As little as a few days ago, pundits were claiming the Minnesota US senate race as being incumbent’s Norm Coleman to lose. That’s changed, as Democratic challenger and Republican whipping boy Al Franken is steadily closing that gap.

The former Air America talk show host appears to be capitalizing on the shrinkage in polling data by capitalizing on healthcare reform as it applies to a rather vocal majority against the backdrop of the aging Operation Iraqi Freedom campaign: the veteran. According to Franken, reforms in the administrative sector of VA healthcare would lead to savings in those healthcare costs — allowing him to promise

Military veterans should be guaranteed medical care for life, Democratic U.S. Senate candidate Al Franken said Tuesday as part of a package of proposals that also would expand the level of care.

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It’s something that we have always done as physicians, and usually quite well at that. The treatment of chronic pain has attracted much in the way of media exposure during the last 10 years or so, and that increased public awareness has usually arisen out of news which has largely been negative.

The concern of punitive actions by law, licensing authorities, and — god forbid — the DEA have all placed undue gravity on a situation for prescribing physicians who have nothing but the best intentions for the care of their patients who suffer from chronic pain. Add to this the possibility of litigation for the undertreatment of chronic (nonmalignant) pain, and it is easy to see why — for many providers — the use of narcotics in these patients represents a futile ethical treatment quagmire.

The FDA is considering attacking this problem head on — but not without its share of criticism to come its way from concerned healthcare providers all over the country who contend that, at the very least, the FDA shouldn’t even venture into the land of the regulation of medical providers. | LINK

• CA Supreme Court: Physicians cannot deny care to homosexuals on religious grounds.
• Since the antidiabetic drug exenatide (Byetta) was approved by the FDA, its role in the cause of adverse events resulting in death has largely flown under the radar of the media….until now.
• WP: For teens, access to prescription drugs easier than trying to procure beer.
• Cool study result: Those who survived the extremely deadly influenza pandemic of 1918 are still producing antibodies over 90 years later.
• Ignorance versus inaccessibility — thousands of Kentucky children missing out on available state funded care.

Yet another story describing wrong-side surgery. Although not surprising in their incidence, one would think that the rate of wrong-side surgical procedures is on the decline in this country, or at the very least, leveling off. Can the quality assurance admonitions of healthcare organizations occur soon enough?

Medicare officials have just announced rate increases in prescription drug premiums for beneficiaries in stand-alone Part D plans.  Starting next year, the average monthly premium will mean $3 more per month for beneficiaries out of pocket.  CMS is quick to buttress news of this increase with the acknowledgement that the popular program continues to function in the financial black.

There are three reasons behind the premium increase, [Kerry Weems, acting administrator of the U.S. Centers for Medicare and Medicaid Services] said.

“First, there is a trend in prescription drug cost growth generally — prices tend to increase because of price increases for existing drugs, the growth in the average number of prescriptions per person, and the introduction of new drugs,” he said.

Second, the 2008 premiums were calculated as part of a demonstration project that has now expired. This project resulted in premiums being 50 cents less in 2008 than had been projected.

“That change is now reflected in the 2009 premium,” Weems said.

Third, drug distributors participating in Part D have found coverage for catastrophic care to be higher than expected. “So they have adjusted their 2009 bids to reflect those higher-than-anticipated costs,” Weems said.

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A single room for the healthcare of an institution’s entire patient population. The relative squalor of certain facilities that threatens the spread of disease to staff and other patients on an almost daily basis. Treatment conditions which one judicial official characterized as one of “incompetence and outright depravity in the rendering of medical care.”

Are these citations from healthcare facilities in some underdeveloped nations? Think again.

The California state prison system is apparently notorious for the substandard and despicable care environments it houses. The problem is so pervasive, the feds became involved and ordered sweeping reforms in how prison medical care is delivered in that state. In fact, the fiscal tug of war between California and the apparent unconstitutionality of its prison system’s healthcare delivery has led to a court order compelling the state to start financing improvements. With a significant budget deficit, the last thing Arnold Schwarzenegger wants to hear is that the bill for this overhaul amounts to $8 billion. | LINK

• A case study in greed?  Minute clinics saturate the healthcare marketplace.
• Minn.-based Allina hospital cited for safety violations.

A patient having heart pacemaker surgery at Abbott Northwestern Hospital was burned on her face, lips and shoulder when a fire burst out from under the sterile drapes covering her body. Doctors and nurses immediately doused the fire and completed the surgery, according to a state investigative report made public Monday.

State health investigators found that the hospital violated safety and procedural policies that contributed to the June 24 incident. The unidentified patient, who was lightly sedated, woke up when the fire ignited and “was very frightened,” according to the report. She suffered first- and second-degree burns, and was kept in the hospital for two days after the accident.

• TX state AG’s office sues nursing home for patient neglect.
• New data emerges on the rare phenomenon of a hightened immune system in keeping HIV from advancing in some patients.
• Take your vitamin D.  Your health may suffer otherwise.

According to a recent poll commissioned by a prominent health insurance lobby, the percentage of Medicare beneficiaries satisfied with their Medicare Part D coverage approached 87%, and that 75% spent less on formulary drugs after Part D was enacted in 2006.

Did someone forget to tell Rep. Dennis Kucinich this?

Rep. Dennis Kucinich (D-Ohio) recently introduced a bill that would replace the Medicare prescription drug benefit with a new program in an effort to reduce costs, CQ HealthBeat reports. The legislation would require Medicare to negotiate directly with pharmaceutical companies for discounts on prescription drugs and eliminate copayments, premiums and deductibles for medications for beneficiaries.

The Kucinich bill is here. | LINK

Mass. Governor Deval Patrick is fine tuning his state’s focus on the safety, accountability, and accessibility of healthcare for its citizens.  Making refinements in shoring primary care numbers and incentives for producing more primary care physicians, enacting limits on the gifts Pharma gives to physicians to prescribe their medicines, and increasing funding for Massachusetts’ system of universal access are at the top of a new law’s multifaceted approach to improving healthcare quality there. | LINK

For those who thought that the racial disparity in healthcare was just limited to the treatment of disease, they should consider the effect of perceived discrimination and bias on minority patients with respect to disease screening and preventive care.  From the American Assn. for Cancer Research:

“We have yet to achieve bias-free health care. This has serious public health implications as we know that higher levels of screening lead to lower levels of mortality. Clinicians need to be aware that they may be sending signals, even unintentionally, that lead minorities to believe they are being discriminated against,” said LaVera M. Crawley, M.D., M.P.H., an assistant professor at the Stanford University Center for Biomedical Ethics.  Exactly what those signals are will need to be determined in future studies, Crawley says, but the relationship between perceived discrimination and failing to get regular screenings is strong.

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It’s a familiar refrain, and one Minnesota senator is making it this time; that is, the call for certain reform of the Medicare payment reimbursement system. In an op-ed, the Democratic senator pushes quality over quantity as the sole parameter for the assignment of Medicare dollars. Although the concept is familiar, Sen. Amy Klobuchar argues, the aggressive adoption of quality claims reporting will result in streamlined payments for “standards of care” which can be applied equally in disparate care settings.

Making Medicare a purchaser of quality, rather than just an indiscriminant government guarantor of entitled healthcare to certain patient populations is a step in that direction, according to Klobuchar. The problem is — this is known already. The initial fixes must reach beyond establishing vague quality parameters to stimulate change among those on the frontlines of healthcare quality — the physicians. Adoption by this critical segment of healthcare delivery in this country will be hard to achieve without discrete, concrete goals. Unfortunately, for the providers on the front lines of healthcare (primary care), getting paid is the immediate quality concern. | LINK

Thought tuberculosis (TB) was an afterthought?  Think again. The rates of the most difficult to eradicate strains — the so-called multi drug resistant (MDR) strains — are creating concern in the epidemiological and public health spheres.  Although not a major problem in this country, the rates of MDR-TB are climbing in developing nations.  The use of what is called “directly observed therapy“, a mode in which patients must take treatment under the supervision of a public health entity, is becoming increasingly challenged practically everywhere.  That fact doesn’t bode well for keeping a key infectious disease as contained as it previously was just a few years ago. | LINK

• There’s a new technique for culturing neurons, the functional units of the nervous system; it may shed light on the origins of amyotrophic lateral sclerosis (Lou Gehrig’s disease).

The new cells were derived from 3-millimeter patches of skin removed from the arm of an 82-year-old woman and her 89-year-old sister, who share a rare genetic mutation that causes about 2% of ALS cases.

The scientists from Harvard University and Columbia University focused on the rare form of ALS in part to test whether cells from elderly patients could be reprogrammed, said biologist Kevin Eggan of the Harvard Stem Cell Institute.

“This opens the door to being able to make patient-specific stem cell lines from diseases which affect people very late in life, like Parkinson’s disease or Alzheimer’s disease,” said Eggan, the study’s senior author.

• The race to the finish line for anti-Alzheimer drug development may prove to be a risky proposition for pharma and its research.
• The House of Representatives moves to give the FDA power to regulate tobacco products.  Great news.
• CMS: Medicare payment rates to long term care facilities to increase by over three quarters of a billion dollars next year.

Medicare payment rates to nursing homes will increase by $780 million next year, the Centers for Medicare & Medicaid Services (CMS) announced.

The boost in payments is the result of a 3.4 percent increase in the annual market basket calculation of the cost of goods and services included in a skilled nursing facility stay.

• Michigan physicians are upset over EPA’s decision to allow the state to use a certain antibiotic to “treat” diseased apples.