Friday, April 6, 2012

FDA probes salmonella that has sickened 90 people

(AP) ? Federal health officials are investigating a growing outbreak of salmonella that has sickened 90 people in 19 states and the District of Columbia, according to a Food and Drug Administration memo.

The outbreak is "rapid and expanding in number of cases," with seven hospitalizations reported, according to a memo distributed to FDA staff Tuesday morning. No deaths have been reported to date.

The salmonella may be linked to sushi and investigators are focusing on spicy tuna rolls as "highly suspect."

Reports of the foodborne illness have mainly come from the eastern seaboard and Gulf Coast, though cases have been reported as far west as Missouri and Texas. Investigators are focusing on six clusters of restaurants in Texas, Wisconsin, Maryland, Rhode Island and Connecticut.

FDA spokesman Curtis Allen would not confirm or elaborate on the information, saying the memo "contains numbers of cases and hospitalizations that cannot be confirmed at this time."

"It is too early to speculate on the cause of the outbreak," Allen said.

The FDA is working with the Centers for Disease Control and Prevention and state officials to identify the source of the outbreak. Investigators conduct interviews with sick patients about what they've eaten and analyze menus and food ingredients to trace the path of the bacteria.

The memo notes there is likely a 30-day lag time between when people become sick and when cases are reported to health officials.

Previous outbreaks of salmonella bareilly have been linked to bean sprouts, which are grown in warm, damp conditions.

The most common symptoms of salmonella are diarrhea, abdominal cramps and fever within eight to 72 hours of eating the contaminated food. The illness can be life-threatening in people with weakened immune systems.

Associated Press

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Doubling Down (talking-points-memo)

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Thursday, April 5, 2012

FACT CHECK: Romney, Obama gloss over realities

President Barack Obama speaks at The Associated Press luncheon during the ASNE Convention, Tuesday, April 3, 2012, in Washington. (AP Photo/Carolyn Kaster)

President Barack Obama speaks at The Associated Press luncheon during the ASNE Convention, Tuesday, April 3, 2012, in Washington. (AP Photo/Carolyn Kaster)

President Barack Obama waves as he leaves The Associated Press luncheon during the ASNE Convention, Tuesday, April 3, 2012, in Washington. (AP Photo/Carolyn Kaster)

President Barack Obama speaks at The Associated Press luncheon during the ASNE Convention in Washington, Tuesday, April, 3, 2012. (AP Photo/Pablo Martinez Monsivais)

Republican presidential candidate, former Massachusetts Gov. Mitt Romney speaks at the Newspapers Association of America/ American Society of News Editors luncheon gathering in Washington, Wednesday, April 4, 2012. (AP Photo/Manuel Balce Ceneta)

Republican presidential candidate, former Massachusetts Gov. Mitt Romney speaks at the Newspapers Association of America/ American Society of News Editors luncheon gathering in Washington, Wednesday, April 4, 2012. (AP Photo/Manuel Balce Ceneta)

(AP) ? Republican presidential hopeful Mitt Romney accused President Barack Obama on Wednesday of inflicting a "government takeover of health care" on Americans, even though Obama's law is closely modeled on the plan Romney achieved in Massachusetts.

Romney's speech to news leaders, like Obama's the day before, was a roll out of the head-to-head rhetoric that will increasingly define the campaign until November. Each aggressively criticized the other side and, in doing so, warped some realities.

Obama ignored divisiveness in Democratic ranks and his own political drifts when he accused Republicans of disavowing anti-pollution legislation and health care changes they once supported. Romney again portrayed Obama as a leader who apologizes for America even though the president has no history of saying "sorry" on behalf of the nation.

A look at some of their statements and how they compare with the facts:

ROMNEY: "The president's attention, it was elsewhere, like a government takeover of health care and apologizing for America abroad."

THE FACTS: Obama's law keeps the private insurance industry at the heart of the health care system and avoids a single-payer government system like Canada's. It seeks to achieve universal coverage by requiring insurers to accept people regardless of medical history, subsidizing costs for many in the middle class as well as the poor, establishing new markets for those who don't get insurance at work and requiring most Americans to obtain coverage, with penalties if they don't.

That's precisely what Romney did, first, as Massachusetts governor.

Romney argues that states have the right to establish an individual insurance mandate and Washington doesn't ? a question the Supreme Court is deciding. But whether the federal law is found constitutional or not, it does not add up to a government takeover.

Even when fully implemented, if the court allows that, the nonpartisan Congressional Budget Office estimates that 58 percent of working-age Americans and their families will be covered through employer plans ? about the same as now.

In his world travels, Obama has said at times that the U.S. acted "contrary to our traditions and ideals" in its treatment of terrorist suspects, that "America has too often been selective in its promotion of democracy," that the U.S. "certainly shares blame" for international economic turmoil and has sometimes shown arrogance toward allies.

Obama's statements that America is not beyond reproach in its history usually come balanced with praise, and he is hardly alone among presidents in acknowledging the nation's past imperfections.

But these were not apologies, formal or informal.

___

OBAMA: "There is a reason why there's a little bit of confusion in the Republican primary about health care and the individual mandate, since it originated as a conservative idea to preserve the private marketplace in health care while still assuring that everybody got coverage, in contrast to a single-payer plan. Now suddenly this is some socialist overreach."

THE FACTS: True, but not the whole story.

Many Republicans into the 1990s, and in some cases beyond, supported the idea of requiring people to have health insurance, even if they disagreed with Democrats on how universal coverage should work. Now that idea is decidedly purged from the GOP mainstream.

But until he became president, Obama, too, thought a mandate was a bad idea. In the 2008 campaign, it was his "core belief" that everyone would get health insurance, without the coercion of a mandate, if only high-quality coverage were affordable.

He relentlessly criticized his primary opponent Hillary Rodham Clinton in debates, speeches, ads and mailers for proposing a mandate, taking it so far that she waved one of his mailers in the air and barked, "Shame on you, Barack Obama," slamming "your tactics and your behavior in this campaign."

___

ROMNEY: "The administration pledged that their stimulus would keep the unemployment rate below 8 percent. It has been above 8 percent every month since."

THE FACTS: Obama never said that he would hold unemployment below 8 percent if Congress adopted his stimulus package. The 8 percent figure cited by Romney, and many other Republicans, comes from a transition staff-written projection written by economists Christina Romer and Jared Bernstein that was issued weeks before Obama was sworn in and long before there even was a stimulus plan before Congress.

Romer, who went on to head Obama's White House Office of Economic Advisers, said after she left the White House in 2010 that the projection was so far off because she ? like nearly every other economic forecaster ? had failed to anticipate how deep the recession was and the extent to which conditions would continue to worsen. Their report was never an official Obama administration assessment or projection.

That stimulus plan, with a price tag of $787 billion at the time, wound up costing $825 billon. The nonpartisan Congressional Budget Office has said that the stimulus increased the number of people employed by 1.4 million to 3.3 million and cut the unemployment rate between 0.7 and 1.8 percentage points. Economists continue to debate whether the stimulus lived up to its promise or was worth the cost, but few seriously argue that it failed to create jobs and many believe it helped to end the recession.

___

OBAMA: "You'd think they'd say: 'You know what? Maybe some rules and regulations are necessary to protect the economy and prevent people from being taken advantage of by insurance companies or credit card companies or mortgage lenders.'"

THE FACTS: As zealous as they sound on the subject, Republicans aren't proposing to throw out all regulations. Romney, for one, proposes changing, but not repealing, the Sarbanes-Oxley law that tightened accounting regulations in response to corporate scandals. He does want to repeal the Dodd-Frank law toughening financial-industry regulations after the meltdown in that sector, and he wants environmental rules loosened to spur energy production.

Even in the heat of GOP primaries, however, Romney wasn't talking about throwing out the federal rulebook. "We don't want to tell the world that Republicans are against all regulation," he said. "No, regulation is necessary to make a free market work. But it has to be updated and modern." He said as much Tuesday night, that "we, of course, understand in a free market that regulations are necessary and critical."

___

OBAMA: "Cap and trade was originally proposed by conservatives and Republicans as a market-based solution to solving environmental problems. The first president to talk about cap and trade was George H.W. Bush. Now you've got the other party essentially saying we shouldn't even be thinking about environmental protection; let's gut the EPA."

THE FACTS: Obama is right that cap and trade was a Republican idea ? first put in place to control sulfur dioxide emissions, or acid rain, under the 1990 Clean Air Act amendments that passed overwhelmingly. The idea is to cap overall emissions of a certain pollutant while letting companies trade pollution allowances, essentially using a combination of the government and private market to make the environment cleaner.

But in recent years, cap and trade failed when Democrats controlled the Senate and the House. Moreover, Republicans argued the legislation was not a truly market-driven mechanism. It would have auctioned off pollution allowances to companies, raising money for the government to help offset higher energy bills and invest in cleaner energy technologies.

They wanted a system that would distribute the allowances for free, letting the private market determine their value. That's how it worked with acid rain.

Republicans have not abandoned the notion of environmental protection, although the presidential primary rhetoric ? all geared to more drilling and energy production ? could lead one to think so.

___

Associated Press writers Ricardo Alonso-Zaldivar, Dina Cappiello and Tom Raum contributed to this report.

Associated Press

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Business Law Firms with All IPR Services and Solutions in India and ...

Over the period of time corporate sector rises at quite massive rate, especially of creating countries where number of firms and organization houses of international level approaches to carry their company activities. Country like India, 1 of the largest and organization center of the world, here you will find number of world leading organizations having their head center to carry their organization in Asian countries. A lot of new firms and company center have started with their new branches in India and many new corporate sectors approaches to India as compared to prior couple of years. All these raises the demand of organization and ipr law firms in India that not only offers sorts of corporate law services but also suggest beneficial data and assistance require for organization growth and development. In India numerous sorts of company?s act are renewed time to time that every single enterprise and corporate home has to follow for smooth functioning of their company activities. Like trademark registration, patent registration, copyright registration, patent registration, patent drafting, intellectual property law, trademark attorney and several far more laws and rules are regulated from time to time by concerned authorities. To hire properly experienced and reputed company law firms in India is not an issue, here you will locate number of prominent corporate law firms that provides wide selection of organization law firms with total paper work and at inexpensive rates.

In India where you will uncover head centers of nearly each and every organization house of the world, in these developing countries corporate law firms plays valuable role in offering accurate solutions for various varieties of complex business problems globally.

It is recommended to all varieties of houses of corporate sector to hire services from any of the nicely skilled and reputed corporate law firm in order to get complete assistance and full legal rewards at the international level. All these Indian enterprise law firms play an important role in handling different types of problems of corporate sector of the nation. These corporate law firms play valuable and essential role, particularly for international organization that faces new challenges and problems from time to time. Among the various company law firms tm-indiais one of the nicely skilled and well-liked law firms comprises a large team of attorneys and lawyers working on diverse kinds of corporate issues including trademark search India, design registration, business trademark registration, trademark classification in India, patent trademark attorney, business patent registration, international trademark registration, PCT filling in India, trademark infringement, firm registrations, brand registration, organization formations, trademark litigation, intellectual property laws and many much more company law services that supplies with total paper work with accurate and systematic manner.

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Workers compensation opt-out measure debated in ... - Insurance

OKLAHOMA CITY?A debate in Oklahoma over legislation that would let employers leave the state?s workers compensation system could spill over to other states that are striving to contain insurance costs, sources say.

The issue is being led by large, multistate employers that have seen cost savings under Texas? nonsubscriber system for workers comp, and hope to achieve the same benefits in Oklahoma, said Bill Minick, president of PartnerSource, a Dallas division of Arthur J. G

allagher Risk Management Services Inc. that supports the Oklahoma bill.

?You?ve got many national employers who are saying this is working so well in Texas, with tremendous cost savings coupled with higher injured-employee satisfaction,? said Mr. Minick, whose company implements benefit plans for employers opting out of Texas? comp system. ?So why shouldn?t we do this in other states??

While insurers generally oppose the legislation, it seems to have a ?real chance? of being approved, said Joe Woods, Austin, Texas-based vp of state government relations for the Property Casualty Insurers Assn. of America. ?I suspect that if this passes in Oklahoma, there will be businesses pushing it in lots of other states.?

Oklahoma H.B. 2155 and S.B. 1378 would establish an alternative workers comp system that would allow certain employers to exempt themselves from the state system. The plan would require employers opting out to establish a substitute plan?including medical, disability and death benefits for injured workers?that meets Employee Retirement Income Security Act requirements.

Only ?qualified employers? with 50 or more employees that have exceeded certain thresholds for workers comp losses would be exempted. Those include an experience modification greater than 1 or total annual incurred claims above $50,000 in one of three preceding insurance policy years.

The legislation, if passed, would not affect workers comp advisory rates in the state, said Lori Lovgren, division executive-state relations for Boca Raton, Fla.-based NCCI Holdings Inc.

If adopted, Oklahoma would be only the second state to allow companies to exempt themselves from the state workers comp system. Texas has allowed opt-outs, or ?nonsubscription,? since its comp system was established in 1913.

The plan is supported by companies such as Oklahoma City-based Hobby Lobby Stores Inc., Seattle-based Nordstrom Inc. and Mooresville, N.C.-based Lowe?s Cos. Inc., according to the Oklahoma Injury Benefit Coalition, a group that backs the opt-out plan.

Becky Robinson, assistant vp, risk management, said Hobby Lobby backs the legislation because of results it has seen from the Texas nonsubscriber system. The retailer, which operates in 40 states, ranks Oklahoma in the top four costliest states for the company?s workers comp costs, while Texas is in the bottom five.

Ms. Robinson said the Texas nonsubscriber system has made the Texas workers comp market more competitive, and hopes similar results can be achieved in Oklahoma.

?It would certainly put (Oklahoma) on the map and give us an economic advantage over many of the other states,? she said.

Sources say Oklahoma has a costly dispute resolution and litigation process that is driving the current debate. It was No. 4 in the nation for workers comp premium rates, according to a 2010 Oregon Department of Consumer and Business Services study.

Mr. Minick of PartnerSource estimates the plan would save exempt employers 50% on their comp costs.

Although Oklahoma adopted workers comp reforms last year, Mr. Minick said many employers are unwilling to wait and see whether the changes will lower insurance costs.

?They want it now, and there?s a proven model right across the Red River to deliver it,? he said.

Insurer groups contend that the Oklahoma plan could limit benefits for injured workers and be less financially secure than traditional workers compensation insurance or self-insurance.

Copyright ? 2012. Crain Communications, Inc.

oklahoma

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Doctors seek end to 5 cancer tests, treatments

NEW YORK (Reuters) - The nation's leading association of cancer physicians urged doctors to stop offering five common tests and treatments for cancer patients, a move that threatens to further inflame concerns about the rationing of medical care.

The recommendations emerged from a two-year effort, similar to a project other medical specialties are undertaking, to identify procedures that are routinely done but do not help patients live longer or better or may even be harmful.

As much as 30 percent of health-care spending goes to procedures, tests and hospital stays that do not improve a patient's health, according to a 2008 analysis by the nonpartisan Congressional Budget Office.

"Our goal was to improve care and improve the value of the care we deliver," said Dr. Lowell Schnipper, a cancer physician at Beth Israel Deaconess Medical Center who led the task force assembled by the American Society of Clinical Oncology (ASCO). The task force of more than 200 oncologists released the list of five tests and treatments in a report in ASCO's Journal of Clinical Oncology.

Eight other medical specialty groups, from cardiologists to nephrologists to radiologists, are also identifying five tests or treatments from their own fields that are commonly ordered but do not benefit patients. It is part of the national "Choosing Wisely" campaign, organized by the American Board of Internal Medicine Foundation and Consumer Reports magazine.

Almost all of the recommendations begin with an emphatic "don't." The nephrologists, for instance, tell physicians not to perform routine cancer screening such as Pap tests and colonoscopies on dialysis patients with short life expectancies. The cardiologists tell physicians not to perform stress cardiac imaging or other advanced imaging in patients without symptoms of heart disease or on those about to undergo low-risk surgery such as cataract removal. From family physicians: Don't automatically do MRI or other imaging in patients with low-back pain, at least until the pain has persisted at least six weeks.

It is the oncologists' recommendations that could prove the most controversial. Unlike back pain and many other ills, "cancer is a terrifying diagnosis," said Schnipper.

Although his task force emphasized that its recommendations -- winnowed from about 10 suggestions by oncologists -- were driven by medical considerations, the report makes clear that expense was a major factor. A number of cancer drugs cost nearly $100,000 but extend life just a few months or not at all. Widely used imaging tests cost up to $5,000 yet do not benefit patients.

The list has been closely guarded, with public announcements scheduled for Wednesday. Patients, advocacy groups and policy experts contacted by Reuters were mixed in their reaction to the recommendations.

"The American people have a much higher opinion of doctors than of government bureaucrats," said Kate Nix, a policy analyst at the free-market Heritage Foundation. Whether the ASCO recommendations to withhold some tests and treatments will be seen as rationing "depends on how they are used," he said.

"Will they inhibit the ability of doctors and patients to make the best decision in each case?" he asked.

PATIENTS VS. FINANCIAL INTERESTS

Advocates for cancer patients applauded the recommendations.

"I think this is a great effort from ASCO," said Dr. Otis Brawley, chief medical officer of the American Cancer Society. "They are putting their patients ahead of their own financial interests," since in the existing fee-for-service healthcare system, physicians make money on every test and treatment they order.

Brawley does not see the effort as leading to healthcare rationing. "This is the rational use of healthcare, not rationing," he said.

Other advocates agreed. "I am shocked, surprised and pleased," said Fran Visco, president of the National Breast Cancer Coalition and a breast-cancer survivor. "Shocked because ASCO has long been loath to say 'do less.' Pleased because it appears that they are trying to follow the science, which is nice."

Following the science, however, can lead to conclusions that do not sit well with all patients. Shari Baker, who was diagnosed with metastatic breast cancer eight years ago and has been in remission since 2007, has already felt the brunt of one of the recommendations: that patients who have been successfully treated for breast cancer and have no symptoms of cancer not undergo CT, PET other imaging, or bone scans, to check for a recurrence or spread of the disease, known as metastasis.

"As a survivor of bone metastasis -- the breast cancer had spread to my spine -- after my doctor told me I was clear those PET scans were my peace of mind," said Baker, a jewelry designer in Scottsdale, Arizona. "By the time you have symptoms it's too late."

Her insurer, guided by the same kind of studies that served as the basis for the ASCO list, would not cover the scan, arguing that it provides no benefit.

ASCO recommends against routine use of four other procedures: chemotherapy for patients with advanced cancers who are unlikely to benefit; advanced imaging technologies such as CT and PET or bone scans to determine the precise stage of both early breast and prostate cancer at low risk for metastasis; and drugs to stimulate white blood cell production in patients receiving chemotherapy if they have a risk of febrile neutropenia, an often-fatal condition marked by fever and abnormally low numbers of certain white blood cells.

The supporting evidence for each recommendation is expected to surprise patients and even some physicians, since these very widely used tests and treatments have little or no scientific basis, said Schnipper.

WITHHOLDING CHEMOTHERAPY

One recommendation likely to stir controversy, and even revive charges of "death panels," is to not use chemotherapy and other treatments in patients with advanced solid-tumor cancers such as colorectal or lung who are in poor health and did not benefit from previous chemo.

Such treatment is widespread. At one large health maintenance organization, for instance, 49 percent of patients with a common form of lung cancer but with poor "performance status" - they were largely confined to a bed or chair and capable of only limited self-care - received chemo. Research shows, however, that it is unlikely to extend life or improve its quality.

Similarly, many patients receive three and even four kinds of chemo after not responding to earlier rounds. Yet in the largest study of its kind, only 2 percent of lung-cancer patients responded to a third form of chemo; 0 percent responded to a fourth form. In another study, withholding fourth-line chemotherapy from patients with non-small-cell lung cancer or colorectal cancer did not shorten their lives compared to that of similar patients receiving last-ditch treatments.

ASCO therefore recommends that such very ill, weak and non-responsive patients receive only palliative and other end-of-life care. An important exception: a cancer whose molecular fingerprint makes it vulnerable to a targeted therapy such as AstraZeneca's Iressa for non-small-cell lung cancer.

"In no way do we want to deprive a desperately ill patient of something that might be helpful," said Schnipper. And every oncologist should continue to base medical decisions on the individual patient, he said.

"But if nature is telling us that something will not help, it is our obligation to do no harm," he added. Giving chemo to a seriously ill patient whose cancer has not responded to earlier treatment "might let grandma live another few weeks. But she is very likely to be made toxic by the chemo and suffer big time. There is a real risk it will make a patient worse."

The challenge for physicians as well as insurers will be balancing the needs of the vast majority of patients against the rare cases. Studies have shown that when very ill lung-cancer patients were given a common chemotherapy, the average survival was half that of stronger patients. But, still, survival was 3.4 months.

FINDING METASTASIS

The recommendation that physicians not perform advanced imaging or bone scans in patients with early-stage breast or low-grade prostate cancer that is unlikely to spread also reflects research that contradicts what many patients believe.

In these patients, imaging such as PET and CT to search for metastasis does not improve detection of metastases or extend survival. Moreover, said Schnipper, "finding metastases early does not improve survival in breast cancer." But the expensive imaging ($2,500 to $5,000) does misdiagnose some harmless changes as cancer, leading to unnecessary invasive procedures or treatments that can shorten lives.

Again, there are exceptions. The most authoritative review found that 99 percent of patients with early-stage, seemingly low-risk prostate cancer do not benefit from imaging or bone scans. That suggests 1 percent might.

In breast-cancer patients who have been successfully treated, such as Shari Baker, neither the advanced imaging nor blood tests for molecules associated with tumors improve survival. (The tests do help patients treated for colorectal cancer, however.) Most recurrences are found through a physical exam or mammogram. Yet the advanced tests are routine.

"Why do doctors keep doing them?" Schnipper asks. "Most of them are aware of the evidence that these tests don't benefit patients. But in my own experience treating breast-cancer patients, sometimes when I go through the explanations of how these things don't help a patient will say, 'But it will help me sleep at night.' And I do it."

It is way too soon to know whether the recommendations will affect how ASCO's 30,000-plus members treat cancer patients. The group is launching a program to educate physicians and patients to understand which tests and treatments are more likely to be harmful than helpful.

(Reporting By Sharon Begley; Editing by Bernard Orr and John Wallace)

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