Leanne Sullivan

Medicare Cuts May Cause Layoffs

The impending 9.9% cut in the Medicare physician fee schedule is likely to result in staff and infrastructure cutbacks by medical group practices, according to a poll taken by the Medical Group Management Association. Of 613 group practice leaders who responded, more than 41% said they expected that their practices would limit the number of Medicare patients treated, and 19% said they would refuse to accept any new Medicare patients. In addition, almost 45% said they would reduce the number of administrative staff employed by their practice, and 33% said they would reduce the number of clinical staff. Respondents said compensation for both staff and physicians also would probably suffer, with 22% eyeing reduced staff salaries and 57% reducing staff benefits; 59% reported they would likely lower physician pay. Reducing funds for information technology and facilities was favored by 53% and 59% of respondents, respectively. “Unfortunately, it's the patients and employees who staff these facilities that bear the burden of the financial belt-tightening in group practice,” Dr. William Jessee, president and CEO of MGMA, said in a statement.

Partisan Views on Health Reform

While 82% of Democrats agreed that “it is the government's duty to ensure that all Americans have adequate health care coverage,” only 47% of Republicans agreed with that statement, according to a WSJ.com/Harris Interactive online survey of 2,185 adults. And 59% of Republicans think the health care system could be improved by giving tax breaks to those who buy private health insurance, vs. 41% of Democrats, according to the September survey. More Democrats (37%) than Republicans (21%) think the most important issue is providing coverage for the uninsured, and more Republicans (33%) than Democrats (23%) put slowing costs at the top of their list. The survey also showed that more Americans believe the Democratic party can do a good job of reforming the health care system, but that trust is eroding, down to 39% in September 2007 from 50% in February 2007. In the current survey, only 26% trusted the Republican party to reform health care, down from 28% in February. Most Democrats (70%) think that of the current front-running presidential candidates, Sen. Hillary Clinton (D-N.Y.) is the most likely to be able to improve the health care system; Republicans (48%) think that former New York City mayor Rudolph Guiliani can do the job.

Social Programs Eat Federal Funds

Social Security, Medicare, and Medicaid combined take up almost half of the federal government's nondefense, nonintelligence spending in 2005, according to the latest edition of the Census Bureau's Consolidated Federal Funds Report, which details government spending at the state and county level. Of the $2.3 trillion spent that year on direct expenditures, grants, contracts, loans, disability, insurance, and salaries and wages, almost $1.1 trillion went to the entitlement programs, with Social Security spending around $568 billion, Medicare around $336 billion, and Medicaid around $192 billion. Total spending was 6% higher than in 2004. Per capita federal spending was highest in Alaska, Virginia, and Maryland. The report can be accessed at

www.census.gov

Put Health Records in the Vault

Microsoft has launched HealthVault, a Web site where consumers can post and maintain their personal health records. Individuals can input their health and medical data on the free site and give permission for their health care providers to access it. The site can accept scanned copies of faxed and paper records, as well as images such as x-rays and CT scans sent by health care providers. HealthVault also allows users to find health information on the Internet and keep it for future reference. Although use of the site is free for consumers, the company will sell sponsored links and advertisements. In response to privacy concerns, Dr. Deborah Peel of the Patient Privacy Rights Foundation, who advised Microsoft on privacy protections, said in a statement that individuals' “personal health information will not be data-mined, because they alone control it.” Microsoft is also working with organizations including the American Heart Association, Johnson & Johnson, and the Mayo Clinic to build consumer-targeted Web services compatible with their HealthVault platform.

Medicare Plans Resume Marketing

All seven of the private fee-for-service Medicare plans that voluntarily suspended marketing last summer (INTERNAL MEDICINE NEWS, Sept. 1, p. 50) have been found to be compliant with Centers for Medicare and Medicaid Services requirements and may resume marketing activities for the 2008 benefit year, the agency announced. CMS officials expressed concern over the summer that insurance brokers and agents were engaging in deceptive practices, such as telling beneficiaries that private fee-for-service plans are accepted by all Medicare providers. A comprehensive review of the plans conducted by CMS has verified that “vast improvements to their internal controls and oversight processes” have been made. The agency also announced that it has beefed up its oversight procedures, including requiring specific disclaimer language in enrollee materials. “We believe the new requirements and compliance plans build a system that is designed to prevent marketing violations,” CMS Acting Administrator Kerry Weems said in a statement. The seven plans are UnitedHealth Group, Blue Cross Blue Shield of Tennessee, Humana, Sterling, WellCare, Coventry, and Universal American Financial Corp.

Medicare Cuts May Cause Layoffs

The impending 9.9% cut in the Medicare physician fee schedule is likely to result in staff and infrastructure cutbacks by medical group practices, according to a poll taken by the Medical Group Management Association. Of 613 group practice leaders who responded, more than 41% said they expected that their practices would limit the number of Medicare patients treated, and 19% said they would refuse to accept any new Medicare patients. In addition, almost 45% said they would reduce the number of administrative staff employed by their practice, and 33% said they would reduce the number of clinical staff. Respondents said compensation for both staff and physicians also would probably suffer, with 22% eyeing reduced staff salaries and 57% reducing staff benefits; 59% reported they would likely lower physician pay. Reducing funds for information technology and facilities was favored by 53% and 59% of respondents, respectively. “Unfortunately, it's the patients and employees who staff these facilities that bear the burden of the financial belt-tightening in group practice,” Dr. William Jessee, president and CEO of MGMA, said in a statement.

Partisan Views on Health Reform

While 82% of Democrats agreed that “it is the government's duty to ensure that all Americans have adequate health care coverage,” only 47% of Republicans agreed with that statement, according to a WSJ.com/Harris Interactive online survey of 2,185 adults. And 59% of Republicans think the health care system could be improved by giving tax breaks to those who buy private health insurance, vs. 41% of Democrats, according to the September survey. More Democrats (37%) than Republicans (21%) think the most important issue is providing coverage for the uninsured, and more Republicans (33%) than Democrats (23%) put slowing costs at the top of their list. The survey also showed that more Americans believe the Democratic party can do a good job of reforming the health care system, but that trust is eroding, down to 39% in September 2007 from 50% in February 2007. In the current survey, only 26% trusted the Republican party to reform health care, down from 28% in February. Most Democrats (70%) think that of the current front-running presidential candidates, Sen. Hillary Clinton (D-N.Y.) is the most likely to be able to improve the health care system; Republicans (48%) think that former New York City mayor Rudolph Guiliani can do the job.

Social Programs Eat Federal Funds

Social Security, Medicare, and Medicaid combined take up almost half of the federal government's nondefense, nonintelligence spending in 2005, according to the latest edition of the Census Bureau's Consolidated Federal Funds Report, which details government spending at the state and county level. Of the $2.3 trillion spent that year on direct expenditures, grants, contracts, loans, disability, insurance, and salaries and wages, almost $1.1 trillion went to the entitlement programs, with Social Security spending around $568 billion, Medicare around $336 billion, and Medicaid around $192 billion. Total spending was 6% higher than in 2004. Per capita federal spending was highest in Alaska, Virginia, and Maryland. The report can be accessed at

www.census.gov

Put Health Records in the Vault

Microsoft has launched HealthVault, a Web site where consumers can post and maintain their personal health records. Individuals can input their health and medical data on the free site and give permission for their health care providers to access it. The site can accept scanned copies of faxed and paper records, as well as images such as x-rays and CT scans sent by health care providers. HealthVault also allows users to find health information on the Internet and keep it for future reference. Although use of the site is free for consumers, the company will sell sponsored links and advertisements. In response to privacy concerns, Dr. Deborah Peel of the Patient Privacy Rights Foundation, who advised Microsoft on privacy protections, said in a statement that individuals' “personal health information will not be data-mined, because they alone control it.” Microsoft is also working with organizations including the American Heart Association, Johnson & Johnson, and the Mayo Clinic to build consumer-targeted Web services compatible with their HealthVault platform.

Medicare Plans Resume Marketing

All seven of the private fee-for-service Medicare plans that voluntarily suspended marketing last summer (INTERNAL MEDICINE NEWS, Sept. 1, p. 50) have been found to be compliant with Centers for Medicare and Medicaid Services requirements and may resume marketing activities for the 2008 benefit year, the agency announced. CMS officials expressed concern over the summer that insurance brokers and agents were engaging in deceptive practices, such as telling beneficiaries that private fee-for-service plans are accepted by all Medicare providers. A comprehensive review of the plans conducted by CMS has verified that “vast improvements to their internal controls and oversight processes” have been made. The agency also announced that it has beefed up its oversight procedures, including requiring specific disclaimer language in enrollee materials. “We believe the new requirements and compliance plans build a system that is designed to prevent marketing violations,” CMS Acting Administrator Kerry Weems said in a statement. The seven plans are UnitedHealth Group, Blue Cross Blue Shield of Tennessee, Humana, Sterling, WellCare, Coventry, and Universal American Financial Corp.

Medicare Cuts May Cause Layoffs

The impending 9.9% cut in the Medicare physician fee schedule is likely to result in staff and infrastructure cutbacks by medical group practices, according to a poll taken by the Medical Group Management Association. Of 613 group practice leaders who responded, more than 41% said they expected that their practices would limit the number of Medicare patients treated, and 19% said they would refuse to accept any new Medicare patients. In addition, almost 45% said they would reduce the number of administrative staff employed by their practice, and 33% said they would reduce the number of clinical staff. Respondents said compensation for both staff and physicians also would probably suffer, with 22% eyeing reduced staff salaries and 57% reducing staff benefits; 59% reported they would likely lower physician pay. Reducing funds for information technology and facilities was favored by 53% and 59% of respondents, respectively. “Unfortunately, it's the patients and employees who staff these facilities that bear the burden of the financial belt-tightening in group practice,” Dr. William Jessee, president and CEO of MGMA, said in a statement.

Partisan Views on Health Reform

While 82% of Democrats agreed that “it is the government's duty to ensure that all Americans have adequate health care coverage,” only 47% of Republicans agreed with that statement, according to a WSJ.com/Harris Interactive online survey of 2,185 adults. And 59% of Republicans think the health care system could be improved by giving tax breaks to those who buy private health insurance, vs. 41% of Democrats, according to the September survey. More Democrats (37%) than Republicans (21%) think the most important issue is providing coverage for the uninsured, and more Republicans (33%) than Democrats (23%) put slowing costs at the top of their list. The survey also showed that more Americans believe the Democratic party can do a good job of reforming the health care system, but that trust is eroding, down to 39% in September 2007 from 50% in February 2007. In the current survey, only 26% trusted the Republican party to reform health care, down from 28% in February. Most Democrats (70%) think that of the current front-running presidential candidates, Sen. Hillary Clinton (D-N.Y.) is the most likely to be able to improve the health care system; Republicans (48%) think that former New York City mayor Rudolph Guiliani can do the job.

Social Programs Eat Federal Funds

Social Security, Medicare, and Medicaid combined take up almost half of the federal government's nondefense, nonintelligence spending in 2005, according to the latest edition of the Census Bureau's Consolidated Federal Funds Report, which details government spending at the state and county level. Of the $2.3 trillion spent that year on direct expenditures, grants, contracts, loans, disability, insurance, and salaries and wages, almost $1.1 trillion went to the entitlement programs, with Social Security spending around $568 billion, Medicare around $336 billion, and Medicaid around $192 billion. Total spending was 6% higher than in 2004. Per capita federal spending was highest in Alaska, Virginia, and Maryland. The report can be accessed at

www.census.gov

Put Health Records in the Vault

Microsoft has launched HealthVault, a Web site where consumers can post and maintain their personal health records. Individuals can input their health and medical data on the free site and give permission for their health care providers to access it. The site can accept scanned copies of faxed and paper records, as well as images such as x-rays and CT scans sent by health care providers. HealthVault also allows users to find health information on the Internet and keep it for future reference. Although use of the site is free for consumers, the company will sell sponsored links and advertisements. In response to privacy concerns, Dr. Deborah Peel of the Patient Privacy Rights Foundation, who advised Microsoft on privacy protections, said in a statement that individuals' “personal health information will not be data-mined, because they alone control it.” Microsoft is also working with organizations including the American Heart Association, Johnson & Johnson, and the Mayo Clinic to build consumer-targeted Web services compatible with their HealthVault platform.

Medicare Plans Resume Marketing

All seven of the private fee-for-service Medicare plans that voluntarily suspended marketing last summer (INTERNAL MEDICINE NEWS, Sept. 1, p. 50) have been found to be compliant with Centers for Medicare and Medicaid Services requirements and may resume marketing activities for the 2008 benefit year, the agency announced. CMS officials expressed concern over the summer that insurance brokers and agents were engaging in deceptive practices, such as telling beneficiaries that private fee-for-service plans are accepted by all Medicare providers. A comprehensive review of the plans conducted by CMS has verified that “vast improvements to their internal controls and oversight processes” have been made. The agency also announced that it has beefed up its oversight procedures, including requiring specific disclaimer language in enrollee materials. “We believe the new requirements and compliance plans build a system that is designed to prevent marketing violations,” CMS Acting Administrator Kerry Weems said in a statement. The seven plans are UnitedHealth Group, Blue Cross Blue Shield of Tennessee, Humana, Sterling, WellCare, Coventry, and Universal American Financial Corp.

Lawmakers OK Rx Rule Delay

Coming down to the wire on a new federal mandate requiring the use of tamper-resistant prescription pads for all Medicaid prescriptions beginning Oct. 1, lawmakers in the House and the Senate passed legislation in late September that would delay the mandate's start until March 31, 2008. At press time, President Bush was expected to sign the legislation, although it was not clear whether he would sign it by Oct. 1, National Community Pharmacists Association spokesman John Norton told this newspaper. The delay was bundled with extensions on several programs due to expire Sept. 30, including an abstinence education initiative that the Bush administration supports, Mr. Norton said. The original mandate, passed as part of war funding legislation earlier this year, requires all Medicaid prescriptions to be written on “tamper resistant” paper to be eligible for federal reimbursement. Even though many states have similar requirements, pharmacists' organizations have maintained that most physicians do not currently use these types of pads, nor are supplies readily available.

Insurance Premium Increase Slows

Employer-sponsored health insurance premiums rose on average 6.1% in 2007, reflecting a continuing slowdown in premium increases. The 2007 premium increase is the smallest hike since 1999, according to an employer survey by the Kaiser Family Foundation and the Health Research and Educational Trust. But experts say the slowdown is likely temporary and isn't providing relief to individuals or employers. In fact, the 6.1% increase is higher than the average increase in wages (3.7%) and in the overall inflation rate (2.6%). In 2007, the average premium for family coverage in the United States is $12,106, with workers paying about $3,281 for their share of the policy. The market continues to be dominated by preferred provider organizations, which insure about 57% of covered workers; consumer-driven plans account for only about 5%. For details, visit

www.kff.org/insurance/7672

N.J. Task Force Examines MD Gifts

The New Jersey Attorney General's Advisory Task Force on Physician Compensation, which met for the first time in September, is examining the potential impact of payments and gifts to physicians from the drug and device industry. The task force will also consider possible public disclosure of gifts, direct disclosure to patients, and limits on payments to physicians. Vermont, Maine, Minnesota, West Virginia, and the District of Columbia have passed laws requiring some form of reporting of payments made to physicians by pharmaceutical and medical device companies. In response to the formation of the task force, the Pharmaceutical Research and Manufacturers of America issued a statement citing its 2002 Code on Interactions with Healthcare Professionals as an important safeguard. The code declares all forms of entertainment to be inappropriate and says that any gifts given to physicians should support medical practice and be valued at less than $100.

Taxing Health Benefits

Proposals to cap the tax deductions employers and employees can take regarding health insurance could spell the end of employer-based health benefits, according to a new report from the Employee Benefit Research Institute. Under the current system, employers are allowed to deduct the cost of the health insurance coverage they provide to their workers with no limits and workers are not taxed on the value of the health coverage they receive. Capping these tax exclusions could cause young, healthy workers to seek insurance outside of their employers' offering, leaving the employer based pool with an older, sicker group of patients, the EBRI report said. The organization also examined the potential effect of offering tax credits as a way to reduce the number of uninsured Americans. But even a sizable tax credit is unlikely to be enough to offset the high costs of health insurance, the report noted. The full report is available online at

www.ebri.org

One-Third of Americans Uninsured

According to a September report by Families USA, almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from about 30% in 1999–2000. Of these, 19% were uninsured for the entire period and 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million individuals who lacked health care coverage, 71% were employed full time and another nearly 9% were working part time; only 17% were unemployed. The states with the highest percentage of uninsured residents under the age of 65 were Texas (46%), New Mexico (44%), and Arizona (42%). The numbers in the report are substantially larger than those published by the U.S. Census Bureau (which cites 47 million uninsured in 2006, or 16%), because Census Bureau statistics include only those who were uninsured for a full year. The report is available at

www.familiesusa.org

Required Audits of Limited Value

The Centers for Medicare and Medicaid Services did not meet the audit requirement for private insurers participating in Medicare for the contract years 2001–2005, nor did it attempt to recover overpayments to the insurers that should have been channeled back to the beneficiaries and government, according a report by the Government Accountability Office. The Balanced Budget Act of 1997 required the CMS to conduct annual audits of at least one-third of the participating insurers. During 2001–2005, between 19% and 23% of organizations were audited, and only 14% were audited in 2006. In 2003, 49 of 220 participating plans were audited; a contractor identified errors for 41 of those, which would have translated into $59 million that could have covered additional benefits or offset costs for beneficiaries. The CMS claimed that it does not have legal authority to pursue such financial recoveries, but the GAO asserted that the CMS has the authority but did not exercise it.

ELSEVIER GLOBAL MEDICAL NEWS

Lawmakers OK Rx Rule Delay

Coming down to the wire on a new federal mandate requiring the use of tamper-resistant prescription pads for all Medicaid prescriptions beginning Oct. 1, lawmakers in the House and the Senate passed legislation in late September that would delay the mandate's start until March 31, 2008. At press time, President Bush was expected to sign the legislation, although it was not clear whether he would sign it by Oct. 1, National Community Pharmacists Association spokesman John Norton told this newspaper. The delay was bundled with extensions on several programs due to expire Sept. 30, including an abstinence education initiative that the Bush administration supports, Mr. Norton said. The original mandate, passed as part of war funding legislation earlier this year, requires all Medicaid prescriptions to be written on “tamper resistant” paper to be eligible for federal reimbursement. Even though many states have similar requirements, pharmacists' organizations have maintained that most physicians do not currently use these types of pads, nor are supplies readily available.

Insurance Premium Increase Slows

Employer-sponsored health insurance premiums rose on average 6.1% in 2007, reflecting a continuing slowdown in premium increases. The 2007 premium increase is the smallest hike since 1999, according to an employer survey by the Kaiser Family Foundation and the Health Research and Educational Trust. But experts say the slowdown is likely temporary and isn't providing relief to individuals or employers. In fact, the 6.1% increase is higher than the average increase in wages (3.7%) and in the overall inflation rate (2.6%). In 2007, the average premium for family coverage in the United States is $12,106, with workers paying about $3,281 for their share of the policy. The market continues to be dominated by preferred provider organizations, which insure about 57% of covered workers; consumer-driven plans account for only about 5%. For details, visit

www.kff.org/insurance/7672

N.J. Task Force Examines MD Gifts

The New Jersey Attorney General's Advisory Task Force on Physician Compensation, which met for the first time in September, is examining the potential impact of payments and gifts to physicians from the drug and device industry. The task force will also consider possible public disclosure of gifts, direct disclosure to patients, and limits on payments to physicians. Vermont, Maine, Minnesota, West Virginia, and the District of Columbia have passed laws requiring some form of reporting of payments made to physicians by pharmaceutical and medical device companies. In response to the formation of the task force, the Pharmaceutical Research and Manufacturers of America issued a statement citing its 2002 Code on Interactions with Healthcare Professionals as an important safeguard. The code declares all forms of entertainment to be inappropriate and says that any gifts given to physicians should support medical practice and be valued at less than $100.

Taxing Health Benefits

Proposals to cap the tax deductions employers and employees can take regarding health insurance could spell the end of employer-based health benefits, according to a new report from the Employee Benefit Research Institute. Under the current system, employers are allowed to deduct the cost of the health insurance coverage they provide to their workers with no limits and workers are not taxed on the value of the health coverage they receive. Capping these tax exclusions could cause young, healthy workers to seek insurance outside of their employers' offering, leaving the employer based pool with an older, sicker group of patients, the EBRI report said. The organization also examined the potential effect of offering tax credits as a way to reduce the number of uninsured Americans. But even a sizable tax credit is unlikely to be enough to offset the high costs of health insurance, the report noted. The full report is available online at

www.ebri.org

One-Third of Americans Uninsured

According to a September report by Families USA, almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from about 30% in 1999–2000. Of these, 19% were uninsured for the entire period and 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million individuals who lacked health care coverage, 71% were employed full time and another nearly 9% were working part time; only 17% were unemployed. The states with the highest percentage of uninsured residents under the age of 65 were Texas (46%), New Mexico (44%), and Arizona (42%). The numbers in the report are substantially larger than those published by the U.S. Census Bureau (which cites 47 million uninsured in 2006, or 16%), because Census Bureau statistics include only those who were uninsured for a full year. The report is available at

www.familiesusa.org

Required Audits of Limited Value

The Centers for Medicare and Medicaid Services did not meet the audit requirement for private insurers participating in Medicare for the contract years 2001–2005, nor did it attempt to recover overpayments to the insurers that should have been channeled back to the beneficiaries and government, according a report by the Government Accountability Office. The Balanced Budget Act of 1997 required the CMS to conduct annual audits of at least one-third of the participating insurers. During 2001–2005, between 19% and 23% of organizations were audited, and only 14% were audited in 2006. In 2003, 49 of 220 participating plans were audited; a contractor identified errors for 41 of those, which would have translated into $59 million that could have covered additional benefits or offset costs for beneficiaries. The CMS claimed that it does not have legal authority to pursue such financial recoveries, but the GAO asserted that the CMS has the authority but did not exercise it.

ELSEVIER GLOBAL MEDICAL NEWS

Lawmakers OK Rx Rule Delay

Coming down to the wire on a new federal mandate requiring the use of tamper-resistant prescription pads for all Medicaid prescriptions beginning Oct. 1, lawmakers in the House and the Senate passed legislation in late September that would delay the mandate's start until March 31, 2008. At press time, President Bush was expected to sign the legislation, although it was not clear whether he would sign it by Oct. 1, National Community Pharmacists Association spokesman John Norton told this newspaper. The delay was bundled with extensions on several programs due to expire Sept. 30, including an abstinence education initiative that the Bush administration supports, Mr. Norton said. The original mandate, passed as part of war funding legislation earlier this year, requires all Medicaid prescriptions to be written on “tamper resistant” paper to be eligible for federal reimbursement. Even though many states have similar requirements, pharmacists' organizations have maintained that most physicians do not currently use these types of pads, nor are supplies readily available.

Insurance Premium Increase Slows

Employer-sponsored health insurance premiums rose on average 6.1% in 2007, reflecting a continuing slowdown in premium increases. The 2007 premium increase is the smallest hike since 1999, according to an employer survey by the Kaiser Family Foundation and the Health Research and Educational Trust. But experts say the slowdown is likely temporary and isn't providing relief to individuals or employers. In fact, the 6.1% increase is higher than the average increase in wages (3.7%) and in the overall inflation rate (2.6%). In 2007, the average premium for family coverage in the United States is $12,106, with workers paying about $3,281 for their share of the policy. The market continues to be dominated by preferred provider organizations, which insure about 57% of covered workers; consumer-driven plans account for only about 5%. For details, visit

www.kff.org/insurance/7672

N.J. Task Force Examines MD Gifts

The New Jersey Attorney General's Advisory Task Force on Physician Compensation, which met for the first time in September, is examining the potential impact of payments and gifts to physicians from the drug and device industry. The task force will also consider possible public disclosure of gifts, direct disclosure to patients, and limits on payments to physicians. Vermont, Maine, Minnesota, West Virginia, and the District of Columbia have passed laws requiring some form of reporting of payments made to physicians by pharmaceutical and medical device companies. In response to the formation of the task force, the Pharmaceutical Research and Manufacturers of America issued a statement citing its 2002 Code on Interactions with Healthcare Professionals as an important safeguard. The code declares all forms of entertainment to be inappropriate and says that any gifts given to physicians should support medical practice and be valued at less than $100.

Taxing Health Benefits

Proposals to cap the tax deductions employers and employees can take regarding health insurance could spell the end of employer-based health benefits, according to a new report from the Employee Benefit Research Institute. Under the current system, employers are allowed to deduct the cost of the health insurance coverage they provide to their workers with no limits and workers are not taxed on the value of the health coverage they receive. Capping these tax exclusions could cause young, healthy workers to seek insurance outside of their employers' offering, leaving the employer based pool with an older, sicker group of patients, the EBRI report said. The organization also examined the potential effect of offering tax credits as a way to reduce the number of uninsured Americans. But even a sizable tax credit is unlikely to be enough to offset the high costs of health insurance, the report noted. The full report is available online at

www.ebri.org

One-Third of Americans Uninsured

According to a September report by Families USA, almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from about 30% in 1999–2000. Of these, 19% were uninsured for the entire period and 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million individuals who lacked health care coverage, 71% were employed full time and another nearly 9% were working part time; only 17% were unemployed. The states with the highest percentage of uninsured residents under the age of 65 were Texas (46%), New Mexico (44%), and Arizona (42%). The numbers in the report are substantially larger than those published by the U.S. Census Bureau (which cites 47 million uninsured in 2006, or 16%), because Census Bureau statistics include only those who were uninsured for a full year. The report is available at

www.familiesusa.org

Required Audits of Limited Value

The Centers for Medicare and Medicaid Services did not meet the audit requirement for private insurers participating in Medicare for the contract years 2001–2005, nor did it attempt to recover overpayments to the insurers that should have been channeled back to the beneficiaries and government, according a report by the Government Accountability Office. The Balanced Budget Act of 1997 required the CMS to conduct annual audits of at least one-third of the participating insurers. During 2001–2005, between 19% and 23% of organizations were audited, and only 14% were audited in 2006. In 2003, 49 of 220 participating plans were audited; a contractor identified errors for 41 of those, which would have translated into $59 million that could have covered additional benefits or offset costs for beneficiaries. The CMS claimed that it does not have legal authority to pursue such financial recoveries, but the GAO asserted that the CMS has the authority but did not exercise it.

ELSEVIER GLOBAL MEDICAL NEWS

Lawmakers OK Rx Rule Delay

Coming down to the wire on a new federal mandate requiring the use of tamper-resistant prescription pads for all Medicaid prescriptions, lawmakers in the House and the Senate passed legislation in late September that would delay the mandate's start until March 31, 2008. At press time, President Bush was expected to sign the legislation, National Community Pharmacists Association spokesman John Norton said. The delay was bundled with extensions on several programs due to expire Sept. 30, including an abstinence education initiative that the Bush administration supports, Mr. Norton said. The original mandate, passed as part of war funding legislation earlier this year, requires all Medicaid prescriptions to be written on tamper-resistant paper to be eligible for federal reimbursement. Even though many states have similar requirements, pharmacists' organizations have maintained that most physicians do not currently use these types of pads, nor are supplies readily available.

Insurance Premium Increase Slows

Employer-sponsored health insurance premiums rose on average 6.1% in 2007, reflecting a continuing slowdown in premium increases. The 2007 premium increase is the smallest hike since 1999, according to an employer survey by the Kaiser Family Foundation and the Health Research and Educational Trust. But experts say the slowdown is likely temporary and isn't providing relief to individuals or employers. In fact, the 6.1% increase is higher than the average increase in wages (3.7%) and in the overall inflation rate (2.6%). In 2007, the average premium for family coverage in the United States is $12,106, with workers paying about $3,281 for their share of the policy. The market continues to be dominated by preferred provider organizations, which insure about 57% of covered workers; consumer-driven plans account for only about 5%. For details, visit

www.kff.org/insurance/7672

N.J. Task Force Examines MD Gifts

The New Jersey Attorney General's Advisory Task Force on Physician Compensation, which met for the first time in September, is examining the potential impact of payments and gifts to physicians from the drug and device industry. The task force will also consider public disclosure of gifts, direct disclosure to patients, and limits on payments to physicians. Vermont, Maine, Minnesota, West Virginia, and the District of Columbia have passed laws requiring some form of reporting of payments made to physicians by drug and medical device companies. In response to the formation of the task force, the Pharmaceutical Research and Manufacturers of America issued a statement citing its 2002 Code on Interactions with Healthcare Professionals as an important safeguard. The code declares all forms of entertainment to be inappropriate gifts and says that any gifts given to physicians should support medical practice and be valued at less than $100.

Taxing Health Benefits

Proposals to cap the tax deductions employers and employees can take regarding health insurance could spell the end of employer-based health benefits, according to a new report from the Employee Benefit Research Institute. Currently, employers are allowed to deduct the cost of the health insurance coverage they provide to their workers with no limits and workers are not taxed on the value of the health coverage they receive. Capping these tax exclusions could cause young, healthy workers to seek insurance outside of their employers' offering, leaving employers with an older, sicker pool of patients, the EBRI report said. The organization also examined the potential effect of offering tax credits as a way to reduce the number of uninsured Americans. But even a sizable tax credit is unlikely to be enough to offset the high costs of health insurance, the report noted. The full report is available online at

www.ebri.org

One-Third of Americans Uninsured

According to a September report by Families USA, almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from about 30% in 1999–2000. Of these, 19% were uninsured for the entire period and 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million individuals who lacked health care coverage, 71% were employed full time and another nearly 9% were working part time; only 17% were unemployed. The numbers in the report are substantially larger than those published by the U.S. Census Bureau (which cites 47 million uninsured in 2006, or 16%), because Census Bureau statistics include only those who were uninsured for a full year. The report is available at

www.familiesusa.org

Required Audits of Limited Value

The Centers for Medicare and Medicaid Services did not meet the audit requirement for private insurers participating in Medicare during 2001–2005, nor did it attempt to recover overpayments to the insurers that should have been channeled back to the beneficiaries and government, according to a report by the Government Accountability Office. The Balanced Budget Act of 1997 required CMS to conduct annual audits of at least one-third of the participating insurers. During 2001–2005, between 19% and 23% of organizations were audited, and only 14% were audited in 2006. In 2003, 49 of 220 participating plans were audited; a contractor identified errors for 41, which would have translated into $59 million for additional benefits or to offset costs for beneficiaries. CMS claimed that it does not have legal authority to pursue such financial recoveries, but the GAO asserted that CMS has the authority but did not exercise it.

Lawmakers OK Rx Rule Delay

Coming down to the wire on a new federal mandate requiring the use of tamper-resistant prescription pads for all Medicaid prescriptions, lawmakers in the House and the Senate passed legislation in late September that would delay the mandate's start until March 31, 2008. At press time, President Bush was expected to sign the legislation, National Community Pharmacists Association spokesman John Norton said. The delay was bundled with extensions on several programs due to expire Sept. 30, including an abstinence education initiative that the Bush administration supports, Mr. Norton said. The original mandate, passed as part of war funding legislation earlier this year, requires all Medicaid prescriptions to be written on tamper-resistant paper to be eligible for federal reimbursement. Even though many states have similar requirements, pharmacists' organizations have maintained that most physicians do not currently use these types of pads, nor are supplies readily available.

Insurance Premium Increase Slows

Employer-sponsored health insurance premiums rose on average 6.1% in 2007, reflecting a continuing slowdown in premium increases. The 2007 premium increase is the smallest hike since 1999, according to an employer survey by the Kaiser Family Foundation and the Health Research and Educational Trust. But experts say the slowdown is likely temporary and isn't providing relief to individuals or employers. In fact, the 6.1% increase is higher than the average increase in wages (3.7%) and in the overall inflation rate (2.6%). In 2007, the average premium for family coverage in the United States is $12,106, with workers paying about $3,281 for their share of the policy. The market continues to be dominated by preferred provider organizations, which insure about 57% of covered workers; consumer-driven plans account for only about 5%. For details, visit

www.kff.org/insurance/7672

N.J. Task Force Examines MD Gifts

The New Jersey Attorney General's Advisory Task Force on Physician Compensation, which met for the first time in September, is examining the potential impact of payments and gifts to physicians from the drug and device industry. The task force will also consider public disclosure of gifts, direct disclosure to patients, and limits on payments to physicians. Vermont, Maine, Minnesota, West Virginia, and the District of Columbia have passed laws requiring some form of reporting of payments made to physicians by drug and medical device companies. In response to the formation of the task force, the Pharmaceutical Research and Manufacturers of America issued a statement citing its 2002 Code on Interactions with Healthcare Professionals as an important safeguard. The code declares all forms of entertainment to be inappropriate gifts and says that any gifts given to physicians should support medical practice and be valued at less than $100.

Taxing Health Benefits

Proposals to cap the tax deductions employers and employees can take regarding health insurance could spell the end of employer-based health benefits, according to a new report from the Employee Benefit Research Institute. Currently, employers are allowed to deduct the cost of the health insurance coverage they provide to their workers with no limits and workers are not taxed on the value of the health coverage they receive. Capping these tax exclusions could cause young, healthy workers to seek insurance outside of their employers' offering, leaving employers with an older, sicker pool of patients, the EBRI report said. The organization also examined the potential effect of offering tax credits as a way to reduce the number of uninsured Americans. But even a sizable tax credit is unlikely to be enough to offset the high costs of health insurance, the report noted. The full report is available online at

www.ebri.org

One-Third of Americans Uninsured

According to a September report by Families USA, almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from about 30% in 1999–2000. Of these, 19% were uninsured for the entire period and 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million individuals who lacked health care coverage, 71% were employed full time and another nearly 9% were working part time; only 17% were unemployed. The numbers in the report are substantially larger than those published by the U.S. Census Bureau (which cites 47 million uninsured in 2006, or 16%), because Census Bureau statistics include only those who were uninsured for a full year. The report is available at

www.familiesusa.org

Required Audits of Limited Value

The Centers for Medicare and Medicaid Services did not meet the audit requirement for private insurers participating in Medicare during 2001–2005, nor did it attempt to recover overpayments to the insurers that should have been channeled back to the beneficiaries and government, according to a report by the Government Accountability Office. The Balanced Budget Act of 1997 required CMS to conduct annual audits of at least one-third of the participating insurers. During 2001–2005, between 19% and 23% of organizations were audited, and only 14% were audited in 2006. In 2003, 49 of 220 participating plans were audited; a contractor identified errors for 41, which would have translated into $59 million for additional benefits or to offset costs for beneficiaries. CMS claimed that it does not have legal authority to pursue such financial recoveries, but the GAO asserted that CMS has the authority but did not exercise it.

Lawmakers OK Rx Rule Delay

Coming down to the wire on a new federal mandate requiring the use of tamper-resistant prescription pads for all Medicaid prescriptions, lawmakers in the House and the Senate passed legislation in late September that would delay the mandate's start until March 31, 2008. At press time, President Bush was expected to sign the legislation, National Community Pharmacists Association spokesman John Norton said. The delay was bundled with extensions on several programs due to expire Sept. 30, including an abstinence education initiative that the Bush administration supports, Mr. Norton said. The original mandate, passed as part of war funding legislation earlier this year, requires all Medicaid prescriptions to be written on tamper-resistant paper to be eligible for federal reimbursement. Even though many states have similar requirements, pharmacists' organizations have maintained that most physicians do not currently use these types of pads, nor are supplies readily available.

Insurance Premium Increase Slows

Employer-sponsored health insurance premiums rose on average 6.1% in 2007, reflecting a continuing slowdown in premium increases. The 2007 premium increase is the smallest hike since 1999, according to an employer survey by the Kaiser Family Foundation and the Health Research and Educational Trust. But experts say the slowdown is likely temporary and isn't providing relief to individuals or employers. In fact, the 6.1% increase is higher than the average increase in wages (3.7%) and in the overall inflation rate (2.6%). In 2007, the average premium for family coverage in the United States is $12,106, with workers paying about $3,281 for their share of the policy. The market continues to be dominated by preferred provider organizations, which insure about 57% of covered workers; consumer-driven plans account for only about 5%. For details, visit

www.kff.org/insurance/7672

N.J. Task Force Examines MD Gifts

The New Jersey Attorney General's Advisory Task Force on Physician Compensation, which met for the first time in September, is examining the potential impact of payments and gifts to physicians from the drug and device industry. The task force will also consider public disclosure of gifts, direct disclosure to patients, and limits on payments to physicians. Vermont, Maine, Minnesota, West Virginia, and the District of Columbia have passed laws requiring some form of reporting of payments made to physicians by drug and medical device companies. In response to the formation of the task force, the Pharmaceutical Research and Manufacturers of America issued a statement citing its 2002 Code on Interactions with Healthcare Professionals as an important safeguard. The code declares all forms of entertainment to be inappropriate gifts and says that any gifts given to physicians should support medical practice and be valued at less than $100.

Taxing Health Benefits

Proposals to cap the tax deductions employers and employees can take regarding health insurance could spell the end of employer-based health benefits, according to a new report from the Employee Benefit Research Institute. Currently, employers are allowed to deduct the cost of the health insurance coverage they provide to their workers with no limits and workers are not taxed on the value of the health coverage they receive. Capping these tax exclusions could cause young, healthy workers to seek insurance outside of their employers' offering, leaving employers with an older, sicker pool of patients, the EBRI report said. The organization also examined the potential effect of offering tax credits as a way to reduce the number of uninsured Americans. But even a sizable tax credit is unlikely to be enough to offset the high costs of health insurance, the report noted. The full report is available online at

www.ebri.org

One-Third of Americans Uninsured

According to a September report by Families USA, almost 35% of Americans had no health care coverage for at least part of 2006–2007, up from about 30% in 1999–2000. Of these, 19% were uninsured for the entire period and 19% were uninsured for longer than 1 year; more than half were uninsured for longer than 6 months. Of the 89.6 million individuals who lacked health care coverage, 71% were employed full time and another nearly 9% were working part time; only 17% were unemployed. The numbers in the report are substantially larger than those published by the U.S. Census Bureau (which cites 47 million uninsured in 2006, or 16%), because Census Bureau statistics include only those who were uninsured for a full year. The report is available at

www.familiesusa.org

Required Audits of Limited Value

The Centers for Medicare and Medicaid Services did not meet the audit requirement for private insurers participating in Medicare during 2001–2005, nor did it attempt to recover overpayments to the insurers that should have been channeled back to the beneficiaries and government, according to a report by the Government Accountability Office. The Balanced Budget Act of 1997 required CMS to conduct annual audits of at least one-third of the participating insurers. During 2001–2005, between 19% and 23% of organizations were audited, and only 14% were audited in 2006. In 2003, 49 of 220 participating plans were audited; a contractor identified errors for 41, which would have translated into $59 million for additional benefits or to offset costs for beneficiaries. CMS claimed that it does not have legal authority to pursue such financial recoveries, but the GAO asserted that CMS has the authority but did not exercise it.

Drinking at least one soda a day is associated with a significantly higher risk of developing metabolic syndrome, compared with drinking less than one soft drink a day, according to an observational study of participants in the Framingham Heart Study.

After adjusting the data for other risk factors, the prevalence of metabolic syndrome in those who drank one or more 12-ounce soft drinks a day was 48% higher than in those who drank fewer than one of these beverages daily, wrote Dr. Ravi Dhingra of Harvard Medical School, Boston, and his colleagues.

The soda drinkers had a 44% higher risk of developing new-onset metabolic syndrome after adjusting for intake of saturated and trans fats, dietary fiber, total calories, smoking, and physical activity.

Metabolic syndrome was defined as the presence of three or more of the following: waist circumference of 35 inches or more for women and 40 inches or more for men; fasting blood sugar of 100 mg/dL or higher, or treatment with insulin; blood pressure of 135/75 mm Hg or higher, or treatment for hypertension; serum triglyceride levels of 150 mg/dL or higher; and HDL cholesterol levels of less than 50 mg/dL in women and less than 40 mg/dL in men.

Consumption of soft drinks has increased over the past 3 decades, so the findings have far-reaching ramifications. The results are consistent with those of previous studies that reported an association between soft drink consumption and increased risk of metabolic syndrome, obesity, high blood pressure, and diabetes (Circulation 2007 [Epub doi: 10.1161/CIRCULATIONAHA.107.689935]).

The study, which spanned the years 1987–2001, included 8,997 person-observations made via physical examinations, physician-administered questionnaires, and a self-administered food-frequency questionnaire. The study population was white Americans, aged 42–66 years, about half of whom were men.

When each marker of metabolic syndrome was analyzed separately using multivariate logistic regression, the researchers found that the frequent soda drinkers had a 25%–32% higher adjusted risk for each trait, with the exception of high blood pressure, which had an 18% higher risk that was of borderline significance.

Dietary behavior may be a factor in the higher risk, as individuals who drink more soda also tend to have a higher-calorie diet that includes more fat and less fiber than the diets of those who are not soda drinkers, and tend to be sedentary and have higher rates of smoking. Yet despite adjusting the data to account for these other risk factors, the researchers still found a significant association between soda drinking and the risk of developing metabolic syndrome. They acknowledged, however, that “there may be residual confounding caused by lifestyle factors not adjusted for in the present analysis.”

Both regular and diet soda consumption resulted in increased risk of metabolic syndrome and its individual traits, which suggests that factors other than calorie and sugar content contribute to the higher risk. The authors theorized such factors may include a greater desire for sweet foods stimulated by the sweetness of soft drinks, and the caramel content of these beverages, which may be a source of glycation end products; these complexes of sugars may promote insulin resistance and inflammation. Similar results also were seen for caffeinated and uncaffeinated soft drinks. The data also “raise the possibility that public health policy measures to limit the rising consumption of soft drinks may be associated with a lowering of the burden of metabolic risk factors in adults,” they said

Drinking either regular or diet soda raised the risk for metabolic syndrome. ©Lisa Smith/Fotolia.com

Drinking at least one soda a day is associated with a significantly higher risk of developing metabolic syndrome, compared with drinking less than one soft drink a day, according to an observational study of participants in the Framingham Heart Study.

After adjusting the data for other risk factors, the prevalence of metabolic syndrome in those who drank one or more 12-ounce soft drinks a day was 48% higher than in those who drank fewer than one of these beverages daily, wrote Dr. Ravi Dhingra of Harvard Medical School, Boston, and his colleagues.

The soda drinkers had a 44% higher risk of developing new-onset metabolic syndrome after adjusting for intake of saturated and trans fats, dietary fiber, total calories, smoking, and physical activity.

Metabolic syndrome was defined as the presence of three or more of the following: waist circumference of 35 inches or more for women and 40 inches or more for men; fasting blood sugar of 100 mg/dL or higher, or treatment with insulin; blood pressure of 135/75 mm Hg or higher, or treatment for hypertension; serum triglyceride levels of 150 mg/dL or higher; and HDL cholesterol levels of less than 50 mg/dL in women and less than 40 mg/dL in men.

Consumption of soft drinks has increased over the past 3 decades, so the findings have far-reaching ramifications. The results are consistent with those of previous studies that reported an association between soft drink consumption and increased risk of metabolic syndrome, obesity, high blood pressure, and diabetes (Circulation 2007 [Epub doi: 10.1161/CIRCULATIONAHA.107.689935]).

The study, which spanned the years 1987–2001, included 8,997 person-observations made via physical examinations, physician-administered questionnaires, and a self-administered food-frequency questionnaire. The study population was white Americans, aged 42–66 years, about half of whom were men.

When each marker of metabolic syndrome was analyzed separately using multivariate logistic regression, the researchers found that the frequent soda drinkers had a 25%–32% higher adjusted risk for each trait, with the exception of high blood pressure, which had an 18% higher risk that was of borderline significance.

Dietary behavior may be a factor in the higher risk, as individuals who drink more soda also tend to have a higher-calorie diet that includes more fat and less fiber than the diets of those who are not soda drinkers, and tend to be sedentary and have higher rates of smoking. Yet despite adjusting the data to account for these other risk factors, the researchers still found a significant association between soda drinking and the risk of developing metabolic syndrome. They acknowledged, however, that “there may be residual confounding caused by lifestyle factors not adjusted for in the present analysis.”

Both regular and diet soda consumption resulted in increased risk of metabolic syndrome and its individual traits, which suggests that factors other than calorie and sugar content contribute to the higher risk. The authors theorized such factors may include a greater desire for sweet foods stimulated by the sweetness of soft drinks, and the caramel content of these beverages, which may be a source of glycation end products; these complexes of sugars may promote insulin resistance and inflammation. Similar results also were seen for caffeinated and uncaffeinated soft drinks. The data also “raise the possibility that public health policy measures to limit the rising consumption of soft drinks may be associated with a lowering of the burden of metabolic risk factors in adults,” they said

Drinking either regular or diet soda raised the risk for metabolic syndrome. ©Lisa Smith/Fotolia.com

Drinking at least one soda a day is associated with a significantly higher risk of developing metabolic syndrome, compared with drinking less than one soft drink a day, according to an observational study of participants in the Framingham Heart Study.

After adjusting the data for other risk factors, the prevalence of metabolic syndrome in those who drank one or more 12-ounce soft drinks a day was 48% higher than in those who drank fewer than one of these beverages daily, wrote Dr. Ravi Dhingra of Harvard Medical School, Boston, and his colleagues.

The soda drinkers had a 44% higher risk of developing new-onset metabolic syndrome after adjusting for intake of saturated and trans fats, dietary fiber, total calories, smoking, and physical activity.

Metabolic syndrome was defined as the presence of three or more of the following: waist circumference of 35 inches or more for women and 40 inches or more for men; fasting blood sugar of 100 mg/dL or higher, or treatment with insulin; blood pressure of 135/75 mm Hg or higher, or treatment for hypertension; serum triglyceride levels of 150 mg/dL or higher; and HDL cholesterol levels of less than 50 mg/dL in women and less than 40 mg/dL in men.

Consumption of soft drinks has increased over the past 3 decades, so the findings have far-reaching ramifications. The results are consistent with those of previous studies that reported an association between soft drink consumption and increased risk of metabolic syndrome, obesity, high blood pressure, and diabetes (Circulation 2007 [Epub doi: 10.1161/CIRCULATIONAHA.107.689935]).

The study, which spanned the years 1987–2001, included 8,997 person-observations made via physical examinations, physician-administered questionnaires, and a self-administered food-frequency questionnaire. The study population was white Americans, aged 42–66 years, about half of whom were men.

When each marker of metabolic syndrome was analyzed separately using multivariate logistic regression, the researchers found that the frequent soda drinkers had a 25%–32% higher adjusted risk for each trait, with the exception of high blood pressure, which had an 18% higher risk that was of borderline significance.

Dietary behavior may be a factor in the higher risk, as individuals who drink more soda also tend to have a higher-calorie diet that includes more fat and less fiber than the diets of those who are not soda drinkers, and tend to be sedentary and have higher rates of smoking. Yet despite adjusting the data to account for these other risk factors, the researchers still found a significant association between soda drinking and the risk of developing metabolic syndrome. They acknowledged, however, that “there may be residual confounding caused by lifestyle factors not adjusted for in the present analysis.”

Both regular and diet soda consumption resulted in increased risk of metabolic syndrome and its individual traits, which suggests that factors other than calorie and sugar content contribute to the higher risk. The authors theorized such factors may include a greater desire for sweet foods stimulated by the sweetness of soft drinks, and the caramel content of these beverages, which may be a source of glycation end products; these complexes of sugars may promote insulin resistance and inflammation. Similar results also were seen for caffeinated and uncaffeinated soft drinks. The data also “raise the possibility that public health policy measures to limit the rising consumption of soft drinks may be associated with a lowering of the burden of metabolic risk factors in adults,” they said

Drinking either regular or diet soda raised the risk for metabolic syndrome. ©Lisa Smith/Fotolia.com

Updated guidelines from the U.S. Preventive Services Task Force on detection of chlamydial infection recommend screening all sexually active, nonpregnant women aged 24 years and younger, as well as older women at increased risk and all pregnant women aged 24 years and younger.

The guidelines, which were last published in 2001, do not recommend screening older women, regardless of pregnancy, if they are not at increased risk. The task force stated that there is not enough evidence to make a recommendation regarding the screening of men.

The updated recommendations are similar to those of the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention, with the difference that these organizations recommend screening for women aged 25 years and younger.

The updated guidelines document can be found at the Web site of the Agency for Healthcare Research and Quality at www.ahrq.gov/clinic/uspstf07/chlamydia/chlamydiars.htm

Updated guidelines from the U.S. Preventive Services Task Force on detection of chlamydial infection recommend screening all sexually active, nonpregnant women aged 24 years and younger, as well as older women at increased risk and all pregnant women aged 24 years and younger.

The guidelines, which were last published in 2001, do not recommend screening older women, regardless of pregnancy, if they are not at increased risk. The task force stated that there is not enough evidence to make a recommendation regarding the screening of men.

The updated recommendations are similar to those of the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention, with the difference that these organizations recommend screening for women aged 25 years and younger.

The updated guidelines document can be found at the Web site of the Agency for Healthcare Research and Quality at www.ahrq.gov/clinic/uspstf07/chlamydia/chlamydiars.htm

Updated guidelines from the U.S. Preventive Services Task Force on detection of chlamydial infection recommend screening all sexually active, nonpregnant women aged 24 years and younger, as well as older women at increased risk and all pregnant women aged 24 years and younger.

The guidelines, which were last published in 2001, do not recommend screening older women, regardless of pregnancy, if they are not at increased risk. The task force stated that there is not enough evidence to make a recommendation regarding the screening of men.

The updated recommendations are similar to those of the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention, with the difference that these organizations recommend screening for women aged 25 years and younger.

The updated guidelines document can be found at the Web site of the Agency for Healthcare Research and Quality at www.ahrq.gov/clinic/uspstf07/chlamydia/chlamydiars.htm

Updated U.S. Preventive Services Task Force guidelines on chlamydial infection detection recommend screening all sexually active, nonpregnant women aged 24 years and younger, as well as older women at increased risk and all pregnant women aged 24 years and younger.

The guidelines, which were last published in 2001, do not recommend screening older women, regardless of pregnancy, if they are not at increased risk. The task force stated that there is not enough evidence to make a recommendation regarding the screening of men.

The updated recommendations are similar to those of the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention, with the difference that these organizations recommend screening for women aged 25 years and younger.

The updated document can be found at www.ahrq.gov/clinic/uspstf07/chlamydia/chlamydiars.htm

Updated U.S. Preventive Services Task Force guidelines on chlamydial infection detection recommend screening all sexually active, nonpregnant women aged 24 years and younger, as well as older women at increased risk and all pregnant women aged 24 years and younger.

The guidelines, which were last published in 2001, do not recommend screening older women, regardless of pregnancy, if they are not at increased risk. The task force stated that there is not enough evidence to make a recommendation regarding the screening of men.

The updated recommendations are similar to those of the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention, with the difference that these organizations recommend screening for women aged 25 years and younger.

The updated document can be found at www.ahrq.gov/clinic/uspstf07/chlamydia/chlamydiars.htm

Updated U.S. Preventive Services Task Force guidelines on chlamydial infection detection recommend screening all sexually active, nonpregnant women aged 24 years and younger, as well as older women at increased risk and all pregnant women aged 24 years and younger.

The guidelines, which were last published in 2001, do not recommend screening older women, regardless of pregnancy, if they are not at increased risk. The task force stated that there is not enough evidence to make a recommendation regarding the screening of men.

The updated recommendations are similar to those of the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention, with the difference that these organizations recommend screening for women aged 25 years and younger.

The updated document can be found at www.ahrq.gov/clinic/uspstf07/chlamydia/chlamydiars.htm

Regular aspirin use for at least 10 years appears to reduce the risk of colorectal cancers that overexpress cyclooxygenase-2, Dr. Andrew T. Chan and his associates reported.

The researchers mailed questionnaires every 2 years to 121,701 women in the Nurses' Health Study and 51,529 men in the Health Professionals Follow-Up Study to determine aspirin use and incidence of colorectal cancer. The women (age range at entry, 30–55 years) received the survey starting in 1976, and the men (age range at entry, 40–75 years) received it starting in 1986.

More detailed questions on aspirin use, including frequency and amount, were added in 1980 for the women and in 1992 for the men. For women, regular aspirin use was defined as taking two or more 325-mg aspirin tablets per week; for men, it was defined as using aspirin at least twice a week (N. Engl. J. Med. 2007;356:2131–42).

Medical and pathology reports were obtained for participants who reported colorectal cancers, said Dr. Chan of Massachusetts General Hospital and Harvard Medical School, Boston, and his associates.

During follow-up, 636 specimens sufficient for immunohistochemical analysis were obtained from patients with confirmed colorectal cancer. Of the 636 tumors, 423 (67%) were COX-2 positive, or had moderate or strong expression of the enzyme.

The researchers analyzed the association between the expression of COX-2 in the tumors and the patients' use of aspirin, and calculated multivariate relative risk after adjustment for factors including age, gender, smoking, BMI, exercise, family history of colorectal cancer, history of polyps, and meat and alcohol consumption.

The multivariate relative risk of colorectal cancer for aspirin users vs. nonregular users was a significant 0.64 for COX-2-positive cancers and a nonsignificant 0.96 for COX-2-negative tumors. Thus, aspirin use was of benefit only in tumors in which COX-2 was overexpressed. However, this benefit was not seen until aspirin had been used for more than 10 years.

A greater amount of aspirin use also was associated with lower incidence of COX-2-positive disease, with more than five tablets per week associated with significantly fewer such cancers; the association was not significant for COX-2-negative disease. This “is consistent with the results of studies in which higher doses of aspirin were required to inhibit COX-2 than to inhibit COX-1,” the investigators noted.

The results of this observational study “suggest that the anticancer benefit of aspirin is mediated, at least in part, by inhibition of COX-2,” Dr. Chan and his associates concluded.

In an accompanying editorial, Dr. Sanford D. Markowitz of Case Western Reserve University, Cleveland, pointed out that aspirin use has its own risk of adverse effects (N. Engl. J. Med. 2007;356:2195–8).

Researchers “need to ask whether there are alternative strategies for targeting the COX pathway that have better efficacy or lower rates of adverse effects,” Dr. Markowitz said. Inhibitors of the COX-2-generated prostaglandin PGE2 receptors or synthases “might provide better specificity for the prevention of colon cancer and, hence, reduced adverse effects,” he suggested.

Regular aspirin use for at least 10 years appears to reduce the risk of colorectal cancers that overexpress cyclooxygenase-2, Dr. Andrew T. Chan and his associates reported.

The researchers mailed questionnaires every 2 years to 121,701 women in the Nurses' Health Study and 51,529 men in the Health Professionals Follow-Up Study to determine aspirin use and incidence of colorectal cancer. The women (age range at entry, 30–55 years) received the survey starting in 1976, and the men (age range at entry, 40–75 years) received it starting in 1986.

More detailed questions on aspirin use, including frequency and amount, were added in 1980 for the women and in 1992 for the men. For women, regular aspirin use was defined as taking two or more 325-mg aspirin tablets per week; for men, it was defined as using aspirin at least twice a week (N. Engl. J. Med. 2007;356:2131–42).

Medical and pathology reports were obtained for participants who reported colorectal cancers, said Dr. Chan of Massachusetts General Hospital and Harvard Medical School, Boston, and his associates.

During follow-up, 636 specimens sufficient for immunohistochemical analysis were obtained from patients with confirmed colorectal cancer. Of the 636 tumors, 423 (67%) were COX-2 positive, or had moderate or strong expression of the enzyme.

The researchers analyzed the association between the expression of COX-2 in the tumors and the patients' use of aspirin, and calculated multivariate relative risk after adjustment for factors including age, gender, smoking, BMI, exercise, family history of colorectal cancer, history of polyps, and meat and alcohol consumption.

The multivariate relative risk of colorectal cancer for aspirin users vs. nonregular users was a significant 0.64 for COX-2-positive cancers and a nonsignificant 0.96 for COX-2-negative tumors. Thus, aspirin use was of benefit only in tumors in which COX-2 was overexpressed. However, this benefit was not seen until aspirin had been used for more than 10 years.

A greater amount of aspirin use also was associated with lower incidence of COX-2-positive disease, with more than five tablets per week associated with significantly fewer such cancers; the association was not significant for COX-2-negative disease. This “is consistent with the results of studies in which higher doses of aspirin were required to inhibit COX-2 than to inhibit COX-1,” the investigators noted.

The results of this observational study “suggest that the anticancer benefit of aspirin is mediated, at least in part, by inhibition of COX-2,” Dr. Chan and his associates concluded.

In an accompanying editorial, Dr. Sanford D. Markowitz of Case Western Reserve University, Cleveland, pointed out that aspirin use has its own risk of adverse effects (N. Engl. J. Med. 2007;356:2195–8).

Researchers “need to ask whether there are alternative strategies for targeting the COX pathway that have better efficacy or lower rates of adverse effects,” Dr. Markowitz said. Inhibitors of the COX-2-generated prostaglandin PGE2 receptors or synthases “might provide better specificity for the prevention of colon cancer and, hence, reduced adverse effects,” he suggested.

Regular aspirin use for at least 10 years appears to reduce the risk of colorectal cancers that overexpress cyclooxygenase-2, Dr. Andrew T. Chan and his associates reported.

The researchers mailed questionnaires every 2 years to 121,701 women in the Nurses' Health Study and 51,529 men in the Health Professionals Follow-Up Study to determine aspirin use and incidence of colorectal cancer. The women (age range at entry, 30–55 years) received the survey starting in 1976, and the men (age range at entry, 40–75 years) received it starting in 1986.

More detailed questions on aspirin use, including frequency and amount, were added in 1980 for the women and in 1992 for the men. For women, regular aspirin use was defined as taking two or more 325-mg aspirin tablets per week; for men, it was defined as using aspirin at least twice a week (N. Engl. J. Med. 2007;356:2131–42).

Medical and pathology reports were obtained for participants who reported colorectal cancers, said Dr. Chan of Massachusetts General Hospital and Harvard Medical School, Boston, and his associates.

During follow-up, 636 specimens sufficient for immunohistochemical analysis were obtained from patients with confirmed colorectal cancer. Of the 636 tumors, 423 (67%) were COX-2 positive, or had moderate or strong expression of the enzyme.

The researchers analyzed the association between the expression of COX-2 in the tumors and the patients' use of aspirin, and calculated multivariate relative risk after adjustment for factors including age, gender, smoking, BMI, exercise, family history of colorectal cancer, history of polyps, and meat and alcohol consumption.

The multivariate relative risk of colorectal cancer for aspirin users vs. nonregular users was a significant 0.64 for COX-2-positive cancers and a nonsignificant 0.96 for COX-2-negative tumors. Thus, aspirin use was of benefit only in tumors in which COX-2 was overexpressed. However, this benefit was not seen until aspirin had been used for more than 10 years.

A greater amount of aspirin use also was associated with lower incidence of COX-2-positive disease, with more than five tablets per week associated with significantly fewer such cancers; the association was not significant for COX-2-negative disease. This “is consistent with the results of studies in which higher doses of aspirin were required to inhibit COX-2 than to inhibit COX-1,” the investigators noted.

The results of this observational study “suggest that the anticancer benefit of aspirin is mediated, at least in part, by inhibition of COX-2,” Dr. Chan and his associates concluded.

In an accompanying editorial, Dr. Sanford D. Markowitz of Case Western Reserve University, Cleveland, pointed out that aspirin use has its own risk of adverse effects (N. Engl. J. Med. 2007;356:2195–8).

Researchers “need to ask whether there are alternative strategies for targeting the COX pathway that have better efficacy or lower rates of adverse effects,” Dr. Markowitz said. Inhibitors of the COX-2-generated prostaglandin PGE2 receptors or synthases “might provide better specificity for the prevention of colon cancer and, hence, reduced adverse effects,” he suggested.