(Circulation. 2000;101:e9058.)
© 2000 American Heart Association, Inc.
Cardiovascular News
Whither Patient Rights’ Legislation?
Two not-unexpected defeats put the issue of patient rights on the front burner of the recent American Medical Association (AMA) meeting, which took place the week of June 12 through 16 in Chicago. The chairman of the AMA’s board of trustees, D. Ted Lewers, MD, called on Senate Republican leadership to stop "the foot-dragging, smoke screens, and posturing," and pass a meaningful patient bill of rights, according to a released statements.
Dr Lewers addressed the group’s 550 delegates at its annual meeting on June 13, 2000 by noting, "Physicians across the country need to send a strong message to Senators (Bill) Frist (R-Tenn and a physician) and (Don) Nickles (R-Okla)," who lead opposition to the legislation. Dr Lewers said the AMA supports the Norwood-Dingell patients’ rights legislation, which was passed by 275 votes in the House of Representatives during the 1999 fall session, and that the group deplored the decision by the Senate to table the same measure last week. He called on Republican senators to "stop dragging their feet and give patients the protections that voters strongly support by wide margins."
Dr Lewers said the AMA will fight for the legislation with a grassroots and media campaign in several key states where Republican senators do not support a meaningful patients’ bill of rights.
This statement came in the wake of an attempt by Senator Edward Kennedy (D-Mass) to put an end to stalled conference committee talks on patient rights legislation by bringing it to a vote on the Senate floor. The vote was 51 to 48 against the measure, with all dissenting votes coming from the Republican side of the aisle.
Senator Phil Gramm (R-Tex) was quoted by the Associated Press as saying that Kennedy committed a "cynical political act" in forcing the vote. In response, Kennedy called the private bipartisan talks "an endless road to nowhere." The vote took place June 8, 2000 on the Senate floor.
The patient rights’ movement took another blow June 12, 2000, when the US Supreme Court ruled that the law does not allow patients to sue health maintenance organizations (HMOs) under federal law on the grounds that the HMOs provide inadequate medical care to save money. In their unanimous decision, the justices ruled that HMOs have no duty to defend their cost-based medical decisions in federal court. One of the rationales for the decision was that such a move would force federal judges to decide medical malpractice cases, which is a duty of the state judiciary.
Although the ruling forestalled federal suits against the managed care organizations, it did not preclude suits in state courts. The justices, however, noted that Congress can change te law to allow federal suits against HMOs for providing inadequate medical care. A provision to allow such suits is one of the major stumbling blocks in the bipartisan talks on patient rights’ legislation in Congress. According to the Houston Chronicle (June 13, 2000:1), Representative Charles Norwood (R-Ga) said, "It is more important than ever that we send to the president’s desk a bill that covers all Americans, provides a review process to challenge HMO decisions, and holds an HMO accountable when it makes a decision that harms or kills someone."
Ron Pollack, executive director of the patient advocacy group FamiliesUSA, said the Supreme Court decision is a reminder that Congress must approve such legislation. Without such a law, "Consumers can do little to hold their health plans accountable. Even when consumers are denied essential care due to improper financial considerations, HMOs are shielded from liability for the harm they cause."
The president of the American Association of Health Plans, Karen Ignagni, said the decision was a bonus for keeping medical costs down. "The court’s decision today validates the principle that the legal system is not the place to make health care work."
The justices ruled on the case of Cynthia Herdrich of Bloomington, Ill, whose appendix ruptured while she waited 8 days for a test to determine the cause of her stomach pain. She sued the HMO to which her physician belonged, alleging that the group’s practice of giving bonuses to doctors who keep medical costs down violated the 1974 Employment Retirement Income Security Act.
Life Expectancy in the Top 7 Industrialized Nations May Exceed Predictions
Citizens of the world’s G-7 (group of 7) industrialized nations—the United States, the United Kingdom, France, Germany, Italy, Canada, and Japan—may live even longer than previous estimates had anticipated, according to a report by researchers at Mountain View Research in Los Altos, Calif. The report, which was published in the June 15 issue of Nature (2000;405:789–792), suggests that by the year 2050, the citizens of these richest nations could live 1.3 to 8 years longer than previous estimates because of improvements in public health and medical care.
The study, which was led by Shripad Tuljapurkar, PhD, predicts that by year 2050, men in Japan will live 82.95 years and women, 90.91 years. French men will live 83.50 yeas and women will live 87.81 years. Men in the United Kingdom as expected to live an average of 82.50 years and women, 83.79 years. German men will live 81.50 years and women, 83.12 years. Italian men will live 82.6 years and Italian women, 86.26 years. Canadian men are expected to live 81.67 years and Canadian women, 85.26 years. US men will live 80.45 years and women will live 82.91 years. The report suggested that programs for caring for aging populations may need to be re-examined to determine if they are sufficient for the population.
Framingham for Sale?
For decades, data from the 50-year heart study of 10 000 Framingham, Mass residents have cast an important light on the natural history of heart disease in the United States. Now, however, a plan to sell the data from the publicly funded project to a for-profit corporation is drawing some disapproving looks.
Boston University, which oversees the project, is forming a company to compile, analyze, and sell the study’s vast collection of clinical, behavioral, and genetic data. The university is working with a group of venture capitalists to form Framingham Genomic Medicine, Inc. Raw data from the study will be available to the public and scientists. How the computer-analyzed data from the for-profit group would be sold to pharmaceutical companies involved in gene therapeutics is not known.
This plan was reported in an article in the Boston Globe (Ethicists debate plan to sell heart data: BU proposal, with safeguards, receives guarded support. June 17, 2000:C01). In this article, University of Pennsylvania ethicist Arthur Caplan said that among the questions raised by the plan are the following: What kind of permission is needed? What are the rights of the participants? What kinds of purposes can the data be used for? How do you distribute the money made from the government-funded project?
The university is now involved in negotiations with the National Heart, Lung, and Blood Institute regarding patient protection and ownership of the computer-enhanced data. The Institute has spent more than $40 million over 50 years to fund the landmark heart study.
The university believes that existing consent forms cover commercial uses, a spokesman told the Globe. Framingham Genomics plans to donate stock to a charitable trust for the town of Framingham and to pay for an ethics oversight committee for the project.
White Coats and Blood Pressure
The phenomenon of "white coat hypertension" (when a patient’s blood pressure increases in a clinical setting) is well documented, but now researchers from the University of British Columbia in Vancouver say that the presence of clinicians can create a "false normal" blood pressure (BP) reading (Arch Fam Med. 2000;9:533–540).
The researchers measured the BP of 319 presumed healthy subjects in the office and as ambulatory readings over periods of 10 to 12 hours. The office readings were taken in a seated position at 0, 4, 8, 12, and 14 minutes during a 15-minute adaptation period. Patients received a battery of psychological tests to measure stress, self-deception, hostility, depression, anger expression, and social support. The researchers found that "white coat normotension" existed in 23% to 24% of patients. This normotension varied with measures of systolic or diastolic BP.
The patients with "false normal" readings were more likely to be
male, past smokers, and to consume more alcohol than those with true
normal readings. The authors noted, "A disturbing observation is that
in this large sample of presumably healthy individuals, 
23% have
truly high BP as defined by ambulatory BP measurements, and these
subjects with true hypertension were missed by office BP
measurements."
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