Flesh and Stone

Global wind power sees large increases in investment

Mon, 08 Feb 2010 08:53:00 -0700

China and the United States are currently heading a worldwide upsurge in the installation of wind power capacity to the surprise of some analysts. The global wind power market generated $63 billion in 2009 and employed over half a million people, according to figures issued by the Global Wind Energy Council (GWEC). The report indicates that the sector is set to repeat its 2009 performance.

Steve Sawyer, the GWEC’s secretary general, offers an upbeat prediction. "The continued rapid growth of wind power despite the financial crisis and economic downturn is testament to the inherent attractiveness of the technology, which is clean, reliable and quick to install. Wind power has become the power technology of choice for a growing number of countries around the world," he said.

China led the pack last year in terms of installations by country, with 13 gigawatts (GW) of wind energy being put on line, thus almost doubling its capacity to 25.1 GW. This puts China in second place in the overall capacity stakes – just in front of Germany – but the United States remains top of the table with 22 percent of all wind power in the world being installed there and an increase in capacity of 40 percent in 2009. The total of installations by all countries represents a substantial 31 percent increase over the year, and world total capacity is now estimated to be just under 158 GW.

These are surprising figures in the triple-context of the world financial crisis, the fact that it is relatively investment-greedy per megawatt, and the meager results of the Copenhagen conference which hardly inspired investment confidence in the immediate future of alternative energy sources.

The figures are explained by national (as opposed to international) energy policies according to Sawyer, who said: "...wind energy continued to grow due to national energy policy in our main markets and also because many governments in prioritised renewable energy development in their economic recovery plans."

Asia, with recent investment in India, Japan, South Korea and Taiwan, is the largest regional investor, followed by North America and Europe.

Europe installed 10.5 GW of wind power capacity in 2009, with Spain’s total of 2.5 GW leading the way. France had a relatively bad 2009 due to an upsurge in court cases brought by opponents of wind power who claim that it results in aesthetic damage to the environment. This phenomenon has led to uncertainly concerning wind power’s future development there and the government is considering aesthetic damage legislation which wind power proponents say will act as a brake on wind power investment.

But the best performance was to be found in the USA, despite dire predictions by analysts in early 2009 who expected investments to fall by up to 50 percent. However, the U.S. Recovery Act, which encourages wind energy development, actually led to an increase of 39 percent of the country’s capacity to a grid-linked total of 35GW.

Sawyer is highly optimistic for the future. "Wind energy is already making a significant contribution to saving CO2 emissions," he concludes. "The 158 GW of global wind capacity in place at the end of 2009 will produce 340 TWh (terawatt-hour) of clean electricity and save 204 million tons of CO2 every year. As we see in Europe and the US, wind power is now often the most attractive option for new power generation, both in economic and environmental terms, and for improved supply security."

French face transplant specialist awaits go-ahead to help wounded GIs

Sat, 06 Feb 2010 11:48:00 -0700

Contacted last year by American authorities for his knowledge and experience in facial transplants, professor Laurent Lantieri, MD, transmitted their appeals to French authorities. Since that time he has not received permission to accede to the Americans’ request and he has the impression that France is ignoring his efforts and putting administrative obstacles in his way.

Lantieri, a plastic surgeon and pioneer in facial transplantation, recently sounded the alarm in an interview given to French daily L’Express, in which he vented his frustrations and explained the issues.

American armed forces in Iraq have repatriated thousands of seriously wounded personnel to the United States since 2001; about 2,500 of them with facial wounds. The face is the least protected part of a soldier’s body and in cases where they are caught in explosions, facial damage can be severe. About 200 victims are estimated to be in need of partial or total facial transplants.

The French possess extensive know-how in facial transplants, and the first-ever operation was carried out in France in 2005 on a young French woman. French specialists have carried out many more transplants since with a relatively high success rate, although the body’s rejection of the transplant remains a major risk. The French are generally acknowledged to be the world leaders in this field.

It is in this context that American military authorities invited Lantieri, who is a world-leading authority on facial transplants, to visit the United States and share French transplant techniques with American military personnel and to see how French and American surgeons could pool their resources in an efficient manner.

Lantieri informed the French health, research and foreign ministries -- and even the president’s health counsellor -- of the American request and his wish to help, but he has not received any positive responses from anyone. He says that the government is stalling by informing him that they didn’t understand what he wanted. He said the Health Ministry responded to repeated queries saying it had not received his demands and asked him to send another demand along with all the “relative explanations for your request.”

The response leaves Lantieri frustrated. “What are they waiting for?” he asked. “Both civil and military medical authorities in America are asking me to train their people here in France for a six-month period, but because their qualifications and diplomas are not recognised here I do not even have the right to discuss the matter with them. The Americans need specialist teams all over the United States and they do not exist at this time. Our specialists have a substantial lead in this field and the Americans know it. That’s why they are asking for our help. But here in France my demands are met with silence.”

Lantieri has visited the United States on several occasions over the last year and is scheduled to visit San Antonio, Texas, in March to meet senior members of American severe burns facilities there and elsewhere.

The challenges posed by facial injuries sustained by American soldiers are substantial in his view. Some of those injuries are of a ballistic nature – caused by bullets or shrapnel – but burning and searing caused by IED (Improvised Explosive Device) explosions are the most common, and they often present extensive lesions of a type and severity which push current operating techniques to their limits. Lantieri claims that this kind of injury would be better treated by transplants than by superficial reparation methods, which can take up to 15 years to complete. This can lead to victims’ lives being constantly disrupted by long and frequent interventions.

No facial transplants have yet been carried out on blast victims. The Americans have adequate personnel according to Lantieri, but he says they need to learn from the more extensive experience of French specialists who have more research and practical work to draw upon. He has been invited to several congresses on the subject, stressing that he is sharing “the character of transplants at this time, but the reality of this type of operation can be completely different.”

The Americans, meanwhile, are making efforts to try and move things forward. The Pentagon recently released $3.4 million (€2.5 million) to fund between six and eight transplants at the Brigham and Women’s Hospital in Boston over the coming year, but Lantieri considers this to be both an unrealistically high target and a drop in the ocean given the timescale and available resources. He adds: “...and even if those operations are carried out, there will still be a waiting list of around 190 patients.”

California is first state to legislate deep cuts in wait times to see HMO doctors

Sat, 06 Feb 2010 07:52:00 -0700

Waiting too long for a medical appointment? California will cut wait time to between 10 and 15 days. Unfortunately, it could take nearly a year to go into effect, nearly eight years after the no-wait law was passed by the state legislature.
“California patients are literally sick of having to wait weeks to see a doctor. What good is health coverage if a patient can’t find a doctor taking new patients or within driving distance? These new rules say that patients can reasonably expect to have timely access to needed health care.” -- Cindy Ehnes, Director of the California Department of Managed Care

After haggling for close to eight years to get a consensus on permissable wait times for getting an appointment with HMO physicians, California appears to be on the cusp of doing just that for the 20 million Californians covered by HMOs.

But even with all the rules in place, the full effect won’t take place for another nine months or a year, Los Angeles Times reporter Duke Helfand told me in an email.

Once implemented, California will be the first state to mandate how quickly HMO members will be able to see their doctors. For many it will be too late; for the rest, it can’t come soon enough.

The regulations, which could have gone into effect as of Jan. 31, were derived from the Timely Access Law passed by the State Legislature in 2002. It seems inconceivable that once the law was passed, they could have let the foot-dragging on the part of the HMOs go on for so long, but they did.

The Timely Access Law was prompted by accusations from patients covered by HMO plans that access to care was delayed because there were too few participating physicians.

Not surprising is the response by HMO providers, and if you were a good prognosticator or just knew how the system works, you could have seen this one coming from the get-go. So should have the legislators who could have written a "no stalling" clause into the bill. It's impossible to estimate how many people they hurt by not doing that.

While the HMO honchos say they support the new rules, they characteristically warned -- you could say threatened -- that because of the new rules, costs may be driven up.

They could have omitted the “may be,” because it’s a sure thing that they will use any excuse to drive up the costs to their policy holders. Health care costs have been steadily going up exponentially, far exceeding the cost of living and the raises that used to go with them. And with no governmental controls in place, they’ll continue to rise.

Ironically, this week, using rising health care costs as their excuse mantra, Anthem Blue Cross in California announced that it’s raising its rates on 800,000 non-group members from as much as 35 percent to 39 percent beginning March 1, according to Helfand's latest report in the Los Angeles Times.

Whatever their customers are paying now is too much, and with a 39 percent increase they might as well put the premium money in a savings account for everyday, minor medical expenses and see if they can find reasonable major medical only.

The no-wait plan not only covers HMO providers that include mental health, vision care and other services, but dental plan providers, too.

The limits set by the plan require that appointments for non-urgent primary care be set within 10 business days; non-urgent appointments with specialists must be made within 15 business days.

The new rules also give HMO members the rights to access to a health care professional at all times, appointments for urgent care within 48 hours of a request, and have a phone call to a doctor returned within 30 minutes.

Non-HMO plan holders will not be directly affected by the new rules.

The foot-dragging will continue as the HMOs have nine months to comply. The one stick the California Department of Managed Health Care has to beat about the heads of any intransigent HMOs is the ability to fine them if they don’t comply with the rules.

For more info:
The Doctor Will See You Now! - California shortens wait times for patient appointments (pdf of press announcement, California Department of Managed Care, Jan 20, 2010)

Would health care reform help you?

Tue, 02 Feb 2010 23:23:00 -0700

Many obstacles and stumbling blocks remain in the way of health care reform. The House and Senate bills will have to be merged, and then the House and Senate both will vote on the final bill. We don’t yet know what will be in the final bill, or if the final bill will be passed into law. Passage will be especially difficult in the Senate, where it will need 60 votes to pass. It is still possible that after all this angst, just one grandstanding senator could kill the whole thing.

But just for fun, let’s look at what conventional wisdom says will be in the final bill and see if there is anything in it that will be an immediate benefit to people with mesothelioma cancer and other asbestos-related disease.

It is likely that the final bill will provide additional funding for state high-risk insurance pools. Currently more than 30 states run such pools, which are nonprofit, state-sponsored health insurance plans for people who can’t buy insurance because of pre-existing conditions. The biggest problem with such pools is that, often, the insurance they offer is too expensive for many who might need it. Both the Senate and House bills provide $5 billion in subsidies for state high-risk pools to make the insurance more affordable.

Under the Senate bill, beginning in 2014, private companies would no longer be able to deny coverage to adults with pre-existing conditions, nor could they charge higher premiums for people with pre-existing conditions. Until then, the state high-risk pools could provide some help.

Closing the Medicare Part D coverage gap — also called the “doughnut hole” — is another potential provision that could help some patients with asbestos-related disease. The “doughnut hole” is the gap between the coverage for yearly out-of-pocket expenses provided by Medicare Part D and Medicare’s “catastrophic coverage” threshold.

For example, in 2009 Medicare Part D paid at least 75 percent of what patients paid for prescription drugs up to $2,700. After that, patients must pay for all of their prescription medications until what they have paid exceeds $6,154. At that point, the catastrophic coverage takes over, and Medicare pays for all but 5 percent of the patient’s drug bills. The final health care reform bill probably will provide for paying at least 50 percent of out-of-pocket costs in the doughnut hole.

You may have heard the bills include budget cuts to the Medicare program, and this has been a big concern to many people. Proponents of the bill insist that savings can be found to pay for the cuts, and that people who depend on Medicare won’t face reduced services. But this is a complex issue that I want to address in a later post.

The long-term provisions probably will include many others that would benefit patients with asbestos-related disease, including increased funding for medical research. Although there are many complaints about the bill coming from all parts of the political spectrum, on the whole it would be a huge benefit to many people.

Barbara O’Brien contributes to many web sites including The Guardian’s Comment Is Free. Since 2008 she’s also been the Buddhism Guide for About.com. She launched her site, The Mahablog, in 2002.

Failing memory could indicate a higher risk for stroke

Tue, 02 Feb 2010 22:18:00 -0700

People who experience memory or other cognitive loss could have a higher risk of developing a stroke, according to a study published in today’s Neurology, the journal of the American Academy of Neurology. The results were true whether or not the patient was diagnosed with dementia.

Bernice Wiberg, MD, Uppsala University in Sweden, and colleagues recruited 930 Swedish men around age 70 for the study. None of the men had had a previous stroke.

The men participated in three tests: Trail Making Test A, which measures attention and visual-motor abilities; Trail Making Test B which measures the ability to execute and modify a plan; and the Mini Mental State Examination, a common tool for measuring cognitive decline.

The men were followed for 13 years. During that time, 166 men developed a stroke or transient ischemic attack (TIA); and 105 patients developed a brain infarction, which prevents the proper amount of blood from reaching the brain and leads to tissue damage. A brain infarction is the most common cause of stroke.

Men who performed at the bottom 25 percent on the Trail Making Test B were three times more likely to have a stroke or a brain infarction compared to those who scored in the top 25 percent on the test. The other two mental tests did not predict brain infarction or stroke.

The Trial Making Test B is simple and cost-effective, said Wiberg, and could be a useful tool for identifying people at risk for stroke so they might take steps to prevent one.

“Stroke is a leading cause of disability and death among older people, making early identification of people at high risk of stroke extremely important, so preventative measures can be taken,” Wiberg said.

Along with Uppsala University, support for the study was provided by the Swedish Stroke Association, Swedish Research Council, the Swedish Heart Lung Foundation, the Geriatric Fund and the Uppsala County Association Against Heart and Lung Diseases.

Source:

Wiberg, B., Lind, L., Kilander, L., Zethelius, B., Sundelof, J. E., Sundstrom, J.
Cognitive function and risk of stroke in elderly men
Neurology 2010 74: 379-385 5

Bush loyalists still touting, getting away with torture

Mon, 01 Feb 2010 21:25:00 -0700

Although the practice is roundly rejected by the international community and was banned by President Barack Obama the day he took office, some just won’t stop defending torture.

Marc Thiessen, speech writer to former president George W. Bush and author of “Courting Disaster: How the CIA Kept America Safe & How Barack Obama Is Inviting the Next Attack,” was invited on CNN to debate torture with Philippe Sands, a University College London professor and barrister who regularly litigates cases before international courts.

Thiessen said policies allowing torture, including water boarding, were “… the most successful and important intelligence programs in the history of the CIA.”

Thiessen is among a group of radicalized ideologues, including a Supreme Court justice, who have defended or are actively campaigning to revive the CIA’s “enhanced interrogation” program. The Bush administration unsuccessfully sought -- through semantic tricks -- to legitimize torture, even though it was specifically outlawed by the UN Convention Against Torture, as well as the U.S. Constitution which, by the way, borrowed the exact words that forbid “cruel and unusual punishment” from the 1300-year-old English Bill of Rights.

Law-schmaw, say the torture radicals. During his interview, Thiessen criticized reporter Christiane Amanpour for comparing U.S. waterboarding with Khmer Rouge water torture. “You’re one of the people who have spread these mistruths,” he said.

Amanpour responded: “That’s called spreading the truth.”

So why is this debate still going on?

No one from the Bush administration has thus far been held accountable for torturing people. In fact, just last week the Dept. of Justice’s Office of Professional Responsibility cleared Bush administration lawyers John Yoo and Jay Bybee, authors of the “torture memos,” of professional misconduct allegations, according to Newsweek.

View Amanpour’s segment “Debating torture.”

Why is it so difficult to eradicate salmonella?

Mon, 01 Feb 2010 19:52:00 -0700

Lene Karine Vestby, MSc, a chemical engineer at Østfold University College, has studied why it is so difficult to eliminate salmonella once established in Norwegian feed and fish meal factories. She discovered that the salmonella bacteria efficient at forming biofilm (bacteria coating) survived longer in the factories than those that had a reduced ability to form this coating. The ability to survive in factories therefore appears to be connected with the ability to form a biofilm and it would seem that removing biofilm is a necessary step towards eradicating salmonella from the factories.

In a biofilm, bacteria are well protected by a slime (matrix) which they produce themselves. Vestby has studied the effect of the nine most frequently used disinfectants in the Norwegian animal feed industry and found that the efficiency of the disinfectants is substantially reduced if the salmonella has managed to form a biofilm. The effect of the majority of the disinfectants was then no longer be satisfactory, but a product containing 70 perent ethanol was the most efficient, followed by one called Virkon S.

Cooperative behavior between bacteria (quorum sensing) is an important factor in the ability to form biofilm. In recent years, so-called furanones have been developed, which are known to inhibit quorum sensing and thereby also the formation and maturation of biofilm. Vestby has shown that a furanone can be a useful tool in the fight against salmonella in factories. The furanone prevented the salmonella bacteria from forming an adequate biofilm and the bacteria were therefore more vulnerable to disinfectants, with the result that the disinfectants worked better.

The matrix produced by the salmonella bacteria in the biofilm consists of many different components, one of which is cellulose. A surprisingly large proportion of salmonella found in Norwegian feed and fish meal factories appeared not to produce cellulose. It has been claimed that cellulose is important for protecting bacteria in a biofilm, but Vestby's laboratory tests have demonstrated that biofilm with or without cellulose respectively afforded the bacteria the same protection against disinfectants. On the other hand, it appeared that cellulose in the biofilm gave the bacteria better protection against dehydration over a period of several months.

Vestby, a chemical engineer, presented her doctoral thesis "Biofilm formation by Salmonella from the Norwegian feed industry – with attention to potential persistence and eradication" at the Norwegian School of Veterinary Science. Vestby has a master’s degree in clinical microbiology from Griffith University, Brisbane, Australia. She worked for a privately run biotechnology firm before embarking on her PhD in the department of bacteriology at the Norwegian Veterinary Institute, where she is currently employed.

Scott Roeder trial: Anti-abortion extremist couldn’t kill the law

Fri, 29 Jan 2010 20:16:00 -0700

Sometimes it feels like normal, law-abiding people have to work to exhaustion just to stay in place. Today was one of those days.

A Kansas jury found Scott Roeder guilty of first degree murder. The issue for anti-abortion crusaders wasn’t if he killed or whether it was premeditated – both of which are undisputed facts. The issue was whether Roeder was justified in murdering abortion doctor George Tiller in cold blood.

Some anti-choice activists continue (albeit anonymously on the Internet) to rally around Roeder, insisting that his was an act of heroism. In their world, Tiller was a murderer of unborn babies and therefore, he deserved to be killed.

These “pro-lifers” who stood behind and encouraged Roeder are not the folks you see at peace marches protesting the killing of innocent babies in Iraq, Palestine, Afghanistan or Pakistan. The “Pro-life” moniker should be changed to “Pre-life” to differentiate them from people who honor life in word and deed -- from birth to grave.

It’s sobering to think what might have followed if the Kansas jury had acquitted Scott Roeder today. Some would see it as encouragement for an open season on abortion doctors, Planned Parenthood clinic staff and others who already are threatened daily.

We have the obligation to learn more about those in Roeder’s supporting network, such as members of the bizarre “Army of God” who believe it is justifiable to kill based on personal beliefs. We’ve seen that blind anger lead to acts of domestic terrorism too often to ignore.

According to a GQ article based on interviews with Roeder (which I found disturbingly sympathetic to the killer), he was angry with politicians who kept promising they’d end abortion but failed to do so.

The right-to-life movement should have long ago gotten a clue that they’ve been duped by the GOP and Blue Dogs. While extensive energy and resources must be spent fending off proposals to restrict reproductive freedom, calculating politicians use the abortion issue as an election wedge tool. According to the National Abortion Federation, about 500 bills restricting abortion were introduced last year.

For decades they’ve dangled abortion like a carrot before an increasingly violent minority that is frustrated to the breaking point.

Today a Kansas jury stood on the side of justice. Maybe tomorrow duplicitous politicians will turn down their dangerous rhetoric that stokes the dreams of vigilantes and extremists.

For excellent coverage of this important case go to the Wichita Eagle and reporter Ron Sylvester’s blog, “What the judge ate for breakfast.”

HHS and DOJ expand health care fraud ‘strike force’

Thu, 28 Jan 2010 09:44:00 -0700

U.S. health care fraud occurs so often and is so widespread that 10 cents of every dollar spent on health care goes toward paying for fraudulent claims, according to the Legal Information Institute at Cornell University. At least 3 percent of all U.S. health care spending, representing $68 billion, is lost to health care fraud. The National Health Care Anti-Fraud Association says what the U.S. spends on fraudulent claims each year exceeds most countries’ GDP.

Perpetrators of health care fraud are “criminals” who must be stopped, said Health and Human Services Secretary Kathleen Sebelius who, along with Attorney General Eric Holder, is hosting a fraud prevention summit today in Washington, D.C.

Closing plenary remarks can be watched via webcast from 3 to 4 p.m. ET at StopMedicareFraud.gov.

Sebelius and Holder picked up the fraud prevention mantle in May 2009 by creating “Strike Force Teams” to investigate and prosecute fraud cases. HHS claims that more than 500 individuals and organizations have been indicted for bilking the federal Medicare program out of $1 billion since the effort began. Fraud prevention efforts are currently underway in Miami and Tampa, Fla., Los Angeles, Detroit, Houston, Brooklyn, N.Y. and Baton Rouge, La.

“Health care fraud isn’t just a government problem. Criminals don’t discriminate and they are stealing from Medicare, Medicaid and private companies at an unacceptable rate,” said Sebelius. “We have a shared interest in stopping these crimes and today’s summit brought us together to discuss how we can all work together to fight fraud.”

Sebelius said President Obama’s FY 2011 budget being unveiled next week will include support for anti-fraud efforts that could save billions over the next 10 years. “He will call for increased investments in programs that have a proven record of preventing fraud, reducing payment errors and returning funds to the Trust Funds,” she said.

Workgroups are focusing on use of technology to prevent and detect health care fraud and improper payments, the role of states in preventing health care fraud, fraud prevention policies, law enforcement strategies, and health care fraud analysis and reporting.

“Health care fraud affects all Americans and demands a coordinated, national response,” said Holder.

Results of the summit will be made available to the public, according to HHS.

For more:

Health care fraud: an overview – Cornell University Law School

The National Health Care Anti-Fraud Association (NHCAA)

Safest hospitals for Medicare and Medicaid patients announced

Tue, 26 Jan 2010 16:16:00 -0700

More than 150,000 Medicare patient deaths and 13,104 in-hospital complications may have been avoided if all hospitals performed at the same level as the top 5 percent, according to HealthGrades, a Golden, Colo.,-based organization that ranks U.S. hospitals, physicians and nursing homes.

“This independent study of mortality and complication rates identifies an elite group of hospitals that are setting the benchmark for outstanding patient outcomes,” said Rick May, MD, HealthGrades vice president of clinical excellence research and a study co-author.

Delaware has the highest percentage of the 269 top hospitals cited in the report, followed by Maryland, Minnesota, Florida and Connecticut. Hospitals making the top 5 percent list had the lowest mortality rates for Medicare and Medicaid patients, according to the HealthGrades report released today. Thirty-six states have one or more hospitals on the list while 13 states had none.

HealthGrades analyzed about 40 million patient records kept by the Centers for Medicare and Medicaid Services for fiscal years 2006, 2007 and 2008, for 26 medical procedures and diagnoses at every one of the nation’s nearly 5,000 non-federal hospitals. All hospitals were required to participate in the rating process.

The analysis found that hospitals that rated in the top 5 percent have a 29 percent lower risk-adjusted mortality rate, had 9 percent lower risk-adjusted complication rates than other hospitals, and are improving their clinical quality at a faster pace than other hospitals, according to HealthGrades. The top hospitals also showed greater improvement in lowering risk-adjusted mortality rates from 2006 through 2008, with an average of 13.91 percent improvement versus 10.41 percent improvement for all other hospitals.

A list of the hospitals with the best outcomes for Medicare patients is available at www.healthgrades.com.