In response to the historic passage of federal health care reform legislation, Donald Crane, President and CEO of the California Association of Physician Groups (CAPG), issued the following statement in strong support of the Senate measure:

“This is the most sweeping health reform legislation since the enactment of Medicare. It will provide an extraordinary opportunity to make a very real difference in the lives of millions of people. This comprehensive bill package addresses major areas in need of change, including expanding coverage to nearly all Americans, eliminating various unfair insurance practices, and beginning to transform our dysfunctional delivery system.”

Both the House and Senate bills will begin to modernize an antiquated fee-for-service payment model — one that has been entrenched for decades and now threatens to bankrupt our current health care system –into a higher quality, more accountable system of care. The existing fragmented structure makes it very difficult for patients to receive optimal care because the fee-for-service model pays physicians for treatment regardless of whether the care provided is appropriate, beneficial, or even warranted. Additionally, within the fee-for-service model, patients are obliged to self navigate through a maze of specialists who frequently have no connection to each other, creating a climate ripe for medical errors, duplicate treatments, waste, and sub-standard outcomes.

Healthcare reform offers us a unique opportunity to transition from this disorganized approach to one that is more affordable, comprehensive, and coordinated through the establishment of Accountable Care Organizations (ACO).

Making ACOs a permanent part of health care reform will help control costs by moving beyond the old model of fee-for-service, and instead advancing “outcome based” medicine, physician networks, and the adoption of health information technology. The implementation of an ACO system will improve care for patients by providing lower cost care, through a network of physicians, who will use the latest technology to provide evidence-based health care to their patients. The Congressional Budget Office estimates the savings of a national ACO “pilot program” at $2.3 billion.

California’s physician groups are among the few throughout the country that have been practicing within an ACO model for the past 20 years. The 150 multi-specialty groups that comprise CAPG represent the backbone of California’s delivery system and are in fact the very “Accountable Care Organizations” that the House and Senate bills have tasked the Center for Medicare and Medicaid Services (CMS) to spread across the country. We are the experts who can demonstrate how the accountable care model can work for the rest of the nation and we are eager to get the process started.

Aetna has commended the U.S. Senate for taking action to significantly expand access to health care coverage for millions of Americans. While noting progress toward meaningful reform, Aetna Chairman and CEO Ronald A. Williams said that more needs to be done to deliver on the full promise of health care system reform.

“Today, the Senate took an important step, but reform that doesn’t deal with affordability, tied to health care quality, is not a complete victory for consumers,” said Williams. “Guaranteeing that Americans cannot be denied insurance and enhancing coverage for millions of people are essential actions. When consumers win, we all win, and that can only happen if health care reform addresses both access and affordability. The Senate has not done enough on addressing costs and has actually exacerbated the problem of affordability by choosing to pay for reform through billions of dollars in additional taxes on the health care system which will be transferred to the consumer through higher costs and will therefore hurt health care affordability for the average American.

“It’s imperative that the House – Senate conference committee get the final outcome right. As a company with a track record of leadership in health care policy, we stand ready to work with the committee to craft a workable outcome that addresses health care affordability and truly helps get the best out of our health care system.”

A new statement on breast cancer by the American College of Surgeons (ACS) underscores the value of an advanced approach to post-surgical radiation therapy provided by the Breast Clinic of Memphis.

The ACS document describes the advantages of accelerated partial breast irradiation such as SAVI™ radiation therapy provided at the Breast Clinic of Memphis.

The consensus statement says accelerated partial breast irradiation “is an approach that may allow more patients to undergo breast-conserving therapy more quickly, at lower cost, and with less risk of long-term complications.” Among the techniques it lists for delivering APBI is brachytherapy with “open single-entry devices with multiple lumens,” a category that includes the SAVI applicator.

“The design of SAVI is quite ingenious in the way it resolves problematic issues presented by other breast brachytherapy methods,” said Michael Berry, M.D., a surgeon at the Breast Clinic of Memphis who is also a course instructor for ACS. “It’s easy to place and comfortable for patients. The device’s expandable array of multiple catheters allows us to customize the radiation dose to the patient’s needs and anatomy. This creates a safer procedure for women with certain body types or tumor locations.”

Working with Dr. Berry to provide SAVI is radiation oncologist Michael Farmer, M.D., of the Memphis Professional Radiological Corporation (MPRC).

“This device is more versatile than balloon brachytherapy because unlike the balloon, it can be used with small-breasted women and women whose lumpectomy cavities are close to the skin,” Dr. Farmer said. “You can lower the dose to healthy tissue such as the heart, ribs, and lungs and then concentrate the dose on the area where it’s really needed. This advantage makes the benefits of breast brachytherapy available to significantly more women.”

SAVI is one of the newest methods for providing APBI, a shortened course of high-dose radiation therapy for early-stage breast cancer patients following lumpectomy surgery. The treatment is completed in just five days — compared to the six weeks of treatment, five days a week, required for traditional, external-beam radiation.

The device’s unique multi-catheter design allows physicians to target radiation to the area that needs it most, minimizing exposure to healthy tissue. Precisely sculpted radiation is delivered from within the breast and targets the area where the cancer is most likely to recur.

Clinical studies show that SAVI provides greater flexibility and fewer complications compared to other forms of breast brachytherapy.

The ACS statement, titled “Image-Detected Breast Cancer: State-of-the-Art Diagnosis and Treatment,” was published in the October 2009 issue of the Journal of the American College of Surgeons.

David Blumenthal, M.D., Department of Health and Human Services’ (HHS) National Coordinator for Health Information Technology, today announced plans to make available $60 million to support the development of Strategic Health IT Advanced Research Projects (SHARP). SHARP projects will conduct focused research in critical areas where breakthrough advances are needed to address existing barriers to the adoption and meaningful use of health information technology (health IT). The SHARP program identifies and works to address barriers to adoption in the following four areas:

• Security of Health Information Technology research to address the challenges of developing security and risk mitigation policies and the technologies necessary to build and preserve the public trust as health IT systems become ubiquitous.
• Patient-Centered Cognitive Support research to address the need to harness the power of health IT in a patient-focused manner and align the technology with the day-to-day practice of medicine to support clinicians as they care for patients.
• Health care Application and Network Platform Architectures research to focus on the development of new and improved architectures that are necessary to achieve electronic exchange and use of health information in a secure, private, and accurate manner.
• Secondary Use of Electronic Health Record Data research to identify strategies to enhance the use of health IT in improving the overall quality of health care, population health and clinical research while protecting patient privacy.

Each project will identify and implement a research agenda addressing the specific goals of the Health Information Technology for Economic and Clinical Health Act (HITECH) and identify the barriers to adoption and meaningful use of heath IT that will be addressed in their research area. HHS expects to award qualified applicants cooperative agreements to support research efforts in these four project areas. Each agreement will last four years. Awardees will implement a collaborative, interdisciplinary program of research addressing short-term and long-term challenges in their focus area. Additionally, the projects are expected to develop and implement a cooperative program between researchers, health care providers, and other health IT sector stakeholders to incorporate research results into health IT practice and products.

Authorized by the American Recovery and Reinvestment Act (ARRA), and part of the HITECH provisions of ARRA, the cooperative agreements are part of a series of grants to help strengthen and support the use of health information technology to improve the quality and efficiency of care provided to all Americans.

“Innovative research and approaches are required to overcome some of the foremost challenges we face in achieving our vision of a transformed health care system enabled through health IT,” said Dr. Blumenthal. “The SHARP program will bring together some of the best and brightest minds in the nation to find breakthrough solutions and innovations that will eliminate barriers to adoption and, over time, increase the meaningful use of health IT to improve the health and care of all Americans.”

Applications are due on Jan. 25, 2010, with awards anticipated in March 2010.

Information about the SHARP program and the cooperative agreement applications can be found at http://HealthIT.HHS.gov/ and at www.grants.gov.

General Mills announced today a public commitment to reduce sugar in cereals advertised to children to single-digit grams of sugar per serving. The initiative is in place and progress has been made, the company said, “with further reductions to continue until single-digit levels are reached on all cereals advertised to children.”

“Ready-to-eat cereals, including presweetened cereals, account for only five percent of the sugar in children’s diets,” said Jeff Harmening, President of General Mills’ Big G cereal division. “Still, we know that some consumers would prefer to see cereals that are even lower in sugar, especially children’s cereals. General Mills has responded – and we are committing to reduce sugar levels even more.”

General Mills has been reducing sugar in cereals advertised to children, while increasing key nutrients, such as calcium and vitamin D, and providing whole grain. “We have already made meaningful changes across our cereal portfolio,” noted Harmening, “and we have reached and exceeded our original goals. So today we are strengthening our goal – by publicly committing to further reduce to single-digit levels of sugar per serving every cereal advertised to children under twelve.”

The company’s commitment is among the most aggressive goals advanced in the food industry. The initiative will extend globally to 130 countries, with Cereal Partners Worldwide – the global cereal joint venture in which General Mills is a partner – adopting similar commitments.

General Mills has led numerous health and nutrition initiatives in cereal. The company was a pioneer in fortifying cereals with vitamins and minerals, and continued its leadership by fortifying its entire line of children’s cereals with calcium and vitamin D in 2008.

General Mills’ 2005 whole grain initiative has been called one of the biggest health initiatives in the food industry. The company committed to ensuring that every Big G cereal would help deliver the benefits of whole grain. As a result, every Big G cereal now provides at least 8 grams of whole grain per serving, with many cereals providing 16 grams of whole grain or more.

Announcing that initiative, General Mills said it would deliver 26 million servings of whole grain every day across America. Today, General Mills’ Big G cereals are delivering 35 million servings of whole grain daily across America. Other companies in the food industry followed with initiatives of their own, and America’s whole grain intake has increased as a result. Ready-to-eat cereal is now the No. 1 source of whole grains in a child’s diet – and whole grain is the number one ingredient in every cereal that General Mills advertises to children.

“Ready-to-eat cereal really is one of the best breakfast choices you could make,” said Susan Crockett, Ph. D, vice president, Health and Nutrition, and director of the Bell Institute of Health and Nutrition at General Mills. “More frequent cereal eaters tend to have healthier body weights – and lower Body Mass Index measures (BMIs). It’s true of men. It’s true of women. It’s true of kids. And that includes people who eat presweetened cereals.”

Ready-to-eat cereal eaters consume less fat, less cholesterol and more fiber than non-cereal eaters. Cereals also deliver important vitamins, minerals and essential nutrients, such as vitamins A, B6, iron, niacin and zinc, making cereal a top source of key nutrients in children’s diets.

“Our first target was to reduce sugar in cereals advertised to children to 12 grams of sugar or less,” explained Harmening. “Many were already lower, but some were not. So we put in place a plan to reduce sugar levels in a series of steps in those cereals and others, while continuing to deliver great taste. As a result, we have already reduced sugar in many cereals, some by as much as 20 percent, and by spring General Mills cereals advertised to children will all have 11 grams of sugar per serving or less.

“Today, we are strengthening our goal,” Harmening added. “We are committing to reduce sugar in cereals advertised to children under 12 to single-digit grams of sugar per serving.”

To ensure the cereals continue to taste great, reductions will continue in a series of smaller steps. “Maintaining great taste while continuing to reduce sugar is a challenge,” noted Harmening. “It requires technology, time and investment. But we’re doing it. We are committed to reaching single-digit levels.”

“General Mills strives to be the health leader in every category in which we compete,” said Harmening, “Big G is going to continue to lead in cereal as well.”

The American Society for Surgery of the Hand (ASSH) Corporate Advisory Council recently gathered in Chicago to create the first ever, ethics guidelines, to be followed by hand surgeons. The ASSH has been an industry leader in developing standards to both embrace the support of industry partners, while also ensuring that such support is accepted without conditions or restrictions.

In 2008, the Corporate Relations Committee was formed by the ASSH Board of Directors (Council) as a means of monitoring and developing clean and ethical relationships. While serving as President of the ASSH at the time, Steven Z. Glickel, MD, conceived the initial concept of a “10 Commandments”. Dr. Glickel, Chair of the Hand Service at Roosevelt Hospital in New York City, believed it was necessary to develop a clearly defined standard to be followed by hand surgeons. In doing so, any appearance of impropriety or the perception that a physician’s ability to independently make decisions regarding the care of a patient, patient would be avoided. William Seitz, Jr., MD., served as the ASSH Commercial Support Chair when Dr. Glickel, conceived the idea. They worked together to make the initial idea, an actual reality. Dr. Seitz, who is at the Cleveland Clinic, is now Chair of the newly formed Corporate Advisory Council. Robert Szabo, MD, (UC Davis) is the current ASSH President and he continues the work to support the initiative. ASSH’s “10 Commandments” will be strictly adhered to by physicians and corporations. L. Andrew Koman, MD, Chair of the Department of Orthopaedics at Wake Forest, was also a key surgeon and President at the time the Corporate Advisory Council held its inaugural meeting.

The following guidelines are also part of the American Foundation for Surgery of the Hand’s (AFSH) commitment to having the highest ethical relationships with the industry in support of hand and upper extremity research. Fred Fakharzadeh, MD, current President of the AFSH, believes these “commandments” will help both industry leaders and surgeons have the kind of relationship that will ultimately benefit patients.

The following 10 Commandments are as follows:

It is the belief of the leadership of the ASSH, that a relationship between medical societies representing physicians and commercial corporations is necessary and beneficial for the future of medicine. It is essential for industry to consult with physicians for their medical expertise. It is also necessary for the medical professionals to rely on industry to support education in order to stay abreast of the latest technology within their chosen field.

In order to avoid any appearance of impropriety or perception that a physician’s ability to independently make decisions regarding the care of the patient has been compromised, we will henceforth strictly adhere to these following guidelines (“our ten commandments”):

• Industry is strongly encouraged to support educational activities to increase knowledge and the skills necessary to improve patient care through the American Society for Surgery of the Hand (ASSH).
• Industry is strongly encouraged to provide support for research through the American Foundation for Surgery of the Hand (AFSH). The subject and content of the research will be determined by the ASSH/AFSH. Corporations will not control the content of supported research.
• The ASSH/AFSH will clearly define research programs and methods of selection of topics and researchers receiving donated funds. The AFSH will provide annual updates to donors on the use of those funds.
• Physicians will be consulted and involved in the development and design of new products as deemed necessary by the device company following a comprehensive review of the specific project requirements as well as the physicians’ credentials, qualifications and expertise on the subject matter by the company.
• Consulting and design activities will be reimbursed by industry at a fair market value on a per-activity or per-time basis. No ASSH members will accept gifts, funding for companion travel, sponsorship of recreational activity, entertainment or sports events.
• ASSH Members and industry will be parties to explicit contracts regarding the scope of service and reimbursement for service.
• ASSH members will not demand or accept unreasonable reimbursement for travel, meals, and lodging, for being involved in an educational activity.
• All funding to support education and research will be controlled by the ASSH and the AFSH.
• Companies will not influence the control of educational or research activities.
• All relationships will be disclosed and readily available to the public.

A newly-released scientific white paper suggests humidifiers may play an important role in reducing the survival of the flu virus on both surfaces and in the air. The research suggests that homes kept at 40-60 percent relative humidity are likely to have fewer flu viruses lingering in the air and on commonly-touched surfaces like sink faucets, door handles, and countertops. By running a humidifier to raise indoor relative humidity levels, the research indicates that flu virus survival in the air and on surfaces can be drastically reduced in households, schools and offices.

Millions of flu particles can linger in the air and on the surfaces we touch day in and day out, from computer keyboards and TV remotes to the kitchen sink or refrigerator door handle. With flu top of mind this year, there has been increased interest by the scientific community in how the flu virus lives, and history may hold the answers.

“After evaluating a number of published peer reviewed studies conducted over the last 70 years, we’ve learned that monitoring and maintaining proper humidity levels in your home to may reduce survival of the flu virus in the air and on surfaces,” said Jim McDevitt, co-author of the report, instructor at the Harvard School of Public Health, and a certified industrial hygienist by the American Board of Industrial Hygiene. “While the typical flu virus can survive on surfaces and in the air for up to 24 hours, the survival time in a more humid environment is markedly lower.”

Indoor heating systems may exacerbate flu survival on surfaces and in the air this winter. Forced air, hot water, and infrared heating all significantly reduce relative humidity levels in a home, office, or school by increasing the temperature of already dry air, thus lowering the relative humidity. The research indicates that in more humid environments, the flu virus survival time is markedly decreased on both surfaces and in the air. The best way to raise indoor relative humidity levels is by running a humidifier. When used according to the manufacturer’s instructions, a humidifier can increase relative humidity above 40 percent.

“Relative humidity is a term used to describe the amount of water vapor that exists in the air and a hygrometer is one such device to measure this,” said Dr. Ted Myatt, Sc.D., senior scientist at consulting firm Environmental Health and Engineering, Inc. and biological safety officer at the Harvard Institute of Medicine in Massachusetts. “It is particularly important to run a humidifier during the winter months when air tends to be colder and drier and when relative humidity levels indoors can reach as low as 20 percent.”

The kids may be sleeping soundly this season with “visions of sugar plums in their heads,” but almost half of the nation’s moms and dads (44%) say they are worried about being able to afford the holidays this year, with one in six Americans (17%) expecting to lose sleep due to holiday-induced stress.

The findings are part of a national year-end survey – the SleepBetter.org Holiday Slumber Index, which measures the impact of the holidays on Americans’ sleep patterns. According to the survey, parents are most susceptible to sleep changes. Two in three (66%) of mothers and fathers, for example, say they will get six or fewer hours of sleep the night before gift-giving. And while 11% of households without kids say that holiday stressors cause them to lose sleep, more than twice as many parents (27%) indicate that this is the case.

“There are many ways that the holidays throw us off our sleep patterns,” said Dan Schecter, vice president of consumer products at Carpenter Co., and creator of SleepBetter.org. “Not only do the anxieties and excitement of the season have an impact on many people’s ability to fall asleep, but added obligations and the added busyness of this time of year mean trying to fit more into our days. And if you’re a parent, there often are not enough hours in the day. Ask most moms and dads what they want for the holidays, and it’s a good bet they have ‘a good night’s sleep’ at the top of their list.”

In fact, when asked what they look forward to most over the holidays, 6% of survey respondents said “sleep and rest,” which nearly tied with “giving/receiving gifts” (7%). (“Being with family” was the most popular response at 77%.) Two in five Americans (43%) say they do get a chance to sleep in over the holidays, while 20% say they typically find time to nap.

Among other findings in the SleepBetter.org Holiday Slumber Index:

• One in five Americans (22%) say they sleep better over the holidays, with almost three times as many women (13%) than men (5%) indicating that they sleep “worse.”
• About half of all respondents (49%) said they get six or fewer hours of sleep the night before gift-giving, but a total of 61% of Midwesterners report getting between seven and 10 hours of sleep on the eve of present exchanges.
• Hispanics are more worried about affording the holidays this year – 46% vs. 35% for the general population.
• While 43% of all respondents say they get to sleep in over the holidays, only 28% of those 55 and older do.

Breast cancer patients, survivors and advocates across the nation celebrated the adoption of an amendment to the U.S. Senate health reform bill by Senator Barbara Mikulski (D-Maryland) that would ensure access to potentially life-saving breast cancer screenings, with no cost sharing for patients. The Susan G. Komen for the Cure® Advocacy Alliance (KAA) supported the amendment’s passage as “a critical safeguard” that will “ensure women have access to potentially life-saving cancer screenings like mammography.”

“In the wake of the recent change in breast cancer screening guidelines by the U.S. Preventive Services Task Force, women all across the country are afraid and confused about whether their access to routine mammograms will be limited,” said Jennifer Luray, president of the Komen Advocacy Alliance. “One-third of women who qualify for screening today are not being screened due to a lack of access, education or awareness. We are concerned that this confusion will drive even more women away from screening.

“As such, the Komen Advocacy Alliance is pleased that the Senate today adopted Senator Mikulski’s amendment, which will allow women access to cancer screenings like mammography at no cost. This is an important step forward that provides essential clarity.

“Senator Mikulski has long been a champion of women’s health and breast cancer. We thank the Senator and her co-sponsors for their leadership on this issue,” said Luray.