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Kaiser Daily Health Policy Report Feature Highlights Recent Blog Entries
"Blog Watch" offers readers a roundup of health policy-related blog posts.Bloggers are tentatively reacting to a report and blog post released by the Congressional Budget Office that summarizes the agency"s approach to estimating the cost of any health overhaul bills. At issue is how CBO will count different stipulations of legislation -- like an individual mandate or a public plan -- and whether their conclusions will result in a heftier price tag. Douglas Elmendorf explained on the Director"s Blog: "In CBO"s view, the key consideration is whether a proposal would be making health insurance an essentially governmental program, tightly controlled by the federal government with little choice available to those who offer and buy health insurance -- or whether the system would provide significant flexibility in terms of the types, prices, and number of private-sector sellers of insurance available to people. The former -- a governmental program -- belongs in the federal budget (including all premiums paid by individuals and firms to private insurers), but the latter -- a largely private-sector system -- does not." Janet Adamy of the Wall Street Journal"s Washington Wire notes that the report doesn"t address the cost estimates of the scenarios. Alan Katz on his Health Care Reform Blog concludes, "the message is clear: the looser government"s hand grips the new health care system the smaller its budgetary impact." Liberal bloggers had a variety of reactions -- some found the report too vague, while others saw it as good news. The New Republic"s Jonathan Cohn says, "you may need a Talmudic scholar to figure out what those implications are." Cohn continues, "Other passages in the briefing are [similarly] vexing and, for what it"s worth, the reactions I"ve gotten from insiders familiar with the report have ranged from sighs of relief to statements not suitable for a family blog." Ezra Klein agrees the report lacks specificity, but says, "Even so, I"m cheered by the simple existence of this ruling. The fact that CBO is explaining its thinking before legislation arrives [is] yet more evidence that CBO appears, insofar as it can, to be trying to help out on health reform. ... That"s an important change from past years." Interesting Elsewhere:
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Joint Meeting - American Academy Of Ophthalmology
The largest and most comprehensive ophthalmic educational meeting in the world, the American Academy of Ophthalmology"s (Academy) 2009 Joint Meeting in conjunction with the Pan- American Association of Ophthalmology (PAAO) will be taking place in San Francisco, Oct. 24 to 27.
News of the day
Premier's Award For Victorian Cancer Treatment Doctor
A breakthrough in the treatment of cancer and an unexpected finding about the life span of blood clotting cells have led Victorian scientist Dr Kylie Mason to be awarded the prestigious 2009 Premier"s Award for Public Health and Medical Research.
Diagnostics

HIV Infection And Chronic Drinking Have A Synergistic, Damaging Effect On The Brain

More than half of clinic patients infected with the human immunodeficiency virus (HIV) report they also drink heavily. While highly active antiretroviral therapy has helped to reduce HIV-related cognitive and motor deficits, neuropsychological deficits may continue and even be exacerbated by alcohol. A study of memory deficits has found that HIV infection and chronic alcoholism have synergistic, damaging effects on brain function. Results will be published in the October issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View. "It has been consistently documented that chronic heavy drinking results in cognitive and motor deficits, particularly impairments in component processes of executive functions, memory, visuospatial abilities, and speed of cognitive processing and motor movements," said Edith V. Sullivan, professor in the department of psychiatry and behavioral sciences at Stanford University School of Medicine and corresponding author for the study. "Chronic heavy drinking co-occurring with HIV infection is highly prevalent, and the separate and combined untoward effects on the brain and its processes can be significant and disruptive of activities of daily living." This prevalence exists despite considerable educational and prevention programs regarding both HIV and alcoholism, added Sara Jo Nixon, a professor in the department of psychiatry at the University of Florida. "Furthermore, their comorbidity constitutes an even greater health concern with implications for treatment adherence, work and interpersonal skill maintenance." Sullivan and her colleagues examined working and episodic memory in four groups (n=164) - 40 individuals with HIV (28 men, 12 women), 38 with chronic alcoholism (24 men, 14 women), 47 with both HIV and chronic alcoholism (38 men; 9 women), and 39 "normal" controls (22 men, 17 women) - at baseline and then again at a one-year follow-up. Measures included accuracy scores, response times, and rate of information processing. "Individuals who are both positive for HIV and have a history of chronic heavy drinking are at greater risk than individuals with only one of these conditions to have trouble learning new information," said Sullivan. "This difficulty in new learning can affect an individual"s ability to use information important to the successful completion of personal and work-related activities." "Too frequently, when widespread deficits are associated with disease, the need to disentangle underlying interacting processes is overlooked," said Nixon. "Specifically, Sullivan and her colleagues" ability to identify a particular component of memory, "episodic," as being impaired, while another, "working," is spared supports the continued to need construct studies which provide explicit contrasts among subprocesses which may be inappropriately grouped under a broad superordinate category." In other words, she said, specific damages were "cloaked" by overall damage prior to this study. "Immediate episodic memory is dependent on intact medial temporal lobe systems that have been shown to be affected in both HIV infection and chronic alcoholism," explained Sullivan, "whereas working memory is primarily associated with more frontally based systems that may not be as severely effected at this moderate stage of disease. Results showed that individuals were able to retain information over time, which suggests that retrieval of information was intact, whereas lower scores on immediate memory suggested that difficulties were associated with ability to learn, or encode, information." "The immediate real-world and clinical impact of this study is considerable," observed Nixon. "The data suggest that specific interventions for enhancing the process of encoding or learning new information, such as prescription regimens, should be employed to enhance treatment outcomes as well as work and interpersonal situations. If individuals are aware and engage in "encoding-rich" strategies, overall quality of life and adaptation may be enhanced." Nixon also noted that questions have been raised regarding the impact of anti-retrovirals on the brain. "While these medications can effectively control obvious markers of HIV, indirect measures on neurocognitive function are less clear," she said. "There is a need to examine this behavioral/biochemical dissociation." Edith V. Sullivan, Ph.D. Stanford University School of Medicine Sara Jo Nixon, Ph.D. University of Florida Alcoholism: Clinical & Experimental Research


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