(Circulation. 2000;102:e9030.)
© 2000 American Heart Association, Inc.
Cardiovascular News |
Cardiovascular News
Uninsured Numbers Drop
An increase in employment contributed to a 1.7 million person drop in the numbers of Americans without health insurance. This is the first decline since 1987, when the US Census Bureau began collecting health insurance data. The numbers of uninsured fell from 44.3 million in 1998 to 42.6 million in 1999. The percentage of US citizens without health insurance dropped from 16.5% in 1998 to 15.5% in 1999. This was again the first drop in percentage since 1987.
Experts attributed the decrease to a robust economy, with more people employed in jobs that provide health benefits, and new federal programs to increase insurance for children. No one knows whether the 1-year drop is part of a trend or if it is an anomaly. Diane Rowland, director of a commission on the uninsured funded by the Kaiser Family Foundation, told the Washington Post, "Nothing magical has happened to turn around the problem. The great concern is what will happen if the economy turns sour or we have a real recession, in which historically health insurance coverage has eroded."
Texas, Arizona, and New Mexico had the highest rates of uninsured people, and Minnesota, Rhode Island, and Hawaii had the smallest proportion. The rate of uninsured people dropped from 12% in 1998 to 11% in 1999. Among Hispanics, the rate of uninsured persons dropped 2 percentage points, from 35% in 1998 to 33% in 1999. The rate of uninsurance among African-Americans, Asians, and Pacific Islanders was 21%. This rate did not change between 1998 and 1999.
The numbers of uninsured children declined from 11.1 million (15.4% of that population) in 1998 to 10 million (13.9%) in 1999. However, young adults aged 18 to 24 were the least likely to have health insurance, with the rate decreasing from 30% in 1998 to 29% in 1999.
Uninsured people were found at many income levels, but the numbers were
concentrated at the poverty level. Of those with incomes <$25 000
annually, 24.1% were uninsured. Only 8.3% of those with annual
incomes of 
$75 000 were without health insurance.
The Census Bureau obtained the information by surveying 50 000 households in March 2000.
Myoblast Transplant to Heart Attempted
Physicians at Temple University Health Sciences Center in Philadelphia announced September 25, 2000, that they had transplanted a patient’s own myoblasts directly into the damaged muscle of his heart. The hope of such a move is to repair the damaged heart muscle, thus strengthening its contractions.
Howard Eisen, MD, medical director of Temple’s heart transplant program, and Satoshi Furukawa, MD, surgical director of the program, are the principal investigators. They have 2 goals for the phase I trial: testing the feasibility and safety of transplanting the cells and determining if the cells will survive and improve cardiac function. The trial is a collaboration with Diacrin, Inc, a Massachusetts-based biotechnology company.
Surgeons took a biopsy from the arm muscle of the 48-year-old Pennsylvania man. The excised cells were then isolated and expanded in culture in laboratories at Diacrin. Two weeks later, these cells were transplanted into the man’s heart at the same time that surgeons implanted a left ventricular assist device. The patient now awaits a heart transplant.
All patients in the Food and Drug Administration (FDA)-approved study will be heart transplant candidates scheduled to receive a left ventricular assist device as a bridge to transplant. After the patients receive their donor heart, their original hearts will be biopsied to determine if the skeletal muscle cells survived and/or began to repair the damaged myocardium.
National Institute of Allergy and Infectious Diseases Challenge Grants Designed to Spark Development of Drugs to Combat Infectious Diseases
The National Institute of Allergy and Infectious Diseases (NIAID) plans to issue $19 million to 8 companies as part of its Challenge Grants program, which is designed to encourage research into ways to prevent and treat major infectious diseases such as tuberculosis, malaria, influenza, and dengue virus. The grants are called milestone awards because the companies must meet certain product goals in the development process to receive continued funding.
"Infectious diseases such as malaria, tuberculosis, and influenza continue to take a devastating toll on people throughout the world," said Anthony Fauci, MD, director of NIAID. "Forging partnerships with industry is an important part of NIAID’s commitment to research on new ways to prevent and treat these diseases, and to move discoveries quickly from the laboratory to the clinic."
Each company will match the award in dollars, and the combination of funds will be used to support 3-year projects.
New Advisory Committee Named to Advise Health and Human Services Secretary Donna Shalala on Organ Transplantation
The US Department of Health and Human Services, acting on a recommendation from the Institute of Medicine, has created the Advisory Committee on Organ Transplantation to oversee scientific, medical, and public involvement in transplantation. The immediate goal for the committee is to advise the Secretary of Health and Human Services, Donna Shalala, PhD, on a revision of organ donation policies now in the development stage at the Organ Procurement and Transplantation Network (OPTN).
In a released statement, Secretary Shalala said, "More lives can be saved through broader sharing of organs, with particular focus on livers... the OPTN has been developing proposals for improving liver allocation policies." The new advisory committee, which will be named later in the fall, will provide an independent assessment of the proposals.
Last year, Secretary Shalala became the center of a storm of controversy over plans to change the way organs are allocated. The proposal would have given organs to the sickest patients nationwide. Previously, organs were offered first to the sickest patients in the region in which the organ was procured. Currently, under mandate from the Secretary and Congress, OPTN is writing rules that would establish universal criteria for which patients should be offered organs first within the boundaries of organ viability.
Abortion Pill Gets FDA Approval
The FDA approved the controversial abortion pill called mifepristone or RU 486 on September 28, 2000, provoking expected responses from both sides of the abortion issue. Supporters of abortion hailed the ruling for giving women the ability to have abortions in privacy and making abortion available through private physicians who have previously not provided that service when it involved a surgical procedure. Those opposed to abortions vowed to fight the decision legislatively and in the courts.
FDA officials denied that politics played a part in the decision. However, the road to approval for the abortion pill has been long and arduous. Approval has been opposed in Congress, and the FDA’s newest ruling is destined to play a part in the ongoing race for the US Presidency.
Doctors who prescribe the drug must be able to determine how long a woman has been pregnant and to ensure that women who take it have access to and agree to have a surgical abortion if the pill does not work. In tests, the abortion pill failed to cause a complete abortion in 5% of cases.
Women take RU 486 or mifepristone first to block the action of progesterone, the drug needed to maintain a pregnancy. After 36 to 48 hours, the woman takes a second drug called misoprostol to cause the body to expel the fetal tissue. Side effects include bleeding, cramping, headaches, vomiting, and diarrhea. All women must receive written instructions on using the pill and information about its side effects.
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