The
computer system that approves Medicaid payments for prescription drugs in
Maryland remained out-of-order yesterday, meaning that hundreds of
pharmacies are giving patients less than their full prescriptions.
Nelson J. Sabatini, the state health secretary, said he was frustrated
that the contractor that has an $8.5 million contract to run the system,
First Health Systems of Glen Allen, Va.,
had fallen short on promises to get it running Friday and Saturday.
"Now we are hoping that we can have the system up and operating again when
business opens up on Monday morning, but we've been hoping and hoping a
lot lately, so you never know," Sabatini said yesterday.
The
cause of the hardware crash Thursday is not known.
Pharmacists are continuing to issue drugs, calling an 800 number to
confirm that a Medicaid patient is eligible, and then they are issuing
about 72 hours' worth of drugs instead of the full month or more on the
prescription, Sabatini said.
No
deaths have been reported because of inability to get medication since the
computer crash.
Maria Leonor Zelaya swung open her kitchen cabinet to reveal an arsenal of
domestic weaponry:
"Combat" baits and metal traps to kill the roaches and mice that scurry
across the floors of her Silver Spring apartment; Pine-Sol cleaner and
Clorox liquid bleach to stave off the specks of brown mold that bloom in
her bathroom; a dustpan and brush to sweep up the paint chips that flake
off the walls near her children's beds.
"This place," the Salvadoran mother of two said with a heavy sigh, "is
going to send me to the madhouse."
It
is a common refrain among tenants of the gritty, low-rise brick apartment
buildings that dot the Langley Park and eastern Silver Spring area, known
as the International Corridor, which has become a magnet for thousands of
low-income immigrants in search of affordable housing, said Maria Elva
Maldonado, co-organizer of a recent study of housing conditions there.
The
study, which focused on a portion of the corridor known as Long Branch
that includes Zelaya's building, was commissioned by Montgomery County and
done by researchers from the University
of Maryland and the immigrant advocacy group CASA de Maryland. A summary
was presented to the County Council in July, and the complete study is to
be released this week.
Its
findings suggest that for many Long Branch residents, low rent comes at a
high cost: More than half of the 268 tenants surveyed said they were not
notified of potential lead-paint hazards by their landlords, possibly in
violation of federal and state laws. About 48 percent reported rodent
infestations in their apartments. Forty percent cited electrical problems,
and almost 20 percent were without heat at least once during the winter.
"If
you take all the results together, you are left with folks living in very,
very poor conditions with a very significant potential for serious
illness," said Maldonado, who also directs the housing project at CASA de
Maryland.
Those problems, said Alex Chen, the study's author, probably extend beyond
Long Branch, a roughly two-square-mile area clustered around Piney Branch Road
and University Boulevard. "Long Branch is representative of the whole
[international] corridor," said Chen, a professor and director of the
urban studies program at the University of Maryland.
Young children who ingest chips or dust from deteriorating lead paint can
suffer permanent brain damage; behavioral problems; slowed growth; blood,
kidney and hearing problems; and possibly death. Pregnant women exposed to
lead are at risk of miscarriage and other reproductive complications.
Federal law requires landlords of properties built before 1978 -- when
lead paint was banned -- to disclose whatever they know about the
lead-paint content in a dwelling, including whether they ever tested for
it, before tenants sign a lease. Landlords must also provide tenants with
a government booklet on how to protect themselves against lead poisoning.
Much of the rental housing in Long Branch
was built before 1978. This fact, coupled with the 40 percent of renters
surveyed who cited problems with peeling or chipping paint, has caused
researchers and county officials to worry that children are at risk of
slow poisoning.
"This was our biggest concern," said Montgomery County Executive Douglas
M. Duncan (D). "We certainly need to focus our attention on this section
of the county."
A
portion of Long Branch falls into a Zip code designated by the Maryland
Department of Health and Mental Hygiene as "at risk" for lead poisoning.
In such Zip codes, pediatricians are required by state law to test infant
patients for lead exposure at ages 1 and 2.
State officials said that 61 children in Montgomery County and 98 in
Prince George's County -- the International Corridor spans both counties
-- were found to have elevated blood-lead levels last year. But even if
the numbers seem low, Duncan said, "that's unacceptable. We don't want any
child to suffer from lead poisoning."
It
is also possible that many cases have not been diagnosed: In both
counties, as well as statewide, fewer than one in five children has been
tested for lead, officials said.
That proportion may increase as a result of a state law that took effect
this month requiring schools in at-risk Zip codes to check that students
have been tested before they are registered for pre-kindergarten,
kindergarten and first grade.
Meanwhile, Montgomery officials said they are contacting all of the
roughly 175 rental properties in Long Branch that are under county
jurisdiction with an offer to pay half the cost of lead-paint testing in
those built before 1950. County officials also are determining whether the
owners of such buildings have complied with a state law requiring them to
register with the state Department of the Environment.
Under that law, the properties are assumed to have lead paint unless it is
proved otherwise, and landlords must take steps to reduce the lead hazard
-- for instance, by repainting walls and smoothing floors so that dust
cannot collect -- every time a new tenant arrives or whenever a young
child or pregnant woman living in the unit is found to have elevated lead
levels.
Yet
based on census data, state officials estimate that only about a third of
owners of pre-1950 buildings in Montgomery and Prince George's counties,
and fewer than half statewide, are in compliance.
Even if Montgomery officials succeed in improving those percentages,
renters such as Zelaya, whose apartment buildings were built a few years
after 1950, would not be affected. That's a problem, said Ruth Ann Norton,
executive director of the Coalition to End Childhood Lead Poisoning,
because many houses and apartments built before 1978 had lead paint.
"If
you live in a house built before 1978," she said, "you really must have
your child tested."
In
theory, the Montgomery
County housing code does provide some protection for tenants of homes
built from 1950 to 1978. For instance, landlords must repaint all
apartments every five years -- every three years if tenants can
demonstrate that the dwelling is in sufficiently bad shape through no
fault of their own.
Zelaya said that has not been her experience. By the third year in her
basement-level apartment, she said, the humidity had caused the paint
behind the family photographs she had hung on her walls to buckle and peel
in large patches.
Unaware of the county code, Zelaya's partner and father of their two
children, Longino Hernandez, repainted the apartment himself. Since then,
he's had to repaint twice more -- most recently this spring after a major
water leak, they said.
The
manager of their building did not return telephone messages left last
week.
Now
Zelaya, who said she has only recently become fully aware of dangers posed
by lead, fears for her two sons. Her oldest, a second-grader, has been
struggling with learning disabilities since he was 4, Zelaya said, and her
second child has chronic asthma. Could lead have played a role? "I'm very
worried about it," she said.
But
moving is not an attractive option. Zelaya and Hernandez said they moved
to Montgomery from Prince George's because they wanted to be near better
schools. And with Hernandez, who works in construction, making about $380
a week, and Zelaya, who worked for a dry cleaner but is temporarily
jobless, the family has enough difficulty paying the $700 a month for its
current apartment.
The
county-sponsored survey found many tenants in a similar predicament.
Despite monthly rates of $500 to $700 for a one-bedroom unit, and $610 to
$871 for a two-bedroom in Long Branch,
almost 60 percent of renters said they were spending more than 30 percent
of their income on housing.
More than a fourth exceeded 50 percent of their income for housing costs.
So,
at present, Zelaya said, her best option is to stay put -- and pray that a
decision she made to improve her sons' lives does not end up harming them.
A
coalition of restaurant owners has said it will sue Montgomery County over
the recently approved prohibition on smoking in area establishments,
accusing the County Council of overstepping its authority to enact the
ban.
The
lawsuit, which will be formally announced at a news conference today,
marks the second time the county has been forced into court to defend its
position that restaurants and taverns are not fit for cigarettes.
Maryland's highest court tossed out an earlier ban on procedural grounds.
"The action that the County Council has taken left us with no other
choice," said Claude Andersen, corporate operations manager for Clyde's
Restaurant Group. "We offered plenty of room for compromise. We keep our
bar area separate from our dining area. We installed special ventilation
systems. Their law took nothing like that into consideration."
The
Montgomery County Council passed the current ban July 1, this time with an
eye on procedural miscues that derailed the earlier ban, passed in 1999.
The latest measure carried far more support and included backing from
County Executive Douglas M. Duncan (D), who said the notion of a
restaurant smoking ban has now become an accepted practice in many states
and large cities.
Council member Phil Andrews (D-Gaithersburg), a sponsor of the measure,
said he believes the new ban will withstand legal scrutiny. But he is
concerned that a judge might block the law from taking effect Oct. 9,
while judicial proceedings are pending. The restaurant group's 1999
lawsuit kept the smoking ban in limbo for four years, until it was thrown
out by the Maryland Court of Appeals in May.
"I'm disappointed," Andrews said about the lawsuit. "The plaintiffs are
choosing to put their convenience over the public's health."
Melvin Thompson, vice president of government relations for the Restaurant
Association of Maryland, said the lawsuit that will be filed today in
Montgomery County Circuit Court is warranted because of the havoc the ban
could cause for businesses locally and the potential for even greater
damage if other jurisdictions follow Montgomery's lead.
Anti-smoking groups in Baltimore and Howard counties, as well as some
state lawmakers, are already looking very closely at what's happening in
Montgomery, Thompson said. "This could set the tone for those efforts," he
said.
A
difference between this lawsuit and the one four years ago, Thompson said,
is that it is being financed not by the tobacco industry but by a
grass-roots coalition of restaurant owners, employees and patrons.
The
Restaurant Association hopes to raise $100,000 for the effort, in part by
distributing fliers in local establishments that lay out their reasons for
opposing it. Those include the prospect of smoking customers driving a
short distance to the District, or to neighboring counties, to spend their
money.
"Restaurants who rely on smokers for up to 40 percent of their income will
go out of business," one flier warns. "Restaurant workers will lose their
jobs. Owners will lose their businesses. Residents will lose restaurant
choices. And Montgomery County will lose major business, personal income,
sales and alcohol taxes. . . . In these tight budget times, this is money
Montgomery
County cannot afford to lose."
Andersen said the ban could be devastating for his company's restaurant in
Chevy Chase because patrons have only a few blocks to walk to reach the
District, where smoking is permitted.
He
said Clyde's invested heavily in extravagant air-exchange systems "so this
would never come to this point."
Supporters of the ban say that such efforts may make restaurants more
comfortable, but not safer. They have argued that secondhand smoke is an
important public health issue and have said that they believe the county
has every right to pass laws protecting restaurant workers and patrons
from its dangers.
"There is no legal reason why the duly elected members of the council
can't enact a regulation like this," said Eric Galley, a lobbyist for the
American Cancer Society and American Heart Association.
"How long are these handful of gadflies willing to say they don't care how
many people die as long as they want to make an extra dollar?" Gally
asked.
Staff writer Susan Levine contributed to this report.
One
of Magellan Health Services' largest unsecured creditors is continuing its
fight to open up the company's reorganization process so that it may file
a competing turnaround plan.
R2
Investments said last week in papers filed with U.S. Bankruptcy Court in
New York that competing plans, including the one it would like to submit,
would guarantee the Columbia-based behavioral health care provider's
emergence from Chapter 11 bankruptcy protection on a prompt basis with
sufficient liquidity to prosper after emergence, according to a report by
Dow Jones Newswires.
R2
Investments, which holds about $240 million in notes, filed the papers
opposing Magellan's recent request to extend its exclusive period for
soliciting plan support from creditors to Nov. 7, according to court
papers.
The
hearing on Magellan's request for an extension is set for today in the
bankruptcy court in New York.
Magellan's hearing on the reorganization plan, in which it would sell a
controlling stake to Onex Corp., is set for Oct. 8. The official committee
of Magellan's unsecured creditors and the company's largest customer,
Aetna Inc., support the plan.
RANDALLSTOWN -- The state Department of Agriculture is scheduled to begin
a two-week mosquito-spraying in the communities of Oakwood
Village and Liberty Manor tonight.
The
spraying was prompted by the discovery of mosquitoes that tested positive
for the West Nile virus. Spraying will take place from 8 p.m. to midnight
twice a week for the next two weeks, weather permitting.
Residents are urged to remain indoors during spraying. Information:
301-927-8357 or 877-425- 6485.
Maryland
lawyers and victims of malpractice have formed a group to oppose caps on
malpractice awards, which they said would limit access to the courts for
those who cannot afford legal services.
Citizens for Patients Rights will work to rebuff efforts from insurance
and doctors groups to cap compensatory rewards for patients and lawyers in
malpractice suits. The new group, backed by the Maryland Trial Lawyers
Association (www.mdtrial- lawyers.com), says patients must be allowed to
sue when wronged by their doctors. If lawyers' compensation is capped,
they may be less likely to take cases, they said.
"I
was very unaware of how much work goes into this kind of thing," said
Doreen Tull, of Pokomoke
City, who joined the group after launching a malpractice suit on behalf of
her mother. "I mean, mounds and mounds of paperwork. Nobody is going to
work for nothing."
"I
suppose that as long as there is a jackpot mentality, that's right,"
countered Jay Schwartz, an attorney for MedChi, the state medical society.
Doctors' groups and others seeking malpractice caps also say rising
insurance premiums -- which have forced doctors out of some high-premium
markets -- are the result of ever-increasing malpractice lawsuits and
rising jury rewards. Capping the lawyers' take for malpractice suits could
stop what they see as a malpractice "crisis."
Proponents of medical liability controls have stepped up their efforts in
recent years, both on the federal and state level. During the 2003 General
Assembly, they successfully closed a loophole that had allowed lawyers to
bring private malpractice suits under the Maryland Consumer Protection
Act, thereby avoiding existing Maryland
award caps.
Citizens for Patients Rights says states that have capped malpractice
awards have seen no decrease in insurance costs. They cite Maine,
Massachusetts, Michigan, Utah and California as examples.
In
Maryland, insurance regulators last month approved a 28 percent
malpractice premium increase requested by Medical Mutual Liability
Insurance Society of Maryland, the state's largest malpractice insurer.
TOWSON
-- The Baltimore County League of Women Voters will hold a public meeting,
"How Will You Pay for Health Care," at 7:30 p.m. tomorrow at East Towson
Carver Community Center, 300 Lennox Ave.
Speakers will be Rep. Benjamin L. Cardin, Baltimore Health Commissioner
Peter L. Beilenson and John Folkemer, executive director of planning and
finance for the state Department of Health and Mental Hygiene. They will
discuss federal, state and local agendas for health care.
For
many, the mention of the words Chase Brexton Health Services Inc. brings
to mind a health center in the Mount Vernon neighborhood that services the
gay, lesbian, bisexual and transgender communities.
Sure, Chase Brexton�s claim to fame is its service to the gay and lesbian
communities. In fact, �they are spoken under the same breath as the Moore
Clinic at [Johns] Hopkins,� says Jay Wolvovsky, president and CEO of
Baltimore Medical System Inc., the state�s largest federally funded
community health center.
But
Chase Brexton, which reached its 25th anniversary this month, is much
more.
In
an effort to meet the needs of the ever-changing communities it serves,
Chase Brexton has evolved into a �full-fledged health center,� said
Executive Director David H. Shippee.
Today, Chase Brexton offers primary medical care as well as mental health,
dental, substance abuse, pharmacy, pediatric and a host of other medical
services.
And
while 45 percent of Chase Brexton�s patients are from the gay and lesbian
communities, the majority are not, Shippee said. The center serves
approximately 6,000 patients, only a handful of whom suffer from HIV.
Chase Brexton has grown from 15 employees in 1991, when Shippee took over,
to 120. In that time, the organization�s annual budget has grown from
$600,000 to $23 million.
�I
can�t foresee a time when those centers will go out of business,� said
Carla S. Alexander, director for palliative care at the Institute of Human
Virology at the University of Maryland School of Medicine. From 1989 to
1997, she was medical director of clinical affairs at Chase Brexton.
Health care experts agree that federally funded community health centers
are a safety net to the health care system, as they provide medical
services to the uninsured.
Clinic
The
center also has diversified its funding sources, relying much less on
federal grants.
But
in the coming years, the roles played by community health centers will
expand. They will be on the �front line,� Wolvovsky said. �Community
health centers are starting to receive the national recognition that�s
been due to them.�
Already, federally funded community health centers are becoming attractive
to young physicians because of their mission and �reasonable schedule,�
Wolvovsky said. The doctors tend to work 40 to 50 hours per week.
Also, physicians that work for federally-funded community health centers
do not have to buy their own malpractice insurance. The federal government
has a pool of funds that cover them.
Malpractice insurance can be an expensive undertaking for doctors.
Already, doctors report leaving the profession, or at least dropping
certain kinds of practices or moving to other states with lower-priced
premiums, because they cannot afford malpractice insurance.
Del. John A. Hurson, chairman of Maryland�s House Health and Government
Operations Committee, is expected to release soon a proposal that will
bolster the position of the state�s federally funded community health
centers in Maryland
An
estimated 600,000 Marylanders lack health insurance.
As
a candidate, President Bush made a commitment to double the funding of
community health centers over a five-year period. This would bring the
funding level of the centers to $2 billion.
This is welcome news for the community health centers. Since federally
funded health centers are subject to public policy decisions, the centers
are always looking for ways to diversify their funding sources, Wolvovsky
said.
Shippee said when he started with Chase Brexton, the organization was
dependent on federal grants for 85 percent of its funding.
�Today, grants represent about 22 percent of our livelihood,� he added.
Shippee said he looked to implement programs that would generate revenues,
such as the organization�s on-site pharmacy. Chase Brexton has also gotten
into the managed care arena.
�We�ve moved a little higher on the food chain,� Shippee said.
In
the next five years, Shippee said, Chase Brexton will still be invested in
its core services, but he expects it to be �a little broader
geographically.�
Copyright 2003 � The Daily Record. All Rights Reserved.
During Prostate Cancer Awareness Month in September, Healthy U of Delmarva
and the American Cancer Society want to remind men and their families of
the importance of good prostate health. Although prostate cancer is the
second-leading cause of cancer death in American men, it remains one of
the most survivable of all cancers.
Just 20 years ago, the survival rate for prostate cancer was 67 percent.
In 2003, more than 97 percent of men diagnosed with the disease are
surviving at least five years. The 10-year survival rate is 79 percent,
and 15-year survival rate is nearing the 60 percent mark. The reasons that
the survival rates jumped significantly are earlier detection and better
treatment options.
"We've made real progress against prostate cancer," said Dr. Robert
Brookland, president of the mid-Atlantic division of the American Cancer
Society's board of trustees. "More men are surviving this disease than
ever before, due in large part to awareness of prostate cancer and taking
aggressive action against it."
Prostate cancer still remains a major cancer killer. An estimated 221,000
new cases will be diagnosed this year, and nearly 29,000 lives will be
lost to this disease in 2003. In the Maryland alone, nearly 4,000 men will
learn that they have prostate cancer this year and an estimated 500 men
will die of the disease. Mortality rates in the African-American community
are almost double the rates for white men.
To
further the battle against prostate cancer, the American Cancer Society
emphasizes four key points:
#
Get as much information about prostate health as you can.
#
Talk with your doctor to determine your personal risk.
#
Understand all available testing and treatment options, so you can make an
informed decision.
#
Contact the American Cancer Society for information about all aspects of
prostate cancer 24 hours a day (1-800-ACS-2345 or www.cancer.org).
The
American Cancer Society has also issued guidelines for prostate screening.
The guidelines are flexible in order to accommodate individual medical and
personal needs, and are subject to revision based on new research
evidence:
#
Men 50 and older should be offered annual screening tests (PSA and DRE).
#
Men at high risk (family history, African-Americans) should begin
screening (PSA and DRE) at age 45.
The
American Cancer Society is an essential resource for public information
about prostate cancer. It provides timely information to help men make
informed medical decisions and offers services to give them a sense of
control, reassurance and hope. Some of the American Cancer Society's
prostate cancer public awareness and service efforts include:
Man
to Man. The American Cancer Society's Man to Man prostate cancer education
and support program helps men and their families cope with prostate
cancer. The community-based program provides patient education, support to
patients and family members and awareness of prostate cancer as a major
health concern for all men.
Man
to Man Groups meet at the following locations:
#
Accomack County at Onley United Methodist Church on the third Wednesday of
each month at 7 p.m.
#
Wicomico County at St. Alban's Episcopal Church on the second Wednesday of
each month at 7:30 p.m.
#
Worcester County at the Ocean Pines Library on the first Tuesday of each
month at 7 p.m.
Prostate Cancer Screening and Education. On Saturday from 8 a.m. to 1
p.m., there will be a prostate cancer screening (PSA blood test) offered
at the Worcester County Health Department on Healthway Drive in Berlin.
This will be an opportunity for men to receive a free PSA blood test and
receive information about prostate cancer and other health issues. In
addition, the University of Maryland's WellMobile will provide oral cancer
screenings and information. This event is being held in cooperation with
Atlantic General Hospital, Worcester County Health Department and the
Worcester County Man to Man program. Healthy U is offering all of their
participants the chance to get credit for the September monthly prize
drawing by attending this event. Look for the Healthy U sign in sheet to
register for the drawing.
Councilman: Hagerstown native N. Linn Hendershot came away from his bout
with pneumonia with a desire to help the disabled and a renewed love of
his hometown.
By
Jeff Barker
Baltimore Sun
Staff
Monday, September 15, 2003
HAGERSTOWN -- City Councilman N. Linn Hendershot's second life began in
the same place as his first, right here in this Western Maryland community
where he is a disability rights advocate, unabashed Hagerstown booster and
the state's first elected official dependent on a ventilator to breathe.
In
his mind, Hendershot, 58, has had two distinctly different existences.
The
first began with his birth here and the childhood polio that left him
using crutches. He followed his love of sports to Atlanta, where he worked
in the late 1960s in public relations for the National Football League's
Falcons under Coach Norm Van Brocklin.
He
did communications work for the Indianapolis Motor Speedway and NASCAR,
and helped the Atlanta Committee for the 1996 Olympic Games ensure that
venues were fully accessible.
Then he got sick again -- so seriously ill with bronchial pneumonia in
1997 that he was hospitalized for 17 months and placed on a ventilator,
which he has used since. He emerged from his illness with a new sense of
urgency and purpose. "When you're on a ventilator, long-term planning
means next Friday," he says.
In
2001, he ran for the Hagerstown City Council and won.
Now, he attends council meetings every week, does public relations for a
hospital in which he was once a long-term patient and serves on numerous
boards of civic and charitable groups. He relies on a powered wheelchair
to get around.
A
hose dangling from his neck keeps his lungs filled with air. His condition
barely affects his speech -- he talks nonstop about his pet causes. The
walls of his office are filled with photos of his earlier life, including
shots of him at stadiums and with sports heroes.
"I
feel like my life is in extra innings," he says.
He
says his life's second phase -- "a second chance," he calls it -- began
during his recovery from the pneumonia in 1997 that left him unable to
breathe on his own. His lungs had been weakened by post-polio syndrome,
and he was unable to speak for several months.
Hendershot, who is divorced, lived in Atlanta at the time but was soon
transferred to the Western Maryland Hospital Center to be near his mother,
sister and brother. His prognosis was uncertain.
"They kept trying to encourage me to sit up, but I would panic. If I would
sit up at over 65 degrees for more than 20 minutes, I would get extremely
short of breath. And I was scared of the machines," he says.
A
new attitude
He
had worn back braces for polio-induced scoliosis as a child, and his back
continued to bother him when he did sit up. But then he started to get
better. He says it wasn't so much his body recovering as his attitude.
Hendershot had always been enamored of computers, and his family won
permission from the hospital to install one in the medical library for his
use.
"I
went to the director and said, 'If he's going to get well, we need to get
his mind off how much he's hurting,'" says his sister, Marion Hardin, 64.
"Other patients saw him working on the computer and stopped by and asked
him about it. This was incentive for him to get up every day."
What made the difference, Hendershot says, was that he went from feeling
useless to feeling needed.
By
the time he was discharged in 1998, he had helped establish a computer lab
for patients' use.
Many of those Hendershot assisted in the lab were spinal cord patients.
One, David Clift, who was paralyzed in a diving accident as a teen, was
hospitalized here for 34 years before being released in March to live on
his own in Hagerstown. "He was truly institutionalized until that computer
lab," Hendershot says. "He discovered a whole new world."
Clift says Hendershot played a critical role in his independence. "He
showed me [how] to use the mouse and the Internet so I can talk to people
and meet people," Clift says.
Hendershot was hired by the hospital in 1998.
Running for council, he says, was a natural extension of working with
patients. He believes he can use politics to help people with disabilities
better function in society's mainstream. He has been working with state
legislators on a measure to provide tax credits for people who build homes
with wider corridors and other specifications that make them accessible to
the disabled.
But
he didn't want to be a single-issue candidate.
He
jokes about his disability. He says his medical condition meant that "you
don't have to worry about term limits with me."
Of
his ventilator, he says, "Somebody's got to represent the heavy
breathers."
Hometown boy
He
stresses his love for Hagerstown and his vision for the city's growth. He
is one of the city's most ardent advocates, often ending a conversation
with a visitor by initiating a tour of the city or offering, "Let me get
back to why I'm so excited about Hagerstown."
He
says the city, with its proximity to Civil War battlefields and its
historic buildings -- such as the sublime, 88-year-old Maryland Theater --
isn't properly appreciated by the rest of the state. "I think the
perception is of Hagerstown as Western Maryland, way out there in the
mountains. But we're not," he says.
He
joined three other Democrats and one Republican when he won election to
the council two years ago.
Now
he says he'll even consider running for Congress, if only to draw
attention to his pet issues: making sure seniors and the disabled have
adequate health care and accessible housing. His health could be an issue,
though. Even with the ventilator, he is hospitalized periodically to clear
his airways.
His
schedule is already demanding.
He
is chairman of a 16-year-old charitable group called MIHI -- "Many
Individuals Helping Individuals" -- supporting recreational, housing and
educational projects for the disabled. The organization, along with
Habitat for Humanity and a local Episcopal church, broke ground in July on
a home for a local woman born with spina bifida who gets around on an
electric scooter. The home is of universal design, which means it doesn't
hinder those with mobility or strength limitations.
It's projects like these that he says have made the past five years the
best of his life.
"I've done a thousand times more since I've been sick than when I was
well," he says.
Older Women Now Surpass Young Men in Admissions; Population Shifts Cited
By
Julie Ishida
Washington Post
Staff Writer
Monday, September 15, 2003; Page A14
Reversing a decades-old pattern, older women have replaced young men as
the group most likely to wind up in a hospital bed after accidental
injury, according to a recent study.
The
shift reflects the growth in the number of frail elderly people and
changes in emergency room treatment that have sharply reduced the need to
hospitalize younger patients, said the researchers from the Harvard Injury
Control Research Center, who published their findings last week in the
journal Injury Prevention.
The
trend is likely to put new burdens on the health care system, and
underscores the need for more efforts to prevent injury and the resulting
costly hospitalizations among older Americans, particularly women, they
said.
"It
makes prevention all the more important because it is so much more costly
to take care of older people who are injured," senior author David E.
Clark said.
Falls account for most injuries in older women, but motor vehicle
collisions are responsible for a significant portion. Older women, who are
at risk for the bone-thinning disease osteoporosis, are especially prone
to hip injuries.
Once elderly patients arrive at the hospital, doctors must be attuned to
the need to minimize complications and restore or maintain physical
functions that can deteriorate rapidly in elderly patients, said Clark,
also a trauma surgeon at Maine Medical Center in Portland.
"We
can't assume that our older patients will bounce back after their injury
is treated, because they are weaker, more likely to have underlying
medical problems and to have complications," he said. "The medical and
social situations are much more complicated than the ones we had to deal
with before when most of the patients were young and relatively healthy."
The
analysis was based on data collected by the U.S. Centers for Disease
Control and Prevention from 1979 to 2000, through the annual National
Hospital Discharge Survey, a random sampling from hospitals nationwide.
From 1996 to 2000, women 65 and older accounted for 28 percent of hospital
admissions after injury, overtaking men younger than 40, who accounted for
26 percent. From 1979 to 1983, young men represented 41 percent of
hospital admissions after injury, while elderly women accounted for 14.5
percent.
The
aging of the population is only a small factor in the trend, the
researchers said. Rates of hospitalization after injury have decreased in
most age groups over the past two decades but fell most dramatically for
young men.
That change may result from a lower rate of injury among young men and
better emergency treatment methods that avoid hospitalization for younger
adults' injuries, Clark said. Older patients may be more likely to be
admitted because of concerns about other medical conditions and safety
upon discharge.
The
study also found that older people are increasingly likely to be
discharged to rehabilitation centers and nursing homes rather than to
their homes. Younger patients were typically discharged from hospital to
home.
CHICAGO -- Human Genome Sciences Inc. said it created a monoclonal
antibody that protected animals against a fatal toxin churned out by the
deadly anthrax bacterium.
Anthrax toxins, potent poisons released by the bacterium, can evade
antibiotics and make it difficult to treat people who have been exposed.
In 2001, five people died and 17 others were sickened when a series of
anthrax-tainted letters were sent through the postal system.
Human Genome Sciences' announcement came at the opening day of a
conference here sponsored by the American Society for Microbiology. The
meeting is known as ICAAC (Interscience Conference on Antimicrobial Agents
and Chemotherapy).
The
Rockville, Md., company said it developed a highly specific
antibody that can bind to an anthrax product called protective antigen,
blocking a key step in the lethal cascade of anthrax toxins. The company
said one injection completely protected laboratory rats from death due to
anthrax toxins. In a separate presentation, Human Genome Sciences also
reported that the monoclonal antibody improved the survival rates of
rabbits and monkeys who were exposed to inhalational anthrax.
Human Genome Sciences said the results support further development of the
antibody as a new anthrax treatment. Of course, human clinical trials,
should it get to that point, would likely be limited to measuring safety
rather than efficacy, as it is unethical to expose anyone to a bioterror
agent for research purposes. In the case of potential new treatments
against bioterrorism, Food and Drug Administration rules allow for the
approval of drugs based on animal efficacy studies alone.
Among other presentations, researchers said that compounds similar to an
old drug, quinacrine, could shed light on dealing with mad-cow disease.
Quinacrine, which has been a treatment for parasitic infections such as
malaria and giardiasis and other disorders, previously had been shown in
the test tube to work against the infectious particles known as prions,
believed to be the culprit in transmitting brain-wasting disease from
infected beef to humans.
Now
researchers at the University of California at San Francisco said oral
quinacrine cleared another key hurdle by crossing the blood-brain barrier
to reach the areas targeted by the fatal infection. The blood-brain
barrier acts as the body's protective moat, which shields the brain from
harm but complicates neurological-disease treatment by blocking drugs from
reaching affected areas.
Quinacrine by itself merely slows but doesn't cure prion disease, said
Lotus Yung, a UCSF prion researcher now with Novartis Pharmaceuticals
Corp., a unit of Novartis AG in Florham Park, N.J. The drug also can cause
psychological and cardiovascular side effects. So the UCSF team is now
tinkering with the structure of quinacrine to build chemical cousins that
would be more potent and less toxic. "The next step is to infect animals,"
she said, to see if any of these compounds can halt the disease.
Copyright 2003 Dow Jones & Company, Inc. All Rights Reserved.
Facing budget-breaking increases in prescription drug bills, the governor
of Illinois took the first step yesterday toward purchasing lower-cost
medications from Canada, a move that puts him in direct conflict with
federal regulators and signals a dramatic escalation in the civil war over
U.S. drug prices.
What began a decade ago with busloads of senior citizens trekking across
the border in search of cheaper medicines has mushroomed into a nationwide
rebellion. It has spread from small, nonprofit groups to the private
sector, and now, to local and state officials who are defiantly ignoring
warnings by the Bush administration and the pharmaceutical industry that
drug reimportation is dangerous and illegal.
Gov. Rod Blagojevich, a Democrat, said he has directed the Illinois
special advocate to draft a plan for buying inexpensive medications in
Canada for as many as 240,000 state employees and retirees. The change
could save the state tens of millions of dollars.
"The status quo on prescription drugs is intolerable and unacceptable,"
Blagojevich said in an interview yesterday. This year, the state is
spending $340 million on prescriptions for its workforce, a 15 percent
increase over last year.
"I
am optimistic we will be able to save literally millions of dollars for
the taxpayers and set a precedent other states will follow," the governor
said.
Although Illinois would become the first state to pursue Canadian drug
purchases for its workers, Blagojevich joins a much larger trend. Even as
Congress debates whether formally to legalize the practice, millions of
Americans -- including horse breeders in New Jersey, a retirement village
in Ohio and the mayor of Springfield, Mass. -- already have decided for
themselves that the financial savings are too large to pass up. Despite
its claim that the practice is illegal, the FDA has generally looked the
other way.
"There are a lot of bad drugs out there," said FDA Senior Associate
Commissioner William Hubbard. "We fear a program like [Illinois's] would
put people at risk."
"In
my opinion the pharmaceutical corporations and the lobbyists have an
absolute stranglehold on Washington," said Springfield Mayor Michael J.
Albano. Since July, he has enrolled more than 800 city employees in a
voluntary program that covers maintenance medications bought from a
Canadian wholesaler.
Before launching the effort, Albano traveled to Canada to check out CanaRx
and then became the first client, ordering his son's insulin and diabetes
supplies from the company. To attract participants, the city waived
co-payments on medications bought through the Internet service.
The
switch saved Albano $250 this year and the city $852 for his family's
medications. If a large percentage of the city's 9,000 workers and
retirees join, the mayor estimates the city will save $4 million to $9
million a year.
"This is a revenue stream for Springfield, the only revenue stream we
have," Albano said, noting that budget cuts have forced him to slash 323
jobs. "I know people have concerns about foreign countries, but we're
talking about Canada here, not Iraq or North Korea or Iran."
Depending on the drug, the discounts in Canada can be as much as 80
percent, savings that have proven especially irresistible to senior
citizens who do not have prescription coverage under Medicare.
"How pathetic can it be that the solution to the high cost of drugs is to
try to sneak them across the borders," said Arthur Caplan, director of the
Center for Bioethics at the University of Pennsylvania. "Even our
government doesn't believe the price of drugs the industry is charging.
The Veterans Administration and the Department of Defense don't pay these
prices."
One
of the vagaries of the U.S. system is that senior citizens -- major
prescription medication users -- often pay the highest prices because they
are not eligible for the bulk discounts government and private insurance
programs provide.
To
ease the strain, the industry distributed free medications to 5.5 million
patients last year, said Jeffrey L. Trewhitt, spokesman for Pharmaceutical
Research and Manufacturers of America. He said that what amounts to
importing other countries' price controls not only endangers patients but
also jeopardizes future investment in research that produces new drugs.
Trewhitt cited FDA warnings that medicine bought from another country may
be counterfeited or tampered with, because it does not undergo the same
strict inspections. The agency has said it has little desire to punish
individual patients in need of lifesaving medicine.
But
with private analysts and the FDA estimating $750 million in prescription
drug revenue now flowing to Canada -- and entrepreneurs capitalizing on
the trend -- the Bush administration is shifting to a more aggressive
stance in the legislative and legal arenas.
"It's complicated and contentious and there's a lot at stake," said James
N. Czaban, a food and drug lawyer at Heller Ehrman in Washington. "It
looks like we're heading to a multifront war in the courts and on the
Hill. I can easily see this becoming a very significant national case
because of the policy issues involved."
Late last week, the Justice Department asked an Oklahoma judge to issue an
immediate injunction against Rx Depot, a chain of 85 storefront businesses
that helps process drug orders in Canada. Justice lawyers, working with
the FDA, argue the company's role as a middleman makes it a de facto
pharmacy that endangers patients by selling "unapproved" products.
"The fact that you have no drugs in the back room doesn't matter," Hubbard
said. "We have been told by state pharmacy boards they are selling
unapproved drugs."
In
some instances, the unapproved drugs are products awaiting licensing in
the United States, though in many others the term "unapproved" simply
means the medicine was bought outside the country. However, many of the
medications sold legally in this country are manufactured overseas.
Carl Moore, the Oklahoma oilman who founded Rx Depot, rejected the notion
he is acting as a pharmacist and said he is exercising his First Amendment
rights to provide information. "If you can find out how to build a bomb on
a Web site, I should be able to tell people drug prices off the Web," he
said.
Moore said his business is the logical extension of the cross-border bus
trips FDA has permitted for a decade: "We developed a concept for people
who live inland."
The
FDA cannot discuss details of the case, Hubbard said. But he volunteered
that an undercover agent who ordered two medications through an Rx Depot
in Oklahoma received a generic substitute for one that has not yet been
approved in the United States. The second medicine is an FDA-approved
drug, manufactured in this country but "became an unapproved drug once it
came from Canada," he said.
The
agency conducted a similar undercover investigation into Springfield's
program and asserts that Albano is allied with an unlicensed drug
distributor. Albano counters the FDA "conducted a sting of the wrong
pharmacy."
Hubbard acknowledged that FDA's discretionary authority has resulted in
inconsistent enforcement. He said FDA hopes Congress and the courts will
bring clarity to the situation and some financial relief to consumers --
perhaps before the 2004 elections.
"The answer is better coverage in this country and a good place to start
is for Congress to finally reach bipartisan agreement on a Medicare drug
benefit," said Trewhitt.
The
House and Senate have approved 10-year, $400 billion drug plans, but
resolving differences between the two versions has proved difficult. With
final passage of legislation in doubt, Reps. Rahm Emanuel (D-Ill.) and Gil
Gutknecht (R-Minn.) are pressing the Senate to adopt their bill legalizing
drug imports from Canada and the European Union. Although it passed the
House overwhelmingly, the White House, the FDA and some powerful senators
are opposing it.
In
the meantime, a growing number of Americans have decided they can't wait
for Washington.
Despite the legal uncertainties, the Standard Breeders Owners Association
in New Jersey signed up for a drug-purchasing plan with SUNRx, which
supplies medications from Canada, if the company offers the cheapest
price.
"After I've seen some of the discounts and realizing how much is added on
to U.S. drugs, I absolutely believe this is the way we need to go," said
Shay Cowan, the health care consultant at HRH of New Jersey Inc. who
signed the breeders up for the Canadian program. For the first time in
recent memory, Cowan said he has helped a client lower its drug costs.
"We
are actually reversing the trend," he said. "There is nobody in the
industry able to do that."
HOUSTON, Sept. 14 � The doctors beat the lawyers on Saturday as Texas
voters narrowly approved a constitutional amendment limiting medical
malpractice awards. The final results came in early this morning.
The
measure, Proposition 12 � one of 22 amendments on the ballot, all of which
won voter approval � was supported by the Texas Medical Association and
other health care interests, large corporations and the Republican state
leadership. Supporters said it would lower medical costs and halt a flight
of physicians from Texas.
Proposition 12 was opposed by trial lawyers and a broad sweep of law
enforcement, environmental and citizen groups that said it would overturn
the Texas Bill of Rights by limiting judicial review of malpractice
claims, thereby closing off public access to the courts.
The
passage of the measure by 51 percent to 49 percent enshrines in the
voluminous Texas Constitution a legislative limit of $750,000 per case on
noneconomic claims for medical malpractice. Under this limit, a patient
injured by faulty medical care can collect a maximum of $250,000 from a
doctor and an additional $500,000 from one or more hospitals or health
care providers for pain and suffering, disfigurement and other
compensation. Awards for loss of income and medical expenses are not
capped. The $750,000 cap cannot be appealed to the courts.
An
especially controversial aspect of the amendment allows the Legislature to
establish caps on other types of lawsuits if it approves them by a
three-fifths majority.
Gov. Rick Perry, who campaigned hard for the measure and made it one of
his leading legislative priorities, was delighted with the result, his
spokeswoman, Kathy Walt, said.
"In
addition to doctors, health care providers and patients, all Texans will
benefit from affordable health care," Ms. Walt said of Proposition 12. She
said the governor and supporters of the amendment monitored the close
tally at the executive mansion in Austin until about 2 a.m. Sunday. Some
1.4 million Texans, more than 12 percent of the electorate, voted on the
measures, almost double the number who usually turn out to vote on
constitutional amendments.
Deborah Hankinson, a former judge on the Texas Supreme Court and a
Republican who is treasurer of the Proposition 12 opposition group Save
Texas Courts, said that although the amendment was approved, "we are very
proud of our campaign; people are paying attention now."
The
final tally provided a boost for Governor Perry, a Republican, who also
appears to be making gains against Democratic opponents in efforts to push
through a plan to remap Congressional districts for the 2004 elections in
a third special legislative session, starting on Monday.
Democratic senators who blocked earlier action by fleeing to New Mexico
have returned, allowing for consideration in the Senate, where Republicans
hold a 19-12 majority. The measure has passed the House, where Democrats
walked out in a revolt in May, fleeing to Oklahoma in a vain attempt to
block a Republican drive for enactment.
Saturday's 22 amendments join 410 others added to the 82,800-word Texas
Constitution since 1876. The document is second in verbosity among state
constitutions only to the Alabama Constitution's 315,000 words (the United
States Constitution weighs in at less than 10,000).
The
Texas Constitution owes its length, experts say, to the determination of
its drafters to fend off hostile government by spelling out each and every
legislative possibility. To an even greater degree, Alabama owes its far
more detailed charter in part to post-Reconstruction efforts to maintain
the structures of white supremacy long after the Civil War.
The
new Texas amendments include two that would allow candidates running
unopposed to take office without an election. Another would allow the
Legislature to regulate wineries in the patchwork of wet and dry
localities throughout the state.
CHICAGO - Outbreaks of Legionnaires' disease are often blamed on germs
spewing from air-conditioning systems in big buildings, but new research
shows home hot water pipes can also be a common source of the disease.
Legionnaires' is a form of pneumonia caused by a bug that occurs naturally
in water. The latest work, combined with earlier studies, suggests that
the bacteria often grow in the slimy gunk lining residential hot water
pipes, and that home water may be responsible for about 20 percent of
cases.
"The evidence suggests that the residential water system is an
underappreciated source of Legionnaires' disease," said Janet Stout, a
microbiologist who is head of the special pathogens lab at the Veterans
Administration Medical Center in Pittsburgh. Stout presented her latest
findings yesterday at a conference in Chicago of the American Society for
Microbiology.
Autism: A study that discounts a suspected cause of the disorder gives way
to more questions than answers.
By
David Kohn
Baltimore Sun
Staff
Monday, September 15, 2003
In
recent years, autism research has been a battleground. A vocal group of
parents, advocates and a few scientists focused on vaccines containing
traces of mercury as the lead suspects in the disorder. But most autism
researchers were suspicious, arguing that the theory didn't fit the
evidence.
Now, with a new Danish study offering the strongest evidence yet against
the vaccine theory, the controversy may give way to a more baffling
question: If vaccines aren't the culprit, then what is?
The
range of theories underscores how little is known about autism, a
developmental illness that afflicts as many as one in 200 American
children and makes it difficult for them to connect with the outside
world.
Researchers are looking at a variety of possible mechanisms: Do these
children suffer from "extreme male" brains? Are they prenatal victims of
their mothers' overaggressive immune systems? Or does faulty insulation
between neurons fill their brains with maddening static? These are a few
of many competing theories.
"There are a variety of tantalizing trails of evidence," says Diana
Schendel, a Centers for Disease Control and Prevention epidemiologist who
studies the disorder. "But none of them are conclusive, by any stretch of
the imagination."
Last week's issue of Pediatrics published a report on autism cases in
Denmark, which stopped using vaccines containing thimerosal, a common
mercury-based preservative, in 1992. (In the past three years, U.S.
manufacturers also have stopped or reduced thimerosal use in children's
vaccines.)
The
Pediatrics study found that Denmark's autism had risen sharply since 1992.
"If thimerosal causes autism, then you'd expect rates to go down after
it's banned," said the study's main author, Dr. Kreesten Madsen of the
Danish Epidemiology Science Center.
Most autism experts agree with Madsen.
"This reaffirms that there is no evidence that thimerosal causes autism,"
said Dr. Neal Halsey, director of the Institute for Vaccine Safety at the
Johns Hopkins University.
But
some critics called Madsen's study deeply flawed. Because Denmark has such
a low autism rate, the study is irrelevant to the United States, said Mark
Blaxill, a director of the parent group Safe Minds. "We still consider
thimerosal a very important suspect," he said.
Yet
even scientists who suspect thimerosal minimize its role in the disorder.
"If thimerosal was a huge contributor, we would have picked that up
already," said University of California researcher Isaac Pessah, who is
hunting for chemical triggers, including mercury and pesticides.
Most researchers suspect that autism is a family of disorders with several
causes. While autistic people share a core of symptoms - they crave
routine, have trouble communicating, and don't understand intuitive social
rules - their behavior can vary greatly. While some have large
vocabularies, others barely speak. Some seem riotously overstimulated;
others seem locked in a world with little sensation.
"Autism is no one thing. It probably has multiple causes," said Dr. Andy
Zimmerman of the Kennedy Krieger Institute's Center for Autism and Related
Disorders.
A
combination of abnormal genes - probably between four and 20 - likely lays
the groundwork for the illness. Dozens of scientists are trying to find
these oddities. Among these is a group at Vanderbilt University, which
recently found that some autistics have a gene that may decrease brain
serotonin levels. This neurotransmitter plays a role in several key
autistic symptoms, including compulsiveness and anxiety.
But
genes alone don't cause the illness. Most experts think genes simply
create a vulnerability, and that environmental factors send some of these
children over the edge.
Zimmerman, a pediatric neurologist, suspects that immune system
abnormalities in mother and child may provide one push. Several studies
have found that maternal infections during pregnancy can increase a
child's autism risk. He theorizes that the illness is set in motion when a
mother's aggressive immune response throws off the rhythm of fetal brain
development.
In
his most recent work, Zimmerman has found that in some autistics, the
brain's immune cells - the microglia - are overactive. His next step: to
find out whether these cells are fighting off an attack or doing harm
themselves.
At
Harvard Medical School, pediatric neurologist Margaret Bauman has recently
found evidence of such subtle brain damage. In studying the brains of
autistic cadavers, she found abnormalities in the "white matter,"
insulation that keeps neuronal messages free of static.
Many scientists think the illness may stem from an oversized brain. A
study published this summer in the Journal of the American Medical
Association found that autistic toddlers had larger than average heads.
This "neuroproliferation" could explain why autistics often seem
overwhelmed by ordinary stimuli.
"There are too many cells, and they could potentially create too much
noise," said Rebecca Landa, director of the Center for Autism. "It's like
sticking your finger in a socket. Their brains can't channel on the
input."
She
is working on a study to measure the levels of neurochemicals that may
control brain size and structure. "Maybe the brain overbuilds itself,"
said Landa, who hopes to correlate neurochemical levels with specific
autistic behavior.
Other scientists are focusing not on the size of the autistic brain, but
its gender. Cambridge University psychiatrist Simon Baron-Cohen argues
that those with the illness have "extreme male brains."
Men, he says, tend to see the world in terms of systems, while women view
it through the prism of emotion and relationship. Autistics - 80 percent
of whom are male - show many hyper-masculine traits, he argues. They focus
on details while neglecting the whole, have trouble interpreting facial
expressions and acquire language slowly. He has also found high rates of
autism in families of physicists and engineers - professions that require
systematizing skill.
Baron-Cohen is testing testosterone levels in the amniotic fluid of 3,000
children, some of them autistic. His hypothesis: high prenatal
testosterone can produce an acutely "male" brain. The hormone may speed
development of the right hemisphere, which probably controls these male
characteristics.
If
testosterone does play a role, prenatal treatments might help the disease.
But Baron-Cohen is leery, arguing that "hormonal engineering" could
radically alter personality.
"Would we want to intervene?" he asked. "You may make your child more
sociable, but also maybe less focused on systems. There could be a cost
for that."
THERE'S TALK in Congress of lowering the bar on providing drug coverage to
Medicare beneficiaries.
The
$400 billion plan endorsed by President Bush and passed in competing
versions by both houses in June has lost momentum. A summer full of
sniping from both ends of the political spectrum fueled jitters among the
elderly, the politically potent constituency the legislation is designed
to help.
Many fear they will wind up worse off than they are today. Considering the
complexity of the measures that propose to make sweeping changes in one of
the nation's most popular programs, it's hard to be certain they won't.
Thus, the siren call to scale back to the bare minimum - such as arming
elderly Americans with a discount card so the one-fourth without drug
coverage don't have to pay top dollar - is seductive.
But
lawmakers who have been struggling for more than a decade to modernize
Medicare, and help with outpatient drug costs totaling thousands of
dollars per person annually, should resist the temptation to give up. They
won't soon come this close again.
The
major threat to the legislation is an internal struggle among Republicans
that perhaps only President Bush can resolve.
Adding prescription drug coverage to Medicare, as the Senate proposes,
balloons the costs of an automatic spending program GOP conservatives
think is already too expensive. But the House plan essentially creates a
voucher system, forcing beneficiaries instead of the government to absorb
cost increases.
Long-term costs to a budget already deep in the red are an important
concern, but shoving elderly Americans over the side in the guise of
helping them is not the answer. Only a final bill based on the Senate
approach has any hope of widespread support, deservedly so.
Expanded use of private insurance companies is a valuable innovation that
offers the potential of closer patient monitoring and better care. But
Congress should not pass up the chance - as both bills currently do - to
use Medicare's broader purchasing clout to get the best possible deals
from the pharmaceutical industry, which has been getting away for years
with outrageous mark-ups.
A
leading complaint among potential beneficiaries is that both versions of
the legislation are too stingy. Both feature high premiums and
deductibles, and huge gaps in coverage, in order to squeeze into the $400
million 10-year price tag.
Sen. Edward M. Kennedy, the chief Democratic backer of the Senate bill,
argues this is only a down payment, that benefits will become generous in
future years. That's a hard sell but an acceptable compromise.
Perhaps most troubling is the danger that adding a prescription drug
benefit to Medicare will harm the majority of older Americans who have
some help already, in part by accelerating the trend of employers dropping
coverage for retirees.
The
legislation offers partial subsidies to employers who continue providing
such coverage, but they are inadequate.
Many, many more concerns could be raised about this legislation. Griping
is easy. Toiling away line by line to shape a workable program, one that
clearly will help more than hurt, is very difficult. But it can be done.
Don't punt yet.
MEMBERS OF CONGRESS are pretending that the Medicare bill, currently
bogged down in conference negotiations, is simply about prescription
drugs. Not quite. Both House and Senate versions of the bill contain
provisions designed to help particular companies and congressional
districts, benefiting everyone from Weight Watchers International to
marriage therapists to doctors in Alaska. The legislation also contains
measures to shore up rural health care, adjust doctors' pay and patch up
bits of the Medicare system that don't work. And it has new rules allowing
the re-importation of prescription drugs from Canada and elsewhere. Some
of these measures are justified, some not.
The
most expensive provision in the House bill would create "health savings
accounts" -- in effect, tax shelters. While it is a good idea, in
principle, for people both to save for health care costs that health plans
don't cover and to manage some of their health-care money themselves, this
is an extremely expensive program. The cost to the budget is more than
$170 billion over 10 years, which comes on top of the $400 billion that
the bill is already going to cost -- and this at a time of soaring budget
deficits. The creation of costly health savings accounts should be
considered as part of a fundamental restructuring of health care, not
tacked on as an afterthought.
If
some of the budgetary costs have attracted little attention, the costs to
Medicare consumers have attracted less. There are a variety of proposed
payment increases, including small co-payments for home health delivery,
as well as higher outpatient charges. Because the bill offers drug
discounts to lower-income seniors and requires higher payments from
wealthier seniors, some in Congress (and outside) worry that all seniors
will be forced to disclose their income to insurance companies, a
violation of privacy.
Both House and Senate bills establish a new bureaucracy, designed
explicitly to administer the private providers of Medicare. In the past,
the Centers for Medicare and Medicaid Services administered the entire
program, but the new bills would create a parallel agency at the cost of
$10 billion. There is also a provision that would, in effect, prevent
doctors who dispense chemotherapy in their offices from charging extra for
the drugs, a practice that has long been used to cover nursing and other
costs associated with delivering chemotherapy outside of hospitals.
Instead of providing a proper compensation for these services, the bill
simply removes the extra charge, a change that could force many cancer
patients back into hospitals.
The
conclusion? Far from the "major piece of reform" this bill is sometimes
styled as being, this Medicare legislation contains yet another hodgepodge
of half-measures that do little to cure the system's deeper ills or to cut
its long-term costs. Is this really better than no bill at all?
Beware of farm lobbies asking Washington for a one-time "going out of
business" deal. They often return for more, starting with a "this time we
mean it" pitch. That is one of many reasons to be leery of a $13 billion
buyout plan for tobacco farmers that is being floated in Washington.
The
tobacco farmers would accept $13 billion in exchange for giving up a price
support system that once served them well but no longer does. Ever since
the late 1930's, the domestic price of tobacco has been artificially
propped up by a federal program aimed at managing production levels.
Farmers get quota allotments allowing them to grow certain amounts of
tobacco each year. Many of them rent quota allotments from their original
holders, adding these leases to their farming costs. Tobacco growers long
resisted attempts to phase out quotas. But faced with foreign competition
and lower consumption, they are willing to try something different � or at
least take the money and run.
Members of Congress from tobacco states are right to try to end the
venerable program. Ultimately, the market should set prices and production
levels. And it is normal to expect lawmakers to ask for relief for their
constituents, many of them small farmers. What is not clear is why these
farmers and other quota holders (who treat their quotas as a cherished
rent-producing family heirloom) should be entitled to lavish compensation
in exchange for accepting a much-needed change in policy. It would be one
thing to help farmers make the transition from tobacco. But the tobacco
legislators are asking for what amounts to unrestricted payouts (farmers
could still grow tobacco) predicated on the notion that these quotas are
bankable assets.
The
prospects for the Senate buyout proposal are enhanced by the fact that it
would force cigarette manufacturers to pick up the $13 billion price tag,
and by the likelihood that the deal would give the Food and Drug
Administration jurisdiction over the tobacco industry. These are not
sufficient reasons to support the buyout. F.D.A. oversight is certainly
overdue. But growers should not be able to demand a payoff in exchange.
And though nobody worries about costs when the cigarette companies are
footing the bill, buyouts are not always the answer. Farmers cannot expect
a big payday every time Washington decides to withdraw farm support
programs that no longer make sense, or are incompatible with global trade
rules.
Last week's news that workers are paying sharply higher health insurance
costs tells only part of the story about runaway medical expenses. Yes,
workers' premiums for employer-provided coverage now average $2,412 a
year, up nearly 50% since 2000, according to a survey by the non-profit
Kaiser Family Foundation. But their out-of-pocket costs for prescription
drugs also jumped: Drugs averaging $13 to $17 a prescription now run $19
to $29, the survey found. No wonder 26% of those polled for the study said
they were "very worried" about their ability to pay for medications.
The
problem goes beyond cost. Consumers, employers and even the doctors
writing prescriptions lack the information needed to judge whether the
drugs they're using are the most effective treatment. The debate this
summer over providing seniors a prescription-drug benefit revealed that
little research is conducted into comparing the effectiveness of
expensive, top-selling drugs.
Yet
the very industry that should be backing such research is fighting
sensible calls for government-sponsored studies. In June, drug industry
lobbyists helped defeat a Senate amendment allocating $75 million to learn
which drugs work best. A measure passed by the House in July earmarking
$12 million for research is also vulnerable.
Only the Defense Department has a vigorous internal program of testing and
monitoring the effectiveness of the drugs used to treat the 8 million
people in its health-care programs. Drug research for the rest of the
population is severely limited.
The
industry doesn't complain publicly about the Pentagon's efforts and says
it supports private drug effectiveness studies. However, it fears that
government-funded research might overlook the benefits of expensive drugs
in the quest to cut costs.
Certainly, doctors need to retain discretion in prescribing. And care
could suffer if studies were used to impose rigid limits on the types of
medicine available to people in various insurance programs.
Recently, though, research has exposed pricey, highly promoted drugs that
are no more effective than lower-priced choices:
●
A federal study reported last year that children with middle-ear
infections recovered just as well after treatment with common antibiotics
as those youngsters using more expensive brand-name products.
●
Oregon's state health plan last year found no evidence that the highly
promoted painkillers Celebrex and Vioxx work better than over-the-counter
ibuprofen, which can cost as little as 10% of the brand-name drugs'
prices. Oregon is looking to save up to $17 million a year through similar
studies.
●
A study published in December found that an inexpensive,
long-established diuretic was more effective than newer, costlier rivals
in lowering blood pressure and preventing complications. Drug companies
point to a more recent study that produced somewhat different results. But
that should be an argument for more research, not less.
As
Congress considers an expensive drug benefit under Medicare, sound
research is more important than ever to identify ineffective or dangerous
therapies and spotlight the most cost-efficient ones.
The
drug companies constantly talk about the value of financing research for
new cures and treatments. The same energy needs to go into establishing
whether the expensive new drugs they produce are any better than
lower-cost medications already available.
� Copyright 2003 USA TODAY, a division of Gannett
Co. Inc.
MARYLAND'S HOSPITAL personnel crisis rolls on despite concerted efforts by
hospitals to stop it. Unless we reverse this alarming trend, patients
seeking health care a decade from now - especially those in the aging
baby-boomer generation - will be in for a rude shock: a lack of skilled
health care workers to tend to their needs.
Earlier this year, the Maryland Hospital Association's annual personnel
survey found 40 percent of the 42 hospital positions reviewed had vacancy
rates of 10 percent or higher. In addition to the well-documented shortage
of nurses, hospitals need more pharmacists, radiation therapy technicians,
respiratory therapy technicians, radiographers and nuclear medicine
technicians - to name a few.
The
problem is not limited to hospitals. Nursing homes, home care and other
providers are reporting shortages, too. Projections indicate that by 2005,
3,300 nurse positions will be vacant in Maryland. By 2012, demand will so
outstrip supply that Maryland's nurse shortage could approach 17,000.
Short-term steps such as flexible schedules, higher salaries and heavy
investments in technology to free nurses from paperwork so they can spend
more time with patients have helped narrow the gaps and lure more students
to nursing. But these steps won't be enough to reverse the long-term
trend. We face a crisis in the making that requires the attention of top
Maryland policy-makers.
Recent budget cuts to reduce Maryland's massive structural deficit make
remedial efforts more difficult. But ways must be found to address this
matter before these vacancy rates reach epidemic proportions.
Last month, the issue of health care work force shortages was the focal
point of a health care summit in Annapolis, sponsored by the Governor's
Workforce Investment Board. The summit highlighted the best recruiting and
training techniques, discussed how they can be applied statewide, analyzed
where Maryland falls short and what needs to be done about it.
It's ironic that recent efforts to stimulate interest in health care
professions have generated so much interest that colleges and universities
can't keep up.
Nationally, nursing schools rejected more than 5,200 qualified applicants
last year. In Maryland, the University of Maryland School of Nursing
turned away 200 qualified applicants. Other schools report similar
experiences. The doors slammed shut on these eager students because of a
lack of classroom and lab space, too few qualified teachers and
insufficient clinical practice space - further hampered by a decline in
public support for higher education.
We've got to reopen those doors. Anne Arundel Community College will add a
nursing class in the spring. The Community College of Baltimore County, in
conjunction with Union Memorial Hospital, is offering a new fast-track
program for licensed practical nurses on its Dundalk campus this fall.
Bowie State University added a new nursing program this year. The
University of Maryland School of Nursing and others have increased their
class sizes.
Still more needs to happen.
Even with a tight budget, the administration of Gov. Robert L. Ehrlich Jr.
and leaders in the General Assembly should establish incentives for
colleges to enlarge classes in nursing and other allied health
occupations. They should create incentives for advanced high school
courses that qualify graduates for immediate entry into nursing programs.
Capital funds should be directed toward building and equipping new health
profession classrooms at community colleges.
Distance learning is proving useful in other states to educate more health
care workers. Students can go online and take classes via their computer.
In Maryland, this approach is still in its infancy. Internet programming,
with the necessary investment in faculty and technology, should be
supported.
The
private sector can play a role by offering financial support to school
efforts to bolster student aid packages and by offering incentives to draw
more people to health care professions.
Maryland's hospitals already give financial assistance to nursing students
and lend faculty to colleges. Hospitals are expanding the use of
technology to mitigate shortages and improve efficiency. But hospitals and
other health care providers are constrained by their own budget
predicaments.
In
the long run, wise public policy will make the difference. If Governor
Ehrlich and leaders in the General Assembly identify key work force
shortages as priority areas for action, educators and health care leaders
will respond.
The
time to act is now, even in difficult fiscal times.
Calvin M. Pierson is president of the Maryland
Hospital Association.
Elias Zerhouni, the executive director of the National Institutes of
Health in Bethesda, said recently that Baltimore -- which boasts both the
University of Maryland and Johns Hopkins medical schools -- should be
referred to as, "The city that heals."
I
couldn't agree more.
However, before we can heal, we need to have the proper tools. And to have
the proper tools, we have to develop new knowledge through biomedical
research.
In
the early days of the human race, life was precarious due to predatory
animals, famine, and infection. While few in our country today need to
fear the first two threats, there are a host of diseases -- new and old --
that threaten our health and well-being.
There are newly emerging pathogens -- HIV, West Nile virus and SARS --
that require vaccines and cures that have not yet been developed. The
post-Sept. 11 world we live in has also made us rethink diseases once
thought to be eradicated, such as smallpox, and those we hadn't previously
given much thought to, such as anthrax.
Multi-drug resistant bacteria -- tuberculosis and staphylococcus -- have
become more widespread than ever.
Such bacteria mutate and develop mechanisms to cope with the presence of
various antibiotics, making the antibiotics ineffective. Bacteria that
cause pneumonia can be lethal killers if they become resistant to all
available antibiotics.
With the warming of the environment, diseases that were once confined to
tropical areas, such as dengue fever and malaria, are now more prevalent
in the southern regions of our country.
Diseases can now rapidly spread around the globe due to the large number
of people traveling on airplanes.
This makes the ability to isolate and contain these diseases much more
difficult, perhaps impossible. An example is the spread of SARS from Asia
to North America through airline travel.
Pollution has become a major threat to our health, too. In addition to the
increased risk of asthma, lung and heart disease, the damage pollution
causes to the atmosphere reduces our protection from the sun and increases
our chances of skin cancer, a preventable disease affecting increasing
numbers every year.
And
I cannot forget to mention the effect our more affluent lifestyle has on
the health of our society. Too much food consumption and too little
activity have led to the epidemics of obesity, diabetes, hypertension and
heart disease.
The
National Institutes of Health reports that obesity kills more people each
year than breast cancer, prostate cancer, lung cancer and AIDS combined.
All
of these threats to our health threaten to undo the progress biomedical
science has made in improving the human life span. It does no good for us
to think that we are safe because only one in every 1,000 people will
become afflicted with a particular disease. If you or your loved one is
that one, you'll wish there were a treatment or cure.
Research is the key to early diagnosis, cure and prevention.
We
never know where discoveries will come from. In the 1970s President Nixon
declared a war on cancer.
And
while progress has certainly been made since then, we do not yet have a
cure for cancer. Some might say that we lost the war, but that would be
too narrow a view.
Part of the research funded by the government was on retrovirus --
research conducted by Dr. Robert Gallo, a scientist on the faculty of the
University of Maryland School of Medicine -- so when HIV came along all
that previous cancer research made it possible to identify a causative
agent and provide a diagnostic test for HIV to protect the blood supply,
which has saved untold numbers, perhaps millions, of lives.
So
research matters to you, to me, to our families, to our friends. Each of
us has the responsibility to do all we can to make sure that research
continues and thrives, and that the knowledge produced is translated into
new tests, new medicines and new cures.
Each of us can help by supporting the use of tax dollars to fund research,
by participating in clinical trials to test new approaches and
interventions, and by keeping ourselves informed so that we can benefit
from the fruits of that research.
Dr. Donald E. Wilson, vice president for medical
affairs and dean of the University of Maryland School of Medicine in
Baltimore, can be reached at dwilson@som.umaryland.edu.
The
Federal Trade Commission recently exonerated the alcohol industry from the
charge that it's trying to seduce underage drinkers with flavored malt
beverages such as Smirnoff Ice and Bacardi Silver, which critics call "alcopops."
The commission, which prefers the less inflammatory term "FMB," reported
to Congress that "adults appear to be the intended target of FMB
marketing." Its investigation "found no evidence of targeting underage
consumers."
Anti-alcohol activists replied that the industry's intent is beside the
point. "It's impossible to construct an advertisement that appeals to a
21-year-old, on his 21st birthday, and doesn't appeal to someone who's 18
years old or maybe even 16," said George Hacker, director of the Alcohol
Policies Project at the Center for Science in the Public Interest.
Mr.
Hacker is right, which is why it's unreasonable to expect manufacturers of
alcoholic beverages to aim their marketing with laser-like precision. They
should not have to ignore the lucrative market of drinkers in their 20s
simply because some of their ads might also be attractive to teenagers.
Yet
that is the implication of a National Academy of Sciences (NAS) report on
underage drinking that was released the same day as the FTC report. The
authors insist the industry has a "social obligation" to keep its ads away
from people under the age of 21.
The
NAS committee concedes that "a causal link between alcohol advertising and
underage alcohol use has not been clearly established." But it says the
possibility of a connection means "alcohol companies should refrain from
displaying commercial messages encouraging alcohol use to audiences known
to include a significant number of children or teens when these messages
are known to be highly attractive to young people."
Acknowledging the constitutional problems with trying to impose such
restrictions by force, the NAS committee settles for the threat of force.
"In the event that the industry fails to respond satisfactorily to this
challenge," the report warns, "the case for government action might become
more compelling."
Only if you think the government is justified in prohibiting messages
because it worries how people will respond to them. Assuming that
teenagers drink more than they would in the absence of advertising (a
doubtful proposition), we are still talking about speech, which should be
countered not with force but with more speech � from parents, from
teachers, even from activists like George Hacker.
Advertising restrictions are not the only way in which the agenda laid out
in the NAS report would impinge upon the rights of adults. The committee
also recommends higher alcohol taxes, suggesting the levy on beer should
be tripled.
It's not clear how effective higher taxes would be at deterring underage
drinking. The FTC says "younger minors obtain alcohol primarily through
noncommercial means" (e.g., from a neighbor's refrigerator), and the NAS
committee notes that "a large percentage of college youth report they do
not have to pay anything for alcohol, presumably because they are at a
party where someone else is supplying the alcohol." Higher taxes might
mean emptier refrigerators or fewer parties, but the ultimate impact on
underage drinking probably would be small.
More fundamentally, raising alcohol prices to deter underage drinking is
like raising the cost of tickets for R-rated movies to deter 13-year-olds
who sneak in without the requisite parent or guardian. In both cases, the
appropriate solution is to enforce the age restriction, not to punish
responsible adults for the misbehavior of other people's kids.
Another way the policies endorsed in the NAS report affect adults is
easily overlooked: When it comes to drinking, current laws put some adults
� 18-to-20-year-olds � in the same category as children. "Explaining
convincingly � to young people as well as adults � why alcohol is
permissible for 21-year-olds but not for anyone younger is a difficult but
essential task," the NAS committee says. "The problem is exacerbated
because the age of majority is higher for alcohol than it is for any other
right or privilege defined by adulthood."
The
report mentions that some people see this situation as not only unfair but
counterproductive, since most teenagers are drinking by the time they
graduate high school and are ill-prepared to do so responsibly by a policy
that treats them like 5-year-olds, demanding abstinence rather than
temperance. But that issue, the authors conclude, is beyond the scope of
the report requested by Congress. The really interesting questions often
are.
Jacob Sullum is a nationally syndicated columnist.
Copyright � 2003 News World Communications, Inc.
All rights reserved.
