Monday, April 6, 2009

News Clipping Archives

 

Maryland / Regional

Clinics to get stimulus money (Hagerstown Herald-Mail)

'Diaries' follows doctors for 21 years (Baltimore Sun)

Armed against allergies (Baltimore Sun)

Shingles more painful in elderly (Baltimore Sun)

Dance event raises awareness of cancer (Baltimore Sun)

 

National / International

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Opinion

A better way (Baltimore Sun)

House lights up FDA regulation (Washington Times)

 

 

Maryland / Regional

 

Clinics to get stimulus money

 

By Marlo Barnhart

Hagerstown Herald-Mail

Monday, April 6, 2009

 

WASHINGTON COUNTY - Debbie Hilliard and the staff at the Walnut Street Community Health Center are rejoicing in the news they will be receiving $155,648 in federal funds - enough to hire a new family practice physician and two support personnel.

 

There was joy in Hancock, too, where the Tri-State Community Health Center has pulled in $276,539 for its facilities in Hancock, Cumberland, Md., and McConnellsburg, Pa.

 

Both awards were announced recently by U.S. Sens Barbara A. Mikulski and Benjamin L. Cardin, Maryland Democrats. The money comes from the American Recovery and Reinvestment Act (ARRA) through the Department of Health and Human Services.

 

"Community health centers provide an important safety net for the people who need it most," Mikulski said in a press release. "This is especially important in these economically trying times when there is more need and fewer resources. These American Recovery Act funds will help community health centers keep their doors open to make sure Maryland families have access to reliable health care in their communities."

 

"We're very pleased with the news," Hilliard said.

 

Hilliard, a registered nurse, is health services coordinator at the federally qualified health center at 24 N. Walnut St.

 

"The feds have a formula and we submitted a proposal," she said.

 

Patients at the Walnut Street clinic have access to family practitioners, mental health services and dental care. Sliding scales are used for the uninsured and underinsured, Hilliard said.

 

Cardin pointed out that for decades, community health centers have provided comprehensive, quality primary health care services to medically underserved communities and vulnerable populations.

 

"I am pleased that the economic recovery package is providing needed funding to community health care centers - centers that we know work and save lives."

 

Sheila DeShong, administrator at Tri-State Community Health Center, said part of the funds will help expand the low-cost medication programs at both the Hancock facility and the clinic in McConnellsburg, Pa., and to provide more services to the uninsured.

 

"We also put together a plan to add a provider and support staff at the Cumberland facility," DeShong said.

 

The Department of Health and Human Services supports community health centers through the Health Resources and Services Administration. Health centers provide comprehensive primary health care to medically underserved communities. They are governed by a community board and are required to meet performance and accountability requirements.

 

Copyright The Herald-Mail.

 

'Diaries' follows doctors for 21 years

MPT documentary takes astonishingly in-depth look at med-school grads

 

By David Zurawik

Baltimore Sun

Monday, April 6, 2009

 

After watching every second of the Peabody- and Emmy Award-winning Hopkins 24/7 and Hopkins documentary series from ABC News, I did not think there was anything that TV had left to tell me about the making of and professional lives of medical doctors.

 

But after seeing the final installment of Nova's 21-year project, Doctors' Diaries, which premieres Tuesday night at 8 on MPT (Channels 22 and 67), I now know I was wrong. It is not that producer-director Michael Barnes finds new emotions, themes or narratives that ABC's Terry Wrong didn't in his brilliant studies of Hopkins and its doctors. But Barnes is able to provide an astonishingly in-depth look at the educational and career arcs of seven medical school graduates because of the two decades he spent with them.

 

Like the 7 Up project that profiled a group of English children every seven years starting in 1964, Barnes started with seven Harvard Medical School students in 1987, and has followed them through school, internships and into their professional careers and personal lives. This is no knock on the Hopkins documentaries, which are marvelous examples of cinema verite filmmaking, but there is simply no substitute for the monumental amount of time Barnes spent with these folks when it comes to establishing a sense of intimacy.

 

One of the seven doctors profiled is now with Hopkins, David Friedman, an ophthalmologist at the Wilmer Eye Institute. Another of the seven, Cheryl Dorsey, grew up in Baltimore. But while she completed her training in pediatrics, she has since changed careers to become a community health worker, and runs a nonprofit in New York.

 

One of the great joys of watching the final two hours of this series, which ends April 14, is how incredibly sure-handed Barnes has become in telling these stories. The editing is superb in its fluidity. In fact, I do not believe I have ever seen a PBS documentary that was more perfectly edited. As a viewer, you feel like you are skating along on a perfect sheet of words and imagery, and then, boom, suddenly Barnes stops you in your tracks to make a major point about the price that must be paid to join the medical priesthood.

 

Among the most powerful moments in Tuesday's episode comes when Jane Leibschultz, a third-year student, sees one of the patients whom she got to know at Beth Israel Hospital die in surgery during a heart operation.

 

Standing near the back of a ring of medical personnel surrounding the operating table, she starts to moan aloud when she realizes the man is dead.

 

"Oh, God, this is terrible," she says. "I told this guy he was going to be fine." And then she starts sobbing loudly.

 

We see one of the surgeons take her aside and hear him saying, "The responsibility we have now is to keep a calm head and help his family."

 

"But it's like a bad dream or something," she says.

 

No, it's her new reality, if she wants to be a doctor.

 

Copyright 2009 Baltimore Sun.

 

Armed against allergies

Sufferers do battle against symptoms with drugs, shots, even acupuncture

 

By Meredith Cohn

Baltimore Sun

Monday, April 6, 2009

 

Spring means the same two things every year for Brian Nehus: The grass grows, and his nose runs.

 

The 27-year-old from Kingsville finally had enough and ended up at the Asthma Sinus Allergy Program at Greater Baltimore Medical Center. He learned after a battery of skin tests that he is indeed allergic to his lawn, as well as weeds and cats.

 

"I need to cut the grass," said Nehus, as he studied his arm, which was full of red blotches, the result of the tests. "I have about an acre of land. It takes me four hours to mow."

 

Many people can't completely avoid the things that make them sneeze, wheeze and itch, but those who treat the problem say there is help for Nehus and the estimated 35 million Americans who suffer from allergies to one or more kinds of pollen and mold.

 

The troubles begin in early spring, when trees begin to pollinate to fertilize other plants. Grass pollen follows in early summer, and weed pollen comes in late summer and fall. The tiny grains are inhaled and greeted in the body as foreign invaders. Chemicals called histamines, normally released in the body to battle viruses or bacteria, are let loose against the allergens. Symptoms of the process include nasal inflammation, sneezing and other watery reactions.

 

The American Academy of Allergy, Asthma and Immunology says such allergies lead to more than 12 million doctor visits annually and are one of the main reasons for missed days of work and school.

 

Dr. Alvin Sanico at the GBMC allergy center said the first step to getting relief is identifying that allergies are the problem, and he and his staff were conducting a stream of tests one recent day. Testing takes 20 minutes and normally involves 42 tiny pricks that place a small amount of allergen from trees, weeds, animals and pests into the skin on the arms. Those spots that develop a significant red bump mean an allergy. Extra tests can be added for less common pets and foods.

 

There generally are three strategies for treatment, Sanico said. The first is avoidance of allergens, which means such things as keeping cats or dogs out of the bedroom, using dust mite covers on pillows and using air conditioning instead of opening windows.

 

The second is medication. That includes over-the-counter antihistamines to stop the reaction to allergens, decongestants to clear up stuffiness, daily steroid sprays that control inflammation and inhalers for asthma.

 

The third strategy is immunotherapy, or shots, to build immunity.

 

"The treatments depend on the frequency and severity of the condition," Sanico said.

 

Mild and intermittent allergy symptoms can be treated with avoidance and medications. More severe or year-round conditions can be treated with nasal steroid sprays. Shots are recommended for people who want long-term relief from their severe reactions such as asthma, have multiple year-round allergies or live with a pet that causes symptoms. (It's the pet's saliva or even urine that can cause allergic reactions, Sanico said, so don't buy a "hypoallergenic" animal or shave the animal for a cure.)

 

Charles Trunk Jr., a 31-year-old from Baldwin, has been getting shots for about a year and a half for his allergies to pollen, grass and dust mites. A lifelong sufferer, he was tired of taking Benadryl, an antihistamine given to him by his pharmacist parents. And after twice-a-week shots for months and now once every two weeks, he's looking forward to less severe symptoms.

 

"I have a house with a yard and like to be out there," he said. "So, I come here at lunchtime. I think it's helping. We'll see how April and May go."

 

Drugs are commonly the first stop for many people, so the American Pharmacists Association recently surveyed members to identify their most recommended over-the-counter medications.

 

Allergy medicines were among the most asked about by pharmacy shoppers, and the antihistamine Claritin, closely followed by Zyrtec, were among the top drugs recommended. These new generation drugs typically do not make the takers as sleepy as older drugs such as Benadryl. Among decongestants, the most recommended was Sudafed.

 

Other options with fewer side effects than drugs are acupuncture and Chinese herbal medicine, said Jeff Gould, a specialist in both at the Johns Hopkins Integrative Medicine & Digestive Center.

 

He prescribes an herbal combination that works like shots and builds immunity to allergens while patients are well. During the season, he offers another combination to treat symptoms. He does not recommend patients mix their own herbs, because some can have dangerous interactions with common pharmaceuticals, such as blood thinners.

 

"Allergies are hyperactive reactions to allergens," he said. "Instead of treating symptoms, we like to treat the imbalance in your body that causes the hyperactive response. If we treat you when you don't have symptoms, next year you're better."

 

For those who don't seem to be allergic to the environment but still have respiratory symptoms, Gould said it could be a food allergy. Gluten and dairy are the most common allergens. He suggested trying to eliminate suspects one at a time for two weeks.

 

For those who just don't want to take anything plant-based, chemical or otherwise, he and Sanico at GBMC said symptoms can be helped with regular use of neti pots and saline rinses that flush allergens out of noses and sinuses.

 

The sensation of salt water flowing in one nostril and out the other can take some getting used to. But the products are becoming so mainstream they are sold at drug and big-box stores, and the neti pot has even been spoofed on YouTube by a writer and cartoonist named Drew, who substituted coffee and whiskey.

 

Allergy professionals do not recommend that.

 

the allergens

Here are the most common allergens, where they come from and some tips for coping:

 

Pollen comes from trees, weeds and grass in spring, summer and fall. Keep windows closed and air conditioning on, and shower after spending time outside. Check pollen counts at pollen.com.

 

Molds can grow on fallen leaves or anywhere there is moisture. Wash it away with cleaner that is 5 percent bleach. Remove carpeting from damp floors, and don't store clothes or papers in damp areas.

 

Dust mites feed on dead skin flakes on pillows, mattresses, upholstery and carpets. Reduce them by encasing pillows and mattresses in zippered covers made for the purpose and not simply hypoallergenic. Keep humidity low. Wash bedding in hot water.

 

Pets produce allergens in their saliva, urine and skin dander. Keep them out of the bedroom. Bathing them isn't likely to produce a clinical benefit. Consider that sticky cat allergens remain in an area up to six months after a cat has been removed and that allergens can be found places where there is no cat, such as schools and homes.

 

Asthma Sinus Allergy Program at Greater Baltimore Medical Center

 

the medications

These are the over-the-counter drugs most recommended by pharmacists, according to a survey by the American Pharmacists Association.

 

Adult antihistamines: Claritin, 32 percent; Zyrtec, 28 percent; Benadryl, 25 percent.

 

Adult decongestants: Sudafed, 66 percent, Sudafed PE, 17 percent, Neo-Synephrine, 4 percent.

 

Adult multisymptom allergy and hay fever products: Claritin-D, 35 percent; Zyrtec-D, 26 percent, Actifed Cold & Allergy, 10 percent.

 

Adult headache products: Tylenol, 29 percent; Advil, 21 percent; Aleve, 15 percent.

 

Copyright © 2009, The Baltimore Sun.

 

Shingles more painful in elderly

 

Expert advice

 

By Liz Atwood

Baltimore Sun

Monday, April 6, 2009

 

Shingles is a painful, and somewhat mysterious, skin disease that affects people who have had chicken pox. It may occur spontaneously or may be induced by stress, fever, radiation therapy, tissue damage or immunosupression. Dr. Oanh Lauring, chief of dermatology at Mercy Medical Center, says doctors do not know the specific mechanism that triggers reactivation.

 

What is shingles?

A reactivation of chicken pox later in life. Another name is herpes zoster, which confuses people because they think it is related to the herpes virus that is sexually transmitted or causes mouth sores, but it isn't. Once a person has had chicken pox, they have the varicella virus for life. The virus lives in a nerve root on one side of the spinal cord, and when you get shingles, you develop symptoms of skin tingling, pain or itching that is quickly followed by an eruption of painful grouped blisters that occur along a strip of skin to which the affected spinal nerve provides sensation. The most common areas affected are the shoulder and chest.

 

Who is likely to get it?

People with a history of chicken pox have a 20 percent lifetime chance of developing zoster. The severity and incidence increases significantly with age. Also, people whose immune system is compromised.

 

What are its causes?

Nobody knows. It occurs in times of stress, whether it's emotional stress or stress from an illness.

 

How common is shingles?

Before childhood vaccination for the virus became routine, 90 percent of children in the United States got chicken pox before the age of 10. Varicella zoster develops in approximately 20 percent of healthy adults and 50 percent of immunocompromised persons (those on chronic steroids, transplant patients on immunosuppressants, HIV patients, cancer patients and people older than age 50).

 

What are the symptoms?

Usually, a person gets soreness, a tingling, itching or numbness of the skin, followed by painful blisters that run unilaterally along a horizontal band of skin that extends from the front to the back but does not cross the midline. It can feel like nerve pain or muscular pain. When the rash occurs on the left chest, people may mistake it for heart attack pain. It differs from a herpes eruption in that lesions of herpes are clustered in a single spot rather than running along a band of skin.

 

What is the treatment?

We give patients acyclovir, famvir and valacycovir. They are FDA-approved anti-viral drugs that decrease the shedding of the virus, shorten the life span of the infection. They can decrease pain if they are taken within 72 hours of the onset of the first blister. Usually, patients receive the medicine for seven to 10 days.

 

What complications can arise without treatment?

If you don't treat shingles, it will go away in children and young adults with intact immune systems. However, the pain, rash and complications become more severe with increasing age and immune compromise. Complications include chronic debilitating nerve pain that can last months to years, secondary bacteria infection, scarring, hepatitis and motor paralysis. Also, if you are immunocompromised, shingles can be life-threatening. Another potential complication is if you get shingles involving the eye, you can develop scarring and blindness.

 

Is it contagious?

People with zoster can infect another with varicella (chicken pox) via direct contact with the blister fluid. A person who has shingles should not be around anyone who is pregnant, infants, people who've never had chicken pox or immunocompromised individuals.

 

How does it spread?

Zoster usually spreads by skin-to-skin contact, but it can also be airborne.

 

Can a person who has been vaccinated for chicken pox but never had the disease get shingles?

Yes, but those who had the chicken pox vaccination in childhood are less likely to develop zoster than those who were naturally infected.

 

How long does shingles last?

If you get early treatment, just a few weeks. You may not have any residual pain. But for some older people, the pain can last the rest of their lives. It is a kind of pain that doesn't respond well to traditional treatments.

 

Can shingles be prevented?

There is a shingles vaccine that can potentially boost the immune system later in life, when we are at more risk for shingles due to a waning immune system. The zoster or shingles vaccine can therefore decrease the risk for contracting shingles later in life.

 

Copyright © 2009, The Baltimore Sun.

 

Dance event raises awareness of cancer

Heartburn can be a sign of fatal trouble

 

By Stephanie Desmon

Baltimore Sun

Monday, April 6, 2009

 

The back of the T-shirt everyone was wearing Sunday said it all: "Heartburn can cause cancer."

 

The Mordecai family didn't know that when John "Monte" Mordecai was diagnosed two years ago with esophageal cancer. He died less than a year later at age 63. In his honor - and ultimately in his memory - his daughter Mara, now 13, wanted to spread the word about this deadly disease, one that claims nearly all who are diagnosed with it, in the hope that no one else would have to lose their father to something that could have been caught sooner if only he had known to be on the lookout.

 

So on Sunday, Mara and her mother, Mindy Mintz Mordecai, put on the second annual Dance for the Cure, an effort to raise money for esophageal cancer research and to raise awareness of the disease, which has been linked to acid reflux.

 

"If we had known that was a risk, he could have gone in for an endoscopy," Mordecai said. "More people in America die every year of esophageal cancer than melanoma. And we all know about sunscreen."

 

About 16,470 new cases of esophageal cancer were diagnosed in 2008 - more than twice the number of cases 30 years ago - and about 14,280 died of the disease last year, according to the American Cancer Society. Of course, not everyone with acid reflux will get cancer.

 

The event, held at the Towson University Center for the Arts, was a way to link two of Mara's great loves: her father and dance. Participants were asked to gather pledges to enable them to dance in classes all day long. Mordecai, a reporter for Maryland Public Television, said she didn't care how much money was raised, just that the dancers went out and talked to people about what they were doing and told people about the risks of the disease.

 

"I don't care if they get a pledge," she said. "If they tell somebody about it, they're doing our job. They're getting the word out."

 

There was every kind of dance imaginable Sunday, from tango to ballet, from Afro-Caribbean to Greek, from hula to tap. A Rockette taught kick lines. A Johns Hopkins thoracic surgeon who had treated Monte Mordecai taught ballroom dancing.

 

John Miller, 66, made a go at belly dancing. Two years ago, he was diagnosed with esophageal cancer, which was discovered after Miller made a throwaway comment to his gastroenterologist that he had long suffered from heartburn but didn't any longer. The doctor ordered an endoscopy, which revealed the cancer. Miller had part of his esophagus removed and the healthy part attached to his stomach. He is now cancer-free. He wants to make sure others - including doctors - understand there can be a link between reflux and cancer.

 

"It's all about awareness," the retired federal worker from Columbia said. "They're trying to make doctors aware [too], because doctors aren't aware."

 

In a studio downstairs, Idaline Lipsky, who teaches fifth and sixth grade at Krieger Schechter Day School in Pikesville, and Kristen Wavle, a middle school counselor there, were having a blast at the hip-hop class taught by Eugene "Bubba" Lloyd, who teaches the youngest Mordecai, 10-year-old Maya.

 

Lloyd began the class by telling them the point was to have fun. That was good, because the complicated moves had the class twisting in knots trying to keep up. "I have this saying in all my hip-hop classes, and you can take it to the bank: Fake it till you make it," Lloyd said. "You got it? Just say you'll try."

 

Though the teachers tried to hide in the back of this class, Lloyd made sure they were in plain sight, moving them up to the front at one point. They laughed through the whole workout. And they were thrilled they could participate in something that means so much to the Mordecai girls, who are students at the school.

 

"I like to dance anyway," Wavle said. "Despite the fact that I have no rhythm, how could I not want to be involved in something like this?"

 

Said Lipsky: "It's just so upbeat, even for the cause it is."

 

Copyright 2009 Baltimore Sun.

 

National / International

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Opinion

 

A better way

Our view: Decades of imprisoning addicts has led to more and more prisons

 

Baltimore Sun Commentary

Monday, April 6, 2009

 

Maryland spends more than $1 billion a year on locking up criminals, and what do we get for it? Prisons overflowing with low-level drug offenders who keep the revolving door spinning as they continue to commit minor crimes to support their habits. It doesn't have to be this way.

 

That's why Kentucky Gov. Steve Beshear recently signed a law sending hundreds of nonviolent drug offenders to treatment instead of prison. The Bluegrass State expects to cut the $20,000-a-year cost of housing a prison inmate in half by incarcerating minor felons in county jails. It will use the savings to set up more than a dozen substance abuse treatment programs inside those facilities at a cost of about $1.3 million. Over time, officials expect prison populations to gradually decline as the rate of recidivism drops.

 

It's an idea that's also been taken up by Kansas, Montana and Pennsylvania, all of which expect to save millions by instituting treatment programs. Sen. Jim Webb of Virginia has introduced a bill to create a national commission on prison reform, saying it's a waste of money to put nonviolent offenders in prison rather than help them get off drugs.

 

The idea that fixing the nation's prisons may require a radical rethinking of the problem is central to a new report sponsored by the Baltimore Open Society Institute, a nonprofit urban advocacy group. It calls for substance abuse treatment for anyone who wants it, more residential and outpatient treatment facilities and better cooperation between government agencies and service providers so people can get treatment and counseling when they need it.

 

None of this is really new. Former Mayor Kurt L. Schmoke called for treating addicts rather than imprisoning them back in the 1980s - and was zapped for being soft on crime. Since then, Maryland has established 33 special courts to divert criminals with drug problems into treatment, but these programs can't meet the demand. .

 

Maryland lawmakers should take a lesson from Kentucky and other states that are looking for more effective ways of dealing with burgeoning inmate populations and hundreds of nonviolent drug offenders who would be better off in treatment than in prison. That's not being soft on crime, it's being serious about finding solutions that work.

 

Copyright 2009 Baltimore Sun.

 

House lights up FDA regulation

 

By Jeff Stier

Washington Times Commentary

Monday, April 6, 2009

 

Congress is now considering two rival approaches to altering tobacco regulations. One, favored by the leading cigarette manufacturer, would lock in the market shares of existing tobacco products and make things difficult for newcomers. The other, far better from a public-health perspective, would allow new, safer forms of tobacco - such as snus - to compete more easily with cigarettes.

 

Snus is smokeless tobacco already popular in Sweden that delivers the nicotine users crave without the dangerous, cancer-causing combustion associated with cigarettes. Sweden has seen huge reductions in lung cancer due to its populace's shift toward snus use instead of cigarettes.

 

Now, it's true that in an ideal world people would kick their nicotine addiction altogether. But in reality, where so few people succeed in doing so, snus makes sense as a means of “harm reduction.” Snus eliminates the risk of heart disease, lung cancer and the other systemic diseases related to smoking. Of course, there's no secondhand smoke from snus.

 

There is a small risk of oral cancer with snus, but even this risk is smaller than the oral cancer risk from cigarettes - and is not accompanied by numerous other risks to nearly every other system of the body. On balance, we would likely reduce tobacco-related deaths to something like a fiftieth of their current frequency if the populace switched to snus.

 

The top cigarette manufacturer and some ostensibly public-health-oriented activist organizations - who have worked with cigarette makers on the less snus-friendly bill - tend to downplay the huge difference in risk between snus and cigarettes. Snus contains nicotine, but nicotine in itself - absent burning - is not harmful, something that health groups like Campaign for Tobacco Free Kids and cigarette-makers like Altria Group Inc. (formerly known as Philip Morris Cos. Inc.) ought to know.

 

The snus-unfriendly bill, known as the Kennedy-Waxman bill (after sponsors Sen. Edward M. Kennedy, Massachusetts Democrat, and Rep. Henry A. Waxman, California Democrat), would give the Food and Drug Administration (FDA) authority to regulate tobacco. This sounds like a neat idea, but the bill has numerous provisions that would harm rather than enhance health.

 

The key is that it would greatly restrict the advertising of new forms of tobacco, effectively shutting products such as snus out of the game and leaving the nicotine-addicted portion of the public thinking that deadly cigarettes remain their only option.

 

People's rate of quitting cigarettes with non-nicotine methods is dismal. Even with the gum, the patch, pharmaceuticals, counseling, public pressure, smoking bans and everything else, quit rates fail to exceed 15 percent. It would be compassionate to give smokers more tools to help them reduce their risk and quit cigarettes.

 

Nearly as insane as shutting out the snus option, the Kennedy-Waxman bill would authorize the FDA to require cigarette-makers to lower the level of nicotine in cigarettes. But then smokers would likely smoke more cigarettes in order to get the nicotine they crave. Great for Altria, not a boon to anyone's health - the more puffs people take to get their hit, the more damage they do to themselves.

 

Finally, by appearing to give cigarettes the FDA's regulatory blessing and approval, this bill may simply make more people think cigarettes are relatively safe - but they will remain the leading preventable cause of death.

 

Even the FDA's most recent commissioner, Andrew von Eschenbach, was opposed to FDA taking on oversight of cigarettes for that reason.

 

Luckily, Rep. Steve Buyer, Indiana Republican, and Mike McIntyre, North Carolina Democrat, are introducing a bipartisan bill, with a companion bill introduced in the Senate by Sen. Richard Burr, North Carolina Republican, that is more sensible from a scientific perspective. It calls for creating a Tobacco Harm Reduction Center based out of the Department of Health and Human Services - rather than involving the FDA - and suggests a regulatory framework that would not favor cigarettes over safer alternatives.

 

Naturally, Altria prefers the Kennedy-Waxman bill. Maybe it's time for citizens to let their representatives know they feel differently.

 

Jeff Stier is an associate director of the American Council on Science and Health (ACSH.org).

 

Copyright 2009 Washington Times.

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