Study: Health Insurers Are Near-Monopolies ... 95 percent of the 294 HMO/PPO metropolitan markets studied were above 1,800

Study: Health Insurers Are Near-Monopolies | Tuesday, April 18, 2006 by the Associated Press

Consolidation among health insurers is creating near-monopolies in virtually all reaches of the United States, according to a study released Monday.

Data from the American Medical Association show that in each of 43 states, a handful of top insurers have gained such a stronghold that their markets are considered "highly concentrated" under U.S. Department of Justice guidelines, often far exceeding the thresholds that trigger antitrust concerns.

The study also shows that in 166 of 294 metropolitan areas, or 56 percent, a single insurer controls more than half the business in health maintenance organization and preferred provider networks underwriting.

"This problem is widespread across the country, and it needs to be looked at," said Jim Rohack, an AMA trustee and physician in Temple, Texas. "The choices that patients have now are more difficult."

The AMA study cited a Justice Department benchmark in citing antitrust concerns, the Herfindahl-Hirschman Index, or HHI. A score above 1,000 shows "moderate" concentration. Those scoring above 1,800 yield a "high" concentration.

Figures show that 95 percent of the 294 HMO/PPO metropolitan markets studied were above 1,800. Raise that HHI bar even higher to 3,000, and 67 percent rise above it.

The AMA study is the latest piece of evidence — and most comprehensive to date — showing the market power of a few companies, and a large number of regional nonprofit Blue Cross operations, is formidable and growing. And it comes as premiums continue to grow at near double-digit percentage rates.

Critics say that carriers are not only creating monopolies and oligopolies in many regions, they also control the other side of the equation in what is known as monopsony power. That means in addition to having the most enrollees, they're also the biggest purchasers of health care and can dictate prices and coverage terms. ...

Co-Payments for Expensive Drugs Soar - [Is this health insurance or just a drug discount program?]

Co-Payments for Expensive Drugs Soar - New York TimesBy GINA KOLATA | Published: April 14, 2008

Health insurance companies are rapidly adopting a new pricing system for very expensive drugs, asking patients to pay hundreds and even thousands of dollars for prescriptions for medications that may save their lives or slow the progress of serious diseases.

With the new pricing system, insurers abandoned the traditional arrangement that has patients pay a fixed amount, like $10, $20 or $30 for a prescription, no matter what the drug’s actual cost. Instead, they are charging patients a percentage of the cost of certain high-priced drugs, usually 20 to 33 percent, which can amount to thousands of dollars a month.

The system means that the burden of expensive health care can now affect insured people, too.

No one knows how many patients are affected, but hundreds of drugs are priced this new way. They are used to treat diseases that may be fairly common, including multiple sclerosis, rheumatoid arthritis, hemophilia, hepatitis C and some cancers. There are no cheaper equivalents for these drugs, so patients are forced to pay the price or do without. ...
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The system, often called Tier 4, began in earnest with Medicare drug plans and spread rapidly. It is now incorporated into 86 percent of those plans. Some have even higher co-payments for certain drugs, a Tier 5.

Now Tier 4 is also showing up in insurance that people buy on their own or acquire through employers, said Dan Mendelson of Avalere Health, a research organization in Washington. It is the fastest-growing segment in private insurance, Mr. Mendelson said. Five years ago it was virtually nonexistent in private plans, he said. Now 10 percent of them have Tier 4 drug categories.

California insurers ordered to reinstate policies - San Jose Mercury News

California insurers ordered to reinstate policies - San Jose Mercury NewsBy SHAYA TAYEFE MOHAJER Associated Press Writer | Article Launched: 04/17/2008 06:03:45 PM PDT

LOS ANGELES—Three of the state's largest health insurance companies have been ordered to reinstate the policies of 26 customers who had their coverage dropped.

A state regulatory agency also warned insurers Thursday that an independent review had been ordered on policies canceled in the past four years, meaning thousands more could be ordered reinstated.

Department of Managed Health Care Director Cindy Ehnes says the practice of dropping coverage, known as rescission, is particularly harsh because it's often done when a consumer is vulnerable. ...

100 studies have been published documenting the harmful effects of racial discrimination on a variety of health measures in African-Americans

The Toxic Power of Racism | Posted March 26, 2008
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However, a growing body of research during the past few years indicates that one of the most glaring inequalities experienced by African-Americans is the disparity in health care that they receive. This week, for example, the New York Times reported that the Department of Veterans Affairs found that black patients "tend to receive less aggressive medical care than whites" at its hospitals and clinics, in part because doctors provide them with less information and see them as "less appropriate candidates" for some types of surgery.

Statistics tell the story. A new government report found the difference in life expectancy between poor black men and affluent white women to be more than 14 years (66.9 vs. 81.1 years)! African-Americans have a higher risk of dying from chronic ailments such as coronary heart disease and high blood pressure than any other ethnic group. Only part of this disparity is explained by differences in income and access to adequate medical care. On average, the most affluent African-Americans suffer more health problems than the least affluent whites.

In the past decade more than 100 studies have been published documenting the harmful effects of racial discrimination on a variety of health measures in African-American men and women. For example, a recent study that followed nearly 60,000 African-American women for six years found that women who reported on-the-job racial discrimination had a 32 percent higher risk of breast cancer than others who did not. Women who said they faced racial discrimination on the job, in housing and from the police were 48 percent more likely to develop breast cancer than those who reported no incidents of major discrimination. Another study of African-American women found that those who reported chronic emotional stress due to their experience of racism had more severely blocked carotid arteries (which supply blood to the brain) than those who did not. In yet another study perceived racism was associated with a significantly increased risk of uterine fibroids in black women, and this was unrelated to differences in health care utilization. ...

Medicines approved right on deadline by the Food and Drug Administration are more likely to cause safety problems

FDA Deadlines May Impact Drug Safety | By LAURAN NEERGAARD – 20 hours ago

WASHINGTON (AP) — Vioxx, Bextra, Rezulin, Baycol. Looking at drugs yanked off the market, Harvard researchers found a disturbing pattern: Medicines approved right on deadline by the Food and Drug Administration are more likely to cause safety problems later than those cleared with more time to spare.

Congress set strict deadlines for FDA to speed the arrival of new medications, but critics have long complained that the ticking clock spurred a dangerous rush to judgment.
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"The article is a wake-up call," said Dr. Steven Nissen, the Cleveland Clinic's influential cardiology chief who helped sound the alarm on the risks of some of those ultimately doomed drugs

"It puts the FDA in a very difficult situation when they're trying to make complex decisions under these very, very tight deadlines," he added. "We've got to reevaluate now whether that's good public policy."
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"FDA staffers by their own admission feel very much under the gun as these deadlines loom," added Dr. Jerry Avorn of Brigham and Women's Hospital in Boston, who co-authored the study. "If they're forced to make decisions prematurely, they may not make the right decisions. That needs to be debated openly." ...

59 percent of US doctors support universal health care ... up from 49% in 2002 ...

US doctors support universal health care - survey | Mon Mar 31, 2008 5:00pm EDT

WASHINGTON, March 31 (Reuters) - More than half of U.S. doctors now favor switching to a national health care plan and fewer than a third oppose the idea, according to a survey published on Monday.

The survey suggests that opinions have changed substantially since the last survey in 2002 and as the country debates serious changes to the health care system.

Of more than 2,000 doctors surveyed, 59 percent said they support legislation to establish a national health insurance program, while 32 percent said they opposed it, researchers reported in the journal Annals of Internal Medicine.

The 2002 survey found that 49 percent of physicians supported national health insurance and 40 percent opposed it. ...
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"Across the board, more physicians feel that our fragmented and for-profit insurance system is obstructing good patient care, and a majority now support national insurance as the remedy," Ackermann said in a statement.

The Indiana survey found that 83 percent of psychiatrists, 69 percent of emergency medicine specialists, 65 percent of pediatricians, 64 percent of internists, 60 percent of family physicians and 55 percent of general surgeons favor a national health insurance plan. ...

Infants born early are more likely to die during childhood and, if they survive, less likely to have children

Premature birth has lasting effects, study finds | By Thomas H. Maugh II, Los Angeles Times Staff Writer

4:26 PM PDT, March 25, 2008 Infants born early are more likely to die during childhood and, if they survive, less likely to have children of their own, researchers report.
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The study, conducted using Norwegian birth data, suggests that, as the percentage of premature infants who make it through their first year continues to grow because of advances in neonatology, the number of troubled infants and adults will also rise.
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Experts said the situation is probably worse in the United States.
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One in eight American infants is now born prematurely, a total of more than half a million per year, despite the best efforts of physicians to bring more pregnancies to full term -- defined as 38 weeks or longer.
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A total of 5.2% of the births were premature, less than half the percentage in the U.S.

For boys born the most prematurely, between 22 and 27 weeks, their risk of death was 5.3 times normal between the ages of 1 and 6 and seven times normal between 7 and 13. For boys born between 28 and 32 weeks, the risk of death was 2.5 time normal in early childhood and 2.3 times normal in late childhood.

The most premature girls had 9.7 times the normal risk of death between ages 1 and 6, but no increased risk between 7 and 13. Girls born between 28 and 32 weeks did not have a significantly increased risk of death.

The investigators are not sure what accounts for the increased risk, but some of it is due to cancer and congenital abnormalities, Swamy said.

In adulthood, boys born the most prematurely were 76% less likely to reproduce, with only about one in seven having children. Women were 67% less likely to reproduce, with one in four having children.
...

Accident -- brain damage -- $1m award --- $417,000 after attorneys ... then Wal-Mart's health plan sued for remainder !

Brain-damaged woman at center of Wal-Mart suit | By Randi Kaye | CNN

JACKSON, Missouri (CNN) -- Debbie Shank breaks down in tears every time she's told that her 18-year-old son, Jeremy, was killed in Iraq.
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Shank suffered severe brain damage after a traffic accident nearly eight years ago that robbed her of much of her short-term memory and left her in a wheelchair and living in a nursing home.
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Two years after the accident, Shank and her husband, Jim, were awarded about $1 million in a lawsuit against the trucking company involved in the crash. After legal fees were paid, $417,000 was placed in a trust to pay for Debbie Shank's long-term care.

Wal-Mart had paid out about $470,000 for Shank's medical expenses, but in 2005, Wal-Mart's health plan sued the Shanks for the same amount.

The Shanks didn't notice in the fine print of Wal-Mart's health plan policy that the company has the right to recoup medical expenses if an employee collects damages in a lawsuit. ...
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Wal-Mart spokesman John Simley, who called Debbie Shank's case "unbelievably sad," replied in a statement: "Wal-Mart's plan is bound by very specific rules. ... We wish it could be more flexible in Mrs. Shank's case since her circumstances are clearly extraordinary, but this is done out of fairness to all associates who contribute to, and benefit from, the plan." ...

"In this invasion we used even more DU bullets. ... "We are living through another Hiroshima," Iraqi doctor says

"We are living through another Hiroshima," Iraqi doctor says | Sherwood Ross | March 24, 2008 - 8:41am

The U.S., Great Britain and Israel are turning portions of the Middle East into a slice of radioactive hell. They are achieving this by firing what they call "depleted uranium" (DU) ammunition but which is, in fact, radioactive ammunition and it is perhaps the deadliest kind of tactical ammo ever devised in the warped mind of man.

There's a ton of data about this on the Internet for the skeptics: from sources such as the 1999 report of the International Atomic Energy Commission to oncologist members of England's Royal Society of Physicians to U.S. Veterans Administration hospital nuclear medicine doctors to officials at the Basra maternity and pediatric hospital to reporter Scott Peterson of the Christian Science Monitor. Peterson used a Geiger counter in August, 2003 to find radiation readings between 1,000 and 1,900 times normal where bunker buster bombs and munitions had exploded near Baghdad. After all, a typical bunker bomb is said to contain more than a ton of depleted uranium.
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And from U.S. veterans: Tom Cassidy, of the 1st Cavalry Division who saw service in Iraq in 2003-05: "After the first gulf war, the level of radiation was 300 times what is considered normal. In this invasion we used even more DU bullets. The effects there are horrible," he told the UCSC paper. Added Dennis Kyne, from the U.S. Army's 18th Airborne division and Desert Storm veteran and who suffers from an "undiagnosed illness": "The scientists call it cell disruption, and they don't know why it's happening to veterans, but it's really radiation sickness, and it's because the DU is all over."

[Depleted Uranium] worms in the Dumfries testing ground had significant traces of poisonous uranium isotopes in their bodies.

Depleted uranium turns earthworms into glowworms | By Jasper Hamill | Mar 25, 2008, 18:38 | Fears that radioactive material has tainted ecosystem.

EARTHWORMS WERE pushed into the firing line last week after a resumption of the testing of depleted uranium shells at Dundrennan.

Significant levels of radioactive uranium isotopes were found in the flesh of worms at the Ministry of Defence's Dumfries weapons range last year. Despite concerns from environmentalists and the international community, the MoD last week started a series of tests of depleted uranium (DU) shells, supposed "safety checks".

A report published in the Journal of Environmental Monitoring found that worms in the Dumfries testing ground had significant traces of poisonous uranium isotopes in their bodies.

Worms are a crucial part of the ecosystem, aerating the soil and aiding the nutrient uptake of plants. If they are contaminated, it suggests the wider environment is tainted. ...

"There is a definite concern that in-office imaging could lead to scanning for dollars,"

Health Insurers Limit Advanced Scans | Sunday, March 23, 2008

TRENTON, N.J. - Insurance companies are taking a harder look at advanced medical scans like CT scans, citing spiraling costs and safety concerns. And some doctors agree there's emerging evidence that these scans are being over-prescribed.

"Costs are soaring in this area, quality concerns are mounting and safety concerns are mounting," said Karen Ignagni, chief executive officer of the trade group America's Health Insurance Plan.
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Doctors, too, are concerned about patients getting excessive radiation exposure when they receive scans that aren't needed or are ordered as "defensive medicine" to protect against possible lawsuits. There also is concern that a small number of unscrupulous doctors without adequate expertise are referring patients for tests in their own offices or imaging facilities in which they have a financial interest.

"There is a definite concern that in-office imaging could lead to scanning for dollars," said Dr. Robert Hendel, a heart specialist who sits on American College of Cardiology panels focused on quality and appropriateness of imaging. ...
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The two doctor specialist groups are fighting improper use of scans by supporting accreditation of the machines and doctors using them and by publicizing criteria for quality and appropriateness of various imaging tests.

"There is substantial evidence that these types of techniques, when used appropriately - and I want to emphasize the word 'appropriately' - can keep the lid on expenses and improve outcomes," such as by catching cardiac problems early enough to prevent a heart attack, Hendel said. ...
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The insurer restrictions seem to be working: After one health plan that was seeing 20 percent annual jumps in advanced imaging use began requiring preauthorization, its growth rate plunged. Yet the insurer said only 1.5 percent of requests were being denied, indicating doctors were ordering fewer tests, according to the report. ...

"workers and households pay for health insurance through lower wages and higher prices,"

Rising Health Costs Cut Into Wages | Higher Fees Squeeze Employers, Workers | By Michael A. Fletcher | Washington Post Staff Writer | Monday, March 24, 2008; Page A01
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The main reason: spiraling health-care costs have been whacking away at their wages. Even though workers are producing more, inflation-adjusted median family income has dipped 2.6 percent -- or nearly $1,000 annually since 2000.

Employees and employers are getting squeezed by the price of health care. The struggle to control health costs is viewed as crucial to improving wages and living standards for working Americans. Employers are paying more for health care and other benefits, leaving less money for pay increases. Benefits now devour 30.2 percent of employers' compensation costs, with the remaining money going to wages, the Labor Department reported this month. That is up from 27.4 percent in 2000.

"The way health-care costs have soared is unbelievable," said Katherine Taylor, a vice president for Local 1199 of the Service Employees International Union. "There are people out here making decisions about whether to keep their lights on or buy a prescription."

Since 2001, premiums for family health coverage have increased 78 percent, according to a 2007 report by the Kaiser Family Foundation. Premiums averaged $12,106, of which workers paid $3,281, according to the report.
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Researchers Ezekiel J. Emanuel and Victor R. Fuchs say that employer-sponsored health-care plans create the "myth" that workers are getting their health benefits for little or nothing. But, in fact, "workers and households pay for health insurance through lower wages and higher prices," they wrote in the March 5 issue of the Journal of the American Medical Association. ...

Doctors Take Kidney, Leave Cancerous One

Doctors Take Kidney, Leave Cancerous One | Pathologist Notices Healthy Kidney Next Day | POSTED: 12:05 pm CDT March 19, 2008
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Officials at a Minnesota hospital said a tragic error led doctors to remove the healthy kidney from a patient with cancer. ...

Uninsured: 36% of Hispanics, 22% of African Americans, 17% of Asians, 13% of whites

Lack of Insurance Hits Us All | By Michelle Singletary | Sunday, March 16, 2008; Page F01
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"I feel bad because I can't afford health care, but I can't afford health insurance, either," said Gomez, whose newborn son, Edward, is covered by Medicaid. "What am I going to do?"

The fact that 47 million people -- 9 million children -- in this country are uninsured has been one of the top issues in the presidential campaign. Equally troubling is this statistic: The lack of health-care coverage is most acute among Hispanics and African Americans, many of whom work in low-wage jobs without benefits or are employed by small businesses that don't offer coverage.
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Thirty-six percent of Hispanics are uninsured, compared with 22 percent of African Americans, 17 percent of Asian/Pacific Islanders and 13 percent of whites, according to the Kaiser Family Foundation's most recent analysis of census data.
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Lavizzo-Mourey said minorities, who disproportionately suffer from chronic illnesses, often avoid getting critical screening or skip treatment because they lack health insurance. She shared the story of Ruth, a diabetic African American in her 50s who came into a clinic with an ulcer on her foot. By the time she sought help, she needed more care than the clinic could offer.

“through a complex series of illegal rackets and lies, Eli Lilly built a multi-billion dollar drug enterprise at the expense of taxpayers

Lilly accused of "sick marketing mindset" in new Zyprexa lawsuit | 12 March 2008

Connecticut has become the latest US state to sue Eli Lilly after claiming that the firm marketed the antipsychotic Zyprexa for unapproved off-label uses,and hid side effects such as weight gain and diabetes.

nnouncing the lawsuit, the state’s Attorney General Richard Blumenthal issued a scathing statement saying that Lilly “allegedly corrupted physicians, pharmacies and administrators at nursing homes and youth detention centres as part of a massive illegal marketing campaign” to promote Zyprexa (olanzapine), notably among children, for anxiety, depression and attention-deficit hyperactivity disorder. He adds that the firm also “dangerously concealed risks associated with Zyprexa”, which was only approved for schizophrenia, including diabetes, cardiovascular problems and significant weight gain.

Mr Blumenthal goes on to claim that “through a complex series of illegal rackets and lies, Eli Lilly built a multi-billion dollar drug enterprise at the expense of taxpayers, consumers and patient lives”. He then says that he is seeking to “recover millions of taxpayer and consumer dollars”, around $190 million, that was “improperly spent” on Zyprexa. ...

influx of reports describing allergic reactions, including four fatalities, which may be linked to contaminated product.

Heparin Stopped at the Border | By MedHeadlines • Mar 15th, 2008 • Category: Drugs, FDA, Poisoning, Prevention, Recalls

On Friday, the US Food and Drug Administration (FDA) announced that it is taking action against shipments of heparin coming into the country from China after an influx of reports describing allergic reactions, including four fatalities, which may be linked to contaminated product. All shipments reaching the US border will now be tested for contamination before further distribution.
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FDA officials announced last week that they discovered a significant amount of a suspicious substance, thought to be a contaminant, in samples of some recalled heparin and in the active ingredient used to manufacture it. The substance is said to be “heparin-like” but it has yet to be identified exactly. Baxter issued a recall of most of its heparin products last month after receiving reports of adverse allergic reactions.

A heparin manufacturer in Germany issued reports of contaminated heparin last week and ordered a recall of all its products. Rotexmedica GmbH also purchases heparin ingredients from China ...

the U.S. healthcare system is killing people. It is especially killing non-white women and children

March 13th, 2008 | Discriminatory Health Care In The U.S.

Meanwhile here in the U.S… RH Reality Check has some appalling statistics about the inequities of health care in this country:

* African-American women are nearly four times more likely to die in childbirth than white women, 23 times more likely to be infected with HIV/AIDS and 14 times more likely to die from the disease.
* American-Indian/Alaskan Native women are over 5 times more likely than white women to have chlamydia and over 7 times more likely to contract syphilis.
* The unplanned pregnancy rate among Latinas is twice the national average; and Latinas are much more likely to contract human papillomavirus, the infection that leads to cervical cancer.

and:

* More young African-American females and Latinas than white women are given abstinence-only instruction in school, instead of comprehensive sex education. This means they aren’t taught about contraceptive use to prevent pregnancy or protect against HIV and other sexually transmitted infections (STIs). Abstinence-only programs have proven ineffective, and in some cases counter-productive, but every year the government has increased their funding dramatically, now totaling $176 million annually.
* Although the U.S. has the resources to reduce maternal deaths and has acknowledged the importance of prenatal care to prevent them, it has adopted policies which force women to delay pregnancy-related care or forego it altogether. Unreasonable requirements for Medicaid like the 5-year bar on benefits for legal residents prevent many immigrant women from receiving even basic services.

Just to be clear–the U.S. healthcare system is killing people. It is especially killing non-white women and children. ...

millions of veterans and their dependents have no access to care in veterans' hospitals and clinics and no health insurance

Veterans Without Health Care | The New York Times | Editorial | Friday 09 November 2007

Although many Americans believe that the nation's veterans have ready access to health care, that is far from the case. A new study by researchers at the Harvard Medical School has found that millions of veterans and their dependents have no access to care in veterans' hospitals and clinics and no health insurance to pay for care elsewhere. Their plight represents yet another failure of our disjointed health care system to provide coverage for all Americans.

The new study, published in the American Journal of Public Health, estimated that in 2004 nearly 1.8 million veterans were uninsured and unable to get care in veterans' facilities. An additional 3.8 million members of their households faced the same predicament. All told, this group made up roughly 12 percent of the huge population of uninsured Americans. ...

Sugar Substitutes May Contribute to Weight Gain

Sugar Substitutes May Contribute to Weight Gain | By Randy Dotinga | HealthDay Reporter | Monday, February 11, 2008; 12:00 AM

MONDAY, Feb. 11 (HealthDay News) -- Surprising research suggests a popular artificial sweetener has the unexpected and unwelcome effect of packing on the pounds.
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To test this theory, the researchers fed two different types of plain Dannon yogurt to male rats. Some received yogurt sweetened with glucose, a form of sugar, while others ate saccharin-sweetened yogurt. All also ate unsweetened yogurt.

The rats who ate artificially sweetened yogurt consumed more food overall and gained more weight. The body temperatures of those rats also didn't rise as high as the others. "That might be a kind of measure of energy expenditure, suggesting not only are the animals eating more calories, they may be expending or burning up fewer calories," Swithers said. ...

Supreme Court on Wednesday made it harder for consumers to sue manufacturers of federally approved medical devices

Wed, Feb. 20, 2008 | Court limits suits over medical devices | By PETE YOST | Associated Press Writer

WASHINGTON -- The Supreme Court on Wednesday made it harder for consumers to sue manufacturers of federally approved medical devices.

In an 8-1 decision, the court ruled against the estate of a patient who suffered serious injuries when a catheter burst during a medical procedure.

The case has significant implications for the $75 billion-a-year health care technology industry, whose products range from heart valves to toothbrushes.

In a recent three-month span, federal regulators responded to over 100 safety problems regarding medical devices.

At issue before the Supreme Court was whether the estate of Charles Riegel could sue a company under state law over a device previously cleared for sale by federal regulators.

Under federal law, a company must substantiate the safety and effectiveness of a medical device before the U.S. Food and Drug Administration will approve it for the marketplace.

State lawsuits are barred to the extent they would impose requirements that are different from federal requirements, said the ruling by Justice Antonin Scalia.

In dissent, Justice Ruth Bader Ginsburg said that Congress never intended "a radical curtailment of state common-law lawsuits seeking compensation for injuries caused by defectively designed or labeled medical devices."

But Scalia, in response, said, "It is not our job to speculate upon congressional motives." ...

lives of 22,000 patients could have been saved if U.S. regulators had been quicker to remove a Bayer AG drug

22,000 died amid delayed Bayer drug recall: doctor | Reuters | Saturday February 16, 2008

The lives of 22,000 patients could have been saved if U.S. regulators had been quicker to remove a Bayer AG drug used to stem bleeding during open heart surgery, according to a medical researcher interviewed by CBS Television's 60 Minutes program. ...

NY AG Charges the Companies Used 'Rigged Data to Manipulate' Reimbursement Rates to Customers

N.Y. AG Prescribes Subpoenas to UnitedHealth Group, Others | Charges the Companies Used 'Rigged Data to Manipulate' Reimbursement Rates to Customers

The nation's largest health care insurer, four of its subsidiaries and a number of other large insurers are being served subpoenas -- 16 in all -- in a suit to be brought by New York Attorney General Andrew Cuomo that charges the companies used "rigged data to manipulate the reimbursement rate to their customers who filed claims."

At the center of the scheme, according to the attorney general, is Ingenix, Inc., "the nation's largest provider of health care billing information, which serves as a conduit for rigged data to the largest insurers in the country."

Cuomo notified Ingenix and its parent company, UnitedHealth Group, of his intent to file suit and subpoenaed 16 other companies, including Aetna, CIGNA, and Empire BlueCross BlueShield. The central allegation is that companies manipulated reimbursement rates. In addition to Ingenix, the suit is also encompassing three other UnitedHealth Group subsidiaries. ...
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"Further, the investigation found that two subsidiaries of United (the "United insurers") dramatically under-reimbursed their members for out-of-network medical expenses by using data provided by Ingenix," Cuomo's office said.

"The Attorney General's investigation found that by distorting the 'reasonable and customary' rate, the United insurers were able to keep their reimbursements artificially low and force patients to absorb a higher share of the costs."

"When insurers like United create convoluted and dishonest systems for determining the rate of reimbursement, real people get stuck with excessive bills and are less likely to seek the care they need," ...

Ccost for treatments of back and neck problems ... increase 65% ... not observe improvements in health outcomes commensurate with the increasing costs

Back and neck problems more costly now than ever | By Sue Mueller | Feb 13, 2008 - 12:01:04 PM

WEDNESDAY FEB 13, 2008 (foodconsumer.org) -- The medical cost for diagnosing and treating back and neck problems has jumped faster than the general medical expenditures during the past decade, but the increase apparently has not resulted in an health status that matches the magnitude of the increased cost, according to a study in The Journal of the American Medical Association.

The cost for treatments of back and neck problems in the United States reached $86 billion in 2005, a 65 percent increase from 1997 after adjusting the inflation, the New York Times reported. In the meantime, the proportion of people with impaired function due to back and neck problems increased drastically during the same period even after the aging factor was considered.
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Among others, the cost for drugs has increased much faster than others. In 2005, US adults spent an estimated $20 billions on drugs for treating back and neck problems, an increase of 171 percent from 1997, according to the New York Times. The cost for some narcotic pain relievers such as OxyContin and others increased more than 400%. ...
Albeit the sharp increase in medical expenditures for treating back and neck problems, the rate of people with spine problems who reported to have physical function limitations due to the conditions increased to 24.7 percent in 2005 from 20.7 percent in 1997.

"These data suggest that spine problems are expensive, due both to large numbers of affected persons and to high costs per person. We did not observe improvements in health outcomes commensurate with the increasing costs over time. Spine problems may offer opportunities to reduce expenditures without associated worsening of clinical outcomes," the researchers conclude.

private audit companies will begin scouring mountains of medical records ... to find over and under payments

Mar 1, 8:07 AM EST | Audits Sting Hospitals, Physicians | By KEVIN FREKING | Associated Press Writer

WASHINGTON (AP) -- In coming weeks, private audit companies will begin scouring mountains of medical records. Their mission: Determine if health care providers erred when billing Medicare and require them to return any overpayments to the federal government. The auditors will keep a tidy percentage for their services.

The contractors have shown they're pretty good at their work. In just three years, they've returned more than $300 million to the federal government - and that's just from three states. That experiment is winding down. But a larger, national program will soon take its place. ....

VA: veterans only get "medical care secretary determines is needed, and only to the extent funds ... are available."

Veterans not entitled to mental health care, U.S. lawyers argue Published on Wednesday, February 06, 2008. | Source: San Francisco Chronicle

Veterans have no legal right to specific types of medical care, the Bush administration argues in a lawsuit accusing the government of illegally denying mental health treatment to some troops returning from Iraq and Afghanistan.

The arguments, filed Wednesday in federal court in San Francisco, strike at the heart of a lawsuit filed on behalf of veterans that claims the health care system for returning troops provides little recourse when the government rejects their medical claims.

The Department of Veterans Affairs is making progress in increasing its staffing and screening veterans for combat-related stress, Justice Department lawyers said. But their central argument is that Congress left decisions about who should get health care, and what type of care, to the VA and not to veterans or the courts.

A federal law providing five years of care for veterans from the date of their discharge establishes "veterans' eligibility for health care, but it does not create an entitlement to any particular medical service," government lawyers said.

They said the law entitles veterans only to "medical care which the secretary (of Veterans Affairs) determines is needed, and only to the extent funds ... are available." ...