Wednesday, August 19, 2009

News Clipping Archives

 

 

Maryland / Regional

 

Swine flu prep ramps up in Maryland, across the country (Baltimore Business Journal)

MARYLAND: Nearly 200 rally for developmentally disabled Posted 4:05 p.m. (Carroll County Times)

Study: Pets, wildlife significant source of waterway bacteria (Baltimore Sun)

New specialty spurs hopes for helping abused kids (Daily Record)

Judge: PG furloughs violate Constitution (Annapolis Capital)

Hospital earns top Medicare improvement, attainment status (Frederick News-Post)

Officials impressed by new hospital (Cumberland Times-News)

Baltimore City jail health lawsuit settles (Daily Record)

Recent sex sting is first in county targeting ‘johns' (The Gazette)

Surgeon Tied to Bone Product Inquiry Resigns (New York Times)

Judge tosses chemical weapons incineration suit (Daily Record)

Va. Tech Gunman's Missing Mental Records Released (Washington Post)

VA Official Will Head FDA's Tobacco Division (Wall Street Journal)

 

National / International

 

HPV vaccine promoted with drug company money (Baltimore Sun)

Medical Groups Promoted HPV Vaccine Using Funds Provided by Drugmaker (Washington Post)

Merck's Gardasil Has Higher Rates of Fainting, Clots (Wall Street Journal)

Swine Flu: The Next Wave (Wall Street Journal)

Swine Flu Threat to Business Seen (Wall Street Journal)

Officials warn employers of swine-flu fall outbreak (Baltimore Sun)

Government officials call on employers to help get swine flu vaccine to vulnerable workers (Baltimore Sun)

State Requires Flu Vaccination for Caregivers (New York Times)

Officials Find Flu Disproportionately Hits Minorities (Wall Street Journal)

Gut Reaction: 'Good' Microbes Under Attack (Wall Street Journal)

Teens Who Live With A Depressed Parent (Wall Street Journal)

Johnson & Johnson gets FDA warning letter on monitoring and conduct of ceftobiprole studies (Baltimore Sun)

COBRA enrollment doubles with subsidy, study says (Baltimore Sun)

Obama faces new dispute over subsidy for Medicare (Baltimore Sun)

Medicare Test Pays for Hospital Performance (Wall Street Journal)

White House Drops Health-Care Tip Line (Washington Post)

Tennessee Experiment's High Cost Fuels Health-Care Debate (Wall Street Journal)

Illegal immigrants and health care reform (Baltimore Sun)

CDS says drop in US death rates led to fewer deaths in 2007, but numbers may rise in 2008 (Baltimore Sun)

One in Four Fish in U.S. Waterways Contaminated with Unsafe Levels of Mercury (Wall Street Journal)

Ibuprofen Best for Injured Kids (Wall Street Journal)

 

Opinion

 

Prescription Privacy Doesn’t Exist (Wall Street Journal Commentary)

A Nurse’s View of Health Reform (New York Times)

 

 

 

Maryland / Regional

 

Swine flu prep ramps up in Maryland, across the country

 

By Julekha Dash

Baltimore Business Journal

Wednesday, August 19, 2009

 

Maryland will receive its supply of vaccines to treat the H1N1 virus, or swine flu, by October, the state’s health department said Wednesday.

 

The state is also communicating with hospitals, community health organizations and schools to determine how and when they can get their vaccines, said David Paulson, a spokesman for the Maryland Department of Health and Mental Hygiene.

 

The state has asked doctors to register on its Web site to receive the vaccine directly from shipping distributors, Paulson said.

 

Vaccines to treat swine flu are currently under clinical trials. The University of Maryland School of Medicine ( http://www.bizjournals.com/baltimore/gen/University_of_Maryland_School_of_Medicine_A79E92D90ABF4AEBA3FED103734A470E.html  ), Emory University, Baylor College of Medicine and other institutions are participating in a nationwide network of vaccine evaluation teams funded by the National Institutes of Health ( http://www.bizjournals.com/baltimore/gen/National_Institutes_of_Health_61088CBF268A496EB9421EDCD01D7252.html ). Once the U.S. Food and Drug Administration approves the company, Maryland biotech company MedImmune ( http://www.bizjournals.com/baltimore/gen/MedImmune_A3B853346CA0439982868F4A80AAA8B3.html ) will manufacture the vaccine for Maryland residents.

 

The virus has been declared a global pandemic by the World Health Organization ( http://www.bizjournals.com/baltimore/related_content.html?topic=World%20Health%20Organization ) and has resulted in six deaths in Maryland.

 

The state is making its preparations just as the Centers for Disease Control and Prevention ( http://www.bizjournals.com/baltimore/gen/Centers_for_Disease_Control_and_Prevention_45360DC412EE48D18A8859D3C37B5E38.html  ) released new federal guidelines Wednesday to help employers prep for the flu season — both the seasonal flu and the H1N1 variety.

 

Employers should encourage employees with flu-like symptoms or illness to stay home and possibly have those at higher risk of serious medical complications from infection work from home, according to the guidance. In preparation for lost manpower, businesses should also address how to operate with less staff.

 

Other preparation guidelines include:

 

• Employers should review sick leave policies and ensure employees understand them. Employers should try to make sick leave policies flexible for workers who may have to stay home with ill family members or if a child’s school is closed.

 

• Employers should consider offering vaccine against seasonal flu, and encourage employees to be vaccinated against seasonal and H1N1 flu.

 

• Employers also might cancel non-essential face-to-face meetings and travel, and space employees farther apart. And employees who are at higher risk for flu complications might be allowed to work from home or stay home if the flu is severe.

 

Tierney Plumb of the Washington Business Journal, a sister publication, contributed to this report.

 

 All contents of this site © American City Business Journals Inc. All rights reserved.

 

 

 

 

MARYLAND: Nearly 200 rally for developmentally disabled Posted 4:05 p.m.

 

Associated Press

Carroll County Times

Wednesday, August 19, 2009

 

ANNAPOLIS — Fear of Maryland’s next round of budget cuts brought about 200 developmentally disabled people and workers who assist them to rally against cuts to state services on Wednesday.

 

The rally next to the governor’s home and the Maryland State House was held a week before the Board of Public Works is scheduled to make about $470 million in spending reductions.

 

Residents with Down syndrome and cerebral palsy rallied with their family members on a hot summer afternoon, holding signs and chanting “No More Cuts” and “Save Our Services.”

 

Supporters say potential cuts to the Developmental Disability Administration could further the wait for thousands on a state-approved waiting list to receive services, even though some already have been waiting for a decade. More than 19,000 people are on the list to receive residential and day program services.

 

“Any further cuts can and will jeopardize their well-being as well as the well-being of those who chose to be their caregivers,” said Stephanie Maskovyak, whose 24-year-old daughter Anne Kirby is developmentally disabled.

 

Advocates say the cuts could create a variety of problems, including deteriorating conditions in group homes in local communities and even shuttering entire programs.

 

Supporters also are fearful that potential budget cuts could widen disparities in pay for people who help the disabled in their communities, compared to people who work in state institutions.

 

O’Malley’s administration is scheduled to submit about $470 million in budget cuts to the Board of Public Works next week to help address a serious shortfall. While about $250 million will come from state aid to local governments, the administration says the rest will come from state agencies and compensation for state workers, including an unspecified number of furlough days.

 

It will be the sixth time the board has made budget cuts during O’Malley’s tenure. The administration has not yet outlined where cuts in state agencies will come from.

 

More than 22,000 adults and children receive community based services in Maryland, according to the Maryland Developmental Disabilities Coalition.

 

Copyright 2009 Carroll County Times.

 

 

 

 

Study: Pets, wildlife significant source of waterway bacteria

 

Associated Press

Baltimore Sun

Wednesday, August 19, 2009

 

A new study finds pets and wildlife are a significant source of waterway bacteria, Maryland environmental officials say.

 

The Department of the Environment said researchers found waste from dogs and wildlife such as fox and deer accounted for about two-thirds of the bacteria in the watersheds of the Furnace Creek and Marley Creek, two Glen Burnie-area waterways where bacteria levels are above state standards. State officials said that the findings suggest that failing to clean up after pets can affect water quality significantly.

 

Researchers studied eight Anne Arundel County watersheds and found the major contributor to bacteria was wildlife, followed by pets, humans and livestock.

 

Copyright 2009 Associated Press. All rights reserved.

 

 

 

 

New specialty spurs hopes for helping abused kids

 

Associated Press

Daily Record

Wednesday, August 19, 2009

 

It appeared to be a clear-cut case of child abuse: An infant hospitalized with bleeding in his brain, his father behind bars suspected of shaking the baby.

 

Only after the boy died without his father at his bedside did doctors realize the bleeding was brought on by a vitamin K deficiency — not abuse.

 

Dr. Jim Anderst, who diagnosed the deficiency about 18 months ago while working at a San Antonio hospital, tells the story to doctors-in-training he teaches at Children's Mercy Hospital in Kansas City and says it underscores why the subspecialty of child abuse pediatrics is necessary.

 

The field involves not only treating suspected abuse victims but coordinating with police and welfare workers and testifying in court hearings. It will reach a milestone in November, when about 200 doctors sit for a board examination offered for the first time by the American Board of Pediatrics in Chapel Hill, N.C.

 

Its recognition as a subspecialty also is expected to lead to a formal system of accreditation for some of the roughly 25 child abuse pediatrics fellowship programs across the country for which there is currently no formal oversight.

 

Anderst, who leads one of the fellowship programs, said his findings sometimes force children from their homes. Other times, like with the boy who died after failing to receive a vitamin K shot typically given to newborns, they free parents from jail.

 

"It stuck with me because it made me realize the impact you can have if you try to go about it appropriately and find out what actually happened to these kids," said Anderst, who said that without the second look the boy's father would likely still be jailed today.

 

"Certainly, there are many cases where it is obvious. There can be multiple fractures and injuries. There are all sorts of things that can happen to kids that could be abuse but might not be, and we have to try to determine the truth."

 

Studies have repeatedly shown that many doctors lack the expertise to handle these difficult cases. Practitioners hope the changes result in more experts who can teach in medical schools, conduct research and serve as a resource for general pediatricians.

 

A survey released this year in Pediatrics, the journal of the American Academy of Pediatrics, found current levels of child abuse training are inadequate. Many residents reported concerns about handing sexual abuse cases and most had difficulty identifying certain genital parts. The report notes concern regarding the lack of knowledge of female genitalia among medical professionals is not new.

 

Desmond Runyan, professor of social medicine and pediatrics at the University of North Carolina at Chapel Hill, said the lack of training makes some doctors reluctant to handle child abuse cases.

 

"I've found in my own experience kids are still kids, and it's not unpleasant to deal with kids," he said. "It's sometimes difficult work and sometimes unpleasant, but I can't imagine that telling people they have cancer or some other fatal disease is any easier."

 

Practitioners also hope greater recognition of the subspecialty will lead to higher payments from insurance companies and government health care programs — a relief for hospitals that typically lose money on their child abuse teams because of the time involved in the cases.

 

Runyan said a clinic he helped found in Durham, N.C., had to stop providing medical examinations for suspected child abuse victims in 2006 because the effort was losing about $400,000 a year.

 

But others fear the subspecialty will make it more difficult for pediatricians who lack the board certification to testify in court. They note that general pediatricians will continue to handle most of the estimated 3.2 million cases of child abuse reported each year.

 

How many of those cases are misdiagnosed is unclear, although only 794,000 were substantiated in 2007, the latest year for which federal information is available.

 

Dr. Rachel P. Berger, a pediatrician in the Child Advocacy Center at Children's Hospital of Pittsburgh, said she worries the shift might lead to difficulties in areas with nobody certified if defense attorneys challenge the credentials of regular doctors.

 

"Who is going to testify on behalf of those children?" she asked. "Are you going to fly in a child abuse expert for every one of these cases? Clearly not. So I think we've created a big problem for being able to testify."

 

Other say the risk is worth it.

 

Dr. Robert W. Block, a professor at the University of Oklahoma of Community Medicine in Tulsa, led efforts to create the subspecialty. He said the designation is a critical development in a field that has evolved rapidly since a 1962 article in the Journal of the American Medical Association that urged doctors to consider the possibility of child abuse.

 

Gradually, doctors gravitated to the field and conducted research on broken bones, burns and sexual abuse.

 

"There are children, their siblings and families in great pain and stress," he said. "This is an area where you can do a whole lot of good."

 

Copyright 2009 Daily Record.

 

 

 

Judge: PG furloughs violate Constitution

 

Associated Press

Annapolis Capital

Wednesday, August 19, 2009

 

GREENBELT, Md. (AP) — A federal judge has ruled that Prince George's County violated the U.S. Constitution when it furloughed 5,900 workers to save $17 million.

 

U.S. District Judge Alexander Williams Jr. ruled Tuesday that the county violated the contract clause, which bars states from passing laws "impairing the obligation of contracts."

 

Williams wrote that county officials could have used "more moderate alternatives" to trim the budget in the last fiscal year.

 

Williams ordered the two sides to discuss how the employees will be repaid. County officials say the ruling will mean "massive layoffs" and they plan to appeal.

 

Last month, the county council approved a second round of 10-day furloughs for the new fiscal year.

 

Copyright 2009 Annapolis Capital.

 

 

 

 

Hospital earns top Medicare improvement, attainment status

 

By Patti S. Borda

Frederick News-Post

Wednesday, August 19, 2009

 

Frederick Memorial Healthcare System earned eight national awards for quality care and a reward of $141,340.

 

The hospital has been part of a Centers for Medicare and Medicaid Services and Premier health care alliance pay-for-performance project that rewards hospitals for delivering high-quality care in five clinical areas.

 

Based on fourth-year results from CMS' Hospital Quality Incentive Demonstration project, Frederick Memorial received a total of eight awards for Top Improvement and Attainment in the clinical areas of heart attack, heart failure, pneumonia, and hip and knee replacement.

 

Sharon Powell, director of the hospital's Performance Improvement Department, has overseen the hospital's efforts.

 

"We're all excited. ... It's like icing on the cake," Powell said.

 

The project evaluates the efficiency of health care. Powell said her department has formed teams of doctors, nurses, respiratory therapists and other medical staff members to look at hospital standards and practices. Powell's teams have been looking for ways to be more efficient, all with a goal to improving patient care.

 

"It's all about the patients," Powell said.

 

Her teams have established new check-off forms for the clinicians dealing with the five areas of care studied. The forms simplify the work of doctors and nurses, Powell said, by listing all the current best practices and evidence-based treatment recommendations available.

 

"It's tried to make more standardization," Powell said.

 

The clinician prescribes treatment or therapy by checking off from the list on the form. However, the medical staff always has the ability to determine care on an individual basis. Powell compared the process to using a recipe. Instead of trying to remember exactly which ingredients one used in the lasagna recipe last time, one has a recipe's list of ingredients.

 

The medical list does not force the clinician to select only the options on the list, but it contains the most likely options to be sought.

 

Frederick Memorial Healthcare System is one of only 20 participants in the country to earn eight awards. CMS awarded incentive payments of about $12 million to 225 hospitals this year.

 

Improved efficiency is good for patients and the hospital, but monetary rewards like this do not affect the commitment to patients, said Amanda Changuris, hospital communications specialist.

 

"It's the proof that we're providing patients the best-quality care that's available." Changuris said. "We're happy to be providing the quality. .... The money's nice, but it's not the point."

 

Copyright 2009 Frederick News-Post.

 

 

 

 

Officials impressed by new hospital

 

By Michael A. Sawyers

Cumberland Times-News

Wednesday, August 19, 2009

 

CUMBERLAND - Allegany County Commissioners Jim Stakem and Bob Hutcheson were treated to a 90-minute personalized tour of the Western Maryland Regional Medical Center on Tuesday and both expressed amazement at the size and future capability of the seven-floor facility scheduled to open in November.

 

“It’s bigger than it looks,” Stakem said. “I am impressed with the variety of medical and health services that are going to be available. It’s phenomenal.”

 

The tour was led by Barry Ronan, president and CEO of the Western Maryland Health System. Matt Diaz, the county’s economic development director, attended as well.

 

The ground-level emergency treatment area, just a few turns of the gurney wheels from the new helipad for Trooper 5, will have separate areas for those needing immediate assistance and patients who are not at severe risk.

 

“Patients will be triaged and those with stuffy noses and other less severe problems will be seen here,” Ronan said, pointing around a large interior room. “My guarantee is that everybody will see a doctor within 30 minutes.”

 

The helipad, according to Ronan, is actually closer to its emergency room than is the current rooftop landing spot at the Memorial campus.

 

Many local physicians, hospital board members and staff have already toured the facility in progress.

 

“The reaction from physicians has been very positive, jaw-dropping in a couple of cases,” said Kathy Burkey, chairwoman of the hospital’s board.

 

The new regional cancer center will be ground level as well, with patient parking immediately outside the door. Both private and communal treatment rooms will be available.

 

“Some patients like to read and others like to socialize during treatments,” said Kathy Rogers, the health system’s community relations director.

 

Ronan said a recent decision was made to use the first floor of the separate administrative building to house the diagnostic center now at the Braddock campus. Administrative offices will continue to operate on the second floor.

 

Besides the subdued browns, grays and blues that make up much of the interior design of the medical center, the other impression is one of natural light.

 

“That’s intentional,” Burkey said. “Natural light has a positive effect on patients and staff.”

 

For example, a large window in the delivery room offers parents a view of the surrounding mountains.

 

It also offers space for 20 newborns and Rogers said there are times when that number has been approached. “Like nine months after a blizzard,” she said.

 

Recently, the system has hired two additional neonatologists and one will always be at the hospital, according to Rogers.

 

Ronan said doctors and staff continue to see an increase in addicted newborns, usually to prescription drugs ingested by the mother. “We see crack babies and heroin babies too,” he said. A specialized room to treat those infants is a part of the new facility.

 

A partial list of services offered on various floors of the medical center includes:

 

• 1 - Admitting, cancer center, emergency, gift shop, pediatrics.

• 2 - Behavioral health, cafeteria, laboratory, nursing administration.

• 3 - Cardiovascular, intensive care, respiratory care, surgical services including same-day.

• 5 - High-level care, progressive care.

• 6 - Labor and delivery, obstetrics and gynecology, comprehensive inpatient rehabilitation unit.

• 7 - North nursing unit, south nursing unit.

 

In April, the health system determined it was having too much of a problem with people coming onto the property to steal or otherwise do no good.

 

“We decided we needed armed officers and we got them from the Allegany County Bureau of Police and the Maryland Natural Resources Police and they have been doing a great job,” Ronan said. “They are here overnight and on weekends.”

 

Ronan called the radiology department “a massive component of the new hospital.” He said 300 staff members, the people who know what they need to get things done, were involved in designing the new hospital.

 

There will be more than 1,000 parking spaces and all are free, Ronan said.

 

The surgical recovery room will have 24 beds.

 

Burkey said she anticipates a halo effect once the new medical center is up and running. “The medical center will be bigger and better and will attract the best and the brightest doctors,” she said of the 585,000-square-foot complex. “Our whole effort has been to improve the quality of health care and life for the people of this area.”

 

Contact Michael A. Sawyers at msawyers@times-news.com.

 

Copyright © 1999-2008 cnhi, inc.

 

 

 

 

Baltimore City jail health lawsuit settles

 

By Caryn Tamber

Daily Record

Wednesday, August 19, 2009

 

The state has settled a long-running lawsuit over poor medical treatment and unsafe conditions at the Baltimore City Detention Center and Central Booking.

 

The federal class-action suit has been around in some form since 1971.

 

In the settlement agreement filed Tuesday, the state agrees to make dozens of changes, including screening new detainees for medical and psychiatric conditions and improving their access to important medications such as insulin for diabetics and antiretroviral drugs for the HIV-positive.

 

“I believe that the state acted in good faith and that if the state continues to act in good faith and actually implements what it has agreed to do, that it will make a significant difference, that detainees locked up in the jail will suffer a reduced risk of dying,” said Elizabeth Alexander, director of the American Civil Liberties Union’s National Prison Project and a lawyer for the detainees.

 

The settlement must still be approved in U.S. District Court by Judge J. Frederick Motz.

 

Now known as Duvall et al. v. O’Malley et al, the case includes two consolidated cases, one filed in 1971 and one in 1976. In 1993, the matter was resolved by a consent decree; however, that decree was put on hold in 1999 after Congress passed the Prison Litigation Reform Act, which allowed states to end litigation if the original constitutional violations had been corrected.

 

Alexander said the ACLU grew concerned again with conditions at the detention center in 2002, when it asked for and received a temporary restraining order regarding excessive heat at the city’s Women’s Detention Center.

 

A 2002 Department of Justice report also enumerated health and safety violations at the jail.

 

In 2003, the detainees’ lawyers moved to reopen the consent decree.

 

In the last two years, while that issue was in litigation, the two sides began talking about a settlement.

 

In addition to screening new detainees and ensuring access to necessary medications, the state agreed to develop care plans for detainees with chronic health problems and provide appropriate housing for the disabled.

 

Rick Binetti, a spokesman for the state’s Department of Public Safety and Correctional Services, said the state has already made most of the changes the agreement dictates.

 

“Basically, most of the things that are discussed in the settlement [have] already been underway and been improving through working together with the Department of Justice over the last five to six years,” he said.

 

Specifically, he said the detention center has instituted a methadone program, hired more medical staff to screen detainees, and brought in contractors to improve sanitation and pest control.

 

But Alexander said there are still big problems to be resolved.

 

“It has been my experience in working with individual clients that the medication system is still not implemented,” she said.

 

She said the jail also has yet to reliably provide sanitary napkins to female detainees.

 

The settlement covers all issues except protecting certain classes of detainees from heat-related injuries. That issue will go to Motz for resolution.

 

In the settlement, the parties agree that the detainees’ lawyers may monitor the state’s compliance for two years. They will have access to detainees’ medical records, will be informed of detainee deaths and may tour the detention center and Central Booking. The state will report quarterly on its compliance with the settlement agreement.

 

If the state does not comply with the agreement, the two sides will first try to resolve the problem; if that fails, the state can move to reopen the lawsuit. The state can also petition the court to reopen the suit in case of an emergency.

 

After two years, if the detainees’ attorneys do not move to reopen the case, it will be dismissed without prejudice.

 

Copyright 2009 Daily Record.

 

 

 

 

Recent sex sting is first in county targeting ‘johns'

Investigation by county police focuses on people looking to pay for sex with minors

 

By Andrew Ujifusa

The Gazette

Wednesday, Aug. 19, 2009

 

An underage sex sting by police that netted at least 18 arrests over the past several months is county law enforcement's first effort to target the "demand" side of prostitution.

 

An equal number of underage and adult prostitutes are working in the county, according to Lt. Robert Bolesta, a member of Montgomery County Police's Special Investigative Division and the Maryland Human Trafficking Task Force. Bolesta said investigating the human trafficking of minors has been the vice squad's top priority for the past five years, and that, like their customers, the prostitutes come from a variety of backgrounds.

 

Over the last five years, police have conducted about 50 investigations into human trafficking networks related to underage and adult prostitutes, their pimps, drivers and other members of prostitution rings, Bolesta estimated. Not all of the investigations led to arrests.

 

"If I had triple the amount of guys, we would have triple the amount of cases," Bolesta said. Currently, six investigators are working on prostitution and trafficking cases, as well as gambling, he said.

 

Some of the unit's previous investigations that focused on prostitutes and pimps rather than johns have lasted as long as 18 months from first contact to arrests.

 

In the county's first attempt at cracking down on the people hiring prostitutes, undercover officers posed as minors on the Internet. At least 18 men between the ages of 20 and 56, some from as far away as Ohio and New Jersey, have been arrested by police for soliciting sex from a minor.

 

Recently, the vice squad has been encouraged by human trafficking advocacy groups, such as the Polaris Project in Washington, D.C., to focus on arresting "johns" in an effort to scare off demand for prostitution services, Bolesta said.

 

Bradley Myles, deputy director of the Polaris Project, said law enforcement groups have begun to reconsider the practice of being tougher on prostitutes than on pimps and johns.

 

"I think law enforcement are the first to say, and to realize, that really isn't going to be a long-term solution," Myles said, adding that johns on the Internet represent "low hanging fruit" for police officers.

 

The lack of any red light district in Montgomery County has made the Internet much more attractive for people soliciting sex from prostitutes, Bolesta said.

 

In the minor sex sting operation, the undercover officer claimed to reside in a city in Montgomery County, but then told the johns to meet at a street intersection or other location in the county where an arrest by other police officers could take place quickly.

 

Roland Denton, a Howard County police officer and president of the Maryland Children's Alliance, said that during some community presentations officers set up computers and pose as an underage prostitute on sex sites, using certain terms to attract people in search of minors.

 

"You'll see very quickly how many hits you'll get from people trying to hook up with this girl," Denton said.

 

But the MySpace page that Montgomery County firefighter Wayne Mothershead allegedly used to contact a female undercover officer posing as a 16-year-old does a bad job of targeting predators, because the pictures and descriptions used are not consistent with minors, said Mothershead's Rockville Attorney Rebecca Nitkin.

 

Mothershead, 44, of Taneytown was arrested July 20 for allegedly seeking sexual contact with a police officer who was posing as a female teen on social networking Web site MySpace.

 

Mothershead's scheduled preliminary hearing on Friday was waived. If a grand jury indicts Mothershead on the felony charge of sexual solicitation of a minor, it must do so by Sept. 11. If he is not indicted, a felony dismissal hearing in District Court in Rockville will take place that day.

 

The 22-year veteran of county Fire and Rescue did not access the pages on MySpace, Nitkin said. She also said there was no "back and forth conversation" between Mothershead and the undercover female police officer.

 

"Mr. Mothershead never looked at them," said Nitkin, referring to the MySpace pages.

 

Mothershead initially contacted the undercover officer through an advertisement for prostitution in the adult section of Craigslist, a Web site for classified ads, according to police charging documents. Nitkin declined to comment on whether Mothershead accessed the Craigslist ad.

 

Montgomery County police executed a search warrant Friday morning at Mothershead's Taneytown home to seize his computer in hope that it would show evidence that he accessed the pages in question, Nitkin said. Charging documents stated that Mothershead used his county e-mail address to initially contact the undercover officer.

 

Police spokeswoman Lucille Baur confirmed on Friday that the search warrant was executed at Mothershead's home.

 

Police have evidence that he used a county computer to contact the undercover officer, Baur said, and are now "trying to confirm whether or not he used his personal computer as well."

 

County employees do not have access to MySpace from county computers, but they do have access to Craigslist, county spokeswoman Donna Bigler said.

 

While Nitkin denied that Mothershead looked at the MySpace pages related to the sting, she also stressed that the sting operation was targeting the "wrong group of people" because it was more likely to catch people looking to hire adult prostitutes rather than predators soliciting sex from minors. The female pictured on MySpace appeared to be significantly older than 16, and the page stated that the individual made $150,000, unlikely for a 16-year-old, Nitkin said.

 

Bolesta, however, said the page clearly represents that the female is 16 years old, and that the $150,000 salary is supposed to represent what an underage prostitute could earn.

 

"One can make a lot of money," he said.

 

Nitkin said that after she began representing clients arrested in the operation in March, she told police that the operation was poorly thought out and executed.

 

"I have been trying to stop this operation from day one," she said.

 

Kimberly Mothershead, Wayne Mothershead's wife, said in an interview at Nitkin's law office Friday morning that the couple has two adult children. Mothershead has been ordered to not have any contact with children.

 

"My husband has been an amazing man," Kimberly Mothershead said. "He's been an amazing husband and father."

 

Copyright 2009 The Gazette.

 

 

 

 

Surgeon Tied to Bone Product Inquiry Resigns

 

By Duff Wilson

New York Times

Wednesday, August 19, 2009

 

A former Army surgeon accused of falsifying a study on a bone growth product used on severely injured Iraq war veterans has resigned his teaching position at Washington University in St. Louis, a spokeswoman said Tuesday night.

 

The surgeon, Dr. Timothy R. Kuklo, 48, was placed on leave earlier this year while the university investigated charges against him. Medtronic, a maker of the bone growth product Infuse, also suspended his consulting contract. The company paid him nearly $800,000 the last few years.

 

“Dr. Kuklo has agreed to voluntarily resign from the university, effective September 30, 2009,” Joni Westerhouse, a spokeswoman for the medical school, said in an e-mail message Tuesday. “Dr. Kuklo will have no clinical, research, or educational duties for the University between now and that date.”

 

Dr. Kuklo tendered his resignation on July 30, according to Don Clayton, associate vice chancellor and director for medical public affairs. University officials declined to comment further.

 

An investigation last year by Walter Reed Army Medical Center in Washington, where Dr. Kuklo worked before joining the university, concluded that he had falsified parts of a study that claimed greater benefits than other Army surgeons reported for the Medtronic bone growth product.

 

The Army reported its findings to the university and a medical journal. Dr. Kuklo was also found to have forged the signatures of four listed co-authors, who told Army investigators that they did not approve the study.

 

The British Journal of Bone and Joint Surgery retracted the study earlier this year. The New York Times first reported on the controversy in May.

 

Medtronic and the university, which had given Dr. Kuklo tenure shortly after hiring him in 2006, have been investigating. The university previously said that it also found he had confidential medical information on Army soldiers on his university computer.

 

Dr. Kuklo, a West Point graduate, listed his house in Wildwood, Mo., outside St. Louis for sale for $2.7 million last month, real estate records show. He did not respond to an e-mail message Tuesday, and a woman who answered the phone at his house declined comment.

 

Dr. Kuklo, who is also a graduate of Georgetown University Law Center, has never commented publicly on the matter.

 

Copyright 2009 New York Times.

 

 

 

 

Judge tosses chemical weapons incineration suit

 

Associated Press

Daily Record

Thursday, August 20, 2009

 

The U.S. Army on Wednesday won a court challenge to its plan to incinerate chemical weapons at storage sites around the country, over objections from a watchdog group that says the practice releases toxic pollution.

 

A federal judge threw out the suit aimed at stopping the plan to destroy the stockpiles dating back as far as World War II, required under an international treaty, the 1993 Chemical Weapons Convention. More than half the United States' aging cache of 31,500 tons of nerve agents and mustard gas has been destroyed so far, with a 2017 congressional deadline for completion.

 

The Army conducted several environmental impact studies comparing different methods of destruction and concluded that incineration was the most safe and effective when explosive munitions are involved.

 

A watchdog organization called the Chemical Weapons Working Group, based in Berea, Ky., sued in 2003, arguing there are new alternative technologies for destruction. They say the Army's environmental impact studies are outdated and failed to assess the impact of weapons, such as mustard agents, containing mercury.

 

The group asked that new studies be required, but U.S. District Judge Richard Eaton ruled Wednesday the group did not prove that “alternatives to incineration are readily available and capable of destroying the quantity and type of chemical warfare agents and munitions at the challenged sites.”

 

Chemical Weapons Working Group Director Craig Williams said the organization is assessing whether to appeal the ruling, which he said was based on outdated information after six years of litigation.

 

“There's no question in our mind that there are alternatives out there that are less emissive of toxic pollution and that those options should be considered for all the communities,” he said.

 

The four storage sites at issue in the suit were in Pine Bluff, Ark., Tooele, Utah, Umatilla, Ore., and Anniston, Ala. — all of which contain chemical agents in one-ton steel containers as well as rockets, artillery shells and other explosive munitions. At those sites, incinerators heat the agents and their containers at thousands of degrees, then run the exhaust through pollution-removing filters and afterburners.

 

Aberdeen’s different  

 

U.S. stockpiles of chemical agents are also destroyed in Aberdeen as well as Blue Grass, Ky.; Newport, Ind.; and Pueblo, Colo., but those four sites only contain the chemical agents in the steel containers.

 

The Army says it uses alternative destruction techniques at those sites, such as chemical neutralization in Aberdeen, because they don't have assembled chemical weapons containing energetics or propellants.

 

Copyright 2009 Daily Record.

 

 

 

 

Va. Tech Gunman's Missing Mental Records Released

Judge's Order for Seung-Hui Cho to Get Treatment Was Never Carried Out

 

By Brigid Schulte and Tom Jackman

Washington Post

Wednesday, August 19, 2009

 

The missing mental health records of Seung-Hui Cho were released Wednesday afternoon and indicate that the Virginia Tech gunman was never treated at the school's counseling center, despite orders from a judge that he get the help.

 

The long-awaited records, which were taken home by the fired director of Cook Counseling Center, do not provide a clearer insight into the mind of the college junior who would later kill 32 students and teachers before shooting himself in the deadliest shooting by an individual in U.S. history. Instead, they provide another window into the broken mental health system that allowed him to slip through its cracks.

 

The records include e-mail traffic, screening forms, discharge papers and three triage reports, all from November and December 2005. The shooting occurred in April 2007, indicating no follow-up by the university or other mental health professionals.

 

One of the triage reports included a Post It note saying: "I met with student for about 30 mins. -- he denied any suicidal or homicidal ideation." Cho, despite the fact that he was detained in a psychiatric hospital, deemed a danger to himself and ordered by a judge to recieve treatment, was never given that help.

 

Perhaps most telling was the triage report of Dec. 14, 2005, the day that Cho was released from Carilon St. Albans psychiatric hospital and ordered to undergo treatment at Cook.

 

In the section where the therapist was to have noted Cho's problems -- a mood disorder, depression or anxiety -- the therapist draw a big X through the pre-printed form. She wrote "Did not assess - student has 2 previous triages in past 2 weeks. Last 2 days ago."

 

Indeed, Cho had been triaged by phone on Dec. 12 by a different therapist.

 

The only handwritten notes by a therapist indicate that Cho was released from St. Albans for "follow-up." Cho had been admitted after telling a roommate that he might as well just kill himself after a female student reported his harassing behavior to campus police in 2005. In the records, the therapist dismisses the incident. "Said the comment he made was a joke. Says he has no reason to harm self and would never do it," she wrote. "Is going home on Saturday. Has last final tomorrow. Did not miss any finals while hospitalized."

 

The therapist did not rate the severity of his condition and noted that while she encouraged him to return in January and gave him emergency numbers should he become suicidal, they did not schedule any appointments.

 

"The absence and belated discovery of these missing files have caused pain, further grief, and anxiety for families of the April 16 victims and survivors," Virginia Tech spokesman Mark Owczarski said in a statement, "as well as for the Cook Counseling Center professionals who interacted with Cho and created and maintained appropriate departmental records."

 

Cho's family agreed on Aug. 4 that the records should be released. "My mother, father and I all agree that it is the correct thing to do to release the newly discovered medical records of my brother," Cho's sister, Sun Cho, wrote to the family attorney in a letter included in the release authorization forwarded to Virginia Tech on Wednesday afternoon.

 

"We will never fully comprehend what led Seung-Hui Cho to carry out his assault on his fellow students and instructors," Gov. Timothy M. Kaine (D) said. "His actions were by nature inexplicable, and I don't expect the questions surrounding the tragedy will ever really end. However, we remain committed to openness around the events at Virginia Tech, and it is important that the public have legal access to these records. I am pleased the Cho family also wanted these records released to the public."

 

A panel created by Kaine to investigate the state and local systems that allowed Cho to fall through the cracks already had criticized the staff at Cook Counseling Center for failing to "connect the dots" about Cho, as well as for losing his records. "The system failed for lack of resources, incorrect interpretation of privacy laws, and passivity," the panel wrote.

 

With the release of Cho's records, what emerges is a counseling center in disarray in the fall of 2005, at just the time when an increasingly erratic Cho was finally persuaded to seek help. The records show that Cho was "triaged," or his mental state assessed, twice on the phone on Nov. 30 and Dec. 12 and once in person on Dec. 14. But he was never treated.

 

That fall, the center's one staff psychiatrist had taken a leave of absence and never returned. Articles that fall published in the student newspaper, the Collegiate Times, warned that the center was understaffed and that students in need of mental health prescription medication were often required to drive as far as 45 miles away to have them filled.

 

In court papers released Tuesday, Robert Miller, who was director of the counseling center from 2002 to 2006 and had worked there since 1988, admitted that he was fired shortly after calling for an independent consultant's review. That review began on Dec. 14, the day that Cho was declared a danger to himself, was ordered into treatment and later showed up at the counseling center.

 

What is clear from the records is that despite a history of bizarre behavior and violent writing that was often reported to Miller by university officials and professors, the information was often not passed on to counselors in a timely or systematic way.

 

On Dec. 14, Miller received an e-mail at 10:46 a.m. that Cho had been taken to a psychiatric hospital under a temporary detention order because a roommate reported that he appeared suicidal and had "blades" in the room.

 

Miller forwarded that e-mail on to his staff at 4:23 that same day, "Fyi in the event this student is seen here," he wrote. Cho, who arrived at 3 p.m. for his appointment, had already come and gone by then.

 

However, investigators have found that neither Miller nor any of the Cook Counseling staff were told of Cho's treatment order.

 

"My cynical presumption from all of this, is you can talk a good game, create tomes of documents to spell everything out, but the question is, does it happen?" said Bela Sood, a professor of psychiatry at Virginia Commonwealth University who served on the Virginia Tech panel. "That was my experience on the panel."

 

For instance, the staff at Cook Counseling Center told investigators after the massacre that they never accepted students who had been involuntarily ordered into outpatient treatment, as Cho was. However, as a matter of practice, they did it all the time. Local lawyers and magistrates said it was common.

 

"I ordered a few people to Cook," said Joe Painter, a Blacksburg attorney who used to serve as special magistrate overseeing mental health commitment proceedings. "And they did take them."

 

In his court filings, Miller does not spell out specifically why he was let go shortly after Cho's only visit to the center. Tech officials on Tuesday declined to elaborate. Nor does Miller clarify in the documents why Cho's records, along with those of fewer than five other students were on his desk and "inadvertently" packed away with his diplomas, thank you notes and other belongings when he cleaned out his office in late February. Miller did not treat Cho.

 

After years of assuming the records had gone missing or been destroyed, Miller discovered them in his home in July after he'd been named in a lawsuit filed by the parents of two of Cho's victims and he was required to thoroughly search his home.

 

Copyright 2009 Washington Post.

 

 

 

 

VA Official Will Head FDA's Tobacco Division

 

By Jared A. Favole

Wall Street Journal

Wednesday, August 19, 2009

 

WASHINGTON -- The Food and Drug Administration tapped a Veterans Affairs official with a long history of public-health experience to head the agency's new tobacco division.

 

Lawrence Deyton was the chief public-health officer at the VA and initiated smoking-cessation programs that lowered smoking rates among veterans. He has served in the National Institutes of Health, started a community-based AIDS service organization in Washington, D.C., and was a legislative aide with the House Subcommittee on Health and the Environment in the 1970s.

 

His experience at building public-health initiatives should come in handy as the FDA grapples with how to regulate the deep-pocketed tobacco industry. The FDA received authority in June to regulate the industry after years of contentious debate in Congress, the public-health arena and among tobacco firms.

 

Dr. Deyton will lead a division that is charged with restricting tobacco advertising and promotions, collecting user fees from tobacco companies and stopping the illegal sales of cigarettes and other products to children.

 

He said in a statement he was eager for what he sees as a "tremendous opportunity" to "make progress in combating tobacco use -- the leading cause of preventable death in the United States."

 

His appointment won praise from public-health advocates. Dr. Deyton is "a highly respected and experienced public health leader," said Matthew Myers, president of the Campaign for Tobacco-Free Kids, adding, he has a "longstanding appreciation of the importance of tobacco."

 

Though the law giving the FDA authority to regulate tobacco is specific, there is some room for discretion -- and that is where Dr. Deyton may have the biggest effect. In anticipation of FDA oversight, large tobacco companies such as Altria Group Inc.'s Philip Morris and Reynolds American Inc. have been in recent years aggressively developing smokeless-tobacco products that are dissolvable in the mouth.

 

Companies want to be able to market the products as being less risky than traditional tobacco products. The new tobacco law says they can't, unless they prove so. Dr. Deyton will likely be a key player in determining what benchmarks companies have to reach to show their products are less risky.

 

Write to Jared A. Favole at jared.favole@dowjones.com  

 

Copyright 2009 Wall Street Journal.

 

National / International

 

HPV vaccine promoted with drug company money

 

By Kelly Brewington

Baltimore Sun –Picture of Health

Wednesday, August 19, 2009

 

Two new studies shed light on the safety of the vaccine to protect women from cervical cancer and call into question the ethics behind the marketing of the shot.

 

Gardasil, the blockbuster vaccine to combat the human papillomavirus (HPV), which can cause cervical cancer, is linked to complications, including 32 deaths, according to an analysis in today's Journal of the American Medical Association. But researchers note that the rate of side effects is low and the safety record is not out of line from other similar vaccines. The most common side effects are fainting, nausea and dizziness at a rate of about 40 to 80 cases per 1 million girls vaccinated.

 

Raising more eyebrows, however, is an accompanying JAMA article revealing that the makers of Gardasil, Merck & Co, provided grants to professional medical associations to help promote the vaccine.

 

"However, much of the material did not address the full complexity of the issues surrounding the vaccine and did not provide balanced recommendations on risks and benefits," the authors note.

 

With some 23 million doses nationwide since its FDA approval in 2006, Gardasil has been marketed heavily with commercials depicting young girls chanting they would become "one less." Approved for girls and women ages 9 to 26, worldwide sales reached $1.4 billion in 2008. Still, the vaccine has been controversial from the start.

 

By marketing it as an anti-cancer vaccine, the company tried to avoid unease from parents and the public about how HPV is spread -- through sexual contact, increasing the threat of cancer to all adolescents, while ignoring the subgroups that are most at risk, said authors Sheila M Rothman and David J Rothman of Columbia University's school of public health.

 

Merck told the Washington Post that it gave professional groups funding for educational programs on the vaccine, but didn't tell the groups what to say.

 

Still, the Rothmans don't mince words when taking on the big drug maker and the professional medical organizations (PMAs):

 

That these arguments were delivered by PMAs is a cause for concern. Professional medical associations are obligated to provide members with evidence-based data so they can present relevant risks and benefits to their patients. To this end, PMAs must become more transparent about their relationship with the industry, disclosing both the precise funding and technical assistance they have received to develop and disseminate the promotional products.

 

Copyright 2009 Baltimore Sun.

 

 

 

 

Medical Groups Promoted HPV Vaccine Using Funds Provided by Drugmaker

 

By Rob Stein

Washington Post

Wednesday, August 19, 2009

 

At least three medical associations promoted a vaccine for a sexually transmitted virus using funds provided by the vaccine's manufacturer, according to an analysis being published in Wednesday's issue of the Journal of the American Medical Association.

 

The groups -- the American College Health Association, the American Society for Colposcopy and Cervical Pathology, and the Society of Gynecologic Oncologists -- promoted Gardasil, which protects against a virus that can cause cervical cancer, using virtually the same strategy that Merck employed in its marketing campaign for the vaccine, the analysis concluded.

 

"I think what happened here was that marketing and medical education got blurred," said Sheila M. Rothman of Columbia University's Mailman School of Public Health in New York, who co-authored the article with her husband, David J. Rothman, who is at the school's Center for the Study of Society and Medicine.

 

Critics of Merck's aggressive marketing efforts said the analysis is the latest evidence that the company is pushing the vaccine inappropriately.

 

"This clearly shows how Merck was able to influence opinion leaders in the medical field to promote the vaccine without presenting any of the downsides," said Diane M. Harper of the University of Missouri at Kansas City, who helped test the vaccine for Merck but has criticized the company's activities. "This shows how they were able to influence physicians."

 

Officials at Merck and the three medical groups disputed suggestions that they acted inappropriately, saying the company provided funding for education about the vaccine but did not influence the content of the groups' programs.

 

"We provided grants that allowed them to develop, independent of Merck, their own information that was distributed to their membership," said Richard Haupt of Merck Laboratories. "Our activities with these societies were done in an appropriate and independent manner." Merck acknowledged that the company provided $199,000 to the American College Health Association, $300,000 to the American Society for Colposcopy and Cervical Pathology and $250,000 to the Society of Gynecologic Oncologists.

 

Gardasil protects against the human papillomavirus, which causes genital warts and can lead to cervical cancer. Although hailed by many health experts, the vaccine has been highly controversial since winning Food and Drug Administration approval in 2006.

 

Social conservatives have worried that providing the vaccine to young girls encourages sexual activity. The company also came under heavy criticism for an aggressive campaign to make the vaccine a mandatory prerequisite of school attendance -- an effort the company later abandoned.

 

Other critics have raised questions about the vaccine's long-term effectiveness and cost-effectiveness and about whether it may be causing serious side effects. Merck, the FDA and the federal Centers for Disease Control and Prevention have repeatedly said there is no evidence that the vaccine is unsafe.

 

In another paper published in the medical journal, the CDC analyzed more than 12,000 reports of adverse events among recipients of the vaccine -- given in a three-shot course -- and concluded that there is no evidence that any of the serious side effects were caused by the vaccine. Although more women who received the vaccine experienced blood clots, other factors such as the use of birth-control pills may be to blame, the researchers said.

 

Harper said the analysis could not rule out uncommon risks from the vaccine, but Haupt praised the findings as confirmation of the vaccine's safety.

 

The Rothmans, meanwhile, charged that the three medical societies relied on company funding to promote the vaccine among their members using arguments that mimicked Merck's approach, which they said deemphasized the downsides of the vaccine and oversimplified the risk of cervical cancer.

 

The American Society of Colposcopy and Cervical Pathology's program encouraged doctors to help persuade "states and federal agencies to pay for the vaccine" and to impose "mandates for use" of the vaccine, the pair wrote.

 

The Society of Gynecologic Oncologists' "teaching materials omitted cautionary qualifications" about the vaccine, they said. And the American College Health Association's efforts included sponsoring a Webcast viewed by 350 members and sending e-mails to college and university students urging them to get vaccinated.

 

"They seem to be repeating the marketing message of Merck," Sheila Rothman said. "If the societies are just repeating the drug company's message, they are not really educating. They are blurring the line between educating and marketing."

 

But spokespeople from the three groups said that they disclosed the funding source for their activities and that their efforts underwent independent scientific review.

 

"I consider the HPV vaccine the greatest prevention tool in women's health since the invention of the Pap smear," said James Turner, president of the American College Health Association. "We're just trying to prevent a disease that occurs in thousands of college students every year."

 

Copyright 2009 Washington Post.

 

 

 

 

Merck's Gardasil Has Higher Rates of Fainting, Clots

 

By Peter Loftus

Wall Street Journal

Wednesday, August 19, 2009

 

Recipients of Merck & Co.'s Gardasil cervical-cancer vaccine had higher rates of fainting and blood clots than those receiving other vaccines, but it doesn't appear to raise the risk of certain severe adverse events, according to a new safety analysis.

 

A separate article accompanying the safety study, published Tuesday in the Journal of the American Medical Association, criticized Merck's marketing of Gardasil, including the company's funding of education campaigns by professional medical associations, which the authors said didn't provide a balanced view of the vaccine.

 

The two articles add to questions about the safety, effectiveness and marketing of Gardasil, which have dogged the vaccine since its 2006 introduction.

 

Doctors have questioned how effectively the vaccine prevents cervical cancer, given that its regulatory approval was for protecting against two strains of human papilloma virus, or HPV, that can cause cancer, but not all cancer-causing strains. Also, the vaccine was tested in only a few hundred 11- and 12-year-old girls, which some doctors said was too small a number to declare it safe for that age group. Critics assailed Merck's efforts to get states to require HPV vaccination, a push Merck backed away from in 2007.

 

Gardasil sales have stalled over the past year after brisk growth initially. U.S. Gardasil sales for the first six months of 2009 declined 34% to $363 million. Merck has had a particularly tough time persuading women ages 18 to 26 to get the shot--which costs nearly $400 for the full three-dose regimen.

 

The shot is designed to prevent infection by some types of HPV, a sexually transmitted virus that can cause cervical cancer, rarer forms of cancer and genital warts. Merck is seeking regulatory approval to market its use in males.

 

The U.S. health authorities who led the safety review say the vaccine is safe, despite the higher rates of fainting and blood clots they identified. The vaccine's benefits and potential to prevent cervical cancer outweigh the risks, said Barbara Slade, the study's lead author and a medical officer in the immunization safety office of the U.S. Centers for Disease Control and Prevention.

 

But others urge greater caution among doctors and patients in deciding on Gardasil vaccination. Cervical cancer takes decades to develop, and there are established methods for detecting and treating it, said Charlotte Haug, editor in chief of the Journal of the Norwegian Medical Association. Ms. Haug, who wrote an accompanying editorial in this week's JAMA, called Merck's marketing for Gardasil "pushy" and "disturbing."

 

Researchers at the CDC and U.S. Food and Drug Administration analyzed more than 12,400 reports of adverse events following Gardasil vaccination that were filed between June 2006 through December. During this time, more than 23 million doses of Gardasil were distributed in the U.S.

 

About 6% of the reported events resulted in hospitalization, permanent disability or death, Dr. Slade said. This was a smaller percentage than other vaccines, and the 32 deaths weren't higher than would be expected among the vaccine's target population--females ages nine to 26. Plus, nothing suggested that Gardasil caused the deaths, Dr. Slade said.

 

Of nearly 1,900 reports of fainting, 200 resulted in falls that caused head injuries including fractures and dental injuries. Anxiety and pain from the shot may be causing the fainting spells, Dr. Slade said. The study's authors recommended health-care professionals keep recipients in the office for about 15 minutes after vaccination to mitigate fainting.

 

Blood clots were less common, occurring 56 times, according to the study. They included four deaths due to pulmonary embolisms. But the authors say the clot data should be viewed with caution because 90% of those with clots had other risk factors, such as being smokers or using oral contraceptives.

 

Rick Haupt, program lead for HPV vaccines at Merck's research arm, said the study supports Merck's view that Gardasil has "high efficacy" and a "favorable safety profile."

 

In the marketing critique, researchers from Columbia University wrote that Merck's strategy maximized the threat of cervical cancer to adolescents, minimized the sexual transmission of HPV, and "practically ignored" the sub-populations most at risk, including African Americans in the South, Latinos along the Texas-Mexico border and whites in Appalachia.

 

Merck, of Whitehouse Station, N.J., funded professional medical associations to help spread the word about Gardasil, including groups of gynecologists and doctors working at colleges. These groups developed lecture programs and other educational materials that, according to the Columbia researchers, "did not address the full complexity of the issues surrounding the vaccine and did not provide balanced recommendations on risks and benefits."

 

Spokespeople for the groups say their educational campaigns were developed with no oversight from Merck, and that the information used was consistent with recommendations by health authorities.

 

Merck said it provided about $750,000 to the three groups highlighted in the JAMA article to help improve understanding of HPV. Also, Mr. Haupt said, Merck's marketing focused on cervical cancer because two HPV types targeted by the vaccine are believed to cause about 70% of all cervical-cancer cases, and health authorities believe routine vaccination of adolescent girls will prevent many cases.

 

Jonathan Rockoff contributed to this article.

 

Copyright 2009 Wall Street Journal.

 

 

 

 

Swine Flu: The Next Wave

What You Need to Know as the Virus Threatens to Spread With the Start of the School Year

 

By Betsy McKay

Wall Street Journal

Wednesday, August 19, 2009

 

With about 55 million U.S. children heading back to school in the next few weeks, concerns are growing that the H1N1 swine flu will spread even further than it already has. Identified by scientists four months ago, the virus has already turned up in nearly every corner of the world, from Argentina to Iran. It defied public-health officials' predictions of a lull in the warm summer months, proliferating in military units and children's summer camps.

 

More than two million people are believed to have contracted the new flu in the U.S.; 7,511 had been hospitalized and 477 had died as of Aug. 13, according to the Centers for Disease Control and Prevention. World-wide, 177,457 people have been confirmed with the disease, and 1,462 deaths had been reported as of Aug. 12, according to the World Health Organization.

 

A vaccine against the new flu is under development, but it is unlikely to be widely available before the flu season gets under way. That could leave many people scrambling to protect themselves and their children.

 

Here is what you need to know:

 

How dangerous is the H1N1 swine flu?

 

Public health officials initially feared a deadly scourge, after reports of dozens of deaths in Mexico. Instead, "what we are seeing looks very much like seasonal flu so far," Health and Human Services Secretary Kathleen Sebelius said earlier this month. Most people suffer unpleasant but not life-threatening symptoms, such as fever, body aches, sore throat and runny nose. Gastrointestinal problems—vomiting and diarrhea—are normally rare for adults with flu, but have been reported globally in as many as 50% of nonhospitalized patients with the virus.

 

Many people don't even develop a fever, though they had other symptoms, says Richard Wenzel, chairman of the department of internal medicine at Virginia Commonwealth University's Medical College, who observed such cases on trips to Latin America. One academic hospital in Chile told Dr. Wenzel that only half of its outpatients infected with H1N1 swine flu had fever; some had only a runny nose, sometimes with a headache, he says.

 

One unusual thing: Young people are getting sick, while the elderly, who normally account for 90% of annual deaths from flu, have largely been spared. Most of those who died—generally of viral pneumonia and other complications—have ranged from 25 through 64 years old, according to a CDC analysis. CDC officials say people 60 and older may have some immunity to the new virus from exposure to H1N1 viruses that circulated between 1918 and 1957.

 

Public health officials are monitoring the disease closely. Scientists point to a few hopeful signs: The new H1N1 virus lacks gene sequences that made the 1918 flu virus so deadly, and it hasn't mutated into a more-virulent form despite its rapid spread.

 

Who is most at risk?

 

Pregnant women and people with asthma, diabetes, heart disease and other chronic diseases. About 70% of those hospitalized and about 80% of those who have died in the U.S. had underlying medical conditions, according to the CDC. In a study published in the Lancet, CDC scientists found pregnant women were more than four times as likely to be hospitalized with the new flu than the general population.

 

It isn't clear whether obesity itself is a risk factor. Morbidly obese patients have had greater complications, but it may be due to diabetes or other chronic diseases they have, health officials say.

 

What if I get swine flu?

 

You can't know for sure if you have the new H1N1 flu unless you get a test. But rapid flu tests haven't proven reliable at pinpointing cases of the new disease; only a lab test can confirm whether you have it.

 

Treatment is similar to that for seasonal flu. Most people get well by resting, staying hydrated and taking medicines to reduce fever. Stay home and keep your distance from others for at least 24 hours after your fever is gone.

 

Children under 18 years old shouldn't be given aspirin due to a risk of Reye's Syndrome, a rare but potentially life-threatening illness. Don't give cold medicines to children under four without first talking with a pediatrician.

 

You should call the doctor if you have trouble breathing, chest or abdominal pain, dizziness, confusion or persistent vomiting, or if your flu symptoms worsen after improving, the CDC says. Call the pediatrician if your child has those symptoms, isn't drinking enough fluids, or is irritable or sluggish.

 

Should I take an antiviral such as Tamiflu?

 

Two antiviral medications, oseltamivir and zanamivir, marketed as Tamiflu and Relenza, respectively, can help shorten the duration and severity of H1N1 swine flu.

 

The WHO and the CDC don't recommend oseltamivir and zanamivir for people with only mild H1N1 swine flu illness, partly out of concern about the potential emergence of H1N1 swine-flu viruses that are resistant to the drugs. But the drugs should be prescribed for adults and children who have severe H1N1 swine flu or who are at risk for complications from the disease, the agencies say.

 

Side effects include nausea, vomiting and dizziness for both drugs. The CDC recommends use of the drugs for pregnant women, given their high risks of flu complications, though it notes that studies to assess their safety in pregnant women are lacking.

 

When will a vaccine be available, and how can I get it?

 

Public health officials say a vaccine is the best defense against the new flu, but you may have to wait until well into flu season to get one. The first 45 million doses—of a total of 195 million—are expected to be ready by mid-October, with approximately 20 million doses delivered each week thereafter. The shots are set to be recommended first for those at highest risk of complications, as well as health-care workers and close contacts of infants.

 

Officials expect each person will need two separate doses, so if demand is high for the voluntary shots, many people will have to wait. The priority groups total about 159 million people, or more than half the U.S. population. It's worth getting the vaccine, to boost your immunity, if you believe you had the virus but aren't sure, or if you did have the virus but are considered at high risk of flu complications, says Nancy Cox, the CDC's flu chief.

 

Shots will probably be offered starting in mid-to-late October in many of the same places where you can get seasonal flu vaccine—doctors' offices, retail outlets and pharmacies. Many schools will also likely offer it.

 

The H1N1 swine flu shot won't protect you against seasonal flu, and the seasonal flu shot, which many locales will start offering in September, won't protect you against the new H1N1 virus. You will need both shots.

 

Is the vaccine safe?

 

The government and vaccine manufacturers are conducting clinical trials to determine whether the vaccine is effective and how large a dose is needed. Initial results are expected in early October. Some experts and advocates have expressed concern that the vaccine may be administered to pregnant women and children before full test results are in. But government officials believe the new vaccine is safe because it resembles seasonal flu vaccines, which normally don't undergo trials.

 

"It's made by the same companies, using the same processes, with the same materials," says Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which is overseeing the trials. Flu vaccines "have been given to tens and tens of millions of people for decades with an excellent safety record, including to pregnant women."

 

Some are also worried about thimerosal, a preservative that contains mercury and is in multi-dose vials of vaccine. The CDC says thimerosal-free vaccine will be available in the form of both shots and nasal spray.

 

First In Line for Swine-Flu Shots

    * Pregnant women

    * Infants' caregivers and contacts

    * Children ages 6 months through 24 years old

    * People up to 65 years old with medical conditions

    * Health-care workers

    * Emergency medical-services workers

 

Source: Centers for Disease Control and Prevention

 

Others have voiced concern that Guillain-Barré Syndrome, a potentially life-threatening neurological disorder, could emerge as a side effect of the vaccine. Hundreds of people out of more than 40 million vaccinated against swine flu in a 1976 campaign contracted GBS.

 

A 2003 report by the Institute of Medicine, a federal advisory body, found that evidence favored a "causal relationship" between the 1976 swine flu vaccine and GBS, but stopped short of declaring that the vaccine had definitively caused the illnesses.

 

Government scientists say that while the reason for the GBS cases remains a mystery, the new H1N1 virus differs substantially from the 1976 virus. Still, they say they plan to monitor closely for GBS. "We will be highly alerted" to symptoms of GBS, says Mark Mulligan, of Emory University, which is conducting some of the clinical trials. The government is working on ways to speed up collection and analysis of reports of side effects from the vaccine, Dr. Cox says.

 

How can I protect myself until I can get the vaccine?

 

Wash your hands often with soap and water, or use hand sanitizer. Avoid touching your eyes, nose or mouth. The virus spreads through respiratory droplets in a cough or sneeze, and people start spreading the virus a day before they develop symptoms. You can also pick it up by touching something that has flu virus on it, then touching your mouth or nose.

 

If swine flu is going around my child's school, should I keep him or her home?

 

No. The CDC recommends that schools monitor closely for ill children and staff, isolate them quickly and send them home–but remain open, in most cases, for classes.

 

Children spread infections easily to one another because they excrete virus in greater amounts than adults and for longer periods. Many schools are taking steps to curb the spread of disease by making sure paper-towel dispensers are kept full in bathrooms and taking other simple steps. Urge your children to wash their hands often or use hand sanitizer, and to cough into their elbows or a tissue to prevent viruses from spreading.

 

Schools would be urged to keep ill students home longer, move desks apart, and take other steps to minimize the spread of the virus if it grows more severe.

 

Copyright 2009 Wall Street Journal.

 

 

 

 

Swine Flu Threat to Business Seen

 

By Cam Simpson and Betsy McKay

Wall Street Journal

Wednesday, August 19, 2009

 

WASHINGTON -- An outbreak of the H1N1 swine flu in the coming flu season could be severe enough to cause staffing shortages and other workplace disruptions, officials said Wednesday.

 

The government also acknowledged that supplies of vaccines to prevent the disease are taking longer to produce than originally forecast.

 

Businesses should allow employees flexibility to stay home to recuperate or care for sick relatives, said Commerce Secretary Gary Locke, Health and Human Services Secretary Kathleen Sebelius and Homeland Security Secretary Janet Napolitano in a news conference. Businesses should consider dropping requirements that workers get doctors' notes for absences, Mr. Locke said, because they could "overload a health-care system that will likely be overstressed during this year's flu season."

 

Employers also should think about alternative work arrangements such as telecommuting for workers who may be at higher risk for contracting the disease or suffering more serious effects, he said. The flu has been most severe for pregnant women, young people and those with existing health problems, including asthma, diabetes and chronic heart disease.

 

U.S. government officials said they now expect only about 45 million doses of H1N1 vaccine to be available by Oct. 15, though they expect about 20 million doses every week after that until they take delivery of 195 million doses purchased by the government.

 

Four of five manufacturers supplying the U.S. market took longer than expected to produce the anticipated amount of antigen for vaccine, an HHS spokesman said.

 

The vaccine-production schedule is shifting, and the government is pushing to increase the number of available doses, said Rear Adm. Stephen Redd of the Centers for Disease Control and Prevention.

 

For example, while Australia-based CSL Ltd. will supply swine flu vaccine first to Australia to help stem a flu season outbreak there, a newly licensed high-speed line for syringes for flu vaccine in Illinois will speed vaccines for the U.S., officials said.

 

The new H1N1 virus accounts for 71% of all flu viruses circulating globally, according to the World Health Organization. More than 182,166 people have been confirmed by laboratory testing to have had the virus, and 1,799 have died, the WHO says. As in the U.S., most cases are mild.

 

The disease has taken a heavy toll and has spread rapidly in the Southern Hemisphere during its winter flu season. In Argentina, second only to the U.S. in number of deaths, those who have died include nurses exposed to ill patients in the hospital. The disease may be receding in South America and parts of Australia now, but is on the rise in southern Africa, according to the CDC.

 

The H1N1 flu strain, first detected four months ago, never took the summer lull that public-health officials anticipated, contributing to concerns this coming season's outbreak could be severe. Still, the impact thus far has been relatively mild, even when compared to normal seasonal flu.

 

Write to Cam Simpson at cam.simpson@wsj.com  and Betsy McKay at betsy.mckay@wsj.com

 

Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved.

 

 

 

 

Officials warn employers of swine-flu fall outbreak

 

By Kimberly Geiger - Washington, D.C. Bureau

Baltimore Sun

Wednesday, August 19, 2009

 

WASHINGTON -- Federal officials urged businesses and other employers today to prepare for a widespread outbreak of swine flu this fall that could result in high rates of sustained absenteeism and leave critical posts vacant.

 

Employers should cross-train workers so that vital functions are covered and must take active steps to ensure that the H1N1 virus that causes the flu does not spread, officials said.

 

Such steps include aggressively cleaning work areas, encouraging hand-washing and sending employees home at the first hint of flu symptoms.

 

"We like to praise the Puritan work ethic," said Commerce Secretary Gary Locke, who appeared at a news conference with other top federal officials. But "common sense" would be a better response to the likely outbreak of swine flu, he said.

 

At the same time, federal officials are not sure how bad the outbreak will be.

 

"In some areas, there may be a lot of flu, in other areas, very little," Health and Human Services Secretary Kathleen Sebelius said.

 

Employers should consider curtailing face-to-face meetings and even limit company travel to prevent the possible spread of the disease, Locke said.

 

Federal officials are urging a "hands and home" approach -- keeping hands clean by washing and sanitizing them, and keeping ill workers at home.

 

"Be responsible and understanding for the absenteeism that needs to occur with this strain of the flu," said Homeland Security Secretary Janet Napolitano, joining Locke and Sebelius at the news conference today.

 

Copyright © 2009, Tribune Interactive.

 

Copyright 2009 Baltimore Sun.

 

 

 

 

Government officials call on employers to help get swine flu vaccine to vulnerable workers

 

By Matthew Perrone

Baltimore Sun

Wednesday, August 19, 2009

 

WASHINGTON (AP) — Government officials are calling on U.S. businesses to help manage swine flu this fall by getting vaccines to vulnerable workers and encouraging employees with symptoms to stay home.

 

Commerce Secretary Gary Locke said Wednesday that employers should develop plans for managing both seasonal and swine flu. Businesses should encourage employees who are at-risk for swine flu to get the vaccine as soon as it becomes available. First in line are pregnant women, health care workers and younger adults with conditions such as asthma.

 

The government is trying to prepare for the possibility of a widespread outbreak this fall, which could hurt businesses along with the broader economy by keeping workers home. Unlike regular seasonal flu, the H1N1 virus which causes swine flu has not retreated during the hot and humid summer months, and so far has infected more than 1 million Americans.

 

Locke briefed reporters on recommendations for U.S. businesses at a press conference alongside Homeland Security chief Janet Napolitano and Health and Human Services Secretary Kathleen Sebelius.

 

The three cabinet secretaries said each company must develop its own unique plan. The officials declined to give more detailed instructions, explaining the scope of a potential outbreak is still unclear.

 

About 45 million doses of swine flu vaccine from GlaxoSmithKline, Novartis and several other companies are expected to be available by mid-October. Federal officials plan to begin shipping vaccines out to the states when they become available.

 

The World Health Organization has estimated that up to 2 billion people could be sickened during the swine flu pandemic, which already is known to be responsible for more than 1,400 deaths.

 

"The government can't do this on its own," Locke said. "For this effort to be successful we need businesses to do their part."

 

Guidelines posted online Wednesday recommend businesses develop plans for operating with reduced staff, in the event of a flu pandemic.

 

Napolitano said this is particularly important for transportation and infrastructure companies.

 

"The country needs to be prepared but it also needs to be resilient," she said.

 

Employers also should consider allowing employees to work staggered shifts or from home if an outbreak becomes severe, the government officials said.

 

Workers with flu symptoms should be encouraged to stay home and remain there at least 24 hours after they no longer have a fever, the government recommends.

 

"If an employee stays home sick, it's not only the best thing for that employee's health, but also his co-workers and the productivity of the company," Locke said.

 

Other recommendations for companies include: keeping work areas clean, stocking up on hand sanitizers and other supplies, and sending employees home at the first sign of flu symptoms.

 

"In some areas there may be a lot of flu," Sebelius said. "In other areas, very little."

 

Copyright 2009 Associated Press. All rights reserved.

 

 

 

 

State Requires Flu Vaccination for Caregivers

 

By Anemona Hartocollis

New York Times

Wednesday, August 19, 2009

 

The State Health Department is requiring tens of thousands of health care workers across the state to be vaccinated for flu, amid fears that swine flu will return in the fall.

 

The new regulation, quietly adopted as an emergency on Thursday, affects workers at hospitals, in home health care agencies and in hospice care, but, because of a technicality in state law, not in nursing homes.

 

The regulation raised protest Tuesday from New York’s largest health care union, 1199 S.E.I.U. United Healthcare Workers East, whose president, George Gresham, said that the policy was “completely unprecedented” and could become punitive if the religious or cultural beliefs of workers prevented them from being vaccinated.

 

“Health care workers on the front lines of providing care deserve the dignity and respect of thoughtful consideration before a regulation like this can just be rushed through and put into effect,” Mr. Gresham said.

 

Until now, flu vaccination has been voluntary, and fewer than half of health care workers have been vaccinated in a typical season, state health officials said.

 

The new regulation, which requires vaccination against seasonal flu and the H1N1 virus, would affect workers and volunteers who come into direct contact with patients, including nurses, doctors and aides, and even nonmedical staff members like food service workers if they enter a patient’s room, a Health Department spokeswoman, Diane Mathis, said.

 

Ms. Mathis declined to comment on Mr. Gresham’s criticism, but said that health officials had met with the union and other professional associations to discuss the proposal before it was adopted.

 

She said that vaccination was “clearly a patient safety issue.”

 

Copyright 2009 New York Times.

 

 

 

 

Officials Find Flu Disproportionately Hits Minorities

 

By Richard Knox

Wall Street Journal

Wednesday, August 19, 2009

 

Young people are more at risk of getting swine flu, and pregnant women, among others, have a higher chance of hospitalization from the new flu. Now public health officials are discovering that blacks and Latinos have a substantially higher risk of both.

 

It is apparently not because of race or ethnicity, per se; it's because of the social circumstances of many African-Americans and Hispanics.

 

The new data are from Boston health authorities. Federal health officials are studying flu disparities on a national basis but haven't released numbers yet.

 

Stark Disparities

 

In Boston, the disproportionate effect of swine flu on minorities is striking.

 

Blacks make up one-quarter of the city's population, but they were 37 percent of the swine flu cases. Latinos are 14 percent of the population, but more than one-third of those with confirmed cases of the new H1N1 virus this spring and summer were Latino.

 

Dr. Anita Barry of the Boston Public Health Commission says she and her colleagues didn't expect such large disparities.

 

"We really didn't know what the race-ethnicity breakdown would be," Barry says. "So, when we saw that this illness was disproportionately affecting black and Latino residents, that really did get our attention."

 

Barry says there is nothing about the new flu virus itself that makes minorities more likely to get sick from it; social factors — especially the makeup of Boston public schools — are key. Most Boston schoolchildren are minorities, though the general population isn't.

 

This, for starters, makes minorities more likely to get swine flu because it disproportionately strikes younger people who don't have decades of exposure to distantly related viruses, which grants some degree of immunity. The typical Boston swine flu victim between April and July was 13 years old.

 

Low-Income Parents

 

There are, however, other reasons why minorities seem to be more at risk of swine flu. Low-income parents have a harder time keeping their sick children home from school.

 

"For some parents in lower-wage jobs, if they don't show up at work, they don't get paid, and people may already be on the economic margins," Barry says. "So parents were desperate to get some of these children back in school."

 

As a result, there were many sick, contagious kids in Boston classrooms this spring. Because of the economic pressures and demographics of the Boston school system, most of them turned out to be black or Hispanic.

 

Barry says this abetted the spread of the new flu among those groups.

 

School officials documented the phenomenon.

 

"It was hard on the school nurses, who had parents on the phone saying, 'I can't come get my child,' or 'I don't have anybody to take care of my child,' " Barry says.

 

Impact On Local Clinics

 

The city's neighborhood health centers saw the disproportionate impact, too. Nurse Jan Smith of the Codman Square Health Center in Boston's Dorchester neighborhood, which treats a low-income population, says she was surprised by the volume of people who sought care for flu symptoms.

 

"Our waiting room was packed," Smith says. "It was as great or greater than late winter."

 

There is another troubling disparity in the new data. Blacks and Hispanics were also twice as likely to require hospitalization for the new H1N1 virus — that is, their infections were more severe than those of nonminorities.

 

That reflects another kind of disparity. About half of the hospitalized cases of swine flu involved people with asthma, which is more prevalent among African-Americans and Latinos.

 

Boston officials have counted four deaths from swine flu so far: two blacks, one Latino and one white. That's too few to draw any conclusions about disparities in the risk of death.

 

Targeting Minorities

 

Given the new data, Boston officials plan to target minority neighborhoods in upcoming flu-vaccination campaigns. Like their counterparts across the country, they will probably have to persuade people to come in three times for flu shots: once, early in the season, to be vaccinated against regular seasonal flu; then, later, twice to get swine flu vaccine. Because it is a novel vaccine, it is assumed that people will need two shots to get adequate antibodies.

 

Dr. Steve Tringale of Codman Square Health Center says it is hard for low-income people to make time for flu shots.

 

"That's always a challenge, to come back a second time for full protection," Tringale says. "Taking the time off work or getting babysitters or whatever it takes is always going to be an effort for patients."

 

To address that problem, Boston Mayor Tom Menino is asking all businesses to give workers time off to get flu shots.

 

Copyright 2009 Wall Street Journal.

 

 

 

 

Gut Reaction: 'Good' Microbes Under Attack

 

By Barbara Martinez

Wall Street Journal

Tuesday, August 18, 2009

 

Add this to the list of reasons why you should be cautious about taking antibiotics: Some of these drugs may permanently wipe out the "good" bugs in your gut that fight off the "bad" ones.

 

In tests on mice, Vincent Young at the University of Michigan Medical School found that a certain antibiotic permanently decreased the diversity of the animals' "microbiota"—the trillions of microscopic bugs that inhabit the gut and which may be very beneficial.

 

The study was published in June in the journal Infection and Immunity.

 

"We may be doing long-term damage to our close friends," said Dr. Young, 46 years old, referring to the good bugs.

 

Dr. Young, who is an assistant professor in the school's departments of internal medicine and microbiology and immunology, has spent the past several years studying communities of microbes found in the gut—the gastrointestinal tract, which includes the mouth, the stomach and the intestines.

 

The gut harbors the largest collection of micro-organisms in the human body. Yet these microbial communities remain largely a mystery to scientists.

 

Studying gut bugs could one day yield much knowledge about the role bacteria play in human development, physiology, immunity and nutrition.

 

Recognizing the potential importance that microbes play in health, the National Institutes of Health in 2007 launched the Human Microbiome Project, a five-year, $140 million effort to study all the micro-organisms that reside in or on the human body as well as their DNA.

 

This summer, the NIH announced that it had awarded more than $42 million to expand its "exploration of how the trillions of microscopic organisms that live in or on our bodies affect our health."

 

Dr. Young has three NIH grants to study microbes.

 

"The gut is an ecosystem, just as much as the rainforests and the oceans," he said. "We're finally getting a better understanding of how this ecosystem assembles and responds to ecologic stress." Dr. Young said the gut ecosystem needs to be preserved and that changing the ecosystem through stresses such as antibiotics "could irreversibly change the ecosystem, with deleterious results."

 

In one experiment, Dr. Young and his colleagues gave two groups of mice different antibiotic treatments to see what happened to the "community" of bugs that had inhabited the mice's intestines. The first group received a combination of amoxicillin, bismuth and metronidazole; the second got cefoperazone.

 

Cefoperazone can attack a broad spectrum of bacteria. It isn't commonly used in the U.S., but it is a cephalosporin, a type of antibiotic that is commonly used in the U.S. for severe infections or pneumonias. The amoxicillin group of antibiotic drugs also has a broad-spectrum effect and is widely used, Dr. Young said.

 

The scientists checked what changes occurred some time after the antibiotics were stopped. Both treatments caused significant initial changes to the microbial communities in the mice. However, in the mice given the cefoperazone, there was no recovery of normal levels of diversity even after six weeks, said Dr. Young.

 

The findings have particular importance in the study of Clostridium difficile, a potentially deadly intestinal bug known as C. diff, whose prevalence has risen sharply in the past decade. C. diff thrives in patients treated with powerful broad-spectrum antibiotics, which clear away other intestinal bacteria that usually keep C. diff in check.

 

A study in November found that more than 1% of U.S. hospital patients are infected with C. diff, which can result in diarrhea, fever, loss of appetite, nausea and abdominal pain. The study, commissioned by the Association for Professionals in Infection Control and Epidemiology, found that more than 7,000 hospital patients nationwide are infected with C. diff on any given day, and roughly 300 of them will go on to die from the bacteria.

 

Many in the health-care community assume that when the broad-spectrum antibiotic treatment is through, the patient's gut microbiota return to a state where they can regain control over C. diff, said Dr. Young. But the rate of recurrence among C. diff patients is increasing, said Dr. Young, suggesting that some people have so altered their gut microbiota that the good bugs don't come back to fend off the C. diff.

 

After documenting the effects of the antibiotics on the mice, Dr. Young began to investigate how the effects might be countered.

 

He added some healthy mice who hadn't been treated with antibiotics to live with those that had been treated. Mice practice coprophagia—which means they eat each other's feces.

 

Compared with mice that didn't have a healthy cagemate added, the diversity of the gut microbial community in the mice that ingested normal feces was restored to normal.

 

That seems to echo findings of a retrospective study on humans in 2003. The study looked at 18 patients over a nine-year period who had recurrent C. diff and who had stool transplants performed.

 

In this case, doctors took stool from a person close to the patient, such as a spouse, and inserted it through a tube into the patient's nose and from there to the stomach.

 

The study found 15 patients had no more recurrences. Two patients died of unrelated illnesses and one patient had a single recurrence of C. diff after the transplant.

 

Dr. Young said he hopes his research "will lead to a better understanding of the complex relationship that we have with our indigenous microbes."

 

That, he said, could lead to "novel ways to prevent and treat a variety of illnesses that involve intentional manipulation of our microbiota, or preventing harmful changes to this beneficial microbial community."

 

"NIH is very enthusiastic about the study of microbes in and on the human body," said Susan Garges, the NIH's program director of the Human Microbiome Project.

 

Ms. Garges said more than a dozen projects are under way that will increase what is now known about microbes.

 

"We already know that they produce vitamins; they have enzymes that can digest things we can't; and there's some good evidence that they're important for developing the immune system," Ms. Garges said.

 

She added that microbes from healthy volunteers are beginning to be sequenced now.

 

Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved.

 

 

 

 

Teens Who Live With A Depressed Parent

 

By Dr. NancyBrown

Wall Street Journal - Healthline - Connect to Better Health

Wednesday, August 19, 2009

 

Teens living with a depressed parent need information and support. The inclination of most people living with someone who is depressed is to take on responsibility for the ill parent and other family members.

 

Life is difficult for anyone living with a depressed parent. The daily home life is complex - with little consistency, irregular habits, plans made at the last minute, little consideration for each person’s wishes or desires, and there is usually a huge decrease in communication. The depressed parent withdraws from the family and the teens are left to manage on their own, creating feelings of loneliness.

 

Teens are not likely to realize how much their life has changed, or how serious the depression is and need adults who see the changes to bring them to the attention of the family, medical and emotional professionals. Even if the depression lifts for a period, everyone in the family will likely be anxious about when it will returns.

 

I believe that all health care professionals are ethically responsible to help teens avoid the responsibility and loneliness associated with living with a depressed parent. As mentioned in a previous post, there are also many resources for those parents who are willing to admit the depression, as well.

 

This post, Teens Who Live With A Depressed Parent, was originally published on Healthine.com by Nancy Brown Ph.D..

 

Copyright 2009 Wall Street Journal.

 

 

 

 

Johnson & Johnson gets FDA warning letter on monitoring and conduct of ceftobiprole studies

 

By Marley Seaman

Baltimore Sun

Wednesday, August 19, 2009

 

NEW YORK (AP) — The Food and Drug Administration has warned Johnson & Johnson that it did not properly monitor two human tests of its antibiotic drug candidate ceftobiprole, which is intended to treat complicated skin infections like MRSA.

 

The agency has twice delayed approval of ceftobiprole, citing similar problems. It said Johnson & Johnson violated the protocols of its own study, by, for example, not making sure patients were storing the drug properly when using it at home. The FDA also said Johnson & Johnson failed to document some doses given to patients, did not conduct thorough examinations of all patients, enrolled some patients who did not meet its own eligibility criteria for the study, and hired unqualified investigators.

 

The warning letter, dated Aug. 10, was posted to the FDA's Web site Tuesday. The agency gave Johnson & Johnson 15 working days to explain the precautions it will take to prevent similar problems in the future. The letter warns of potential "regulatory action" if the company does not detail its response.

 

The agency sends warning letters when it is concerned about violations that could threaten the value of data being collected in the trial, or compromise the rights, safety or welfare of patients, said FDA spokeswoman Pat El-Hinnawy.

 

El-Hinnawy said she could not detail what actions the FDA would take against J&J while the case is under review by FDA scientific investigators.

 

"The finest option, and the one that everyone hopes for, is that there will be corrective action taken, meaning the deficiencies that were noted would be corrected," she said.

 

Ernie Knewitz, a spokesman for Johnson & Johnson Pharmaceutical Research & Development LLC, had no comment on the particulars of the warning letter, but said the company is preparing a response.

 

"We have a period of time to react to the letter and address their questions. We have people working on that right now," he said in a telephone interview.

 

In addition to the FDA's postponements, the European Union also delayed a ruling on the product in February. Basilea Pharmaceutica Ltd., which licensed the drug to Johnson & Johnson in 2005, filed a lawsuit against the New Brunswick, N.J.-based drugmaker, saying it has been hurt by the delays.

 

One of the two studies was started by Basilea and taken over by Johnson & Johnson, the world's biggest maker of healthcare products. J&J conducted the second study on its own.

 

Copyright 2009 Associated Press. All rights reserved.

 

 

 

 

COBRA enrollment doubles with subsidy, study says

 

By Stephanie Desmon

Baltimore Sun - Picture of Health

Wednesday, August 19, 2009

 

cobraLaid-off workers have been flocking in recent months to COBRA, the federal program that has long allowed them to keep their employers' health insurance for 18 months -- but for a hefty price.

 

Lots of people have become eligible for the program -- with unemployment at a 25-year high -- but few are able to afford it when they lose their income. COBRA allows involuntarily terminated to pay 100 percent of the premium plus 2 percent for administrative costs. The cost: roughly $8,800 a year for the average worker.

 

The doubling of COBRA enrollment has been since February, when the government began paying a subsidy to make the coverage actually affordable to some unemployed people, according to an analysis by Hewitt Associates, a human resources consulting firm.

 

According to Hewitt's data, eligible workers receive a nine-month subsidy that leaves them responsible for paying only 35 percent of their COBRA premium -- about $3,300 a year. The firm says that, on average, workers with employer-sponsored health coverage pay 22 percent of the premium cost, about $1,900 a year. The company's data was culled from enrollment activity for 200 large U.S. companies representing eight million employees.

 

In the six months before the subsidy, Hewitt says, only 19 percent of those eligible for COBRA signed up for it; that was up to 38 percent from March to June. Some of those who lose their health insurance when they lose their jobs end up covered by a spouse's employer or by a new employer. But many are likely foregoing health insurance altogether.

 

COBRA usage varies by industry and those hardest hit by layoffs -- manufacturing, construction, leisure and retail -- have seen their rates spike the most since the temporary subsidy was introduced.

 

Copyright 2009 Baltimore Sun.

 

 

 

 

Obama faces new dispute over subsidy for Medicare

 

Tribune Newspapers

By Christi Parsons and Andrew Zajac

Baltimore Sun

Wednesday, August 19, 2009

 

WASHINGTON — With the wildfire over so-called "death panels" still smoldering, President Barack Obama faces what could become another emotion-charged obstacle to his vision of overhauling health care - his plan to trim the federal subsidy for a program called Medicare Advantage.

 

The program pays insurance companies a hefty premium above traditional Medicare reimbursements for enrolling senior citizens in managed care. But whether the higher payments are worth the cost is a matter of dispute.

 

Obama and many congressional Democrats see Medicare Advantage as a wasteful bonanza averaging about $17 billion a year for the companies, which critics say provide few benefits beyond regular Medicare. And cutting out the extra pay is crucial to financing the health care overhaul under the Democrats' plans.

 

The companies and their supporters say they earn the extra payments by providing seniors with significant added benefits, including freedom from government red tape. And many Medicare recipients who may pay nothing for the "extras" seem to agree. Almost a quarter of Medicare beneficiaries are enrolled in Advantage programs.

 

But what lifts the disagreement over Medicare Advantage above many other points of contention in health care is its potential for spreading fear and outrage among Medicare recipients as a whole, much like the outcry after Republicans accused Democrats of trying to create "death panels" to cut off care for severely ill seniors.

 

Though scaling back Advantage payments would have no effect on most Medicare users, it would create an opening for opponents to make the allegation that Obama wants to cut Medicare benefits, as some Republicans are beginning to say. Obama and his supporters acknowledge the risk.

 

"Some beneficiaries will be dislocated," said Robert Berenson, a physician and health care policy analyst at the Urban Institute. "This is not painless."

 

The White House is counting on persuading seniors, with their powerful lobbying presence in Washington, that in order to fix the health care system, they have to cut the fat out of one part of it.

 

For the past few years, Medicare Advantage has been a sheltered corner of the national health plan. When congressional Republicans began expanding private insurance Medicare options in 1997, advocates said the plans would deliver services more efficiently, and hence less expensively, than Medicare's traditional fee-for-service reimbursement. But the spending on Advantage plans grew, with critics contending that GOP majorities were deliberately overfunding it to make the private plans more attractive to seniors than traditional Medicare.

 

As a result, the private plans now cost the government about 14 percent more per person than does regular Medicare, according to a recent analysis by the Medicare Payment Advisory Commission, which recommends reimbursement rates to Congress.

 

"Payment increases have been so large that plans no longer need to be efficient to attract enrollees," MedPAC Executive Director Mark E. Miller told Congress in 2008.

 

Today, the sheer size of the private program, which serves about 10.2 million seniors out of more than 45 million Medicare users overall, offers an opportunity for savings that the Office of Management and Budget puts at $177 billion over 10 years. That is an inviting figure to an administration looking for ways to expand access to health care to millions of Americans.

 

Obama joined Advantage critics in 2007 as a candidate on the stump in Iowa, when he began to criticize the arrangement as an example of waste that hurts the Medicare program as a whole. Now, his plan is to reduce the payments to Advantage so that it receives little or no federal subsidy.

 

As part of their health care talks, lawmakers have suggested reducing the rates through competitive bidding or by fiat, perhaps mandating that payments for the private plans not exceed those of traditional Medicare.

 

"We should not be subsidizing insurance companies to provide Medicare benefits that cost 14 percent more," said Kenneth Baer of the president's Office of Management and Budget, "especially when we can reform this system and save approximately $177 billion over the next 10 years."

 

Some members of the senior citizens lobby like the idea of trimming Advantage payments.

 

"We think having choices and competition within Medicare is important," said AARP's Jordan McNerney, "but they should not add to the cost of the program." Though the organization isn't backing a particular health care bill at the moment, McNerney said, "We are in support of cutting back the subsidies to private insurers over time so they compete on a level playing field with traditional Medicare."

 

But the insurers who provide the Advantage plans see it differently. And so do many seniors who have enrolled in it.

 

In July, Maurice Engleman, 82, of Palm Springs, Calif., made the rounds on Capitol Hill, presenting himself as living testimony to the benefits of Medicare Advantage. Last year, Engleman was diagnosed with tongue cancer shortly after his wife of 59 years died. His Medicare Advantage managed care firm, Desert Oasis Healthcare, assigned a nurse to guide him through a thicket of doctor visits and hospitalizations, including what turned out to be 30 radiation treatments.

 

"There wasn't an appointment she didn't come meet me," Engleman said. "Physically and emotionally, I felt completely supported. I really don't think I would have made it without this continuum of care."

 

Engleman, who said he is now cancer-free, acknowledged the added expense of Medicare Advantage - to taxpayers, not to him - compared with traditional Medicare, but said it was cost-effective in the long run. "It might cost $1,000 more, but if I didn't have to go to the hospital, that might save Medicare $5,000," he said.

 

Copyright © 2009, The Baltimore Sun.

 

 

 

 

Medicare Test Pays for Hospital Performance

 

By Jane Zhang

Wall Street Journal

Monday, August 17, 2009

 

WASHINGTON-A pilot project by Medicare that links hospital payments to the quality of care has helped prevent infections in pneumonia patients and cut death rates in heart-attack patients, according to data to be released Monday.

 

In the project, hospitals compete for cash incentives from Medicare, the government insurance program for the elderly and disabled. On Monday, Medicare officials are expected to announce that 225 hospitals will divide $12 million in bonuses; three poor performers will be penalized.

 

Some lawmakers see the experiment, which began in 2003, as a model as they debate ways to overhaul the nation's health-care system.

 

In the four years ended Sept. 30, 2007, the hospitals saw about 4,700 fewer deaths among heart-attack patients than if they hadn't been participating in the program, said Premier Inc., a health-information company that is Medicare's contractor on the project. That was among more than 30 quality measures in which hospitals scored higher, Premier said. It said, for example, that 92.6% of the pneumonia patients during the period received antibiotics, flu vaccines or other recommended treatments to prevent acquiring other infections in the hospital, up from 69.3%.

 

The lesson is that "financial incentives can increase quality of care," said Tim Love, director of the research office at the Centers for Medicare and Medicaid Services, the federal agency that manages Medicare.

 

Senate Finance Chairman Max Baucus (D., Mont.) has said he wanted to establish a hospital pay-for-performance program partly based on the Medicare pilot project. An aide said the committee hasn't settled on any specifics yet as it drafts its proposal for health-care legislation. Lawmakers in the House are also discussing the idea.

 

The American Hospital Association supports the Medicare project, but Beth Feldpush, the group's senior associate director for policy, urged caution in expanding the voluntary program nationwide, especially when hospitals are already suffering from the recession. "There are costs involved every time you beef up a program," she said.

 

There are other caveats. The hospitals participating in the voluntary pilot project tend to be highly motivated, and their performance might not be a precise indicator of other hospitals' performance under a similar system. Some hospitals and advocates have expressed concern that the bonuses Medicare hands out to top performers come from other health-care providers, instead of from additional federal funding. The bonus system means hospitals that maintain their existing quality of care but are ranked low on the list could lose some funding.

 

Doctors and hospital officials who participate in the project also say Medicare needs to overhaul its current payment system to control costs and boost quality across the board. The current fee-for-service payment system compensates doctors and hospitals more for providing more care, but it doesn't pay for many measures aimed at improving quality of care, such as coordinating with other providers and visiting homes of patients with chronic illnesses. Hospitals say these measures cost money to implement.

 

"Quality is not without cost," said Michael Goler, chief medical officer at the Cleveland County HealthCare System, whose hospital in Shelby, N.C., is a top performer in the Medicare project. "People are doing this because they feel this is the right thing to do, but they are doing that despite the economic burdens."

 

The hospital, for example, hired 1 1/2 full-time-equivalent nurses to track quality data and also bought new beds that helped reduce infections. Its success in keeping heart-failure patients from returning to the hospital-readmission rates dropped 37% over three years-actually cost the hospital money because fewer admissions meant less reimbursement from Medicare, hospital officials said.

 

Write to Jane Zhang at Jane.Zhang@wsj.com

 

Printed in The Wall Street Journal, page A3

 

Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved.

 

 

 

 

White House Drops Health-Care Tip Line

E-Mail Effort Raised Privacy Concerns

 

By Garance Franke-Ruta

Washington Post

Wednesday, August 19, 2009

 

After complaints from Republicans, the White House has shut down a two-week-old e-mail tip line where people could report "disinformation about health insurance reform."

 

"An ironic development is that the launch of an online program meant to provide facts about health insurance reform has itself become the target of fear-mongering and online rumors that are the tactics of choice for the defenders of the status quo," the White House's new media director, Macon Phillips, wrote in announcing the change.

 

"The White House takes online privacy very seriously," he added.

 

The e-mail tip line, flag@whitehouse.gov, was launched Aug. 4 as part of the White House's Health Insurance Reform Reality Check, a rapid-response effort reminiscent of the war room that the Obama campaign began last summer to fight online rumors about Obama's patriotism and religion.

 

But the new effort quickly sparked concern among Republicans about the government collecting information on private citizens' political speech.

 

"I am not aware of any precedent for a president asking American citizens to report their fellow citizens to the White House for pure political speech that is deemed 'fishy' or otherwise inimical to the White House's political interests," Sen. John Cornyn (Tex.) wrote in an Aug. 5 letter to the White House that called for an end to the program.

 

"By requesting that citizens send 'fishy' emails to the White House, it is inevitable that the names, email addresses, IP addresses, and private speech of U.S. citizens will be reported to the White House. You should not be surprised that these actions taken by your White House staff raise the specter of a data collection program," wrote Cornyn, chairman of the National Republican Senatorial Committee.

 

White House press secretary Robert Gibbs sought to tamp down concerns at a briefing the next day, saying: "We're not collecting names from those e-mails. . . . All we're asking people to do is, if they're confused about what health-care reform is going to mean to them, we're happy to help clear that up for you. Nobody is keeping anybody's names."

 

Cornyn kept up the pressure, scoffing in an Aug. 7 statement: "Of course the White House is collecting names. As I wrote to the president, it is inevitable."

 

By Aug. 11, pressure from bloggers and the mainstream media had grown to the point where the president himself addressed the concerns during a town hall meeting in Portsmouth, N.H.

 

The issue surfaced again after it was reported that people were receiving e-mails from the White House that they had not signed up for. Fox News's Major Garrett asked Gibbs about the reports at a briefing Thursday, telling him, "I have received e-mails from people who did not, in any way, shape or form, seek any communication from the White House."

 

In announcing the end of the e-mail tip line, Phillips acknowledged, "It has come to our attention that some people may have been subscribed to our email lists without their knowledge," but he said this was probably "a result of efforts by outside groups of all political stripes."

 

The problem of people being added to White House's e-mail list was separate from questions about the tip line, according to a person familiar with the system.

 

E-mails to the canceled address now refer people to the Reality Check site, where they can report distortions through an online interface that includes the warning: "Please refrain from submitting any individual's personal information, including their email address, without their permission."

 

Cornyn hailed the decision but said he would still like more information on how the program worked. "I'm glad the White House recognizes its own bad idea and has disabled their data collection program. They've finally come to their senses and acknowledged that this is compromising citizens' free speech rights by causing them to be concerned whether complaints will be compiled into some sort of enemies list," he said. "Questions still remain about information that's already been collected over the past few weeks."

 

Privacy concerns also attended the administration's use of YouTube, which came with an unusual exemption to White House rules banning the use of tracking software known as cookies. A White House proposal this month to permanently change the rules on cookies has again raised these concerns; the administration is seeking to overturn the ban on the use of cookies by federal Web sites.

 

Copyright 2009 Washington Post.

 

 

 

 

Tennessee Experiment's High Cost Fuels Health-Care Debate

 

By Avery Johnson

Wall Street Journal

Monday, August 17, 2009

 

In 1994, Tennessee launched an ambitious public insurance program to cover its uninsured. The plan, TennCare, fulfilled that mission but nearly bankrupted the state in the process.

 

As originally envisioned, the Tennessee plan expanded Medicaid, the government health-care program for the poor, to cover people who couldn't afford insurance or who had been denied coverage by an insurance company.

 

With an initial budget of $2.6 billion, TennCare quickly extended coverage to an additional 500,000 people by making access to its plans easy and affordable. But the program became so expensive that Tennessee was forced to scale it back in 2005.

 

Now, as Congress debates a national health-care overhaul, state experiments like Tennessee's are informing the discussion.

 

Unlike Massachusetts's more recent universal coverage law, the TennCare plan is most often cited by opponents. They say TennCare's runaway costs show that the public health-insurance proposal by House Democrats could bankrupt the federal government.

 

In a letter to Congress last month, Rep. Marsha Blackburn (R., Tenn.) compared the public plan envisioned in the House bill to TennCare, warning that TennCare became so costly at its peak that it ate up one-third of Tennessee's budget.

 

"The promise of TennCare has gone unrealized," she wrote. "Many of the concerns we have expressed about the proposal before us today are the stark realities of a system that went terribly wrong in Tennessee."

 

The Obama administration says TennCare is different from the proposed public plan because its administration of the Tennessee program is contracted out to private companies. A federal public plan would more likely be run by the government, although the White House on Sunday signaled that it wouldn't insist on having a public option.

 

Another difference, the administration says, is that a public option would increase competition in the health-insurance market by offering an alternative to private insurers; TennCare was the primary option for Tennessee's uninsured.

 

What the Tennessee experiment did share with health-care-overhaul supporters was its ambition to cover the uninsured. To qualify, patients only had to show a denial letter from an insurance plan. TennCare charged $2.74 a month in premiums for people earning just above the poverty level. Its rolls quickly swelled to 1.4 million people, leaving only 6% of Tennessee's population without health insurance. It never achieved complete universal coverage in part because of an income cap.

 

"The lesson is you can quite quickly cut the number of uninsured," said Alan Weil, executive director of the National Academy for State Health Policy. "Tennessee is not a well-off state and they just kind of did it."

 

TennCare had its failings. The plan, for example, paid health providers less than private insurance plans, prompting some physicians and hospitals to increase charges to private insurers. Some of this resulted in so-called cost shifting, with insurance companies passing on the costs through higher premiums. Opponents of a public option warn the same thing will happen nationally, to the detriment of people who already have health insurance.

 

Rep. Blackburn says TennCare shows that a public plan would undermine the current employer-based health-care system, citing data from University of California at San Diego that showed 45% of people claiming TennCare's benefits had left employer-provided insurance. Darin Gordon, TennCare's current director, says the switching was more limited than critics allege.

 

Another Tennessee congressman, Republican Phil Roe, says that as a physician who worked under the program, he saw TennCare's shortcomings up close. He says TennCare reduced access to care: physicians refused to see TennCare patients because of the program's lower reimbursement rates.

 

"As soon as I heard about this public option, I thought, 'I know how this works,"' said Dr. Roe. He said he has been repeating his cautionary tale about TennCare to colleagues "until I'm hoarse."

 

TennCare aimed to pay for much of its expanded coverage with cost savings -- mostly by reducing unnecessary care.

 

In its first five years, TennCare had the lowest per capita cost of any Medicaid program in the country, saving between $245 million and $2 billion by cutting down on emergency-room visits by uninsured patients, for example, according to the Tennessee Justice Center, a public-interest law firm for the poor. It has championed the program and sued the state over cutting people from its rolls.

 

"TennCare covered the majority of people and did it with the money that was saved by squeezing waste out of health-care infrastructure," said Michele Johnson, managing attorney at the Center.

 

However, the program's costs quickly escalated. After rising at a roughly $300 million annual rate in its early years, TennCare's budget swelled from $5.4 billion in 2000 to $8.5 billion in 2004. During that period, the state re-assumed much of the risk of managing the program from private insurers who complained they were losing money administering it.

 

In 2005, with the state's solvency in jeopardy, Gov. Bredesen reduced TennCare's rolls by about 170,000 by booting some people who weren't eligible for Medicaid. He also created a separate limited insurance option called CoverTN that covers only up to $25,000 in annual medical costs.

 

Emily Tell of Nashville is among those who got bumped off TennCare's rolls. Uninsured after she lost a job in customer service at an insurance agency, she went on TennCare in 2001. She said the program paid an expensive medical bill from a car wreck that resulted in two foot surgeries.

 

When she got a letter in the mail several years ago telling her she no longer qualified for the program, she says she didn't know what to do. She eventually enrolled in CoverTN, which covers most of her medications for high blood pressure, cholesterol and attention deficit. But she gripes about its $125-a-month premium and regular co-payments.

 

"That's expensive for a single person," she said. "I know they are trying to save money, but we should have access to health care."

 

Write to Avery Johnson at avery.johnson@WSJ.com  

 

Copyright 2009 Wall Street Journal.

 

 

 

 

Illegal immigrants and health care reform

 

By Kelly Brewington

Baltimore Sun - Picture of Health

Wednesday, August 19, 2009

 

And you thought the uproar over "death panels" had reached a fever pitch. Well, here's another topic making the heated rounds in the health care reform brawls: Should illegal immigrants be eligible for coverage?

 

First off, none of the plans currently in Congress include illegal immigrants. President Obama and Nancy Pelosi have made a point of underscoring this lately. In fact, up until the town halls got ugly in recent weeks, no one in Congress was even talking about health insurance for illegal immigrants. That hasn't stopped angry opponents from asserting all sorts of false claims -- free insurance to non-citizens, among them. (PolitiFact debunks a that claim, for the record.)

 

It also hasn't stopped immigrant advocates from asking -- wait a second, what about us?

 

There's a moral obligation to provide access to health coverage to all Americans, regardless of their immigration status, they say. Any plan that excludes illegal immigrants will fall short, says the advocacy group the National Council of La Raza, considering that illegal immigrants account for 15 percent -- nearly 7 million -- of the nation's 47 million uninsured. But proponents of strict immigration enforcement counter that providing insurance would only encourage more immigrants to flock here illegally.

 

Thing is, just how much illegal immigrants cost the health care system is unknown and therefore, up for debate. Nearly half the country's estimated 12 million illegal immigrants don't have health insurance, according to the Pew Hispanic Center, a non-partisan think tank.

 

Some groups claim this means they are more likely to jam hospital emergency rooms -- which by law can't turn anyone away -- ratcheting up health care costs even higher. But others insist illegal immigrants are actually less likely to clog emergency rooms and have lower health care costs than U.S. citizens.

 

What is clear is no elected official is likely to touch the incendiary issue, if they can help it. Before coming to the health beat, I covered immigration for eight years. I can think of no other issue that's sure to spark a backlash for politicians already under heavy scrutiny by voters. Couple that with health care reform and oh man, go grab yourself some popcorn and get ready for the drama.

 

Copyright 2009 Baltimore Sun.

 

 

 

 

CDS says drop in US death rates led to fewer deaths in 2007, but numbers may rise in 2008

 

By Mike Stobbe

Baltimore Sun

Wednesday, August 19, 2009

 

ATLANTA (AP) - U.S. life expectancy has risen to a new high, now standing at nearly 78 years, the government reported Wednesday. The increase is due mainly to falling death rates in almost all the leading causes of death. The average life expectancy for babies born in 2007 is nearly three months greater than for children born in 2006.

 

The new U.S. data is a preliminary report based on about 90 percent of the death certificates collected in 2007. It comes from the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.

 

Life expectancy is the period a child born in 2007 is expected to live, assuming mortality trends stay constant. U.S. life expectancy has grown nearly one and a half years in the past decade, and is now at an all-time-high.

 

Last year, the CDC said U.S. life expectancy had inched above 78 years. But the CDC recently changed how it calculates life expectancy, which caused a small shrink in estimates to below 78.

 

The United States continues to lag behind about 30 other countries in estimated life span. Japan has the longest life expectancy - 83 years for children born in 2007, according to the World Health Organization.

 

The CDC report found that the number of deaths and the overall death rate dropped from 2006 - to about 760 deaths per 100,000 people from about 776. The death rate has been falling for eight straight years, and is half of what it was 60 years ago.

 

Heart disease and cancer together are the cause of nearly half of U.S. fatalities. The death rate from heart disease dropped nearly 5 percent in 2007, and the cancer death rate fell nearly 2 percent, according to the report.

 

The HIV death rate dropped 10 percent, the biggest one-year decline in 10 years.

 

"It was kind of a surprise to see it go down so much" and it's unclear if it will be a one-year fluke or not, said Bob Anderson, chief of the agency's mortality statistics branch.

 

The diabetes death rate fell about 4 percent, allowing Alzheimer's disease to surpass diabetes to become the sixth leading cause of death. Alzheimer's has been climbing the death chart in recent years, though that may be partly because declines in other causes are enabling more people to live long enough to die from Alzheimer's, Anderson said.

 

The nation's infant mortality rate rose slightly in 2007, to 6.77 infant deaths per 1,000 births, but the rise was not statistically significant. It has been at about the same level for several years.

 

That's not a shock, some experts said. Medical care improvements can improve infant survival, but they also mean that some troubled pregnancies now make it to infancy before death, said Paul Terry, an assistant professor of epidemiology at Atlanta's Emory University.

 

Another recent CDC report containing early data for 2008 counted 2.45 million deaths last year. That's an increase of more than 29,000 deaths from the 2.42 million deaths in 2007.

 

CDC data sometimes changes as more records come in and researchers eliminate duplicate reports. But it's likely an increase will hold up because of the growing number of elderly, experts said.

 

___

On the Net:

CDC report: http://www.cdc.gov/NCHS/

 

Copyright 2009 Associated Press. All rights reserved.

 

 

 

 

One in Four Fish in U.S. Waterways Contaminated with Unsafe Levels of Mercury

A U.S. Geological Survey study finds mercury levels above federal standards in 25 percent of fish

 

By Sara Goodman  

Wall Street Journal

Wednesday, August 19, 2009

 

Mercury contamination found in a quarter of U.S. freshwater fish exceeds federal safe levels for human consumption, according to a study released today by the U.S. Geological Survey.

 

The agency examined mercury in fish, sediment and water drawn from 291 rivers and streams between 1998 and 2005, finding 25 percent carried mercury at levels above the safe standard for human consumption (0.3 parts per million wet weight), while all of the fish had detectable mercury levels.

 

"This study shows just how widespread mercury pollution has become in our air, watersheds, and many of our fish in freshwater streams," Interior Secretary Ken Salazar said in a statement. "This science sends a clear message that our country must continue to confront pollution, restore our nation's waterways, and protect the public from potential health dangers."

 

Atmospheric deposition of mercury is responsible for the contamination of most waterways, but that alone does not account for all of it, USGS noted. Wetlands, forests and organic soils can enhance the conversion of mercury to highly toxic methylmercury, which accumulates in the food chain and can cause serious public health problems.

 

Overall, the scientists found concentrations in fish corresponded with increasing concentrations of methylmercury in the water.

 

Some of the highest levels of mercury in fish were found in "blackwater" streams in North and South Carolina, Georgia, Florida and Louisiana, all of which have large, undeveloped, forested watersheds. Some high levels were also found in the western United States, which the scientists attributed to mining.

 

"This study improves our understanding of where mercury ends up in fish in freshwater streams," USGS scientist Barbara Scudder said in a statement. "The findings are critical for decision-makers to effectively manage mercury sources and to better anticipate concentrations of mercury and methylmercury in unstudied streams in comparable environmental settings."

 

Gavin Gibbons, a spokesman for the National Fisheries Institute, emphasized that the study does not address commercial fish, which mostly come from the oceans or aquaculture.

 

"To suggest that this study in any way represents a health hazard for normal consumption of commercial seafood would be a distortion," Gibbons said. "For those who rely on subsistence fishing or those who enjoy recreational fishing, it highlights the need to check with local and regional fish advisories. This is not a study that should have consumers in any way concerned about the commercial fish they regularly enjoy."

 

Reprinted from Greenwire with permission from Environment & Energy Publishing, LLC. www.eenews.net, 202-628-6500

 

Copyright 2009 Wall Street Journal.

 

 

 

 

Ibuprofen Best for Injured Kids

 

Associated press

Wall Street Journal

Tuesday, August 18, 2009

 

Kids with a broken arm do better on a simple over-the-counter painkiller than on a more powerful prescription combination that includes a narcotic, a study found.

 

It tested ibuprofen, sold as Advil, Motrin and other brands, against acetaminophen plus codeine—a combo called Tylenol No. 3 that is also sold in generic form. The children on ibuprofen did better, said study leader Amy Drendel of the Medical College of Wisconsin. "They were more likely to play, they ate better and they had fewer adverse effects."

 

The results, published online by the Annals of Emergency Medicine, don't mean that ibuprofen beats acetaminophen for everyday pain relief. The study tested pain in the first three days after a broken arm and the acetaminophen was combined with the narcotic codeine, not tested alone. Researchers randomly assigned 336 children ages 4 to 18 to go home with liquid versions of either ibuprofen or the acetaminophen-codeine combo after being treated for a broken arm at Children's Hospital of Wisconsin. Neither the children, parents nor the doctors knew who received what treatment until the study ended.Full results were available on 244 children. The portion who failed to get relief from their assigned medicine was roughly the same. However, half of those on the combo medicine reported side effects—mostly nausea and drowsiness that can occur with narcotics like codeine—versus 30% of those given ibuprofen. The ibuprofen users also had fewer problems eating, playing, going to school or sleeping. They and their parents reported more satisfaction with the treatment.

 

Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved.

 

 

 

Opinion

 

Prescription Privacy Doesn’t Exist

 

Dr. Wes - Musings in the life of an internist, cardiologist and cardiac electrophysiologist.

 

ByWestby G. Fisher, MD, FACC

Wall Street Journal Commentary Blog

Wednesday, August 18, 2009

 

I wish this was hard to believe:

 

    Like many other people, Ms. Krinsk thought that her prescription information was private. But in fact, prescriptions, and all the information on them - including not only the name and dosage of the drug and the name and address of the doctor, but also the patient’s address and Social Security number - are a commodity bought and sold in a murky marketplace, often without the patients’ knowledge or permission.

 

But given the money involved, I’m afraid it isn’t.

 

But with the pharmaceutical industry soon to release $150M dollars of ads promoting health reform as they cozy up to Congressional leaders, the conflicts of interest for patient’s privacy are staggering. Further, the promotion of the electronic medical record, personal health records, and ultimately, cloud computing (where no one will know where health data resides), are firmly part of the health reform landscape.

 

Now before people think I’m totally against the EMR, let me be candid: I’m not. It does facilitate care and is an incredible means of communication between physicians and laboratories and pharmacies and the like. When used properly, they are miraculous.

 

But the risks of losing information remain huge. Certainly, the above referenced New York Times article notes that safeguards are supposed to be enacted to prevent this wholesale marketing of your health data.

 

But suddenly, we learn of a White House snitch line where they will collect e-mails of people who might be spreading “misinformation” about the health reform efforts underway. (Thanks to my previous blog post, I am happy to report I’ve been reported! ;)) But this occurs at a time when privacy issues in health care must be seen as paramount and electronic medical records protected as secure.

 

Ooops.

 

So now we have a White House eager to build a snitch line as they cozy up to pharaceutical interests that are already selling personal information from prescription data, all while trying to promote the security of electronic medical records to the masses.

 

Who are they kidding?

 

But then, shucks, just think of the marketing possibilities for the government:

 

And lest people think I’m too partisan (who me?), the Republicans with their travel junkets aren’t any better.

 

Sheesh!

 

-Wes

 

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem, Evanston, IL and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.

 

Reference: White House blog with snitch e-mail link at flag@whitehouse.gov .

Musings of a cardiologist and cardiac electrophysiologist.

 

*This blog post was originally published at Dr. Wes*

 

Copyright 2009 Wall Street Journal.

 

 

 

 

A Nurse’s View of Health Reform

 

Oncology nurse Theresa Brown is a regular contributor to Well.

 

By Tara Parker-Pope

New York Times - Well on Health

Wednesday, August 19, 2009

 

I saw a bumper sticker a few days ago that said, “I used up all my sick days so I called in dead.” I liked it because it was absurd, but also because it seemed so apt to the battle raging right now over reforming health care in America.

 

I could offer a tableau of stories, but instead I will tell just one. A patient we had several months ago was admitted for leukemia treatment. In his 60s, kind and immensely likable, he went through three different rounds of what we call “induction chemo” — the regimen and dose designed to cure. But in trying to cure his leukemia we’d weakened his immune system to such an extent that he no longer had any reserve, and fluids and intravenous antibiotics could not save him from the infection growing in his lungs.

 

I took care of this patient fairly often, and I got pretty attached to him. I had the privilege of being in his room when he told me, with tears in his eyes, that his first granddaughter had been born that day in a different hospital across town. A Pittsburgh Steelers fan, he hung a “terrible towel” from the TV in his room and grumbled whenever we dislodged it with the I.V. pole. One of his chemo regimens included the drug Topetecan, and the name of this drug led to many jokes: about drinks with little umbrellas called Topetecans, an entire island paradise named Topetecan, even the walks he and his gentle wife took prompted the question, “Are you dancing . . . the Topetecan?”

 

The dark side of this patient’s visit, in addition to his fight for his life against a very aggressive disease, was that he did not have good health insurance. We talked about it. He was in business for himself selling insurance, but his own personal health insurance was inadequate and didn’t cover all the care he was getting. They were a solidly middle-class family, and he explained that if he had any medical bills in the past he just paid for them out of pocket. Getting leukemia was not part of the plan, and neither was an unexpected six week hospital stay that included thousands of dollars of chemotherapy.

 

Six weeks is a standard amount of time for new leukemia patients going through their first round of induction chemo. We make them so vulnerable to infection that we keep them in the hospital to ensure quick action if they do get sick. This patient’s six weeks turned into two months, and then three months, as one chemo regimen after another made no headway against his disease.

 

During periods when he was feeling sort of O.K., he was constantly on the phone and the Internet trying to find a way to pay his mounting hospital bills. He told me, “I know there’s money out there; I just have to find it.” He was confident that he could locate money for his care and that he would “beat” the cancer.

 

And then I came to work one day, and he was dead as a result of pneumonia. During the fraught and too quick final three months of his life, the cost of his care weighed on him as heavily as his possible death. His wife lost her husband. In addition to mourning him, is she also saddled with a medical debt that will burden her for years to come?

 

Can we all agree that the worry provoked by any kind of serious illness should not be compounded with the concern that we cannot afford the treatment we need?

 

I’m a nurse so I’m focused on need, and the treatment required to save someone’s life represents a profound need. It is also a need that is always unanticipated. My patient thought he had planned well for his health care needs. He just never thought he would wake up one day with a diagnosis of leukemia.

 

But which of us does? And that’s why we need health care reform. My patient was savvy about the business side of health insurance, but not about how cruel and unfair life can be. He was suddenly confronted with an illness, and treatment costs, outside the realm of his imagination. Any of us could wake up tomorrow and find ourselves in the same terrible predicament: really sick, needing treatment we can’t afford.

 

So I ask the people who oppose health care reform to consider what they would do if they found themselves in my patient’s situation — because they very well could, sooner than they know. Any of us could wake up sick, without the coverage we need, in danger of losing the very job that gives us health insurance. Our lifetime cap on insurance, which we never thought we would approach, can be brought so near that the question of costs cannot be separated from the treatment needed to stay alive.

 

I have no statistics to support the need for reform; I can only describe what I have seen, because what I have seen brings the discussion of health care reform down to the level of individuals. What do you do when you’ve used up all your sick days and you’re still too sick to go to work? And what if you’ve reached the cap on your health insurance, need a drug that isn’t covered by your plan, or require a scan that you can’t possibly pay for?

 

We’re not there yet as a country, but if some kind of reform doesn’t happen, the most ill among us, and the most unlucky, may just have to start calling in dead.

 

Copyright 2009 The New York Times Company.

 

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