Salt Wars: Revenge of CSPI
First the federal government was sued for taking too seriously data concluding that high salt intake contributes to heart disease. Now it's being sued for not taking those data seriously enough. In the latest suit, filed in the U.S. Court of Appeals for the District of Columbia Circuit, the Center for Science in the Public Interest alleges that the Food and Drug Administration has unreasonably delayed recognizing salt as a food additive and regulating its use in processed foods. “There is no way the FDA can look at the science and say with a straight face that salt is 'generally recognized as safe,'” said Michael Jacobson, of CSPI. The Salt Institute, which sued the Department of Health and Human Services for failing to release the data supporting its recommendation of cutting down on salt intake as a way to avoid heart attacks and strokes, took a dim view of CSPI's action. “Mr. Jacobson says that diets too high in salt are responsible for 150,000 premature deaths each year in the United States,” said institute president Richard L. Hanneman. “There is no evidence supporting this claim.”
Alzheimer's Bill Introduced
Rep. Christopher Smith (R-N.J.) has introduced H.R. 1262, the Ronald Reagan Alzheimer's Breakthrough Act. The measure would double funding for Alzheimer's disease research at the National Institutes of Health from $700 million to $1.4 billion and increase funding for gerontology training, patient education, and caregiver support programs. The act “offers a comprehensive approach for treating current Alzheimer's patients and researching potential cures to reduce the number of those who will struggle with this disease in the future,” Rep. Smith said in a statement. “We will be working overtime to secure passage of this critical legislation.” The House measure is cosponsored by Rep. Ed Markey (D-Mass.) and Rep. Mike Burgess (R-Tex.); a companion bill was introduced in the Senate by Sen. Kit Bond (R-Mo.) and Sen. Barbara Mikulski (D-Md.).
CMS on Diabetic Neuropathy
The Centers for Medicare and Medicaid Services has issued instructions to carriers explaining how to reimburse physicians for diagnosing and treating diabetic neuropathy. The instructions note that Medicare covers evaluations of the feet “no more often than every six months for individuals with a documented diagnosis of diabetic sensory neuropathy and loss of protective sensation (LOPS), as long as the beneficiary has not seen a foot care specialist for some other reason in the interim.” LOPS should be diagnosed with a 5.07 monofilament using established guidelines. The instructions also note that “once a beneficiary's condition has progressed to the point where routine foot care becomes a covered service, payment will no longer be made for LOPS evaluation and management services.” The instructions can be viewed online at
http://www.cms.hhs.gov/manuals/pm_trans/R498CP.pdf
Autism Education Costs High
The cost of educating children with autism is almost triple that of educating children who receive no special education services, according to a report from the Government Accountability Office. The GAO reviewed data from the Special Education Expenditure Project funded by the Department of Education and found that the average cost of educating a child with autism was $18,000 in the 1999-2000 school year. That estimate “was among the highest per-pupil expenditures for school-age children receiving special education services in public schools,” the report stated. It also noted that the number of children with autism who were given special education services has increased by more than 500% in the last decade.
Pay-for-Performance Principles
Any “pay-for-performance” program should offer voluntary physician participation and foster the relationship between physician and patient, the American Medical Association asserted in a new set of principles for such programs. Such a program should also use accurate data and fair reporting, provide program incentives, and ensure quality of care, the AMA stated. If done improperly, “some so-called pay- for-performance programs are a lose-lose proposition for patients and their physicians with the only benefit accruing to health insurers,” AMA Secretary John H. Armstrong, M.D., said in a statement. Both private and public sector organizations have started offering incentive payments to physicians based on an appraisal of their performance. Before taking on such reforms, however, Congress should try to fix Medicare's flawed payment formula, according to recent AMA testimony.
Conflict-of-Interest Rules Targeted
People with direct financial conflicts of interest should not be put on Food and Drug Administration advisory committees, a coalition of public interest groups has recommended. Financial conflicts undermine “the public's faith in the fairness and credibility of the panel's work,” the Center for Science in the Public Interest, the National Women's Health Network, the U.S. Cochrane Center Consumer Coalition, and eight other groups said in a letter to Acting FDA Commissioner Lester Crawford, D.V.M., Ph.D. The groups cited the FDA advisory committee that recently reviewed the safety of cyclooxygenase-2 inhibitors, noting that 10 of the 32 members had direct financial conflicts. In addition to prohibiting scientists, physicians, and clinicians with relevant conflicts of interest from serving on advisory committees, the groups also recommended that people with any industry ties make up no more than half of a committee.