WEDNESDAY, FEBRUARY 5, 2014 • THE BULLETIN
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TART TODAY
• Discoveries, breakthroughs,trends, namesin the news— the things you needto know to start out your day
It'sWednesday,Feb.5,the 36th day of 2014. Thereare 329 days left in the year.
HAPPENINGS Syria —Thecountry is expected to miss adeadline to export all its chemical munitions for destruction.A2
HISTORY Highlight:In 1937,President Franklin D. Roosevelt proposed increasing the numberof U.S. SupremeCourt justices; the proposal, which failed in Congress, drewaccusations that Roosevelt wasattempting to "pack" the nation's highest court. In1783, Swedenrecognized the independence ofthe United States. In1811, George, the Princeof Wales, was namedPrince Regent due to themental illness of his father, Britain's King George III. In1914, "Beat Generation" author William S. Burroughswas born in St. Louis. In1919, movie studio United Artists was incorporated by Mary Pickford, Douglas Fairbanks, D.W.Griffith and Charles Chaplin. In1922, the first edition of Reader's Digest waspublished. In1940, Glenn Miller and his orchestra recorded "Tuxedo Junction" for RCA Victor's Bluebird label. In1953, Walt Disney's animated feature "Peter Pan"wasfirst released. In1967, "The Smothers Brothers ComedyHour" premiered on CBS-TV. In1971, Apollo 14astronauts Alan ShepardandEdgar Mitchell stepped onto thesurface of the moon in the first of two lunar excursions. In1973, services wereheld at Arlington National Cemetery for U.S. ArmyCol. William Nolde, the last official American combat casualty before the Vietnam cease-fire took effect. In1989,the Soviet Union announced that all but asmall rear-guard contingent of its troops had left Afghanistan. In1994,white separatist Byron De La Beckwithwasconvicted in Jackson, Miss., of murdering civil rights leader MedgarEvers in1963, and wasimmediately sentenced to life in prison. (Beckwith died Jan.21, 2001 at age 80.) Sixty-eight people were killed when a mortar shell exploded in amarketplace in Sarajevo, Bosnia-Herzegovina. Ten yearsnge: CIADirector George Tenetoffered a forceful defense of prewar intelligence in a speech atGeorgetown University. Pakistani President Gen. PervezMusharraf pardoned thecountry's top nuclear scientist, Dr. AbdulQadeer Khan, for leaking weapons technology to Iran, Libyaand North Korea. Five years egn:Supreme Court Justice Ruth Bader Ginsburg underwent surgery for pancreatic cancer. USA Swimming suspendedOlympic gold medalist Michael Phelps for three months after a photo showing him inhaling from a marijuana pipebecamepublic. One yearagn: President Barack Obamaasked Congress for a short-term deficit reduction package ofspending cuts and tax revenuethat would delay the effective date of steeper automatic cuts scheduled to kick in on March1. (The president and congressional leaders failed to reach anagreement, and the $85 billion in federal spending cuts, known assequester, went into effect.)
ADVANCEMENT
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Baseball Hall-of-Famer Hank Aaron is 80. Tony-winning playwright John Guare is76. Football Hall-of-Famer Roger Staubach is 72. Movie director Michael Mann is 71.Actress Charlotte Rampling is 68. Actor Christopher Guest is 66. Actor Tom Wilkinson is 66. Actor-comedian Tim Meadows is 53. Actress Jennifer Jason Leigh is 52. Actress Laura Linney is 50. Actor-comedian Chris Parnell is 47.Singer Bobby Brown is 45. Actor Michael Sheen is 45. — From wire reports
OI' e SO BI'e
Analytic software called ePASS is being rolled out at Walgreens clinics across the nation. It uses data from millions of patients to guide health care providers toward the right path of treatments. By Mohana Revindrannth
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The Washington Post
The next t im e
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walks into a Walgreens dinic, the clinician may not be the only one assessing patients. Soon, hundreds of Walgreens dinics will be equipped
The ethics behind genetic testing of embryos By Gina Kolata New York Times News Service
Her first thought af-
with new software that guides
ter she heard the n ews
healthcare providersthrough checkups — requiring them to
was that she would never have children. Amanda
askcertain questions orrequest
Baxley's doctor had just
particular lab tests depending on the patient's history.
told her she had the gene for G erstmann-Strauss-
The software, called ePASS,
ler-Scheinker disease, or
was developed by Inovalon,
GSS, which would inevitably lead to her slow and
a Bowie, Md.-based health IT firm with about 3,000 employ-
terrible death. This rare
ees worldwide. Inovalon's analytics churn
neurological disease had s talked her family f or generations. On the spot, Baxley, 26,
through data from more than
100 million patients and uses predictive algorithms to sug-
declared she would not let the disease take anoth-
gest health conditions they
might have. Last week, Inovalon and Walgreens announced
er life in her family line, Jeffrey MacMillan I TheWashington Post
that dinicians may use ePASS
Keith Dunleavy, chief executive of Inovnlon, says ePASS is meant to guide — not replace — health
to assess any patient whose records Walgreens has on file, expanding the number of patients Inovalon reaches. Previously, only patients whose health-plan providers had granted Inovalon access
cere providers by suggesting questions relevant to each patient. of Walgreens dinics.
conditions the patient is likely to have, based on Inovalon's assessment of millions of other
Coming soon to a pharmacy near you
patients.
Walgreens has been gradusing ePASS. ually setting the system up in Inovalon is one of manybusi- dinics across the United States, nesses managing and analyz- beginning with Philadelphia. "Being able to have the powing the large volumes of data stored in electronic health-re- er of advanced analytics at the cord systems to predict prob- point of care, and being able lems; others include Reston, to combine that with immuniVa.-based Altruista H ealth, zation and lab resources we which identifies high-risk pa- have" means clinicians have tients forhealthinsurance com- "as much information up front panies; Vitera, a Tampa, Fla.- as possible when a patient based firm whose analytic soft- checks in for assessment and ware tracks tests and referrals; is taken into the back room," and New York-based startup Helle said. AllazoHealth, which focuses Upon arriving at a Walon whether patients are taking greens clinic, patients sign in their medication. at a computer kiosk and their Before partnering with In- names are fed into a list on a ovalon in September, Wal- dinician's computer in an exgreens did not use any predic- amination room. During the to theirfiles would be assessed
tive software to help dinicians
question patients, said Heather Helle, divisional vice president
checkup, the software tailors questions to the patient's histo-
ry fromhealth records,and to
The system also takes into account patients' behavior-
whether they are likely to get regular checkups and tests or if they avoid them, for instance — so dinicianscan make a note to follow up if necessary. As an example, the software
might suggest that a clinician discuss ways to improve kidney function with a 70-year-old diabetic so the patient does not develop blindness, but that dis-
said. "If you had days to spend with this person and access to all their past care, you could
deliver a similar" service. At the end of the checkup, ePASS compiles a SOAP
note — a "subjective, objective assessment and plan," or a quick summary of the checkup and treatment — which is then transferred back into the patient's electronic health re-
cords. The predictive system can sometimes be stymied by gaps in health records, Dunleavy said. If a patient's primary-care
cussion might be optional for a provider has n o t r e corded healthy 25-year-old with a cold the results of a lab test, for inwho gets regular checkups. stance, ePASS notifies the pro-
Guide,nota replacement EPASS ultimately is meant
vider that certain data points
are missing. The more patients who use
to guide — not replacethe service, the more data Inhealth care providers by sug- ovalon's software collects, gesting questions relevant to gradually improving the algoindividual patients, Inovalon rithm's predictive capability, chief executive Keith Dunleavy Dunleavy said.
even if that meant forgoing childbirth. The next
day, her boyfriend, Bradley Kalinsky, asked her to marry him. But the Kalinskys' wedded life has taken an un-
expected turn, one briefly described Monday in The Journal of the American
Medical Association Neurology. Like a growing number of couples who know a disease runs in the family, they chose in vitro fertilization, and had cells
from the embryos tested for the disease-causing gene. Only embryos without the gene were implanted in her womb. The Kalin-
skys are now parents of twin 3-year-olds and a 9-month-old, children who
will be free of the fear of GSS. The in vitro fertilization
and testing are expensive, but they make it possible
for couples to ensure that their children will not in-
herit a faulty gene and to avoid the difficult choice
of whether to abort a pregnancy if testing of a fetus detects a genetic problem. But the procedure rais-
STUDY
es ethical questions that trouble advocates for the
disabled and have left some doctors struggling with w ha t
t h e y s h ould
tell their patients. When are prospective parents
justified i n d i s carding embryos? Is it acceptable, for example,for diseases like GSS, that develop in adulthood? What if a gene only increases the risk of a
disease'? Ethicists are
d i vided
about use of the method.
Janet Malek, a bioethicist at the Brody School of Medicine at East Caro-
lina University, said people who carry a gene like GSS have a moral duty to
use pre-implantation diagnosis — if they can af-
pvs
Ted S.Warren/The Associated Press file photo
A new study published Monday in the journal JAMA Internal Medicine says diets high in sugar are linked to increased risks for fatal heart
ford it — to spare the next
generation.
disease, and it doesn't take that muchextra sugar to boost the risk —anything more than a 20-ounce Mountain Dew soda aday.
Study: Highsugarintaketied to fatal heart problems By Lindsey Tanner
times greater than for people unhealthy cholesterol and triwho eat only foods with little glycerides; and also may inC HICAGO — C o uld t o o added sugar. crease signs of inflammation much sugar be deadly? The For someone who normally linked with heart disease, said biggest study of its kind sug- eats 2,000 calories daily, even Rachel Johnson, head of the gests the answer is yes, at least consuming two 12-ounce cans American Heart Association's when it comes to fatal heart of soda substantially increases nutrition committee and a Uniproblems. the risk. For most American versity of Vermont nutrition It doesn't take all that much adults, sodas and other sugary professor. extra sugar, hidden in many drinks are the main source of Yang and colleagues anaprocessed foods, to substantial- added sugar. lyzed national health surveys ly raise the risk, the researchers Lead author Quanhe Yang between 1988 and 2010 that found, and most Americans eat of the U.S. Centers of Disease included questions about peomore thanthe safest amount. Control and Prevention called ple's diets. The authors used Having a cinnamon roll the results sobering and said national death data to calculate with your morning coffee, a su- it's the first nationally repre- risks of dying during 15 years per-sized sugary soda at lunch sentative study to examine the of follow-up. and a scoopof ice cream after issue. Overall,more than 30,000 dinner would put you in the Scientists aren't certain ex- A mericanadultsaged 44 on avhighest-risk category in the actly how sugar may contribute erage were involved. study. That means your chance to deadly heart problems, but Previous studies have linked of dying prematurely from ithas been shown to increase diets high in sugar with inheart problems is nearly three blood pressureand levels of creasedrisksfornonfatalheart The Associated Press
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