September 10, 2010
By Allison Cohen and Leah Voigt*
Money for ESC Research Flows Again, for Now
A federal appeals court has ruled that government funding of embryonic stem cell (ESC) research can resume while it mulls a federal judge's injunction blocking the funds. The three-member U.S. Court of Appeals for the District of Columbia Circuit issued a three-paragraph ruling Thursday that lifts the ban on National Institutes of Health (NIH) funding imposed two and a half weeks ago by District Court Judge Royce Lamberth.
Lamberth ruled that NIH funding for ESC research violates a federal law, known as the Dickey-Wicker amendment, which bars use of government money to destroy human embryos. He also found that a suit brought by researchers opposed to ESC had merit and could proceed. The injunction stunned the ESC research community, and forced the NIH to pull fifty grants that were awaiting peer review and freeze another twenty-two that were up for annual renewal.
Thursday's Court of Appeals decision suspends Lamberth's ruling for now while the court takes time to consider the Department of Justice's motion. The ruling "should not be construed in any way as a ruling on the merits of that motion," the appeals court judges wrote in their three-paragraph order. Still, supporters of ESC hailed the ruling.
"This is terrific news," the co-director of the Harvard Stem Cell Institute said in a prepared statement. "I realize that this is a temporary order, but I am hopeful that the Court of Appeals understands the enormous potential this research holds, it's promise for millions of patients, and will allow regular funding of the work to resume." Senator Tom Harkin (D-Iowa), a supporter of ESC research, announced on Thursday that he'll hold a hearing on the issue on September 16, and has invited NIH Director Francis Collins and several ESC supporters to testify. No opponents of ESC research are currently scheduled to testify.
The ethical debate over embryonic stem cell research heated up in 2001 when President George W. Bush issued an executive order making it illegal to use federal funds for research on embryonic stem cell lines derived after the date he issued his order. In March of last year, President Obama issued his own executive order lifting the one issued by Bush, and legalized research on newer embryonic stem cell lines, putting NIH in charge of drafting guidelines for doing so. Since Obama's order, the NIH has approved a total of seventy-four ESC lines to be used in research.
Emily P. Walker, Money for ESC Research Flows Again, for Now, MedPage Today (Sep. 9, 2010).
At Hospitals, New Methods with a Focus on Diversity
At Elmhurst Hospital Center in Queens, a borough that is home to
2.3 million people from more than 100 countries, lactation consultants spend extra time explaining to Bangladeshi women that the yellow breast milk they produce right after birth is not dirty. Female obstetricians are always on duty overnight at the hospital's maternity ward in case a Muslim woman arrives in labor and does not want to be treated by a male doctor.
As more immigrants crowd its waiting rooms, Elmhurst Hospital is joining a growing number of hospitals in New York and across the country that are going beyond hiring interpreters and offering translated paperwork and are adopting practices intended to improve care for an increasingly diverse patient population. Doctors and nurses are interviewing religious leaders, visiting cultural centers, and even traveling abroad to better understand their patients.
The lessons are redefining traditional notions of healthcare not just in immigrant hubs like New York, California, and Texas, but also in places like Storm Lake, Iowa, a city of 12,000 that has been transformed by an influx of Hispanics who work in the area's meatpacking plants. "We can't just say, 'You're different,' call an interpreter and consider our job done," said the chief diversity officer at the University of Pittsburgh Medical Center, which operates fifteen hospitals and clinics throughout Pennsylvania. "What we have to say is, whatever cultural beliefs you have, they're going to be acknowledged and respected."
Fernanda Santos, At Hospital, New Methods with a Focus on Diversity, N.Y. TIMES (Sep. 6, 2010).
Houston-Area Hospitals Mobilize to Serve a Graying Population
Isabel Nuñez sees a slew of specialists, including an internist, cardiologist, gastroenterologist, and allergist, her children explained during a recent appointment with a geriatric primary care physician at the UT Center for Healthy Aging. The eighty-six-year-old has been to an emergency room twice in two months for roller coaster blood pressure, her daughter revealed. "I wanted somebody to help me," Nuñez told a thirty-four-year-old geriatric internist.
During the nearly hour long talk, the internist focused on the woman's obsession with checking her blood pressure. Options to address the unique health concerns of older adults are becoming increasingly common in Houston, thanks to the longevity of the oldest seniors and graying baby boomers. In the past year, Memorial Hermann-Southwest Hospital opened the state's first senior emergency center. The UT Center for Healthy Aging, meanwhile, focuses on primary care and specialty care as well as brain and memory healthcare for older adults.
"That's the elder scare now: memory problems and dementia. By providing all three services, we think we can span the continuum of care and meet the needs of older persons," said a geriatric internist who directs the UT center.
Over the next few decades, the nation's population will become much older. The most senior baby boomers turn sixty-five next year and qualify for Medicare. According to a recent U.S. Census Bureau report on older Americans, roughly one in five U.S. residents will be sixty-five or older by 2030. In Texas, a relatively young state, residents sixty-five and older are expected to account for 16% of the population by 2025. That's why it's important for specialists, such as the geriatric internist that treated Isabel Nuñez, to have the expertise to diagnose her older patient's preoccupation as a symptom—not a cause.
The UT center also uses a coordinated approach, incorporating a geriatric social worker and therapists into patient care, as well as educating the patient's team of caregivers—from relatives and neighbors to home health providers. The center's electronic health records are connected with Memorial Hermann hospitals and the Harris County Hospital District. "We're able to access their records and doctors communicate with each other," said a geriatrics professor at the University of Texas Medical School at Houston who also leads geriatrics at both LBJ General Hospital and Memorial Hermann in the Texas Medical Center.
Cindy George, Houston-Area Hospitals Mobilize to Serve a Graying Population, HOUSTON CHRONICLE (Sep. 7, 2010).
Patients Expect More from PCI Than It Delivers
Cardiologists fully understand the limits of percutaneous coronary interventions (PCI)—but their patients are often overly optimistic about the benefits of PCI, a new survey revealed. The survey, of twenty-seven cardiologists and 153 stable angina patients undergoing elective catheterization with potential PCI, found that 80% of patients expected that angioplasty would prevent MI and nearly 90% of patients who responded to the survey thought PCI would reduce the risk of death, according to Michael B. Rothberg, MD, MPH, of the Baystate Medical Center in Springfield, MA, and colleagues.
However, those beliefs were held by fewer than 20% of the Baystate cardiologists who performed PCI on patient respondents, Rothberg and co-authors reported in the September 7, 2010, issue of Annals of Internal Medicine.
The survey results suggest that cardiologists aren't doing a good job of educating patients on the efficacy of PCI, even though they may be candid about the risks, the authors commented. Rothberg's team noted that widely publicized trial results—notably the 2007 COURAGE study—have persuaded many cardiologists that angioplasty and stenting do not reduce events relative to drug treatment, but "most patients undergoing the procedure still believe that PCI will prevent infarction or death."
"Despite spending substantial time personally explaining the procedure to the patients . . . our cardiologists were not successful in dispelling patients' erroneous beliefs," the researchers wrote. They also found that only half of the patients had received written materials explaining the risks of PCI but not the benefits.
John Gever, Patients Expect More from PCI than It Delivers, MedPage Today (Sep. 7, 2010).
AHLA Teaching Hospital Updates are intended to provide quick summaries of cutting-edge issues of interest to teaching hospitals and their counsel. Additional information and more in-depth coverage on these topics may be available from AHLA Health Lawyers weekly and appropriate AHLA Practice Groups.
*We would like to thank Allison Cohen, Esquire (Washington, DC), and Leah Voigt, Esquire (Squire Sanders & Dempsey LLP, Washington, DC), for providing this week's update.