Summaries of several recent editorials and opinion pieces about efforts to overhaul the U.S. health care system appear below. Editorials Indianapolis Star: President-elect Barack Obama signaled that he is “serious about his campaign promise to make [health care] a first-term priority” by reportedly selecting former Senate Majority Leader Tom Daschle (D-S.D.
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Archive Page 8
Editorials, Opinion Pieces Discuss Health Care Overhaul Efforts
Published at November 28th, 2008About One In Nine U.s. Children Uninsured In 2007, Study Finds
Published at November 28th, 2008More than 11% of children nationwide, or about one in nine, had no health coverage in 2007, according to a new Families USA analysis of U.S. Census Bureau data, the Boston Globe reports. The number of U.S.
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Advocates Urge Obama Administration To Develop U.s. Hiv/aids Strategy
Published at November 27th, 2008HIV/AIDS advocates on Tuesday called on President-elect Barack Obama to adopt a comprehensive approach to domestic HIV/AIDS policy when he takes office, CQ HealthBeat reports. The groups encouraged the incoming administration to develop a national strategy to address HIV/AIDS in the U.S. and recommended implementing a domestic HIV/AIDS program modeled after the President’s Emergency Plan for AIDS Relief. HIV/AIDS researcher Robert Gallo recently proposed a similar approach. “It is astonishing that [the U.S.] has never really set an overall plan and agenda for the country, with measurable outcomes, accountability established and specific timetables for getting to those results,” Rebecca Haag, executive director of AIDS Action Council, said. The advocates also called for increased federal funding for HIV/AIDS prevention, treatment and research programs and called for a departure from some policies enacted under the Bush administration.
Carl Schmid, director of federal affairs at the AIDS Institute, said he is “optimistic” about Obama’s election and hopes the new administration will bring “renewed leadership on the domestic HIV/AIDS front” because the disease is “still a major, significant health crisis” in the U.S. Advocates in a letter sent to Obama’s transition team — which included policy recommendations aimed at guiding him during his first 100 days in office — encouraged the administration to support the higher amounts proposed for federal funding for HIV/AIDS prevention, treatment and research programs in competing fiscal year 2009 appropriations measures. According to Schmid, the priority given to HIV/AIDS programs in the President-elect’s first budget “will be a good signal to the Obama administration’s commitment to the domestic [HIV/AIDS] epidemic.”
The advocates also called for an increase in federal funding for NIH, including an increase of $450 million for HIV/AIDS research. They also support additional funding for CDC, including an increase of $200 million for HIV prevention and surveillance. In addition, the group called for a $100 million increase in FY 2009 funding for the Ryan White Program and a $614.49 million increase for the program in FY 2010. Christine Lubinski, vice president of global health at the Infectious Diseases Society of America, said the Ryan White Program “has not been funded at adequate levels,” adding, “We’ll be looking for a budgeting increase and leadership in extending the Ryan White Care Act, which will sunset on Sept. 30.”
Haag called on Obama to end some existing policies, including the ban on federal funding for needle-exchange programs, which she called “one of the most effective” tools to reduce HIV transmission. Haag also criticized abstinence-only sex education programs. According to Haag, strong leadership will be necessary to unite and coordinate the efforts of 17 federal agencies that currently work on HIV/AIDS issues. “We have asked that the national AIDS strategy be driven out of the White House,” Haag said, adding that “the force of the president’s leadership” will be necessary to address HIV/AIDS in the U.S. (Weyl, CQ HealthBeat, 11/25).
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Testing, Immediately Treating Hiv/aids Cases In Africa Could Halt Epidemic, Model Predicts
Published at November 27th, 2008Testing all adults annually for HIV and immediately treating every person who tests positive “could virtually end the AIDS epidemic in Africa in about a decade,” according to a mathematical model published Wednesday in the journal Lancet, the Washington Post reports. The “thought experiment” underscores the “usefulness of antiretroviral drugs as tools for preventing the spread of HIV infection as well as treating it” (Brown, Washington Post, 11/26). According to the AP/Google.com, this “intriguing solution” to ending the HIV/AIDS epidemic is “based on assumptions rather than data and is riddled with logistical problems.”
For the study, Charlie Gilks, an AIDS treatment expert at the World Health Organization, and colleagues used data from South Africa and Malawi. In the model, people were voluntarily tested each year and immediately given antiretrovirals if they were found to be HIV-positive, even if they were not ill. Within 10 years, HIV cases decreased by 95% (Cheng, AP/Google.com, 11/25). According to the Post, under this strategy, incidence rates would decrease from 20 new cases per 1,000 people annually to one case per 1,000 people annually in about 10 years (Washington Post, 11/26). Other initiatives such as comprehensive sex education and male circumcision also were used (AP/Google.com, 11/25). The model assumed that all HIV cases were transmitted through heterosexual sex (Kahn, Reuters, 11/25). The model also assumed that HIV testing would be voluntary and that no one would be forced to start treatment. According to the Post, about 20% of HIV-positive people in developing countries are aware of their status, and this model would detect most cases (Washington Post, 11/26).
According to the researchers, the strategy would reduce the estimated number of AIDS-related deaths between 2008 and 2050 by about 50%, from about 8.7 million to 3.9 million deaths, leaving only sporadic HIV cases (AP/Google.com, 11/25). They wrote, “Although other prevention strategies, alone or in combination, could substantially reduce HIV incidence, our model suggests that only universal voluntary testing and immediate initiation of antiretroviral drugs could reduce transmission to the point at which elimination might be feasible by 2020 for a generalized epidemic, such as that in South Africa” (Reuters, 11/25).
Bloomberg reports that the study “hinges on emerging research suggesting that effective [antiretroviral] treatment can keep levels of the virus so low in people that the possibility it will spread is almost nil.” Kevin De penis, director of WHO’s HIV/AIDS Department, said the findings are theoretical and that the organization is not changing its recommendations regarding HIV testing or treatment. However, he said in a statement that the “concept of antiretroviral treatment for HIV prevention is a very important, urgent thing to examine,” adding, “We aim to stimulate discussion about what is probably the most important question in HIV prevention: when to start therapy?” (Lauerman, Bloomberg, 11/25).
According to experts, the cost of the strategy would peak at about $3.4 billion annually and decline after an initial investment (AP/Google.com, 11/25). In addition, the model would save money in the long term because there would be fewer HIV-positive people in need of treatment, the researchers said (Reuters, 11/25). “If we were to invest radically up front, we would have the opportunity to change the course of the epidemic,” Julio Montaner — an AIDS researcher affiliated with the University of British Columbia and the president of the International AIDS Society, who did not participate in the study — said, adding, “What was cost effective based on patient outcomes now becomes cost averting once you add in the ability of antiretroviral therapy to reduce HIV transmission” (Goldstein, Wall Street Journal, 11/26).
WHO researcher Reuben Granich said wider HIV/AIDS treatment also would likely reduce costs associated with other diseases common among HIV-positive people, including tuberculosis and malaria (Bloomberg, 11/25). Nevertheless, the Journal reports that the strategy could encounter logistical and financial hurdles. “You can do a mathematical model, but that’s different than actually testing an entire population, getting everyone who’s positive into treatment and keeping them on treatment for the rest of their life,” U.S. Global AIDS Coordinator Mark Dybul said (Wall Street Journal, 11/26). For example, increasing access to HIV testing and drugs could overwhelm already weak health care systems in Africa, according to the AP/Google.com. “This is not like giving someone a Tylenol,” Jennifer Kates — vice president and director of HIV policy at the Kaiser Family Foundation — said, adding, “The idea should be explored, but it’s a huge leap.” Myron Cohen of the University of North Carolina said, “This is certainly beyond the bounds of the current infrastructure for many countries, but that is not a reason not to think big.”
Another concern regarding the strategy is that providing every HIV-positive person with antiretrovirals could increase drug resistance. Furthermore, researchers do not yet know if it is safe to take antiretrovirals for decades; the oldest drug combinations have been around for about 12 years. Other experts also question whether the strategy might infringe on patients’ rights because once an individual tests positive for HIV, he or she would be advised to begin treatment, even if they showed no symptoms. According to the AP/Google.com, “That would benefit the community, but not necessarily the patients themselves” (AP/Google.com, 11/25).
The Post reports that the model only applies to the type of epidemic seen in Southern Africa, where nearly all transmission occurs through heterosexual intercourse. Whether the findings might also apply to an epidemic in which the virus is mainly transmitted among injection drug users and men who have sex with men is not yet known. According to De penis, WHO plans to hold a meeting early next year to examine the implications of the model (Washington Post, 11/26).
In an accompanying editorial, Geoffrey Garnett of Imperial College London said, “At best, the strategy would prevent morbidity and mortality for the population, both through better treatment of the individual and reduced spread of HIV.” He added, “At its worse, the strategy will involve over-testing, over-treatment, side effects, resistance and potentially reduced autonomy of the individual in their choices of care” (Reuters, 11/25).
The study is available online.
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Bill To Implant Microchips In ’sexually Aggressive’ Hiv-positive People In Indonesian Province Generates Support, Criticism
Published at November 26th, 2008An Indonesian bill that includes a bylaw requiring “sexually aggressive” people living with HIV/AIDS to be implanted with microchips is causing debate between some lawmakers, who argue that the bill is necessary to curb the spread of the virus, and advocates, who say the bylaw is discriminatory and a violation of human rights, the AP/Minneapolis Star Tribune reports. According to John Manangsang, a lawmaker who supports the bill, authorities would be able to identify, track and punish people living with HIV/AIDS in the country’s province of Papua who intentionally spread the virus with a $5,000 fine or up to six months in jail. In Papua, the HIV prevalence is 15 times the national average at 61 cases per 100,000 people (Karmini, AP/Minneapolis Star Tribune, 11/24).
According to Reuters, Manangsang said the microchip is “a simple technology. A signal from the microchip will track their movements and this will be received by monitoring authorities” (Anjani, Reuters, 11/22). According to the Jakarta Post, the microchips would only be implanted in people living with HIV/AIDS who are labeled as “aggressive.” Manangsang said, “Aggressive means actively seeking sexual intercourse” (Flassy, Jakarta Post, 11/22). According to the AP/Star Tribune, a committee would be created to establish which HIV-positive people should be implanted with microchips and to monitor their behavior. The technical and practical details of the bill are still being decided by lawmakers. The provincial parliament of Papua has given its full support to the measure, which will be enacted next month if it receives the expected majority vote (AP/Minneapolis Star Tribune, 11/24). Manangsang said the program is “one way to protect healthy people” and that “real action” must be taken “because 47% of (the country’s) HIV/AIDS (cases) are in Papua.”
Critics of the bill say it is discriminatory toward people living with HIV/AIDS and a violation of human rights, the Post reports. Constan Karma, executive director of the Papua AIDS Commission, said the law “will violate the rights of people living with HIV/AIDS because they will be implanted with microchips.” Gunawan — a liaison officer of the West Papua chapter of Save Papua — said that people living with the virus “do not always have sex, especially those with AIDS.” He also questioned how officials would measure aggressiveness. Although reported incidents of discrimination against HIV-positive people in Papua have declined, Enita Rouw — coordinator of the Papua branch of the Indonesian Network of People Infected with HIV — said that “stigmatization is still there. So please don’t use microchips. We are humans, not animals” (Jakarta Post, 11/22). Tahi Ganyang Butarbutar, an advocate in Papua, said that increased funding for sex education and condom promotion would be more effective for addressing the HIV/AIDS epidemic in the region. He also said the people living with the virus “aren’t animals; we have to respect their rights” (AP/Minneapolis Star Tribune, 11/24).
Weynand Watari, a lawmaker who supports the bill, said the region’s “health situation is extraordinary, so we have to take extraordinary action.” According to the AP/Star Tribune, the HIV epidemic in Indonesia is one of the fastest-growing in Asia, with as many as 290,000 cases in the country’s population of 235 million. HIV/AIDS in Indonesia primarily is spread through commercial sex work and injection drug use (AP/Minneapolis Star Tribune, 11/24). According to Reuters, the rapid spread of HIV/AIDS in the Papua region primarily is because of inadequate education programs, lack of condoms and partner swapping rituals that take place in the region (Reuters, 11/22). According to the Post, Manangsang said that people should not concentrate solely on the bylaw but should focus on the entirety of the bill, which requires universal HIV testing “so that preventative measures can be taken early on.” He also said that “if we respect the rights of the people living with HIV/AIDS, then we must also respect the rights of healthy people” (Jakarta Post, 11/22).
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Kenya Launches Male Circumcision Program
Published at November 25th, 2008The Kenyan Ministry of Health on Monday launched a voluntary male circumcision program as part of the country’s national HIV prevention strategy, the Kenya Broadcasting Corporation reports.
The ministry has allocated one billion Kenyan shillings, or about $13.2 million, for the program over the next two years (Achienga, Kenya Broadcasting Corporation, 11/24). In addition, Family Health International has received an $18.5 million, five-year grant from the Bill & Melinda Gates Foundation to establish the Male Circumcision Consortium in partnership with the Kenyan government, the University of Illinois at Chicago and EngenderHealth. The President’s Emergency Plan for AIDS Relief also is supporting the program. The consortium will conduct research and training on the safest and most effective ways to provide male circumcision as part of an HIV prevention strategy.
The consortium’s members have consulted officials from the World Health Organization to ensure the consortium’s objectives are in line with WHO and UNAIDS recommendations on male circumcision. The consortium will support the Kenyan government and local partners to develop and implement the national male circumcision strategy. It also will expand a research and training center in Kisumu, Kenya, to train providers, increase capacity of health facilities and monitor outcomes. In addition, the consortium aims to address misunderstandings about male circumcision (FHI release, 11/24).
The program will be launched in six districts in Kenya’s Nyanza province before being expanded to the rest of the country (Kenya Broadcasting Corporation, 11/24). The initiative aims to reduce HIV prevalence in Kenya by 60%, Public Health and Sanitation Minister James Gesami said Monday at the program launch. Gesami also emphasized the importance of ensuring that all circumcisions are performed in sanitary conditions. “Traditional circumcisers should use septic techniques by not using one knife on several individuals,” he said.
WHO Country Representative David Okello said that circumcision should not be seen as an excuse to practice risky behaviors. “Circumcision should be promoted along with other HIV prevention strategies including safer sex, reduction in the number of sexual partners, plus the correct and consistent use of condoms,” Okello said (Ndong’a, Capital News, 11/24).
Gesami added that the health ministry will provide no-cost counseling to couples on the benefits of male circumcision to prevent HIV transmission as part of the program. According to the Daily Nation, two-thirds of HIV-positive adults in Kenya are married or in a relationship, and one spouse is HIV-positive in 10% of marriages. Peter Cherutich, head of the national task force on circumcision, said that counseling is critical for couples and that women “have to be involved for the full benefits [of the procedure] to be felt” (Ngirachup, Daily Nation, 11/24).
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Insufficient Government Intervention Contributing To Spread Of Hiv In Russia, Official Says
Published at November 25th, 2008The number of registered HIV cases in Russia is increasing by 10% annually despite increased federal funding for HIV/AIDS efforts, Vadim Pokrovsky, head of the government-funded Federal AIDS Center, said on Friday, the AP/Google.com reports. According to Pokrovsky, Russia’s rising HIV prevalence likely stems from the government’s focus on HIV/AIDS treatment instead of prevention.
Pokrovsky estimates that more than one million people in Russia — or almost 1% of the country’s population of 142 million people — are HIV-positive. However, Russia officially has registered only 470,000 HIV cases, Pokrovsky said, adding that the country registers about 130 new HIV cases each day. According to experts, a large number of HIV-positive people in Russia are injection drug users. In addition, many people are unaware of HIV risk factors because of denial, insufficient information and social stigmas, the AP/Google.com reports. According to Pokrovsky, many regional governors in Russia “have simply refused to acknowledge the problem” of HIV/AIDS, while others have chosen to increase funding for the disease rather than promote awareness about the issue. Pokrovsky said that Russia appears to have “no national policy” on HIV/AIDS and is “running in place” while the disease spreads.
Pokrovsky encouraged the government to develop a clear strategy for publicizing HIV/AIDS-related issues and spend money wisely to maximize results. “Everyone needs to understand that [HIV] is a threat to the nation, and it’s necessary to mobilize as one would for war,” he said. According to the AP/Google.com, Russia’s government said it allocated about $445 million for HIV/AIDS-related efforts last year, which was 50 times more funding than in 2005. Pokrovsky said the government will spend about $270 million for HIV/AIDS programs this year, which includes $193 million for treating 30,000 HIV-positive people and $7.6 million for prevention efforts. Pokrovsky said that HIV prevention funding is inadequate and is “the weakest point” in Russia’s HIV/AIDS efforts. “We are doing practically nothing” to prevent new HIV cases, he added.
The government reduced HIV/AIDS funding because of the financial crisis, and Pokrovsky said that future funds also could be at risk. He also expressed concern that prevention funding could be misspent, citing an example of a $3.6 million HIV/AIDS awareness television program that aired at 8:30 a.m., a time when many high-risk populations were unlikely to view the show (Gutterman, AP/Google.com, 11/21).
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Metastatic Renal Cell Carcinoma: Results Of A Population-based Study With 25 Years Follow-up
Published at November 24th, 2008UroToday.com - The Munich Cancer Registry (MCR) was established in 1978 as the clinical registry of the Munich Cancer Centre and in the beginning cooperated with the two University hospitals in Munich. Since 1988 collaborations have extended to all hospitals in the city and district of Munich, monitoring 2.3 million people.
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Bipartisan Group Of Senators Opposes Proposed Rule That Would Require Tricare To Use Medicare’s Reimbursement System For Outpatient Hospital Care
Published at November 24th, 2008A bipartisan group of 55 senators has signed a letter asking the Department of Defense to reconsider a proposed rule for the military’s Tricare health insurance program that would require hospitals that treat Tricare beneficiaries to use the same reimbursement system for hospital outpatient services as Medicare, CQ HealthBeat reports. The letter will be sent to U.S.
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The Benefits Of Multiple Mates
Published at November 23rd, 2008New research could explain why females of many species have multiple partners. Published on Friday 21 November 2008 in leading journal Science, the study was carried out by a team from the Universities of Exeter (UK), Okayama (Japan) and Liverpool (UK). Females of most species, including many mammals, mate with multiple partners.
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