Message from the President
President Obama and Congress Work through Healthcare Reform
As we move through summer, healthcare reform has taken center stage at our nation's capital. Committees in both the Senate and House of Representatives are drafting bills aimed at extending coverage to millions of uninsured, reducing costs, and improving quality. The President hopes to sign a comprehensive bill by the year's end.
I believe the National Jewish HealthTM model of preventive, personalized medicine with an emphasis on coordinated care serves as an innovative model for patient care and research:
Integrated, multispecialty care that develops comprehensive diagnosis and treatment plans for the whole person, improves quality of care and reduces fragmentation of services, while decreasing costs.
Research and clinical care, incorporating genetic data, specifically coordinated within an innovative process can enable us to predict and prevent disease while creating customized, effective and efficient therapies.
Quitline tobacco-cessation programs and FitLogix weight-management programs address behaviors associated with leading causes of morbidity and preventable death in our society with the goal of long-term wellness and human health.
As this issue goes to press, much in healthcare reform remains to be regulated. Hopefully we will see continued progress on behalf of the patients we serve. Best wishes.
Michael Salem, MD
President and CEO of National Jewish Health
Review the case study, "Asthma or Sarcoidosis" by National Jewish Health pulmonologists, Gregory P. Downey, MD and Ali I. Musani, MD.
Recent Progress in the Diagnosis of Immunodeficiency Disease
The March 2009 annual meeting of the American Academy of Allergy Asthma and Immunology (AAAAI) introduced important new tools for the diagnosis of Primary Immunodeficiency Disease (PIDD). Dr. Hernandez-Trujillo and colleagues surveyed pediatricians and reported that while 77% have followed such patients, 35% were uncomfortable with the diagnosis of PIDD.
So how can you demystify diagnosis?
Dr. Cunningham-Rundles and Hernandez-Trujillo advised that since 70% of such patients have an antibody deficiency, "the most cost effective workup, aside from examining the CBC for neutropenia and lymphopenia, includes quantitative serum immune globulins and several antibody determinations, such as tetanus and diphtheria."
Anticipating such diagnostic needs, Advanced Diagnostic Laboratories (ADx) at National Jewish Health unveiled a new guide to the laboratory diagnosis of PIDD, including simple ordering of screening tests.
PIDD - represented by defects in humoral, cellular or combined, phagocytic, complement, or Toll-like receptor pathways - has a broad spectrum of severity and is significantly under-diagnosed. The NIH estimates that 2-3 fold more patients should be diagnosed each year, and the Modell Foundation concludes the healthcare cost of undiagnosed PIDD is very high.
Common variable immunodeficiency (CVID), a frequent form of PIDD, requires careful diagnostic steps to justify appropriate payer reimbursement for intravenous immunoglobulin therapy. ADx announced at AAAAI new tests to confirm the diagnosis of CVID: a new memory B cell phenotyping panel and individual tests for BAFF-R, CD40, ICOS, and CD40L. Together with the existing memory B cell panel, ADx provides the broadest available menu of tests to definitively diagnose CVID.
Defects in Toll-like receptors (TLR), an important component of innate immunity, was a hot topic at AAAAI. No less than 40 oral and poster presentations evaluated the contribution of TLR to immunodeficiency. ADx announced its unique and simple approach to assessing TLR defects - a single screening test to identify a signalling defect in any of nine different TLRs. The test relies on stimulation of a patient's blood mononuclear cells with purified ligands for each TLR, and is available for both diagnostic use and clinical studies.
If you would like more information please contact ADx at 800-550-6227.
Alumni New Survey Results
At the beginning of this year, we surveyed National Jewish Health Former Fellows regarding the frequency, content and format of this newsletter. We mailed 699 surveys and 48 were returned-a nice 6% return when the average direct mail return is 2%. The consensus among your votes was to keep the newsletter frequency at two times per year. You also requested to keep the content generally as it is, but asked for emphasis on research and clinical news in quick read format with an occasional case study.
In response to your suggestions, we've inserted a case study in this issue. We are also the process of developing an online directory and other features just for our Former Fellows. Details to come.
The Professional Education Department at National Jewish Health would like to invite you to become part of our speaker's bureau. We receive speaking engagement requests from all over the United States for allergy, pulmonology and many other topics, and often use local providers to fill those needs. If you are interested, please contact Sheila Jordan at 303-398-1150.