Despite the improved chances for a Republican takeover of the House, some unions are spending against Democratic incumbents who voted "no" on healthcare reform.

Unions vowed to go after members who didn't support the bill, and some are keeping that pledge.

The Service Employees International Union (SEIU), for instance, has spent almost $300,000 on direct mail and other activities in support of union activist Mac D'Alessandro's primary challenge to Rep. Stephen Lynch (D-Mass.).

D'Alessandro and SEIU officials say he wasn't recruited to run because of Lynch's vote against the healthcare reform bill in March, but it's been the main issue of his candidacy.

"I made a decision on my own, and what I like to say is that the only person who asked me to get into this race was Steve Lynch," D'Alessandro told The Ballot Box.

He said healthcare wasn't the only reason he decided to run but rather, it was the "final straw."

"It goes all the way back to his vote to authorize the war in Iraq and its continued funding time and time again, even as our economy here at home fell apart," he said, also citing Lynch's anti-abortion position.

Lynch wasn't without union support — he was endorsed by the AFL-CIO during the primary, but the union didn't make any independent expenditures on his behalf.

D'Alessandro maintains that support for Lynch among "working families" has dropped since he voted against healthcare reform.

"I've canvassed and door-knocked and talked to small-business owners in every city and town in this district and there is a lot of frustration with Congressman Lynch’s vote on healthcare reform," he said. "A lot of it."

"I think that his 'no' vote on healthcare was a vote against the interests of middle income families, middle-class families, working families, not to mention small businesses," he said. "Those are reforms that benefit a lot of working families in this district."

Lynch's campaign says concerns about government spending and the deficit are what the congressman hears about from his constituents.

"When Steve knocks on doors he hears concerns about the healthcare reform bill and the Wall Street bailout, and the concern is with the positions Mac holds on both of those bills," said Scott Ferson, a spokesman for Lynch's campaign.

Ferson suggested D'Alessandro had been knocking on doors in Somerville and Cambridge, which are in the more liberal 8th district. "Thank God we're running in the 9th," Ferson said.

The Massachusetts primary vote is Tuesday.

Almost half of surgeons who received $1 million or more in fees from orthopedic device companies failed to report those payments when publishing scientific articles, according to a new study.

The study, published online Monday by the Archives of Internal Medicine, for the first time cross-referenced a public database of companies' consultant payments with the disclosure information in medical journals and found significant shortcomings. That means doctors who rely on these studies are not being informed of potential conflicts of interest.

"The findings raise troubling questions about undisclosed payments or royalties and other fees from medical device companies that could lead to biased scientific conclusions," senior author David Rothman said in a statement.

Researchers with the New York-based think tank Institute of Medicine as a Profession looked at 2007 physician payment information from five orthopedic device companies (Biomet, DePuy Orthopedics, Smith & Nephew, Stryker and Zimmer). They then narrowed their focus to 41 surgeon researchers who were paid $1 million or more for consulting, honoraria and other services and found more than half of 95 articles they published after being paid did not disclose the financial relationship.

Even those that did report a relationship, the authors write, did not reveal how substantial the payments were — up to $8.8 million in one case. Almost all the studies were directly related to devices made by the companies making the payments. The authors point out that scientific journals often rely on the honor system and do not check multiple databases that are now available.

The new study comes at a time of increased transparency in the health sector. The healthcare reform law mandates that drug and medical device manufacturers report payments to physicians in a searchable public database by 2013. And the public has also become increasingly skeptical: Half of patients said they suspected that the choice of drugs their doctors recommended was influenced by corporate gifts, according to a recent study by Consumer Reports.

In June, the medical journal Anesthesia & Analgesia thoroughly revised its publication guidelines after one of its contributors pleaded guilty to healthcare fraud. Scott Reuben, former chief of the acute pain clinic at Bay State Hospital in Springfield, Mass., was sentenced to six months of imprisonment on charges of falsifying research funded by Pfizer and other drug makers and publishing results of studies he never conducted.

"Patients have a real stake in transparency," Rothman said. "You want to make sure that the surgeon is choosing the device that is best for you and that your doctor is not getting biased information."

The American Health Care Association announced Monday that Kansas Gov. Mark Parkinson (D) will take over as president of the long-term care industry group and its National Center for Assisted Living in January following his term in office.

Parkinson has owned and operated long-term care facilities for more than 15 years, AHCA said in a press statement, making him an ideal choice to head the group.

"In this new era of health reform, Parkinson’s deep background in this sector coupled with his policy expertise, will serve our members well as we look to future challenges," the statement said. "As a policymaker who knows how Washington works, and as the owner and operator of several skilled nursing and assisted living facilities, he will be a measured voice to speak on the elderly’s behalf."

Sen. Arlen Specter (D-Pa.) introduced legislation to dodge a federal judge’s injunction against the Obama’s administration’s expansion of stem-cell research.

Defunding healthcare reform, as some Republicans have suggested, "is just Washington-speak for taking us back to the days when insurance companies — not you and your doctor — were in control of your care" Stephanie Cutter wrote Monday on the White House blog.

The assistant to the president for special projects lays out the following arguments:

• The Patient’s Bill of Rights, which prohibits lifetime caps and requires first-dollar wellness and prevention coverage among several insurance regulations, would not receive federal oversight; 
• Healthcare tax credits for small businesses could not be administered; 
• The $250 Medicare prescription drug rebate checks would stop being delivered to seniors, and next year’s discounts would not materialize and the doughnut hole would remain;
• Insurance plans could skirt their requirement to spend 80 percent of premiums on care if there was no enforcement;
• Likewise, the law's $250 million in grants to help states strengthen their oversight of premium increases would dry up;
• Medicare first-dollar coverage for preventive services such as mammograms and colonoscopies would be scrapped.

"In the days ahead," Cutter promises, "we’ll post more information about what’s at stake if the new law is defunded and why families and businesses can’t afford a return to the bad old days."

First lady Michelle Obama is urging restaurant owners to consider "reformulating" menus to address childhood obesity.



In a speech Monday morning to the National Restaurant Association in Washington, D.C., Obama called on restaurants to offer a wider variety of "healthy choices" as part of her "Let's Move!" campaign.

"I'm not asking any of you to make drastic changes to every single one of your recipes or to totally change the way you do business," she said. "But what I am asking is that you consider reformulating your menu in pragmatic and incremental ways to create healthier versions of the foods that we all love."

She praised restaurant owners for their role in "our own lives and in the life of our nation."


"You’re responsible for one-third of the calories our kids get on a daily basis," she said. "The choices you make determine what’s listed on the menus, what’s advertised on billboards and what’s served on our plates."
 
She later gave examples of how restaurants could promote greater health, saying some dishes could be prepared with less butter or cream and that portion sizes could be reduced.

"Right now, many restaurants ... are serving more low-fat dishes, whole grain breads, fruit on the side. Some are even offering kid-size portions of the meals they serve on the main menu. And chefs across the country are partnering with local schools to help them make healthy choices. 

"But as positive as these examples are, the reality is it’s just not enough," she added. "Together, we have to do more. We have to go further."

The House Energy and Commerce Committee has postponed two hearings originally scheduled for Tuesday.

An oversight panel hearing on salmonella and the recent egg recall has been rescheduled for Tuesday, Sept. 21. And the health subpanel will hold its hearing on 18 mostly uncontroversial public health bills on Wednesday after its hearing on Medicare's competitive bidding program for durable medical equipment.

The 18 public health bills are:

    •    H.R. 211, Calling for 2-1-1 Act of 2009;
    •    H.R. 758, Pediatric Research Consortia Establishment Act;
    •    H.R. 1032, Heart Disease Education, Analysis Research, and Treatment for Women Act;
    •    H.R. 1210, Arthritis Prevention, Control, and Cure Act of 2009;
    •    H.R. 1230, Bone Marrow Failure Disease Research and Treatment Act of 2009;
    •    H.R. 1362, National MS and Parkinson's Disease Registries Act;
    •    H.R. 1995, Eliminating Disparities in Diabetes Prevention Access and Care Act of 2009;
    •    H.R. 2408, Scleroderma Research and Awareness Act;
    •    H.R. 2818, Methamphetamine Education, Treatment, and Hope Act of 2009;
    •    H.R. 2941, Johanna’s Law Reauthorization;
    •    H.R. 2999, Veterinary Public Health Workforce and Education Act;
    •    H.R. 5354,  Gestational Diabetes Act of 2009;
    •    H.R. 5462, Birth Defects Prevention, Risk Reduction, and Awareness Act of 2010;
    •    H.R. 5986, Neglected Infections of Impoverished Americans Act of 2010;
    •    H.R. 6012, Diabetes Screening Utilization;
    •    H.R. 6081, Stem Cell Therapeutic and Research Reauthorization Act of 2010;
    •    H.R. ___, Telehealth Improvement and Expansion Act of 2010;
    •    H.R. ___,  Health Data Collection Improvement Act.

Healthcare battle greets returning lawmakers: While it's clear by now that passage of healthcare reform won't be Democrats' saving grace in the mid-term elections, the messaging battle is still red hot despite the renewed focus on the economy.

Late last week, Health and Human Services Secretary Kathleen Sebelius warned insurers not to blame the new law for their rate increases: http://bit.ly/9lnqwk. The warning came after insurers in recent state filings tied increases of between 1 percent and 9 percent to more generous coverage mandated by the new law.

Adding fuel to the fire, the Centers for Medicare and Medicaid Services (CMS) reported that the new law would increase healthcare spending by 0.2 percentage points over 10 years. But the law also covers 32 million people and the rate of growth in spending slows after 2015. http://bit.ly/9aQx8x

Several congressional reporters have pointed out that no Democrats are known to be running campaign ads highlighting their votes for reform - and at least four are touting their 'no' vote. But that doesn't mean the party is running away from its signature domestic achievement: The New York Times' FiveThirtyEight political blog took an in-depth look at the Web sites of Democratic and Republican candidates in 33 toss-up districts and found that healthcare was the most frequently mentioned issue — by an overwhelming 97 percent of Republicans and a healthy 79 percent of Democrats. http://bit.ly/cimuZg

Meanwhile, senior White House adviser David Axelrod said on Sunday on NBC’s "Meet the Press" that he still thinks voters will eventually come around.

States are reporting lower than expected participation, raising concerns that a lack of public engagement could affect the program's success.