A
64-year-old Baltimore
woman may be the first person in the city to have contracted the West Nile
virus this year, Baltimore's health commissioner announced yesterday.
The
woman - who was not named - was hospitalized with encephalitis, but has been
doing well, and tests are expected to show a high probability that she was
infected with the virus, said the commissioner, Dr. Peter L. Beilenson.
The
state health department said it is investigating one probable case of West
Nile in the city, but would not provide details. The state has confirmed two
cases of West Nile this year - in a 76-year-old HarfordCounty
woman and a 56-year-old Crofton woman.
University
of Maryland awarded $42 million for bioterrorism defense; Largest grant in its
history; Coalition of 16 institutions to participate in research
By
Scott Shane
Baltimore Sun Staff
Friday, September 5, 2003
The
University of Maryland School of Medicine won the largest grant in its history
yesterday, $42 million in federal money over five years to lead a coalition of
more than 60 scientists at 16 institutions to find better defenses against
bioterrorism and emerging diseases.
"It's an amazing array of people," said Dr. Myron M. Levine, director of the
University of Maryland's Center for Vaccine Development, who will head the
venture. "We're very excited."
The
Baltimore medical school was one of eight institutions chosen by the National
Institute of Allergy and Infectious Diseases to create regional "centers of
excellence" as part of the federal government's expansion of biodefense in the
aftermath of the Sept. 11 terrorist attacks and anthrax mailings in 2001.
The
mid-Atlantic center, with a small administrative staff and headquarters at the
University of Maryland, will seek improved vaccines against smallpox and
anthrax, look for ways to fight deadly hemorrhagic fever viruses such as Ebola
and assess the bioterror danger from deadly forms of common bacteria such as
E. coli. It will also study natural threats such as West Nile virus.
Beyond research, the center will provide public health departments with expert
advisers and spokesmen in the event of a bioterror attack and link medical
scientists with industrial partners.
Health secretaries in Maryland,
Virginia, West Virginia, Pennsylvania, Delaware and the District of Columbia
have pledged to cooperate with the venture, Levine said.
Levine, 59, said that in 33 years of working on National Institutes of Health
grants, "I've never seen anything so innovative and broad in scope" as the
biodefense initiative.
Already, he said, it has encouraged longtime competitors, such as his vaccine
center and the Center for Immunization Research at the Johns Hopkins Bloomberg
School of Public Health, to find ways to work closely together. Dr. Donald S.
Burke, who heads the Hopkins
facility, will be co-principal investigator of the new biodefense venture.
"Rather than be competitive or redundant, we can be truly synergistic," Levine
said.
Two
pharmaceutical giants, Merck & Co. and Aventis Pasteur Inc., will serve as
hosts for scientists at training sessions on turning medical research into
useful products. The communications school at George Washington University
will train researchers to reduce complex science to understandable
explanations for the media.
The
University of
Pittsburgh will specialize in using primates for vaccine testing. The Virginia
Bioinformatics Institute at Virginia Tech will provide researchers with the
huge computing capacity necessary to make sense of complex genetic sequencing
information.
Some scientists worry that fear of bioterrorism is diverting resources from
research on diseases that pose a greater health threat.
But
Levine said research on bioterror should also speed progress against natural
disease threats. And he said the country has no choice but to prepare for the
worst.
"Those anthrax spores [mailed in 2001] created a huge civil disruption and
paralyzed many of our public institutions," he said. "We have to respond to
the threat."
A
Texas couple is suing Legal Sea Foods Inc. after the husband and wife
allegedly contracted Hepatitis A from improperly prepared mussels during a
visit to the company’s Inner Harbor restaurant.
The
suit, filed in U.S. District Court in Baltimore, seeks in excess of $150,000
in compensatory and punitive damages for Ryan and Juliet Foster, of Houston.
The
Fosters “sent the plate back a second time” during their visit on Feb. 8,
2002, said attorney Warren A. Hampton, of Uwchland, Pa. “A month later, he was
on the liver transplant list.”
Hampton
says 85 percent of his practice involves food cases — “usually the result of
human error. Someone gets slammed and moves a plate up before it should go or
doesn’t wash his hands after using the restroom.”
According to the three-count suit, Hampton
alleges the Fosters’ “injuries and damages were caused by and through the
negligence and carelessness, strict liability in tort, and breach of contract
(warranty) of the Defendant.”
Officials at Legal Sea Foods, a Delaware
corporation headquartered in Boston,
did not return phone calls.
Legal
Sea Foods this month celebrates its fifth anniversary at its location in
Baltimore’s Inner Harbor.
According to its Web site, “… [W]e source our own fish, handle it ourselves,
prepare it and serve it. … Our quality assurance team oversees this process
from the pier to your plate.”
But
the suit charges that Legal Sea Foods failed to test the product or guard
against purchasing contaminated mussels and other food stuffs.
As
well, it accused the company of failing to instruct the staff on proper
preparation of mussels and failing to supervise proper food handling.
Trans Healthcare Inc. and Abe Briarwood Corp. have closed a purchase and lease
deal with Integrated Health Services Inc. of Sparks.
Under the deal, announced in February, New York-based Briarwood bought
Integrated's nursing homes and other health facilities, and THI leases and
operates them.
THI,
which moved its headquarters from Camp Hill, Pa., will lease the old
Integrated corporate offices in Sparks. Anthony Misitano, THI's chief
executive officer, said his company is operating 115 former Integrated
facilities and has more than 400 workers in Sparks, the majority of them
former Integrated employees.
Authorities dissecting Pepco's response to the power failures that darkened
wide swaths of the Washington
suburbs last week said yesterday that they are deeply concerned about the
company's failure to give priority to customers with serious medical
conditions.
"That's going to be a key issue for us," said Montgomery County Council member
Nancy Floreen (D-At Large), who is helping to organize an inquiry by top
county officials. "Why weren't our neediest residents turned on in the fastest
time possible?"
About 10,000 Pepco customers have coded accounts indicating they need
electricity to power such life-sustaining medical equipment as ventilators.
During planned or localized outages, Pepco can use that list to prioritize its
response so that power to those customers is restored first.
But
Pepco spokesman Robert Dobkin said that in a situation with widespread outages
-- last week's thunderstorms knocked out power to more than 200,000 customers
-- the list is of little value.
"There is no way we could possibly respond to them all," he said. "It's just
beyond our means."
That was unnerving to public officials, but even more so to Michael Maloy, 46,
a New York television producer whose elderly parents, both recently out of the
hospital, live on Meadowlark Lane in Bethesda.
Maloy said he rushed to Bethesda
when he learned of the outage because his parents were too frail to function
safely in a darkened home. Despite his efforts to persuade Pepco to respond
quickly to their house, it remained dark for more than four days.
"I
called Pepco 10 times a day and advised them very plainly as to my parents'
condition," Maloy said. "We were begging for help."
Barbara McCall, president of her Chevy Chase condominium association, said she
made similar frantic attempts to reach the utility Friday night, the fourth
day without power at her five-story, 35-unit building. She said several
residents are in their seventies or eighties and in poor health.
"These were people who should not have been going up five flights of stairs,"
she said.
There have been no reports of anyone being injured, becoming sick or worse as
a result of the prolonged outage. Pepco officials said they did everything
they could to advise residents with medical needs to find help elsewhere.
Dobkin said that message is on a company brochure and appears on its Web site.
"We
tell any customer experiencing any form of medical distress to seek medical
assistance," Dobkin said. "Our trucks aren't equipped with flashing lights and
sirens. If the customer is in distress, call 911. That's the best we can do."
Whether it is the best they can do is a question Maryland regulators studied
extensively after a 1999 ice storm, when a six-day blackout prompted residents
and public officials to raise similar concerns on behalf of the frail elderly
and medically fragile.
A
task force set up by then-Gov. Parris N. Glendening (D) recommended to the
Maryland Public Service Commission that all utilities implement "protocols to
provide special needs customers with priority restoration service."
But
the commission was hesitant to force the power providers to do that. In their
report, the commissioners explained the dilemma.
"Freed from all other considerations, the answer is easy and obvious -- those
in the greatest danger should be helped first," they wrote. "In application,
it is much more difficult as there can be a variety of unintended
consequences."
The
commission said it determined "that the better approach is to . . . provide
the more general benefits of restored utility service to the maximum number of
customers as quickly as possible."
Dobkin said that is the approach Pepco took last week.
Faced with damage that included 1,325 downed power lines, 1,675 blown fuses
and service disruptions at 19 substations, Pepco crews focused first on
repairing 113,000 feet of electric cable, planting 75 new poles and replacing
85 transformers.
"We
were able to restore over 150,000 customers in the first 48 hours, and nobody
should lose sight of that," Dobkin said.
But
that did not satisfy state Sen. Leonard H. Teitelbaum (D-Montgomery), whose
district includes Leisure World, one of the region's largest senior living
communities. Teitelbaum said he does not think it should take a loss of life
to spur a change to the company's policy.
"In
today's computer age, I would think it would be very easy for them to know
exactly where the people are who most need continuous power," Teitelbaum said.
"There should be some way to help those people without disrupting the overall
response."
Teitelbaum said he is now considering legislation that will force Maryland
utilities to give priority to those with serious medical needs.
"These people should be among the first to be taken care of," he said. "Until
that happens, I don't think anyone will be satisfied."
WASHINGTON (AP) — Eight U.S. universities will receive government grants
totaling nearly $350 million over five years to establish biodefense research
centers, the Department of Health and Human Services said Thursday.
The
centers will be clustered around Duke University, Harvard Medical School, the
University of Chicago, the University of Maryland, the University of Texas
Medical Branch in Galveston, the University of Washington, Washington
University in St. Louis and Columbia University.
The
eight centers will form a key element of the nation's biodefenses, studying
infectious diseases and developing new vaccines, antibiotics and approaches to
combat potential agents of terrorism including anthrax, smallpox and plague.
Each center comprises a lead institution to work with affiliated institutions
in the same geographic area.
The
research facilities will also be open to approved investigators from
government agencies and biotech and pharmaceutical companies.
"These new grants ... will not only better prepare us for a bioterrorism
attack, but will also enhance our ability to deal with any public health
crisis, such as SARS and West Nile virus," HHS Secretary Tommy G. Thompson
said.
The
grants will be administered by the National Institute of Allergy and
Infectious Diseases, a part of HHS' National Institutes of Health.
Copyright 2003 The Associated Press. All rights reserved.
HAMILTON,
N.J. (AP) — The Postal Service plans to test a fumigation system at a New
Jersey mail center, the first step in cleaning up the building almost two
years after it was closed because of anthrax.
The
tests on Friday will determine how well a limited amount of chlorine dioxide
gas can be sent into the ductwork of the 282,000 square-foot building and then
removed. The work will be overseen by state and federal environmental
departments.
The
building near Trenton
was sealed as a hazardous site in October 2001, after at least four
anthrax-laden letters bearing Trenton
postmarks were processed there. It's the last contaminated site to be cleaned
in the wake of the anthrax attacks.
Another postal facility and a Senate office building in Washington, D.C., were
also contaminated during fall 2001.
The
HartSenate
Office Building was cleaned up first, followed by Washington's
massive Brentwood postal facility. Several tests were conducted at Brentwood
before the actual decontamination began last December.
The
buildings couldn't be cleaned at the same time because there is only one set
of equipment for the process.
New Jersey
saw five confirmed anthrax infections and two suspected cases, but no
fatalities. Nationwide, five people died and 17 others were sickened in the
attacks, according to the postal service.
Burt St. John, a Postal Service spokesman, said a minimal amount of gas would
be used during the tests, posing little health risk to nearby residents.
If
the process works, further testing will occur later this year, and officials
hope to fumigate the building sometime in November, St. John said.
Postal officials have said the Hamilton
post office will open in spring 2004 if the cleanup proceeds as expected.
No
arrests have been made in the anthrax attacks, despite a $2.5 million reward
and a continuing FBI investigation.
Copyright 2003 The Associated Press. All rights reserved.
WASHINGTON,
Sept. 4 — Senior Republicans from the House and the Senate tried today to
thrash out their differences over a bill adding prescription drug benefits to
Medicare, but after a two-hour meeting they still appeared to be far from
agreement on major issues.
Democrats, even those who supported the bipartisan Medicare drug bill passed
by the Senate in June, were excluded from today's meeting.
"It's important for the Republicans to get their act together," said Senator
John B. Breaux, Democrat of Louisiana, an architect of the Senate bill. "They
don't yet have a common position."
Representative Bill Thomas, Republican of California, the chairman of the Ways
and Means Committee, said House and Senate negotiators from both parties would
meet next week to vote on tentative agreements worked out by aides in August.
Those agreements involved relatively noncontroversial topics like drug
discount cards. Elderly people could use such cards to buy medicines at
reduced prices in 2004 and 2005, before Medicare begins covering outpatient
drugs. Negotiators from both parties may also vote next week on proposals to
enhance Medicare coverage of preventive health services, including blood tests
to measure cholesterol levels.
Mr.
Thomas and Senator Charles E. Grassley, Republican of Iowa, the chairman of
the Finance Committee, made only a few brief comments after today's meeting.
None of those suggested that they had resolved their disagreements over
political strategy and Medicare policy.
The
10 Republican members of the Medicare conference committee are all eager to
give private health plans a larger role in Medicare, alongside the traditional
fee-for-service program. But they have not figured out how to pay such plans.
In
the thick of the 2000 presidential campaign, executives at Bristol-Myers
Squibb, one of the nation's largest drug companies, received an urgent
message: donate money to George W. Bush.
The
message did not come from Republican campaign officials. It came from top
Bristol-Myers executives, according to four executives who say they donated to
Mr. Bush under pressure from their bosses. They said that they were urged to
donate the maximum — $1,000 in their own name and $1,000 in their spouse's —
and were warned that the company's chief executive would be notified if they
failed to give.
Bristol-Myers said no one was forced to donate. But elsewhere in the drug
industry, the message about the election was much the same. At some companies,
officials circulated a videotape of Vice President Al Gore railing against the
high price of prescription drugs. A torrent of contributions for Mr. Bush and
other Republicans resulted. And the money kept flowing, right through the
elections of 2002.
Those donations may soon pay off handsomely for the pharmaceutical business.
Four years ago, a Democrat was in the White House and the industry was
bitterly fighting a prescription drug proposal that it said would have led to
price controls. Today, a Republican-controlled Congress is preparing to send a
Republican president a measure with a central provision — the use of private
health plans to deliver Medicare prescription drug benefits — that is
tailor-made to the industry's specifications.
The
story of how pharmaceutical manufacturers helped shape the Medicare drug
benefit is, in part, that of a calculated decision by a lucrative industry to
throw its financial weight behind one political party — with $50 million in
campaign contributions over the last four years, the vast majority to
Republicans. It is also the story of a dogged, mostly unseen campaign that
included a small army of lobbyists in Washington and a network of
industry-financed groups, which carried the drug makers' message to the
public.
Throughout, the industry had a single goal: to defeat any legislation that
would let Medicare negotiate steep discounts on the prices of medicines for
its 40 million beneficiaries.
Instead, if there had to be a prescription drug benefit, industry executives
agreed that it should be administered by the private sector, where insurance
companies would negotiate on their own, without Medicare's influence. That is
precisely what will occur if bills passed by the House and Senate are
reconciled and a law is signed by President Bush. Both measures envision
taxpayers spending $400 billion over the next 10 years on the drug makers'
products, while banning government officials from even seeking volume
discounts.
"The drug lobby has just emasculated Congress with tons of money," said
Representative Pete Stark of California, the senior Democrat on the health
subcommittee of the House Ways and Means Committee, whose Republican leaders
wrote the House Medicare bill. "They bought themselves a deal."
But
Republicans say that their legislation will lead to discounts and that the
industry gave up as much as it got.
"I
think the drug industry would rather not have any bill," said Senator Charles
E. Grassley, the Iowa Republican who, as chairman of the Senate Finance
Committee, is a driving force behind the legislation. "But they know there is
going to be a bill because of public demand for it, and I think they are just
swallowing hard."
For
the manufacturers, the stakes could hardly be higher. The United States, the
last industrialized country with unregulated drug prices, provides half of the
industry's revenues, up from less than a third a decade ago, and most of its
profits. And the elderly are its best customers. Some companies estimate that
up to half of their sales in the United States come from drugs bought by the
elderly. Pfizer alone sells medicines to treat cholesterol, blood pressure and
arthritis problems that brought in $17 billion last year — nearly all from
Medicare-eligible patients.
Some companies, like Merck, are pressing hard for the legislation, while
others are lukewarm. A number of drug executives say they fear that the
proposed benefit is so skimpy that Congress will be forced over time to
improve it — a move that will eventually lead to price controls. One described
the measure as "deeply flawed."
Yet
even those drug executives with reservations say they will not stand in the
legislation's way. A spokesman for the Pharmaceutical Research and
Manufacturers of America, an industry trade group, said that passing a
Medicare drug benefit "remains the top priority."
"I
kind of hate to say the industry got what it wanted," said Ian Spatz, vice
president for public affairs at Merck. "But I think it's a fair solution that
does give people access to our medicines, and does it in a way that is least
likely to lead to price controls."
The Beginnings -- Clinton Plan Spurred Industry Into Action
It
was the White House — the Clinton White House — that provided the impetus for
the drug makers' long-running campaign to shape the public discussion about a
Medicare drug benefit.
Late in his second term, Mr. Clinton proposed giving elderly Americans some
relief from the cost of prescription drugs. Knowing that a benefit
administered by Medicare would never pass muster with Republicans, he called
for Medicare to contract with private pharmaceutical benefits managers, or
P.B.M.'s — one per region of the country — to manage drug purchases for the
government.
The
drug industry hated the idea. Private benefits managers had muscled their way
into positions of considerable power just a few years earlier, and drug makers
were stunned by their ability to drive down prices and even shift sales to
competitors' pills.
So
the drug makers took a page from the insurance industry's successful Harry and
Louise advertising campaign, which helped defeat the Clinton health care plan
in 1994.
This time, an arthritic bowler named Flo was featured in a $30 million ad
campaign. Flo's message was simple and direct: "I don't want big government in
my medicine cabinet."
The
ads were devastatingly effective — and infuriating to the Clinton
administration, which responded by threatening the industry with price
controls and issuing reports that excoriated drug prices and profits.
With the drug companies being painted as pariahs, a handful of executives
concluded that they could not stand in the way of a Medicare drug benefit
forever. Among them was Raymond V. Gilmartin, the chief executive of Merck.
"We
came to believe that people will deal with the affordability of medicines one
way or another — either through access and competition or price controls," Mr.
Gilmartin said. "We decided that getting seniors access reduced the risk of
price controls."
On
Capitol Hill, meanwhile, Senator Edward M. Kennedy, Democrat of Massachusetts,
was quietly reaching out not just to Mr. Gilmartin, but to Gordon Binder, then
the president of the industry trade group.
"It
was apparent to me that if they were going to block it, nothing was going to
be achieved," Mr. Kennedy said. "I've been around here long enough to know
that was the case. So the question was whether you could find any common
ground."
Administration officials also had talks with industry officials, hoping for a
compromise. But when news of conciliatory moves between drug makers and
Democrats became public, some Republicans and a few industry executives were
furious. Executives at several companies suspected that Mr. Gilmartin
supported a drug benefit because he had hopes that Medco, a Merck pharmacy
benefits subsidiary, would land a crucial role in buying drugs.
"Having the whole benefit run through a couple of P.B.M.'s — especially if one
were Merck-Medco — could be a disaster," said one industry executive, speaking
on condition of anonymity. Another, at a different pharmaceutical company,
said, "Gilmartin wrapped himself in some clever rhetoric of private-sector
solutions, and it used to drive us crazy."
Merck has since spun off Medco, and Mr. Gilmartin said that his support of a
Medicare drug benefit had nothing to do with Medco.
In
the end, the talks between the drug industry and Democrats went nowhere. The
industry pinned its hopes on the election of Mr. Bush, who supported a
Medicare drug benefit, so long as it was administered through the private
sector. In early 2000, the pharmaceutical industry announced it would do the
same.
"When Bush came out for it, that nailed it," one industry executive said.
"Where else are we going to go?"
The Contributions -- A Push for Money, Mostly for the G.O.P.
Republican campaign officials were keenly aware of the drug industry's growing
anxiety about how a drug benefit might be set up.
In
a letter dated April 9, 1999, Jim Nicholson, then the Republican National
Committee chairman, wrote to Charles A. Heimbold Jr., then the chief executive
of Bristol-Myers, to discuss plans for a coalition to lobby for issues
important to drug companies.
"We
must keep the lines of communication open if we want to continue passing
legislation that will benefit your industry," Mr. Nicholson wrote in the
letter, which has since become public as part of litigation on campaign
finance rules.
He
encouraged Bristol-Myers — already a major donor to Republicans — to give
$250,000 to join the national committee's Season Pass program, which offered
donors "premier seating" at a fund-raising gala and "V.I.P. benefits" at the
Republican convention in Philadelphia in 2000.
Bristol-Myers and its employees contributed $2 million to the party and its
candidates during the 2000 campaign, according to the Center for Responsive
Politics, a nonpartisan group that tracks campaign financing. That ranked
Bristol-Myers second, behind Pfizer. Mr. Heimbold, who was a co-host at a
fund-raiser for Mr. Bush, gave $206,830 to Republicans in the 2000 campaign,
according to the center.
In
one letter from Richard J. Lane,
who at the time was president of Bristol-Myers's worldwide medicines division
and co-chairman of its employee political action committee, company executives
were chided for failing to contribute in sufficient numbers. "The politically
motivated attacks against our industry have intensified during this election
season and hostile candidates have one goal in mind — to shackle our industry
with price controls," Mr. Lane
wrote.
Although the letter said contributions were voluntary, four former
Bristol-Myers executives, all speaking on condition of anonymity, said the
company's huge contributions resulted in part from aggressive internal
solicitations. Each said they were told that a list of those who did not
contribute would be given to Mr. Heimbold.
"The need to gather in money to provide green power for our Washington
activities was spelled out in excruciating detail to all company officers,"
one of these executives said.
A
spokeswoman for Mr. Heimbold, now the United States ambassador to Sweden, said
she had no comment.
Federal election law bars companies from using coercion to force someone to
make a political contribution. A spokesman for Bristol-Myers, John Skule, said
yesterday that while "we ask for active participation in the political
process," no one was forced to donate, and the company "takes very seriously
its duty" to comply with election laws.
"There was not one person in the company who lost their job because they
didn't donate," Mr. Skule said.
The
push to gather money for Republicans was prevalent throughout the drug
industry during the 2000 campaign. With Vice President Gore saying that drug
makers were gouging the elderly, the industry contributed $20 million to
candidates and parties during the campaign, 79 percent of it to Republicans,
according to the Center for Responsive Politics.
More important, the industry bought $50 million in TV commercials and millions
more in radio, newspaper and direct-mail ads. The ads assured voters that
Republican lawmakers were fighting for a Medicare drug benefit. Drug makers
also gave the United States Chamber of Commerce $10 million more to run ads
under its name. Months before the election, House Republicans passed a bill
along the industry's preferred lines.
The
bill never gained traction in the Democratic-controlled Senate. And when Mr.
Bush won the election, the drug makers celebrated. As one industry executive
said, "There were a lot of high-fives around here."
The Victories -- A New Congress and a New Outlook
Having a Republican in the White House, however, was not enough to bring
elderly people the relief they were clamoring for. In the two years after the
2000 election, a Medicare drug benefit remained bogged down in partisan
politics on a divided Capitol Hill.
The
drug industry contributed $26 million in the 2002 election, again mostly to
Republican candidates. And it again spent millions on television ads in
crucial districts around the country — this time telling voters that
Republican incumbents had been fighting to add prescription drugs to Medicare.
"What they did, which was so clever, was run ads in Republican districts
saying, `Thank Congressman X for coming up with a prescription drug program
for seniors,' " said Senator John McCain, Republican of Arizona, who voted
against this year's Medicare bill, saying it favored drug makers while
providing the elderly scant relief. "They were helping these guys get
re-elected who had done nothing."
Afterward, the drug industry claimed credit for several crucial victories that
helped keep Republicans in charge of the House — and, more important, helped
them win back the Senate. Once again, industry executives celebrated on
election night.
"Having both houses of Congress Republican-controlled was great," one drug
lobbyist said. "Like in Monopoly, when you get to add hotels."
By
the time the 108th Congress convened in January 2003, drug makers no longer
faced the danger of a benefit administered by Medicare. Lobbyists for consumer
groups knew not to bother trying. "The whole question of Medicare being the
direct purchaser was off the table at the beginning of this Congress," said
John C. Rother, the chief lobbyist for AARP, the organization representing
retired people.
Changes within the drug industry also increased the likelihood of a drug
benefit delivered through the private sector. Merck's spinoff this year of
Medco assuaged much of the concern in the industry that any bill would give
Merck an unfair advantage.
With the framework of a privately delivered benefit already settled, industry
lobbyists went to work on the details. A critical issue was ensuring that
Medicare administrators could not press directly for discounts. Both the House
and Senate bills have language barring Medicare officials from interfering "in
any way with negotiations" between insurers and drug companies.
The
industry also won a provision in the House bill that puts Medicare in charge
of drug benefits for the elderly poor. That would strip the responsibility
from state Medicaid programs, which have begun to rein in costs by limiting
purchases of high-price drugs.
In
addition, several drug companies pressed lawmakers to include provisions that
would allow patients to appeal insurers' decisions to deny coverage for
certain drugs, and they fought an amendment to the Senate bill, offered by
Senator Hillary Rodham Clinton, Democrat of New York, that would have included
money for studies comparing drugs' cost-effectiveness.
"It
seems to me if we are going to move toward a market mechanism — which I have a
lot of questions about — markets thrive on information, and this is
information which is largely within the province of the drug companies," Mrs.
Clinton said.
Her
amendment failed, receiving just 43 votes. That was no surprise to Senator
Clinton, or to others who voted against the Senate bill, including Senator
McCain. "There's no doubt in my mind that the drug industry got everything it
wanted and more," he said. "It perhaps should be called the `Leave No Lobbyist
Behind Bill.' "
In
fact, the industry did not win every battle. Both the House and Senate bills
contain provisions that would speed generic drug approvals — a move the
manufacturers of brand-name drugs oppose.
And
in the House, a provision that would make it easier for Americans to import
cheap drugs from Canada
and Europe passed, despite intense industry lobbying against it. Later, the
industry persuaded 53 senators to sign a letter saying they oppose the
provision. The matter must now be settled in conference.
While the lobbyists worked behind closed doors, the industry financed
citizens' groups to bring its message to the public. One such group was the
United Seniors Association, whose national spokesman, Art Linkletter, took to
the airwaves this spring, congratulating lawmakers who voted to add
prescription drugs to Medicare. Gone was the strident campaign featuring Flo,
the bowler. Mr. Spatz, of Merck, said there was no need.
"Back then it was really about opposing President Clinton's proposal," he
said. "This wasn't about opposing anything. This was about supporting
something."
The
industry's silence could change, of course, as the House and Senate reconcile
their bills. But so far, the behind-the-scenes strategy seems to have been
successful. Industry opponents see the low public profile as evidence of the
drug makers' satisfaction.
"The dog is not barking," said Bill Vaughan, a lobbyist for Families USA, a
consumer group. "I think the dog got what it wanted."
A
virus found in wild animals captured and sold for food in China is genetically
similar to the virus that infects humans with severe acute respiratory
syndrome, strengthening the likelihood the disease jumped from animals to
humans and could do so again, a study says.
Chinese scientists reported this week in the journal Science that they
compared the genetic makeup of a virus isolated from human SARS patients with
a virus found in animals that had been captured and then held in a retail food
market.
Tests showed the animals had a coronavirus that was 99.8 percent genetically
identical to a virus that causes SARS in humans.
The
researchers found the virus in civets, raccoon dogs and ferret badgers sold as
food in a market in Shenzhen, in Guangdong province, but said it is not clear
if these animals were the natural source of the virus.
"It
is conceivable that [the market animals] were all infected from another, as
yet unknown animal source which is in fact the true reservoir in nature," they
said.
They also tested merchants in the market and found that eight of 20 wild
animal traders and three of 15 workers who slaughter the animals had
antibodies to the virus. Only 5 percent of the vegetable traders in the same
market had the antibodies.
SARS first appeared in Guangdong in China in November. It spread to Hong Kong
in February and eventually to more than 30 other countries. More than 8,400
people worldwide developed SARS and more than 900 died, according to the World
Health Organization.
To
the surprise of federal health officials, diabetes in the United States rose
only slightly during the 1990s, despite a sharp increase in obesity.
A
study by the Centers for Disease Control and Prevention found that diabetes
rates crept up from an estimated 8.2 percent of adults from 1988 to 1994 to
8.6 percent in 1999-2000, an increase of less than 5 percent.
The
CDC expected a larger increase because obesity -- which can lead to diabetes
-- has been rising quickly. As of 2000, about 30 percent of U.S. adults were
obese, according to the CDC, up from 23 percent from 1988 to 1994.
But
health officials warned that because diabetes is a slow-developing disease,
diabetes rates could climb sharply over the next few years.
Lifestyle changes, including dieting and more exercise, may also explain why
some high-risk adults have not developed diabetes, the CDC said.
The
government has notified Tenet Healthcare that it will hold proceedings to bar
what had once been one of its most profitable hospitals from federal health
care programs, the company announced yesterday.
The
move comes after accusations that potentially hundreds of patients had
unnecessary heart tests and surgery at the hospital, the Redding Medical
Center in Redding, Calif.
Tenet was notified late Wednesday by the office of the inspector general with
the Department of Health and Human Services of plans to begin proceedings.
Tenet has 35 days to submit documents and other evidence to prove that the bar
is unnecessary, and it said in a statement yesterday that it would do so.
In
the notice, Tenet said in a statement, the inspector general's office said it
made its decision after determining that Redding Medical Center had "furnished
cardiology and cardiac services (including several cardiac catheterizations
and coronary artery bypass grafts) that were medically unnecessary and failed
to meet professionally recognized standards of health care." The government
determined that the improper treatments and procedures were provided at least
from 1999 through 2002.
The
investigation of Redding was disclosed last October, when agents with the
F.B.I. raided the hospital and the offices of Dr. Chae Hyun Moon and Dr. Fidel
Realyvasquez. Dr. Moon was chief of Redding's cardiology department; Dr.
Realyvasquez was its top cardiac surgeon.
Since then, the Redding cardiology program was effectively — albeit
temporarily — shut down. Recently, Dr. Moon agreed to surrender his medical
license pending resolution of the investigation. In August, Tenet agreed to a
deal with the Justice Department and other federal agencies, under which it
agreed to pay $54 million to settle accusations that it engaged in what is
known as medical necessity fraud — billing health care programs for treatments
or diagnostic tests that were unnecessary.
Under the settlement's terms, however, the Department of Health and Human
Services was allowed to continue its inquiry into whether the hospital should
be barred from receiving reimbursement from Medicare and other federal health
programs. Such a move could be financially devastating; American hospitals
often depend on such payments for half of their revenue or more.
In
its statement, Tenet said it would work with the government to ensure that the
services provided by the hospital, a 269-bed facility that serves nine rural
communities, would continue without interruption.
As
if living in the suburbs hadn't been maligned enough in recent years, now
researchers are blaming a house in the burbs for an overweight America.
An
article published last week in the American Journal of Public Health and
American Journal of Health Promotion highlighted a survey in which researchers
looked at suburbs and more urbanized areas and determined that living in the
suburbs was unhealthy.
People in densely populated areas, apparently, can walk to the bus stop, to
school or to the shopping center. Live in the burbs is different. Everything
is too far away to walk and, even if someone had the urge, in most cases there
aren't any sidewalks to use. Instead, people jump into their cars to go to the
store, go to work or to run other errands.
The
suburbs have taken a lot of heat in recent years. Everything from clogging
roads and increasing pollution to destroying farmland has been placed on the
shoulders of suburbanites looking for a clean environment in which to raise
their families.
Now
this survey adds insult to injury.
To
be sure, there likely is some correlation between how often someone jumps in
their car to get groceries and how often they might walk to the store, but
what they purchase while in that store also contributes. The suburbs also have
more outdoor activities than a typical city, and there are more options for
people who want to live a healthy lifestyle.
No
doubt that people who are forced to walk to the bus stop will burn a few more
calories than someone who hops in the car, but perhaps the problem isn't so
much the suburbs as it is our propensity for laziness.
That's one area, however, that the survey failed to look at.
While I sympathize with the difficulties that Johns Hopkins Hospital and other
teaching hospitals face, solutions other than working medical residents
around-the-clock must be found ("Hopkins residency program loses accreditation
over labor rules," Aug. 27).
The
Accreditation Council for Graduate Medical Education (ACGME) gave much thought
to balancing the needs of patients, hospitals and medical residents before
adopting the 80-hour average monthly work week rule.
And
this rule allows hospitals flexibility. Some individual work weeks during the
month may exceed 80 hours provided all the work weeks during the month don't
average more than 80 hours a week.
Why
did ACGME feel a need to limit the work hours? Previously, some hospitals
would continually work medical residents 100 to 120 hours per week, depriving
them of sleep. Studies show that people deprived of sleep make more errors -
which can be deadly in a hospital. Also, continual sleep deprivation is bad
for the health of medical residents.
Having a little time off to socialize with family and friends - without having
to sacrifice needed sleep - makes for a better medical resident and future
doctor.
Even if, perhaps, some additional people need to be hired, the public should
insist that Johns Hopkins and other hospitals respect and comply with the
80-hour work week cap to retain their accreditation.
