Sunday, August 02, 2009

Elderly Brits last in line for swine flu vaccine

Even though they probably need it most as they often have other infirmities

Pensioners will be at the back of the queue for the new swine flu vaccine as a list of priority groups are drawn up, it has emerged. Health and social care workers will be vaccinated first, followed by pregnant women and all children under the age of five, under initial plans. The first batches of H1N1 vaccine are due to arrive next month with enough for half the population expected to be delivered by December.

It will be the biggest vaccination programme undertaken by the NHS since smallpox in the 1950s. The groups most at risk from the disease will be vaccinated in order of priority as the batches arrive. Experts have said healthy pensioners are not a priority group as they seem to have some immunity to the virus and are not catching it as readily as younger people. [But if they do they are more likely to die]

People under the age of 65 with long-term health problems which may include asthmatics, those with heart disease and people with kidney problems will be vaccinated after young children. Next in line are all young people under the age of 18, followed by the rest of the population, including healthy over 65s, according to sources quoted in Pulse magazine.

Meanwhile the Scottish Executive has also published its vaccine priority groups with healthy over 65s the very last group to be vaccinated. A similar list has been published by the American health authorities and it too lists healthy over 65s as the final group to receive the H1N1 vaccine.

The final decision about the priority list for England will not be made by Andy Burnham, the Health Secretary, until the middle of this month. It will be revealed after a meeting of Cobra – the emergency committee chaired by Mr Burnham – that was set up to co-ordinate the swine flu response from Whitehall. Mr Burnham has made it clear that the priority list will be based on scientific evidence.

On Thursday a meeting was held that looked at the evidence that will guide the vaccination priority list. Those advisers present will now go away and do further work on "prioritisation," according to Whitehall sources before presenting it to the next Cobra meeting. Two plans will be released after that Cobra meeting. The first will look at "critical care planning policy." The second will detail vaccine "licencing, delivery, administration and priority."

A senior Government source said: "We will be governed by the scientific advice and evidence alone. If that says over 65s are not the priority then we will act on that."

Ministers are said to be "irritated" by this week's House of Lords report which questioned aspects of the Department of Health's planning and preparation for the pandemic.

Data released by the Department of Health shows that children under one year old are ten times more likely to contract the virus than the over 75s. Since the outbreak began in England at the end of April an estimated one in every 90 children under the age of one have had H1N1, followed by one in 77 children aged between one and four, then one in 95 children aged between four and 14. In comparison one in 251 people aged between 45 and 64 have so far had swine flu, followed by one in 490 people aged between 64 and 75 and then one in every 833 people aged over 75.

The Government has contracts, worth £155.4m with GlaxoSmithKline and Baxter International for enough vaccine for the entire population, with each person receiving two doses.

A spokesman for the Department of Health said: "We have not yet taken a final decision on who will receive the vaccine first, and are discussing this with our independent scientific experts. Decisions will be made on the basis of the most up-to-date evidence about the severity and spread of the disease and the delivery supply timetables. "By the end of August, we will publish a vaccination plan that will include decisions on priority groups and the method of delivery."

Once the groups most at risk from swine flu and those most likely to develop complications have been vaccinated ethicists have argued that the fairest way of distributing the vaccine to the rest of the population would be on a lottery basis, however this has officially been discounted.

Pensioners [i.e. elderly retirees] and those with chronic conditions, such as heart disease, liver disease, kidney disease, and diabetes controlled by insulin, are offered the seasonal flu vaccine every year and this will not change this winter. [So the oldsters get priority for seasonal flu vaccine but not swine flu vaccine?? Some confused thinking there]

There are early signs that the summer outbreak of swine flu may be peaking with GP consultation rates about flu-like illness having dropped in the past week. However cases are expected to surge again the autumn peaking in December and January.

Earlier this week researchers said where supplies antiviral drugs, used to treat flu and reduce symptoms, are limited they should be prioritised to the young over the elderly because deaths were lower in the over 65s. Prof Robert Dingwall, who sits on the Committee on Ethical Aspects of Pandemic Influenza, set up three years ago, said the debate over prioritisation of the pandemic vaccine based on age had been held within the committee several times.

He said it was unlawful to discriminate against people only by virtue of age. He said: "On the information we have so far unless there is an aggravating factor [which there often is] over 65s don't seem to be at risk from this as they are with seasonal flu. There is a good ethical argument for saying that the fit healthy over 65s are not a priority but there is no reason to discriminate between a 70-year-old asthmatic and a 10-year-old asthmatic."

Prof Dingwall said it was unacceptable to say that over 65s would not get the vaccine because younger people are of more value. But if there was good clinical evidence that younger people were getting swine flu more often and getting it more severely and that was the reason for prioritising younger people for the vaccine then that would be ethically acceptable. Prof Dingwall added: "There will be enough vaccine eventually (for everyone) but we may not be in a position to vaccinate the entire population well into next spring."

Prof Peter Openshaw, director of the centre for respiratory infection at the National Heart and Lung Institute Imperial College London, said: "It is sensible to make sure that the elderly get the ordinary seasonal flu vaccine as they are more likely to contract that. The elderly will in all likelihood [that sounds like a mere specualation] have some antibody protection because of exposure to similar viruses prior to 1968."

He said was also advisable to wait until test results on whether the swine flu vaccine with interact with the seasonal vaccine if given at the same time. The 1918 influenza pandemic was caused by an H1N1 virus and similar strains circulated throughout the 1950s.

The World Health Organisation issued guidance earlier this month saying that all countries should vaccinate front line health workers as their first priority. [That is the obvious priority but I would argue that the second priority ought to be people with other infirmities, regardless of age. Because the people with other infirmities are usually the ones who die. I think that there is a definite devaluing of the elderly above, probably because they usually pay little tax -- JR]


Public Option: Frank Admits What Obama Will Not

On June 15, Barack Obama told the American people the following regarding his proposed health care plan:
What are not legitimate concerns are those being put forward claiming a public option is somehow a Trojan horse for a single-payer system. … So, when you hear the naysayers claim that I’m trying to bring about government-run health care, know this - they are not telling the truth.

Meanwhile, his allies in Congress are telling a completely different story. Democratic Congressman Barney Frank (Mass.) had the following exchange when questioned by a group named Single Payer Action:
Single Payer Action: "Why shouldn't we start with single payer now?"

Congressman Frank: "Because we don’t have the votes for it. I wish we did. I think that if we get a good public option it could lead to single payer and that is the best way to reach single payer. Saying you’ll do nothing till you get single payer is a sure way never to get it. … I think the best way we’re going to get single payer, the only way, is to have a public option and demonstrate the strength of its power."

Hmm. I didn't think I'd ever say this, but I think Barney Frank is right! Either Obama doesn't understand basic economic principle, or he's the one lying to the American people.


The One Big Question on Health Reform

Any American who’s ever bought insurance will be able to answer the key question about health care reform. What happens to your insurance premiums when the benefits go up—way up? Will you pay more if you suddenly move from a bare-bones, high deductible policy to a new gold-plated policy that covers everything?

This is a key question because the Obama reforms call not only for a new government-sponsored health plan, but also for new regulations on existing policies—requiring that they remove benefit caps, lower deductibles and co-pays, and insure (at no extra cost) even those with dire, pre-existing conditions.

Aside from the huge tax burden to support the government program, crushing new rules on private insurance will force premiums sky high—striking hard at both employers and individuals, and starkly limiting their choices.


Health Reform and Cancer

The danger is that ObamaCare will stifle medical innovations that could save patients like me


I have been battling non-Hodgkin’s lymphoma, an incurable blood cancer, for the past nine years. Last year, I was also diagnosed with uterine cancer. I didn’t run to Canada for treatment. Medicare took care of my needs right here in New York City. To endure, I just need the freedom to choose my insurance, my doctors, and get the diagnostic scans and care I need. And one more thing: I need hope that a treatment will be developed that can control my diseases the way insulin controls diabetes.

Every cancer patient needs these things, especially hope. But the government’s plan to reform the health-care system in this country threatens all of this—particularly the development of new treatments.

When I was first diagnosed in 2000 I had chemotherapy. It put me in remission, but nearly killed me. Three years later the lymphoma was back and I faced more chemo. This is so often the pattern of cancer: recurring disease and repeated chemo. In the end patients often die not from the disease, but from the treatments.

I took a different path, seeking a cancer vaccine. One had been developed at Stanford University 12 years earlier that had given 90% of patients very long remissions and cured some entirely. Unlike chemotherapy, there were no severe side effects. But I couldn’t get the vaccine because the Food and Drug Administration required another trial that would take nine more years. Over-regulation has kept this treatment from patients for 21 years, as some 24,000 lymphoma patients died each year.

My husband and I searched the Internet and found another vaccine being tested at Freiburg University in Germany. That vaccine has helped me avoid chemotherapy for years. My oncologist says he’s never seen another patient do so well with the type of lymphoma I have. I am still here because my care was managed by doctors—not a government agency. My doctors do what the bureaucracy can’t: They see me as a human being.

Patient-as-person will be a lost concept under the new health-care plan, where treatments will be based not upon individual patient needs, but upon what’s best for everyone. So cancer drugs for seniors might take second place to jungle gyms and farmers’ markets—so-called preventive care—which are covered under both the House and Senate versions of the health bill.

The stimulus package passed earlier this year allocated $1.1 billion for hundreds of “Comparative Effectiveness Research” studies. This project will compare all treatment options for a host of diseases in order to develop a database to guide doctors’ decisions. Research of this sort typically takes years. But the data will likely be hastily drawn conclusions that reflect the view of the government agencies that fund the studies: Cheap therapies are just as good as expensive ones.

In order to finance health-care reform, Democrats in Congress have proposed cutting $500 billion from Medicare over the next 10 years. Yet in his press conference last Wednesday, President Barack Obama denied that Medicare benefits would be cut. He has surrounded himself with advisers who believe otherwise.

Tom Daschle, Mr. Obama’s original pick to head Health and Human Services, argues in his book “Critical: What We Can Do About the Health-Care Crisis,” that we should accept “hopeless diagnoses” and “forgo experimental treatments.” Mr. Daschle blames the “use and overuse of new technologies and treatments” for runaway health-care costs. He suggests a Federal Health Board modeled after the British “NICE” board to make decisions on health-care rationing. But the British system is infamous for denying state-of-the-art drugs to cancer patients. Thus cancer-survival rates in Britain are far below those in America, just as they are in Canada.

Canadian cancer patients told to wait months for treatment and diagnostic scans frequently go south and pay out-of-pocket for care in the United States. A number of Quebeckers even sued their government for violating their “right to life and security” under the Quebec Charter of Rights and Freedoms. Canada’s Supreme Court has acknowledged the pervasive rationing that occurs. In the 2005 case Chaoulli v. Quebec (Attorney General) , the majority opinion stated: “The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care.”

Despite such evidence, the Obama plan is likely to target various treatments—including radiology scans—in order to cut costs. I survived this long because my radiologist examines each of my scans with me in detail. One of those scans also saved my life by picking up unsuspected uterine cancer. The congressional majority seems blissfully unaware that all cancer patients need those scans to monitor their diseases.

Also uneasy with the cost of medical progress is Dr. David Blumenthal, Mr. Obama’s new head of Health Information Technology. It is not reassuring that he stresses that two-thirds of the annual increases in health spending result from medical innovation, as he has written in The New England Journal of Medicine. Cancer patients need nothing more than such innovation. Yes, developing more effective, less toxic treatments is expensive. The prices of new cancer therapies reflect the billion-dollar cost of developing each new drug. But such treatments can be life-saving, as they have been for me.

Despite its warts, our system works. Carelessly tinkering with it will have a world-wide penalty—the stifling of new drug development. What company would spend a billion dollars to develop a drug that will not be reimbursed by the new health plan? This would be a direct, devastating blow to the most vulnerable Americans.

In spite of the president’s assurances, there is every sign that this plan will be financed by deep cuts to Medicare, which, like the public option, will limit payments for specialists, radiology scans, and cutting-edge cancer drugs. These are prime targets because they are more expensive than other services. But are we really expected to forgo new medical technology and return to the cancer care of the 1970s? When members of Congress are asked if they will opt for the public plan, they say no. That’s for the rest of us.

The number of Americans who have cancer exceeds 10 million. It’s time for cancer patients and their families to remind those on Capitol Hill that health-care reform is a matter of life and death for us.


House Health-Care Bill (H.R. 3200, America Affordable Health Choices Act of 2009) Would Establish 'Medical Homes' for the Elderly and Disabled

This is how Hitler's extermination of "useless eaters" started out

The House health-care reform bill proposes to decrease hospital visits by establishing a “medical home pilot program” for elderly and disabled Americans. Such a medical home would not require a physician to be on the staff, and therefore could be run solely by nurse practitioners and physician assistants. Medical homes also would practice “evidence-based” medicine, which advocates only the use of medical treatments that are supported by effectiveness research.

But physicians’ groups say the legislation could lead to restrictions on which treatments may be used for certain conditions, despite the fact that some patients might require a unique or unconventional approach. It also may lead to dumping Medicare/Medicaid patients in facilities that are not required to have physicians on staff.

The Center for Medicine in the Public Interest (CMPI) expressed its concerns in a report that explains why statistical evidence does not always reflect reality of effective medicine. “‘One size fits all’ rarely does,” the report said. “From clothes to shoes to hats, few people find that items carrying that label work with their individual bodies. So why do we entrust the health of our bodies -- one of the most important assets we have -- to a one-size-fits-all mentality?”

According to CMPI and individual physicians, however, this one-size-fits-all mentality is just what congressional health-care reform suggests. “Unfortunately, policies being advanced under the guise of ‘evidence-based medicine’ (EBM) could do just that,” the CMPI report said. “The idea behind EBM, empowering physicians with sound evidence to incorporate into their treatment decisions for individual patients, is a good one. “Unfortunately, EBM now is being distorted by government bureaucrats and HMOs in ways that impose top-down, one-size-fits-all restrictions on patients and their healthcare providers.”

Rather than enforcing a formulaic approach to medicine based on statistical and clinical research, CMPI says health-care reform should preserve physicians’ autonomy to use the research in conjunction with their experience and knowledge of the patient. ”It is so critically important for the physician to maintain his or her ability to combine study findings with their expertise and knowledge of the individual in order to make the optimal treatment decisions. Evidence-based medicine in its present, distorted form emphasizes just one aspect of the clinical pie over all the others,” the report found.

Kathryn Serkes of the American Association for Physicians and Surgeons echoed the observation. “There is no typical patient,” Serkes told “Every patient is different from a medical perspective. If we have evidence-based medicine that basically says ‘well, we start at treatment one, which leads you to treatment two, to treatment three to treatment four. In practice, that doesn’t work for the patient. That’s the ‘art’ part of the art and science of medicine. That’s what we still need doctors to do, is to figure out what’s right for the patient.”

In the long run, according to CMPI, evidence-based medicine may not even cut costs as Congress suggests it would. “Evidence-based medicine may provide transitory savings in the short term, but the same patient who takes the cheapest available statin today may very well be the patient costing you -- the taxpayer, the policymaker, the thought-leader, the sister, the spouse -- big bucks when that patient ends up in the hospital because of improperly treated cardiovascular disease,” . “The repercussions of choosing short-term thinking over long-term results and cost-based medicine over patient-based are pernicious to both the public purse and the public health,” the CMPI report said.

Provisions for the medical home pilot program are an amendment to the Social Security Act, which governs the administration of Medicare and Medicaid services. The medical home is an approach to medical practice that “facilitates partnerships” between patients and physicians, according to the proposed bill. The pilot program targets Medicare beneficiaries who have a high medical “risk score” or who require regular monitoring, advising or treatment. This currently applies to more than 22 million Americans, according to Kaiser Family Foundation statistics. At least $1.5 billion would be redirected from the Federal Supplementary Medical Insurance Trust Fund to fund the medical homes, “in addition to funds otherwise available,” according to the bill. The Senate health-care reform bill also includes provisions for medical homes, although to lesser detail than the House bill.

If this portion of the legislation passes through Congress, medical homes will be part of the greater health-care reform experiment known as "the public (health insurance) option." According to the committee, the provisions for medical homes will make the public option a stronger competitor against private health insurance companies. “The public health insurance option will be empowered to implement innovative delivery reform initiatives so that it is a nimble purchaser of health care and gets more value for each health care dollar,” the House Committee on Energy and Commerce’s summary says about the bill.

Medical homes are tied to “comparative effectiveness research” via something called “evidence-based medicine.” “It will expand upon the experiments put forth in Medicare and be provided the flexibility to implement value-based purchasing, accountable care organizations, medical homes, and bundled payments. These features will ensure the public option is a leader in efficient delivery of quality care, spurring competition with private plans,” the committee’s summary also said.

A statement by the American College of Emergency Physicians (ACEP) said that the effectiveness of the medical home model should be carefully evaluated before applying the model far and wide. “There should be more research to demonstrate the benefits and continuing costs associated with implementation of the full (patient-centered medical home) model,” the ACEP statement said. “Demonstration projects being conducted by the Centers for Medicare & Medicaid Services must be carefully evaluated. There should be proven value in healthcare outcomes for patients and reduced costs to the healthcare system before there is widespread implementation of this model.”

The proposal, meanwhile, specifically allows for facilities to be run by staff who do not possess medical degrees – including nurses and nurse practitioners.


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