Cheese included, insurance extra: Pizza lovers may have to scrounge for extra dimes when new health regulations requiring businesses with 50 or more full-time employees to offer health insurance come into effect in the United States in 2014. The pizza chain Papa John’s, with about 4000 restaurants in 33 countries, says the costs of paying for employee insurance will be passed onto customers, increasing orders by 15–20 cents. Other fast-food chains, including White Castle and Burger King, have also voiced dismay over the expense the new regulations will require. The National Restaurant Association claims the legislation will have a large negative impact on the industry, slowing expansion and hiring. — Roger Collier, CMAJ
Reproductive redaction: The Delhi Charter School in Louisiana is changing a policy that required girls suspected of being pregnant to take a pregnancy test. If they were pregnant, the girls were kicked out and offered home schooling opportunities, according to the policy (www.delhicharterschool.org/www/dcscharter/site/hosting/Delhi_Charter_school_policy_manual.html). The school came under fire from the American Civil Liberties Union (ACLU), which threatened to sue it for violating a federal law that prohibits discrimination on the basis of sex in educational programs and activities that are federally funded. The policy also violated the US Constitution, the ACLU contended. The school’s chairman told the Associated Press that no one realized there was anything wrong with its policy or that it violated the law. The school changed its policy after receiving a letter from the Louisiana State Department of Education ordering it not to discriminate against pregnant students. Charter schools are funded by the state as an alternative to public schools and may also receive private donations. — Laura Eggertson, Ottawa, Ont.
Contraceptive kerfuffle: A proposed bill to reduce the Philippine’s high birth rate by promoting contraception and family-planning information has led thousands of citizens to protest. Observers suggest the Roman Catholic Church, which is very influential in the country, is the primary opponent of the suggested policy. The country’s high birth rate (25 births per 1000 people every year) has been blamed for worsening social problems, such as poverty, and increasing demand for limited natural resources. On average, the lowest-income families tend to have nearly twice as many children (about six) as affluent families (fewer than three). — Roger Collier, CMAJ
Visitors’ value: Hospital visitors provide valuable support to patients, helping to monitor medical care, prevent prescription errors and facilitate transitions back into the community, so it’s important that hospitals avoid restrictive, controlling approaches to patient visitation, according to the New Yorkers for Patient and Family Empowerment and the New York Public Interest Research Group. However, in a review of visiting policies in 99 acute care hospitals in the state of New York, the groups found “significant, unexplained variations” in visiting hours, visiting restrictions and transparency regarding visiting policies on hospital websites (www.nypirg.org/patientandfamily/pubs/20120807/Sick-Scared-Separated%20from%20Loved%20Ones%208-2012.pdf). Of the hospitals evaluated, 39% provided 10 or more hours of visiting time per day, 11% provided seven hours or fewer and 22% provided no visiting hours during mornings. — Roger Collier, CMAJ
Revising Helsinki: The World Medical Association (WMA) will hold an expert conference in Cape Town, South Africa, in December to explore possible revisions to the Declaration of Helsinki, a landmark set of ethical regulations that guide biomedical research. Changes may be required to bring the declaration in line with new developments in biomedical research. Adopted in 1964, the declaration has already been revised several times, most recently in 2008. International experts have been invited to provide presentations (www.wma.net/en/50events/20otherevents/40doh2012/Agenda_DoH_120803.pdf). Another expert conference will be held in Tokyo, Japan, and the WMA working group leading the revision process hopes to finish its work by the 50th anniversary of the declaration in 2014. — Roger Collier, CMAJ
Recession repercussions: The downturn in the economy has negatively affected the health of people in the United Kingdom, according to British doctors. More than three-quarters of 300 general practitioners surveyed claimed the recession has made British residents unhealthier, according to a report by Insight Research Group, a health care market research agency (www.insightrg.com/downloads/austerity-britain-key-findings-august-2012.pdf). Difficult economic times appear to have taken a toll on mental health in particular, leading to increases in cases of anxiety, panic disorders and substance abuse. Some doctors also believe money worries are delaying many patients from having children while pushing some pregnant patients to opt for abortions. Many physicians also report working longer hours to accommodate an increased caseload and lengthier patient visits. — Roger Collier, CMAJ
Micro-flush: The phrase “toilet technology” is something of an oxymoron. The flush toilet has not changed much in over two centuries. Microsoft Corp. cofounder Bill Gates hopes to spur innovation in toilet design to save lives in the developing world. The sanitary nightmare resulting from open defecation in many countries spreads disease and causes millions of deaths, particularly among children under age five. Western-style toilets, however, aren’t the solution. They use too much water and require complex sewers. To address this problem, the Bill and Melinda Gates Foundation have invested US$6.5 million in a “Reinvent the Toilet Challenge” (www.gatesfoundation.org/watersanitationhygiene/pages/reinventing-the-toilet.aspx). On Aug. 14, the foundation awarded the California Institute of Technology US$100 000 for its solar-powered design that recycles water and converts human waste into energy. — Roger Collier, CMAJ
Plain victory: The World Health Organization (WHO) has extended a hearty “Good on ya, mate!” to Australia for its victory against tobacco marketing. The country’s high court dismissed a legal challenge from the tobacco industry to shoot down legislature requiring all tobacco products to be sold in plain packaging without branding. “With Australia’s victory, public health enters a brave new world of tobacco control,” WHO Director-General, Dr. Margaret Chan said in a statement (www.who.int/mediacentre/news/statements/2012/tobacco_packaging/en/index.html) “Plain packaging is a highly effective way to counter industry’s ruthless marketing tactics.” Starting in December, Australia will become the first country to sell cigarettes in plain packaging. According to WHO, tobacco products contribute to the deaths of half of the people who use them, a death toll that could reach eight million a year by 2030 if governments fail to address the problem. — Roger Collier, CMAJ
Billing protest: Members of the BC Health Coalition and Canadian Doctors for Medicare are protesting what they believe are illegal billing practices followed by private health clinics in Vancouver, British Columbia. The two clinics, the Cambie Surgery Centre and the Specialist Referral Clinic, were given a 30-day deadline on July 18 by the Medical Services Commission to stop what it referred to as extra billing for publicly insured services (www.health.gov.bc.ca/msp/legislation/pdf/srccsc-audit-report-2012.pdf). The deadline has passed, and the BC Health Coalition and Canadian Doctors for Medicare have organized a press conference outside the Cambie Surgery Clinic to urge the provincial government to enforce the Medicare Protection Act and put an end to the billing (www.marketwire.com/press-release/doctors-other-public-health-care-advocates-protest-illegal-billing-outside-private-clinic-1692278.htm). The two private clinics were founded by Dr. Brian Day (former president of the Canadian Medical Association), who has filed a lawsuit against the Medical Services Commission and the province’s minister of health and attorney-general. — Roger Collier, CMAJ
Breast health expansion: Planned Parenthood will dedicate US$3 million to offer more breast health services across the United States while also expanding education and outreach. The funding was received from more than 77 000 donors following the controversial decision earlier this year by Susan G. Komen for the Cure, an influential breast cancer advocacy group, to stop providing grants to Planned Parenthood. (The decision was later reversed.) There will be emphasis on helping to cover the cost of follow-up ultrasound and biopsies, providing digital education resources targeted to women aged 18–39, reaching out to educate the Latino population and better assessing breast cancer risk in patients. — Roger Collier, CMAJ
Branching abroad: The British government has plans to encourage hospitals in the United Kingdom to establish for-profit branches in other countries to raise the profile of the nation’s health service and raise money to invest at home. The initiative is expected to be launched in the fall by the Department of Health and the UK Trade and Investment department. Government officials have touted the proposal as good for British patients, who will receive better services paid for by profits reaped abroad, and good for the nation’s economy. But not everyone thinks the move is a good idea. The Patients Association, a patient advocacy group, claims operating commercial ventures abroad will only distract the National Health Service from its core purpose: treating patients in the UK. — Roger Collier, CMAJ
Brand-name savings: Brand-name drug makers are offering coupons to customers in the United States in a bid to compete with generic versions of their products with expired patents. Drugs included under the co-payment reduction plans include popular products such as the blood thinner clopidogrel (Plavix) and the cholesterol medication atorvastatin (Lipitor). Pfizer Inc. offers co-pay coupons that allow people with insurance low-cost access (as little as US$4 a month) to several of their products. Other companies now offering coupons include Bristol-Myers Squibb and Novartis AG. Because the coupons only work with private insurance, patients covered under Medicare or other government health programs can’t use them. Private insurers, however, aren’t happy about the coupons because they have to pay far more for brand-name drugs than for generic equivalents. — Roger Collier, CMAJ