Appeals Court Overturns Stem Cell Research Ban

Opponents of taxpayer-funded stem cell research lost a key round in a U.S. appeals court Friday.

In a 2-1 decision, a panel of the court of appeals in Washington overturned a judge's order that would have blocked taxpayer funding for stem cell research. The judges ruled that opponents of taxpayer-funded stem cell research are not likely to succeed in their lawsuit to stop it.
The panel reversed an opinion issued last August by U.S. District Judge Royce Lamberth, who said the research likely violates the law against federal funding of embryo destruction.
"We're thrilled with this decision and look forward to allowing federally funded scientists to continue with their work without political constraints," said Sean Tipton, a spokesman for the American Society for Reproductive Medicine.
Researchers hope one day to use stem cells in ways that cure spinal cord injuries, Parkinson's disease and other ailments. Opponents say the research is a form of abortion because human embryos must be destroyed to obtain the stem cells.
The 1996 law prohibits the use of taxpayer dollars in work that harms an embryo, so private money has been used to cull batches of the cells. Those batches can reproduce in lab dishes indefinitely, and the Obama administration issued rules permitting taxpayer dollars to be used in work on them
The lawsuit was filed by two scientists who argued that President Obama's expansion jeopardized their ability to win government funding for research using adult stem cells — ones that have already matured to create specific types of tissues — because it will mean extra competition.

Lamberth, the chief judge of the U.S. District Court in Washington, issued a preliminary injunction in August to block the research while the case continued.
The Obama administration immediately appealed and requested the order be stopped. The appeals court quickly ruled that the research could continue at the National Institutes of Health while the judges took up the case.
The opinion tossing out Lamberth's ruling was written by Judge Douglas Ginsburg, nominated to the court by President Ronald Reagan, and supported by Judge Thomas Griffith, a nominee of President George W. Bush. The dissent came from Judge Karen LeCraft Henderson, a nominee of President George H.W. Bush; she agreed with the lower court judge that the lawsuit was likely to succeed.
As a result of the appellate ruling Friday, the original lawsuit can continue before Judge Lamberth, but the taxpayer-funded research also will go on. Lamberth hasn't thus far either held a trial or issued a final ruling, which he could do based on court filings without taking testimony.
Once the cells are culled, they can reproduce in lab dishes indefinitely. So government policies said using taxpayer dollars to work with the already-created batches of cells is allowed.
The Obama administration has expanded the number of stem cell lines created with private money that federally funded scientists could research, up from the 21 that President George W. Bush had allowed to at least 75 so far. To qualify, parents who donate the original embryo must be told of other options, such as donating to another infertile woman.
Congress twice passed legislation specifically calling for tax-funded stem cell research, which President Bush vetoed.

@AP

Pic : Judge Royce Lamberth

Imaging's Torrid Growth Rate Is Slowing

 Is the era of rapid growth in medical imaging procedure volume over? The volume of advanced imaging services delivered to Medicare beneficiaries decreased in 2009 -- the first decrease in 11 years, according to a study released Wednesday.
Washington, DC-based research and consulting firm the Moran Company found that the volume of advanced imaging services billed within the Medicare system decreased by 0.1% in 2009 compared with 2008, while overall imaging services declined by 7.1% for the same year-to-year comparison.

"It's pretty clear the era of very rapid growth in advanced medical imaging seems to have come to an end at this point in time," said Don Moran, president of the Moran Company. "All the data point to a leveling. It's unclear whether we will see further declines, but the prior growth of these modalities and the advantages they offer to clinicians seems to be peaking."
The study, released today by the Access to Medical Imaging Coalition (AMIC), reviewed Medicare claims data from 1999 through 2009, examining both spending and volume of advanced imaging services, such as CT, MRI, nuclear medicine, and PET, as well as overall imaging services, including mammography.

Declining Volume

The analysis also found that the total volume of mammography screenings decreased by 0.3% in 2009, compared with a 2.8% compound annual growth rate in the past decade. In addition, the total volume of dual-energy x-ray absorptiometry (DEXA) exams fell by 2.2%, while spending on this technique decreased by 16% from 2008 to 2009.
The new findings are comparable to a 2008 analysis of Medicare claims data that showed a 19.2% reduction in Medicare spending on advanced imaging from 2006 to 2007. It also revealed a significantly reduced procedure volume growth rate of only 1.9%, which was less than the overall rate of physician-payment growth.
In addition, a study presented by David C. Levin, MD, and colleagues at the 2010 RSNA meeting found that imaging procedure volume grew at a compound annual growth rate (CAGR) of 1.4% between 2005 and 2008, well down from the 4.1% CAGR experienced between 1998 and 2005.
Imaging industry observers have attributed the slowing growth rate to reimbursement cuts for medical imaging such as those enacted by the Deficit Reduction Act of 2005. The healthcare reform legislation passed in 2010 includes additional reimbursement reductions.
The study shows that "medical imaging has been decimated by these cuts," said Tim Trysla, executive director of AMIC. "The impact of these cuts, even by the government's own estimates, has 'de facto' caused access problems for patients and providers. We are very concerned about choking off the access to these lifesaving technologies."
John Patti, MD, a radiologist at Massachusetts General Hospital in Boston and chair of the American College of Radiology Board of Chancellors, said he and fellow radiologists are concerned with imaging's declining growth rate, because the Medicare population is increasing and the incidence and prevalence of disease remain the same.

Early Diagnosis

"One of the tremendous benefits of advanced imaging over the years is that it has obviated the need for more costly and evasive diagnostic evaluation," Patti said. "This reversal of trend suggests that Medicare patients may not be receiving those appropriate exams and thus the benefit of early diagnosis."
In addition, he said the decrease may have "negative downstream effects on the health of our aging citizens and on the cost of providing the more complex care that may be necessary to treat disease if it is discovered in advanced stages."
One potential victim of the decline is outpatient imaging center owners and operators. Because of reimbursement cuts for outpatient imaging, some physicians have sold or given their imaging activities to hospitals, which are reimbursed at a higher rate under the Hospital Outpatient Prospective Payment System (HOPPS). That scenario, in turn, could lead to less access to advanced imaging services.
In other study data, Medicare spending for advanced imaging services increased by less than half the spending growth for physician services overall. With a 1.2% increase in spending for advanced imaging, compared with 2.6% for services overall, imaging was one of the slowest-growing segments of the physician fee schedule in 2009.


Some Optimism
Despite the volume downturn in 2009, Trysla believes that advanced medical imaging will continue to contribute to patient care. "Medicine will not turn its back on advanced technology, especially with the benefits of early detection of disease, such as Parkinson's disease and cancer," he said. "I think you will see growth through new applications in technology, and medicine will continue to evolve from exploratory surgery toward early and more exact detection."
ACR's Patti also speculated that the dip in growth in 2009 would be temporary. "I don't think there are any physicians who are taking direct care of patients who don't understand the value of advanced imaging," he added. "And, I don't think there are any physicians who are willingly withholding [advanced imaging] from patients."


by : Wayne Forrest

Parkinson's Disease : Pallidal vs Subthalamic Stimulation

an interesting study about Parkinson's disease management;comparison of Pallidal and Subthalamic stimulation published in New England Journal of Medicine.

Background:
Deep-brain stimulation is the surgical procedure of choice for patients with advanced Parkinson's disease.The globus pallidus interna and the subthalamic nucleus are accepted targets for this procedure .In this study the 24 month outcomes for two groups of patients undergone two procedures are comapred:patients who had undergone bilateral stimulation of the globus pallidus interna (pallidal stimulation) or subthalamic nucleus(subthalamic stimulation).


299 patients with idiopathic parkinson's disease were randomly assigned to undergo either pallidal stimulation(152) or subthalamic stimulation (147).The primary outcome ws the change in motor function,as blindly assessed on the Unified Parkinson's Disease Rating Scale,part III(UPDRS-III),while patients were recieving but not recieving antiparkinsonian medication.Secondary outcomes included self-reported function ,quality of life ,neurocognitive function,and adverse events.

Results:
Mean changes in the primary outcome did not differ significantly between the two study groups(P=0.50).There was also no significant difference in self-reported function.Patients undergoing subthalamic stimulation required a lower dose of dopaminergic agents than did  those undergoing pallidal stimulation(P=0.02).One component of processing speed(visumotor)declined more after subthalamic stimulation than after pallidal stimulation(P=0,03).The level of depression worsened after subthalamic stimulation and improved after pallidal stimulation(P=0.02).Serious adverse events occured in 51% of patients undergoing pallidal stimulation and in 56% of those undergoing subthalamic stimulation ,with no significant between-group differences at 24 months.

Conclusions:
patients with Parkinson' disease had similar improvement in motor function after either pallidal or subthalamic stimulation .Nonmotor factors may reasonably be included in the selection of surgical target for deep-brain stimulation .