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GOVERNMENT WATCH

HOUSE PASSES STEM CELL RESEARCH BILL OPPOSED BY BUSH

Four years after President Bush declared strict regulations for the federal financing of embryonic stem cell research, the US House of Representatives passed a bill on May 23 that would support the research. Shortly after the House vote, sponsors of an identical bill in the Senate urged Majority Leader Bill Frist to put it on the agenda.

The House bill, which passed with a tally of 238 to 194, failed to garner the two-thirds majority required to override an expected veto from the President, according to the New York Times. At press time, Senator Frist had not yet indicated whether the Senate would debate the issue.

Mr. Bush has publicly stated he is against this type of research because it “destroys life in order to save life,” and has pushed for research on adult stem cells as a viable alternative, according to the New York Times. His presidential order, announced on Aug. 9, 2001, mandated that federal funds could be used for research only on stem cells derived from embryos already destroyed as of that date.

The House bill would allow the federal government to fund research on human embryos donated by couples seeking fertility treatment, if the couples confirm that the embryos were not to be implanted and would otherwise be discarded.

Rod Larson, Director of the AAN Center for Health Policy, said in an e-mail to Neurology Today that support for these bills in Congress is mirroring the rising tide of public opinion in favor of embryonic stem cell research. In fact, a CNN/USA Today/Gallup poll released on May 23 found that 53 percent of Americans favor relaxing restrictions on the research.

Mr. Larson added that Congress is probably also feeling pressure from advances made in other countries, most notably in South Korea, where scientists there announced one week before the House vote that they had created the world's first embryonic stem cells that genetically match injured or sick patients (www.sciencemag.org/cgi/content/full/1082795/DCI).

Mr. Larson compared this scientific development to the launching of the Soviet satellite Sputnik in 1957, which he said resulted in shocking Americans that they had been surpassed in the “Space Race” and then prompted a massive investment the nation's science infrastructure.

“Although the Korean research does not pose a threat in the way Sputnik did, it sends us all a clear sign that we can't coast on this issue and still be innovative,” he said. “If the US does not lead the world in this research, other countries are eager and capable of paving the way.”

TWO MORE STATES VOTE TO SUPPORT STEM CELL RESEARCH

Embryonic stem cell research received an additional boost of support in early June when lawmakers in Massachusetts and Connecticut passed measures that endorse the research in those states and, at the same time, ban human cloning.

Massachusetts lawmakers overrode a veto from Gov. Mitt Romney to pass a bill that gives state health officials regulatory control over such research, reported the Boston Globe. Prior to that, scientists conducting embryonic stem cell research were required to obtain approval from their local district attorney.

The Connecticut State Congress passed a measure that would commit $100 million in tax dollars to embryonic stem cell research and Gov. M. Jodi Rell has publicly stated that she would sign the bill, according to the Hartford Courant. The bill will provide $10 million annually for 10 years, beginning July 1, 2006.

This bill makes Connecticut the third state, after California and New Jersey, to pass a law that allows for state financing of embryonic stem cell research. In addition, Massachusetts lawmakers are now working to pass a spending package that would use tax dollars to finance the research.

Stem cell investigators are hopeful that these latest developments will help stop the “brain drain” that has drawn leading investigators to California, where voters approved a $3-billion funding initiative to support stem cell research. Rudolf Jaenisch, MD, Professor of Biology at the Massachusetts Institute of Technology, said the Massachusetts law will bring more stem cell researchers to the Bay State only if it is properly funded. Dr. Jaenisch is also a member of the Whitehead Institute for Biomedical Research in Cambridge, MA.

Richard Hynes, PhD, Daniel K. Ludwig Professor for Cancer Research at MIT, said that the new law in Massachusetts communicates to researchers that the state is supportive of their work and speeds up the approval process necessary to conduct the research.

The Connecticut law, according to Diane Kraus, MD, PhD, Associate Professor in the Department of Laboratory Medicine at Yale University, will help the state recruit stem cell researchers “by making CT a safe place to do this work, and by providing the much-needed resources for these studies.”

The AAN and American Neurological Association have stated support for expanded federal and state funding for embryonic stem cell research in a position paper issued in October 2004. It can be found at www.aan.com/advocacy/pdfs/stem_cell_statement.pdf. It was also published in late May in Neurology (2005;64:1679–1680).

DEBATES ON LEGISLATION THAT WOULD CURB MEDICARE CUTS

Congress is currently debating two bills that would curb cuts to Medicare and that, some say, will provide greater access to care for seniors.

The bills – Preserving Patient Access to Physicians Act of 2005 – would prevent a projected 4.3 percent cut in Medicare payments scheduled to begin on Jan. 1, 2006. Between 2007 and 2012, Medicare will be cut by approximately 30 percent, Representative Benjamin Cardin (Dem-MD) told the House of Representatives.

Representatives Cardin and Clay Shaw (Rep-FL) introduced a version of the bill to the House on May 12 that would increase physician payments for 2006 at no less than 2.7 percent. Beginning in 2007, the bill would permanently replace the sustainable growth rate (SGR) formula, the current method of calculating Medicare physician payments, with a new formula that takes into account the increases in physician expenses each year.

The Senate bill, introduced by Jon Kyl (Rep-AZ) and Debbie Stabenow (Dem-MI) on May 19, also increases Medicare payments by at least 2.7 percent in 2006. It would also link payment increases in 2007 to changes in physician expenses (using a medical economic index). However, the Senate bill takes a more incremental approach by only proposing these changes for the next two years.

Both bills are based on recommendations made by the Medicare Payment Advisory Commission, MedPAC, in a report issued to Congress this March.

AAN Federal Affairs Director Mike Amery said the Academy supports the House bill. Prior to the bill being introduced, he said, AAN representatives were advocating to members of Congress to either fix the SGR or to make a positive update to it for 2006. Mr. Amery added that the bill would put physicians on the same footing as hospitals, nursing homes, and other providers that use a medical economic index to determine payment rates.

Mr. Amery warned that the current cuts would force physicians to stop taking new Medicare patients. “If somebody is a new Medicare patient and can't get physician services, eventually they will be on the doorsteps of the Congressman asking why,” he said.

In the June Neurology Today (page 32), Rod Larson, Director of the AAN Center for Health Policy, cited an AAN survey conducted in February and March that asked its members about issues related to reimbursement. More than 6 percent of respondents indicated they have already reduced the number of Medicare patients in their practice and 13 percent are considering that option.

HELMET BILL FAILS IN SENATE

A Senate bill amendment introduced on May 11 that would have encouraged states to pass laws requiring helmets for motorcycle riders failed, an event that some advocacy groups are claiming will increase the rate and severity of head injuries resulting from motorcycle-related accidents. The amendment would have restored the federal universal helmet usage law that was repealed in 1995.

Senator Frank Lautenberg (Dem-NJ) hoped to attach the amendment to H.R.2566, which temporarily extends federal transportation and traffic safety programs. In states that do not mandate the wearing of helmets, the amendment would have diverted federal highway funding to motorcycle safety programs.

The American College of Emergency Physicians (ACEP) has been lobbying Senate members to consider the amendment, claiming that helmet use reduces the fatality rate, the probability and severity of head injuries, the cost of medical treatment, and the probability of long-term disability, according to a news release. Likewise, George Zitnay, PhD, Chairman of the National Brain Injury Research, Treatment and Training Foundation, said his group will continue pressing Congress to pass a universal helmet law.

They will have to contend with the American Motorcyclist Association, a 270,000-member organization, which favors voluntary helmet use, citing the right of adults to make their own personal safety decisions.

“It's not a matter of personal choice because society pays for people who then sustain a brain injury…. The public's health and safety should outweigh the individual's right to not wear a helmet,” said Dr. Zitnay, who is also Clinical Professor in the Department of Physical Medicine and Rehabilitation at the Medical College of Virginia.

James P. Kelly, MD, Visiting Professor in the Department of Neurosurgery at the University of Colorado School of Medicine in Denver, said in an e-mail to Neurology Today that traumatic brain injury is a major health issue in motorcycle crashes. “Since helmet laws require helmets as protective devices, the injuries are typically of less severity or prevented altogether, at least in the age groups required by law to be wearing them,” he said.

A study by the Agency for Healthcare Research and Quality found that 80 percent of motorcycle crashes in 2001 resulted in injury or death. That trend coincides with an increase in the number of states repealing laws that make motorcycle helmet use mandatory and a drop in helmet use from 71 percent in 2000 to 58 percent in 2002 (A J Preventative Med 2004: 27(5); 355–362).