Spring 2010 Issue

Kevin Pho, MD, is a practicing primary care physician in Nashua, New Hampshire, as well as creator and author of KevinMD.com, a leading blog for healthcare commentary. KevinMD.com provides a rare physician’s perspective on current and provocative views in healthcare today. It was voted the best medical blog of 2008 and has appeared on top blog lists on Forbes.com and CNN.com. Dr. Pho has been cited in “The Wall Street Journal”, “The New York Times”, “British Medical Journal” and “Newsweek” to name a few. He has also appeared on the CBS Evening News with Katie Couric and is a member of “USA Today’s” Board of Contributors.

The Mental Health Parity Act of 2008 was signed into law in October 2008. Under the law, a company that provides mental health benefits as part of a company health plan must provide them at parity with coverage for physical health services. Any deductible, co-payment or treatment restriction applied to the cost of treating a mental illness must be equal to that applied to a physical illness.4 While the law is a significant step forward, it has limited potential for helping those with severe mental disorders; the law excludes the homeless and unemployed, does not address the stigma associated with severe mental illness, and will benefit those with less severe mental illness more than those with severe mental illness. In order for the law to be effective in treating those with severe afflictions like schizophrenia and bipolar disorder, legislators must address the social stigma associated with severe mental illness.

This paper examines the barriers to inoculating against polio in Nigeria and the difficulties it presents for the global eradication of polio. Without full population immunity against polio, a polio pandemic remains a real possibility. Poor education and ineffective leadership are two of the main difficulties groups face with immunization efforts in this West African country. Community level approaches and volunteer engagement are just a couple of the possible options to address vaccination difficulties. Establishing governance with organizations committed to international health, including the World Health Organization, the Global Polio Eradication Initiative and Rotary International will help Nigeria meet health goals and overcome this disease.

The United States of America became the first country to implement a mandatory, universal, childhood varicella vaccination program. This program specified a single dose for children between the ages of twelve months and twelve years. However, two years ago, the vaccination program was changed to a two-dose regimen because the efficacy of the varicella vaccine in producing immunity decreased noticeably with time. Concerns regarding the effectiveness of the vaccine, the potential for fewer, but more severe cases of varicella, and the increasing incidence of herpes zoster not only exist but also are especially serious. The potential for adverse effects brings attention to an important question addressing the implementation of any vaccination program: whether the taking of risks incapable of being calculated is worthwhile if there is clear potential for adverse events.

Periodontal disease is an infectious, inflammatory disease that can be caused by infection from bacteria found to commonly exist in the oral bacterial flora. Genetics, early childhood contacts, certain systemic diseases, unhealthy behaviors, poor oral hygiene, as well as pregnancy can facilitate infection and/or progression of the disease. Periodontal disease is not uncommon among pregnant women and is correlated to adverse pregnancy outcomes, especially preterm birth and low birth weight neonates. Although there are guidelines in place for healthcare professionals to standardize prenatal care, there are currently no existing guidelines for prenatal maternal dental care. Studies have shown that most health professionals that provide prenatal care do not regularly incorporate oral examinations for pregnant mothers as part of standard prenatal care. Periodontal disease can be safely diagnosed, which could lead to positive effects on the outcome of her pregnancy.

In this paper, I will argue that the sometime contradictory nature of taxation on tobacco products between fiscal goals and public health goals under EU tax harmonization efforts creates a taxation regime that is less than optimal in terms of meeting public health goals and ensuring uniformity among all member states. I will show how this tax regime, with its incongruous state-by-state policies, is threatened by illicit trade, both large and small, despite efforts for harmonization.

With the advent of genome sequencing, and the development of technological methods to analyze genomes quickly and accurately, a new type of whole-genome analysis has emerged to analyze the contribution of genetic variation towards disease. Genome-wide association studies (GWAS) are a tool to understand complex diseases ranging from diabetes to lupus. At the root of the functionality of GWAS are the multiple polymorphisms shared within the human population and the extent and frequency which they appear in relation to the incidence of certain pathologies. By merging these fundamental aspects of biology with cutting edge technology, researchers have utilized GWAS to uncover potential mechanisms of disease, and in turn, potential pathways for treatment. This paper discusses both the background and the detail of genome-wide associa- tion studies and highlights their current role in the field of lupus research.

Oxytocin is a hormone and neuropeptide unique to mammals. Animal studies suggest that central oxytocinergic action is involved in normal social cognition, including social motivation, pair bonding, and social memory. The role of oxytocin in humans is not completely understood; however, an analogous role has been suggested. The present review introduces the animal literature and discusses the implications towards the role of oxytocin in humans. Oxytocin system dysfunction is discussed as a possible mechanism by which impaired social cognition arises in patients with autism spectrum disorders and may provide a link to solving autism’s elusive heritable component.