Medicaid Coverage Is Debated

For Obesity Surgery in Elderly

Obesity surgery has helped many patients lose weight and improve their health, a panel of experts told regulators yesterday, but they added that there were not enough data on how well it has worked for elderly patients covered by Medicare.

The Centers for Medicare and Medicaid Services is considering whether the health insurance plan for the elderly and disabled should change its payment policy for the surgery, which shrinks the stomach by removing part of it or by implanting a removable band.

"I didn't see any data whatsoever that these very same results could be applied" to Medicare patients, said Barbara J. McNeil, vice chairman of the panel and head of health care policy at Harvard Medical School.

Regulations limit CMS coverage to defined diseases, and earlier this year the agency deleted language saying obesity is not a disease. The panel's advice is not binding but will help CMS officials decide if changes are needed.

Hepatitis B Vaccine Has Reduced

Occurrence Among Children, Teens

Cases of hepatitis B among children and teenagers have dropped by almost 90 percent in the past decade because of a vaccination program against the virus, the government said yesterday.

A total of 13,829 youngsters had hepatitis B in the United States between 1990 and 2002, the period of the study. The rate dropped from 3.03 cases per 100,000 people in 1990 to 0.34 per 100,000 in 2002, the Centers for Disease Control and Prevention said.

A government recommendation that all infants receive hepatitis B vaccinations was put in place in 1991. The program was expanded in 1995 to 11- and 12-year-olds and in 1999 to all children.

Hepatitis B attacks the liver and can be transmitted by contact with blood or other bodily fluids, through sex or shared needles, or from mother to baby during birth.

Evidence in 2000 Showed Vioxx Risk

To Heart, Swiss Researchers Report

Swiss researchers reported yesterday in an international science journal that evidence was clear and overwhelming in 2000 that Vioxx doubled the rate of heart attacks, and said Merck & Co. should have withdrawn the arthritis drug four years ago.

The analysis, by Peter Juni and colleagues at the University of Berne, looked at results from 18 studies, all sponsored by Merck, that showed that 41 patients out of about 11,000 Vioxx users had suffered heart attacks by late 2000, twice the rate of those receiving a placebo.

The study, funded by the Swiss National Science Foundation, analyzed 18 randomized controlled Vioxx trials and 11 related observational studies. The results were published online by the British journal the Lancet. The data were based on information obtained primarily from the Food and Drug Administration.

When Merck withdrew Vioxx on Sept. 30, after a company-sponsored study found a doubling of the risk of heart attack and stroke in users after 18 months, Merck said the data were "unexpected."

Merck said that it has been "vigilant in monitoring and disclosing the cardiovascular safety of Vioxx."

-- From News Services