Monday, July 28, 2008

Patching a hole in the Americans With Disabilities Act

Over the last ten year or so, the employment protections afforded to disabled Americans have shrunk as a result of federal-court decisions (notably the Supreme Court's decisions in Sutton v. United Airlines, 527 U.S. 471 (1999) and Albertson's, Inc. v. Kirkingburg, 527 U.S. 555, 565 (1999) focusing on who is a "qualified individual with a disability" and what is an "impairment." The gist of the rulings is that a person is not disabled for purposes of the ADA if the person can eliminate substantial limitations on major life activities by mitigating measures such as drugs, devices, and coping mechanisms. The National Council on Disability has a nice summary of the role of mitigating measures in ADA cases.

The House of Representatives recently passed a bill (HR 3195) to revamp some of the statutory language of the ADA in order to undo what the Court has done with Sutton and Kirkingburg. Both major-party presidential candidates have indicated their support (scroll down to "Broader scope for disabilities act") for such legislation, so maybe it has a chance of enactment.

Hey, didja know Michelle Obama's dad has MS? It's too bad that the causes of disabled Americans are fragmented into individual "disease lobbies," but wouldn't it be great to have someone in the White House who knew first-hand what it's like to live with MS?

More on worm therapy for MS

A while back, I mentioned that my neurologist was conducting a small study to see if ingesting the eggs of teensy little worm might benefit MS patients. It's been pretty well-documented that such intention infections have immunomodulatory effects, and now a recent study has identified specific effects that hold promise for MS. Snip:
Helminth infections in MS patients created a B-cell population producing high levels of IL-10, dampening harmful immune responses through a mechanism mediated, at least in part, by the ICOS-B7RP-1 pathway. The IL-10-producing B-cell phenotype detected expressed high levels of CD1d and was similar to the one observed in mature naive B2 cells (namely, CD11b(-), CD5(-), CD27(-), and IgD+). Moreover, B cells isolated from helminth-infected MS patients also produced greater amounts of brain-derived neurotrophic factor and nerve growth factor compared with those of normal subjects, T. cruzi-infected subjects, P. brasiliensis-infected subjects, or uninfected MS patients, raising the possibility that these cells may exert a neuroprotective effect on the central nervous system.

Thursday, July 24, 2008

MS in the US vs. MS in the UK

NPR has been airing stories comparing the American health care system to systems in other countries. This morning, a story used MS as a way of illustrating the differences between the US and the UK. Here's the gist: In Britain, Linda starts having odd feelings in her legs. Her GP refers her to a specialist, who promptly orders an MRI and other tests, which are performed the same day. Linda starts taking Copaxone, though the NHS does not cover it at the time. Later, the NHS approves Copaxone and refunds Linda's out-of-pocket costs. Her only complaint is that she has to pay for physical therapy. In the US, Jeffrey gets diagnosed with MS and loses his job due to disability. With no job, Jeffrey has no health insurance and can't afford his meds. He loses his house and declares banko. His doctors don't take Medicaid, and he ends up in the 2-year waiting period before Medicare will kick in. He attempts suicide, but fails. He now has coverage through his wife's employer, but it isn't as good as what he had when he was working.

Lucky Linda. Lucky Doug, too: I was studying in the UK when I developed the numbness in my legs that sent me to a GP, who sent me to a neurologist.

Every weekday, I silently curse the alarm clock when it goes off at 6. Then I thank my lucky stars that I'm lucky enough to still be working.