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			Tuesday, February 10, 2009 News Clipping Archives *Maryland / Regional* Insurer reaches deal with Maryland to help expand dental services (Insurance and Financial Advisor) Health Department Releases New Report on Drugs (Capital News 2) Baltimore intoxication deaths down in 2008 (Daily Record) Most Research Suspended at Fort Detrick (Washington Post) Model of efficiency: Health-care oriented nonprofit recognized for worldwide Services (Carroll County Times) *National / International* Sobering results for cost-cutting Medicare project (Washington Post) Young Black Men Unaware of H.I.V. Risks, Survey Finds (New York Times) F.D.A. to Place New Limits on Prescriptions of Narcotics (New York Times) *Opinion* Withdrawal from the war on smoking (Baltimore Sun) *Maryland / Regional* Insurer reaches deal with Maryland to help expand dental services By Keith L. Martin Insurance and Financial Advisor Tuesday, February 10, 2009 Maryland’s Board of Public Works has approved a deal with Wisconsin-based Doral Dental Services to reimburse dentists for treating Medicaid patients. The three-year, $6.8 million contract was announced Jan. 29 as a move to help access to dental care for nearly 435,000 low-income children and pregnant women. The move to expand coverage was prompted by the 2007 death of Deamonte Driver, a 12-year-old who died from an infected tooth. “The tragic death of Deamonte Driver in 2007 showed us that our dental public health safety net was nowhere near as inclusive as it needed to be,” said Gov. Martin O’Malley in a prepared statement. “Today’s action puts in place a system that will make it easier to link every child with Medicaid to a dental home where care is available.” The contract is a result of a recommendation put forth by the state’s Dental Action Committee, formed by Department of Health and Mental Hygiene Secretary John M. Colmers in 2007, to carve dental services out of the seven Managed Care Organization service packages and administer services through a single Administrative Services Organization. “This contract simplifies the system for dentists who want to participate in Medicaid,” said Colmers. “It will now be easier for more than 435,000 children enrolled in Medicaid to access comprehensive dental services on a regular basis.” In addition to arranging for services, the contract calls for Doral to enroll and train dental providers; prepare outreach materials for both providers and families; and pay provider claims, beginning March 1. © 2008 New Horizon Group, Inc. :: Insurance & Financial Adivsor \| IFAwebnews.com. Health Department Releases New Report on Drugs Channel 2 News Tuesday, February 10, 2009 The Baltimore Health Department is releasing a quarterly report on intoxication deaths associated with drugs and alcohol. The report covers the first three quarters of the 2008 calendar year. The report found declines in overdose deaths in the city. The Maryland Office of the Chief Medical Examiner recorded 33 intoxication deaths associated with drugs and alcohol among Baltimore residents. There were also 39 deaths from drugs and alcohol outside the city. These totals represent a 50 percent decrease compared to the third quarter of 2007. Overall, intoxication deaths associated with drugs and alcohol were 34 percent lower during the first three quarters of 2008 than in the same period in 2007. "These are the lowest numbers of drug overdose deaths in the city since at least 1995. This is the last year we have data," said Dr. Joshua M. Sharfstein, Commissioner of Health. "Baltimore is making progress against this major public health problem." City health officials said a number of efforts are underway like the expansion of substance abuse treatment to help the decline in overdoses. http://www.abc2news.com/content/gmm/story/Health-Department-Releases-New-Report-on-Drugs/tX6a4eOjx0qAXUywvDjn_w.cspx Copyright 2009 The E.W. Scripps Co. All rights reserved. Baltimore intoxication deaths down in 2008 Associated Press Daily Record Monday, February 10, 2009 Baltimore health officials say intoxication deaths were down in the first nine months of 2008, and the statistics include a significant decline in overdose deaths. Health officials say there were 134 intoxication deaths in the city, compared to 202 during the first nine months of 2007. Deaths associated with drug abuse dropped 34 percent, while those associated with alcohol fell 6 percent. Deaths associated with heroin decreased 39 percent, cocaine deaths fell 42 percent, and methadone deaths fell 38 percent. Health officials aren't sure why the number of deaths is down, but they say a variety of efforts are under way to expand drug treatment and educate drug users and others on how to avoid overdoses. Copyright 2009 Daily Record. Most Research Suspended at Fort Detrick By Nelson Hernandez Washington Post Tuesday, February 10, 2009; B02 The U.S. Army's Frederick-based laboratory for studying some of the world's deadliest diseases has suspended most research activities as it tries to find errors in an inventory of its biological materials, a spokeswoman for the institute said yesterday. Col. John P. Skvorak, the head of the U.S. Army Medical Research Institute of Infectious Diseases at Fort Detrick, ordered most lab work to stop last Friday, according to an order first obtained and posted on the ScienceInsider blog. He said the order was required to meet the Army and Defense Department's standards for keeping track of "biological select agents and toxins," known as BSAT, such as anthrax bacteria and the Ebola virus. The lab has been under heavy pressure to tighten security since the 2001 anthrax attacks, which killed five people and sickened 17 others. FBI investigators think the anthrax strain used in the attacks originated at the Army lab, and its prime suspect in the investigation, Bruce E. Ivins, researched anthrax there. Ivins committed suicide last year. The order to stop most work came after a spot check last month found 20 samples of Venezuelan equine encephalitis in a box of vials instead of the 16 that had been listed in the institute's database, according to Caree Vander Linden, the spokeswoman for the institute. The lab has made inventory mistakes before, "probably due to accounting errors, transcription errors, or BSAT that had not been reassigned when an employee left the Institute," Skvorak wrote in the memo. "I believe that the probability that there are additional vials of BSAT not captured in our . . . database is high." One common reason for mistaken tallies of biological materials was that researchers would leave samples behind when they took other jobs, said a scientist who works at the institute who spoke on the condition of anonymity because of the sensitivity of lab security. "They want those freezers cleared out and to find anything that's unaccounted for," the researcher said. "We would find stuff that had been left there by investigators who had departed the institute five years or even longer ago. It was difficult to backtrack what those samples are." Vander Linden said the search could take months. "It's going to be labor intensive," she said. "We've estimated up to three months. That's a ballpark, but we'll see. We've got to do it right. We've got to be accurate. We're not going to try to speed it up and miss anything." The scientist, as well as others no longer at the lab, said the order could frustrate researchers because keeping inventories for biological materials is next to impossible. Unlike nuclear weapons materials, which can simply be weighed, viruses and bacteria are constantly multiplying and dying, meaning the amount of material changes from hour to hour, they said. "It's extremely difficult to completely account for replicating agents because, by definition, they replicate," said Thomas W. Geisbert, associate director of the National Emerging Infectious Diseases Laboratories at Boston University, who previously worked on Ebola at the Army lab. "You can make a large amount from a small amount." "That certainly is an issue," Vander Linden said. "At the end of the day, people realize this is the cost of doing business now. We have to be accountable, and we'll have to do it." Copyright 2009 Washington Post. Model of efficiency: Health-care oriented nonprofit recognized for worldwide services By Erica Kritt Carroll County Times Tuesday, February 10, 2009 NEW WINDSOR - International nonprofit IMA Worldhealth, headquarted in New Windsor, has been listed by Forbes.com as one of the 20 most efficient large charities in America. IMA got its start in 1960 under the name Interchurch Medical Assistance. Then it represented 12 Protestant relief and development agencies. “Our job was from 1960 to the mid-1990s to receive donations of medicine and medical supplies,” said IMA CEO Paul Derstine. The medicine and medical supplies were distributed overseas to health ministries. Now, along with providing daily medical aid, the nonprofit helps Third World countries strengthen their health-care systems, and develop programs to prevent and treat disease. For the 10th straight year Forbes compiled a list of America’s 200 largest charities, based on private donations. Of that 200, Forbes has identified 20 for being the most efficient. This is determined by the donations left after solicitation costs, according to Forbes. Of the organization’s expenses from fiscal year 2007, IMA spent approximately $117 million. All but $1 million of that money went toward services. None of that money went to fundraising efforts, according to Forbes. In the same fiscal year, IMA’s revenue was approximately $158 million. About 10 percent of that money came from the government and the remainder came from private support and donations, according to Forbes. The difference between what IMA raised and what it spent, $41 million, represents the value of donated medicines, according to Randy West, senior writer for IMA. “The private contributions are really important,” Derstine said. “Grants provide certain things; they don’t cover everything.” Derstine said the organization credits a lot of its success to the partnerships with Carroll County organizations. “I’m grateful to be in Carroll County,” Derstine said. “It’s a tremendous place to do our work.” The residents who attend services at Carroll Lutheran Village give a portion of their Sunday offerings to IMA, Derstine said. The Rev. Jimmie Schwartz said it allows for the residents’ money to travel and help out others. Another partnership is with the Brethren Service Center, the organization where IMA leases office space. Derstine said the location, on Main Street in New Windsor, allows many people a chance to see the organization, when they visit the SERRV store or go to events at the Brethren Service Center. “The conference center brings all kinds of people here,” he said. “People see the work and want to contribute.” Another strong partnership has been with Rotary and Soroptimist clubs in and around the county. IMA has partnered with the Bonds Meadow Rotary Club for more than five years to acquire money for supplies to be sent to Africa to treat and cure River Blindness, a disease in which a parasite enters and lives in the body. It is the second-leading infectious cause of blindness in the world. Pat Amass, a member of the Rotary Club, got IMA involved to create safe motherhood kits for distribution in the Democratic Republic of Congo and Tanzania. The kits include sterile items for birth, soap, a washcloth and clothing items for the baby. “We raise funds to purchase materials, and [IMA] purchases it in bulk,” Amass said. The Rotary members put the kits together as well, but then rely on IMA to make sure they get to the mothers in need. “The club has been such a wonderful partner for us,” Derstine said. Derstine said he became a member of the service group after working with them on projects. “All this happens in Carroll County, New Windsor of all places,” he marveled. Reach staff writer Erica Kritt at 410-857-7876 or erica.kritt@carrollcountytimes.com. Copyright 2009 Carroll County Times. *National / International* Sobering results for cost-cutting Medicare project Associated Press By Lindsey Tanner Washington Post Tuesday, February 10, 2009 CHICAGO -- An ambitious effort to cut costs and keep aging, sick Medicare patients out of the hospital mostly didn't work, a government-contracted study found. The disappointing results show how tough it is to manage older patients with chronic diseases, who often take multiple prescriptions, see many different doctors and sometimes get conflicting medical advice. The study showed just how hard it is to change the habits of older patients and their sometimes inflexible doctors. And it points up the challenges the Obama administration will face in trying to reform health care for an aging nation. Most of the patients had serious, but common, age-related illnesses including diabetes, heart disease and lung disease. Programs were set up at 15 centers around the country. Only two cut the number of times these patients were hospitalized, and those are still in operation. None saved Medicare any money. The authors of the study called the results "underwhelming." An editorial in the Journal of the American Medical Association, where the study appears Wednesday, used the term "sobering." "The only way you can really do it is by changing patients' behavior and by changing physicians' behavior, and both things are really hard to do," said study author Randall Brown, a researcher at Mathematica Policy Research Inc., in Princeton, N.J., which was hired to evaluate the programs. Often, these patients need to stop smoking, or lose weight, exercise more, eat healthier foods _ a challenge even for generally healthy people. Those changes are especially tough for sick, older patients who often are set in their ways. "The same thing with physicians," Brown said. "A lot of them feel like they know how to take care of patients, so why do they need a nurse calling up and asking them why the patient isn't on some certain medication?" Many patients in the study had more than one chronic disease, a common Medicare scenario. In 2002 alone, half of Medicare patients had been treated for five or more ailments, and they accounted for 75 percent of Medicare spending, the study authors noted. Seeking ways to reduce those costs and improve care, the Centers for Medicare & Medicaid Services selected 15 proposals for test-site programs in 2002. The sites developed their own programs, enrolling a total of 18,309 fee-for-service Medicare patients through 2006. About half got the patients got the usual care. The others got more intensive, coordinated care. That often involved nurses who acted as go-betweens, helping doctors give patients clear, appropriate advice; counseling patients on changing bad habits and recognizing worrisome symptoms. The nurses were available on a regular basis by phone or in person to answer patients' questions. Jim Reid, a 74-year-old retired Pennsylvania welder, was among study patients who got coordinated care. When he enrolled in 2002 in a test program run by Health Quality Partners, a nonprofit group in Doylestown, Pa., he was obese, had high blood pressure, high cholesterol and pre-diabetes. But Reid was a rare success story. He actually took the advice offered in group sessions run by nurses. He learned how to read food labels and avoid salty, calorie-laden foods. He also started exercising, walking with a pedometer and building up to a few miles daily. Now, he breakfasts on oatmeal or vegetable omelets instead of coffee and doughnuts He's lost almost 60 pounds. His blood pressure and cholesterol have greatly improved and his pre-diabetes is gone. Sticking with the program "is hard," he acknowledged. "As you get older, you don't want to do it." But he said it has "put an extra 10 years in my life." Reid credits his success to the personal attention of a nurse coordinator. "I have to have somebody to own up to," he said. That close, in-person contact with nurses was also a feature of the project's other more successful, still-operating program, at Mercy Medical Center-North Iowa in Mason City, Iowa. In both programs, each patient had face-to-face contact an average of about once a month with a nurse. That was far more frequent personal contact than in other programs. Both reduced hospitalizations _ 17 percent yearly compared with usual-care patients at Mercy, and by about 20 percent in the Pennsylvania program, but only among its sicker patients. That program worked with Doylestown Hospital and recruited patients from area physicians' offices. Targeting sicker patients and providing frequent in-person contact show the approach has some benefits and that success with future reform efforts "is possible, but it's not easy," Brown said. Peter Ashkenaz, a spokesman for the Centers for Medicare & Medicaid Services, said the agency is evaluating the Iowa and Pennsylvania programs to see if their positive results persist. He said there are other approaches being tested, some that offer incentives to doctors who meet quality benchmarks, or who use electronic health records to improve quality. But so far, Ashkenaz said, "as the study shows, we have not yet found broad success." On the Net: JAMA:http://jama.ama-assn.org Centers for Medicare & Medicaid Services:http://www.cms.hhs.gov. © 2009 The Associated Press. Young Black Men Unaware of H.I.V. Risks, Survey Finds By Roni Caryn Rabin New York Times Monday, February 10, 2009 A small survey of young black men from the South who tested positive for H.I.V. in their teens and early 20s found that most had engaged in risky sexual behaviors but thought it unlikely they would be infected, according to the federal Centers for Disease Control and Prevention. More than half of the 29 gay or bisexual men surveyed said they had engaged in unprotected anal sex in the year before they were infected and had had sex with slightly older men, the survey found. Both are risky behaviors, yet the vast majority of the young men said they had not thought that they would ever be infected. Young black gay and bisexual men are becoming infected with H.I.V. at alarming rates, particularly in the South, and health officials are trying to analyze their risk factors in order to refine education and intervention strategies. “We need to make sure that H.I.V. infection does not become a rite of passage for young black men who have sex with men,” said Dr. Alexandra Oster, one of the authors of the survey published last week in the agency’s Morbidity and Mortality Weekly Report. After the Mississippi State Department of Health notified the C.D.C. in late 2007 that the number of new H.I.V. diagnoses had spiked at a sexually transmitted disease clinic serving Jackson, Miss., , the agencies teamed up to do the survey. The number of newly diagnosed H.I.V. cases among all black men in the Jackson area had increased 20 percent between 2004-2005 and 2006-2007, but infections among those ages 17 to 25 had jumped 45 percent. The agencies surveyed 29 black men ages 17 to 25 who had tested positive for H.I.V. between 2006 and 2008 and who reported having sex with other men. Twenty reported having unprotected anal intercourse with a man during the year before their positive H.I.V. tests, and 16 reported having male sex partners who were 26 or older. Having older sex partners increases the risk of infection because older men are more likely than younger men to be infected. Only three of the 29 men thought it likely they would acquire H.I.V. during their lifetime. More than half thought it unlikely or very unlikely, the survey found. Health officials were particularly concerned about the lack of routine H.I.V. testing in this group of young men. Six of the men had not had a single H.I.V. test in the two years prior to testing positive, and five had had only one test in the two years before the positive result, the survey found. “These men may have taken what they believed were reasonable steps to reduce their risk, but unfortunately the rates of H.I.V. infection are so high in this population that sometimes people have partners who are H.I.V. positive and do not know it,” said Richard Wolitski, director of the C.D.C.’s division of H.I.V./AIDS Prevention. Sexually active men who have sex with men should be tested at least once a year, C.D.C. officials say. Copyright 2009 New York Times. F.D.A. to Place New Limits on Prescriptions of Narcotics By Gardiner Harris New York Times Tuesday, February 10, 2009 WASHINGTON - Many doctors may lose their ability to prescribe 24 popular narcotics as part of a new effort to reduce the deaths and injuries that result from these medicines’ inappropriate use, federal drug officials announced Monday. A new control program will result in further restrictions on the prescribing, dispensing and distribution of extended-release opioids like OxyContin, fentanyl patches, methadone tablets and some morphine tablets. These products are classified as Schedule II narcotics and already are restricted according to rules jointly administered by the Food and Drug Administration and the Drug Enforcement Agency. But the current restrictions have failed to “fully meet the goals we want to achieve,” said Dr. John K. Jenkins, director of the F.D.A.’s new drug center. “What we’re talking about is putting in place a program to try to ensure that physicians prescribing these products are properly trained in their safe use, and that only those physicians are prescribing those products,” Dr. Jenkins said in a news conference on Monday. “This is going to be a massive program.” Hundreds of patients die and thousands are injured every year in the United States because they were inappropriately prescribed drugs like OxyContin or Duragesic or they took the medicines when they should not have or in ways that made the drugs dangerous. The agency has issued increasingly urgent warnings about the risks, but the toll has only worsened in recent years. The blame for this is shared among doctors who prescribe poorly, patients who pay little attention to instructions or get access to the medicines inappropriately, and companies that have marketed their products illegally. The F.D.A. this year will hold meetings with manufacturers, patient and consumer advocates, and the public to ask for advice on how to carry out the new control program, officials announced. The first meeting will be on March 3, and no immediate changes in access to the drugs is planned. The 24 medicines under review had 21 million prescriptions written for them in 2007, to 3.7 million patients, Dr. Jenkins said. They are extremely effective in reducing pain, which many medical studies suggest is widely undertreated in patients suffering serious illness. (A complete list of the drugs is at www.fda.gov/cder.) But many doctors prescribe the drugs far too cavalierly, Dr. Jenkins said. The F.D.A. has received reports of patients’ being prescribed such medicines to treat something as simple as a sprained ankle, he said. In such patients, the medicines can be dangerous. Part of the problem is marketing. Several reports, for instance, have suggested that Purdue Pharma, the maker of OxyContin, helped fuel widespread abuse of the drug by aggressively promoting it to general practitioners not skilled in either pain treatment or in recognizing drug abuse. The company has denied such a connection, but a holding company connected with Purdue and three top Purdue executives pleaded guilty last year to criminal charges that the company had misled doctors and patients by claiming for five years that OxyContin was less prone to abuse because it was a long-acting narcotic. Doctors are also to blame. A common reason for disciplinary actions at state medical boards is the use of narcotics in patients who show clear signs of addiction or for whom the drugs are obviously inappropriate. The F.D.A. generally avoids interfering with the practice of medicine because doctor behavior is governed by state medical boards. Instead, the agency usually tries to provide doctors with the best and most current information, and then allows them to decide how to use it. Most of the drugs withdrawn over the last 20 years, however, were taken off the market because doctors continued to use the medicines in ways that the F.D.A. warned against. For decades, the agency’s armory in these battles held only a popgun and a cannon - the popgun being the issuance of widely ignored warnings; the cannon being its ability to force a medicine’s withdrawal. But a law passed in 2007 gave the agency a new, intermediate weapon - Risk Evaluation and Mitigation Strategies. Known as REMS, these programs allow the agency to place strong restrictions on the distribution of certain drugs. Copyright 2009 New York Times. *Opinion* Withdrawal from the war on smoking Baltimore Sun Editorial Tuesday, February 10, 2009 Our view: Permanently cutting state support for anti-smoking effortsyields false savings February 10, 2009 If Maryland is going to taxcigarette smokers and say it's for their health, isn't the stateobligated to spend some minimum amount to help them quit or preventothers from starting the habit in the first place? That was theargument heard in the State House a decade ago when the tax oncigarettes was raised to $1 a pack and lawmakers set a relativelymodest mandate for anti-smoking programs. Now, Gov. Martin O'Malley is looking to cut the state's $21 millionminimum for tobacco prevention and cessation programs to a mere $7million a year. In the midst of a recession, it's not hard tounderstand why - the governor wants more flexibility on where moneygoes when tax revenues have fallen so sharply. Yet it's not as if smokers aren't paying. Between the now-$2-a-pack state tax on cigarettes and the state's share of the Cigarette Restitution Fund (the money from legal settlements with tobacco companies), Maryland will collect more than $1 billion next year. The restitution money represents a refund for tobacco-related health care costs of the past. But while some of the $1 billion benefits smokers now (in terms of health care and cancer research, for instance), much of it winds up helping the state balance its budget. Two years ago, the federal Centers for Disease Control and Prevention estimated how much Maryland should be spending on tobacco control. The minimum amount was $46.8 million. The governor's budget proposal would reduce it to less than one-sixth that; the cut would probably mean the loss of a toll-free "quitline," which provides counseling and referrals to smokers, and an end to school-based prevention programs. Although it's certainly reasonable to reduce funding for various health programs in times of financial emergencies, it seems morally wrong for the state to set one of the nation's highest tobacco taxes and then choose to permanently reduce spending on cessation. Such a move might be interpreted by the cynical as an effort to keep smokers smoking - and paying taxes. For all the taxes they pay, smokers create a real hardship on the health care system. Smoking costs about $2.2 billion each year in cancer and disease treatment, and about half that cost is usually billed to taxpayers. That makes spending an adequate amount on stop-smoking ampaigns one of the smarter government investments around. Copyright 2009 Baltimore Sun. BACK TO TOP


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