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			Friday, May 19, 2006 News Clipping Archives 7 hospitals temporarily OK'd to do angioplasty (Baltimore Sun) Has path been paved to universal health care in Md.? (Daily Record) Spring allergies hit Marylanders harder than most (Baltimore Examiner) Diagnosis out of thin air (Baltimore Sun) William H. McBeath; Ran Health Agency (Washington Post) A voice silenced (Baltimore Sun) Medical Care Contractor At Va. Prisons Under Fire (Washington Post) FDA Panel Endorses Cervical Cancer Vaccine (Baltimore Sun) Panel Backs Cervical-Cancer Vaccine (Wall Street Journal) Flu vaccine supply expected to soar (Baltimore Sun) FDA Panel Urges Prominent Warning Label for Antibiotic (Wall Street Journal) Stretching uses of prescription drugs (Baltimore Sun) Bristol-Myers Discontinues Development of Diabetes Drug (Wall Street Journal ONLINE NEWS ROUNDUP) Mumps Shots Urged In Area of Outbreak (Wall Street Journal) Government Condition Barred on AIDS Funds (Baltimore Sun) Colo. Patient Dies of Rare Brain Disease (Baltimore Sun) Scientists Begin Testing For Bird Flu in Alaska (Wall Street Journal) Doctor: States Unprepared for Bird Flu (Baltimore Sun) WHO Reports 2 Bird Flu Deaths in Indonesia (Baltimore Sun) WHO Probes Bird Flu Cluster (Washington Post) In addiction discussion, don't dismiss the importance of choices (Baltimore Sun Commentary) Are there options to moving my parent into a nursing home?(Daily Record Commentary) Life and death information (Frederick News Post Editorial) Take time out to remember work done by school nurses (Salisbury Daily Times Letter to the Editor) Vaccine won't cover all the cancer cases (Baltimore Sun Letter to the Editor) Mentally ill need shelter from streets (Baltimore Sun Letter to the Editor) Lyme disease is high risk in Cecil (Cecil Whig Letter to the Editor) 7 hospitals temporarily OK'd to do angioplasty By M. William Salganik Baltimore Sun Friday, May 19, 2006 The Maryland Health Care Commission approved conditional, one-year extensions yesterday for six Baltimore-area hospitals to treat heart-attack patients with emergency angioplasties, a procedure using a tiny balloon to clear blocked blood vessels. The hospitals, whose programs for emergency angioplasties without surgical backup were under review for the first time, had been seeking two-year extensions. The six failed, for at least some of the time over the past two years, to meet some of the state standards for the program, including 24-hour operation and getting 80 percent of patients treated within two hours. All six said they had taken steps to remedy the problems, such as recruiting additional staff. A seventh hospital, Anne Arundel Medical Center in Annapolis, was found to have met all the standards and was granted a two-year extension. The commission said it would monitor the hospitals during the year, and could take stronger action if the problems aren't fixed. Dr. Rex W. Cowdry, the commission's executive director, said there was no indication that patients had been harmed. He said the only measure of patient outcomes - whether the blockage was successfully cleared - was over 90 percent for the group, considered a good rate. Eventually, he said, the commission hopes to set up measures in such areas as mortality and infection rate. Getting conditional, one-year extensions were Baltimore Washington Medical Center in Glen Burnie; Franklin Square Hospital Center in White Marsh; Howard County General Hospital in Columbia; and Johns Hopkins Bayview Medical Center, Mercy Medical Center and St. Agnes Hospital, all in Baltimore. For years, the state only allowed angioplasty in hospitals that had the capacity to do heart surgery as a backup in case complications developed. In 1996, a group of hospitals that don't do heart surgery were approved to do emergency angioplasty on an experimental basis for patients with a certain type of heart attack. Based on that study, they were allowed to continue. The commission acted on Baltimore-area hospitals yesterday. At future meetings, it will consider extensions for other hospitals in the state, and applications for approval from hospitals which haven't done angioplasty in the past. Copyright 8 2006, The Baltimore Sun. Has path been paved to universal health care in Md.? By Dori Berman Daily Record Business Writer Friday, May 19, 2006 Sure, the health care plan recently passed in Massachusetts aims to insure every state resident and was hailed as groundbreaking. But it won=t change Vinnie DeMarco=s plan to insure all Marylanders. DeMarco, the president of the Maryland Citizens= Health Initiative, said he applauds the Massachusetts plan as progressive, but his organization will continue to push its own health care for all plan that aims to provide health insurance for all of Maryland=s uncovered. Many Maryland policymakers likely will look at the Massachusetts plan to determine if it might work here. But in reality, the Massachusetts plan leaves a number of important questions unanswered. Observers will not know how the plan works until Massachusetts regulators hammer out the fine details, and until then, lawmakers and advocates in Maryland seem content to continue down the path they=ve already begun. DeMarco=s group is perhaps best known as the force behind the Fair Share Health Care Fund Act, or the Wal-Mart bill, that passed in 2005. The measure requires Maryland companies with 10,000 or more employees to spend a certain amount on worker health insurance, or pay the difference to a state Medicaid fund. The measure, which is currently stalled amid court challenges, received national attention and inspired lawmakers in a number of other states to push similar proposals. Some considered the bill to be pioneering C while others considered it devastating C but it was only one piece of a larger, comprehensive plan developed by DeMarco=s group. AOur overall proposal is a better way to go because we don=t put key decisions to regulators. Massachusetts did some great things, but they did not do health care for all,@ DeMarco said. The Massachusetts plan creates subsidies for low-income people to purchase health insurance. But the amount of the subsidy, available to individuals with incomes up to 300 percent of the poverty level, will be on a sliding scale. The plan did not determine the scale. The plan also established penalties for individuals above a certain income level that do not purchase health insurance if there is an affordable plan available, though it failed to determine exactly who would be subject to the penalty and how much it would cost. It also failed to define Aaffordable.@ Under the plan, employers that do not offer fair coverage would have to pay a per-employee fee to the state, though the legislation did not determine what level of coverage employers must provide. AThere=s a long list of problems,@ said Michael Miller, policy director at Community Catalyst, a national health care policy organization that worked with advocates in Massachusetts. Miller also works with DeMarco. AThey=re supposed to get subsidized plans up and running for folks, and then by 2007 the individual requirements are supposed to kick in. We=re halfway through 2006, so it=s a very ambitious timetable.@ Miller suggested that the method employed by DeMarco and some lawmakers of moving one piece forward at a time, such as the Fair Share bill, is a good idea. AI think it lets people build support for the overall goal and the overall vision, but because some parts are more controversial than others, it=s good to go one piece at a time,@ Miller said. Smoke tax Indeed, DeMarco and other advocates are currently pushing another piece of the pie. Known as the Healthy Maryland Initiative, the newest proposal would increase the cigarette tax by $1 and use the proceeds to fund expanded health care access for the uninsured. Though the proposal failed during this year=s General Assembly session, DeMarco said he believes it will have more momentum next year. Of course, the comprehensive plan is on the table each year, but more as a reminder of where DeMarco and other advocates hope to end up. Del. James W. Hubbard, a Prince George=s County Democrat, has sponsored the Public-Private Partnership for Health Coverage of All Marylanders, this year=s HB 1510, for several years. AThat=s why the full bill is in, to remind everybody what the theory behind this is,@ Hubbard said. AThe Wal-Mart piece was part of that bill. The tobacco tax is part of that bill. We use the big bill as the big picture. Sometimes you have to crawl before you can walk.@ Hubbard co-chairs the Joint Legislative Task Force on Universal Access to Quality and Affordable Health Care, which should report its findings in time to make recommendations for the 2007 legislative session, he said. The task force, he said, will look at the tobacco tax and other proposed measures as well as the Massachusetts plan when determining how to go about providing uninsured Marylanders with coverage. One of the ideas likely to be brought before the task force resembles the Massachusetts provision requiring individuals above a certain income level to purchase health insurance. Del. Donald B. Elliott, a Republican representing Carroll and Frederick counties, has sponsored that provision twice now. The bill, introduced as HB 1121 this year, would impose a $1,000 tax surcharge on individuals who earn more than 500 percent of the federal poverty guideline but do not have health coverage. The proceeds would subsidize health insurance for lower-income people. AWe=ll work on it this summer again, and we=ll review the Massachusetts bill. And then we=ll come in next year with guns-a-blazin=,@ Elliott said. Purchasing health insurance, if it is affordable, is the responsible thing to do, Elliott said. Big difference But another lawmaker who has attempted to push forward-thinking health insurance policies said Maryland might not be ready for some of the provisions approved in Massachusetts. Sen. E.J. Pipkin, an Upper Shore Republican, said a provision like the one endorsed by Elliott is Alike step No. 8 in an eight-step process.@ Pipkin said policymakers would first have to take away any excuses people might have for not buying insurance. He applauded parts of the Massachusetts plan that did just that. For instance, the Massachusetts measure allows for the creation of a new minimum coverage plan for young adults, since they often choose not to purchase health insurance because they believe they will not need it. Still, even if lawmakers wanted to adapt the Massachusetts plan for Maryland, some health care policy experts warn Maryland and Massachusetts differ greatly. About 14 percent of Marylanders have no coverage while about 11 percent of Massachusetts residents are uninsured, according to the most recent Census numbers. Meanwhile, policy makers in Massachusetts already had expanded state-subsidized health care to cover more parents, according to Alice Burton, the director of the State Health Policy Group at AcademyHealth, a policy research organization. AMy observation is Massachusetts was at a time where they were able to package all these things together and make the case for a universal coverage plan,@ Burton said, while cautioning against inadvertently creating gaps in coverage by creating the plan incrementally. While Maryland is at a different point in the process of conquering the uninsured problem than Massachusetts, Burton said the step forward in the Bay State could spark some enthusiasm to move forward in the Free State. So even though Maryland might not take the same steps as Massachusetts next year, or even the year after, those interested in seeing health insurance reform believe it could help to get the ball rolling. AI think sometimes being the first state to do it has its drawbacks in terms of getting some people to visualize what you=re trying to do,@ Hubbard said. AI think Massachusetts has taken the first step in opening peoples= eyes as to how the health system works and is supposed to work.@ Copyright 2006 8 The Daily Record. All Rights Reserved. Spring allergies hit Marylanders harder than most Luke Broadwater Baltimore Examiner Friday, May 19, 2006 BALTIMORE - On a recent trip back from the island of Bonaire in the Caribbean, Catonsville resident Mary Beth Shelton=s sinuses announced to her that she was nearing Baltimore. AAs soon as we crossed into Maryland, I could feel myself clog up,@ she said. AI thought, >Man, you=re back in the Maryland pollen.= @ Shelton, the owner of a plumbing and heating business, experienced what many in the Baltimore area are feeling this time of year C the pain of allergy season. With pollen at a high level this spring, some Baltimore residents are kept up all night with runny noses, congestion and itchy eyes. In fact, Baltimore recently was named one of the Top 10 Spring Allergy Capitals of the United States by the Asthma and Allergy Foundation of America. ABaltimore is a challenging place for someone if they suffer from spring allergies,@ said Angel Waldron, an AAFA spokeswoman. AThe pollen level in Baltimore is higher than the national average. People are experiencing allergies for longer this spring. A normal allergy season spans from March to May. This year, we=ve seen high pollen levels starting in February. Instead of two or three months of suffering, you=ve got three or four.@ Waldron has some common sense tips to help allergy sufferers, such as staying indoors, removing their shoes when they enter their homes, changing their clothes and washing their hair before they go to sleep. APollen spores love to stick to your hair,@ she said. AIf you sleep on your pillow, you=re keeping those spores in your bed until you change the sheets.@ Patty Wheeler, a school teacher from Elkridge, said she dreads the allergies that come with a Baltimore spring. Like the rest of pollen sufferers, Wheeler said she has learned to deal with it. AI=ve had allergies since I was in preschool,@ she said. ABut this has been a relatively bad pollen season.@ The Top 10 2006 Spring Allergy Capitals: 1. Hartford, Conn. 2. Greenville, S.C. 3. Boston, Mass. 4. Detroit, Mich. 5. Orlando, Fla. 6. Knoxville, Tenn. 7. Omaha, Neb. 8. Sacramento, Calif. 9. Washington, D.C. 10. Baltimore Source: Asthma and Allergy Foundation of America Copyright 2006 Baltimore Examiner. Diagnosis out of thin air Using new laser technology, identifying what is wrong with patients may one day be as simple as analyzing their breath By Dennis O'Brien Baltimore Sun Friday, May 19, 2006 Your breath may tell the world what you ate for lunch or that you had too many margaritas to wash it down. But researchers in Baltimore and elsewhere are collaborating on a new, laser-based breath analyzer that can go far beyond that, picking up hidden clues about your health. "The concept is simple. You can measure in the breath what you measure in the blood," said Dr. Steven Solga, an expert on liver disease at the Johns Hopkins School of Medicine. Breath tests have long been used to identify drunken drivers. But your breath contains as many as 400 compounds, and many of them can be used to detect diseases and track a patient's recovery, experts say. Doctors already use breath samples to monitor patients with asthma, those in intensive care and others recovering after heart transplants. They are also testing breath-based diagnostic tools designed to detect breast cancer, lung cancer and tuberculosis. "Breath is a window of what's going on in the body normally, what's going on in the body abnormally and what you've been exposed to," said Terence Risby, a researcher at Hopkins' Bloomberg School of Public Health. During the past 20 years, Risby has asked 50,000 sick children, organ transplant recipients and patients with a variety of diseases to blow into a tube that deposits their breath into a plastic sack. He has used those breath samples to show that elevated ammonia levels can be a sign of liver and kidney disease, and that increased ethane can signal vitamin deficiencies in children, as well as organ damage after transplants. He points out that collecting breath samples offers a distinct advantage over the blood test: It doesn't hurt. "Breath represents a totally innocuous way of collecting a biological sample," he says. But Risby and colleagues agree that breath-testing technology still needs work. For years they have been using the same basic devices to detect so-called "biomarkers" in the breath - gas chromatographs that separate out individual compounds in the air. The problem is that the technology is expensive and results can take days. Researchers at several universities - including the University of Maryland, Baltimore County, the Bloomberg School of Public Health, the Johns Hopkins University Homewood campus and the Hopkins medical school - hope to change that. The consortium has won a five-year, $15 million grant from the National Science Foundation to find ways to build a cheaper and easier tool that doctors and patients can use. NSF may extend the grant to 10 years and $40 million, the researchers say. The goal is to develop a relatively low-cost, laser-based device that could be used not only to diagnose diseases, but also to detect pollutants in the air, gaseous emissions from the soil and the presence of nearby explosives and biological weapons. "What we're hoping to develop is small, cheap sources that can be used by just about anyone," said Anthony Johnson, a lead investigator who is director of the Center for Advanced Studies in Photonics Research at UMBC. Specifically, they want a cheap quantum cascade laser, which was developed at Bell Laboratories in 1994 and is used by researchers worldwide. Current lasers are difficult to use and must be custom designed for specific researchers, said Claire Gmachi, a professor of electrical engineering at Princeton University who is principal investigator of the NSF project. To build their lasers, researchers at UMBC and other institutions will tightly bundle stacks of thin semiconductor wafers with optical and electrical properties designed to emit light at specific wavelengths. "If you want to look for ammonia, you need one wavelength. If you want to look for nitric oxide, you need another," she said. The technology is expensive. Commercially produced models cost between $8,000 and $24,000, said John Bruno, chief executive of Maxion Technologies, a Hyattsville firm that sells them. Maxion, one of several corporate sponsors of the NSF research, has sold about 50 quantum cascade lasers to U.S. defense contractors and other firms. Sponsorship means that in return for an undetermined fee, firms will gain access to the researchers and a potential customer base. "We want to develop relationships with these companies," Bruno said. Lasers are devices that emit a highly concentrated beam of light at a prescribed wavelength - but there are many different kinds used for purposes as diverse as surgical tools, gun sights and CD players. In a quantum cascade laser, Johnson said, the light passes through a medium - such as a breath of air - to a detector. By looking at how much light is transmitted or absorbed at a specific wavelength, researchers can determine the levels of specific compounds in the air mass that the light passed through, he said. Quantum cascade lasers are the focus of the study because of two major advantages, Johnson said. They work at room temperature and emit light in the mid-infrared range, which gives them the ability to detect tiny amounts of gases such as ammonia, carbon dioxide, methane and other compounds that can signal disease, environmental hazards and biological weapons. "Eventually, you would be able to install them in a room somewhere and they'd function like a fire alarm system, putting out a signal if they detect something dangerous in the air," said the UMBC's Johnson, an expert on lasers. NASA scientists placed a quantum cascade laser on a redesigned spy plane six years ago and took finely tuned measurements of the ozone hole at 70,000 feet above the Earth. "They're a dream come true," said Christopher Webster, the atmospheric scientist at the NASA Jet Propulsion Laboratory in Pasadena, Calif., who conducted the study. Webster also used a quantum cascade laser to uncover fresh details about the composition of clouds for a study published in Science two years ago. He plans to send one into space to look for signs of life on the red planet as part of the 2009 Mars Science Laboratory Mission. "It has the potential for the measurement of any gases you want measured at extremely low levels, from sniffing the emissions from the tailpipe of your car to respiration rates of carbon dioxide in hospital patients," Webster said. Not everyone is convinced that lasers will expand the horizons of breath testing. "Lasers are always going to be the next big thing. But they never seem to come out as good as you want them to be," said Dr. Michael Phillips, an internist and professor at New York Medical College who has been researching breath biomarkers for 20 years. Phillips developed Heartsbreath, a supplemental diagnostic tool that won Food and Drug Administration approval in 2004 to measure alkane levels in the breath of heart transplant patients. The tests help determine whether the patients are accepting or rejecting their new hearts. Phillips is testing similar breath-test technology designed to detect lung cancer, breast cancer and tuberculosis, he said. Much of his work is funded by the National Institutes of Health, he said. But Risby, who is part of the NSF research group, is optimistic. He is exploring the laser's potential as a tool for monitoring liver and kidney function by measuring ammonia levels in the breath. "Theoretically, there's a huge market for this," he said. Exhalation We release as many as 400 compounds each time we exhale and many of them can serve as signals of disease, whether our organs are functioning properly and what we have recently eaten and inhaled. Preliminary studies show the following compounds in our breath are signals of specific conditions: Sulphur // Gingivitis, bad breath and liver damage Ammonia // Liver and kidney function Ethane and Propane // Whether transplanted lungs, heart, liver and other organs have been damaged during transplant surgery. Nitric Oxide // Effectiveness of a patient's asthma therapy Isoprene // Cholesterol levels Acetone // Detection of diabetes Carbon Dioxide // Used to monitor overall health of patients in intensive care and as a signal of stomach ulcers Ethane // Levels of oxygen-free radicals and antioxidants -- keys to the immune system. Copyright 8 2006, The Baltimore Sun. William H. McBeath; Ran Health Agency By Patricia Sullivan Washington Post Staff Writer Friday, May 19, 2006; B07 William H. McBeath, 75, a physician who for 20 years was executive director of the American Public Health Association, died May 15 at Suburban Hospital in Bethesda after a heart attack. He lived in Rockville. Dr. McBeath directed the 125-year-old association from 1973 to 1993. Under his leadership, the APHA helped broaden and strengthen the scientific base for national public health policy, improve access to care, and reduce racial and ethnic barriers to health care, said Dr. Georges Benjamin, the APHA's current executive director. "He was a phenomenal leader," said Benjamin, who called Dr. McBeath one of his heroes and mentors. "He led the public health movement through the effort to use science to advocate for public policy." Upon his retirement, Dr. McBeath was awarded the organization's Sedgwick Memorial Medal for his leadership in responding to public policy issues and improving diversity in the health-care field. Dr. McBeath testified many times before congressional committees on an array of health issues and publicly warned of the dangers of appointing a U.S. surgeon general who didn't have public health experience. In a letter to the editor of The Washington Post in 1992, he supported then-Mayor Sharon Pratt Kelly's proposal to distribute condoms in D.C. schools and prisons and begin a needle-exchange program, calling it "a welcome act of public-health leadership." He cited studies showing that young people who get effective AIDS education have fewer sexual encounters, fewer partners and greater condom use, and other studies showing that easy access to clean needles decreases the spread of AIDS among those who inject drugs. Dr. McBeath was born in Leitchfield, Ky., and graduated from Kentucky's Georgetown College in 1953. He received a medical degree from the University of Louisville in 1957 and a master's degree in public health from the University of Michigan in 1964. From 1958 to 1961, he was a flight surgeon in the Air Force, and then became a field officer in the heart disease control program with the U.S. Public Health Service. He became director of the Kentucky State Health Department's division of medical care as new federal legislation, including Medicare and Medicaid, began to alter health care for the poor. In 1966, Dr. McBeath moved on to direct the Ohio Valley Regional Medical Program until 1973, when he moved to Washington. Dr. McBeath was a fellow of the American College of Preventive Medicine and past president of the World Federation of Public Health Associations. He also was a delegate to the world assembly of the World Council of Churches, a member of First Baptist Church in Washington, a board member of the American Baptist Churches and a trustee of the Southern Baptist Theological Seminary. He was a member of the St. Andrew's Society of Washington and the Cosmos Club. He enjoyed investigating his Scottish heritage, videography, music and cemetery biography. A daughter, Angela McBeath, died in 1981. Survivors include his wife of 46 years, Shirley Nickell McBeath of Rockville; two children, Rebecca McBeath of Portsmouth, N.H., and Wil McBeath of Bethesda; a brother; a sister; and nine grandchildren. 8 2006 The Washington Post Company. A voice silenced Death has ended the rants of a Fells Point homeless man, and for some the quiet is disquieting By Rob Hiaasen Baltimore Sun Tuesday, May 9, 2006 Thames Street in Fells Point is quieter these days. Michael Sibert, also known as "Screaming Mike," passed away at the age of 53, or maybe he was 57. His age, like his background, remains sketchy. Either way, the man looked 70. The street person died on the street April 4. Two weeks later at St. Stanislaus Cemetery in East Baltimore, Sibert was quietly buried among old headstones of babies who lived only two days, five days, six months. At least Mike Sibert lived 53 or 57 years. "He might have been crazy, but he was our crazy," says Wes Robison, a Fells Point resident. "I loved him, and I miss him." Sibert was a loud regular and regular nuisance sometimes. Tourists would walk the other way when shaggy-haired Sibert was on one of his rants; his obscenities would often echo from the underbelly of Recreation Pier. He was not an easy presence even in Fells Point, with its history of harboring and even embracing down-on-their-luck souls. He was, for better or worse, a member of this waterfront community. Here, despite the neighborhood's more recent reputation for upscale bars and pricey condos, Sibert had a group of residents and shopkeepers who would care for him, calm him down, move him along. And now, bury him. "Despite his constant, insane rambling, you knew there was someone inside and you could get to that person," says Robison, who paid for Sibert's April 18 funeral at a neighborhood funeral home, Lilly & Zeiler. Sibert's body was taken to St. Stanislaus in a hearse -- perhaps the best ride the man ever had. "I knew no one was else was going to bury him," Robison says, "and he deserved a decent burial." Sibert did receive a decent burial, attended by two friends under a cemetery tent. In Row 9, Grave 2-A, the dirt is dried and cracked above Sibert's coffin. Topsoil, seeding and a flat marker are on their way. A bouquet of red carnations rests on the mound among the children's headstones at St. Stanislaus. Robison chose this sentiment for the marker: He gave those who helped him a reason to feel better about themselves. "It's very admirable that Wes took it upon himself to do that," says Andrew Dowell, Lilly & Zeiler's funeral director. It's unusual for his funeral home to receive a call about services for a street person, and he felt inspired by Robison's commitment to Sibert. "If Wes was going out on a limb, I figured I'd like to play a little part in helping Mike out, too." Not that cost is the point, but neither man wanted to talk about the cost of Sibert's funeral, to which St. Stanislaus also lent a charitable hand. Cremation had been briefly considered. "I was thinking of putting his ashes in the harbor," Robison says, "but with my luck, the wind would blow him right back on the street." Robison, a manager at Henderson's Wharf, first noticed Sibert eight years ago -- although others say the man had been in Fells Point longer. Robison, who has befriended other homeless people, says Sibert never asked for money, which seemed to separate him from his street brethren. He wasn't a con man, Robison says. He was also alone -- a troubled, sick man living alone on the street. "I see some fakers down on Thames trying to mumble, but it isn't very effective," Robison says. "There was only one Mike." After Sibert's death, no one had any luck tracking down family members. People weren't sure of his last name. Did Sibert have family? He seemed to have been hospitalized at one point. Was he an alcoholic? More often he was seen with a cup of coffee in his hand rather than a bottle. Some wondered if Sibert had Tourette's syndrome, given his vocal tics; others believed he might have been schizophrenic, given his ramblings and mood swings. Maybe he served in Vietnam and suffered post-traumatic stress disorder, others thought. "Where is a person like this to go? It just seems Fells Point was a safe area for him," says Andriana Pateris, owner of Trixie's Palace, a Thames Street boutique featuring such funkables as "Emily the Strange" socks, Betty Boop merchandise and stickers that read "I haven't had my coffee yet -- don't make me kill you." After Sibert spent time in her store, Pateris would light incense to dull his street scent -- but not before listening to him riff ("Las Vegas!" he screamed once) and offering him free sunglasses. "Oh yeah, he'd always say crazy stuff, but he'd also say, 'Thanks,' too." An "R.I.P. Mike 1953-2006" poster hangs in her window. Pateris drew hearts on the sign in honor of her homeless neighbor. "He had this total rock-star quality to him. The street seems very empty with Mike gone." Sibert was often seen -- and heard -- outside the Daily Grind. Maybe you stepped around him. He might have been wearing polka-dotted pajamas, listening to a broken Walkman or wearing sunglasses from Trixie's. He might have been hollering obscenities or carrying on a heated conversation with a cigarette butt as tourists gave him a wide berth. "Everything he said was weird and poetic," says Rudy Gomez, who works at the Grind. They called Sibert "Stud," and he called them "Stud" back. His complimentary drink of choice was a decaf (the man did not need caffeine, Gomez says) with whipped cream and raspberry syrup, or what he called "red with clouds." He also asked for cigarettes, Snickers and toast. (He had a thing for toast.) And he wasn't always the Screaming Mike version. "Sometimes," says Daily Grind employee Maria Geisbert, "he was just hanging out, just being a dude and talking about Motley Crue." But when Sibert was not just being a dude, the staff had a code phrase with him. They'd tell him he had a telephone call at the end of the block. He knew then it was time to chill out or move along, Geisbert says. He'd usually comply. In the last two months of his life, however, Sibert had apparently worn out the patience of some business owners and residents on Thames Street. There was talk about whether he should be hospitalized, Robison says. People were worried about Sibert's health, but they also thought his behavior had become more offensive. Robison, who probably knew Sibert as well as one could, often gave him a cup of coffee in exchange for his not screaming. In one of their last conversations, Robison warned Sibert about making a scene. "Mike, shut up and listen to me. You can't scare the tourists," Robison says he told Sibert. "You need to make yourself scarce. Some people want to put you back in a hospital." "I don't want to go back there," Robison says Sibert responded. Sibert made himself scarce -- on Thames Street, anyway. He simply walked to Broadway, where David Myers -- who works behind the counter at Broadway Liquors -- would see him digging through the trash cans with his blackened fingers. He also took an interest in Sibert's well-being. "I heard he had refused medical service many times," Myers says. Then, Sibert's body was discovered on Broadway. He died of "natural causes," according to Dowell at the funeral home. Word spread among the folks who regularly kept an eye on Sibert. Myers later called the city morgue to see if anyone had claimed the body. "He died over there," Myers says, pointing across from the liquor store to a pair of green transformers, where someone placed a flower bouquet the day Sibert died. Myers attended the funeral with Robison. "We said some prayers," Myers says. "He didn't have anybody." A local photographer named Nik Bowie took perhaps the last picture of Sibert -- a rare quiet portrait. Bowie had been hanging out in Fells Point with his camera since moving to Baltimore last year. Of all the subjects he photographed, he spent the most time with Sibert who, in lucid moments, would sit for photographs in exchange for a few bucks. There was something about Mike's face, something in his pained expression, Bowie says. "He was just kind of a reminder to people in their SUVs and new condos in Fells Point that they got it good," Bowie says. "Not everyone is as well off as them." Bowie says Sibert was in between fits -- "just taking a rest" -- for the black-and-white photo, which hangs in the Daily Grind. Head down, hands together, Sibert does appear to be resting on one of the last days. He does not look scary or like a rock star. He looks tired, finished even. Friends David Myers and Wes Robison want to believe the man was praying. Copyright 8 2006, The Baltimore Sun. Medical Care Contractor At Va. Prisons Under Fire Other States Question Company's Treatment of Inmates Associated Press By Kristen Gelineau Washington Post Thursday, May 18, 2006; PW02 A prison health-care company that has come under fire nationally for what some call shoddy medical care is under contract with the Virginia Department of Corrections and is stirring similar complaints here. Prison Health Services, the largest U.S. provider of health care to inmates, has been the target of lawsuits and allegations of poor medical care and neglect in other states. The company provides care to about one-third of Virginia's 31,270 inmates. In 2004, 330 medical grievances were filed by inmates at Virginia prisons using the Brentwood, Tenn., company, Department of Corrections spokesman Larry Traylor said. The department does not track how many of those grievances were deemed justified, he said. Inmates, however, in dozens of complaints shared with the Associated Press, say the care is so bad, some fear for their lives. "I know we're in prison, and I know things won't operate how they do out there -- but we are not sent here to die," said Aimee Mootz, a former inmate medical aide in the infirmary at Fluvanna Correctional Center for Women. Prisoners regularly received substandard care at the infirmary -- including one seriously ill inmate who, Mootz said, was often left alone by medical staff to sleep in a pool of her vomit. Prison Health Services and the Department of Corrections said they are unable to defend themselves against complaints because of patient confidentiality laws. A spokeswoman for the contractor would not disclose how many lawsuits have been brought against the company but said 96 percent of such cases are dismissed before trial. "It's worth noting that the practice of medicine is fraught with exposure to lawsuits, and a disproportionately high number of lawsuits originate in prisons and jails," company spokeswoman Susan Morgenstern e-mailed in response to questions. "We have an excellent team of medical professionals in Virginia, and they work hard every day to provide quality medical care." Prison Health Services provides medical care at more than 310 jails and prisons in 37 states. It has been under contract with the Virginia Department of Corrections since 2001 and is used by eight of Virginia's 42 prisons, Traylor said. Between Feb. 1, 2004, and Jan. 31, 2005, the company was paid nearly $44 million, he said. The Department of Corrections' Office of Health Services is charged with monitoring health care for Virginia's inmates. Traylor provided AP with a copy of a 2004 internal audit report that analyzed how well the agency was monitoring two Prison Health Services-run infirmaries and a third run by the Department of Corrections. For the most part, the audit concluded, there were adequate controls over health service operations at all three medical units. The audit noted, however, that there were areas that needed improvement. They included oversight of drug distribution, documentation of medical procedures and inmate medical records and compliance with inmates' special dietary needs. The audit did not include a review of the quality of the inmates' health care. Traylor pointed out that while there were 330 medical grievances filed against the contractor in 2004, hundreds of grievances were also filed that same year at Virginia prisons that do not use the company, indicating it is not a company-specific issue. Many inmates, he said, arrive at prison with multiple medical conditions they have long neglected and often expect immediate cures. Still, other states have encountered problems with Prison Health Services: A In Alabama, a court-ordered monitor of health care at the state's women's prison found that Prison Health Services made mistakes in prescribing drugs and gave substandard care to 19 of 22 prisoners whose charts he reviewed. Women suffering from HIV, staph infections and other medical problems were consistently denied treatment, the monitor wrote in a report. A In South Carolina, a mentally ill inmate who committed suicide last year left a letter for his wife complaining that he hadn't received his medication for seven days. A special jury assembled by the county coroner later concluded the inmate died because of poor medical care from Prison Health Services. The Richland County Council terminated its contract with the company, with one member calling its service "unacceptable and inhumane." A In New York state, the Commission of Correction began investigating Prison Health Services in 2000, soon after it entered into a contract with many New York prisons. The commission found the company cut corners in staffing by hiring physicians with questionable credentials and asking lower-paid medical providers to deliver care beyond their levels of expertise to save money, said James Lawrence, the commission's director of operations. New York continues to use the company in some of its prisons. "The fundamental problem with [Prison Health Services] and the companies that are like it is that they're business corporations holding themselves out as medical care providers," Lawrence said. "Physicians are not in charge, [and] profit imperatives and other business practices tend to trump medical autonomy." Morgenstern said Prison Health Services' doctors and medical staff have exclusive control over decisions requiring professional medical judgment. She noted that under Virginia laws, the company does not need to be owned by physicians. Security concerns often overshadow the medical needs of inmates, said Robert Cohen, former director of medical services at New York City's Rikers Island jail and now a national expert on correctional medical care. "It is my experience that for-profit health-care providers fail to respond to the routine conflicts between health care and security to the detriment of prisoners' health," Cohen said. Fluvanna inmate Marguerite Brown, 51, said the prison's nurses repeatedly ignored her pleas for help after she told them she'd been bleeding heavily from fibroid tumors. Brown said the nurses sent her away with vitamins for anemia. She said she eventually had to be rushed to the emergency room for a blood transfusion. "It's been rough -- real rough," said Brown, serving a 13-year sentence on a variety of fraud and credit card theft charges. "If it weren't for God, I probably wouldn't know which way to go." Inmates from every prison in Virginia that uses Prison Health Services have lodged medical complaints with the American Civil Liberties Union of Virginia, executive director Kent Willis said. The ACLU received 167 inmate health-care complaints in 2005, Willis said. In letters to the ACLU that were shared with AP, inmates from Prison Health Services-run facilities complained about a variety of problems, including chronic medication shortages and constant neglect of serious medical issues. "This place is killing me," wrote inmate Larry AsBury, who said more than half the inmates he knows at Greensville Correctional Center are covered in rashes that go untreated. AsBury, who said he also has tuberculosis, wrote that he once waited months for a doctor to remove a cast from his wrist, finally becoming so frustrated he used a pair of fingernail clippers to cut it off. Willis acknowledged that getting public sympathy for inmates is tough. "You combine that with the fact that the whole process is so isolated, [and] it's difficult for information critical of the services to surface," Willis said. 8 2006 The Washington Post Company. FDA Panel Endorses Cervical Cancer Vaccine Associated Press By Andrew Bridges Baltimore Sun Friday, May 19, 2006 WASHINGTON -- A drug company hopes to win federal approval early next month for a novel cervical cancer vaccine that it touts as the next biggest thing since the pap test in fighting the No. 2 cancer in women. Merck & Co. already has won a key endorsement of the vaccine, called Gardasil, from a Food and Drug Administration advisory committee. A final decision by the FDA is expected by June 8. The vaccine, administered in three shots over six months at a cost of $300 to $500, protects against the two types of human papillomavirus (HPV) believed responsible for about 70 percent of cervical cancer cases. If Gardasil ultimately wins approval, it could prove a boon to public health, though the cost could hinder its broad use. "The vaccine community will see this as an opportunity to prevent cancer. They will also see issues of availability and cost," said Dr. Bruce Gellin, a committee member and head of the federal vaccine policy office. Even though Merck has played up the cancer benefits of Gardasil, it also protects against two other virus types that cause 90 percent of genital wart cases. All four virus types are sexually transmitted. In fact, HPV is the most common sexually transmitted disease. It affects more than 50 percent of sexually active adults. The cervical cancer it can cause kills about 290,000 women worldwide each year, including 3,500 women in the United States, where regular pap smears often detect precancerous lesions and early cancer. Merck seeks to license Gardasil in dozens of countries. The Whitehouse Station, N.J. company estimates the vaccine could slash worldwide deaths from cervical cancer by more than two-thirds. "Gardasil has the potential to meet an unmet medical need as the first vaccine to prevent cervical cancer," Merck's Dr. Patrick Brill-Edwards told the Vaccine and Related Biological Products advisory committee. The committee endorsed the vaccine as safe and effective in five separate 13-0 votes late Thursday. The vaccine is a "wonderful, good step" in helping eradicate cervical cancer, said Dr. Monica Farley, who heads the advisory panel. She is a bacterial infectious disease expert at the Emory University School of Medicine. During public comment, several speakers said the vaccine should not replace screening. Merck said the drug is not intended to do that. However, it could reduce some of the dread involved in the annual tests by eliminating many of the abnormalities they often turn up, said Dr. Eliav Barr, head of the HPV vaccine program at Merck. The national Advisory Committee on Immunization Practices will decide late in June whether to endorse routine vaccination with the vaccine, including in what age groups. Merck seeks approval for use of the vaccine in females age 9 to 26. The vaccine works best when given to people before they become sexually active. That garnered some early opposition to Gardasil, out of concern that it could encourage sexual activity in the preteens and teens. But that largely faded away because of the vaccine's potential for reducing cancer. Early vaccination remains important, since Gardasil does not necessarily protect against one or more of the four viruses in people already infected before they get the vaccine, and can increase their risk for precursors to cervical cancer. Also, Gardasil does not protect against infection from the many other virus strains not included in the vaccine. Copyright 8 2006, The Associated Press. Panel Backs Cervical-Cancer Vaccine By Jennifer Corbett Dooren Wall Street Journal Friday, May 19, 2006; Page B2 WASHINGTON -- A Food and Drug Administration panel said a proposed Merck & Co. vaccine designed to protect against cervical cancer in women was safe and effective. The decision of the outside panel of medical experts amounts to a recommendation that the agency approve Gardasil for use in girls and women ages 9 to 26. The FDA typically follows its panels' advice but isn't required to. The agency is set to make a decision on the vaccine by June 8. If approved, it would be the first vaccine on the market that would offer protection against many cases of cervical cancer and genital warts. Gardasil is designed to protect against four strains of human papillomavirus, or HPV, that can cause cervical cancer and genital warts. HPV is spread mainly by sexual contact and is the most-common sexually transmitted disease in the U.S. There are more than 100 types of HPV, but the four strains Gardasil targets account for most cervical-cancer cases. While Merck submitted data in support of using the proposed vaccine in young men and women, the FDA said it was considering approval of the vaccine for use in females ages 9 to 26 because Merck had submitted complete studies of the vaccine in that group. The company tested Gardasil in boys ages 9 to 15 because HPV can cause genital warts and head and neck cancer in men. Merck submitted to the FDA data on tests of Gardasil's ability to induce immune responses in boys, but not on its effect in preventing disease. Those studies are ongoing. The FDA suggested it wanted complete data before considering approval of the vaccine for males. Rick Haupt, Merck's executive director of vaccine affairs, said the company hopes for a gender-neutral approval. Assuming the vaccine is approved, another advisory panel is set to meet in late June to make recommendations about who should receive the vaccine and when. In the U.S. it is likely the vaccine would be given to 11- or 12-year-olds along with other routine vaccinations. Ideally, people would be vaccinated before they become sexually active and exposed to HPV because it can take years for cancers and genital warts to develop. The vaccine would be given in three doses over six months. WALL STREET JOURNAL VIDEO 4 CNBC's Mike Huckman talks to Merck's Eliav Barr5 about an FDA advisory panel's decision that Gardasil, the company's cervical-cancer vaccine, is safe and effective. If the FDA limits the vaccine's approval to females, it is more likely that the other federal advisory panel, which advises the Centers for Disease Control and Prevention, would go along with that recommendation, rather than suggest that males also receive the vaccine. During the FDA panel meeting, Nancy Miller, an FDA medical reviewer, said the agency was concerned about five congenital anomalies seen in infants born to recipients of Gardasil who were vaccinated near the time of conception. There were no defects found in infants born to women who had received a placebo, or fake, vaccine. Dr. Miller said there was no pattern to the problems seen in the infants, which suggests there's no link to the vaccine. Merck said it will keep studying the vaccine once it's on the market to look for potential health problems. The company will also track whether it reduces the incidence of cervical cancer over time. GlaxoSmithKline PLC is working on a similar vaccine and hopes to submit it for FDA approval by year end. About 9,710 new cases of invasive cervical cancer are expected to be diagnosed in the U.S. this year, and about 3,700 women are expected to die from the disease, according to the American Cancer Society. It's estimated the cancer kills about 300,000 women annually world-wide. The FDA and other health experts have said a cervical-cancer vaccine could help dramatically cut that rate. The vaccine wouldn't replace routine pap-test screening for cervical cancer because it doesn't protect against all HPV strains that can cause the cancer. Copyright 2006 Dow Jones & Company, Inc. All Rights Reserved. Flu vaccine supply expected to soar Health authorities to urge more Americans to get shots; possible move to universal vaccination By Frank D. Roylance Baltimore Sun Friday, May 19, 2006 If all goes well this year, the nation's supply of annual flu vaccine should be the largest on record, so health authorities say they'll urge that more Americans - especially young children and health care workers - get flu shots next fall. Authorities say they also want 90 percent of Americans 65 and older to receive annual flu shots by 2010, up from 65 percent today. And there may be a recommendation next month that the nation move toward universal flu vaccination. Unlike a bird flu pandemic, which remains just a possibility, "there will be influenza annually - real, traditional seasonal influenza that on average kills 36,000 Americans each year and results in 200,000 hospitalizations," Dr. William Schaffner of the National Foundation for Infectious Diseases said at a gathering of flu experts yesterday. "And vaccination remains the single most effective preventive measure," he said. The United States got off relatively easily during the 2005-2006 flu season, which was milder and less disruptive than the previous two seasons, according to the U.S. Centers for Disease Control and Prevention. Even so, many shot-seekers had difficulty finding vaccine during the fall - the result of an unusually large response to the flu shot campaign. Supplies became more plentiful during the winter, but by that time many people had given up the search. In Maryland, "it looks like this flu season was relatively mild," said Greg Reed, program manager for the Maryland Center for Immunization, part of the state Department of Health and Mental Hygiene. The seasonal flu is not a reportable disease, so there are no comprehensive counts. But a network of "sentinel" physicians does send viral samples to the state for laboratory testing each year, and that provides a rough indicator of year-to-year trends. Reed said there have been 854 laboratory-confirmed flu cases since October, down from 2,395 during the same period last year. In recent years about 80 million doses of annual flu vaccine have been produced for the U.S. market. The number fell to about 60 million in 2004 when one vaccine maker, Chiron Corp., was forced to shut down because of a production problem. That led to widespread shortages, long lines and forgone immunizations during the autumn, at the peak of annual demand. Flu experts who spoke yesterday at the National Press Club in Washington said if there are no manufacturing glitches, there should be at least 100 million doses, and perhaps 120 million, this year. "It's a bumper crop, more influenza vaccine than has ever been produced in the U.S. before," said Dr. Ray Strikas of the National Vaccine Program Office, part of the U.S. Department of Health and Human Services. "We've begun to talk about how to promote vaccine, rather than how to ration vaccine." One reason for the brighter outlook is a $7.2 billion investment of federal money in vaccine development and production, driven in part by fears of an avian flu pandemic and by post-Sept. 11 concern about bioterrorism. Vaccine production may get a boost this year from the possible addition of a new manufacturer to the four licensed by the Food and Drug Administration. The newcomer, a GlaxoSmithKline subsidiary, could produce 15 million to 20 million additional doses. More encouragement comes the CDC's Advisory Committee on Immunization Practices. In February, the committee recognized the key role of children in spreading the flu. It recommended expansion of priority vaccination to include children 6 months through 5 years, instead of just 6 months to 2 years. Those younger than 6 months are considered too young for the vaccine. Next month, the ACIP will consider recommending two doses of flu vaccine for children ages 6 months to 9 years, instead of one, and the panel might propose a move toward universal flu vaccination, according to the CDC. Health authorities are already urging more health care workers to get flu shots. "With vaccination there is less chance of health care workers both contracting and transferring [flu] to susceptible patients," said Dr. Ardis D. Hoven, a member of the board of trustees at the American Medical Association. "Yet only 40 percent of health care workers get immunized." Still more stimulus for vaccine makers and care providers could come from Medicare's decision to increase reimbursement for flu shots from $8 to $18 per dose. Increased vaccine production would reverse the trend of recent years, in which vaccine makers have left the flu vaccine market because of low and inconsistent demand and skimpy profits. "I think the manufacturers believe that the market for influenza vaccine is going to grow, that we are going to do a better job of immunizing people in the target groups," Schaffner said. Increased supplies should help ease the frustration many people have had trying to get flu shots. But some supply-and-demand problems still need to be addressed, officials said. Public demand for flu vaccine typically peaks in October, while production and shipment are not complete until January. Not surprisingly, not everyone who seeks a shot in the fall can find one. "One of the things we're hoping to do is extend the vaccination season beyond November," said Christine Layton of RTI International, a nonprofit research firm that has studied vaccine issues. The 2005-2006 flu season didn't peak until March, and the previous season peaked in February. "The benefits from flu vaccine remain, even when you're vaccinated in January and beyond," Hoven said. Copyright 8 2006, The Baltimore Sun. FDA Panel Urges Prominent Warning Label for Antibiotic By Anna Wilde Mathews Wall Street Journal Friday, May 19, 2006; Page B1 Food and Drug Administration safety reviewers have linked the antibiotic Ketek to 12 cases of liver failure, including four deaths, and they are recommending adding a prominent new label warning that "severe, life-threatening, and in some cases fatal" liver toxicity has been reported in patients taking the drug. The findings, in a confidential May 16 memorandum by the FDA's Division of Drug Risk Evaluation reviewed by The Wall Street Journal, raise new questions about the Sanofi-Aventis SA antibiotic. They also put more pressure on the FDA as Congress carries out investigations of the agency's handling of Ketek. Senate Finance Committee Chairman Charles Grassley, an Iowa Republican, and House Democrats Edward Markey of Massachusetts and Henry Waxman of California want to know more about a large clinical trial that was designed to demonstrate the drug's safety but was dogged by fraud and other problems. The FDA ended up discounting the study but approved Ketek anyway in April 2004. The lawmakers are also examining ongoing clinical trials of Ketek in children. Last year, Ketek was prescribed 3.35 million times in the U.S. and had sales of $193 million, according to IMS Health. A strong label warning would probably depress sales of the drug, but the agency doesn't always follow recommendations from its drug-safety office. In a statement, an FDA spokeswoman said that the memo reflects the drug-safety office's "interpretation of adverse-event data" and recommends "labeling revisions be considered but not product withdrawal." Calling some of the liver-failure cases "clinically remarkable," the memo describes "profound" liver injury that set in as soon as a few days after some patients took Ketek and had a "signature of rapid onset and tempo." The document says that many of the 12 cases appeared to have few other possible causes and occurred in people who were "generally healthy." Besides the four deaths, one patient had a liver transplant and three others were considered for transplants but recovered. In a statement, Sanofi-Aventis said it "continues to believe that Ketek is safe and effective when used as directed." It said that it is engaged in "ongoing discussions with the FDA regarding a detailed medical evaluation of hepatic events" reported in connection with Ketek use and that it is evaluating the data with leading experts. The company said a detailed response to the findings in the memo would be inappropriate while it is in discussions with the agency. The internal FDA memo analyzes incidents reported through the end of April in people in the U.S. who were prescribed Ketek after the drug won FDA approval. The reviewers found 23 reported cases of serious liver injury, as well as the 12 liver failures, that were "associated" with Ketek. The FDA also got reports of 44 liver-related events that weren't serious. The overall estimated rate of reported liver failures tied to Ketek, known generically as telithromycin, was 23 per 10 million prescriptions. That compares with a reported rate of 6.6 per 10 million prescriptions for Avelox, six for Tequin and 2.1 for Levaquin. For two antibiotics in a class similar to Ketek -- Biaxin and Zithromax -- the rates were 4.2 and 3.7. Use of an older antibiotic, Trovan, was sharply restricted in 1999 after the FDA received reports of 14 liver failures, which translates into an estimated reporting rate of 58 per 10 million prescriptions. The rates include any generic versions of the drugs. The memo cautioned that such comparisons aren't definitive, because they may at least partly reflect differences in how likely health-care providers and others were to report events. The rates were also calculated based on different time frames. The memo says the rate of liver-event filings about Ketek rose after the January publication online of a medical-journal article on liver damage in people who took the drug. By some estimates, the FDA gets reports of only 10% or less of potential drug side-effects. Despite the system's flaws, such reports have been a major factor in the withdrawal of several drugs. The FDA spokeswoman said that the safety reviewers found "the numerical risk appears higher in the Ketek database" but "they are not able to conclude greater risk for liver injury in patients receiving Ketek than other drugs in the category." The finding will be "carefully considered along with all other sources of expert review" in the FDA's final assessment of Ketek, she said. Calculated a different way, the rate of reported liver failures in people who took Ketek was 167 per one million person-years of use of the drug (a person-year is a year of one patient taking the drug), the FDA document says. Even before the medical-journal article stimulated more reports, the rate was 89, the memo says, well above the liver-failure rate for the general population, which is about one per one million person-years. The document concludes that the Ketek rates are "consistent with an association" between the drug and liver failure. The memo says it is from an FDA safety evaluator named Ronald Wassel and a team leader, Allen Brinker. Mark Avigan, director of the drug-risk-evaluation division, signed off on the memo as well. The document is addressed to Janice Soreth, the head of the FDA division that approves antibiotics, which is likely to spearhead any negotiations the agency has with Sanofi-Aventis about adding warnings to the label. The congressional investigations are focusing on a large clinical safety trial of more than 24,000 people. The study -- whose problems were detailed in the Journal May 1 -- was conducted by the drug maker after the FDA initially refused to approve the medication because of lingering concerns about liver damage and other potential risks. Despite the worries about the safety study, the FDA approved Ketek to treat sinusitis, bronchitis and pneumonia acquired outside a hospital. FDA officials wrote at the time that there was a "systemic failure" of the safety study's monitoring program to "detect data integrity problems when they clearly existed." But they wrote that they were "able to rely on the post-marketing experience" outside the U.S., where there was a low rate of side-effect reports tied to Ketek, "to conclude there was substantial evidence of safety." After 3.7 million overseas prescriptions, there had been one death related to a liver reaction, and it wasn't clearly linked to Ketek. But according to the new drug-safety reviewers' memorandum, the number of U.S. reports of liver failures among Ketek users is far higher than those the agency has received from overseas. The memo cites just two reports of possible liver failure in other countries, both from Japan, even though the drug was approved in Europe in 2001. The reason for the discrepancy isn't clear. Currently, Ketek's label carries a mildly worded caution that liver dysfunction "has been reported with the use of Ketek" and that "these events were generally reversible." When the medical-journal report came out, the FDA urged doctors to watch for signs of liver damage. But the agency said that based on the information it had when it approved Ketek, including the large safety study, the liver risk tied to the drug appeared similar to that of other antibiotics. The drug-safety memo recommended that the Ketek label carry a warning about liver risk set apart by bold type or a black box, which is reserved for the most serious safety concerns. Among other things, the proposed warning would mention reports of liver necrosis and liver failure, and say that in some cases liver injury "progressed rapidly and occurred after administration of a few doses of Ketek." The suggested labeling would also warn doctors to watch patients for signs of hepatitis. Copyright 2006 Dow Jones & Company, Inc. All Rights Reserved. Stretching uses of prescription drugs Some researchers worry about doctors giving medications for 'off-label' ailments Los Angeles Times Baltimore Sun Friday, May 19, 2006 Millions of Americans are prescribed drugs each year that are not approved for their specific medical condition, a practice known as "off-label" use, that is legal and logical in many cases. But a new study has found that 20 percent of all prescriptions are written for non-approved off-label uses and that most of these uses - three-quarters - are not well-supported by scientific research. This widespread use of medications off-label could threaten patients' safety while escaping the attention of federal regulators, some experts suggest. "What surprised me about this study is that in many cases there is a paucity of scientific studies supporting the drug's use off-label," says Kenneth I. Kaitin, director of Boston's Tufts Center for the Study of Drug Development. "It's an issue that should be discussed in the medical community." Still, Kaitin says, it's unclear whether consumers are being put at undue risk. "There has not been a significant problem with off-label prescribing that I'm aware of," he says. The study, published last week in the Archives of Internal Medicine, polled 3,500 randomly selected doctors on their patient interactions during two consecutive days in 2001, including any drugs they may have prescribed. Researchers then retrieved information on the 100 most commonly prescribed drugs as well as 60 more drugs also randomly selected. Among other things, the scientists found that cardiac medications, anticonvulsants and asthma medications were the most likely to be prescribed off-label. Psychiatric drugs and allergy medications were the most likely types of drugs to be used off-label with little scientific support. In fact, scientific support was lacking for 96 percent of the psychiatric drugs prescribed off-label. Dr. Randall S. Stafford, lead author of the study and an associate professor of medicine at the Stanford Prevention Research Center in Palo Alto, Calif., said the findings were troubling. Even though drugs are thoroughly reviewed by the Food and Drug Administration before they are allowed to go to market, "the FDA does not vouch for the safety and efficacy of all the various ways that drugs are used," he says. Drugs, he adds, are tested and approved at specific doses with detailed information about side effects that occurred during trials - but those data may be irrelevant when a medication is used for a different diagnosis and in different patients. Off-label use of drugs is not rare. Once a drug reaches the market, doctors can legally prescribe it for any diagnosis. This long-standing practice has been lauded for allowing doctors the freedom to treat their patients based on the latest scientific studies and clinical information. In certain areas of medicine, such as pediatrics, off-label use of medications is almost unavoidable because, until recently, drug manufacturers were not required to conduct research on how their products affect children. And in cancer treatment, off-label use allows doctors to try different strategies for seriously ill patients who have exhausted other options. Off-label use also makes sense when the drug is prescribed for a condition very similar to its approved indication. For example, Stafford says, doctors can reasonably assume that a drug used to treat asthma will be effective for other lung diseases. "There are plenty of situations where off-label use is completely legitimate," Stafford says. "But there are other ways that drugs are used that are quite distinct from the FDA indication and where we don't have good information." Copyright 8 2006, The Baltimore Sun. Bristol-Myers Discontinues Development of Diabetes Drug Wall Street Journal ONLINE NEWS ROUNDUP Thursday, May 18, 2006 Bristol-Myers Squibb Co. discontinued the development of muraglitazar, an investigational oral treatment for Type II diabetes, and will focus its efforts on other priority portfolio projects. The pharmaceutical company had previously disclosed a request by the Food and Drug Administration for more information on the drug's cardiovascular safety profile. After analysis, Bristol-Myers said it concluded that a long-term trial is needed to achieve regulatory success for the treatment. Based on the assessment, the commercial evaluation of other diabetes alternatives likely to be available in five years, and consideration of competing development opportunities, the company decided on the discontinuation. In September, the FDA released its review of the proposed drug, which had been planned to be sold under the brand name Pargluva. Merck & Co. was originally going to co-market the treatment, but the company ended its partnership in the drug in December, with rights returning to Bristol-Myers. The FDA review said that while the drug's effectiveness was "clear" in helping patients control their blood sugar and improve their lipid profiles, or fats in the blood, the treatment might increase the risk of heart attacks. Increases in cardiovascular events and deaths were small and were mostly seen at 10- and 20-milligram doses of the drug. The firms were seeking FDA approval of a 2.5 mg and 5 mg dose. Copyright 2006 Dow Jones & Company, Inc. All Rights Reserved. Mumps Shots Urged In Area of Outbreak Associated Press Wall Street Journal Thursday, May 18, 2006 ATLANTA -- A U.S. government vaccine panel is urging mumps shots for everyone in the region of an outbreak unless they are immune to the virus from childhood exposure or from being vaccinated. And health-care workers under age 50 should get two doses unless they still have immunity from childhood, the immunization advisory committee said. The more aggressive policy by the panel, which advises the federal Centers for Disease Control and Prevention, is an effort to thwart future outbreaks like the one that is plaguing Iowa and some other Midwestern states. "Hopefully, the current outbreak is waning," said CDC spokesman Curtis Allen. "This is for future outbreaks." Health officials in Iowa say there are still more than 1,700 cases statewide, but the number is on the decline. Last week, the state urged people ages 18 to 46 to get vaccinated. The CDC and a drug company have been providing extra vaccine. The panel's advice is usually adopted by the CDC. Copyright 8 2006 Associated Press. Copyright 2006 Dow Jones & Company, Inc. All Rights Reserved. Government Condition Barred on AIDS Funds Associated Press By Toni Locy Baltimore Sun Thursday, May 18, 2006 WASHINGTON -- A federal judge on Thursday barred the Bush administration from requiring nonprofit AIDS groups to sign a pledge opposing prostitution and sex trafficking in exchange for federal dollars. U.S. District Judge Emmet G. Sullivan said a law passed by Congress in 2003 violates the free-speech rights of groups such as DKT International Inc., which provides family planning and HIV/AIDS prevention programs in 11 countries. Sullivan said the law goes too far because it insists that DKT "parrot" the U.S. government's position on prostitution and bars the group from taking and putting in place a different viewpoint on the issue in the way it spends privately obtained funds. "By mandating that DKT adopt an organization-wide policy against prostitution, the government exceeds its ability to limit the use of government funds," Sullivan wrote. In a lawsuit filed last year, DKT accused the U.S. Agency for International Development and its administrator of violating the free speech rights of AIDS nonprofit groups by requiring them to sign an anti-prostitution pledge to become eligible for U.S. government money. In 2003, Congress created a $15 billion program for fighting AIDS worldwide. Under the law, groups that do not adopt a policy "explicitly opposing prostitution and sex trafficking" cannot receive federal money. The group's representatives refused to sign the pledge because they are involved in a program to distribute condoms to prostitutes and other sex workers in Vietnam. Signing the pledge, they argued, would stigmatize and alienate many of the people they are trying to help. The administration argued the law is narrowly tailored to prevent a "garbling" of U.S. policy goals, control use of federal dollars and ensure the U.S. government speaks with one voice internationally. Sullivan disagreed, saying the Supreme Court repeatedly has ruled that the government cannot compel private groups "to speak in a content-specific, viewpoint specific manner" as a condition of receiving federal money. On the Net: U.S. District Court: http://www.dcd.uscourts.gov Copyright 8 2006, The Associated Press. Colo. Patient Dies of Rare Brain Disease Associated Press By Chase Squires Baltimore Sun Thursday, May 18, 2006 LITTLETON, Colo. -- Officials at a suburban Denver hospital alerted six brain surgery patients after another neurosurgery patient died of classic Creutzfeldt-Jakob disease, a rare degenerative brain ailment, the hospital said Thursday. The six people had neurosurgery at Littleton Adventist Hospital after an operation on the Creutzfeldt-Jakob patient. They were alerted because of the remote possibility that the disease could be transmitted by surgical instruments, even after they are sterilized, the hospital said. It was not immediately clear whether the instruments used on the victim were also used on any of the other six patients. The disease could take years to manifest itself and a brain biopsy is the only way to confirm it, said Dr. Lawrence Wood, the hospital's chief medical officer. The Creutzfeldt-Jakob patient, whose name was not released, died March 23, nearly six weeks after the surgery. The disease was confirmed on May 9, officials said. The hospital did not say how the patient contracted the disease. Wood described instrument sterilization at the hospital as "state of the art." Even so, there is a slim chance the damaged protein that leads to the disease could survive standard sterilization. No Creutzfeldt-Jakob cases have been transmitted through surgical instruments since the 1970s, when sterilization guidelines were more lax, according to the federal Centers for Disease Control and Prevention. The last known case involving transmission that way occurred in Europe. Classic Creutzfeldt-Jakob disease is not related to mad cow disease -- variant Creutzfeldt-Jakob disease. Classic CJD occurs sporadically, appearing in about one in 1 million people in the United States each year, according to the CDC Web site. It progresses quickly and is always fatal. On the Net: CDC site: http://www.cdc.gov/ncidod/dvrd/cjd Creutzfeldt-Jakob Disease Foundation: http://www.cjdfoundation.org Copyright 8 2006, The Associated Press. Scientists Begin Testing For Bird Flu in Alaska Associated Press Wall Street Journal Thursday, May 18, 2006 ANCHORAGE, Alaska -- Federal scientists have started testing migratory birds for signs of a dangerous bird flu that could show up on this continent this spring. The testing of shorebirds began Wednesday on an Anchorage coastal wildlife refuge, said Bruce Woods, spokesman with the U.S. Fish and Wildlife Service. It's the first sampling of a summer-long project to swab birds for bird flu throughout the state. Nationwide, the goal is to sample 75,000 to 100,000 wild birds. In Alaska, about $4 million in federal money will be allocated to study about 15,000 birds, Mr. Woods said. "We had some success in catching some of the target species," he said Thursday. More than 40 species of waterfowl and shorebirds are considered susceptible to infection by a highly pathogenic H5N1 bird flu virus that's killed more than 100 people, in other parts of the world, mostly in Asia. Scientists will only test birds in the Anchorage area through early next week. "In this location, it's very brief, birds go through and they're gone," he said. To screen the birds for the deadly virus, the U.S. Fish and Wildlife Service and Alaska's Fish and Game Department also are setting up more than 50 remote backcountry camps accessible mainly by float planes or boats. Many birds will be tested and released, while others killed during seasonal hunts will be tested after they have died. Alaska is an ideal bird flu laboratory because it's at the crossroads of migratory pathways for birds flying between the U.S. and other countries. Some of these birds arrive in Alaska each year from Asia. Copyright 8 2006 Associated Press. Copyright 2006 Dow Jones & Company, Inc. All Rights Reserved. Doctor: States Unprepared for Bird Flu Associated Press By Lara Jakes Jordan Baltimore Sun Friday, May 19, 2006 WASHINGTON -- Bird flu will hit the United States -- it's only a matter of time -- and not all states are ready to respond to the deadly virus, the Homeland Security Department's top doctor warns. Dr. Jeffrey Runge, homeland security's chief medical officer, said "it's not a matter of if, but when" bird flu enters the country. But it won't pose a critical threat until the virus can spread consistently between people, he said. In an interview Thursday with The Associated Press, Runge said states with experience in dealing with hurricanes or terrorist attacks are more ready to face bird flu. He did not identify those that have been slow to prepare, but said state and local governments must carry most of burden of planning for an outbreak, including readying emergency medical workers, providing hospital beds and setting up treatment centers outside of immediate disaster areas. "Some states still have the idea that if it makes people sick, it's simply a health event," Runge said. "And others are much more forward reaching, and understand that they have to prepare for things like civil unrest, or interruption of the supply chain, or the failure of critical infrastructure to keep going, to keep the nation going in the event of some catastrophic event. And those are the ones that we think are the best prepared." Gov. Mike Huckabee, R-Ark., who leads the National Governors Association, said states have "pretty much been told to prepare to row their own boat" in responding to bird flu. Federal health officials "were pretty candid with us," Huckabee said in an interview. "The federal government simply does not have the resources themselves to deal with this on a mass level. And if a pandemic does occur, it will overwhelm their resources, just like it will overwhelm ours." Scientists believe the flu most likely would be carried into the United States by a wild bird migrating from a country that has had an outbreak. Runge credited agriculture inspectors and poultry producers with adopting tough security standards to prevent visitors from exposing fowl to the virus. He recalled hearing from an inspector that "it was tougher to get into a chicken coop than it was to get into our DHS headquarters." Runge's department is responsible for blocking potentially infected birds and bird products from entering the U.S. at airports, seaports and international borders. Unions representing U.S. Customs and Border Protection officers have complained they have not been trained to identify bird smugglers or to quarantine birds arriving from countries that have had flu outbreaks. Runge expressed some frustration with the level of training so far. "I wish I could say it had all already been done," he said. "Right now the planning is coordinated, but the education is not as coordinated as we'd like. That having been said, everybody around here's gotten a lot smarter about it." On the Net: Homeland Security Department: http://www.dhs.gov/dhspublic Customs and Border Protection: http://www.cbp.gov Copyright 8 2006, The Associated Press. WHO Reports 2 Bird Flu Deaths in Indonesia Associated Press By Zakki Hakim Baltimore Sun Friday, May 19, 2006 JAKARTA, Indonesia -- Two young boys died of bird flu in Indonesia -- one from a family that has already lost four members to the disease, the World Health Organization said Friday. Bird flu has killed 123 people worldwide, nearly a quarter of them in Indonesia, which saw its official toll jump to 32 with Friday's announcement. Health Ministry spokesman Sumardi, who goes by only one name, said the latest victims died in the last week. One was a 10-year-old boy from Sumatra -- one of five extended family members to have died of the H5N1 virus in recent weeks -- and the other a 12-year-old from the eastern outskirts of Jakarta, he said. The multiple deaths of relatives living in the village of Kubu Sembelang on Sumatra, previously believed to be free of the disease, raised concerns that the virus may have mutated to a form that is easily transmissible between people. Health experts say such a scenario could lead to a pandemic, killing millions of people worldwide. But it appeared unlikely Friday that the virus, which is usually passed to humans through contact with infected birds, had mutated, said Health Minister Siti Fadilah Supari. Tests indicate they got the virus from poultry, she told reporters, adding that the government was awaiting confirmation of its findings from a WHO-approved laboratory. Indonesia has come under fire in recent months for doing too little to stop the spread of bird flu, which has been found in poultry in two-thirds of the country's 33 provinces. Copyright 8 2006, The Associated Press. WHO Probes Bird Flu Cluster Signs of Human Transmission Sought in Indonesian Deaths By Alan Sipress Washington Post Foreign Service Friday, May 19, 2006; A17 JAKARTA, Indonesia, May 18 -- An international team of health investigators arrived on the Indonesian island of Sumatra on Thursday to determine whether an unusually large cluster of human bird flu cases indicates that the highly lethal virus has mutated into a form easily spread among people. Laboratory tests conducted for the World Health Organization confirmed this week that five members of one extended family in Kubu Sembilang village had died of bird flu during the first two weeks of May and a sixth had been infected but was recovering. A seventh family member, a 37-year-old woman who had been the first to fall ill, is also suspected of succumbing to the disease but was buried before samples could be taken. The Sumatran cluster is the world's largest since the disease emerged in East Asia in 2003, although several dozen others have been reported. Any cluster raises the prospect that the virus has undergone genetic change allowing it to spread more readily among people, increasing the likelihood of a global pandemic. WHO dispatched two investigators from its Jakarta office to northern Sumatra last week, but their initial efforts were stymied by distraught relatives' reluctance to discuss the cases. A second team, which arrived Thursday, included a senior epidemiologist from WHO's headquarters in Geneva and investigators from the Centers for Disease Control and Prevention in Atlanta and WHO's regional office in New Delhi. "We are taking this very seriously," said Sari Setiogi, spokeswoman for WHO's Indonesia office. "The good news is that from our investigation to date, there's no evidence of further spread of the virus beyond the family." Setiogi said that relatives, neighbors and health-care workers who treated the patients were being monitored and that none had shown influenza-like symptoms. Influenza specialists have said they suspect human transmission played a role in several other clusters of infection, including instances in Thailand, Vietnam and elsewhere in Indonesia. But the disease has yet to demonstrate it can pass beyond the confines of a family, which would be necessary for bird flu to spark a global epidemic. The source of the Sumatra outbreak remains unclear. Health officials said that they had heard a report of sick chickens near one of the victims' homes but that tests of poultry and other livestock in the village had failed to identify any infected animals. Agriculture Minister Anton Apriyantono said Thursday, however, that samples taken from chickens, ducks and pigs from the surrounding district had tested positive for exposure to bird flu. Some Indonesian health officials have speculated that the afflicted family members, who lived near each other in four houses, had contracted the virus either by sharing a feast of infected chicken and pork or from contaminated manure. Health Minister Siti Fadilah Supari minimized the possibility that the virus had spread from one family member to another. If they had all caught bird flu from the same contaminated source, the victims would have been expected to become sick within the normal incubation period for the disease, which at most is slightly more than one week. But the final victim, a toddler, became ill after that, raising the possibility that the virus was passed between relatives. Nur Rasyid Lubis, who heads the bird flu prevention team at Adam Malik Hospital in North Sumatra, said five members of the family, including at least two children, were admitted at the same time on May 8 with fever and respiratory problems. X-rays showed symptoms of pneumonia. They all died over the following week. Lubis reported that all seven victims from the family were related to one another by blood rather than through marriage, reinforcing the suspicions of some influenza specialists that genetic susceptibility could play a role in determining who catches bird flu. The Sumatra cases and a separate fatal infection confirmed this week in Surabaya, Indonesia's second-largest city, increased the country's death toll from the disease to at least 30. Bird flu has infected more than 216 people worldwide, killing more than half. Special correspondent Yayu Yuniar contributed to this report. 8 2006 The Washington Post Company. In addiction discussion, don't dismiss the importance of choices By Gordon Livingston Baltimore Sun Commentary Friday, May 19, 2006 The recent difficulties occasioned by the abuse of "prescription medication" on the part of radio talk-show host Rush Limbaugh and Democratic Rep. Patrick J. Kennedy of Rhode Island have again raised the issue of the disease model of addiction vs. the concepts of legal and personal responsibility. It has been said that "truth is a matter of emphasis." To understand this concept clinically, consider the struggle we have in dealing with the tension between biological predisposition and volitional behavior. This is a continual problem in addictions and in psychiatry. A common example is our evolving conception of alcoholism. Because a vulnerability to the effects of alcohol is clearly genetically determined, and because unchecked drinking produces organic changes, notably cirrhosis of the liver, it has become an article of faith among mental health professionals that alcoholism is an illness. You can, after all, die from it. This appears to represent a commendable effort by the medical community to destigmatize a condition that for centuries has been treated as a moral lapse, a failure of will, a deficit of character so deplorable that those who manifested it were discouraged from getting help. If we label it an illness, the reasoning goes, people will treat it like any other sickness and seek treatment. This treatment, directed at abstinence, does involve an act of will, albeit with group support. The problem, of course, is relapse. How do we deal with the tendency of substance abusers to resume drinking or drugging after a period of not doing so? We don't condemn people with asthma or heart disease when they relapse. These are understood to be chronic illnesses. Theoretically, we should adopt a similarly nonjudgmental attitude toward those with addictions. They can't help it. Or can they? What can we reasonably expect from a drinking alcoholic? This is not a theoretical question for a family member who is coping with the ruinous secondary effects of alcoholism. What they observe looks to them like voluntary behavior: The person they love and depend on insists on taking a drink. Followed by another drink. And so on. Yet the family has been told that their loved one has a chronic, relapsing illness. So how can they be angry with the alcoholic for simply displaying the symptoms of this illness? Where is the truth? Where is the line between the helplessness that most of us feel in the face of our genetic heritage and our obligation to control our destructive impulses? Beware of psychiatric diagnoses, the primary purpose of which is to relieve people of responsibility. If someone claims that he is not guilty because his body is inhabited by multiple personalities and that it was his evil alter ego that committed the crime, I would notice the similarity between this plea and the assertion that "the devil made me do it." Even as we attach medical diagnoses to human behavior, we are confronted with the essential questions of how to discern what it is that we are responsible for and what we must accommodate. One analogy is to heart disease. Clearly, there are things that predispose us to suffer coronary events over which we have no control - our gender and genetic backgrounds, for example. If your family history is one of early death from heart attacks, it is a good idea to refrain from smoking, watch your diet and exercise regularly. But you still stand a good chance of suffering a myocardial infarction. So does it make sense to say "the heck with it" and eat, drink and smoke as you please for as long as you can? That, of course, is a personal decision. And so it is that we must live our lives in the gray area between the extremes of biological determinism and individual responsibility. What can we choose and what are we helpless to control? If we err, it probably ought to be in the direction of emphasizing the importance of choices. Gordon Livingston, a psychiatrist who lives in Columbia, is the author of "And Never Stop Dancing." His e-mail is gslcvk@aol.com Copyright 8 2006, The Baltimore Sun. Are there options to moving my parent into a nursing home? By Dr. Bob Sheff Daily Record Friday, May 19, 2006 Dr. Bob Sheff, a retired Maryland physician and author of AThe Medical Mentor,@ has agreed to answer questions from Daily Record readers every Friday. To ask a question, e-mail Dr. Sheff at drbobsheff@themedicalmentor.net. My mother has been living independently all her life. She is starting to have troubles living alone. Does she have to go into a nursing home? This is a problem that more and more of us are facing. Nursing homes are reserved for patients who have complex medical problems that need special nursing care. However, assisted-living facilities are for people who need support in the tasks of daily living but not specialized medical care. In order to decide on the right solution for your family, you want to consider all the options. First of all, consider whether your mother could continue in her own home with some in-home assistance. Sometimes family members can stop by as necessary to provide this assistance. There are also home care agencies that can have home care providers visit your mother=s home regularly. Depending on your mother=s needs and your financial resources, you might consider a live-in home health aide to provide more around-the-clock assistance. A second alternative is whether there is a family member that wants to care for your mother in their home. If so, this is often the best solution. It is certainly a major commitment but, if feasible, it may be emotionally the easiest solution. If these options do not work for you, then you need to consider having your mother move to some other home. If your mother just needs some help with meals, cleaning, transportation and possibly taking her medications, then an assisted-living facility may be ideal. Assisted living facilities vary from individual homes with a few elderly residents living in a supported and supervised environment to large multi-story buildings with hundreds of residents. There are a range of costs attributed to assisted living facilities as well as a range of facilities. There is often a unique environment to each facility, so visiting several may help you decide. As you can see, if your mother=s problem is that she needs help with life=s daily chores, then a nursing home is not necessary. Dr. Bob Sheff is a retired physician, medical group leader, health insurance executive and experienced patient. He brings the learnings from these past roles to bear in answering your questions. He is the author of AThe Medical Mentor,@ which is available on the Web and at book stores. You can learn more about patient advocacy at his Website www.themedicalmentor.net. Please e-mail your questions to drbobsheff@themedicalmentor.net. Copyright 2006 8 The Daily Record. All Rights Reserved. Life and death information Frederick News Post Editorial Friday, May 19, 2006 The U.S. Centers for Disease Control and Prevention recently came out in favor of widespread testing for HIV. The CDC recommends that the test be standard for all Americans from ages 13 to 64. Some people may be alarmed by this proposal; others may see it as overkill. We think it's highly justified and long overdue. AIDS has proven itself incredibly resistant to both prevention and cure. While new antiviral and other drugs have helped AIDS victims live longer, preventing the disease or curing it outright remains among medical researchers' great challenges. Meanwhile, the AIDS epidemic continues to rage, especially in Africa, where millions have died and millions more are infected. AIDS is transmitted most often through sexual contact. And contrary to initial beliefs, it is hardly confined to the population of gay men. One of the particularly insidious aspects of HIV infection is that the infected person may be unaware of his or her condition for weeks, months, even years. During that time he or she may be unwittingly infecting others. They, in turn, may do the same. The CDC is recommending that any patient entering a hospital for urgent or emergency care be tested for the presence of HIV as part of the standard battery of tests received. It is also recommending that an HIV test be periodically included in a person's annual physical exam, and that for people in high-risk groups -- including IV drug users, gay men and hospital workers in areas where the disease is common -- the test be administered yearly. The CDC believes such universal testing would be tremendously effective in identifying new AIDS patients and reducing the spread of the disease. This is based on the fact that nearly half of all new HIV infections come to light when physicians are attempting to diagnose what ails a patient who has come to them for treatment. In other words, half of all the new reported cases of AIDS involve people who do not know they have the disease. While such universal testing would be far from free, it would likely be a real bargain when compared to the cost of treating AIDS patients, who require expensive medications and care for the rest of their lives. Most people are responsible and compassionate enough to avoid infecting others if they know they are themselves infected with HIV. We wonder how many cases of this disease could have been prevented if the infecting person had known that he or she was carrying the virus. If implemented, these CDC recommendations would impart this valuable life-and-death information to infected persons both sooner and in greater numbers. One might ask why this recommendation has been so long coming. The answer may lie partly in the fear, loathing and denial that has characterized the general public attitude about this devastating disease since it arrived on the scene 25 years ago. Copyright 1997-06 Randall Family, LLC Take time out to remember work done by school nurses Salisbury Daily Times Letter to the Editor Friday, May 19, 2006 It's Nurses Appreciation Week. It seems fitting to mention and give thanks to our Wicomico County school nurses. They are dedicated, professional registered nurses and nurse practitioners who are first responders, health and wellness promoters and oftentimes the medical professionals who assess and recognize a first sign of illness in your school-age child. Their roles comprise that of a professional nurse, social worker, dietitian, teacher and numerous other roles combined. School nurses administer medications daily and manage medication regimens and treatment plans for diabetics, epileptics and asthmatics, as well as many other diseases and disorders. School nurses render first aid, manage the health room, screen your child for possible hearing/vision difficulties and manage and update your child's immunization records regularly. They are an integral part of a team of professionals whose goal is to keep your child in school, learning and developing lifelong skills enabling him or her to become part of our next generation of healthy, productive adults. We are fortunate to have a team of well-educated, experienced and dedicated nursing professionals who are always looking out for the welfare of our children. Thanks for a job extremely well done. Michele Ardis, RN Salisbury Copyright 8 2006 The Daily Times Vaccine won't cover all the cancer cases Baltimore Sun Letter to the Editor Friday, May 19, 2006 As an internist and patient empowerment expert, I wanted to thank The Sun for educating readers about the pending vaccines for human papilloma virus (HPV) and the continued need for screening for cervical cancer ("HPV vaccine nearing approval," May 11). However, I feel its important to educate women about all their screening options, because the Pap smear alone is not enough. As The Sun's article correctly notes, the vaccine protects against only the 70 percent of cervical cancer cases caused by two strains of HPV, which leaves 30 percent of these cases out of reach. Thus for the foreseeable future, millions of women will have to look elsewhere for protection. And even though the Pap smear does detect precancerous cells, multiple studies have shown that the Pap smear alone isn't foolproof. In fact, the Pap smear test is inaccurate up to 50 percent of the time. However, by administering an HPV test along with the Pap smear to women age 30 and older (those most likely to get a form of HPV that puts them at high risk for cervical cancer), screening accuracy can be improved to nearly 100 percent. Dr. Marie Savard Wynnewood, Pa. The writer is a clinical associate professor of internal medicine at Thomas Jefferson University and a trustee at the University of Pennsylvania. Copyright 2006 Baltimore Sun. Mentally ill need shelter from streets Baltimore Sun Letter to the Editor Friday, May 19, 2006 I applaud The Sun's coverage of Fells Point resident Mike Sibert, whose untimely death has brought some needed attention to the plight of those people who are homeless and mentally ill ("A voice silenced," May 9). However, let's not believe that Mr. Sibert's situation is unique - there are many individuals who are living on the streets in Maryland (not just in Baltimore, mind you) who suffer from serious mental illness. Many more live on the brink of homelessness or cycle in and out of it. This is no way for people to live - homelessness is a social disgrace, for all of us. This society is capable of better than that, and we should demand better. The next time we talk about moral values and the sanctity of life, let's talk about Mr. Sibert's life and about implementing solutions to homelessness. It's long overdue. Barbara DiPietro Baltimore The writer is a member of the Maryland Interagency Council on Homelessness. Copyright 8 2006, The Baltimore Sun. Lyme disease is high risk in Cecil Cecil Whig Letter to the Editor Friday, May 19, 2006 8:16 AM EDT To: The editor From: Ron Hamlen, Elkton Excellent editorial in the May 15 Cecil Whig on Lyme disease threat. The Centers for Disease Control 2005 national provisional Lyme disease case numbers illustrate the increasing magnitude of Lyme disease in this area. Maryland increased from 8th in 2004 to 4th in 2005 while our neighbors in Pennsylvania climbed from 2nd to 1st and Delaware from 9th to 7th. Chester and New Castle County cases increased by 31 percent and 44 percent, respectively. Cecil County numbers for 2005 are not available. The CDC acknowledges that their surveillance criteria account for only approximately 10 percent of actual cases. So the true numbers of Lyme disease cases could be staggering. A Lyme disease prevalence survey of the Cecil County 21921 zip code in 2005 found 16 percent of individuals and 34 percent of households reported a Lyme disease diagnosis, respectively. The numbers of children and adults reported with Lyme disease were comparable to CDC data confirming the high risk to our children and teens. While the emphasis is on Lyme disease the same tick can transmit other microorganisms (Anaplasma, Ehrlichia, Bartonella, and Babesia) causing additional serious illnesses. Unquestionably, we in Cecil County live in a high risk area for contracting Lyme and other tick-borne diseases and preventive measures reported in the Whig editorial are key to avoiding infection leading to possible chronic and debilitating illness. Well done Whig editorial team n your timely editorial may have prevented someone from contracting Lyme and other devastating tick-borne illnesses. EDITOR=S NOTE: Ron Hamlen, PhD, is with the Lyme Disease Association of Southeastern Pennsylvania (www.lymepa.org/) Copyright 8 2006 Cecil Whig BACK TO TOP


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