Tag Archives: Minnesota

New health-related state laws for 2011

Many thanks to Melissa Preddy for pointing out, in a post on the Reynolds Center’s businessjournalism.org, the National Conference of State Legislatures’ roundup of new laws that have already go into effect in 2011, or will soon. It’s a national list loaded with localization-ready ideas and issues that should be surfacing throughout the year. Hot-button topics include expanding medical coverage and several nutrition-related laws.

Here are a few highlights, taken directly from the NCSL’s list.

Connecticut will soon be requiring health insurance policies that cover anticancer medications to cover the oral drugs at least as favorably as it does the IV ones. The law prohibits insurers from reclassifying anticancer medications or increasing the patient’s out-of-pocket costs as a way to comply.

A new Missouri law requires all group health benefit plans to cover the diagnosis and treatment of autism spectrum disorders. Coverage is limited to medically necessary treatment ordered by the insured’s treating physician. The law also requires the Department of Insurance and other institutions to submit a report to the legislature regarding the implementation of this coverage, including specified costs.

California became the first, on Jan. 1, 2010, to prohibit oil, shortening or margarine containing artificial trans fats in restaurants and other food facilities. Beginning Jan 1, 2011, the original law will extend to other foods containing artificial trans fats, primarily baked goods.

Retailers in Minnesota will now be banned from selling cups and bottles intended for children age 3 or younger that contain bisphenol A (BPA). These same restrictions went into effect for in-state manufacturers and wholesalers on Jan. 1, 2010.

California lawmakers have also enacted a new law requiring free drinking water for students in school cafeterias or food service areas. Schools must comply by July 1, 2011.

California will soon require all children under the age of 18, including patrollers and resort employees, to wear helmets while skiing or snowboarding. Resorts will be required to post notice about the law, including on trail maps and resort websites.

Rules for journalists reporting on genetics

It appears that University of Minnesota biologist and blogger PZ Myers has finally seen a few too many “x gene linked to y condition” stories. He snapped, writing that “I just get so annoyed at this tendency for the media to focus on simplistic discrete causes that are split into a black & white nature or nurture false dichotomy.” He also felt compelled to write a few rules for journalists, as scientist-bloggers so often do.

Two of the four rules cover subjects which should be old hat for most AHCJ members, namely “understand science and causality” and “put news and numbers in context,” and it’s not until he focuses specifically on genetics that the list really shines.

For the first rule, he uses a story headlined “Male infertility gene discovered” as a teaching example. The emphasis is mine.

Do not describe genes by the disease they cause when broken. This is a gene that contributes to male fertility. There is no infertility gene. If a man has a missing, damaged, or mutant form of this fertility gene, he may have problems conceiving children.

And, for the final rule, he builds on the basic, well-trod ideas of causality and context to provide a framework for interpreting gene discovery stories.

Learn this simple principle: genes affect how your body responds to environmental factors. Finding an allele associated with a particular physiological state does not mean you have described a cause. We also need to know how that gene acts, what triggers a particular pattern of expression, and what the gene changes in the cell. There are forms of genes that only have deleterious (or advantageous) effects given certain conditions; that effect must be described as a consequence of both the gene and a certain background or environment.

Ethics professor takes on clinical trials, marketing

Writing for Mother Jones, University of Minnesota medical ethics professor Carl Elliott digs into the Dan Markingson story first covered by St. Paul Pioneer Press reporters Jeremy Olson and Paul Tosto. Elliott works at the same institution as the physicians who who administered a Seroquel trial that the 26-year-old was enrolled in when he committed suicide.

Given his teaching field and institution, it’s not surprising that Elliot couldn’t stay away from the Markingson story.

…the more I examined the medical and court records, the more I became convinced that the problem was worse than the Pioneer Press had reported. The danger lies not just in the particular circumstances that led to Dan’s death, but in a system of clinical research that has been thoroughly co-opted by market forces, so that many studies have become little more than covert instruments for promoting drugs. The study in which Dan died starkly illustrates the hazards of market-driven research and the inadequacy of our current oversight system to detect them.

Elliot goes after the idea that the new wave of anti-psychotics was any safer than its predecessors, then explains the clinical trial manipulations he says were used to claim they were.

From there, Elliot takes on the use of clinical trials for marketing purposes. Clinical trials can be dangerous, which is theoretically acceptable if they have the potential to advance medical care. But what if patients are just being exposed to those dangers in an effort to sell more drugs?

Frugal Minnesota splurges on lower backs

For physicians and patients, treating lower back pain is an exercise in restraint and patience. According to federal guidelines, such pain usually resolves itself within six weeks with minimum intervention, so it’s often a matter of resisting the temptation to order a $500 MRI within that time window. And in Minnesota, a state known for its health-care-related moderation, that temptation seems to be too much.

As the Christopher Snowbeck of the St. Paul Pioneer Press reports, Minnesota doctors are worse than the national average when it comes to giving lower back pain patients MRIs without exploring cheaper alternatives. And in the land of Lake Wobegon, being below average is a big deal. The conclusions come from Hospital Compare’s newly released 2008 outcomes data. To learn more about this data, check out AHCJ’s recent conference call on the subject.

For some help reading between the lines of Snowbeck’s story (and the Hospital Compare data), see Gary Schwizter’s recent blog post on the subject; he doesn’t mince words.

The story includes other excuses from local providers along the lines of “the data are outdated…we’ve changed…we’re better now…that can’t be right…it’s not us!” When have you ever seen a story on health care data that didn’t have these predictable reactions? It reminds me of The Tobacco Institute continually rejecting any new finding that showed new harms from smoking. When you don’t like the data, damn the data. For most of the history of medicine we had no outcomes data to show patterns of practice or what happens to people over time. Now that we’re starting to collect some such data, vested interests find that information is a menacing thing.

For more about treatment of back pain, particularly how much money is spent on it, see the just-released “Back Problems: Use and Expenditures for the U.S. Adult Population, 2007” (PDF) from the Agency for Healthcare Research and Quality.

Rise in uncompensated care forces hospital cuts

MinnPost.com‘s Dr. Kay Schwebke reported that uncompensated care — both charity care and bad debt taken on by hospitals to fulfill moral and legal obligations — has climbed at “unprecedented rates” in Minnesota as folks lose insurance through layoffs or employer cutbacks or otherwise can’t afford out-of-pocket expenses and high deductibles.

In Minnesota, uncompensated care made up about 2.1 percent ($247.4 million) of hospital operating expenses in 2007, up from 1.6 percent ($128.7 million) in 2003, and there are indications that those numbers are rising.

Driven in large part by uncompensated care, “net hospital income fell from a positive 4.8 percent in third quarter 2007 to a negative 2.5 percent in third quarter 2008,” Schwebke reported.

Schwebke also looked at what these decreases meant in terms of layoffs, cutbacks and the availability of charity care at the state’s largest hospitals.