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Tuesday, September 2, 2014

ESC: Left or Right Nerve Stimulation Feasible in HF

ESC: Left or Right Nerve Stimulation Feasible in HF

Published: Sep 1, 2014

By Ed Susman , Contributing Writer, MedPage Today

 

Action Points

  • Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

BARCELONA -- Stimulation of either the right or left vagus nerve appeared to improve cardiac function in patients with heart failure, researchers said here.

In the ANTHEM-HF (Autonomic Neural Regulation Therapy to Enhance Myocardial Function in Heart Failure) trial, left ventricular ejection fraction (LVEF) increased from 32.4% to 37.2% with the stimulation device (VNS Therapy System) after 6 months, a statistically significant and clinically meaningful change (P<0.0001), reported Inder Anand, MD, DPhil, from the University of Minnesota in Minneapolis, and colleagues.

"We pooled the results of the left and right side vagus nerve stimulation because there were no major differences in outcomes based on which nerve is stimulated," Anand said at a press conference at the European Society of Cardiology meeting. The study results will also be published in the Journal of Cardiac Failure.

In addition to the improvement in left ventricular function, about 70% of the patients in the ANTHEM-HF study improved their NYHA heart failure class by at least one class, Anand reported, and those changes were also statistically significant (P<0.0001).

"No patients' conditions worsened," he told MedPage Today.

Anand also reported that the patients significantly bolstered their distance in the 6-Minute Walk Test, improving by 56 m from baseline (P<0.0001) and saw their heart rates slowed by 3.9 beats per minute (P<0.005). Also, patients recorded an 18-point reduction in the Minnesota Living with Heart Failure Questionnaire (P<0.0001).

"We saw both improvements in objective measures of heart failure and in subjective measures," he said.

The results of the ANTHEM-HF trial differed from another trial of vagal stimulation presented at ESC -- NECTAR-HF showed no benefit was observed.

"ANTHEM showed a very significant effect on beneficial remodeling as a result of vagus nerve stimulation," Mariell Jessup, MD, professor of medicine at the University of Pennsylvania in Philadelphia told MedPage Today. "They compared right sided vagus nerve stimulation to left sided stimulation and both were effective. This is in contrast to NECTAR-HF which showed absolutely no signal, but was done primarily on the right side."

"So we are kind of confused," she added. "We will really have to understand, in a better way, what the differences were in the techniques and how they used the stimulation. There is still a possibility that this is going to offer a new avenue of therapy."

The researchers set out to test whether stimulating the right vagus nerve or the left vagus nerve would better improve outcomes, but Anand said that stimulation of either nerve appeared to help patients achieve changes in cardiac function. There were 60 patients -- all with chronic symptomatic heart failure with LVEF ≤40% -- enrolled, and outcomes were studied at 6 months. Patients were on optimal medical therapy including beta-blockers. There was no control group.

The experimental autonomic regulation therapy system delivered chronic intermittent stimulation to the vagus (10 Hz natural frequency, 250-microsecond pulse width). The stimulation intensity titrated over 10 weeks to maximum tolerable current. The average stimulation current was 2.0 mA.

There were three deaths in the study, including one that involved implantation of the device (postsurgical embolic stroke). The other two deaths were adjudicated as due to worsening heart failure and sudden death. Other serious adverse events were equally distributed among patients with either right or left implantation. The most common nonserious adverse events included voice alternation and hoarseness, cough, and oropharyngeal pain.

There were no instances of system malfunction, the authors reported.

"There is attractiveness to using the left side because that is where we put most of our devices," explained Jessup, who is immediate past president of the American Heart Association. "In theory, if you were implanting a device, you could be implanting the vagal nerve stimulator and, I suppose, you could put the generators in one single pocket."

Kenneth Dickstein, MD, professor of medicine at the University of Bergen, Norway, said the use of the right vagus nerve has been targeted because it was believed that method provided more of a baroreceptor impact than the left side vagus nerve. He said that ANTHEM-HF indicated that the left vagus nerve is at least as effective as the right side and may be easier to access.

The study was sponsored by Cyberonics.

Anand disclosed relevant relationships with Amgen, Critical Diagnostics, Cyberonics, Novartis, and Zensun.

Jessup disclosed no relevant relationships with industry.


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Primary source: European Society of Cardiology
Source reference: Premchand R, et al "Autonomic regulation therapy for the improvement of left ventricular function and heart failure symptoms: The ANTHEM-HF Study" ESC 2014.

http://www.medpagetoday.com/MeetingCoverage/ESC/47450

Monday, September 1, 2014

Cyberonics device improves heart function after Boston flop

Cyberonics device improves heart function after Boston flop

Monday, September 01, 2014 2:35 a.m. CDT

By Ben Hirschler

BARCELONA (Reuters) - A nerve stimulation device from Cyberonics improved cardiac function in heart failure patients in a small clinical trial, in contrast to an unsuccessful study backed by Boston Scientific.

However, the Cyberonics trial reported on Monday did not contain a control arm - unlike the one using the Boston device in which some patients received sham treatment - and experts said further research was now needed.

Both companies are trying to improve outcomes for patients with heart failure, in which the heart fails to pump blood efficiently, by stimulating the vagus nerve – a superhighway connecting the brain to the rest of the body.

Vagus nerve stimulation (VNS), which involves delivering mild electrical pulses to the nerve in the neck, is already used successfully to treat severe epilepsy and treatment-resistant depression.

Cyberonics is the leading proponent of such therapy and the six-month heart failure trial, involving 60 patients, used its system to stimulate both the left and right-sided vagus nerve.

Patients, on average, showed a 4.5 percent improvement in left ventricular ejection fraction, a key measure of heart function, the study found, and there was no difference in the results between the left and right sides.

"I think, at six months, that (4.5 percent improvement) is a very impressive achievement," study leader Inder Anand from the University of Minnesota told reporters at the European Society of Cardiology annual meeting.

The fact that the device worked equally well on both sides is important because the system could be combined with cardiac devices such as implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices, the vast majority of which are implanted on the left side.

http://wtaq.com/news/articles/2014/sep/01/cyberonics-device-improves-heart-function-after-boston-flop/

Sunday, August 31, 2014

NECTAR-HF fails to demonstrate clinical benefit of vagus nerve stimulation in Heart Failure

Cardiomyopathy Trial

arraybiopharma.com/array797-231

Investigational study: LMNA dilated cardiomyopathy. Learn more.

 

NECTAR-HF fails to demonstrate clinical benefit of vagus nerve stimulation in Heart Failure

Saturday, August 30, 2014

 

BARCELONA, Spain – Stimulating the vagus nerve, which regulates the body’s internal organ systems including the heart, does not improve cardiac function in heart failure patients, according to results of the NEural Cardiac TherApy foR Heart Failure (NECTAR-HF) trial.


NECTAR-HF was presented as a Hot Line today at ESC Congress 2014,  with simultaneous publication in the European Heart Journal.


The trial’s failure to show a cardiac benefit of vagal nerve stimulation (VNS) was unexpected, said study investigator Faiez Zannad, MD, PhD, from l'Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, in Vandoeuvre-lès-Nancy, France.

“There is robust pre-clinical data showing the benefit of VNS, but the NECTAR-HF trial failed to demonstrate a successful clinical translation of this protocol,” he said.

 

The study is the first randomised, controlled trial designed to evaluate the safety and efficacy of right-sided VNS.


It enrolled 96 heart failure patients from 24 centres across Western Europe to assess the impact of six months of VNS on cardiac function, as well as on cardiac biomarkers, exercise capacity, and quality of life.


Patients, who were about 59 years old and receiving optimal medical therapy, had the VNS device implanted in their neck, near the right vagus nerve, and connected to a pulse generator implanted under the skin of the chest.


After baseline testing of the system, patients were then randomized to either a control group in which the devices remained switched off, or an active VNS group in which the mean stimulation amplitude was 1.24 mA at the start of the study, and 1.42 mA at the 3-month follow-up visit.


After six months, the study found no difference in objective endpoints between the groups.
Both groups had comparable changes from baseline in the primary endpoint of left ventricular end-systolic dimension (LVESD),  as well secondary echocardiographic endpoints, exercise capacity, and levels of the heart failure serum biomarker N-terminal prohormone brain natriuretic peptide (NT-proBNP).


However, there were significant differences between the groups for three subjective endpoints related to quality of life.


Analyses of the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Short Form 36 Health Survey (SF-36) demonstrated statistically significant improvement in quality of life with VNS treatment compared to controls (MLHFQ p=0.049; SF-36 Physical and Mental, p=0.02 and 0.24, respectively).


Additionally, 62% of patients in the VNS group had an improvement of at least one point from baseline in their New York Heart Association (NYHA) functional classification compared to only 45% of control patients (p=0.032).

“The safety profile for this application of VNS appeared acceptable, with an overall infection rate of 7.4%, which is comparable to that in patients implanted with a VNS system for the treatment of epilepsy,” noted Professor Zannad.


Given that preliminary studies suggested a benefit of VNS, there are a number of possible explanations for NECTAR-HF’s negative findings.


First, there is still much to learn about the appropriate dosing and technique of VNS. Data from epilepsy VNS studies show that higher-amplitude dosing might be more effective, but it is often not possible because it causes patient discomfort, said Professor Zannad.


Second, patients in the NECTAR-HF trial were relatively well-managed on medical therapy alone, making them perhaps not the best candidates to show a strong benefit of VNS.

Third, the six-month study period may have been too short to detect changes in cardiac function.


Although patients were blinded to their group assignment, meaning they were not told if they were receiving active treatment, it is possible that those in the active treatment group were able to feel the sensation of stimulation. If this was the case, patients could have been vulnerable to a placebo effect, knowing that they were receiving active therapy.
For this reason, the higher quality of life scores among VNS patients compared to controls should be interpreted with caution, he said.

Authors: ESC Press Office
For background information, please contact the ESC Press Office.
For independent comment on site, please contact the ESC Spokesperson coordinator.

Notes to editor
SOURCES OF FUNDING: The study was funded by Boston Scientific Corporation.
DISCLOSURES: Professor Zannad receives honoraria from Air Liquide, Bayer, Biomérieux, Biotronik, Boston Scientific, CVCRx, Janssen, Novartis, Pfizer, Resmed, Roche Diagnostics, Sanofi, Servier, St Jude, Takeda, speaker fees from Mitsubishi and owns stocks at CVCT and CardioRenal diagnostics. Co-author Gaetano De Ferrari receives honoraria from Amgen, Boston Scientific, Menarini and Merck. Co-authors Stephen Ruble, Doug Daum, Scott Meyer, Craig Stolen, Bernd Schubert, Agnes Ramuzat, Nicholas Wold and Kenneth Stein are employees of Boston Scientific Corporation.


About the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 80 000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.
About ESC Congress 2014


The ESC Congress is currently the world's largest international congress in cardiovascular medicine.  The spotlight of this year's event is “innovation and the heart”.  ESC Congress 2014 takes place from 30 August to 3 September at the Fira Gran Via in Barcelona, Spain. For more information on ESC Congress 2014 contact the ESC Press Office.
To access all the scientific resources from the sessions during the congress, visit ESC Congress 365.


This press release accompanies both a presentation and an ESC press conference at the ESC Congress 2014. Edited by the ESC from material supplied by the investigators themselves, this press release does not necessarily reflect the opinion of the European Society of Cardiology. The content of the press release has been approved by the presenter.

http://www.healthcanal.com/blood-heart-circulation/heart-disease/54662-nectar-hf-fails-to-demonstrate-clinical-benefit-of-vagus-nerve-stimulation-in-heart-failure.html

Sunday, August 24, 2014

VNS Therapy for Depression - Are we really going to break the bank?

From: Herbert Stein [mailto:fabrik@bellsouth.net]
Sent: Monday, August 25, 2014 12:55 AM
To: Madam Secretary Sylvia Matthews Burwell, United States Secretary of Health and Human Services
Subject: VNS Therapy for Depression - Are we really going to break the bank?

Dear Madam Secretary Burwell,

I am always trying to piece together little tidbits of information as I collaborate with another reasonably informed patient to ascertain the enormity of my advocacy for the VNS Therapy volunteer study subjects and patients implanted for depression before the CMS denial of May 4, 2007 that seek to continue with their therapy.  I’ve never received any answer to this question from the sponsor, Cyberonics, when I posed the question to them.  So I keep on searching and recently began to re-extrapolate some figures from the information that’s come available.

This past week I received a telephone call from a representative of CMS in which I asked were they busy helping VNS patients obtain insurance coverage.  The answer was “no”.  Then I quickly listened into the recording of Cyberonics financial teleconference of August 21, 2014.  With the help from this other VNS patient I learned there were two (2) occasions in the teleconference when the depression indication was mentioned.  One mark was at 21:30 minutes into the recording and the other at 45:30 minutes.  I learned there were 28 patients implanted with VNS Therapy for Depression in Cyberonics most recent reported financial quarter and in the prior quarter only 24 patients and as I vaguely recall in the quarter before that only 16.  Furthermore it was stated in this teleconference by the CEO, Mr. Daniel Moore, that they believed most all of these were “replacements”.  This slow increase may well correlate to or be attributed to my advocacy as patients learn that CMS has made some informal accommodations for the Medicare/Medicaid subscribers.

So if I used a number on the high-side such as 40 replacements a quarter that would represent about 160 patients that were benefiting from the therapy who want to continue with their therapy.  Therefore where I previously referred to the “enormity” of my advocacy it may simply boil down to about 160 to 200 patients who have responded to the therapy and achieved a significant degree of wellness and wish to continue.

Why continue this policy of not formally recognizing and caring for this aggrieved patient group through absolutely no fault of their own?  Recognize the serious error and oversight made by CMS and rightfully correct their mistake; now. 

These very, very long-time suffering depression patients have benefited from the VNS Therapy and wish to continue as well as maintain their wellness.  In the long-term it is a significant financial savings to CMS and the health insurers.

Once again, please issue a formal document (i.e. “Compassionate Use”) to insure their medical care now and into the future.  It is the right, humane and honorable thing to do.

Sincerely,

Herb

Joyce and Herbert Stein

1008 Trailmore Lane

Weston, FL 33326-2816

(954) 349-8733

vnsdepression@gmail.com

http://www.vnstherapy-herb.blogspot.com

http://www.vnstherapy.wordpress.com

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Friday, August 22, 2014

Harsh tone requires an apology

From: Herbert Stein [mailto:fabrik@bellsouth.net]
Sent: Thursday, August 21, 2014 6:37 PM
To: Madam Secretary Sylvia Matthews Burwell, United States Secretary of Health and Human Services
Subject: Harsh tone requires an apology.

Dear Madam Secretary Burwell,

This past evening after emailing with Murray, a very dear and life-long friend, he had suggested I keep up my campaign to influence you and others in your administration to do the morally right thing while he also suggested toning down my rhetoric to you.

I am truly fortunate that many caring people read my missives and offer their thoughts and suggestions to help achieve our goals while at the same time emotionally sighting me on the objective.

If I’ve come off somewhat harsh in some of my words I do sincerely apologize.  

I understand that you do have a major governmental position and an enormous responsibility and that my issue and advocacy may seem minute in the scheme of things.  While our issue of VNS Therapy for the existing volunteer study subjects and patients implanted prior to CMS decision of May 4, 2007 may seem insignificant as compared to many of your other issues and challenges the fact is this group of patients has been egregiously wronged and harmed by those responsible within CMS to not have grandfathered and considered the medical needs and health insurance coverage for their care in that decision.  CMS cut off medical insurance coverage for medical devices already implanted into real-live-patients.  That decision also let the private health insurers off the hook whereas CMS has since partially made a make-shift effort to help the Medicare/Medicaid patients.

Please take a moment to think if it were your Mom or Dad, spouse or child or sibling implanted with a medical device and then you learn that the medical insurance you pay religiously will not cover your loved ones.  I’m sure you too would be agitated and fiercely advocating.

Only I’ve been at this advocacy for more than seven (7) years and prior to CMS denied coverage.  Actually my advocacy goes back half century when advocating for parity in mental health.  As my spouse Joyce was one of the earliest volunteer study subjects for VNS Therapy for depression I also recognized the potential loophole and conundrum in insurance coverage pending the denial from CMS.  At that time I conversed several times with the former CEO of Cyberonics, Mr. Skip Cummins, to share my thoughts and alert him to the predicament the study subjects were potentially facing.

As I am doggedly hounding you and advocating for these patients so too did I similarly direct my attention and efforts toward Mr. Cummins.  He assured me not to worry and then publicly issued the following corporate press release on January 18, 2006:  "Lifetime Reimbursement Guarantee for All TRD IDE Study Patients"

As it more recently evolved the current CEO, Mr. Daniel Moore, reneged on this guarantee citing federal kickback statues.

So here I am still bucking my head against all these bureaucracies trying to get department heads/bosses/CEO to act humanely and to do what is morally right. 

Joyce will need another replacement device in about 8 years.  I do not want to have to go through this same struggle to get her health insurer to cover her replacement or that of the other patients.  At the same time I want to pressure the private insurers to cover their already implanted patients and I can only do so with your help and assistance.

Again, I am asking for a moment of your time to issue a formal document (i.e. Compassionate Use) or some other instrument signed by you that will formalize and establish the rightful care for these patients, once and for all.

Sincerely,

Herb

Joyce and Herbert Stein

1008 Trailmore Lane

Weston, FL 33326-2816

(954) 349-8733

vnsdepression@gmail.com

http://www.vnstherapy-herb.blogspot.com

http://www.vnstherapy.wordpress.com

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Disclaimer: This E-Mail is covered by the Electronic Communications Privacy Act, 18 U.S.C. §§ 2510-2521 and is legally privileged. The information contained in this E-Mail is intended only for use of the individual or entity named above. If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. If you receive this E-Mail in error, please notify the sender immediately at the email address and/or phone number above and delete the information from your computer. Please do not copy or use it for any purpose nor disclose its contents to any other person.

CONFIDENTIALITY NOTICE: This e-mail message including attachments, if any, is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail, destroy all copies of the original message, and do not disseminate it further. If you are the intended recipient but do not wish to receive communications through this medium, please advise the sender immediately.

Thursday, August 21, 2014

How to Tell If Your Health Insurance Covers Mental Health Treatment

How to Tell If Your Health Insurance Covers Mental Health Treatment

 

Pending approval Elizabeth Renter

 

8/21/14 2:00pm 41 minutes ago

 

How to Tell If Your Health Insurance Covers Mental Health TreatmentExpand

For some, the stigma associated with mental illness keeps them from seeking help, but others may be avoiding treatment simply because they are unsure of whether they can afford it or whether their health insurance covers it.

This post originally appeared on Nerdwallet.

Each year, more than 5 million American adults experience a major depressive episode and do not seek treatment, according to a recent NerdWallet study. While insurance coverage for mental health treatment is more widely available and comprehensive thanks to recent changes, some say it still doesn't go far enough.

Five Lessons I Learned From Dealing with DepressionFive Lessons I Learned From Dealing with DepressionFive Lessons I Learned From Dealing with Depressio

Depression is a hard topic to talk about. It's an even harder thing to live through. I've …Read moreRead on

If you purchased your health insurance through state exchanges set up by the Affordable Care Act, mental health care is covered. It is one of the ten benefits that must be covered on all plans under the law. If you have insurance through your employer, there's a pretty good chance you're covered, too. A Society for Human Resource Management survey of 2014 employee benefits found that 87% of employer health plans cover mental health treatment. But exactly what mental health services are covered under these plans varies and depends on what medical services are covered.

Mental Health Parity Law

Historically, mental health coverage had been treated as a less important health concern than medical coverage by the insurance industry. That has changed over the years, culminating with the passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act in 2008. Also referred to as the mental health parity law, the act essentially mandates mental health and substance abuse coverage to be comparable to physical health coverage.

"New efforts are underway to expand coverage to the millions of Americans who have lacked access to affordable treatment for mental and substance use disorders," said Labor Secretary Thomas Perez, upon passage of the final parity rules. "These rules will increase access to mental health and substance abuse treatment, prohibit discriminatory practices and increase health plan transparency. Ultimately, they'll provide greater opportunities for affordable, accessible, effective treatment to Americans who need it."

The parity law says that insurance policies covering mental health care must treat that care as they do other medical coverage. If you generally pay a $40 copay for doctor's appointments and treatments, for instance, an appointment with your psychologist can't carry a higher price tag.

Before the final rules of the parity law took effect, patients in need of mental health treatment would often have to seek pre-approval for coverage, and even then, they would be limited to a certain number of visits per year. That is no longer the case. Though health insurance companies can always review whether covered treatments are necessary, they can no longer put arbitrary caps on mental health visits that they wouldn't put on medical appointments.

Depending on the specifics of your policy, and whether similar medical treatments are covered, your mental health coverage can include: emergency room visits, hospital stays, individual and group therapy appointments, psychiatrist visits and coverage for mental health prescriptions.

How Do I Select a Therapist or Counselor?How Do I Select a Therapist or Counselor?How Do I Select a Therapist or Counselor?

Dear Lifehacker, Things have been really rough for me lately, and I'm thinking about talking…Read moreRead on

Plans Still Not Required to Have Mental Health Coverage

"The parity law, on paper, certainly appears to be an improvement in health care policies", says Lisa Blackstock, a patient advocate from Soul Sherpa. "The key is whether or not your policy covers [mental] health care."

The law does increase the quality of care for those who have mental health coverage, but it does not mandate mental health coverage on all policies. Instead it requires health insurance plans that do cover mental health treatment to cover it on par with medical treatment. The American Psychological Association points out there are some programs exempt from the parity law. Some state government employee plans can opt out of parity requirements. Likewise, Medicare is not subject to the law.

Even if mental health coverage is available, some providers may not accept your insurance. Blackstock told NerdWallet that mental health providers are often reluctant to accept these policies because reimbursement rates are so low.

If you are unclear about your coverage, consult your description of plan benefits or contact your insurance carrier directly.

Deductibles and Copays Still Apply

The parity law, along with requirements under the ACA, may mean mental health care is more accessible than ever. But that doesn't mean there aren't costs. Just like your medical care, mental health care is subject to copays, coinsurance, deductibles and other out-of-pocket costs. It is likewise still subject to coverage denials from insurance companies.

You can prepare for these costs by becoming familiar with your plan's coverage specifics before you seek mental health treatment. If you receive an unexpected denial or higher-than-anticipated bills after treatment, you may find help through a medical bill advocate.

Blackstock says patients with mental health questions shouldn't be afraid to get help.

"My advice to all persons regarding emotional well-being and mental health is to maintain a strong support group, be open when stress gets to be too much, and don't be hesitant to appoint an agent for you in your advance health care directive who you can trust to help navigate your care when the going gets tough," Blackstock says. "If you incur a big bill for mental health treatment that isn't covered by insurance, find a patient advocate with a proven track record in bill negotiation […] Someone needs to pick it apart and aggressively advocate on your behalf, not unlike an attorney or realtor doing their job in their respective fields."

Does My Health Insurance Cover Mental Health Treatment? | Nerdwallet

http://www.nerdwallet.com/blog/health/2014/08/18/health-insurance-cover-mental-health-treatment/


Nerdwallet offers data-driven tools and impartial information to help you make solid decisions about the money you work hard to earn. In short, we do the homework so you don't have to.

Image adapted from Lightspring (Shutterstock).

Want to see your work on Lifehacker? Email Andy.

Wednesday, August 20, 2014

Message About Tragic Passing of Robin Williams

From: Herbert Stein [mailto:fabrik@bellsouth.net]
Sent: Wednesday, August 20, 2014 3:38 AM
To: Madam Secretary Sylvia Matthews Burwell, United States Secretary of Health and Human Services
Subject: Message About Tragic Passing of Robin Williams

Dear Madam Secretary Burwell,

“Unfortunately, every day over 100 Americans die as a result of suicide.” --- Jeffrey Borenstein, M.D., President & CEO, Brain & Behavior Research Foundation

Just what does it take for you and your cadre of subordinates to understand that there are a number of VNS Therapy volunteer study subjects and patients who have finally achieved a degree of wellness and wish to continue doing so if not for the obstacles your organization and the health insurance industry has put before them.

I have previously laid out before you that the CMS decision of May 4, 2007 was careless, ignorant, stupid, egregious, unconscionable and criminal by overlooking care for the existing patients and especially for those having benefited from the VNS Therapy and wishing to continue with the therapy.  Judge John Smith’s decision further justifies this position.

How many more individuals have to be added to Dr. Borenstein’s list of “Americans die as result of suicide”?  Does the buck not stop at your desk?  Are you not the “boss”?

Again, I am asking you for a formal document be signed to protect this patient population to insure that they have access to and obtain medical health insurance coverage.  I am also asking for your office to influence the private health insurance companies to similarly follow suit.

This issue has drawn on since May 4, 2007.  These patients have been seriously wronged like no other by the short-sightedness of CMS.  Is it not time to right this harmful wrong?  Please act now. 

Sincerely,

Herb

Joyce and Herbert Stein

1008 Trailmore Lane

Weston, FL 33326-2816

(954) 349-8733

vnsdepression@gmail.com

http://www.vnstherapy-herb.blogspot.com

http://www.vnstherapy.wordpress.com

---------- Forwarded message ----------
From: The Brain & Behavior Research Foundation <enews@bbrfoundation.org>
Date: Wed, Aug 13, 2014 at 1:03 PM
Subject: Message About Tragic Passing of Robin Williams
To: Herbert <vnsdepression@gmail.com>

 

View this email in your browser

clip_image002

Dear Foundation Supporters,I am saddened by the very tragic passing of Robin Williams. Unfortunately, every day over 100 Americans die as a result of suicide. The national conversation in the media about Robin Williams will hopefully encourage people to seek treatment and not suffer in silence. I also hope that the media attention will reduce stigma and encourage increased support for research to develop new methods of treatment of brain disorders. I had the privilege of representing our Foundation and joining the national conversation about suicide and suicide prevention. Please see the links to the CBS Evening News, WPIX News, and Bloomberg article.
Thank you for your ongoing commitment to the Brain & Behavior Research Foundation. Please help the families of today and tomorrow by SUPPORTING brain research.
Better treatments and breakthroughs come from scientific discovery.
With warmest regards and appreciation,
Jeffrey Borenstein, M.D.
President & CEO
Brain & Behavior Research Foundation


Read an article from Bloomberg.com.

bbrfoundation.org

 

Copyright © 2014 Brain & Behavior Research Foundation, All rights reserved.
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