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Court Ruling on Health Care Subsidies Risks Loss of Coverage

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Two Americas on Health Care, and Danger of Further Division

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Key Question on Health-Law Subsidies: Were Plaintiffs Harmed?

David Klemencic, a 54-year-old who owns a flooring retail business in West Virginia, says it would be a burden to buy health insurance even with a hefty federal subsidy. The federal government says Mr. Klemencic’s beef isn’t a financial one because he would pay just $20 a year for a policy.

That argument is simmering beneath court battles about the legality of insurance subsidies tied to the Affordable Care Act. Mr. Klemencic is a key plaintiff in a case in which a Washington, D.C., court Tuesday invalidated subsidies for…

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How Apple and Google plan to reinvent health care

Mike Dittenber had always wanted to go skydiving. There was only one problem: “At my heaviest I clocked in around 330 pounds,” says Dittenber, a technical writer from Michigan. “That’s above the weight restriction for a tandem jump.” During a doctor’s visit last spring, he got some more bad news. “I had delayed getting a physical for a while, but eventually I had to. Turned out I was borderline diabetic and right on the cusp of hypertension.” His doctor warned him that if he didn’t get his weight under control quickly he would need to begin taking medication. “It was a wake-up call.”

Dittenber had previously tried Weight Watchers, which worked for a time, but didn’t last for long. This time he decided to take matters into his own hands with MyFitnessPal, a mobile app that helps users track their calorie intake and exercise. The app became a gateway to a universe of digital health products. “I ended up buying a Fitbit, because that pairs with MyFitnessPal,” he says. “Turns out I don’t hate running. I don’t love it, but I can take it.” He added the Runkeeper app to log his distance and purchased a Garmin Forerunner 220 to help him maintain the right pace. Since he began using the tracking his health data in June of 2013, Dittenber has lost 110 pounds.

Using a smartphone as the central hub for tracking, analyzing, and motivating exercise has become a phenomenon. MyFitnessPal, which now claims over 65 million registered users, is one of the most popular digital health apps. But its success is part of a much broader trend. Venture funding for startups in the sector reaching $2.3 billion in the first half of 2014, more than was invested in all of 2013. More importantly, three of the biggest players in tech — Apple, Google, and Samsung — have all thrown their weight behind platform plays aiming to aggregate and simplify the universe of devices and apps available to consumers.

“We could be at a real tipping point,” says Harry Wang, an analyst who leads health and mobile research for Park Associates. “Fitness devices and apps have been a fast-growing but still relatively niche market. These new ecosystems, if they gain traction, could finally push the industry into the mainstream.” Success isn’t guaranteed, but Wang says it makes sense for the fragmented digital health industry to rally behind powerful companies. Apple’s Healthkit and Google Fit can help reach a broader audience and forge partnerships with the traditional health care industry that would be hard for startups to accomplish alone. “It would be a transformation, with a lot of big winners, and losers as well.”

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Broad Institute receives $650 million mental research gift

The Broad Institute, a biomedical research juggernaut in Cambridge, has received the biggest gift worldwide for psychiatric research, a $650 million commitment that could help scientists unravel the genetic underpinnings of diseases such as schizophrenia and bipolar disorder and begin to develop better treatments.

The gift from philanthropist and businessman Ted Stanley, to be announced Tuesday, coincides with the publication of the largest genomic study of schizophrenia, which identified more than 100 spots in the genome that are associated with the disease. That study, done by a group that includes Broad researchers and published in the journal Nature Monday, is only a first step toward the ultimate goal of developing treatments that target the molecular causes of the disease, but it is the type of research the donation will help support.

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Such information would allow scientists to finally understand what causes diseases that have remained some of medicine’s toughest puzzles, so difficult that they have been largely abandoned by many drug companies though hundreds of millions of people suffer from mental illness at a global cost of $2.5 trillion per year, according to the World Health Organization.

RELATED: Study finds mutations in lung cancer DNA

Already, Stanley has given the Broad $175 million, and the new commitment makes him the research center’s largest benefactor so far. The $650 million will be provided as an annual cash flow that will vary, but is in the ballpark of tens of millions each year. The remainder will be given after Stanley’s death.

Stanley, 83, made his fortune heading MBI, a Connecticut company that markets and sells collectibles. He and his late wife, Vada, became deeply invested in mental health issues when their son, Jonathan, suffered from bipolar disorder in college. Jonathan was successfully treated with lithium and now works as an attorney and advocate for people with mental illness, but the struggle to help their son was, Stanley said, “a revelation moment” that gave direction to their philanthropy.

“There was a pill that saved his life. Essentially, it gave him the ability to have a normal life with a normal functioning brain,” Stanley said in an interview. “If I had had the same downfall at the same age that he had, I would have had my life ruined . . . because in between when I was that age and he was that age, someone had discovered that lithium makes people well when they have that illness.”

Stanley had read everything he could get his hands on while his son was sick and had become acutely aware that many people with mental illness were not as fortunate, a situation that he hoped he and his wife could help solve.

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His donation will provide long-term security for the research program at a critical moment, when US government funding for biomedical research has become uncertain and more competitive. It is the latest in a series of high-profile gifts from private donors to support mental health research.

RELATED: Broad Institute moves 800 researchers to new building

The Simons Foundation Autism Research Initiative has given more than $200 million to support research on autism. Microsoft cofounder Paul G. Allen has given $500 million to support the Allen Institute for Brain Science in Seattle.

“The federal support for biomedical research broadly, from cancer to mental health, really has stalled out over the last decade,” said Dr. Thomas Insel, director of the National Institute of Mental Health. “We’re at a point where we have the tools to be able to answer these questions. . . . We have the samples. We have the tools. We just haven’t had the funds to be able to do the actual [gene] sequencing that we need to. These funds will certainly help the Broad Institute, which is already at the forefront of this field, to move faster and further.”

Studying mental illness is particularly challenging.

“Cancer biology is very hard, of course,” said Dr. Steven Hyman, director of the Stanley Center for Psychiatric Research at the Broad, founded by Stanley and his wife in 2007. “But in cancer, the surgeon literally hands the scientist the cells that are the disease, and then people can go to work on them.”

With mental illness, the cells are inaccessible. “Our brains are both sacrosanct and protected behind a bony skull,” Hyman said, leaving genetics as the only way to get “molecular clues . . . that could be exploited for therapy.”

Eric Lander, founding director of the Broad, said he hopes that better characterizing the molecular underpinnings of psychiatric diseases will finally give researchers the insights they need to start a revolution like the one that has occurred in cancer, where there are hundreds of drugs in development.

“It isn’t going to lead to any new cures next week or next year, but it will — as with cancer, I believe — lead to major therapies and in some cases, cures,” Lander said. He pointed to the new Nature paper as both an example of the scale of the problem and the promise of the approach.

Previously, roughly 30 spots in people’s DNA had been identified that were associated with schizophrenia. The new study, which drew on the efforts of hundreds of doctors and scientists from more than 20 countries, compared the genomes of 37,000 people with schizophrenia and 113,000 people without the disease.

The spots found to be associated with the disease confirm leading theories behind schizophrenia’s origins, for example, underscoring the importance of signaling between brain cells involving a chemical called dopamine.

The findings also point to new spots to be investigated further, including a region of the genome involved in how the body learns to recognize pathogens, suggesting that the immune system may play a role in the disease.

“The scale of this effort is amazing and has few precedents in human genetics,” said Steve McCarroll, director of genetics for the Stanley Center.

The study was done by an international consortium including researchers from the Broad and Massachusetts General Hospital.

Insel said that what was most exciting to him was a promising finding hinted at near the end of the paper. When researchers looked for particular genetic changes in several groups of people, they found signature genetic patterns that appeared to be signs of elevated risk of the disease.

“We’re pretty convinced in schizophrenia, we’re getting involved very late in the game,” Insel said. “It’s a little bit like for heart disease we only used to see patients when they had a heart attack. Wouldn’t it be great if we could figure out who was at risk for schizophrenia and give them all the support they need, so they don’t actually become psychotic?”

Already, researchers are planning their next project, including studying even greater numbers of people with disease and without. They also hope to use advances in stem cell biology and genome editing tools to begin to figure out what genetic changes do to alter cell function and cause disease.


A tale of two cities in Cambridge

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Science, tech fields await high school grads

Cambridge guides lead tour of science frontiers

Broad Institute moves 800 researchers to new building

Scientists hoping to ease interpretation of the DNA ‘book of life’

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Rulings on Health Law Are Far From Last Word

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Hibachi Grill’s health permit suspended indefinitely – Springfield News

A north Springfield restaurant is closed after it had its health permit suspended indefinitely by the Springfield-Greene County Health Department due to “repeat critical violations as well as issues found during inspection that determined imminent health hazards.”

During a July 10 visit, inspectors found 14 critical violations at Hibachi Grill Supreme Buffet on East Kearney Street, including live cockroaches under the buffet bar and other areas, buffet items not being changed out at the proper time and backed-up drains. The person in charge was listed as being “unable to demonstrate sufficient knowledge of food safety.”

“We didn’t walk out of there unless they were closed,” Senior Public Health Investigator Roxanne Sharp said of the July 10 inspection.

According to records on the department’s website, the restaurant was inspected or reinspected more than half a dozen times in 2013; most restaurants, according to the department, are inspected one to three times annually. Critical violations found during the inspections prompted a 24-hour closure in January 2013 and a three-day closure in June 2013. Sharp said the restaurant also closed twice in March 2013 due to violations.

An individual who answered the phone at the restaurant Monday afternoon said she had “no comment at the moment.”

The July 10 inspection was Hibachi Grill’s third of 2014, according to the records. One in January found five critical violations, and another in May found two critical violations. The establishment is the second Springfield restaurant to have its permit suspended this year. The first, Mr. Yen’s, ultimately announced in May that it would close after 16 years in business.

Sharp said the department met with restaurant staff on July 14 to discuss what needs to be done before the restaurant can reopen. Employees also attended a class on Friday, she said, and met with an Ozarks Technical Community College instructor on another date. Still, Sharp said, the restaurant has not submitted the plans necessary to reopen yet and will need to indicate an understanding of the required protocol.

“There are a lot of problems,” Sharp said.

Health department staff will meet with restaurant staff again Tuesday morning; it remains up in the air whether the restaurant could reopen as a result.

The News-Leader ran a restaurant profile on the establishment in June 2012. The squid, the review noted, was “especially tender.” The button mushrooms were “umbrellas of delicate smoothness.”

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Poor teens’ health may benefit from top schools

The researchers compared behavior in almost 1,000 kids in 10th through 12th grade who were admitted to the high-performing schools and in those who went elsewhere. Overall, 36 percent of the selected kids engaged in at least one of 11 risky behaviors, compared with 42 percent of the other teens.

The study doesn’t prove that the schools made the difference and it has limitations that weaken the results, including a large number of students who refused to participate. Still, lead author Dr. Mitchell Wong said the results echo findings in less rigorously designed research and they fit with the assumption that ‘‘better education will lead to better health.’’ Wong is an internist and researcher at the University of California, Los Angeles.

The study involved mostly Latino students who applied to one of three top-performing public charter schools from 2007 to 2010. About half of the kids had parents who didn’t graduate from high school and most didn’t own their own homes.

Results were published online Monday in Pediatrics.

Teens were given computerized questionnaires to answer in private, to improve the chances for accurate self-reporting. Standardized test scores were obtained from the California Department of Education.

The results aren’t a referendum on charter schools but the lottery system they use for enrollment made the comparison fairer, Wong said.

Despite the limitations, the study ‘‘is a beautifully conducted natural experiment’’ that could occur because there’s more demand for high-performing schools than there is space available, said Kelli Komro, a professor of health outcomes and policy at the University of Florida in Gainesville. She was not involved in the research.

Because the Los Angeles schools’ lottery system selects students randomly, not on grades or other differences, the study design ‘‘mimics a randomized controlled trial, the gold standard in health research,’’ Komro said.

Most of the selected kids chose to attend those schools, while 83 percent of those not picked went to schools with worse performance records. Math and English scores after freshman year were higher in selected kids than the other teens. Moreover, just 9 percent of the selected kids dropped out of school, versus almost 1 in 4 of the others.

Prof. Harold Pollack, a University of Chicago public health researcher, said the study is important and highlights the challenge — and need to — create ‘‘a much larger number of schools that serve kids well.’’

Pollack said better academic performance among the charter school kids is likely more important for their long-term health than their risky behavior choices.

‘‘Educational outcomes are just so critical for people’s well-being,’’ he said.





AP Medical Writer Lindsey Tanner can be reached at

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What The Odds Fail To Capture When A Health Crisis Hits

Brian Zikmund-Fisher with his wife, Naomi, and daughter, Eve, in 1999, after he had a bone marrow transplant. He says he made the decision to have the treatment based on factors he couldn't quantify.i i

hide captionBrian Zikmund-Fisher with his wife, Naomi, and daughter, Eve, in 1999, after he had a bone marrow transplant. He says he made the decision to have the treatment based on factors he couldn’t quantify.

Courtesy of Brian Zikmund-Fisher

Brian Zikmund-Fisher with his wife, Naomi, and daughter, Eve, in 1999, after he had a bone marrow transplant. He says he made the decision to have the treatment based on factors he couldn't quantify.

Brian Zikmund-Fisher with his wife, Naomi, and daughter, Eve, in 1999, after he had a bone marrow transplant. He says he made the decision to have the treatment based on factors he couldn’t quantify.

Courtesy of Brian Zikmund-Fisher

How well do we understand and act on probabilities that something will happen? A 30 percent chance of this or an 80 percent chance of that?

As it turns out, making decisions based on the odds can be an extremely difficult thing to do, even for people who study the science of how we make decisions.

Brian Zikmund-Fisher would know. He teaches about risk and probability at the University of Michigan School of Public Health. Back in 1998, when he was studying behavioral decision theory in graduate school, he was diagnosed with myelodysplastic syndrome. People with the disorder can’t produce blood cells the way they should, making them much more susceptible to bleeding and infection.

Zikmund-Fisher was told that without treatment he’d have about 10 years to live. The other option was a bone marrow transplant that had a 70 percent chance of curing him and ensuring a normal life.

“But the transplant itself — because of the chemotherapy, because of the infection risks — had roughly a 25 to 30 percent chance of killing me within six months to a year,” Zikmund-Fisher says.

Brian Zikmund-Fisher now teaches about risk and probability at the University of Michigan School of Public Health.i i

hide captionBrian Zikmund-Fisher now teaches about risk and probability at the University of Michigan School of Public Health.

Courtesy of Donaghue Foundation

Brian Zikmund-Fisher now teaches about risk and probability at the University of Michigan School of Public Health.

Brian Zikmund-Fisher now teaches about risk and probability at the University of Michigan School of Public Health.

Courtesy of Donaghue Foundation

At the time, Zikmund-Fisher was 28, married, and had a child on the way. Ultimately, he made his life-or-death decision based on factors even he couldn’t quantify.

He concluded that with no transplant and 10 years of life, he would get to know his then-unborn daughter, but she would remember him as a father in and out of hospitals. Those were not the 10 years he wanted. So he chose to gamble on the transplant.

“My experience, my outcome has been very positive,” Zikmund-Fisher says. “I was on a hospital floor with 20 other patients, going through very similar procedures. Four of them never left the floor. I was one of the lucky ones.”

What became apparent to Zikmund-Fisher was that probabilities, while useful, are quite limited in their ability to predict what will happen to any one person.

“We’re never 95 percent alive. We either live or die. We experience outcomes,” he explains. “On a population level, I can have 100 people in a room, and some will have something happen to them and some will not. And that’s the hard part because if you happen to be the unlucky one who has that rare event happen to you, you still have the bad thing happen to you in its full awfulness.”

Still, Zikmund-Fisher says, when it comes to medical treatment, it’s important that doctors think about the overall numbers — not individual cases.

“A doctor doesn’t see one patient. They see hundreds of patients — thousands of patients — over their career. We want doctors to make choices that give all of their patents the best possible outcomes regardless of whether that particular choice turned out well in the last time they tried it, or turned out poorly,” he says. “We want doctors to take the long view, to give us the best chances of success, knowing that sometimes it’s going to work well, and sometimes it’s not.”

On a personal level, Zikmund-Fisher acknowledges there’s a harder reality.

“I only have one hand in this poker game. I only get one life,” he says. “I can play the odds. I can try to give myself the best opportunities. But risk is a part of our everyday life, and rare things do happen, and we have to accept that.”

This is part one of an All Things Considered series on Risk and Reason.

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Billing issues crop up on health plans sold through Colorado exchange

A sign placed out on the 16th Street Mall, beckons people to sign up for health insurance through the Affordable Care Act on March 24, 2014.

Pueblo resident Lisa Bridwell said she has spent hours trying to get billed for the health insurance she purchased through the state exchange, and she’s afraid her coverage will be dropped because the exchange and Kaiser Permanente can’t get the billing issue straight.

Bridwell and her husband signed up for insurance effective May 1, and since then she received only one bill — and that bill was sent after she already paid that month by phone.

“I’m afraid of going to the doctor and being told (the policy) is void,” she said. “They’re having a lot of problems, and I’m not sure what they’re doing.”

The Daily Dose prescribes an enriched mix of news, features, consumer issues and in-depth followups to The Denver Post’s coverage of medicine and health care.

In response to a request from The Denver Post, Connect for Health Colorado provided data showing that the categories covering billing issues and questions were about 5.8 percent of calls to customer service in June. That was the fourth-largest percentage after individual categories of general customer assistance questions, Medicaid questions and exchange representatives calling customers to resolve a problem.

Exchange chief executive Patty Fontneau said billing delays were a big issue at the beginning of the year but not at this point.

“I believe there are exceptions and problems, and we will absolutely get them resolved and investigate,” she said.

Fontneau said the billing category includes people calling with questions and not just problems, but she conceded the exchange does not know what percentage of the roughly 1,800 customers who called last month had problems with or didn’t receive their bills.

“Is it a huge problem?” she asked. “I don’t believe so. We haven’t been hearing that.”

After the problems last winter, Fontneau said the exchange recently began sending notifications to health insurance companies three times a day, and the companies usually confirm a new policyholder within 48 hours. Individuals are billed by the insurance companies — not the exchange — so usually it is more effective to call the insurer with billing concerns, exchange officials said.

Kaiser regional president Donna Lynne said the company received about 70,000 new members through the exchange and Medicaid expansion this year, and only about 1,600 have had trouble receiving bills.

“Given the magnitude of the numbers enrolled and the complexity of the system … we are putting all resources into fixing this problem,” she said. “We’re sorry about inconvenience.”

Lynne said Kaiser has set up special “concierge” teams to help people who have not received bills, and the company treats patients who say they signed up even if they can’t provide documentation. She expects the problems for the 1,600 customers will be fixed in the next 30 days.

Anthem, another major insurer on Colorado’s exchange, said it doesn’t release its enrollment figures for competitive reasons. Anthem isn’t experiencing issues related to members not being billed, spokeswoman Joyzelle Davis wrote in an e-mail.

Bridwell estimates she has called the exchange three or four times on billing issues and spent about 45 minutes to an hour on each call. She also called Kaiser once to pay by phone and was told she should just pay by phone each month until the billing issue is resolved.

Connect for Health communications director Linda Kanamine said exchange records show Bridwell called just twice — both times in April — primarily to put her son on the policy and discuss how to provide verification documentation.

“She made us aware that she was not receiving statements but she didn’t ask that we contact Kaiser,” Kanamine said.

Bridwell said she called a third time from her son’s phone last month, and she expected the exchange to help when she complained about Kaiser’s failure to send her bills.

Kanamine conceded her records might be incomplete if Bridwell called from a different phone and the customer service representative did not note that third call in her account.

“The important thing is we are going to resolve it now,” she said.

Bridwell said she feels like she’s getting the run-around on something that should be simple.

“I don’t think one hand knows what the other is doing,” she said.

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

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