DHMH Daily News Clippings


Columbia Council joins opposition to methadone clinic (Baltimore Sun)
Oral cancer gets more focus locally (Carroll County Times)
Bioterror Self-Triage Hopes to Avert Panic (Washington Post)
Nursing needs some nursing (Salisbury Daily Times)
Patients' satisfaction may be tested in report (Baltimore Business Journal)
NIH's neighbors worry over new biodefense lab (Daily Record)
Recovering addicts discover strength in artistic endeavors (Baltimore Sun)
Add-Ons Expand Medicare Measure (Washington Post)
Reaction mixed in Singapore to SARS vigilance (Baltimore Sun)
Prescription for Politics (Wall Street Journal)
Smallpox Fiasco (Washington Post Editorial)
The Booze Lobby vs. America's Youth (Washington Post Commentary)
Methadone patients need manners lesson (Baltimore Sun Letter to the Editor)
Consumers can go online for updated health information (Baltimore Business Journal Letter to the Editor)
Senator says he's had enough of CareFirst BlueCross BlueShield (Baltimore Business Journal Letter to the Editor)




Columbia Council joins opposition to methadone clinic
Residential site for center inappropriate, critics say; 'We'll all work together'

By Laura Cadiz
Baltimore Sun Staff
Monday, July 14, 2003

The Columbia Council has pledged to support the Oakland Mills community in its protest of a proposed methadone clinic that is scheduled to open in the village.

In a resolution the 10-member council unanimously approved Thursday night, the council voiced its opposition to a methadone facility opening in an Oakland Mills residential area or any similar site in Columbia.

"It's all of Columbia, not just the Village of Oakland Mills," council Chairman Miles Coffman told a group of about a dozen Oakland Mills residents at the council meeting. "We'll all work together on this one."

Coffman said the council would collaborate with Oakland Mills residents to contact local, state and federal officials to voice their opposition to the center planned at Stevens Forest Professional Center.

The clinic, Human Care Development Service, would be dispensing methadone -- a synthetic opiate intended for heroin addicts to control withdrawal symptoms and curb their addiction -- near four schools and three preschools or day care centers.

The clinic's president, Aktam Zahalka, had been working with Howard County Councilman David A. Rakes to try to find another location after facing overwhelming community opposition.

But after Zahalka and Rakes visited a number of sites Wednesday without finding a suitable location, Zahalka said he would open the clinic in Oakland Mills.

Zahalka has said the clinic's lease begins this month, but he does not know when the facility will open. The clinic is not fully approved.

Councilman Joshua Feldmark of Wilde Lake said a clinic dispensing methadone in a residential area is a "horrible idea," and the council should develop a plan to protest the facility.

"I think this is a good time for us to show what we can really be for the people of Columbia," Feldmark said.

Residents asked the council for its help Thursday night, explaining that they feared the clinic would attract more traffic, crime and drug dealers to the area.

"We cannot allow this to happen to any of Columbia's neighborhoods," resident Charlie Koppelman told the council. "... The proper place for a drug treatment clinic is in a location that is primarily commercial or near the Howard County hospital complex. The proper place is not in a residential neighborhood like Oakland Mills or River Hill or Dorsey's Search or any other of Columbia's residential neighborhoods."

Barbara Russell of Oakland Mills told fellow council members that she was grateful for their united support and said it was important for them to act as "one voice, saying we represent Columbia ... and [the proposed clinic] is an improper and awful thing."

Also Thursday, the Columbia Association's board of directors -- which is comprised of the same 10 people on the council -- approved $265,000 to renovate the Hobbit's Glen Golf Club clubhouse.

For the fiscal 2004 budget, the board had approved $175,000 so the association could study necessary repairs. The amount was not based on specific estimates, said Rob Goldman, the association's vice president for sports and fitness.

The repairs will include renovating the clubhouse's locker rooms, improving its fire detection system and making the entryway comply with Americans with Disabilities Act requirements.

Goldman originally proposed a $375,000 project, which included renovating the clubhouse's loft and making additional improvements to the entryway. But the board felt those were unnecessary at this time.

The golf course is scheduled to undergo a major renovation in August to repair its damaged greens, and the course will be closed until May. Goldman said the project will cost at least $65,000 less than the $679,000 that the board approved for the project.

Copyright � 2003, The Baltimore Sun



Oral cancer gets more focus locally

By Maria Tsigas
Carroll County Times Staff Writer
Monday, July 14, 2003

Maryland ranks eighth in the nation in the number of deaths from oral cancer, prompting Carroll County to launch its own campaign to increase awareness and promote the prevention of this sometimes deadly and often overlooked disease.

Oral cancer affects over 500 Marylanders each year, with 65 percent of those diagnosed at a late stage of the disease, when its usually very difficult to treat, according to the state's Department of Health and Mental Hygiene.

Oral cancer refers to a cancer of the mouth, tongue, lips, gum area or throat.

The five-year survival rate of these cancers is only about 50 percent, according to the Centers for Disease Control and Prevention.

Dr. Elizabeth Ruff, deputy health officer of the county's Health Department, said the Health Department received a $20,000 grant in July 2002 from the state to promote oral cancer screening throughout the past year.

The grant was specifically used to increase awareness about the disease through community events, such as health fairs. By increasing awareness, the people most at risk would be encouraged to undergo early screening, Ruff said.

She said the information reached about 30,000 people who attended those community events and that 2,000 people received direct instruction.

Ruff said the Health Department, in conjunction with Carroll County General Hospital, also conducted oral cancer screening training for 58 health care workers, which included dentists, physicians and health department staff.

Dr. Pari Moazed, president of the Carroll County Dental Society, said early detection is vital in battling oral cancer. If left undetected and untreated, it can lead to death. Also, treatment of late-stage oral cancer can be very invasive and the patient may have to undergo chemotherapy, radiation and possibly the removal of an organ, such as the tongue or jaw bone.

However, the foolproof method of avoiding the disease is awareness and prevention.

"Ninety percent of the people diagnosed with the disease use tobacco products of one kind or another. Eliminating the use of these products can significantly reduce the possibility of developing the disease," Nelson Sabatini, secretary for the state's DHMH, said in a statement.

Tobacco smoking, which includes cigarette, cigar or pipe smoking, and use of smokeless tobacco, particularly when combined with heavy alcohol consumption - greater than or equal to 30 drinks per week - has been identified as the primary risk factor for about 75 percent of oral cancers in the United States, according to the CDC.

The disease is six times more prevalent in alcohol drinkers than in nonrinkers, according to the DHMH.

Prolonged exposure to the sun is also a risk factor for oral cancer. Over 30 percent of patients with lip cancers have outdoor occupations linked with increased exposure to sunlight, according to the DHMH.

Moazed said dentists and doctors should screen for oral cancer during annual visits.

Danger signs

Consult a doctor or dentist if the following signs and symptoms are prevalent for more than two weeks:

# A white or red patch in mouth

# A sore, irritation, lump or thickening of the mouth

# Hoarseness or feeling that something is caught in the throat

# Difficulty moving the tongue or jaw

# Numbness of tongue or other areas of mouth, or

# Swelling of jaw that causes dentures to fit poorly or become uncomfortable.

For more information on oral exams and oral cancer prevention, call the local health department or go to www.maryland-oralcancer.org

Source: Maryland Department of Health and Mental Hygiene

Copyright � 2003 Carroll County Times



Bioterror Self-Triage Hopes to Avert Panic

By Avram Goldstein
Washington Post Staff Writer
Monday, July 14, 2003; Page B01

Bioterrorism experts are developing a do-it-yourself triage system in an attempt to prevent panicky crowds from overwhelming Washington area hospital emergency rooms during an epidemic or terror attack.

The idea is to get the public to use a sophisticated electronic questionnaire that would get an instant medical risk assessment and to help persuade those who seem not to be at risk to stay away and give medical professionals time to focus on patients who are.

After the computer leads someone through the questions, either online or over the telephone, the patient would be advised according to what the symptoms seem to be. The options the system might offer include: stay home in voluntary quarantine, go to a designated site for follow-up care, move to an isolation facility or just relax.

The system could be updated with localized information about the hazard and the nearest appropriate medical help, said one of its developers, Georgetown University biodefense coordinator Michael D. McDonald. Programmed correctly, it could be used to respond to severe acute respiratory syndrome, smallpox, nerve agents, radiological hazards and unforeseen diseases or emergencies.

The project is being coordinated by McDonald and Harvard psychiatrist Stephen E. Locke. They have secured no formal funding commitments, but Georgetown officials are conducting meetings that include discussions of the concept with public health officials.

Proponents say the electronic assessments would ease pressure on hospitals while protecting the so-called "worried well" from gathering where they would be in close quarters with people who actually had been exposed to pathogens or chemical agents.

Some experts, though, question whether the screening tool might give bad advice, and they said they doubt many people would seek or accept electronic advice when they are fearful. Others said they worry the system might inadvertently discourage some sick people from seeking help that they need.

Most local public health officials and bioterrorism experts are not familiar with the program, but several said anything that might limit a post-event surge of people to hospitals would be welcome. "If it doesn't cost much and keeps anybody away from the ER, it's worthwhile," said Arlington County Health Director Susan Allan.

"Many patients we saw in our emergency room during the anthrax attacks would not have needed to come in for care if they could have had simple questions answered," said the director of a large emergency room who spoke on the condition of anonymity. "You could lop 20 or 30 percent off the top."

"It's a very exciting and potentially valuable tool," said Michael S.A. Richardson, the D.C. Health Department's chief medical officer. "It gives the public a way to access important information in a crisis so they can act appropriately . . . The physical facilities are not going to be able always to handle large amounts of people efficiently. Large groups of people should not be out on the streets."

Richardson wants the District to anchor the Washington region testing of the software, and triage system leaders at Georgetown and Harvard say they plan to make the national capital area a "test bed" for the project, along with Pittsburgh and Massachusetts. Another group is working on a similar concept in Los Angeles, they said.

But McDonald and Locke said that some experts have doubts. "Somebody is scared to death, and you suggest going to the computer and starting to answer questions," said Ken Alibek, a former Soviet bioweapons expert who defected and now is a biodefense specialist at George Mason University. "Some people would do it, but the great majority wouldn't be able to do it. The major engine is fear."

Concern about the "surge capacity" of health care facilities has sharpened since the anthrax attacks of 2001, when about 20,000 people in the region were given preventive antibiotics, mostly by public health agencies.

Thousands of others went to doctors and emergency rooms complaining of symptoms. Few turned out to be at risk of contracting anthrax. The rest, McDonald said, were somatizing -- experiencing physical symptoms caused solely by psychological distress. Experts say physical ailments rooted in the mind account for up to half of office visits to primary care doctors.

"Even in normal times, somatization is the leading reason why people seek care from a doctor," said Locke, who also is president of the American Psychosomatics Society. "People go to doctors with physical complaints in which careful evaluation fails to reveal an organic cause from one-third to one-half of the time."

In a major outbreak, stress-related symptoms could run wild, causing huge lines and flooding facilities with people who do not need to be there, McDonald and Locke say.

"Conservatively, the somatizers will likely outnumber those actually exposed by 5 to 10 times," according to a report on the screening tool by Harvard researchers supervised by Locke. "However, it is conceivable that this number may in fact be much larger."

Georges C. Benjamin, executive director of the American Public Health Association and former Maryland health secretary, said he knows telephone triage protocols can be effective because he used to write them for private health plans.

"You absolutely can sort people into high-risk and low-risk groups," he said. "The research needs to be done to figure out what you do with people who are giving you exactly the symptoms they read about or saw on television . . . And you have to make sure that you identify people who are both somatizing and [also] sick."

SARS, smallpox, chemical agents, radiological bombs or an entirely new "engineered agent" -- a combination of deadly pathogens -- could trigger a far more intense public response than anthrax did, according to experts working on the triage project.

"When you put a lot of people under stress, you suddenly have a huge surge in demand of people needing help determining whether their symptoms are due to stress or exposure," Locke said.

Models of the questionnaire ask for personal and contact information, take the patient through descriptions of symptoms, inquire whether the patient often somatizes and ask about the patient's attitudes about health care and life.

Dan Hanfling, director of emergency management and disaster medicine for Inova Health System, said of the anthrax scare that brought large numbers of the uninfected people to emergency rooms, "That opens a window of experience on what we are likely to face in the next event." He added, "We need to preserve the ability to deliver acute health care. This will have hiccups, but I think it's a great step in the right direction."

Some say they think the system needs extensive testing. "I think the concept would be fine, but I see all kinds of possible problems," said Philip S. Brachman, an Emory University epidemiology professor who spent 32 years at the Centers for Disease Control and Prevention in Atlanta. "It has to be field-tested very carefully in a random way with good controls by an independent group."

� 2003 The Washington Post Company



Nursing needs some nursing
Years of decreased nursing enrollment, an aging nursing workforce and a baby boom bubble make this profession highly in demand

By Robin S. Wallace, Delmarva Business Weekly Editor
Salisbury Daily Times
Monday, July 14, 2003

In an economy facing the highest number of Americans filing claims for jobless benefits in five weeks, the job market seems to be bleak at best. But for Laurel native Shea Ellis, who just graduated from Salisbury University, securing a job caused very little trouble. In the fall, she begins her career at Georgetown University Hospital.

Finding a job for Chris Ackerman, a fellow SU graduate and resident of Sykesville, Md., wasn't the issue. Rather, she discovered that her degree brought competitive offers from various companies and even a cross-country flight to San Diego, where she interviewed and accepted an offer with The Children's Hospital.

While recent graduates and workforce veterans struggle across the nation to attain and retain employment, these two women represent a profession where the demand is so great, that it will take decades to fulfill the needs.

In these turbulent times, nursing may be the hottest ticket for a secure career.

While this field has received much public and media attention in the past year, the need for nurses has not been all that new to the health care industry. In fact, it has been the result of a couple compounding issues that plays a pertinent role in everyone from college students' to retired people's lives.

Nursing shortages have been declared in more than 30 states, and that number is projected to climb in the next couple years.

"The projections right now are that in another seven to eight years we will still have 40 to 42 states with a declared nursing shortage," said Susan Battistoni, chair of the Salisbury University nursing department. "So this is not going to be a problem that will go away any time soon."

According to the U.S. Bureau of Labor and Statistics, the year 2010 will bring a need for 1 million new and replacement nurses.

The causes to this dilemma, that stretches beyond the borders of the United States, stems from four notable issues: Steep population growth in several states, a diminishing pipeline of new students, an aging nursing workforce and a baby boom bubble that will require additional health care services.

Decreased nursing enrollment

With the enrollment in entry-level baccalaureate nursing programs down by 10 percent since 1995, the health care industry and educators have watched a generation of students bypass the profession for other career options.

"Usually somewhere around middle school the career choice is made -- it may not be exact, but the process has begun," Battistoni said. "And if you look at the time when the students who were enrolling in 1995, they grew up in a time when so many choices were available, and especially for women."

According to Denise Marshall Wor-Wic Community College chair of nursing, the transition of women out of "the traditional three -- homemaker, teacher and nurse," has been a direct result of more avenues that women can take and consequently, a factor in the nursing shortage.

Gaining national attention, the shortage has evoked the help of Johnson and Johnson through a national media campaign "for enhancing the image of nursing and gearing it for 6 to 15 year old students with the message that you can make a difference in someone's life and taking away the image of the lovely lady in the white dress who takes care of sick dogs and children," remarked Battistoni. "So they are showing nurses doing so many different things."

Since image has a lot to do with recruiting, Salisbury University holds an annual open house to recruit students to the nursing department. Since the high schoolers do not have to be accepted to the university, the department's main mission lies in educating and providing students with information on the profession.

In recent years, it seems that the image of "the lovely lady" has slowly been broken, with men stepping across the stereotypical gender lines of the profession.

"It is reasonably safe to say that as a profession we are getting more and more men into the field," Battistoni said. "I think that it has a lot to do with men being more secure with it being "OK" to be caring and the idea of taking care of children."

Still the enrollment issue persists.

"Since 1995 enrollment has dropped but if you look at the past 2 years you'll find that the enrollment numbers have gone up, yet nowhere

Originally published Monday, July 14, 2003

Copyright �2003 DelmarvaNow



Patients' satisfaction may be tested in report

Tim Hyland
Baltimore Business Journal Staff
Monday, July 14, 2003

The Maryland Health Care Commission's nursing home report card, a guide that reveals the best and worst of Maryland nursing homes, may be getting a makeover sometime soon.

Then again, it may not.

The commission is seeking proposals from companies with ideas on how the state can incorporate a patient satisfaction component into the existing nursing home information database. The patient satisfaction information would add an important new component to the system, which as of now provides information on quality of care, resident characteristics, compliance records and other information about the state's nursing homes.

Though the commission (www.mhcc.state.us) believes the patient-satisfaction component would be a useful addition to the current reporting system, they also know getting that information could be complicated, expensive and, ultimately, impractical, said Enrique Martinez-Vidal, deputy director of the commission.

"Most of the anecdotal evidence is that these things are very expensive," Martinez-Vidal said.

The commission first considered adding a patient-satisfaction component to the system while developing the guide, but eventually decided to put the idea on "the back burner" because of its complex nature and because of more pressing issues, including finishing the state's hospital report card system.

Now that nursing home and hospital guides are up and running, the commission believes it is time to revisit the patient satisfaction issue. But there's no rush, Martinez-Vidal said.

"The reason we didn't go out and say, 'Let's have somebody do it,' is because we want somebody to review what's out there," he said.

Getting patient satisfaction in nursing homes is made more difficult by the nature of nursing homes themselves. Families and patients may not necessarily be capable or willing of offering useful, unbiased information.

"There's a lot of difficult issues in cognitive ability, and you can just imagine the issues that go on with the emotional aspect," Martinez-Vidal said. "Most people don't want to be in a nursing home. So are they critiquing it because they hate it, or are they doing it more objectively? The same sort of issue comes up for families. There's all kinds of emotional issues tied up with that. Are you going to say, 'This nursing home is horrible,' even though you just put your mother in there?"

Academics are looking for other ways to get the information using doctors or other staff, but they have not found any answers yet. The commission hopes to get a better idea of what tools exist to accurately and inexpensively get the patient satisfaction information. A recommendation is likely by the end of the year, Martinez-Vidal said.

"It may just turn out that while it's a great idea, it's cost-prohibitive," he said.

UM declared safe haven for confidential service

The University of Maryland Hospital for Children this week declared itself a "safe haven" for women who have given birth to unwanted children.

Under the Maryland Safe Haven Act, women who come to the hospital with unwanted newborns -- the children can be no more than three days old -- will have access to medical care and adoption services. The service is anonymous and confidential, and the women are also shielded from legal action. The children will be put up for adoption.

Malpractice reform hits the U.S. Senate

The U.S. Senate this week was set to consider legislation that would set a strict cap on the amount of money patients and their families could win from malpractice suits.

Though a similar bill has already passed the House and the malpractice caps have the support of the Bush administration, by press time the medical liability bill -- which would have set caps on pain and suffering due to malpractice at $250,000 -- seemed doomed to failure.

But while the movement may have stalled for now, it's unlikely to go away for good, and a compromise bill is not unlikely. That means changes to Maryland's malpractice caps -- currently set at more than $600,000 -- aren't entirely out of the question.

If a low federal cap were to be implemented -- even if the new law were to exempt Maryland and other states with existing caps -- doctors and others here would likely seize on the federal action to bring similar changes home to Maryland.

"We think that would give a pretty powerful signal," said Michael Preston, executive director of MedChi, the state medical society (www.medchi.org). "It would have the effect of setting a national standard, and clearly that would be something that we and others would be interested in seeing emulated here."

� 2003 American City Business Journals Inc.



NIH's neighbors worry over new biodefense lab

By Stephen Manning, Associated Press
Daily Record
Monday, July 14, 2003

Its name seems harmless enough � Building 33, a laboratory planned for the edge of the National Institutes of Health's Bethesda campus.

But inside the 150,000 square-foot facility, the federal government plans to house researchers working on potentially lethal airborne germs such as severe acute respiratory syndrome, anthrax and tuberculosis.

That has residents in the high-density neighborhoods around NIH worried that the lab would be a target for terrorists seeking a convenient way to let loose biowarfare agents.

�If the whole building blows up and all kinds of things are airborne, we're going to be affected,� said Marilyn Mazuzan of the nearby town of Oakmont.

NIH plans to begin work in August or September on the $186 million building a few hundred feet from a heavily traveled intersection in Bethesda near the Capital Beltway. The lab is slated to open in 2005.

About 25 scientists and 240 workers will use Building 33 labs to study dangerous infectious diseases to develop possible treatments. The facility will be outfitted with biosafety level 3 labs, which have double doors and negative airflow systems to keep germs from escaping. Workers will wear protective suits to shield them from contamination.

NIH already has several high-security laboratories on campus, including a small biosafety level 4 lab that has even more rigorous safety standards than the proposed Building 33.

The lab, which has been planned for five years but didn't receive funding until this year, will be just as safe as the other secure labs on the campus, said Stella Fiotes, director of the facilities planning division.

�The whole notion of biodefense is a scary notion, I understand that,� she said. �But I don't think this facility is any higher risk than any of our other facilities.�

Nearby residents wonder why it is necessary to build the lab in the heavily populated Washington suburbs.

At the very least, many want NIH to move the building away from the edge of its 332-acre campus to a more central location, away from the busy road. Residents say that would make it harder for a terrorist to use a truck bomb or other explosive to attack the building.

They suggest the facility be moved to a place like Fort Detrick in Frederick, an Army post that conducts research on deadly biological agents. The National Institute of Allergy and Infectious Diseases, or NIAID, plans a biosafety level 4 lab at Fort Detrick, about 40 miles northwest of Washington.

�I don't think it should be done in Bethesda with the density of population that we have,� said Eleanor Rice, who once worked at NIH and lives nearby.

Tom Kindt, director of intramural research at NIAID, said it is logical to put the biosafety level 3 lab on the Bethesda campus. The work done in Building 33 will be part of larger programs at other NIH labs and researchers can do clinical work with patients on campus.

�It's not a new program. The majority will be expansion of ongoing research,� he said.

Residents got a boost Wednesday from Rep. Chris Van Hollen, a Democrat who represents the area. Van Hollen sent a letter to NIH Director Elias Zerhouni, urging him to release more information about the planned lab.

NIH has stepped up security since the Sept. 11 terrorist attacks, and is in the process of building an iron fence around the perimeter of its campus to limit access to the grounds.

Van Hollen wondered why NIH would build the lab so close to the street if it thought the threats the installation faces are real enough to build the fence.

�Why they would build this lab on one of the biggest intersections in Montgomery County seems to be inconsistent with their arguments about the need to take those security precautions,� he said.

NIH has hired a consultant to review the security of the proposed lab and is reviewing possible disaster scenarios that seem straight out of a thriller novel. They include a terrorist dropping a bomb on Building 33 from a hovering helicopter, the theft of pathogens from the lab or the accidental release of germs through a malfunctioning ventilation system, according to Ralph Schofer, a member of the NIH community liaison panel.

However, the terrorism fears are a bit overblown, according to Kindt. Even a major explosion Building 33 would likely not put nearby homes at risk. Heat from an explosion would probably destroy most of the organisms scientists are working with, except for anthrax.

�If one draws a circle around the exact location of the building, the possibility of damage to neighborhoods is not so great,� he said.

Despite their concerns, many in the neighborhoods around NIH have concluded the lab will eventually be built. The drive for homeland security far outweighs their worries of terrorism, some say.

�I have great doubt about whether our voices are really going to make a difference,� said Jack Costello, a member of the Bethesda Parkview Citizens Association.

Copyright 2003 � The Daily Record. All Rights Reserved.



Recovering addicts discover strength in artistic endeavors
Meetings at Arundel clinic foster friendships, healing

By Kara Eide
Baltimore Sun Staff
Monday, July 14, 2003

Mike Kimble says his painting technique comes from natural ability. But painting and visual art in general offers the recovering addict more than just a showcase for his talent.

"I'm really high-strung, so this calms me down," said Kimble, 45, who takes part in a weekly art group as a patient at the Adult Addictions Clinic of the Anne Arundel County Department of Health.

The dozen or so members of the 3-year-old art group meet Wednesday mornings for 90 minutes in a basement room at the clinic building, where they can express themselves visually and bond together.

With soft music in the background and a watercolor technique video playing silently in the corner, they work around a large table dotted with sponges, brushes, palettes, name placards and instruction books. The object is to promote socialization and self-esteem, said Roberta Brown, clinical supervisor and leader of the group.

"The art group is just an extension of helping them with other issues in their life," she said.

Brown, the group's originator, said participation is voluntary. Patients can join after they complete required educational counseling groups at the clinic.

Once admitted to the art group, the patients' work is entirely their own creative endeavor, from abstracts to landscapes, sculpture to photography.

"After an addiction, most of us feel like we have nothing to offer, and no creativity, but it makes you realize you can still do things," said Ginny Slabaugh, 33, another patient in the group. "And it builds your confidence."

The clinic admits people who have addictions to drugs such as heroin and pain medication, said James Dorsey, medical director at the clinic. Many have other addictions as well, such as to cocaine or alcohol.

Dorsey's role at the clinic is to prescribe methadone for patients. Methadone is a substitute narcotic used to treat heroin addiction.

Group interaction

Prescription treatment aside, the art class fulfills another need, Dorsey said.
"Methadone doesn't really treat the substance-abuse problem, but just prevents [the patients] from having withdrawal problems," he said. "Other activities treat the substance-abuse problem."

That's been the case for Kimble, who said he was "a mess" before he came to the clinic. "I just couldn't get myself together," he said.

Kimble, who has been attending for more than a year, said his favorite aspect of the group is the interaction with the rest of the class.

"I enjoy it. I look forward to it," he said as he painted a tropical beach scene with a deep-purple sky.

In fact, the group members enjoy it so much that last year they got together and successfully lobbied the staff to lengthen the sessions from one hour to 90 minutes.

"We'd actually like to extend it even longer," said Kimble, who drives in from his Pasadena home. "I wouldn't mind if it was a couple days a week."

"It's kind of like hanging out with a bunch of friends," said Garry Seals, 32, who on a recent day was painting concentric circles in shades of blue. "I'd be comfortable discussing just about anything that's going on with me with the people here."

The art of learning

The patients' efforts are further rewarded with artwork displays. In a public show held one day last month, visitors could view the patients' creations, including tie-dye, hand-tinted photos, decoupage, homemade Christmas ornaments and cigar boxes with collages. The works are still on display in the clinic building.

After each new art project, Brown issues written questions for the patients to use in evaluating themselves and reflecting on their feelings about doing the artwork. They considered, for example, whether a finger-painting stint was more freeing or frustrating.

"The art group is just an extension of helping them with other issues in their life," Brown said. "We do see patients progress from coming to the art group."

Dorsey said he saw such progression in the attitude and sociability of the patients. "Sometimes when they've been in the art group, we start noticing things, like they start speaking," he said. "They tend to smile, whereas before they didn't."

While encouraging social interaction, the art group also offers mental relief, according to patients and staff.

"It's hard coming off an addiction," Slabaugh said. "You're not used to sitting down and keeping your mind occupied on one task." But the art group promotes that, she said.
And other patients said the class was one place where they didn't have to sit around and talk about themselves for a length of time.

"It brings my thoughts together so I can focus on something instead of being all over the place," Kimble said. "It's very therapeutic."

Copyright � 2003, The Baltimore Sun



Add-Ons Expand Medicare Measure
Special Interests' Lobbying Pays Off

By Dan Morgan
Washington Post Staff Writer
Monday, July 14, 2003; Page A01

Congress's $400 billion Medicare prescription drug bill, advertised as a way to help elderly Americans pay for their medicine, has become a magnet for dozens of unrelated provisions benefiting hospitals, doctors, medical equipment companies and an array of other health care interests.

Tucked into the small print of the 1,043-page Senate version, for example, is a "demonstration project" allowing selected chiropractors to bill Medicare for many services not now covered. If the experiment shows that chiropractors can save money for Medicare by steering patients away from costlier services, it could be instituted nationwide.

Other provisions -- many of them dropped into the legislation in the small hours of June 27, just before Senate passage -- would benefit marriage counselors, the weight-management industry, rural ambulance services, Hawaii's Medicaid program and doctors in Alaska.

The stampede by lawmakers to add unrelated provisions to the bill received scant attention at the time. Interest focused instead on the historic attempt to expand Medicare to help elderly Americans pay for their medicine, a goal that will become law if negotiators can resolve differences between the House and Senate versions.

But the legislation proved to be an irresistible target for an army of health care lobbyists lured by the first major Medicare bill to move through Congress in three years. Proposed changes in the basic Medicare program now consume about 200 pages in the Senate bill, one-fifth of the total. Preliminary estimates suggest the special provisions will add tens of billions of dollars to the legislation's cost, although Republicans say the bills also contain offsetting savings.

The House version includes provisions sought by the American Physical Therapy Association, the Advanced Medical Technology Association, the Federation of American Hospitals and dozens of other groups. The lobbying is sure to intensify in the weeks ahead as House-Senate negotiations move forward.

"It's a vehicle, a train moving down the tracks, and many ideas that haven't had homes are catching a ride," said Robert Reischauer, president of the Urban Institute in Washington. "In terms of the costs, this is still overwhelmingly a prescription drug bill. But there are lots of bells and whistles attached representing the wishes of other components of the health sector."

The White House budget office has criticized "provisions that would increase the cost of the program and that are unrelated to strengthening and improving Medicare." It cited an expansion of payments to teaching hospitals that train clinical psychologists and the Senate bill's chiropractor demonstration project.

The Congressional Budget Office has not finished calculating the cost of all the changes, but it is certain to be in the billions of dollars. To keep the price tag of the overall prescription drug measure below a $400 billion ceiling, congressional leaders are relying, in part, on some budgetary sleight of hand.

For example, the Senate bill counts on $8 billion in savings from more rigorous enforcement of a long-standing rule that says a Medicare recipient must tap all of his or her private insurance (such as an automobile policy) before Medicare will pay. The extent of those savings is questionable, administration health officials say.

Lawmakers strongly defend the added provisions.

Language in the Senate bill that eases the disparity between Medicare reimbursements for rural and urban hospitals was a top priority for Sen. Charles E. Grassley (R-Iowa), the Finance Committee chairman who ushered the Medicare bill through the Senate. The estimated cost of the rural package is $17 billion to $19 billion over 10 years. The House bill contains similar provisions.

Another senator from a rural state, Kent Conrad (D-N.D.), used his influence as senior member of the Finance Committee and ranking Democrat on the Budget Committee to press for the hospital provisions and others that he deemed essential to rural health care.

"Rural parts of the country are disadvantaged by formulas that are badly out of date because they were based on costs of 20 years ago," Conrad said.

Conrad was principal sponsor of a provision that for the first time would cover some drugs that patients inject themselves. He said it would save patients in his and other rural states from long drives to doctors' offices, where Medicare covers the treatment.

The North Dakota senator said 44 patient groups supported the change, which would cover drugs used by individuals suffering from diseases such as multiple sclerosis, rheumatoid arthritis, deep vein thrombosis and hepatitis C. But Conrad said his staff was also heavily lobbied by the pharmaceutical industry, including Biogen, which makes the multiple sclerosis drug Avonex.

The provision would expire in 2006, when self-injected drugs would be covered by the new Medicare prescription drug plan.

The cost to the Medicare program would be about $500 million during the next two years, according to a preliminary estimate of the Congressional Budget Office. But Conrad said a private estimate suggested it actually could save $86 million by reducing the use of doctors and, in some cases, substituting drugs that are less costly to administer.

Along with Sens. Tom Harkin (D-Iowa) and Craig Thomas (R-Wyo.), Conrad inserted a provision to provide a temporary fee increase for rural ambulance services that are stretched thin. Another provision would benefit air ambulance services, of particular interest in states such as Montana and Alaska. An increase in Medicare reimbursement rates has been a top priority of the American Ambulance Association, which called on members in February to begin an all-out lobbying effort for relief under Medicare.

Since the Senate included language sought by the American Chiropractic Association, that organization has asked for "immediate grassroots action" to ensure that House conferees accept the demonstration project.

"ACA efforts to win inclusion of this provision are being strongly opposed by the powerful physical therapy lobby and certain medical interests," says the ACA Web site. "We can win this issue but only if there is a strong expression of support for our provision."

Medicare now covers only "spinal manipulation" performed by chiropractors. The six pilot projects in the Senate bill could open the way for all services to be covered eventually. Chiropractors say they provide preventive care that saves Medicare large sums in the long run. But administration officials said last week they feared it was a backdoor effort to expand the Medicare program.

The stakes are also high for the Advanced Medical Technology Association, also known as AdvaMed, which represents more than 1,000 manufacturers of medical devices, including Johnson & Johnson, Medtronic, Baxter and Abbott Laboratories. The House bill would expand the eligibility for Medicare coverage of innovative devices used in various procedures.

Both houses also have language that, for the first time, would allow Medicare to pay partly for clinical trials of "breakthrough" devices. "It's all about bringing Medicare into the 21st century," said Stephen Ubl, AdvaMed's executive vice president for government relations.

A key champion of the provisions is Rep. Jim Ramstad (R), whose home state of Minnesota is a center of medical technology.

While numerous groups are lobbying hard to keep beneficial provisions in either the House or Senate bills or both, other groups are trying just as hard to undo provisions that House and Senate leaders wrote into their bills to curb the rising cost of Medicare.

The National Association of Home Care is aiming its lobbying at trying to remove a House provision that would make patients receiving home care services pay part of the bill themselves, a charge known as a co-payment. The provision is estimated to save $3 billion to $4 billion over 10 years.

National Home Care Association President Val J. Halamandaris has made a video appeal on the group's Web site, asking members "to push the Senate as far as we can to stay by their version of the bill."
To fight Senate language that would require patients to make a similar co-payment for work done by independent laboratories outside hospitals, the College of American Pathologists, the American Society of Microbiology and other organizations have formed the Clinical Laboratory Coalition.

The government has estimated the co-payment would save Medicare $18 billion in a decade, but that is disputed by Robert J. Waters, a lobbyist hired by the coalition. The co-payment would have to be collected by labs testing blood, urine or other specimens and would be a major burden on the industry and patients, Waters argues.

"If a medical beneficiary needs a test, he should be able to get one," he said.

His coalition, he added, "may be doing some print, and maybe radio" advertising aimed at members of Congress.

� 2003 The Washington Post Company



Reaction mixed in Singapore to SARS vigilance
Some think government is overdoing demand for continued precautions; Experts say disease could return

By Erika Niedowski
Baltimore Sun Staff
Monday, July 14, 2003

SINGAPORE - It has been more than six weeks since this tiny island nation was declared free of SARS, and still it seems the deadly respiratory disease is everywhere.

The international airport uses thermal-imaging scanners to screen travelers for signs of fever. Bus and taxi drivers, who are required to take their temperatures daily, display cards in their windshields declaring, "I'm Okay."

And a popular actor who has been described as Singapore's version of Jim Carrey was recently enlisted to record the Sar-Vivor rap - a satirical plug for good hygiene that reminds people to wash their hands, throw away their tissues and refrain from spitting in public.

Though no new cases of severe acute respiratory syndrome have been reported here since May, the disease has become a part of everyday life.

Some scoff at the increased vigilance, dismissing the need for mandatory temperature checks and education efforts such as the government's SARS TV channel, which went off the air only about a week ago.

A little inconvenience

But others think the measures are well-intended and say they don't mind putting up with a little inconvenience here or there if it means peace of mind.

"People are willing to make the small sacrifices for their own health and safety," said Jacqueline Lee, 25, who gets her temperature taken every morning at the electronics firm where she works.

"It does get to be a chore after some time, but I think it is necessary," said Paul Sim, 26, an employee at a food manufacturing company who also has his temperature checked daily.

To enter some buildings, visitors have to fill out forms leaving their contact information so they can be reached if there is another outbreak.

Workers at hotels wear dark blue buttons on their uniforms that say "COOL," a program designed to recognize establishments that have adopted anti-SARS measures ranging from employee temperature checks to more frequent cleaning. Taxi drivers carry SARS "battle kits," which include masks, thermometers, alcohol swabs and information in several languages.

The "Free Singapore from SARS" sweepstakes, which is being run by the government-sanctioned lottery operator, is offering a top prize of $1 million in a drawing next month. Proceeds from ticket sales will benefit SARS-related causes.

On the health care front, hospitals are on "orange alert," meaning that fever screenings and other precautions, including restricted visiting privileges, are still in effect. Staff members taking temperatures at National University Hospital wear masks, gloves and gowns and hand out stickers that display each person's thermometer reading for all to see.

About 10,000 patients there and at two other affected hospitals reportedly have had their medical records rechecked to make sure their symptoms didn't mimic those of the dreaded disease. Blood samples from 2,000 people who had been hospitalized as suspected SARS cases also are being collected and screened.

More than 200 people in Singapore were infected during the worldwide outbreak; 32 died here.

The effects went far beyond hospital wards. Normally bustling shopping centers were suddenly quiet. Scores of hotel rooms and airline seats were empty. Some restaurants had to close their doors. Tourism plummeted, and the island's economy sagged.

A huge government SARS relief package - worth more than $131 million - is beginning to help turn the situation around. The Singapore Tourism Board estimates that 300,000 people visited last month, compared with 170,000 in May.

During a recent stop in Singapore, the director of the U.S. Centers for Disease Control and Prevention, Dr. Julie L. Gerberding, praised the country's anti-SARS efforts as "exemplary" but warned that the disease is likely to be back.

That's the message local government officials have been trying to get out.

The SARS rap, which is being backed by the Ministry of Health, is one gimmick to that end. It is performed by actor Gurmit Singh, who plays the character Phua Chu Kang in a popular television sitcom. He sings in a mix of local dialect and English, known as Singlish, which has been an object of the government's scorn.

"Some say 'leh,' some say 'lah,' Uncle Phua says, 'Time to fight SARS,'" it begins. "Everybody, we have a part to play to help fight SARS at the end of the day."

A later verse reminds people not to spit - or "kak-pui" in Singlish.

"Cover your mouth if you cough or sneeze. You think everyone want to catch your disease? Don't 'kak-pui' all over the place. You might as well 'kak-pui' on my face."

Though there were at least a half-dozen copies at Sembawang, a music seller at Raffles City shopping center, a clerk said they have been selling quickly.
Fadzlina Rahman, who works at the concierge desk at the mall, says she kind of likes it.

"It's hip, and there's a message from the song itself," she said.

Complacency sets in

Despite the government's push to keep residents on guard, one recent newspaper poll found that complacency has begun to set in.

More than 40 percent of respondents hadn't picked up free anti-SARS kits, according to the survey in The New Paper. And although 62 percent took their temperatures daily during the height of the outbreak, only 38 percent do now. What's more, nearly a quarter believe that the country is being too vigilant in its continuing battle against SARS.

The Ministry of Health is sponsoring a commemorative ceremony this month at the Botanic Gardens to honor those who died of SARS and health care workers who were on the front lines in the fight against it.

As another sign of appreciation, Singapore's two health groups are giving their employees a bonus of $1,000 and 10 percent of their monthly pay.

What has most upset one man about the SARS situation now is what people leaving Mount Elizabeth Medical Center have been doing with their temperature-check stickers: plastering them all over fences, lamp posts and trash bins. In a letter to the editor of the Straits Times, another English-language daily, he said he was "appalled" and compared the behavior to littering or vandalism. He urged the government to impose a fine of $100 or more on those who are caught.

"Such behavior paints us as ugly Singaporeans," he wrote. "You won't see this in other developed countries like Japan."

Copyright � 2003, The Baltimore Sun



Prescription for Politics
Lobbyists Pursue Special Provisions to Get A Part of Biggest Health Measure in Years

By Laurie McGinley and Sarah Lueck, Staff Reporters
Wall Street Journal
Monday, July 14, 2003

WASHINGTON -- The House and Senate Medicare bills would provide a lot more than a drug benefit to seniors. An array of other provisions would help -- and in some cases, hurt -- specific companies, industries and states, including biotech titan Amgen Inc. and doctors in Alaska.

Some provisions would extend Medicare coverage for specific products or services, or give their makers a foot in the door. Others would increase reimbursements for items covered by the government health-insurance programs. A number of the special provisions won't survive the House-Senate conference that is to begin soon and is likely to produce a final Medicare bill after Labor Day. But all are being pushed feverishly by lobbyists determined not to miss the biggest piece of health legislation in years.

"It's all pent-up demand," says Fred Graefe, who lobbies for the for-profit hospital industry and other interests. Ron Pollack, executive director of Families USA, a liberal advocacy group that wants Congress to pass a more-generous drug benefit, adds: "It's an industry pattern. Different parts of the industry try to get their piece of the gravy train."

The political impulse to do favors for constituents is restrained this year by a cap on the size of the Medicare bill. As a result, many of the single-issue provisions don't carry price tags. One of the most contentious, for example, involves specialty hospitals. Sometimes called "boutique" hospitals and "cash cows" by critics, these facilities focus on areas such as heart or orthopedic care and often are owned in part by physicians. Backers say the facilities provide high-quality and efficient care. But community hospitals say the ventures are skimming profitable specialties while leaving general hospitals to handle money-losing treatments such as trauma care.

The Louisiana Hospital Association appealed to the state legislature this year to rein in the specialty hospitals, and was rebuffed. But Sen. John Breaux (D., La.) inserted a provision in the Senate Medicare bill that would freeze the growth of specialized hospitals by barring doctors from referring patients to any new facilities in which they hold ownership interests; existing facilities and those nearly completed would be grandfathered.

Big hospital groups such as the American Hospital Association, which represents 5,000 hospitals, and the Federation of American Hospitals, made up of more than 1,000 for-profit hospitals, strongly support the provision. Specialty hospitals say the change would severely hamper the industry and reduce competition.

The House, leery of the Senate approach, would merely require a study of the issue -- an approach endorsed by MedCath Corp., a chain of cardiac-care hospitals based in Charlotte, N.C., and its lobbyists, which include the law firm of Republican bigwig Haley Barbour and former Democratic Sen. Birch Bayh. The American Surgical Hospital Association, made up of 50 surgical hospitals, agrees.

On a smaller scale, Theragenics Corp., which makes rice-sized radioactive seeds implanted in the prostate to treat cancer, is also looking for a change in Medicare rules. The Buford, Ga., company says Medicare's payment method penalizes hospitals that use a high number of seeds, often required in treating older men or patients with more aggressive cancer. The congressman whose district includes the company, Rep. Nathan Deal, (R., Ga.), added a provision to provide full reimbursement for the therapy for next three years while more data are collected. The Senate bill doesn't go as far. Heading the lobbying effort for Theragenics is the Washington Group, which is run by former New York Rep. Susan Molinari. Her father, former New York Rep. Guy Molinari, underwent the Theragenics treatment in 1997 and has been cancer-free since, she says.

In some instances, drug companies are trying to get Congress to mandate things the Medicare bureaucracy can't or won't do. The Senate bill would force Medicare to cover self-injectable medications for diseases such as rheumatoid arthritis and multiple sclerosis. Due to a quirk in Medicare policy, the program typically doesn't cover medicines unless they are administered in a doctor's office, giving an advantage to products that must be injected by a health professional. For example, Medicare pays for Johnson & Johnson's arthritis drug Remicade, given intravenously in medical offices, but not to rivals Humira, made by Abbott Laboratories Inc., or Enbrel, marketed by Amgen and Wyeth.

The Senate legislation would begin covering self-injectable drugs next year -- if the drugs have alternatives already covered by Medicare. The provision would cost $500 million for two years; after that, the drugs would be covered under the new drug benefit. Other self-injected medicines that could gain coverage include Avonex, made by Biogen Inc.; Rebif by Serono SA; Copaxone by Teva Pharmaceutical Industries Inc., and Betaseron by Schering AG unit Berlex Laboratories and Chiron Corp., all for multiple sclerosis. A House provision would limit such coverage to a three-state demonstration project.

The Medicare bills also would boost payments for providers in certain areas, including hospitals in rural locales. Sen. Ted Stevens (R., Alaska) won a provision that would increase Medicare payments to physicians in his state by an average of 50% under a two-year demonstration project that would cost $48 million. Because of Alaska's high costs, Medicare on average covers only 37% of physicians' costs, said a Stevens aide.

Hospitals in Puerto Rico, which traditionally have gotten lower payments than their counterparts on the mainland, also would get an increase under the bills. "It's a fairness issue," says Chip Kahn, president and chief executive of the Federation of American Hospitals. At the time the rates were set, he says, the island's costs were so much lower, but they have escalated since and payments haven't kept pace. Two of his group's members, Universal Health Services Inc., based in King of Prussia, Pa., and United Medical Corp., based in Windermere, Fla., own hospitals in Puerto Rico.

In addition, both the House and Senate bills would speed up Medicare coverage of medical devices. That would likely help Medtronic Inc., St. Jude Medical Inc. and Guidant Corp., as well as the legions of small device makers.

Key players in the Medicare legislation can use their positions to pursue pet projects -- and do. Senate Finance Committee Chairman Charles Grassley of Iowa, for instance, along with Sen. Olympia Snowe (R., Maine), are pushing an experiment that could pave the way for Medicare to pay for weight-loss programs. Sarah Ferguson, the duchess of York and a spokeswoman for Weight Watchers International Inc., recently was lobbying lawmakers. Medicare currently covers only one-on-one nutrition counseling. The demonstration project would explore how group programs measure up.

Sen. Grassley, whose state is home to Palmer College of Chiropractic in Davenport, is also pushing a three-year demonstration project to determine whether Medicare should expand coverage of chiropractic services. Medicare now covers manipulation of the spine but not X-rays, physical therapy and other services.

MEDICARE'S SPECIAL INTERESTS

Both House and Senate Medicare bills are jammed with provisions that would help a specific company, industry or state.

Some examples:

BENEFICIARIES	PROVISION
Community Hospitals	Senate bill would halt creation of new specialty hospitals with physician investors.
Amgen, and other drug makers	Senate bill would provide Medicare coverage for some self-injectable drugs, including Amgen's Enbrel and Kineret for rheumatoid arthritis.
Device makers.	House, Senate bills would speed up Medicare coverage of new devices
United Health Services*	House, Senate bills would boost Medicare payments for hospitals in Puerto Rico. The payments have lagged behind those for hospitals on the U.S. mainland.

*And other hospitals in Puerto Rico

Sources: WSJ research; Medicare legislation




Smallpox Fiasco

Washington Post Editorial
Monday, July 14, 2003; Page A20

TO DATE, THE ADMINISTRATION'S biggest commitment to biodefense has been its smallpox vaccination campaign. Launched last December with great fanfare, the first phase of the campaign aimed to vaccinate about 450,000 health workers, all volunteers. As many as 10 million people were to have been vaccinated in a second phase. The initial goal was to have enough immune people on hand to care for the ill and to vaccinate -- quickly -- those who were not yet sick, in case of a smallpox outbreak. The administration collected and distributed enough vaccine for every American in a remarkably short period.

But that feat, as it turned out, was not enough. Although a spokesman for the Department of Health and Human Services insists on describing the vaccination program as a "success," fewer than 40,000 civilians have been vaccinated. This is not due to technical or logistical difficulties: In a far shorter period, the military managed to vaccinate 450,000 people while simultaneously preparing many of them to fight a war in Iraq. Nor was the vaccine itself at fault: The military experience revealed the vaccine to be less dangerous than the decades-old evidence had suggested.

Analyzing what went wrong with the civilian program, insiders and outsiders point in part to the government's mistakes and in part to the political and even psychological resistance of the doctors and nurses who were meant to carry out the vaccinations. Health workers say the government failed to consult widely enough with hospital administrators and doctors, who, short-staffed already, feared the vaccination program would prove too costly and take staff away from other tasks. The administration's initial failure to propose compensation for health workers who were made seriously ill by the vaccine helped fuel a union-led revolt against the program. And because the program was launched on the eve of the Iraq war, many concluded that it was part of a Bush administration propaganda campaign and declined to participate on political grounds.

At base, the problem was one of priorities: The administration, wrapped up in its war with Iraq, did not convey a sense of urgency about the possibility of a smallpox outbreak (and has been even less vocal about the threat since the war ended). The medical community did not take on board the real possibility of a smallpox outbreak. The result, in the words of Michael Osterholm, an independent epidemiologist who has served as an HHS adviser, is that the nation is not at a level of even "minimal preparedness." In the event of a smallpox outbreak, unvaccinated health workers and others might flee hospitals -- as their Chinese counterparts did during the SARS outbreak -- and panic could break out as the public demanded immediate vaccinations.

Is this scenario a real possibility? If government officials think so -- and some say they are convinced that smallpox remains a threat -- then they need to educate the public, and the medical community in particular, with more dedication. Stockpiling vaccines is not enough if people are not willing to use them, and 40,000 volunteers are not enough if 10 times as many would be required to provide even minimal protection.

� 2003 The Washington Post Company



The Booze Lobby vs. America's Youth

By Jim Gogek
Washington Post Commentary
Monday, July 14, 2003; Page A21

By all accounts, alcohol is the most dangerous drug to young people. Far more than any illegal drug, alcohol is linked to the three main causes of teen deaths: accidents, murder and suicide. It kills 61/2 times as many American youths as all illegal drugs combined. So why do we have a national youth anti-drug campaign and not a national anti-underage-drinking campaign?

Simple: Alcohol has a better lobby.

Six years ago Congress enthusiastically embraced a $1 billion campaign to get kids off illegal drugs. But proposals to include alcohol were quickly defeated by alcohol industry supporters. Congress did, however, authorize $500,000 for a National Academy of Sciences (NAS) study on underage drinking that was supposed to define a national strategy for reducing the No. 1 health and safety threat to teens.

A panel of respected researchers, academics and prevention experts was chosen last summer, and its study is now undergoing final review. Meanwhile, the alcohol industry and its supporters in Congress and the administration have conducted a campaign of intimidation against the NAS and the committee of experts that wrote the study. NAS officials say they've never seen such intense industry interest in one of their reports. Industry lobbyists are going all-out, and in the forefront of their assault is, as might be expected, the National Beer Wholesalers Association.

Beer is the alcoholic beverage kids like best. Teens consume more than 1 billion cans and bottles of beer each year, according to a U.S. Department of Health and Human Services study. Another study, published in February in the Journal of the American Medical Association, showed that underage drinking accounts for 20 percent of all alcohol consumed. Young people provide a big chunk of revenue for the $116 billion industry.

In Congress, the alcohol industry can be as intimidating as anybody in Washington. The energetic leader of the beer wholesalers, David Rehr, is closely connected to members of the House Republican leadership. Since joining the beer wholesalers a decade ago, Rehr has transformed the association into a cohesive network of local distributors who donate heavily to, and lean heavily on, their members of Congress. Rehr's lashing speech against anyone who would regulate his industry fires the blood of his membership. To a beer industry legislative conference last year, he proclaimed: "We'll grind our adversaries into dust!"

While the beer wholesalers and other industry groups publicly supported the study when Congress approved it, they immediately went on the offensive as soon as the research panel was chosen. Rehr and other industry association leaders complained in a letter to NAS administrators last August that the panel was biased, and they named five panel members they insisted were particularly objectionable.
This spring the assault intensified. The beer wholesalers began issuing press releases accusing the NAS of misusing taxpayer money by choosing a panel of "controversial individuals" who focused on antiquated or untested solutions in order to "vilify a legal industry," although no panel members had made any public statements about the study, nor had information about the study been released. Next came a letter signed by 138 members of Congress sent to the NAS president, warning him that the $500,000 appropriation was not intended to produce policy changes that would adversely affect the alcohol industry.

In February, a Health and Human Services administrator wrote to the study's program officer asking that the alcohol industry be allowed to peer-review the report before it was released. Such a bold request on behalf of an industry with a clear financial interest stunned the research community. Had the program officer allowed this unprecedented intrusion, which she didn't, it would have compromised the scientific integrity of the report and tarnished the entire NAS research process.

The alcohol industry's political connections have reached a remarkable level. Robert Koch is the newly installed president of the Wine Institute, a lobby for 600 American wineries. He is also married to President Bush's sister, Doro Bush Koch. Last year, Robert Koch was appointed to the search committee for a new director of the National Institute on Alcohol Abuse and Alcoholism, a committee made up entirely of influential medical experts and federal research directors -- and one industry lobbyist.

Because substance abuse prevention has been so widely researched, it's very unlikely the NAS underage-drinking panel will endorse any strategies that don't have good science behind them. The study will probably propose a range of well-known options, from ads warning teens about the dangers of drinking, which the alcohol industry might accept, to restrictions on marketing and advertising, which the industry would reject.

Even if alcohol lobbyists can't bury this study, they will try to make sure it finds little support on Capitol Hill or in the administration, so that the idea of a national campaign against what the American Medical Association calls an epidemic in every community will just die quietly.

The writer, a journalist, is a Robert Wood Johnson Foundation fellow.

� 2003 The Washington Post Company



Methadone patients need manners lesson

Baltimore Sun Letter to the Editor
Monday, July 14, 2003

Not only are Awakenings Counseling Center patients bothering businesses in the Timonium Business Park, they are a menace on the light rail as well ("Methadone clinic clients cause trouble at business, owner says," July 9).

All day, they get on the train in groups -- cursing, smoking and harassing riders while high on methadone. Although I understand the illness, their lack of respect and their disgusting behavior are intolerable.

While Awakenings is doling out its substitute drug, it should also dole out lessons on manners.

Traci Folkes
Cockeysville




Consumers can go online for updated health information

Baltimore Business Journal Letter to the Editor
Monday, July 14, 2003

Editor:

I read with interest John Berndt's article, "Internet a blessing, curse for health info seekers," [Vol. 21, June 27-July 3, 2003]. I certainly do agree that there is a lot of outdated or inaccurate health information available out on the Internet. Mr. Berndt discusses a method of ensuring accuracy of online medical information by cross-checking among multiple sites and by connecting to sites from more prestigious medical institutions.

Another avenue health consumers can take is to consult with a medical librarian. It is probably a little-known fact that hospitals contain medical libraries staffed with professional health sciences librarians who are experts in obtaining the best medical information available today. A call to your local hospital library could put you in the hands of an information specialist who could provide up- to-date information or point you in the right direction as far as suggesting the most appropriate Web site to search.

Alternatively, the Medical Library Association provides a link at mlanet.org/resources/userguide.html#5 called "Top Ten Most Useful Consumer Health Web Sites."

Deborah A. Thomas
Co-President, Maryland Association of Health Sciences Librarians
Baltimore

� 2003 American City Business Journals Inc.



Senator says he's had enough of CareFirst BlueCross BlueShield

Baltimore Business Journal Letter to the Editor
Monday, July 14, 2003

Editor:

Forewarned is forearmed.

And we certainly have had enough forewarning to know that CareFirst does not deal from a full deck where the people and the General Assembly are concerned. The General Assembly should know from CareFirst's past performance that the implementation of CareFirst reform, approved unanimously by the 2003 Assembly, must be watched closely to make sure it actually happens.

The history bears reviewing. For the past decade, while wearing its nonprofit hat, CareFirst has behaved just like a for-profit insurer abandoning every program that didn't turn a profit. Its Medicare and Medicaid HMO programs were scuttled, leaving thousands of Maryland seniors without prescription drug coverage and thousands of poor people without any coverage at all. High health risk people have been dumped because coverage for these people always loses money.

Although CareFirst executives said they supported the reform legislation during the session, these same executives waged a campaign to get the governor to veto the reform and threatened to test the constitutionality of the reform in the courts. Protesting the manner in which the reform legislation restructured the CareFirst board, after the session adjourned, the national BlueCross and BlueShield Association withdrew its licensing of CareFirst.

After the session adjourned, the state, CareFirst and the association agreed on certain concessions regarding the replacement and appointment of CareFirst board members in order to keep the association license and trademark. However, the provision in the reform legislation, which prohibits CareFirst conversion to for-profit, remains untouched.

Let's face it, CareFirst, through its executive staff and board members, have fought reform every step of the way. CareFirst board members rubberstamped the executive staff's plans to blatantly and shamefully abandon elderly, poor and high health risk enrollees.

Despite the profuse apologies of CareFirst's representatives and their promises to implement the legislation, actions speak louder than words.

This senator, with just about every member of the General Assembly, has just about had it with CareFirst.

State Sen. James E. DeGrange Sr.
Majority Whip
D-Anne Arundel County
� 2003 American City Business Journals Inc.