Monthly Archives: March 2007

To sleep, perchance to dream: New insight into melatonin production

Contact: Heather Cosel
coselpie@cshl.edu
Cold Spring Harbor Laboratory

In the April 1 issue of G&D, a Korean research team led by Dr. Kyong-Tai Kim (Pohang University) describes how melatonin production is coordinated with the body’s natural sleep/wake cycles.

Melatonin is a hormone produced by the pineal gland in the brain, which helps to regulate our bodies’ circadian rhythm (the roughly-24-hour cycle around which basic physiological processes proceed). Normally, melatonin production is inhibited by light and enhanced by darkness, usually peaking in the middle of the night. Melatonin’s expression pattern is mimicked by a protein called AANAT, which is a key enzyme in the melatonin biosynthesis pathway.

Dr. Kim and colleagues uncovered the mechanism of rhythmic control of AANAT mRNA translation, and thereby melatonin synthesis. The researchers found that rodent AANAT mRNA translation is mediated by IRES (internal ribosome entry site) elements in the 5′ end of the transcript, through binding of another protein, called hnRNP Q. In fact, siRNA knock-down of hnRNP Q reduced AANAT and melatonin production under nocturnal conditions.

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Subgroups of fibromyalgia.

1: Schmerz. 2007 Mar 29; [Epub ahead of print]

[Article in German]
Muller W, Schneider M, Joos T, Hsu HY, Stratz T.
Rheumatologische Forschungsabteilung, Park-Klinik Bad Sackingen, Weihermatten 1 , 79713, Bad Sackingen, Deutschland.

As has been shown by a number of working groups, primary fibromyalgia syndrome does not represent a single clinical entity. It is possible to distinguish between a subgroup with high pain sensitivity and no associated psychiatric condition, a second subgroup characterized by depression and concomitant pain symptoms associated with fibromyalgia syndrome, and a third group with somatoform pain disorder of the fibromyalgia type. Bland inflammatory processes must be considered as the cause in the first group, while depression is the underlying reason for the development of pain in the second group. In the third group, serious previous or still existing psychological problems or also insufficient coping with illness symptoms must be regarded as the reason for pain chronification.Group 1 benefits from a blocking of the 5-HT3 receptors by means of tropisetron, for example. This not only affects pain chronification but also the inflammatory process itself. Group 2 needs antidepressant treatment, whereas the focus should be on psychotherapy is group 3. Groups 1 and 2 will also profit from multimodal physical treatment programs; to a certain extent this applies to group 3 as well. So-called mixed types require a combination of therapeutic measures.

PMID: 17393187 [PubMed - as supplied by publisher]

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Unique partnership produces life-critical 3D structures

Contact: Katarina Sternudd
katarina.sternudd@ki.se
46-852-483-895
Karolinska Institutet

Most diseases are caused by malfunctions in the body’s complex protein machinery. The next generation of drugs will be designed on the basis of 3D protein models that scientists are creating. The Structural Genomics Consortium laboratory at Swedish medical university Karolinska Institutet has now made available the structure of PARP3, the four hundredth structure in this unique project to chart the body’s proteins.

The Structural Genomics Consortium (SGC) is a collaborative project involving scientists in Sweden, Britain and Canada. Since 2004, the SGC has devoted itself to determining the structure of human proteins of particular medical and therapeutic relevance. The four hundredth protein structure PARP3, which today is made freely available to other scientists, can be used in the development of cancer therapies.

“The structural data from the SGC will be a unique resource for accelerating the early phase of drug development projects,” says Jan Lundberg, Executive Vice President Discovery Research at AstraZeneca. “We see great value in this kind of focused and effective work identifying human proteins, and congratulate the SGC on its advances.”

Since the SGC’s goal – to have 386 structures available by June 2007 – has been met by a wide margin, it is also a victory for the unusual partnership between the public and private sectors. The SGC is a charitable organization and publishes the 3D structural models it determines without delay or priority rights for its private or public financers.

“This result wouldn’t have been possible if it had been done by individual research groups focusing on their own special interests,” says Professor Jan Carlstedt-Duke, Dean at Karolinska Institutet. “The dialogue with the scientific community has also ensured that the results come to the benefit of other scientists.”

The structural models are not only powerful tools for drug development, they are also of fundamental importance to our understanding of disease mechanisms and of how proteins operate.

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Karolinska Institutet is one of the leading medical universities in Europe. Through research, education and information, Karolinska Institutet contributes to improving human health. Each year, the Nobel Assembly at Karolinska Institutet awards the Nobel Prize in Physiology or Medicine. For more information, visit ki.se

About the SGC

The Structural Genomics Consortium (SGC) is a not-for-profit organization with laboratories in Oxford, Toronto and Stockholm. The SGC is an instance of a public-private partnership and receives funding from Swedish, British and Canadian sponsors representing both the public and private sectors: Swedish Foundation for Strategic Research, the Knut and Alice Wallenberg Foundation, Swedish Governmental Agency for Innovation Systems, Karolinska Institutet, the Wellcome Trust, GlaxoSmithKline, Canada Foundation for Innovation, Genome Canada through the Ontario Genomics Institute, Ontario Research and Development Challenge Fund, Ontario Innovation Trust and Canadian Institutes of Health Research. The Stockholm laboratory focuses on proteins of significance to diseases such as cancer, inflammation and metabolic diseases. About 25 scientists are involved in the project, which is being led by Johan Weigelt (Chief Scientist) and Pär Nordlund (Scientific Coordinator).

Contact SGC Stockholm:

Chief Scientist Johan Weigelt
Tel: +46 (0)8-524 868 40
Email: johan.weigelt@ki.se

For further information:

SGC Stockholm – sgc.ki.se
SGC Toronto – www.sgc.utoronto.ca
SGC Oxford – www.sgc.ox.ac.uk
World Wide Protein Data Bank – www.wwpdb.org

Download 3D presentation:
ftp://www.sgc.ox.ac.uk/pub/datapacks/SGCStockholm/PARP3A_2pa9_v1_349d.icb

Required software (free):
http://www.molsoft.com/getbrowser.cgi

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Arthritis pain, the brain and the role of emotions

Contact: Amy Molnar
amolnar@wiley.com
John Wiley & Sons, Inc.

Arthritis pain is processed in brain areas concerned with emotions and fear, finds study, indicating target for pain-relieving therapies
How does the brain process the experience of pain? Thanks to advances in neuroimaging, we now know the answer lies in a network of brain structures called the pain matrix. This matrix contains two parallel systems. The medial pain system processes the emotional aspects of pain, including fear and stress, while the lateral system processes the physical sensations—pain’s intensity, location, and duration.

Marked by morning stiffness, joint aches, and flare-ups, the pain of arthritis tends to be acute and recurrent, in contrast to many chronic pain conditions. Arthritis pain therefore makes an ideal model for comparing common clinical pain with experimental pain. Inspired by this observation, researchers at University of Manchester Rheumatic Diseases Centre in the United Kingdom conducted the first study to compare directly the brain areas involved in processing arthritis pain and experimental pain in a group of patients with osteoarthritis (OA). Their results, published in the April 2007 issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/journal/arthritis), shed light on the role of emotions in how patients feel arthritis pain.

The study focused on 12 patients with knee OA—6 women and 6 men, with a mean age of 52 years. All subjects underwent positron emission tomography (PET), to measure and map 18F-fluorodeoxyglucose (FDG) uptake in the brain as an indicator of brain activity. PET scans were performed during three different pain conditions: arthritic knee pain; experimental pain, achieved by heat application; and pain-free. The brain responses to each pain state were then rigorously examined and statistically evaluated and compared for significant differences.

In all OA subjects, both pain conditions activated the entire pain matrix. However, during arthritic pain, activity was increased within the medial pain system of the brain, including most of the cingulate cortex, the thalamus, and the amygdala. This suggests that, for these patients, arthritis pain has more emotional impact—and perhaps stronger associations with fear and distress—than experimental pain. Arthritis pain also prompted heightened activation of the prefrontal cortex and the inferior posterior parietal cortex, areas of the brain instrumental in the supervision of attention. Their activation while suffering arthritis pain may reflect the patients’ concentration on coping strategies.

“The present study demonstrates the importance of the medial pain system during the experience of arthritic pain and suggests that it is a likely target for both pharmacologic and nonpharmacologic interventions,” notes its leading author, Prof. A.K.P. Jones. “Considering the recent concerns about the long-term safety of cyclo-oxygenase inhibitors, we hope that our current findings will stimulate partnerships between academia and the pharmacological industry to develop a new class of analgesics for arthritic pain that specifically target the medial pain system.”

As Prof. Jones acknowledges, the study’s main limitation is its small number of subjects. Larger studies of the relationship between arthritis pain and the medial pain system are critical, particularly for exploring the effect of variables from depression and anxiety to guided imagery, meditation, and other mind-based pain management techniques. “Researchers should be moving toward more naturalistic studies in patients,” Prof. Jones suggests, “in order to fully understand the perception of different types of clinical pain.”
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Article: “Arthritic Pain Is Processed in Brain Areas Concern With Emotions and Fear,” B. Kulkarni, D.E. Bentley, R. Elliott, P.J. Julyan, E. Boger, A. Watson, Y. Boyle, W. El-Deredy, and A.K.P. Jones, Arthritis & Rheumatism, April 2007; (DOI: 10.1002/art.22460).

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Altered cortical excitability in subjectively electrosensitive patients: Results of a pilot study.

1: J Psychosom Res. 2007 Mar;62(3):283-8.

Landgrebe M, Hauser S, Langguth B, Frick U, Hajak G, Eichhammer P.

Department of Psychiatry, Psychosomatics, and Psychotherapy, University of Regensburg, Regensburg, Germany.

OBJECTIVE: Hypersensitivity to electromagnetic fields is frequently claimed to be linked to a variety of unspecific somatic and/or neuropsychological complaints. Whereas provocation studies often failed to demonstrate a causal relationship between electromagnetic field exposure and symptom formation, neurophysiological examinations highlight baseline deviations in people claiming to be electrosensitive. METHODS: To elucidate a potential role of dysfunctional cortical regulations in mediating hypersensitivity to electromagnetic fields, cortical excitability parameters were measured by transcranial magnetic stimulation in subjectively electrosensitive patients (n=23) and two control groups (n=49) differing in their level of unspecific health complaints. RESULTS: Electrosensitive patients showed reduced intracortical facilitation as compared to both control groups, while motor thresholds and intracortical inhibition were unaffected. CONCLUSIONS: This pilot study gives additional evidence that altered central nervous system function may account for symptom manifestation in subjectively electrosensitive patients as has been postulated for several chronic multisymptom illnesses sharing a similar clustering of symptoms.

PMID: 17324677 [PubMed - in process]

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Long-term opioid contract use for chronic pain management in primary care practice. A five year experience.

1: J Gen Intern Med. 2007 Apr;22(4):485-90.

Hariharan J, Lamb GC, Neuner JM.
Division of General Internal Medicine, Medical College of Wisconsin, Froedtert East Clinic Bldg., Suite E4200, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA, jharihar@mcw.edu.

BACKGROUND: The use of opioid medications to manage chronic pain is complex and challenging, especially in primary care settings. Medication contracts are increasingly being used to monitor patient adherence, but little is known about the long-term outcomes of such contracts. OBJECTIVE: To describe the long-term outcomes of a medication contract agreement for patients receiving opioid medications in a primary care setting. DESIGN: Retrospective cohort study. SUBJECTS: All patients placed on a contract for opioid medication between 1998 and 2003 in an academic General Internal Medicine teaching clinic. MEASUREMENTS: Demographics, diagnoses, opiates prescribed, urine drug screens, and reasons for contract cancellation were recorded. The association of physician contract cancellation with patient factors and medication types were examined using the Chi-square test and multivariate logistic regression. RESULTS: A total of 330 patients constituting 4% of the clinic population were placed on contracts during the study period. Seventy percent were on indigent care programs. The majority had low back pain (38%) or fibromyalgia (23%). Contracts were discontinued in 37%. Only 17% were cancelled for substance abuse and noncompliance. Twenty percent discontinued contract voluntarily. Urine toxicology screens were obtained in 42% of patients of whom 38% were positive for illicit substances. CONCLUSIONS: Over 60% of patients adhered to the contract agreement for opioids with a median follow-up of 22.5 months. Our experience provides insight into establishing a systematic approach to opioid administration and monitoring in primary care practices. A more structured drug testing strategy is needed to identify nonadherent patients.

PMID: 17372797 [PubMed - in process]

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Johns Hopkins housing and testing only 256-slice CT scanner in North America

Contact: David March
dmarch1@jhmi.edu
410-955-1534
Johns Hopkins Medical Institutions
Device can image whole hearts or brain and tiny vessels safely
Johns Hopkins Medicine has installed for three months of initial safety and clinical testing a 256-slice computed tomography (CT) scanner, believed to be the world’s most advanced CT imaging software and machinery.

The new 2-metric-ton device – the first of its kind in North America and only the second outside of Japan, where its manufacturer is based – has four times the detector coverage of its immediate predecessor, the 64-CT. It can measure subtle changes in blood flow or minute blockages forming in blood vessels no bigger than the average width of a toothpick (1.5 millimeters) in the heart and brain.

Made by Toshiba, the Aquilion beta 256 is expected to win approval for general clinical use within a year, its makers say. Hopkins is negotiating purchase of the equipment, whose sticker price is more than $1 million.

Johns Hopkins cardiologist João Lima, M.D., who will lead all cardiovascular testing, says the scanner’s strength means it can find the earliest signs of restricted blood flow, long before symptoms appear or an organ becomes permanently damaged.

Lima, an associate professor at The Johns Hopkins University School of Medicine and its Heart Institute, says blockages in arteries, veins or capillaries in any organ can simmer for years, with signs of chest pain, severe fatigue and headache emerging only after the disease has become seriously life-threatening.

The key technological advance of the 256-CT, which looks like a patient table surrounded by a massive, doughnut-shaped metal ring, called a central gantry, is its greater number of detectors, which cover in a single scan four times the area of the 64-CT. Hopkins currently has a 64-slice CT scanner.

According to company descriptions, a single rotation of the device’s X-ray-emitting gantry can image a diameter of 12.8 centimeters (or 5 inches), a slice thick enough to capture most individual organs in one swoop, including the brain and heart, entire joints, and most of the lungs and liver. This is an increase in coverage from 3.2 centimeters per image with the 64-slice, which required several rotations or scans to fully image an organ.

Interventional neuroradiologist Kieran Murphy, M.D., an associate professor of radiology at Hopkins, says he believes that whole-head perfusion imaging scans will be able to find slowed blood flow areas in the brain that are vulnerable to stroke, and with just one scan.

CT imaging consists of X-rays sent through the body to produce digitized signals that can be detected and reconstructed by computers. Each of the 256 detectors on the new machine picks up a “slice” of an organ or tissue. The more detectors, the better is the resolution of the picture. A computer puts all the slices together to render detailed, 3-D images of the heart or brain and surrounding arteries. In some cases, a patient is injected with a contrast solution to increase the visual detail.

Murphy, who is in charge of neurological testing with the scanner, says the expanded coverage is a “tremendous advantage” over older machines, where images had to be matched and stacked, “like reconstructing layers of a marble statue on top of each other over time,” a technologically complex procedure.

Cooling systems, he also notes, will no longer be required to deal with the friction and heat caused by multiple rotations of the gantry, although a cooling system will still be required for the computer hardware. Murphy says the increase in data traffic will range from 5 gigabytes to 10 gigabytes per scan with the 256-CT. With 64-CT, the range is 1gigabyte to 2.5 gigabytes.

However, he does not expect the higher volume of data to slow testing, which is expected to speed up imaging the brain to less than 1 second for the 256-CT, down from 4 or 5 seconds with the 64-CT. Lima says the overall time required for testing the heart will similarly decline to 1 or 2 seconds with the 256-CT, from eight to 10 seconds with the 64-CT.

Lima says the new, faster device will also make it possible to scan patients with arrhythmia, or irregular heartbeats. The 256-CT can acquire a full image in the time it takes for just one beat, whereas the 64-CT takes longer, as much as six or eight heartbeats. Any disturbances between successive beats, he notes, such as those produced in arrhythmia, can lead to distortions in the composite scanned image.

A single scan with the 256-CT device can also perform a full bank of five key diagnostic tests on hearts or single tests in the brain of the most severely ill patients, exposing them to far less radiation, as little as one-eighth to one-third of the dose required in testing with the 64-slice scanner.

Because single scans with the 256-CT should provide a patient’s calcium score, to detect hardening of the arteries, along with blood-flow data and strength of the pulse and heartbeat, it is expected to have value in determining more precisely the best candidates for more invasive procedures, such as cardiac catheterization or catheter angiograms of the brain.
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The new scanner and nine technicians are on loan to Hopkins from Toshiba America Medical Systems Inc. Installation and renovation costs for its temporary installation at Hopkins were also paid for by Toshiba.

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New Consortium Will Develop Computer Systems to Connect Genomic Data With Disease – 2007-03-25

A $20 million grant awarded to a consortium of four research universities including Duke University Medical Center will help scientists collaborate to develop the powerful computing systems and analyses to trace the origins of neurologic disease from alterations in the basic structural information of the human genome to the diseases they produce.

By focusing on mouse models of neurologic disease, scientists at Duke University, University of California at Los Angeles (UCLA), California Institute of Technology (Caltech) and University of California at San Diego (UCSD) hope to make basic discoveries about the genetic basis of neuropsychiatric diseases and drug abuse that will lead to more effective treatments

The project — funded by the National Center for Research Resources (NCRR), a division of the National Institutes of Health — will be known as the Biomedical Informatics Research Network (BIRN).

Construction of the computer infrastructure for the project will be coordinated by scientists at the UCSD Supercomputer Center and will also involve neuroscientists and imaging specialists from the UCSD, UCLA and Caltech in Pasadena, Calif.

Medical researchers have long used mouse models that mimic specific human maladies to decipher the causes of the disease and to test new drugs. But now, said the participating scientists, by harnessing the unique abilities of laboratories at the four institutions, they will soon have a new perspective on a number of important neurological diseases.

“This project will provide the needed infrastructure to allow neuroscientists studying such devastating diseases as Parkinson’s disease and schizophrenia to integrate information ranging in scale from the whole brain down to a single neuron, the functional unit of the brain,” said G. Allan Johnson, director of the Center for In Vivo Microscopy at Duke. “This will lay the foundation enabling neuroscientists throughout the world to bring together imaging abilities and other information required to understand the growing number of mouse models of neurologic diseases.”

The Center for In Vivo Microscopy, which will receive $1.5 million of the project grant, has been funded for 15 years by the NCRR as a National Resource. The center has been a pioneer in the field of magnetic resonance microscopy (MRM), which will be used to examine and evaluate disease processes in a number of mouse models. MRM, the cousin to clinical magnetic resonance imaging (MRI), is founded on the same physical principles.

Through the use of higher field magnets and specialized imaging hardware and software, Johnson’s group has achieved resolution of more that 100,000 times that typical of clinical MRI.

Johnson will serve as principal investigator of one of two subcomponents of the BIRN. He will head the Mouse Brain Imaging Research Network (MBIRN), which will concentrate initially on two critical models of human neurologic disease: the dopamine transporter knockout mouse and a model of experimental allergic encephalomyelitis. A parallel effort within BIRN will allow scientists at multiple sites including Duke to share human MRI data.

“We have chosen to focus on an important mouse model of human disease that has been developed by Marc Caron and his colleagues here at Duke,” Johnson said. “The model has many attributes of the symptoms of schizophrenia and attention deficit disorder as well as symptoms accompanying drug abuse. (MR) microscopy permits accurate 3D comparison of the structural difference between the model and controls in a volumetric fashion not possible with conventional 2D histologic sections.”

Mouse brains imaged at Duke will be sent to Arthur Toga’s National Resource at UCLA were the specimens will be cryosectioned for comparative histopathology. Powerful statistical software developed at UCLA will enable probabilistic alignment and comparison of MRM and histologic sections. Additional specimens will be sent on to Mark Ellisman’s National Resource at UCSD where Ellisman and his colleagues will explore differences at the cellular and subcellular level using confocal microscopy and high voltage electron tomography. A parallel effort that will be undertaken by Russell Jacobs at Caltech will use MR microscopic data from his laboratory at the Beckman Institute in conjunction with data from UCLA and UCSD to explore a model of experimental allergic encephalomyelitis. All the data will be assembled into federated databases using a new approach to knowledge engineering developed at UCSD by Maryann Martone and Ellisman.

By examining the models across scales ranging from the whole brain to the subcellular level, researchers will be able to get a much more comprehensive picture of the models which can then be connected to the human disease.

Using the high-speed Internet 2 network connections among the sites, images can be rapidly incorporated into a set of federated databases, from which three-dimensional images can be extracted and integrated across a wide range of scale. Internet 2 will also support interactive videoconferencing between all of the collaborating scientists. None of this can be accomplished today, although many of the elements of the systems exist, Johnson explained.

“BIRN is the nation’s first test bed for sharing and mining data for both basic and clinical research using the next generation of the Internet,” Johnson said. “It depends on the new computational and networking technologies that have been developed to bring researchers together over the Internet. BIRN is a test of a new mode of doing large scale medical science.”

“We have chosen two very important models of neurologic disease as the drivers to push the collaborative infrastructure,” Johnson continued. “As this infrastructure grows and matures, there is little doubt that BIRN will expand to accommodate a much broader range of neurologic diseases. In the post genomic era, tools such as BIRN will be critical if we hope to effectively correlate the wealth of information required to relate the genome to its expression.” 
 
 Source: Duke University Medical Center
 

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HHS Secretary Leavitt Announces Steps Toward a Future of ‘Personalized Health Care’

WASHINGTON, March 23 /PRNewswire-USNewswire/ — HHS Secretary Mike Leavitt today outlined a course for achieving gene-based medical care combined with health information technology, which he called “Personalized Health Care.” He said the initiative has the potential to transform the quality, safety and value of health care for patients in the future.

“Personalized health care will combine the basic scientific
breakthroughs of the human genome with computer-age ability to exchange and manage data,” Secretary Leavitt said. “Increasingly it will give us the ability to deliver the right treatment to the right patient at the righttime — every time.”

In a speech before the annual meetings of the Personalized Medicine Coalition, at the National Press Club, the Secretary outlined steps already under way to develop the needed information, as well as new steps he is undertaking to build the foundation for personalized health care and ensure that gene-based medical data and health information technology are used
appropriately.

“Every one of us is biologically unique. We’ve always known that, but we haven’t had the knowledge or the tools to deliver health care at that kind of individual level. That’s what’s changing,” Secretary Leavitt said.

Gene-based medicine can help individuals identify their particular
susceptibilities to disease while they are well and take effective
preventive steps. In the future, it will help detect the onset of disease much earlier, enabling treatment to prevent disease progression, and can help bring about medical products that are tailored more precisely to the needs of each individual.

Health information technology, including powerful new tools for
managing vast amounts of information, will be needed both to continue building basic scientific knowledge and to make the new knowledge useable and accessible for patient care.

Secretary Leavitt emphasized how much work remains to build a system that can deliver personalized health care. He has identified this issue as one of his priorities for the next two years.

“The Human Genome Project was a dramatic success, but it has correctly been called a race to the starting line,” he said. “The work that remains is sweeping, from the most fundamental science to the details of health
care practice.”

Secretary Leavitt announced new steps that HHS is taking to lay the foundation for a personalized health care future:

– HHS is engaged in a broad review of the implications for privacy protection as health information technology is increasingly adopted, including needs for genetic information, and the anticipated effect on the confidentiality, privacy and security of individually identifiable health information.

– HHS will review existing structures for ensuring that genetic tests are accurate, valid and useful.  The objective will be to ensure that responsibilities are clearly and appropriately assigned among HHS agencies to support useful genetic testing for patients.

– HHS will develop consistent policies for its agencies regarding access to and security of federally supported research.  The goal will be to ensure open information access for researchers, to support progress, while still rewarding discovery and innovation.

– The President’s budget for 2008 includes $15 million in start-up funding to create a new electronic network that would draw together the nation’s major health data repositories.  This network of networks would enable researchers to match treatments and outcomes, and in that way learn from the nation’s day-to-day medical practice and improve safety and effectiveness of medical treatments.

– The American Health Information Community (AHIC) will develop recommendations to identify health IT standards for including genetic test information on electronic health records.  AHIC is charged with developing recommendations for establishing or identifying consensus standards and for other specific actions toward achieving President Bush’s goal that most Americans have electronic health records by 2014.

Current efforts at HHS agencies supporting personalized health care total $277 million this year, and are proposed to grow to $352 million in FY 2008. Current work at HHS agencies includes:

– At the National Institutes of Health (NIH), genome-wide association studies are using information from years of clinical trials to find associations between genetic elements and health outcomes.  A milestone event is expected this fall when research from the long-running Framingham Heart Study, involving some 10,000 volunteers who have been followed over two generations, may be posted at NIH’s Genotype and Phenotype (dbGaP) Web site.

– At the Food and Drug Administration (FDA), the Critical Path initiative is organizing work across 76 science and regulatory areas to improve product development, especially for gene-oriented drugs and diagnostic tests.  Regulatory guidance on the co-development of drugs and diagnostic products, which is an important stepping stone for gene-based medical care, will be published this fall.

– The Centers for Disease Control and Prevention (CDC) has worked with the National Cancer Institute to define the leading 100 genetic variants of public health significance.  CDC is using its National Health and Nutrition Examination Survey (NHANES), one of the nation’s largest health surveys, to determine how common these variants are in the U.S. population.  Results will be released this summer and will be important for researchers.

“In the future, we’ll understand diseases at a new level,” Secretary Leavitt said. “We’ll know them as gene- or molecular-based diseases. And that will give us new kinds of treatments that will be effective for both the very specific condition and the individual patient.”

More information about the Personalized Health Care initiative is
available at http://www.hhs.gov/myhealthcare.

Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.

SOURCE U.S. Department of Health and Human Services

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Health insurance fails to protect Americans from financial risk

Contact: Nancy Kohn
nkohn@accessproject.org
617-654-9911 x230
Brandeis University

Low premiums do not mean affordable insurance

Boston, MA—Sickness or injury can leave people in serious financial jeopardy even when they have health insurance, according to a report released today by The Access Project and Brandeis University. The Illusion of Coverage: How Health Insurance Fails People When They Get Sick, reports findings based on in-depth interviews with dozens of insured Americans in seven states.

“Widespread debt and access problems among insured people represent major product failure in our private health insurance market,” stated Carol Pryor, Senior Policy Analyst at The Access Project and co-author of the report. “Confusing and complex insurance policies, routine denial of claims that should be paid, and poor customer service plague the insurance industry. These problems call for the establishment of clearer rules and standards of accountability for health insurers.”

“For too many Americans, health insurance fails to protect them from the costs of medical care,” said Jeff Prottas, coauthor and professor at The Heller School for Social Policy and Management at Brandeis. “A large percentage of the insured find themselves with unmanageable burdens of medical debt. This study details the many ways in which health insurance can fail to provide the financial protection people believe they are paying for,” said Prottas.

Key findings from The Illusion of Coverage include:
Shifting more costs of care onto patients through high deductibles, co-insurance, and less comprehensive coverage creates significant health access and financial consequences.

Confusing insurance company policies and procedures leave patients confused, in debt, reluctant to seek health care, and vulnerable to predatory scam products.

Affordability of health insurance must be judged on more than premiums—it is necessary to consider the costs that people will face should they get sick.

The findings in The Illusion of Coverage are consonant with other national research and reports. “The national research data consistently point to the same disturbing trend: more and more insured people face out-of-pocket medical bills that leave them in debt and afraid to go to the doctor and face even more bills,” noted Kathleen Stoll, Health Policy Director from Families USA. “Insured people with medical debt exhibit care-seeking behavior more like the uninsured than the well-insured.”

From Massachusetts to California, states are crafting public policies that rely on private health insurance to achieve universal coverage. As the costs of health care continue to escalate faster than wages and inflation, the question facing policy makers is how to make insurance affordable. “Health plans that keep premiums down by instituting high deductibles and scaled-back coverage don’t address the underlying problem of rising costs. Instead, these plans shift costs onto consumers, leaving them vulnerable to financial and access problems when they need insurance the most,” asserted Pryor.

The Illusion of Coverage outlines policy options to help address the medical debt crisis among the insured:

1. SET STANDARDS FOR WHAT CONSTITUTES COMPREHENSIVE, AFFORDABLE INSURANCE. Standards must include both the range of benefits covered and the out-of-pocket amounts for which consumers are liable.

2. PROVIDE CLEAR INFORMATION THAT ALLOWS PEOPLE TO MAKE INFORMED DECISIONS WHEN PURCHASING HEALTH INSURANCE. For example, insurance companies could be required to provide consumers with standard disclosure forms that clearly detail the services products cover and the out-of-pocket expenses for which consumers are liable.

3. CONDUCT OVERSIGHT TO ENSURE THAT HEALTH INSURANCE PREMIUMS ARE REASONABLE. States should require insurers to file requests for premium increases and hold public hearings on the requests. Requests should be evaluated with respect to insurers’ efficiency and resources.

4. DEVELOP PUBLIC/PRIVATE PARTNERSHIPS TO SHARE COSTS OF QUALITY COVERAGE. Some states have already implemented programs that combine state and private funding to provide comprehensive coverage for groups that could not otherwise afford it.

Nancy Warrington from San Diego, California, has experienced inadequate insurance first-hand. Because her husband’s employer did not offer insurance, the family purchased it on the individual market. The only plan they could afford had a deductible of $2500, which increased to $5000 the next year. “The out of pocket expenses drove us into debt and ruined our credit,” Nancy related. “It is heartbreaking for me to see my husband working so hard for his family, paying for our insurance because it is the right thing to do, only to be buried. It makes even honest, hardworking people like us wonder if it would have been better to not have had insurance in the first place.”
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To view the full report, The Illusion of Coverage: How Health Insurance Fails to Protect People When They Get Sick, visit www.accessproject.org.

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