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Sticker Shock Threatens To Stall Health Care Overhaul
"No one can figure out a politically acceptable way to pay for an overhaul of America"s health care system, and until someone does, the effort is stalled. Maybe indefinitely," McClatchy reports. Michael Tanner, a "health care analyst" at the Cato Institute, says "it"s quite feasible that the whole thing could crash and burn because of sticker shock." The Senate Finance Committee has postponed writing legislation until July. "Legislative committees plan hearings and bill-writing sessions next week, and will face two key cost-related obstacles: No one really knows any plan"s price tag, and few so far are willing to take the political risk of raising taxes to pay for it. Add to that growing public wariness: Polls show people are increasingly disturbed by record federal deficits. A Wall Street Journal/NBC News poll conducted June 12 to 15 found that 58 percent said that the president and Congress should focus most on keeping the deficit down, even if that means it will take longer for the economy to recover."
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Microbial Analysis, Micropatterning Methods Featured In Cold Spring Harbor Protocols
Microbial populations have traditionally been studied in carefully controlled, laboratory-grown cultures. New metagenomic approaches are being developed to study these organisms in environmental or medical samples. The July issue of Cold Spring Harbor Protocols presents a method developed by Holger Daims from the University of Vienna for quantifying populations of microorganisms in a variety of naturally occurring conditions such as plankton samples or biofilms. Use of Fluorescence In Situ Hybridization and the daime Image Analysis Program for the Cultivation-Independent Quantification of Microorganisms in Environmental and Medical Samples combines fluorescent in situ hybridization using rRNA-targeted probes with digital image analysis. The results show an organism"s "biovolume fraction" in a given sample; this indicates the share of biochemical reaction space occupied by the quantified population and can be more relevant ecologically than absolute cell numbers. The article is freely available on the website for Cold Spring Harbor Protocols.
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Renowned Surgeon Examines Our Most Significant Contributions To Surgery - From Crude Procedures To Precision Operations
As a result of the scientific advances and medical innovations made in the twentieth century, the United States today occupies an established and unchallenged leading role in the field of surgery. Renowned surgeon Seymour I. Schwartz, MD, gives a sweeping history of American surgical practice in "Gifted Hands: America"s Most Significant Contributions To Surgery" (Prometheus Books). He describes how surgery in the United States has advanced from the comparatively crude practices of pioneering physicians in the pre-Columbian and colonial eras to its current level of preeminence in scientific surgery today.
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Advances In Genomic Medicine Will Mean Massive Changes For The NHS It Is Now Time To Prepare For Them - Lords Science Committee

The House of Lords Science and Technology Committee has published a report on Genomic Medicine which argues that recent developments in genomic science stemming from the sequencing of the human genome represent a unique opportunity for real advances in medical care and that the Government and the NHS must take a range of steps to ensure that these advances are realised. The Committee says that the Government should now produce a new White Paper on genomic medicine - pointing out that the last White Paper on this issue was published in 2003 and dealt mainly with the diagnosis and management of rare single-gene disorders. The potential impact of "genomic medicine" has moved on significantly since then and now has implications for patient care across the NHS and a range of common, genetically complex diseases such as diabetes, heart disease and cancer. The report recommends that the new White Paper should include details on: * How the Department of Health will facilitate the translation of advances in genomic science into clinical practice, including the operational changes needed to bring genetic testing into mainstream clinical practice. * A roadmap for how such developments will be incorporated into the NHS. * Proposals for a programme of sustained long-term funding to support these measures. A range of genetic tests are already being used within the NHS to improve the diagnosis and treatment of a range of common illnesses. However, the Committee found several barriers to the translation of new tests from invention through to use within the NHS. To alleviate these problems, the Committee recommends that the National Institute for Health Research ring-fence funding through a Health Technology Assessment programme to fund research into the use of genomic tests within the NHS, and that the Office for Strategic Coordination of Health Research should be tasked with outlining a strategic vision to overcome the translational barriers identified. The report also recommends that the Government push for the re-classification of genetic tests within European law from "low" to "medium" risk to ensure that all tests are subject to pre-market review to prove their effectiveness before they are available for use either by the NHS or directly by consumers. The Committee looks specifically at the growing market for Direct to Consumer Tests (DCTs) and raises concerns about the effect of consumers receiving DCT results via the internet without proper medical advice to put those results in context. They also point out that because most companies that offer DCTs are based abroad the Advertising Standards Agency has no power to police bogus claims made by DCT providers for their products. To counter these problems the Committee supports the Human Genetics Commissions work to develop a voluntary code of practice for DCT providers. The code of practice should require firms to publish details of the effectiveness of the tests they offer. It should also include guidelines for the provision of appropriate pre- and post test counselling to help consumers interpret the results of DCTs. Genetic tests are placing increasing demands on doctors and nurses in mainstream specialties who are poorly equipped to use the tests effectively for diagnosis and treatment The Committee recognises that ensuring NHS staff have adequate training in genomic medicine will be vital. They recommend that training in using and interpreting genetic tests should be an integral part of training for healthcare workers. The Committee found significant inequalities in the provision of genetic services across the NHS, for investigation and management of both rare and common diseases, due to the lack of a national policy on commissioning of genetics services. Significant changes to the operational systems within the NHS are vital to ensure that an equitable and cost effective service is provided across the country including the need to consolidate laboratory services, introduce commissioning routes for new genetic tests, and increase efforts to change the way that genetic and patient health data is stored and used for diagnosis and for research. This will require the recruitment of bioinformaticians to facilitate the process, and the establishment of a new institute of biomedical informatics. The report recognises that there are privacy concerns about the retention and use of genetic data as well as apprehension about how the data may be used by, for example the insurance industry. To alleviate privacy concerns the Committee recommends that the Information Commissioner should publish a set of clear guidelines for researchers handling genetic data. The Committee suggests the Government should work with the Association of British Insurers to draw up a new agreement on the use of genetic tests results for insurance purposes beyond the current moratorium which runs out in 2014. They also recommend that beyond 2014 insurers should be prevented from asking for details of tests results carried out while the current moratorium was in force. Commenting Lord Patel, who chaired the Inquiry, said: "Genomic medicine will clearly have a huge impact on health provision and the NHS in particular over the next few years. It is an ever developing technology that presents both challenges and exciting opportunities for health care. "The Government must now take the lead on this issue and produce a new White Paper on genomic medicine. It has been six years since the last one and in this area times move on very quickly. It is time for a comprehensive statement from the Government on how genomic medicine will be incorporated into the NHS, including details of the extra training doctors and nurses will need in this area. "We have concerns about the growth of "at home" Direct to Consumer Tests. Without proper qualified interpretation results of genetic and genomic tests could cause people to worry unnecessarily and place new demands on NHS services. It is time firms offering these tests were required to provide counselling and guidance on interpreting the raw results they provide." Notes 1. The report Genomic Medicine is available from The Stationery Office, House of Lords Science and Technology Committee, 2nd Report of 2008/09, HL Paper 107. 2. The report will be available online shortly after publication at: http://www.parliament.uk/hlscience 3. Lord Patel will be discussing some of the key recommendations in the report following publication in a YouTube video which will be available at: http://www.youtube.com/ukparliament House of Lords


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