Automated External Defibrillators Improving Survival After Sudden Cardiac Arrest

The use of automated external defibrillators (AEDs) is an efficient method of delivering defibrillation to people who have an out-of-hospital cardiac arrest, according to a study in the March 7, 2001 issue of the Journal of the American Medical Association. In addition, the use of the defibrillators by traditional and nontraditional first responders seems to be safe and effective (JAMA. 2001;285:1193–1200).

In their study, researchers led by John P. Marenco, MD, of the New England Cardiac Arrhythmia Center in the Division of Cardiology at the New England Medical Center in Boston, evaluated 101 articles on the use of AEDs that were published in peer-reviewed journals. Analyzing and combining the data in these studies led the researchers to determine that AEDs are valuable additions to the “chain of survival.” However, they noted that “how widespread the availability of the AED should be is unknown and whether AEDs should be placed in shopping malls, convention centers, and large office buildings is largely untested.” A study that is jointly funded and sponsored by the National Heart, Lung, and Blood Institute and the American Heart Association should answer some of those questions.

Spending for Health Care Rising Again While Some Insurers Report Increased Profits

US healthcare costs are breaking out of the control mode of the 1990s and may soon be skyrocketing, says David Blumenthal in the second installment of the New England Journal of Medicine’s Health Policy 2001 series (N Engl J Med. 2001;344:766–769). Blumenthal noted that according to the projections of the Health Care Financing Administration, healthcare spending will climb 6.8% each year until 2008, when it will total $2.2 trillion. “Dealing with this challenge, which dominated the health policy agenda from the late 1960s until the mid-1990s, will be extremely difficult under any circumstances. It may prove impossible unless the factors that prevent poor and uninsured persons from obtaining medical care are addressed simultaneously.”

Managed care, which gained its savings from negotiated discounts with physicians and hospitals, can no longer count on that mechanism to reduce costs. The 1990s was also a period during which health insurers reduced premiums because of competition. That cycle is now over, and premiums are rising.

Over the long term, Blumenthal said, new technology will drive up spending. That prediction was echoed by a Project Hope analysis for Blue Cross/Blue Shield and the Health Insurance Association of America. That study found that new medical technologies could account for as much as one-third of the projected increases in US health care over the next 5 years. The report’s authors said that the challenge for the future is to understand when technology adds value and to use economic incentives to encourage more appropriate use of the technology. Dr Blumenthal argues that the numbers of people in the United States who will become senior citizens in the coming years will also prompt increased spending on health care.

In the meantime, American Medical News, in its March 12, 2001 edition, reported that some insurers’ profits are up, despite rising costs. During the last quarter of 2000, some insurers raised premiums, instituted cost controls by leaving some markets, cut jobs, and changed some operations. As a result, the newspaper said, United Healthcare had a record fourth quarter in 2000, with earnings increasing 33% over the same period in 1999. Profits were $120 million, up from $157 million for the same quarter in 1999. Humana increased premiums, left some losing markets in the year 2000, and cut 500 employees. As a result, it posted a profit of $27 million for the fourth quarter of the year 2000 compared to a $416 million loss from the same period in 1999.

Cleveland Clinic Plans Medical School by 2003

The Cleveland Clinic plans to begin a 30- to 40-student medical school as early as 2003. It has not yet decided whether the school will be independent or operated in partnership with another institution, such as the Case Western Reserve or Ohio State universities, according to the Cleveland Plain Dealer in its March 6, 2001, edition.

“It is our intention to broaden our medical student education activities and to have a medical school on our campus,” Dr Andrew Fishleder, chairman of the Clinic’s education division, told the Plain Dealer. “The exact form of that medical school remains uncertain, and we’re still exploring opportunities to potentially do this collaboratively.” Officials told the Plain Dealer that they will train physicians for a few areas where they are specifically needed, such as physician-scientists.

The Cat Can Stay—Maybe

Cats may not be the asthma trigger that parents and physicians consider them to be, according to a study in the March 10 issue of The Lancet (2001;357:752–756). Apparently, said the researchers, who were funded in part by the National Institute of Allergy and Infectious Diseases and the National Institute of Environmental Health Sciences, high levels of cat allergen in the home decrease the risk of asthma attacks by altering the children’s immune response to their feline friends.

Thomas A. Platts-Mills, MD, PhD, and colleagues at the University of Virginia’s Asthma and Allergic Diseases Center showed that cat exposure was different from exposure to house dust mites, which cause people to produce immunoglobulin E or IgE antibodies. The researchers measured the levels of antibodies to cat allergen in 226 children aged 12 to 14 years and tested the children for asthma. They also measured the amount of cat allergens in the children’s homes and discovered that low-to-moderate amounts of cat allergen seemed to trigger allergy but that high amounts reduced both IgE antibodies and the likelihood of asthma.

“This result alters the advice we give patients,” says Dr Platts-Mills. “I would not recommend that parents get rid of their cat because they are concerned their child might develop asthma. However, high exposure to cat allergen seems to be protective for some children and a risk factor for others. If the child is wheezing and has a positive skin test to cat allergen, then you should get rid of your cat.”