Johns Hopkins Gazette: December 9, 1996 Form

In Brief

The gathering of the greens

Biff Brown and the grounds crew on the Homewood campus invites the university community to attend the annual Gathering of the Greens.

Pine, holly and other festive holiday greenery will be available at no cost on Friday, Dec. 13, beginning at 10 a.m. in front of Gilman Hall.

Medical News

Brain scan could resolve diet drug controversy

Johns Hopkins researchers have developed a new method for studying an important group of brain cells that they say should help define the cells' functions and help resolve the controversy over the safety of two popular diet drugs.

Using an imaging method called positron emission tomography and a new tagging compound, the researchers have found a way to visualize brain cells that release serotonin in animals.

Hopkins scientists and others showed in previous experiments that two popular diet drugs, fenfluramine and dexfenfluramine, can damage serotonin-releasing nerve cells in animals including non-human primates. Critics insist the damage does not occur in human brains.

Hopkins researchers plan to use the new PET technique to study humans who have used fenfluramine for several years. Studies of dexfenfluramine, approved earlier this year by the FDA as a prescription diet drug, are likely to follow. Studies of Ecstasy, a chemically related recreational drug, are already in progress.

HMOs vary in coverage of new medical technology

Health Maintenance Organizations are generally less likely to cover expensive but effective new medical technologies than equally effective, but less expensive technologies, according to results of a national survey published in the Dec. 5 issue of The American Journal of Managed Care.

One of the first systematic, national studies of HMO decision making on coverage of new medical technologies, the survey also found that the type of HMO (staff, group, network, independent practice association) and the method of physician payment (salary, fee-for-service, capitation) influence the type of medical technology covered.

Neil R. Powe, associate professor of medicine at the School of Medicine, Gerard F. Anderson, professor of health policy at the School of Hygiene and Public Health, and Claudia A. Steiner, of the Agency for Health Care Policy and Research, asked 395 HMOs to respond to questions about their coverage of laser technology used in 15 different procedures, including laser angioplasty, laser discectomy and laser photodynamic therapy. Lasers were selected as the focus of the survey questions because of the technology's widespread use among medical specialties.

HMO coverage of the technologies varied substantially, ranging from 25 percent to 90 percent. Staff models (HMOs that hire physicians as employees of the HMO) covered three to four fewer laser technologies than did independent practice association models. Staff models also had more rigid controls on coverage and more strongly limited access to newer medical technologies.

Physicians practicing in organizationally "looser" HMOs, such as independent practice associations, and in HMOs incorporating financial risk-sharing arrangements with physician members, appear to have wider latitude in the use of new medical technologies, according to Powe.

"What this study shows is that we are in a new era of health care where cost has become a factor for those who make decisions about whether people should have access to new medical technologies," said Powe. "If only cost-neutral and cost-saving technologies are approved for coverage, then the use of technologies with enhanced health outcomes but higher costs may be discouraged. Although managed care's use of cost effectiveness in medical coverage decisions to improve efficiency is laudable, it may be necessary to ensure that access to beneficial technology and quality of care is maintained."

Endocrine surgery safer, less costly at busier centers

Parathyroid gland surgery is more successful and less expensive at academic medical centers with specialized endocrine facilities and experienced surgeons than at hospitals where fewer of the operations are done, a Hopkins study suggests.

The results, published in the December issue of Surgery, also underscore the role of academic medical centers in delivering high-quality, low-cost treatment as the nation moves more patients into health care systems that emphasize cost controls.

"Our findings show that improved outcomes and lower costs depend on an experienced surgeon," said Robert Udelsman, the study's senior author and director of endocrine and oncologic surgery at Hopkins.

About 100,000 new cases of hyperparathyroidism are diagnosed each year in the United States. Surgical removal of the parathyroid glands is the only cure.

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