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The Impact of the 2010 Elections on U.S. Healthcare Reform

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Election Week – November 2010

This Week’s Health Industry News


The Republicans gained control of the House of Representatives in Tuesday’s election, and, as expected, attention shifts from the campaign trail to what the G.O.P. can do in practical terms to try to unravel pieces of the newly enacted health care overhaul.

Republicans in the House are expected to try to choke off funding for measures they opposed and restore it where their campaigns promised, like in the Medicare Advantage program for older Americans. The Times’s David Herszenhorn pointed out in an article on Monday that the Republican Speaker-in-waiting, John Boehner, of Ohio, promises to defund or replace the health legislation, a feat considered unlikely if Democrats retain control of the Senate. And any House actions to block funding or new regulations will probably lead to a showdown with the Obama administration.

With Republicans taking over the chairs of key committees in the House, too, we can expect a parade of oversight and investigative hearings challenging what the G.O.P. likes to call “Obamacare.” Joe Barton, Republican of Texas, is in a particular position of power if he takes the gavel from Henry Waxman, Democrat of California, in the House Energy and Commerce Committee. Mr. Waxman is a leading liberal voice. Mr. Barton is laying plans to grill the health and human services secretary Kathleen Sebelius and the Medicare chief Donald Berwick, according to Kaiser Health News.

While the Senate is expected to remain in Democratic hands, one of the results to follow on Tuesday night for public sentiment on health care was the Wisconsin race between the incumbent, Senator Russ Feingold and Republican challenger Ron Johnson. Senator Feingold, unlike some Democrats, did not distance himself from the health care overhaul. Rather, he ran television ads highlighting changes to insurance laws for pre-existing medical conditions. Mr. Johnson, a businessman, who held narrow leads in polls, said he ran for the Senate specifically to repeal the law.

Governorship races also foretell major changes in the nitty-gritty of implementing the health care law or not. States hold the power to review insurance rates and start setting up insurance exchanges for use after 2014.

Three states — – Arizona, Colorado and Oklahoma –  voted directly Tuesday on proposed constitutional amendments to overturn the health law’s provision on tax penalties to enforce individual mandates for nearly universal insurance.

The Harvard School of Public Health is sponsoring a Web-cast on Friday afternoon with experts assessing the impact of the election on the health care overhaul. The program features Douglas Holtz-Eakin, president of the American Action Forum and a former adviser to Senator John McCain’s presidential campaign, David Cutler, a Harvard professor and former senior health care adviser to the Barack Obama’s presidential campaign, and Robert J. Blendon, executive director of the Harvard Opinion Research Program.

In business news in the week ahead, dozens of medical drug, device and insurance carriers are rolling out their third-quarter earnings statements. Pfizer, the world’s biggest pharmaceutical company, reported on its profits and plans before the market opened Tuesday.

The Food and Drug Administration heard from two advisory committees this week: Tuesday from a joint meeting of panels on nerve system drugs and drug safety, reviewing intravenous anti-seizure medicines, with Pfizer products in the spotlight, and Wednesday from the gastrointestinal drug advisory committee considering label changes for some anti-inflammatory drugs like AstraZeneca’s Vimovo, which say they lower the risk of gastric ulcers.

Amino acids have extended mouse life by 12% Could you be next?, October/November 2010, by Aaron Saenz  —  Researchers in Italy may have struck upon a health supplement that could extend life. Enzo Nisoli and colleagues developed a cocktail of amino acids and gave it to mice via their water supply. Those mice that received the supplement had a longer median lifespan – 869 days compared to 774 days in the control group, an impressive 12% increase. As recently reported in the journal Cell Metabolism, the mice were all middle aged when testing began, and those given amino acids showed increased energy, muscle coordination, and stamina. Essentially the cocktail helped the middle aged mice stay more youthful. Nisoli believes that the antiaging effects of the amino acids were due to increased production of mitochondria, and lower incidence of damage caused by reactive oxygen species (ROS), associated with free radicals. The amino acids used in the cocktail (leusine, isoleusine, and valine) are known as branched-chain amino acids (BCAA) and are already found in many widely used health supplements! With further research it may be possible to understand if increasing BCAA levels in humans could extend our healthy youthful years as well as it does in mice.

Extending the life of mice is one of the most common metrics for evaluating longevity treatments. The Methuselah Foundation (Dr. Aubrey de Grey) uses mice as the basis for deciding the winners of its MPrize, an award to encourage research in lifespans. As we discussed previously, the leaders in the MPrize have impressive recordsStephen Spindler got median lifespan of mice to reach 1356 days! That’s considerably better than recent Italian work, but I’m still more impressed with Nisoli. Why? Spindler, and many others, use calorie restriction to promote longevity. I don’t think humans can really use that technique. Eating very little while not being malnourished is hard, and frankly not very enjoyable. Nisoli and his colleagues used a cocktail of commonly available amino acids that almost anyone could take as a health supplement. BCAAs are really cheap too.

BCAAs seem to increase longevity by affecting the production of mitochondria.

But before you go off to the vitamin store and stock up on amino acids, we should discuss the limitations of this experiment. First and foremost, the work is in mice. Yes, mice are one of the most common test animals for longevity, and yes, the same BCAA cocktail also worked with yeast cells (another common test organism), but none of that means that humans are guaranteed to benefit. Second, the mice used were all males, and as we’ve seen with previous work in longevity, some techniques simply do not translate from one sex to another. Third, only 30 mice were used in the BCAA test group (30 in the control as well). That’s simply not a very big sample (though Spindler only used 6 to set his record). According to The Telegraph, Nisoli is calling for larger scale experiments, but few institutions seem willing to sponsor research into health supplements and there’s not much profit to be made since BCAAs are so widely available and relatively cheap. Finally, we should point out that while the Italian experiment showed a 12% increase in median lifespan, the range of lifespans didn’t improve nearly as much. Maximum longevity for the BCAA mice was 1043 days compared to 979 days in the control group – a more modest 6.5% increase. If we look at the top 10% of mice in each group, the BCAA mice only improved 4.5% (981 compared to 938). In other words, while the amino acid treatments helped the mice live longer as a group, they didn’t produce any super old mice. To apply it to humans: it would be like more people reaching 80, or even 90, but still no one would live to 125.

Some of the most useful information out of this experiment dealt with understanding how BCAAs could improve the health and youthful vigor of those in middle age. The amino acids increased the production of mitochondria, the energy suppliers of the cells, but only in cardiac and skeletal muscle tissues. Fat tissue and the liver were unaffected. That’s probably a really good thing as we don’t want to unbalance those systems. BCAAs seem to increase SIRT1 activity – the protein linked to the benefits of resveratrol; which in turn is the substance in red wine associated with longevity. BCAAs, probably through mitochondrial regulation, seem to negate ROS which cause oxide damage – another important factor in helping people live longer and healthier lives.

Results from the research. Wild type (WT), i.e. normal, mice lived 12% longer with BCAA supplements. Genetically altered mice with disrupted NO regulation enzymes (eNOS) did not benefit as much from BCAA – further evidence of the link to mitochondria.

The experiment spent considerable energy exploring the role of endothelial nitric oxide synthase (eNOS), an enzyme that regulates nitric oxide (NO) in the blood. In previous work, Nisoli has found that decreased NO leads to increases in mitochondria. In genetically altered mice who had their NO regulation disrupted, the benefits of BCAA were much smaller. This suggests that, as Nisoli theorized, the mitochondria really are the cornerstone of increased longevity and energy, and that BCAA works through mitochondria regulation.

That information may have far reaching effects in other longevity studies. In fact, it’s kind of amazing how the results of different experiments are already finding complementary answers. SIRT1 (and other sirtuins) seem to be a key element and are affected by BCAA production. Scientists discovered a gene related to production of mTOR protein and rapamycin that could be removed to make them live 20% longer – and mTOR is also part of the mechanism used by BCAAs interacting with mitochondria. Russia’s recent ‘cure for aging’ relies on antioxidants, and BCAAs seem to fight ROS damage. While each study in lifespans only produces moderate success, together they are revealing a more complete understanding of how our cell chemistry could be altered to fight aging.

I try not to get too excited about longevity discoveries that are still being tested on animals as it’s simply too soon to know how they’ll pan out with humans. Yet I’m very hopeful about the work from Nisoli and his colleagues. It would be relatively easy for us to increase our BCAA intake. Many people already use these amino acids as supplements after weight lifting workouts. Not only that, but the benefits shown in mice – increased energy, better coordination, more youthful stamina – are what we’d all like to enjoy when we reach middle age. Of all the prospective ways to moderately increase lifespan, BCAAs seem to be the easiest to employ – no genetic modifications, no drinking tons of red wine. I really hope that Nisoli or other researchers will receive the funding they need to further explore the benefits of amino acids. If the tests had larger sample sets, and were repeated across several labs, I’d start taking BCAAs today.

*UPDATE 10/15/10: At the request of readers (via email and the first comment below) I have been asked to share the proportions of the BCAA supplement given to the mice in the experiment listed above. Before I share this information, I would like to make it very clear that I am in no way promoting the use of these supplements, nor do I verify that they are safe to take, nor do I, in anyway, suggest that they will positively affect your lifespan. I am not a doctor, nor a biologist. I am excited about the potential of this work, but that’s not an endorsement to take any particular supplement.

But science demands we share information, so here we go.

Nisoli bases his BCAA enriched mixture (BCAA-em) on earlier work on mouse muscle in 2005. Guiseppe D’Antona was a researcher for that experiment as well as the lead author for Nisoli’s recent work. The amino acids seem to have been taken from a commercial supplement from Professional Dietetics in Milan called BigOne

For both experiments, mice were given 1.5mg/g of body weight in their water each day. The ratio for amino acids can be seen in the table below (taken directly from Pellegrino et al European Journal of Applied Physiology 2005). The Nisoli paper discussed in the article above doesn’t specify whether they used the BigOne supplement or reproduced its contents.

Taken from Pellegrino et al Eur. J. of App. Physio. 2005

[image credits: Rama via WikiCommons, D’antona et al Cell Metabolism 2010]

[sources: D’Antona et al Cell Metabolism 2010,]

The New York Times, November 4, 2010, By GARDINER HARRIS

ATLANTA — Federal vaccine advisers recommended on Wednesday that 16-year-olds be given a booster dose of a vaccine against meningococcal meningitis and that people ages 11 to 64 get a booster to protect against whooping cough, diphtheria and tetanus.

The reason for the meningitis recommendation is that two popular vaccines against the disease do not seem to work as well as hoped. Instead of providing 10 years of protection, they may work for only five years or less.

That is not long enough to protect teenagers and young adults through the riskiest years because the vaccine is usually given at 11 or 12 years of age. The hope is that a booster dose at 16 would yield protection through the first few years of college, when outbreaks occur most often.

Members of the Advisory Committee on Immunization Practices debated whether to recommend that the first dose simply be delayed by three or four years or to add a second dose. The vaccine is about $100 a dose, and the disease is rare. So adding a second dose ensures that every death averted would be expensive. Federal officials estimated that while the current strategy prevents 9 deaths each year, delaying the first dose would prevent 14 deaths and adding a second dose would prevent 24.

Since the federal government pays for about half of all vaccines, the additional cost would be partly borne by taxpayers. The committee voted 6 to 5 to support a booster, but for the recommendation to take effect, the Department of Health and Human Services would need to endorse it, which generally happens but not always.

Dr. Janet Englund, a committee member from Seattle Children’s Hospital, said that delaying the vaccine by three or four years would result in fewer teenagers being vaccinated. A smaller share of 16-year-olds are vaccinated compared with preteenagers, she noted. And because teenagers may drop out of high school, she said, “by moving the age up, I very strongly fear we’re going to be missing at-risk youths.”

Dr. James Turner, a liaison representative to the committee from the American College Health Association, said that if the vaccines were truly so ineffective after five years, more meningitis cases would be popping up on college campuses. But he said a recent survey of 207 schools found just 11 cases, and fewer than half of those cases would have been prevented by vaccination because of differences in strains of the disease.

“If there is waning immunity, we’re not seeing any emerging disease yet,” he said. “So I don’t know that there’s a lot of urgency today in deciding on a booster.”

Meningococcal meningitis is a horrifying disease. It strikes so quickly that often only a day passes between the first signs of illness and the death of the child. Lori Buher of Mount Vernon, Wash., told the committee about how her 6-foot-4, 14-year-old son, Carl, was playing football one day and was being airlifted, near death, to Seattle Children’s Hospital the next. His heart stopped three times during the flight.

Carl survived but lost both legs below the knee, as well as three fingers and the use of his knuckles. He underwent 11 skin graft operations. She urged a booster shot, she said, because vaccination at age 11 would have saved Carl from his illness. His illness struck in 2003, before the current vaccines were approved.

“I can’t tell you what it would have meant if we’d been able to vaccinate him at 11,” Ms. Buher said.

Separately, the committee discussed a growing epidemic in California of whooping cough, also known as pertussis. The state so far this year has had 6,257 cases, the most since 1960. Ten infants have died in California this year, and cases have risen nationally as well.

One way to prevent infant deaths is to vaccinate family members. The committee voted to recommend a booster shot of a vaccine against diphtheria, tetanus and pertussis to those between ages 11 and 64, and to those over 65 if they come in close contact with infants. The committee said uncertainty about whether someone had recently received a combined tetanus and diphtheria vaccine should not rule out getting the combined vaccine that also protects against pertussis.

The New York Times, November 4, 2010, By NICHOLAS WADE

Researchers have made significant progress in understanding the biology of pancreatic tumors, suggesting that there may be ways of identifying the usually fatal cancer at a much earlier and more treatable stage.

A principal finding is that pancreatic tumors are not aggressive cancers. To the contrary, they grow slowly, taking an average of 21 years to become fatal. This creates an opportunity for detecting and removing the cancers at an early stage. At present they are diagnosed far too late, when a patient has on average only two more years to live and the cancer has already spread from the pancreas to other tissues.

The new advances, reported online Wednesday in Nature, have been made by two cooperating groups, one led by Shinichi Yachida and Christine Iacobuzio-Donahue at the Johns Hopkins Medical Institutions in Baltimore, and the other by Peter Campbell and Andrew Futreal at the Sanger Institute near Cambridge, England. Both teams used a new method for decoding DNA very rapidly. This means that instead of studying one gene at a time, researchers can now afford to look across the whole genome, tracking all the mutations that occur in cancer cells.

The Johns Hopkins team was able to identify a long series of mutations that had accumulated in the original tumors of seven patients, as well as in the secondary cancers that had spread from the pancreas to the liver, lung and peritoneum, the membrane that lines the abdominal cavity.

The mutations were then arranged in a family tree.

Since the rate at which DNA-level mutations clock up is well known, the researchers could date the development of the patients’ pancreatic tumors from the length of the branches in the tumor’s family tree, said Bert Vogelstein, a leading cancer researcher and member of the Johns Hopkins team.

It turns out that at least 10 years elapse between the first cancerous cell and the emergence within the tumor of the first cell with the ability to spread to other tissues, a process known as metastasis. At least five more years are required for this cell to develop metastatic ability.

Both the Johns Hopkins team and the Sanger group are now looking for specific DNA changes that might help diagnose pancreatic tumors. A leading candidate is a gene called KRAS (pronounced kay-rass), which is involved in transmitting messages inside a cell. “Almost all of the pancreatic cancers have mutations in KRAS, so that’s an ideal situation from a screening point of view,” Dr. Vogelstein said.

Scientists at the Sanger Institute have analyzed the same tumors as the Johns Hopkins group with a view to reconstructing the biological history of pancreatic tumors. They find that after the initial damage, possibly in the KRAS signaling gene, the natural controls on cell division are lost. “That unleashes a maelstrom of genetic instability,” Dr. Campbell said. The cell divides so many times that it uses up its telomeres, the mechanism at the tip of every chromosome that forces a cell to self-destruct if it divides too many times. A few cells evidently dodge this mechanism and learn how to survive in the tumor environment. These survivors find that it is now in their interest to stabilize their genome and switch on the genes that rebuild the telomeres.

The stabilized cancer cells now start to spread but must develop a further set of mutations that help them adapt to the specialized environment of the tumor’s target tissues.

“That is in some ways ominous for the treatment of cancer, because all the metastasized tumors are slightly different and would need different treatments,” Dr. Campbell said.

There is some chance of picking up the KRAS mutation in stool, which is hard to do at present. “But the techniques are getting better all the time,” Dr. Campbell said.

Stuart Bradford

The New York Times, November 4, 2010, by Tara Parker-Pope  —  Veterinarians around the country are reporting a strange phenomenon: spayed dogs and cats, even some puppies and kittens, are suddenly becoming hormonal.

In female pets, the symptoms resemble heat: swollen genitals, bloody discharge and behavioral problems. Male animals are showing up with swollen breast tissue and hair loss. Standard treatments and even repeated operations have had no effect.

Now vets have identified the culprit. The pets were all owned by women who used hormone creams on their hands, arms and legs to counter symptoms of menopause. Animals who licked or cuddled their owners, or rubbed up against their legs, were being inadvertently exposed to doses of hormone drugs.

These anecdotal reports, about 20 of which were first collected by the Veterinary Information Network, a news service for veterinarians, suggest that many women are not taking proper precautions when using topical hormone products — putting not only pets but also family members at risk for hormone exposure.

“The dogs are licking and rubbing the treated area and absorbing the drug, which is putting them back into heat,” said Dr. Terry Clekis, a veterinarian in Bradenton, Fla. Dr. Clekis has seen about five cases of pet exposure to menopause creams, including a dog that appeared to go into heat about six months after being spayed.

Dr. Clekis feared he had left remnants of ovarian tissue behind after the spaying. So he repeated it, but found nothing. It was his wife, chatting with the pet owner, who discovered she was using a hormone cream. Once the owner took precautions against exposing her pet, the symptoms disappeared.

The Food and Drug Administration issued a warning in the summer after eight children exposed to the estrogen spray Evamist showed signs of premature puberty like nipple swelling and enlarged breasts. The agency also received two reports of dogs exposed to Evamist, and last year it issued another warning after eight children were exposed to topical testosterone.

Use of topical estrogen, in the form of creams, sprays and gels, has surged since a major government study linked oral menopause drugs with a higher risk of heart attacks and cancer.

Last year, doctors wrote 440,000 prescriptions for brand-name topical estrogen products alone, nearly triple the 2006 figure, according to IMS Health, a drug information service. And those numbers do not capture the estimated one million women using compounded hormone creams, which are custom-mixed by pharmacists and have been widely promoted as an alternative to commercial menopause drugs — even though the F.D.A. has said these so-called bio-identical hormones are no safer than hormones from drug companies. (The compounds’ popularity surged after the former sitcom star Suzanne Somers wrote two books claiming they delivered many health benefits.)

Dr. Cynthia A. Stuenkel, an endocrinologist at the University of California, San Diego, and a former president of the North American Menopause Society, said the society was surveying its members to collect case reports of inadvertent hormone exposure to pets or children. The problem, she added, is that the doctors who prescribe the drugs typically treat older women, but the doctors who see the problems are pediatricians and veterinarians.

“We need to connect the dots between these groups so pediatricians and vets think of it early before subjecting these children and animals to extensive testing,” she said. But some vets say women aren’t forthcoming about the use of hormone drugs because it simply doesn’t occur to them that it might be related to a pet’s problem.

Dr. Walter R. Threlfall, a veterinarian who specializes in reproductive health, had a case involving a small lap dog that was experiencing a regular bloody discharge. During three different visits he asked the owner if the dog could have been exposed to an estrogen product, and she answered no each time before finally acknowledging she had been using an estrogen cream on her arm.

“The dog licks it off every night,” she told Dr. Threlfall, who said in an interview, “She spent lots of money on that dog, and I could have solved it the first time by telling her to get the dog off the estrogen cream.”

Dr. Richard Fried, owner of the Lincoln Square Veterinary Hospital in Manhattan, said he recently saw two cats that seemed to go back into heat after spaying by a different vet. Tests in one cat showed high blood levels of estrogen, but before he could spay it again, the cats’ breeder suggested that the culprit might be the owner’s hormone treatment.

“We are always warning pet owners to be careful about their medications,” Dr. Fried said. “But this is a much more insidious kind of problem that most people don’t think about.”

Dr. Stuenkel says women should be counseled about safe use of the drugs.

After using a topical hormone cream, they should thoroughly wash their hands before handling food, children or pets. Products should dry completely before the user comes into contact with people or animals, and women may want to consider changing the area where they apply the cream or covering it with long sleeves or slacks.

“We’ve learned a lot from these puppy stories,” Dr. Stuenkel said. “People are letting dogs lick their hands after using the cream or holding them when the cream is fresh on them. We need to teach women to be sensible about how they use these products.”

The New York Times, November 4, 2010, by David Kocieniewski  —  Denture wearers will get a tax break on the cost of adhesives to keep their false teeth in place. So will acne sufferers who buy pimple creams.

People whose children have severe allergies might even be allowed the break for replacing grass with artificial turf since it could be considered a medical expense.

But nursing mothers will not be allowed to use their tax-sheltered health care accounts to pay for breast pumps and other supplies.

That is because the Internal Revenue Service has ruled that breast-feeding does not have enough health benefits to qualify as a form of medical care.

With all the changes the health care overhaul will bring in the coming years, it nonetheless will leave those regulations intact when new rules for flexible spending accounts go into effect in January. Those allow millions of Americans to set aside part of their pretax earnings to pay for unreimbursed medical expenses.

While breast-feeding supplies weren’t allowed under the old regulations either, one major goal of the health care overhaul was to control medical costs by encouraging preventive procedures like immunizations and screenings.

Despite a growing body of research indicating that the antibodies passed from mother to child in breast milk could reduce disease among infants — including one recent study that found it could prevent the premature death of 900 babies a year — the I.R.S. has denied a request from the American Academy of Pediatrics to reclassify breast-feeding costs as a medical care expense.

In some respects, the biggest roadblock for mothers’ groups and advocates of breast-feeding is one of their central arguments: nursing a child is beneficial because it is natural.

I.R.S. officials say they consider breast milk a food that can promote good health, the same way that eating citrus fruit can prevent scurvy. But because the I.R.S. code considers nutrition a necessity rather than a medical condition, the agency’s analysts view the cost of breast pumps, bottles and pads as no more deserving of a tax break than an orange juicer.

Many mothers’ groups and medical experts say that breast milk provides nutrition and natural supplements that prevent disease, and would like to see its use expanded. Hospital accreditation groups have been prodding maternity wards to encourage parents to feed only breast milk until a child is 6 months old.

The new health law does include one breakthrough for nursing mothers, a mandate that they be permitted unpaid breaks to use breast pumps. Spurned by tax authorities, breast-feeding advocates say they will return to Congress to get a tax break, too.

“There’s been a lot of progress in the past few years making the public, the medical establishment and even Congress recognize the health benefits of breast-feeding,” said Melissa Bonghi, a lactation consultant in Bainbridge Island, Wash. “But I guess the I.R.S. will just take a little longer.”

With the new regulations set to take effect in two months, millions of American workers now in the open enrollment period at their employers have to determine whether, and how much, to set aside for 2011. More than 20 million people have flexible spending or other tax-exempt health care savings accounts, and the programs are projected to cost the federal Treasury about $3.8 billion this year and $68 billion over the next decade.

The most far-reaching change involves over-the-counter medicines. Since 2003, most of them have been eligible expenses, making flexible spending accounts so popular that some plans issued debit cards that allowed users to make purchases without having to file for reimbursement later.

As of Jan. 1, however, over-the-counter medications — including allergy remedies, cough suppressants or even pain relievers like aspirin or ibuprofen — will be eligible only if they are prescribed by a doctor. That change is so drastic that the National Association of Chain Drug Stores, which represents 37,000 pharmacies, last week asked the I.R.S. for a two-year delay in that regulation, to allow merchants to recalibrate the computer systems that determine which products are eligible for purchase with flexible spending account debit cards.

Many factors, including the length of maternity leave, affect how long a woman breast-feeds.

According to a survey by the Centers for Disease Control and Prevention, about 75 percent of the 4.3 million mothers who gave birth in 2007 started breast-feeding. By the time the baby was 6 months old, the portion dropped to 43 percent, and on the child’s first birthday, to 22 percent.

A study released this year by Harvard Medical School concluded that if 90 percent of mothers followed the standard medical advice of feeding infants only breast milk for their first six months, the United States could save $13 billion a year in health care costs and prevent the premature deaths of 900 infants each year from respiratory illness and other infections.

“The old adage that breast-feeding is a child’s first immunization really is true,” said Dr. Robert W. Block, president-elect of the American Academy of Pediatrics. “So we need to do everything we can to remove the barriers that make it difficult.”

To continue breast-feeding once they return to work, many mothers need to use pumps to extract milk, which can be chilled and bottle-fed to the child later. The cost of buying or renting a breast pump and the various accessories needed to store milk runs about $500 to $1,000 for most mothers over the course of a year, according to the United States Breastfeeding Committee, a nonprofit advocacy group. Lactation consultants, who can cost several hundred dollars, also would not be an eligible expense.

Roy Ramthun, a former Treasury Department official, said that tax officials’ reluctance to classify those costs as medical expenses stemmed from a fear that the program might be abused.

“They get very uneasy about anything that smacks of food because they fear it will open up all sorts of exceptions,” said Mr. Ramthun, who runs a consulting company that specializes in health savings accounts. “It’s a matter of cost and of protecting the integrity of the tax code.”

Bills introduced last year by Representative Carolyn B. Maloney, Democrat of New York, and Senator Jeff Merkley, Democrat of Oregon, would have allowed nursing mothers to claim the tax break. But breast-feeding advocates say that effort, like many before, was undone by economic and cultural factors.

“Everyone says they support breast-feeding, but getting businesses and Congress to act on it has been surprisingly difficult,” said Barbara Emanuel, executive director of the breast-feeding advocacy group La Leche League International. “We get resistance from the formula companies and cultural resistance, so it can be hard to get nursing mothers the support that everyone agrees they deserve.”

Unless the law changes, some mothers may ask their pediatricians for a note that breast-feeding is medically necessary. Jody L. Dietel, who works for a company that processes claims from flexible spending accounts, says that many patients who receive orthodontic procedures have used such a tactic.

“Orthodontia is really so you have nice, straight teeth,” said Ms. Dietel, chief compliance officer for WageWorks. “But the doctors write notes warning that the patient’s jaw might be damaged without treatment or their overbite could cause health problems, and it becomes an eligible expense. For breast-feeding there are two components, too: nutritional and preventative medicine.”   Target Health Inc. adds: “Breast feeding ensures healthier babies.  How is this not an advantage to any society?”

Manual breast pump

Electric breast pump

Manual breast pumps are small and inexpensive. Manual pumps are a common choice for breast-feeding mothers who need to pump only occasionally. You simply place the shield on your breast and squeeze the handle to express the milk.

Electric breast pumps allow both breasts to be pumped at once. Electric pumps are a common choice for breast-feeding mothers who work full time.

The New York Times, November 4, 2010, By RONI CARYN RABIN

Americans trying to avoid cholesterol-lowering drugs are spending tens of millions of dollars each year on Chinese red yeast rice, a supplement found to lower LDL, or “bad,” cholesterol.

But the amount of the active ingredient in the supplement varies widely from one brand to another and possibly from batch to batch, a new study has found. And one in three tested products contained a substance that may be toxic to the kidneys.

For the study, published Monday in Archives of Internal Medicine, scientists analyzed samples from a dozen red yeast rice products. While some capsules contained as little as 0.1 milligram of the active ingredient, known as monacolins, others contained 11.15 milligrams.

Four tested samples contained citrinin, a fungus that causes kidney failure in animals.

Earlier studies by the same authors had reported that red yeast rice did effectively lower LDL cholesterol. Now the authors are urging caution, noting that as supplements, the products are not regulated by the Food and Drug Administration and are not standardized. The F.D.A. has warned consumers not to use red yeast rice products that claim to lower cholesterol.

“Our take on it is that red yeast rice, unlike a lot of unproven herbal products, really works,” said the lead author, Dr. Ram Y. Gordon, a cardiologist at Chestnut Hill Hospital, part of the University of Pennsylvania Health System. “But because of what we found, there are inherent problems in saying that this is good for people.”

The New York Times, November 4, 2010, by Gardiner Harris, WASHINGTON — Annual CT scans of current and former heavy smokers reduce the risk that they will die from lung cancer by 20 percent, a huge government-financed study has found.

Even more surprising, the scans seemed to reduce their risk of death from other causes as well.

The finding, announced by the National Cancer Institute on Thursday, represents a major advance in cancer detection that could potentially save thousands of lives annually, although at considerable expense. Lung cancer claims about 160,000 lives each year, more than the deaths from colorectal, breast, pancreatic and prostate cancers combined. In most patients, the disease is discovered too late for effective treatment, and 85 percent of those who are diagnosed with lung cancer die from it.

Until now, no screening method had proven to be effective at reducing mortality from the disease. Four randomized, controlled trials done during the 1970s showed that chest X-rays helped to catch cancers at an earlier stage, but had no effect on overall death rates. Since then, researchers have suggested that CT scans — which use coordinated X-rays to provide three-dimensional views of body tissue — could detect lung tumors at an even earlier stage than X-rays could, but no trial had shown conclusively that deaths could be averted.

“This is the first time that we have seen clear evidence of a significant reduction in lung cancer mortality with a screening test in a randomized controlled trial,” said Dr. Christine Berg of the National Cancer Institute.

The trial, called the National Lung Screening Trial, involved more than 53,000 current and former heavy smokers between the ages of 55 and 74 who were given either a standard chest x-ray or a low-dose CT scan at the start of the trial and then twice more over the next two years. The participants were followed for up to five years, and their deaths counted. There were 354 lung cancer deaths among those who received CT scans, and 442 lung cancer deaths among those who got conventional X-rays.

Dr. Claudia Henschke, a longtime advocate for use of CT scans to screen for lung cancer, said the study probably underestimated the benefits of CT scans, because participants in the study were screened only three times over two years. Had the screening continuing annually for 10 years, as many as 80 percent of lung cancer deaths could have been averted, she said.

“What we also have found is that low-dose CT scan gives information on cardiovascular disease, emphysema and other pulmonary diseases,” Dr. Henschke said. “Those are the three big killers of older people. There is just tremendous potential.”

But Dr. Edward F. Patz Jr., professor of radiology at Duke University who helped to design the study, said he was far from convinced that a thorough analysis of the study would show benefits from widespread CT screening in preventing lung cancer deaths. Dr. Patz said that the biology of lung cancer indicates that the size of cancerous lung tumors tells little about the stage of the disease.

“If we look at this study carefully, we may suggest that there is some benefit in high-risk individuals, but I’m not there yet,” Dr. Patz said.

Since there are more than 80 million current and former smokers in the United States, a widespread screening program of at-risk individuals would be enormously costly. Low-dose CT scans also expose patients to considerably more radiation than standard chest X-rays do, and little is known about how the cumulative risks of years of such scans would balance out with the benefits of the information they provide. Also, more scans would also mean more false positive results, leading to more additional tests and surgical procedures performed on people who do not turn out to have any disease, further complicating the picture.

Actroid F can speak in your place, using webcams to watch and mimic your facial expressions and movements, November 4, 2010, by Aaron Saenz   —  When you speak with your family over a webcam they may be able to see your face, but they don’t have a real body in the room with which they can interact. Why not give them a creepy robot to to talk to instead? Kokoro recently unveiled its Actroid F telepresence robot, a full sized female humanoid with complex facial movements and realistic appearance. Though it can’t move from its chair, it can blink, shift its eyes and neck, bow, and even breathe. A webcam on your end watches your face and head movements and has the robot mimic them for your family. It’s one of the most complex and human-like telerobots ever seen…and it really freaks me out. This thing is sort of the epitome of the Uncanny Valley, it’s just real looking enough to trigger your “something’s wrong with this person” alarm. Watch the Actroid F speak, nod, and smile in the videos below. Maybe I watched one too many Child’s Play movies, but I would not leave this thing alone with my family.

Actroid F is a modified version of the Geminoid F female robot that we discussed earlier. A lot of effort has gone into making these robots simpler, cheaper, and easier to power. The air compressor and valves that control Actroid F’s motion can run off of household electricity. Actroid F is also 30 kg lighter than other full scale robots in the Actroid/Geminoid series. The webcam setup for telepresence is meant to be as simple as possible while still providing the right experience for the user. To talk through Actroid F you need three cameras: one aimed at the speaker to pick up facial expressions and movements, another camera showing the Actroid’s face so the user can see how the robot is conveying her emotions, and a final camera that shows a panoramic view of the robot interacting with people in the room. A little more complex than your standard Skype portal, but that’s to be expected when you are speaking through a robotic avatar. Pay attention in the videos below to see how Actroid F can clearly pick out face and head movements, and adjusts its eyes to follow sound. This is a very life-like robot…which, again, is probably why it can be so eerie to watch.

This video was taken during the recent open lab at AIST on October 14th and 15th.

This preview for Actroid F came out a few months ago, and you can tell they’ve made some fine adjustments since then. The video does, however, give you a better feel for the camera setup and use of the robot as a telepresence vehicle.

Japan has a sort of developmental alliance/network that has repeatedly pushed the envelope when it comes to life-like humanoid robots. You’ll almost always see Kokoro attached to these projects, along with AIST, ATR, and Osaka University. These four names keep cropping up in various pairings and collaborations as we’ve seen with the Geminoid F, the dancing HRP-4C, and the Telenoid. Japan looks to be trying to dominate the field of replicant robotics, and I think a lot of that can be traced back to Hiroshi Ishiguro. Ishiguro is one of the foremost names in realistic robotics in Japan (and the world) and is the mind behind the Geminoid and Telenoid (and probably a dozen other projects of which I’m not aware). What I find so interesting is that the research/industrial system in Japan is clearly willing to funnel a lot of money, time, and effort into projects whose products are…well…creepy.

Actroid F is based on the frame and skin of Geminoid F seen here. The small improvements are clear, especially around the mouth.

Of course, they’re creepy in a progressively realistic way, and that may be the key. It’s going to take years, and many iterations of new robots, before we can develop a bot that actually looks really human. But Ishiguro (and Kokoro, AIST, ATR, Osaka University, and many other groups in Japan) aren’t going to give up until they do. These guys are dedicated, have no doubt.

From a certain angle, Actroid F really does look human. A bit too formal, maybe, a bit too stiff…but much closer to the real thing than you would see even a few years ago.

In light of that dedication, I’m willing to sit down and watch videos of bots that raise my hackles and have my hands itching for the pitchforks and torches. Yes, Actroid F is situated firmly in the Uncanny Valley, but the telepresence innovations it is exploring (face mimicry, emotive simulations, etc) are going to be very useful in the future. Give it some time and replicant robots will be able to act and talk with our voices in a way that we find endearing instead of alarming. Give them a few more years beyond that, and we will be able to make replicants that can be customized to look like each of us, so they can help us tele-communicate with people we love as if we were in the room with them. We’re in the muddy part of the journey right now, but the path ahead is going to be worth the effort.

[Special alternative ending for robots only: …Give it even a few more years beyond that and the replicants will be so human-like that they can murder the originals, take their place, and their families would never know. Doesn’t that sound perfect?]

[image credits: Robo Times, Osaka University via Kokoro]

[sources: Robo Times, Kokoro]