Woman’s Blindness Cured By Tooth Implanted in Her Eye

Nine years ago, Sharron Thornton’s hair and nails fell out, while her skin developed a blistering rash. Turns out she was suffering from a very rare condition—know as Stevens-Johnson syndrome—caused by a reaction to a medication. She eventually went blind after the cells in her eye died and left corneal scarring.

While her hair and skin grew back, her eyes remained useless. Her condition devastated her: She thought about suicide, and tried a stem cell procedure, but couldn’t be considered for a cornea transplant. Finally she went on a desperate search for any experimental treatment to cure her blindness.

For the first time in the U.S., surgeons decided to perform a rare procedure called modified osteo-odonto keratoprosthesis, to correct corneal scaring. While the procedure has been done a total of 600 times since the 1980s, it’s still pretty complicated: First the surgeons took Thornton’s tooth and part of her jawbone, and made a hole for the prosthetic lens. Then it got weirder: The surgeons implanted the modified tooth into the woman’s chest and left it there for a few months so the two parts could grow together. And finally, the tooth was implanted into her eye.

CNN reports:

Dr. Ivan Schwab with the American Academy of Ophthalmology told CNN he believes the process is too difficult and the result too disfiguring. There are alternatives that are nearly as good, he added.

“We’ve known about the procedure since the ’80s. It’s been going on for a while,” he said. “We’ve viewed it with some skepticism. It requires a sizable team and several operations. It seems to be reasonably successful on the small numbers that have been done,” though it does bring some disfigurement.

Surgeons doubt the procedure will be common in the U.S. anytime soon. But for Thornton, it gave her a reason to live.

Breaking down the Baucus bill

By: Carrie Budoff Brown and Patrick O'Connor September 17, 2009 05:13 AM EST

Senate Finance Committee Chairman Max Baucus (D-Mont.) worked for months to find common ground with Republicans on health care reform — but when he released his long-anticipated proposal Wednesday, the real problem quickly came into focus. He set the stage for a titanic struggle within his own party. Reaction from congressional Democratic leaders was lukewarm to worse, progressives were downright hostile and Republicans were scornful of what they described as brazen government grab. But Baucus may have provided lawmakers with the only viable blueprint for winning support across Congress, because he sought to find elements that pleased all sides. “There are honest and principled differences on all of us working for reform, and this package may not represent all of our first choices,” Baucus said. “But at the end of the day, we all share a common purpose: that is to make the lives of Americans better tomorrow than they are today and to get health care reform done, which means the time for action is now.” The next challenge for Baucus and the Senate leadership is to get the bill out of the Finance Committee — but after that, Senate Majority Leader Harry Reid (D-Nev.) will need to merge the Finance bill with one approved in July by the Senate Health, Education, Labor and Pensions Committee. Even Reid, who has generally supported Baucus’s efforts, sounded less than pleased, saying he needs to be convinced the bill is right for Nevada on a proposed Medicaid expansion. House Speaker Nancy Pelosi (D-Calif.) dug in on the element dear to her liberal caucus — the public insurance option — and whacked the Baucus bill for shunning it. Baucus has made the challenge clear for Democrats, who now must choose between competing visions of health reform: an employer mandate versus fees on employers, a public insurance option versus nonprofit insurance cooperatives, and taxes on millionaires versus industry and people with expensive health care plans. The proposal capped months of closed-door discussions that, in the end, produced no immediate Republican support — and critical comments from negotiators Chuck Grassley of Iowa and Mike Enzi of Wyoming, both of whom complained about “artificial deadlines” from the White House and Democratic leaders to push through a bill, as Grassley said. Baucus put the cost of his bill at $856 billion. It would require nearly all Americans to carry insurance and employers to help cover the costs of providing government subsidies, while prohibiting insurance companies from dropping or denying coverage for people with pre-existing conditions. The Congressional Budget Office estimated the bill would cost $774 billion over 10 years and cover 94 percent of Americans. It would leave 25 million people uninsured in 2019 — a third of whom are illegal immigrants — compared with 17 million in the House bill. The analysis came in $82 billion lower than Baucus had thought it would, suggesting there could be room for senators to make adjustments. However, any expenses added to the bill must be offset with new revenue, making the task politically difficult. Another looming battle between Baucus and fellow Democrats is over how to pay for the bill — especially since the Finance bill came in at least $100 billion cheaper than the House bill. The House would pay for health reform in part by taxing high earners, families who make at least $1 million, but Baucus proposed an excise tax on insurers for their top-of-the-line plans. And Republicans think both plans cost too much. “Bipartisanship on Capitol Hill is the equivalent of a child looking for the unicorn,” Rep. Anthony Weiner (D-N.Y.) said, referring to the months of negotiations between Baucus and three Republican senators on the committee — none of whom has embraced his bill. Weiner, an outspoken defender of the public option, said the Baucus bill would be “dead on arrival” in the House — a far stronger claim than that of his party’s leaders in that chamber. “It has been said that the Senate is the cooling saucer of our democracy,” Weiner said. “At this point, it is more akin to the meat locker. ... The Senate proposal will not pass muster in the House.” But Baucus aides said there is plenty for progressives to like: tax credits to purchase insurance for families with incomes of $88,200 or less, immediate creation of a high-risk pool to provide coverage to the uninsured and people with pre-existing conditions, an expansion of Medicaid, and Medicare coverage for annual prevention and wellness checkups. “It is common sense. It is a balanced bill. It certainly is a bill that can pass,” Baucus said. “And the choice now is up to those on the other side of the aisle — if they want to vote for it or not.”

Baucas Press Conference

Greater Louisville Medical Society President's eVoice September 2009

The future's so bright, I gotta wear shades... This article was written during a tennis tournament "road trip" with my daughter. I sent Mackenzie ahead with another lucky family, and drove the 6 plus hour trip to North Carolina by myself. This allowed me the opportunity to think but also to listen to whatever I wanted on the radio. I ended up with the 70's and 80's channels (and hence the title to this article). Almost each and every song brought a smile to my face and brought back the memory of a moment from high school, college or some aspect of medical training. I was clearly in my "happy place." This tournament is also a little different than others. Most tennis tournaments include mainly singles events, where it's all about you. You either win or lose, and if it's the latter, you head home a lot sooner than everyone else. In this tournament, the "zonals," the kids are placed on teams representing different regions (Southern, Caribbean, Mid-Atlantic, etc), 6 girls, and 6 boys, and each day they play doubles, mixed doubles and singles, for a total of 18 possible points per day. The teams with the most points after several days, play each other at the end of the tournament, but in general, everyone plays every day, win or lose. And the best part, team members can clap and yell and cheer for each other, which is mostly forbidden in all other tournaments. This tournament takes what can be a very solitary, individual sport and turns it into a team sport. It's a lot of fun. If she's played well enough through the year to be selected, it is clearly my daughter's favorite tournament. Could this be where medicine is going? Most of us perform as individuals, working directly with patients to diagnose, plan and implement treatments. Will health care reform transform us into something like tennis "zonals?" Will we be put on teams with other physicians? Michael Porter wrote a book on reforming healthcare even before all this recent talk of reform, and he predicted that care in the future would be delivered around a patient's main type of disease (diabetes, cardiovascular disease, etc), and that physicians would be organized in groups in order to manage chronic illnesses. Will primary care be delivered through a "medical home," a team of physicians, nurses and other professionals? Will physicians need to form larger group practices in order to be successful? Will physicians be on teams with hospitals or health systems in order to receive bundled payments? As the debates go on in Washington, the GLMS, KMA and AMA continue to try to participate and influence the discussions. I think we all realize that the status quo will likely not continue, and that patient care is improved by more collaboration and continuity. Figuring out how we can make the practice of medicine more of a team sport instead of an individual one is likely a good idea, and maybe it will be even more fun than practicing alone, just like the "zonals." Sincerely, Lynn T. Simon, MD GLMS President Louisville Medicine wants your proposals on health care reform: By now you've read and heard many pundits' views of how to provide access to working health insurance for all, or at least more, Americans. Louisville Medicine wants to know what your proposals are. What kinds of solutions do you favor, and how would you design and finance them? Please join in and enlighten us - we who provide the care have a valuable perspective. Send your responses to bert.guinn@glms.org or by mail to the GLMS Communications Dept., 101 W. Chestnut, Louisville, KY 40202. Thanks from all of us - Mary G.Barry, MD and the Editorial Board

GLMS Mission - Promote the science, art and profession of medicine - Protect the integrity of the physician-patient relationship - Advocate for the health and well-being of the community - Unite physicians to achieve these ends

President Obama announces medical liability initiative, responds to AMA call to address cost of defensive medicine

In his health reform address to a joint session of Congress, President Obama announced that he has directed the Secretary of Health and Human Services to begin work immediately to offer state demonstration grants on alternative medical liability reforms. The announcement follows months of dialogue with the president, senior White House officials, AMA leadership and advocacy staff, beginning immediately after the elections.

During a meeting in May with President Obama, AMA President J. James Rohack, MD, linked the cost of defensive medicine to desires to “bend the spending curve” and urged consideration of “safe harbors” for physicians adhering to best practice guidelines. In addition, the AMA has advocated funding for states to test health courts, early offer programs and certificates of merit to dispense with nonmeritorious claims.

This concept of state pilots to test alternatives has been previously advanced in legislation sponsored by Sen. Michael Enzi, R-Wyo., and Sen. Max Baucus, D-Mont. In July, the House Energy and Commerce Committee adopted an amendment to H.R. 3200 that provided state grants to test early offer and certificate-of-merit programs.

At the federal level, caps on noneconomic damages have created a challenge for the AMA and state medical societies. When Republicans held a majority in the Senate and an effort was made to secure Democratic support for caps on noneconomic damages, the discussion focused on a $500,000 cap with exceptions for certain cases. Some Republican senators also expressed support for exceptions to a noneconomic damages cap. The AMA has consistently opposed federal proposals that would undermine effective state laws such as those in California, Texas, Louisiana, Indiana, Kansas, Georgia and Mississippi.

The state pilot projects announced by President Obama will be administered by the Agency for Healthcare Research and Quality. The AMA will provide additional information on this initiative as soon as it is available.

Sept. 16, 2009

Here's your regular update on efforts by the American Medical Association (AMA) to work with lawmakers in reforming the nation's health care system in a way that provides quality, affordable health care for all.

Senate Finance Committee releases health system reform proposal
U.S. Senate Finance Committee Chair Max Baucus (D-Mont.) released a health system reform proposal this morning that will be considered by his committee next week. "America's Healthy Future Act of 2009" (PDF) is a comprehensive proposal that includes insurance market regulations, income-related subsidies for purchasing coverage and other reforms. Notably, the proposal does not include a public plan option; rather, it creates authority for the formation of a Consumer Owned and Oriented Plan, or CO-OP. Also, as anticipated and reported previously, the proposal differs significantly from the U.S. House of Representatives health system reform bill in that it would not repeal the sustainable growth rate (SGR) formula used to calculate Medicare physician payment updates. Instead, the Senate Finance Committee proposal replaces the scheduled 21 percent cut in 2010 with a 0.5 percent Medicare physician payment update. The package includes several other proposals of concern to physicians as well.

After further review of the 223-page document, the AMA will continue its ongoing discussions with Chairman Baucus and other Senate Finance Committee members to strengthen and improve the proposal.

The committee has asked its members to submit their proposed amendments to the legislation by Friday, Sept. 18, so that markup can begin next week. The Senate leadership announced previously their intention to complete floor consideration of health system reform legislation before Columbus Day.

Dr. Rohack testifies at House hearing on "urgent need for health system reform"
AMA President J. James Rohack, MD, testified yesterday at a hearing convened by the House Democratic Steering and Policy Committee regarding health system reform. More than 70 members of the House Democratic Caucus attended the meeting. In hisstatement (PDF), Dr. Rohack emphasized the critical elements identified by the AMA as essential to health system reform, touching on key issues such as repealing the SGR, enacting medical liability reforms and ensuring that patients are able to privately contract with their physicians.

Flat rate for Healthcare?

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