Mary Ellen Schneider

Bisphenol-A Is Focus Again

The Food and Drug Administration is conducting a new safety review of the chemical bisphenol-A in consumer products such as food containers. Rep. Henry Waxman (D-Calif.), chairman of the House Energy and Commerce Committee, recently wrote to the FDA to request that officials reevaluate the Bush administration's conclusion that the chemical is safe at current exposure levels, especially in light of the agency's reliance on industry studies. At a health subcommittee hearing in June, FDA Commissioner Dr. Margaret A. Hamburg told lawmakers that the agency's acting chief scientist, Dr. Jesse Goodman, would head up the review and that it could be completed by this fall. Rep. Waxman has called on the FDA to determine not only whether its interaction with industry groups during the review of bisphenol-A was appropriate, but also whether the agency's processes in such reviews need to be changed.

Abortion Discrimination Case Settled

The former head of an ob.gyn. residency program in Phoenix has reached a $1.4 million settlement with his former employer, Maricopa County, after alleging that he was discriminated against for supporting abortion training of residents. Dr. J. Christopher Carey claimed in a 2005 lawsuit that he was removed from his position at Maricopa Medical Center because he publicly opposed the county's plan to eliminate abortion training. He asserted that his first amendment rights had been violated and that officials had discriminated against him for his moral and religious beliefs. In a statement through the law firm representing him, Dr. Carey said, “I am extremely pleased with the settlement, but it's important to remember that the shortage of abortion providers in this country is extensive.” Although he settled with the county and its health care system, Dr. Carey's case remains open against two individuals with whom he worked.

CMS to Review Cervical PET Scans

Officials at the Centers for Medicare and Medicaid Services will evaluate whether to cover positron emission tomography more broadly for the staging of cervical cancer outside of clinical studies, the Gray Sheet reported. PET is covered without data collection requirements during the initial treatment phase for cervical cancer only if conventional imaging is negative for extrapelvic metastasis. The CMS already covers PET outside of clinical studies for some cervical cancer patients in subsequent treatment phases, such as in determining whether cancer treatments have been effective or whether post-treatment symptoms can be attributed to a recurrence. CMS plans to issue a proposed decision memo in November and a final ruling by February 2010. The Gray Sheet and OB.GYN. NEWS are both owned by Elsevier.

Fertility Bill Wins More Support

Legislation aimed at helping men and women with fertility problems access costly, high-tech treatments has a new champion in the Senate. Sen. Kirsten Gillibrand (D-N.Y.) has pledged to introduce The Family Building Act in the Senate. The bill was originally introduced in the House by Rep. Anthony Weiner (D-N.Y.). The House bill (H.R. 697) would expand coverage for fertility treatments by requiring insurance carriers to cover technologies such as in vitro fertilization, gamete intrafallopian transfer, and intracytoplasmic sperm injection. Sen. Gillibrand estimates that the legislation would help one in eight American couples affected by infertility.

Childbirth Injuries Drop Sharply

The number of potentially avoidable injuries to women during childbirth fell by more than 20% between 2000 and 2006, according to the Agency for Healthcare Research and Quality. The drop was 30% among mothers who gave birth vaginally without the use of forceps or other instruments. Overall in 2006, there were nearly 158,000 potentially avoidable childbirth injuries to mothers and newborns. The highest rate of obstetrical injuries occurred during vaginal births with instruments. Mothers with private insurance also had higher rates of obstetrical trauma than women with Medicaid coverage. Conversely, newborns covered by Medicaid had higher injury rates than those under private insurance. Blacks and Hispanics had lower newborn- and maternal-injury rates during vaginal deliveries than did whites. The findings are based on community hospital data from the Healthcare Cost and Utilization Project.

Bisphenol-A Is Focus Again

The Food and Drug Administration is conducting a new safety review of the chemical bisphenol-A in consumer products such as food containers. Rep. Henry Waxman (D-Calif.), chairman of the House Energy and Commerce Committee, recently wrote to the FDA to request that officials reevaluate the Bush administration's conclusion that the chemical is safe at current exposure levels, especially in light of the agency's reliance on industry studies. At a health subcommittee hearing in June, FDA Commissioner Dr. Margaret A. Hamburg told lawmakers that the agency's acting chief scientist, Dr. Jesse Goodman, would head up the review and that it could be completed by this fall. Rep. Waxman has called on the FDA to determine not only whether its interaction with industry groups during the review of bisphenol-A was appropriate, but also whether the agency's processes in such reviews need to be changed.

Abortion Discrimination Case Settled

The former head of an ob.gyn. residency program in Phoenix has reached a $1.4 million settlement with his former employer, Maricopa County, after alleging that he was discriminated against for supporting abortion training of residents. Dr. J. Christopher Carey claimed in a 2005 lawsuit that he was removed from his position at Maricopa Medical Center because he publicly opposed the county's plan to eliminate abortion training. He asserted that his first amendment rights had been violated and that officials had discriminated against him for his moral and religious beliefs. In a statement through the law firm representing him, Dr. Carey said, “I am extremely pleased with the settlement, but it's important to remember that the shortage of abortion providers in this country is extensive.” Although he settled with the county and its health care system, Dr. Carey's case remains open against two individuals with whom he worked.

CMS to Review Cervical PET Scans

Officials at the Centers for Medicare and Medicaid Services will evaluate whether to cover positron emission tomography more broadly for the staging of cervical cancer outside of clinical studies, the Gray Sheet reported. PET is covered without data collection requirements during the initial treatment phase for cervical cancer only if conventional imaging is negative for extrapelvic metastasis. The CMS already covers PET outside of clinical studies for some cervical cancer patients in subsequent treatment phases, such as in determining whether cancer treatments have been effective or whether post-treatment symptoms can be attributed to a recurrence. CMS plans to issue a proposed decision memo in November and a final ruling by February 2010. The Gray Sheet and OB.GYN. NEWS are both owned by Elsevier.

Fertility Bill Wins More Support

Legislation aimed at helping men and women with fertility problems access costly, high-tech treatments has a new champion in the Senate. Sen. Kirsten Gillibrand (D-N.Y.) has pledged to introduce The Family Building Act in the Senate. The bill was originally introduced in the House by Rep. Anthony Weiner (D-N.Y.). The House bill (H.R. 697) would expand coverage for fertility treatments by requiring insurance carriers to cover technologies such as in vitro fertilization, gamete intrafallopian transfer, and intracytoplasmic sperm injection. Sen. Gillibrand estimates that the legislation would help one in eight American couples affected by infertility.

Childbirth Injuries Drop Sharply

The number of potentially avoidable injuries to women during childbirth fell by more than 20% between 2000 and 2006, according to the Agency for Healthcare Research and Quality. The drop was 30% among mothers who gave birth vaginally without the use of forceps or other instruments. Overall in 2006, there were nearly 158,000 potentially avoidable childbirth injuries to mothers and newborns. The highest rate of obstetrical injuries occurred during vaginal births with instruments. Mothers with private insurance also had higher rates of obstetrical trauma than women with Medicaid coverage. Conversely, newborns covered by Medicaid had higher injury rates than those under private insurance. Blacks and Hispanics had lower newborn- and maternal-injury rates during vaginal deliveries than did whites. The findings are based on community hospital data from the Healthcare Cost and Utilization Project.

Bisphenol-A Is Focus Again

The Food and Drug Administration is conducting a new safety review of the chemical bisphenol-A in consumer products such as food containers. Rep. Henry Waxman (D-Calif.), chairman of the House Energy and Commerce Committee, recently wrote to the FDA to request that officials reevaluate the Bush administration's conclusion that the chemical is safe at current exposure levels, especially in light of the agency's reliance on industry studies. At a health subcommittee hearing in June, FDA Commissioner Dr. Margaret A. Hamburg told lawmakers that the agency's acting chief scientist, Dr. Jesse Goodman, would head up the review and that it could be completed by this fall. Rep. Waxman has called on the FDA to determine not only whether its interaction with industry groups during the review of bisphenol-A was appropriate, but also whether the agency's processes in such reviews need to be changed.

Abortion Discrimination Case Settled

The former head of an ob.gyn. residency program in Phoenix has reached a $1.4 million settlement with his former employer, Maricopa County, after alleging that he was discriminated against for supporting abortion training of residents. Dr. J. Christopher Carey claimed in a 2005 lawsuit that he was removed from his position at Maricopa Medical Center because he publicly opposed the county's plan to eliminate abortion training. He asserted that his first amendment rights had been violated and that officials had discriminated against him for his moral and religious beliefs. In a statement through the law firm representing him, Dr. Carey said, “I am extremely pleased with the settlement, but it's important to remember that the shortage of abortion providers in this country is extensive.” Although he settled with the county and its health care system, Dr. Carey's case remains open against two individuals with whom he worked.

CMS to Review Cervical PET Scans

Officials at the Centers for Medicare and Medicaid Services will evaluate whether to cover positron emission tomography more broadly for the staging of cervical cancer outside of clinical studies, the Gray Sheet reported. PET is covered without data collection requirements during the initial treatment phase for cervical cancer only if conventional imaging is negative for extrapelvic metastasis. The CMS already covers PET outside of clinical studies for some cervical cancer patients in subsequent treatment phases, such as in determining whether cancer treatments have been effective or whether post-treatment symptoms can be attributed to a recurrence. CMS plans to issue a proposed decision memo in November and a final ruling by February 2010. The Gray Sheet and OB.GYN. NEWS are both owned by Elsevier.

Fertility Bill Wins More Support

Legislation aimed at helping men and women with fertility problems access costly, high-tech treatments has a new champion in the Senate. Sen. Kirsten Gillibrand (D-N.Y.) has pledged to introduce The Family Building Act in the Senate. The bill was originally introduced in the House by Rep. Anthony Weiner (D-N.Y.). The House bill (H.R. 697) would expand coverage for fertility treatments by requiring insurance carriers to cover technologies such as in vitro fertilization, gamete intrafallopian transfer, and intracytoplasmic sperm injection. Sen. Gillibrand estimates that the legislation would help one in eight American couples affected by infertility.

Childbirth Injuries Drop Sharply

The number of potentially avoidable injuries to women during childbirth fell by more than 20% between 2000 and 2006, according to the Agency for Healthcare Research and Quality. The drop was 30% among mothers who gave birth vaginally without the use of forceps or other instruments. Overall in 2006, there were nearly 158,000 potentially avoidable childbirth injuries to mothers and newborns. The highest rate of obstetrical injuries occurred during vaginal births with instruments. Mothers with private insurance also had higher rates of obstetrical trauma than women with Medicaid coverage. Conversely, newborns covered by Medicaid had higher injury rates than those under private insurance. Blacks and Hispanics had lower newborn- and maternal-injury rates during vaginal deliveries than did whites. The findings are based on community hospital data from the Healthcare Cost and Utilization Project.

In March, Dr. David Blumenthal, a Harvard professor and a senior health adviser to President Obama's campaign, was appointed to the position of National Coordinator for Health Information Technology in the Health and Human Service Department. He is assuming the post at a critical time, with Congress recently setting aside billions of dollars in incentives for physicians and hospitals to adopt health IT as part of the American Recovery and Reinvestment Act.

In an interview with this news organization, Dr. Blumenthal talked about some of the challenges and progress so far.

OB.GYN. NEWS: As a primary care physician, what do you see as the biggest challenge for physicians in adopting interoperable electronic health records by 2014? Cost? Misaligned incentives? Products that don't meet their needs? Security?

Dr. Blumenthal: Surveys have shown all of those to be issues. I think security is a lesser issue, according to the surveys that my group did at Harvard when I was there. But the cost of acquisition, the lack of return on investment, [and] concern about the usefulness of products all ranked high in our survey results. So I think all are important issues for physicians right now.

OB: The Recovery Act includes about $17 billion in incentives for physicians and hospitals to adopt health IT. What impact do you expect this to have on the sluggish adoption rate and the health IT marketplace?

Dr. Blumenthal: Let me first make a minor correction in the number: $17 billion is a Congressional Budget Office number and it is actually a combination of two numbers: a spending number and a cost savings number. Both are estimates. The actual CBO projections of spending are about $29 billion, and they project a $12 billion savings, which gets you to $17 billion. Some estimates of the spending are that it will be considerably higher than that, and how much is spent depends on how many physicians adopt, how many hospitals adopt, and how fast they adopt. So if we think more on the order of $30 billion or even more than that, I do think that's enough to change the dynamic in the marketplace.

We are also counting on peer-to-peer influence and on a growing appreciation among physicians of the value of health information technology and of the fact that it will be difficult to practice up-to-date, high-quality, professional medicine in the 21st century without an electronic health record. We are counting to some degree on professionalism to complement the incentives.

OB: Can you say where there is consensus so far?

Dr. Blumenthal: I don't want to get into specifics, but I will tell you that I think the consensus is clear around one thing, and that is that we should concentrate on performance and usability rather than on technical specifications. We should be constantly linking our definition of meaningful use to clinically meaningful capabilities and performance attributes.

OB: You and the president frequently have said that health IT is a tool, not a fix for our health care system. What can we reasonably expect to achieve through the widespread adoption of health IT in terms of reducing health care spending? And can physicians expect to realize any of those savings within their own practices?

Dr. Blumenthal: I think you've correctly captured my view of the role of health information technology. There are three essential components for achieving the president's goal and the administration's goal and, I think, the public's goal for a higher-performing health system.

The first is better information on what works and what doesn't in the daily practice of medicine.

The second is the ability to apply that knowledge rapidly to practice. And it's in that setting that I think health care information technology becomes a vital tool. It enables practitioners to access in real-time and have the benefit of … the latest information that is approved by their peers and recognized by their peers as valid and useful for patient care. And it helps overcome the human factors that limit the ability of clinicians to do their best at all times and in all places. Of course, it provides better information about individual patients to factor into decision making as well.

The third element is changes in the financing and organization of care that make it more valuable and more rewarding for physicians and easier for physicians to take cost and quality into account when they make their decisions.

Health information technology is the major part of the second [component], but can't function optimally unless all three are in place. So we are vitally dependent for the savings and the quality improvement that could come out of HIT, we are vitally dependent on health care reform more generally.

If physicians are going to realize savings in their practice and gain the benefit of those savings, there will have to be some change in the way that we pay for care and some change in the way that we recognize excellence in medicine so that physicians, as well as their patients, feel very directly and personally the benefits of making the health care system a better health care system.

OB: The Recovery Act provides for incentives for HIT adoption starting in 2011, but there are many areas where there are still not uniform standards. Can the industry keep up with this aggressive timetable, and what is the government doing to accelerate that process?

Dr. Blumenthal: Frankly, I think we have most of what we need in the way of standards to permit the physicians to get to meaningful use as it is likely to be defined by 2011. I also think that the industry can reconfigure their software in time to make it possible for physicians to meet those standards. I'm not very concerned about that. What I'm mostly concerned about is that—in recognizing those standards and in certifying the software and hardware that we need to certify—we also make certain that we are laying the groundwork for a dramatically improved set of technologies as we go forward. We are looking very hard at how we [can ensure] that when we certify a system and we set a set of standards, we are leaving room for innovation and improvement.

'We should be constantly linking our definition of meaningful use to clinically meaningful capabilities.' DR. BLUMENTHAL

In March, Dr. David Blumenthal, a Harvard professor and a senior health adviser to President Obama's campaign, was appointed to the position of National Coordinator for Health Information Technology in the Health and Human Service Department. He is assuming the post at a critical time, with Congress recently setting aside billions of dollars in incentives for physicians and hospitals to adopt health IT as part of the American Recovery and Reinvestment Act.

In an interview with this news organization, Dr. Blumenthal talked about some of the challenges and progress so far.

OB.GYN. NEWS: As a primary care physician, what do you see as the biggest challenge for physicians in adopting interoperable electronic health records by 2014? Cost? Misaligned incentives? Products that don't meet their needs? Security?

Dr. Blumenthal: Surveys have shown all of those to be issues. I think security is a lesser issue, according to the surveys that my group did at Harvard when I was there. But the cost of acquisition, the lack of return on investment, [and] concern about the usefulness of products all ranked high in our survey results. So I think all are important issues for physicians right now.

OB: The Recovery Act includes about $17 billion in incentives for physicians and hospitals to adopt health IT. What impact do you expect this to have on the sluggish adoption rate and the health IT marketplace?

Dr. Blumenthal: Let me first make a minor correction in the number: $17 billion is a Congressional Budget Office number and it is actually a combination of two numbers: a spending number and a cost savings number. Both are estimates. The actual CBO projections of spending are about $29 billion, and they project a $12 billion savings, which gets you to $17 billion. Some estimates of the spending are that it will be considerably higher than that, and how much is spent depends on how many physicians adopt, how many hospitals adopt, and how fast they adopt. So if we think more on the order of $30 billion or even more than that, I do think that's enough to change the dynamic in the marketplace.

We are also counting on peer-to-peer influence and on a growing appreciation among physicians of the value of health information technology and of the fact that it will be difficult to practice up-to-date, high-quality, professional medicine in the 21st century without an electronic health record. We are counting to some degree on professionalism to complement the incentives.

OB: Can you say where there is consensus so far?

Dr. Blumenthal: I don't want to get into specifics, but I will tell you that I think the consensus is clear around one thing, and that is that we should concentrate on performance and usability rather than on technical specifications. We should be constantly linking our definition of meaningful use to clinically meaningful capabilities and performance attributes.

OB: You and the president frequently have said that health IT is a tool, not a fix for our health care system. What can we reasonably expect to achieve through the widespread adoption of health IT in terms of reducing health care spending? And can physicians expect to realize any of those savings within their own practices?

Dr. Blumenthal: I think you've correctly captured my view of the role of health information technology. There are three essential components for achieving the president's goal and the administration's goal and, I think, the public's goal for a higher-performing health system.

The first is better information on what works and what doesn't in the daily practice of medicine.

The second is the ability to apply that knowledge rapidly to practice. And it's in that setting that I think health care information technology becomes a vital tool. It enables practitioners to access in real-time and have the benefit of … the latest information that is approved by their peers and recognized by their peers as valid and useful for patient care. And it helps overcome the human factors that limit the ability of clinicians to do their best at all times and in all places. Of course, it provides better information about individual patients to factor into decision making as well.

The third element is changes in the financing and organization of care that make it more valuable and more rewarding for physicians and easier for physicians to take cost and quality into account when they make their decisions.

Health information technology is the major part of the second [component], but can't function optimally unless all three are in place. So we are vitally dependent for the savings and the quality improvement that could come out of HIT, we are vitally dependent on health care reform more generally.

If physicians are going to realize savings in their practice and gain the benefit of those savings, there will have to be some change in the way that we pay for care and some change in the way that we recognize excellence in medicine so that physicians, as well as their patients, feel very directly and personally the benefits of making the health care system a better health care system.

OB: The Recovery Act provides for incentives for HIT adoption starting in 2011, but there are many areas where there are still not uniform standards. Can the industry keep up with this aggressive timetable, and what is the government doing to accelerate that process?

Dr. Blumenthal: Frankly, I think we have most of what we need in the way of standards to permit the physicians to get to meaningful use as it is likely to be defined by 2011. I also think that the industry can reconfigure their software in time to make it possible for physicians to meet those standards. I'm not very concerned about that. What I'm mostly concerned about is that—in recognizing those standards and in certifying the software and hardware that we need to certify—we also make certain that we are laying the groundwork for a dramatically improved set of technologies as we go forward. We are looking very hard at how we [can ensure] that when we certify a system and we set a set of standards, we are leaving room for innovation and improvement.

'We should be constantly linking our definition of meaningful use to clinically meaningful capabilities.' DR. BLUMENTHAL

In March, Dr. David Blumenthal, a Harvard professor and a senior health adviser to President Obama's campaign, was appointed to the position of National Coordinator for Health Information Technology in the Health and Human Service Department. He is assuming the post at a critical time, with Congress recently setting aside billions of dollars in incentives for physicians and hospitals to adopt health IT as part of the American Recovery and Reinvestment Act.

In an interview with this news organization, Dr. Blumenthal talked about some of the challenges and progress so far.

OB.GYN. NEWS: As a primary care physician, what do you see as the biggest challenge for physicians in adopting interoperable electronic health records by 2014? Cost? Misaligned incentives? Products that don't meet their needs? Security?

Dr. Blumenthal: Surveys have shown all of those to be issues. I think security is a lesser issue, according to the surveys that my group did at Harvard when I was there. But the cost of acquisition, the lack of return on investment, [and] concern about the usefulness of products all ranked high in our survey results. So I think all are important issues for physicians right now.

OB: The Recovery Act includes about $17 billion in incentives for physicians and hospitals to adopt health IT. What impact do you expect this to have on the sluggish adoption rate and the health IT marketplace?

Dr. Blumenthal: Let me first make a minor correction in the number: $17 billion is a Congressional Budget Office number and it is actually a combination of two numbers: a spending number and a cost savings number. Both are estimates. The actual CBO projections of spending are about $29 billion, and they project a $12 billion savings, which gets you to $17 billion. Some estimates of the spending are that it will be considerably higher than that, and how much is spent depends on how many physicians adopt, how many hospitals adopt, and how fast they adopt. So if we think more on the order of $30 billion or even more than that, I do think that's enough to change the dynamic in the marketplace.

We are also counting on peer-to-peer influence and on a growing appreciation among physicians of the value of health information technology and of the fact that it will be difficult to practice up-to-date, high-quality, professional medicine in the 21st century without an electronic health record. We are counting to some degree on professionalism to complement the incentives.

OB: Can you say where there is consensus so far?

Dr. Blumenthal: I don't want to get into specifics, but I will tell you that I think the consensus is clear around one thing, and that is that we should concentrate on performance and usability rather than on technical specifications. We should be constantly linking our definition of meaningful use to clinically meaningful capabilities and performance attributes.

OB: You and the president frequently have said that health IT is a tool, not a fix for our health care system. What can we reasonably expect to achieve through the widespread adoption of health IT in terms of reducing health care spending? And can physicians expect to realize any of those savings within their own practices?

Dr. Blumenthal: I think you've correctly captured my view of the role of health information technology. There are three essential components for achieving the president's goal and the administration's goal and, I think, the public's goal for a higher-performing health system.

The first is better information on what works and what doesn't in the daily practice of medicine.

The second is the ability to apply that knowledge rapidly to practice. And it's in that setting that I think health care information technology becomes a vital tool. It enables practitioners to access in real-time and have the benefit of … the latest information that is approved by their peers and recognized by their peers as valid and useful for patient care. And it helps overcome the human factors that limit the ability of clinicians to do their best at all times and in all places. Of course, it provides better information about individual patients to factor into decision making as well.

The third element is changes in the financing and organization of care that make it more valuable and more rewarding for physicians and easier for physicians to take cost and quality into account when they make their decisions.

Health information technology is the major part of the second [component], but can't function optimally unless all three are in place. So we are vitally dependent for the savings and the quality improvement that could come out of HIT, we are vitally dependent on health care reform more generally.

If physicians are going to realize savings in their practice and gain the benefit of those savings, there will have to be some change in the way that we pay for care and some change in the way that we recognize excellence in medicine so that physicians, as well as their patients, feel very directly and personally the benefits of making the health care system a better health care system.

OB: The Recovery Act provides for incentives for HIT adoption starting in 2011, but there are many areas where there are still not uniform standards. Can the industry keep up with this aggressive timetable, and what is the government doing to accelerate that process?

Dr. Blumenthal: Frankly, I think we have most of what we need in the way of standards to permit the physicians to get to meaningful use as it is likely to be defined by 2011. I also think that the industry can reconfigure their software in time to make it possible for physicians to meet those standards. I'm not very concerned about that. What I'm mostly concerned about is that—in recognizing those standards and in certifying the software and hardware that we need to certify—we also make certain that we are laying the groundwork for a dramatically improved set of technologies as we go forward. We are looking very hard at how we [can ensure] that when we certify a system and we set a set of standards, we are leaving room for innovation and improvement.

'We should be constantly linking our definition of meaningful use to clinically meaningful capabilities.' DR. BLUMENTHAL

Racial and ethnic minorities have higher rates of disease and reduced access to health care compared with the general population, according to a new report from the Department of Health and Human Services.

African Americans, for example, suffer from chronic diseases such as diabetes at nearly twice the rate of whites. About 15% of African Americans, 14% of Hispanics, and 18% of American Indians have type 2 diabetes, compared with 8% of whites, according to the report.

Racial and ethnic minorities and low income individuals also have reduced access to health care. For example, the report found that Hispanics are only half as likely as whites to have a usual source of medical care. Racial and ethnic minorities were also less likely to lack health insurance.

These disparities highlight the need for larger health reform that invests in prevention and wellness and ensures access to affordable health care, the report concluded. HHS Secretary Kathleen Sebelius repeated that message during a roundtable discussion at the White House.

“Certainly the kind of disparities we've seen too often in the health care system are disproportionately represented by low income Americans and minority Americans,” she said. “Health reform is key to helping to address these challenges.”

But new health reform legislation will be only one part of the administration's push to reduce health disparities, Ms. Sebelius said. She pledged to do whatever possible under the current authority given to HHS to close the gap on disparities, including working within the Medicare and Medicaid programs.

The roundtable event included representatives from various minority and public health groups who offered their suggestions for how health reform legislation could help to close the gap on disparities.

While nearly all expressed their eagerness to help get a health reform bill passed this year, many cautioned the administration that health coverage alone does not equal meaningful access. Other critical elements that are needed to help improve the equity of health care include a greater investment in prevention, more data collection to identify disparities, and access to more culturally competent care, the representatives said.

Racial and ethnic minorities have higher rates of disease and reduced access to health care compared with the general population, according to a new report from the Department of Health and Human Services.

African Americans, for example, suffer from chronic diseases such as diabetes at nearly twice the rate of whites. About 15% of African Americans, 14% of Hispanics, and 18% of American Indians have type 2 diabetes, compared with 8% of whites, according to the report.

Racial and ethnic minorities and low income individuals also have reduced access to health care. For example, the report found that Hispanics are only half as likely as whites to have a usual source of medical care. Racial and ethnic minorities were also less likely to lack health insurance.

These disparities highlight the need for larger health reform that invests in prevention and wellness and ensures access to affordable health care, the report concluded. HHS Secretary Kathleen Sebelius repeated that message during a roundtable discussion at the White House.

“Certainly the kind of disparities we've seen too often in the health care system are disproportionately represented by low income Americans and minority Americans,” she said. “Health reform is key to helping to address these challenges.”

But new health reform legislation will be only one part of the administration's push to reduce health disparities, Ms. Sebelius said. She pledged to do whatever possible under the current authority given to HHS to close the gap on disparities, including working within the Medicare and Medicaid programs.

The roundtable event included representatives from various minority and public health groups who offered their suggestions for how health reform legislation could help to close the gap on disparities.

While nearly all expressed their eagerness to help get a health reform bill passed this year, many cautioned the administration that health coverage alone does not equal meaningful access. Other critical elements that are needed to help improve the equity of health care include a greater investment in prevention, more data collection to identify disparities, and access to more culturally competent care, the representatives said.

Racial and ethnic minorities have higher rates of disease and reduced access to health care compared with the general population, according to a new report from the Department of Health and Human Services.

African Americans, for example, suffer from chronic diseases such as diabetes at nearly twice the rate of whites. About 15% of African Americans, 14% of Hispanics, and 18% of American Indians have type 2 diabetes, compared with 8% of whites, according to the report.

Racial and ethnic minorities and low income individuals also have reduced access to health care. For example, the report found that Hispanics are only half as likely as whites to have a usual source of medical care. Racial and ethnic minorities were also less likely to lack health insurance.

These disparities highlight the need for larger health reform that invests in prevention and wellness and ensures access to affordable health care, the report concluded. HHS Secretary Kathleen Sebelius repeated that message during a roundtable discussion at the White House.

“Certainly the kind of disparities we've seen too often in the health care system are disproportionately represented by low income Americans and minority Americans,” she said. “Health reform is key to helping to address these challenges.”

But new health reform legislation will be only one part of the administration's push to reduce health disparities, Ms. Sebelius said. She pledged to do whatever possible under the current authority given to HHS to close the gap on disparities, including working within the Medicare and Medicaid programs.

The roundtable event included representatives from various minority and public health groups who offered their suggestions for how health reform legislation could help to close the gap on disparities.

While nearly all expressed their eagerness to help get a health reform bill passed this year, many cautioned the administration that health coverage alone does not equal meaningful access. Other critical elements that are needed to help improve the equity of health care include a greater investment in prevention, more data collection to identify disparities, and access to more culturally competent care, the representatives said.

New ADHD Society

The American Professional Society of ADHD and Related Disorders (APSARD) made its debut in June. The Mt. Royal, N.J.-based society says it is the first devoted to ADHD and aims to improve quality of care, boost research, and disseminate best practices. The organization is also launching the quarterly peer-reviewed Journal of ADHD and Related Disorders. The board of directors includes Dr. Ronald Kessler of Harvard Medical School and Dr. Joseph Biederman, chief of the adult ADHD program at Massachusetts General Hospital. Dr. Biederman has been under fire from Sen. Chuck Grassley (R-Iowa) for alleged failures to disclose conflicts of interest. According to APSARD Executive Director Gene Terry, the society expects to fund the majority of its activities from journal subscriptions, advertising, and membership dues, and it will accept industry support for independent continuing medical education.

Raising Childhood Stroke Profile

Two members of Congress want people to realize that children are at risk of strokes too. Rep. John Boozman (R-Ark.) recently introduced House Resolution 451, and Sen. Robert P. Casey, Jr. (D-Pa.) offered Senate Resolution 163 in support of a National Childhood Stroke Awareness Day. The resolutions state that each year, strokes occur in 26 out of every 100,000 newborns and nearly 3 out of every 100,000 children overall—and that stroke is among the top 10 causes of death for children in the United States.

Neurologic Disease Registries

A small bipartisan group of lawmakers is proposing to create national registries of Parkinson's disease, multiple sclerosis, and other neurological diseases in an effort to find better treatments. At a minimum, lawmakers say, the registries should provide more accurate information on the incidence and prevalence of these neurological diseases. “In order to gain a better understanding of these diseases, doctors and researchers must have as much information in their hands as possible,” Sen. Byron Dorgan (D-N.D.), one of the bill sponsors, said in a statement. Currently there are only small and uncoordinated registries, surveillance systems, and databases around the world. The registries would collect information on age, race or ethnicity, gender, military service, and family history.

NIH Targets Rare Diseases

The National Institutes of Health has created a pipeline for drugs to treat rare and neglected diseases. This spring, Congress provided $24 million for the program, which focuses on collaborations among NIH researchers in these areas. The initiative is supposed to go beyond the Orphan Drug Act by offering support for preclinical research and product development. For products coming out of the program with an Investigational New Drug designation from the Food and Drug Administration, NIH will seek private companies to carry out testing with patients. The program “will develop promising treatments for rare diseases to the point that they are sufficiently 'derisked' for pharmaceutical companies, disease-oriented foundations, or others to undertake the necessary clinical trials,” Dr. Alan E. Guttmacher, acting director of NIH's National Human Genome Research Institute, said in a statement.

Vermont Bans Most Pharma Gifts

Vermont Gov. Jim Douglas (R) has signed into law a bill that prohibits manufacturers of drugs, medical devices, and biologics from providing free gifts to physicians and other health care providers. It also requires disclosure of any allowed gifts or payments, regardless of their value. Manufacturers can give physicians only gifts such as samples intended for patients, “reasonable quantities” of medical device evaluation or demonstration units, and copies of peer-reviewed articles. They still can provide scholarships or other support for medical students, residents, and fellows to attend educational events held by professional associations.

New ADHD Society

The American Professional Society of ADHD and Related Disorders (APSARD) made its debut in June. The Mt. Royal, N.J.-based society says it is the first devoted to ADHD and aims to improve quality of care, boost research, and disseminate best practices. The organization is also launching the quarterly peer-reviewed Journal of ADHD and Related Disorders. The board of directors includes Dr. Ronald Kessler of Harvard Medical School and Dr. Joseph Biederman, chief of the adult ADHD program at Massachusetts General Hospital. Dr. Biederman has been under fire from Sen. Chuck Grassley (R-Iowa) for alleged failures to disclose conflicts of interest. According to APSARD Executive Director Gene Terry, the society expects to fund the majority of its activities from journal subscriptions, advertising, and membership dues, and it will accept industry support for independent continuing medical education.

Raising Childhood Stroke Profile

Two members of Congress want people to realize that children are at risk of strokes too. Rep. John Boozman (R-Ark.) recently introduced House Resolution 451, and Sen. Robert P. Casey, Jr. (D-Pa.) offered Senate Resolution 163 in support of a National Childhood Stroke Awareness Day. The resolutions state that each year, strokes occur in 26 out of every 100,000 newborns and nearly 3 out of every 100,000 children overall—and that stroke is among the top 10 causes of death for children in the United States.

Neurologic Disease Registries

A small bipartisan group of lawmakers is proposing to create national registries of Parkinson's disease, multiple sclerosis, and other neurological diseases in an effort to find better treatments. At a minimum, lawmakers say, the registries should provide more accurate information on the incidence and prevalence of these neurological diseases. “In order to gain a better understanding of these diseases, doctors and researchers must have as much information in their hands as possible,” Sen. Byron Dorgan (D-N.D.), one of the bill sponsors, said in a statement. Currently there are only small and uncoordinated registries, surveillance systems, and databases around the world. The registries would collect information on age, race or ethnicity, gender, military service, and family history.

NIH Targets Rare Diseases

The National Institutes of Health has created a pipeline for drugs to treat rare and neglected diseases. This spring, Congress provided $24 million for the program, which focuses on collaborations among NIH researchers in these areas. The initiative is supposed to go beyond the Orphan Drug Act by offering support for preclinical research and product development. For products coming out of the program with an Investigational New Drug designation from the Food and Drug Administration, NIH will seek private companies to carry out testing with patients. The program “will develop promising treatments for rare diseases to the point that they are sufficiently 'derisked' for pharmaceutical companies, disease-oriented foundations, or others to undertake the necessary clinical trials,” Dr. Alan E. Guttmacher, acting director of NIH's National Human Genome Research Institute, said in a statement.

Vermont Bans Most Pharma Gifts

Vermont Gov. Jim Douglas (R) has signed into law a bill that prohibits manufacturers of drugs, medical devices, and biologics from providing free gifts to physicians and other health care providers. It also requires disclosure of any allowed gifts or payments, regardless of their value. Manufacturers can give physicians only gifts such as samples intended for patients, “reasonable quantities” of medical device evaluation or demonstration units, and copies of peer-reviewed articles. They still can provide scholarships or other support for medical students, residents, and fellows to attend educational events held by professional associations.

New ADHD Society

The American Professional Society of ADHD and Related Disorders (APSARD) made its debut in June. The Mt. Royal, N.J.-based society says it is the first devoted to ADHD and aims to improve quality of care, boost research, and disseminate best practices. The organization is also launching the quarterly peer-reviewed Journal of ADHD and Related Disorders. The board of directors includes Dr. Ronald Kessler of Harvard Medical School and Dr. Joseph Biederman, chief of the adult ADHD program at Massachusetts General Hospital. Dr. Biederman has been under fire from Sen. Chuck Grassley (R-Iowa) for alleged failures to disclose conflicts of interest. According to APSARD Executive Director Gene Terry, the society expects to fund the majority of its activities from journal subscriptions, advertising, and membership dues, and it will accept industry support for independent continuing medical education.

Raising Childhood Stroke Profile

Two members of Congress want people to realize that children are at risk of strokes too. Rep. John Boozman (R-Ark.) recently introduced House Resolution 451, and Sen. Robert P. Casey, Jr. (D-Pa.) offered Senate Resolution 163 in support of a National Childhood Stroke Awareness Day. The resolutions state that each year, strokes occur in 26 out of every 100,000 newborns and nearly 3 out of every 100,000 children overall—and that stroke is among the top 10 causes of death for children in the United States.

Neurologic Disease Registries

A small bipartisan group of lawmakers is proposing to create national registries of Parkinson's disease, multiple sclerosis, and other neurological diseases in an effort to find better treatments. At a minimum, lawmakers say, the registries should provide more accurate information on the incidence and prevalence of these neurological diseases. “In order to gain a better understanding of these diseases, doctors and researchers must have as much information in their hands as possible,” Sen. Byron Dorgan (D-N.D.), one of the bill sponsors, said in a statement. Currently there are only small and uncoordinated registries, surveillance systems, and databases around the world. The registries would collect information on age, race or ethnicity, gender, military service, and family history.

NIH Targets Rare Diseases

The National Institutes of Health has created a pipeline for drugs to treat rare and neglected diseases. This spring, Congress provided $24 million for the program, which focuses on collaborations among NIH researchers in these areas. The initiative is supposed to go beyond the Orphan Drug Act by offering support for preclinical research and product development. For products coming out of the program with an Investigational New Drug designation from the Food and Drug Administration, NIH will seek private companies to carry out testing with patients. The program “will develop promising treatments for rare diseases to the point that they are sufficiently 'derisked' for pharmaceutical companies, disease-oriented foundations, or others to undertake the necessary clinical trials,” Dr. Alan E. Guttmacher, acting director of NIH's National Human Genome Research Institute, said in a statement.

Vermont Bans Most Pharma Gifts

Vermont Gov. Jim Douglas (R) has signed into law a bill that prohibits manufacturers of drugs, medical devices, and biologics from providing free gifts to physicians and other health care providers. It also requires disclosure of any allowed gifts or payments, regardless of their value. Manufacturers can give physicians only gifts such as samples intended for patients, “reasonable quantities” of medical device evaluation or demonstration units, and copies of peer-reviewed articles. They still can provide scholarships or other support for medical students, residents, and fellows to attend educational events held by professional associations.

Racial and ethnic minorities have higher rates of disease and reduced access to health care compared with the general population, according to a new report from the Department of Health and Human Services.

African Americans, for example, have chronic diseases such as diabetes at nearly twice the rate of whites. About 15% of African Americans, 14% of Hispanics, and 18% of American Indians have type 2 diabetes, compared with 8% of whites, according to the report.

Racial and ethnic minorities and low income individuals also have reduced access to health care. For example, the report found that Hispanics are only half as likely as whites to have a usual source of medical care. Racial and ethnic minorities were also less likely to lack health insurance.

These disparities highlight the need for larger health reform that invests in prevention and wellness and ensures access to affordable health care, the report concluded. HHS Secretary Kathleen Sebelius repeated that message during a roundtable discussion at the White House in June.

“Certainly the kind of disparities we've seen too often in the health care system are disproportionately represented by low-income Americans and minority Americans,” she said.

But new health reform legislation will be only one part of the administration's push to reduce health disparities, Ms. Sebelius said. She pledged to do whatever possible under the current authority given to HHS to close the gap on disparities, including working within the Medicare and Medicaid programs.

Nearly all of the various minority and public health groups at the roundtable event expressed their eagerness to help get a health reform bill passed this year, but many cautioned the administration that health coverage alone does not equal meaningful access. They called for greater investment in prevention, data collection, and access to culturally competent care.

Racial and ethnic minorities have higher rates of disease and reduced access to health care compared with the general population, according to a new report from the Department of Health and Human Services.

African Americans, for example, have chronic diseases such as diabetes at nearly twice the rate of whites. About 15% of African Americans, 14% of Hispanics, and 18% of American Indians have type 2 diabetes, compared with 8% of whites, according to the report.

Racial and ethnic minorities and low income individuals also have reduced access to health care. For example, the report found that Hispanics are only half as likely as whites to have a usual source of medical care. Racial and ethnic minorities were also less likely to lack health insurance.

These disparities highlight the need for larger health reform that invests in prevention and wellness and ensures access to affordable health care, the report concluded. HHS Secretary Kathleen Sebelius repeated that message during a roundtable discussion at the White House in June.

“Certainly the kind of disparities we've seen too often in the health care system are disproportionately represented by low-income Americans and minority Americans,” she said.

But new health reform legislation will be only one part of the administration's push to reduce health disparities, Ms. Sebelius said. She pledged to do whatever possible under the current authority given to HHS to close the gap on disparities, including working within the Medicare and Medicaid programs.

Nearly all of the various minority and public health groups at the roundtable event expressed their eagerness to help get a health reform bill passed this year, but many cautioned the administration that health coverage alone does not equal meaningful access. They called for greater investment in prevention, data collection, and access to culturally competent care.

Racial and ethnic minorities have higher rates of disease and reduced access to health care compared with the general population, according to a new report from the Department of Health and Human Services.

African Americans, for example, have chronic diseases such as diabetes at nearly twice the rate of whites. About 15% of African Americans, 14% of Hispanics, and 18% of American Indians have type 2 diabetes, compared with 8% of whites, according to the report.

Racial and ethnic minorities and low income individuals also have reduced access to health care. For example, the report found that Hispanics are only half as likely as whites to have a usual source of medical care. Racial and ethnic minorities were also less likely to lack health insurance.

These disparities highlight the need for larger health reform that invests in prevention and wellness and ensures access to affordable health care, the report concluded. HHS Secretary Kathleen Sebelius repeated that message during a roundtable discussion at the White House in June.

“Certainly the kind of disparities we've seen too often in the health care system are disproportionately represented by low-income Americans and minority Americans,” she said.

But new health reform legislation will be only one part of the administration's push to reduce health disparities, Ms. Sebelius said. She pledged to do whatever possible under the current authority given to HHS to close the gap on disparities, including working within the Medicare and Medicaid programs.

Nearly all of the various minority and public health groups at the roundtable event expressed their eagerness to help get a health reform bill passed this year, but many cautioned the administration that health coverage alone does not equal meaningful access. They called for greater investment in prevention, data collection, and access to culturally competent care.

Public health advocates are applauding a new law that gives the Food and Drug Administration unprecedented authority to regulate the sale, marketing, and ingredients in tobacco products.

President Obama signed into law the Family Smoking Prevention and Tobacco Control Act (H.R. 1256) at a June 22 White House ceremony. The new law gives the FDA the power to regulate the levels of tar, nicotine, and other ingredients in tobacco products. While the law does not give the FDA the authority to ban tobacco products, it does give the agency broad authority to regulate labeling, packaging, and advertising of such products.

During a White House Rose Garden signing ceremony, President Obama said the law would “save lives and dollars” and would aid health reform efforts by reducing tobacco-related health care costs.

The law bans the use of cigarette additives or flavoring such as strawberry or grape that many public health advocates have said has been used by tobacco manufacturers to make smoking more appealing to minors. The law also prohibits tobacco companies from using descriptors such as “light” or “mild.”

Additionally, the bill calls on the FDA to consider fast-tracking the approval of new smoking-cessation products.

The new law also aims to prevent youth smoking by placing restrictions on outdoor tobacco advertising within 1,000 feet of schools and playgrounds, as well as on tobacco-product sponsorships of entertainment and sporting events.

Cigarette packs themselves will also be designed to deter smoking. Under the law, about half of the front and back of the package will be taken up by the warning label.

Manufacturers can choose from a selection of warnings such as “WARNING: Smoking can kill you” or “WARNING: Cigarettes cause cancer.”

These types of restrictions on advertising and labeling will help chip away at some of the ways tobacco companies have successfully created an aura of “cool” around smoking, said Danny McGoldrick, vice president for research at the Campaign for Tobacco-Free Kids.

Physician groups hailed enactment of the new law. “The new law represents an important break from the past, as it signifies broad acceptance that nicotine is a drug harmful to people's health,” Dr. J. James Rohack, president of the American Medical Association, said in a statement.

The American College of Physicians also praised the new law. Dr. Joseph W. Stubbs, ACP president, said it was “high time” the government began to regulate tobacco products, which contribute to so many chronic illnesses. Dr. Stubbs said that he hopes that the law will lead to stronger efforts related to smoking cessation.

One of the ways the FDA will be able to use its new authority to assist in smoking cessation is by regulating the ingredients in tobacco products. But finding the best way to do that may take some time, said Erika Sward, director of national advocacy for the American Lung Association.

Under the law, for example, the FDA is gaining the authority to reduce the amount of nicotine in cigarettes but scientists don't yet know if that would only lead people to compensate by smoking more, she said.

Aside from the concrete elements of the law, Ms. Sward said she hopes the law will also help people understand that tobacco addiction is powerful and that most people can't quit “cold turkey.”

It's important for physicians to talk to patients repeatedly about the need to quit smoking, she said.

Public health advocates are applauding a new law that gives the Food and Drug Administration unprecedented authority to regulate the sale, marketing, and ingredients in tobacco products.

President Obama signed into law the Family Smoking Prevention and Tobacco Control Act (H.R. 1256) at a June 22 White House ceremony. The new law gives the FDA the power to regulate the levels of tar, nicotine, and other ingredients in tobacco products. While the law does not give the FDA the authority to ban tobacco products, it does give the agency broad authority to regulate labeling, packaging, and advertising of such products.

During a White House Rose Garden signing ceremony, President Obama said the law would “save lives and dollars” and would aid health reform efforts by reducing tobacco-related health care costs.

The law bans the use of cigarette additives or flavoring such as strawberry or grape that many public health advocates have said has been used by tobacco manufacturers to make smoking more appealing to minors. The law also prohibits tobacco companies from using descriptors such as “light” or “mild.”

Additionally, the bill calls on the FDA to consider fast-tracking the approval of new smoking-cessation products.

The new law also aims to prevent youth smoking by placing restrictions on outdoor tobacco advertising within 1,000 feet of schools and playgrounds, as well as on tobacco-product sponsorships of entertainment and sporting events.

Cigarette packs themselves will also be designed to deter smoking. Under the law, about half of the front and back of the package will be taken up by the warning label.

Manufacturers can choose from a selection of warnings such as “WARNING: Smoking can kill you” or “WARNING: Cigarettes cause cancer.”

These types of restrictions on advertising and labeling will help chip away at some of the ways tobacco companies have successfully created an aura of “cool” around smoking, said Danny McGoldrick, vice president for research at the Campaign for Tobacco-Free Kids.

Physician groups hailed enactment of the new law. “The new law represents an important break from the past, as it signifies broad acceptance that nicotine is a drug harmful to people's health,” Dr. J. James Rohack, president of the American Medical Association, said in a statement.

The American College of Physicians also praised the new law. Dr. Joseph W. Stubbs, ACP president, said it was “high time” the government began to regulate tobacco products, which contribute to so many chronic illnesses. Dr. Stubbs said that he hopes that the law will lead to stronger efforts related to smoking cessation.

One of the ways the FDA will be able to use its new authority to assist in smoking cessation is by regulating the ingredients in tobacco products. But finding the best way to do that may take some time, said Erika Sward, director of national advocacy for the American Lung Association.

Under the law, for example, the FDA is gaining the authority to reduce the amount of nicotine in cigarettes but scientists don't yet know if that would only lead people to compensate by smoking more, she said.

Aside from the concrete elements of the law, Ms. Sward said she hopes the law will also help people understand that tobacco addiction is powerful and that most people can't quit “cold turkey.”

It's important for physicians to talk to patients repeatedly about the need to quit smoking, she said.

Public health advocates are applauding a new law that gives the Food and Drug Administration unprecedented authority to regulate the sale, marketing, and ingredients in tobacco products.

President Obama signed into law the Family Smoking Prevention and Tobacco Control Act (H.R. 1256) at a June 22 White House ceremony. The new law gives the FDA the power to regulate the levels of tar, nicotine, and other ingredients in tobacco products. While the law does not give the FDA the authority to ban tobacco products, it does give the agency broad authority to regulate labeling, packaging, and advertising of such products.

During a White House Rose Garden signing ceremony, President Obama said the law would “save lives and dollars” and would aid health reform efforts by reducing tobacco-related health care costs.

The law bans the use of cigarette additives or flavoring such as strawberry or grape that many public health advocates have said has been used by tobacco manufacturers to make smoking more appealing to minors. The law also prohibits tobacco companies from using descriptors such as “light” or “mild.”

Additionally, the bill calls on the FDA to consider fast-tracking the approval of new smoking-cessation products.

The new law also aims to prevent youth smoking by placing restrictions on outdoor tobacco advertising within 1,000 feet of schools and playgrounds, as well as on tobacco-product sponsorships of entertainment and sporting events.

Cigarette packs themselves will also be designed to deter smoking. Under the law, about half of the front and back of the package will be taken up by the warning label.

Manufacturers can choose from a selection of warnings such as “WARNING: Smoking can kill you” or “WARNING: Cigarettes cause cancer.”

These types of restrictions on advertising and labeling will help chip away at some of the ways tobacco companies have successfully created an aura of “cool” around smoking, said Danny McGoldrick, vice president for research at the Campaign for Tobacco-Free Kids.

Physician groups hailed enactment of the new law. “The new law represents an important break from the past, as it signifies broad acceptance that nicotine is a drug harmful to people's health,” Dr. J. James Rohack, president of the American Medical Association, said in a statement.

The American College of Physicians also praised the new law. Dr. Joseph W. Stubbs, ACP president, said it was “high time” the government began to regulate tobacco products, which contribute to so many chronic illnesses. Dr. Stubbs said that he hopes that the law will lead to stronger efforts related to smoking cessation.

One of the ways the FDA will be able to use its new authority to assist in smoking cessation is by regulating the ingredients in tobacco products. But finding the best way to do that may take some time, said Erika Sward, director of national advocacy for the American Lung Association.

Under the law, for example, the FDA is gaining the authority to reduce the amount of nicotine in cigarettes but scientists don't yet know if that would only lead people to compensate by smoking more, she said.

Aside from the concrete elements of the law, Ms. Sward said she hopes the law will also help people understand that tobacco addiction is powerful and that most people can't quit “cold turkey.”

It's important for physicians to talk to patients repeatedly about the need to quit smoking, she said.

The chances of passing health reform legislation this year could depend on whether lawmakers can resolve their differences over the public insurance plan option.

The decision on whether to include a government-sponsored health plan that would compete against private insurance has become a major wedge in the health care debate, according to observers. And how much to pay physicians under such a plan is one of the major sticking points.

“It could wind up bringing down the whole agenda,” said Grace-Marie Turner, president of the Galen Institute, a nonprofit research organization that advocates for free-market ideas in health care.

Ms. Turner, who opposes the public plan option, said that although Democrats have control of the presidency and both chambers of Congress, there is disagreement within their own ranks, with many moderate and conservative Democrats saying they cannot support a public plan.

The physician community is also wrestling with this issue. The idea of a public plan was debated extensively at the recent policy-making meeting of the American Medical Association, and delegates there ended up passing policy that supports “health system reform alternatives that are consistent with AMA principles of pluralism, freedom of choice, freedom of practice, and universal access for patients.”

The AMA leadership has shied away from coming out for or against the public plan option. But the organization has stated publicly that it does not support any plan that would force physicians to participate in a public plan or that would pay physicians based on Medicare rates. The AMA has said, however, that it will consider some of the variations on a public plan that are being discussed in Congress now, such as a federally chartered co-op health plan.

Officials at the American College of Physicians agree that provider participation in any plan should be voluntary and not tied to current participation in Medicare. The college also advocates for payment rates to be competitive with commercial payers, rather than based on the low rates currently offered by Medicare.

But the ACP also sees potential advantages to creating a public plan, according to its president, Dr. Joseph W. Stubbs. A public plan could provide a “nationwide blanket” of fall-back coverage, which would be especially helpful in areas of low penetration by insurance carriers. It could also offer a mechanism for rapidly introducing new models of care and reimbursement, such as the medical home concept. A public plan could also be a way to hold private plans accountable in areas where there is little competition currently.

“The devil will be in the details as far as whether this is a good idea or not,” Dr. Stubbs said.

Meanwhile, other physicians have been disappointed by talk of a public plan for different reasons. Dr. David Himmelstein of Harvard Medical School, Boston, and the cofounder of Physicians for a National Health Program, said that what's being discussed in Congress now is really “just a clone of private insurance.”

Dr. Himmelstein, who favors a single-payer health system, said a public plan would fall far short of realizing the savings that could be seen with a single-payer system. A public plan wouldn't even be able to achieve the type of low overhead seen with Medicare, he said, which benefits from automatic enrollment and easy premium collection, and has no need to spend money on marketing.

President Obama, who reached out to physicians for support at the AMA meeting last month, said he understands that many physicians are skeptical about how they would fare under a public plan. In his speech to the AMA, President Obama said he intended to change the way physicians get paid, rewarding best practices and good patient care. “The public option is not your enemy,” he said. “It is your friend.”

Part of the problem with evaluating the public plan option is that there isn't just one. There are a number of health reform proposals circulating in both the House and the Senate, some of which include a government-run or quasi-government-run option to compete with private insurance.

The purest form of a so-called public plan would be one that is something like Medicare, in which federal dollars, not just premiums, are used to support it, said Kathleen Stoll, health policy director at Families USA, which supports the general idea of a public plan but hasn't yet supported a particular proposal. But many lawmakers and analysts have said that this design would give the public plan an advantage over private insurance products and cause private payers to leave the market, she said.

A proposal being put forward by leaders in the House would create a public plan on the same footing as other insurance plans. For example, public and private plans alike would have to adhere to the same benefit requirements and insurance market reforms, and would have to be financially self-sustaining based on premiums. This proposal would not require participation by physicians but initially would use payment rates similar to those of Medicare.

Rates would be unlinked from Medicare rates over time as other payment mechanisms were developed.

In the Senate, an approach getting a lot of attention is to create not a public plan but rather a federally chartered, nonprofit cooperative plan, Ms. Stoll said. This proposal is seen by many as a compromise between a government-run plan and no public plan at all.

Overall, the discussion on a public plan is heading in a direction that is positive for physicians, said Elizabeth Carpenter, associate policy director for the Health Policy Program at the New America Foundation, a nonpartisan think tank.

The chances of passing health reform legislation this year could depend on whether lawmakers can resolve their differences over the public insurance plan option.

The decision on whether to include a government-sponsored health plan that would compete against private insurance has become a major wedge in the health care debate, according to observers. And how much to pay physicians under such a plan is one of the major sticking points.

“It could wind up bringing down the whole agenda,” said Grace-Marie Turner, president of the Galen Institute, a nonprofit research organization that advocates for free-market ideas in health care.

Ms. Turner, who opposes the public plan option, said that although Democrats have control of the presidency and both chambers of Congress, there is disagreement within their own ranks, with many moderate and conservative Democrats saying they cannot support a public plan.

The physician community is also wrestling with this issue. The idea of a public plan was debated extensively at the recent policy-making meeting of the American Medical Association, and delegates there ended up passing policy that supports “health system reform alternatives that are consistent with AMA principles of pluralism, freedom of choice, freedom of practice, and universal access for patients.”

The AMA leadership has shied away from coming out for or against the public plan option. But the organization has stated publicly that it does not support any plan that would force physicians to participate in a public plan or that would pay physicians based on Medicare rates. The AMA has said, however, that it will consider some of the variations on a public plan that are being discussed in Congress now, such as a federally chartered co-op health plan.

Officials at the American College of Physicians agree that provider participation in any plan should be voluntary and not tied to current participation in Medicare. The college also advocates for payment rates to be competitive with commercial payers, rather than based on the low rates currently offered by Medicare.

But the ACP also sees potential advantages to creating a public plan, according to its president, Dr. Joseph W. Stubbs. A public plan could provide a “nationwide blanket” of fall-back coverage, which would be especially helpful in areas of low penetration by insurance carriers. It could also offer a mechanism for rapidly introducing new models of care and reimbursement, such as the medical home concept. A public plan could also be a way to hold private plans accountable in areas where there is little competition currently.

“The devil will be in the details as far as whether this is a good idea or not,” Dr. Stubbs said.

Meanwhile, other physicians have been disappointed by talk of a public plan for different reasons. Dr. David Himmelstein of Harvard Medical School, Boston, and the cofounder of Physicians for a National Health Program, said that what's being discussed in Congress now is really “just a clone of private insurance.”

Dr. Himmelstein, who favors a single-payer health system, said a public plan would fall far short of realizing the savings that could be seen with a single-payer system. A public plan wouldn't even be able to achieve the type of low overhead seen with Medicare, he said, which benefits from automatic enrollment and easy premium collection, and has no need to spend money on marketing.

President Obama, who reached out to physicians for support at the AMA meeting last month, said he understands that many physicians are skeptical about how they would fare under a public plan. In his speech to the AMA, President Obama said he intended to change the way physicians get paid, rewarding best practices and good patient care. “The public option is not your enemy,” he said. “It is your friend.”

Part of the problem with evaluating the public plan option is that there isn't just one. There are a number of health reform proposals circulating in both the House and the Senate, some of which include a government-run or quasi-government-run option to compete with private insurance.

The purest form of a so-called public plan would be one that is something like Medicare, in which federal dollars, not just premiums, are used to support it, said Kathleen Stoll, health policy director at Families USA, which supports the general idea of a public plan but hasn't yet supported a particular proposal. But many lawmakers and analysts have said that this design would give the public plan an advantage over private insurance products and cause private payers to leave the market, she said.

A proposal being put forward by leaders in the House would create a public plan on the same footing as other insurance plans. For example, public and private plans alike would have to adhere to the same benefit requirements and insurance market reforms, and would have to be financially self-sustaining based on premiums. This proposal would not require participation by physicians but initially would use payment rates similar to those of Medicare.

Rates would be unlinked from Medicare rates over time as other payment mechanisms were developed.

In the Senate, an approach getting a lot of attention is to create not a public plan but rather a federally chartered, nonprofit cooperative plan, Ms. Stoll said. This proposal is seen by many as a compromise between a government-run plan and no public plan at all.

Overall, the discussion on a public plan is heading in a direction that is positive for physicians, said Elizabeth Carpenter, associate policy director for the Health Policy Program at the New America Foundation, a nonpartisan think tank.

The chances of passing health reform legislation this year could depend on whether lawmakers can resolve their differences over the public insurance plan option.

The decision on whether to include a government-sponsored health plan that would compete against private insurance has become a major wedge in the health care debate, according to observers. And how much to pay physicians under such a plan is one of the major sticking points.

“It could wind up bringing down the whole agenda,” said Grace-Marie Turner, president of the Galen Institute, a nonprofit research organization that advocates for free-market ideas in health care.

Ms. Turner, who opposes the public plan option, said that although Democrats have control of the presidency and both chambers of Congress, there is disagreement within their own ranks, with many moderate and conservative Democrats saying they cannot support a public plan.

The physician community is also wrestling with this issue. The idea of a public plan was debated extensively at the recent policy-making meeting of the American Medical Association, and delegates there ended up passing policy that supports “health system reform alternatives that are consistent with AMA principles of pluralism, freedom of choice, freedom of practice, and universal access for patients.”

The AMA leadership has shied away from coming out for or against the public plan option. But the organization has stated publicly that it does not support any plan that would force physicians to participate in a public plan or that would pay physicians based on Medicare rates. The AMA has said, however, that it will consider some of the variations on a public plan that are being discussed in Congress now, such as a federally chartered co-op health plan.

Officials at the American College of Physicians agree that provider participation in any plan should be voluntary and not tied to current participation in Medicare. The college also advocates for payment rates to be competitive with commercial payers, rather than based on the low rates currently offered by Medicare.

But the ACP also sees potential advantages to creating a public plan, according to its president, Dr. Joseph W. Stubbs. A public plan could provide a “nationwide blanket” of fall-back coverage, which would be especially helpful in areas of low penetration by insurance carriers. It could also offer a mechanism for rapidly introducing new models of care and reimbursement, such as the medical home concept. A public plan could also be a way to hold private plans accountable in areas where there is little competition currently.

“The devil will be in the details as far as whether this is a good idea or not,” Dr. Stubbs said.

Meanwhile, other physicians have been disappointed by talk of a public plan for different reasons. Dr. David Himmelstein of Harvard Medical School, Boston, and the cofounder of Physicians for a National Health Program, said that what's being discussed in Congress now is really “just a clone of private insurance.”

Dr. Himmelstein, who favors a single-payer health system, said a public plan would fall far short of realizing the savings that could be seen with a single-payer system. A public plan wouldn't even be able to achieve the type of low overhead seen with Medicare, he said, which benefits from automatic enrollment and easy premium collection, and has no need to spend money on marketing.

President Obama, who reached out to physicians for support at the AMA meeting last month, said he understands that many physicians are skeptical about how they would fare under a public plan. In his speech to the AMA, President Obama said he intended to change the way physicians get paid, rewarding best practices and good patient care. “The public option is not your enemy,” he said. “It is your friend.”

Part of the problem with evaluating the public plan option is that there isn't just one. There are a number of health reform proposals circulating in both the House and the Senate, some of which include a government-run or quasi-government-run option to compete with private insurance.

The purest form of a so-called public plan would be one that is something like Medicare, in which federal dollars, not just premiums, are used to support it, said Kathleen Stoll, health policy director at Families USA, which supports the general idea of a public plan but hasn't yet supported a particular proposal. But many lawmakers and analysts have said that this design would give the public plan an advantage over private insurance products and cause private payers to leave the market, she said.

A proposal being put forward by leaders in the House would create a public plan on the same footing as other insurance plans. For example, public and private plans alike would have to adhere to the same benefit requirements and insurance market reforms, and would have to be financially self-sustaining based on premiums. This proposal would not require participation by physicians but initially would use payment rates similar to those of Medicare.

Rates would be unlinked from Medicare rates over time as other payment mechanisms were developed.

In the Senate, an approach getting a lot of attention is to create not a public plan but rather a federally chartered, nonprofit cooperative plan, Ms. Stoll said. This proposal is seen by many as a compromise between a government-run plan and no public plan at all.

Overall, the discussion on a public plan is heading in a direction that is positive for physicians, said Elizabeth Carpenter, associate policy director for the Health Policy Program at the New America Foundation, a nonpartisan think tank.

Racial and ethnic minorities have higher rates of disease and reduced access to health care compared with the general population, according to a new report from the Department of Health and Human Services.

African Americans, for example, suffer from chronic diseases such as diabetes at nearly twice the rate of whites. About 15% of African Americans, 14% of Hispanics, and 18% of American Indians have type 2 diabetes, compared with 8% of whites, according to the report.

Racial and ethnic minorities and low income individuals also have reduced access to health care. For example, the report found that Hispanics are only half as likely as whites to have a usual source of medical care. Racial and ethnic minorities were also less likely to lack health insurance.

These disparities highlight the need for larger health reform that invests in prevention and wellness and ensures access to affordable health care, the report concluded. HHS Secretary Kathleen Sebelius repeated that message during a roundtable discussion at the White House in June.

“Certainly the kind of disparities we've seen too often in the health care system are disproportionately represented by low income Americans and minority Americans,” she said. “Health reform is key to helping to address these challenges.”

But new health reform legislation will be only one part of the administration's push to reduce health disparities.

The roundtable event included representatives from various minority and public health groups who cautioned the administration that health coverage alone does not equal meaningful access. Other critical elements that are needed to help improve the equity of health care include a greater investment in prevention, more data collection to identify disparities, and access to more culturally competent care, the representatives said.

Racial and ethnic minorities have higher rates of disease and reduced access to health care compared with the general population, according to a new report from the Department of Health and Human Services.

African Americans, for example, suffer from chronic diseases such as diabetes at nearly twice the rate of whites. About 15% of African Americans, 14% of Hispanics, and 18% of American Indians have type 2 diabetes, compared with 8% of whites, according to the report.

Racial and ethnic minorities and low income individuals also have reduced access to health care. For example, the report found that Hispanics are only half as likely as whites to have a usual source of medical care. Racial and ethnic minorities were also less likely to lack health insurance.

These disparities highlight the need for larger health reform that invests in prevention and wellness and ensures access to affordable health care, the report concluded. HHS Secretary Kathleen Sebelius repeated that message during a roundtable discussion at the White House in June.

“Certainly the kind of disparities we've seen too often in the health care system are disproportionately represented by low income Americans and minority Americans,” she said. “Health reform is key to helping to address these challenges.”

But new health reform legislation will be only one part of the administration's push to reduce health disparities.

The roundtable event included representatives from various minority and public health groups who cautioned the administration that health coverage alone does not equal meaningful access. Other critical elements that are needed to help improve the equity of health care include a greater investment in prevention, more data collection to identify disparities, and access to more culturally competent care, the representatives said.

Racial and ethnic minorities have higher rates of disease and reduced access to health care compared with the general population, according to a new report from the Department of Health and Human Services.

African Americans, for example, suffer from chronic diseases such as diabetes at nearly twice the rate of whites. About 15% of African Americans, 14% of Hispanics, and 18% of American Indians have type 2 diabetes, compared with 8% of whites, according to the report.

Racial and ethnic minorities and low income individuals also have reduced access to health care. For example, the report found that Hispanics are only half as likely as whites to have a usual source of medical care. Racial and ethnic minorities were also less likely to lack health insurance.

These disparities highlight the need for larger health reform that invests in prevention and wellness and ensures access to affordable health care, the report concluded. HHS Secretary Kathleen Sebelius repeated that message during a roundtable discussion at the White House in June.

“Certainly the kind of disparities we've seen too often in the health care system are disproportionately represented by low income Americans and minority Americans,” she said. “Health reform is key to helping to address these challenges.”

But new health reform legislation will be only one part of the administration's push to reduce health disparities.

The roundtable event included representatives from various minority and public health groups who cautioned the administration that health coverage alone does not equal meaningful access. Other critical elements that are needed to help improve the equity of health care include a greater investment in prevention, more data collection to identify disparities, and access to more culturally competent care, the representatives said.

The number of cosmetic medical procedures performed in the United States last year increased slightly because of growing demand for minimally invasive procedures like Botox and laser skin resurfacing, according to data from the American Society of Plastic Surgeons.

Despite the faltering economy, Americans opted for nearly 12.1 million cosmetic medical procedures last year, up 3% from 2007. That 3% rise, however, was the smallest increase recorded in cosmetic procedures since 2000. Popular surgical procedures such as liposuction and breast augmentation had double-digit decreases in the percentage of procedures performed in 2008. Overall, Americans spent $10.3 billion on cosmetic procedures last year, down 9% from 2007.

Botox continues to be the most popular cosmetic procedure in the United States, with more than 5 million procedures performed last year, up 8% from 2007. The number of procedures performed with hyaluronic acid fillers increased by 6%. The number of laser skin resurfacing procedures jumped 15% from 2007 to 2008, but microdermabrasion was down 6%.

It seems that the most effective procedures, such as Botox and fillers, are increasing, while interest in less effective procedures like microdermabrasion is dropping, said Dr. Leslie Baumann, director of cosmetic dermatology at the University of Miami. “This is not surprising,” she said. “Patients quickly realize that these ineffective procedures are a waste of money.”

The statistics on cosmetic procedures from the ASPS are based on a combination of data from its online national database of plastic surgery procedures and the results of an annual survey of about 21,000 board-certified dermatologists; ear, nose and throat specialists; and plastic surgeons. The responses are then extrapolated to the entire population of physicians most likely to perform cosmetic and reconstructive plastic surgery procedures.

The 2008 statistics also highlight a trend toward greater use of cosmetic procedures by ethnic minorities. Cosmetic procedures increased slightly in all ethnic groups except in white patients, though white patients still accounted for the vast majority of cosmetic procedures performed last year.

The greatest level of increased interest was among Hispanic and black patients. The use of cosmetic procedures jumped 18% among Hispanic patients and 10% among blacks patients, compared with 2007. The most commonly requested procedures for ethnic minorities were Botox, injectable fillers, and chemical peels.

“We're seeing a rise in Hispanics opting for cosmetic procedures that coincides with the growth we're seeing in the nation's population,” Dr. John Canady, ASPS president, said in a statement.

The increased use of cosmetic procedures by ethnic minorities is encouraging, said Dr. Eliot F. Battle Jr., a cosmetic dermatologist in Washington and an expert in treating ethnic skin. However, it raises serious concerns that some physicians are performing these procedures without the proper understanding of skin of color.

Dr. Battle said that he is seeing more patients who come to him after experiencing side effects from laser treatments performed by other physicians. He urged physicians to use care when treating patients with skin of color. Without understanding the nuances of darker skin, patients can be harmed. “These patients cannot be treated as guinea pigs,” he said.

ELSEVIER GLOBAL MEDICAL NEWS

The number of cosmetic medical procedures performed in the United States last year increased slightly because of growing demand for minimally invasive procedures like Botox and laser skin resurfacing, according to data from the American Society of Plastic Surgeons.

Despite the faltering economy, Americans opted for nearly 12.1 million cosmetic medical procedures last year, up 3% from 2007. That 3% rise, however, was the smallest increase recorded in cosmetic procedures since 2000. Popular surgical procedures such as liposuction and breast augmentation had double-digit decreases in the percentage of procedures performed in 2008. Overall, Americans spent $10.3 billion on cosmetic procedures last year, down 9% from 2007.

Botox continues to be the most popular cosmetic procedure in the United States, with more than 5 million procedures performed last year, up 8% from 2007. The number of procedures performed with hyaluronic acid fillers increased by 6%. The number of laser skin resurfacing procedures jumped 15% from 2007 to 2008, but microdermabrasion was down 6%.

It seems that the most effective procedures, such as Botox and fillers, are increasing, while interest in less effective procedures like microdermabrasion is dropping, said Dr. Leslie Baumann, director of cosmetic dermatology at the University of Miami. “This is not surprising,” she said. “Patients quickly realize that these ineffective procedures are a waste of money.”

The statistics on cosmetic procedures from the ASPS are based on a combination of data from its online national database of plastic surgery procedures and the results of an annual survey of about 21,000 board-certified dermatologists; ear, nose and throat specialists; and plastic surgeons. The responses are then extrapolated to the entire population of physicians most likely to perform cosmetic and reconstructive plastic surgery procedures.

The 2008 statistics also highlight a trend toward greater use of cosmetic procedures by ethnic minorities. Cosmetic procedures increased slightly in all ethnic groups except in white patients, though white patients still accounted for the vast majority of cosmetic procedures performed last year.

The greatest level of increased interest was among Hispanic and black patients. The use of cosmetic procedures jumped 18% among Hispanic patients and 10% among blacks patients, compared with 2007. The most commonly requested procedures for ethnic minorities were Botox, injectable fillers, and chemical peels.

“We're seeing a rise in Hispanics opting for cosmetic procedures that coincides with the growth we're seeing in the nation's population,” Dr. John Canady, ASPS president, said in a statement.

The increased use of cosmetic procedures by ethnic minorities is encouraging, said Dr. Eliot F. Battle Jr., a cosmetic dermatologist in Washington and an expert in treating ethnic skin. However, it raises serious concerns that some physicians are performing these procedures without the proper understanding of skin of color.

Dr. Battle said that he is seeing more patients who come to him after experiencing side effects from laser treatments performed by other physicians. He urged physicians to use care when treating patients with skin of color. Without understanding the nuances of darker skin, patients can be harmed. “These patients cannot be treated as guinea pigs,” he said.

ELSEVIER GLOBAL MEDICAL NEWS

The number of cosmetic medical procedures performed in the United States last year increased slightly because of growing demand for minimally invasive procedures like Botox and laser skin resurfacing, according to data from the American Society of Plastic Surgeons.

Despite the faltering economy, Americans opted for nearly 12.1 million cosmetic medical procedures last year, up 3% from 2007. That 3% rise, however, was the smallest increase recorded in cosmetic procedures since 2000. Popular surgical procedures such as liposuction and breast augmentation had double-digit decreases in the percentage of procedures performed in 2008. Overall, Americans spent $10.3 billion on cosmetic procedures last year, down 9% from 2007.

Botox continues to be the most popular cosmetic procedure in the United States, with more than 5 million procedures performed last year, up 8% from 2007. The number of procedures performed with hyaluronic acid fillers increased by 6%. The number of laser skin resurfacing procedures jumped 15% from 2007 to 2008, but microdermabrasion was down 6%.

It seems that the most effective procedures, such as Botox and fillers, are increasing, while interest in less effective procedures like microdermabrasion is dropping, said Dr. Leslie Baumann, director of cosmetic dermatology at the University of Miami. “This is not surprising,” she said. “Patients quickly realize that these ineffective procedures are a waste of money.”

The statistics on cosmetic procedures from the ASPS are based on a combination of data from its online national database of plastic surgery procedures and the results of an annual survey of about 21,000 board-certified dermatologists; ear, nose and throat specialists; and plastic surgeons. The responses are then extrapolated to the entire population of physicians most likely to perform cosmetic and reconstructive plastic surgery procedures.

The 2008 statistics also highlight a trend toward greater use of cosmetic procedures by ethnic minorities. Cosmetic procedures increased slightly in all ethnic groups except in white patients, though white patients still accounted for the vast majority of cosmetic procedures performed last year.

The greatest level of increased interest was among Hispanic and black patients. The use of cosmetic procedures jumped 18% among Hispanic patients and 10% among blacks patients, compared with 2007. The most commonly requested procedures for ethnic minorities were Botox, injectable fillers, and chemical peels.

“We're seeing a rise in Hispanics opting for cosmetic procedures that coincides with the growth we're seeing in the nation's population,” Dr. John Canady, ASPS president, said in a statement.

The increased use of cosmetic procedures by ethnic minorities is encouraging, said Dr. Eliot F. Battle Jr., a cosmetic dermatologist in Washington and an expert in treating ethnic skin. However, it raises serious concerns that some physicians are performing these procedures without the proper understanding of skin of color.

Dr. Battle said that he is seeing more patients who come to him after experiencing side effects from laser treatments performed by other physicians. He urged physicians to use care when treating patients with skin of color. Without understanding the nuances of darker skin, patients can be harmed. “These patients cannot be treated as guinea pigs,” he said.

ELSEVIER GLOBAL MEDICAL NEWS

Diagnosis and treatment of depression in children and adults dropped significantly in the wake of a 2003 Food and Drug Administration public health advisory regarding the risk of suicidality among children taking antidepressants, according to a review of claims data from 1999 to 2007.

After steady increases in depression diagnoses among children between 1999 and 2004, the diagnoses of depression began to decline in 2005, dropping to 3.5 per 1,000 enrollees in 2007, nearly back to 1999 levels.

Although the October 2003 FDA warning related only to children, the researchers found a “spillover” effect in adults. Given historical trends, the rate of depression diagnoses should have been about 20.3 per 1,000 enrollees in 2007; however, the actual observed rate was just 12.4 (Arch. Gen. Psychiatry 2009;66:633-9).

Anne M. Libby, Ph.D., and her colleagues at the University of Colorado, Denver, examined the diagnosis of depression, antidepressant use for depression, use of psychotherapy after depression diagnosis, and the use of antidepressant alternatives after depression diagnosis for the periods before and after the FDA public health advisory was issued.

The findings are based on a nationally representative database of claims from PHARMetrics, a unit of IMS, Inc., which includes more than 55 million patients enrolled in managed care plans. The researchers created a cohort of new episodes of depression with a total of 643,313 individual patients. The cohort included 792,807 episodes of diagnosis and possible treatment of depression. The episodes of care include 91,748 pediatric cases (aged 5-18 years at time of diagnosis), 70,311 young adult cases (aged 19-24), and 630,748 adult cases (aged 25-89). The researchers analyzed trends in these cases from July 1999 to June 2007.

The researchers also identified changes in the type of providers who diagnosed depression. In the post-advisory period from 2004 through June 2007, the case finding of depression decreased significantly among both pediatricians and primary care providers.

During the post-advisory period, diagnoses of new episodes of depression by primary care providers also dropped 37% for young adults and 29% for adults. “Non-psychiatrist other mental health providers” was the only provider type that increased case finding following the 2003 FDA advisory, the researchers found. The trend was small but was seen across all age groups, according to the study.

Prescriptions for selective serotonin reuptake inhibitors (SSRIs) also declined following the 2003 FDA warning. Prescriptions for SSRIs within 30 days of the new depression episode fell by 10% for children and 15% for adults from the post-advisory period through 2007. But the drop in SSRI use generally did not mean that depressed patients were getting alternative treatments, the researchers found.

The researchers reported receiving unrestricted, investigator-initiated research grants from Eli Lilly and Company, Forest Pharmaceuticals Inc., Lundbeck, and the American Foundation for Suicide Prevention.

Diagnosis and treatment of depression in children and adults dropped significantly in the wake of a 2003 Food and Drug Administration public health advisory regarding the risk of suicidality among children taking antidepressants, according to a review of claims data from 1999 to 2007.

After steady increases in depression diagnoses among children between 1999 and 2004, the diagnoses of depression began to decline in 2005, dropping to 3.5 per 1,000 enrollees in 2007, nearly back to 1999 levels.

Although the October 2003 FDA warning related only to children, the researchers found a “spillover” effect in adults. Given historical trends, the rate of depression diagnoses should have been about 20.3 per 1,000 enrollees in 2007; however, the actual observed rate was just 12.4 (Arch. Gen. Psychiatry 2009;66:633-9).

Anne M. Libby, Ph.D., and her colleagues at the University of Colorado, Denver, examined the diagnosis of depression, antidepressant use for depression, use of psychotherapy after depression diagnosis, and the use of antidepressant alternatives after depression diagnosis for the periods before and after the FDA public health advisory was issued.

The findings are based on a nationally representative database of claims from PHARMetrics, a unit of IMS, Inc., which includes more than 55 million patients enrolled in managed care plans. The researchers created a cohort of new episodes of depression with a total of 643,313 individual patients. The cohort included 792,807 episodes of diagnosis and possible treatment of depression. The episodes of care include 91,748 pediatric cases (aged 5-18 years at time of diagnosis), 70,311 young adult cases (aged 19-24), and 630,748 adult cases (aged 25-89). The researchers analyzed trends in these cases from July 1999 to June 2007.

The researchers also identified changes in the type of providers who diagnosed depression. In the post-advisory period from 2004 through June 2007, the case finding of depression decreased significantly among both pediatricians and primary care providers.

During the post-advisory period, diagnoses of new episodes of depression by primary care providers also dropped 37% for young adults and 29% for adults. “Non-psychiatrist other mental health providers” was the only provider type that increased case finding following the 2003 FDA advisory, the researchers found. The trend was small but was seen across all age groups, according to the study.

Prescriptions for selective serotonin reuptake inhibitors (SSRIs) also declined following the 2003 FDA warning. Prescriptions for SSRIs within 30 days of the new depression episode fell by 10% for children and 15% for adults from the post-advisory period through 2007. But the drop in SSRI use generally did not mean that depressed patients were getting alternative treatments, the researchers found.

The researchers reported receiving unrestricted, investigator-initiated research grants from Eli Lilly and Company, Forest Pharmaceuticals Inc., Lundbeck, and the American Foundation for Suicide Prevention.

Diagnosis and treatment of depression in children and adults dropped significantly in the wake of a 2003 Food and Drug Administration public health advisory regarding the risk of suicidality among children taking antidepressants, according to a review of claims data from 1999 to 2007.

After steady increases in depression diagnoses among children between 1999 and 2004, the diagnoses of depression began to decline in 2005, dropping to 3.5 per 1,000 enrollees in 2007, nearly back to 1999 levels.

Although the October 2003 FDA warning related only to children, the researchers found a “spillover” effect in adults. Given historical trends, the rate of depression diagnoses should have been about 20.3 per 1,000 enrollees in 2007; however, the actual observed rate was just 12.4 (Arch. Gen. Psychiatry 2009;66:633-9).

Anne M. Libby, Ph.D., and her colleagues at the University of Colorado, Denver, examined the diagnosis of depression, antidepressant use for depression, use of psychotherapy after depression diagnosis, and the use of antidepressant alternatives after depression diagnosis for the periods before and after the FDA public health advisory was issued.

The findings are based on a nationally representative database of claims from PHARMetrics, a unit of IMS, Inc., which includes more than 55 million patients enrolled in managed care plans. The researchers created a cohort of new episodes of depression with a total of 643,313 individual patients. The cohort included 792,807 episodes of diagnosis and possible treatment of depression. The episodes of care include 91,748 pediatric cases (aged 5-18 years at time of diagnosis), 70,311 young adult cases (aged 19-24), and 630,748 adult cases (aged 25-89). The researchers analyzed trends in these cases from July 1999 to June 2007.

The researchers also identified changes in the type of providers who diagnosed depression. In the post-advisory period from 2004 through June 2007, the case finding of depression decreased significantly among both pediatricians and primary care providers.

During the post-advisory period, diagnoses of new episodes of depression by primary care providers also dropped 37% for young adults and 29% for adults. “Non-psychiatrist other mental health providers” was the only provider type that increased case finding following the 2003 FDA advisory, the researchers found. The trend was small but was seen across all age groups, according to the study.

Prescriptions for selective serotonin reuptake inhibitors (SSRIs) also declined following the 2003 FDA warning. Prescriptions for SSRIs within 30 days of the new depression episode fell by 10% for children and 15% for adults from the post-advisory period through 2007. But the drop in SSRI use generally did not mean that depressed patients were getting alternative treatments, the researchers found.

The researchers reported receiving unrestricted, investigator-initiated research grants from Eli Lilly and Company, Forest Pharmaceuticals Inc., Lundbeck, and the American Foundation for Suicide Prevention.