The Mayo Clinic will hold its 2008 Health Policy Symposium Monday, March 10 in Lansdowne Resort near near Leesburg, Va.

Registration is closed, but a blog will link to streaming (and archived) video of the plenary sessions:

http://www.mayoclinic.org/healthpolicycenter/

Moderator of the opening panel, “Building a Mandate for Change,” will be former NBC Nightly News anchor Tom Brokaw. Panel members include James Guest, president and CEO, Consumers Union; Gary Kaplan, M.D., president and CEO Virginia Mason Medical Center; Ian Morrison, Ph.D., Institute for the Future; and Michael Porter, Ph.D., Harvard University.

To see the day’s agenda, go to:

http://www.mayoclinic.org/healthpolicycenter/2008-agenda.html

Joanne Silberner, NPR health correspondent, will moderate a second session, “In Their Own Words: What Patients Want in a New Health Care System.”

Panel members include Nancy Davenport-Ennis, president and CEO, National Patient Advocate Foundation; Harold Freeman, M.D., The Ralph Lauren Center for Cancer Care and Prevention, Harlem, N.Y.; M. Cass Wheeler, chief executive officer, American Heart Association, Inc.; Sanne Magnan, M.D., Minnesota Commissioner of Health; and Melissa Ortega, patient.

In an evening session Cokie Roberts, correspondent for National Public Radio and ABC News, will moderate a panel examining the health care platforms of the presidential candidates. Her panelists include Karen Davis, Ph.D., Commonwealth Fund; Elizabeth McGlynn, Ph.D., RAND Health; and Steven Pearlstein, Washington Post.

A session on Tuesday, March 11 will be moderated by Pat Mitchell, president and CEO of The Paley Center for Media, and will include, among others, Aaron Brown, former CNN anchor; Ceci Connolly of the Washington Post and Shannon Brownlee, author of Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer and Schwartz Senior Fellow, New America Foundation.

If you’re like me, you’ve read and possibly reread summaries of the Presidential candidates healthcare platforms, and you’re still confused. Where do the candidates really stand? And how close do their positions approximate yours?

A healthcare site, Healthcentral.com, puts the candidates’ positions on a grid and allows you to plot your stance on healthcare issues in relationship to the candidates’ positions. The PoliGraph summarizes candidates’ positions on healthcare reform, the uninsured, drug prices, prevention, technology and stem cells.

A grid on the site places the candidates on an “X” axis defined as “Government Driven” and a “Y” axis that plots the importance of each particular issue to the various candidates.

Not surprisingly in the arena of healthcare reform, Obama and Clinton are left of center with their reliance on government-driven programs, while Paul is farthest to the right on the market-driven scale with McCain and Huckabee closer to the center.

What I like best about the site is that it utilizes the interactive ability of the Web to make arcane distinctions obvious to the user. One graph can say more than 200 words of text.

Joy Buchanan, a content producer with Healthcentral.com, wrote in an email that the site’s producers wanted Web visitors to “see if their views were similar to many other people like them… We also thought people would be surprised to see that maybe they didn’t match their favorite candidates as much as they thought!”

Several producers at Healthcentral.com collated material primarily from candidates’ Websites, but also reviewed white papers, press releases, videos, blog entries, debate transcripts, news articles (from publications like the The New York Times, The Washington Post and the Chicago Tribune), voting records and even candidate-sponsored commercials on YouTube. The producers then assigned numerical values to each candidate’s position on a host of issues.

“On Drug Prices, for example, importing drugs from other countries would have scored a -2 [on the X-axis], while completely forbidding foreign drug importation scored a 2,” Buchanan wrote. “The average of the sub-issue scores became the score for the overall issue.“

“On the importance scale, or Y-axis, we measured how prominently the candidates discussed this issue — was it prominent on their Web sites? Did they vote on legislation? Did they discuss it in interviews? — and how often. The more they talked about it, the higher the score. If there were few or no public record of them discussing an issue, the lower they scored,” she wrote.

“Candidates who ‘flip-flopped’ or reversed their stance scored in the middle.”

Buchanan noted that her biggest surprise was “how far to the left some of the Republican candidates fell on certain issues. For example, McCain, Romney and Giuliani… [the latter two are no longer running] were further left on stem cells and drug prices than any other Republicans. However, no Democrats appeared on the conservative side of the graph for any issue.”

In all, six people worked on the site, according to Buchanan. Craig Stoltz, former health editor for The Washington Post, was the project director. Jack Kustanowitz led the technology team. Buchanan was part of the content team along with Mary Katherine Stump. Zachary Gavin created the Flash tools that graphically displayed the candidates’ positions. Val Ruland-Schwartz was the designer. Healthcentral.com took three months to compile all the information, create the tool and launch the site.

The biggest change to the site in the last month has been the deletion of various candidates as they drop out of the race. The site has not aggregated positions plotted by visitors to the site, although Healthcentral.com may do that in the future, Buchanan wrote.

Last weekend marked the second annual North Carolina Science Blogging Conference in Research Triangle Park, N.C. More than 200 scientists, journalists, educators and students from around the U.S., Canada, Serbia, Sweden and England registered for the event held this year at Sigma Xi, the scientific research society.

For me the highlight was a breakout session moderated by Adnaan Wasey, a producer/writer for The Newshour With Jim Lehrer.

In “unconference mode” suggested by blogging organizers Anton Zuiker and Bora Zivkovic, participants tried to nail down the definition of a science blog. Various categorizations included science diary, science opinion piece, backgrounder, news analysis… bottom line is that science blogs are as diverse as the backgrounds of those who write them.

Where science blogs fit in the evolving world of science journalism was another focus of discussion. Journalists from large media companies talked about the schizophrenia of writing traditional science stories overseen by one or more editors and then opining on the latest scientific controversies with little or no editorial oversight.

Still, serious science bloggers follow many journalistic and academic conventions, including scrupulous sourcing. Conference organizer Zuiker noted in an email after the conference, “…the way bloggers link to other perspectives, primary sources (and often multiple instances of a primary source, such as video clips of a speech) and open-source resources shows that science bloggers want the reader to judge the accuracy and validity of a blog post. This isn’t so much adopting journalistic conventions as triangulating them with the science publishing conventions.”

The beauty of the medium is that freelance science bloggers can attract a following without the baggage of being under the umbrella of major media companies who invariably will exert an influence — albeit sometimes subtle — on the topics and treatments of their blogs. As Zuiker observed, “Science blogs can inform, educate, entertain, same as a science magazine or radio show or newspaper column. But blogs can do it faster and more frequently.”

For a huge number of science blogging links, go to the Science Blogs page that Zuiker, Zivkovic and co-organizers Brian Russell and Paul Jones have set up. It may be hours before you come out the other side.

Imagine a day when a genetic test not only will determine your risk for a particular disease, but also the ideal medication and the ideal dose to treat that disease.

For those who receive a blood-thinning agent called warfarin, that day has already arrived. One third of people who receive warfarin, known by the trade name of Coumadin®, metabolize the drug differently from the rest of the population. A genetic screening test can identify those individuals who are more prone to bleeding when taking warfarin.

Earlier this year the Food and Drug Administration required a change in drug labeling to advise patients and doctors that a genetic test could identify that subgroup of people at greater risk for bleeding after taking warfarin.

So what does this advance in genetic screening have to do with the current debate about health care reform? A commentator in the Dec. 12 issue of the Journal of the American Medical Association argues advances in genetic screening and genetically directed treatment are pushing health insurance to a moral precipice.

James P. Evans, MD., Ph.D, a professor of genetics at the University of North Carolina at Chapel Hill, writes that modern health insurance is premised on the assumption that you can accurately predict aggregate risk, but not as easily predict individual risk. As scientists develop more sophisticated genetic tests, the prediction of individual risk will become easier. Insurance companies then would be able to cherry pick those at greatest risk and either deny them coverage or make coverage more expensive.

To prevent that, the U.S. House of Representatives passed the Genetic Nondiscrimination Act of 2007 (GINA) in April. The legislation has yet to pass the Senate. Even with passage of this act, Evans argues that individualized medicine will shift the burden of inequity back onto insurers by allowing individuals to choose coverage based on their specific risks. “Either way, the foundation of the system is undermined: the solution is for all to pool their risks,” Evans writes.

Without a universal health care system, the uninsured will not benefit from genetic screening and individualized treatment. That will lead to even greater disparities in health care delivery between the haves and the have nots. Pharmaceutical companies will have incentives to develop genetically engineered drugs (in a process scientists call pharmacogenomics) for those who have the means to pay for them. Those without insurance or with second-tier insurance won’t have the benefit of the latest advances in drug therapy.

So, advances in pharmacogenomics combined with inequitable distribution of treatment options will result in a rationing of genetically derived drugs. Evans argues that this disparity will lead to a genetic underclass. To prevent that, Evans writes, “… it will be necessary to share risks and pool resources to ensure that, regardless of genetic makeup, a humane and basic level of medical care will be available to all.”

For those who don’t have a family history of diabetes, heart disease or cancer, don’t think individualized medicine won’t benefit you. Evans reminds us that every individual has mutations in his or her genetic code. You may just need to wait until you’re old enough for that mutation to manifest itself.

“This inevitable bad news for individuals is actually good news for the common lot and represents a compelling inducement to share risk,” Evans writes. “Because all are flawed at the level of the genome, all people need each other.”

The news that the former chief executive of UnitedHealth Group is forfeiting at least $618 million to settle claims related to backdated stock options points to everything that’s wrong with the U.S. health care system. The system really has nothing to do with health. It has everything to do with extracting profits for those who run and game health care to the detriment of most Americans.

Take Dr. William W. McGuire. He’s the former United Health CEO who reached that settlement with the Securities and Exchange Commission and UnitedHealth shareholders. According to the New York Times, Dr. McGuire will still be allowed to keep stock options valued at more than $800 million.

I assume Dr. McGuire worked hard to make UnitedHealth the largest health insurer in the country, but you have to question the equity of a system that gives Dr. McGuire stock options worth $800 million, an amount that would pay annual health insurance policies for about 69,000 families of four, assuming an annual premium of about $11,500.

Why does the American health care system generate huge profits for the few and exclude the many from reasonably priced health care services? The answer is that the United States has lost its sense of community. Politicians give lip service to the concept of the common good, but the reality is that most America’s politicians and business leaders place self-interest above all else.

The individual has run amuck in American society. As Forbes magazine reports, we are in the gilded age with more than 400 American billionaires. True, a few billionaires like Bill Gates, Warren Buffett and Ted Turner have pledged billions for philanthropy, but the U.S. health care system can’t depend on handouts to serve the needs of its citizens. In 2005 health care expenditures in the U.S. represented 16 percent of our gross national product. Each year we’re spending more and getting less for our health care dollars. Public health is suffering. For example, a recent study in the New England Journal of Medicine revealed that only about 50 percent of children from 12 metropolitan areas in the U.S. were fully immunized by age two.
So what do we do? Eliminating the influence of big money from the political process would help, but that’s not going to happen overnight in the United States. The insurance industry will not willingly give up the golden goose that laid an $800 million egg for one former CEO and smaller but significant eggs for many others. Nor is the pharmaceutical industry going to loosen its grip on Washington. We all remember how big pharma lobbied Congress in 2003 to pass the so-called Medicare Modernization Act of 2003 that, among other provisions, prohibited Medicare from negotiating drug prices with pharmaceutical companies. The legislation turned out to be a multibillion-dollar windfall for the pharmaceutical industry. As Congresswoman Louise Slaughter wrote in the New England Journal of Medicine, “The final legislation, heavily influenced by drug-company and health insurance lobbyists, focused mainly on the needs of those industries instead of those of the seniors it should serve.”

So if we can’t turn to Congress and if we can’t expect the health care industry to kill its golden goose, what can we do? The coming election provides an opportunity to elect a Congress and a President who could put common good above private gain. Most of the candidates have shared at least an outline of their plans. You can view their positions on YouTube. The question I ask is will the U.S. electorate recognize the exigency of the moment and elect representatives and a President who put the health and welfare of all its citizens ahead of the financial interests of the rich and powerful? It’s that simple.