Direct-to-consumer sales of genetic tests were rare until November 2007, when three companies began offering them. Since then, tests have been easily available on the Internet, allowing people to send a DNA sample — usually saliva — to companies such as California-based 23andMe and Navigenics and, for a few hundred dollars, get back information about their genetic ancestry and medical risks. [Footnote 11]
DTC vendors say the tests help curious people learn about themselves and that their analyses are based on the best current scientific understanding. Critics, however, contend the science of genetic testing isn't far enough along to yield meaningful results.
“Customers empowered with this information have made lifestyle changes aimed at reducing their risks of developing disease and have provided information to their doctors to aid in diagnosis and treatment. These actions have improved and even saved lives,” 23andMe general counsel Ashley C. Gould told a House oversight committee last July. [Footnote 12]
While saying she could not speak for the whole industry, Gould said her firm provides “extensive information to our customers so they understand that the data we provide can change as new scientific studies are completed.” [Footnote 13]
Purchasers of DNA health-risk profiles are mainly well-off, technically savvy people, so it's not clear how far one can generalize from their response to DTC testing, said David Kaufman, director of research and statistics at the Genetics & Public Policy Center, a research and survey group jointly sponsored by the Pew Charitable Trusts and Johns Hopkins University. Nevertheless, current customers' self-reported responses to test results suggest testing's potential in preventive health, he said. [Footnote 14]
Asked whether they'd made health-related lifestyle changes after DTC tests informed them they had medical risks, 34 percent of people surveyed by the center said they were more careful about what they ate, 14 percent said they exercised more and 16 percent had changed their medications or dietary supplements. “We don't give enough credit to people's abilities to decide what's useful to them,” said Kaufman. [Footnote 15]
But Congress' nonpartisan auditing and investigative arm, the Government Accountability Office (GAO), blasted current DTC tests in a report last July. After buying tests from four websites, GAO analysts created biographical profiles of several “fictitious consumers” of various ages, weights and lifestyle descriptions and submitted them along with DNA samples taken from only one woman and one man. Although the DNA came from just two people, the companies sent back a wide and bewildering variety of risk profiles and recommendations, the GAO said. [Footnote 16]
“Although there are numerous disclaimers indicating that the tests are not intended to diagnose disease, all 14 results predict that the fictitious consumers are at risk for developing” conditions ranging from osteoporosis to cancer, presumably based on lifestyle profiles, not DNA, said Gregory Kutz, GAO managing director for forensic audits and special investigations. “If the recommendations were truly based on genetic analysis,” then all the fictitious females “should have received the same recommendations because their DNA came from the same source. Instead, they received a variety of different recommendations, depending on their fictitious lifestyles.” [Footnote 17]
“Test results can be unreliable and difficult to interpret, and they are often offered to people with little or no genetic counseling or support,” said Christopher Hood, of the Nuffield Council on Bioethics in London. “People should be aware that other than prompting obvious healthy lifestyle choices such as taking more exercise, eating a balanced diet and reducing alcohol consumption, the tests are unlikely to inform them of any specific disease risks that can be significantly changed by their behavior,” said Hood, chairman of the council's Working Group on bioethics and Gladstone professor of government at All Souls College, University of Oxford. [Footnote 18]
“With only a few exceptions, what the genomics companies are doing right now is recreational genomics,” said David B. Goldstein, a professor of molecular genetics and microbiology at Duke University. [Footnote 19]
Having access to one's own sequenced genome, once that becomes feasible and affordable for everyone, won't add much to most people's understanding of their health risks, says Barbara Bernhardt, a genetic counselor and clinical professor of medicine at the Hospital of the University of Pennsylvania. “You're going to find every single difference in your genome from what may be considered normal. But you won't have a clue about what that means,” nor will anyone, including scientists, she says.
“Even highly educated people misinterpret test results,” says Kaufman of the Genetics and Public Policy Center. For example, told that a DTC test found a hypothetical woman having a risk of diabetes that was lower than the general population's risk, 7 percent of people, most of them fairly well-educated, erroneously concluded that the woman actually was at high risk of the disease.
“People were more likely to misinterpret a low-risk number” as predicting a high risk, Kaufman says. This might happen “because people are just looking for high-risk information,” he suggests.
Timothy Caulfield, a professor of law and public health at the University of Alberta, one of Canada's largest research institutions, said that in one study, a whopping 78 percent of people who said they are interested in being tested also said they “would ask their physician for assistance with interpreting the data. Further, 61 percent of respondents felt that physicians have a professional obligation to help with this interpretive process,” he said. [Footnote 20]
However, “the data is of only marginal health benefit,” according to most analyses, meaning that the costs and time used up in those physician visits would provide “little or no health benefit” to anyone, Caulfield said. Cash-strapped health-care systems can ill afford such luxuries, he said. [Footnote 21]
In addition, hopes by some that genetic testing will eventually hold down costs by dissuading doctors and patients from using medical treatments that gene tests show won't work for them are probably overly optimistic, genetics counselor Bernhardt speculates.
Diseases once thought to be single conditions are now known to have quite different genetic origins in different individuals. As a result, scientists already know that people with certain genetic profiles simply won't benefit from some therapies. And such findings will certainly proliferate, Bernhardt says. But even if testing definitively demonstrates that a patient won't benefit from a given therapy, physicians will most likely prescribe it anyway, since “no one will do nothing” for a sick patient, she says.
The Issues:
* Are effective therapies derived from gene science on the horizon?
* Is selling genetic tests directly to consumers a good idea?
* Should the government award patents for “naturally occurring” genes?
For more information on the CQ Researcher report on "Genes and Health" [subscription required] or purchase the PDF.
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Footnotes
[11] For background, see Jordan P. Lerner-Ellis, J. David Ellis and Robert Green, “Direct-to-consumer Genetic Testing: What's the Prognosis?” Council for Responsible Genetics website, www.councilforresponsiblegenetics.org.
[12] Testimony before the House Energy and Commerce Subcommittee on Oversight and Investigations, July 22, 2010, http://energycommerce.house.gov.
[13] Ibid.
[14] Quoted in “Personal Genomics Tests Prompt Lifestyle Changes,” New Scientist online, Nov. 5, 2010, www.newscientist.com.
[15] Quoted in ibid.
[16] Testimony before House Energy and Commerce Subcommittee, op. cit.
[17] Ibid.
[18] Quoted in Ben Richmond, “Direct to Consumer Genetics Testing Kits Aren't Worth Spit, According to British Study,” Medill Reports, Northwestern University Medill School of Journalism, Oct. 20, 2010, http://news.medill.northwestern.edu/chicago/news.aspx?id=170660.
[19] Quoted in Nicholas Wade, “Genes Show Limited Value in Predicting Diseases,” The New York Times, April 16, 2009, p. A1.
[20] Timothy Caulfield, “Direct-to-consumer Genetics and Health Policy: A Worst-Case Scenario,” The American Journal of Bioethics, June-July 2009, p. 48.
[21] Ibid.
Is selling genetic tests directly to consumers a good idea?
Health Care Law Struck Down
By Kenneth Jost
CQ Press Supreme Court Editor
President Obama has suffered the first legal blow to his health-care reform law with a ruling by a federal judge in Virginia striking down the act’s central provision requiring all Americans to have health insurance.
In a 42-page ruling released Monday (Dec. 13), U.S. District Court Judge Henry Hudson in Alexandria said that the individual health insurance mandate—also called the “minimum essential coverage provision”—went beyond Congress’s power to regulate interstate commerce.
“Neither the Supreme Court nor any federal circuit court of appeals has extended Commerce Clause powers to compel an individual to involuntarily enter the stream of commerce by purchasing a commodity in the private market,” Hudson wrote in Virginia ex rel Cuccinelli v. Sebelius. “In doing so, enactment of the Minimum Essential Coverage Provision exceeds the Commerce Clause powers vested in Congress under Article I [of the Constitution].”
Hudson left the other parts of the law intact, but Republican opponents of the ruling hailed the ruling and called on the Obama administration to join in asking for an expedited appeal to the Supreme Court. From the opposite side, supporters of the law said the ruling would undermine other provisions of the act imposing new requirements on health insurers and ultimately raise insurance rates across the board.
In a posting on the White House blog, presidential assistant Stephanie Cutter said the administration “disagrees” with what she called Hudson’s “narrow” ruling. She also predicted that the challenges would ultimately fail. “In the end,” Cutter wrote, the “Affordable Care Act will prevail and the American people will enjoy the benefits of reform.”
The ruling, in a suit by Virginia Attorney General Ken Cuccinelli, represented the Obama administration’s first setback in defending the health care law, formally called the Patient Protection and Affordable Care Act. Federal judges in Detroit and Lynchburg, Va., had earlier rejected similar challenges to the individual insurance mandate; a dozen other suits had been dismissed on technical legal grounds.
Hudson, a former Republican prosecutor appointed to the federal bench in 2002 by President George W. Bush, had clearly signaled his doubts about the individual insurance mandate in August by refusing to dismiss Cuccinelli’s suit. A separate suit brought by Florida and the National Federation of Independent Businesses has also survived a preliminary motion to dismiss. U.S. District Court Judge Roger Vinson, a Republican appointed to the bench by President Ronald Reagan in 1983, is scheduled to hear arguments on Thursday (Dec. 16) in that case, Florida v. U.S. Department of Health and Human Services.
Hudson’s ruling would normally be appealed to the intermediate level Fourth U.S. Circuit Court of Appeals. But Cuccinelli, a Republican elected as Virginia’s top law enforcement officer in November 2009, said he would seek to bypass the Fourth Circuit and move the appeal directly to the Supreme Court.
On Capitol Hill, Rep. Eric Cantor, a Virginia Republican slated to become House Majority Leader after the GOP gains control in January, called on the Obama administration to join in seeking an expedited high court ruling. He also vowed to press Republican efforts to pass what he called “a clean repeal of Obamacare” in the next Congress.
Supporters of the law denounced Hudson’s ruling. In a conference call with reporters, Neera Tanden, chief operating officer of the liberal Center for American Progress, said the decision could force health insurers to raise rates. “Without a minimum-coverage provision, rates will increase because people will wait until they’re sick to get insurance,” Tanden said.
Tim Jost (no relation), a health law expert at Washington and Lee University Law School in Lexington, Va., and a supporter of the law, said it was “very unlikely” that the Supreme Court would agree to the unusual procedure of hearing the appeal directly from a district court. He noted that under the law, the health insurance mandate is not scheduled to take effect until 2014.
Under a normal schedule, the high court would likely get the case sometime during the term that begins in October 2011. A ruling would then be likely in June 2012, in the midst of a presidential election year.
For background, see these CQ Researcher reports (subscription needed): Kenneth Jost, “States and Federalism,” Oct. 15, 2010; Marcia Clemmitt, “Health-Care Reform,” June 11, 2010.
Do chemicals in the environment cause breast cancer?
The following is an excerpt from this week's CQ Researcher issue on "Breast Cancer" by Barbara Mantel, April 2, 2010
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There is no single cause of breast cancer. 
Yet understanding the etiology of this complex disease is essential to understanding how to prevent it. While 5 to 10 percent of breast cancer cases are thought to be hereditary, the majority of women who develop the disease will never know why.
Scientists have identified certain risk factors, like early menstruation and late menopause, alcohol consumption and obesity, but “most of these risk factors account for very small increases or decreases in a woman's chances of developing breast cancer,” according to the National Breast Cancer Coalition. [Footnote 28]
Environmental chemicals may play a role, say some researchers, by damaging DNA, by mimicking hormones that signal tumor cells to grow or by altering mammary gland development early in life. They say the size of the dose may not be what matters most but how early in life and for how long the exposure occurs and to whom; some women may be more susceptible than others. “Breast cancer rates increased enormously over the decades since World War II at the same time that we have had increasing exposure to a wide variety of chemicals and radiation in the environment,” says Janet Gray, director of the program in science, technology and society at Vassar College in Poughkeepsie, N.Y., who wrote an extensive review of the research on breast cancer and the environment for the Breast Cancer Fund, an advocacy group in San Francisco, Calif.
But correlation does not prove a link. For that, scientists turn to animal and human studies. One team of researchers reviewed hundreds of animal studies and found that 216 chemicals have been shown to cause mammary gland tumors, mostly through DNA mutations. There could be many others, since only a small fraction of the more than 80,000 chemicals used in the United States today have been tested in animals for carcinogenic potential. [Footnote 29]
“The laboratory evidence is very strong that there are environmental chemicals that affect biological processes linked to breast cancer,” says Julia G. Brody, who participated in the review of chemicals and is the executive director of the Silent Spring Institute in Newton, Mass., which researches the environment and women's health. The chemicals include benzene, found in gasoline; polycyclic aromatic hydrocarbons, found in vehicle exhaust, air pollution, tobacco smoke and charred foods; methylene chloride, a common solvent in paint strippers and glues; and some pharmaceuticals, like furosemide, a diuretic, and griseofulvin, an anti-fungal. [Footnote 30]
Most of the 216 chemicals also caused tumors in multiple organs, not just mammary tissue, and in multiple species of animals. “These characteristics are generally believed to indicate likely carcinogenicity in humans,” Brody's team reported. [Footnote 31]
A growing number of animal studies also implicate endocrine-disrupting compounds (EDCs) — found in certain plastics, pesticides, flame retardants and personal care products — which mimic or block hormones. “There are literally hundreds of studies demonstrating that low doses of endocrine disruptors in early development have profound effects on mammary tissue, breast development and incidence of breast cancer, especially in a variety of rodent models,” says Gray. [Footnote 32]
But extrapolating from animal studies to the human experience is tricky. “We're on very thin ice inferring from animal models that there's a high probability that a chemical is a carcinogen in humans,” says David Hunter, a professor of epidemiology at Harvard University in Cambridge, Mass. “There is a relatively low correlation between exposures that cause cancer in animals and those exposures causing cancer in humans,” says Hunter. “And if there is a relationship, it's a different type of cancer in the human compared to the animal.”
The gold standard would be human studies, but there haven't been many, and most that have been done have not found a link. Perhaps that's because human studies have mostly measured levels of a single chemical in adult women, while the critical period of exposure might be puberty, or early childhood, or even in utero. In addition, it might be exposure to a mix of chemicals that is important.
But it is extremely difficult to study early exposure to multiple chemicals. Most people don't know what chemicals they are exposed to now, let alone decades ago. And when interviewing women with breast cancer, “How do you know the diagnosis itself isn't influencing their recall of events?” asks James Lacey, a cancer epidemiologist at City of Hope, a comprehensive cancer center in Duarte, Calif. “People want to put a narrative to their experiences,” he says. Researchers also may not be able to find an unexposed control group, since many chemicals are pervasive. And finally, chemicals may increase breast cancer risk only for women with certain genetic mutations.
Instead, some researchers have combed through state environmental data and medical records looking for reliable information. One group found blood samples taken from young women at the time they gave birth, measured their levels of the pesticide DDT, and then followed the women for two decades. Early exposure to DDT was associated with a fivefold increase in risk of developing breast cancer before age 50. [Footnote 33] DDT, though banned in 1972, continues to linger in the environment.
“That is an important study, and it provides the kind of evidence that is very difficult to get,” says Brody.
Four human studies show higher breast cancer risk from exposure to polychlorinated bipheyls (PCBs) in women with a gene mutation that affects how they metabolize these now banned chemicals that were once used in electrical equipment, but still linger.
But Hunter cautions that no single epidemiological study is definitive. “We only accept something as likely to be causal if the majority of studies point in the same direction,” he says. Brody also calls the number of human studies sparse and says there are “huge knowledge gaps.”
Experts say more chemicals must be tested — both in the lab and in animals and in forward-looking human studies — not dependent on memory. For instance, the federal National Children's Study will examine the effects of environmental influences on the health and development of 100,000 children in the United States, following them from before birth until age 21. [Footnote 34]
“However, that doesn't help us right now,” says Gray. That's why she and Brody both advocate relying on the animal data to propel action in the short term. “I don't think most families want to take unnecessary risks with their daughters,” says Brody. A progressive policy, she says, would acknowledge that we know enough now to start reducing those exposures.
For Michael Thun, emeritus vice president of epidemiology and surveillance at the American Cancer Society, it's not so clear. “The precautionary principle says that if you have some evidence you should take action — you don't need conclusive evidence — but the question that remains unresolved is where do you draw the line?” says Thun.
Brody says the U.S. should look to Europe and Canada for a model of how to implement the precautionary principle. These countries have developed systematic programs for assessing the health consequences of synthetic chemicals — both old and new — as a prerequisite for use. [Footnote 35]
- Is mammography oversold?
- Should “stage zero” cancer be watched and not treated?
- Do chemicals in the environment cause breast cancer?
Footnotes:
[28] “Environmental Risk Factors for Breast Cancer,” National Breast Cancer Coalition, September 2006, p. 2.
[29] Ruthann A. Rudel, et al., “Chemicals Causing Mammary Gland Tumors in Animals Signal New Directions for Epidemiology, Chemical Testing, and Risk Assessment for Breast Cancer Prevention,” Environmental Factors in Breast Cancer, supplement to Cancer, June 15, 2007, pp. 2635–2636.
[30] Julia Green Brody and Ruthann A. Rudel, “Environmental Pollutants and Breast Cancer: The Evidence from Animal and Human Studies,” Breast Diseases: A Year Book Quarterly, Vol. 19, No. 1, 2008, p. 17.
[31] Rudel, et al., op. cit.
[32] Julia G. Brody, “Everyday Exposures and Breast Cancer,” Reviews on Environmental Health, Vol. 25, No. 1, 2010, p. 3.
[33] Janet Gray, ed., “State of the Evidence: The Connection Between Breast Cancer and the Environment,” Breast Cancer Fund, 2008, p. 9.
[34] “What is the National Children's Study?”
[35] Brody, op. cit., p. 4.
Health-Care Reform
Is universal coverage too expensive?
By Marcia Clemmitt, August 28, 2009
For the first time in 15 years, health-care reform has moved to the top of Washington's agenda.
A new Democratic president and Democratic majorities in the House and Senate have declared two major goals: increase coverage to near-universal levels and stop the huge, annual cost increases that are gradually putting health care out of reach for small businesses and low-income families. Most proposals would subsidize insurance for low-income Americans and create new, government-regulated insurance markets for those without employer-provided coverage. One controversial scheme would create a publicly run insurance plan and require individuals to buy coverage. Congressional Republicans and some Democrats argue, however, that the plan would be too expensive and would allow government to meddle too much in health care. And at angry town hall meetings in August, some even charged, incorrectly, that the arrangement would establish “death panels” that would deny treatment to elderly and disabled patients.
The Issues:
* Could a single-payer health-care system work for America?
* Should reform include a publicly run health insurance plan?
* Would universal coverage be too expensive?
To view the entire report, login to CQ Researcher Online [subscription required], or purchase the CQ Researcher PDF
Obesity and Health Costs
By Tom Colin, CQ Researcher Managing Editor
July 29, 2009
It occurs to me that when you’ve been in the news biz as long as I have (don’t ask, and I won’t tell) there is one phrase in French that’s indispensable because it sums up so much of what we do: “Plus ça change, plus c’est la même chose” – “The more things change, the more they stay the same.”
Take the just-released report on the link between obesity and soaring health-care costs. Among its mind-blowing findings:
*Americans who are 30 or more pounds over healthy weight cost the country an estimated $147 billion in weight-related medical bills in 2008;Indeed, as CQ Researcher health-care specialist Marcia Clemmitt reported last year in “Heart Health” (Sept. 12, 2008):
*Obesity accounts for 9.1% of all medical spending, up from 6.5% in 1998;
*Overall, an obese patient has $4,871 in medical bills a year compared with $3,442 for a patient at a healthy weight.
*About 34% of adults—more than 72 million Americans – were obese in 2006.
With obesity rates rising steeply, waves of high-cost heart-disease patients will drive health-system costs sky-high over the next few decades, according to David Herrington, a professor of internal medicine at the Wake Forest University School of Medicine in Winston-Salem, NC. High costs of caring for the first wave, made up of baby boomers, will begin hitting the system in the next few years. Among boomers, the number of heart-disease patients is "astronomically large," said Herrington.Which brings us back to “Plus ça change”….., because that’s pretty much what we have reported in several other previous CQ Researcher reports, including:
The second wave will hit around 2030, as baby boomers' children, to date the most obese generation the United States has seen, begins aging into heart disease and other obesity-related chronic ills. At that point, "the lid is going to blow off vascular diseases, and it could bankrupt society," according to William Boden, a professor of medicine and public health at the State University of New York at Buffalo.
“Rising Health Costs” (Marcia Clemmitt), April 7, 2006; and “Obesity Epidemic” (Alan Greenblatt), Jan. 31, 2003.
We’ll have the latest on rising health costs soon, in Marcia's forthcoming report on “Health Care Reform,” August 28.
Tom Colin
Managing Editor
From the CQ Researcher Archives: "Sickness Insurance", July 9 1934
Below are excerpts from the July 9, 1934 issue of CQ Researcher on "Sickness Insurance and Group Hospitalization"
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New Plans for Meeting the Burdens of Sickness
Appointment by President Roosevelt on June 29. 1934, of a committee to formulate plans for a comprehensive system of social insurance, including insurance against sickness, has enhanced the likelihood that such protection will be made available to the people of the United States at the next regular sessions of Congress and the state legislatures, scheduled to meet in January, 1935.
The problem of providing against sickness and accident, always a difficult one for persons of small means, has been rendered more acute by the long-continued depression. Wide interest in group hospitalization plans and advance provision for medical services through fixed periodic payments has been stimulated meanwhile by the reports of the Committee on the Costs of Medical Care.
Present tendencies in the direction of group hospitalization and sickness or health insurance have disclosed sharp differences of opinion on these subjects in the ranks of the medical profession. The American Medical Association, the most representative body of American physicians, maintains its traditional attitude of hostility to group practice and health insurance, insisting that the present relationship between doctor and patient must not be disturbed. The American College of Surgeons, on the other hand, has recently assumed leadership in the movement for health insurance, recognizing that there are important groups in the population for whom adequate medical services are not now available.
Roosevelt on Need for Comprehensive Social Insurance
The importance of the problems raised by the high costs of medical care and the maldistribution of medical facilities were recognized by President Roosevelt while serving as governor of New York. “Because large groups of the population seem unable to provide themselves with adequate medical services,” he wrote in 1932, “the problem was of major importance five years ago.” Its importance had been vastly increased, he said, by the change in the economic situation since 1929.
In a special message to Congress. June 8, 1934, the President announced his conviction that a comprehensive system of social insurance was needed to provide security for the people of the United States. Fear and worry based on unknown danger contributed, he said, to social unrest and economic demoralization. It was the plain duty of the federal government under the Constitution to promote the general welfare by providing for that security upon which welfare depends. The great task of furthering the security of the citizen and his family through social insurance might well be undertaken next winter. This was not an untried experiment, for lessons of experience were available from states, from industries, and from many nations of the civilized world.
I believe there should be a maximum of cooperation between states and the federal government [Roosevelt continued]. I believe that the funds necessary to provide this insurance should be raised by contribution rather than by an increase in general taxation, Above all, I am convinced that social insurance should be national in scope, although the several states should meet at least a large portion of the cost of management, leaving to the federal government the responsibility of investing, maintaining and safeguarding the funds constituting the necessary insurance reserves.In a radio speech on June 28, the President again asserted that the agencies of government should help provide “sound and adequate protection against the vicissitudes of modern life—in other words, social insurance.” He took the initial step the following day by creating the President's Committee on Economic Security to collect and coordinate information and formulate a program under which state and local governments might cooperate under federal leadership in solving the problem of insecurity.
The White House statement announcing appointment of the committee said that facts would he gathered and analyzed with regard to unemployment compensation, old age pensions, workman's compensation, health insurance, mothers' pensions, maternity benefits, and insurance against the special hazards of self-employment in small business and agriculture. Hearings will be held to obtain the views of labor, business, agricultural, social welfare, governmental, and other interests. “It is expected,” the White House statement concluded, “that the compilation of existing information, supplemented by newly-gathered facts, buttressed by national opinion revealed by the hearings, and summed under a final analysis, will constitute the most comprehensive treatment of the problem of economic and social well-being ever presented to the people.”
Opposition of American Medical Association to Insurance
A report submitted to the house of delegates by the Association's Bureau of Medical Economics asserted that “existing systems of insurance have failed to solve the problem of medical care for the people and have brought a great many evils along with some benefits.” Evidence was cited to indicate that the huge sums necessary for insurance might be expended in other forms of health care with much greater effect.
It is shown by documented evidence [the report declared] that insurance has nowhere reduced morbidity, that no actuarial basis has ever been set up that has not been proved defective, and that the vast sums required for insurance and the dominance of such systems in the political and social life of a country tends to focus attention on insurance to the exclusion of other forms of effort and therefore indicates that it is not the most effective method of meeting the problems of medical care for the mass of the people.The Bureau cited a large number of recent writers to show that there was a widespread movement in insurance countries to substitute for sickness insurance some form of compulsory saving with payment of an immediate sum for medical services and the return of a portion of the unused savings for insurance needs. Fishbein has asserted that, after carefully scanning examples of socialized medicine in 23 European countries, he has found that “not one of them had been established as a success.”
In his recent volume on social insurance, I. M. Rubiuow expresses amazement that the medical profession is “so ignorant of the nature of health insurance.” Physicians could easily ascertain, Rub now asserts, that
1. Compulsory health insurance is not tied up with any specific plan for organization of medical aid.
2. That among all the various plans for providing medical aid under a compulsory health insurance system, the method of salaried full-time service—so hateful to the American tradition—is the least popular.
3. That medical organization under health insurance is almost the direct opposite to “state medicine,” and
4. That a system of free “state medical service” is an alternative that will eventually be forced upon the United States, if the working masses are not given the opportunity to pay for their medical needs collectively through the insurance method.
The only present alternatives for low-income groups, Rub now declares, are to go without necessary medical aid, or to receive it as an act of charity from a benevolent, profession. Both of these he believes to be unacceptable to the American people.
To view the entire report, login to CQ Researcher Online [subscription required]
Court: Big Tobacco 'Lied' on Health Issues
A federal appeals court in Washington, D.C., has ruled that the tobacco industry engaged in a decades-long campaign of deception regarding the health hazards of smoking. But the three-judge panel rejected most of the remedial steps sought by the government in a massive civil suit and instead ordered tobacco companies merely to issue statements correcting previous denials that smoking was addictive and dangerous to health. (Hat Tip: SCOTUSBlog).
In its unsigned, 92-page decision, the court on May 22 refused to order the industry to conduct nationwide campaigns to discourage youth smoking or to offset past marketing tactics. The court also reaffirmed an earlier ruling in the case that it would not order the industry to disgorge profits made from the deceptive advertising and public relations campaign.
What do you think? Should tobacco companies be held responsible for concealing health hazards of smoking? Should they do more to discourage smoking by young people? For background, see Mary H. Cooper, “Tobacco Industry,” CQ Researcher, Dec. 10, 2004.
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Recurrences of Flu in History from the CQ Researcher Archive
The following is an excerpt from the CQ Researcher Archives report on "Influenza Control", September 24, 1976. In the fall of 1976, the federal government sponsored a National Influenza Immunization Program that at the time was the most ambitious such effort in history. It was the first time a nation's government attempted to vaccinate virtually an entire population against a potential influenza epidemic.
Influenza apparently has plagued humankind throughout history, A flu-like epidemic swept through the Athenian army in 412 B.C., and Hippocrates described another epidemic in the same century that was probably influenza. The name influenza was coined by two Italian historians, Domenico and Pietro Buoninsegni, in 1580. They believed that fevers, sore throats, soreness and nausea were attributable to un influenza—an influence—of the stars. The word influenza was introduced to the English language in the mid-1700s.
For many years influenza was thought to be passed along by the winds. It was not until the late 19th century that this idea was dispelled. In 1892 Richard Pfeiffer identified the influenza bacillus, a tiny organism of varied forms that lives on certain substances in blood. For a time, this bacillus was thought to be the causative agent of influenza. But that notion was proved wrong during the period of intensive research and experimentation that followed the worst outbreak of influenza in world history, in 1918.
Devastating Influenza Pandemic of 1918–19
The great influenza pandemic that swept the world in 1918–19 may have been the most virulent outbreak of disease in history, at least in terms of the swiftness of its devastation. It killed more than 20 million persons around the world, including some 550,-000 in the United States—all within two years. [1] “Mathematically, had the epidemic continued its rate of acceleration, humanity would have been eradicated in a matter of months,” Joseph E. Persico wrote in American Heritage. [2] The pandemic killed about one out of every 100 people living in the world at that time. Influenza deaths outnumbered World War I fatalities by more than two to one.
The disease was known as the “Spanish flu” or the “Spanish lady” in the United States because, although waves of it swept many European countries during the final year of World War I, only in neutral, uncensored Spain did the newspapers report the full extent of the epidemic. No one knows for sure where the flu originated. Some scientists believe it may have started independently in Europe and Asia, or that Chinese workers carried it to Europe. Others say the best evidence points to the United States. At Ft. Riley, Kan., in March 1918, hundreds of soldiers came down with flu after a severe dust storm had whipped up clouds of dirt and smoke from burning piles of manure. Many of the soliders later sailed for France, and the French and British armies soon were hit by influenza outbreaks. Crowded military camps, unsanitary wartime conditions and constant troop movements contributed to the spread of the disease.
The German army was soon stricken, as were inhabitants of such faraway places as India, Japan, Chile, Greenland, Alaska and Africa. Among the world leaders who fell ill were British Prime Minister David Lloyd George, King George V, French Premier Georges Clemenceau, German Premier Prince Max of Baden, Kaiser Wilhelm II, Gen. John J. Pershing and Navy Assistant Secretary Franklin D. Roosevelt. Roosevelt nearly died, and Clemenceau lost a son to the flu. Densely populated cities naturally were centers of contagion, but people in remote farmhouses, lumber camps and sheepherders' cabins also were afflicted.
There were three “waves” of the pandemic in the United States: it appeared in the spring of 1918, peaked in the early fall, and reappeared in the spring of 1919. The disease completely disrupted everyday life throughout the nation. Doctors were virtually helpless in treating the illness, and were forced to fall back on the most rudimentary public-health measures. In Washington, D.C., schools, theaters and bars were closed, public gatherings were prohibited, and federal employees went on staggered work shifts. In Boston, the stock exchange was open only half a day, sports events were canceled, and “churchless” Sundays were declared. In New York City, huge signs warned that public coughing or sneezing without a handkerchief was unlawful and punishable by fines or jail sentences. San Francisco was one of many cities that required people to wear face masks in public. Around the country hospitals overflowed, health agencies ran short of supplies and personnel, and coffins became scarce.
Efforts to Develop a Vaccine Against Flu
The influenza struck abruptly, without warning. One minute a person would feel fine and the next minute he or she would be weak and helpless. Headache, chills, fever, sore throat, and leg or back pains were among the early symptoms. Severe coughing and gasping for breath followed, with accompanying symptoms of swollen ankles, bloody urine and eye-muscle paralysis in some people. The lungs filled with a dense fluid, and showed signs of hemorrhaging, abscessing and swelling; sometimes they collapsed. Since the capillaries could not carry oxygen to the bloodstream, the actual cause of death was asphyxiation. Some patients succumbed to pneumonia after being weakened by the flu. But those who did not die were usually up and around within a week. Strangely, the disease hit the young and strong harder than the old or weak.
For the medical profession, the 1918–19 pandemic was a frustrating and sobering experience. That generation of physicians had developed the germ theory of disease and had found vaccines or other means of preventing typhoid fever, diphtheria, tetanus, meningitis, tuberculosis, malaria and yellow fever. But influenza was unaffected by known medications. No one knew what caused it, how it traveled or why it killed people. Various theories attributed the disease to chemical warfare gases, cosmic rays, coal dust, atmospheric stagnation, cats, dogs, fleas and dirty dishwater.
In September 1918, at the National Swine Breeders' show in Cedar Rapids, Iowa, a prophetic discovery was made—but few people realized it at the time. Many hogs at the show had been stricken by a debilitating disease, and Dr. J. S. Koen, a hog cholera inspector from the Bureau of Animal Husbandry, noted a similarity to human influenza. In his report to Washington, Koen called the sickness “hog flu,” but it was years before researchers found a connection between the human and animal illnesses.
The American virologist Richard E. Shope, who studied swine flu extensively, was the first to demonstrate, in 1931, that it was caused by a virus in conjunction with influenza bacteria. In 1933 influenza virus, type A, first was isolated by three British scientists, and in 1936 one of them, Patrick Laidlaw, suggested that swine flu was the cause of the 1918–19 pandemic. Shope supported Laidlaw's contention, and demonstrated that swine flu can survive in a latent form in hog worm parasites and can erupt suddenly for various reasons. During the 1930s, several scientists found that influenza viruses could be transmitted from humans to animals, and that animals infected with the virus developed an immunity to the disease. This discovery led to the development of flu vaccines.
In 1943, a U.S. Army commission on influenza conducted experiments with influenza virus vaccines grown on chick embryos in eggs. A test group of 6,250 vaccinated men experienced only one-fourth as much illness from type A influenza as a similar group of unvaccinated men. In 1945 the entire U.S. Army was vaccinated, and during a type B influenza epidemic that winter only 1 per cent of all the soldiers fell ill, compared to 10–13 per cent of the unvaccinated population.
Outbreaks of the Disease in Recent Years
The most severe influenza outbreak in recent years was the Asian flu of 1957–58. There were 45 million cases of Asian flu in the United States during the fall of 1957 alone, according to HEW estimates, and 70,000 persons died. From its point of origin in central China in February 1957, the Asian flu spread quickly to Hong Kong, Taiwan, Singapore and other nearby countries. By summer there were reports of influenza in Europe, the Middle East and the United States.
The West Coast was hit first in this country, followed by the South and then the East. In the fall the epidemic spread to the central and northern states, reaching its peak in late October. A second wave peaked in February 1958, but the number of cases was far fewer by then. Intensive efforts were made to prepare for the epidemic, through large-scale production of vaccines and nationwide cooperation of many agencies. A considerable amount of vaccine was available just before the fall outbreak and its usage is believed to have prevented much illness and death.
A decade later, there was a pandemic of the so-called Hong Kong flu, which started in that city in July 1968. It spread to the Far East, India and Australia by the early fall, and then to the United States. There were major outbreaks nationwide in the fall and winter of 1968–69, starting in Puerto Rico and Alaska in late September. California reported the first outbreak in the continental United States in late October, and large numbers of cases appeared in the eastern states in mid-November. By Christmas, the Hong Kong flu epidemic had touched all 50 states. The disease spread so swiftly that vaccination efforts were largely ineffectual. About 50 million cases were reported, 33,000 persons died, and the estimated cost to the nation was $3.8-billion in medical bills, sick leave and related costs.
[1] The Plague of Justinian, which began in 542 A.D., may have claimed 100 million lives, but it lasted for 50 years. The bubonic plague, or Black Death, of the 14th century, killed more than 60 million over a period of several years.
[2] “The Great Swine Flu Epidemic of 1918,” American Heritage, June 1976, p. 84.
To view the entire report, login to CQ Researcher plus Archives [subscription required]. The 1976 article is not currently available for individual sale, but you may be interested in a related report from 2006 on "Avian Flu"
Overview of the New Report on Heart Health
The sudden death of 58-year-old “Meet the Press” host Tim Russert in June from a massive heart attack shocked millions of middle-aged Americans.
Diagnosed with high cholesterol and high blood pressure, the gregarious NBC Washington bureau chief had been taking cholesterol and blood-pressure medications and aspirin and was told to diet and exercise, says Roger S. Blumenthal, an associate professor of medicine at the Johns Hopkins University Hospital in Baltimore.
“He exercised, but, like many other patients, he was not able to motivate himself” to diet, and “he knew that he had a tendency to overeat and to gorge when he was stressed,” says Blumenthal.
The American diet – built all too often on a shaky, fast-food foundation – leaves most of us with arteries coated with fatty plaques, especially once middle age approaches. Some of those plaques – medical science doesn’t yet know which ones – have a tendency to break away from the blood-vessel wall. Then blood cells called platelets can stick to the dislodged plaque, forming a blood clot that can trigger a heart attack.
Russert had just returned to work after a family trip to Italy when he suffered such a plaque rupture, possibly triggered by stress and lack of sleep, along with another potentially fatal complication – a heart arrhythmia. He died before he could be taken to a hospital. Although his office had a publicly accessible AED – automated external defibrillator – his colleagues waited for an ambulance crew to arrive rather than trying to shock his heart back into rhythm.
“One in every six heart attacks has sudden death as its first, last and only symptom,” says William B. Kannel, a Boston University professor of medicine and public health. And among heart-attack fatalities, nearly half are sudden-death events, he adds.
Overall, about 40 percent of both women and men die of a heart-related ailment, says Blumenthal. “Most of us face it after the age of 60.” On the plus side, he notes, the death rate is declining.
In 1999, the American Heart Association (AHA) declared a goal of reducing deaths from cardiovascular illnesses by 25 percent by 2010, “and we’re there already,” says AHA President-elect Clyde Yancy, medical director of Baylor University Medical School’s Heart and Vascular Institute in Houston, Texas. In January, data from the U.S. Centers for Disease Control and Prevention (CDC) showed coronary heart-disease death rates down by 25.8 percent and stroke deaths down 24.4 percent since 1999.
In fact, it’s “fairly likely that in the next 10 to 15 years cancer will supplant [cardiovascular disease] as the leading cause of death,” says Peter W. Groeneveld, an assistant professor of medicine at the University of Pennsylvania in Philadelphia.
Nonetheless, sedentary lifestyles and a diet heavy in saturated fats and processed carbohydrates have created several generations of young Americans vulnerable to cardiovascular disease. As a result, the downward trend in cardiovascular disease rates is expected to reverse itself in the coming decades.
“In a nation in optimal health,” adults would reach a stable health status around age 20, and then their health status “would stay relatively flat until almost the time they die,” says David Herrington, a professor of internal medicine at the Wake Forest University School of Medicine in Winston-Salem, N.C. “You’d have a very, very long period of being mobile, high-functioning and able to take care of yourself.”
But in American society, he explains, many people experience a gradual decline in health status beginning in their 50s – usually related to cardiovascular conditions, which can cause disability for 10-30 years. Due largely to unhealthy lifestyles, “We already have several generations on this trajectory” who will require “lots of care provided by friends and family, nurses, home-health workers and hospitals, which is an incredible drain on society,” he says.
William Boden, a professor of medicine and public health at the State University of New York’s University at Buffalo, agrees. “In 2008, we’re looking at the tip of the iceberg” on heart disease as a widespread illness, he says. In the next few years, two large waves of patients with cardiovascular disease will sweep through the system, beginning with the nation’s 76 million aging baby boomers – born between 1946 and 1964.
“Because of demographics, the sheer numbers [of cardiovascular diseases] are up,” says Herrington, even though the percentage of people who get the disease has declined. “The number of people who have them is astronomically large.”
The second wave of cardiovascular disease will hit between 2030 and 2050, triggered by the obesity epidemic now plaguing the nation. Two-thirds of Americans are overweight, and a growing number of adolescents are being diagnosed with Type 2 diabetes – both markers for subsequent cardiovascular disease, Boden says. “The lid is going to blow off vascular diseases, and it could bankrupt society.”
Michael A. Blazing, an associate professor of medicine at Duke University, in Durham, N.C., blames the rise in cardiovascular disease in part on the failure of the health-care and insurance industries to focus on healthier lifestyles. Such low-cost initiatives have often been ignored while medical research produced techniques to prolong lives after people have suffered a first stroke or heart attack, he explains.
“We continue to move forward in reducing risk of a second heart attack,” Blazing says. “Today 65-year-olds come in with a heart attack, and they’re golfing a week later.” But cardiovascular illnesses are long-building diseases with well-known risk factors, many of them controllable, he continues. “And the cost of providing the care only after the disease has manifested itself is becoming more and more astronomical.”
Meanwhile, nutrition counseling and other health-education efforts haven’t been reimbursed by public or private insurers, he points out, but physicians “get paid wonderfully” for opening a blocked artery.
In addition, there’s plenty of high-tech waste in the system, says Blumenthal, such as requests for sophisticated diagnostic tests that may not reveal much of significance. “Physicians shouldn’t be reimbursed for giving someone a nuclear stress test every July,” he says, because it not only costs more but also exposes patients to more radiation than traditional stress testing. State-of-the-art procedures like nuclear stress tests, which record the heart’s electrical activity, “take up a bigger and bigger part of the Medicare budget” without providing a clear return, he says.
Other physicians defend Americans’ love affair with high-tech.
“We’ve been telling patients not to eat cheeseburgers for 50 years, and they still don’t believe us,” says Andrew Rosenson, a radiologist in Oak Forest, Ill., outside of Chicago. But when patients actually see the plaque in their arteries, via a high-tech scan, “I’ve had 50-year-old CEOs sitting in my office crying,” pledging to follow the preventive regimens their doctors have long recommended in vain.
Currently, Medicare is experimenting with risk-factor reduction programs with its age-65-and-up enrollees, but such programs should be expanded to people who are 60 or younger, says Kenneth Thorpe, a professor of health policy and management at the Emory University School of Public Health in Atlanta. However, insurance companies and employers who provide health coverage for younger people see no financial benefit in offering preventive services for illnesses that, for most people, won’t become really costly until patients are old enough for Medicare, he says.
Beneficial dietary change would see people switching from McDonald’s fast-food to sweet potatoes and broccoli, says John A. McDougall, an internist in Santa Rosa, Calif., and advocate of a stringent, low-fat vegetarian diet as the only successful preventive strategy. But “there’s no support in our society for this kind of change,” he says. Rather, advertising unceasingly preaches that high-calorie food is good and that medicines are what control disease.
For proof that the health-care system ignores unhealthy lifestyles, one need only note that “in the intensive-care unit you get the same diet served to you that brought you there in the first place,” McDougall says.
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New Report: Heart Health
By Marcia Clemmitt, September 12, 2008
Is America ready for the coming cardiac crisis?
“Meet the Press” moderator Tim Russert’s fatal heart attack in June tragically reminded middle-aged Americans that cardiovascular disease is the nation’s leading cause of death. One in every six heart attacks has sudden death as its first, last and only symptom. Overall, about 40 percent of both women and men die of a heart-related ailment. On the plus side, U.S. cardiovascular-disease deaths have dropped dramatically in recent years. But public health officials warn that the downward trend is about to reverse itself as two large waves of cardiovascular disease wash over the U.S. health-care system in the next several decades – one caused by the aging of the nation’s 76 million baby boomers and the other by Americans’ sedentary lifestyles and poor diet. “The lid is going to blow off vascular diseases, and it could bankrupt society,” according to one cardiovascular expert.
* Is the burden of cardiovascular disease lessening?
* Can Americans make the lifestyle changes needed to eliminate cardiovascular disease?
* Do we rely too much on high-tech medicine to combat cardiovascular disease?
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