Category Archives: Biotechnology

Inside a high-level biocontainment unit

Share


The United States Centers for Disease Control commissioned The Nebraska Medical Center biocontainment unit in 2005.

It was designed to provide the first line of treatment for people affected by bio terrorism or extremely infectious naturally occurring diseases. It’s the only non-governmental facility of its kind in the U.S.

The staff, all receive specialized training and participate in drills throughout the year. In a recent drill, the staff practiced dressing in spacesuit-like personal protection suits.

The suits provide each staff member the ability to care for an infected patient without exposing themselves. They also practice transporting an infected patient in a “bio pod” into a specially designed room inside the biocontainment unit.

The entire unit is specially isolated from the rest of the hospital, using its own ventilation system and security access.

Share

One proton center closes, but that doesn’t slow new construction

Share
proton therapy baltimore 300

In this May 2013 photo, construction continues at the Maryland Proton Treatment Center. (Photo by Jenny Gold/KHN).

This KHN story also ran on NPR

Proton therapy has been touted as the next big thing in cancer care. The massive machines, housed in facilities the size of football fields, have been sprouting up across the country for a decade.

There are already 14 proton therapy centers in the U.S., and another dozen facilities are under construction even though each can cost $200 million to build.

But Indiana University shocked experts who watch the industry last month when it announced that it plans to close down its facility in Bloomington, as reported by Modern Healthcare.

“I never thought that in my lifetime I would see a proton center close,” says Amitabh Chandra, a professor at Harvard’s Kennedy School of Government who studies the cost of American medical care.

He’s surprised because until now, industry growth has been entirely in the other direction, even though there’s little evidence that proton therapy is better than standard radiation for all but a few very rare cancers.

“But we do know it is substantially more expensive and substantially more lucrative for physicians and providers to use this technology,” Chandra says.

In the Washington, D.C., area alone, three proton therapy centers are under construction — one at Johns Hopkins Medicine Sibley Memorial Hospital, another at MedStar Georgetown University Hospital, and a third, the Maryland Proton Treatment Center, is slated to open at the University of Maryland in Baltimore next year.

All three say they are continuing to build their centers, despite the news out of Bloomington. In email statements, two said that the larger population of the DC-Baltimore area can support a proton facility better than a small city like Bloomington. The third said it’s building a smaller, one room center that will be more cost effective.

Proton Therapy Baltimore 2 300

Dr. Minesh Mehta, medical director of the Maryland Proton Therapy Center stands with Dr. William F. Regine, radiation oncologist at the University of Maryland and James DeFilippi, vice president of project development at the construction site of the Maryland Proton Treatment Center in this May 2013 photo (Photo by Jenny Gold/KHN).

But in Indiana, a review committee determined that it just wasn’t worth spending the money that would be necessary to update their proton facility.

One reason for the closure is that insurers have been refusing to cover the treatment for common diseases such as prostate and breast cancer.

Cigna, for example, only covers proton therapy for a single rare eye cancer, says Dr. David Finley, the insurer’s national medical officer.

“When it’s used, however, for all other tumors, it’s not been shown to be any more effective than other forms of radiation therapy,” says Finley.

Proton beam therapy costs three to six times as much as standard radiation therapy for illnesses like prostate cancer, according to Finley. He adds that when insurers pay for expensive care that isn’t any better than the cheaper options, it can increase the cost of everyone’s health care.

“We said if two services offer the same result and one is much more expensive than the other one, we’re only going to pay for the one that is less expensive,” Finley says.

Other major insurers have also limited what they’ll cover with proton therapy, including Aetna and Blue Shield of California.

One health care payer that has not put any restrictions on proton therapy is Medicare. And Medicare pays much more for the treatment than it pays for standard radiation therapy.

“That’s the problem with Medicare payment policy,” says Harvard’s Chandra, “it not only covers treatments that are dubious treatments, it also covers dubious treatments extremely generously.”

But the doctors and researchers involved with building new proton beam facilities don’t think the treatment is dubious. They point to proton therapy’s potential to kill cancer without damaging surrounding tissue, and they say that it’s just a matter of time before clinical trials prove that proton therapy is worth the extra money.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

khn_logo_lightKaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

 

Share

Insurers hesitant to cover many proton beam treatments

Share

Comparison_of_dose_distributions_between_IMPT_(right)_and_IMRT_(left)By Michelle Andrews
KHN

Everyone seems to agree that proton beam therapy–a type of radiation that can attack cancerous tumors while generally sparing the surrounding tissue–is an exciting technology with a lot of potential.

But some insurers and disease experts say that, until there’s better evidence that proton therapy is more effective at treating various cancers than traditional types of less expensive radiation, coverage shouldn’t be routine.

That approach doesn’t sit well with proponents, some of whom say that insurance coverage is critical for necessary research of the controversial therapy’s uses.

Critics assert that the rush to build the centers is putting a very large cart before the horse.

Meanwhile, the number of proton therapy centers — huge structures that can cost more than $200 million — continues to increase.

Fourteen are in operation in the United States and a dozen more under development, according to Leonard Arzt, executive director of the National Association for Proton Therapy.

Critics assert that the rush to build the centers is putting a very large cart before the horse. Continue reading

Share

Quantifying the ‘Angelina Jolie effect’

Share

Actress’ impact on genetic testing for breast, ovarian cancer is ‘global and long lasting’

Angelina Jolie - Photo courtesy of the UK Foreign and Commonwealth Office

Angelina Jolie – Photo courtesy of the UK Foreign and Commonwealth Office

By Mary Engel / Fred Hutch News Service

Sept. 18, 2014

The so-called Angelina Jolie effect not only is real but has been “global and long lasting,” leading to a twofold increase in the number of women getting genetic testing to help determine their risk for hereditary breast cancer, according to new studies from the United Kingdom and Canada.

The number of women found to have a genetic mutation that increased their risk also has doubled.

And contrary to concerns that women at low risk for hereditary breast cancer would flood testing centers, researchers said that those being tested are women like Jolie who have a family history of breast cancer or who have personal risk factors such as ethnicity.

Certain ethnic groups, including Ashkenazi Jews, have a higher prevalence of BCRA mutations, which significantly increase breast cancer risk.

Women got the correct message

“What surprised us was that we didn’t get the worried well,” said Dr. Andrea Eisen, head of preventive oncology for breast cancer care at the Sunnybrook Odette Cancer Centre in Toronto and an author of the Canadian study, in a phone interview.  “We got women who got the correct message. That was gratifying.”

Jolie disclosed in a May 2013 op-ed in The New York Times that she had undergone a preventive double mastectomy after finding that she carries the rare BRCA1 gene mutation, which dramatically raises her risk of breast and ovarian cancers. Continue reading

Share

County receives $6m grant to improve hepatitis C care

Share

Hepatitis C by the numbersKing County has received a four-year, $6 million grant to improve testing, treatment and cure rates of people with chronic HCV infection.

Hepatitis C virus (HCV) affects large numbers of people in King County, but it often goes unnoticed until it’s too late.

“Thousands of people in King County have chronic HCV, but many don’t know they have it,” said Dr. Jeff Duchin, Chief of Communicable Disease & Epidemiology at Public Health – Seattle & King County. “This grant will allow us to make sure that patients with chronic HCV are not just identified, but also seen by a provider, receive follow-up testing, and get the care they need.”

The grant will fund the Hepatitis C Test & Cure Project, which will provide training for clinicians on the diagnosis, evaluation, and treatment of HCV and connect them to specialists. Continue reading

Share

Infertility patients finding creative financing help

Share

IVF egg thumbBy Michelle Andrews
KHN

Infertility treatment is a numbers game in some respects: How many treatments will it take to conceive a child? And how much can you afford?

Even as insurance plans are modestly improving their coverage of such treatments, clinics and others are coming up with creative ways to cover the costs to help would-be parents reduce their risk  for procedures that can run tens of thousands of dollars.

Some even offer a money-back guarantee if patients don’t conceive. Continue reading

Share

NIH to test Ebola vaccine in humans

Share

From the US National Institutes of Health

Trial will evaluate vaccine’s safety

Initial human testing of an investigational vaccine to prevent Ebola virus disease will begin next week by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

ebola

The early-stage trial will begin initial human testing of a vaccine co-developed by NIAID and GlaxoSmithKline (GSK) and will evaluate the experimental vaccine’s safety and ability to generate an immune system response in healthy adults.

The pace of human safety testing for experimental Ebola vaccines has been expedited in response to the ongoing Ebola virus outbreak in West Africa.

Testing will take place at the NIH Clinical Center in Bethesda, Maryland.

The study is the first of several Phase 1 clinical trials that will examine the investigational NIAID/GSK Ebola vaccine and an experimental Ebola vaccine developed by the Public Health Agency of Canada and licensed to NewLink Genetics Corp.

The others are to launch in the fall. These trials are conducted in healthy adults who are not infected with Ebola virus to determine if the vaccine is safe and induces an adequate immune response. Continue reading

Share

Are your medical records vulnerable to theft?

Share

This KHN story also ran in .

A decade ago almost all doctors kept paper charts on every patient. That is changing quickly as laptops become as common as stethoscopes in exam rooms. Recent hacking attacks have raised questions about how safe that data may be.

Here are some frequently asked questions about this evolution underway in American medicine and the government programs sparking the change.

Are my medical records stored electronically? Continue reading

Share

Variation in hospital charges for blood tests called ‘irrational’

Share

RedBloodCellsBy Roni Caryn Rabin
KHN

One California hospital charged $10 for a blood cholesterol test, while another hospital that ran the same test charged $10,169 — over 1,000 times more.

For another common blood test called a basic metabolic panel, the average hospital charge was $371, but prices ranged from a low of $35 to a high of $7,303, more than 200 times more.

The wide disparity in hospitals’ listed charges for routine blood tests at California hospitals was revealed in a study published in the August issue of BMJ Open. The study examined the listed charges for routine blood tests performed in 2011. Continue reading

Share

Cut the Crapshoot | RAND

Share

From the RAND Corporation:

U.S. policymakers need to counteract the perverse financial incentives that induce inventors and investors to bet big on new medical technologies that offer the highest payouts without substantially improving health.

Dice pair

Costly new technology is a primary driver of health care spending. This should come as no surprise, because all players in the dicey U.S. market for new medical technologies — inventors, investors, payers, providers, and patients — face long odds if they want to put money on products that could curb health spending while also boosting health.

The rules of the game need to change.

via Cut the Crapshoot | RAND.

Share

If you have a stroke, better it should be in Paris

Share
Frank Browning (Photo by Christophe Sevault)

Frank Browning. (Photo by Christophe Sevault)

Frank Browning writes from Paris
KHN

I had a stroke last month, oh boy.

It’s just that I didn’t know it. Here’s what happened:

Only after three days of flashing, floating visual squiggles — commonly known as ocular migraines that usually last 20 minutes — do I email my old friend Dr. John Krakauer, who helps run stroke recovery at Johns Hopkins Hospital in Baltimore.

After a few questions he told me to get an MRI scan as soon as possible.

In the U.S. that could involve the emergency room (with its hours-long wait) or a complicated process of getting the referral — and then finding a radiologist who would take my coverage.

Here in France, it is so much simpler. Continue reading

Share

Cord Blood: What You Need to Know – FDA

Share

Consumer Update from the US Food and Drug Administration

RedBloodCellsCord blood is found in the blood vessels of the placenta and the umbilical cord, cord blood is collected after a baby is born and after the umbilical cord is cut—an important point.

“Because cord blood is typically collected after the baby is delivered and the cord is cut, the procedure is generally safe for the mother and baby,” explains Keith Wonnacott, Ph.D., Chief of the Cellular Therapies Branch in FDA’s Office of Cellular, Tissue, and Gene Therapies. Continue reading

Share

‘Telepsychiatry’ helps bring mental health care to rural areas

Share

 

telepsych

Ed Spencer, director of South Carolina’s telepsychiatry program, (seated) and Ralph Strickland, program coordinator, (on screen) conduct a simulation of a typical emergency room telepsychiatry consultation at their offices in Columbia.

By Christine Vestal
Stateline

When emergency room patients are deemed “a danger to themselves or others,” every state requires hospitals to hold them until a psychiatrist conducts a face-to-face evaluation to decide whether it is safe to let them leave. In rural hospitals across the country, it can take days for a psychiatrist to show up and perform the exam.

Five years ago, rural hospitals in South Carolina illustrated the problem. On a typical morning, more than 60 people were waiting in the state’s emergency rooms for psychiatric exams so they could either be discharged or admitted for treatment.

Today the scene is quite different, thanks to a “telepsychiatry” program that allows psychiatrists to examine South Carolina patients through videoconferencing, reducing the average wait time from four days to less than 10 hours.

In 2010, North Carolina began rolling out a similar program, and a dozen other states, including Alabama, Kentucky and Wisconsin, plan to follow suit. Continue reading

Share

Bionic pancreas outperforms insulin pump in adults, youth – NIH

Share
Diabetes pump

From right, researcher Dr. Steven Russell of Massachusetts General Hospital stands with Frank Spesia and Colby Clarizia, two participants in a type 1 diabetes trial testing an electronic device called a bionic pancreas – the cellphone-sized device shown – which replaces their traditional fingerstick tests and manual insulin pumps. Photo courtesy of Adam Brown,

From the National Institutes of Health

People with type 1 diabetes who used a bionic pancreas instead of manually monitoring glucose using fingerstick tests and delivering insulin using a pump were more likely to have blood glucose levels consistently within the normal range, with fewer dangerous lows or highs.

The report was published online by the New England Journal of Medicine

TThe researchers — at Boston University and Massachusetts General Hospital — say the process of blood glucose control could improve dramatically with the bionic pancreas. Currently, people with type 1 diabetes walk an endless tightrope.

Because their pancreas doesn’t make the hormone insulin, their blood glucose levels can veer dangerously high and low.

Several times a day they must use fingerstick tests to monitor their blood glucose levels and manually take insulin by injection or from a pump.

In two scenarios, the researchers tested a bihormonal bionic pancreas, which uses a removable tiny sensor located in a thin needle inserted under the skin that automatically monitors real time glucose levels in tissue fluid and provides insulin and its counteracting hormone, glucagon, via two automatic pumps. Continue reading

Share