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			Monday, February 2, 2009 News Clipping Archives *Maryland / Regional* Flu Season Is Off to Slow Start, But for Va. (Washington Post) No one should be turned away (Baltimore Sun) Seeking Help for Autistic Kids (Washington Post) Nightly dialysis keeps teen alive (Baltimore Sun) Study makes case for paperless hospitals (Baltimore Examiner) Md. EMS Is Pressed To Share Triage Study (Washington Post) Company: Md. EMS delaying triage study report (Daily Record) Hopkins researchers find new use for old drug (Baltimore Examiner) Gender differences in heart attack symptoms (Baltimore Examiner) *National / International* Welfare Aid Isn’t Growing as Economy Drops Off (New York Times) Frostbite: what to look for (Baltimore Sun) *Opinion* Sins of Omission: The Forgotten Poor (Baltimore Sun Editorial) Peanut Bummer (Washington Post Editorial) *Maryland / Regional* Flu Season Is Off to Slow Start, But for Va. State Is the First With Widespread Reports of Illness By Ashley Halsey III Washington Post Monday, February 2, 2009; B01 Virginia is the first state in the nation to report a widespread outbreak of the flu, and the federal Centers for Disease Control and Prevention says the chronic winter illness might spread rapidly after a relatively slow start this season. "We could really get slammed in two weeks," Anthony Fiore, a CDC epidemiologist, responded when asked whether much of the nation might be spared this year. "Oh, no, it'll get here." The weekly survey conducted by the CDC during flu season found localized outbreaks of the illness in Maryland and sporadic cases in the District, but Virginia was the only state so far where the flu was widespread. "We can expect to see high incidence for the next six to eight weeks," said Laura Ann Nicolai, an epidemiologist for the Virginia Department of Health. "You can see the illness into March, April, even May." Although the flu season generally begins with the onset of colder weather in October and November, in some years it peaks later. People who get sick during that period often mistake one of the scores of other winter viruses for the flu, whose symptoms include fever, aching muscles, headache, a dry cough, sore throat and lack of energy. Although it doesn't keep track of the others as meticulously, the federal government carefully monitors influenza because severe strains can result in death. The 1918 worldwide flu epidemic killed an estimated 20 million to 40 million people, including 675,000 Americans. Flu vaccination grew out of that pandemic, when desperate doctors discovered that blood transfusions from recovered flu patients to new patients had a positive effect. The first vaccines were approved for use by the military in the 1940s, and a decade later researchers developed the current production methods, which grow the virus in chicken embryos. The illness presents itself in a mix of strains, some more powerful than others, so, as they formulate the vaccine each year, researchers make an educated guess as to which strains the vaccine should protect against. "The years when we tend to have more illness tend to be the years when there's not a good match," said David Blythe, an epidemiologist with the Maryland Department of Health. "This year, there's a good match with the two A strains, and some of the B strains don't match quite as well." The fact that the vaccine matches up well with this year's version of the flu is one explanation for the somewhat slow advance of the illness outside Virginia. "It's out there, but no question, it's breaking late," said Susan Fay, coordinator of the communicable disease program in Fairfax County. "That's happened the last few seasons." The fact that the District and Maryland are next door to Virginia doesn't necessarily mean that they will be next to cross the threshold into the "widespread" flu designation that every state in the nation achieved last year. "The flu has 100 different entry points to a given area," Fiore said. "For example, if West Virginia has high reports next week, that doesn't necessarily mean it comes from Virginia." A designation of widespread means the illness is affecting wide areas of the state. Health officials do not know the exact number of cases in Virginia. Fiore said that, particularly in jurisdictions where the illness has not become widespread, it's important for people to get flu vaccinations. The vaccine begins to provide effective protection two weeks after it's received. In Montgomery County, senior epidemiologist Jamaal Russell said there have been no significant outbreaks. "That's not to say you don't need to get a flu shot," Russell said. "It usually picks up from now until March. Last year, we had a spike in March." In years when flu vaccine has been in short supply, young children and people 50 or older were given preference, but this year plenty of vaccine is available, and health officials are encouraging people of all ages to receive shots. "Every year, there are otherwise healthy young people who are hospitalized or die of the flu," said Loudoun County Health Director David Goodfriend. "The more people who get the flu shot, the fewer people you come in contact with will have the flu." Copyright 2009 Washington Post. No one should be turned away Our view: Extra shelter beds should keep the city's homeless safe at night Baltimore Sun Monday, February 2, 2009 The call came to Greg Sileo's City Hall office on a day in late November. A 22-year-old father needed help. The mother of his two children had left them, he was out of work and homeless; he, his year-old son and 2-year-old daughter had slept in an abandoned house the night before. Within 48 hours, Mr. Sileo brought to bear all that Baltimore Homeless Services could provide, and the young family moved into a two-bedroom, semi-furnished apartment thanks to a helpful landlord. City social services found day care for the children, so the dad could participate in job training for which he qualified. It was an unusually swift outcome for one homeless family in a city that, for all its attention to the problems of Baltimore's homeless, recently added 50 more emergency shelter beds to ensure people aren't left out in the cold on bitter winter nights. But those beds, which are in addition to the 350 spots the city shelter provides during the winter, have been in doubt since their funding ran out last week. This occurred as city officials were concluding their annual census of homeless, a count expected to exceed the 2007 estimate of 3,002. Diane Glauber, director of the city's office of homeless services, attributes the increase to rising unemployment, the foreclosure crisis and a more precise count. Mayor Sheila Dixon has bravely made reducing homelessness a priority. But it remains a challenge because of its vexing, underlying causes of poverty, joblessness and mental illness. Despite that, the city continues to make strides. It has managed to place 1,335 homeless people in transitional housing that lasts from six months to two years, and during the winter months has available 1,046 shelter beds. Its proposal for a permanent 275-bed shelter on the Fallsway is headed now to the City Council, after officials worked diligently with communities to address their concerns and needs. But as one advocate put it, "This is a growth industry." City officials were hopeful that their homeless services provider would receive a $25,000 grant to keep available the 50 overflow beds during the winter season. But no one should be turned away, especially on a bitter cold night. Copyright 2009 Baltimore Sun. Seeking Help for Autistic Kids Va. Parents Want Insurers to Pay for Therapy, but Critics Worry About Costs By Fredrick Kunkle Washington Post Monday, February 2, 2009; B01 Gareth Oldham does not look like a child at the center of a growing debate over a childhood disease. On a cold morning in Leesburg, the autistic 4-year-old scoots around his family's playroom in his bare feet. He hurls himself onto a giant tire swing dangling from the ceiling. He squeals in pleasure as it whirls him madly around. But other than a simple command -- "Push me!" -- Gareth has trouble saying anything at all. Then his mother, Cassandra Oldham, asks him to say a prayer, the only complete sentence he is able to say. "Dear God, help me. Done," Gareth says in a rush. His parents, along with many others in Northern Virginia, have their own plea. They have marched on Richmond to ask the Virginia General Assembly to require insurers to cover the cost of therapy for autism. The District of Columbia and 27 states, including Maryland, already do. The help could would come none too soon for the Oldhams: The youngest of their three boys, Korlan, 2, is also autistic. They estimate that their out-of-pocket bills have hit $50,000 for both boys over two years. Although Bill Oldham, 38, runs a high-tech company that provides very well, they cannot afford the amount of occupational and speech therapy their sons need. "In some ways, if this bill doesn't pass, we're going to get driven out of this state," said Cassandra Oldham, 36. The national debate over the explosion in autism cases has arrived in Richmond this year, and the legislation is one of the few bills to draw attention in a session consumed by fixing a $2.9 billion hole in the budget. The measure, which brought about 200 demonstrators to the Capitol grounds last month, has been backed by Democrats and Republicans. Del. Robert G. Marshall, a conservative Republican from Prince William County who is co-sponsoring the bill with a Democrat, said Oldham, a stay-at-home mother, made a strong impression on him. "She doesn't have enough money to take care of one," he said. But private businesses, already facing the worst economy in generations, have lined up against another government-ordered mandate that would drive up health-care premiums. Every increase causes some companies, especially small businesses, to consider dropping their policies and leaving employees without coverage, they say. "It's the cumulative effect of many mandates that we object to and we find damaging to the affordability of health care coverage for small businesses," Hugh Keogh, the Virginia Chamber of Commerce president, said in an interview. Autism, first identified in the 1940s, is generally regarded as a lifelong disorder that affects a person's ability to communicate and relate socially to others. The Centers for Disease Control and Prevention says autism affects about one in every 150 8-year-old children, about a tenfold increase since the early 1990s. Many people think of a severely autistic child as seeming locked inside his or her own world. Today, autism diagnoses fall along a spectrum of behaviors. States with autism laws require insurers to cover therapy for children into early adulthood, according to the National Conference of State Legislatures. That means until the age of 19 in Maryland, and 21 in the District. "We can say there are more children being diagnosed with autism than at any other time in the past," Thomas R. Insel, director of the National Institute of Mental Health, said Tuesday. Insel said the soaring rate could be explained by many factors, including broader diagnostic categories and more vigilance among parents, teachers and physicians. As the number of reported cases has risen, research spending has tried to keep up. Insel said the federal government spent $118 million in 2008 on autism research, a sixfold increase in the past decade, in hopes of finding its cause. Some families with autistic children have blamed exposure to pesticides, fire-retardant clothing and early immunizations, but scientists say no cause is known. Experts believe early and aggressive intervention, such as speech therapy and behavior modification, can make the difference between a child becoming a functioning adult or needing intense services, or even institutional care. There are also financial benefits. Spending on early therapy has been proved to lower long-term costs. Insel said the lifetime cost of treatment and care for an autistic person is estimated at $3 million. By comparison, early treatment runs $60,000 to $80,000 a year. Therapists can charge as much as $180 an hour for applied behavioral methods that help children learn to care for themselves and communicate with others. The Virginia bill, HB 1588, would mandate insurance coverage for the diagnosis and treatment of autism and related disorders. It would apply only to policies offered by businesses with more than 50 employees and would cap the amount spent on treatment at $36,000 a year. A companion bill, sponsored by Sen. Jill H. Vogel (R-Winchester), is in the Senate. "This [is] of one of the most serious problems affecting Virginia families, and it's growing at an alarming rate," said Del. David E. Poisson (D-Loudoun). Loudoun County schools reported 200 children receiving therapy for autism when he joined the legislature in 2006; today the number is 600, Poisson said. He said he believes the bill's prospects are good if it survives in committee. But the National Federation of Independent Businesses says the autism bill comes at the worst time for companies already laboring under well-intentioned but costly mandates from government. "We would love to be able to provide the Cadillac of plans, but the cost is driving us out of the market," said NFIB state director Julia Hammond. She said that Virginia already ranks third in mandating health-care benefits and that less than 48 percent of Virginia's small businesses now offer health care. "In a year when we're begging them to do no harm, I want to believe they're not doing something as harmful as that," Hammond said. But the parents say they feel costs that go beyond tapping home equity lines, in-laws and grandparents. Like other parents of autistic children, Rachel Kirkland saw her little boy suddenly start sliding backward in time. Kirkland, a school librarian who lives in Manassas Park, said her son Jacob, now 5, was saying a few words by the end of his first year. Then his progress came to a halt. "He quit talking. He quit walking," said Kirkland, 39. Her HMO would not pay for therapy. But his school began to intervene, and she paid for what she could afford. "We were easily spending my salary -- $36,000," she said. And that still wasn't enough. "It's just the most sickening, helpless feeling in the world," she said. Copyright 2009 Washington Post. Nightly dialysis keeps teen alive Nightly dialysis keeps Eric Washington alive - even as it circumscribes his adolescent life By Stephanie Desmon Baltimore Sun Monday, February 2, 2009 No matter what Eric Washington is doing - be it catch-up work from the classes he has missed or a game of pick-up football that his doctors have forbidden - he must be home by 10 p.m. No exceptions. As he has every night for nearly three years, the Polytechnic Institute senior must hook himself up to a suitcase-sized contraption that will clean his blood as he sleeps. It's something Eric's kidneys used to do on their own, before they failed him when he was just 14. Now, as he waits for a kidney transplant, he relies on a dialysis machine beside his bed to keep him alive. "I'd like to one time go home and just go to sleep," he says, "without having to worry about it." It is a struggle to reconcile being a kid with having a chronic disease, the need to rebel with the life-threatening consequences of breaking the rules. There aren't a lot of children on dialysis - roughly 1,600 in the United States require a machine to perform the normal functions of their kidneys. But there are more than ever, because many children whose kidney disease would have killed them in infancy are surviving to need organ transplants. Eric, 17, is but one example of the millions of children nationwide with a chronic illness, from kids with diabetes who are on strict diets and even give themselves insulin shots to those with cystic fibrosis who may need four treatments a day to maintain their ability to breathe. Many face uncertain futures. All have obstacles the healthy do not. Many miss school, causing them to fall behind. They may find it hard to fit in. Some show physical symptoms they can't hide. "It's extremely difficult for them to transition to adulthood as other teens do," says Barbara Fivush, head of pediatric nephrology at the Johns Hopkins Children's Center. "That journey that they take is harder. ... It's different, and teens don't really like to be different." Here's how different: Eric has a catheter implanted in his abdomen by which he connects himself to bags of a cleaning solution that helps remove toxins from his blood. He has to limit what he eats - no bags of chips or liters of soda allowed. And he has spent a lot of time in the hospital - six stays in the first six months of 2008, making keeping up with schoolwork more than a chore. All the stress has led him to develop an ulcer. Eric's close-knit family - his mother, Michelle Washington-Garrett, a systems engineer at Fort Meade; his stepfather, Lamar Garrett, a research analyst at Aberdeen Proving Ground; and his sister, Erica, a student at Western High School - tries to help him through it all, but also makes sure he keeps his plight in perspective. "This is what God has laid before him," his mother says. "Either you accept it and deal with it, and take the positive out of it ..." "What positive?" Eric says, interrupting. "It could be a lot worse," she says. "He hasn't been dealing with this since birth. He was at least able to grow." (Eric is nearly 6 feet tall.) "You accept your lot in life. You deal with it." Adds his stepfather: "There are some really sad stories." Shannon S. Joslin, child life manager at the University of Maryland Hospital for Children, sees children with those sad stories all the time. She and her staff work hard to be sure that kids get to be kids, even if they have an all-consuming illness. "They have hopes and dreams for what they want their lives to be ... but that chronic disease goes with them," she says. "How do you still live your life and not let your chronic illness define you?" It may be hard for a parent to let her ill child go on sleepovers or camping trips, experiences that are part of the fabric of adolescence. At the same time, it is important for a parent to step back and allow some freedom, Joslin says. Otherwise, that child might have a hard time becoming an independent adult. "In the old days, the goal was to get them through it, to live," Hopkins' Fivush says. "Now, more and more, we're focusing on the quality of life. We spend so much time on the medical side. It's important to do everything we can to make them as whole as they can be." Eric Washington appeared healthy when he got a physical in the summer of 2005 for a Christian camp. The doctor found something unusual in Eric's urine, and a biopsy revealed severe scarring on his kidneys. It was later determined Eric had focal segmental glomerulosclerosis, or FSGS, an acquired immune disorder. Doctors still don't know why Eric got sick. His kidneys were failing and quickly. Eric's stepfather offered one of his. In the summer of 2006, both were prepped for surgery when a mishap occurred as Garrett was getting a catheter inserted. The surgery was called off. Ultimately, Garrett had to go in for a second surgery, and Eric's mother decided someone else would have to donate a kidney to her son. In the meantime, Eric started dialysis. He had to go to a clinic twice a week, three hours each time, and have the blood removed from his body to be cleaned and then recirculated. Sometimes he had to miss school. His Saturdays were usually ruined. Eric hated every moment. But after two months, he was able to switch to the machine he uses while he sleeps. His main complaint about in-home dialysis, aside from the freedom it steals, is the alarms that go off whenever he lies on one of the tubes wrong, piercing beeps that wake him from a deep sleep. His mother was deemed a poor donor. So as Eric waits to hear if he got into college, he also waits for a kidney through the national transplant list. The family thinks it could be a few years. He desperately wants to get into the University of Maryland, College Park. He wants to live outside of the house he is tethered to, to strike out on his own. But he figures he is a long shot for UM. His SAT scores might be high enough, he says, but so many days out of school haven't been kind to his grade point average. More likely, he says, is that he will go to his mother's alma mater, Morgan State University, which he fears could mean staying at home. "Every teenager I know wants to leave their house after high school. I don't want to be the one living with mom after high school. I want to try to be as normal as possible," he says. Eric's illness often intrudes on his thoughts. He needs to remember to take his medication (which sometimes he forgets). He needs to remember his doctor's appointments (ditto). He needs to stay away from foods that will give him headaches or make him extra tired. He wants to let loose, if only a little bit. He tells a story about a Saturday night with his buddies that ended when it was time for him to go home for dialysis. "On Monday, they told me they stole traffic cones and blocked off the Wendy's," Eric recalls. "I wanted to do that, but I couldn't because I had to be on the machine." He knows such mischief is silly. He also knows it's the kind of thing he has been missing out on. He has felt normal in the hospital and at an annual camp for children with kidney disease, where other kids are sick, too. There, the friendships are instantaneous. Everyone is going through the same thing, and Eric's version of normal is just like theirs. Tomorrow, Eric will turn 18. He will become one of the 350,000 to 400,000 adults on dialysis in the U.S. There will be new doctors, less hand holding. Should he have to visit a dialysis center, the person in the next bed could be a shackled prisoner getting a kidney treatment. Then again, each day brings a chance that Eric will get a kidney. That, of course, would change everything. Dreams about that day bring a smile to his face. "I want to go out," he says, "and not come home until the next day." Copyright 2009 Baltimore Sun. Study makes case for paperless hospitals By Sara Michael Baltimore Examiner Monday, February 2, 2009 Hospitals that replace paper forms with information technology systems are safer and more efficient, according to a large-scale Johns Hopkins study of more than 40 hospitals and 160,000 patients. "Patients appear safer and hospital bottom lines may improve when health care information is gathered and stored on computers rather than on paper," senior author Dr. Neil Powe, of the Johns Hopkins University School of Medicine, said in a statement. The study of Texas hospitals and patients recently was published in the Archives of Internal Medicine. Researchers rated the quality of the technologies and compared them with discharge information for patients. The study found that hospitals whose electronic systems ranked in the top third had a 15 percent decrease in the chances that a patient would die while hospitalized. Higher scores for electronic order entry systems were associated with a 9 percent decrease in the chances of death from heart attacks and a 15 percent decrease in the chances for coronary artery bypass procedures, the study found. Similarly, high scores in computerized systems that guide doctor's treatment choices were associated with a 21 percent decrease in the chances a patient would develop complications, according to the study. Hospitals with the highest technology scores also showed significantly lower costs. Previous studies have focused on one electronic system or a single hospitals, researchers said. Powe said he hopes the results with encourage more hospitals to go paperless. Copyright 2009 Baltimore Examiner. Md. EMS Is Pressed To Share Triage Study By Rosalind S. Helderman Washington Post Monday, February 2, 2009; B01 As Maryland lawmakers wrestle with the future of the state's emergency medical service following the fatal crash of a state helicopter taking accident victims to a hospital, a private company has come forward with a new concern about the independent agency. The company accuses state EMS leaders of dragging their feet in releasing the results of a study of a new method for triaging patients in mass casualty incidents, a method that company leaders believe could save lives. In a Jan. 19 letter, Thomas B. McCord, the chief executive of Bel Air-based ThinkSharp, wrote that the Maryland Institute for Emergency Medical Services System, the group that oversees all emergency medicine in the state, had displayed "disregard, disbelief and delay" about the results of the April 2007 study that the company conducted jointly with the state group. "To me, it's just wrong to sit on this information for this long," McCord said in an interview about the 22 months that have passed since the study was done. "No matter what your reasons are -- it's wrong." Institute Executive Director Robert R. Bass said the agency is still interested in publishing a paper with ThinkSharp on the test of the company's triage method and said the delay stemmed from discussions about what the paper should say. He said that the method requires further study and that some paramedics have found the method to be confusing and difficult to use. Maryland has one of the nation's most centralized systems for conducting emergency medicine. All state ambulance services and hospitals are overseen by the institute, which is led by a director hired by an 11-member board of gubernatorial appointees. The system has long been considered a national model for coordination between first responders and hospitals. However, the agency also oversees the Maryland State Police medical helicopter program, which has been under scrutiny since the Sept. 27 crash that killed four people in Prince George's County. Flights since the crash have decreased significantly, with no immediate adverse impact on trauma victims, leading some lawmakers to question the size of the program. They say they believe that the institute, once a national leader, has become resistant to change. "These are the most politically wired interest groups in the state, and they are aligned to prevent change," said Sen. E.J. Pipkin (R-Queen Anne's), who is pushing a bill to replace Bass with a Cabinet secretary who answers to the governor. "Whether it's this company or another, I think the question they raise about MIEMSS are valid," he said. The helicopter issue has also highlighted national discussions about how triage decisions are made. The family of a car accident victim killed in the helicopter crash has questioned whether her injuries warranted an airlift in the first place. ThinkSharp developed the triage method under study and estimates that it would cost Maryland about $3.9 million over three years to adopt it. The method is designed to use statistical data of survivability rates of people with certain symptoms to help paramedics decide the order in which to dispatch injured patients to hospitals in mass casualty events. Examples of such an event include train accidents and natural disasters, plus more routine accidents in rural areas where a serious car crash could swamp emergency resources and force workers to prioritize care. Paramedics are trained to use a variety of factors, including physical condition of a patient and how an injury occurred to assign patients a color-coded tag -- red, yellow or green. Red indicates immediate need of attention, green signals minor injuries. But some studies have shown inconsistency in paramedics' tagging decisions. ThinkSharp's method is designed to eliminate guesswork by assigning each patient a number, derived by adding up scores tied to different physical symptoms. The scores are based on a mathematical formula developed by William J. Sacco, a statistician long involved in trauma care, and are designed to take into account the chances that a patient treated quickly will survive given different patient characteristics, such as pulse. "In the middle of an incident, people get excited," said William B. Long, trauma medical director at Legacy Emanuel Hospital in Portland, Ore. Long, who has done some work on contract for ThinkSharp, supports the method. "We were looking for ways to get a mathematical, better way to determine how to treat people -- to take away some of the anxiety." After agreeing that the method held promise, ThinkSharp and the state agency organized a drill in April 2007. Paramedics first used the current protocol, then ThinkSharp's Sacco method, to decide the order in which to send dozens of "patients" to hospitals. Later analysis showed that under the current protocol, paramedics sent only two of the 13 most seriously injured patients to the hospital in the first 13 ambulances they dispatched. Under ThinkSharp's method, the 13 most seriously injured patients were sent to the hospital in the first seven ambulances dispatched. "The results of the MIEMSS exercise are overwhelming," McCord said. "People who had never seen it before or used it before actually did far better than the protocol they've used since 1995." He said he believes the nearly two years that have passed since the drill was conducted is an unreasonably long time for the state agency to agree to a draft of a paper on the study to submit for publication in academic journals. But surveys from the drill also showed that after brief training, first responders thought the current protocol was easier to use and remember than ThinkSharp's method. Paramedics' concerns are problematic for the method, Bass said. "Triage needs to be something that is easy to teach, easy to remember and logistically easy to do in the field," he said. ThinkSharp officials said their method is no more confusing than the protocol paramedics learn now. They said that during the 2007 drill, the first responders received only 20 minutes of training in the new method -- the same amount of time devoted to a refresher session for the current protocol. Bass said the delay is a result of negotiations between the state agency and ThinkSharp on what, exactly, the study showed -- but he said that even after the results are published, Maryland would be unlikely to adopt the method without a national consensus that the technique is better. He said adopting a method different from what other states use would be challenging because it would make sharing first responders in a major crisis difficult. "We're not saying this concept doesn't have validity," Bass said. "What we're saying is that there isn't any consensus at the national level that this is the way to go, and if we went that way, it would incur additional expense and put us out of step with the rest of the nation." Copyright 2009 Washington Post. Company: Md. EMS delaying triage study report Associated Press Daily Record Monday, February 2, 2009 ANNAPOLIS — A Bel-Air company is accusing the state's emergency medical service of delaying the release of a study of a new method for triaging patients in mass casualty incidents. The company, ThinkSharp believes its method could save lives and the Maryland Institute for Emergency Medical Services System, the independant agency that oversees emergency medicine statewide, has been sitting on the study too long. In a letter, ThinkSharp Chief Executive Thomas McCord says the agency displayed "disregard, disbelief and delay" about the results of the April 2007 study. But Institute Executive Director Robert Bass says the delay stemmed from discussions about what a paper should say. He says the method needs to be studied further and some paramedics found the method confusing and difficult to use. Copyright 2009 Daily Record. Hopkins researchers find new use for old drug By Sara Michael Baltimore Examiner Monday, February 2, 2009 A 100-year-old drug once used as a treatment for leprosy now holds promise as a treatment for multiple sclerosis and other autoimmune diseases, Johns Hopkins researchers found. The new use for the drug, clofazimine, was discovered as scientists were screening FDA-approved drugs to find new uses for them. Researchers were looking for immune system control agents in the Johns Hopkins Drug Library, a collection of more than 3,000 drugs in pharmacies of trials. Hopkins researchers said they were surprised that clofazimine interferes with a molecular pathway involved in the immune system. "People have been working for years and spending tens of millions of dollars on developing a drug to inhibit a specific molecular target involved in these diseases, and here, we have a safe, known drug that hits that target," Johns Hopkins pharmacologist Jun Liu said in a statement. The findings were reported in Public Library of Science. Copyright 2009 Baltimore Examiner. Gender differences in heart attack symptoms By Leigh Vinocur Baltimore Examiner Monday, February 2, 2009 Men usually have the typical chest pain while women most commonly have atypical indigestion-type symptoms. MEN · Chest pain or pressure (Feels like an elephant sitting on your chest.) · Sweating · Shortness of breath · Pain in arm, neck or jaw WOMEN · Indigestion · Unusual fatigue · Anxiety · Possible chest pain · Shortness of breath · Change in sleeping pattern Copyright 2009 Baltimore Examiner. *National / International* Welfare Aid Isn’t Growing as Economy Drops Off By Jason Deparle New York Times Monday, February 2, 2009 WASHINGTON — Despite soaring unemployment and the worst economic crisis in decades, 18 states cut their welfare rolls last year, and nationally the number of people receiving cash assistance remained at or near the lowest in more than 40 years. The trends, based on an analysis of new state data collected by The New York Times, raise questions about how well a revamped welfare system with great state discretion is responding to growing hardships. Michigan cut its welfare rolls 13 percent, though it was one of two states whose October unemployment rate topped 9 percent. Rhode Island, the other, had the nation’s largest welfare decline, 17 percent. Of the 12 states where joblessness grew most rapidly, eight reduced or kept constant the number of people receiving Temporary Assistance for Needy Families, the main cash welfare program for families with children. Nationally, for the 12 months ending October 2008, the rolls inched up a fraction of 1 percent. The deepening recession offers a fresh challenge to the program, which was passed by a Republican Congress and signed by President Bill Clinton in 1996 amid bitter protest and became one of the most closely watched social experiments in modern memory. The program, which mostly serves single mothers, ended a 60-year-old entitlement to cash aid, replacing it with time limits and work requirements, and giving states latitude to discourage people from joining the welfare rolls. While it was widely praised in the boom years that followed, skeptics warned it would fail the needy when times turned tough. Supporters of the program say the flat caseloads may reflect a lag between the loss of a job and the decision to seek help. They also say the recession may have initially spared the low-skilled jobs that many poor people take. But critics argue that years of pressure to cut the welfare rolls has left an obstacle-ridden program that chases off the poor, even when times are difficult. Even some of the program’s staunchest defenders are alarmed. “There is ample reason to be concerned here,” said Ron Haskins, a former Republican Congressional aide who helped write the 1996 law overhauling the welfare system. “The overall structure is not working the way it was designed to work. We would expect, just on the face it, that when a deep recession happens, people could go back on welfare.” “When we started this, Democratic and Republican governors alike said, ‘We know what’s best for our state; we’re not going to let people starve,’ ” said Mr. Haskins, who is now a researcher at the Brookings Institution in Washington. “And now that the chips are down, and unemployment is going up, most states are not doing enough to help families get back on the rolls.” The program’s structure — fixed federal financing, despite caseload size — may discourage states from helping more people because the states bear all of the increased costs. By contrast, the federal government pays virtually all food-stamp costs, and last year every state expanded its food-stamp rolls; nationally, the food program grew 12 percent. The clashing trends in some states — more food stamps, but less cash aid — suggest a safety net at odds with itself. Georgia shrank the cash welfare rolls by nearly 11 percent and expanded food stamps by 17 percent. After years of pushing reductions, Congress is now considering a rare plan that would subsidize expansions of the cash welfare rolls. The economic stimulus bills pending in Congress would provide matching grants — estimated at $2.5 billion over two years — to states with caseload expansions. Born from Mr. Clinton’s pledge to “end welfare as we know it,” the new program brought furious protests from people who predicted the poor would suffer. Then millions of people quickly left the rolls, employment rates rose and child poverty plunged. But the economy of the late 1990s was unusually strong, and even then critics warned that officials placed too much stress on caseload reduction. With benefits harder to get, a small but growing share of families was left with neither welfare nor work and fell deeper into destitution. “TANF is not an especially attractive option for most people,” said Linda Blanchette, a top welfare official in Pennsylvania, which cut its rolls last year by 6 percent. “People really do view it as a last resort.” The data collected by The Times is the most recent available for every state and includes some similar programs financed solely by states, to give the broadest picture of cash aid. In a year when 1.1 million jobs disappeared, 18 states cut the rolls, 20 states expanded them, and caseloads in 12 states remained essentially flat, fluctuating less than 3 percent. (In addition, caseloads in the District of Columbia rose by nearly 5 percent.) The rolls rose 7 percent in the West, stayed flat in the South, and fell in the Northeast by 4 percent and Midwest by 5 percent. Seven states increased their rolls by double digits. Five states, including Texas and Michigan, made double-digit reductions. Of the 10 states with the highest child poverty rates, eight kept caseloads level or further reduced the rolls. “This is evidence of a strikingly unresponsive system,” said Mark H. Greenberg, co-director of a poverty institute at the Georgetown University law school. Some administrators disagree. “We’re still putting people to work,” said Larry Temple, who runs the job placement program for welfare recipients in Texas, where the rolls dropped 15 percent. “A lot of the occupations that historically we’ve been able to put the welfare people in are still hiring. Home health is a big one.” Though some welfare recipients continue to find jobs, nationally their prospects have worsened. Joblessness among women ages 20 to 24 without a high school degree rose to 23.9 percent last year, from 17.9 percent the year before, according to the Bureau of Labor Statistics. Some analysts offer a different reason for the Texas caseload declines: a policy that quickly halts all cash aid to recipients who fail to attend work programs. “We’re really just pushing families off the program,” said Celia Hagert of the Center for Public Policy Priorities, a research and advocacy group in Austin, Tex. Some officials predict the rolls will yet rise. “There’s typically a one- to two-year lag between an economic downturn and an uptick in the welfare rolls,” said David Hansell, who oversees the program in New York State, where the rolls fell 4 percent. Indeed, as the recession has worsened in recent months, some states’ rolls have just started to grow. Georgia’s caseload fell until July 2008, but has since risen 5 percent. Still, as of October the national caseloads remained down 70 percent from their peak in the early 1990s under the predecessor program, Aid to Families with Dependent Children. Nationally, caseloads fell every year from 1994 to 2007, to about 4.1 million people, a level last seen in 1964. The federal total for 2008 has not been published, but the Times analysis of state data suggests they remained essentially flat. Some recent caseload reduction has been driven by a 2006 law that required states to place more recipients in work programs, which can be costly and difficult to run. It threatened states with stiff fines but eased the targets for states that simply cut the rolls. “Some states decided they had to get tougher,” said Sharon Parrott of the Center for Budget and Policy Priorities, a Washington research and advocacy group. Rhode Island was among them. Previously, the state had reduced but not eliminated grants to families in which an adult had hit a 60-month limit. Last year, it closed those cases, removing 2,200 children from the rolls. Under the new federal accounting rules, that made it easier to meet statistical goals and protected the state from fines. Michigan also imposed new restrictions, forcing applicants to spend a month in a job-search program before collecting benefits. Critics say the up-front requirement poses obstacles to the neediest applicants, like those with physical or mental illnesses. “I think that’s a legitimate complaint,” said Ismael Ahmed, director of the Michigan Department of Human Services, though he blamed the federal rules. The program “was drawn for an economy that is not the economy most states are in.” While food stamps usually grow faster than cash aid during recessions, the current contrast is stark. Many officials see cash aid in a negative light, as a form of dependency, while encouraging the use of food stamps and calling them nutritional support. “Food assistance is not considered welfare,” said Donalda Carlson, a Rhode Island welfare administrator. Nationally, the temporary assistance program gives states $16.8 billion a year — the same amount they received in the early 1990s, when caseloads were more than three times as high as they are now. Mr. Haskins, the program’s architect, said that obliged them to ensure the needy could return to the rolls. “States have plenty of money,” he said. But most states have shifted the money into other programs — including child care and child welfare — and say they cannot shift it back without causing other problems. Oregon expanded its cash caseload 19 percent last year, so far without major backlash. “That’s the purpose of the program — to be there for that need,” said Vic Todd, a senior state official. But California officials expressed ambivalence about a 6 percent rise in the cash welfare rolls in that state when it is facing a $40 billion deficit. “There’s some fine tuning of the program that needs to occur, to incentivize work,” said John Wagner, the state director of social services. Among those sanguine about current caseload trends is Robert Rector, an analyst at the Heritage Foundation in Washington who is influential with conservative policy makers. He said the program had “reduced poverty beyond anyone’s expectations” and efforts to dilute its rigor would only harm the poor. “We need to continue with the principle that you give assistance willingly, but you require the individual to prepare for self-sufficiency,” he said. Copyright 2009 The New York Times Company. Frostbite: what to look for Expert advice By Meredith Cohn Baltimore Sun Monday, February 2, 2009 It's cold outside. And as people shovel snow, scrape car windows or just spend time in the frigid air, some find that their hands and feet become numb or painful. Better get indoors or warm up, because this could mean frostbite or, more likely, frostnip, says Dr. John Wogan, attending physician in the Department of Emergency Medicine at Greater Baltimore Medical Center. What is frostbite? Frostbite is what happens when exposure to severe cold temperatures reduces blood flow and causes ice-crystals to form inside body tissues, leading to serious, even irreversible, damage. Frostbite can result in permanent nerve injury - primarily numbness or pain - and tissue destruction, even the loss of fingers or toes. Frostnip is a milder, reversible, cold-related illness in which the numbness and pain are only temporary. How common is it? Frostbite is not terribly common in Maryland. Most people are able to avoid really frigid weather. Of the cases of frostbite that we treat in emergency departments, many involve people who are homeless, intoxicated, have psychological illness, exercise poor judgment or don't take typical precautions. Are women, seniors or children more likely to suffer from it? Yes and no. The single most important contributing factor to the development of frostbite is behavior. The people who are most prone to develop frostbite are those who make bad decisions about things like exposure to the elements, clothing or alcohol and drug use. Children and adolescents, who may be responding to peer pressure, and people with psychiatric illness are especially vulnerable. Seniors are at marginally greater risk for frostbite because they have conditions, such as diabetes, atherosclerosis, collagen vascular diseases and anemia, which compromise good blood flow. Certain medications, especially those taken for heart disease or high blood pressure, can also play a role. Alcohol not only interferes with sound judgment but also dilates blood vessels, leading to heat loss, and reduces sensation, a triple threat when it comes to cold-related illness. How do you know you have it other than really cold body parts? If the symptoms - numbness, pain and changes to skin color - do not improve despite re-warming for 15 to 30 minutes, seek medical attention. Frostnip is quickly reversible. With frostbite, the skin looks pale, thick and inflexible, and may even blister. In addition, the skin usually feels numb, although there may be minimal sensation to touch. Does frostbite affect more than hands and feet? Yes. Those body parts that are furthest from the core - abdomen and chest - of the body including the fingers, toes, nose, ears and chin, are most susceptible to frostbite. What's the first thing you should do? Rewarming is the key to treatment. If you are out of doors, get indoors. If you can't get indoors, use adequate, dry clothing or try to position the symptomatic body parts in a warm place, like under your armpits or between your thighs. If you think you have frostbite, do not rub the skin because friction can lead to more damage. Warm, never hot, water is useful for treating frostbite. Should people avoid running their cold hands under hot water? Yes. Hot water burns, especially in patients with frostbite, which can produce further tissue destruction. Also, since your skin may feel numb if you have frostbite or frostnip, you could have trouble sensing just how hot the water is, causing even worse burns. Do you always need to seek medical help? Not always. If you really think you have frostbite, seek medical attention. But if your symptoms - pain, numbness, color changes - resolve as you warm up, you should not need to see a doctor. Are you more likely to get frostbite if you've had it before? Yes. The damage to tissues and blood vessels caused by frostbite does make you more susceptible to recurrent frostbite. Also, the behavioral issues that led to the first episode of frostbite may still be present. Are there long-term problems associated with frostbite? Yes. You may develop numbness to the skin and sensitivity to the cold. Severe frostbite can cause loss of the involved body tissue, e.g., tips of the nose, ears, toes and fingers. What's the best way to prevent it? Avoid exposure to extremely cold weather. Layer your clothing and keep it dry. Use mittens rather than gloves. Cover your head, including your ears, with a warm hat, preferably wool. Use a scarf. Cover your face, e.g., with a balaclava. Tight-fitting clothing, especially shoes, can cut off circulation, interfering with your ability to stay warm. Wear warm, water-resistant shoes or boots. Stay well-hydrated. Limit alcohol use. Don't smoke cigarettes because nicotine further constricts blood vessels. Copyright 2009 Baltimore Sun. *Opinion* Sins of Omission: The Forgotten Poor Baltimore Sun Editorial Monday, February 2, 2009 Also lost in the wrangling over the huge House economic measure were two programs for the poor that are in urgent need of Congressional attention: legal services and access to family planning. The proven national program of civil legal aid for impoverished Americans, created in the 1960s, is suffering from multiple blows in funding. While the poor are caught increasingly by foreclosure, eviction and food-stamp fights for their daily bread, deficit-bedeviled statehouses across the country are cutting support for legal services or dropping the programs outright. Creative funding that taps lawyers’ escrow accounts has evaporated because it is tied to the Fed’s fading interest rate. Local governments, charities and pro bono law firms are similarly tight-pursed. Scores of legal aid societies are cutting their staffs just as requests for help are booming, according to The Times’s Erik Eckholm. Bar associations continue to help, and even in these tough times probably could do more. But federal funding is the ultimate hope in a dire situation. In 2008, Congress chipped in $350 million for the nonprofit Legal Services Corporation, which then distributed the money throughout the country. Given the tough times — underfunded programs and ever more desperate clients — more money is needed. Congress still has the opportunity to renew the regular appropriation in a coming omnibus budget bill, but it must bolster that with extra support for the program. At the same time, it was distressing to see President Obama strip Medicaid coverage of family planning services out of the House economic package at the last minute in what turned out to be a futile effort to secure Republican support for the huge recovery bill. Under current law, states wanting to use Medicaid money for family planning services, including cancer screenings, must obtain a waiver from Washington, as some 27 states have done. The modest provision that was cut would have done away with the cumbersome process. The Congressional Budget Office has estimated that the measure would provide coverage to 2.3 million women by 2014 and save $200 million over five years. The Medicaid family planning provision would reduce the number of abortions by helping an estimated half-million women avoid unplanned pregnancy, according to a study by the Guttmacher Institute. The knee-jerk opposition of House Republicans was but the latest sign of G.O.P. insensitivity to women’s rights and health. President Obama should no longer placate it. Copyright 2009 The New York Times Company. Peanut Bummer The latest salmonella outbreak highlights gaps in the nation's food supply. Washington Post Editorial Monday, February 2, 2009; A12 EVEN THOUGH he's not caught up in this mess, Mr. Peanut must want to clobber the geniuses at Peanut Corporation of America (PCA) with his cane. The Food and Drug Administration revealed last week that the company's Blakely, Ga., facility knowingly shipped salmonella-tainted peanut products 12 times between 2007 and 2008 to locations in the United States and abroad. The company, based in Lynchburg, Va., has urged anyone in possession of its products made in the past two years to throw them out. This is one of the biggest recalls in U.S. history and another example of vulnerability in the nation's food supply. None of PCA's peanut products are sold directly to consumers. But the FDA says that more than 70 firms used the company's goods in all manner of foods, from cookies and pet food to ice cream and cereal. Since the salmonella outbreak was discovered last summer, the Centers for Disease Control and Prevention believes that eight deaths and 501 illnesses spread across 43 states and Canada may be linked to the Georgia plant. The FDA alleges that not only did PCA knowingly ship bad merchandise but it went to another testing facility to get a clean bill of health after initially getting test results that were positive for salmonella. The company denies this allegation. The FDA said that the problems that led to the contamination were not fixed. The FDA uncovered the problems by securing inspection reports done by the state of Georgia, using a special 2002 law meant to prevent bioterrorism. The agency last inspected the Blakely plant in 2001 and then contracted out the inspections to the Georgia Department of Agriculture. While this practice is not uncommon for the FDA, it speaks volumes about the lack of resources the agency has to protect the nation's food supply. According to Caroline Smith DeWaal, director of food safety at the Center for Science in the Public Interest, the FDA has lost more than 600 inspectors since 2004. "The fewer inspectors the FDA has, the more it relies on state inspectors," she told us. Rep. John D. Dingell (D-Mich.) has reintroduced legislation that would give the FDA more money and authority over food safety, including the power to issue mandatory recalls of contaminated food. Rep. Diana DeGette (D-Colo.) will try again to get a bill passed that would require the FDA to devise a system that would make it possible to trace food and produce from the farm to the dinner table. Rep. Bart Stupak (D-Mich.) has a bill that would give the FDA more money and authority to conduct inspections. As we have learned over the past year, much of the food safety system in this country is based on the trust that manufacturers are introducing products into the food supply that are clean and safe. President Ronald Reagan had a mantra for dealing with Russia that is apt here: "Trust but verify." Congress must give the FDA and other relevant agencies the power to do it. Copyright 2009 Washington Post. 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