The Senate Committee on Health, Education, Labor and Pensions decision to postpone a vote on… FDA Acting Commissioner Lester Crawford’s nomination to head the agency was large because of concerns about the agency’s delay in issuing a decision about whether to approve Barr Laboratories’ application for the emergency contraceptive Plan B, Committee Chair Michael Enzi (R-Wyo.) said on Thursday, CQ Today reports. Although Enzi confirmed that he had received a letter from an anonymous FDA employee that included allegations about Crawford, Enzi said the allegations were not the reason for the delayed vote, according to CQ Today. Enzi said the delay is an attempt to allow the committee to discuss various “concerns” about FDA’s decision-making process, CQ Today reports. “The only thing that’s holding up the vote is the pure safety issue,” Enzi said (Schuler, CQ Today, 4/14). Enzi said he hopes the delay will allow the panel to unanimously approve Crawford in the next two weeks, CongressDaily reports (Heil, CongressDaily, 4/15).

Allegations Background
Committee spokesperson Craig Orfield on Wednesday said that Enzi had requested that FDA’s Office of Internal Affairs begin an investigation into allegations made by an anonymous FDA employee. According to Orfield, the FDA employee delivered the allegations to the committee and Enzi forwarded them to the White House (Kaiser Daily Health Policy Report, 4/14). Enzi on Thursday did not give any additional details about the allegations but said that the letter is “badly spelled and badly written” and that he is convinced that the allegations are false, CQ HealthBeat reports (CQ HealthBeat, 4/14). According to congressional staffers, the letter involves allegations about Crawford’s “personal relationship” with a senior female FDA staff member and raises questions about the woman’s “significant promotions,” the Washington Post reports (Kaufman, Washington Post, 4/15).

Plan B Background
Sens. Patty Murray (D-Wash.) and Hillary Rodham Clinton (D-N.Y.) earlier this month said they planned to block a full Senate vote on Crawford’s nomination after a meeting with Crawford and Sen. Edward Kennedy (D-Mass.) that ended without a commitment by Crawford about when FDA would make a decision on Barr’s application. FDA in January expected to rule on a revised version of Barr’s application, which would allow EC to be sold without a doctor’s prescription to women ages 17 and older but be dispensed only with a doctor’s prescription for girls ages 16 and younger. However, the agency in January announced that the decision would be delayed. On March 17, Crawford in a confirmation hearing told the Senate health committee that FDA would approve the application “within weeks.” The agency in May 2004 issued a “not approvable” letter in response to Barr’s original application, which would have allowed Plan B to be sold to any woman without a doctor’s prescription. The agency decision contradicted the recommendations of two agency advisory panels and cited inadequate data on the use of the pills among girls ages 16 and younger (Kaiser Daily Health Policy Report, 4/14).

“Reprinted with permission from kaisernetwork kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

New research led by the University of Cincinnati (UC) suggests that the hunger hormone ghrelin is activated by fats from the foods we eat – not those made in the body – in order to optimize nutrient metabolism and promote the storage of body fat.

The findings, the study’s author says, turn the current model about ghrelin on its head and point to a novel stomach enzyme (GOAT) responsible for the ghrelin activation process that could be targeted in future treatments for metabolic diseases.

The laboratory study, led by Matthias Tsch?¶p, MD, UC associate professor of psychiatry and internal medicine, was published online ahead of print Friday, June 5, 2009, in the journal Nature Medicine.

Ghrelin is a hormone that was believed to accumulate during periods of fasting and is found in the body in high concentrations just before meals. It is dubbed the “hunger hormone” because it has been shown that administration of pharmacological doses acts in the brain to stimulate hunger and increase food intake in animal models and humans.

The ghrelin hormone is unique in that it requires acylation (the addition of a fatty acid) by a specific enzyme (ghrelin O-acyl transferase, or GOAT) for activation. Originally it was assumed that the fatty acids attached to ghrelin by GOAT were produced by the body during fasting.

The new data by Tsch?¶p and his team suggests that the fatty acids needed for ghrelin activation actually come directly from ingested dietary fats. In a departure from an earlier model that was upheld for nearly a decade, Tsch?¶p says, it appears that the ghrelin system is a lipid sensor in the stomach that informs the brain when calories are available – giving the green light to other calorie-consuming processes such as growing.

Tsch?¶p and his team used mouse models to test the effects of over expressing the GOAT enzyme, or “knocking it out.” They found that, when exposed to a lipid-rich diet, mice without GOAT accumulated less fat than normal mice, while those with over-expressed GOAT accumulated more fat mass than normal mice.

“When exposed to certain fatty foods, mice with more GOAT gain more fat,” says Tsch?¶p. “Mice without GOAT gain less fat since their brain does not receive the ‘fats are here, store them’ signal.”

Tsch?¶p says that although his study can’t be immediately extrapolated to humans, recent human studies at the University of Virginia measured (separately) active and inactive ghrelin concentrations. Those studies showed that during fasting, active ghrelin levels were flat, but during the presence of fat from foods, ghrelin levels peaked with meals as previously described. Tsch?¶p says these human studies support the new model for ghrelin.

“Our GOAT studies in mice offer an explanation of what could have been happening during the longer fasting periods in these human studies,” Tsch?¶p adds. “Without dietary fats, ghrelin peaks remain inactive and don’t affect storage of fat.

“We are particularly interested in how ghrelin may be involved in the rapid benefits of gastric bypass surgery,” says Tsch?¶p. “This powerful obesity therapy frequently reduces appetite and improves metabolism before substantial weight loss occurs. Intriguingly, this procedure causes food to bypass the stomach and gut sections that contain GOAT/ghrelin cells, which, based on this newly described model, would prevent ghrelin activation.”

Notes:
The study was supported by the Leibniz Graduate College and by the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases. Co-authors include Paul Pfluger, PhD, and Ronald Jandacek, PhD, both from the University of Cincinnati; Henriette Kirchner, graduate student from the University of Cincinnati and the German Institute of Human Nutrition; Annette Sch??rmann, PhD, and Hans-Georg Joost, MD, PhD, both of the German Institute of Human Nutrition; and Traci Czyzyk, PhD, John Hale, PhD, Mark Heiman, PhD, Jesus Gutierrez, PhD, Patricia Solenberg, PhD, and Jill Willency, PhD, all from Lilly Research Laboratories.

Source:
Dama Kimmon

University of Cincinnati Academic Health Center Continue reading →

Statement attributable to: Tracey Moorhead, President and Chief Executive Officer, DMAA: The Care Continuum Alliance

“Tens of thousands of chronically ill Medicare beneficiaries today face a distressing gap in access to valuable support services for managing their conditions. These beneficiaries, as well as their providers and family caregivers, enthusiastically welcomed these services, as evidenced by participation rates, satisfaction measures and a demonstrated willingness to take important steps toward better health.

“Ending Phase I of Medicare Health Support without ensuring continuity of these services as regulators consider movement toward Phase II will strand the many chronically ill fee-for-service beneficiaries who most need coordinated care. These beneficiaries, among Medicare’s most costly, require and deserve high-quality, targeted care tailored to the extraordinary demands of their conditions.

“Their physicians, likewise, suffer with this decision by CMS. As part of the physician-led care team, Medicare Health Support Organizations provide day-to-day, evidence-based management of chronically ill patients–invaluable support that a busy practice can ill-afford to lose.

“DMAA urges federal regulators to move on an accelerated track toward Phase II and ensure continued provision and expansion of needed chronic care services for our nation’s elderly.

“We also request an expeditious, thorough review of the documented shortcomings of the pilot’s design and execution, including participant selection and randomization. The CMS position that Phase I failed to meet statutory requirements is not supported by last year’s interim report, which found insufficient evidence for any firm conclusion about the pilot’s performance and noted significant disparities between the control and intervention groups and other critical flaws.”

About DMAA: The Care Continuum Alliance

DMAA: The Care Continuum Alliance convenes all stakeholders providing services along the care continuum toward the goal of population health improvement. These care continuum services include strategies such as health and wellness promotion, disease management and care coordination. DMAA: The Care Continuum Alliance promotes the role of population health improvement in raising the quality of care, improving health outcomes and reducing preventable health care costs for people with chronic conditions and those at risk for developing chronic conditions. DMAA: The Care Continuum Alliance represents more than 200 corporate and individual stakeholders, including health plans, disease management organizations, health information technology innovators, employers, physicians, nurses and other health care professionals and researchers and academicians.

DMAA: The Care Continuum Alliance Continue reading →

A recent study found that many parents feel they lack the knowledge to adequately detect symptoms of head injuries in their children. Yet keeping young athletes off the field until they’ve fully healed from a concussion is key to preventing serious and potentially fatal complications.

Sports medicine specialists at Hospital for Special Surgery in New York say there are steps parents can take to identify concussions.

“Symptoms such as headache, dizziness, irritability, difficulty following instructions these are things that parents and coaches should watch out for,” says James J. Kinderknecht, M.D., Sports Medicine and Shoulder Service physician, Hospital for Special Surgery. “If any of these symptoms are evident, the first thing a parent should do is have their child medically evaluated.” Dr. Kinderknecht recently gave a presentation on concussions at the 13th Annual Sports Medicine for the Young Athlete Symposium at Hospital for Special Surgery in New York.

Up to 3.8 million sports- and recreation-related concussions occur in the United States each year, particularly affecting individuals who play high-contact and high-collision sports such as football, soccer, lacrosse and hockey.

While a single concussion cannot necessarily be prevented, what is most important is understanding second-impact syndrome, a condition in which a second head injury, even if less severe, can compound the first. This can occur when an athlete returns to play too quickly, before the initial head injury has healed completely. Young adults under age 25 are especially susceptible a second concussion can lead to a massive brain swell that may be untreatable.

With more than 44 million children and adolescents participating in sports nationwide, Dr. Kinderknecht emphasizes the steps that parents and coaches can take to recognize a concussion and prevent second-impact syndrome:

– In the hours and days immediately following the injury, be on the lookout for headaches, dizziness, mood changes, vomiting or changes in vision or hearing. These can all be symptoms of a concussion.

– Ask specific questions of the athlete, such as what year they were born, or what their address is, to test their awareness and to help determine if they are experiencing confusion.

– If an athlete has any of these symptoms, restrict physical activity until he or she is evaluated by a physician.

– If at first the athlete says he or she doesn’t have symptoms after a significant injury, repeat the same questions a few times that day, and again the next morning to ensure consistency.

– If your child has experienced a concussion, symptoms may disappear before the healing process is completed. Your physician may test your child’s readiness to return to the field by engaging him or her in a non-contact physical activity to start and watching for any remaining symptoms that may not appear when the athlete is at rest.

It is also important to recognize that young athletes may not always be forthcoming in reporting symptoms, especially if they are participating in a highly competitive game and are eager to return to the field.

To minimize the likelihood of head injury in the first place, Dr. Kinderknecht recommends taking the following precautions:

– Ensure the athlete uses proper fitting equipment, especially helmets.

– Coaches of sports such as football should teach safe blocking and tackling techniques that minimize risk of injury.

“I always tell my patients, if it’s a sore knee, it may be alright to try to play,” says Dr. Kinderknecht. “But, you can’t take chances with what may be a brain injury. If there are any symptoms, even mild ones, it is not appropriate to participate. With educated parents and coaches supporting a stringent policy about keeping injured players off the field, we can all worry less about second-impact syndrome.”

Source: Hospital for Special Surgery Continue reading →

In an article published in the March 2010 Archives of Dermatology, researchers report that in the United States, melanoma treatment in late stages of the disease is of significant cost in the population 65 years and older.

The incidence of melanoma has risen dramatically over the years, and older white men have the highest rate of mortality. Epidemiologists say that one in 49 men and one in 73 women are affected in a lifetime, in contrast to one in 1,500 persons in the 1930s. The American Cancer Society reports that melanoma is the sixth most commonly diagnosed cancer in the United States.

“We already know the more quickly melanoma can be detected and treated, the lower the mortality rate,” says Suephy C. Chen, MD, MS, assistant professor in the Department of Dermatology at Emory University School of Medicine, and principal investigator of the study.

“The data from this study help show that early detection is also very important in decreasing the economic burden from melanoma, especially in the older population.”

The researchers gathered data from the Surveillance, Epidemiology and End Results (SEER) – Medicare-linked population-based database for fiscal years 1991-1996 of persons 65 years or older who had late-stage melanoma. Their findings showed that average monthly, per-patient melanoma charges were $2,194 during the initial four months of treatment; dropped to $902 during the interim phase; but increased to $3,933 during the terminal six months of treatment.

The study authors concluded from the data that if all patients were diagnosed and treated in stage 0 or 1, the annual direct costs for the population 65 years or older would be between $99 million and $16 million – 40-65 percent of the current costs of $249 million.

“The US population is aging rapidly,” explains Chen. Routine screening of these individuals to diagnose melanoma before it reaches an advanced stage will not only impact the physical outcome, but could also vastly reduce the financial burden of the disease.”

Other researchers involved in the study are Anne M. Seidler, MD, MBA, and Michelle L. Pennie, MD, Emory Department of Dermatology; Emir Veledar, PhD, Emory Department of Medicine, Division of Cardiology and Steven D. Culler, PhD, Emory Rollins School of Public Health.

The study was funded by a Mentored Patient Oriented Career Development Award from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, and an American Skin Association David Carter Martin Career Development Award.

Reference:
Economic Burden of Melanoma in the Elderly Population, Arch Dermatol/Vol 146 (No. 3) March 2010

Source:
Kathi Baker
Emory University Continue reading →

What: More than 12,000 biological and biomedical scientists will gather for Experimental Biology 2007. This annual meeting, now in its 16th year, brings together scientists from dozens of different disciplines, from laboratory to translational to clinical research, from throughout the United States and the world. The theme of Experimental Biology 2007 is “Today’s Research: Tomorrow’s Health.” Thousands of lectures, symposia, research presentations, career development workshops, and exhibits present the newest scientific concepts and research findings shaping current and future clinical advances.

When: Saturday, April 28 – Wednesday, May 2.

Where: Washington Convention Center, Washington, DC.

Who: Sponsoring societies of Experimental Biology 2007 are: American Association of Anatomists; The American Physiological Society; American Society for Biochemistry and Molecular Biology; American Society for Investigative Pathology; American Society for Nutrition, Inc.; and American Society for Pharmacology and Experimental Therapeutics. Experimental Biology includes these societies’ annual meetings, as well as numerous programs aimed specifically at women, minorities, and students in science. Eighteen U.S. and international guest societies further broaden the scope of the meeting.

Why: Experimental Biology offers an unparalleled opportunity to see medical advances being made. With its unique breadth of scientific disciplines and mix of laboratory scientists and active clinicians, the meeting also provides insight into how good science works. Many thousands of scientific presentations include talks, posters, and symposia, all listed in programs and searchable computer disks before the meeting and in “fast-breaking” announcements made during the meeting itself. All scientific sessions are open to all registered attendees and to members of the press, allowing scientists and journalists to learn from colleagues tackling similar medical problems and other questions from the viewpoint of entirely different disciplines. Also open to all registered attendees and members of the press: an exhibit hall filled with the latest scientific equipment, supplies, and publications.

###

Contact: Sylvia Wrobel

Federation of American Societies for Experimental Biology Continue reading →

House Oversight and Government Reform Committee Chair Henry Waxman (D-Calif.) on Tuesday wrote a letter to acting CMS Administrator Kerry Weems expressing concern for how premium increases for the Medicare prescription drug benefit will affect beneficiaries, CQ HealthBeat reports. According to CQ HealthBeat, Waxman believes that CMS was “misleading” when it stated that during the open enrollment period beginning Nov. 15, beneficiaries would have access to drug plans with lower premiums than the previous year.

In a Sept. 25 statement, CMS said that beneficiaries nationwide would have access to “at least one prescription drug plan with premiums of less than $20 a month” and that “97% of beneficiaries enrolled in a stand-alone prescription drug plan will have access to Medicare drug and health plans in 2009 whose premiums would be the same or less than their coverage in 2008.” According to data gathered by Waxman’s staff, 16.3 million Medicare beneficiaries, including 92% of all drug plan members, will pay higher monthly premiums if they stay with the same plan next year. He also stated that in January 2009, average premiums for the drug benefit will increase by 22%, from $31.15 per month to $38.07 per month.

Waxman said since the beginning of the drug benefit the average Medicare drug plan premium has increased “by almost 50%, costing the average senior an additional $150 annually.” He also noted that 2009 will be the third consecutive year that drug plan premiums have risen above the inflation rate. “These price increases are causing significant hardships, particularly seniors who live on fixed incomes, and who are already faced with rapidly increasing costs for food, gasoline and shelter,” Waxman added.

Waxman requested that CMS provide his panel with information on the cause of premium increases; their effect on the program’s enrollment, costs and beneficiaries; and estimates of increases for 2010 through 2012. He asked that the information be presented by the end of the month.

CMS spokesperson Peter Ashkenaz said the agency is collecting data to respond to Waxman. “We have been telling beneficiaries since August (when we announced the benchmarks) that they will need to compare the value of their current plan by looking at the plan coverage and costs as they enter the open enrollment period,” he said, adding, “Ninety-seven percent of beneficiaries do have access to lower cost options, but as we have said before, they may need to change plans” (Vadala, CQ HealthBeat, 10/16).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation.?  All rights reserved. Continue reading →

Researchers at the University of Cincinnati (UC) have found that fat around the outside of arteries may lead to the development of cardiovascular disease and could be linked to its onset in individuals with diabetes.

David Manka, PhD, a researcher in the division of cardiovascular diseases, and his team found that this fat – known as perivascular adipose tissue – could possibly lead to the formation of fatty buildup inside of arteries and could cause existing buildup to break loose, leading to stroke or heart attack.

These findings are being presented at the American Heart Association’s Russell Ross Memorial Lectureship in Vascular Biology: Emerging Concepts in Vascular Disease on Nov. 16.

“Obesity is a growing problem, but most information that is coming from scientists and clinicians involves visceral adipose tissue – or the beer belly – which leads to a higher risk of cardiovascular disease,” Manka says. “The fat that grows around the larger arteries throughout the body has been largely ignored. With this study, we wanted to see if it had any effect on the onset of cardiovascular disease, particularly in diabetics or those who are at risk.”

Manka and his team transplanted fat tissue around the arteries of knockout mouse models that were predisposed for cardiovascular disease and diabetes.

“Your typical mouse doesn’t naturally have that perivascular adipose tissue outside of the artery,” he explains. “We found that disease and buildup formed right inside of the artery next to the transplanted fat in these mice models. Besides the disease, we found that this fat tissue caused smaller blood vessels to grow around the larger blood vessles, called the vasa vassorum, which we don’t see otherwise. Both of these effects are local effects on the adjacent artery.”

Manka says this is the first time this development has been observed.

“Before this, we didn’t know which came first – the vasa vassorum formation or the fat formation in the arteries,” he says. “If you don’t have the fat outside of the vessel, you won’t have the activation of the vasa vassorum, which is thought to cause fat deposits to rupture, leading to stroke or heart attack. We are trying to establish cause and effect between the vasa vasorum and plaque instability, and now we have the model to test this.”

Manka says these results show that perivascular fat is sensitive to metabolic cues and could be the link between metabolic dysfunction and vascular disease.

“This may be one of the reasons diabetics have increased rates of cardiovascular disease,” he says. “We still don’t know exactly what that link is. The perivascular fat is sensing these metabolic stimuli and is becoming dysfunctional itself, translating to local inflammation of vessel.”

Manka says the next step for researchers is to identify the molecular pathways that are differentially regulated in the various kinds of fat to see which cause disease and which are linked to inflammation.

“We can then try to find ways to target them and stop or reverse the adverse effects of this perivascular fat on vascular disease,” he says. “These findings will help us discover targeted therapies and may lead to quicker diagnosis, impacting the way physicians diagnose and treat cardiovascular disease.”

This study was funded by the National Institutes of Health.

Source:
University of Cincinnati Academic Health Center

Continue reading →

Several neurologically based afflictions, such as Huntington’s, Parkinson’s, and Alzheimer diseases, have been correlated to a higher than normal presence of a specific type of enzymes, called transglutaminases (TGase) in the human body. TGases, whose function is to catalyze covalent bonds among proteins, are commonly found in several different human tissues.

In the presence of unusually high levels of these enzymes, some proteins tend to form denser clusters than normal in vivo. If the aggregates grow in size, it can lead to a build-up of insoluble plaques that can block neurovascular transport and cause neural cell death.

“If higher TGase concentrations in cerebrospinal fluid and in the brain lead to protein agglomeration, then their inhibition could reduce symptoms, delay the onset of agglomeration, and maintain viable neural cell health extending the quality of life for those afflicted,” hypothesizes Brian Love, a professor of materials science and engineering (MSE) at Virginia Tech.

Love, who focuses his research on tissue and cell engineering, and Elena Fernandez Burguera, a post-doctoral research associate, are evaluating specific therapies to fight the abnormally high TGase binding. Based upon the prior work of several others who are conducting clinical trials, Love and Burguera are developing an in vitro model to evaluate the ability of several inhibitors to block protein aggregation by TGases.

Again, based on the work of other scientists, “several compounds show some positive effects,” Love says. These include creatine, cystamine hydrochloride, and a few others. “The development of an inhibition protocol may help test the efficacy of other inhibitors as well,” the engineer adds.

The Virginia Tech researchers are looking at the enzymatic binding of protein-bound polystyrene particles as models. Groups of particles are dispersed in calcium-rich aqueous solutions containing TGases. Once mixed, the particle binding begins. The bigger agglomerates attempt to settle out of the solution, and Love and Burguera track particle sedimentation.

The tracking method, called Z-axis Translating Laser Light Scattering (ZATLLS), is unique to Virginia Tech and based on key concepts in transport phenomena. It has been used to gauge how other complex fluids, such as paints and sealants, are dispersed. Now Love and Burguera are resolving when protein coated particles are effectively dispersed in vitro and under what conditions they are unstable enough to agglomerate.

They track in situ sedimentation of protein-coated particles exposed to transglutaminase, both in the presence of and without transglutaminase inhibitors. “We can use ZATLLS to resolve whether inhibitors prevent agglomeration of protein coated particles by TGase if the inhibitors lower the particle sedimentation velocity,” Love says. “Our goal is to find the safest and most effective inhibitors that prevent the agglomeration-based crosslinking found throughout these neurological disorders.”

This work is funded by the Commonwealth Health Research Board.

Love is a participating member in the School of Biomedical Engineering and Science (SBES), a joint venture between Virginia Tech’s College of Engineering and the Wake Forest University School of Medicine. SBES is the partnership of the two eminent educational institutions. Virginia Tech’s highly acclaimed engineering college has long been the university’s educational centerpiece. Since 1987, when U.S. News & World Report starting ranking the top undergraduate engineering program, and later, the graduate schools, Virginia Tech’s College of Engineering has consistently appeared in the magazine’s listings. And, today, the National Science Foundation lists the College among the top 15 for research expenditures. Wake Forest University Baptist Medical Center gained nearly $10 million in funding from the National Institutes of Health (NIH) for the fiscal year that ended on Sept. 30, 2004, reaching $114,768,124 and ranking 36th overall among 125 American medical schools.

Lynn Nystrom
tansyvt.edu
540-231-4371
Virginia Tech
vtnews.vt.edu Continue reading →

The Philadelphia Inquirer on Tuesday — in the second article of a series titled “Falling Through: Casualties of the Health Insurance Crisis” — examined how people with chronic illnesses face challenges in obtaining affordable health coverage.

The article profiles a small business owner who allowed his health coverage to lapse and then was diagnosed with Crohn’s disease. The man tried to purchase private insurance, but monthly premiums and copayments were unaffordable because of the pre-existing condition and he was forced to pay for treatment out-of-pocket. His children are enrolled in FamilyCare, New Jersey’s version of SCHIP, but he and his wife do not qualify for the program because their income is too high. The man now is in debt and relies on discounts from health care providers, charity care, and skipping or reducing doses of medication to save money on health care (Vitez, Philadelphia Inquirer, 9/30).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation.?  All rights reserved. Continue reading →