As part of its crackdown on free speech following last week’s rigged elections, Iran’s government is exerting unprecedented control over the country’s Internet communications. And to do that, it’s using products supplied by European companies.

Based on interviews with technology experts inside and outside Iran, the Wall Street Journal reported yesterday that those pesky mullahs are carrying out deep packet inspection on a massive scale.

In addition to blocking or slowing Internet communication, deep packet inspection gathers information about users and can be used to alter the content of the communication itself—changing a “yes” to a “no,” for example—which may be more disruptive than shutting off Internet communication altogether.

The nefarious capabilities are there for the mullahs to use, courtesy of a JV between the German multinational, Siemens, and Nokia, a Finnish mobile phone provider.

According to spokesperson Ben Roome, the company installed a “monitoring center” within the Iran’s government-run telecom monopoly as part of a larger gig that included the installation of mobile-phone networks.

“If you sell networks, you also, intrinsically, sell the capability to intercept any communication that runs over them,” Roome told the Journal.

The Iranian government had briefly experimented with the Big Brother-like equipment in the run-up to last week’s travesty, but few people fully understood the system’s capabilities until its powers were unleashed in the face of escalating street protests.

Deep packet inspection involves the deconstruction and subsequent reconstitution of Internet data including email, Internet phone calls, and images and messages sent via social-networking sites like Twitter and Facebook.

It could explain why the mullahs allowed Iran’s Internet to function rather than shutting it down altogether, and why it has been running at glacial speed since things started getting out of hand.

Iran is “now drilling into what the population is trying to say,” Marshal8e6 director of technical strategy Bradley Anstis told the Journal. “This looks like a step beyond what any other country is doing, including China.”

When the Big O lifted the curtain on federal funding for embryonic stem cell research in March, scientists applauded the move as a long-overdue boost for the promising field.

Now, these same scientists worry his plan may have the unintended effect of dampening progress by forcing researchers to comply with ethical standards that were enacted after their research began.

“We’re very concerned,” Amy Rick, chief executive of the Coalition for the Advancement of Medical Research told the Washington Post. “If they don’t change this, very little current research would be eligible. It’s a huge issue.”

Ongoing stem cell research has already passed ethical scrutiny, but when Obama lifted the ban, he charged the NIH to develop new guidelines governing the field. Those guidelines would be difficult to meet in retrospect.

This is essentially moving the goal post,” the Harvard Stem Cell Institute’s George Daley told the Post.

For example, the new NIH guidelines require that couples sign documents stating that they agree to donate their embryos for research and that they have been informed about other options like donating the embryos to other couples instead.

Many clinics did just this, but their consent forms did not necessarily specify as such.

No one knows how many stem cell lines would be affected by retrospective enforcement of the NIH guidelines, but experts believe most would not pass muster.

The NIH has a chance to clean up the mess when it releases the final version of its guidelines on or before July 7. 

“We know issues like this have been raised, and we will take them into consideration,” Raynard Kington, the NIH’s acting director told the Post. “The intent of the president was to expand opportunities and research in this area.”

To determine whether Big Pharma’s $80 billion contribution to the Big O’s health reform movement represents a magnanimous gesture or a negotiation ploy designed to save $20 billion, it’s worth taking a moment to review pertinent history.

Sixteen years ago, the pharmaceutical industry teamed up with Big Insurance and providers to sink HillaryCare.

This time ‘round, it has chosen to defend its interests by sitting at the table, in part because that’s what  everyone else did.

Its interests are to maintain drug prices and profit, which means insurers and providers would be left to take the cost-reduction hit.

Big Pharma loves the idea of universal health coverage, since enabling the uninsured to gain access to its products will increase sales by some $18 billion per year.

It’s also a fan of payment schemes that foster disease prevention, since they pump up sales of its cardiac and diabetes drugs.

Big Pharma has spent lavishly to push this agenda. Company disclosure reports reveal it poured $47.4 million into lobbying efforts in Q1, 2009 alone, up 36% from last year.

AZ Chief Executive David Brennan told the Wall Street Journal that since prescription drugs account for “just about 10% of the overall cost” of US spending health care, the cost cutters ought to look elsewhere.

Pfizer Chief Executive Jeffrey Kindler’s against a Medicare-like public insurance plan that would enact “price controls” on drugs, robbing the industry of just rewards for the risk associated with drug development.

Meanwhile, the industry has bumped prices on many drugs more than 15% in the last quarter, according to data from Credit Suisse, in all likelihood to squeeze out every penny from its pills before its patents perish and policymakers pare prices.

Still, Big O spokesperson Linda Douglass praised the industry for playing in the band. Big Pharma is “agreeing we can no longer live with the status quo. It wasn’t that way 15 years ago,” she reasoned.

The Pharmaceutical Research and Manufacturers of America (PhRMA) has agreed to cut prices on drugs purchased by Medicare in a symbolic gesture designed to show support for the Big O’s scheme to overhaul America’s Rube Goldberg health system.

In effect, Big Pharma is pledging to cut $80 billion off its charges to the Feds over the next 10 years, according to a Washington Post post source who requested anonymity. 

“We applaud the president’s efforts on health care reform and are pleased to participate to expand access to medicines to seniors and disabled persons,” Kevin Sharer told the Post. Sharer was the chairman of PhRMA before becoming CEO at Amgen.

The proposal would affect 3.4 million elderly and disabled Americans that fall into the “doughnut hole,” a coverage gap in which Medicare patients end up paying the sticker price for brand-name drugs after incurring $2,200 in partially subsidized drug costs and before reaching a $5,100 outer limit, at which point the subsidies kick-in once again.

The proposal is that Big Pharma will offer 50% discounts to Medicare recipients that have fallen into the “doughnut hole,” and throw in some perks to bring the total cuts to $80 billion.

“This is real money on the table,” the source told the Post.

Big Pharma’s offer leaves the Big O to find another $920 billion to pay for the cost of the overhaul. Apparently he has made some serious coin in this regard by ordering inspections of the couches occupied by foreign dignitaries during White House visits.

Obama had hoped to snag $100 billion from Big Pharma, and some insiders feel the latter’s $80 billion offer amounted to a public negotiation ploy designed to save the industry the difference. 

“There was a great deal of sticker shock” regarding the $100 billion proposal, according to a Big Pharma executive who also spoke on conditions of anonymity.

Everyone knew the US’ Rube Goldberg healthcare system was plagued by high costs for billing- and insurance- related activities, but few would have believed it was this bad.

A recently concluded 3-year study of the matter has revealed that administrative (non-physician) costs associated with these 2 activities add up to $51,221 per FTE physician per year.

That’s not including the astonishing $34,052 per year per FTE physician to account for the physician’s own time spent on billing and insurance.

Summing the 2 brings the annual spend on these activities to $85,273 per FTE physician, or 10% of the total operating revenue for an average practice.

Approximately 0.67 FTE non-clinical personnel per FTE physician is allocated to billing and insurance, according to the study.

To reach their conclusions, Julie Sakowski and colleagues at the Sutter Health Institute interviewed business office personnel, observed office work flows, conducted budget and expense reviews and implemented a survey to assess clinician time spent on billing and insurance.

The study was funded by the Commonwealth Fund and the Robert Wood Johnson Foundation.

In a separate study just released by the Medical Group Management Association, investigators found that physicians spend about 43 minutes per workday interacting with insurance plans.

MGMA estimated that system-wide, overall staff time spent on insurance matters alone equaled $21-$31 billion per year, or $68,000 per physician per year, a number that can be reconciled with results from the above-mentioned Commonwealth Fund study.

“Minimizing billing and insurance-related activities is not the only goal of (health system) reform, (but) standardizing health plan features and processing requirements presents a tremendous opportunity for improving efficiency in a multi-payer health care system,” Sakowski told HealthCareITnews.

The Senate Finance Committee has circulated a draft health reform proposal that features an individual mandate, authorizes an expansion of Medicaid, and–hold the presses!–dumps the Big O’s pet project, a government-sponsored plan that would compete with Big Insurance.

The draft also includes scaled-back coverage provisions that limit costs associated with the overhaul.

One such provision cuts the number of middle-class folks that would qualify for tax credits designed to render insurance more affordable.

The Big O, HHS Secretary Kathleen Sebelius, and many House Democrats including Nancy Pelosi favor a public option to keep Big Insurance honest. Senate Democrats have been divided on the issue since Day 1.

In lieu of a public option, the draft proposes consumer-owned cooperatives similar in design to rural telecom and electricity providers. They would be “subject to government oversight and funded with federal seed money,” according to the Washington Post.

Meanwhile, House Democrats are divining ways to pay for the overhaul. They’re considering a Robin Hood tax on the rich, increased payroll taxes on employees, sin taxes on sugary drinks and alcohol, and a new value-added tax.

The House is also considering the Senate’s preferred approach to paying for reform, which is to tax health benefits received by Americans through their employers, as well as the Big O’s idea to limit itemized deductions for the rich.

A particularly controversial issue, according to the Post, is the extent to which employers must subsidize public coverage for employees if they don’t offer coverage to employees themselves.

People worry that if lawmakers don’t get this right, employees will flee to federal plans and send government costs through the roof.

The draft includes preliminary proposals for handling this nightmare.

Biotech giant Genzyme has shuttered a drug production complex after discovering a virus in a bioreactor used to produce its best selling drugs, Cerezyme and Fabrazyme.

The virus, Vesivirus 2117, is not thought to harm humans, according to company officials. It does affect growth of the cells used to produce the drugs, however. The tainted plant will stay closed for at least 6 weeks while decontamination takes place.

For about 8,000 people worldwide, the drugs are life-savers, although the temporary interruption in production should not pose significant risks to them.

Cerezyme is used for Gaucher disease, a hereditary condition in which an inactive enzyme causes fats to accumulate in multiple organs. 

Fabrazyme is used to treat Fabry disease, another inherited enzyme deficiency that leads to fat build-ups in various organ systems as well.

As a result of the shutdown, Cerezyme patients could miss one or 2 treatments. Those taking Fabrazyme could miss up to 4 doses.

Patients usually receive IV infusions of the drugs every 2 weeks. Any missed doses will not result in significant health sequellae, since it takes more than a few missed treatments to result in significant reaccumulation of the fatty substances.

“It is not a life-and-death situation we’re dealing with here,’’ Henri Termeer, the company’s chief executive told the Boston Globe.

The production glitch will cost the company $200-$300 million in lost revenue, however. Last year, Cerezyme garnered $1.2 billion in revenue, about  a quarter of the company’s total. Fabrazyme generated $500 million.

“This is an unusual event, but they’ll solve it and go on,” Leerink Swann’s John Sullivan told the Globe. “Traditionally, in cases like these, you worry about a market share shift. With these products, that is not a consideration.’’

As chairman of the Senate Finance Committee, Montana Senator Max Baucus is right in the eye of Hurricane Health Reform.

A Democrat that hasn’t lost an election since 1972 in a state that has voted for the Republican presidential candidate every time but once over that period, Baucus sometimes infuriates party partisans.

Take the time for example, when he lambasted HillaryCare’s proposals for employer mandates and regional insurance cooperatives. They “smack of excess government and the smell of socialism,” he said back then.

So far though, the Big O couldn’t be happier with the support he’s received from Baucus on this health reform go-round.

In describing the current challenge, the Montana Democrat told the Washington Post “we’re doing something. It’s holistic, it’s our health-care apparatus. We don’t even have a system in America, really. (People) know the train is leaving the station. There’s a sense of inevitability here.”

His Finance Committee is trying to draft deficit-neutral legislation that expands coverage and cuts costs. He is said to favor an individual mandate, in which people are required to purchase health insurance, and a tax on employer-provided health benefits, issues known to rankle Republicans.

At the same time, Baucus’ track record shows he has upheld the Finance Committee’s bipartisan traditions. In the 8 years he and Republican Charles Grassley have run Finance, just 4 bills have passed on straight party-line votes.

“That’s a pretty good record of bipartisanship,” Grassley told the Post.

But then he turned ominous. ”(Baucus has) a large share of his caucus who thinks government can run health care better than the private sector, and they want that intervention,” Grassley said. 

The Montanan responded like a Blue-stater. “They may get to the point where they’re not there,” he said of Republicans. “The president (and) I want a bipartisan bill. I hope that happens. But I don’t know. Crunch time is coming up pretty soon.”

A fair share of Georgetown University family practitioner Steven Schwartz’s patients can’t name one or more of pills they’re taking.

“But usually they can tell you what it looks like,” he told the Washington Post. “They might say it’s a blue, triangular pill for hypertension.”

So Schwartz whips out his iPhone, accesses Epocrates, one of 674 medicine-related applications for the device sold on iTunes, inputs pill descriptors like color, shape and so forth, and voila! He’s presented with a list of matches from which he can deduce the identity of his patients’ mystery pills.

Schwartz and many tens of thousands of other clinicians also use the handheld device to display instructional diagrams and videos for patients, check for drug-drug interactions, view X-rays and write electronic prescriptions.

About 64% of physicians now use smartphones, according to Manhattan Research, a market research company.

BlackBerrys are also popular. At GW and Johns Hopkins for example, more than 95% of the smartphones used by clinicians are BlackBerrys, Mike McCarty told the Post.

The chief network officer at Hopkins explained that most of the provider’s medical software runs Windows, as does the BlackBerry.

“I think over time we will be replacing pagers with these devices,” McCarty added.

“Every clinician I meet says they want to be carrying one device, rather than two or three.”

Ohio State University’s medical school plans to distribute an iPod Touch to every medical student by fall, according to Catherine Lucey, the vice dean for education.

“It allows residents and students to ask questions at the bedside, and not rely on memory and not guess,” Lucey told the Post. “I predict that in a couple years, all medical schools will be using them.”

UCLA scientists are reporting that certain regions in the brains of longtime meditators are bigger than those who do not engage regularly in the practice.

Eileen Luders and colleagues used high resolution, 3-dimensional MRI to study 22 people that had practiced either Samatha, Vipassana or Zazen meditation for between 5 and 46 years (average 24 years) and 22 controls. Most meditated between 10-90 minutes per day.

They found that the meditators had larger cerebral measurements in the right hippocampus and more gray matter in the right thalamus, the right orbito-frontal cortex and the left inferior temporal lobe. These regions are known to be involved with the regulation of emotions.

In no region did control subjects have larger brain volumes or more gray matter than the meditators.

The study is in Neuroimage.
 
“We know that people who consistently meditate have a singular ability to cultivate positive emotions, retain emotional stability, and engage in mindful behavior,” Luders told BurrillReport. “The observed differences in brain anatomy might give us a clue why meditators have these exceptional abilities.”
 
Scientists had previously shown that meditators have better concentration skills and emotional control, reduced stress levels and jacked immune systems, but this is the first study of the link between meditation and brain morphology.
 
According to Luders, the group’s findings might represent the “neuronal underpinnings” through which meditators “regulate their emotions and allow for well-adjusted responses to whatever life throws their way.”

She adds however, that her imaging techniques were unable to assess any possible microscopic correlates of the phenomenon, such as increased neuron counts, larger neurons or more neuronal connections.