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Cindy Mann To Lead Center For Medicaid And State Operations
CQ HealthBeat reports on reactions to Cindy Mann"s appointment as Director of the Center for Medicaid and State Operations, noting that liberals are hailing her appointment and "saying she"ll counter steps taken by the Bush administration to tighten eligibility and alter benefits."

Four In 10 Emergency Department Visits Billed To Public Insurance
More than 40 percent of the 120 million visits that Americans made to hospital emergency departments in 2006 were billed to public insurance, according to the latest News and Numbers from the Agency for Healthcare Research and Quality.
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Reich: Obama Must Increase Pressure To Reform Health Care
NPR interviewed Robert Reich, professor of public policy at the University of California at Berkeley and former Secretary of Labor in the Clinton administration, on the steps President Barack Obama needs to take to successfully reform health care. Recently, Reich sent Obama a memo "outlining six things the president must to do save universal health care." Reich told NPR that "health care is stalling in the Senate," and Obama must "fire people up" and "be tough" to counter the medical industry, which has "some of the most formidable lobbies in the country." Reich said that Obama is only going to succeed if he "counts noses, cajoles, twists arms, threatens - and I think he does have it in him." He adds that while "bipartisanship is a noble aspiration," "we"re getting to the point where the president has got to say if I do not get your votes on this, Republicans, I"m going to go through reconciliation. I"m going to do it without you" (Martin, 6/29).
Sexual Health

Immune Genes Adapt To Parasites

Thank parasites for making some of our immune proteins into the inflammatory defenders they are today, according to a population genetics study that will appear in the June 8 issue of the Journal of Experimental Medicine (online May 25). The study, conducted by a team of researchers in Italy, also suggests that you might blame parasites for sculpting some of those genes into risk factors for intestinal disorders. Parasite-driven selection leaves a footprint on our DNA in the form of mutations known as "single nucleotide polymorphisms" (SNPs). Making sure that genetic variation (in the form of multiple SNPs) is maintained within certain immune genes over time helps ensure that the host can fend off different infections in different environments. In the new study, Matteo Fumagalli and colleagues sift through 1,052 SNPs in genes that code for immune proteins called interleukins from roughly 1000 people worldwide. Of 91 genes assessed, 44 bore signatures of evolutionary selection, meaning that the genetic variation was neither due to chance nor to the migration of populations over time. And some of that variation correlated with the diversity of parasites that live alongside humans. The data suggests that having lots of different parasites around has shaped the evolution of our interleukin genes. In general, parasitic worms appear to have had a more powerful influence on certain interleukin genes than smaller microbes such as viruses, bacteria, and fungi. That isn"t surprising, says senior author Manuela Sironi, because worms typically evolve slower than bacteria or viruses, giving their human hosts time to adapt in response. Some of the genes that were shaped by worm diversity made perfect sense, as the proteins they encode help generate the precise type of immune response required to rid the body of worms. Other genes, however, seemed to be influenced more by the diversity of viruses, bacteria, and fungi than by that of worms. SNPs in some of these genes are known risk alleles for inflammatory bowel diseases, such as Crohn"s and celiac disease. These "risky" alleles were probably maintained during evolution because they promote the kind of immune response needed to fend off viruses and bacteria. But this type of response also contributes to inflammatory bowel diseases. Fumagalli, M., et al. 2009. J. Exp. Med. doi: 10.1084/jem.20082779 Amy Maxmen Rockefeller University Press


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