fight and demand a public option and a strong one at that.”

Republicans strongly oppose the public option, arguing that it would give government too big a role in healthcare and that private insurers would be unable to compete. They also argue the bill, which is paid for through tax increases and spending cuts, is too expensive. Many of the proposed spending cuts in the Medicare health program for the elderly are unlikely to go into effect, said Republican Senator Jon Kyl.

“There’s no way to fix this bill,” Kyl told “Fox News Sunday.” He and other Republicans have called for less sweeping legislation that would allow insurers to sell across state lines as a way to lower insurance premiums. Currently insurance is regulated and sold at the state level, where one or two insurers can dominate the market.

(Editing by Cynthia Osterman)

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GENEVA (Reuters) – More than 1,000 deaths from the H1N1 swine flu virus were officially reported in the past week, a sharp rise which brings the global total to at least 7,826, the World Health Organization (WHO) said on Friday.

More than half of the latest fatalities were reported by health authorities in the Americas region.

The winter flu season arrived early in the northern hemisphere this year and continues to be intense across parts of North America and much of Europe.

“In the United States and Canada, influenza transmission remains very active and geographically widespread,” the WHO said, adding that the disease now appeared to have peaked in all U.S. regions.

“In Canada, influenza activity remains similar but (the) number of hospitalizations and deaths is increasing,” it said.

It is too early to say whether there has yet been a peak in infections in the northern hemisphere, the WHO’s top flu expert said on Thursday, and it will be some weeks before there is a downward trend in the numbers of those catching the virus.

The H1N1 pandemic virus is causing widespread and increasing infections in Europe, with many reporting a rapid rise.

Sweden, Norway, Moldova and Italy are reporting “very high activity” and health care services are reeling under the strain in Albania and Moldova, it said. Flu has peaked in other European countries including Belgium, Ireland and Serbia.

Flu transmission is active in East Asia and it remains “stably elevated” in Japan, but may be decreasing slightly in cities there, according to the United Nations health agency.

In temperate zones of the southern hemisphere, little pandemic flu activity has been reported.

(Reporting by Stephanie Nebehay; Editing by Jonathan Lynn)

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BEIJING (Reuters) – People in China living with HIV and AIDS face widespread discrimination and stigma, with even medical workers sometimes refusing to touch them, according to a U.N. survey released on Friday.

China’s Health Ministry and UNAIDS estimate that the country has between 97,000 and 112,000 people infected with AIDS.

But more than 40 percent of people surveyed in a new UNAIDS report said they had been discriminated against because of their HIV status. More than one-tenth said they had been refused medical care at least once.

Chinese AIDS activist Yu Xuan, talking at a news conference to unveil the report, recounted the story of a friend who was refused an urgent operation because of her HIV status, and who ended up dying as a result.

“I don’t want people to have the kind of experiences I have had,” said Yu, who also has AIDS.

China has long faced a problem in tackling a disease which officials once refused to acknowledge, and where for many people taboos surrounding sex remain strong, limiting public or even private discussion.

Deputy Chinese Health Minister Huang Jeifu said the government would work harder to address issues related to AIDS stigma and ignorance, but admitted it would be difficult.

“The biggest obstacle is that there is not enough education or publicity about AIDS. Society does not know enough about the disease, and people think you can get it just from touch, talking, shaking hands or eating together,” Huang said. “This is a huge problem.”

The government will launch a video campaign to break the stigma of AIDS featuring Chinese and NBA basketball star Yao Ming which will be shown on 20 large outdoor screens in 12 cities, but will likely have their work cut out.

The survey found that some children with infected parents but who were not necessarily infected themselves had been forced to leave school.

“Many of the respondents knew who they could go to for support in addressing discrimination and taking action against those that violate their rights,” the report said.

“Unfortunately, the success rate when addressing problems encountered is very low.”

(Reporting by Ben Blanchard, Editing by Dean Yates)

© Thomson Reuters 2009 All rights reserved

By Julie Steenhuysen

CHICAGO (Reuters) – By 2034, nearly twice as many Americans will have diabetes and spending on the disease will triple, further straining the U.S. health system and testing the viability of Medicare and other government health insurance programs, U.S. researchers said on Friday.

“We forecast that in the next 25 years, the population size of people with diabetes — both diagnosed and undiagnosed — will rise from approximately 24 million people to 44 million people by the year 2034,” said Dr. Elbert Huang of the University of Chicago, whose study appears in the journal Diabetes Care.

“We anticipate that the cost of taking care of those people — and these are direct medical costs — will triple over the same period of time, going from $113 billion today to $336 billion (per year),” Huang said in a telephone interview.

Huang said the burden of treating so many people with diabetes will strain the viability of Medicare, the U.S. health insurance program for the elderly and disabled.

Huang projects that the number of people covered by Medicare will rise from 8.2 million to 14.6 million, and annual Medicare spending on diabetes will jump from $45 billion to $171 billion.

In the United States, about 11 percent of adults have diabetes. Most have type 2 diabetes, the kind closely linked to obesity.

The rising diabetes burden could further complicate efforts to rein in U.S. healthcare spending in the coming decades.

Congress is grappling with legislation to extend health coverage to millions of uninsured people, control healthcare spending and bar insurance industry practices such as denying coverage to people with pre-existing medical conditions.

‘MAJOR PUBLIC HEALTH PROBLEM’

“Diabetes is a major public health problem right now, but it’s important for the country and for policymakers to have an idea of what will happen in the next couple of decades,” Huang said.

“We already have a financial crisis at hand in healthcare and we need to plan for how we can deal with those costs in the future,” Huang said.

For the study, the researchers built a forecasting model of diabetes population costs that tracks how many people will develop diabetes over the next decades and how much it will cost. The model accounts for the size of different generations that will be entering the diabetes population.

“That is important to account for because we know that age itself is a major predictor of diabetes, and we know that the baby boomer generation is entering an age where there’s a high risk of developing diabetes,” he said.

It also assumes that no progress is made in terms of rates of obesity, diabetes prevention and diabetes care. If obesity levels rise, Huang said, the model may actually underestimate the problem.

He said the study emphasizes the importance of public health efforts already under way to try to reverse the number of people who have diabetes.

“We know from a recent trial — the Diabetes Prevention Program — we know we can prevent diabetes through diet and exercise,” Huang said.

In that 10-year study, overweight people with elevated blood sugar levels who lost a modest amount of weight lowered their risk of developing diabetes by at least a third.

People over age 60 got even more dramatic results, cutting their risk of diabetes during the study period by about half.

“I do feel preventing diabetes is the first step,” Huang said.

(Editing by Will Dunham)

© Thomson Reuters 2009 All rights reserved

By Stephanie Nebehay

GENEVA (Reuters) – Tamiflu resistance in some H1N1 patients with badly weakened immune systems does not seem to reflect a major change in the virus’ susceptibility to the frontline drug, the World Health Organization said on Thursday.

Nine people in Britain and the United States developed a Tamiflu-resistant form of swine flu while being treated in hospital mainly for blood cancers, said WHO flu expert Keiji Fukuda.

“We don’t know the full answer. But it is more likely that we are not seeing a change, a major shift in the epidemiology or in the properties of these viruses with regard to oseltamivir resistance,” he told a weekly news conference.

He said Tamiflu, known generically as oseltamivir and made by Switzerland’s Roche, was effective when used correctly and early.

About 75 cases of oseltamivir-resistant viruses have been reported worldwide in recent months, mostly isolated cases which have arisen after preventive treatment with the drug, he said.

“Right now we do not see any evidence of a large impact in immuno-compromised people with milder forms and we do not see a large impact in HIV-infected populations,” he said.

FLU TO CONTINUE FOR WEEKS

Swine flu is expected to infect more people in the northern hemisphere in the next weeks before there is a downturn, but is less prevalent in the southern hemisphere, Fukuda said.

“… it’s still too early to say whether we are seeing peaking of activity in the northern hemisphere. Again, we see differences on a country by country basis,” he said.

H1N1 has killed at least 6,770 people, according to the WHO. Most people suffer mild symptoms and recover without special treatment.

Some serious side effects have occurred after inoculation, but mostly “we have seen that the serious events are not related to the pandemic vaccine,” Fukuda said.

In Canada, six people had severe allergic reactions after vaccination, but all recovered. Canadian provinces have stopped using a particular batch of GlaxoSmithKline Plc vaccine.

“As we understand, none of this vaccine was distributed outside Canada,” Fukuda said. “All of the unused doses of vaccine have been put on hold, that is they are not being used at this point while investigations go on.”

© Thomson Reuters 2009 All rights reserved

By Gene Emery

BOSTON (Reuters) – Rituxan, a drug used to treat cancer and rheumatoid arthritis, may help slow the development of newly discovered type 1 or juvenile diabetes, researchers reported on Wednesday.

The drug may interfere with the body’s mistaken destruction of the insulin-producing cells in the pancreas, the researchers reported in the New England Journal of Medicine.

“What this study does is open the door to a whole new way to approaching type 1 diabetes,” Dr. Mark Pescovitz of Indiana University, who led the study, said in a telephone interview.

Rituxan, known generically as rituximab, is made by Genentech, a unit of Roche Holding AG and Biogen Idec Inc. It was designed to wipe out immune cells known as B lymphocytes, which proliferate out of control in lymphoma.

The same cells are also involved in the autoimmune destruction of healthy cells and tissue seen in rheumatoid arthritis and, in theory, in juvenile diabetes.

Usually, by the time diabetes symptoms appear, 80 to 90 percent of those insulin-producing cells have been destroyed. The Pescovitz team gave Rituxan hoping to save the remaining cells.

The treatment worked at first and the body produced more insulin. But over time, the effects faded, and insulin production began to decline at the same rate as among people who received placebo.

Pescovitz said he was not disappointed. Further tests will show if repeated treatments with Rituxan or newer drugs that also eliminate B lymphocytes will keep insulin production up.

“When you look at rituximab in patients with rheumatoid arthritis, patients do require redosing at four- to six-month intervals,” he said.

That was not tried in this study, said Pescovitz, because “at the time, we didn’t know if it would work and we didn’t know if it would be safe. So we aimed for a one-year endpoint and a single course of drug. We got what we hoped we would see.”

About 15,000 children and teenagers in the United States are diagnosed with type 1 diabetes each year, according to the Center for Disease Control and Prevention. Type 1 diabetes accounts for about 5 percent of diabetes cases globally.

(Editing by Maggie Fox and Cynthia Osterman)

© Thomson Reuters 2009 All rights reserved

By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) – U.S. health officials said on Wednesday they are seeing a worrying pattern of serious bacterial infections in swine flu patients, mostly among younger adults not normally vulnerable to them.

The pattern is typical of pandemics such as the current H1N1 pandemic but shows the need for patients and doctors to keep an eye out for the infections and treat them quickly, Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention told reporters.

“We are seeing an increase of serious pneumococcal infections around the country,” Schuchat told a telephone briefing.

“That is the serious type of pneumococcal disease where the bacteria invades the blood and other internal sites.” These so-called secondary infections can follow infection with a virus such as flu and often are seen among people who die from influenza.

A close look in Denver showed 58 cases of serious Streptococcus pneumonia infections in October, a month when usually about 20 cases are seen, Schuchat said. And while such infections normally affect people over 65, these were almost all among people under 60, she said.

“The findings in Denver probably reflect infections that are occurring in other parts of the country where surveillance hasn’t been as invasive,” Schuchat said.

Merck makes a vaccine called Pneumovax to protect adults against 23 strains of these streptococcal bacteria, which is recommended for adults with diabetes, asthma, cancer and other conditions, as well as smokers. But only about a quarter of adults who should get it ever do, Schuchat said.

Children are protected against seven strains of these bacteria with Pfizer Inc’s Prevnar.

Strep infections can be treated with antibiotics and the symptoms are often clear, Schuchat said.

“Having a high fever and cough and then feeling miserable and then feeling better and then suddenly taking a turn for the worse — that is a serious warning sign,” she said.

The U.S. government is trying to vaccinate as many as 160 million high-priority people but companies are having trouble making and packaging vaccine. As of Wednesday, Schuchat said 61.2 million doses of H1N1 vaccine had been used or were ready to order.

She said surveillance so far had shown the H1N1 vaccine was as safe as the seasonal flu vaccine

“We don’t see any problems at all,” Schuchat said. Ten cases of a rare neurological condition called Guillain Barre Syndrome have been reported among people who got vaccinated, which is no more than would be seen among people not vaccinated, she said.

“So far, the vaccine data suggests that this is a safe vaccine,” Schuchat said.

“We are expecting to see vaccination efforts really step up as we head into December,” Schuchat added.

The CDC estimates swine flu has infected at least 22 million Americans and killed 3,900. The World Health Organization says the pandemic is moving from west to east and appears to have made one peak in the United States and the westernmost parts of Europe.

Globally, WHO estimates that 80 million doses of influenza vaccine have been distributed.

(Editing by Cynthia Osterman)

© Thomson Reuters 2009 All rights reserved

By Amy Norton

NEW YORK (Reuters Health) – Exercise seems to simultaneously make people hungrier, yet more readily satisfied by a meal — and differences in these responses from person to person may help explain why some exercisers shed pounds more easily than others, researchers say.

In a study of 58 overweight and obese adults who started an exercise regimen, researchers found that exercise tended to boost participants’ hunger before a meal, compared with their sedentary days.

On the other hand, they were also more easily satisfied by their morning meal than they had been before becoming active.

But while both effects were generally at work across the study group, there were subtler differences between participants who were more successful in their weight loss and those whose extra pounds stubbornly hung on.

In general, exercisers who did not meet their expected weight loss were both hungrier after fasting — that is, right before breakfast — and throughout the day, compared with their hunger ratings at the study’s start.

In contrast, those who were more successful in shedding pounds generally saw their pre-breakfast appetites increase after becoming active. But they were not hungrier throughout the day.

“The reason that some people are more successful (at weight loss) could be due to a lesser increase in appetite and the prevention of an increase in food intake,” lead researcher Dr. Neil King, an associate professor at Queensland University of Technology in Brisbane, Australia, told Reuters Health in an email.

But the bottom line for new exercisers, he said, is that they should not throw in the towel if they start feeling more hungry than normal — or fail to shed as many pounds as they’d been hoping.

Other research shows that exercise has health benefits — like improved cardiovascular fitness, and lower blood pressure and cholesterol — even if weight loss is modest.

For the current study, published in the American Journal of Clinical Nutrition, King’s team had 58 overweight men and women go through a 12-week supervised exercise regimen designed to burn 500 calories per session.

At the beginning and end of the study, participants were given a breakfast of cereal and toast, and were asked to rate their hunger before the meal, immediately after and throughout the rest of the day.

After 12 weeks, 32 participants had lost the expected amount of weight based on the calories they burned during exercise; 26 had not. On average, both groups showed a revved up appetite before breakfast on week 12, but daily hunger was greater in those who had not lost a substantial amount of weight.

Both groups of exercisers, though, seemed to be more readily satisfied by their breakfast than they had been before becoming active.

It’s not clear why these two different appetite effects arise from exercise. But physical activity, while spurring hunger, may also boost the sensitivity of the body’s fullness-signaling system, according to King’s team.

“The key messages,” King said, “are exercise is good for you, don’t expect unrealistic weight loss and don’t give up exercising just because of lower-than-expected weight loss.”

SOURCE: American Journal of Clinical Nutrition, October 2009.

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