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			Friday, April 24, 2009 News Clipping Archives *Maryland / Regional* State health agency could move staff, labs to E. Baltimore biotech park (Baltimore Business Journal) Two separate measles outbreaks demonstrate threat of imported cases (Pediatric SuperSite - Infectious Diseases In Children – Pediatric Annals) Missouri measles case reported (Bellville News Democrat - Southwestern Illinois and the St. Louis region) Human Contact Spreading Mutated Strain of Swine Flu (EIN News online) Are ‘working families' really session's winners? (The Gazette) Catania, Director Fighting Over AIDS Clinic Mission (Washington Post) Army investigates death in Annapolis (Capital News) Parents who lost children to suicide share experiences, advice (Frederick County Gazette) *National / International* CDC: Swine flu cases rise to 7 in California and Texas; health officials expand Investigation (Associated Press) Five more U.S. swine flu cases reported (United Press International) Unusual Strain of Swine Flu Is Found in People in 2 States (New York Times) Investigators in swine flu outbreak look to Mexico (CNN) Bird Flu and Swine Flu Outbreaks: The Health Risks of Hysteria (Discover Magazine) 17-Year-Olds to Gain Access to Plan B Pill (Washington Post) When the Medical Bills Swell, Seize Control (New York Times) As Insurance Coverage Increases, ERs Get Busier (Wall Street Journal) *Opinion* -- *Maryland / Regional* State health agency could move staff, labs to E. Baltimore biotech park By Julekha Dash Baltimore Business Journal Friday, April 24, 2009 The Maryland Department of Health and Mental Hygiene is planning to move its public health offices to the biotechnology park near Johns Hopkins Hospital, bringing 250 workers to a new building on the campus. The 180,000-square-foot building would likely be financed through $157 million in bonds issued by the Maryland Economic Development Corp. (Medco), which helps fund state projects, said James Johnson, the agency’s assistant secretary. The state also allocated $6.5 million from ist 2010 capital budget so the department can create preliminary designs for the project. The new building would give the East Baltimore biotechnology park a boost. Leaders of the $1.8 billion residential and office project welcome any new tenant as they weigh changes to the scope of the commercial development. Though the move would come at taxpayers’ expense, it is necessary because the 33-year-building at its current home is woefully inadequate, Johnson said. The west side building known as State Center lacks adequate infrastructure and modern labs that would help the state prepare for bioterrorism threats, Johnson said. Being near Hopkins will enable the state’s public health lab to collaborate with the Bloomberg School of Public Health and tap graduate students to work for the department. Private firms that want to sell to the government or collaborate with it will hopefully move to East Baltimore with the addition of the health department, said Jack Shannon, the outgoing CEO of East Baltimore Inc., the nonprofit that oversees the project. Government agencies typically are part of any biotechnology park, he said. For instance, NASA is a tenant in the biotech cluster in Cambridge, Mass. The health department’s move still needs approval from the state Board of Public Works, which needs to approve the financing structure. Under the financing arrangement, Medco will hire a developer and the state leases back the building from the developer. Copyright 2009 Baltimore Business Journal. Two separate measles outbreaks demonstrate threat of imported cases Infectious Diseases In Children – Pediatric Annals By Colleen Zacharyczuk Pediatric SuperSite Friday, April 24, 2009 Health officials are contacting hundreds of people to assess their risk for contracting measles after two separate outbreaks of the disease in Maryland and Pennsylvania. Both outbreaks are believed to have started with unvaccinated travelers from foreign countries. In Montgomery County, Maryland, four patients with measles have been reported since February. The most recent patient was tested for measles this weekend at Shady Grove Hospital. David Paulson, communication director for the Maryland Department of Health and Mental Hygiene, said at this point it is uncertain whether this patient, who at press time was presumed to have measles, is connected to the other three patients – the index case, another adult and an 8-month-old infant. In Allegheny County, Pennsylvania, health officials reported this week that the source of an outbreak there was a traveler from India who arrived in the United States on March 7, 2009. Initial exposures occurred at Children’s Hospital of Pittsburgh. The number of confirmed measles cases in southwestern Pennsylvania now totals six, with additional probable cases awaiting confirmation. State and county investigators from both states have contacted thousands of people who might have been exposed to measles to assess each person’s risk. While most of those exposed have been found to be vaccinated against the disease, some non-immune people have been asked to stay home until they are cleared of risk. Copyright 2009 Infectious Diseases In Children – Pediatric Annals. Missouri measles case reported Associated Press By Jim Salter Bellville News Democrat (Southwestern Illinois and the St. Louis region) Friday, April 24, 2009 An eastern Missouri resident contracted the measles after attending a meeting in Maryland, health officials from both states said Friday. Health authorities, citing privacy laws, declined to name the person or release details about his or her condition. Measles, once a common childhood illness, has been largely wiped out in the U.S. thanks to vaccinations. Missouri has reported just four cases over the past four years, state health department spokesman Kit Wagar said. But for those who do get it, especially adults, the viral illness can be serious, even fatal. Symptoms include a telltale red rash, along with high fever, watery eyes, a runny nose and a cough. Wagar said the department is hopeful this is the only case resulting from the Maryland exposure. "We've alerted public health agencies to be on the lookout for this," he said. "Also, we're tracking down every Missouri resident who was at that meeting to look for it." The Missourian came down with the disease in Chevy Chase, Md., earlier this month, said David Paulson, a spokesman for the Maryland Department of Health and Mental Hygiene. Paulson said the Missourian is part of an organization that was meeting in the same building as a local church in Chevy Chase. A church member had the measles but didn't know it at the time. The disease is highly contagious, and the Missourian contracted it simply by being in the same building. "You cough into a room and within minutes the air is highly infectious, and it remains infectious for hours after the individual leaves," Paulson said. Six other recent cases of measles have been confirmed in Washington, D.C., and its Virginia and Maryland suburbs, all apparently after an infected man and his wife, who may also be infected, visited several public places earlier this month. But Paulson said officials don't believe the Chevy Chase measles case is connected to the others. Health officials, citing confidentiality laws, declined to name the organization that was meeting in Chevy Chase. Wagar said 620 adults and young people who are part of the organization were potentially exposed to measles at the meeting. However, because most people are vaccinated, officials are hopeful no one else will come down with the illness. It wasn't clear how many of those people are from Missouri. Missouri health officials caution anyone who believes they have measles symptoms to call a health care facility before going there because the sick person will need to be kept away from others. Tom Skinner, a spokesman for the Centers for Disease Control and Prevention in Atlanta, said 140 cases of measles were confirmed last year in the U.S. Illinois had the most with 33; Missouri had one. So far this year, there have been 22 confirmed cases. © 2007 Belleville News-Democrat and wire service sources. All Rights Reserved. Human Contact Spreading Mutated Strain of Swine Flu CDC Expects Number of Cases to Rise EIN News Online Friday, April 24, 2009 WASHINGTON, April 24 - /EIN NEWS/ An unusual strain of swine flu has infected seven people Texas and Southern California, and the CDC believes that, unlike many animal-borne illnesses, this virus can spread from person to person. According to the CDC's Nancy Cox, the virus appears to be a mixture of the swine, avian and human strains of influenza. This mutant virus cropping up near the Mexican border comes on the heels of a mystery respiratory illness in Mexico that has baffled the health community. More than 20 people have died from influenza in Mexico, forcing Mexico City to cancel school for millions of children. Is the world watching the start of a flu pandemic? And its starting point: North America? If not, the mutation of such viruses and spread within the human population is cause enough for alarm. Learn more about this breaking story from the EIN News team on these news sections: -- Latest news from Healthcare Industry Today - http://health.einnews.com -- Latest swine flu pandemic news - http://health.einnews.com/news/swine-flu-pandemic -- Latest H1N1 flu virus news - http://health.einnews.com/news/h1n1-flu-virus -- Latest Mexico flu news - http://health.einnews.com/news/mexico-flu Copyright 2009 EIN News online. Are ‘working families' really session's winners? By Barry Rascovar The Gazette Friday, April 24, 2009 The 2009 General Assembly session proved to be a mixed bag for Gov. Martin O'Malley. He won far more bills than he lost, but he was miffed by the ones that got away. He avoided tax increases, program cutbacks and layoffs in his spending plan, but he postponed tough decisions on the state's gaping structural deficit that will exceed $2 billion by 2011. His propaganda machine couched this session's achievements as victories for "working families." That was O'Malley's constant theme. Indeed, by session's end you half-expected him to justify his bill to seize Maryland's thoroughbred race tracks on the basis that it would save the jobs of working men and women. The governor showed great flexibility this session. He allowed lawmakers to amendment - and in some cases grotesquely distort - his bills. He didn't protest. Instead, O'Malley took credit for the passage of these greatly emaciated measures. Take approval of a bill designed to repeal the state's death penalty. In its final form, the bill fails to accomplish that goal. The death penalty is still on the books. It just will be harder for prosecutors to meet the new, higher standards for a death sentence. Still, O'Malley declared victory. He loudly proclaimed that he had triumphed. The governor also submitted a package of environmental bills to give the state greater power over local zoning decisions. The bills failed to make much headway, but he called this a win anyway. O'Malley's bill to create a two-tier drivers license system for illegal immigrants received a major facelift that takes the state in a totally different direction. Yet O'Malley told lawmakers he'd sign anything they passed. He then crowed about the final product. Tallying up the session, O'Malley got much of what he wanted from lawmakers. That's not surprising given the heavy Democratic majority in both chambers. In a one-party state like Maryland, a Democratic governor's wishes are almost always granted. It also helped that the governor didn't ask for much. The recession robbed O'Malley of the funds he needed for an expansive agenda and he knew it was the wrong time to seek higher taxes. So he kept big-ticket items off his 2009 legislative shopping list. Legislators did buck the governor a few times. By one vote, the Senate killed his request for a False Claims Act that would legalize the targeting of doctors and hospitals by bounty hunters on the prowl for Medicaid fraud. On another bill, a House panel overwhelmingly killed O'Malley's attempt to end consumer choice when it comes to shopping for lower electric rates. In each case, the governor reacted badly to criticism and defeat. He was so irritated hospitals and physicians fought his bounty-hunter fraud bill that he stripped $30 million out of the budget in Medicaid payments earmarked for those two groups. Then he vowed to resubmit the bill next year. On electric rates, O'Malley mocked the House Economic Matters Committee for voting nearly unanimously to kill his electric re-regulation bill. They knew the subject matter, he said. There was no excuse for not passing the bill. They can read, can't they? His snide remarks won't endear O'Malley to those legislators. Their skepticism of the electric re-regulation bill was justified. Delegates were slighted by the governor, who shut them out of substantive discussions about this measure. Besides, there are plenty of unanswered questions that deserve a full airing before the next legislative gathering in January. By then, the electric supply picture may look quite different since Maryland finally is moving toward a competitive marketplace for residential power rates. That is precisely the point those delegates were trying to make in rejecting the governor's bill: Let's not rush back into a non-competitive, government controlled environment for power rates just as more homeowners start saving up to 15 percent on their electric bills by shopping around. Re-regulation could turn out to be politically foolish. Nevertheless, O'Malley was not amused by the bill's failure. He vowed to resubmit the measure in 2010. This governor takes offense when his proposals are rejected. He has a tendency to pillory those who get in his way. He can hold a grudge, too, if he is opposed. It didn't happen very often over the course of the 90-day session, though. Democrats remain unified behind their governor. They don't want him to fail. It's the polar opposite of how Democrats in the legislature dealt with O'Malley's predecessor, Republican Bob Ehrlich. Now the governor once again has Annapolis to himself. He gets the chance to monopolize the state's media and to do what he is best at: campaigning. Rest assured we will hear lots more about O'Malley's efforts to help "working families" weather this recession. It has been his constant theme, one he hopes will bring him a second term as governor a year and a half from now. Barry Rascovar is a communications consultant and veteran State House columnist. His e-mail address is brascovar@hotmail.com. Copyright © 2009 Post-Newsweek Media, Inc./Gazette.Net. Catania, Director Fighting Over AIDS Clinic Mission Funding, Expansion Beyond Gay Base at Issue By Tim Craig Washington Post Friday, April 24, 2009 As the District struggles to respond to an HIV/AIDS epidemic, a nasty fight is underway between a powerful member of the D.C. Council and leaders of the Whitman-Walker Clinic, which has been on the front lines of fighting the disease for three decades. The battle between the clinic and council member David A. Catania (I), the openly gay chairman of the Health Committee, reflects the challenges city leaders and health providers face in working together to combat a disease that Mayor Adrian M. Fenty (D) calls the No. 1 public health threat. The flap centers on Whitman-Walker's efforts to expand into a full-service health-care provider as it struggles with declining revenues. Concerned that the clinic is abandoning its historical ties to the city's gay community, Catania alleges that the clinic is mismanaged and could close because it is failing to tap new sources of revenue. In preparation for a council hearing Monday, Whitman-Walker turned over 2,000 documents to Catania, who promises "to explore substantial allegations of mismanagement." At a January council hearing, Catania accused Donald Blanchon, the clinic's chief executive officer, of "gross negligence and malfeasance" and suggested he be replaced. Whitman-Walker's board of directors, which has rallied around Blanchon, was so shaken by the hearing that it asked for an independent audit of Catania's charges. The 300-page report, a copy of which was obtained by The Washington Post, refutes many of Catania's allegations. Catania calls it a "total whitewash" conducted by the law firm of Arnold & Porter LLP, where James J. Sandman, chairman of Whitman-Walker's board of directors, used to work. Yesterday, Sandman resigned rather than testify before Catania's committee. The chief counsel for the D.C. public school system, Sandman wrote in a letter to Catania that he wants to "avoid any potential conflict of interest." He could not be reached for comment. Blanchon and some Whitman-Walker board members accuse Catania of punishing the clinic after it laid off several of his friends "We are supposed to be fighting HIV/AIDS in this city, and there is no good reason this [investigation] is continuing," said Paul Murphy, a clinic board member. "I do believe this has reached a point now where this is a vendetta." Catania, who says he has directed more than $6 million in city funds to the clinic in recent years, dismissed the notion. "My feelings toward Mr. Blanchon are not personal; they are professional," he said, adding that fundraising has dropped 57 percent since Blanchon took over. The clinic-sponsored report says Whitman-Walker, incorporated in 1978, is evolving as the nature of HIV/AIDS changes in the city. When Whitman-Walker began responding to the AIDS epidemic in the 1980s, the disease largely afflicted gay white men. HIV/AIDs is now a citywide epidemic. Last month, city health officials released a report that least 3 percent of residents have HIV/AIDS, which it called a "severe epidemic." Black men, with an infection rate of nearly 7 percent, carry the weight of the disease. Nearly 3 percent of black women and white men have the disease, according to the report. "We see a whole bunch of people in the District of Columbia -- gay, straight, black, white -- now at risk, and our job is we need to retool how we talk about this," Blanchon said in an interview. Efforts to broaden its health services come as the clinic, which relies on private donations and state and local subsidies, has been battered by financial turmoil that almost forced it to close in 2005. Blanchon, the clinic's first heterosexual director, took over in 2006. A few months later, he started transitioning the clinic into a federally approved health center. But its financial hurdles continued, including a steep drop in its fundraising. As a result, the clinic curtailed or eliminated several programs that were targeted exclusively at the gay community. It also closed satellite centers in Northern Virginia and Maryland. In December, Whitman-Walker laid off 45 employees, including three senior-level managers who had been with the organization for more than a decade. In January, Catania suggested that Blanchon laid off the three managers because they are lesbians, which he said underscores his assertion that the clinic is turning its back on the gay community. "No one is suggesting you can't expand the mission of the clinic to the non-GLBT community, but what many of us feel is happening is in the effort to expand, that is really just a guise . . . that the real intent is to extinguish the GLBT influence," Catania said. Blanchon said it was "preposterous" to suggest that sexual orientation played a role in the layoffs, saying they were aimed at "administrative and management overhead." Council member Yvette M. Alexander (D-Ward 7), who sits on the Health Committee, said she is puzzled by the controversy. "I have read the report . . . and they seem to be doing a great job," she said. But one of the women laid off the week before Christmas, Pat Hawkins, says the clinic has lost its focus. "Mr. Blanchon has a whole different vision for what the clinic should be, and those of us in the GLBT community are heartbroken," said Hawkins, who started volunteering at the clinic in 1984 and eventually became its associate executive director. Council member Jim Graham (D-Ward 1), who is gay, headed the clinic from 1984 to 1999 and said "recent decisions by Whitman-Walker have been very problematic." "I think whether or not the clinic is being properly managed is a very appropriate question for the D.C. government, which has invested so much money for so long into the clinic," said Graham, who is requesting that the clinic rehire several laid-off staff members. Catania questions why the clinic shut satellite centers in Maryland and Virginia without first pushing state lawmakers to help subsidize them. He also disagrees with the reduction of staff at the clinic's Max Robinson Center in Southeast Washington, the part of the city at the heart of efforts now to fight HIV/AIDS. Blanchon appears be digging in for a fight. This week, he sent out a mass e-mail urging recipients to call council members and say, "Enough is enough." "Council member Catania is still determined to use his political power to burden us in a political and personal vendetta. . . . We think you would agree that our best efforts should be focused on fighting HIV/AIDS in the District of Columbia," he wrote. Catania said he is fighting for the survival of Whitman-Walker. "This center, and all it has represented for the community, is slipping away," he said. Copyright 2009 Washington Post. Army investigates death in Annapolis Capital News Friday, April 24, 2009 ANNAPOLIS — The Army is investigating the death of a soldier who was pronounced dead at Anne Arundel Medical Center early Thursday morning, Army officials confirmed today. Officials at Fort Belvoir, Va., said the soldier was taken to the hospital by ambulance after a roommate went to check on the soldier. The soldier's name, age and sex are being withheld pending family notification. County police officials said they are not investigating the death and that they do not consider it suspicious. Officials would not give a cause of death. Copyright © 2009 \| Capital Gazette Communications, Inc., Annapolis, Maryland. Parents who lost children to suicide share experiences, advice By Christian Brown Frederick County Gazette Thursday, April 23, 2009 Though it is never easy to bring up suicide with a teenager, it is much easier than living with the thought that you could have done something to prevent it. Two recent suicides - one of a former Urbana Middle School student and one of a Virginia teen with ties to Urbana - prompted PTSA member Liz Breitsameter to organize a presentation on teen suicide Monday night. None of the parents who spoke at the presentation are experts in mental health. Rather, they were sharing their personal experiences with the suicides of their children, and encouraging other parents to talk about suicide just as they would alcohol, drugs or sex. Trish Traylor of Germantown, who lost her son to suicide, said some parents worry that by talking about the issue of suicide, they will be "planting a seed," as if the mere mention might make their children more likely do harm to themselves. Traylor said this is not the case, and reaching out to children about the dangers of suicide will help educate, not harm. "That's a myth," she said. Kim Edmands' 22-year-old son, Bryant, killed himself in May 2006 by jumping off the Monocacy River Bridge on Md. Route 144. This was particularly painful for Edmands because she is trained in suicide prevention, she said. "Sometimes things can be right in front of you," she said. Edmands, of Middletown, urged parents who are worried about behavioral changes in their children to reach out to them. Edmands said the recent murder-suicides of the Billotti-Wood family in Middletown stirred painful memories for her family. But as Sharon Cardarelli of Rockville knows, sometimes there are no signs. Cardarelli, one of the parents who gave the presentation, lost her son, Greg, to suicide. Greg was the victim of an online prank in which two acquaintances pretended to be a girl who was interested in Greg, and persuaded him to share personal information. After months of this charade, they spread this information throughout his school. Overcome with embarrassment, Greg drove his car into a tree, killing himself. "To my knowledge there was nothing I could do," she said. Often those children who are labeled "dark, gothic, or troubled" are considered the most likely to commit suicide. Troy Crites of Rockville, whose daughter, Rachel, committed suicide in 2007, said that is "absolutely not the case." Crites said both his daughter and her best friend, Rachel Smith, were two active, successful students who were well-liked by their peers. Crites said that his daughter had exhibited signs of severe depression - she was undergoing treatment following an earlier suicide attempt - but following improvements in therapy sessions and a positive reaction to anti-depressants, it seemed like Rachel was improving. Then, she and Rachel Smith disappeared after claiming they were going to watch a movie in Georgetown. The pair of women was found dead in Rachel Crites' car on a back road in Loudoun County, Va., after committing suicide by carbon monoxide poisoning. Crites said his daughter's apparent emotional improvement was not reflected in her diary entries. He also said that teens don't commit suicide when they appear to be their most depressed: they don't generally have the energy to do so. He said teens generally kill themselves when they are feeling better. He said adults need to watch their children for signs of depression, such as weight loss, weight gain, or falling behind in school. Also, Crites said it is important to treat depressed children, and to make sure that they stick with it. If a child is prescribed medication for a mental illness, it is vital for parents to ensure that they keep taking it, and to work with psychiatric professionals to make sure the medication is right for the child. "You have to go through multiple medications until you get it tuned into your kid," he said. Urbana Middle School Principal Frank Vetter, who attended the presentation, addressed parental concerns about bullying. The school is piloting a program, called the Olweus Bullying Prevention Program, which empowers children and teachers to do something positive about bullying by reporting instances and intervening with bullies to teach them a better way. Developed in the 1990s by Dan Olweus, a Swedish psychologist, the program encourages the school community to more actively deal with bullying by surveying students to find out where it occurs, and encouraging teachers not to tolerate it, Vetter said. He said there are many people who overcome bullying without committing suicide, and that underlying mental illness might be a more likely cause for those cases of suicide. In those cases, teachers and parents need to be sensitive to signs of mental illness, he said. "We need to be careful when we link bullying to suicide," Vetter said in a phone interview Tuesday. "Ninety percent of people who commit suicide have a diagnosable mental illness." Copyright © 2009 Post-Newsweek Media, Inc./Gazette.Net. *National / International* CDC: Swine flu cases rise to 7 in California and Texas; health officials expand investigation By Mike Stobbe Associated Press Friday, April 24, 2009 ATLANTA (AP) — Health officials are investigating a never-before-seen form of the flu that combines pig, bird and human viruses and which has infected seven people in California and Texas. All the victims recovered, but the cases are a growing medical mystery because it's unclear how they caught the virus. None of the seven people were in contact with pigs, which is how people usually catch swine flu. And only a few were in contact with each other, according to the U.S. Centers for Disease Control and Prevention. Still, health officials said it's not a cause for public alarm: The five in California and two in Texas have all recovered, and testing indicates some mainstream antiviral medications seem to work against the virus. Dr. Anne Schuchat of the CDC said officials believe it can spread human-to-human, which is unusual for a swine flu virus. The CDC is checking people who have been in contact with the seven confirmed cases, who all became ill between late March and mid-April. Because of intensive searching, it's likely health officials will find additional cases, said Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases. CDC officials detected a virus with a unique combination of gene segments that have not been seen in people or pigs before. The bug contains human virus, avian virus from North America and pig viruses from North America, Europe and Asia. Health officials have seen mixes of bird, pig and human virus before, but never such an intercontinental combination with more than one pig virus in the mix. Scientists keep a close eye on flu viruses that emerge from pigs. The animals are considered particularly susceptible to both avian and human viruses and a likely place where the kind of genetic reassortment can take place that might lead to a new form of pandemic flu, said Dr. John Treanor, an infectious disease specialist at the University of Rochester Medical Center. The virus may be something completely new, or it may have been around for a while but was only detected now because of improved lab testing and disease surveillance, CDC officials said. The virus was first detected in two children in southern California — a 10-year-old boy in San Diego County and a 9-year-old girl in neighboring Imperial County. The cases were detected under unusual circumstances. One was seen at a Navy clinic that participates in a specialized disease detection network, and the other was caught through a specialized surveillance system set up in border communities, CDC officials said. On Thursday, investigators said they had discovered five more cases. That includes a father and his teenage daughter in San Diego County, a 41-year-old woman in Imperial County (the only person hospitalized), and two 16-year-old boys who are friends and live in Guadalupe County, Texas, near San Antonio. The Texas cases are especially puzzling. One of the California cases — the 10-year-old boy — traveled to Texas early this month, but that was to Dallas, about 270 miles northeast of San Antonio. He did not travel to the San Antonio area, Schuchat said. The two 16-year-olds had not traveled recently, Texas health officials said. The swine flu's symptoms are like those of the regular flu, mostly involving fever, cough and sore throat, though some of the seven also experienced vomiting and diarrhea. CDC are not calling it an outbreak, a term that suggests ongoing illnesses. It's not known if anyone is getting sick from the virus right now, CDC officials said. It's also not known if the seasonal flu vaccine that Americans got last fall and early this year protects against this type of virus. People should wash their hands and take other customary precautions, CDC officials said. U.S. health officials are consulting with Mexican and Canadian health officials, and the CDC is beginning to receive samples from Mexico for testing, a CDC spokesman said. The ethnicity of the seven confirmed cases was not disclosed. Web link: www.baltimoresun.com/features/health/sns-ap-med-swine-flu,0,5628385.story Copyright 2009 Associated Press. Five more U.S. swine flu cases reported United Press International Friday, April 24, 2009 ATLANTA, April 24 (UPI) -- U.S. health officials say they have discovered five more people infected with swine flu, confirming that it is being spread from person to person. The new cases -- three in California and two in Texas -- brought the total number of U.S. swine flu cases discovered to seven, the federal Centers for Disease Control and Prevention in Atlanta told Friday's Washington Post. CDC officials told the newspaper there is no reason for alarm, but urged vigilance for more cases as they took preliminary steps to produce a vaccine if it becomes necessary. "We don't think this is time for major concern around the country," Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, told reporters. "We are taking steps to know more and stay on top of the situation." CDC scientists were awaiting samples from Mexico, where a respiratory illness has killed as many as 20 people, CNN reported. An agency spokesman would not confirm to the broadcaster if the samples were related to the U.S. swine flu cases, but he said the CDC "understand(s) Canada has samples, and is testing, and has placed a travel alert for travel to Mexico." Web link: http://www.upi.com/Top_News/2009/04/24/UPI-NewsTrack-TopNews/UPI-49061240574304/ Copyright 2009 United Press International. Unusual Strain of Swine Flu Is Found in People in 2 States New York Times By Donald G. McNeil Jr. Published: April 24, 2009 An unusual strain of swine flu is circulating among people in the Southwest but is not known to have caused any deaths, the Centers for Disease Control and Prevention said Thursday. The agency, which has found only seven cases, expects to find more now that it has begun looking intensively for them. “We don’t yet know the extent of the problem,” said Dr. Anne Schuchat, the director of respiratory diseases for the agency, “but we don’t think this is a time for major concern.” Five of the people infected were in Imperial and San Diego Counties in California and two were in San Antonio. They were 9 to 54 years old. None had any contact with pigs, and in two sets of cases - involving a father and daughter and two 16-year-old schoolmates - those infected had contact with each other. That convinced the authorities that the virus was being transmitted from person to person. The seven people were apparently infected from late March to mid-April. Only one was hospitalized, and all recovered. The A (H1N1) flu strain they had was quite unusual, said Dr. Nancy Cox, the chief of the agency’s flu division. It contained gene segments from North American swine, bird and human flu strains as well as one from Eurasian swine. Like some human strains, it is resistant to two older flu drugs, amantadine and rimantadine. It is not resistant to Tamiflu or Relenza. However, Tamiflu resistance is common in the H1N1 human flu strain circulating this year, so the swine strain could become resistant to Tamiflu if the viruses mixed in humans or, possibly, in pigs. Swine flus rarely infect humans. There have been about a dozen cases since 2005, but almost all were in farm workers or others in contact with pigs. In 1976, there was a cluster of swine flu cases among soldiers at Fort Dix, in New Jersey, one of whom died. That led to a rush to make a new vaccine and administer it to 40 million Americans. No epidemic materialized, but thousands of people claimed that the vaccine had given them Guillain-Barré syndrome, which can cause lethargy or paralysis. The episode led to the resignation of the director of the disease control center, and the agency has been wary of causing panic over influenza cases ever since. The unusual strain this year was noticed, Dr. Schuchat said, only because the agency was trying out a new diagnostic test at a Navy laboratory and doing more testing than usual through a new Border Infectious Disease Surveillance Project along the Mexican border. Officials at the public health agency in Canada said their Mexican counterparts had warned them this week of a “relatively high” fatality rate for people in Mexico who have had respiratory illnesses this season, some of whom had tested positive for flu. Asked about that, American officials said they had no information. A spokesman said the disease control center had asked Mexican officials to send samples for testing. The United States flu season is tailing off now. It has been relatively mild; the major surprise had been the widespread Tamiflu resistance in the circulating human H1N1 strain. Dr. Cox of the disease control center said officials did not yet know whether the flu shot this year protected against the new swine strain. Web link: http://www.nytimes.com/2009/04/24/us/24flu.html?ref=us Copyright 2009 New York Times. Investigators in swine flu outbreak look to Mexico CNN Friday, April 24, 2009 (CNN) -- U.S. medical experts investigating a novel swine flu outbreak in California and Texas will examine samples from Mexico, where a respiratory illness has killed at least 20 people. As a precaution to avoid further contamination, schools and universities in Mexico City and the state of Mexico were closed Friday, said National Health Secretary Jose Angel Cordova. He indicated Friday the schools may remain closed for a while. In the United States, seven cases of a previously undetected strain of swine flu have been confirmed in humans, the Centers for Disease Control and Prevention said. All of the patients have recovered, officials said. None of the patients had direct contact with pigs. Five of the cases were found in California, and two in Texas, near San Antonio, said Dr. Anne Schuchat, the CDC's interim deputy director for science and public health program. The Mexican samples will be tested at the centers based in Atlanta, Georgia, spokesman David Daigle told CNN by e-mail. The samples were taken from an affected area just north of Mexico City. Canada also is testing samples from Mexico "and has placed a travel alert for travel to Mexico," Daigle said. The Public Health Agency of Canada issued a respiratory alert for Mexico on Wednesday, recommending that health providers "actively look for cases" in Canada, particularly in people who've returned from Mexico within the last two weeks. An alert issued Friday by the International SOS medical and consulting company said more than 130 cases of a severe respiratory illness have been detected in south and central Mexico, some of which are due to influenza. "Public health officials in Mexico began actively looking for cases of respiratory illness upon noticing that the seasonal peak of influenza extended into April, when cases usually decline in number," the medical alert said. "They found two outbreaks of illness -- one centered around Distrito Federal (Mexico City), involving about 120 cases with 13 deaths. The other is in San Luis Potosi, with 14 cases and four deaths." Authorities also detected one death in Oaxaca, in the south, and two in Baja California Norte, near San Diego, California. The majority of cases are occurring in adults between 25 and 44 years of age. The CDC reported Tuesday that two California children in the San Diego area were infected with a virus called swine influenza A H1N1, whose combination of genes had not been seen before in flu viruses in humans or pigs. The seven patients range from age 9 to 54, the CDC's Schuchat said. "The good news is that all seven of these patients have recovered," she said. The first two cases were picked up through an influenza monitoring program, with stations in San Diego and El Paso, Texas. The program monitors strains and tries to detect new ones before they spread, the CDC said. Other cases emerged through routine and expanded surveillance. The human influenza vaccine's ability to protect against the new swine flu strain is unknown, and studies are ongoing, Schuchat said. There is no danger of contracting the virus from eating pork products, she said. The new virus has genes from North American swine and avian influenza; human influenza; and swine influenza normally found in Asia and Europe, said Nancy Cox, chief of the CDC's Influenza Division. Swine flu is caused by type A influenza, according to the CDC. The virus does not normally infect humans, but cases have occurred among people, especially those with exposure to pigs. There also have been cases of one person spreading swine flu to other people, the CDC said. In 1988, in an apparent swine flu infection among pigs in Wisconsin, there also was evidence of a patient transmitting the virus to health workers, the CDC said. Experts think coughing, sneezing and contaminated surfaces spread the infection among people. From December 2005 to February 2009, 12 human cases of swine flu were documented. Symptoms include fever, lethargy, lack of appetite, coughing, runny nose, sore throat, nausea, vomiting and diarrhea, the CDC said. The new strain of swine flu has resisted some antiviral drugs. The CDC is working with health officials in California and Texas and expects to find more cases, Schuchat said. There's no need for alarm, but people at risk -- those who live in or have visited areas where patients live or have had contact with pigs -- should get tested if they notice symptoms, said Dr. William Short at the division of infectious diseases at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania. A pandemic is defined as: a new virus to which everybody is susceptible; the ability to readily spread from person to person; and wide geographic spread, said Dr. Jay Steinberg, an infectious disease specialist at Emory University Hospital Midtown in Atlanta. The new strain of swine flu meets only one of the criteria: novelty. History indicates that flu pandemics tend to occur once every 20 years or so, so we're due for one, Steinberg said. However, it is not likely to be swine flu, he said. "I can say with 100 percent confidence that a pandemic of a new flu strain will spread in humans," he said. "What I can't say is when it will occur." Web link: http://www.cnn.com/2009/HEALTH/04/24/swine.flu/index.html Copyright 2009 CNN. Bird Flu and Swine Flu Outbreaks: The Health Risks of Hysteria Discover Magazine Friday, April 24, 2009 Egyptian health officials have just reported two deaths from bird flu within days of each other. The dangerous virus variant H5N1 struck down a six-year-old boy and a young woman, bringing the total death toll in Egypt to 25. While bird flu experts note that Egypt has seen a surge in human cases in recent months, with 16 confirmed since the start of the year, compared to seven cases between January 1 and April 17 last year [Reuters], they also say that the Egyptian people’s level of alarm is out of proportion to the threat. Rumors have appeared in the Egyptian media that the virus is circulating widely, and that some people get “silent infections” which show no symptoms, but still allow them to pass on the virus. The rumors have been fueled by the pattern of recent infections: Many of the infected patients have been toddlers, leading to the belief that stronger adults are also infected but simply show no symptoms. Although thousands of Egyptians have rushed their children to hospitals this flu season, there is no evidence yet of asymptomatic avian flu cases or any significant mutation in the H5N1 virus. “Right now, it’s all hot air,” said Dr. Robert G. Webster, a flu expert…. “I hope to hell it’s not happening, because it would mean the virus is adapting to humans. But there’s not a shred of data” [The New York Times]. While the H5N1 virus rarely infects people, the looming fear is that the virus may mutate into a form that can be transmitted easily from person to person, which could spark a deadly pandemic. However, an outbreak of swine flu across the world from Egypt, in Southern California, has reminded people of the hazards of overreacting before all the information is in. Swine flu is found in pigs and very rarely in humans who have direct contact with pigs; the United States reports one human case every one or two years. However, two California children were diagnosed with the disease this spring, sparking an investigation by the Centers for Disease Control. Since neither of the two children, a 10-year-old boy and a 9-year-old girl, had contact with pigs, it “increases the possibility that human-to-human transmission of this new influenza virus has occurred,” according to a CDC report. The girl did attend an agricultural fair four weeks before becoming sick, she said, but did not have any contact with pigs or other livestock [CNN]. The incident has brought back memories of another swine flu outbreak in 1976 among army recruits at Fort Dix, New Jersey, which taught public health officials a tough lesson. That winter, 13 men got sick and one died of what proved to be swine influenza viruses–viruses that were thought to be similar to the one responsible for the 1918 Spanish flu pandemic. U.S. officials ordered the manufacture of swine flu virus vaccine and the country proceeded to launch a mass immunization program that saw upwards of 40 million people injected with the vaccine. The feared pandemic never occurred. But the vaccine appeared to trigger a high level of cases of Guillain-Barre syndrome, a type of paralysis [The Canadian Press], and thousands of vaccine recipients filed injury claims. Copyright 2009 Discover Magazine. 17-Year-Olds to Gain Access to Plan B Pill FDA Approves Nonprescription Sales By Rob Stein Washington Post Thursday, April 23, 2009 The federal government said yesterday that it will allow the sale of the morning-after pill Plan B without a prescription to women as young as 17, a move that would make the contraceptive available to minors for the first time without a doctor's order. The Food and Drug Administration took the action to comply with a judge's ruling last month holding that the agency's 2006 decision to limit availability of the controversial contraceptive to women 18 and older was invalid and politically motivated. In a statement posted on its Web site, the FDA said it had notified the company that makes Plan B that it will approve sales to 17-year-olds at the manufacturer's request -- a request a company spokeswoman said it will make. The FDA's decision was welcomed by women's health and family planning advocates, who had challenged the agency's original decision in federal court. "It's a good indication that the agency will move expeditiously to ensure its policy on Plan B is based solely on science," said Nancy Northup, president of the Center for Reproductive Rights, one of the groups that challenged the FDA's age limitations in court. "It's time the FDA restores confidence in its ability to safeguard the public health and put medical science first." The announcement was condemned by opponents, who questioned Plan B's safety. "This decision is driven by politics, not what is good for patients or minors," said Wendy Wright of Concerned Women for America. "Parents should be furious at the FDA's complete disregard of parental rights and the safety of minors." Plan B consists of higher doses of a hormone found in many standard birth-control pills. Taken within 72 hours of unprotected sex, it has been shown to be highly effective at preventing pregnancy. Barr Pharmaceuticals, which makes Plan B, asked the FDA in 2003 to allow the contraceptive to be sold without a prescription. Advocacy groups and conservative members of Congress opposed the request. They questioned the drug's safety and argued that wider availability could encourage sexual activity and make it easier for men to have sex with underage girls. They also maintain that Plan B can cause the equivalent of an abortion. The FDA delayed its decision for three years even though its outside advisers and internal reviewers endorsed nonprescription sale, leading to criticism that politics influenced the decision. The agency eventually approved nonprescription sale in August 2006, allowing pharmacists to dispense the drug from behind the counter. But the agency said that there was too little safety data to approve the drug for those younger than 18 and that pharmacists would be unable to enforce the age cutoff. But in response to the lawsuit, U.S. District Judge Edward R. Korman in New York instructed the agency on March 23 to make Plan B available to 17-year-olds within 30 days and to reconsider other restrictions, including whether the drug could be made available to all ages. In his 52-page decision, Korman repeatedly criticized the FDA's handling of the issue, agreeing with allegations in the lawsuit that the original decision was "arbitrary and capricious" and influenced by "political and ideological" considerations of the Bush administration. It remains unclear, however, if the agency will review whether Plan B should be available to those younger than 17. Suzanne Novak, a senior staff attorney at the Center for Reproductive Rights, said the FDA was required to review all restrictions. "It has to do it," she said. "They are under court order." But government health officials said the agency would consider other issues only if requested by the company, and Denise Bradley of Teva Pharmaceuticals, which owns Barr, said the company has no plans to market Plan B to anyone younger than 17. Copyright 2009 Washington Post. When the Medical Bills Swell, Seize Control By Lesley Alderman New York Times Friday, April 24, 2009 Medical bills have a way of piling up - especially when you’re sick or underinsured. Just ask Kirk Kupka, 48, and his wife, Susie, 53. Mr. Kupka has multiple sclerosis. The Kupkas, who live in Lindstrom, Minn., have an annual income of $45,000 - a combination of her salary as an office manager and his disability payments. More than 20 percent of that income goes toward health care. Their annual insurance premiums total $5,400, and then there’s the $4,000 Mr. Kupka spends on drugs, doctor’s visits and lab fees before he fulfills his policy’s deductible. In the three years since Mr. Kupka’s disability forced him to stop working as a mental health therapist, he has accumulated $12,000 in debt. “It’s frustrating,” he says. “We earn too much to qualify for state and county assistance, but not enough to stay ahead of the bills. I’ve thought maybe my wife and I should get divorced. But not only is it against our faith, it turns out it wouldn’t help.” Medical debt can lead to drastic measures, forcing people to raid their 401(k)s, tap into home equity lines and, in some cases, declare bankruptcy. Surveys by the Commonwealth Fund, a nonprofit health care research foundation, found that 41 percent of adults said they were struggling to pay their health care bills in 2007, up from 34 percent in 2005. That percentage is almost surely growing. And as Mr. Kupka’s situation illustrates, it’s not just uninsured patients who rack up large bills. Nearly two-thirds of those with debt problems, according to Commonwealth, had health insurance. But insurance covers less and less these days, as employers continue shifting more health care costs to their employees, and as consumers resort to lower-cost plans that come with high deductibles or less generous benefits. “People who have been faithfully paying insurance premiums for years are coming in with medical bills they can’t pay,” said Gail Cunningham, a spokeswoman for the National Foundation for Credit Counseling, an umbrella group for services that help consumers cope with debt. But if you’re having trouble paying your medical bills, you’re not helpless, either. There are ways to reduce, or at least more effectively manage, medical debt. CONFRONT, DON’T IGNORE Procrastinating only leads to trouble. If your bills are turned over to a collection agency, the debt goes on your credit report and will remain there for lenders, and even potential employers, to see. You may have difficulty getting a loan and, if you do get one, you’ll be charged higher rates. So take action - even if that doesn’t mean writing any checks right away. Proceed to Step 2: SCRUTINIZE YOUR BILLS Look over your outstanding bills and make sure the listed services actually square with the care you received. Errors are common. If terms or procedures confuse you, call the hospital’s or doctor’s billing department and ask for an explanation. If your insurer denied one or more of your claims, resubmit the bills, advises Mark Rukavina, executive director of the Access Project (www.accessproject.org), a nonprofit group in Boston that helps consumers cope with medical debt. “If that doesn’t work, file a formal grievance or appeal with the insurer,” Mr. Rukavina said. “Even it that fails, most states allow insured patients the right to an external review by a certified third party, often a state agency. And patients should exercise this right.” HIRE AN EXPERT Try first to negotiate with your providers for a discount or an extended payment plan. Explain that you simply can’t pay your bills in full right now, and you need some leeway. If this tactic doesn’t work, or you don’t have the time or energy to haggle, consider hiring a billing specialist - a professional trained to spot errors who speaks the language that medical providers understand and respond to. (You can find a medical mediator at the Medical Billing Advocates of America Web site, www.billadvocates.com). Some billing experts charge only if they save you money, others may ask for a retainer up front. Make sure you clarify the terms at the outset. BE WARY OF PLASTIC It’s tempting to get rid of your medical debts by paying them off with a credit card. But if you don’t pay off your card balance swiftly, a $1,200 doctor’s fee could balloon to $1,500 or more over the course of a year. Your large debts might also cause a rate increase on other lines of credit. And while medical debt on your credit report is often viewed with some sympathy, credit card debt is not. If a hospital offers you a medical credit card at zero percent interest, be skeptical, warns Ms. Cunningham of the credit counseling foundation. The rate typically jumps to double-digit interest if you miss a payment. SET BOUNDARIES WITH COLLECTORS If your debts are turned over to a collection agency, you do have rights. “Debt collectors can be very aggressive and frightening,” says Tena Friery of the Privacy Rights Clearinghouse, a nonprofit consumer advocacy organization. “If they call, ask for the name of the caller, and insist that they send you in writing the name of the collector and the amount you owe.” According to federal law, a collector can call only between 8 a.m. and 9 p.m. They cannot threaten you with a lawsuit just to scare you into paying the debt. And they can’t garnish your wages, unless they take you to court and win. For a guide to debt collection, see the Privacy Rights Clearinghouse’s Web site, www.privacyrights.org/fs/fs27-debtcoll.htm. If a collector is harassing you, you can file a formal complaint with the Federal Trade Commission. And many states have their own consumer protection laws on medical debt. And Next Time... LEARN YOUR POLICY’S RULES. Study your plan’s Explanation of Benefits carefully so you won’t be blindsided by unexpected charges. “Not knowing is what gets people in the most trouble,” says Arden Lee Taber, a lead negotiator for HealthCare Mediation, a mediation firm based in Austin, Tex. He handles hundreds of billing disputes each year. KEEP A DIARY. Write down every instance of medical care you receive - all exams, tests, medications and procedures. This will help you or a mediator when reviewing your bills. NEGOTIATE BEFOREHAND. If possible, discuss ahead of time the fees you will be charged for a procedure, test or exam. If you expect difficulty paying, ask about price breaks. “You can often get discounts of up to 50 percent if you offer to pay right away,” says Mr. Rukavina. “We’re seeing more flexibility these days on the part of providers. Everyone wants to avoid the collection process.” Copyright 2009 The New York Times Company. As Insurance Coverage Increases, ERs Get Busier By Jacob Goldstein Wall Street Journal Friday, April 24, 2009 emergency roomVisits to Massachusetts emergency rooms appear to have increased in the aftermath of the state’s push toward universal health insurance. The news is the latest blow to the popular idea that ERs are crowded with the uninsured. The number of trips to the ER rose by 7% between 2005 and 2007, the Boston Globe reports this morning. The state’s universal health insurance mandate went into effect in 2006. State officials caution that it’s too soon to say whether there’s a cause-and-effect relationship, or whether this is just a coincidence. But preliminary data for six Boston hospitals also show a rise in ER visits between 2006 and 2008, the Globe says. In an analysis published last year in the Annals of Emergency Medicine, researchers found overall visits to the ER increased by 26% nationwide between 1996 and 2004. A disproportionate share of the growth came from those whose incomes put them at more than four times the poverty level, and who typically get their care at a doctor’s office. The percentage of uninsured ER patients remained flat, at roughly 15%. “Focusing the political debate and the health-care debate about the overuse and sometimes the ‘abuse’ of emergency departments by the poor and the uninsured is really missing the point,” the study’s author told the Health Blog last year. Instead, he and his colleagues suggested, many of those in the ER are patients who can’t get in to see their primary-care doctor for a routine complaint. And, as we noted last fall, the increase in insurance coverage in Massachusetts has coincided with longer waits to see primary care doctors and a decline in the number of practices accepting new patients. This has important implications for the national health-reform push. If you give everyone insurance, there are going to be more people trying to get in to see primary-care doctors — and, perhaps, heading to the emergency room when they can’t get an appointment. Copyright 2008 Dow Jones & Company, Inc. All Rights Reserved. *Opinion* --- BACK TO TOP


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