News-Record.com

The Guilford County Department of Public Health is working with some area nonprofits to provide free HIV/AIDS testing at several clinics scheduled for this month in Greensboro and High Point. The department's blog post here has more information.

UNCG's Exercise and Sport Psychology laboratory is seeking volunteers for a study.

Candidates need to be between 60 and 90 years old. Subjects would volunteer for one day of activity, including reading or exercise, and cognitive tests.

For more information or to volunteer, e-mail lisabarella@hotmail.com or call 253-5539.

If you've read much about medical research, you've probably come across the term "placebo effect." It refers to the fact that something as simple as a sugar pill (or "placebo"), administered as a drug, may actually have a beneficial effect. It's not entirely clear whether the patient has to believe that the placebo is a real drug for the placebo effect to take place. One 1964 study found that some patients experienced the placebo effect even when they had been told that the pill they were taking wasn't a real drug.

Well, like everyone else, the placebo effect now has a blog of its own. You can actually buy placebos there -- 700-count bottles of sugar pills -- but mainly you'll just want to read some of the clear, and light-hearted, posts about how the placebo effect works and how much we still don't understand about it. Light-hearted though some of the posts may be, the placebo effect is a serious and important factor in such areas of research as whether certain antidepressant medications really work.

Medicare, with the complicity of the American Medical Association, has increased the financial pressure on already-pressured primary-care physicians. At least, so says The Health Care Blog.

According to the blog, Medicare's payment structure (and those of many private insurers whose pay structures closely parallel Medicare's) is largely rigged by specialists in favor of specialists despite research indicating that more emphasis on primary care leads to lower health-care costs overall.

It's a self-worsening problem: As financial pressures on primary-care physicians increase, more PCPs get out of that line of work and fewer new physicians enter it. That means a relative increase in specialists, with their higher fees, to handle patient care, with more specialists thus involved in the process by which fees are set.

Read the whole thing -- it's very easy to understand. Unfortunately, it's not a very optimistic piece. Among other things, it points out that Congress would have to act to get Medicare to change its ways (that is, reduce the role of specialists in helping it set its fee structure, if I understand correctly), and as I've pointed out elsewhere in other contexts, expecting Congress to do the right thing by the average person (or small employer, on whom the greatest health-care expense burden falls) is becoming more and more a sucker's bet.

Within the past few days, a record 143 million pounds of beef that had been processed by the Hallmark/Westland Meat Packing Company in Chino, California, was recalled. The recall was prompted by Humane Society video documentation that cattle too sick to stand -- so-called "downer cows" -- were being stood up by workers so that they could be slaughtered and their beef used. U.S. Department of Agriculture policy bans downer cows from the food chain.

One concern about downer cows is that they may be infected with "prion diseases," rare but uniformly fatal brain disorders that can be passed on to humans. The best-known prion disease in humans is Creutzfeldt-Jakob Disease. It has several variations, one of which is believed to be passed to humans from cattle infected with the prion disease BSE (bovine spongiform encephalopathy).

The risk of such infections is not great; the foundation estimates that infection from all sources involves between 250 and 300 U.S. patients per year. But Department of Agriculture regulations are there for a reason, and in the case of Hallmark/Westland, they were being violated on a scale large enough to justify a record-breaking recall.

The Creutzfeldt-Jakob Disease Foundation has more information on this phenomenon. It also has bad news to report regarding inspections for food safety. In a letter to members released Tuesday, the foundation reported that in its opinion, the food-safety net is full of holes:

The CJD Foundation and its members have been vocal advocates for more stringent [U.S. Department of Agriculture] BSE policies and oversight for a long time. Over the past five years we have met with our elected representatives on Capitol Hill to talk about our concerns, and in July 2006 some of us participated in a meeting with the USDA Secretary Mike Johanns and Dr. Richard Raymond, USDA under secretary for food safety. We urged them not to scale back BSE testing from 375,000 to 40,000 (which they proceeded to do one week after our meeting). The statement that the USDA's BSE policy is "not to protect the human food supply but to provide animal surveillance" is chilling. Who then is protecting our food supply and at what point in the process are they doing so?

UPDATE: The Agriculture Department tells Congress that things are just fine:

Agriculture Secretary Ed Schafer told Congress yesterday that he would not endorse an outright ban on "downer" cows entering the food supply or back stiffer penalties for regulatory violations by meat-processing plants in the wake of the largest beef recall in the nation's history.

Appearing at a Senate Appropriations subcommittee hearing, Schafer said the department is investigating why it missed the inhumane treatment of cattle at the Westland/Hallmark Meat Co. in Chino, Calif., including workers administering electric shocks and high-intensity water sprays to downer cows -- those too sick or weak to stand without assistance.

The secretary announced interim steps such as more random inspections of slaughterhouses and more frequent unannounced audits of the nearly two dozen plants that process meat for federal school lunch programs.

But he deflected calls from Sen. Herb Kohl (D-Wis.), the subcommittee chairman, for the government to ban all downer cows from the food supply, increase penalties for violators and require installation of 24-hour surveillance cameras in processing plants.

"The penalties are strong and swift, as we have shown," Schafer said. "Financially, I don't see how this company can survive. People need to be responsible and, from USDA's standpoint, they will be held responsible. . . . They broke the rules. That does not mean the rules are wrong. I believe the rules are adequate."

The hearing came 11 days after Agriculture officials ordered the recall of 143 million pounds of beef processed by Westland/Hallmark, including 37 million pounds that had gone to school lunch and other public nutrition programs. No illnesses have been linked to the recalled meat.

The Internet search-engine giant Google is going to begin storing some patients' private medical records:

Google Inc. will begin storing the medical records of a few thousand people as it tests a long-awaited health service that's likely to raise more concerns about the volume of sensitive information entrusted to the Internet search leader.

The pilot project to be announced Thursday will involve 1,500 to 10,000 patients at the Cleveland Clinic who volunteered to an electronic transfer of their personal health records so they can be retrieved through Google's new service, which won't be open to the general public.

Each health profile, including information about prescriptions, allergies and medical histories, will be protected by a password that's also required to use other Google services such as e-mail and personalized search tools.

Google views its expansion into health records management as a logical extension because its search engine already processes millions of requests from people trying to find about more information about an injury, illness or recommended treatment.

But the health venture also will provide more fodder for privacy watchdogs who believe Google already knows too much about the interests and habits of its users as its computers log their search requests and store their e-mail discussions.

On the good side, this gives patients unprecedented access to their own medical records, which is important for people who want to take a more active role in managing their own health care.

On the bad side, data stored by Google won't, at least for now, be covered by the Health Insurance Portability and Accountability Act (HIPAA), which protects the privacy of medical records. In addition to an increased risk of privacy violations, there's at least an outside chance that the records could be used for marketing purposes.

On the good side, Google has a record of dedication to individual privacy. Under pressure from users, it developed a system to purge search records after 18 months, and two years ago it fought and won a case in which the U.S. Department of Justice wanted to examine large numbers of its records.

Would you let your records be stored by Google if it meant you could access them more freely?

No, the title of this post doesn't refer to dead patients ... at least, not directly.

Via Mark Schaver's Depth Reporting comes this post at the Bad Science blog (new to me) on how drug-company-sponsored studies that don't show good results get buried.

Blogger Ben Goldacre says the withdrawal of Vioxx from the marketplace was just a dramatic example, but less dramatic examples permeate drug research, depriving doctors of information they need:

... a paper in the New England Journal of Medicine dug out a list of all trials on SSRIs [a kind of antidepressant -- Lex] which had ever been registered with the Food and Drug Administration, and then went to look for those same trials in the academic literature. There were 37 studies which were assessed by the FDA as positive and, with a single exception, every one of those positive trials was written up, proudly, and published in full. But there were also 33 studies which had negative or iffy results and, of those, 22 were simply not published at all -- they were buried -- while 11 were written up and published in a way that portrayed them as having a positive outcome.

The new study, published this week, has analysed all of the data from the FDA, using the Freedom of Information Act to obtain the results for some of the trials. That medical academics should need to use that kind of legislation to obtain information about trials on pills which are prescribed to millions of people is absurd. More than that, it breaks a key moral contract between patient and researcher.

When a patient agrees to participate in a clinical trial, they give their consent on the understanding that their information will be used to increase the sum of our knowledge about treatments, to ensure that other people, in the future, will be treated more effectively. Burying unwelcome results is an unambiguous betrayal of their trust and generosity.

Goldacre says this "publication bias" has been recognized in medical literature for half a century. (And not just in medical literature, but elsewhere, as in Cynthia Crossen's 1994 book "Tainted Truth: The Manipulation of Fact in America.")

He also offers some solutions to the problem:

... there are two very simple and widely accepted solutions, which have been discussed in the academic literature at length since the 80s, but which are still not fully in place.

The first is obvious. Nobody should get ethical approval to perform a clinical trial unless there is a clear undertaking that the results will be published, in full, in a publicly available forum, and that the researchers will have full academic freedom to do so. Any company trying to silence academics should be named and shamed, and even attempting to do so should be a regulatory offence.

That's the butch solution. But there is also a more elegant one, which is arguably even more important: a compulsory international trials register. Give every trial an ID number, so we can all see that a trial exists, they can't go quietly missing in action, and we know when and where to look if they do.

Doctors -- and, with the growth in marketing of drugs directly to consumers, patients -- need to know not only when something works but also when it doesn't, or when it works no better than existing, cheaper medications. Goldacre points us helpfully in the right direction.

The Health Care Blog compares Hillary Clinton and Barack Obama's health-insurance proposals and finds little difference between them.

CancerMonthly.com compares the records on cancer of Clinton, Obama and John McCain.

I'm not endorsing either of these analyses (let alone a candidate), just passing them on for whatever they might be worth.

The World Health Care Congress has launched a new site, ReformPlans.com, which compares the health-care plans of the remaining presidential candidates and also offers all manner of news and comment about health-care reform at the federal and state levels. Check it out.