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			Saturday, April 18, 2009 News Clipping Archives *Maryland / Regional* County Departments Scramble To Meet 5% Cuts In Spending (Maryland Coast Dispatch) Ocean City Health Clinic Closes (WBOC-TV 16 online) Patching the Safety Net (Washington Post) VA: 3 patients HIV-positive after clinic mistakes (Washington Post) *National / International* New model of female condom touted to fight HIV, STDs (USA Today) Study: Impotence drugs don't harm men's vision (USA Today) NIH prohibits stem cells from embryos created for science (USA Today) *Opinion* --- *Maryland / Regional* County Departments Scramble To Meet 5% Cuts In Spending By Cara Dahl Maryland Coast Dispatch Saturday, April 18, 2009 SNOW HILL - Several county agencies that presented budget requests to the County Commissioners Wednesday all managed to cut their requests by at least 5 percent, as requested, and one by as much as 29 percent. Cuts mean less services in some cases, including a reduction in health services from the Worcester County Health Department, a state agency funded in large part by the county. One notable casualty of the health budget cuts is the Caroline St. summer health clinic in Ocean City. County Health Officer Debbie Goeller noted there has been a decrease in clinic visits in recent year as a result of other health care providers in operating Ocean City. Pocomoke City’s health office has shifted to a four-day week. Mother and child home visits have been cut in half. Emergency preparedness and family planning funding has also been cut, as have addictions and tobacco cessation funding. Nine positions in the health department are staying vacant, with one staffer laid off so far. “We’ve done more with less for a number of years now, and it’s getting to the point of being very concerning,” said Goeller. To comply with the county’s request, the Emergency Services Department has cut training, overtime, supplies, and equipment. Currently, two positions are vacant because of the hiring freeze, said Emergency Services Director Theresa Owens, leaving the rest of the staff unable to take vacation time because there are not enough employees to cover shifts. Overall, emergency services cut its budget by 18 percent. Of the hiring freeze instituted in the fall, Administrator Gerry Mason said, “We went back later and said no public safety either.” “We’ll get back to you,” said County Commission President Louise Gulyas. “You’ve got to have somebody sitting there,” said Commissioner Virgil Shockley. The Worcester County Sheriff’s office is not asking for any new deputy positions, but five current deputies are expected to retire this year. “I simply need people on the road to fill these positions,” said Sheriff Chuck Martin, adding that he would appreciate any consideration the commissioners could give. One cut he would like to get back, Martin said, is the elimination of off-duty use of police cars. “That hurts because you lose some visibility of police cars in the community,” said Martin. “You lose the ability of them to respond to other units on the road.” The Worcester County Jail has cut its budget by the required 5 percent, though it was difficult, Warden Ira Shockley said. The jail is on target to exceed expected revenues for renting cell space to other jurisdictions, a revenue stream that could increase when the new jail wing is completed this fall. The Worcester County Board of Elections made deep cuts, despite an election to be held next fall. “I think we did really well on the budget. We cut it by 29 percent,” said Elections Director Patty Jackson. More county agencies will formally present their budgets to the County Commissioners next Wednesday. Copyright 2009 Maryland Coast Dispatch. Ocean City Health Clinic Closes By Steve Dorsey WBOC-TV 16 online April 16, 2009 Ocean City, Md. – A health clinic in Ocean City near the boardwalk that has been operating there for 30 years, will close due to budget cuts. Worcester County Health Officer Deborah Goeller said due to county budget cuts, the health department can’t afford to operate the Caroline Street clinic that see hundreds of patients staying or living in the town each summer. Goeller said the department will save $64,000 without the clinic operating. The clinic is part of a set community health service initiatives that are available on Caroline Street, run by the county. The county runs a homeless shelter and youth run-away service, as well. Goeller said counselors will remain available at the location for those services. But town leaders said the clinic had been a big help to international students who work in the town each summer. The Student Workforce Committee, which coordinates the thousands of foreign students that come to work each year, said these students have depended on the clinic. These students must have insurance provided by their sponsors that accepts them into work programs in the town, according to committee member Amy Tingle. However, Tingle said students would use the clinic for minor medical problems and testing, because they could not afford their insurance deductibles that are necessary when they visit the ER. “It’s definitely going to be a little harder this year for these international students to get health care that was so readily available down on the boardwalk,” Tingle said. www.OCEANCITYTODAY.NET Copyright 2000 - 2009, WorldNow and WBOC. All Rights Reserved. Patching the Safety Net Stimulus Money Extends Md. Clinic's Operation, for Now By Megan Greenwell Washington Post Saturday, April 18, 2009 One in a series on how the recession is touching lives. Deborah Foerter is a first responder, whether the problem is a broken ankle or an empty pantry at home. On the table in Foerter's tiny exam room, Barbara Pickle describes numbness in her toes as Foerter, a nurse practitioner by training, checks her vital signs. A day earlier, an illiterate patient needed Foerter's help filling out an application for food stamps. Last year, an 85-year-old woman who broke her ankle walking to her outhouse was given indoor plumbing after Foerter called the local Christmas in April program. In one of the world's most advanced medical systems and one of America's wealthiest states, Foerter and her clinic are a lifeline for hundreds of poor and working-class residents of Nanjemoy, an isolated peninsula in rural southwestern Charles County. Dozens of people here live without running water, some in unheated trailers or shacks, just 37 miles from Washington. There is no grocery store and no gas station, no Laundromat or restaurant. This spring, Foerter told them that the clinic's services almost certainly would be ending in the next few months. The recession has hit nonprofit health clinics hard. This one had lost $150,000 during each of the past 14 years, and other grants were drying up. The board of Greater Baden Medical Services, which runs the clinic tucked inside the Nanjemoy Community Center, decided it no longer could be sustained and voted to close it. And then, just as some patients had given up on the idea of affordable medical care within their reach, they received word of a small miracle: Two weeks ago, the federal government announced that all but a handful of the nation's health clinics would receive a total of $2 billion through the federal stimulus package. Greater Baden was awarded $270,372, enough to keep Nanjemoy Health Services open for two years. "The fact that someone stepped in and did something about the crisis that this was going to cause is reason for celebration," said Rick Campbell, a longtime patient who has multiple sclerosis. "It doesn't solve Nanjemoy's underlying issues, but it's a start." At some point, Greater Baden will likely have to move the Nanjemoy clinic to a more central location, where it might attract walk-in patients with private insurance or the ability to pay more out of pocket. But for the moment, Pickle is receiving diabetes treatment just down the road from her house. "I think for a lot of us, losing the clinic would be losing an important part of our lives," she said. "It's not fair to take it away from people who don't have any other options." Most of Foerter's patients have no health insurance, unless they receive Medicaid. Their oasis is the clinic, with its harsh fluorescent lighting, uncomfortable waiting room chairs and well-worn equipment. The scale isn't digital. The exam tables don't move up and down at the push of a button. A doctor is available only on alternating Fridays. But for the clinic's 750 patients, there is simply nowhere else to go. "My patients are people who feel beaten up by life after so many years of not having the typical standard of living," Foerter said. "The clinic is the only connection a lot of them have to some basic services." Greater Baden runs six other clinics in Prince George's and St. Mary's counties. If Nanjemoy closes, its patients would have to travel more than 30 miles to Oxon Hill, or 15 miles to an overcrowded clinic in La Plata, the closest facility that accepts Medicaid. The trip to La Plata can take as long as 45 minutes by car, and appointments must be booked months in advance. Many of Nanjemoy's patients can't afford cars. The bus ride can take more than two hours. County officials said they recognized Nanjemoy residents' concerns but couldn't afford to save the clinic. Greater Baden board members said they don't want to pull out of Nanjemoy, but its losses are hurting the whole system. Without the clinic, Foerter said, many people wouldn't go to the doctor at all, whether out of stubbornness or a lack of transportation, or they would wait until they needed an ambulance. Without the clinic, patients tell her, they might as well start making funeral arrangements. The recession has worsened conditions at rural clinics such as the one in Nanjemoy, many of which had barely enough money to cover expenses before the economy started its downward spiral. Mary Wakefield, administrator of the U.S. Health Resources and Services Administration, which oversees the nation's 1,128 federally qualified nonprofit health clinics, said it is not uncommon for such providers as Foerter to play social worker as well as medical professional, and to do it on a shoestring budget of federal grants and private gifts. "Many of these clinics were already stretching every dollar as far as they could, and then the recession caused a huge increase in demand from people who have lost jobs and health insurance," Wakefield said. Community health centers serve 18 million Americans, many in underserved rural areas such as Nanjemoy, others in poor urban neighborhoods. They are generally equipped to practice only basic medicine but often will cover the costs of a patient's visit to a specialist. Prescription medications are offered at drastically reduced prices thanks to partnerships with pharmaceutical companies or the clinic's willingness to take a loss on the cost of drugs. Many of Nanjemoy's patients were struggling before the economic downturn. Just 10 percent have private insurance. More than 50 percent don't qualify for Medicaid or Medicare, so they pay according to a sliding scale. Calvin and Joyce Eller are uninsured. They ran an auto body shop for years, making too much to qualify for Medicaid but too little to buy health insurance. They sold the business nine years ago, after Calvin Eller had end-stage emphysema diagnosed and was told he had six months to live. Today, Calvin Eller sees Foerter every few weeks and a takes a handful of medications to keep the disease under control. Joyce Eller receives regular checkups for her high blood pressure and chronic obstructive pulmonary disease. The clinic has treated both -- and Joyce's mother -- for 14 years, absorbing thousands of dollars of losses because the Ellers can't afford more than $10 or $20 a visit. "I just don't think we'd find a doctor in La Plata who would be willing to squeeze us in if we call the day of with a problem," Joyce Eller, 59, said. "But to our family, that's necessary." Copyright 2009 Washington Post. VA: 3 patients HIV-positive after clinic mistakes Associated Press By Bill Poovey Washington Post Saturday, April 18, 2009 CHATTANOOGA, Tenn. -- Three patients exposed to contaminated medical equipment at Veterans Affairs hospitals have tested positive for HIV, the agency said Friday. Initial tests show one patient each from VA medical facilities in Murfreesboro, Tenn.; Augusta, Ga.; and Miami has the virus that causes AIDS, according to a VA statement. The three cases included one positive HIV test reported earlier this month, but the VA didn't identify the facility involved at the time. The patients are among more than 10,000 getting tested because they were treated with endoscopic equipment that wasn't properly sterilized and exposed them to other people's body fluids. Vietnam veteran Samuel Mendes, 60, said he was surprised to learn of an HIV case linked to the Miami facility, where he had a colonoscopy. He was told he wasn't among those at risk. "I was hoping and expecting to not get anyone contaminated like that," he said. "It's probably a little worse than we thought." The VA also said there have been six positive tests for the hepatitis B virus and 19 positive tests for hepatitis C at the three locations. There's no way to prove patients were exposed to the viruses at its facilities, the agency said. "These are not necessarily linked to any endoscopy issues and the evaluation continues," the statement said. The VA has said it does not yet know if veterans treated with the same kind of equipment at its other 150 hospitals may have been exposed to the same mistake before the department had a nationwide safety training campaign. An agency spokeswoman has said the mistake with the equipment was corrected nationwide by the time the campaign ended March 14. The problems discovered in December date back more than five years at the Murfreesboro and Miami hospitals. The VA's disclosure Friday was the department's first comment since April 3, when the VA reported the one positive HIV test. VA spokeswoman Katie Roberts has declined to provide any details on how widespread the problems might have been other than saying a review of the situation continues. She said in an e-mail Friday that "there is a very small risk of harm to patients from the procedures at each site." She said the HIV results "still need to be verified" in additional tests. The VA statement shows the number of "potentially affected" patients totals 10,797, including 6,387 who had colonoscopies at Murfreesboro, 3,341 who had colonoscopies at Miami and 1,069 who were treated at the ear, nose and throat clinic at Augusta. More than 5,400 patients, about half of those at risk, have been notified of their follow-up test results, the VA said. The Friday statement said the VA is "continuing to notify individuals whose letters have been returned as undeliverable, and working with homeless coordinators to reach veterans with no known home address." The statement also said the VA has assigned more than 100 employees at the three locations to "ensure that affected veterans receive prompt testing and appropriate counseling." All three sites used endoscopic equipment made by Olympus American Inc., which has said in a statement it is helping the VA address problems with "inadvertently neglecting to appropriately reprocess a specific auxiliary water tube." Charles Rollins, 62, who served three tours in Vietnam with the Navy from 1966 to 1969, said the news concerns him because he's used the Augusta ear, nose and throat clinic several times. "That's terrible," he said by phone as he socialized at an American Legion post in Augusta. Associated Press writers Lisa Orkin in Miami and Dorie Turner in Atlanta contributed to this report. © 2009 The Associated Press. *National / International* New model of female condom touted to fight HIV, STDs Associated Press By David Crary USA Today Friday, April 17 ,2009 NEW YORK — Advocates of the female condom are promoting a less costly, more user-friendly version that they hope will vastly expand its role in the global fight against AIDS and other sexually transmitted diseases. An early version of the female condom was introduced in 1993, and it remains the only available woman-initiated form of protection against both STDs and unintended pregnancy. Yet despite global promotion by the United Nations and other organizations, its usage is still minuscule, even as women bear an ever-growing share of the AIDS epidemic. Advocates hope the dynamics will change following last month's approval by the Food and Drug Administration of the FC2, a new version of the female condom produced by the Chicago-based Female Health Co. About 35 million female condoms were distributed worldwide last year, but that compares to more than 10 billion male condoms, which are far cheaper and, at least initially, easier to use. However, in some nations with high HIV rates, many men refuse to wear condoms, putting women at risk. Though it looks similar to its predecessor — a soft, transparent sheath with flexible inner and outer rings — the FC2 is made from synthetic rubber rather than polyurethane, making it cheaper to produce. Mary Ann Leeper, former president of Female Health Co. and now its strategic adviser, said the FC2 also is less noisy during use. Complaints about squeaky noises were among the factors that slowed acceptance of the original version. The cost of the FC2 is one-third less than its predecessor, and may go lower, enabling health organizations to distribute many millions more than at present. For now, the price is about 60 cents compared to less than 4 cents for mass-distributed male condoms — a difference that's an issue in the developing world. The FC2 had been accepted previously by some international organizations, and the Female Health Co. distributed 14 million of them abroad last year along with 21 million of the older version. Advocates of the female condom praised the FDA announcement because it opens the door for the U.S. Agency for International Development (USAID), one of the largest global providers of condoms, to distribute the FC2 overseas. "This is a tremendous victory," said Susie Hoffman, an assistant professor of clinical epidemiology at Columbia University who contends the female condom has suffered from misconceptions. "In the United States, there has been strong bias against it," Hoffman said. "Some people involved in AIDS and family planning would say, 'Why do we need these? ... It's so weird that women are not going to pick it up.'" "But if presented in the right way, many women do like it," Hoffman said. "To find these people and help them and train them, you need systematic programming, which costs money." Resistance is less of a problem in some developing nations. The U.N. Population Fund, government agencies and nonprofits are aggressively promoting female condoms in places such as Brazil, Ghana, Zimbabwe and South Africa. Women's groups in Zimbabwe collected more than 30,000 signatures demanding access to the female condom. In Ghana, nonprofits say more than 10,000 people have attended training programs that teach women how to insert female condoms — they require careful instruction to be used properly — and how to negotiate with their male partners. "The mindset is changing, but there are still a lot of challenges," said Bidia Deperthes, the Population Fund's HIV technical adviser for condoms. "Accessibility is still minimal. There's a huge demand, and we're not meeting it." Deperthes hopes that with FDA approval of the FC2, the number of female condoms distributed globally could climb to 50 million this year. If the numbers keep rising, she said, the cost to public-sector distributors for each FC2 could drop as low as 25 cents. Jeff Spieler, a science adviser with USAID's Office of Population and Reproductive Health, said the female condom's future may depend on whether its promoters can develop a private-sector market. Its commercial price in the United States generally has been more than $2. Another challenge is a stigma associated with the female condom in some places because prostitutes are among those deemed to benefit most from using it. On the other hand, advocates of the female condom say it has invaluable safe-sex potential for married women whose husbands are unfaithful and shun male condoms. Serra Sippel, executive director of the Center for Health and Gender Equity in Washington, said FDA approval of the FC2 is a key step toward "putting the power of prevention in women's hands." But she bemoaned the product's limited over-the-counter availability. "We'd love to see the profile raised, to have commercials about it and normalize it so people aren't embarrassed," she said. Mary Ann Leeper said the Female Health Co. is seeking a corporate partner to help market the FC2. She suggested that concern about HIV/AIDS may generate interest among women in communities with high infection rates. The female condom's advocates stress that it will never be the "magic bullet" that by itself turns the tide in fighting AIDS. But, they say, it should be a bigger part of the arsenal. "It's not going to be the one answer," Hoffman said. "But it's got a lot more to contribute than it has to date." Copyright 2009 The Associated Press. All rights reserved. Study: Impotence drugs don't harm men's vision HealthDay By Robert Preidt USA Today Saturday, April 18, 2009 The erectile dysfunction drugs Cialis (tadalafil) and Viagra (sildenafil) didn't appear to damage vision in men who took the medications daily for six months, according to a drug company study. These drugs, called selective phodiesterase type 5 (PDE5) inhibitors, treat erectile dysfunction by interfering with the action of the compound PDE5 in the blood vessels of the penis. But there are concerns that PDE5 inhibitors may also act on similar compounds in the retina, the part of the eye that receives and transmits images to the brain, according to background information in the study. Men taking PDE5 inhibitors have reported mild and temporary blurred vision, altered light perception, and blue-tinged vision. This Eli Lilly study included 244 men, ages 30 to 65, who were randomly selected to take either 5 milligrams of tadalafil, 50 mg. of sildenafil, or a placebo daily for six months. The men underwent thorough eye tests before, during and after treatment. By the end of the study, the researchers found no significant differences in vision between the men who took the drugs and those who took the placebo. The findings were published in the April issue of the journal Archives of Ophthalmology. "There are several reasons ophthalmologists need to be acquainted with the pharmacologic profiles of PDE5 inhibitors and their potential side effects," the authors wrote "The frequency of erectile dysfunction, which is a form of peripheral vascular disease that impairs men's abilities to achieve and maintain an erection, increases dramatically with age and in the presence of cardiovascular risk factors. Therefore, many men who take PDE5 inhibitors to treat their erectile dysfunction will also be followed up by ophthalmologists for ocular disorders such as diabetic retinopathy, macular degeneration and ocular vascular disease." "Furthermore, PDE5 inhibitors can exert direct effects on the retina, and such effects probably account for many of the visual side effects such as blue-tinged vision and light sensitivity that have been reported," they concluded. But they said their "results indicate that there is no cumulative damage or effect of clinical significance for either 5 milligrams of tadalafil or 50 milligrams of sildenafil taken daily for six months." Copyright 2009 USA Today. NIH prohibits stem cells from embryos created for science By Dan Vergano USA Today Saturday, April 18, 2009 The National Institutes of Health will fund human embryonic stem cell research on cells donated by fertility clinic patients, but won't underwrite studies in which embryos are created solely for producing cloned cells for treatments, the federal agency said Friday. NIH also will not fund any cell research mixing human and animal embryonic cells, so-called "chimeras," under the guidelines. "No question these guidelines will greatly expand the number of cells available for research," says acting-NIH head Raynard Kington. In March, President Obama called for increased federal support of embryonic stem cell research, and requested the NIH guidelines. "We think this is the best way to pursue research which is ethically acceptable," Kington says. NIH spent $88 million on human embryonic stem cell research last year. 1n 1998, a University of Wisconsin team first isolated human embryonic stem cells in the lab. The cells are controversial because they are collected by destroying early-stage human embryos, a reason for limiting federal funding cited in 2001 by then-President George W. Bush. Medical researchers, however, say the cells may reveal the genetic origins of ailments and someday serve as sources of replacement tissues in everything from spinal cord injury to diabetes. "We see this as tremendous progress. Some groups and scientists have wanted the administration to go further, but we are happy to have this progress after such a long period of limited opportunities to pursue this very important line of research," says Alan Leshner, head of the American Association for the Advancement of Science. Following a 30 day-comment period, the new guidelines would come into force on July 7, 2009. Stem cell researchers who have already submitted grant proposals to NIH will only receive funding after that date. In 2001, President Bush restricted federal funding of embryonic stem research to cell lines already created, a decision that limited federal support to about 21 lines, or families of cells derived from one embryo. "There is no way to know" how many cell lines would eventually become available to funding under the new guidelines, Kington said, although he cited reports of about 700 in scientific reviews. No cloned human embryonic stem cell lines are currently in existence, he added. Copyright 2009 USA Today. *Opinion* --- BACK TO TOP


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