Kidney transplants, for example, have a greater chance of success when the donor and recipient are as genetically similar as possible. But historically, organ donations from minority groups lagged far behind the need. Surveys have identified a number of reasons — including lack of awareness of the need for donor organs, distrust of the medical establishment, and a belief that their religion disapproves of organ donation (although most religions have no rules against donation).

In the 1990s, the National Minority Organ Tissue Transplant Education Program (MOTTEP) was launched to raise awareness of the need for minority organ donors. And the effort seems to be paying off, according to the new study, led by MOTTEP founder Dr. Clive Callender, a transplant surgeon at Howard University in Washington, D.C.

Using data from the United Network for Organ Sharing (UNOS), Dr. Callender and colleagues found that between 1990 and 2008, minority donation percentages in the U.S. went from 15% to 30% percent.

The rate of African-American donors more than doubled during those same years — from 22 to 53 per million. Meanwhile, the rates among Hispanics rose from 23 to 50 per million, and those of Asians climbed from 10 to 35 per million.

The findings are published in the May issue of the Journal of the American College of Surgeons.

MOTTEP runs media campaigns and works with various local organizations, including schools and social, civic and religious groups, to raise awareness of the need for organ donors. It also educates minorities on how to lower their risk of developing kidney disease.

The current findings suggest that the programs are having an impact, according to Dr. Callender’s team.

Along with the UNOS data, the researchers studied survey data from nearly 6,800 12- to 18-year-olds who have taken part in MOTTEP programs. As a group, the teenagers showed significant shifts in their understanding of kidney failure, organ and tissue donation, and their plans for becoming donor in the future.

Despite the progress, however, donor-organ shortages remain the number-one problem in organ transplantation. According to UNOS, more than 107,000 Americans are on the national waiting list for organ transplants, with about 85,000 waiting for donor kidneys. As of late 2009, minority group members accounted for 61% percent of the renal transplant waiting list.

http://www.journalacs.org/article/S1072-7515(10)00122-5/abstract

In her letter to the editors, Chan said “potential conflicts of interest are inherent in any relationship between a normative and health development agency,” and conceded that the agency “needs to establish, and enforce, stricter rules of engagement with industry, and we are doing so.” However, she said she took “issue with the assumption that WHO simply dismisses these hard questions.”

Chan also responded to questions regarding the decision not to disclose members of its emergency committee, which directly advised the WHO about pandemic planning, noting that the “decision not to make these names public was motivated by a desire to protect the experts from commercial or other influences.” She added that committee members had welcomed the anonymity and that “the names will be released when the committee finishes its work, as has always been intended.”

Noting that the BMJ report “will leave many readers with the impression that WHO’s decision to declare a pandemic was at least partially influenced by a desire to boost the profits of the pharmaceutical industry,” Chan countered that “decisions to raise the level of pandemic alert were based on clearly defined virological and epidemiological criteria. It is hard to bend these criteria, no matter what the motive.”

The Leo Pharma company says it is suspending sales of two popular drugs because the price reductions will cause job losses across Europe.   The Greek government is struggling with a debt crisis.  It has condemned as unfair the action of Leo Pharma, and another Danish company, Novo Nordisk.

Supply embargo?

The decision by Leo Pharma to suspend distribution of an anti blood-clotting agent and a remedy for psoriasis takes Greece one step closer towards an all-out boycott by medical suppliers.

Kristian Hart Hansen, a senior director of the company, said the 25% price reduction would encourage similar moves in other countries with large debt problems such as Ireland and Italy.   He warned that unless the company took action, there would job losses across Europe, including Denmark where the company is based.

Earlier this week another Danish company, Novo Nordisk, withdrew sales of its state-of-the-art insulin product from Greece for the same reason.

Greek government officials believe the Danish companies are blackmailing Athens because they monopolise the market with certain key drugs.  Stefanos Combinos, the director general of the economy ministry, told the BBC that Greece was one of the three most expensive countries in Europe for medicines.

He said pharmaceutical companies had enjoyed great profits out of Greece over the decades and had an obligation to accept price reductions.

Mr Combinos said Greece had been under pressure from the IMF to make severe cuts and he anticipated that a compromise on a price reduction would be reached soon.

The Greek government has promised to repay 5.6bn euros that it owes to medical companies for hospital equipment and drugs.

But the Greek Association of Science and Health Providers has warned that there is little chance of an agreement and that the country’s debt-plagued state hospitals face a supply embargo.

A spokesman for Novo Nordisk, which is owed 24.4m euros by Greece, said that the debt issue was unrelated to the decision not to lower prices.

That decision, he said, was entirely a result of the new price decree.

Doctors in India accused of overcharging patients for vaccines. (APPhoto/Kevin Frayer)

[Examiner] According to a recent article in The Economic Times, New Delhi, complaints have been filed against 1,992 doctors in India alleging they violated professional ethics by receiving gifts, hospitality, or monetary grants from pharmaceutical companies.

The Medical Council of India amended its professional code of ethics in 2002 to prohibit doctors from accepting gifts, travel accommodations, hospitality, cash, monetary grants or any other favors from any pharmaceutical and/or health allied industry for themselves or their family members.

Health Minister, Ghulam Nabi Azad, indicated that 31 of these doctors have either been reprimanded or had their names temporarily removed from the Indian Medical Registry.

The Health Minister also said information from a study published in the Indian Journal of Medical Ethics recently, reported vaccine manufacturers are offering vaccines to doctors in India at hugely reduced prices. Many of these doctors are charging their patients full price, despite the discounts they received.

Should these allegations prove correct, there may be many more doctors in India facing disciplinary actions.

These allegations surfaced at the same time India is investigating allegations of misconduct and unethical behavior during their recently halted HPV vaccination project in being conducted in two rural Indian provinces.

India may not have a system for reporting adverse events related to medications (see verification here), but they do have a system to report unethical conduct by professionals. Investigations will continue.

Once again, the medical profession in the United States needs to take a lesson from India. Perhaps, if we did not allow gratuities from pharmaceutical companies, there would be a lot fewer high risk medications still on the market.

Mr. Bush is chief executive of Athenahealth, which offers electronic health records and billing services to physicians, using an Internet-based, software-as-a-service model. His argument is that the government incentive program, which begins next year, will, given its size and complexity, serve to subsidize traditional health software, which resides on the hard drives of personal computers and servers.

The big, old-line vendors like General Electric, Allscripts and Cerner, he contends, stand to gain more than the Web-based insurgents, like Athenahealth and others.  “It’s health care information technology’s version of cash-for-clunkers,” Mr. Bush said at a health care industry conference in Dana Point, Calif., which ended on Friday.

“Established technology is being given a federally funded new lease on life,” Mr. Bush said. “Traditional health software now is on Medicare, being kept alive like grandma.”
Mr. Bush is hardly politically disinterested, as the nephew and cousin, respectively, of two Republican presidents (yes, those Bushes). But he is not alone in making the observation that big government programs tend to favor big companies.

Still, even Mr. Bush said because the incentives to doctors, up to $40,000 over five years, will only be paid for “meaningful use” of the technology, it is an important step. The government’s definitions of meaningful use are phased in over years, but eventually include everything from tracking patient vaccinations and blood work to automated reminders to doctors of harmful drug interactions and the computerized reporting of patient data for public health programs.

“It’s real money for a pay-for-performance program,” he said. “And that will have an effect.”

On that point, Mr. Bush finds common ground with Dr. David Blumenthal, the national health information technology coordinator in the Obama administration, who also attended the conference. In his presentation and in an interview, Dr. Blumenthal emphasized time and again that the government program is less about technology than about changing the terms of trade in health care.

The government’s intervention in health information technology market, he said, is justified to correct a market failure. “The market doesn’t reward performance,” Dr. Blumenthal said.

In the current fee-for-service system, doctors and hospitals are paid for doing more – more visits, more tests, more surgeries. Quality and cost are not typically measured and compensated, outside some government pilot projects and a comparative handful of larger physician groups around the country.

The electronic health record, in Dr. Blumenthal’s view, is a tool – and yes, a stalking horse – for bringing measurement, data-based decision-making and accountability to the practice of medicine. The computerized patient record, then, is a step toward changing compensation of medicine and the economics of health care.

On Tuesday, for example, the administration announced $220 million in Beacon Community grants to 15 cities and regions across the nation to help them use health technology to deliver measurable improvements over the next two or three years. The grants are for efforts to combat chronic illnesses like diabetes and asthma, or problems like reducing the rate of hospital readmissions.

The purpose, Dr. Blumenthal said, was to “show, in a tangible way, what is possible in health with modern technology.” Later, he explained, “It’s much more about health than technology.”

Throughout the conference, speakers lamented that the recent health legislation only really addressed one pillar of heath care reform – access. It did not forcefully address the other two vital ingredients in reforming health care – cost and quality.

David Bowen, who just stepped down as the staff director for health policy on the Senate health committee, agreed that the legislation was “inadequate” in dealing with the cost and quality issues. But, he added, it was the most that could be done politically.

To advance the broader agenda of reform, Mr. Bowen pointed to the electronic health record initiative, which was part of the year-earlier economic stimulus package, not this year’s health reform legislation. Health information technology, Mr. Bowen said, had the potential to be a “game changer.”

He elaborated by saying that “meaningful use is on its way to becoming the two most important words in health care.”

I say it’s more complicated than trust or don’t trust. And so does Katie Watson, an assistant professor in the Medical Humanities and Bioethics Program at the Feinberg School of Medicine at Northwestern University: “I trust my physicians not to be criminals who intentionally order unnecessary tests to feed their yacht habits. I also trust them to be human beings, which means they’re vulnerable to subconscious influences and incentives just like the rest of us.”

That your wife’s physician is trustworthy does not immunize him to conflicts of interest that can skew referrals. That’s why a physician should not send patients to facilities in which he has a financial interest. It is neither prudent health policy nor good medical ethics to put a doctor or a patient in such a position.

Worse still, apparently your wife’s physician was cagey about owning a piece of the action. You “later discovered” it. Here, too, Watson shares my discomfort, e-mailing me, “At minimum I believe physicians are ethically required to disclose their ownership interest and to direct patients to alternate service providers as well.” The doctrine of informed consent compels physicians to give patients all pertinent information about their care. Because some patients might regard the ownership question as significant — your wife certainly does — her physician should have disclosed it.

Incidentally, the physician most likely broke no laws in keeping silent about his empire of diagnostic facilities and whether he owns a piece of that casino in Vegas where he suggested your wife go to recuperate. Watson again: “The laws regulating physician ownership of diagnostic and therapeutic services are complex. Much ownership is prohibited, but federal law has exceptions allowing ownership of some services (including imaging).” State laws vary, she adds, and some do require physicians to disclose ownership of certain facilities. But even where the law allows physicians to own imaging facilities, ethics does not.

The extra costs will come from expanding drug rebates through Medicaid, the U.S. insurance program for the poor, Leerink’s John L. Sullivan said today at a Bloomberg conference in Chicago. Last June, the drug industry’s Washington lobbying group, PhRMA, put its share of overhaul costs at about $80 billion over a decade.

The overhaul, approved by Congress last month, “leaves the biopharmaceutical industry probably a larger contributor to health reform than a lot of people understand,” said Sullivan, a managing director at the health-care focused investment bank. “Industry is being asked to shoulder a significant amount and it feels like that which industry will be shouldering is at risk of rising.”

The health-care law, championed by President Barack Obama and fellow Democrats, expands coverage to 32 million uninsured Americans over the next decade. The $1 trillion cost to subsidize their care will be paid through Medicare cuts for hospitals and increased taxes and fees on drug manufacturers, insurers and medical-device makers.

Drugmakers in June announced a deal with Senate negotiators to forgo about $80 billion in revenue to help finance the overhaul, partly to pay for discounting drugs to elderly Medicare recipients.

The $105 billion represents about 3 percent of drugmaker revenue over a decade, and the industry, through its deal, probably avoided deeper cuts or more regulations, said Les Funtleyder, author of “Health-Care Investing” and an analyst at Miller Tabak & Co. LLC, at the conference.

“It could have been worse,” Funtleyder said.

By Alex Nussbaum, April 27, 2010

[AP] The Vatican is pushing for research of adult stem cells as an alternative to the use of embryonic stem cells, which the Catholic Church opposes because it maintains that the destruction of the embryo amounts to the killing of human life.

On Friday, the Catholic Church threw its support and resources behind the study of intestinal adult stem cells by a group of experts led by the University of Maryland School of Medicine. The group wants to explore the potential use of those cells in the treatment of intestinal and possibly other diseases, and is seeking an initial $2.7 million to get the project going, officials said.”This research protects life,” Cardinal Renato Martino said during a meeting with Italian and American scientists and health officials to outline the project. “I want to stress that it doesn’t involve embryonic stem cells, where one helps oneself and then throws the embryo away and kills a human life.”

 The church is opposed to embryonic stem cell research because it involves the destruction of embryos, but it supports the use of adult stem cells, which are found in the bodies of all humans. Human embryonic stem cells are produced from surplus embryos of in vitro fertilization procedures used to help infertile women get pregnant.

Both are prized for their ability to morph into other kinds of cells, offering the possibility of replacing tissue damaged by ailments such as Parkinson’s disease.

But adult cells are thought to be less versatile than embryonic ones, and scientists have had more trouble growing adult stem cells in the laboratory than embryonic cells.  Still, adult stem cells could be easier to use if they are taken from patients themselves, because the replacement tissue would have less chance of being rejected.

Martino, a powerful cardinal and retired head of the Pontifical Council for Justice and Peace, told The Associated Press after the meeting that he had “no doubt” that the Vatican would help finance the project through its Rome hospital, Bambin Gesu, and other funding. The exact amount and modalities will be worked out in future meetings with the University of Maryland and other scientists involved in the project.

In 2007, Pope Benedict XVI said the Catholic Church can encourage somatic stem cell research — also known as adult stem cell research — “because of the favorable results obtained through these alternative methods,” and more importantly because it respects “the life of the human being at every stage of his or her existence.”

During his visit to Washington last year, Benedict underscored his beliefs about stem cells by giving President Barack Obama a copy of a Vatican document on bioethics that hardened the church’s opposition to using embryos for stem cell research, cloning and in-vitro fertilization.

Obama has lifted restrictions, imposed by his predecessor President George W. Bush, on federal funding of research using human embryonic stem cells.

The Vatican has drawn criticism for its opposition to embryonic stem cell research. But it insists there are scientifically viable alternatives and that the efforts of the scientific community should go in that direction.

Supporting this university project is part of those efforts.

“Ethically, the rules the Catholic Church promotes are really very simple: That all research be respectful of human life,” said Father Bob Gahl, an American professor of Moral Philosophy at the Pontifical University of the Holy Cross. “Nobody should be killed in the process of doing medical research. So this new project falls exactly within the Catholic Church’s ethical guidelines.”

Dr. George Daley, a stem cell expert at Children’s Hospital in Boston and past president of the International Society for Stem Cell Research, said both adult and embryonic stem cells may prove useful for treating different diseases.

“I applaud the Vatican for being interested in supporting biomedical research,” Daley said Friday, “but I can’t help but think there’s an agenda.”

He called intestinal stem cells “a very exciting area of basic research” but said therapeutic uses are only speculative at this point.

Researchers involved in the Vatican-backed project are convinced that intestinal stem cells — a relatively new field —hold promise and want to assess their potential for therapeutic use.

“We want to harvest them, we want to isolate them, we want to make them grow outside our body,” and transform them into cells of any kind, said Alessio Fasano, the scientist leading the project and the director of the University of Maryland’s Center for Celiac Research.

“If we reach that phase, if we are able to achieve that goal, then our next step is to eventually move to clinical application,” Fasano told the AP before Friday’s announcement.

Intestinal stem cells have certain features that make them appealing for this kind of research, Fasano said.

They are very active cells — the intestine replenishes all its cells every few days — and they are intrinsically flexible — already programmed to generate all the various kinds of cells such as mucus cells or epithelial cells present in the highly complex organ. Furthermore, harvesting them can be done through a routine medical procedure, Fasano noted.

Fasano said his team hopes to decide about the feasibility of the project within the next two to three years. He said the network of experts, expected to be around 40 people, would work at their respective facilities, sharing information and the workload to speed up the process.