The Obama administration touts it as a key solution to the nation’s runaway health-care spending: a new national center set up by the 2010 health-care law to test and implement groundbreaking ways to cut costs while improving patient care.

On Thursday, a little more than 14 months after the center opened, officials will release a report summarizing its progress: 16 recent initiatives, funded with more than $1.7 billion in federal money, that will involve more than 50,000 providers over the next five years.

The Center for Medicare and Medicaid Innovation is technically limited to experimenting with payment incentives and methods of delivering care within Medicare and Medicaid, as well as the Children’s Health Insurance Program (CHIP). But its director, Richard Gilfillan, said he will work with providers who also see a large share of private patients, to ensure that the models tested are effective for those populations as well.

The sheer number of seniors covered by Medicare and low-income Americans covered by Medicaid suggests that any changes embraced by the doctors and hospitals that serve those patients could soon be adopted system-wide.

“The reality is that over the years, the private sector has by and large followed Medicare’s lead in payment systems,” Gilfillan said. “Medicare has been the most innovative payer if you look back over the last 30 years.”

Like

Unlike

The current controversy over the publishing of H5N1 research is good news for one unlikely group: bioethicists. Controversy in medicine breeds conversation about ethical questions, and the more people are talking, the more likely researchers are to go looking for ethical guidance as they design studies. Some bioethicists think the best way to address such questions is via ethics consultation services that act independently of institutional review boards (IRBs) so that formal regulatory and informal consulting functions are kept separate.

One of those bioethicists is David Magnus, director of Stanford University Center for Bioethics in California. Writing today in Science Translational Medicine, Magnus and his colleagues argue that IRBs are ill-equipped to provide consultation to researchers on thorny protocol design issues in translational areas such as DNA banking and stem cell therapies because IRBs are already overseeing protocols as regulators..

“There are pitfalls to having a regulatory body in a consulting role,” Magnus told Nature Medicine. “It can lead to slowdowns in the oversight system.”

Like

Unlike

The pharmaceutical industry won approval to market a record number of new drugs for rare diseases last year, as a combination of scientific innovation and business opportunity spurred new treatments for diseases long-ignored by drug companies.

Drug companies are increasingly taking advantage of the commercial benefits of developing so-called orphan drugs, which include extra patent protections, higher pricing and a streamlined review process by FDA. Among the innovative treatments approved in the past year were the first new drug for lupus in 50 years and the first new drug for Hodgkin’s lymphoma in 30 years.

But the focus on specialty drugs has put pressure on the U.S. government to ramp up its own spending on vaccines, antibiotics and drugs for more widespread health threats, which are less profitable for companies.

Since 2006, government spending on research for familiar diseases like staph infections, smallpox and botulism has increased more than 660 percent, from $54 million to $415 million last year

Like

Unlike

The criteria for depression are being reviewed by the American Psychiatric Association, which is finishing work on the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., the first since 1994. The manual is the standard reference for the field, shaping treatment and insurance decisions, and its revisions will affect the lives of millions of people for years to come.

In coming months, as the manual is finalized, outside experts will intensify scrutiny of its finer points, many of which are deeply contentious in the field. A controversy erupted last week over the proposed tightening of the definition of autism, possibly sharply reducing the number of people who receive the diagnosis. Psychiatrists say current efforts to revise the manual are shaping up as the most contentious ever.

The new report, by psychiatric researchers from Columbia and New York Universities, argues that the current definition of depression — which excludes bereavement, the usual grieving after the loss of a loved one — is far more accurate. If the “bereavement exclusion” is eliminated, they say, “there is the potential for considerable false-positive diagnosis and unnecessary treatment of grief-stricken persons.” Drugs for depression can have side effects, including low sex drive and sleeping problems.

But experts who support the new definition say sometimes grieving people need help. “Depression can and does occur in the wake of bereavement, it can be severe and debilitating, and calling it by any other name is doing a disservice to people who may require more careful attention,” said Dr. Sidney Zisook, a psychiatrist at the University of California, San Diego.

Like

Unlike