*Note inaccurate reference below to
relocation costs at proposed New
Orleans academic medical center
The state is going
through a rough patch financially and that isn't good news for either health
care or education.
State Sen. Elbert
Guillory, D-Opelousas, spoke to the Opelousas Rotary Club on Tuesday about
his assessment of the just completed legislative session and what it will
mean for this area.
The bad news is
that the state had to deal with a $1 billion deficit this year and things
aren't looking any better for at least the next two years. The loss of $1
billion in federal stimulus funds alone means next year's budget will start
off in the red.
estimates are showing a significant shortfall. The next two years will be
worse than this," Guillory said.
Because of the
many protected funds in the state budget, health care and higher education
are among the few areas where significant cuts can be made and, according to
Guillory, Gov. Bobby Jindal is too willing to make
them do most of the heavy budget lifting for the state.
"Many of us
were disappointed with the budget the governor presented us with. It cut too
deeply into higher education and health care. A lot of time was spent trying
to make those cuts less draconian and we were largely successful,"
Legislature's efforts, Guillory said savings may be possible by streamlined
"There is no
question that higher education is bloated. We have too many universities that
offer the same degrees, that offer the same courses.
There is too much duplication," Guillory said.
significant savings can be made by consolidating programs and closing
under-performing colleges. "You will see a lot of consolidation in the
next four years," Guillory predicted.
While that may be
bad news for some areas, especially New
Orleans, he said it shouldn't hurt this area too
badly. Both UL and LSUE in Eunice are the only schools in their respective
As for health care, Guillory said the big
debate is on the fate of "Big Charity."
CharityHospital in New
Orleans is controlled by the LSU system.
The hospital was all but destroyed by
hurricanes Katrina and Rita. LSU and the hospital are proposing it be reborn,
bigger, better - and more expensively than ever.
"They are talking about a 29 city
block area. You are looking at more than $5 billion to relocate families
alone," Guillory said.
He said the project, as currently
envisioned, would suck up every available dime of health care spending in the
state for the next 10 years, which Guillory called excessive.
Instead, he proposed decentralizing health
care for the state, putting the money into multiple, smaller, regional
"That way the people of Acadiana would have a hospital nearby, the same for
central and northern Louisiana,"
outlined some of the host of bills passed - or rejected - by Legislature.
On the subject of
local member amendments, often called "pet projects" that are
designed to fund a community center here, a police department there -
Guillory called them "neither pet nor petty."
vetoed almost every one of them last year and is threatening to do the same
Referring to his
own projects to fund local libraries, local men's and women's shelters and
law enforcement, Guillory said: "These are all valuable and valid
He said the
Legislature gave the governor the line-item veto to remove any inappropriate
use of such funds but called Jindal's blank veto
"a lazy way to govern. He needs to understand that local government
needs assistance from Baton Rouge,"
For Guillory this
session was a special challenge. He started the session in the House and then
won a special election to replace retiring state Sen. Donald Cravins Jr., meaning he finished out the term on the
That meant a lot
of starts and stops and scrabbling but Guillory said: "I love what I do
even though I have never worked harder for less money in my career."
Physical therapist Shannon Davis helps Peyton Roth
walk with the body weight support system on a treadmill Tuesday afternoon at ShrinersHospital in Shreveport.
may get a reprieve.
Members of the
board that oversees the hospital are discussing a partnership with LSU Health
Sciences Center-Shreveport. Representatives of each group met Tuesday in
anticipation of the Shriners annual meeting, at
which some 1,500 delegates will decide the fate of the Shreveport hospital and five others.
"I was at a
meeting today with most of the powers that be at LSU, and they were upbeat
about it," Shriner Bryant Yopp
Yopp is an emeritus member of the local ShrinersHospital board and one
of the delegates who will attend the annual meeting. He heads to San Antonio today for discussions with national hospital
trustees about the Shreveport
A $10 million
chunk of the state's budget surplus provided to LSU Health Sciences
Foundation in Shreveport will help fund a
children's hospital in Shreveport.
everybody's exploring the possibilities" of how LSUHSC-S would be
involved in a partnership with Shriners, said Sen.
Sherri Cheek, R-Keithville.
will open many doors. Overall, I think everyone is very pleased. Everybody's
goal is to have better health care for children."
News that the
hospital might close spurred groups and individuals to donate and raise
money. Biker Gene Stewart raised $1,500 with a motorcycle show and related
events last weekend. He's planning another fundraiser in the fall.
"Years ago, I
played in a band. And we would go out there on Sunday afternoons and play for
the kids," Stewart said. "The Shriners do
a lot of good work. To make it even better, Shriners
Yopp believes the ShreveportShrinersHospital
will continue providing orthopedic care for children from throughout the
region with the help of hospital partners and supporters like Stewart. The
hospital was the first in the Shriners system.
"The way I
have it pictured, (the Shriners delegates) are not
going to close a hospital. They're not going to close Shreveport nor any other hospital in the Shriners
system," Yopp said. "But I do think the
delegates are going to be intelligent enough to know they need to do
He believes the
delegates may approve measures requiring long-range planning for Shreveport and other Shriners hospitals with an eye toward cutting budgets.
"ShrinersHospital will still
have a budget. Even though it won't be as big as it was, we're still going to
have a significant amount of money coming into Shreveport
delegates also will approve accepting insurance, Medicare and Medicaid
payments. Since its inception, the Shriners
hospital system has provided free care to children.
However, as the
hospital system's endowment shrank during the stock market crash, national
trustees started exploring other ways to underwrite the hospitals' budgets.
pay is something a potential partner would handle," Yopp
said. "We could start doing that right away."
He cautioned that
nothing is set in stone but said everything discussed to date would allow Shriners to keep its name and unique, child-friendly
drove up in front of ShrinersHospital,
you wouldn't be able to tell any difference at all."
Felicia McGee, of Bossier City, wants the Shreveport hospital to stay open. She and
her family moved here from Kansas,
in part, so son Peyton Roth could be treated there.
The 4-year-old has
cerebral palsy. He underwent leg and hip surgery and is working on physical
therapy so he'll be able to stand and walk on his own.
"I would be
heartbroken if the hospital closed," McGee said.
"We have an
amazing doctor, and the therapists have been outstanding. If it closed, we
would have to follow his doctor."
LSUHealthSciencesCenter MD/PhD Student Awarded NIH Grant for
Research on Protective Effects of Fish Oil in Stroke
LSUHealthSciencesCenter | 06.30.09
NEW ORLEANS, June
30 (AScribe Newswire) -- Tiffany Niemoller, a 5th year MD/PhD student at LSU Health
Sciences Center New Orleans Schools of Medicine and Graduate Studies, has
been awarded a grant in the amount of $148,480 over four years by the
National Institute on Aging of the National Institutes of Health. A training
grant for individual predoctoral students, the Ruth
L. Kirschstein National Research Service Award is
an individual fellowship (F30) is given to "promising applicants with
the potential to become productive, independent, highly trained
physician-scientists." It is a very competitive grant. The project is
being supported with funds from the American Recovery and Reinvestment Act.
Niemoller is working with Dr. Nicolas Bazan, Boyd Professor and Director, at the LSUHSC
Neuroscience Center of Excellence. She is investigating potential therapeutic
uses of novel omega-3 fatty acid derivatives in experimental stroke. Injuries
like stroke affect the brain's ability to communicate which it does through
signaling by chemicals messengers. Niemoller has
identified new mechanisms by which omega-3 fatty acids influence cascades of
pro-survival protein signaling. Her goal is to define these interactions and
characterize their therapeutic potential specifically for the aging brain
According to the
National Institutes of Health, each year in the United States, there are more
than 780,000 strokes. Stroke is the third leading cause of death in the
country and causes more serious long-term disabilities than any other
disease. Nearly three-quarters of all strokes occur in people over the age of
65 and the risk of having a stroke more than doubles each decade after the
age of 55. Stroke places a major health burden on our society in terms of
mortality, morbidity and economic costs. The National Stroke Association
estimates stroke costs the U.S.
about $43 billion a year. Direct costs for medical care and therapy average
$28 billion a year. The average cost per patient for the first 90 days after
a stroke is $15,000 although 10 percent of those cases exceed $35,000.
"Tiffany is a
very bright and talented medical student also working on a doctorate who came
after she distinguished herself at the University of California
Berkeley," said Dr. Nicolas Bazan, Boyd Professor and Director of the Neuroscience
Center of Excellence at LSU Health Sciences Center New Orleans. "It's
remarkable how she has grasped an extremely complex research project and has
already advanced knowledge about these signals that are decisive in whether
brains cells live or die after stroke. Even at this young stage of her
career, she is making a difference."
The new state
fiscal year starts today with far less drastic budget cuts than Gov. Bobby Jindal originally proposed.
are no longer as likely on public college campuses. Rosedown
Plantation in St. Francisville should remain open
seven days a week. Food bank shelves should not be completely bare.
But late Tuesday Jindal used his line-item veto to cross $3 million out of
$34 million for projects in legislators’ districts.
Locally, Jindal refused $150,000 for the Louisiana Art and ScienceMuseum
in downtown Baton Rouge.
He also vetoed
funding for several festivals, a library summer movie program in Beauregard
Parish, a boat launch, a few Girl Scouts organizations and some senior
citizen programs. Jindal stated in his veto message
that the projects did not meet his criteria for spending taxpayer dollars on
“member amendments.” But he did leave alone $31 million of the legislators’
last-minute additions by the Legislature and more than $1 billion in federal
stimulus money, the $28 billion operating budget for 2009-2010 fiscal year
still contains significantly less spending than last year’s $30.1 billion
budget. Higher education institutions, health care programs and other state services
received less money. About 1,200 state government jobs were eliminated,
though most were vacant and few people went unemployed.
In the final hours
of the legislative session that ended last week, lawmakers decreased the
reductions to many areas of the budget by tapping into the state’s “rainy day
fund” and drawing on other revenue sources.
Michael Martin said he is grateful the Legislature allowed colleges to avoid
the “worst-case scenario,” despite the large cuts that remain.
Commissioner Mike Strain said lawmakers reduced the cuts to his agency by
about $4 million.
“We did as good as we could have under the circumstances,” Strain
said. “We are all going to have to tighten our belts up.”
secretary of the state Department of Culture, Recreation and Tourism, said
her agency still is facing substantial cuts.
“Within two weeks,
we’ll have all of the plans in place to move forward with organizational
strategies that limit the public impact of these cuts,” Breaux said Tuesday.
Natalie Jayroe with Second Harvest Food Bank of Greater New
Orleans and Acadiana said, “We’re trying to
scramble and figure out how we’re going to meet the needs.”
legislative session began with grim talk about budget cuts to public
colleges, health care programs, the arts, state historic sites and
The state is
facing a $1.3 billion shortfall in revenue. Like the rest of the nation, Louisiana is suffering
from the effects of the recession.
Jindal proposed a $26.7 billion budget that
contained heavy cuts to many state services.
and universities stood to lose $219 million in state funding — a 15 percent
reduction — underJindal’s plan. The Legislature chopped those
proposed cuts nearly in half.
program that treats the poor and uninsured faced hundreds of millions of
dollars in reductions. Roughly one in every four Louisiana residents is covered by
Medicaid. The extent to which lawmakers reduced those cuts still is being
Under Jindal’s original spending plan, the Department of
Culture, Recreation and Tourism’s budget was supposed to shrink from $127
million to $89 million.
The arts community
protested the proposal in a march outside the State Capitol.
CRT officials asked
lawmakers to add $13 million for historic sites, tourism, the Main Street
program, state aid to libraries and two art grants.
that the cuts would:
* Eliminate 47 positions at state
* Reduce the sites’ opening hours to two
days a week instead of seven days.
* Slash $455,000 from the Main Street
Program, which helps small communities with downtown development.
* Trim state aid to public libraries from
$3 million to $800,000.
* Reduce arts program funding from $7.3
million to $3.2 million.
* Postpone the grand openings of three
parks — BogueChitto in
Washington Parish, PalmettoIsland in Vermilion Parish and Fort Randolph/Buhlow near Alexandria.
revamped the governor’s proposal to add an additional $2.3 million for state
historic sites and $210,490 for the Main Street Program.
With the added
funding, Breaux said there will be $1.7 million less in state aid to public
libraries and $1.2 million less for arts grants.
She said lawmakers
chopped cuts to the Main Street Program in half.
inserted $2.1 million for BogueChittoState Park but added no funding for PalmettoIsland or Fort Randolph/Buhlow.
Strain said the
forestry and boll weevil programs within his department are short despite
“We were grateful
for what we have received,” he said.
Jayroe said the $500,000 that food banks received
— compared to the $5 million received in the past –—was a blow.
BATON ROUGE - Gov.
Bobby Jindal use his veto pen Tuesday to scratch
through 53 items and provisions, slicing millions of dollars that were to go
to local projects across the state.
Prior to the
recently concluded legislative session, the governor reminded lawmakers that
he had established criteria for funding non-government organizations and that
he would veto any that didn't meet those specifications.
Many of the 53
line-item vetoes were local projects but some were within state government.
Three just struck language that was deemed unnecessary.
families and businesses do in response to challenging financial times, we
took steps to make sure that government lives within its means, passing a
state budget for the upcoming fiscal year that tightens the belt of state
government while also protecting critical services," Jindal
said in a news release.
Many of the
projects injected into House Bill 881, a supplemental appropriations bill,
had been vetoed from HB1, the primary appropriations bill that funds state
For most of the 55
items vetoed from HB881, this was their axing in a month.
purpose of HB881was to restore funding that was being cut from higher
education and health care. Lawmakers chose to also add 434 million in local
Much of the
funding was in HB1 but because the bill passed by the Legislature relied on
funding sources contingent on legislation that the governor vowed to veto, he
Jindal said that "working closely with the
Legislature, we took steps through House Bill 881 to mitigate reductions to
higher education and healthcare and to give us an opportunity to prepare for
continuing budget challenges in the years ahead."
$118.1 million to higher education, which was facing a $219 million cut.
That's a reduction of 6.78 percent from current funding, after a $50 million
The Department of
Health and Hospitals, including restorations made in HB881 and $212.8 million
authorized by House Bill No. 879 to hospitals for uncompensated care and
hurricane related losses, has a 2.94 percent decrease from the previous
fiscal year, Jindal said.
private provider program for FY 10 totals $4.2 billion, which the governor
says is a $179 million or 4 percent decrease from
the previous year. That does not include the special one-time payment of
$212.8 million to hospitals. When these one-time hospital payments are
included, the net Medicaid private provider program expenditures will
increase by 0.75 percent.
Some of the
oddities vetoed were the Mayhaw Festival in
Calcasieu Parish and Friends of the Fire Departments Engines.
Some of the
additional Family Violence Program assistance in Iberia Parish
- $5,000 for
additional Family Violence Program assistance in St. Martin Parish
- $25,000 for the
Voluntary Council on Aging of Iberia
- $25,000 to the
St. Martin Parish Government for the St. Martin
Council on Aging
- $300,000 to the
Louisiana Immersive Technologies Enterprise (LITE) at UL for year two of the
3D Squared digital media technologies and creative processes initiative, and
related leadership development program.
Department of Health and Hospitals is giving Louisiana
$411.7 million in Recovery Act grants to 24 community health centers around Louisiana.
The grants were
announced Tuesday, as a center in Winnfield opened. It already has $100,000
under the act; U.S. Sen. Mary Landrieu says Tuesday's grants bring another
Others, up to
$805,485, go to centers in Baton Rouge, Sicily Island, Shreveport,
New Orleans, New Iberia,
Innis, Avondale, Bastrop,
Opelousas, St. Gabriel, Luling,
Greensburg, Lake Charles,
Franklin, St. Joseph
is getting the largest grant. The St. ThomasCommunityHealthCenter in New
Orleans, like the WinnCommunityHealthCenter, is getting
BATON ROUGE --
Gov. Bobby Jindal used his line-item veto authority
Tuesday to eliminate $14.2 million the Legislature had earmarked for the New OrleansAdolescentHospital,
a move that means the Uptown mental facility is likely to close by Sept. 1.
The governor also
reduced at least $3 million legislators set aside for their own pet projects
as he signed the last major spending bill from the 2009 legislative session
that wrapped up last week.
A Department of
Health and Hospitals spokesman said the hospital money will be redirected
elsewhere in the mental health budget, and that the 35 inpatient beds at NOAH
will be shifted to SoutheastLouisianaHospital
J.T. Lane, deputy chief of staff to Health and
Hospitals Secretary Alan Levine, said there will be no net reduction of
services in the New Orleans area as a result
of the veto and that the department plans to open two new outpatient clinics
by the end of the summer: one on Canal
Street and another on the West
Jindal's original budget blueprint proposed closing
NOAH and moving its operations to the Mandeville hospital, a move that
administration officials said would save $9.1 million without any loss of
services. But legislators disagreed, and added language designed to keep the
Uptown hospital open, albeit with a smaller operating budget than in the
In his veto
message, Jindal said the restorations for NOAH
"do not appropriate new funds, but only shift funds from Southeast
Louisiana Hospital in Mandeville and from other outpatient mental health
services . . . therefore requiring additional cuts to these inpatient and
fought to keep the hospital open said they were disappointed with the
Abramson, D-New Orleans, whose Uptown district includes NOAH, disputed the
administration's claims that restoring money for the hospital would lead to
cuts elsewhere. He said the $14 million restoration plus $3 million for
outpatient services would have meant an overall budget cut of about 15
percent for NOAH, an amount Abramson said is "in line with" what
many other agencies will take.
Cecile Tebo, director of the New Orleans Police Department's
mental health crisis unit, said the administration's priority should have
been finding more inpatient beds in the city -- the center of the
metropolitan area -- rather than Mandeville.
The NOAH veto was
among 53 separate cuts by Jindal to House Bill 881
by Rep. Jim Fannin, D-Jonesboro, a supplemental
spending bill that lawmakers approved in the final minutes of the 2009
session and which restores millions of dollars to health care, higher
education and lawmakers' pet projects.
The bill resulted
from a series of last-minute negotiations between the House and Senate over
the size and shape of budget cuts to health care and education programs. It
used money from the state's rainy-day fund, an expired insurance-incentive
program and other one-time sources to plug back some -- but not all -- of the
spending that Jindal had tried to cut.
Besides the NOAH
language, Jindal also eliminated financing for
dozens of legislators' earmarks, including $500,000 for the Algiers
The reductions for
the development district appear to be directed at House Speaker Jim Tucker,
R-Algiers, who championed the money but broke with the administration on a
bill that sought to open more records in the governor's office to public
Jindal offered no explanation for vetoing the Algiers money.
include $60,000 for the New Orleans Afrikan Film
and Arts Festival; $150,000 for the Louisiana Arts & Science Museum;
$300,000 for a boat ramp in St. Charles Parish; $50,000 for the SatchmoSummerFest; and $7,755
for the Starks Mayhaw Festival in Calcasieu Parish.
New Orleans Mayor Nagin has responded to Louisiana Governor Bobby Jindal after the Governor vetoed funding for the New OrleansAdolescentHospital.Previously, the Mayor had written the
Governor expressing in advance his concerns about the possible closure of the
hospital and has made NOAH the leading legislative item for the spring 2009
Here is the
statement from Mayor C. Ray Nagin after discovering
that the Governor vetoed funding for NOAH.
"I want to
thank the New Orleans
legislative delegation for their hard word during this legislative session to
ensure that the needs of our citizens are met. I am disappointed that
Governor Jindal has vetoed funding for NOAH, as we
continue to face a mental health crisis, with increased suicides, higher
rates of depression and more mental health related arrests.
"I am calling
on Governor Jindal to ensure that appropriate
mental health services are available to all New Orleanians.
I will be asking to meet with the Governor to discuss how the state can use
recovery resources to restore our health and mental health network, which was
decimated by Hurricane Katrina."
Vetoes New Orleans Mental, Health Services: Louisiana DHH Comments
The following is a
statement from DHH Secretary Alan Levine on Mental Health Services in New Orleans and Veto of
New Orleans Adolescent Hospital:
It is clear Gov. Jindal has listened to the stakeholders and decided to
follow the evidence by opening two new clinics in New Orleans, maintaining the inpatient bed
count in the region and adding new community- and home-based services.
Without a veto of the New
OrleansAdolescentHospital, which was
underfunded by HB 881, DHH would have been forced to make cuts that would
harm New Orleans-area children, adults and families.
In the executive
budget, we offered a proposal that would expand evidence-based, community
placed services in New Orleans
without decreasing the number of inpatient beds available to serve adults and
youth.The Department’s proposal
expanded these important community-based services while also saving the state
$9.1 million annually.
The cost of
operating the New Orleans Adolescent Hospital (NOAH) annually is $24
million.We proposed retaining $4
million to dedicate to community-based services, including the opening of at
least two additional community mental health sites in Algiers and Mid-City.Of the remaining $20 million cost to
operate the inpatient services at NOAH, the HB 881 NOAH amendment only funded
$14.2 million – leaving a shortfall of $5.8 million.Problematic is the fact that $10.2 million
of the $14.2 million restoration would have been required to be moved from
Southeast Louisiana Hospital (SELH) in Mandeville, leaving a shortfall at
SELH as well.And, the amendment
required $4 million of SSBG funding be moved from the Area A mental health
programs, further reducing the dollars available for proven community-based
To deal with these
shortfalls, significant cuts would have had to be made to existing services.
These cuts could have been implemented in a number of ways, including, among
others, the following options or combination of options:
-Closure of 20
adult beds at NOAH, reducing the total number of beds in the region and
thereby reducing access for at least 400 adults.
evidence-based community services such as Forensic Assertive Community Teams,
Assertive Community Teams or Child and Adolescent Response Teams, for
example, resulting in the loss of capacity for these services for nearly
1,000 children, adults and families.Currently, the FACT team is serving 83 individuals, the ACT team is
serving 74 individuals, the CART team is serving 335 children and 128
families and individuals are receiving supported housing.
-Closure of 12
adult beds and 10 youth beds at SELH, reducing the total number of beds in
the region and thereby reducing access for 288 adults and 60 youth.
-A combination of
other bed closures or service reductions.
The net result of
these, and other, options was the potential for the reduction of as many as
49 adult and child beds in the region or a step backwards in the recent
investments made in community-based services, such as FACT, ACT and
CART.This would have had a
devastating impact on literally hundreds of people currently seeking, or
potentially requiring, services.
This is clearly
unacceptable, as these options missed the goal of reducing cost while
optimizing services.In fact,
continuing to fund the inpatient beds at NOAH, at twice the daily cost as
other inpatient facilities, makes no financial sense, and would have led to
the unnecessary reduction of critical services to the region.Last year, NOAH served only 70 children as
inpatients, while the recent investments in community-based services are
helping literally hundreds of children and adults.NOAH is not a crisis unit for adults, and
therefore consolidation of the beds at SELH will have no impact on the crisis
system.The data shows that most
referrals for institutional care from the Mental Health Emergency Room
Extension at the InterimHospital are made to
DePaul and not to NOAH – demonstrating that other institutions play a far
more significant role in the provision of inpatient mental health
services.Quite simply, this
amendment subsidized higher cost inpatient services by reducing beds at
another institution, or worse, retreating on the major investments made in
evidence-based community services.
Robust Continuum of Care in New
Last year, a
tragedy unfolded in New Orleans that captured
the collective concern of all who are frustrated with Louisiana’s lagging mental health
system.A heroic young police
officer, Nicola Cotton, was murdered with her own weapon at the hands of Bernel Johnson.As
reported in the press, Mr. Johnson was released from a state mental health
institution prior to this horrific act.In reviewing this case, it was clear the lack of available
community-based services—and the lack of a means to compel participation by
Mr. Johnson in these services once released from institutional care—had a
great deal to do with this terrible outcome.This event led to swift and aggressive action by Gov. Jindal and the Department, in partnership with the local
community.The Governor issued an
emergency Executive Order directing DHH to intervene in the Metropolitan
Human Services District, leading to new leadership and massive reforms.The state sought from the Legislature an
emergency appropriation, and invested in millions of dollars in proven
community-based services, such as Forensic Assertive Community Teams,
Assertive Community Teams and Child and Adolescent Response Teams.A variety of other therapies were expanded,
such as Multi-Systemic Therapy, Functional Family Therapy and other
programs.And, the Governor proposed
several pieces of legislation intended to begin a transformation of the
mental health system in New Orleans
and statewide.Among the legislation
was a bill referred to as “Nicola’s Law.”This law permits DHH to seek Involuntary Outpatient Treatment for
people who need these preventive services, but whom refuse to—or
cannot—participate or comply, as was the case with Mr. Johnson.If an individual is proven to need the
services in order to protect themselves or the public, they would be
compelled to comply or face the potential for being involuntarily placed in
inpatient care by a judge.
These actions were
taken because it was clear that once released from the state inpatient
institution, there were few community-based services available to Mr.
Johnson, and no means by which the patient could be directed to participate,
even if they were available.There was
no Forensic Assertive Community Team or, for that matter, no other
coordinated way of ensuring the patient received the services that may have
helped avoid this tragedy.Today,
because of our actions, with the support of the Legislature, these venues are
now available, and hundreds of people are benefiting.We cannot afford to go backwards.
According to the
Surgeon General’s Mental Health report, which was co-authored by the National
Institutes of Health and the U.S. Substance Abuse and Mental Health Services
Administration, the national trend in mental health is to reduce dependence
on inpatient services and move toward effective evidence-based community
services.One such service is
Assertive Community Treatment (ACT), which has proven to reduce inpatient
hospital days by at least 58 percent, jail days by 83 percent and
homelessness by 37 percent, according to studies by Dartmouth
Medical School, Indiana
University and PurdueUniversity.Additionally, National Mental Health
Association studies show that at least 40 percent of the hospital placements
of children are not appropriate and the children would be better-served by
states are moving toward a community-based model of care, and are reducing
and reorganizing state psychiatric inpatient units.This is evidenced by simply evaluating the
changes in state expenditures.Data
shows that in 1981, states spent roughly 63 percent of their mental health
budgets on hospital beds and 33 percent on community-based mental health
services.By 1993, those same
expenditures were equal. By 2004, about 69 percent of state mental health
budgets were spent on community-based services and 29 percent were spent on
inpatient hospital beds—a complete reversal of more than 20 years ago.Today, Louisiana spends 57 percent on inpatient
hospital beds and 43 percent on outpatient, community-based mental health
services – clearly demonstrating we are lagging the nation in needed
improvements.This is both wasteful of
resources and demonstrates an improper balance of service provisions.Plainly, as demonstrated by our proposal,
the state could save $9.1 million without reducing bed capacity while
increasing access to community-based services.This happens when we make better use of
limited resources, and spend the money where it will work the hardest—in the
community closest to our families and neighborhoods.
In 2005, DHH, in
partnership with other state agencies, began developing a plan for specific
changes to Louisiana’s
System of mental health care delivery.Last year, through HCR 184, the Legislature created the Mental Health
Care Improvement Task Force to study the ongoing mental health crisis in Louisiana and the
progress made on the 2005 plan.The
Task Force—including representatives from DHH, LSU, Louisiana Mental Health
Planning Council, Mental Health America of Louisiana, Louisiana State Medical
Society, Louisiana Psychiatric Medical Association and the AFL-CIO—recognized
the significant advances made in last year’s implementation of the new
community-based programs and called for continued coordination in the
system.Indeed, if the mental health
funding available is misdirected and used to support inefficient hospital
services, the very advances we have made in improving the system will be lost.Specifically, the task force recommended:
evidence-based practices as the initial focus for statewide training and
implementation: Cognitive Behavioral Therapy, Dialectical Behavioral Therapy,
Assertive Community Treatment, Forensic Assertive Community Treatment,
Multi-Systemic Therapy, Functional Family Therapy, Illness Management and
Recovery, Family Psychoeducation, Medication
Management Approaches in Psychiatry, Supported Employment, and Co-Occurring
Katrina, several community access points were closed, and families were
required to commute to NOAH in order to receive these otherwise
community-based services.We proposed
reopening outpatient access points on New
Orleans’ east and west banks—thereby bringing these
services closer to the communities that lost them after Katrina.Set to open in August, these clinics will
offer the ACT, FACT, CART and Supportive Housing programs, as well as other
new programs, in easily accessible locations near public transportation.
These clinics will offer screening and assessment, psychiatry and medication
management, collateral counseling with parents, life skills treatment for
youth and substance abuse prevention and treatment services. DHH will
continue to offer services from the Mobile Mental Health van (NOAH’sArk)
that travels throughout the three parish area and especially serves families
in low lying areas of St. Bernard and Plaquemines parishes.DHH will staff all sites with psychiatrists
and psychologists from the LSU and Tulane Departments of Child Psychiatry,
which will train the mental health workforce of the future.
Of note, we will fully staff three new
community- and home-based Medicaid-billable teams:
Multi-Systemic Treatment (MST) teams, which will treat 120 children,
adolescents and their families; and
Functional Family Therapy team.
MST therapy, one
of the services targeted for expansion, is an intensive service that treats
severe behavioral problems and decreases out-of-home care by 64 percent,
according to juvenile justice and mental health experts.FFT, an evidence-based family systems
approach, also lessens out-of-home placement and reduces recidivism by up to
In addition to the commitment to continue
the services referenced above, as well as the expanded services, the
following ongoing services will be continued through this transformation
-Access Unit to
triage all the calls and coordinate with the Child and Adolescent Crisis
Response Team (CART), which responds to prevent or quickly de-escalate crisis
situations and serves 300 people each year.
Community-based Crisis Respite beds for diversion from hospital and
out-of-home placements and serves nearly 300 clients per year.
Spirit Specialty Access Teams with 20 staff members will be available to
schools and communities for children and families still struggling from
Spirit General Outreach Teams comprising 50 staff members will be providing
ongoing storm recovery counseling 24/7 to adults and children in the
communities of Orleans, Plaquemines, St.
Bernard and Jefferson parishes.
-DHH’s LA-YES’s System of Care
Initiative, which provides intensive case management to 150 youth involved in
the juvenile justice or child welfare systems each year.
Supports and Services program, which treats children ages 0-5 and is a future
Mental Health Rehabilitation (MHR) provider. This program is the state-wide
training site for all infant mental health providers through an MOU with the
Tulane Department of Psychiatry’s Infant Mental Health Division.
MHSD’s Child and Adolescent Division for
utilization of wrap-around funds to pay for unmet needs such as
transportation, uniforms, cash subsidies, recreational programming.
DHH is moving
forward to carry out this plan on behalf of the children, adults and families
of the Greater New Orleans area. I remain committed to transforming our
health care delivery system to one that is responsive to the needs of people
rather than the needs of government.
Because of its
size and cost, Medicaid has been called the "workhorse" of the U.S.
health system. Now it’s front and center in the debate on overhauling the U.S
health system and expanding coverage to the uninsured. With 60 million
enrollees, Medicaid dwarfs other insurance programs, including its cousin,
Medicare, which covers 44 million elderly and disabled people.
knowledge of Medicaid:
1. Medicaid is a
national program of the federal government.
Medicaid is a joint federal-state program, with the federal government
picking up about 57 percent of the overall Medicaid tab. But the federal
contribution varies by state, ranging from 50 percent to 73 percent, with
poorer states getting a bigger matching rate.
Medicaid isn’t a
one-size-fits-all program; after meeting certain federal requirements, each
state has the flexibility to shape coverage and benefits. As a result, the
Medicaid program in Pennsylvania bears
little resemblance to the one in Louisiana.
For example, non-working parents in Pennsylvania
qualify for Medicaid if their incomes are below twice the federal poverty
level ($44,100 for a family of four). But in Louisiana, non-working parents qualify
only if their incomes are below 11 percent of the poverty level ($2,426 for a
family of four). States frequently experiment with new concepts in benefit
design, eligibility and delivery systems.
2. If you're poor
enough, Medicaid will cover your health care needs.
covers about 45 percent of poor Americans, defined as those with incomes
below the federal poverty level (about $22,000 for a family of four). To be
eligible for coverage, individuals must fall below certain income thresholds,
which vary by state, and belong to certain categories, such as having
dependent children, or being pregnant or disabled. In 20 states, a parent in
a family of four who gets paid the federal minimum wage makes too much to
qualify. Only 18 states cover adults without dependent children.
provides bare-bones coverage compared to what’s available in the private
least on paper, Medicaid has a longer list of benefits than many private
plans," said John Holahan, director of the
health policy center at the Urban Institute, a Washington think tank. Medicaid benefits
include mental health services, transportation-to-health services, and
comprehensive screenings and treatment for children. In addition, Medicaid
enrollees have much lower out-of-pocket costs than people with private
coverage. There are typically no monthly premiums and no, or very low,
patients get better treatment than patients covered by private insurance.
In many states, specialists and dentists don’t see Medicaid patients.
"It is far from a given to get referrals to specialists," said Dan
Hawkins, policy director for the National Association of Community Health
Centers. Providers typically blame low reimbursement rates as the main reason
for not accepting Medicaid patients. In Kentucky, Medicaid pays doctors $210 for a
colonoscopy; Medicare pays $333. Private insurers usually pay more. In Pennsylvania, Medicaid
pays doctors $300 for an appendectomy, while Medicare pays $575. "It's a
sad fact that Medicaid payments don't come close to covering the cost of
caring for the vulnerable patient population that relies on it for
coverage," said Dr. Joseph Heyman, chairman of
the American Medical Association Board of Trustees.
5. Most Medicaid
enrollees are children and their parents.
True. About 76
percent of all enrollees are children and their parents. And 65 percent of
people on Medicaid come from working families.
6. Most Medicaid
spending pays for services for children and their parents.
False. About three
quarters of Medicaid spending is for the elderly and disabled, even though
the two groups make up only about one quarter of the program’s enrollees.
Medicare provides little coverage for long-term care, so many elderly, after
depleting their savings, rely on Medicaid to pay their costly nursing home
7. Medicaid is
more efficient than private insurance.
Administrative costs of Medicaid are less than 7 percent, or half the rate
that’s typically seen in the private sector. Medicaid holds down costs in
part by paying providers lower fees and doing little marketing.
ADELPHI, Md. (AP)
-- Government experts say prescription drugs like Vicodin
and Percocet that combine a popular painkiller with stronger narcotics should
be eliminated because of their role in deadly overdoses.
A Food and Drug
Administration panel voted 20-17 that prescription drugs that combine
acetaminophen with other painkilling ingredients should be pulled off the
The FDA has
assembled a group of experts to vote on ways to reduce liver damage
associated with acetaminophen, one of the most widely used drugs in the U.S.
FDA data indicating 60 percent of acetaminophen-related deaths are related to
prescription products. Acetaminophen is more commonly found in
over-the-counter medications like Tylenol and Excedrin.
U.S. scientists say implantable cardiac
resynchronization devices can produce a 29 percent reduction in heart failure
or death in heart disease patients.
University of RochesterMedicalCenter researchers said the results
came from a 4 1/2-year clinical trial that involved more than 1,800 patients
in the United States, Canada and Europe.
Some of the patients used an implanted cardiac resynchronization therapy
device with defibrillator and some were given only an implanted cardiac
The study, led by
Dr. Arthur Moss, ended last week.
A prior study by
Moss and associates in 2002 showed implantable cardiac defibrillators were
effective in reducing mortality. The new study sought to determine if cardiac
resynchronization devices with defibrillators could reduce the risk of
mortality as well as heart failure.
Moss said the
results are very positive.
"Now we can
prevent sudden cardiac death and inhibit the development of heart failure,
thus improving survival and outcome in patients with heart disease,"
Moss said. "There is a very large population of patients with heart
disease who will benefit from this combined therapy."
Claire and Larry Yurdin
filed for bankruptcy when his insurance didn’t cover his medical bills.
is supposed to offer protection — both medically and financially. But as it
turns out, an estimated three-quarters of people who
are pushed into personal bankruptcy by medical problems actually had
insurance when they got sick or were injured.
And so, even as Washington tries to
cover the tens of millions of Americans without medical insurance, many health
policy experts say simply giving everyone an insurance card will not be
enough to fix what is wrong with the system.
Too many other
people already have coverage so meager that a medical crisis means financial
One of them is
Lawrence Yurdin, a 64-year-old computer security
specialist. Although the brochure on his Aetna policy seemed to indicate it
covered up to $150,000 a year in hospital care, the fine print excluded
nearly all of the treatment he received at an Austin, Tex.,
He and his wife,
Claire, filed for bankruptcy last December, as his unpaid medical bills
In the House and
Senate, lawmakers are grappling with the details of legislation that would
set minimum standards for insurance coverage and place caps on out-of-pocket
expenses. And fear of the high price tag could prompt lawmakers to settle for
less than comprehensive coverage for some Americans.
advocates argue it is crucial for the final legislation to guarantee a base
level of coverage, if people like Mr. Yurdin are to
be protected from financial ruin. They also call for a new layer of federal
rules to correct the current state-by-state regulatory patchwork that allows
some insurance companies to sell relatively worthless policies.
the great hidden risk of the American health care system,” said Elizabeth
Warren, a Harvard law professor who has analyzed medical bankruptcies.
“People do not realize they are one diagnosis away from financial collapse.”
Last week, a former
Cigna executive warned at a Senate hearing on health insurance that lawmakers
should be careful about the role they gave private insurers in any new
system, saying the companies were too prone to “confuse their customers and
dump the sick.”
“The number of
uninsured people has increased as more have fallen victim to deceptive
marketing practices and bought what essentially is fake insurance,” Wendell
Potter, the former Cigna executive, testified.
Mr. Yurdin learned the hard way.
At St. David’s MedicalCenter
in Austin, where he went for two separate
heart procedures last year, the hospital’s admitting office looked at Mr. Yurdin’s coverage and talked to Aetna.
St. David’s estimated that his share of the payments would be only a few
thousand dollars per procedure.
He and the
hospital say they were surprised to eventually learn that the $150,000
hospital coverage in the Aetna policy was
mainly for room and board. Coverage was capped at $10,000 for “other hospital
services,” which turned out to include nearly all routine hospital care — the
expenses incurred in the operating room, for example, and the cost of any
medication he received.
In other words, Aetna would have paid for Mr. Yurdin
to stay in the hospital for more than five months — as long as he did not
need an operation or any lab tests or drugs while he was there.
Aetna contends that it repeatedly informed Mr. Yurdin and the hospital of the restrictions in policy,
which is known in the industry as a limited-benefit plan.
The company says
such policies offer value by covering some hospital expenses, like surgeons’
fees or a stay in the intensive care unit. Aetna
also says all of its policyholders receive significant discounts on the
overall cost of hospital care. But Aetna
also acknowledges that a limited-benefit plan was inappropriate in Mr. Yurdin’s case because his age and condition — an
irregular heartbeat — made him likely to require more comprehensive coverage.
aren’t right for everyone, and it clearly wasn’t right for Mr. Yurdin,” said Cynthia B. Michener, an Aetna
Grassley, the ranking Republican on the Senate Finance Committee, which is
taking a lead on health legislation, says Congress needs to make “meaningful”
insurance coverage more affordable and accessible. But “until that happens,”
he said, “any presentation of limited-benefit plans ought to be completely
straightforward, and not misleading in any way.”
Insurers like Aetna generally defend limited-benefit policies as a
byproduct of the nation’s flawed health care system, which they say makes it
too expensive to adequately insure someone like Mr. Yurdin.
If everyone in the
country were required to have insurance, the industry says — a mandate that
Congress is contemplating — the costs and risks of insurance would be spread
over a large enough pool of people to let insurers provide full, affordable
coverage even to people with pre-existing medical conditions.
Mr. Yurdin worked at TEKsystems,
which employs people for short periods as contractors for other companies. TEKsystems says it does not pay for the contract workers’
health benefits, but it does enable them to purchase individual policies with
limited benefits so they have at least some coverage.
“There’s no way we
make this sound like regular coverage,” said Neil Mann, an executive vice
president at Allegis Group, which owns TEKsystems.
Although Mr. Mann
acknowledged that the plan Mr. Yurdin purchased
excluded routine hospital care, he said he thought it still provided value to
employees who wanted “peace of mind.”
True peace of
mind, however, comes with a much higher price tag. When Mr. Yurdin no longer qualified for the Aetna coverage after
he left TEKsystems and his eligibility eventually
ended, his only option was a special state plan in Texas for people who are at high risk for
expensive medical care. He has been paying more than $1,000 a month for
comprehensive coverage, compared with the roughly $250 a month he was paying
for the Aetna plan.
But as of
Wednesday, his future insurance problems are largely solved: he qualifies for
Medicare because he turns 65.
Many insurers, as
part of the Congressional overhaul of their business, say they expect the
demand for limited-benefit policies to fall. “Until the nation achieves the
universal coverage that we strongly support, some individuals will want to be
able to choose limited indemnity products, but with comprehensive health
reform we think that need should diminish,” said Simon Stevens, an executive
criticism last year for selling policies with sharply limited coverage
through AARP, the advocacy group for older people. One of the plans capped
reimbursement for an operation at $5,000, for example, although many
procedures cost at least several times that amount. After Senator Grassley
began investigating its sales practices, UnitedHealth agreed to stop offering
the limited AARP plans.
Mr. Yurdin and his wife say it was not clear that he was
liable for tens of thousands of dollars in hospital bills until after he had
the first two of what would eventually be four operations. St. David’s says
it tried to persuade them to apply for charity care, under which the hospital
would absorb much, or all, of the unpaid bills.
But the couple
says a lawyer advised them to turn to bankruptcy as the way to be certain
they would not be left with too much debt. “I knew we were getting way, way
over our heads,” Mrs. Yurdin said.
While Aetna disputes the Yurdins’
and the hospital’s version of events, it also says it has tried to clarify
the language it uses to describe the coverage. In its most recent brochure,
the fine print describing the limits to “other” hospital services now defines
what they are in a footnote on the same page and warns that the excluded
expenses could be “significant.”
Senator John D.
Rockefeller IV, Democrat of West Virginia, who is also on the Finance
Committee, has introduced legislation that would require insurers to be more
clear about what they do — and do not — cover. He says he advocates such a
change, even if Congress cannot agree to a more sweeping overhaul of the
health insurance industry.
But advocates for
broad changes to the health care system say Congress can succeed only by
making sure health reform goes beyond giving every American a buyer-beware
insurance card. One such person is Len Nichols, a health economist for the
New America Foundation.
said, “insurance means normal people should not go bankrupt from serious
It isn’t clear whether drugs or ablation, a surgical
procedure, is more effective to treat a heart problem called atrial fibrillation.
scientific advisory panel has recommended that federal officials give top
priority to comparing the effectiveness of competing medical strategies in
areas that include treating prostate cancer, reducing hospital infections and
lowering the rate of unwanted pregnancies.
In a highly
anticipated report, released Tuesday morning, a panel assembled by the Institute of Medicine released a list of 100 health
topics that it said should get high priority as the Obama administration proceeded with a plan to spend $1.1 billion in comparing
the effectiveness of competing drugs, medical devices, operations and other
treatments for specific health conditions.
The report is one
of the first concrete steps in a broad effort by administration officials and
health experts to shift the focus of medical practice toward scientific
evidence — rather than a physician’s personal views or treatments promoted by
medical product companies.
in many areas of medicine there is scant data that compare competing
strategies. And systems for gathering such data by mining hospital or
insurance industry records are also very limited.
decisions too often are a matter of guesswork, because we lack good evidence
to inform them,” said Dr. Harold C. Sox, the editor of The Annals of Internal
Medicine, a medical journal, who was co-chairman of the panel.
comparative effectiveness reviews include many medical researchers, consumer
groups, unions and insurers. They say such studies are essential to curbing
the widespread use of ineffective treatments and to helping control health
care costs, which totaled $2.2 trillion in 2007, or 16 percent of the
nation’s gross domestic product.
But the effort has
come under attack by critics, including some conservative commentators and
medical products companies, who warn that the process could lead to
inadequate treatment for some patients and even the rationing of health care.
There also may be sharp Congressional debate in the weeks ahead on issues like
whether a new federal entity should be created to oversee government-financed
comparative research and what role private industry might play in the effort.
Dr. Sox said that
medical products makers had a “muted” response to the panel’s efforts,
including its call for public comments and recommendations on what should
receive financing for comparativeness reviews. Of the approximately 2,000
recommendations the panel received, only 28 came from makers of medical
devices, drugs or biologic products, he said.
products manufacturers pay for clinical trials of their own products, such
studies often compare a drug or device’s effectiveness in treating an illness
against a placebo or no treatment, rather than against a competing product or
treatment. In addition, people selected for clinical trials often do not
represent the many different types of patients who will receive a drug or
device after it is approved by federal regulators for sale.
In many areas of
medicine, there is frequently more than one treatment with no clear winner.
To treat prostate cancer, for example, a patient is faced with strategies
ranging from watchful waiting to surgery to the use of radioactive implants.
conundrum faces patients diagnosed with abnormal heart rhythm known as atrial fibrillation. In such cases, a doctor may
recommend drugs or a surgical procedure known as ablation, with little
evidence as to which strategy works better or has fewer side effects.
The Institute of Medicine panel said studying both
those conditions should be among the top priorities.
composed of doctors, health care experts and consumers, was convened at the
request of Congress. Its recommendations are expected to have an impact on
how some of $1.1 billion initially allotted by lawmakers for comparative
effectiveness research is spent.
recommending 100 health areas for comparative effectiveness reviews, the
panel’s report focused heavily on setting up systems for collecting the data
to undertake such studies and ensuring that such information is clearly
communicated to patients. The panel also urged that the government subsidize
the training of a new generation of researchers skilled in doing comparative
While most of
health areas cited by the panel involved medical treatments, others included
topics like the best way to reduce hospital-based infections or to compare
the effectiveness of differing medical imaging technologies.
Some of the
panel’s recommendations also involved social or preventative issues that
could generate controversy among industry or interest groups. For example,
the panel urged that researchers look at the effectiveness of school programs
to reduce childhood obesity through means like bans on vending machines. It
also recommended research to determine the programs most effective in reducing
unwanted pregnancies, including the free distribution of contraceptives.
reporters Tuesday, Dr. Sox, the medical journal editor, said that based on
public comments, the panel had decided it was important to look at such
public health issues.
A blood protein that only a short time ago was thought by
some to be more important than cholesterol in heart disease now appears to be
little more than a bystander.
The substance, C-reactive protein, or CRP, a marker of
inflammation in the body, is unquestionably associated with heart disease:
the more CRP in a person’s blood, the greater the likelihood of heart
But in a paper to be published Wednesday in The Journal of
the American Medical Association, researchers analyzing genetic data from
more than 100,000 people conclude that their study “argues against” the
notion that the protein causes heart disease.
Dr. David Altshuler, a professor
of genetics and medicine at HarvardMedicalSchool,
said the distinction was important. If CRP caused heart disease, lowering it
would protect people. But if it was merely associated with the disease,
lowering CRP would have no more effect on health than quelling a shrieking
fire alarm would have on putting out a fire.
Many believed CRP caused heart disease, especially after a
widely publicized study released last year suggested that people with low
cholesterol but high CRP levels had fewer heart attacks if they took a statin, a cholesterol-lowering drug that also lowers CRP.
That could mean that lowering CRP could prevent heart
disease. Of course, it also could have been the cholesterol lowering that was
protective, but many researchers argued that it was the reduction in CRP.
“There certainly has been a very vocal constituency in the
idea that CRP causes or contributes to the development of heart disease,”
said Dr. Daniel Rader, a lipid expert at the University of Pennsylvania.
He noted that some companies were trying to develop drugs to lower CRP.
But Dr. Michael S. Lauer, director of the division of
prevention and epidemiology at the National Heart, Lung and Blood Institute,
said it might now be smart to abandon that search.
“It is likely that drugs or agents that specifically
target CRP are not going to work,” Dr,. Lauer said.
The findings will not change current treatment. And one
leading CRP researcher, Dr. Paul M. Ridker of
Brigham and Women’s Hospital in Boston,
director of last year’s study, called Jupiter, and the researcher most
closely associated with the excitement over CRP, said the new study did not
change anything for him.
Dr. Ridker, an inventor of a
laboratory test for CRP who profits from its use, said that while the new
results did not support causality, he did not think they definitely excluded
Anyway, he said, it does not matter because the real issue
is inflammation. CRP goes along with inflammation, and it is inflammation
that is likely to be causing heart disease, Dr. Ridker
The thought is that white blood cells invade artery walls
and release damaging chemicals, leading to plaque formation.
The new study, by Dr. Paul Elliott of ImperialCollege
in London and
35 co-authors, used a recently developed technique
that can get answers quickly about causality. Without it, the only method was
what is seen as the gold standard in medicine: large clinical trials in which
people are randomly assigned to take a drug, or not, and followed for years.
The new method, Mendelian
randomization, “is changing the way we think about causality,” Dr. Lauer
said. It only recently became feasible as researchers found genetic variants
associated with proteins like CRP and developed tools to analyze data from
what was, in this case, more than 100,000 people.
Different people produce different amounts of CRP, and the
amount a person produces is determined by tiny inherited changes in the CRP
gene. So in a population, there are people who just happen to produce more
CRP throughout their lives and others who just happen to produce less. If CRP
causes heart disease, those who make more would have more heart disease.
That, however, is not what the study found.
“There was no association” between CRP genes and heart
disease rates, Dr. Elliott said.
The association between CRP and heart disease must be
reflecting something else. For example, if CRP levels go up when heart
disease begins, because of inflammation in arteries, CRP levels would be
higher in people with incipient heart disease. But CRP itself would be playing
no role in heart disease risk; it was just marker of inflammation.
A smaller study of CRP, using the same method and
published last October in The New England Journal of Medicine, came to the
But this second, larger, study was needed to convince
heart experts, said Dr. SekarKathiresan,
director of preventive cardiology at Massachusetts GeneralHospital.
“It’s a very important question particularly in the
context of the Jupiter trial,” Dr. Kathiresan said.
Dr. Rader, at Penn, said he still did CRP tests on
selected patients and expected to continue. An elevated CRP level indicates
increased risk, even if the protein does not cause the risk. Dr. Rader tests
CRP to help decide whether to give a statin to
patients with normal cholesterol but with a family history of heart disease.
A high CRP, he said, could tip the balance, leading him to prescribe a statin.
Dr. Altshuler noted that part of
the power of a Mendelian randomization study was
that it could stop a hypothesis from prematurely becoming viewed as fact.
Ordinarily, science starts with an observation, like the
one associating CRP with heart disease. That generates a hypothesis — that
CRP causes heart disease. Then comes a trial, if there is a treatment, like a
drug to specifically attack CRP, that people can be randomly chosen to take
But it can be years or decades before the clinical trials
are completed. In the meantime, Dr. Altshuler said,
the hypothesis comes to be regarded as true.
And if the clinical trial contradicts the hypothesis,
“some people are unwilling to question their beliefs, even if there was no
evidence of causality to begin with,” Dr. Altshuler