Approximately 57.2 million people under the age of 65—more than one in five (22.4 percent) of America’s non-elderly population—have a diagnosed pre-existing condition that could lead to a denial of coverage in the individual health insurance market, according to a report released today by the consumer health organization Families USA.

Once the newly-enacted health reform law is implemented, these people will gain significant protections: The new law prohibits insurance companies from denying health coverage to people due to pre-existing conditions; from charging discriminatory premiums based on health status; and from excluding benefits that would treat their health conditions.

The report shows that, while individuals in all age groups have pre-existing health conditions, this is a problem that grows with age:

• Nearly one in six (15.9 percent of) young adults aged 18 to 24 have a diagnosed pre-existing health condition that could lead to a denial of coverage.
• More than one-third (35.3 percent) of adults aged 45 to 54 have a diagnosed pre-existing condition that could lead to a denial of coverage.
• In the 55 to 64 age group, the portion of adults with diagnosed pre-existing conditions climbs to more than two in five (45.5 percent).
• Although the portion of children under 18 years of age with diagnosed pre-existing conditions is low compared to adult groups, there are nearly 5 million children with such conditions.

“The tens of millions of Americans with diagnosed health conditions, and the many others who at some point may receive such a diagnosis, are the people most in need of health care coverage,” said Ron Pollack, Families USA’s Executive Director. “Thankfully, the new health reform legislation will protect all these individuals from the most harmful insurance company abuses that deny such critical coverage.”

In its analysis, Families USA indicated that the 57.2 million number may understate how many people have pre-existing conditions because it only reflects those with diagnosed pre-existing conditions. Americans who are currently uninsured or underinsured, and who cannot afford care, often do not seek treatment and, as a result, their health condition may not be diagnosed.

The uninsured and those who do not have access to job-based coverage are at greatest risk; however, even those who now have coverage at work could be at risk if they lose or leave their jobs and have to find coverage in the individual market.

Income is no protection against an individual’s having a pre-existing condition that could lead to a denial of coverage, and the 57.2 million Americans with diagnosed pre-existing conditions range across all income levels.

• The lowest-income Americans are most likely to have a pre-existing condition. Nearly one-quarter (24.2 percent) of those individuals in families with incomes below 100 percent of the federal poverty level—less than $22,050 for a family of four—are affected.
• Approximately 21.9 percent of individuals in families with incomes between 100 and 199 percent of poverty—between $22,050 and $44,100—are affected.
• While the lowest-income Americans are slightly more likely to be affected by pre-existing conditions, more than two-thirds (69.8 percent) of those with pre-existing conditions that could lead to a denial of coverage are middle class and higher-income Americans. These are individuals in families with incomes above 200 percent of poverty, or more than $44,100 for a family of four in 2010.

Individuals in every racial and ethnic group have diagnosed pre-existing conditions that, absent reform, could lead to a denial of coverage.

• Approximately one-quarter (24.4 percent) of non-Hispanic whites have pre-existing conditions.
• Nearly one-quarter (23.4 percent) of African Americans (non-Hispanic) have such a condition.
• Slightly more than one-quarter (25.9 percent) of American Indians and Alaska Natives are affected.
• More than one in six (16.9 percent) Hispanics are affected. It is important to note, however, that disparities in access to care and in the delivery of care may mean that many individuals have a pre-existing condition that has not been diagnosed. For example, more than a quarter (25.2 percent) of Hispanic adults had no health care visits in 2007, compared to 14.7 percent of non-Hispanic adults.

“As our study shows, more than one-fifth of the non-elderly population will now gain protections that they need to secure affordable health coverage,” said Pollack. “As more and more people learn about these protections, they will no doubt cherish the enactment of health care reform.”

The data for the report were based on data on health conditions from the federal Medical Expenditures Panel Survey and demographic data from the U.S. Census Bureau’s Current Population Survey (CPS). Families USA commissioned The Lewin Group to analyze the data.

Childhood obesity rates have risen drastically over recent years. Experts at The Children’s Hospital in Denver, Colo., cite a variety of reasons for this increase, including the following:

• Portion sizes have nearly tripled in the last 20 to 30 years
• Kids often drink too many sugar-sweetened beverages
• Recess and physical education have drastically decreased in schools
• Kids eat out more than ever before

With so many risk factors prevalent in today’s society, parents are increasingly concerned about making sure their children don’t fall prey to this alarming trend.

According to Renee Porter, obesity clinical nurse coordinator at The Children’s Hospital, to avoid the serious, often lifelong health risks associated with childhood obesity, parents should focus on prevention. “Parents should focus on being positive with regard to making changes in their homes,” says Porter. “The important thing is for families to feel empowered and confident.”

Prevention can take the form of simple lifestyle changes such as the following eight tips offered by The Children’s Hospital:

• Increase parental involvement at school and at home.
  • Know food and exercise policies at your child’s school and try to influence those policies if there is concern.
  • Don’t send young children to school with money for vending machines.
  • Send lunch to school with your child and involve your child in packing that lunch.
  • Prepare food for the week on Sunday nights.
  • Prepare healthy snacks ahead of time. Cut up fruits and vegetables to “grab and go.”
• Keep it predictable. Setting regular schedules for healthy eating and physical activity is important for children, especially young children, because it makes them feel secure, and they are more likely to adopt them as habits.
• Eat the right breakfast. Skipping breakfast leaves children with an empty stomach and low on energy, but eating the wrong breakfast can be just as bad. Children should eat a breakfast high in protein and fiber and low in sugar.
• Eat at home. Eating out exposes children to unhealthy food choices and inappropriate portion sizes. Children who eat at home are more likely to eat fruits and vegetables than children who eat many of their meals at restaurants.
• Keep it small. Children do not need to eat as much as adults, but parents often feed them as though they do. “I often have to remind parents that a two-year-old needs a different portion size than a 15-year-old,” says Porter.
• Lose the soda. Most kids who drink sugar-sweetened beverages will drink an excess of 200 calories a day, calories that are over and above the daily needs of most children. The problem extends beyond soda to include any sugar-sweetened beverage, including fruit juice drinks. Most fruit drinks contain 10 percent juice and 90 percent water and sugar. Unless children drink 100 percent juice, it is no better than drinking soda, as it is all sweetened with sugar.
• Eat your fruit, don’t drink it. Children who drink fruit juice instead of eating a whole piece of fruit often end up consuming more calories. Solid fruit fills children up more than juice.
• Play outside. “Studies have shown that kids who are more fit do better in school,” says Porter. “We advise parents to promote physical activity by encouraging kids to play outside. This can include any activity, like biking or hiking with the family, but can also include simple outdoor exploration. The important thing is that children get at least 60 minutes of physical activity every day. For children more than adults, this is usually divided into many short bursts of activity.”

Nancy Krebs, M.D., director of the clinical nutrition program at The Children’s Hospital, adds, “Parents should be role models with regard to the food choices that are made and provide encouragement to their kids. Children will follow the examples that their parents set.”

U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced that more than $267 million has been awarded to 28 additional non-profit organizations to establish Health Information Technology Regional Extension Centers (RECs). This investment, funded by the American Recovery and Reinvestment Act of 2009, will help grow the emerging health information technology (health IT) industry which is expected to support tens of thousands of jobs ranging from nurses and pharmacy techs to IT technicians and trainers.

RECs enable health care practitioners to reach out to a local resource for technical assistance, guidance, and information on best practices. RECs are designed to address unique community requirements and to support and accelerate provider efforts to become meaningful users of electronic health records.

“Health care in our country is community-based. Today’s awards represent our ongoing commitment to make sure that health providers have the necessary support within their communities to maximize the use of health IT to improve the care they provide to their patients,” said Secretary Sebelius.

This round of awards, bringing the total number of REC’s to 60, will provide nationwide outreach and technical support services to at least 100,000 primary care providers and hospitals within two years. The primary care provider is usually the first medical practitioner contacted by a patient. Studies have also found that primary care providers are at the forefront of practicing preventative medicine, a key to improving population health and reducing overall health costs. More than $375 million had been awarded earlier to RECs under this program.

Additionally, all REC awardees, those announced today and the 32 announced on Feb. 12, 2010, now have an opportunity to apply for a two-year expansion supplemental award. The supplemental awards would ensure that health IT support services are available to over 2,000 of the nation’s critical access hospitals and rural hospitals, both defined as having 50 beds or less. Approximately $25 million is available through this supplemental expansion program.

“Regional extension centers will provide the needed hands-on, field support for all health care providers to advance the rapid adoption and use of health IT. RECs are a vital part of our overall efforts to improve the quality and efficiency of health care through the effective use of health IT,” said Dr. David Blumenthal, national coordinator for health information technology.

Today’s awards are part of the $2 billion effort by the American Recovery and Reinvestment Act of 2009 to achieve widespread meaningful use of health IT and provide use of an electronic health record by every person by the year 2014.

The U.S. Department of Health and Human Services (HHS) announced the release of more than $1.84 billion to ensure that people living with HIV/AIDS continue to have access to life-saving health care and medications. The grants are funded through the Ryan White HIV/AIDS Program, which helps more than half a million individuals every year obtain clinical care, treatment and social support services.

“These grants help ensure Americans, especially those in underserved rural and urban communities, affected by HIV/AIDS get access to the care they need through quality health care and support systems,” Secretary Sebelius said. “The care and services these grants support will help Americans living with HIV/AIDS to live longer, healthier lives.”

The Health Resources and Services Administration (HRSA), an agency within HHS, oversees the Ryan White HIV/AIDS Program, which provides funding for health services for people who lack sufficient health care coverage or financial resources to cope with HIV disease.

Approximately $1.145 billion will be sent to States and Territories under Part B of the Ryan White program, with $800 million of that total designated for the AIDS Drug Assistance Program (ADAP). Part B awards also include formula base grants that can be used for home and community-based services, insurance continuation, ADAP assistance, and other direct services. Sixteen states will also receive Emerging Community grants based on the number of AIDS cases over the most recent 5-year period. For a list of Part B awards, visit http://newsroom.hrsa.gov/releases/2010/partb.htm.

A total of $652 million will pay for primary care and support services for individuals living with HIV/AIDS under Part A of the Ryan White program. Part A awards are distributed to eligible metropolitan areas with the highest number of people living with HIV/AIDS and to transitional grant areas experiencing increases in HIV/AIDS cases and emerging care needs. The Part A awards include $44.8 million for the Minority AIDS Initiative. For a list of Part A awards, visit http://newsroom.hrsa.gov/releases/2010/parta.htm.

More than $48.1 million will fund early intervention services that support medical, nutritional, psychosocial and other treatments for HIV-positive individuals. These grants, awarded under Part C of the program, go to community-based organizations such as health centers and nonprofit providers of primary health care for people living with HIV. Part C grants also may be used to hire case managers to help patients access care and remain in treatment. Additional Part C grants will be awarded this July. For a list of Part C awards, visit http://newsroom.hrsa.gov/releases/2010/partc.htm.

Seventy-five percent of Part A, B and C funds must be spent on “core medical services,” which include outpatient health services, drug assistance, health insurance payments and medical nutrition therapy. The remaining 25 percent pays for support services that help people living with HIV/AIDS achieve desired medical outcomes. These services include but are not limited to respite care, medical transportation and linguistic services.

Despite the uncertainty of health care reform, most U.S. employers say they are continuing to make investments today that will improve the long-term health and productivity of their workforce, according to a new survey by Hewitt Associates, a global human resources consulting and outsourcing company. But while well-intentioned, Hewitt’s survey shows most companies are just beginning to consider and implement the types of strategies, tactics and goals that will create positive and sustainable improvements in employee health and constrain escalating health care costs.

Hewitt’s annual health care trends survey of nearly 600 large U.S. companies representing more than 10 million employees shows that employers’ short- and long-term approaches to health care remain consistent with last year. Almost two-thirds (65 percent) say they currently invest in long-term solutions to improve the overall health and productivity of their workforce while less than a third (32 percent) are primarily focused on controlling their annual health care costs. Just 3 percent reported currently moving away from directly sponsoring health care. When asked about their future approach to health care, more companies (80 percent) plan to focus on improving health and productivity in the next three to five years.

Hewitt’s survey, conducted from December 2009 to January 2010, found that employer concerns regarding rapidly rising health care costs continue to grow. Almost all (95 percent) of companies say managing costs is a top business issue, up slightly from 91 percent in 2009. This concern is not surprising; Hewitt’s research shows that total health care costs¹ have more than doubled in a decade—from $4,793 in 2001 to $11,058 in 2010—and are expected to continue increasing over the next 10 years.

“The harsh reality is that with or without comprehensive health care reform, employers remain on course for having the same or greater cost and employee health problems over the next few years as they have in recent years,” said Jim Winkler, leader of Hewitt’s U.S. Health Care practice. “Employers know they aren’t getting results using traditional approaches and are taking steps to reverse that trend. However, they still have a lot of work to do to get on a path where they’ll see positive, sustainable changes that really move the needle.”

Developing a Health Care Strategy Is Critical

Even with the uncertain health care landscape, Hewitt’s survey shows that fewer than half (42 percent) of employers have a formal policy or strategic health care plan in place, which is consistent with last year. In addition, while 80 percent say offering competitive benefits is a key component of their health care strategy, most indicate managing cost as their top business priority—a clear disconnect between HR benefit goals and overall business objectives.

“Health care is one of the biggest expenditures for a company, yet most organizations don’t have a formal plan that outlines their program’s goals and ties them to business objectives,” said Ken Sperling, leader of Hewitt’s Global Health Care practice. “This makes it easy for companies to revert to traditional, less-sophisticated cost-cutting tactics when things get tough and short-term challenges need to be resolved.”

Laying the Groundwork for the Future

Despite a minority of companies having a formal overall strategy in place, Hewitt’s survey suggests there is a growing recognition among employers that programs and tactics, tailored to an employee’s specific needs, will provide them with the best foundation for future change. These programs and tactics are often built on existing targeted initiatives. For example, disease management and health improvement programs continue to remain a priority for employers. More than half (53 percent) of companies currently have a disease management/health improvement strategy in place. Of those that don’t, 11 percent plan to implement one in 2010 and another 75 percent plan to implement one in the next three to five years.

• Increasing the focus on improving both physical and mental health. While still emerging, there is an increasing interest among employers to incorporate mental health and absence management programs into their health and productivity strategy. Today, just over a third (35 percent) of companies incorporate behavioral health programs (e.g., Employee Assistance Programs and/or targeted networks of mental health specialists) into their strategies, and more than half (58 percent) are planning to do so over the next three to five years. In addition, while less than one in five (19 percent) consider absence management as part of their current health and productivity strategy, 56 percent plan to incorporate it over the next three to five years.
• Using incentives and penalties to encourage participation. To encourage participation in health care programs, more than a half (58 percent) of companies offer incentives to employees and a quarter (24 percent) extend these incentives to spouses and/or family members. The number of companies offering cash incentives for completing a health risk questionnaire almost doubled from last year—from 35 percent in 2009 to 63 percent in 2010. In addition, 37 percent of companies provided cash incentives for participating in health improvement and wellness programs, up from 29 percent in 2009.

Penalties, such as higher benefit premiums or deductibles, are also emerging as a popular tactic. Almost one in five (18 percent) employers already use penalties and another 29 percent say they will use them in the next three to five years. Smoking and failure to participate in disease management programs are the most common behaviors where penalties are deployed.

“It’s important for employers to tie incentives to steps that require actual behavior change,” said Winkler. “Giving a diabetic $100 to complete a health risk questionnaire may identify that diabetic as high risk, but it won’t do much to ensure he/she is taking steps to exercise, eat properly and get preventative care. Employers with programs that require workers to demonstrate these sustainable behaviors before receiving an incentive will have a more meaningful impact than those that base the reward on one-time actions, such as signing up for a disease management program.”

• Considering the diverse workforce. Hewitt’s survey shows that nearly 60 percent of employers say they take the diversity of their workforce into account when they design and communicate their health plans.

“Leading-edge employers are beginning to use this information to understand cultural nuances in the use of health care services as well the role of the extended family in health decisions,” said Sperling. “They can then change their approach to employee communication, how they provide access to on- site services and how they offer family versus individual incentive programs to drive positive behavior change.”

• Measuring success through behavior change. Hewitt’s survey shows that the majority of companies continue to measure the success of their health and productivity programs by how well they manage medical costs (58 percent) or by how well their programs are being utilized (57 percent). Just 19 percent measure employee behavior change and 15 percent measure behavioral modification. However, employers expect to reverse this emphasis in three to five years. More than half (53 percent) say they plan to measure employee behavior change and/or behavioral modification in the next three to five years.

“The way employers intend to measure these programs over the next three to five years are encouraging and shows they are thinking about moving beyond short-term financial tactics,” said Sperling. “Measuring clinical changes in health risk, for example, can help employers gauge whether these programs are actually changing employee behaviors and ultimately leading to longer-term cost mitigation and improved employee health.”

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.

With Plavix’s gurney on the golf course, Cialis’ twin bath tubs and Ambien’s rooster in the office, many drug commercials make for great water cooler conversations but do they translate into more conversations in the physician’s office? And if so, are those conversations positive or negative – improving disease awareness and brand requests, or raising concerns around fair balance statements and side effects?

As pharmas continue to make significant investment in DTC, a recent study from Verilogue revealed that the biggest DTC budgets don’t always result in positive pull-through – or pull-through at all – in the physician’s office. From this analysis, Verilogue derived three key recommendations for how pharmas can convert DTC investment into positive patient-physician interactions.

Tweet this: Verilogue study: Does higher DTC mean better patient pull through? http://bit.ly/1Ns2tk

Verilogue’s analysis tracked brand requests coupled with a reference to specific promotional campaigns across 12,500 doctor-patient conversations from 2008 and covered 20 disease states and 46 different branded prescription medications. Overall, DTC pull-through in conversations in the doctor’s office is low – 3% (n=392) – and specific patient requests for advertised medications are even lower – .002% (n=23). Most significantly, the most frequently pulled-through brands from Verilogue’s database fail to align with the brands with the biggest DTC ad spend:

Brand analysis: How does DTC come up in patient-physician conversations?

Most of the time, DTC is referenced by the physician to try to increase patient acceptance for already-chosen medicines. Unaided (spontaneous) patient mentions or actual patient requests for medication are rarer. Regarding five of the top DTC brand spenders of 2008, here is how their DTC campaigns influenced the doctor-patient conversation:

1) Advair
Patients most often brought up side effect concerns arising from fair balance statements in Advair TV commercials; for instance: “I saw on TV that Advair can cause pneumonia in some patients.”

2) Plavix
Although frequently mentioned and discussed by physicians, Plavix’s DTC campaign was not mentioned by patients in Verilogue’s database.

3) Cymbalta
This is the most mentioned DTC campaign out of the five top spenders. Approximately half of the patients expressed positive sentiment about the ad (e.g. they reflected on other depression symptoms, for instance: “That commercial they have out showing depression and how it affects everything else. It’s not just that person that feels that way. Your whole family that’s around you.”), while the other half expressed negative sentiments (e.g. “No, I don’t want to take Cymbalta. And I don’t like the commercials, and plus I’m on Zoloft and that’s it. I don’t want any more of those drugs.”)

4) Lyrica
The main outcome of the campaign was increased awareness about fibromyalgia in addition to the brand. (e.g. “Do you do a lot of patients with fibromyalgia? That’s how I found about a neurologist when I seen it on TV for that Lyrica. And they sent me some stuff in the mail.”)

5) Ambien
This is the most likely to be requested out of the top five spenders. However, like Advair, patients commonly expressed side effect concerns arising from fair balance statements in Ambien TV commercials, both positive (e.g. “But I saw where it is Ambien that helps you get to sleep and stay asleep. I saw the commercial for it. You think that’s a good one for me?”) and negative (e.g. “Yeah, I saw the commercial. I think it’s, uh, Ambien that says you might go out and eat and not remember. I thought great all I need.”)

DTC Recommendations: How can pharmas get the most bang for their buck?

Verilogue’s study revealed three key recommendations for every pharma in creating effective DTC ads:

1) Validate patient experiences
In order to drive greater patient awareness and more robust, meaningful discussions about a disease, akin to Cymbalta DTC pull-through, pharmas should structure DTC to validate patient experiences with health conditions. Use DTC as a tool to engage patients in constructing the meaning of – rather than simply mirroring experiences with – a health condition. Tactics to support such a strategy might go beyond traditional TV spot advertising to include embedded marketing where health conditions and treatments are woven into the lives of television/film characters, among other relevant tactics.

2) Better prepare physicians for the fair balance fight
While there’s no way around the regulatory mandate for fair balance statements, pharmas can better prepare physicians to address patient side effect concerns arising from DTC promotion. This might include providing physicians with tools (visual aids, stories/narratives, etc.) to put side effects into perspective by couching potential side effects in incidence scales/descriptions or in risk-benefit scenarios.

3) Connect meaningfully with patients
The most frequently pulled-through DTC campaign was Boniva’s “Rally with Sally,” which employed a well-known and trusted “friend” to deliver messages to the targeted middle-aged woman audience. This tactic was markedly different from tactics in other campaigns where messages are delivered by physicians and actors portraying patient family members, for example,“I know [Boniva]. Yes. Sally’s on the commercial.”

Science now offers us ever more advanced ways to understand and control pain. But with those new treatments come new questions about the use (and misuse) of state-of-the-art technology and how far pain management can and should go. Is pain a symptom or a disease? How much pain should be relieved? Can reducing pain be inappropriate or detrimental? Can technologies capable of scanning the brain tell us whether a patient is really experiencing pain? And what questions arise in confronting (and treating) pain in animals and other non-human beings?

On November 13, the Center for Neurotechnology Studies at the Potomac Institute for Policy Studies will present the lecture “From a Neuroscience of Pain to a Neuroethics of Care” by Prof. James Giordano, internationally known for his work on the neuroscience and neuroethics of pain. The program will address the neuroscientific progress achieved during the Congressionally-designated Decade of Pain Control and Research, and discuss the ethical implications of this knowledge for medicine, and society at large. Researchers are now looking ahead to a Decade of the Mind, and this lecture raises questions about whether what we know about pain will both guide and be guided by what we seek to learn about the mind, and the nature of self and others.

What: CCNELSI Lecture: “From a Neuroscience of Pain to a Neuroethics of Care”

Who: James Giordano, Ph.D.

Where: Potomac Institute for Policy Studies, 901 North Stuart Street, Suite 200, Arlington, VA, 22203

When: November 13, 2009, 3:30 – 6:00 pm

More info: www.ccnelsi.com

Autumn has arrived in the northern hemisphere and with shades of yellow and orange comes a less-welcome visitor: cold and flu season. Made worse this year by the H1N1 (swine flu) pandemic, people around the world are flocking to drugstores and supermarkets to stock up on over-the-counter (OTC) medicine, says market research firm Mintel.

Mintel’s Global Market Navigator (GMN) predicts Americans will cough up a total $3.6 billion on cold, cough and throat remedies this year, 1.7% more than during 2008. In Britain, people could fork over an eye-watering £428 million by year’s end, a 4.2% increase over 2008.

Diana Nhan, senior market analyst for Mintel GMN, comments on how swine flu could impact OTC medicine sales this year:

“The US cold, cough and throat remedy market saw a 13.4% spike in sales during 2005, when the avian flu dominated media stories. Already, swine flu has received equivalent media exposure, and many Americans are worried about the virus. I wouldn’t be surprised to see a similar trend-busting increase in US cold, cough and throat remedy sales for 2009 and the early part of 2010.”

In total, Americans will spend more than $32 billion on OTC pharmaceuticals this year, while Britons dedicate £2.6 billion towards alleviating symptoms. The Chinese are expected to spend over ¥58 billion, while Russians bear out cold weather in the name of $3.4 billion. Mintel GMN expects all four countries to see sales increases for OTC medication in 2010.

Americans dedicate more funds towards treating the sniffles than people in the UK, China or Russia. In the US, OTC medicine sales account for 0.22% of GDP, compared to 0.20% in Russia and approximately 0.17% in the UK and China.

As we head into a flu season where the 2009 H1N1 swine flu is expected to cause increased sickness, hospitalization and deaths across the U.S., something as simple as inaccurate body temperature measurements may lead to social and economic turmoil – and may cause many more deaths.

At the same time that reports estimate that half the U.S. population, or greater than 150 million people, may be affected by the flu this season and the Centers for Disease Control (CDC) recommends that people with influenza remains at home until at least 24 hours after they are free of fever, other reports have shown that approximately 40% of thermometer readings overestimate and 20% underestimate body temperature. The result is a perfect storm with 60% of Americans — or 90 million people – receiving the wrong temperature readings during the flu season.

The consequences of these errors in temperature readings could have severe results. It can cause people who are sick to be falsely diagnosed as healthy, further spreading the flu virus. At the same time, healthy individuals can be falsely diagnosed as having fever and “forced” to remain at home. This can have a serious detrimental effect on our entire health care system and the economy as companies face shortages of healthy workers and consumer spending is curtailed.

Just sorting out which patients to treat and which to send home, for example, could strain our healthcare system. A recent report from the nonprofit Trust for America’s Health noted that if 33% of the population caught swine flu, 15 states could run out of hospital beds at the peak of the outbreak.

Businesses can be affected in two ways. Overall productivity will be reduced simply because there are fewer workers, and businesses that rely on customers, such as restaurants, movie theaters, malls and the travel industry, will be affected if more people, possibly millions, are not able – or willing, due to false fever readings – to go out. This will cause a ripple effect throughout the economy.

Children are particularly at risk because of their parent’s dependence on the only objective emergency warning sign, which is fever, according to the CDC. The other signs are subjective and difficult to interpret, such as fast breathing, not drinking enough fluids, bluish color or irritability. Therefore, wrong thermometry jeopardizes children in two ways — lack of detection, which can lead to complications and possibly death; and false fever, which can expose them to the dangers of infections in a medical setting.

In addition, the military could be one of the greatest casualties of incorrect temperature measurements because they live in close quarters where disease can be easily transmitted. This was the case almost 100 years ago when the first wave of what became known as the 1918 flu pandemic appeared in military camps causing an enormous number of deaths.