New Cholesterol Calculator Tells Healthy People They Need Statins

The cholesterol guidelines released last week are already poised to drastically increase the number of people prescribed statin drugs, and this calculator that the American College of Cardiology just unveiled will help people miscalculate their risk (substantially upwards, of course) even more.

This is beyond the beyond. Worth reading this whole article if you or a loved one are considering taking statins.

“[It] overpredicted risk by 75-150%, depending on the population. A man whose risk was 4 percent, for example, might show up as having an 8 percent risk. With a 4 percent risk, he would not warrant treatment…..  Miscalibration to this extent should be reconciled and addressed before these new prediction models are widely implemented. If real, such systematic overestimation of risk will lead to considerable overprescription.”

“Something is terribly wrong,” Dr. Nissen said. Using the calculator’s results, he said, “your average healthy Joe gets treated, virtually every African-American man over 65 gets treated.”…

Southern (and Some Northern) States Choose to Leave Millions of Their Citizens Uninsured

This intransigence will bring with it a great deal of unnecessary suffering, death and, not so incidentally, economic hardship in its wake. Will they change their minds eventually? Only if their own citizens force them to.

From the Institute of Southern Studies:

But in Rome, 27 percent of adults under 65 are uninsured, a rate that holds true across the state. Last year, the city’s two hospitals report spending more than $80 million delivering uncompensated care, often in the emergency room, where costs run high. Taxpayers and those with health insurance will end up paying for that care through government subsidies and higher premiums, industry experts say.

Rome’s dilemma is exactly the situation that the Patient Protection and Affordable Care Act, also known as “Obamacare,” was designed to fix — but that fix isn’t coming to Georgia.

The Patient Protection and Affordable Care Act provides for expansion of insurance coverage for low-income and middle-class adults, with the goal of reducing the $41 billion spent covering uninsured care each year.

A key provision, set to kick in on Jan. 1, 2014, offers states federal funding to expand Medicaid coverage to all adults making up to 133 percent of the poverty line, or $25,975 for a family of three. In Georgia, over half of that group is uninsured.

But in the Deep South and Florida, Republican governors and state legislatures have turned down the funding, citing cost concerns and philosophical opposition to the safety net insurance program, which was signed into law on July 30, 1965. In Louisiana, Mississippi, Alabama, Georgia, South Carolina and Florida, the move will exclude 2.7 million low-income residents from Medicaid eligibility, according to the Urban Institute.

“In Georgia, these people are the working poor,” said Dr. Leonard Reeves, a family physician in Rome who volunteers at the city’s privately-funded free clinic. “I had an uninsured patient in his late 30s who worked every day of his life, and one day he finally came in when he felt he couldn’t go on any more.”

Dr. Reeves diagnosed the man, who was married and worked part-time as a forklift operator, with diabetes, but it was too late for insulin. After years without basic treatment, his kidneys had failed, and he needed weekly dialysis treatments to stay alive.

“He’s now on disability,” said Dr. Reeves. “If he’d had that insurance, he’d still be paying into the tax rolls instead of taking from them. There’s an old saying — ‘An ounce of prevention is worth a pound of cure.’ And that’s exactly what we’re talking about here.”

 

Supreme Court Rules That Human Genes Cannot Be Patented

This may be best Supreme Court decision in recent years. Human genes may not be patented. Those that have patents on genes no longer have them.

I confess to some surprise at this decision. But my main emotion is elation.

The decision was unanimous.

“A naturally occurring DNA segment is a product of nature and not patent eligible merely because it has been isolated,” Justice Clarence Thomas wrote for a unanimous court. But manipulating a gene to create something not found in nature is an invention eligible for patent protection.

The case concerned patents held by Myriad Genetics, a Utah company, on genes that correlate with increased risk of hereditary breast and ovarian cancer.

The central question for the justices in the case, Association for Molecular Pathology v. Myriad Genetics, No. 12-398, was whether isolated genes are “products of nature” that may not be patented or “human-made inventions” eligible for patent protection.

The patents were challenged by scientists and doctors who said their research and ability to help patients had been frustrated.

The court’s ruling will shape the course of scientific research and medical testing, and it may alter the willingness of businesses to invest in the expensive work of isolating and understanding genetic material.

Supreme Court Accepts Gene Patenting Case

In the long run, this case may have greater influence than many of the higher profile cases on which the Court decides.

The U.S. Supreme Court on Friday agreed to decide whether human genes can be patented, a hotly contested issue with broad practical and ethical consequences for the future of gene-based medicine for millions of people worldwide.

The nation’s highest court in a brief order agreed to review a case over whether Myriad Genetics Inc may patent two genes linked to hereditary breast and ovarian cancer.

In a 2-1 ruling on Aug. 16, a panel of the U.S. Federal Circuit Court of Appeals in Washington, D.C., upheld the biotechnology company’s right to patent “isolated” genes that account for most inherited forms of the two cancers.

That ruling also denied Myriad’s effort to patent methods of “comparing” or “analyzing” DNA sequences.

The appeal against Myriad and the University of Utah Research Foundation was being pursued by a variety of medical associations and doctors, led by the Association for Molecular Pathology. Their case is being handled by lawyers for the American Civil Liberties Union.

There are many issues at play here. Consider this one: gene patents like these held by Myriad can be used (and are used) to deny researchers the right to conduct research related to the patented genes (i.e., breast cancer research) unless they pay the patent holder whatever fee the corporation wishes to charge.

From both ethical and economic perspectives, this is a most controversial topic. I hope the Court decides that genes are the common heritage of all humanity and are not patentable under any circumstances.

Learning What Your Genome Contains

From today’s Wall Street Journal health blog, here’s the story of a Stanford professor who used information from his genome to change his diet and exercise patterns to bring his blood sugar levels back to normal. It appears to illustrate the upside of genetic testing.

Snyder, who is 56, two years ago decided to see what genetics might tell him about his own health. He’s not alone, as the cost of mapping a person’s full genetic profile has been dropping quickly, as WSJ reports, raising questions about how best to use the information. Colleagues sequenced Snyder’s whole genome, which revealed a number of potential health issues.

He learned he has an elevated risk for heart disease, not unexpected since “everyone on my father’s side died of heart failure,” he says. Surprisingly, he also discovered he is at higher risk for Type 2 diabetes. “For me, that came out of nowhere,” he says.

Snyder is physically active and isn’t overweight. And, at the time of the genome test, his glucose level was normal. But the level began rising gradually over the next few months. Finally, at a physical, the doctor told him the latest tests showed, “You are diabetic.”

He ramped up his bike riding and added running to his regimen. He cut out most sweets. “It took six months, but my glucose came back to normal,” he says. His doctor now calls him a “managed diabetic,” says Snyder, who has so far avoided needing medication.

Snyder is one of the drivers behind a Stanford study of faculty members in the genetics department who were offered the chance to get their genome sequenced and interpreted. Participants will be followed for more than a year to see how they use the information to manage their health, how they react to unexpected findings and other issues.

A downside of having your genome analyzed is that, legally or illegally, risk factors could potentially be used against you by employers or insurers. Federal law has some protections in place against such abuses, but we are at such an early stage in the application of this technology that the future is very much uncharted territory.

An interesting sidelight of this doctor’s story, not fully addressed in this article, is the fact that his diabetes first emerged very shortly after he was told that he had a genetic predisposition to that disease.

Certainly that could be a coincidence and there’s no overt indication to the contrary. But what an odd coincidence!

 

Doctors Urge Their Colleagues to Quit Doing Worthless Tests

This is a very difficult policy to implement as long as doctors and hospitals continue to be paid more when they perform more procedures. Radiology departments are major profit centers for hospitals and other health care facilities.

To see major medical groups such as the American Board of Internal Medicine endorse this policy is heartening. I would add that my profession, chiropractic, has made major changes along these lines within our educational institutions over the last decade. Student interns cannot routinely x-ray patients; for imaging studies to be approved, specific guidelines (such as the Canadian Cervical Spine Rule) must be followed.

Nine national medical groups are launching a campaign called Choosing Wisely to get U.S. doctors to back off on 45 diagnostic tests, procedures and treatments that often may do patients no good.

Many involve imaging tests such as CT scans, MRIs and X-rays. Stop doing them, the groups say, for most cases of back pain, or on patients who come into the emergency room with a headache or after a fainting spell, or just because somebody’s about to undergo surgery.

The Choosing Wisely project was launched last year by the foundation of the American Board of Internal Medicine. It recruited nine medical specialty societies representing more than 376,000 physicians to come up with five common tests or procedures “whose necessity … should be questioned and discussed.”

The groups represent family physicians, cardiologists, radiologists, gastroenterologists, oncologists, kidney specialists and specialists in allergy, asthma and immunology and nuclear cardiology.

Eight more specialty groups will join the campaign this fall, representing hospice doctors, head and neck specialists, arthritis doctors, geriatricians, pathologists, hospital practitioners, nuclear medicine specialist and those who perform a heart test called echocardiography.

Consumer groups are involved, too. Led by Consumer Reports, they include the AARP, National Business Coalition on Health, the Wikipedia community and eight others.

The effort represents a growing sense that there’s a lot of waste in U.S. health care, and that many tests and treatments are not only unnecessary but harmful.

Harvard economist David Cutler estimates that a third of what this country spends on health care could safely be dispensed with.

h/t Stephen Perle