Thursday, April 26, 2012

New health care reform agenda

Excerpted from "Restarting Health Care Reform: A New Agenda," by Nina Owcharenko, Director, Center for Health Policy Studies, the Heritage Foundation: "Lawmakers should also set in place an alternative that will permanently fix the broken parts of the health care sector. Unlike Obamacare, Congress should pursue an approach to health care reform that preserves the doctor-patient relationship and cutting-edge innovation while controlling costs and expanding access to private health coverage.

In sharp contrast to a centralized, government-based structure, the alternative is based on a patient-centered, market-based model. This new vision for health care reform would focus on personal ownership. Unlike today’s flawed third-party payment system, consumers would be in charge of their health care dollars and decisions. Health plans and providers would be directly accountable to patients—not a government official, a managed care executive or an employer.

There are four key steps to moving toward patient-centered, market-based health care reform.
  1. Make tax policy fair and rational. Congress should replace the current tax treatment of health insurance with a credit that is individually based.
  2. Start health care entitlement reform. As a first step, Congress could easily allow individuals facing retirement to keep their private health insurance into retirement and receive a defined contribution from the Medicare program.
  3. Promote choice and competition through insurance market reforms. Congress should focus on removing market barriers to interstate purchase of health insurance, addressing access issues for the hard-to-insure and making pooling arrangements more effective.
  4. State-based reforms. State policymakers should begin by assessing their own health insurance challenges related to insurance markets and their Medicaid programs.

CMA Vice President for Government Relations Jonathan Imbody:
"My friend Nina Owcharenko outlines sensible innovations that promise the potential to begin to bend the curve of health care costs and shift decision-making back toward patients and physicians. Hopefully having learned its lessons from ramming through a massive health care law that only one party and less than half the country supported, Congress should come together to craft a pragmatic and measured approach to health care reform that doesn't involve taking over the world.

"Assuming the Court declares "Obamacare" unconstitutional, cooler heads in Congress can focus on those reforms most likely to garner enough bipartisan agreement for passage. Start by ramping up tracking and enforcement programs to cut Medicare fraud and waste. Provide compassionate, fiscally sustainable safety nets for the most needy, such as indigent patients and those caught in health care crises not covered by insurance. Tamp down costs by increasing competition and allowing patients to purchase insurance plans beyond state borders, as with car insurance. Stanch the hemorrhage of doctors from medicine by reasonably reforming malpractice lawsuits, slashing paperwork and bureaucratic meddling, and clarifying First Amendment conscience protections for health care professionals.

"The jacobinic health care revolution has failed. It is time now to reform health care democratically with careful, considerate compromise on the pragmatic principles that most Americans support."

CMDA Healthcare Reform Resource Pages

CMDA members in New England Journal of Medicine on conscience

Editor's note: When the original commentary below appeared in NEJM, we notified the Freedom2Care federal registry, the CMA-sponsored LinkedIn registry of members who want to keep updated on news and opportunities in federal public policy. Several members who responded to that request had their letters posted by NEJM; those letters are below the original commentary by Alta Charo.

CMDA members, staff raise awareness of human trafficking

Excerpted from [CMDA member] Dr. Bill and Laurie Bolthouse have been passionately pursuing health care and justice issues for the past few years in such diverse places as Macedonia, Uzbekistan, Zimbabwe and India. This recent foray into film is their attempt to leverage their impact in championing the cause of victims of child sex trafficking. The story of Trade of Innocents, set in the seedy brothels of Cambodia, is close to their hearts as Bill and Laurie’s paths have intertwined with a few of these precious girls rescued from sex slavery and the brave men and women who labor tirelessly to help them. Their three teenage daughters Meredith, Madison and Molly actively participated with them on the set in Bangkok, Thailand. They reside in Littleton and Breckenridge, Colorado.

The story: In the back streets of a tourist town in present-day Southeast Asia, we find a filthy cinder block room; a bed with soiled sheets; a little girl waits for the next man to use her. Alex, a human trafficking investigator, plays the role of her next customer as he negotiates with the pimp for the use of the child. Claire, Alex’s wife, is caught up in the flow of her new life in Southeast Asia and her role as a volunteer in an aftercare shelter for rescued girls. Claire and Alex both still are dealing with their grief of losing a child years earlier. As both of them struggle in their own way to overcome the pain of their past and realities of child exploitation where they now live and work, they find themselves being pulled together into the lives of local neighborhood girls whose freedom and dignity are threatened. Parallel story lines intertwine and unfold twists against the backdrop of the dangerous human trafficking world, in a story of struggle, life, hope and redemption in the Trade of Innocents.

CMA Vice President for Government Relations Jonathan Imbody: "I enjoyed the privilege of meeting with the Bolthouses during a two-day event that integrated a preview of their movie with a symposium on human trafficking. The symposium, held at Yale Law School, included an address by Lou CdeBaca, U.S. ambassador at large for anti-trafficking in persons, and a video greeting from Sec. of State Hillary Clinton. The Trade of Innocents movie is due out this Fall and will include CMDA among a resource list of organizations fighting human trafficking.
"CMA has worked with the U.S. Department of State, the Department of Homeland Security and the U.S. Department of Health and Human Services to develop and encourage efforts to educate health care professionals on how to recognize, report and treat victims of human trafficking. To that end, CMDA staff and members, led by Global Health Outreach director Dr. Don Thompson and CMDA member Dr. Jeff Barrows, have developed online curricula that carries AMA PRA Category 1 CreditTM and AGD PACE Credit.

"Data suggest that health care professionals can play a lifesaving role in identifying and reporting victims of human trafficking. Consider taking the time to begin our online course to equip yourself and others to save lives. And when Trade of Innocents comes to a theater near you this fall, take some friends and colleagues to see it.”

Christian Doctor's Digest interview with Dr. Bill and Laurie Bolthouse
Trade of Innocents Story
CMDA Human Trafficking Resource Pages
Human Trafficking Continuing Education Credits

Thursday, April 12, 2012

Making Products Based on Fetal Cells

Excerpt from "Pepsi Not Only Company Making Products Based on Fetal Cells,", by Steven Ertelt. March 6, 2012--Pepsi is coming under criticism from pro-life advocates because it has been contracting with a research firm that uses fetal cells from babies victimized by abortions to test and produce artificial flavor enhancers. The Obama administration is set to face more criticism because an agency has declared that Pepsi’s use of the company and its controversial flavor testing process constitutes “ordinary business.” In a decision delivered to the Security and Exchange Commission ruled that PepsiCo’s use of aborted fetal remains in their research and development agreement with Senomyx to produce flavor enhancers falls under “ordinary business operations.”

As pro-life blogger Susan Michelle notes, the full 36-page document submitted by PepsiCo attorneys in January 2012 to respond to a shareholder resolution from PepsiCo shareholders upset by Pepsi’s reliance on Senomyx shows other companies are problematic as well. “It’s tragic that this is true. Precedent exist; we’ve created pharmaceuticals and wrinkle cream from cells and tissue from aborted babies, so why wouldn’t we make that the product of flavor testing now? People love their food and spend lots of money every year on their snack foods. We are the market for this, and we buy this stuff,” the pro-life advocate continues.

“The precedent does exist because we have furthered the culture of death. When we allowed fetal cell research, we opened the door for this. While that law needs to be changed as soon as possible, what needs to happen immediately is that PepsiCo (which includes Frito-Lay) Nestle and Kraft need to display morality and ethics and pull out, regardless of the cost, from Senomyx,” she concludes. “We can’t feign shock because we’ve been doing this for years with medicine and skin creams, so this was bound to happen. And only the changing of hearts will reverse it. As long as we are a consumer-driven culture with an appetite for what pleases us, these companies have us where they want us, and we are a part of the profit from the shedding of innocent blood.” “The SEC decision is a result of its upholding the status quo, the current culture of death. We’ve allowed a society that couldn’t permit anything else. Now we have to change it,” Michelle said.
As recently as May, Pepsi ignored concerns and criticism from dozens of pro-life groups and tens of thousands of pro-life people who voiced their opposition to PepsiCo contracting with biotech company Senomyx even after it was found to be testing their food additives using fetal cells from abortions.

Mailee SmithStaff Counsel American United for Life Mailee Smith: "Recent news reports detailing Pepsi’s potential use of fetal cells for 'flavor testing' has left the American public asking many questions. Is this true? Pepsi says no, but pro-life watchdogs say yes. Pepsi claims that '[t]here are no stem cells, cell lines derived from embryos or fetuses, or fetal tissues in any PepsiCo products.' But that is not the same as saying the company does not use stem cells or aborted fetuses for any purposes.
"And it raises an additional question: Are other companies using fetal cells? LifeSiteNews has reported that Kraft, Cadbury and others also use aborted fetal cell lines.

"But there are some absolutes we can focus on as we sift through this information. First, biotechnologies are vastly outpacing regulation. Simply put, the law has not kept up with science.
"Second, we know that companies can experiment on the cells of aborted children in 45 states—meaning there is no limit to what Pepsi or Kraft or any private citizen can do in those states. While 19 states prohibit fetal experimentation to some degree, only five of those states prohibit experimentation on aborted fetuses at any stage of development. The remaining 14 states only prohibit experimentation if done on a viable aborted fetus or on a live fetus. In other words, 45 states do not prohibit experimentation on first trimester fetuses, when most abortions are performed.

"Ten years ago, the fight (which is still waging) was to prevent research on so-called 'leftover embryos,' allegedly conducted for the 'common good' of medicine. We have already slipped so far that today, companies are using cell lines not to seek cures for human disease or somehow improve medical treatments—no, companies are using cell lines to make our food taste better. The time is now for states to rise up and legislate fences around 'biotechnology.'"

CMDA Ethics Statement: Stem Cell Research

Fetal Pain-Based Abortion Ban

Excerpt from "Georgia Legislature OKs Fetal Pain-Based Abortion Ban, Atlanta Journal Constituion, by Kristina Torres and Christopher Quinn. March 29, 2012--Two of the most contentious issues of this year's General Assembly passed on the last day of this year's session, salvaged by Republican leaders who wanted to tout them as major victories this election year. New restrictions on late-term abortions in Georgia, which had appeared dead in the morning, and a bill that would cut unemployment benefits for Georgians, passed with just minutes remaining in the 2012 session. The work to get them passed highlighted a more-than-14-hour day, one full of compromises that dominated much of lawmakers' work.

The day's most intense dealmaking was on abortion, the passage of which sparked protests in both the House and Senate. Commonly referred to as a "fetal pain" bill, House Bill 954 was all but gutted Monday after a bipartisan coalition in the state Senate forced key changes. As originally written by its sponsor, state Rep. Doug McKillip, R-Athens, the proposal would have cut by about six weeks the time women in Georgia may have an elective abortion. The Senate's changes forced into the bill an exemption for "medically futile" pregnancies, giving doctors the option to perform an abortion past 20 weeks when a fetus has congenital or chromosomal defects. Although the House -- including McKillip and House Speaker David Ralston, R-Blue Ridge -- initially balked, they agreed Thursday to move forward with a compromise. It was to include a definition in the bill describing what "medically futile" means: Profound and "irremediable" anomalies that would be "incompatible with sustaining life after birth."

Commonly referred to as a "fetal pain" bill, House Bill 954 would tighten medical exemptions for terminating pregnancies and require any abortion performed after 20 weeks of pregnancy be done in a way to bring the fetus out alive. No exemption is made for rape or incest. The measure says that a fetus can feel pain at 20 weeks, therefore the state has an interest in protecting it. Supporters of the new Georgia bill said it would save lives and protect more fetuses. Opponents said the bill would legislate decisions that should be made by doctors and would put doctors at risk who work with difficult pregnancies. Doctors who are involved in abortions after 20 weeks that do not meet the bill's restrictions could be charged with a felony and face up to 10 years in prison.

Emidio Novembre, DOCMDA Member Emidio M. Novembre, DO Revival Pain Management: "I recently had the privilege of being asked by CMDA to testify at the Atlanta state Capital in support of this fetal pain bill. I am board certified in anesthesiology and fellowship trained in obstetric anesthesia and pain management. The bill was to protect fetuses from the pain endured during an abortion.

"The opposition consistently focused on the right of the woman and seemed to be uncaring about the fetus. The darkness at the hearing was as thick as I’ve ever been confronted with.

"The spiritual powers and principalities appeared to have completely deceived the pro-abortion advocates. This battle is being waged for our nation’s youth. I have entered into it, and I am willing to go forward. No one will accuse those battling abortion of being passive in this fight. Will you join the fight?

“'For we wrestle not against flesh and blood, but against principalities, against powers, against the rulers of the darkness of this world, against spiritual wickedness in high places’ (Ephesians 6:12, NKJV)."

CMDA Ethics Statement: Abortion
Testimony of Emidio M. Novebre, DO on Fetal Pain

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Action Item
If you are interested in testifing on behalf of CMDA regarding fetal plain please contact Margie Shealy.

Fewer Tests for Patients

Excerpt from "Doctor Panels Recommend Fewer Tests for Patients," New York Times, by Roni Caryn Rabin. April 4, 2012--In a move likely to alter treatment standards in hospitals and doctors’ offices nationwide, a group of nine medical specialty boards plans to recommend that doctors perform 45 common tests and procedures less often, and to urge patients to question these services if they are offered. Eight other specialty boards are preparing to follow suit with additional lists of procedures their members should perform far less often. The recommendations represent an unusually frank acknowledgment by physicians that many profitable tests and procedures are performed unnecessarily and may harm patients. By some estimates, unnecessary treatment constitutes one-third of medical spending in the United States.

“Overuse is one of the most serious crises in American medicine,” said Dr. Lawrence Smith, physician-in-chief at North Shore-LIJ Health System and dean of the Hofstra North Shore-LIJ School of Medicine, who was not involved in the initiative. “Many people have thought that the organizations most resistant to this idea would be the specialty organizations, so this is a very powerful message.” Many previous attempts to rein in unnecessary care have faltered, but guidance coming from respected physician groups is likely to exert more influence than directives from other quarters. But their change of heart also reflects recent changes in the healthcare marketplace. Insurers and other payers are seeking to shift more of their financial pain to providers like hospitals and physician practices, and efforts are being made to reduce financial incentives for doctors to run more tests. “Any information that can help inform medical decisions is good — the concern is when the information starts to be used not just to inform decisions, but by payers to limit decisions that a patient can make,” said Kathryn Nix, healthcare policy analyst for the Heritage Foundation, a conservative research group. “With healthcare reform, changes in Medicare and the advent of accountable care organizations, there has been a strong push for using this information to limit patients’ ability to make decisions themselves.”

“These all sound reasonable, but don’t forget that every person you’re looking after is unique,” said Dr. Eric Topol, chief academic officer of Scripps Health, a health system based in San Diego, adding that he worried that the group’s advice would make tailoring care to individual patients harder. “This kind of one-size-fits-all approach can be a real detriment to good care.” Many commended the specialty groups for their bold action, saying the initiative could alienate their own members, since doing fewer diagnostic tests and procedures can cut into a physician’s income under fee-for-service payment schemes that pay for each patient encounter separately. “It’s courageous that these societies are stepping up,” said Dr. John Santa, director of the health ratings center of Consumer Reports. “I am a primary care internist myself, and I’m anticipating running into some of my colleagues who will say, ‘Y’ know, John, we all know we’ve done EKGs that weren’t necessary and bone density tests that weren’t necessary, but, you know, that was a little bit of extra money for us.’”

J. Scott Ries, MDCampus & Community Ministries National Director J. Scott Ries, MD: "'Just because we can, doesn’t mean we should.' An often spoken phrase, but when considered in regard to medical tests and procedures, seemingly rarely followed. I do not recall the last time I heard a colleague deny the unsustainability of our current healthcare economics. Yet, when was the last time we put our own ordering patterns under the microscope?

"There exist three potential outcomes of the decision to order a test or a procedure:
1. It will clearly influence the treatment of the patient.
2. It may (or may not) influence recommended intervention for the patient.
3. There will likely be no change in course of treatment, regardless of its result.

"What factors might motivate our decision? Would we ever really consider ordering a test in the third category? Consider these influencers of our decision making:
•Fear of litigation
•Patient demands
•Profitability for the doctor, practice or hospital
•Confusion regarding the value or indication of the test or procedure itself

"An honest look at how some of our ordering patterns compare to the recommendations from the affiliated specialty partners of the ABIM-Foundation may prove insightful.

"As followers of Christ, maintaining a kingdom-oriented view of our practice is instrumental in becoming more like the Great Physician. 1 Thessalonians 5:22 reminds us, “...don’t be gullible. Check out everything, and keep only what’s good...” (MSG). To avoid even 'the appearance of evil' we must carefully guard our professionalism and integrity, even to the selection of tests we order. Others (beyond tort attorneys) are watching, including the students and residents we are influencing."

CMDA Ethics Statement: Healthcare Delivery
CMDA Ethics Statement: Principles of Christian Excellence in Medical & Dental Practice