(Circulation. 2001;103:e9026.)
© 2001 American Heart Association, Inc.
Cardiovascular News
Families USA Says Proposed Bush Budget Could Bankrupt Medicare
Families USA, a Washington, DC–based consumer health group, released a report March 13, 2001 predicting that the Bush budget will bankrupt the Medicare Hospital Insurance Trust Fund by 2010 by diverting $526 billion from the fund over the next 10 years. The bankruptcy would occur 15 years sooner than projected under the budget plan, according to the consumer group. The fund would also lose $172.5 billion in interest payments during the same period.
Without the Bush budget changes, the Trust Fund’s surplus would be $592.7 billion in 2011. According to Families USA, the new budget would reverse the surplus to a $105.8 billion debt.
The same day that the report was released, the US Senate blocked an attempt to restrict Congress’ ability to use surplus Medicare revenues for a tax cut or general spending. According to the March 14, 2001 issue of the Wall Street Journal, the Congressional Budget Office estimated the surplus in the Medicare fund to be $392 billion through 2011. The White House has estimated the surplus as $526 billion. According to the Journal, Democrats said the vote demonstrated that the Republicans would raid Medicare to pay for the tax cut promised by President Bush during his campaign.
National Institutes of Health Researching Way to Combat Antibiotic Resistance
The National Institutes of Health, the US Food and Drug Administration, and the federal Centers for Disease Control and Prevention in Atlanta are combining bench research with public and professional education to combat the growing problem of bacterial resistance to antibiotics.
The National Health Institutes’ research examines the cellular mechanisms that encourage bacterial resistance, as well as what makes various forms of bacteria pathogenic, Marissa Miller, DVM, MPH, antimicrobial resistance program officer at the National Institute for Allergy and Infectious Diseases, told American Medical News in its March 19, 2001 issue. The program is also exploring novel avenues of treatment such as "phage therapy" to attack the bacteria.
The other agencies will work on patient education programs to teach patients about the limits of antibiotics and to stop pressuring physicians to prescribe the drugs for colds and the flu. In addition, they will monitor the patterns of drug-resistance diseases and set up systems to enable them to monitor patterns of antibiotic drug use in people as well as in agricultural and consumer products, AMNews reported.
Depression Increases Risk of Heart Disease Death
Depression can dramatically increase the risk of dying from heart disease, according to Dutch and US researchers reporting in the March issue of the Archives of General Psychiatry (2001;58:221–227).
A cohort of 2847 men and women aged 55 to 85 years were evaluated for 4 years. They were scored on scales that defined major and minor depression. The effects of depression were evaluated on 2397 people without heart disease and 450 with heart disease. Patients with heart disease who had minor depression had a 1.6 relative risk of cardiac mortality; heart patients with major depression had a 3.0 relative risk of cardiac mortality. Among patients without heart disease, the relative risk of cardiac mortality was 1.5 for those with minor depression and 3.9 for those with major depression.
The authors said, "Several plausible mechanisms for the link between depression and cardiac mortality exist, of which pathophysiological and behavioral ones are the most important." Among the physical effects of depression are impaired platelet function, decreased heart rate variability, immune activation, and hypercortisolemia as a stress response. The authors noted that depressed people are more likely to have unhealthy lifestyles and to use forms of medication that might have "cardiotoxic" effects. "It is possible that depression may be an indirect indication of disease severity or it may represent a reaction to (sub)clinical cardiovascular symptoms (eg, dyspnea) that places subjects at a greater risk for cardiac mortality," the authors wrote.
They said that prevention and treatment of depression may be "one of the most effective targets for interventions aimed at reducing the risk for fatal cardiac events." The researchers came from the Vrije University in Amsterdam; the Academic Hospital and the University of Maastricht, Maastricht, The Netherlands; and Wake Forest University School of Medicine in Winston-Salem, North Carolina.
Hold Off on Tetanus Boosters Until Year’s End
The federal Centers for Disease Control and Prevention (CDC) is asking the nation’s physicians to delay routine tetanus booster shots until supplies of the vaccine reach normal levels, which probably will not happen until the end of the year, according to the March 19, 2001 American Medical News.
Supplies of vaccine should be sufficient for people who need protection because of an injury that penetrates the skin and for children aged 2 months to 6 years, who are receiving routine immunizations.
The CDC told AMNews that Aventis Pasteur, the sole manufacturer of the vaccine, is rationing supplies to hospitals and doctors. The CDC had hoped the shortage of tetanus vaccine would end by December 2000. However, Wyeth-Ayerst Laboratories decided to stop producing the standard vaccine, which meant that the shortage would continue.
Top priority is being given to patients who must receive the vaccine to treat wounds or burns, the CDC told AMNews. People who must travel to a country where the risk of diphtheria is high are also given priority. Tetanus and diphtheria vaccines are manufactured together.
Aventis Pasteur has stepped up vaccine production, but it takes 11 months to make the vaccine. That accounts for the lag time before supplies are up to par.
Proposed Legislation Would Reduce Medical School Debt
Bills proposed in the US House and Senate would repeal the limit on the amount of time that students can deduct the interest they pay on loans and increase the total graduates can make and remain eligible for the tax break.
The proposals in the House and Senate differ, but they have the support of the American Medical Association, the American Dental Association, and a variety of academic institutions. The legislation applies to all students, but the tax breaks would be especially helpful for medical school graduates, who have an average debt of $95 000, according to the March 19, 2001 issue of American Medical News.
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