The Centers for Medicare & Medicaid Services said it is not formally seeking to alter its current policy of covering the surgery, but some analysts and doctors have voiced concern that officials may use the panel recommendations to reverse course.

Such a turnaround would affect a number of companies that make related products, including Medtronic Inc, Stryker Corp and Johnson & Johnson's DePuy unit, as well as some hospitals and surgeons. Many private insurance companies also base their own coverage on Medicare policy.

At the meeting, most panelists said overall fusion was reasonably likely to be beneficial in the short term but less likely in the long term, based on available data.

Results from several major studies are less likely to be useful in determining possible risks for Medicare patients, they also said. The panel was more mixed over whether the findings could help gauge pain relief for those patients.

The panelists told Medicare officials that current studies are flawed and more solid trials are needed.

"I don't think there's enough information," to compare the various data, panelist Dr. Steven Ondra, a surgeon at Northwestern University, said. So we now need to know how "to design a study to answer these questions."

Six groups representing surgeons told panelists that while more evidence is needed, data now show fusion helps some patients regain basic functions like walking. Most of the doctors who spoke said they received some funding from device makers.

Another expert, University of Washington surgeon Dr. Sohail Mirza, told the panel the number of fusion procedures for degenerative discs is growing, especially among the elderly.

In 1992, Medicare paid $75 million to cover fusion compared to $482 million in 2003, he added.

Device makers are developing more artificial spinal discs as an alternative that aim to relieve pain while allowing the spine to move.

"Artificial disc replacement may get around some of the problems with fusion...but that, I think, remains to be shown," Mirza said.

Medicare earlier this year agreed to pay for Johnson & Johnson's Charite disc for those younger than 60 but questioned its benefits as well as those of fusion. This week, the agency said it would reconsider its spinal disc coverage.

That could pave the way for older Medicare patients to receive Synthes's ProDisc, which won U.S. approval in August. Medtronic and Stryker are also developing their own discs, which have not yet been approved.

Steve Phurrough, director of coverage for the Centers for Medicare & Medicaid Services, said the agency was unlikely to curb coverage. "I think we would have a difficult time saying we would not pay for fusion except in trials. That would be a challenge," he said.

Medicare is expected to post the final panel votes on its Web site by Monday.

Copyright © 2006 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

Urban living linked to higher rates of bulimia

Last Updated: 2006-12-01 13:00:29 -0400 (Reuters Health)

By Patricia Reaney

LONDON - Living in big cities raises the risk of suffering from the eating disorder bulimia but not anorexia nervosa, Dutch psychologists said on Friday.

They found women in cities were five times more likely to have the binge-and-purge illness than those who live in villages and hamlets but that there was no difference in anorexia rates.

Although the research was done in the Netherlands, Gabriella van Son, of the Center for Eating Disorders in Leidschendam believes the findings are relevant to other developed countries.

"Bulimia, which is closely related to anorexia nervosa, is more common in large cities when you compare it with rates in rural areas," she said in an interview.

"The number of newly diagnosed patients with bulimia is about five times higher in cities."

Bulimia and anorexia affect mainly girls and women. Both are linked with an obsessive desire to be thin.

But while anorexics eat very little, bulimics binge and then force themselves to vomit or use laxatives and diuretics to purge food from their body.

Anorexia usually begins during the teen years and bulimia, which affects about one percent of women, can occur at the same time or later. Both can be treated with behavioral therapy and counseling.

"Bulimia is also more secretive than anorexia because people are ashamed of their behavior. They try to avoid telling other people about it," said Van Son.

She and her colleagues, who reported their findings in the British Journal of Psychiatry, said they do not know why there is a difference in the incidence of bulimia between women in cities and rural areas.

"The reason for the association is speculative," she said.

They suggested it could be related to the anonymity of cities where it would be easier for a woman to conceal her bulimia and use of laxatives than in a small town.

Women may also have symptoms that are not detected until they are older and have moved to urban areas to continue their education and to further their careers.

The findings are based on a study of newly diagnosed cases of bulimia and anorexia by a network of 63 general practitioners between 1985-1989 and 1995-1999. The bulimia rate was 2.5 times higher in urban areas than in the countryside and five times higher in large cities.

Van Son said the findings provide a promising avenue for further research into the causes of bulimia and anorexia.

Copyright © 2006 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.