Health Care Policy News

The Same Rotten Rx
If at first you don't succeed, try, try, try, try again. With Plans A, B and C having failed miserably, President Obama yesterday unveiled his latest "new and improved" version of health-care reform. He says that this incarnation "incorporates the best ideas from Democrats and Republicans — including some of the ideas that Republicans offered during the health-care summit." Unfortunately, its fundamental premise remains exactly the same — a government takeover of the health-care system.

South Carolina, Oklahoma And Arkansas Grapple With Medicaid Cuts To Help Balance Budget
States consider major cuts to Medicaid services and reimbursement rates to help fill gaps in the budget.
The Associated Press: "Lawmakers are considering cutting all services for nearly 26,000 people with disabilities as South Carolina tries to plug a $560 million budget hole. Parents say the proposed cuts to day care programs and other services would force them to give up much-needed jobs to stay home and care for their young and adult children." But "[l]awmakers say they have little choice.

Medicine News

Proton-Pump Inhibitor Use Is Not Associated With Osteoporosis or Accelerated Bone Mineral Density Loss
Recent studies have shown an association between proton-pump inhibitor use (PPI) and hip fracture. The mechanism by which PPI use promotes the development of hip fracture is uncharacterized. A study out of Gastroenterology sought to determine whether PPI use is associated with osteoporosis or accelerated bone mineral density (BMD) loss. PPI use was not associated with having osteoporosis at either the hip (OR, 0.84; 95% CI, 0.55–1.34) or the lumbar spine (OR, 0.79; 95% CI, 0.59–1.06) for PPI use >1500 doses over the previous 5 years. In the longitudinal study no significant decrease was observed in BMD at either site attributable to PPI use.

Orthostatic Syndromes Differ in Syncope Frequency
There are conflicting opinions on whether postural tachycardia syndrome predisposes to syncope. We investigated this relationship by comparing the frequency of syncope in postural tachycardia syndrome and orthostatic hypotension. Of 810 patients referred for postural tachycardia syndrome, 185 met criteria while another 328 patients had orthostatic hypotension. Of the postural tachycardia syndrome patients, 38% had syncope on head-up tilt, compared with only 22% of those with orthostatic hypotension (P<.0001). In the postural tachycardia group, syncope on head-up tilt was associated with a clinical history of syncope in 90%, whereas absence of syncope on head-up tilt was associated with a clinical history of syncope in 30% (P<.0001). In contrast, syncope on head-up tilt did not bear any relationship to clinical history of syncope in the orthostatic hypotension group (41% vs 36%; P=.49). results demonstrate that syncope (both tilt table and clinical) occurs far more commonly in patients who have postural tachycardia syndrome than in patients with orthostatic hypotension. More Information on Postural Tachycardia Syndrome, also from the National Institute of Health