Eye on Washington

Members of Congress are at home this month, trying to persuade voters to return them to office in the November election. The conduct of the war-either on terrorism or in Iraq, depending on how you see the issue-is almost the only topic of campaign oratory. Promised big reforms-on lobbying, earmarked special interest legislation, Social Security, immigration, health care-have all gone by the wayside.

• Whenever the supposed link between autism and immunization has been questioned, those pursuing the debunking have deplored the lack of information on the actual causes of the disorder and called for research. Last month, the National Institute of Mental Health (NIMH) took a major step in that direction when it announced the launch of three major clinical studies of autism at its research program in Bethesda, Md. One study will compare children with regressive (loss of previously attained skills) and non-regressive autism with children who have one of a number of other developmental disorders and with children who are demonstrating a typical course of development. Another will examine the use of minocycline, an antibiotic with anti-inflammatory effects, on regressive autism. A third study will evaluate chelation therapy, espoused by believers in the thimerosal theory and by others.

• Loose ends that Congress left behind when it adjourned last month included action to stave off cuts in Medicare reimbursement to physicians and hospitals that were scheduled to take effect in 2007, and a package of regulations and incentives intended to prod hospitals and physicians to adopt information technology (IT) appropriate for the 21st century. The reimbursement battle pits physician and hospital organizations-whose members feel squeezed by current reimbursement levels-against those in Congress committed to restraining Medicare spending and imposing higher standards of quality on Medicare providers. The IT stalemate between House and Senate versions of the legislation has to do with differences on whether hospitals that provide software to physicians should be exempt from anti-kickback laws, as well as differences about funding, privacy provisions, and interoperability.

• A year ago, an Institute of Medicine (IOM) report deplored widespread overweight and obesity in our nation's children and called on the federal government, the food industry, schools, and parents' groups to do something about it. Last month, IOM revisited the topic at the behest of the Robert Wood Johnson Foundation to examine what progress has been made on curbing the epidemic. The answer, in a phrase, is: some but not much, and certainly not enough: "The current level of investment by the public and private sectors still does not match the extent of the problem.... Interventions generally remain fragmented and small-scale." For details on what's been accomplished and what needs to be done, download "Progress in Preventing Childhood Obesity: How Do We Measure Up?" at http://www.iom.edu/.

• Parents who grew up with the popular cartoon character Popeye heard the gruff sailor tell them he was "strong to the finish/Cause I eats my spinach." So the news last month for Mom and Dad, earnestly cajoling their offspring to eat the green stuff, was a shock: According to the FDA, bagged fresh spinach was the likely culprit in an outbreak of deadly Escherichia coli O157:H7 disease. Consumers were advised to throw out bags in their refrigerators and not to buy any more. The product disappeared quickly from produce departments in markets across the country. Illness has been reported in more than 20 states, including Idaho, Indiana, Michigan, New Mexico, Oregon, Utah, and Wisconsin-approaching 200 cases reported to the Centers for Disease Control and Prevention by late September. That toll includes eight cases of hemolytic-uremic syndrome and one death.

• A US District Court judge has ruled against the tobacco industry in a racketeering case brought by the Department of Justice (DOJ), finding that Big Tobacco conspired to deceive the public about the dangers of smoking over a 50-year period. The Court's ruling ordered the companies to stop using such meaningless terms as "light" and "low-tar" in their advertising, place "corrective statements" in advertising, and provide the court with detailed marketing data for the next 10 years. The new ruling gathered additional impact from a finding by the Massachusetts Department of Health that the nicotine content of cigarettes had increased by about 10% between 1998 and 2004. Higher nicotine content makes the cigarette habit harder to kick-and the added wallop can hardly be a coincidence.

• The National Institute of Child Health and Human Development (NICHD) has launched a redesigned Web site ( http://www.nichd.nih.gov/) where parents, pediatricians, researchers, and the media will find a range of information on how children grow, learn, and cope with disability. The site's A-to-Z list of topics reveals the breadth of NICHD's portfolio-from attention deficit hyperactivity disorder and autism to gestational diabetes, preeclampsia, fragile X syndrome, reading disabilities, and sudden infant death syndrome (SIDS). The site provides links to relevant NICHD publications, clinical trials, and public education campaigns.