May 10, 2011
Hepatitis C infections rise among young
Even as the overall infection rate for hepatitis C is flat, more young adults in Massachusetts are contracting the virus, a new
state report shows. State epidemiologist Dr. Alfred DeMaria called it an epidemic affecting cities, suburbs, and small towns:
People between 15 and 24 are getting hooked on prescription opiates, moving onto intravenous drugs, and becoming infected
when they share needles and other paraphernalia.
The rate of infection among teenagers and young adults nearly doubled between 2002 and 2009, the state Department of Public
Health reported in a study published yesterday by the Centers for Disease Control and Prevention.
DeMaria, an author of the study, said he once expected hepatitis C to all but disappear after the death of baby boomers who
had acquired it through drug use decades ago, or transfusions given before the blood supply was screened for the virus. In
2002, he said, people ages 15 to 24 accounted for 413, or 5 percent, of newly reported cases of hepatitis C in the state. In 2009,
931 cases were reported in this age group — 11 percent. From 2007 to 2009, 72 percent of the young cases reported current or
past IV drug use.
DeMaria and other specialists said young users are less educated about how to avoid transmission by using clean needles and
not sharing items used to prepare drugs. Some of the increase could be a result of the state looking harder now, he said, but not
all of it.
Older people, who may have been infected with hepatitis C for decades without knowing it because symptoms, including liver
damage, are often slow to develop, still account for the majority of new diagnoses. But the teens and young adults are a new
wave of the disease, and because many of the infections are hidden, this may be only the start.
In Boston, the trend is somewhat less clear. The number of cases among 15- to 25-year-olds has fluctuated considerably since
2004, exceeding 100 in both 2007 and 2010, but totaling about half that in 2009. What is clear is that Charlestown and South
Boston are seeing high rates of the disease among young people, she said.
Dr. Arthur Kim, infectious disease specialist at Massachusetts General Hospital, said he has seen the increase over the years.
“We’re seeing a repeat of the epidemic that occurred in the ’70s and ’80s,’’ Kim said, but with one key difference. Young African-
Americans are less likely to inject drugs now. That shows in the infection rates. Seventy-eight percent of the young people
identified by race in the study were white, while 3 percent were black and 2 percent were Asian.
The state has just four needle exchange programs, and people under age 18 can’t buy clean needles at pharmacies, Kim said.
The study noted that the younger users are more likely to use drugs with people they trust, which means they may be less
careful about transmission. And reaching them through prevention efforts can be challenging because parents and schools are
reluctant to talk about drugs at an early age, he said.
The report raises the question of whether the hepatitis C trend could signal a similar rise in HIV infection rates among young
adults, though none has been detected through screening efforts. Some specialists said they are hoping that the availability of
new, more effective treatments for hepatitis C, including one developed by Cambridge-based Vertex Pharmaceuticals and
recently recommended for approval by a Food and Drug Administration panel, will help boost screening for the disease overall.
Visit the Boston Globe for the article. http://articles.boston.com/2011-05-06/news/29517335_1_young-adults-infection-young-
people
Hospital workers axed for snooping
Allina says it has fired 32 employees at two of its Minneapolis-area hospitals for privacy violations. After auditing its electronic
medical records, Allina found the patient care employees had accessed patient medical records without a legitimate medical
reason. Allina fired 28 employees at Unity Hospital in Fridley and four at Mercy Hospital in Coon Rapids, Allina spokesman
David Kanihan said. They were fired Thursday, the Minneapolis Star Tribune reported. The records accessed were related to a
mass drug overdose at a party that took place in March. Visit UPI for the article.
http://www.upi.com/Business_News/2011/05/07/Hospital-workers-axed-for-snooping/UPI-
76521304811591/print/#ixzz1LljWmG00
Kids' birth month seems to be linked to celiac disease
Celiac disease is more common among children born in the spring and summer months, according to a new study from the
Massachusetts General Hospital for Children. The findings suggest that the higher incidence of this autoimmune disease may
be related to a combination of seasonal and environmental factors.
Celiac disease is a digestive disorder triggered by consuming the protein gluten, which is primarily found in bread and other
foods containing wheat, barley or rye. It can damage the small intestine and make it difficult to absorb certain nutrients, causing
problems ranging from abdominal pain to nerve damage.
Examining data on 382 Massachusetts children diagnosed with celiac disease at between 11 months and 19 years of age,
researchers found that in the 15- to 19-year-old set, birth season appeared to make no difference. But among 317 children
younger than 15 years of age, 57 percent were born in the "light" season of March through August, compared with 43 percent
who were born in the "dark" season of September through February.
Even though the exact cause of celiac disease is unknown, potential triggers include the timing of infants' introduction to gluten,
and viral infections contracted during the first year of life. The study's findings suggest the season of a child's birth is another
potential risk factor for the disease. The researchers pointed out that infants are generally introduced to solid foods containing
gluten at around 6 months of age, which for spring and summer babies would coincide with cold and flu season.
Based on the findings, the study's lead researcher, Dr. Pornthep Tanpowpong, said that the age at which gluten is first offered
to some babies may need to be altered.
The study also noted that exposure to sunlight may also play a role in celiac disease, since vitamin D deficiency has been
associated with the disease. The study was presented Sunday in Chicago during Digestive Disease Week, an international
gathering sponsored by the American Gastroenterological Association and other organizations. (HealthDay) Visit US News &
World Report for the article. http://health.usnews.com/health-news/family-health/womens-health/articles/2011/05/08/kids-birth-
month-seems-to-be-linked-to-celiac-disease-study
Boston Scientific offers new CRT-D warranty program covering phrenic nerve stimulation
Boston Scientific Corporation announced that it is offering a new warranty program in the U.S. that covers its cardiac
resynchronization therapy defibrillator (CRT-D) devices and leads in the event of chronic phrenic nerve stimulation (PNS).
"Under the program, implanting centers in the U.S. can qualify for a full refund if they have to replace a Boston Scientific
COGNIS CRT-D device, attached to any Boston Scientific bipolar left ventricular (LV) lead, with a competitive device due to
unmanageable PNS within six months post-implant," said Hank Kucheman, Executive Vice President and Group President,
Cardiology, Rhythm and Vascular for Boston Scientific. "With this warranty program, we are firmly standing behind the
performance of our CRT-D devices and LV lead portfolio to ensure patients get the heart failure therapy they need without
complications related to phrenic nerve stimulation."
PNS is an occasional complication of CRT therapy due to close proximity of the phrenic nerve to the desired pacing location in
the left ventricle. It causes the diaphragm to contract, resulting in a "hiccup-like" sensation and patient discomfort. To avoid PNS
when it occurs, physicians attempt to reprogram the device to use a different pacing configuration. If this fails to correct the
issue, physicians must manually reposition the lead (insulated wire used to stimulate the heart) into a new location. If PNS
manifests after the implant procedure has been completed, lead repositioning would require a second surgery.
"This warranty is based on confidence in our CRT-D system's performance and physicians' ability to avoid PNS when using it,"
said Kenneth Stein, M.D., Chief Medical Officer, Cardiac Rhythm Management for Boston Scientific. "Physicians must also
consider the entire system when choosing which device to implant. Boston Scientific has the smallest and thinnest high-energy
devices on the market with excellent longevity and proven long-term lead reliability. Our clinical evidence also shows our
LATITUDE remote monitoring system helps physicians manage their heart failure patients."
Real-world performance data showed that current Boston Scientific bipolar LV leads have an acute dislodgement rate of less
than 1 percent within 30 days post-implant (0.90 percent based on latest Product Performance Report). St. Jude's quadripolar
lead had a dislodgement rate of 3.7 percent in a published study. For more information visit www.bostonscientific.com.
Tenet Healthcare rebuffs Community Health's
Hospital operator Tenet Healthcare Corp. Monday stated that it has decided to reject the $7.25 per share acquisition offer from
its competitor Community Health Systems, Inc. Further, Tenet's board has authorized to buy back up to $400 million of its
common shares.
Rejecting the offer, Tenet said it believes that the proposal grossly undervalues the company and is not in the best interests of
its shareholders. The company also noted that the proposal fails to offer value sufficient to warrant discussions with Community
Health.
It was on May 2 that Tenet confirmed the receipt of a revised proposal from Community Health to acquire all of the outstanding
shares of Tenet for $7.25 per share in cash. On November 12, 2010, Community Health had offered to acquire Tenet for $6 per
share in cash and stock. Later, on April 18, 2011, Community Health amended the bid, proposing to buy Tenet in all cash deal,
but retaining the offer price.
Tenet has sent a letter to Wayne Smith, chairman, president and CEO of Community Health, explaining the company's stand. In
the letter, Trevor Fetter, president and CEO of Tenet, said that Community Health's latest proposal does not reflect the
company's current financial position, 2011 outlook, and positive future growth prospects. Visit here for the article.
http://www.rttnews.com/ArticleView.aspx?Id=1618389
Antipsychotic drugs called hazardous for the elderly
Nearly one in seven elderly nursing home residents, nearly all of them with dementia, are given powerful atypical antipsychotic
drugs even though the medicines increase the risks of death and are not approved for such treatments, a government audit
found. More than half of the antipsychotics paid for by the federal Medicare program in the first half of 2007 were “erroneous,”
the audit found, costing the program $116 million for those six months.
“Government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek
solutions,” Daniel R. Levinson, inspector general of the Department of Health and Human Services, wrote in announcing the
audit results. Levinson noted that such drugs — which include Risperdal, Zyprexa, Seroquel, Abilify and Geodon — are
“potentially lethal” to many of the patients getting them and that some drug manufacturers illegally marketed their medicines for
these uses “putting profits before safety.”
The audit is an unusual assessment by the government of whether doctors are treating Medicare patients appropriately in
nursing homes. Levinson suggested that the government should collect information on the diagnoses given Medicare patients
so that the government can assess whether the drugs prescribed to them are appropriate.
While common in the private sector, such basic oversight is unheard of in the Medicare program and would almost certainly be
opposed by doctors’ groups and many in Congress who view government intrusions into the doctor-patient relationship as
inappropriate. In response to the audit, the Centers for Medicare and Medicaid Services said that some of the inappropriate use
of antipsychotics in elderly nursing home patients is a result of drug makers’ paying kickbacks to nursing homes to increase
prescriptions for the medicines.
Omnicare Inc., a pharmacy chain for nursing homes, paid $98 million in November 2009 to settle accusations that it received
kickbacks from Johnson & Johnson and other drug makers for antipsychotic prescriptions.
Medicare officials said that diagnosis information is not generally included with prescriptions so the government cannot assess
in real time whether prescription payments are appropriate.
While the FDA has warned doctors that using antipsychotic drugs in elderly patients with dementia increases their risks of
death, doctors continue the practice because they have few other good choices, said Dr. Daniel J. Carlat, editor in chief of The
Carlat Psychiatry Report, a medical education newsletter for psychiatrists.
The government auditors found that of the 2.1 million elderly patients in nursing homes during the first six months of 2007,
304,983 had at least one Medicare claim for an antipsychotic medicine. Nursing home residents received 20 percent of the 8.5
million claims for antipsychotic medicines for all Medicare beneficiaries at a cost of $309 million during those six months. The
auditors found that 83 percent of antipsychotic prescriptions for elderly nursing home residents were for uses not approved by
federal drug regulators, and 88 percent were to treat patients with dementia — for whom the drugs can be lethal.
“These results are alarming,” said Senator Charles E. Grassley, Republican of Iowa, who asked for the audit. “Medicare officials
need to pay attention.”
Federal rules require that any drugs that are paid for by the government be given only for uses that are approved either by the
government or one of three independent drug usage encyclopedias. Auditors found that 51 percent, or 726,000 of 1.4 million
claims, for antipsychotic medicines did not meet this criterion and were thus paid for by the government improperly.
Government rules also ban drugs that are used in excessive doses or duration, even if patients are found to have a condition for
which the drug is appropriate. Auditors found that 22 percent, or 317,971 of 1.4 million claims, for antipsychotic medicines failed
this standard. Visit the New York Times for the article.
http://www.nytimes.com/2011/05/10/health/policy/10drug.html?_r=1&ref=health
Androgen exposure may put the finger on ALS risk
A patient's risk of amyotrophic lateral sclerosis (ALS) may actually be foretold by palm reading -- as long as you're looking at the
right lines, researchers said. When measured from the defined crease at the base of the digits, ALS patients have a smaller
index-to-ring-finger ratio, according to Ammar Al-Chalabi, MD, of King's College London in England, and colleagues.
Longer ring fingers are a marker of higher prenatal exposure to testosterone, which has been associated with motor neuron
disease later in life, they reported online in the Journal of Neurology, Neurosurgery, and Psychiatry.
Studies have shown that in adults, low testosterone levels are associated with motor neuron degeneration. It's hypothesized
that in utero exposure to the hormone could diminish a patient's sensitivity to it later in life. One way to measure that exposure is
to look at the index-to-ring-finger ratio, which, according to established findings, is lower for patients who had greater
testosterone exposure in the womb.
Though the disease is more common in men (who generally have a higher exposure to testosterone in utero), the researchers
hypothesized that prenatal testosterone exposure, rather than male sex alone, is tied to ALS.
"This finding suggests that the reason [for developing ALS] is not something to do with maleness necessarily, but more to do
with the balance of hormones in the womb," Al-Chalabi said in an email. Al-Chalabi and colleagues wrote that the ratio says
nothing about adult circulating testosterone levels, "making it compatible with the observation that people with ALS have low
levels of free testosterone."
Al-Chalabi emphasized that the relationship shouldn't be used as a screening tool for ALS risk. "Everyone is exposed to male
and female hormones during their development, and those with a slightly more masculine mix are more likely to be male, sporty,
and to have relatively longer ring fingers," he wrote. "Hardly any of them will go on to develop ALS, so this is not a predictor of
ALS any more than it is of being male." Visit here for the article http://jnnp.bmj.com/content/82/6/635.full
Hospital chain misdiagnosed infections, probe says
A California hospital chain under investigation for allegations of overbilling the Medicare system has inaccurately diagnosed
patients with a blood infection known as septicemia, a complex and deadly condition that hospitals are paid a premium to treat,
a state investigation has found. California Department of Public Health inspectors examined records at four hospitals owned by
Prime Healthcare Services and found that 22 of 120 patients diagnosed with septicemia showed few symptoms of the disease.
At a San Bernardino County hospital, a patient was diagnosed with septicemia even though records showed "no sign of
infection," inspectors found. At a Los Angeles County hospital, inspectors said seven patients diagnosed with septicemia
showed signs of having urinary tract infections, a far less serious condition.
Medicare pays bonuses of several thousand dollars per case for treating elderly patients with septicemia, federal records show.
Prime Healthcare's chairman, Dr. Prem Reddy, testified in a 2005 trial that his hospitals were reimbursed about $9,000 for
treating a septicemia case - $6,000 more than a urinary tract infection.
Prime has disputed the state findings and insists that its coding and diagnoses were appropriate.
The state health department probe is the latest to focus on issues involving Medicare billings at Prime, a fast-growing hospital
chain based in Southern California.
As California Watch has reported, the U.S. Department of Health and Human Services is investigating Prime to determine
whether it overbilled the government for treating septicemia among the elderly. The probe began last year in response to a
computer study of medical records by the Service Employees International Union. The study said Prime hospitals reported
septicemia rates among Medicare patients that were more than triple the national average.
Two members of Congress said they feared Prime had overbilled Medicare by $18 million. The California attorney general's
office has also said it is investigating Prime.
The union represents many Prime workers, and the company criticized the study as biased and flawed - part of an effort to
"extort concessions" on labor contracts, a spokesman claimed.
In February, California Watch analyzed Prime's Medicare billing records for 2009 and found that the hospital chain had reported
high rates of malnutrition, another condition eligible for enhanced reimbursement from Medicare.
Two Prime hospitals, including one in Redding, also reported extremely high rates of a rare nutritional disorder, known as
kwashiorkor, among elderly patients. Kwashiorkor is widely associated with impoverished children in the Third World, experts
say.
The Department of Public Health's probe of septicemia at Prime began last fall, after the California Watch story appeared, and
focused on patient records from 2008 and 2009. The department reviews tend to point out problems and ask facilities to fix
them. Only in rare cases do they culminate in actions against a facility license.
State Sen. Ed Hernandez, D-West Covina (Los Angeles County), chairman of the Senate Health Committee, wrote a letter in
April to the Department of Public Health saying that working with the hospital to fix problems may be "inappropriate," given the
"the possibility of systemic fraud."
In a separate statement to California Watch, Hernandez said: "I am prepared to work with all relevant state agencies to ensure
this company is thoroughly investigated and no new licenses are granted to them while those investigations continue. The more
I find out about this case, the more questions I have." Hernandez also has called for an investigation of Prime in connection with
the kwashiorkor and malnutrition rates first noted by California Watch.
Prime has strongly disputed the health department findings, saying the staff that reviewed patient medical records and
submitted bills for treatment of sepsis acted appropriately. The company says it would never engage in "upcoding," a term for
exaggerating a patient's diagnosis to increase reimbursement from Medicare or insurance companies. The chain has said it has
an early intervention and treatment program for sepsis. Prime added that it uses a more comprehensive set of indicators for
septicemia than the state used in its surveys.
Chain vice president and general counsel Michael Sarrao wrote in an e-mail that the state reports are not "the final accounting
of this matter" and described them as "erroneous, misleading and possibly defamatory." Striking a more conciliatory note, Prime
also submitted "plans of correction" to the state, saying it will begin routine medical record reviews and deal with problems by
"counseling" coding staff or assigning physicians to peer review.
According to records, the state health department has said it will pass its findings to auditors and investigators at Medi-Cal, the
health insurance program for the needy that is conducting another review of Prime Healthcare.
The health department review noted the highest number of problems at San Dimas Community Hospital, a hospital in the San
Gabriel Valley area of Los Angeles County. Inspectors determined that seven patients with urinary infections and one with a
bone infection were documented as having sepsis. Overall, the inspectors found that in 17 of 29 cases - 59 percent - patients
were reported as having septicemia even though they didn't have bacteria in their blood or at least two other symptoms of the
illness, according to inspection reports. Visit the San Francisco Chronicle for the article. http://sfgate.com/cgi-
bin/article.cgi?f=/c/a/2011/05/08/MNC81JBSGL.DTL