Senate Failures To Address Medicare Physician Payment Cuts

The American Academy of Family Physicians is dismayed and deeply disappointed that the U.S. Senate has failed in its responsibility to enact legislation to prevent a 10.6 percent cut in Medicare physician payment that took effect on July 1.
The impact of this failure goes beyond the medical community; it threatens Medicare beneficiaries’ access to health care because it further drives family physicians toward financial insolvency. Access problems for these patients are emerging. In its 2007 presentation to Congress, MedPAC reported that 30 percent of Medicare beneficiaries were having trouble finding a new primary care physician. In March, the Medical Group Management Association reported that nearly 24 percent of physicians in all specialties had begun limiting or not accepting new Medicare patients; 46 percent would limit or stop accepting new Medicare patients with implementation of the 10.6 percent pay cut.
Family physicians have worked tirelessly on behalf of Medicare patients. Despite those efforts, family physicians have struggled with 20 percent inflation in costs for office space, equipment, supplies, health and administrative staff, medical liability insurance and other costs of business since 2001. During that time, their Medicare compensation for their services has stagnated. No small business – as most family physician practices are – can sustain that kind of loss and remain open to care for people.
It is unconscionable that our elected officials – who were sent to Washington to represent the needs of the American public – cannot act to ensure access to care for millions of their elderly and disabled constituents.
The Senate must get back to work and find a solution that will allow family physicians to serve their Medicare patients. Of all their constituents, elderly and disabled Americans are least able to cope with the instability that Congressional inaction forces on their access to health care.

Botox, More Than a Wrinkle Eraser

Botox®, the neurotoxin that is best known for its ability to temporarily erase wrinkles and frown lines, was approved by the Food and Drug Administration (FDA) for medical purposes more than a decade before it was approved for cosmetic reasons (Botox® Cosmetic). Since Botox was first approved as a treatment for several eye conditions in 1989, it has been used to treat a wide variety of medical conditions ranging from excessive sweating to migraine, cerebral palsy, postsurgical pain, bladder spasms, and dystonia.
The recent death of Kristen Spears, whose family says the seven-year-old died as the result of an overdose of Botox that she received to treat her cerebral palsy, has lifted the neurotoxin into the spotlight once again. This controversial drug uses a powerful poison called botulinum toxin, which is derived from the bacterium Clostridium botulinum. It is a nerve blocker that binds to the nerves that lead to the muscles and prevents the release of a neurotransmitter called acetylcholine, which activates muscle contractions. When the signals are blocked, muscle spasms are reduced significantly.
Medical Uses of Botox
Botulinum toxin has been studied for decades for its therapeutic properties, and it has been used to treat patients for various conditions for 20 years in 80 countries. In the United States, Botox has been FDA approved for a limited number of conditions, although the drug can be legally prescribed by doctors for additional medical uses as well (off-label use), including cerebral palsy.
In the 1950s, scientists first discovered that the active ingredient in Botox could relieve muscle spasms. Several decades of research ensued, and in 1989, the FDA approved botulinum toxin to treat blepharospasm (eyelid spasms) and strabismus (crossed eyes or lazy eye) in adults. Blepharospasm is an abnormal, involuntary blinking or spasms of the eyelid. Most people develop the condition without any warning symptoms, and may also experience sensitivity to light, fatigue, and emotional tension. Botox provides improvement in about 15 percent of cases.
People with strabismus experience double vision, loss of depth perception, eye fatigue, reading difficulty, and blurry vision. Treatment with Botox can relax the muscles for several months and may even permanently cause a change in eye alignment. Botox is not indicated for treatment of strabismus in children.
Botox was then approved by the FDA in 2000 for treatment of cervical dystonia. This condition, also known as spasmodic torticollis, is characterized by involuntary contracting of the neck muscles and sometimes the shoulders, which causes abnormal movements and awkward posture of the head and neck. It is associated with considerable pain and discomfort, and can severely limit an individual’s ability to perform everyday tasks, such as eating, getting dressed, or driving.
In 2002, Botox Cosmetic was approved for reduction of frown lines, and a drug that was formerly relatively unknown by the general public reached star status. In 2004, individuals who suffer with excessive underarm sweating that does not respond to topical medications had a new FDA-approved treatment option when Botox was approved for axillary hyperhydrosis. The excessive sweating is caused by over stimulation of the sweat glands in the autonomic system, and Botox inhibits the activity of the nerves responsible.
In addition to FDA-approved uses for Botox, the drug is also sometimes prescribed for treatment of migraine, chronic pelvic pain, overactive bladder, pain following mastectomy, and tinnitus. A recent article published in the Expert Opinion on Biological Therapy reviewed clinical trials that used Botox in a variety of migraine patients, for example, found that the neurotoxin produced mixed results but has provided good relief for some patients.
In the case of postsurgical mastectomy pain, Julio Hockberg, MD, professor and chief of plastic and reconstructive surgery at West Virginia University, found that women who received Botox injections for pain control required 89 percent less morphine during the first 24 hours after surgery and had shorter hospital stays. Other general surgeons also sometimes use Botox for pain management following surgery.