Two justices may decide fate of Obama healthcare law

The justices of the U.S. Supreme Court gather for a group portrait in the East Conference Room at the Supreme Court Building in Washington, October 8, 2010. Seated from left to right in front row are: Associate Justice Clarence Thomas, Associate Justice Antonin Scalia, Chief Justice John G. Roberts, Associate Justice Anthony M. Kennedy, Associate Justice Ruth Bader Ginsburg. Standing from left to right in back row are: Associate Justice Sonia Sotomayor, Associate Justice Stephen Breyer, Associate Justice Samuel Alito Jr., and Associate Justice Elena Kagan.

The legal fate of President Barack Obama's signature healthcare law will likely come down to two Republican appointees on the U.S. Supreme Court -- Chief Justice John Roberts and Justice Anthony Kennedy.

That would be a familiar role for Kennedy, a moderate conservative who often has cast the decisive vote on the most contentious issues before the nine-member high court divided between conservative and liberal factions.

A Supreme Court ruling on the healthcare law, adopted by a Democratic-controlled Congress after a bruising political battle, could be a defining moment for Roberts, who was named chief justice in 2005 by Republican President George W. Bush.

"Given the deep ideological divisions over the case and the lack of precedent clearly on point, the court could easily rule either way," Ilya Somin, associate law professor at George Mason University, wrote in a recent blog post.

U.S. appeals courts have issued conflicting rulings on whether Congress exceeded its power under the Constitution when, in adopting the healthcare law in 2010, it required that Americans buy insurance or face a penalty.

The latest decision, handed down on Friday from an Atlanta-based appeals court, struck down that individual mandate provision, making it more likely the Supreme Court will get involved.

University of Richmond assistant law professor Kevin Walsh said the Supreme Court seemed virtually certain to decide the issue by the end of June next year. That would mean a ruling before the U.S. elections in November 2012, with the law seen as a major political issue.

Obama has championed the individual mandate as a major accomplishment of his presidency and as a way to try to slow the soaring costs of healthcare while expanding coverage to more than 30 million Americans without it.

"If the Supreme Court follows existing precedent, existing law, it should be upheld without a problem," Obama said in Minnesota during a town hall discussion. "If the Supreme Court does not follow existing law and precedent, then we'll have to manage that when it happens."

REPUBLICANS CRITICAL

Republican presidential candidates have strongly criticized the law as costly and evidence of intrusive government power.

Legal experts said the court's four liberals, all appointees of Democratic presidents, were likely to uphold the individual mandate. Justices Stephen Breyer and Ruth Bader Ginsburg were appointed by President Bill Clinton while Obama named Justices Sonia Sotomayor and Elena Kagan.

The experts said Justice Clarence Thomas was expected to vote to strike down the mandate, based on his past opinions, and could be joined by fellow conservatives, Justices Antonin Scalia and Samuel Alito. All three were named by Republican presidents.

That would leave Roberts, a conservative who on occasion has refused to join far-right positions taken by Scalia and Thomas, and Kennedy to control the outcome.

Kevin Russell, a Washington lawyer who argues before the Supreme Court and who has followed the healthcare law, said Kennedy has been one of the justices most protective of state power against federal government encroachment.

"If he views the mandate as invading an area of traditional state authority, I think he may be one of the least likely justices to vote to uphold it," Russell said.

Orin Kerr, a George Washington University law professor, predicted Roberts and Kennedy both would likely end up voting to uphold the individual insurance mandate.

He cited an opinion by Kennedy in 1995 and the expansive view that Roberts recently supported of the power of Congress under the Constitution to adopt laws necessary and proper.

Sources: http://www.reuters.com/article/2011/08/15/us-usa-healthcare-analysis-idUSTRE77E5A820110815

More tests not always needed for diagnosis

An EKG technician performs an electrocardiogram on a patient at a hospital in Houston, Texas, July 27, 2009.

Examining patients and taking a medical history are more useful to hospital doctors in diagnosing patients than high-tech scans, according to a study from Israel.

Tests such as CT scans and ultrasounds add to hospital bills, but doctors said that such tests given right after patients showed up in emergency rooms only helped with diagnosis in roughly one of three cases, the study -- published in the Archives of Internal Medicine -- said.

There is also research showing that the radiation from multiple CT scans might increase the risk of cancer over the long term.

To see whether such scans were really helpful, researchers led by Ami Schattner of Kaplan Medical Center in Rehovot, Israel, followed all the patients who showed up at the emergency room of a teaching hospital and were subsequently admitted.

"Basic clinical skills remain a powerful tool, sufficient for achieving an accurate diagnosis in most cases," Schattner and his colleagues wrote.

"Physicians may count more on their clinical faculties when making decisions about patients."

Over about two months, Schattner and his colleagues observed 442 consecutive patients. Each was separately examined by two doctors, a resident and a senior physician, who also asked patients about past health problems.

Both doctors had access to results from all routine tests, including blood and urine analysis, and any extra scans that had been done when the patient first got to the emergency room.

The researchers later looked at how accurate the clinicians were in their decisions, compared to the final diagnoses patients were given during or after their hospitalization. They also asked the doctors what factors they relied on most when diagnosing each patient.

Both clinicians made the correct diagnosis between 80 and 85 percent of the time.

Only about one in six patients had extra testing -- mostly CT scans, usually of the head -- done in the emergency room. The rest just had simple blood, urine or heart tests.

But even for the patients who did have extra scans, the doctors said the results helped to make a diagnosis only about one-third of the time.

Instead, patient history alone or history plus a physical exam were most important to a doctor's correct diagnosis in almost 60 percent of cases. When basic tests were included, they were the basis of more than 90 percent of correct diagnoses along with the history and exam.

"The doctoring process is still a personal communication between the patient and the clinician," said Matthew Sibbald, a cardiologist at the University of Toronto who wasn't involved in the study.

"As much as we want to... rely on the technology, it's not the technology that helps us make a diagnosis," he told Reuters Health.

Sources: http://www.reuters.com/article/2011/08/15/us-tests-idUSTRE77E0DL20110815

Young gay men who use meth may risk HIV

Young gay and bisexual men who use methamphetamine are more likely to take sexual risks that boost their chances of contracting HIV, a new study suggests.
Researchers say the findings underscore the fact that meth, and its associated HIV risk, is not just a problem of middle-aged white men.
Methamphetamine triggers a massive release of the feel-good chemical dopamine in the brain, making users feel disinhibited, energized -- and prone to sexual risk-taking.
Studies of gay and bisexual men have found that roughly 43 percent have ever used meth, and that the habit is strongly linked to their risk of contracting HIV, the virus that causes AIDS.
But much less has been known about meth use and HIV risk among teenagers and young men.
So for the new study, researchers surveyed 595 12- to 24-year-old gay and bisexual males from eight U.S. cities. They found that 31 percent had ever used hard drugs -- one-third of whom had used methamphetamine.
And young men who'd used meth were more likely to report a range of risk factors for HIV.
Nearly 86 percent said they'd had sex with at least two different partners in the past 90 days (versus 63 percent of non-drug users). Almost 52 percent had ever had sex with an injection-drug user (versus 11 percent), and one-third had had sex with someone who was HIV-positive (against 11 percent).
Despite all of that, meth users were less consistent with condoms: one-third said they used them every time they had sex, compared with 54 percent of young men who'd never used hard drugs.
"In many ways, these findings mirror what's been seen in older MSM (men who have sex with men)," said Dr. Robert Garofalo of Children's Memorial Hospital in Chicago.
That's concerning, he told Reuters Health in an interview, and it also points to a large public health need.
"There are not a lot of proven HIV prevention programs for this age group," Garofalo said. More programs, including ones that target meth abuse, need to be piloted, according to Garofalo and his colleagues.
"We shouldn't wait," he said. "This is a real public health crisis."
The findings, which appear in the Archives of Pediatrics & Adolescent Medicine, are not representative of all young gay and bisexual men in the U.S. The researchers recruited their participants from clubs, bars, parks and other urban venues where they might find higher-risk young men.
But the researchers also consider that a strong point of the study.
"It tells us something about where to find these young men, and where we might be able to run some type of intervention," said lead researcher Peter Freeman, who is also with Children's Memorial.
For parents and teenagers, he said, the findings highlight the importance of having open conversations about both drug use and risky sexual behavior.
Garofalo said there still may be many parents who do not know that methamphetamine is something they need to worry about. So the current findings may be something of an eye-opener for some, he added.
Finding effective ways to curb HIV risk among young gay and bisexual men will only become increasingly important, according to Garofalo and Freeman.
In 2004, Americans between the ages of 13 and 24 accounted for 13 percent of new HIV diagnoses.
And gay and bisexual males, especially minorities, have been particularly vulnerable. A study of seven cities by the U.S. Centers for Disease Control and Prevention found that 14 percent of African-American gay and bisexual males ages 15 to 22 had HIV. The same was true of 7 percent of Hispanics.

Sources : http://www.reuters.com/article/2011/08/03/us-gay-men-meth-risk-idUSTRE7726UR20110803

Magnetic field exposure linked to asthma risk

Children whose mothers had high exposure to electromagnetic fields while pregnant may have an increased risk of developing asthma, U.S. researchers said on Monday in a study that adds to an ongoing debate.
Many prior studies have failed to consistently show that chronic exposure to electromagnetic fields -- from power lines and appliances such as microwaves ovens, hair dryers and vacuum cleaners -- are harmful to human health.
But many of these studies required people to estimate their exposure levels over several years, says Dr. De-Kun Li, senior research scientist at the Kaiser Permanente in Oakland, California, whose study appears in Archives of Pediatrics & Adolescent Medicine.
To get a more conclusive answer, Li designed a so-called prospective study in which 801 pregnant women wore monitors that measured their exposure to magnetic fields for 24 hours.
These monitors measured their exposure to low-frequency magnetic fields from electronics such as microwaves, hair dryers, fans, coffee grinders and fluorescent light bulbs, power lines, and transformer stations.
It did not monitor exposure to higher frequency electromagnetic fields generated by cellphones or cellphone towers.
The team used medical records to follow the women's children for 13 years. During the follow-up, 130 children, or 20.8 percent of study participants, developed asthma.
Most of these cases were diagnosed before age 5.
They then compared exposure levels during pregnancy to rates of asthma and found that children whose mothers had the highest exposure levels -- within the top 10 percent of women in the study -- were 3.5 times more likely to develop asthma than those who were in the bottom 10 percent.
The risk for children whose exposure was somewhere in the middle -- between 10 percent and 90 percent -- was 75 percent higher than for those in the lowest exposure group.
For the average population, Li said, children of women whose exposure levels were in the range of the bottom 10 percent in the study would have about a 13.6 percent absolute risk of developing asthma. Women whose exposure was in the highest range would have about a 33 percent risk of having children who developed asthma over the 13 year study period.
Some 13 percent of children under age 18 have asthma, which is caused by malfunction of the respiratory organs and the immune system.
Li said it is not clear why exposure to power lines might increase the risk of asthma, but he said there are several possibilities.
He said a prior study by his team found high exposure to electromagnetic fields increased the risk of miscarriages. And some animal studies have suggested that electromagnetic field exposure can affect immune response, which could increase the risk of asthma.
Exposure to power lines has been fodder for significant debate, and while many studies have found an effect of some sort -- ranging from immune disorders and poor semen quality to certain types of cancers -- Li said his study offers a stronger argument that concerns about magnetic fields may affect human health.
"This really needs to be studied," Li said. He said there have been a lot of dismissive attitudes about the health effects of exposure to magnetic fields, and he hopes his study -- which measured exposure levels ahead of time -- will encourage others to look further.
Still, he concedes that his findings need to be replicated by different scientists.
Li said if the findings are confirmed, it may offer new strategies for preventing the chronic disease in children.

Sources : http://www.reuters.com/article/2011/08/01/us-pregnancy-asthma-idUSTRE77066420110801

Acute-care hospitals to see higher Medicare payments

The U.S. government announced an increase in reimbursement rates to acute-care hospitals for 2012, a sharp contrast to the cut it announced for skilled nursing facilities on Friday.
The Centers for Medicare and Medicaid Services (CMS) increased payment rates to acute-care hospitals by 1 percent, compared with a 0.5 percent cut it had proposed earlier.
The CMS expects the rate increase will result in Medicare's operating payments to acute-care hospitals rising by $1.13 billion, or 1.1 percent.
On Friday, the CMS cut 2012 payments for skilled nursing facilities by 11.1 percent, or $3.87 billion, leading to a sharp decline in shares of Skilled Healthcare, Kindred Healthcare and Sun Health Care.
There was a broad sell-off in healthcare stocks on Monday on fears that the debt-ceiling deal to be voted on by the U.S. Congress would cut healthcare spending for federal programs such as Medicare.
Acute-care hospital operators such as HealthSouth Corp, Kindred Healthcare Inc, Tenet Healthcare Corp and Community Health Systems Inc are expected to benefit from the hike in payment rate.

Sources : http://www.reuters.com/article/2011/08/01/us-acutecarehospitals-idUSTRE77062U20110801

U.S. says insurers must fully cover birth control

A box of Tri-Cyclen Lo birth control medication for women is seen in a pharmacy in Toronto January 31, 2008.

U.S. health insurance companies must fully cover women's birth control and other preventive health care services under Obama administration rules released on Monday.
The mandate from the Health and Human Services Department represents a landmark decision in a decades-long debate on women's health issues that has pitted family planning groups against conservative organizations.
"Under the law, we're making it illegal to charge women more just because of their gender," HHS Secretary Kathleen Sebelius said on Monday.
The guidelines, a product of last year's healthcare overhaul, go into effect on Monday, and require insurers to do away with co-payments on coverage of preventive care services for women in all new plans beginning in August 2012.
The rules largely follow recommendations from a scientific advisory group released last month.
The U.S. Institute of Medicine (IOM) said in a July report that all government-approved birth control methods -- including the "morning-after pill," taken shortly after sexual intercourse to stop a pregnancy -- should be included in the U.S. list of preventive health services.
The newly required coverage also includes free screenings for gestational diabetes, testing for human papillomavirus in women over 30, counseling for HIV and sexually transmitted infections, and screening for domestic violence.
"Today is a historic victory for women's health and women across the country," said Cecile Richards, president of Planned Parenthood Federation of America. "The decision by HHS is monumental for millions of women."
Conservative groups balked at the decision to force private insurers to fully cover birth control. "HHS says the intent of its 'preventive services' mandate is to help 'stop health problems before they start,'" said Cardinal Daniel DiNardo, chairman of the pro-life activities committee at the U.S. Conference of Catholic Bishops. "But pregnancy is not a disease, and children are not a 'health problem.'"
In a nod to conservative groups, the HHS included an amendment to its final rules that would allow religious employees and institutions to choose whether to cover contraception services in their insurance.
MORAL DEBATE
For at least 50 years, religious objections to birth control have made the topic a hot-button social issue in the United States.
In 1965, a Supreme Court ruling ended an era when states could ban the use of contraceptives, arguing that such power violated "the right to marital privacy." In 1972, another case upheld unmarried couples' rights to the use of contraceptives.
Monday's rules mark another turn in the debate and could help put birth control in financial reach for some women.
Many of the bigger employers must include birth control among the services covered by their insurance, but require women to pay part of the price. The HHS guidelines would get rid of the co-pay.
"(Contraception) is not controversial in the lives of women... To an extent, this is not really new, but it's filling in the gaps," said Judy Waxman, vice president for health and reproductive rights at the National Women's Law Center, a non-profit pro-choice education center.
There is some question about how much impact the rule will have on coverage of the "morning-after pill."
The HHS rule requires coverage of contraceptives "as prescribed." Two most commonly used government-approved emergency contraceptives -- "Plan B" from Teva Pharmaceuticals and "Next Choice" from Watson Pharmaceuticals -- are sold over the counter. The only prescription emergency pill is Watson's "ella," approved in 2010.
"It's regulatory sleight of hand on the part of HHS," said Dr. Michele Curtis, an obstetrician and gynecologist at the University of Texas-Houston Medical School.
Still, some women said the government's mandate for full coverage of birth control is a welcome step.
"I'm not on it now, but I took it in my twenties, and it cost a small fortune back then," said 47-year-old Carole Murphy, who was shopping at a local CVS on Monday. "It's good to have the option if you need it."

Sources : http://www.reuters.com/article/2011/08/01/us-usa-health-preventive-idUSTRE7703C420110801

Boys who masturbate likelier to have safe sex?

Masturbation could play an important role in sexual self-awareness and condom use in teenage boys, according to a new report.
Researchers found 86 percent of boys who said they'd worn a condom last time they had sex also reported masturbating over the past year, compared to only 44 percent of boys who didn't masturbate.
While that link doesn't prove that masturbation itself leads to safer sex, "the association of any behavior with increased condom use deserves further investigation, given the rates of unintended pregnancies and sexually transmitted infections in adolescents," the report says.
In 2009, there were nearly 410,000 births to girls aged 15 to 19 in the U.S., where teen motherhood racks up public costs of an estimated $9.1 billion.
The new study, supported by Trojan condom maker Church & Dwight Co, is based on a nationally representative survey of 820 adolescents between 14 and 17 years old.
Dr. Cynthia Robbins at Indiana University in Indianapolis and colleagues found that nearly three-quarters of boys said they masturbated, while less than half of girls did so.
Those kids who masturbated reported having more sex than those who didn't, including oral sex and vaginal intercourse.
After taking age and partner status into account, sexually active boys who masturbated were about eight times as likely to have used a condom during their last intercourse as boys who didn't masturbate.
For unknown reasons, there was no such link for girls.
Writing in the Archives of Pediatrics & Adolescent Medicine, the researchers note that masturbation is a highly stigmatized topic in the U.S., and that many doctors shy away from discussing the common phenomenon.
"The findings of this study together with existing publications on masturbation should be used by health care providers to inform, educate and reassure adolescents about masturbation to provide competent and comprehensive sexuality education in the clinical setting," they conclude.

Sources : http://www.reuters.com/article/2011/08/01/us-masturbate-idUSTRE7705VM20110801

Obama healthcare battle appealed to Supreme Court

A Michigan-based legal group on Wednesday asked the Supreme Court to review and overturn a decision that found President Barack Obama's signature healthcare law constitutional.
In the first of several appeals likely to reach the high court, the Thomas More Law Center said it asked the justices to review a U.S. appeals court ruling last month that Congress had the power to require that Americans buy health insurance.
The group argued in the appeal that Congress exceeded its power under the Commerce Clause of the U.S. Constitution by requiring that Americans either obtain insurance or pay a fine by 2014. It urged the court to strike down that provision.
The appeal was the first challenge of the healthcare law to reach the Supreme Court under its normal procedures. In April, the justices rejected the state of Virginia's request to review the law before an appeals court had ruled.
At least two other appeals courts are considering challenges to the law, including one by Virginia and another by more than half the U.S. states. Once the appeals courts rule, those cases are likely to be appealed to the Supreme Court.
The law, which aims to provide medical coverage to more than 30 million uninsured Americans, has wide ramifications for the health sector, affecting health insurers, drugmakers, device companies and hospitals.
Legal experts have said they expect the Supreme Court to ultimately decide whether it is constitutional, most likely during its upcoming term that begins in October.
The Thomas More Law Center filed its lawsuit on March 23, 2010, the day that Obama signed the law. The lawsuit argued that Congress could not regulate how Americans paid for healthcare services and insurance.
The law is also likely to be a major issue during Obama's re-election campaign and congressional elections.

Sources : http://www.reuters.com/article/2011/07/27/us-usa-healthcare-court-idUSTRE76Q7AB20110727