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Evidence Challenges Effectiveness Of Embryo Screening For Older Women
There is growing evidence that a procedure for identifying chromosomal abnormalities in embryos prior to in vitro fertilization is ineffective at helping older women become pregnant, the Wall Street Journal reports. The procedure -- known as pre-implantation genetic screening, or PGS -- is performed in dozen of U.S. fertility clinics and sometimes marketed to older women as a way to increase the odds of a healthy live birth. PGS involves extracting a single cell from a six-cell embryo and inspecting it for chromosomal abnormalities known as aneuploidies; unaffected embryos can then be implanted through IVF. Women older than age 35 have a higher risk of aneuploidies, in which embryos have fewer or more than the usual number of 23 pairs of chromosomes. Aneuploidies can trigger early miscarriage or certain genetics conditions, such as Down syndrome. Most medical experts agree that embryo screening is capable of significantly reducing the risk of Down syndrome and other serious chromosome-related illnesses. However, evidence from several studies increasingly suggests that the procedure does not increase older women"s chances of healthy live births. The American Society for Reproductive Medicine released an initial opinion about PGS in 2007, saying that available evidence does not support the use of embryo screening to increase live birth rates in older women. Andrew La Barbera, scientific director of the society, said, "Since that time, there have been several more trials that have reached the same conclusion." Another shortcoming is that most clinics can only test for fewer than half of the 23 chromosomes, meaning that many defects can go undetected. However, medical experts say that the use of PGS has increased in the two years since ASRM issued its recommendations. According to the Journal, PGS can add more than $2,000 to the roughly $10,000 cost of one IVF cycle. Very few health insurers cover PGS, though some pay for IVF. Some experts contend that studies showing a lack of clinical benefit from PGS do not use more efficient biopsy techniques that can prevent damage to the embryo. Santiago Munne, scientific director for Reprogenetics, said that the treatment is "effective." In a 2007 study, Munne and colleagues used PGS to reduce the rate at which patients miscarried. However, the chances of a woman getting pregnant largely were unchanged, which the authors said could be attributed to the small number of study participants (Naik, Wall Street Journal, 6/1).

White Matter Changes May Predict Dementia Risk
Elderly people with no memory or thinking problems are more likely to later develop thinking problems if they have a growing amount of "brain rust," or small areas of brain damage, according to a study published in the July 14, 2009, print issue of Neurology®, the medical journal of the American Academy of Neurology.
News of the day
House Health Bill To Include Public Plan, Insurers Resisting
On Monday, House Ways and Means Committee Chairman Charles Rangel, D- N.Y., told reporters that the House bill will include a new public insurance plan, Reuters/The Boston Globe reports. "Similar to legislation being developed in the Senate, the House bill would establish an insurance exchange to help people without employer-sponsored insurance find medical coverage." The government-sponsored public insurance plan would be "one of the options available, lawmakers said." The bill would also establish a mandate that would "require individuals and businesses to obtain coverage."
Endocrinology

J & J: Hospital Deal Will Hurt Medical Device Sales

The CFO for Johnson & Johnson"s said President Obama"s deal with hospitals to cut Medicare costs will reduce the sales of medical devices, Bloomberg reports: "Hospitals buy medical devices, including J&J"s artificial hips and stents to prop open clogged arteries, directly from the manufacturer, (Johnson and Johnson CFO Dominic) Caruso said today in an interview with Bloomberg News. The hospitals are reimbursed by government-run health plans for the cost of a procedure regardless of the price of the equipment, pressuring hospitals to cut purchases of the latest technologies, he said. ò€¦ "The deal that the hospital industry struck will obviously have an impact on the medical-device business," Caruso said. "Medicare reimburses the hospital for a basket of costs related to a procedure, of which medical devices are included"" (Randall, 7/14). Caruso"s comments come on the day Johnson & Johnson revealed that its 2nd quarter profits fell 3.5 percent, The Associated Press reports in a separate story. "Still, the company beat Wall Street"s expectations, as the firm reduced spending on sales, administration and research by about 13 percent and production costs by 6 percent." The company blamed generic competition, the global recession and a stronger dollar on its showing (Johnson, 7/14). This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org. © Henry J. Kaiser Family Foundation. All rights reserved.


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