Monday, August 10, 2009

News Clipping Archives

 

 

Maryland / Regional

Code Red for today, tomorrow (Baltimore Sun)

Volunteers arrive at UM center for swine flu vaccine trials (Baltimore Sun)

Ganglion cysts can be easily removed (Baltimore Sun)

 

National / International

Preparing for Swine Flu's Return (Washington Post)

In Reversal, Highly Developed Nations See Rise in Fertility (Washington Post)

Can We Fight Obesity by Slapping a Heavy Tax on Soda? (Washington Post)

A Day in the Life of a Family Doctor (New York Times)

Mentally Ill Offenders Strain Juvenile System (New York Times)

 

Opinion

The power of suggestion (Baltimore Sun Editorial)

Ending homelessness in Baltimore (Baltimore Sun Editorial)

Swine Flu and Schools (Washington Post Editorial)

STD Tests at High School? (Washington Post Letter to the Editor)

Medicare Drug Costs (New York Times Letter to the Editor)

 

 

Maryland / Regional

Code Red for today, tomorrow

Cooling centers open around city; those at risk urged to stay indoors as heat, humidity return

 

By Joe Burris

Baltimore Sun

Monday, August 10, 2009

 

With some of the highest temperatures of the summer predicted through Tuesday, Baltimore city's health department issued the year's first Code Red Heat Alert and announced Sunday that the city will open emergency cooling centers and provide free bus passes to help residents seek shelter from the heat.

 

Interim Health Commissioner Olivia D. Farrow declared the alert after the National Weather Service forecast a potentially hazardous combination of high temperatures and humidity for the next two days. Spokesman Brian Schleter said that the city's last heat alert before this was Sept. 14.

 

The weather service issued a heat advisory for the Baltimore-Washington area from noon to 10 p.m. today. The service's Web site said that temperatures will rise into the 90s throughout the area by noon and reach the upper 90s by afternoon. The high temperatures, combined with relative humidity near 50 percent, will create several hours of heat indices near 105 this afternoon, making heat illnesses possible, it said.

 

Today is also forecast to be a "Code Orange" day for air quality, meaning ozone pollution could reach unhealthy levels for sensitive people, including children and those with heart or lung problems. Clean Air Partners, a Washington-based nonprofit group distributing air-quality information for local and state governments, urged such people to limit their time outdoors.

 

On Tuesday, air quality is expected to return to Code Yellow, meaning ozone pollution levels pose a risk only to highly sensitive individuals, the group says. The weather service predicts it will be cloudy that day, with a high of 94 and 40 percent chance of rain.

 

The city housing department will maintain air-conditioned cooling shelters on both days, with water and ice available at six community centers. They are open from 9 a.m. to 7 p.m.

 

The sites are: Northern Community Action Center, 5225 York Road; Southern Community Action Center, 606 Cherry Hill Road (inside the shopping center's second floor); Northwest Community Action Center, 3314 Ayrdale Ave.; Western Community Action Center, 1133 Pennsylvania Ave.; Southeastern Community Action Center, 3411 Bank St.; and Eastern Community Action Center, 1400 E. Federal St.

 

Another five cooling centers will be run by the Commission on Aging at these sites: Waxter Center, 1000 Cathedral St.; Oliver Center, 1700 Gay St.; Sandtown-Winchester Center, 1601 Baker St.; Hatton Center, 2825 Fait Ave.; and John Booth Senior Center, 229 1/2 S. Eaton St.

 

In addition, residents can go to recreation and parks centers throughout the city for relief from the heat.

 

The Maryland Transit Administration plans to distribute passes good for one free bus trip on Code Red heat alert days. The passes are available at emergency departments, social service agencies, churches, cooling centers and other venues. City residents concerned about their neighbors also can request them from local fire stations.

 

"The Fire Department ... will have extra medics available on the street," Farrow said. "We really want to get the message out for people to look for friends and neighbors who don't have air conditioning."

 

Farrow said that residents should take precautions during the heat wave: Drink plenty of water or juice, avoid alcohol and caffeine, wipe skin with cool water as needed, reduce outside activities, wear lightweight and light-colored clothing, and stay inside during the hottest time of day. Also, watch for signs of heat exhaustion and heat stroke, including nausea, light-headedness and high body temperature with cool and clammy skin.

 

Copyright © 2009 The Baltimore Sun.

 

Volunteers arrive at UM center for swine flu vaccine trials

First human tests set to fight virus that has contributed to deaths of 5 in state

 

By Kelly Brewington

Baltimore Sun

Monday, August 10, 2009

 

Kevin Stranen left his home in Philadelphia at 5 a.m. Monday, eager to make it to Baltimore to roll up his sleeve for the University of Maryland Medical Center's swine flu vaccine trial.

 

The biochemist and seasoned vaccine volunteer jumped at the chance to participate in the first human tests of the H1N1 vaccine. Just last month, he had his blood drawn at the medical center as a participant in its bird flu vaccine trial. While his drinking buddies think he's "a bit wacky" for offering up himself as a test subject, he insists that the benefits outweigh the risks and that everyone ought to be concerned about swine flu this fall.

 

"Without testing the efficacy and safety, we can't say for sure what this will do," he said. "As a biochemist, I know the importance of this, so I'd feel a little hypocritical not being a part of it."

 

Stranen was among 47 adult volunteers who began arriving at the medical center as early as 7 a.m. for the first wave of trials for a new vaccine to fight the H1N1 virus -- the first step in what could be a mass vaccination campaign this fall. The University of Maryland is one of nine testing sites nationwide launching tests in adults and children to determine if the vaccine is safe and effective in fighting the pandemic -- which has claimed some 436 lives in the United States, including five in Maryland -- and sickened as many as 1 million, according to estimates by the Centers for Disease Control and Prevention.

 

Copyright © 2009, The Baltimore Sun.

 

Ganglion cysts can be easily removed

 

Expert advice

Baltimore Sun

Monday, August 10, 2009

 

A ganglion cyst is an abnormal growth or mass adjacent to any joint in the body. It is most commonly seen around the wrist or digits, but can develop near the shoulder, knee or foot. Depending on the location of the cyst, various names have been used to describe the mass. A ganglion adjacent to the nail of the finger is called a mucous cyst, and one behind the knee is called a Baker's cyst.

 

Dr. Keith Segalman, hand surgeon at the Curtis National Hand Center at Union Memorial Hospital in Baltimore, discusses what to do about this kind of inflammation:

 

•A ganglion cyst is the most common tumor or growth that occurs in the hand and wrist. It is a benign lesion, and the most common location is on the back side of the wrist. A ganglion arises because of inflammation within the joint. Inflammation can arise from overuse, arthritis or underlying medical conditions. Ganglions can be confused with aneurysms of the artery in the wrist, chronic infections or very rarely a cancerous process.

 

•Adolescents are the most common patients with a ganglion cyst, but they can be seen in patients of all ages. Patients with ganglion cysts typically have only one lesion, but some people seem to be predisposed to having them in multiple locations. Patients may describe increasing stress on the individual joint prior to the onset of symptoms, such as weight lifting, push ups or gardening, but for most people we never know the cause.

 

•The patient will notice a mass, growth or "knot." The mass typically will vary in size and can cause some discomfort but rarely causes true pain. There may be some stiffness in the involved joint and rarely some numbness in the hand if the ganglion is in the wrist. Most of the time, an X-ray is taken to ensure that the ganglion is not arising from some underlying joint problem such as arthritis or a ligament tear.

 

•Treatment for ganglions ranges from splinting to aspiration and injection to surgical removal. Since most ganglions arise from overuse of the joint, resting the joint with a protective splint will allow the mass to resolve. For a wrist ganglion, splinting in a "cock-up" wrist splint at night will relieve the symptoms.

 

If the symptoms do not improve, the ganglion can be aspirated. Aspirations are helpful to confirm the diagnosis and relieve the symptoms, but the ganglion will recur if the patient doesn't modify the activity that causes the symptoms.

 

The indications for removal include recurrence, enlarging size and progressive pain. The procedure is done as an outpatient under general or regional anesthesia. Usually, the wrist is splinted for about 10 days and then motion is begun. Depending on the location of the cyst, recovery can take four to six weeks.

 

•If the ganglion is removed, the recurrence rate is about 5 percent. The biggest reason for the ganglion to recur is that the surgeon does not use adequate anesthesia to allow him or her to dissect down to the capsule or "root." For this reason, ganglions should be removed only by those trained in the area of the body in which they arise. Other complications include persistent stiffness in the joint. Because of the stiffness, many patients will require therapy after surgery. Rarely seen complications include infection, pain, some numbness around the incision and arterial injury.

 

Copyright © 2009, The Baltimore Sun.

 

National / International

Preparing for Swine Flu's Return

New Wave Expected After Virus Flourished in Southern Hemisphere

 

By Rob Stein

Washington Post

Monday, August 10, 2009

 

As the first influenza pandemic in 41 years has spread during the Southern Hemisphere's winter over the past few months, the United States and other northern countries have been racing to prepare for a second wave of swine flu virus.

 

At the same time, international health authorities have become increasingly alarmed about the new virus's arrival in the poorest, least-prepared parts of the world.

 

While flu viruses are notoriously capricious, making any firm predictions impossible, a new round could hit the Northern Hemisphere within weeks and lead to major disruptions in schools, workplaces and hospitals, according to U.S. and international health officials.

 

"The virus is still around and ready to explode," said William Schaffner, an influenza expert at the Vanderbilt University School of Medicine who advises federal health officials. "We're potentially looking at a very big mess."

 

President Obama arrived in Mexico on Sunday for a two-day summit that will include discussions on swine flu, along with Mexico's drug wars, border security, immigration reform and economic recovery.

 

"Everyone recognizes that H1N1 is going to be a challenge for all of us, and there are people who are going to be getting sick in the fall and die," said John O. Brennan, the U.S. deputy national security adviser for counterterrorism and homeland security. "The strategy and the effort on the part of the governments is to make sure we . . . collaborate to minimize the impact."

 

Since emerging last spring in Mexico, the virus, known as H1N1, has spread to at least 168 countries, causing more than 162,000 confirmed cases and playing a role in at least 1,154 deaths, including 436 in the United States.

 

Scientists have been closely monitoring the flu's spread for clues to how much of a threat it might pose this fall. So far, no signs have emerged that the virus has mutated into a more dangerous form. Most people who become infected seem to experience relatively mild illness.

 

Still, the virus has caused major outbreaks involving a disproportionate number of younger people in Australia, New Zealand, Argentina and other countries, prompting schools to close, causing theaters to shut down, and straining some emergency rooms and intensive care units, sometimes forcing doctors to postpone other care, such as elective surgeries.

 

Swine flu has also begun to spread in South Africa, where at least two deaths have been reported; the national laboratory, meanwhile, was overwhelmed last week with samples that needed testing. In India, a 14-year-old girl became the first person to die from the disease in that densely populated nation.

 

In Britain, meanwhile, where anxiety was increasing because of high-profile cases including "Harry Potter" films actor Rupert Grint, health officials were trying to determine the cause of a sharp rise in reported cases in recent weeks.

 

"This is something that we could see here soon," said Arnold S. Monto, a University of Michigan infectious-disease expert who advises the World Health Organization, the U.S. Centers for Disease Control and Prevention, and other federal health agencies. He noted that some emergency rooms were overwhelmed by last spring's outbreak in New York City. "We have to be worried about our ability to handle a surge of severe cases."

 

Concern about a second wave has prompted a flurry of activity by federal, state and local officials, including intensifying flu virus monitoring and making plans to distribute vaccine and antiviral drugs and other treatments if necessary.

 

"There's a lot of moving parts to this," said Joseph S. Bresee, who heads the CDC's influenza epidemiology and prevention branch. "Hopefully we won't have a panic, but instead we'll have the appropriate level of concern and response."

 

The Obama administration has been updating recommendations for when to close schools, what parents should do if their children get sick, how doctors should care for patients and how businesses should respond to large-scale absences. Officials are hoping to navigate a fine line, urging precautions to minimize spread, serious illness and deaths while avoiding undue alarm and misinformation.

 

"The last time we had anything similar to this was prior to the Internet," said one senior official who spoke on the condition of anonymity last week during one of a series of background briefings for reporters.

 

A Gathering Storm

 

The virus could cause nothing more than a typical flu season for the Northern Hemisphere this winter. But many experts suspect the second wave could be more severe than an average flu season, which hospitalizes an estimated 200,000 Americans and contributes to 36,000 deaths. Because the virus is new, most people are not immune to it.

 

"This epidemic will transmit faster than usual, because the population is more susceptible," said Marc Lipsitch, a professor of epidemiology at the Harvard School of Public Health who has been helping the CDC project the severity of the upcoming wave. "It's fair to say there will be tens of millions of illnesses and hundreds of thousands of hospitalizations, and tens of thousands of deaths. That's not atypical. It just depends on how many tens of thousands."

 

Perhaps more important, in every country where the virus has spread, it has continued to affect children and young adults much more commonly than typical flu viruses.

 

"In a pandemic where a greater fraction of illness and deaths occur in kids and young adults, that will be clearly noticeable to the public. There will be a sense that this is a greater severity of illness even if fewer people die overall," the CDC's Bresee said.

 

Most of those who have developed serious illness and died have had other health problems. But those include many common conditions, such as diabetes, asthma and obesity. Pregnant women appear to be especially at risk. And the virus can cause severe illness and death in otherwise healthy people in perhaps a third of cases.

 

The virus continued to simmer in the United States over the summer, causing more than 80 outbreaks in camps in more than 40 states. Officials estimate that more than 1 million Americans have been infected.

 

The number of cases could increase rapidly as soon as schools begin to reopen in the next few weeks and could accelerate further as cooler, drier temperatures return, possibly peaking in October.

 

That is much earlier than the usual flu season, and it could create confusion. People could start becoming sick with the swine flu before a vaccine is widely available and nonetheless be urged to get the regular seasonal flu vaccine, which will be available first. Because different groups are being given priority for the different vaccines, officials are concerned it could be difficult to make sure the right people get the vaccine at the right time to provide optimal protection. The elderly are a top priority for the seasonal vaccine, but not for the swine flu vaccine.

 

The first batches of swine flu vaccine are not expected to become available until mid-October, assuming studies indicate it is safe and effective. And officials have yet to answer many key questions, including how many doses will be needed. If it is two, as many suspect, it could take at least five weeks after the first shot before vaccinated people are fully protected.

 

 Southern Hemisphere

 

In the Southern Hemisphere, which experiences winter during the Northern Hemisphere's summer, the swine flu virus caused a more intense and somewhat earlier flu season in some places. In Argentina, which was hit particularly hard, school breaks were extended and the economy suffered as people avoided restaurants, clubs and other public places.

 

"There was panic and I felt it, too," said Cristina Malaga, a maid in Buenos Aires who stayed home for a week in July out of fear. "I was scared. It is three buses to get to work and there were many people on those buses who are coughing."

 

At the Gutiérrez Children's Hospital, officials set up a trailer with specially outfitted examination rooms to help deal with the influx of sick people.

 

"The system did not collapse, because we prepared special units for outpatients and for inpatients," said Eduardo López, who heads the hospital's medical department.

 

Paula Morey, a housewife who lives in an affluent neighborhood in Buenos Aires, said she and friends stopped sharing the national tea, which is served in a communal gourd. Now, she said, they bring their own gourd. Morey also began cleaning her 4-year-old daughter's hands constantly and carrying a tube of disinfectant to dab on the moment she touches anything like a doorknob.

 

"She had to learn to take care of herself," Morey said.

 

Greater Concerns

 

The appearance of the virus in countries such as South Africa and India is raising concern that the pandemic could be devastating if it begins to sicken large numbers of people in places with fewer resources.

 

"These are countries with vulnerable populations and fragile health-care systems," said Nikki Shindo, acting head of the WHO's influenza program.

 

Indian doctors and health officials were scrambling last week to prepare for a sharp increase in cases. Despite well-run clinics for the wealthy, many of India's government health services are overcrowded, understaffed, chaotic and antiquated.

 

"If we start investigating every case of H1N1 virus, I think the government facility will not be able to cope with the rush," said Dharam Prakash, the Indian Medical Association's secretary general.

 

In Kenya, white-coated health workers have been passing out questionnaires at the Nairobi airport and putting up glossy posters about the virus on the walls of downtown cafes. False alarms about the virus have spawned a sense of panic in some places. When a health clinic in a Nairobi mall recently suspected a patient of being infected, word leaked out and soon shoppers were sending out text messages across the city warning people to stay away. The clinic was shut

down for a day.

 

Northern Hemisphere

 

In Britain, chief medical officer Liam Donaldson said there were several possible explanations for that country's recent increase in cases, including London's role as an international transport hub. In an effort to relieve intense pressure on doctors, the government recently launched the National Pandemic Flu Service, a phone and Internet hotline that allows patients to diagnose themselves and prescribe their own drugs.

 

"It's changing the way people are responding," said Alan Hay, who directs the WHO's World Influenza Centre in London.

 

Meanwhile, health officials in Virginia, Maryland, the District and other localities said they have been preparing all summer for the swine flu's return, including making plans to set up special clinics to treat and vaccinate patients if necessary.

 

"We're doing a tremendous amount of contingency planning," said Frances Phillips, Maryland's deputy secretary for public health.

 

Although strains of the virus have emerged that are resistant to Tamiflu, one of two antiviral drugs effective in treating it, scientists say both drugs generally appear to continue to be effective. The U.S. government shipped 11 million doses of the drugs to states to add to the 23 million they already had on hand and bought an additional 13 million doses to replenish its supplies.

 

"There's only so much that can be done to get ready. Flu, like a hurricane, is a force of nature. You can't stop it. You can't make it less severe than it would be otherwise," said Eric Toner of the University of Pittsburgh's Center for Biosecurity. "All you can do is try to be prepared to deal with the consequences."

 

The last flu pandemic, the 1968-69 Hong Kong flu, was the mildest of the 20th century, contributing to perhaps 1 million deaths worldwide, including about 34,000 in the United States. After emerging, many flu viruses continue to circulate for years, while others disappear or combine with other viruses.

 

Correspondents Juan Forero in Buenos Aires, Emily Wax in Mumbai and Stephanie McCrummen in Nairobi; special correspondent Karla Adam in London; and staff writer Cheryl W. Thompson in Guadalajara, Mexico, contributed to this report.

 

Copyright 2009 Washington Post.

 

In Reversal, Highly Developed Nations See Rise in Fertility

Prosperity's Effect on Birthrate Changes

 

By Rob Stein

Washington Post

Monday, August 10, 2009

 

For decades, the rate at which women were having babies in many of the world's most highly developed countries slowly declined.

 

While the trend cheered some environmentalists worried about overpopulation, it stoked increasing concern among policymakers, demographers and social scientists about the long-term impact on societies as their populations aged and sometimes began to shrink.

 

Now, however, new research has produced the first glimmer of hope that economic prosperity may not be linked to an inexorable decline in fertility. The new analysis has found that in many countries, once a nation achieves an especially high level of development, women appear to start having more babies again.

 

"This is something like a light at the end of the tunnel for some of these countries whose populations were on the path to decline," said Hans-Peter Kohler, a professor of sociology at the University of Pennsylvania who helped conduct the research. "We project a more optimistic future where fertility will go up, which reduces fears of rapid population decline and rapid aging."

 

Other researchers praised the new analysis as a milestone with potentially far-reaching political and social implications.

 

"This is very significant," said Shripad Tuljapurkar, a biology and population studies professor at Stanford University, who wrote a commentary accompanying the new research in the scientific journal Nature. "This debate has been going on for some time about these amazingly low fertility rates in some of these countries. It's been a classic policy quandary that people tend to sit around and shake their heads and worry about."

 

The concern has focused on a nation's "fertility rate," which is generally considered desirable by demographers and sociologists when it hovers around the "replacement rate" -- when the average number of babies born to each woman is about two. That means a country is producing enough young people to replace and support aging workers without population growth being so high that it taxes national resources.

 

Throughout the 20th century, the fertility rate has generally fallen as economic prosperity has risen, sometimes far below the replacement rate in some of the world's most highly developed nations, such as Japan, South Korea, Germany, Spain and Italy.

 

"There was a consensus that as countries develop, become richer and provide more education, that fertility would know only one trend -- and that trend was downward," Kohler said. "This raises a broad range of concerns. Systems such as pension systems would not be sustainable. A rapid decline in the labor force could result in an economic decline and a loss of competitiveness and perhaps a loss of innovation."

 

Resistant to the notion of replenishing their populations through immigration, some countries, such as Sweden and Italy, have become so concerned about their stubbornly low fertility rates that they have tried offering women financial incentives to have more babies, without significant success.

 

To explore whether economic development is necessarily linked to falling fertility, Kohler and his colleagues examined fertility trends between 1975 and 2005 in 37 of the most developed countries. They used a measure developed by the United Nations known as the human development index (HDI), which combines income data with other measures of advancement, such as longevity and education levels.

 

Fertility rates did tend to decline as a nation's HDI rose, the analysis showed. But for 18 of 26 countries that crossed a certain threshold of development -- an HDI of at least .9 -- their fertility rates began to rise again.

 

"This basically shattered this notion that as countries develop, fertility would only decline," Kohler said. "Quite to the contrary, in the very advanced societies, fertility may go up as countries get richer and more educated."

 

The timing of the turnaround varied from country to country. In the United States, for example, the turnaround occurred in the mid 1970s. In Norway, it happened in the early 1980s. In Italy, it was in the early 1990s.

 

The cause remains unclear. But Kohler speculated that once countries reach a certain level of development, they can afford changes that enable women both to work and have children. Many Scandinavian countries, for example, created generous welfare systems that include free day care. In the United States, women's salaries rose enough to make paying for child care more affordable.

 

Although the analysis did not specifically examine the impact of immigration on fertility rates, Kohler said other studies indicate that while immigration may play some role in the increases in fertility in countries that reach a high level of development, it would not explain all of it.

 

"My best guess is that increasingly in these rich countries, the benefits of greater development are flowing more to women," Tuljapurkar said. "Women have more education, and because they have more education and skills they probably find it easier to take a year off and have a baby and pay for the additional costs, and then get back into the labor force."

 

But others questioned the relationship.

 

"I don't think the concern about low fertility is over," said S. Philip Morgan, a sociology and international studies professor at Duke University. "There are a lot of things that may have made fertility go back up aside from social and economic development. Suppose there was a growing consensus that having babies was important. It could be an ideological change that could have produced this result. We just don't know."

 

Kohler acknowledged that there were some exceptions. Japan, for example, continued to experience a decline in fertility despite a high HDI. Kohler said the reason for the outliers remained unclear, but he speculated that stubborn gender inequalities in Japan may create roadblocks to women working and having children.

 

"In Japan, there's high gender inequality that makes it difficult for women to remain in the labor market once they have children, perhaps because of a lack of daycare and social pressures," he said.

 

But Canada was another exception with no clear explanation.

 

Whatever the reason, the trend appears to be working for many countries. The United States recently achieved replacement-rate fertility and some countries, such as Norway and France, are now approaching a replacement rate again. Many countries, such as Italy and Spain, continue to have very low fertility rates. But at least they are headed in the right direction, Kohler said.

 

"This shows that having families is something that continues to be highly valued in advanced societies. As we become affluent and developed, children are likely to remain an essential part of an individual's life. The family is not necessarily on its way out."

 

Copyright 2009 Washington Post.

 

Can We Fight Obesity by Slapping a Heavy Tax on Soda?

 

By Jennifer LaRue Huget

Washington Post

Tuesday, August 11, 2009

 

The solution to America's ballooning obesity epidemic lies not in weight-loss counseling or programs to make people more physically active, Kelly Brownell has come to believe. To effect real change, he argues, we need to shift the economic balance between healthful and unhealthful foods, to curtail the all-pervasive marketing of junk food -- and to tax soda.

 

Brownell, a professor of psychology and director of the Rudd Center for Food Policy and Obesity at Yale University, has been pondering obesity for decades, trying to tease out its causes and figure out how to counter them. Along the way, he has become a flashpoint figure in the obesity debate and a go-to guy when the media want to chew the fat about fat.

 

Co-author of the 2004 book "Food Fight: The Inside Story of the Food Industry, America's Obesity Crisis, and What We Can Do About It," Brownell made a splash again in April when his argument in favor of taxing soft drinks sweetened with sugar and high-fructose corn syrup was published in the New England Journal of Medicine. It's an idea he first proposed some 15 years ago; he believes its time may now have come. In addition to the advent of a new federal administration, one he sees as more open to such measures, "what's made it feasible now is the convergence of the bad economy -- states need the revenue -- and the awareness that the obesity problem has stampeded out of control," Brownell says.

 

The idea is simple: Slap an 18 percent tax on soda, and people will drink less of it. Since increased soda consumption is, Brownell says, one of the main contributors to our rising obesity rate, cutting back should lead to nationwide weight loss. Brownell sees such taxes starting with the states and eventually taking hold at the federal level, much the way tobacco taxes evolved.

 

Revenue from a soda tax might be used to fund obesity-prevention programs, particularly those aimed at helping kids maintain healthy lifestyles. Better yet: Use soda tax revenue to subsidize farming of healthful fruits and vegetables, just as government subsidies currently support corn that's turned into high-fructose corn syrup, which many blame for soda's insidious effect on our weight. While Brownell says that pledging to use revenue in those ways might make the new tax more palatable to the public, he concedes it would be impossible to ensure the funds would be used for healthful purposes unless such a requirement were written into law.

 

With or without a soda tax, public health officials and experts have signaled that combating obesity is a top priority. Late last month the Centers for Disease Control and Prevention held a three-day "Weight of the Nation" conference in Washington, bringing together academics, scientists, physicians and public health officials from all over the world.

 

Research presented at the meeting estimated the 2008 cost of treating obesity-related ailments in the United States at $147 billion, highlighting what a weighty matter obesity has become for the nation.

 

And the problem is, er, widespread. In late June, the Trust for America's Health and the Robert Wood Johnson Foundation issued a report showing that in 31 states, more than a quarter of adults are obese; in only one state, Colorado, are fewer than one in five adults obese, and in no state had the obesity rate decreased since last year.

 

Obesity-busting tactics embraced at the CDC conference included encouraging communities to build schools within walking distance of students' homes and making it easier for people to get access to healthful foods. These are in keeping with Brownell's stance that the public-health approach to fighting obesity must shift from treatment of those who are already fat to preventing others -- especially kids -- from getting that way.

 

But while Brownell is supportive of those community-based efforts, he believes their effects will be severely limited unless big changes are made in the way food is marketed and in the basic economics of food. Until healthful foods routinely cost less than unhealthful ones, getting people -- especially low-income people -- to eat them will remain a challenge, he says.

 

And unless limits are placed on the marketing of unhealthful foods, the whole anti-obesity effort hardly stands a chance, Brownell believes. "Community programs won't work by themselves" in an environment where industry-funded temptations to eat poorly are constant and pervasive, Brownell says. "How can community programs contend with all that marketing?"

 

To some critics -- and, I'll confess, to me -- Brownell's approach smacks of paternalism and over-reliance on government intervention. Shouldn't diet and weight be a matter of personal responsibility, not the government's concern? Brownell counters that the ubiquity and marketing of fattening food stack the deck against individual willpower, and their allure is more than many people can resist on their own, no matter how responsible they are.

 

"If you take lab rats and throw them a bunch of food you got at 7-Eleven, some of those rats will triple their body weight," Brownell says research has shown. "Are those rats irresponsible? When people move to the U.S., they gain weight. Have they become less responsible? We have more obesity this year than last. Are we all less responsible?"

 

I'll concede that if we individuals are supposed to take charge of our own weight, too many of us are shirking that duty. And obesity's impact on health-care costs makes it everyone's problem, like it or not.

 

So, if obesity is one of the top public-health issues facing the nation (and the new administration in Washington), what to make of the nomination of Regina Benjamin, a highly accomplished and well-regarded physician who happens to be overweight, to the post of surgeon general? What message does President Obama's choice of her to lead America's public-health agenda send?

 

"She seems a very kind person who has persevered through very challenging circumstances," says Brownell, who, it bears noting, is not exactly thin himself. "What more do you need to know about a person?"

 

Benjamin, Brownell continues, "is an excellent role model because she does struggle with her weight. Her nomination underscores that there are better ways to judge a person than by how much she weighs."

 

Point well taken, Professor Brownell.

 

Check out Tuesday's Checkup blog post, in which Jennifer invites further debate on the soda tax. Subscribe to the Lean & Fit newsletter by going to http://www.washingtonpost.com and searching for "newsletters."

 

Copyright 2009 Washington Post.

 

A Day in the Life of a Family Doctor

 

By Tara Parker-Pope

New York Times

Monday, August 10, 2009

 

How many different health problems do family doctors deal with in a given day? In a fascinating post on the blog Dr. Malia Reckons, family physician Dr. Timothy Malia decided to keep track of all the different health issues he had to treat on a single day. Here’s his list:

 

·         Diabetes, type 2, poorly controlled

·         Hypertension

·         Obesity

·         Vaccinations (tetanus and pneumonia)

·         Low back pain in elderly man

·         Increased thoughts of suicide

·         Attention deficit disorder

·         Acne

·         Bronchitis

·         Insomnia

·         Emotional stress (marital and child issues)

·         Weight loss, unexplained

·         Infant - well child check

·         Complete physicals, father and son (camp forms completed)

·         Ringworm

·         Premature breast tissue development in infant

·         Toenail fungal infection

·         Dyshidrotic eczema

·         Lipoma (a benign fatty growth)

·         Allergic conjunctivitis

·         Sliver of fiberglass in finger

·         Alcoholism

·         High cholesterol

·         Asthma

 

At a time when Congress is debating health care reform, the list is a good reminder of the enormous responsibilities the family physician has as the gatekeeper of the health care system. Most experts agree that for any plan to succeed, reform must also address the growing shortage of family doctors. According to the American Academy of Family Physicians, most medical school graduates now choose better-paying specialty fields like dermatology or orthopedic surgery, a trend that is expected to lead to a shortage of tens of thousands of family doctors within a decade.

 

So what do you think of this list? Were you surprised at the variety of health problems one doctor has to address?

 

Copyright 2009 New York Times.

 

Mentally Ill Offenders Strain Juvenile System

 

By Solomon Moore

New York Times

Monday, August 10, 2009

 

FRANKLIN FURNACE, Ohio — The teenager in the padded smock sat in his solitary confinement cell here in this state’s most secure juvenile prison and screamed obscenities.

 

The youth, Donald, a 16-year-old, his eyes glassy from lack of sleep and a daily regimen of mood stabilizers, was serving a minimum of six months for breaking and entering. Although he had received diagnoses for psychiatric illnesses, including bipolar disorder, a judge decided that Donald would get better care in the state correctional system than he could get anywhere in his county.

 

That was two years ago.

 

Donald’s confinement has been repeatedly extended because of his violent outbursts. This year he assaulted a guard here at the prison, the Ohio River Valley Juvenile Correctional Facility, and was charged anew, with assault. His fists and forearms are striped with scars where he gouged himself with pencils and the bones of a bird he caught and dismembered.

 

As cash-starved states slash mental health programs in communities and schools, they are increasingly relying on the juvenile corrections system to handle a generation of young offenders with psychiatric disorders. About two-thirds of the nation’s juvenile inmates — who numbered 92,854 in 2006, down from 107,000 in 1999 — have at least one mental illness, according to surveys of youth prisons, and are more in need of therapy than punishment.

 

“We’re seeing more and more mentally ill kids who couldn’t find community programs that were intensive enough to treat them,” said Joseph Penn, a child psychiatrist at the Texas Youth Commission. “Jails and juvenile justice facilities are the new asylums.”

 

At least 32 states cut their community mental health programs by an average of 5 percent this year and plan to double those budget reductions by 2010, according to a recent survey of state mental health offices.

 

Juvenile prisons have been the caretaker of last resort for troubled children since the 1980s, but mental health experts say the system is in crisis, facing a soaring number of inmates reliant on multiple — and powerful — psychotropic drugs and a shortage of therapists.

 

In California’s state system, one of the most violent and poorly managed juvenile systems in the country, according to federal investigators, three dozen youth offenders seriously injured themselves or attempted suicide in the last year — a sign, state juvenile justice experts say, of neglect and poor safety protocols.

 

In Ohio, where Gov. Ted Strickland, a former prison psychologist, approved a 34 percent reduction in community-based mental health services to reduce a budget deficit, Thomas J. Stickrath, the director of the Department of Youth Services, said continuing cuts would swell his youth offender population.

 

“I’m hearing from a lot of judges saying, ‘I’m sorry I’m sending so-and-so to you, but at least I know that he’ll get the treatment he can’t get in his community,’ ” Mr. Stickrath said.

 

But youths are often subjected to neglect and violence in juvenile prisons, and studies show that mental illnesses can become worse there.

 

George, 17, an inmate at Ohio River Valley, detailed his daily cocktail of psychiatric medications, including Abilify and Seroquel. In addition to having bipolar disorder, he is a sex offender and is H.I.V. positive — severe stigmas in prison.

 

“I be getting punked,” he said, using prison slang to describe how gang youths routinely humiliate him. He blinked, and his leg shook uncontrollably. “They take my food, they hit me, they make me do things.”

 

Demetrius, 16, another inmate there, said he had received a diagnosis of bipolar disorder. Officials said he has psychotic episodes and attacks other inmates. In an interview in June, he said he was receiving no mental health counseling or medications. Andrea Kruse, a spokeswoman for Mr. Stickrath, said that since July 1, he has had more than 20 counseling sessions.

 

According to a Government Accountability Office report, in 2001, families relinquished custody of 9,000 children to juvenile justice systems so they could receive mental health services.

 

Donald has been in and out of mental health programs since he attacked a schoolteacher at age 5. As he grew older, he became more violent until he was eventually committed to the Department of Youth Services.

 

“I’ve begged D.Y.S. to get him into a mental facility where they’re trained to deal with people like him,” said his grandmother, who asked not to be identified because of the stigma of having a grandson who is mentally ill. “I don’t think a lockup situation is where he should be, although I don’t think he should be on the street either.”

 

Lawsuits and federal civil rights investigations in Indiana, Maryland, Ohio and Texas have criticized juvenile corrections systems for failing to meet their obligation to prohibit cruel and unusual punishment of prisoners.

 

Despite downsizing to about 1,650 juvenile inmates from about 10,000 youth offenders in 1996, California’s state system remains under a 2004 federal mandate to improve conditions, including mental health services — the result of a class-action lawsuit that documented the systematic physical and sexual abuse of wards.

 

Under a plan to reduce the state juvenile inmate population, many youths who once would have been held by the state are now detained by the Los Angeles County juvenile detention system. Los Angeles County is also under a federal mandate to improve psychiatric services for juvenile inmates, especially at the six camps at its Challenger Memorial Youth Center, which holds most of the county’s medium- and high-risk offenders and most of its mentally ill ones.

 

“We were told that the Challenger camps are, paradoxically, the only camps at which staff are authorized to carry O.C. spray,” wrote federal civil rights investigators in a 2008 report to county authorities, referring to oleoresin capsicum, known as pepper spray. “One supervisor told us that he believed that allowing staff to carry and use O.C. spray made sense given the ‘mental health population.’ ”

 

The investigators also recounted how staff members body slammed unruly juveniles, often breaking their bones.

 

In May, a reporter toured the Los Angeles County Central Juvenile Hall with Eric Trupin, a consultant hired by the Department of Justice to monitor mental health services in California’s juvenile justice system. Dr. Trupin, a psychologist, said some detainees appeared to be held there for no reason other than that they were mentally ill and the county had no other institution capable of treating them.

 

One inmate at the county’s juvenile hall, Eric, 18, was given a diagnosis of bipolar disorder and prescribed Risperdal, a powerful antipsychotic, to help him avoid violent flashes of temper.

 

A public defender who specializes in juvenile mental health issues, said Eric had been arrested more than 20 times near his South Los Angeles home. Dr. Trupin worried that if Eric is released and arrested again, he will be charged as an adult and enter the Los Angeles County jail, the nation’s largest residential mental institution, with 1,400 mentally ill inmates.

 

In the 1960s and ’70s, the increasing availability of antipsychotic medications coincided with a national movement to close public mental hospitals. Many private hospitals barred psychotic patients, including juveniles. By the 1980s, juvenile justice systems had become the primary providers of residential psychiatric care for mentally ill youths.

 

But as cutbacks have worsened, the debate has intensified over what constitutes adequate mental health care. Often juvenile justice systems have very little to go on when attempting a diagnosis.

 

“Often Daddy is nowhere to be found, Mommy might be in jail,” said Daniel Connor, a psychiatrist for the Connecticut juvenile corrections system. “The home phone is cut off. The parent speaks another language, so it’s often hard to figure out exactly what’s going on with each kid.”

 

School records often do not arrive with arrested youths, nor do files often come from other corrections institutions. The lack of information is particularly problematic when psychiatrists try to prescribe medications. Joseph Parks, medical director for the Missouri Department of Mental Health and a national expert on pharmaceutical drug use in corrections facilities, said many juvenile offenders are prescribed multiple psychiatric drugs as they move from mental health clinics to detention halls to juvenile prisons.

 

A decade ago, it was rare to find juvenile offenders on two psychotropic drugs at once, Dr. Parks said. Now, many take three or four at a time, often for nonprescribed uses like helping the youths sleep.

 

“If you just give a kid a pill, the prison administration doesn’t have to do anything differently,” he said. “The staff doesn’t have to do anything differently. The guards don’t have to get more training.”

 

Census studies of child mental health professionals show chronic shortages. A 2006 study estimated that for every 100,000 youths, there were fewer than nine child psychiatrists. Dr. Penn of Texas said the state youth prison system there recently instituted a system of telepsychiatry sessions, conducting videoconferences between mental health professionals and youths being detained hundreds of miles away.

 

Inadequate mental health services increases recidivism. In a February report on psychiatric services at the Ohio River Valley center, Dr. Cheryl Wills, an independent mental health expert, found that officials were unnecessarily extending incarceration for youths who acted out because of their mental illnesses.

 

Mr. Stickrath, the director of the Ohio Department of Youth Services, said that one challenge in dealing with large numbers of psychologically ill youths is determining who is “mad versus bad.” He mentioned Donald, whose file he knew by heart.

 

“He’s been in 130 fights since he’s been with us, and there were no resources in the small county he’s from to deal with him,” Mr. Stickrath said. “Our staff worked to get him in a sophisticated psychiatric residential program, but they said he had to leave because he was attacking staff.”

 

Mr. Stickrath shook his head. “He just wears you out.”

 

Copyright 2009 New York Times.

 

Opinion

The power of suggestion

Our view: Gov. O'Malley is getting a truckload of ideas for saving Maryland money from ordinary citizens, but he missed a chance for real dialogue about the budget

 

Baltimore Sun Editorial

Monday, August 10, 2009

 

Someone from Allegany County wrote in with a detailed suggestion for reducing the number of trips corrections employees take to transfer files from one prison to another. "It may not save much, but every little bit helps," the person wrote. Someone in Harford County advocated going to a four-day workweek for all state employees. Someone in Baltimore pitched an early retirement plan for state workers. And, not to traffic in regional stereotypes, but someone from Montgomery County insisted on higher income tax rates before the state cuts a penny from the social safety net.

 

Those are a handful of the nearly 600 pages of responses Gov. Martin O'Malley had received in his suggestion box for ways to save the state government money as of late last week. (The cut-off for submitting ideas is today; the Web site to send in your idea is www.gov.state.md.us/budgetcuts.asp.) Having just cut $280 million from the budget and faced with the need to cut $400 million more by the end of the month, and probably a good bit more than that next year, Mr. O'Malley can use all the help he can get.

 

The ideas are often well thought out and detailed. They make good reading, but, unfortunately, you won't be able to see them if you go to the governor's Web site. Though he professes a commitment to transparent government, Mr. O'Malley's set up the page so that the suggestions aren't posted online. The governor's office provided The Baltimore Sun with a four-page sampling of the suggestions that came in on July 29, and it promises to make the entire list public once it is completed and categorized, probably later this week.

 

But that will be too late to serve the greater purpose of allowing citizens the chance for an unfettered dialogue about how the state is spending its money. One of the great strengths of the Internet is its interactivity, the opportunity for give and take and exchange of ideas. As it is, the governor's office has put a high-tech gloss on an old way to get input. If the administration was apprehensive that the people who posted suggestions would be unruly or rude or make Mr. O'Malley look bad, that fear appears to have been unfounded - assuming the suggestions his office released are, in fact, a random sampling. They are generally constructive and respectful.

 

When the administration does release the list of suggestions, it should accompany them with a platform for people to discuss the ideas and offer more of their own. The exercise shouldn't be a one-time effort to find savings but the basis for an on-going evaluation of the state government.

 

During the next six months, as the governor forms his budget proposal for the next fiscal year, he should compile a report showing what became of those ideas. Citizens should know exactly which of their ideas are being adopted and how much they're projected to save. Not only would that show that the process was more than window dressing but it would also convey the enormity of the budget challenge Maryland faces. The writer from Allegany County is right that every little bit helps, but Maryland is facing a budget shortfall next year that could hit $1.5 billion, and fixing that is going to require choices much more painful than closing state offices early to save on energy costs. Mr. O'Malley is bound to find that the more he brings ordinary Marylanders into the process of solving the problem, the more receptive they'll be when asked to make sacrifices.

 

Copyright © 2009, The Baltimore Sun.

 

Ending homelessness in Baltimore

 

Baltimore Sun Editorial

Monday, August 10, 2009

 

Here's a preview of an editorial we're working on. Let us know what you think. The best comments will run alongside it in the print edition.

 

Too bad the city is just breaking ground on a new homeless shelter and not opening it today – with temperatures climbing into the dangerous range for the first time this summer, it's a reminder of how important it is to make sure all of the city’s residents have proper shelter. The construction of the shelter downtown is the most important and concrete step yet in Mayor Sheila Dixon’s laudable effort to end homelessness in Baltimore. She has tackled an issue that is unlikely to win her votes and guaranteed to cause headaches in a way previous mayors have not. For example, not only has her administration has taken steps designed to clear out the eyesore homeless encampment at the foot of the Jones Falls Expressway, but she has coupled that with efforts to find permanent, appropriate shelter for the city's homeless. It’s a refreshing change. There will certainly be plenty of obstacles – lack of funds, opposition among neighbors to any new shelters, resistance from the homeless themselves – and Ms. Dixon’s goal may ultimately be unachievable. But the fact that she’s trying says a lot.

 

Copyright 2009 Baltimore Sun.

 

Swine Flu and Schools

Common-sense guidelines aimed at minimizing disruption while ensuring safety

 

Washington Post Editorial

Monday, August 10, 2009

 

STAY OPEN. That was the guidance issued Friday by the Obama administration to the nation's schools as they prepare for the fall return of students, and swine flu. Ultimately, it's up to local authorities whether to shut their schools. But the information gathered during and since the initial outbreak in April shows that in many cases it will make more sense to keep school in session.

 

Fears of swine flu (or H1N1, the scientific moniker preferred by the administration and the pork industry) led to the closure of more than 700 schools across the country in the spring. The guidelines released by the departments of Education and of Health and Human Services and the Centers for Disease Control and Prevention outline three situations when a school closure would be warranted: one, children with special needs are the majority, and swine flu emerges; two, large numbers of students and staff are hit with H1N1; or, three, parents send sick, feverish kids to school.

 

The CDC also recommends that students and staff return to school 24 hours after their fever is gone, not after an extra week. Schools with students and staff members who appear to have flu-like symptoms are encouraged to send the sick to a separate room until they can be sent home. Students with ill household members should stay home for five days from the day that relative got sick. For more information, go to http://www.flu.gov.

 

Concern about swine flu is understandable. It roared to life in Mexico, came to the United States and then made its way to just about every corner of the world. The World Health Organization classifies it as an unstoppable pandemic. So far, it is less deadly than regular flu, which claims 36,000 lives in the United States every year. But researchers are carefully following the virus's progression and potential mutations as it makes its way through the Southern Hemisphere's winter.

 

As they have since the initial outbreak of swine flu, federal officials are counseling common sense in responding to the next wave of illness. Those who feel sick should stay home. If you sneeze or cough, cover your mouth. And wash your hands frequently or use a hand sanitizer. In the end, you are your best defense against the pandemic's spread.

 

Copyright 2009 Washington Post.

 

STD Tests at High School?

 

Washington Post Letter to the Editor

Monday, August 10, 2009

 

The program to provide STD education and testing is an important opportunity for District students and parents. For students, it provides critical information about a harsh reality of sexual activity. For parents, it offers another resource for handling the challenging talks we need to have with our children.

 

One undeniable fact: Students need to know more. The troubling number who test positive for sexually transmitted diseases indicates that neither schools nor parents are doing a good job teaching students how to make healthy decisions about sex. A program that provides information, an immediate opportunity to be tested for an STD and treatment gives students resources that they clearly need.

 

The expansion of this program gives educators a valuable opportunity to engage parents, as well. By informing parents about the realities of teen sexual activity, we can better support them in supporting their children.

 

This program provides one more tool as our community tackles the public health challenge of STDs. And the magnitude of the HIV/AIDS epidemic in the District demands that we continue to use every tool at our disposal.

 

The writer is a member of the D.C. State Board of Education (Ward 4) and executive director of Jumpstart for Young Children.

 

Sekou Biddle

Washington

 

Copyright 2009 Washington Post.

 

Medicare Drug Costs

 

New York Times Letter to the Editor

Monday, August 10, 2009

 

To the Editor:

 

Re “White House Affirms Deal on Drug Cost” (front page, Aug. 6):

 

We are glad to see the brand-name pharmaceutical industry reaffirm its support for fixing the health care system and beginning to close the Medicare doughnut hole. Millions of people in Medicare will see their drug costs fall as a part of the deal you reported.

 

But AARP has no plans to stop there. That’s why we are continuing to support measures that would close the doughnut hole over time, as well as provisions to bring more generic drugs to the market, safely import less expensive drugs from abroad, and allow the government to negotiate lower drug prices for people in Medicare.

 

Cutting drug costs in half for people in Medicare is not the end of our efforts — it is just the latest.

 

Combined, these policies will offer immediate relief for millions of Americans struggling with unaffordable health care bills, while simultaneously lowering drug costs even more over time. For those Americans, these solutions are not mutually exclusive.

 

Nancy LeaMond

Executive Vice President, AARP

Washington, Aug. 6, 2009

 

Copyright 2009 New York Times.

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