Office of Public Relations

Office of Public Relations

Tuesday, October 3, 2006

News Clipping Archives

Center for disabled cited for hazardous conditions (Baltimore Examiner)
Week celebrates mental illness awareness (Cumberland Times-News)
Cumberland touted as site for Md.'s second veterans nursing home (Baltimore Examiner)
Chase Brexton opens its doors to wider community (Baltimore Examiner)
Howard launches new domestic violence team (Baltimore Examiner)
Ex-inmate treated for Legionnaires' (Hagerstown Herald-Mail)
Meade stables being weighed as quarantine center (Annapolis Capital)
CDC: Black Lung Disease on Rise in Va. (Baltimore Examiner)
New guidelines on Lyme disease (Baltimore Sun National Digest)
Heart patients face flu risk (Baltimore Examiner)
Avoid The Flu (Baltimore Examiner)
New Guidelines For Common Childhood Virus (Wall Street Journal)
One-third of U.S. kids are out of shape, study finds (USA Today)
Experts Test Drugs That Fight NeuroAIDS (Baltimore Examiner)
N.J. moves to end ban on over-the-counter syringes (USA Today)
Quest Loses Contract to Provide Lab Services For United Health (Wall Street Journal)
Patient record-sharing appeal fails (Daily Record)
Study Links Doctor Errors, Bad Diagnoses (Baltimore Examiner)
In Antipsychotics, Newer Isn't Better (Washington Post)
Medicare Drug Plans: The New Choices (Wall Street Journal)
Mass. Signs Up Poor for Health Insurance (Baltimore Examiner)
Americans Share Nobel Prize in Medicine (Baltimore Examiner)
Dengue Outbreak Kills 14 in India (Baltimore Examiner)
Maryland must not turn its back on its senior citizens (Baltimore Sun Commentary)
$4 generics (Cumberland Times-News Editorial)
What everyone should know before a flu epidemic strikes (Hagerstown Herald-Mail Editorial)


Center for disabled cited for hazardous conditions

By Stephanie Tracy
Baltimore Examiner
Tuesday, October 3, 2006

Owings Mills - Conditions at the state’s largest residential center for the developmentally disabled have led state regulators to issue immediate orders for change in order to protect the well-being of an estimated 200 patients.

Disabilities advocates said the conditions at Rosewood Center in Owings Mills have been a problem for years. The notice of immediate jeopardy issued last week by the state’s Office of Health Care Quality brought to light chronic issues long overlooked.

As part of an annual review, the Office of Health Care Quality discovered dangerous conditions at Rosewood that included instances of patients being bitten and beaten by other patients, or harming themselves during emotional outbursts. In one instance, two residents who had a history of arguing and fighting were place in the same dormitory area.

The office informed the facility last week that it had three weeks to address the hazardous conditions or face losing funding.

Wendy Kronmiller, director of the Office of Health Care Quality, was out of town Monday and could not be reached for comment.

Nancy Pineles, a managing attorney for the Maryland Disability Law Center, said the advocacy group had noticed an unusually high use of straight jackets and seclusion at Rosewood based on past complaints filed with the state.

“We have been complaining about conditions at this facility for years,” said Lauren Young, director of litigation for the law center in a written statement. “We have asked the governor to work with us to help individuals leave Rosewood and get the services they need.”

A letter was sent by the law center to Gov. Robert Ehrlich asking the residents of Rosewood be transferred.

The law center receives copies of all incident reports and allegations of abuse, neglect or death at the state’s four residential centers for the developmentally disabled, but Pineles said she doubted whether all incidents of abuse or neglect are reported.

In 2000, a Rosewood resident died in an incident that involved a type of restraint, according to Pineles. Since then, Pineles said the Developmental Disabilities Administration had made “some significant efforts” toward change, but said the problems run much deeper.

Rosewood currently serves an estimated 200 patients, mostly adults with developmental disabilities. Pineles said many of the residents could be cared for outside of an institutional setting.

Copyright 2006 Baltimore Examiner.

Week celebrates mental illness awareness

Maria Smith
Cumberland Times-News
Tuesday, October 3, 2006

CUMBERLAND - For the past six decades, people involved in the mental health community have worked to develop new programs and drugs to help the mentally ill.

Many people are getting well, but society hasn't always followed.

Jerry Ruby, president of the local chapter of the National Alliance for the Mentally Ill, said the workforce sector is one place where people with mental illness have found it hard to break the stigma.

"Mentally ill people need to work ... but it's very hard to re-enter the workforce as a mentally ill individual," he said.

To educate the community more, the local chapter of NAMI will celebrate its 12th Mental Illness Awareness Week this week. Congress established the week in 1990.

With the theme, Building Community, Taking Action, a candlelight celebration will be held Thursday from 6 to 9:30 p.m. at the Salvation Army, 701 E. First St.

The day also is Bipolar Disorder Awareness Day and will be part of the program as well.

"Bipolar claims about as many lives as cancer and some heart diseases because the suicide rate is so high," Ruby said.

The evening will feature presentations by Denise Sulzbach of the state's Mental Hygiene Administration; David Washington, Trauma-Addiction-Mental Health and Recovery program; local businessman Robert Sinclair; and Lt. Rhonda Downton of the Allegany County Sheriff's Office.

"I think there's more of a movement with understanding mental illness and a big movement looking at recovery," Jeff Vanderhout, a member of NAMI, said. "That's what people want."

Ruby said he is encouraged by the Department of Rehabilitation Services, which offers individuals an opportunity to become entrepreneurs.

Vanderhout said Building Community has become a movement because the effort now is on "recovery rather than just maintaining a person in an institution." That also means they're seeking help in becoming employed and obtaining higher education.

Public housing is another issue.
Ruby said waiting lists are huge. With the Social Security Income allotment at about $600 per month and the national average rent for a one-bedroom apartment at $800, he asks what's one to do.

He said people on public assistance often can't get many of their medications, especially those that are more expensive and do a better job.

"I think that's rotten," he said. "They've developed these drugs but we can't get them. I think our medication should depend on what your physician says, not what the government says."

Ruby said while he has noticed stigma has been reduced in the community, more can be done, especially when it comes to Hollywood. He said movies often have an "anti-mental illness theme" from "Halloween" to "Friday the 13th," where people with a mental illness are depicted as murderers.

"A Beautiful Mind" was one that portrayed mental illness well, he said.

The Mental Health System Office at the health department supports the efforts of NAMI.

Laura Miller, child and adolescent coordinator, said the Consumer Advisory Board is a way for the department to receive information from the community in regard to mental health. Both Ruby and Vanderhout serve as members. The board is looking for members who either have a mental illness and use local services or have a family member who does.

For more information about the board, call (301) 759-5069, Ext. 5070.

More information about the celebration is available at (301) 724-0091, (301) 689-2133 or www.nami.org/miaw.

© 2006, The Cumberland Times-News



Cumberland touted as site for Md.'s second veterans nursing home

Associated Press
Baltimore Examiner
Tuesday, October 3, 2006

CUMBERLAND, Md. - Officials in Cumberland are touting the western Maryland city as an ideal site for the state's second veterans nursing home.

Mayor Lee Fiedler said he has asked federal elected officials to help bring such a facility to Cumberland, where hospital consolidation could create a surplus of institutional care space by 2010. Construction of a planned new hospital could leave the city's two existing medical campuses, Sacred Heart and Cumberland Memorial, in need of new tenants.

The city and the Allegany County Chamber of Commerce have formed committees to study prospects for those buildings, including the possibility of converting the 148-bed Sacred Heart hospital into a veterans retirement community or nursing home, the Cumberland Times-News reported Sunday.

Fiedler declined to specify either site as a prospective nursing home location. But Lisa Wright, a spokeswoman for Rep. Roscoe Bartlett, R-Md., said Bartlett "has discussed this with Mayor Fiedler and has asked the Veterans Affairs to explore the potential use of the Sacred Heart facility."

The U.S. Department of Veterans Affairs has expressed interest in providing a 120-bed nursing home in western Maryland, VA spokeswoman Jo Schuda said. But before such a project can move to the agency's priority list, the state must agree to pay 35 percent of the cost, she said.

Frank Salvas, chief of the agency's home construction grant program, said Maryland's portion would be about $4 million of an $11.5 million project.

The state's only veterans nursing home, Charlotte Hall Veterans Home in St. Mary's County, has 478 beds. The VA realizes that Charlotte Hall is in a remote location and that the state needs more beds, Salvas said.

Fiedler said the VA has ruled out establishing a veterans hospital in Cumberland. The nearest VA hospital is in Martinsburg, W.Va., nearly 70 miles away.

The Western Maryland Health System, which operates both the Sacred Heart and Memorial hospitals, has said it hopes to break ground for the new, 275-bed hospital late this year or early in 2007, with completion expected three years after that. The two existing hospitals have a total of 321 beds.

Copyright 2006 The Associated Press. All rights reserved.

Chase Brexton opens its doors to wider community

By Karl B. Hille
Baltimore Examiner
Tuesday October 3, 2006

BALTIMORE - The Chase Brexton clinic in downtown Baltimore developed a reputation for caring for AIDS patients for nearly 30 years, even before they had the understanding or sympathy of the nation. Not so many people know they now offer community clinic services to anyone, regardless of AIDS status or ability to pay.

Chase Brexton opened its second facility in Randallstown in 1999 and a third in Columbia last month. They offer comprehensive AIDS care, preventive medicine and a network of visiting specialists, as well as in-house pharmacies and drug addiction and treatment services. Health care is priced on a sliding scale, based on patient’s ability to pay.

“Clearly, we’re into a lot different territory than we were a long time ago,” Chase Brexton CEO David Shippee said. “The thing that still pays is compassion. People seek us out based on our reputation.”

By 2011, Chase Brexton Health Services will be “a nationally recognized center of excellence for community health services,” according to its Web site. Future developments include moving into research and providing team-based care, the site states.

“It’s great that they’re doing it,” said Vincent DeMarco, president of the Maryland Health Care for All! Coalition. “There are other companies offering care to the uninsured, but they are the leaders.”

Chase Brexton has its work cut out for it, according to the coalition’s estimates. More than 800,000 adults in the state lack insurance and more than 90,000 children are eligible for free state-sponsored health care are not enrolled.

Shippee shared the private, nonprofit clinic’s history.

“A lot of the patients we had been seeing with the HIV disease, nearly every one of them, by the time they finished their course of care with us — which usually meant they died — had somebody in their life who accompanied them here,” Shippee said. “We usually had a much closer relationship with the caregiver than even with the patient by that time.”

Many of Chase Brexton Health Services patients in their ’80s and even early ’90s lost much of their ability to function before AIDS claimed them. Chase Brexton began expanding their services to include mental health care, counseling and addictions services for the caregivers as well as patients. Many of these companions ended up being HIV positive as well, Shippee said. Many were uninsured, and in 1995, Chase Brexton expanded their services to all people.

Working through a combination of grants and charity, Chase Brexton relied heavily on doctors volunteering for the challenge of treating complex cases and offering crisis care to those who could not afford the stabilizing routine care of the insured. Since its founding, Chase Brexton has gradually increased the number of paid staff, allowing them greater freedom to expand coverage and set their own agenda, Shippee said.

Copyright 2006 Baltimore Examiner.


Howard launches new domestic violence team

By Luke Broadwater
Baltimore Examiner
Tuesday, October 3, 2006

Howard County - Howard County police are launching a new unit that officials say will better tackle the growing problem of domestic violence.

“We recognize that these investigations are best served by officers who are specially trained to understand the issues surrounding domestic violence cases,” said acting Chief William McMahon, announcing the new team Monday.

“Domestic violence cases are on the rise not just in Howard County but other places as well,” police spokeswoman Sherry Llewellyn said.

The department obtained a $400,000 two-year federal grant to create a unit comprising a police supervisor, officer and administrative employee.

The responsibilities of the new team include:
» Receiving specialized training in domestic violence issues and devoting all their time to these cases
» Helping victims obtain protective orders
» Working to increase the number of arrests for domestic violence crimes
» Developing a tracking system to identify repeat offenders
» Focusing attention on foreign-born victims, who may not report domestic violence incidents because of language or cultural barriers.

In Baltimore and Anne Arundel counties, an officer in each district is assigned to work exclusively with domestic violence.

In each Baltimore City police district, there is a small domestic violence unit, along with the department’s central unit.

The Harford County and Carroll County sheriff’s officers also have domestic violence units.

AT A GLANCE

Domestic violence offenses in Howard
» 2005: 804
» 2004: 753
» 2003: 675
» 2002: 676
» 2001: 665

Domestic violence by county in 2005
» Anne Arundel: 1,259
» Baltimore City: 4,991
» Baltimore County: 4,829
» Carroll: 418
» Harford: 685
» Howard: 804

Source: Maryland State Police

Examiner Staff Writer Megan McIlory contributed to this report.

Copyright 2006 Baltimore Examiner.


Ex-inmate treated for Legionnaires'

By Karen Hanna
Hagerstown Herald-Mail
Tuesday, October 3, 2006

HAGERSTOWN - A former Roxbury Correctional Institution inmate has received treatment for Legionnaires' disease, and portions of the facility have tested positive for the water-borne bacteria, a prison spokeswoman said Monday.

According to Denise Glesinger, a public information officer for Roxbury, Legionella, which can cause pneumonia, was found in a unit where the inmate had been housed and in a cooling tower. Crews worked during the weekend to make sure the facility was safe, Glesinger said, and she said she was unaware of anyone else who had become ill.

"We were not sure whether he contracted it at Roxbury, or he could have actually contracted it while he was out on the street," Glesinger said.

According to a press release from the Maryland Department of Public Safety and Correctional Services, an inmate was diagnosed with the disease after being released from the facility early last month. Tests have not isolated where the inmate contracted the disease or whether he was sickened after being released from prison, Glesinger said.

Staff members have provided safe water to inmates in the unit where the disease was detected, but Glesinger said Monday evening she could not confirm whether access to showers had been restricted, as the press release states.

Glesinger said Monday evening that she was unsure when the inmate was diagnosed or when the prison began testing for the bacteria. About 450 correctional officers and staff work at the prison, which houses about 1,750 inmates, Glesinger said.

Legionella at a glance

· The disease is spread by the release of small droplets of contaminated water into the air.

· Symptoms can include high fever, chills, coughing, muscle aches and headaches.

· The disease cannot be spread from one person to another, and most people who are exposed to the bacteria do not get sick.

Source: Centers for Disease Control and Prevention

Copyright The Herald-Mail ONLINE


Meade stables being weighed as quarantine center

By Jeff Horseman
Annapolis Capital
Tuesday, October 3, 2006

Anne Arundel County could become an Ellis Island for horses under a plan proposed by the Maryland Department of Agriculture.

MDA officials want to study the possibility of converting Fort George G. Meade's dormant stables into a federal livestock quarantine center, able to screen animals flown in from overseas.

The center would be only the fourth such facility in the United States. The others are in Miami, Los Angeles and Newburgh, N.Y.

Keith Menchey, assistant secretary for policy with MDA, said officials had been kicking around the quarantine center idea for at least two years.

With Maryland horses finding an active market in Russia, Ukraine, South Korea and elsewhere, a local quarantine center would be a great asset, Mr. Menchey said.

He was reluctant to talk about how much the center would cost. But he said the Newburgh facility cost $28 million when it was built in the 1970s.

Steuart Pittman, a Davidsonville horse trainer familiar with quarantine centers, said they resemble normal horse farms.

Horses flown into BWI Thurgood Marshall Airport would be sent to the center, where they would be held for at least a few days while being checked for contagious diseases such as CEM, a venereal disease.

Horses with a clean bill of health would be sent on their way. Those that don't pass inspection would not be allowed to enter the country. The center would be run by the U.S. Department of Agriculture.

While the center would screen a variety of animals, horses would make up at least 90 percent of the business, Mr. Menchey said.

The center would be located at the fort's old stables, which are adjacent to the Patuxent Wildlife Refuge off Route 32.

The 14-acre equestrian center was closed on April 30, 2005. At the time, Fort Meade officials were worried about bird and mosquitoes in the barns that carried the West Nile Virus.

While the riding trails were cleared of unexploded ordnance, there were concerns about riders straying off those trails into unsafe areas. Also, officials said it didn't make sense to spend more than $200,000 to fix the stables' two barns for the benefit of less than 30 horse owners.

The federal Department of the Interior, which owns the site, began to tear down the stables. But the demolition is on hold while the quarantine center concept is on the table.

The barns are still standing, as is a double-fence that would be required for any quarantine facility. Mr. Menchey said the site also is desirable because it's far from any other livestock, but close to BWI.

"It seems like it would be a perfect spot for a quarantine operation," he said.

Mr. Pittman said the center would be a boon for the horse industry, especially businesses that import horses. "It encourages people to do business in this state," he said.

Mr. Pittman also is a leading proponent of the Maryland Stadium Authority's controversial proposal to build a state horse park at the former Naval Academy Dairy Farm in Gambrills. The quarantine center and horse park plans are unrelated.

"If the horse park happens, we already would have everything to attract exciting horse shows in the county," Mr. Pittman said. "It paints the picture of economic development that's going to be very attractive to politicians."

But the two men seeking to represent the Fort Meade area on the County Council are wary of a quarantine center in their district.

Jamie Benoit, the Odenton Democrat running for the District 4 seat, said he would oppose the center if he thought it would open the door for the horse park.

He's also concerned about what route the livestock would take from BWI to the facility. "How's the convoy of livestock going to be controlled?" he asked.

Republican Sid Saab of Crownsville said he wants to know the risk a quarantine center poses to the community.

"If there's no danger or potential risk to the citizens of the county, I would support it," said Mr. Saab, who opposes the horse park.

The current council representative, Democrat Bill D. Burlison of Odenton, could not be reached for comment.

The Maryland Horse Industry Foundation is asking for the council's blessing for a $21,250 grant application to the Maryland Department of Business and Economic Development. The council needs to give its consent for the application to go forward.

The grant would help fund the study, which has a total price tag of $60,000. No county dollars are involved.

MDA will hire a consultant to perform the study, which will examine whether a local quarantine center would take business away from the Newburgh facility. The study is expected to be completed this spring.

The council is expected to vote at its meeting today on a resolution supporting the horse industry foundation's grant request.

Copyright © 2006 The Capital.

CDC: Black Lung Disease on Rise in Va.

Associated Press
Baltimore Examiner
Tuesday, October 3, 2006

ROANOKE, Va. - Black lung disease is posing a greater threat to coal miners in far southwest Virginia, and scientists aren't sure why.

A report released by the U.S. Centers for Disease Control and Prevention shows that the number of cases of black lung disease is rising in Lee and Wise counties and that the cases are more severe. Scientists are still analyzing data from Dickenson, Russell, Tazewell and Buchanan counties.

Black lung disease - known medically as coal workers' pneumoconiosis - is caused by inhalation of coal dust. After a federal law was passed in 1969 setting dust limits to protect miners' health, the number of miners who developed the disease decreased, according to the study.

"Something doesn't add up, because we're seeing lots more disease than would be expected at those levels of dust," said Vinicius Antao of the National Institute for Occupational Safety and Health, the lead researcher on the project.

The study, published last month in the CDC's Morbidity and Mortality Weekly Report, built on 2003 research that showed pockets where black lung disease was progressing rapidly, particularly in southwest Virginia and eastern Kentucky.

The increase both in the number of cases and their severity "justifies a comprehensive assessment of current dust-control measures," the recent report said.

Researchers examined 328, or 31 percent, of some 1,055 coal miners who were working underground in Lee and Wise in March and May of this year. They ranged in age from 21 to 63 and had worked in the mines for an average of 23 years.

Thirty of the miners had evidence of black lung, and 11 of the cases were advanced, according to the report.

The miners with the advanced cases had an average age of 51 and had spent an average of 31 years working in underground coal mines.

Researchers suggested several possible reasons for the increase and severity of the black lung cases: that the allowable dust limit may be too high; that the levels of coal dust reported may be underestimated; and that the toxicity of the coal being mined may be higher.

The theory used to be that black lung disease would disappear if coal dust was controlled, said Dr. Randy Forehand, a respiratory medicine specialist at Lewis-Gale Medical Center in Salem who has treated black lung patients for 16 years in Richlands in Tazewell County.

"Overall, the levels (of coal dust) and incidences (of black lung disease) are going down, except in these hot spots," Forehand said.

National Institute for Occupational Safety and Health investigators have suggested that they are seeing more cases of miners with black lung disease in small, nonunion mines.

Genetics also plays a role in who develops black lung disease, Forehand said.

"Not everybody who works down there gets it," he said.

Copyright 2006 The Associated Press. All rights reserved.

New guidelines on Lyme disease

Wire Reports
Baltimore Sun National Digest
Tuesday, October 3, 2006

Newly updated guidelines on the diagnosis and treatment of Lyme disease were released yesterday, after an exhaustive evaluation of the infection and its aftermath. The Infectious Disease Society of America based the guidelines on findings from clinical studies and changes in treatment practices in recent years. Recommendations were last updated in 2000. Attention to the guidelines will aid physicians' diagnosis and help patients better understand the disease, said Dr. Gary Wormser, chief of infectious diseases at New York Medical College and lead author of the recommendations. He said the updated guidelines, which are posted on the society's Web site, were written in response to mounting concern and confusion about Lyme disease.

Copyright © 2006, The Baltimore Sun.

Heart patients face flu risk

By Karl B. Hille
Baltimore Examiner
Tuesday, October 3, 2006

Flu-related death is more common among those with heart disease than any other chronic disease; however, only one in three heart patients got the vaccine in 2005, according to a report by the American Heart Association and the American College of Cardiology.

“Immunization against seasonal influenza has a critical but perhaps underappreciated role in the prevention of ... mortality in patients with cardiovascular disease,” the report states. Flu “vaccination is now recommended with the same enthusiasm as control of cholesterol, blood pressure and other modifiable risk factors.”

The flu virus causes more than 36,000 deaths and 225,000 hospitalizations in the United States every year, according to the Centers for Disease Control and Prevention.

The report will be published in the College of Cardiology’s Journal today.

The AHA And ACC Recommend:
All patients with heart disease get a flu vaccine.
Younger heart patients especially need to get the vaccine.
Only 23% of heart patients 18 to 49 are getting the shots.
Cardiologists should strongly promote flu vaccines to their patients.
Cardiologists should stock and give the vaccine.

Copyright 2006 Baltimore Examiner.

Avoid The Flu

By Allison Gutman
Baltimore Examiner
Tuesday, October 3, 2006

As much as 20 percent of the population gets the flu every year, with more than 225,000 people hospitalized, according to the Centers for Disease Control and Prevention.

Larry Baskind, a clinical associate professor of pediatrics at New York Medical College, is coming to the Natural Products Expo East In Baltimore next week with a list of 10 steps to stay healthy and avoid the flu.

Most of Baskind’s tips are basic: Listen to your body, wash your hands, eat healthy and get a good night’s sleep.

He also recommends taking Oscillococcinum, a natural flu medicine, to help reduce the duration land severity of flu symptoms. Four clinical studies show it reduces the severity as well as the duration of fever, chills, body aches and pains associated with flu.

Flu Advice

Getting a flu shot is the most effective way to prevent the flu.
Wash your hands several tiimes a day, and avoid rubbing your eyes and noses.
Eat a healthy diet rich in vitamins C and E.
Staying hydrated will always keep you healthier.
Exercising regularly stimulates the immmune system and promotes healthy sleep patterns.
Listen to your body, and take it easy if you feel the flu coming.
Don’t overdose on over-the-counter remedies.
Seek help from a doctor if symptoms become significantly worse after three days.

Copyright 2006 Baltimore Examiner.

New Guidelines For Common Childhood Virus

By Elena Cherney
Wall Street Journal
Tuesday, October 3, 2006; Page D3

Children suffering from a common and sometimes serious viral respiratory infection, bronchiolitis, don't benefit from the medicines and diagnostic tests that are often deployed in doctors' offices and hospitals, according to new treatment guidelines from the American Academy of Pediatrics.

Bronchiolitis, an inflammation of the airways leading to the lungs, is caused by different viruses, but most often stems from respiratory syncytial virus, or RSV, which infects 90% of U.S. children by the age of two. Bronchiolitis can result in wheezing serious enough to cause breathing problems and can require hospitalization. The cost of hospitalizing children younger than one with bronchiolitis was more than $700 million in 1999, according to the study.

Babies younger than two and children who were born prematurely or have lung or heart disease are more likely to get seriously ill with bronchiolitis. The sickness can be life-threatening in some cases, but the number of children who die from bronchiolitis has decreased in recent years.

Although there's no evidence for the practices, doctors send children with bronchiolitis for chest x-rays and blood tests, and treat them with bronchodilating drugs or steroids, says Allan Lieberthal, chairman of the American Academy of Pediatrics' subcommittee on the diagnosis and management of bronchiolitis. Dr. Lieberthal is also a pediatrician with Kaiser Permanante in Panorama City, Calif., and a clinical professor of pediatrics at University of Southern California in Los Angeles.

But studies have shown that x-rays don't help to diagnose the illness in most cases -- and expose children to unnecessary radiation. "It's a clinical diagnosis," he says, and should be based on the history of the illness and a physical examination: wheezing that develops after a child has had congestion and a cough. Chest x-rays need to be done only if the sickness "isn't following its usual course," or if the child has other signs pointing to possible pneumonia, says Dr. Lieberthal.

The medicines that are being used also don't help and shouldn't be given routinely, he says. Instead, "the main treatment is observation," he says. "It runs its natural course." Parents need to watch carefully for signs that a child is having trouble breathing, he says.

While clinical studies show that inhaled bronchodilating medicines don't help in most cases, some children do respond to the drugs, and "it may be reasonable to administer" a dose of one of the drugs "and evaluate clinical response," the guidelines state. But the drugs should be continued only if the child shows a marked improvement, says Dr. Lieberthal. The medicines that may be tried in such cases include racemic epinephrine and albuterol. Children who are given these drugs don't get better faster as the drugs only help with symptoms.

Doctors sometimes treat bronchiolitis patients with inhaled bronchodilators because it can be difficult to distinguish bronchiolitis from a first episode of asthma, says Maurice Chianese of ProHealth Care Associates in Lake Success, N.Y. "It's hard to know, is this a child who's having a first asthma exacerbation or is this bronchiolitis? It's not mutually exclusive." If a child doesn't seem to be in distress -- a type he calls a "happy wheezer" -- Dr. Chianese recommends observation.

But if the child is struggling "or just looks sicker than the average," he says he will then try one of the medicines to see if it helps.

Bronchiolitis occurs mostly between November and April but can happen at any time of year, Dr. Lieberthal says.

Copyright 2006 Dow Jones & Company, Inc. All Rights Reserved.

One-third of U.S. kids are out of shape, study finds

By Nanci Hellmich
USA Today
Tuesday, October 3, 2006

A third of U.S. adolescents are unfit, according to a landmark analysis of health data, and experts say it's time to get them moving.

Russell Pate, professor of exercise science at the University of South Carolina, and colleagues based their conclusion on the number of kids who wear out quickly on a basic treadmill test.

The researchers also found that overweight teens are more likely to fail a cardiovascular fitness test than those at a normal weight, and males are slightly more likely to meet the fitness standard than females.

The team examined data on 3,287 boys and girls, ages 12 to 19, taken from a large government survey. Teens' heart rates were measured and oxygen intake was estimated during short treadmill tests.

The more oxygen people can take in during vigorous exercise, the fitter they are and the better their endurance during physical activity, Pate says. Maximum oxygen intake is considered the gold standard for determining cardiovascular fitness, he says.

The data were part of the National Health and Nutrition Examination Survey, a series of periodic surveys that collect height, weight and other information on the U.S. population. Pate says this is the first time this particular data, collected from 1999 and 2002, has been analyzed.

Kids who are unfit are likely to become unfit adults, he says. Cardiovascular fitness reduces the risk of chronic disease and early death, as well as decreasing a person's ability to chase the dog, climb stairs quickly or play basketball and run without being exhausted, Pate says.

"About half the overweight adolescents failed to meet the fitness standard, but a large majority of the normal weight kids met it," Pate says. Other findings published in October's Archives of Pediatrics and Adolescent Medicine:

• 28% of males and 38% of females, ages 18 and 19, did not meet the fitness standards.

• 30% of males and 33% of females, ages 14 to 15, did not pass the tests.

• The passing rates were no different between ethnic groups.

"These data clearly call for us to redouble our efforts to provide kids with high-quality physical activity in a range of settings from sports to PE classes to recreation programs to home-based activity," Pate says.
Charlene Burgeson, executive director of the National Association for Sport & Physical Education, a group of physical education and sports professionals, says, "This study reinforces the importance of all youth being physically active, spending minimal time in sedentary activities such as TV watching, and maintaining a healthy weight.

"As a society, it's time to move past the need to prove that there is a problem and to find ways to actually create environments and a culture where these healthy behaviors are the norm," Burgeson says.

One-third of children and teens — about 25 million kids — are overweight or on the brink of becoming so, which increases their risk of developing diabetes, high cholesterol, high blood pressure and other illnesses, according to a government survey. James Hill, co-founder of America on the Move, which encourages increased physical activity, says, "This is more evidence that we have a crisis with our children's health. ... It is time for us to devote serious efforts now to get our kids more physically active."

OVERWEIGHT KIDS
Study: One-third of U.S. kids out of shape
Signs your child is at risk | See how little it takes to fill 'em up
Report pleads for united front against childhood obesity
Most overweight toddlers don't lose baby fat
Other demands outmuscling PE instruction
Q&A: How parents can handle weight

PERCENTILE LEAPS IN WEIGHT COULD SIGNAL OBESITY AHEAD

Some experts define children as obese if they are above the 95th percentile in the weight-to-height ratio, meaning they weigh more than 95% of children at the same height, and as overweight if they fall in the 85th to 95th percentiles.

If your child's weight is jumping up percentiles on the weight charts at annual checkups, it could be a red flag that something must be done, says William Cochran, head of the Pediatric Weight Management Program at Geisinger Clinic in Danville, Pa.

For instance, if a child is in the 25th percentile for weight at age 2, the 50th percentile at age 3 and the 75th percentile by age 4, family and doctor must assess the child's eating and physical activity habits before he or she hits the overweight category, he says.

Sometimes a simple intervention can keep children from getting too heavy, Cochran says.

In many cases, slightly overweight children are consuming too much soda and juice.
A study released this month showed that 60% of toddlers and preschoolers who were overweight or obese during their preschool years still weighed too much at age 12, setting them on a path to adult obesity.

By Nanci Hellmich, USA TODAY



Copyright 2006 USA TODAY, a division of Gannett Co. Inc.



Experts Test Drugs That Fight NeuroAIDS

Associated Press
By Lauran Neergaard
Baltimore Examiner
Tuesday, October 3, 2006

WASHINGTON - It's an Achilles' heel of HIV therapy: The AIDS virus can sneak into the brain to cause dementia, despite today's best medicines. Now scientists are beginning to test drugs that may protect against the memory loss and other symptoms of so-called neuroAIDS, which afflicts at least one in five people with HIV and is becoming more common as patients live longer.

With almost 1 million Americans, and almost 40 million people worldwide, living with HIV, that's a large and underrecognized toll.

"That means HIV is the commonest cause of cognitive dysfunction in young people worldwide," says Dr. Justin McArthur, vice chairman of neurology at Baltimore's Johns Hopkins University, who treats neuroAIDS. "There's no question it's a major public health issue."

While today's most powerful anti-HIV drugs do help by suppressing levels of the virus in blood - so that there's less to continually bathe the brain - they can't cure neuroAIDS. Why? HIV seeps into the brain very soon after someone is infected, and few anti-HIV drugs can penetrate the brain to chase it down.

"Despite the best efforts of (anti-HIV) therapy, brain is failing," says Dr. Harris Gelbard, a neurologist at the University of Rochester Medical Center. He is part of a major new effort funded by the National Institutes of Health to find the first brain-protecting treatments.

What's now called neuroAIDS is much different from the AIDS dementia of the epidemic's early years, when patients often had horrific brain symptoms similar to end-stage Alzheimer's, unable to move or talk. They'd die within six months.

Today, anti-HIV medication has resulted in a more subtle dementia that strikes four years or more before death: At first, patients forget phone numbers and their movements slow. They become less able to juggle multiple tasks.

Some worsen until they can't hold a job or perform other activities, but not everyone worsens - and doctors can't predict who will. In a vicious cycle, the memory loss makes many forget their anti-HIV pills, so the virus rebounds.

Gelbard estimates that neuroAIDS reduces patients' mental function by 25 percent.

If HIV patients live long enough, many specialists worry, nearly all of them may suffer at least some brain symptoms.

"They're living longer with HIV in the brain," explains Kathy Kopnisky of the NIH's National Institute of Mental Health, which is spending about $60 million investigating neuroAIDS. "And they're aging, so they're going through the normal brain aging-related processes" that can make people vulnerable to Alzheimer's and other brain diseases.

Biologically, this is a different type of dementia from any caused by Alzheimer's or Parkinson's, and drugs for those brain-degenerating diseases so far are proving disappointing against neuroAIDS.

So the government-funded attack has two fronts:

-First, figure out which of the powerful anti-HIV cocktails are the best bet for HIV patients with memory problems.

A few of today's HIV-suppressing drugs, such as nevirapine, abacavir, AZT and indinavir, can penetrate the blood-brain barrier, says Dr. Ron Ellis of the University of California, San Diego.

But no one knows if using those drugs instead of others will slow the brain damage once neuroAIDS symptoms begin. Early next year, Ellis will begin a study of 120 such patients - at UCSD, Hopkins and Washington University in St. Louis - to try to tell, by randomly assigning them to either a brain-penetrating cocktail or different drugs.

-Second, find drugs that protect nerve cells from the inflammation-triggered toxic chain reaction that seems to be how HIV wreaks its damage.

Topping the candidates are the epilepsy drug valproic acid and lithium, a drug long used in manic-depression. Both inhibit an enzyme, called GSK-3b. The body normally makes the enzyme, but too much is poisonous. In the brain, HIV knocks that careful balancing act out of whack, leading to death of connections key to memory and other neuronal functions.

In a recent pilot study, Gelbard found tantalizing signs that valproic acid might increase brain connections in a few neuroAIDS patients, and improve their symptoms. He's about to begin a second-stage study to try to tell if the effect is real; a similar pilot trial with lithium is under way.

Seeking a one-two punch, Gelbard also hopes to soon begin a human study of an experimental drug that targets a second inflammatory protein that HIV uses, this one to trigger brain cells to kill themselves.

EDITOR'S NOTE - Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

Copyright 2006 The Associated Press. All rights reserved.

N.J. moves to end ban on over-the-counter syringes

By Martha T. Moore
USA Today
Tuesday, October 3, 2006

New Jersey, the last state with restrictions on access to syringes without a prescription, may be ready to end its ban in the name of AIDS prevention.

All other states allow over-the-counter sales of syringes in pharmacies or let drug users exchange used needles for sterile ones.

Now New Jersey may go along. A bill authorizing six cities to launch needle-exchange programs cleared the state Senate health committee last month, the furthest such a proposal has gone since a needle exchange bill was first introduced in 1993.

Political leaders, among them Gov. Jon Corzine, favor the needle-exchange proposal, which passed the state's lower house in previous years but never got anywhere in the Senate.

States began loosening restrictions on syringes after the AIDS epidemic emerged two decades ago and one route of infection was found to be needles shared by drug users. New Jersey was the last holdout after two states relaxed laws on syringes this year:

•In Massachusetts, the sale of syringes without prescriptions became legal last month under a law passed in July.

•Delaware legislators approved the state's first needle-exchange program in June. The five-year pilot program in Wilmington is to begin by early 2007. Over-the-counter sales of syringes are still prohibited.

Some still oppose idea
Of all the states, only New Jersey, Pennsylvania, Georgia, Delaware, Kansas, Vermont and the District of Columbia require a prescription to buy syringes. All but New Jersey have needle-exchange programs run by the state or cities.

In New Jersey, 44% of all AIDS cases resulted from drug users sharing contaminated needles, according to the Kaiser Family Foundation, which studies health policy. The national rate is 24%.

The percentage of new AIDS cases reported each year that are caused by drug needles has declined since 2001, according to the Centers for Disease Control and Prevention.

In 2004, the latest year for which national statistics are available, 22% of new AIDS cases were caused by injection drug use, down from a high of 31% in 1993, according to the Kaiser Family Foundation.
In New Jersey, 14% of the 1,839 HIV/AIDS cases reported in 2005 were attributed to injection drug use, according to the state Department of Health. The low rate is the result of prevention efforts and a decline in needle use by younger drug abusers, says Fred Jacobs, the state health commissioner. Young users "are not so much shooting up anymore. Nevertheless, it's still a significant percentage" of new cases, he says.

A needle-exchange program would lower the rate further, he says.

The Senate committee approval "was a huge, huge step for New Jersey," says Roseanne Scotti, director of Drug Policy Alliance New Jersey, which lobbies for needle exchange programs.

Then-governor Jim McGreevey signed an order permitting needle exchanges in three cities in 2004, but a court challenge killed it.

The idea still faces opposition, especially from state Sen. Ronald Rice, a Democrat from drug- and violence-plagued Newark.

"I'm not ever going to vote to give people a needle," Rice says.

He argues that exchanging needles supports the drug trade and the violent crime that goes with it.

"If you give somebody a needle, you need the substance for the needle, which means you have to go back to the same corners in Newark and Camden." Then, he says, "They're out there doing all the things they have to do to get the dollars to get the substance."

Proponents of needle-exchange programs argue that addicts show up to get needles but eventually accept other services.

"It's a bridge to treatment," Scotti says.

"They come for the syringes but they feel comfortable there. Needle exchange programs do thousands and thousands of referrals" to treatment programs, she says.

'Policy debate is over'
Studies of needle exchanges have found that they reduce HIV risk. Since 1994, when Baltimore began a needle exchange, the number of HIV cases attributed to injection drug use has dropped from about 60% of all cases to 41% in 2003, according to the Baltimore Health Department.

"The policy debate is over," says Scott Burris, a Temple University law professor who has tracked syringe-access laws for 10 years. "One after another, the states that made it hardest to get syringes, and therefore also tended to have the worst drug HIV problems, have all made it easier. There's still huge problems of scale and funding, because begrudging acceptance doesn't add up to an effective public health program."

There is no federal funding for needle-exchange programs. The White House Office of National Drug Control Policy opposes them. Its position is that the focus for AIDS prevention should be on stopping drug use through treatment.

Addiction "is a treatable disease," says David Murray, the agency's lead scientist. "Treatment should be our first choice, not sustaining people, not continuing to abet their ongoing drug use."

Copyright 2006 USA Today.

Quest Loses Contract to Provide Lab Services For UnitedHealth

Wall Street Journal ONLINE NEWS ROUNDUP
Tuesday, October 3, 2006

Quest Diagnostics Inc. announced Tuesday that it has lost its national contract to provide lab services for UnitedHealth Group Inc., effective Jan. 1.

UnitedHealth is the nation's largest managed-care company in terms of revenue.

Shares of Quest sank on the news, falling $6.69, or 11%, to $54.21 in early trading on the New York Stock Exchange.

Earlier, Laboratory Corp. of America Holdings disclosed that it has received a $3 billion contract to be UnitedHealth's exclusive lab-services provider for several health-benefit plans over 10 years. LabCorp agreed to reimburse UnitedHealth up to $200 million in transition costs associated with the deal.

In a conference call following the deal, LabCorp Chairman and Chief Executive Thomas Mac Mahon called the contract "historic," saying no other relationship in the lab industry has such scope of geography, services and time frame.

Quest, one of the nation's top providers of diagnostic testing, said it still expects to provide contracted lab services for UnitedHealth in some markets. Currently, UnitedHealth accounts for about 7% of Quest's annual revenues.

Quest said it can't estimate the financial impact of losing the national contract, but added that the terms and conditions offered by UnitedHealth to continue the national agreement "would have be irresponsible for us to accept."

Heath-care providers like UnitedHealth have been under the microscope this year as investors worry about profit growth potential. Investors are concerned that providers are having a hard time drumming up new business without cutting into the meaty margins they've enjoyed in recent years.

Copyright 2006 Dow Jones & Company, Inc. All Rights Reserved.

Patient record-sharing appeal fails
Coalition of privacy advocates challenged rule

Bloomberg
By Greg Stohr
Daily Record
Tuesday, October 3, 2006

Privacy advocates lost a U.S. Supreme Court challenge to a federal rule that allows health-care providers and insurers broad latitude to share patients’ records.

The justices, without comment, yesterday turned down an appeal by a coalition of consumers, providers and privacy-rights groups that said the policy violates patients’ constitutional rights. The Bush administration defended the rule, contending that it helps the health-care industry provide efficient service.

The case is Citizens for Health v. Leavitt, 05-1311.

The rule stems from a 1996 law that directed the Health and Human Services Department to adopt standards for information transfers in the industry. Although an early version of the regulations required patient consent before providers could disclose information, the department eventually decided to exempt “routine uses,” such as treatment and payment.

The 3rd U.S. Circuit Court of Appeals upheld the rule, saying the federal government wasn’t requiring nonconsensual disclosure of information. The Philadelphia-based court said those types of disclosures had been legal even before the federal government acted.

The Supreme Court made no comment yesterday, rejecting the appeal by Citizens for Health and other privacy advocates as part of a list of orders released in Washington.

Copyright 2006 © The Daily Record. All Rights Reserved.

Study Links Doctor Errors, Bad Diagnoses

Associated Press
By Patrick Walters
Baltimore Examiner
Tuesday, October 3, 2006

PHILADELPHIA - Basic errors made by doctors, including tests ordered too late or not at all and failure to create follow-up plans, played a role in nearly 60 percent of cases in which patients were allegedly hurt by missed or delayed diagnoses, a study found.

Researchers in the study, published in the Annals of Internal Medicine on Monday, reviewed 307 closed medical malpractice claims, 181 of which allegedly involved diagnostic errors that ended up harming patients. A large majority of those cases involved various types of cancer.

While researchers acknowledged that most claims involved several factors, they said major ones included mistakes by doctors: failure to order appropriate diagnostic tests (100 cases); failure to create a proper follow-up plan (81); failure to obtain an adequate history or perform an adequate physical examination (76); and incorrect interpretation of tests (67).

Doctors not involved with the study said the findings highlight the fact that physicians - and patients- need to err on the side of caution when it comes to ordering diagnostic tests, keeping detailed records and doing follow-up.

"It seemed like the bottom line was that the problems were problems that would occur less if a person was just very compulsive or very diligent," said Dr. Steven Sorscher, an oncologist at Washington University Medical School in St. Louis. "It highlights the fact that the causes of serious errors are often preventable."

The study's lead author, Dr. Tejal K. Gandhi, director of patient safety at Brigham and Women's Hospital in Boston, said the research shows that doctors could use more help in making decisions. Things that could help include more use of electronic records, better algorithms for making evaluations and the use of nurse practitioners to help ensure that follow-ups actually occur, she said.

"I don't want to say that it's not the physician's responsibility," Gandhi said. "We think there could be tools to help physicians make these decisions better."

The study looked at random samples of claims from four malpractice insurance companies throughout the U.S. The reviewers were instructed to ignore the outcomes of the claims, all of which closed between 1984 and 2004; nearly 60 percent of the cases resulted in serious harm and 30 percent resulted in death. All involved missed or delayed diagnoses in office settings.

Most of the errors occurred in doctor's offices and primary care physicians were those most frequently involved. More than half of the missed diagnoses involved cancer, primarily breast and colorectal cancer, and biopsies were the test most frequently at issue.

The researchers said the leading factors that contributed to errors included failures in judgment (79 percent), vigilance or memory (59 percent), knowledge (48 percent), patient-related factors (46 percent) and handoffs (20 percent).

Dr. Edward Langston, chair-elect of the board of the American Medical Association, said doctors have become more aggressive in recent years as far as ordering tests such as biopsies and colonoscopies. They also do more screens even when the patient shows no symptoms, he said.

But the study also showed the importance of patients paying close attention to their care, voicing their opinions and bringing loved ones with them to appointments to help process information and ask questions, he said.

"Communication issues are major issues," said Langston, a primary-care doctor in Lafayette, Ind. "The message is we need to take a hard look at what's happening and how can we decrease it."

Copyright 2006 The Associated Press. All rights reserved.

In Antipsychotics, Newer Isn't Better
Drug Find Shocks Researchers

By Shankar Vedantam
Washington Post
Tuesday, October 3, 2006; A01

Schizophrenia patients do as well, or perhaps even better, on older psychiatric drugs compared with newer and far costlier medications, according to a study published yesterday that overturns conventional wisdom about antipsychotic drugs, which cost the United States $10 billion a year.

The results are causing consternation. The researchers who conducted the trial were so certain they would find exactly the opposite that they went back to make sure the research data had not been recorded backward.

The study, funded by the British government, is the first to compare treatment results from a broad range of older antipsychotic drugs against results from newer ones. The study was requested by Britain's National Health Service to determine whether the newer drugs -- which can cost 10 times as much as the older ones -- are worth the difference in price.

There has been a surge in prescriptions of the newer antipsychotic drugs in recent years, including among children.

The study, published in the Archives of General Psychiatry, is likely to add to a growing debate about prescribing patterns of antipsychotic drugs. A U.S. government study last year found that one of the older drugs did as well as newer ones, but at the time, many American psychiatrists warned against concluding that all the older drugs were as good.

Yesterday, in an editorial accompanying the British study, the lead researcher in the U.S. trial asked how an entire medical field could have been misled into thinking that the expensive drugs, such as Zyprexa, Risperdal and Seroquel, were much better.

"The claims of superiority for the [newer drugs] were greatly exaggerated," wrote Columbia University psychiatrist Jeffrey Lieberman. "This may have been encouraged by an overly expectant community of clinicians and patients eager to believe in the power of new medications. At the same time, the aggressive marketing of these drugs may have contributed to this enhanced perception of their effectiveness in the absence of empirical information."

Peter Jones, a psychiatrist at the University of Cambridge in England who led the study, searched yesterday for the right word to describe what had happened to his colleagues.

" 'Duped' is not right," he said. "We were beguiled."

One drugmaker immediately questioned the findings. Carole Puls, a spokeswoman for Eli Lilly and Co., which makes Zyprexa, said it was problematic to compare large groups of medications because there are differences between the drugs in each class. Individual patients need different medication options, she said.

Janssen Pharmaceutica, which makes Risperdal, and AstraZeneca, which makes Seroquel, did not respond to requests for comment.

Schizophrenia is a serious mental disorder that is believed to affect about one in 100 adults. It is characterized by psychotic symptoms such as hallucinations and delusions and negative symptoms such as social withdrawal.

Especially over the past decade, older antipsychotics such as Haldol have been widely criticized for triggering uncontrolled body movements, even as the new "atypical" antipsychotics were hailed for causing fewer side effects. Recently, however, concern has grown that antipsychotics in general, and some of the newer drugs in particular, may be causing metabolic side effects.

The new study randomly assigned 227 schizophrenia patients to two groups -- one received a newer antipsychotic, the other an older drug. The patients were evaluated for more than a year by experts who did not know which drug was being taken.

While the researchers had expected a difference of five points on a quality-of-life scale -- showing the newer drugs were better -- the study found that patients' quality of life was slightly better when they took the older drugs. Jones said a conservative interpretation of the data suggested that there is no difference, "so the notion you would pay 10 times as much would be difficult to justify."

"Why were we so convinced?" he asked, referring to the widespread opinion among psychiatrists that the new drugs were worth the great difference in cost. "I think pharmaceutical companies did a great job in selling their products. That is certainly one issue.

"It became almost a moral issue on whether you would prescribe these dirty old drugs," he added. "It became the 'my son' phenomenon. What would you prescribe for your son?"

In retrospect, Jones and others said, there were hints going back many years. In 2003, Robert Rosenheck, a psychiatrist at the Department of Veterans Affairs, found there was no difference between Haldol and Zyprexa -- after patients taking Haldol were treated to prevent the movement side effects.

Last year, the U.S. government trial found that an older drug called perphenazine did about as well as the newer medications. Still, the belief in the newer drugs was so ingrained that many psychiatrists insisted that the results could not be extrapolated to other old drugs, said Rosenheck, who helped conduct that study.

Darrel Regier, who directs research at the American Psychiatric Association, cautioned against drawing broad conclusions after the new study and said that "a thoughtful and prolonged process " is needed before treatment guidelines are changed. Not all the drugs used in the British study were available in the United States, he said, and with many of the newer medications reaching the end of their patent lives, he predicted that questions of cost would fade away.

Jones and Rosenheck said the problem with many drug company studies that seemed to show that new drugs are better is that they focused on short-term results -- a symptom or side effect -- rather than the big picture: how patients fare long-term.

"The story of these newer antipsychotic drugs is a story that reveals an institutional gap," Rosenheck said. "It should not have needed 10 years to get three government studies."

Jones said the studies also illustrate the importance of trusting data, rather than judgment. He drew an analogy with his hobby of walking.

"Sometimes the compass tells you go straight in front of you, but you somehow know it is wrong and that north is behind you," he said. "I have learned to follow the compass."

© 2006 The Washington Post Company.

Medicare Drug Plans: The New Choices
More Offerings, Shifting Prices Mean Seniors Face Fresh Round Of Decisions as 2007 Sign-Up Nears

By Vanessa Fuhrmans and Jane Zhang
Wall Street Journal
Tuesday, October 3, 2006; Page D1

Here we go again.

After spending months sorting through a multitude of Medicare drug-benefit options for 2006, seniors have the chance to undergo the dizzying experience all over again. That is because this week insurers begin marketing their 2007 drug plans before the six-week enrollment season kicks off Nov. 15.

The good news is that most seniors who are satisfied with the plan they are enrolled in don't have to do anything. Some analysts had predicted a shakeout after dozens of providers rushed into the new drug-benefit market last year, but few companies are actually canceling plans.

Still, the drug-benefit landscape is changing enough that even enrollees who are content may want to review how their plan stacks up against new offerings. Beneficiaries in most states will have 50 to 60 offerings to choose from, at least 10 more than in 2006. Some plans are adding benefits -- including eliminating co-payments for generic drugs. But at least one, Humana Inc., is rolling back one of the richest benefits on the market: coverage for brand-name drugs during a phase known as the "doughnut hole" that requires many beneficiaries to pay the full cost of drugs after reaching a certain cost threshold.

For the most basic plans, prices are converging, though there are still some big differences. Last year companies announced drug-benefit premiums without knowing how the competitive landscape would shape up. Consequently, prices ranged widely, from as little as $1.87 a month to more than $35 for a basic plan. Now for 2007, Humana still sells the cheapest plan in 38 states, but premiums for its basic option have climbed to between $10.20 and $18.20. Meanwhile, Cigna Corp. and Aetna Inc., whose prices were some of the highest, have lowered theirs by as much as 30%. (Cigna's basic option ranges from $17 to $31; Aetna's costs $24.80 to $30.80.)

To compare the 2007 plan offering, seniors can also tap a number of new or enhanced online tools. Later this month, Medicare's Plan Finder at www.medicare.gov and www.mymedicare.gov will let beneficiaries compare out-of-pocket costs and benefits for the 2007 plans in their area. Seniors can see what plans are available in each state at www.medicare.gov/medicarereform/local-plans-2007.asp. A new Web site, www.partdoptimizer.com, is run by DestinationRx, which provided software for Medicare's comparison tools. It provides tips on avoiding the doughnut hole and compares how much seniors would save by switching to alternative medicines within their current plan. The site currently has data for 2006 plans but will be able to crunch 2007 information after the enrollment period has ended Dec. 31.
Who should consider switching? Prime candidates are those who picked plans for this year that provided coverage of the so-called doughnut hole, or who fell into that gap and now want coverage for it. The doughnut hole refers to a portion of drug spending that the government-subsidized plans don't have to cover. Seniors get coverage for up to $2,400 in spending in 2007. The federal subsidies then stop until the patient reaches $3,850 in out-of-pocket expenses. After that, the coverage kicks in again and covers 95% of drug purchases for the rest of the year. For a higher premium, some plans offer to cover drug expenses through the gap.

Filling the Gap
It is these higher-end plans that are seeing some of the biggest changes in 2007. For starters, there are many more available. Just 15% of plans this year provided coverage of the doughnut hole, according to Avalere Health LLC, a health-care consulting firm in Washington, D.C. Next year 29% of them will.

This year in New Jersey, for instance, Humana sold one of these more-comprehensive plans for a $48.50 monthly premium, while Cigna's cost a bit more -- $51.36. In 2007, the Humana premium will jump 46% to $71.20. Cigna, though, which signed up fewer beneficiaries than it had hoped for 2006, has dropped its price, to $38.20.

What's more, Humana is joining the majority of its rivals in providing coverage for only generics during the doughnut hole. This year, it was the only major insurer to provide coverage of many brand-name drugs through the gap. But as a result, it says it attracted more than its share of sicker enrollees with higher-than-average medication costs -- and lost money on the higher-end plan. "We'd assumed that other national plans would offer brand coverage through the gap, but none did," says Scott Latimer, Humana's market president for central and northern Florida.

Of Humana's 3.5 million drug-plan enrollees, about 12%, or 420,000 people, are currently in its most-comprehensive plan and will no longer have their brand-name drugs covered through the doughnut hole, Humana says.

On the whole, though, 5% of all plans will offer both brand-name and generic drug coverage through the gap, an increase from this year, according to Avalere. In Michigan, Coventry Health Care Inc. is one of just a few companies that is raising the price of its most comprehensive plan, from $42.40 to $48. In doing so, it is adding generics and brand-name drugs to its gap coverage. But seniors should check if such benefit improvements apply to their drugs. Coventry says only some preferred brand drugs in its first tier of coverage are included alongside the generics.

"You have to read the fine print," says John Gorman, president and chief executive of Gorman Health Group, a Washington health-care consulting company.

In another shift, many plans are making changes that will reduce the chances that consumers will even reach the $2,400 level where the coverage gap starts. By eliminating co-pays for generic drugs in some plans, for instance, insurers are making such treatments essentially free to patients (at least until they reach the coverage gap). Aetna is dropping co-pays for generics in many of its plans, while Cigna says it is eliminating generic co-pays in all of its most basic drug plans.

Peter Ashkenaz, a spokesman for the federal Centers for Medicare and Medicaid Services, says every beneficiary will be notified if there is any change in their plan.

Even if beneficiaries want to stay in their current plan, they should still check that the drugs they take are remaining on their plan's formulary and on the same co-pay "tier" as before. A move from the lowest to a higher tier of co-payments for a drug can translate into a rise in co-pay to $40 a month from $5.

New Shoppers
There may be a huge market of potential shoppers. Only 20% of 3,400 beneficiaries surveyed last month by J.D. Power & Associates said they would definitely stay with the plan they had. About two million Americans will turn 65 in 2007 and also will be eligible. At least another four million, including three million low-income beneficiaries not subject to penalties for missing the deadline earlier this year, have yet to enroll.

Still, unless another plan has the potential to save a beneficiary substantial money each month, some Medicare watchers say that many may decide to stay put. Few predict that any player will break the lock that the country's three biggest plans -- UnitedHealth Group Inc., Humana and WellPoint Inc. -- have on the majority of the market.

"People went through so much trauma picking a plan the first year," says Robert Laszewski, a Washington-based health-care consultant. "They're not going to open this up all over again just to save a few bucks."

New Landscape
Some changes for next year’s Medicare drug-benefit plans.
More offerings. Beneficiaries in most states will have 50 to 60 plans to choose from.
More plans with coverage during the “doughnut hole,” though mostly for generics.
The median premium fell to $33 from $36, but some companies did raise premiums.
Fewer low-cost plans available. In 2007, 5.5% of plans have premiums lower than $20, down from 6.3% in 2006.

Source: Avalere Health.


Price List Here’s a look at how premiums and deductibles will change next year for the top 10 Medicare drug plans, by enrollment.
PLAN	ENROLLMENT*	2006 PREMIUMS	DEDUCTIBLE	2007 PREMIUMS	DEDUCTIBLE
AARP MedicareRx Plan	3,192,276	$22.85-$30.18	$0	$24.70-$32.00	$0
Humana PDP Standard	2,043,660	1.87-17.91	250	10.20-18.20	265
Humana PDP Enhanced	965,975	4.91-25.36	0	17.10-29.60	0
WellCare Signature	872,362	17.13-32.73	0	17.80-36.30	0
Community Care Rx BASIC	818,390	26.26-33.31	250	23.30-34.30	265
PacifiCare Saver Plan	726,766	19.02-34.88	0	This plan is not offered in 2007; enrollees will re-enrolled into another offering
MedicareRx Rewards	490,819	17.18-31.30	250	16.90-33.10	265
YOURx PLAN	415,087	27.10-35.54	250	31.40-37.40	100
Humana PDP Complete	410,601	38.70-73.17	0	69.50-88.40	0
SilverScript	399,970	23.67-33.38	250	22.40-33.00	265
*as of July 2006 Source: Avalere Health




Mass. Signs Up Poor for Health Insurance

Associated Press
By Steve LeBlanc
Baltimore Examiner
Tuesday, October 3, 2006

BOSTON - Massachusetts began signing up it poorest residents for virtually free health insurance Monday under the state's landmark health care law, even as administration officials urged lawmakers to close a "loophole" they say could let thousands of children go insured.

"This is a historic day for us," Gov. Mitt Romney said at a news conference at a health care center in the city's Dorchester neighborhood trumpeting the milestone. "Today is the first day that we have someone actually applying for Commonwealth Care. It's real today."

As reporters and administration officials looked on, Madeline Rhenisch, a 56-year-old Boston woman who said she's spent the money she'd been saving for her retirement to pay for doctor's visits and medication, became the first to sign up for Commonwealth Care, the new state-administered plan.

Rhenisch will be followed by about 62,000 of the state's poorest residents living at or below the federal poverty line of about $9,800 a year. If she qualifies, the state will pay her premiums and she will be responsible for just nominal co-pays.

It's a first step toward Massachusetts' ultimate goal of becoming the first state to require all its citizens have health insurance.

Rhenisch, who says she works only sporadically now and has been without health insurance for the past eight years, said she looked forward to having insurance again.

"I've worked hard all my life. I've paid benefits all my life. I never wanted to be a burden on my family or friends," she said. "It's been very embarrassing to have to beg and scratch."

Romney officials used the news conference to press lawmakers to close what they called a "loophole" in the law that fails to require all children have health insurance.

Health and Human Services Secretary Tim Murphy said he's asked lawmakers to "clean up" the law, which currently only requires adults over 18 have insurance.

"We felt that that should extend not only to people 18 and above, but also younger," he said. "If there are affordable products out there, all the evidence suggests that parents will cover their children."

Murphy said as many as 40,000 children might fall through the holes, but Democratic lawmakers said they have already taken steps to expand coverage for children, over the objections of the Romney administration.

Rep. Patricia Walrath, D-Stow, who helped write the final version of the bill, said most of the children reported as uninsured by Murphy live with parents who make less than three times the federal poverty level and will be covered under the state's Medicaid program.

Walrath said lawmakers expanded the Medicaid definition despite opposition from the administration, which preferred requiring parents to buy health insurance for their children.

"If after that we still find that there are children who are not covered, we will certainly fix it," she said. "We really think it's a non-story."

Those being enrolled in the new Commonwealth Care insurance program are currently part of Massachusetts' "free care pool." A goal of the new law is to replace that pool by giving those same individuals health insurance.

Romney called the new health insurance program "a first-class product that as good as anybody else has in the commonwealth" that will let the poor have access to preventative medicine instead of relying on hospital emergency rooms for their health care.

Most of those in the first batch of 62,000 are already known to the state and will be automatically enrolled. Others who match the criteria can sign up at community centers or hospitals.

While the poorest residents will essentially receive free health care, those earning up to three times the federal poverty level won't get off free.

Beginning in January, they will be required to pay a portion of their monthly premiums, from $18 to $106 per month depending on their income, with the state picking up the balance of the full premiums, which range from $280 to $387 a month.

Finally in July 2007, all Massachusetts residents earning more than three times the federal poverty level will be required to have health insurance - on their own or through work - or face tax penalties.


Americans Share Nobel Prize in Medicine

Associated Press
Malcolm Ritter
Baltimore Examiner
Tuesday, October 3, 2006

NEW YORK - Two Americans won the Nobel Prize in medicine Monday for discovering a way to silence specific genes, a revolutionary finding that scientists are scrambling to harness for fighting illnesses as diverse as cancer, heart disease and AIDS.

Andrew Z. Fire, 47, of Stanford University, and Craig C. Mello, 45, of the University of Massachusetts Medical School in Worcester, will share the $1.4 million prize.

They were honored remarkably swiftly for work they published together just eight years ago. It revealed a process called RNA interference, which occurs in plants, animals and humans. It's important for regulating gene activity and helping defend against viruses.

It is "a fundamental mechanism for controlling the flow of genetic information," said the Karolinska Institute in Stockholm, which awarded the prize.

Since the discovery, scientists have already made RNA interference a standard lab tool for studying what genes do. And they're working to use it to develop treatments against a long list of illnesses, including asthma, cystic fibrosis, diabetes, flu, Parkinson's and Huntington's diseases, and age-related macular degeneration, a major cause of blindness.

"This has been such a revolution in biomedicine, everybody is using it," said Thomas Cech, president of the Howard Hughes Medical Institute, for which Mello is an investigator.

"It's so important that people almost take it for granted already, even though it was discovered fairly recently," said Cech, who won a Nobel in 1989 for RNA research.

Nobel prizes are generally awarded decades after the work that they honor, so a prize now for a finding published in 1998 is striking.

But it's appropriate, said Bruce Stillman, president of the Cold Spring Harbor Laboratory in Cold Spring Harbor, N.Y., because the work "is recognized now as one of the really revolutionary changes in the way we think about how genes are controlled."

Genes produce their effect by sending molecules called messenger RNA to the protein-making machinery of a cell. The messenger RNA directs that machinery to produce a particular protein.

In RNA interference, certain molecules trigger the destruction or inactivation of the messenger RNA from a particular gene, so that no protein is produced. Thus the gene is effectively silenced.

For instance, researchers have shown they can lower cholesterol levels in lab animals by suppressing a gene through RNA interference.

Could this ability to block disease-promoting genes produce new treatments?

"In principle it works. In controlled laboratory conditions it works," Cech said. "And the next five years will tell whether this is a whole new class of pharmaceuticals with the potential to defeat numerous human diseases."

Mello, who is still doing research on RNA interference, said "there's a lot of work to do" to turn the basic work into drug treatments.

Ironically, when the congratulatory call from the Nobel committee reached his home at 4:40 in the morning, he was checking the blood level of his diabetic 6-year-old daughter.

"You don't really appreciate how important the work of the last 50 years or so of modern molecular medicine ... has been until you know somebody who is alive and well because of it," he said.

Fire said the award showed the importance of publicly funding basic research that doesn't appear to have any near-term payoff. He also said he had not decided how to use his half of the prize money.

Fire, who was working for the Washington-based Carnegie Institution at the time of the discovery, and Mello did their groundbreaking experiment in a tiny worm called C. elegans.

They found they could block the effect of a specific gene by injecting worms with a particular double-stranded version of RNA. Usually RNA - ribonucleic acid - has only one strand.

"That was the breakthrough that set the whole field on fire, no pun intended," Cech said.

While scientists had already known that RNA played a role in gene silencing in plants, they didn't understand the process. The prize-winning research "was like opening the blinds in the morning," said Erna Miller, a member of the Nobel committee. "Suddenly you can see everything clearly."

Jeremy M. Berg, director of the National Institute of General Medical Sciences in Bethesda, Md., which has funded work by Fire and Mello for years, said he had predicted the two men would win this year.

"It's an example of a discovery of a fundamental biological process that has an almost unlimited number of implications," Berg said. "The impact has just been steadily growing."

Monday's prize was the first Nobel of this year, to be followed by the awards for physics, chemistry, literature, peace and economics.

Alfred Nobel, the Swedish inventor of dynamite, established the prizes in his will in the categories of literature, peace, medicine, physics and chemistry. The economics prize is technically not a Nobel but a 1968 creation of Sweden's central bank.

Winners receive a check, handshakes with Scandinavian royalty, and a banquet on Dec. 10 - the anniversary of Nobel's death in 1896. All prizes are handed out in Stockholm except for the peace prize, which is presented in Oslo.

Biotechnology writer Paul J. Elias in Palo Alto and reporter Ken Maguire in Boston contributed to this report.


Dengue Outbreak Kills 14 in India

Associated Press
Baltimore Examiner
Tuesday, October 3, 2006

NEW DELHI - Authorities in New Delhi on Tuesday called for calm after an outbreak of dengue fever killed 14 people in northern India, including in the capital, over the past six weeks.

"There is no need to panic and we are not declaring it an epidemic yet," New Delhi Health Minister Yoganand Shastri told reporters after an emergency meeting of local government.

Shastri said that so far, in New Delhi, 497 cases of the mosquito-borne disease have been reported, and 11 people have died.

New Delhi is filled with pools of stagnating water where the insects breed - and on Monday, thousands of health workers went door to door, spraying pesticides to try to stop the disease's spread.

Shastri also advised school children to wear long-sleeve shirts to school to prevent against mosquito bites.

One of the country's premier state-run health institutes has also been hit by the disease.

At the All India Institute of Medical Sciences, 19 doctors and students have fallen ill with dengue, and one has died.

Shastri on Tuesday headed a meeting of local hospital administrators. He said that hospital officials would be held responsible if the disease was not brought under control there and strict action would be taken if there were found to be any lapses in tackling the situation.

An awareness campaign on preventing the spread of the disease will also be intensified, he said.

Female Aedes mosquitoes transmit the disease, and symptoms include high fever, joint pain, headache and vomiting. It is fatal in rare cases.


Maryland must not turn its back on its senior citizens

By Isabella Firth
Baltimore Sun Commentary
Tuesday, October 3, 2006

It's not a sexy issue such as gay marriage or illegal immigration, yet the importance of what we do - or don't do - regarding the health and housing needs of our seniors may have more economic, physical and moral relevance for families than any other problem before us.

Let's face it, Americans simply don't plan for old age - either individually or as a society. We focus on youth; envy and sex lurk behind our every advertised need.

The media, with their focus on the scandalous and the sweet, don't help much. Coverage of senior care means, more often than not, a story about something bad happening at a nursing home. Scary stuff, but not indicative of the thankless care thousands provide our families across the state every day. Or we see cute video clips of seniors when they reach 100 with little mention of the daily lives preceding that century mark.

Many politicians ignore senior issues. They are aided by those among us who equate senior care with "nursing home" - and assume "it won't happen to me."

But we can't ignore the facts. An increasing number of us will be forced to live with disabilities. Senior care is expensive. By 2030, the number of Marylanders age 65 or older will have doubled. Most assisted-living and nursing options cost more than $60,000 a year - unaffordable to most. Long-term care insurance is one answer, but just 10 percent nationally have purchased it.

What should elected officials be doing to deal with this looming crisis?

For starters, state officials, led by the governor, should overhaul the Medicaid Home and Community-Based Services Waiver program, which allows seniors in assisted living to enroll in Medicaid rather than be forced into a nursing home to gain Medicaid eligibility. The savings for taxpayers are enormous; instead of paying $5,000 per month for nursing home care, the state, with a waiver, can pay just $1,600 per month - and the seniors often can stay in their own homes.

Instead, Maryland maintains a 20-year waiting list of more than 7,000 people and reimburses less than half of the daily nursing care per diem of $193 per day to assisted-living providers -an amount that doesn't even meet expenses. The state should increase the reimbursement rate and fully fund this program. Everybody wins.

It's really all about the money. Since gaining office, Maryland Gov. Robert L. Ehrlich Jr. has taken $100 million in Medicaid dollars out of the state budget. Providing health and housing services is a cost-based system. Controlling Medicaid costs shouldn't mean reducing provider rates and not reimbursing the cost of care provided - but that's what we are doing.

Controlling costs also has a lot to do with personal responsibility. People should save more toward covering their own care to the extent they are able. We need to encourage that habit with new tax credits, savings plans, insurance products and other incentives. Maryland should stop looking at senior care as an annual budgetary event and plan for it as a lifetime responsibility. Medicaid won't just step in and pay for long-term care services.

We also need action on legislation that would streamline Medicaid eligibility by updating Maryland's computer systems.

Collectively, we have a lousy record when it comes to investing in older people. If there is a bright spot, it is that Maryland is a hot and growing "active adult" market. Nearly 30 such communities are under construction in the Mid-Atlantic corridor. Builders are way ahead when it comes to addressing the needs of seniors. Unfortunately, it isn't enough.

Not so long ago, older Americans faced bleak prospects as old age and misery often met on the same path. Those days may be returning if we don't act responsibly. We need political leaders to champion our concerns and act rather than react to problems.

Improving the lives of Maryland's seniors may not be sexy, but it's the right thing to do.

Isabella Firth is president of LifeSpan, a senior care association representing 300 facilities, companies and organizations that serve more than 45,000 seniors in Maryland and Washington.


$4 generics
Wal-Mart Rx move will offer welcome relief

Cumberland Times-News Editorial
Tuesday, October 3, 2006

In the complex, politically charged debate over health care reform and the rising cost of prescription medication, it's often hard to sort the truth. One side puts up a proposal that seems to make sense, then the other side shoots it full of holes, saying it won't help or will make things worse. Thus, nothing gets done.

That's why last month's news from Bentonville, Ark., was so refreshing and welcome. Although the political class in Washington and the pharmaceutical CEOs may disagree, Wal-Mart's announcement that it will sell generic medications for $4 offers the kind of pocketbook relief every American can truly appreciate.

Wal-Mart plans to sell nearly 300 generic drugs for $4 per monthly prescription, whether individuals have health insurance or not. The program was launched in 65 Wal-Marts around Tampa, Fla., and is to be expanded statewide by January, then taken nationwide throughout 2007.

Included on the list of low-price medications are generic versions of many popular prescription drugs, including the antibiotic amoxicillin and the heart and the blood-pressure treatment lisinopril, sold under the brand names Prinivil and Zestril.

The average price of a 30-day supply of generic medications was $29 in 2004. Wal-Mart says it will still make a profit on the drug sales, with part of that calculation assuming that customers will also purchase higher priced prescriptions at the store, as well as other, non-medicinal items. That's called capitalism. However, it also highlights the profit level under current pricing schemes. According to the Washington Post, Wal-Mart last week was selling lisinopril for nearly $21. And they'll still make money selling it for $4.

The new prescription pricing grew out of criticism that Wal-Mart offers its employees poor health benefits. We won't enter that debate or the larger debate over health care. What we will say is that Wal-Mart's new pricing policy will benefit millions of Americans struggling to afford ever more expensive medication.

That's good news, plain and simple.



What everyone should know before a flu epidemic strikes

Hagerstown Herald-Mail Editorial
Tuesday, October 3, 2006

Sometimes the things citizens have been warned about but don't really expect to take place happen anyway.

In 1972, rains brought by Hurricane Agnes swelled local streams and the Potomac River, causing widespread flooding.

In January 1996, a blizzard hit the Tri-State area, burying its counties in several feet of snow and sending temperatures down into the teens.

In both cases, the National Weather Service had provided ample warnings - warnings that some citizens didn't heed. Fortunately, thanks to friends, relatives, neighbors and dedicated fire/rescue personnel, most came through with few problems.

Now another agency is warning Washington County residents that sooner or later they will face a health emergency that could kill those who are unprepared.

It has happened here previously. In November 2005, Melinda Marsden, executive director of the Washington County Historical Society, gave an historical lecture noting that 400 county residents died here in 1918, after an outbreak of the "Spanish Flu."

By comparison, only 72 county residents died in World War I, Marsden said.

For more than a year, local health department and medical officials have been warning that another outbreak of flu, perhaps the H5N1 strain that has been detected in some parts of Asia, might hit here

How bad could it be? More than 40,000 could contract the disease and hundreds could die.

But citizens need not just wait for the worst to happen. There are steps they can take now to prepare.

They include:

· Getting a flu shot. Health officials say that while today's flu vaccine might not prevent someone from being infected with a new strain, vaccinated citizens who become ill could alert health workers that other measures are necessary.

· Wash hands frequently, with soap and warm water.

· Cover coughs and sneezes with a hand or tissue.
· Avoid others when you are ill and stay out of crowds during flu season, if possible.

· Prepare a two-week supply of food for the family, including one gallon of water per person for every day. For a two-person household, that would be 28 gallons.

· Obtain an extra supply of prescription medicine and other supplies needed to maintain hygiene and care for ailing family members.

· Make sure you have flashlights, portable radios and the batteries they require.

· Finally, sit down now and plan for what you will do if schools or offices are closed for extended periods and how you will care for an ailing family member without becoming ill yourself.

If you would like more detailed information, a community roundtable will be held at 7 p.m. Thursday, Oct. 12, at the Robinwood Medical Center, Suite 142.

Following a presentation on pandemic flu, officials from the Health Department, Washington County Hospital and local emergency services will be available to answer questions.

To make sure there is adequate seating, officials ask that citizens register in advance. To register, call 301-790-8907 or 1-888-803-1518.

If you cannot attend, but have Internet access, you may want to visit these Web sites:

www.pandemicflu.gov or www.washhealth.org.

If you don't have Internet access, The Herald-Mail can send you a transcript of a May 30 online chat about flu pandemics with officials of the health department, the medical profession and emergency services.

To do that, you may write to the address below and request a copy of the "flu transcript."

Yes, this is frightening stuff, and complicated, too. We don't want to frighten anyone, but we do want to tell people how to protect themselves.

In that we join Mauireen Theriault, a spokesperson for the the Washington County Hospital, who said this week that "our aim is not to scare people, but to help them be prepared."

Copyright The Herald-Mail ONLINE

[newsclippings/dhmh_footer.htm]