Sunday, April 19, 2009

News Clipping Archives

 

Maryland / Regional

Environmental poverty issues eyed (Cumberland Times-News)

Diabetes? Some beat it, but are they cured? (Washington Post)

 

National / International

Senate to tackle health care reform (USA Today)

Using Medicare to lower health care costs (Washington Times)

Your Health: Skin color matters in the vitamin D debate (USA Today)

AIDS treatment still eludes Chinese children (Washington Post)

 

Opinion

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Maryland / Regional

 

Environmental poverty issues eyed

 

By Tess Hill

Cumberland Times-News

Sunday, April 19, 2009

 

CUMBERLAND - What is environmental poverty? Is Allegany County a sustainable community with a sustainable economy?

 

According to John Jastrzembski, forestry teacher at Allegany College of Maryland, environmental poverty is when people or a community are not using resources to the best of their capabilities.

 

“We have a tendency to exploit and under-appreciate our natural resources,” he told Rotarians last Tuesday. “We have great resources in Allegany County but, in Western Maryland, people continually devalue that by not managing our soil and ecosystems. We need to realize in order to grow economically we need sustainable, viable lands.”

 

Jastrzembski is trying to help the community realize that through education and outreach programs.

 

“Being a teacher at ACM, it’s easy for me to reach the students,” he said. “I am able to talk about these issues and the students will go out and try to better manage the landscapes and ecosystem here.”

 

He teaches students to think economically as well as environmentally.

 

“In a failing economy, we tend to exploit our resources more and cause more stress on our resources,” Jastrzembski said. “So we try to teach our students to think long-term economics instead of short-term. We need to maintain working landscapes and work toward green communities.”

 

The nation is beginning to go in this direction, he added. But he asks Rotarians if this is enough.

 

“Are you promoting sustainable development? Are you inadvertently encouraging county and regional environmental poverty?” Jastrzembski asked Rotarians. “We’re still thinking like it’s the 1900s and cutting land to make road ties; we’re not managing our lands.”

 

He adds, because the U.S. is efficient at producing food, we have the cheapest food, with only 10 percent of people’s income going to food while India is closer to 51 percent.

 

“It has to do with the economic infrastructure we have, but this is about to change,” he said. “Based on what’s happening now, we’re projecting food costs to increase to perhaps the 20 percent level over the next half of a generation, close to 13 years. This is due to the lack of good land management.”

 

Jastrzembski said communities need to look for red flags such as how to keep providing clean water at an affordable price.

 

“This is the No. 1 environmental poverty issue,” he said. “Even in the United States, there are lots of areas where clean water is going to become more and more expensive. So one of the things we need to be doing is making sure we continue to get clean water; it adds a lot to infrastructure costs if we don’t have clean water.”

 

Another issue Jastrzembski said communities need to think about is energy streams - the impact caps on trade will have on energy sources and where the next generation of energy will be coming from.

 

“We need to continually think about working landscapes and managing them at a local level,” he said. “We need to maintain them to stay efficient. We need to maintain them in order to grow as a community.”

 

Contact Tess Hill at thill@times-news.com.

 

Copyright © 1999-2008 cnhi, inc.

 

Diabetes? Some beat it, but are they cured?

 

Associated Press

By Jamie Stengle

Washington Post

Sunday, April 19, 2009

 

JoAnne Zoller Wagner's diagnosis as prediabetic wasn't enough to compel her to change her habits and lose 30 pounds. Not even with the knowledge her sister had died because of diabetes.

 

"I didn't have that sense of urgency," said the Pasadena, Md., woman.

 

But nine months later, doctors told Wagner her condition had worsened. She, too, now had Type 2 diabetes.

 

That scared her into action.

 

Now, two years later, the 55-year-old woman has slimmed down. She exercises regularly and her blood sugar levels are back in the healthy, normal range. Thanks to her success, she was able to avoid diabetes medication.

 

Diabetics like Wagner who manage to turn things around, getting their blood sugar under control _ either escaping the need for drugs or improving enough to quit taking them _ are drawing keen interest from the medical community.

 

This summer an American Diabetes Association task force will focus on this group of patients and whether they can be considered "cured." Among the points of interest:

 

_What blood sugar range qualifies as a cure and how long would it have to be maintained?

 

_How might blood pressure and cholesterol, both linked to diabetes, figure into the equation?

 

_And what if a "cured" diabetic's blood sugar soars again?

 

"For right now, we're not saying they're cured, but the bottom line is ... good glucose control, less infections," said Sue McLaughlin, president of health care and education for the American Diabetes Association. The organization has no estimate of how many people fall into that category.

 

Being overweight is the leading risk for Type 2 diabetes. Genetics also plays a role, and blacks, Hispanics and American Indians are at greater risk than whites.

 

Nearly 57 million Americans are prediabetic. Another 18 million have been diagnosed with diabetes, while the diabetes association estimates almost 6 million more Americans have diabetes and don't know it. About 90 to 95 percent of diabetics have Type 2, the kind linked to obesity.

 

The future is potentially even gloomier, with one study estimating that one of every three children born in the U.S. in 2000 will eventually develop diabetes.

 

But the news isn't all bad. Thirty minutes of daily exercise and a 5 to 10 percent loss in body weight can lower the odds of diabetes by nearly 60 percent and is more effective than medicine in delaying its onset, according to a diabetes prevention study.

 

Still, such lifestyle changes are often difficult.

 

"It sounds like such a nonmedical recommendation, and yet it's the thing people say is the toughest to implement," said McLaughlin, the diabetes association official.

 

For Wagner, it meant changing not just her diet, but her lifestyle. A teacher, she now cooks most of her meals at home and avoids the sweets in the school lounge. She also tries not to stay late at work, using the extra time to exercise and make healthy meals.

 

Alice Stern describes a similar journey back to health since her diabetes diagnosis in 2007. The 50-year-old Boston woman was able to avoid diabetes drugs through diet and exercise, managing to trim 40 pounds off her 5-foot-2 frame.

 

"It is about willpower. That's how you make the changes," said Stern.

 

Even diabetics who have resorted to weight loss surgery have seen their blood sugar levels return to normal.

 

Lucy Cain, 61, of Dallas tried to control her diabetes through diet and exercise after she was diagnosed in 2004. But she found it difficult, and two years later had gastric bypass surgery. The 5-foot-7 Cain, who once weighed over 300 pounds, is down to about 185, still losing weight and is off diabetes medication.

 

Whatever the route, weight loss is key, doctors say.

 

"There is no special diet. You've got to eat fewer calories than your body burns," said Dr. Robert Rizza, a Mayo Clinic endocrinologist and former president of the American Diabetes Association.

 

Many doctors stop short of calling these successful patients cured.

 

Dr. Philipp Scherer, director of the diabetes research center at University of Texas Southwestern, describes diabetes as a one-way road. He said it can be stopped in its tracks with diet and exercise, but there's no turning back.

 

Dr. Kevin Niswender, an assistant professor in the department of medicine at Vanderbilt Medical Center, said "technically, you could call somebody cured," but that patient still needs to be followed closely.

 

Doctors caution that, for some diabetics, lowering blood sugar may be only temporary. Stress, weight gain and other factors can push it back to unhealthy levels.

 

"Blood sugars can come down to normal. Then the issue is how long does that last?" said Dr. Sue Kirkman, vice president of clinical affairs for the diabetes association. "Sometimes people start putting weight back on and their blood sugars come back up."

 

In other cases, patients are diagnosed so late that blood sugar levels can't be brought back to normal, even with weight loss, she said. As the disease progresses, even those who made diet and lifestyle changes might eventually have to go on medications.

 

That's one reason Wagner and some other diabetics who've managed their disease through diet and exercise are also reluctant to consider themselves "cured."

 

"American culture, our environment, is not conducive to having good health," said Wagner. She believes diabetes will always be lurking in the background, waiting for her to slip.

 

On the Net:

American Diabetes Association:http://www.diabetes.org/

 

© 2009 The Associated Press.

 

National / International

 

Senate to tackle health care reform

 

Associated Press

By Ricardo Alonso-Zaldivar and Erica Werner

USA Today

Sunday, April 19, 2009

 

WASHINGTON — This time it's really going to happen. Or so they claim.

 

Senators get down to work this coming week on turning ideas into legislation to cover some 50 million people without health insurance and contain costs for everyone else. Hopes are high that Democrats and Republicans can find common ground for a bill to emerge by summer.

 

They will have to defy history.

 

Grand plans to revamp health care have a half-century history of collapsing. More focused proposals, such as the creation of Medicare in 1965, have succeeded.

 

Lawmakers are far apart on some of the most important issues today, from the reach of government to the responsibilities of employers and individuals. And guaranteeing coverage for all could cost $1.5 trillion over 10 years, an eye-popping sum in a time of recession and mounting national debt.

 

Yet major constituencies often at odds are now clamoring for change. They range from consumer groups to insurers, from employers to doctors and hospitals. President Barack Obama has pledged to chip away at hardened ideological positions to find compromises.

 

"This is the toughest issue we have ever taken on — every part has got a chance of blowing up," said Iowa Sen. Charles Grassley of Iowa. He is the top Republican on the Senate Finance Committee, which oversees government health programs and taxes, and plans to start work Tuesday.

 

Grassley said he is reasonably confident that he and the chairman, Sen. Max Baucus, D-Mont., can produce a bill that appeals to the middle. "Our only hope is if we do it in a way that keeps the vast majority of both parties going in the same direction," Grassley said.

 

Sen. Ron Wyden, D-Ore., sees opportunity. "There is a very appealing philosophical truce within the Senate's grasp," he said.

 

"Democrats are right on the idea that we've got to cover everybody. Republicans have been right on the role of the private sector, not freezing innovation and staying away from price controls," Wyden said. "You meld those philosophical views and you are on your way to 68 to 70 votes."

 

Consensus is growing on many points: Changes should build on the current system, not scrap it; hospitals and doctors should be paid for quality, not quantity; insurers shouldn't be able to discriminate against people with health problems; small businesses need special attention.

 

But huge differences remain. Three of the hardest issues are:

 

Costs:

Obama set aside $634 billion in his budget as a "down payment" for health care. Many experts believe that represents less than half the cost. Covering the uninsured could cost $100 billion to $150 billion a year, or more.

 

Liberal Democrats want to follow Obama's example and get half the money from tax increases and half from spending cuts. Upper-income tax increases and sales tax increases on alcoholic beverages, tobacco products and even sugary sodas are being discussed.

 

But Republicans and fiscally conservative Democrats want most of the financing to come from spending cuts and from making the health care system less wasteful.

 

Mandates:

Health insurance is based on pooling risk: premiums from the vast majority of healthy people cover care for the sick. For the system to work, economists say, everyone should have health insurance from the outset so uninsured people don't end up going to the emergency room and driving up costs for everyone else.

 

Because insurance is expensive, requiring people and businesses to pay for it is politically difficult. Most people now get insurance from their employers, but companies aren't required to offer it and as the economy skids more have cut back.

 

Obama and Democrats are considering a combination of requirements on individuals, parents and employers, with exemptions for small businesses and sliding-scale subsidies for families making as much as $80,000 a year.

 

Republicans opposed an employer mandate in the 1990s, but have mixed views on an individual requirement. The insurance industry is supporting an individual mandate. Labor unions are pushing for employer mandates.

 

Public Plan:

Obama and the Democrats want to give middle-class workers and families the option of joining a government-sponsored insurance plan that would be offered alongside private ones through a new insurance clearinghouse.

 

Supporters say a public plan could be a testing ground for innovations and a check on private insurers. Republicans see it as a thinly disguised step toward a government-run system. Insurance companies say they wouldn't be able to compete with a government plan.

 

Efforts are underway to find a compromise, maybe by limiting the scope of the public plan. But Rep. Dave Camp, who is playing a leading role in the House, said he doesn't think a deal is possible. "The public plan is a bright line for us," said Camp, R-Mich.

 

Senators begin their work in public Tuesday at a Senate Finance Committee meeting on how to change the health care delivery system to make it more efficient. They will meet the following week in closed session to consider specific proposals that would affect doctors, hospitals and other medical providers.

 

Similar sessions are scheduled on expanding coverage and paying for a revamped system. Leaders are hoping the committee can vote on a bill by mid-June.

 

Separately, the Senate Health, Education, Labor and Pensions Committee is working on a complementary bill, with the goal of merging the two in the full Senate. It's unclear whether Senate Republicans will offer their own bill.

 

In the House, the Democratic leadership aims to introduce legislation by late June. The bill will be considered by three committees that share jurisdiction over health care. Republicans are planning to offer their own measure.

 

Democratic leaders want the full House and Senate each to pass legislation before Congress leaves town for its August break.

 

Democrats probably will allow the use of a legislative device that would let them pass a health bill in the Senate with 51 votes, instead of the 60 needed to defeat a filibuster. Republicans say that would be an act of bad faith and could poison chances for a deal.

 

Copyright 2009 The Associated Press. All rights reserved.

 

Using Medicare to lower health care costs

 

By Len M. Nichols

Washington Times

Sunday, April 19, 2009

 

Our nation must re-establish fiscal balance as soon as macroeconomically permissible. At this moment, there is no question that we must take substantive steps to stimulate our economy and address the crises in our housing and financial markets.

 

In fact, I have never seen such consensus in a profession as argumentative as economics. But America's economic and social futures are also threatened by several long-term challenges. First among these is the ever-rising cost of health care.

 

Health care costs are the largest threat to our nation's fiscal future because Medicare, which accounts for 20 percent of government spending, buys health care from the same inefficient health care system as the rest of us. With Medicare and systemwide health care costs rising faster than economywide productivity year after year, the lines between fiscal reform and health reform are increasingly blurred.

 

Therefore, we should start thinking of health, Medicare and fiscal reforms as inexorably linked. The only way we are going to improve our nation's long-term economic outlook is to fix our health care system.

 

One way to move toward a more sustainable health system is by using Medicare — the nation's largest purchaser of health care — as a catalyst for improving quality, value and efficiency throughout the health care marketplace. Today's Medicare payment structure rewards providers for delivering volume, not value, and for doing more care, not better care. These incentives are perverse. In short, Medicare must buy smarter.

 

What does buying smarter really mean? Respected analysts estimate that more than 30 percent of what we spend on health care does not make patients healthier. We must reduce this misdirected spending. Medicare could achieve savings and improve patient care by basing its purchasing decisions on value, clinical evidence and observed outcomes.

 

In the Medicare program, this could mean a payment structure that rewards team-based care and or new and innovative treatment processes for individuals with chronic diseases. This also means giving doctors and patients more information about what treatments work best and bringing 21st-century technology to health care through electronic medical records and decision-support tools.

 

Whatever the specific reforms, Medicare and its beneficiaries must get more clinical value for the money they spend on health care. This will improve care for Medicare patients, while lessening the financial burden for taxpayers in the long run.

 

Yet, Medicare's governance structure hinders its ability to become a value-based purchaser and in doing so perpetuates the health care cost growth problems that threaten our nation's fiscal future. This a result of too much micromanaging by congressional committees and not enough decision-making in the field, as some members of Congress will admit.

 

Therefore, we must change the way Medicare is governed to achieve our goals.

 

This is why I believe (along with several lawmakers and stakeholder organizations) that we should create a new entity to insulate Congress and the White House from lobbying about technical, scientific issues related to the Medicare program. Congress should delegate a set of Medicare decisions to this politically shielded authority, which will then be free to structure value-based payment incentives and make more decisions based on evidence and fewer choices because of politics.

 

Yet, tackling Medicare reform alone will not solve our problems. We must also improve the efficiency of the entire health care system from which Medicare buys. By revamping Medicare's pricing structure, however, we can create incentives for providers to adopt high-value care processes.

 

In turn, this should make the delivery of care to the under-65 population more efficient (as did the move to diagnosis-related group payments to hospitals in the 1980s) and inspire private insurers to adopt similar, if not identical, incentive-based contracts. Therefore, we must reform our Medicare program to both improve the budgetary outlook for our nation and incent the delivery system to produce higher-value care at lower costs than it does today.

 

Medicare reform and broader health system reform are inextricably linked to each other and to our nation's fiscal future. We cannot change our Medicare cost trajectories without reforming the broader health system. We cannot create a credible road map to a higher-quality, lower-cost heath system without using Medicare as a catalyst for widespread private sector reforms.

 

We cannot get our fiscal house back in order without slowing the rate of Medicare and health care system cost growth. The goals of comprehensive health reform, Medicare reform and fiscal responsibility should not be viewed separately, but rather jointly.

 

Our current economic crisis has highlighted the need to finally address our nation's long-term challenges. Meaningful reforms to our Medicare program and our health system are the keys to a more fiscally sustainable economic future.

 

• Len M. Nichols directs the Health Policy Program at the New America Foundation, a nonprofit, nonpartisan policy research institute with offices in the District and Sacramento, Calif.

 

Copyright 2009 The Washington Times, LLC.

 

Your Health: Skin color matters in the vitamin D debate

 

By Kim Painter

USA Today

Sunday, April 19, 2009

 

Can dark skin be a health hazard? It might be — if you are a dark-skinned person who lives far from the equator, gets little sun exposure and consumes little vitamin D.

 

That describes many African Americans and helps explain why studies find that average African-American children and adults have much lower blood levels of the vitamin than white Americans do. Vitamin D is produced in response to sun exposure in a process that works most efficiently in pale skin. It's also in fortified dairy products and fatty fish, but few Americans — of any skin color — consume enough of those foods to meet recommendations.

 

AT RISK: Low levels of vitamin D can increase chances of premature death

VITAMIN D IN KIDS: Pediatricians say children need more

 

Just how much vitamin D Americans need and how they should get it is under debate. Scientists also are debating evidence that vitamin D, best known for building bones, can lower the risk of cancer, diabetes, heart disease and other ailments.

 

And they are asking this intriguing question: Could varying vitamin D levels contribute to the health gap between black and white Americans?

 

Boston University professor Michael Holick, a leading vitamin D researcher, says yes: "We think it's why African Americans develop more prostate cancer, breast cancer and colon cancer and get more aggressive forms of those cancers."

 

John Flack, principal investigator at the Center for Urban and African American Health at Wayne State University, Detroit, says: "I think it's potentially a very important explanation for some of the differences, from hypertension to cancer to heart failure. The actual proof is not there, but it's plausible."

 

But Flack adds that many factors contribute to African Americans' poorer health. Studies suggest those factors include reduced access to health care, pervasive barriers to healthful living (for example, neighborhoods that lack fresh groceries), differences in income and education and the stress of racial inequality itself.

 

Solving those problems will be difficult, he says. Closing the vitamin D gap could be easier.

 

It won't be as easy as recommending more sun exposure, however. Though someone in Boston with pale skin can get adequate vitamin D by exposing their arms and legs to the sun for 10 to 15 minutes twice a week in the summer, someone with the darkest skin might need two hours of exposure each time, Holick says. "It's impractical," he says, and it also darkens skin, which many people find cosmetically unacceptable.

 

Dermatologists also warn that sun exposure increases the risk of skin cancer and wrinkling, even in dark-skinned people.

 

How much is enough?

 

Holick endorses "sensible, limited sun exposure" but says it's also time to recommend that everyone, regardless of skin color, take a daily vitamin D supplement of at least 1,000 international units (IU).

 

Not all scientists agree, but an expert panel at the non-profit Institute of Medicine is reviewing recommended daily intakes, now at 200 IU for people up to age 50, 400 IU for people ages 51 to 70 and 600 IU for those over age 70. An 8-ounce glass of fortified milk contains 100 IU.

 

"All Americans, but particularly people with darker skin, should pay attention" to new guidelines due next year, says Adit Ginde, a researcher at the University of Colorado Denver School of Medicine. Ginde led a recent study, published in the Archives of Internal Medicine, that found that vitamin D levels are falling in all racial groups but are especially low in African Americans.

 

Copyright 2009 USA Today.

 

AIDS treatment still eludes Chinese children

 

Reuters

By Lucy Hornby and Nick Macfie

Washington Post

Sunday, April 19, 2009

 

BEIJING (Reuters) - Chinese children with AIDS, especially from rural families, are going without treatment because their families are too poor to afford it, despite a government policy of free treatment, an activist group said on Monday.

 

Some families don't even know AIDS treatment programs exist, it said.

 

"China has made great progress in the fight against AIDS, but far too many children are getting the wrong AIDS treatment," said Sara Davis, executive director of Asia Catalyst, which issued the report.

 

As many as 10,000 Chinese children may be HIV-positive, most because of botched blood transfusions or transmission from their mothers. They are concentrated in central Henan province, where the blood supply was contaminated in the 1990s, or in Yunnan province in the southwest, a hub for drug trafficking.

 

In 2005, 9,000 cases of children contracting HIV from their mothers were reported. Many children with AIDS die before the age of five, often undiagnosed.

 

Some live too far from hospitals and others have been turned away from hospitals and schools that fear contagion from AIDS patients.

 

China guarantees free drug treatment for AIDS, but many poor families cannot afford the associated fees or treatment for other diseases which may strike the weakened children.

 

The government provides generic versions of four drugs for front-line treatment, but many patients have developed resistance.

 

Asia Catalyst called for the Chinese government to "fill in the gaps" by extending coverage for additional medical costs, and providing cheaper second-line drugs.

 

© 2009 Reuters.

 

Opinion

 

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