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Morning Report

The Morning Report provides a quick look at today’s medical news, research and features.  









Court Delivers Major Blow To Obamacare; Strikes Down Subsidies
A federal appeals court dealt a potentially major blow to President Obama’s health care law Tuesday, ruling that participants in health exchanges run by the federal government in 34 states are not eligible for tax subsidies, according to USA Today. The 2-1 ruling by a three-judge panel of the U.S. Court of Appeals for the D.C. Circuit, which is sure to be appealed by the government, threatens the framework of the health care system for about 5 million Americans without employer-provided health plans.

The appeals panel ruled that as written, the health care law allows tax credits to be offered to qualified participants only in state-run exchanges. The administration had expected most if not all states to create their own, but only 16 states did so. The court said the Internal Revenue Service went too far in allowing participants in other states served by the federal exchange to qualify for billions of dollars in government assistance. The aid has helped boost enrollment figures to more than 8 million.

“We reach this conclusion, frankly, with reluctance,” Judge Thomas Griffith said. “At least until states that wish to can set up exchanges, our ruling will likely have significant consequences both for the millions of individuals receiving tax credits through federal exchanges and for health insurance markets more broadly.”

The New York Times said that subsidies, in the form of tax credits, are a crucial element of the Affordable Care Act. Without them, insurance would be unaffordable to millions of Americans. The Congressional Budget Office estimates that subsidies this year will average $4,400 for each person who receives a subsidy. The case, filed by a coalition of states, employers and individuals, had been considered a long shot effort to derail the Affordable Care Act.

Concerns About Hysterectomy Procedure Linked to Cancer Spread
New evidence adds strength to arguments that doctors should be extremely cautious about using a procedure performed on about 50,000 women a year during surgery to remove the uterus because of the risk that it may spread cancer. The procedure, power morcellation, uses a device to cut uterine tissue into pieces before removal through small incisions made during minimally invasive surgery. It is also used to remove fibroid tumors.

Recent reports indicate that some women have been harmed when the morcellator sliced into tumors they and their doctors did not know existed and spread cancer cells through the abdomen. Now, a new study, published Tuesday in the medical journal JAMA found that undetected tumors in women having hysterectomies are more common than many experts had previously thought, a conclusion that is likely to fuel calls to limit or eliminate the procedure.

The study found 36,470 women who had power morcellation between 2006 – 2012. Of those, 99 women had uterine cancer that was detected afterward. That means one in 368 women undergoing a hysterectomy had cancerous tumors that risked being spread by morcellation. The FDA said in April that the procedure should be discouraged and this month held hearings to evaluate morcellation. (NY Times)

Docs Tell Patients: “Beware of Health Apps”
At its annual meeting in Chicago, physicians in the American Osteopathic Association over the weekend agreed to warn patients that health apps and websites are no substitute for a visit to the doctor.

The AOA adopted a resolution that the docs will ”actively educate patients on the importance of seeing a physician when ill or injured and in need of a medical diagnosis, and that patients not allow recommendations from these medical websites or applications to be used as a basis for delaying, or as a substitute for, evaluation and treatment by a physician.”

The resolution was based on the belief that patients are increasingly turning to the web for medical information, and sometimes for advice. The AOA cites a September 2013 survey from Makovsky Health and Kelton saying that the average American spends about 52 hours each year on the Internet looking up health information. The group called out the “symptom checker” functions at WebMD, the Isabel Symptom Checker, and EverydayHealth as being potentially dangerous if used as a sole source of medical information.

“The AOA policy recognizes that every patient is unique and may present symptoms in a different manner, which makes it necessary to schedule an in-person appointment with a physician or consult by phone, email or telemedicine,” the group said in a statement Monday. “The AOA wants to make sure patients realize that these sites and apps, no matter how convenient, cannot replace the patient-physician relationship.” (Venture Beat)


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