-
-
-
- WJLA-TV
- Wednesday, January 7, 2009
-
- POOLESVILLE, Md. - Neighbors say a dreaded disease
is popping up more and more in their Montgomery County
community.
-
- Poolesville residents Fred and Betsy Kelly have
their hands full with their two-month-old daughter
Helena Lucia and a life-shattering cancer diagnosis.
-
- Right after her daughter was born, doctors removed
Betsy Kelly's kidney -- the five-pound tumor on it
weighed more than the newborn. Kelly has since lost part
of her arm and has tumors in her lungs.
-
- "It's a very aggressive cancer, it's very rare in
people my age," Kelly explained. "I have no family
history of kidney cancer at all," she added. "So that's
our concern: what has caused it?"
-
- Kelly is one of five women, including her next-door
neighbor, living on Hempstone Avenue to get cancer. Now,
residents are saying it seems to be too much of a
coincidence.
-
- "The people that we've seen and heard of, especially
I've talked to my neighbors, have been mostly women, in
their late 30s and early 40s, to have gotten cancers,"
Fred Kelly said.
-
- The Kellys suspect the water in their town may be
the culprit. Almost all of Poolesville, a community of
5,000, relies on town wells.
-
- Town officials insist the wells pass state and
federal regulations. "We are consistently safe in all
our analysis that are returned to us that MDE and EPA
take, so yes, it is safe to drink by their standards,"
said Poolesville town manager Wade Yost.
-
- Health officials cite many possible sources of
carcinogens. Nearby Dickerson, in fact, is home to an
incinerator, coal-burning power plant and a nuclear
facility -- a potential Superfund site.
-
- That all is little consolation to the Kellys, who
now only drink bottled water and hope they will all be
OK.
-
- © 2009 WJLA-TV.
-
- County studies high number of cancer cases in
community
-
- WTOP-TV
- Wednesday, January 7, 2009
-
- POOLESVILLE, Md. -- Montgomery County is studying a
high number of cancer cases in the Poolesville
community, the Gazette reported.
-
- Residents believe the reason could be in the water.
-
- One resident alerted the Montgomery County
Department of Health after his pregnant wife, who has no
family history of cancer, was diagnosed with renal
cancer in October.
-
- Their neighbor, a 15-year resident of Poolesville
who also has no family history of cancer and who doesn't
drink or smoke, was diagnosed with a cancer that affects
the salivary glands two years ago. Another woman on the
street was diagnosed with the same rare form of cancer
14 years ago, the Gazette reported.
-
- Some residents wonder whether a trash incinerator, a
nuclear facility or a coal-burning power plant is to
blame, but there is also concern about Poolesville's
water supply, samples from which have tested for high --
but necessarily above federal limits -- levels of
radionuclide particles, which the EPA said can cause
cancer in large doses over a long period of time.
-
- © NBC Universal, Inc.
-
-
- Baltimore Sun Letter to the Editor
- Thursday, January 8, 2009
-
- A recent letter regarding the Keswick Multi-Care
Center's proposal for the Baltimore Country Club
property misrepresents the zoning aspects of the
proposal ("Roland Park proposal imperils zoning code,"
Jan. 5).
-
- Keswick's plan for its continuing-care community
would require the City Council to approve a planned unit
development (PUD) ordinance for the property but would
not require the area's existing R-1 zoning to be
changed.
-
- The R-1 zoning category was not designed as an
exclusive single-family enclave but, in fact, expressly
permits such nonresidential uses as schools, museums,
community recreation centers and religious institutions.
-
- It further allows such conditional uses as nonprofit
clubs, hospitals, nursing and elderly care facilities,
swimming pools and residential planned unit
developments.
-
- Indeed, the Roland Park area already has four
successful planned unit developments, including Roland
Park North, which is in an R-1 district, Roland Park
Place and the mixed-use Village of Cross Keys, which is
across the street from the land Keswick proposes to
develop.
-
- The planned unit development provision was an
important feature of the city's last comprehensive
zoning code, which was adopted in 1971.
-
- More than 100 of them have been adopted since then,
and they have proved successful in all areas of the city
when communities and developers have worked together.
-
- The mayor was correct in urging Roland Park to work
with Keswick and come up with the best plan for both
parties.
-
- Alfred W. Barry III
- Baltimore
-
- The writer is a former assistant director of
planning for the city of Baltimore who is now a planning
consultant for the Keswick Multi-Care Center.
-
- Copyright 2008 Baltimore Sun.
-
-
- By Ceci Connolly
- Washington Post
- Thursday, January 8, 2009; A01
-
- The pharmaceutical industry, confronting sluggish
growth, low prestige and the prospect of more-aggressive
government oversight, is moving on several fronts to
burnish its image and align itself rhetorically with the
health reform goals of President-elect Barack Obama and
the Democratic Congress.
-
- Conceding that it has long been viewed as
Republican-dominated, the industry's lobbying arm plans
to spend tens of millions of dollars on an advertising
blitz promoting Obama-style health coverage for every
American. The first spot -- sponsored by the drug lobby,
consumer and labor groups, and health providers -- will
be unveiled today.
-
- Beginning this month, drug companies also will
voluntarily submit to a host of marketing restrictions
in an attempt to preempt stricter regulations that
lawmakers in both parties are pursuing.
-
- "We had better self-police and stop doing the things
that cause so much criticism, or we're going to get
legislated and regulated by government," said W.J.
"Billy" Tauzin, the Republican former congressman who
runs the Pharmaceutical Research and Manufacturers of
America (PhRMA), a trade association. The changes, he
said in an interview, are an effort to move away from
the industry's "slash-and-burn kind of policy" in
response to previous regulatory and legislative efforts.
-
- Even before Obama's victory, the drug lobby took a
dramatic political turn: In 2008, for the first time in
18 years, industry contributions to Democrats were on
par with money given to Republicans, according to an
analysis by the Center for Responsive Politics, a
watchdog group.
-
- "PhRMA had been isolated into a one-party camp,"
Tauzin said. "We're trying to reposition as less of a
partisan player."
-
- The maneuvering comes at a time of great stress for
America's drugmakers, which have not been enthusiastic
proponents of past health-care reform efforts. After
double-digit growth throughout the 1990s and much of
this decade, the pharmaceutical industry is expected to
grow less than 2 percent in 2009, according to the
independent research firm IMS Health. Analysts say it
will be difficult to improve on that in the next few
years, given the weak economy and a dwindling supply of
new blockbuster medications coming to market.
-
- Equally worrisome to many in the business is the
arrival of a Democratic president who, in tandem with a
Democratic-controlled Congress, is expected to add
muscle to the Food and Drug Administration and press for
an overhaul of the U.S. health system.
-
- Some individual companies are moving independently,
suggesting strains in the once-unified drug lobby. In
mid-December, Merck announced that it was joining a
coalition in support of broad health-care reform,
including controversial measures to compare the
performance and price of medications.
-
- "We understand clearly that we are entering this
debate at a time when the pharmaceutical industry's
standing is low," Kenneth Frazier, president of Merck's
Global Human Health unit, said in a speech. "We face a
choice of acting from a place of fear of the potential
harms that could occur to us in reform or acting on the
hope of what reform could mean to our industry."
-
- On the immediate horizon are two proposed regulatory
changes that would dramatically alter how the industry
markets its products.
-
- Sen. Charles E. Grassley (R-Iowa) intends to refile
a bill requiring drug and biotech companies to report to
the federal government all gifts or payments to
physicians for research, speeches, travel, consulting or
anything else. Companies failing to report would face
financial penalties. The bill is in response to lavish
industry spending, which critics maintain creates
conflicts of interest for doctors.
-
- Rep. Henry A. Waxman (D-Calif.), the incoming
chairman of the Energy and Commerce Committee, supports
legislation giving the FDA power to selectively ban
direct-to-consumer advertising in the initial years a
medication is on the market.
-
- "It is in these first few years of a drug's life
that drug companies often aggressively market their
products," Waxman said in a recent speech. "This
increases the number of consumers exposed to safety
risks of new products, long before those risks are truly
understood."
-
- The drug industry supported a watered-down version
of the Grassley bill and has opposed giving the FDA
power over ads directed at patients. Instead, PhRMA
members have adopted a voluntary marketing code.
-
- As of the start of this year, about 40 companies
agreed to stop distributing notepads, pens, T-shirts,
soap dispensers, napkins and other tchotchkes festooned
with product logos. Drugmakers describe the gifts as
"reminder items" for doctors and nurses who may forget
what cholesterol pill or diabetes medication they want
to prescribe. But many consumers suspect that the
goodies, as well as more extravagant gifts such as
travel and meals, lead to medical decisions that have
less to do with sound science than with clever
marketing.
-
- The voluntary code, which encourages but does not
require companies to hire an independent auditor to
monitor their compliance, also sets new restrictions on
buying meals for physicians. Fancy restaurant dinners
are out unless they include a substantive presentation
from a medical expert. Food deliveries to a physician's
office are still acceptable, as are some meals at
conferences.
-
- In 2005, the industry spent more than $6.8 billion
on the goodies, meals and other office visits, according
to a report in the New England Journal of Medicine.
-
- Patient advocacy groups say the voluntary changes
will fall short of altering the cozy relationship
between doctors and pharmaceutical companies.
-
- "I'm not sure it actually changes the number of
meals the industry is providing all that much," said
Allan Coukell, policy director of the Prescription
Project, a Boston-based nonprofit that often finds
itself pitted against drugmakers.
-
- In March, drug companies will also begin following
stricter advertising policies. Actors posing as doctors,
as well as celebrity endorsers such as artificial-heart
inventor Robert Jarvik, will be identified accurately in
commercials. Suggestive ads for products such as the
impotence drugs Viagra and Cialis will be pulled from
day time slots when children are likely to be watching.
And ads will contain information on programs designed to
help patients understand and afford the medications.
-
- "You're seeing a greater trend toward transparency
and openness among pharmaceutical companies to let
people know how we do business and what services are
available," said AstraZeneca spokesman Tony Jewell.
AstraZeneca's spots conclude with a plug for the
company's prescription savings program, information that
Jewell says helps patients.
-
- Tauzin defended direct advertising as a means to not
only educate patients about treatments but also alert
them to illnesses they may not realize they have. Even
so, he recognized the "perception problem" of the ads, a
problem he characterized as "you're smoking in bed and
the house is on fire."
-
- In a speech last month, Roche Pharmaceuticals chief
executive William Burns hinted that the Swiss company
may go further than the PhRMA guidelines.
-
- "Direct-to-consumer promotion was the single worst
decision for the industry," he said. "When industry
says, 'We're spending all the money on [research and
development],' but actually it's spending it on DTC
advertising to preserve margins, it doesn't get much
credibility."
-
- Grassley and consumer watchdog groups say they are
far more troubled by sizable industry payments to
doctors for activities often labeled as consulting,
research or continuing medical education. In addition,
they note that the PhRMA guidelines have no enforcement
mechanism.
-
- "People are less apt to violate a federal law than a
code of ethics of its own profession," Grassley said. He
also said companies making biotech drugs, including a
number of very expensive new treatments for cancer and
other diseases, should not be exempt. So far, the trade
group BIO -- the Biotechnology Industry Organization --
has refused to adopt even the PhRMA code.
-
- The industry's voluntary efforts are "a start, not
an end," Grassley said in an interview. "You can't say
it's a substitute for what I'm trying to do."
-
- Copyright 2008 Washington Post.
-
- Provider of HIV-AIDS Programs Cuts Its Staff, Sells
Buildings to Survive
-
- By Timothy Wilson
- Washington Post
- Thursday, January 8, 2009; DZ01
-
- Moving day had arrived last month for the
Whitman-Walker Clinic at 1407 S St. NW. For more than 20
years, the location had been an enclave for clients,
volunteers and staff members in the effort to fight the
spread of HIV-AIDS in the District.
-
- Times had been rough recently, prompting the
building's sale and a move to consolidated quarters
around the corner, at 14th and R streets, to get out
from under a mountain of debt.
-
- But just when staff members thought they had reached
bottom, the situation got worse.
-
- The day after the move, the clinic announced that it
would be forced to outsource some programs, close a
clinic in Arlington County and lay off up to 45 of its
178 employees by the end of March.
-
- "Clearly, this is a difficult situation for us,"
Donald Blanchon, Whitman-Walker chief executive officer,
said in a statement. "The current state of the economy
has forced us to make tough decisions."
-
- The decisions have included abruptly laying off 15
veteran staff members without severance Dec. 19, four
days after the S Street location was closed.
-
- Whitman-Walker, which began life as a health center
for gay men and grew into a nationally recognized
provider of programs for people with HIV-AIDS, has been
struggling with declining revenue and increased expenses
because of an increase in patient care for most of a
decade. But the faltering economy has made the clinic
scale back even further.
-
- "The clinic is not immune to anything that is going
on," Blanchon said in an interview. "The days of
Whitman-Walker Clinic being all things to all people is
probably not practical now."
-
- This recent round of layoffs will reduce staffing at
the clinic by 25 percent. In 2005, the clinic had about
260 employees. By March, that number will have been
reduced by almost half, Blanchon said.
-
- Until she was let go, Patricia Hawkins was an
associate executive director at the clinic.
-
- On the Friday before Christmas, Hawkins said, a
procession of employees entered Blanchon's office one at
a time to learn their fates. Mary Bahr, a former
director of administration and grant writer, was let go
first. The last, Barbara Chinn, a former director of the
Max Robinson Clinic in Southeast, would follow hours
later.
-
- "I had to keep back a tear or two as some of the
clients said goodbye," said Chinn, who began working at
the clinic in 1987. "I felt like I had walked out on a
portion of my life. It was a little unnerving."
-
- Chinn and Hawkins, who began volunteering at the
clinic in 1984, had experienced some turbulent years
there.
-
- In 1997, about 25,000 people participated in the
clinic's annual AIDS Walk. The event was the largest
fundraiser for the clinic and netted $1.7 million that
year. Five years later, only 7,000 people participated,
and the event netted about $100,000. In 2003, the clinic
began charging for some of its services to offset
declining donations and rising costs.
-
- By 2005, Whitman-Walker had reached a point where it
couldn't meet its payroll one week. It swung into
retrenchment mode.
-
- It sold a group home in Northern Virginia and a
facility housing a clinic in Maryland. It discontinued
programs for substance abusers, a food bank and
affordable housing. As it consolidated and ended
programs, it laid off staff members. It began selling
more of its buildings across the region. The S Street
property was the latest to go, in the fall, and to some
it looked like a solution was in sight.
-
- "I thought that once we got the [S Street] building
sold, we'd be stable," Hawkins said.
-
- But solid ground remained elusive.
-
- Blanchon said the building sale helped to resolve
only some past financial problems, and that other
measures were necessary to deal with an influx of new
patients.
-
- He said the layoffs would reduce the number of
administrative and management positions at the clinic
and would allow them to focus on providing high-quality
health care to the patients who visit on a daily basis.
-
- But with steep declines in government funding,
private donations and staffing, the clinic faces
significant challenges in providing primary medical care
to people living with HIV-AIDS.
-
- According to the District's Department of Health,
the number of new HIV-AIDS cases and deaths has declined
annually from 2002 to 2006, but the number of people
living with HIV-AIDS has increased by almost 50 percent
during that time. That increase has led more people with
HIV to the doors of the Whitman-Walker Clinic.
-
- "We need more doctors, dentists, psychotherapists
and addiction counselors," Blanchon said. "Every one of
our employees now understands the challenges we are
facing. The quality of what we do matters."
-
- Chinn said the staff members who remain are
extremely responsive to the needs of the gay, lesbian,
bisexual and transgender community and will provide
excellent care. She said she hopes the lack of resources
won't compromise the message of HIV-AIDS awareness.
-
- "I only hope the clinic can quickly get itself on
solid ground," Chinn said. "I hope this last cut is the
last that the clinic has to make in terms of staffing.
Maybe it can see its way toward rebuilding. It'd be a
shame for the community to lose the Whitman-Walker
Clinic."
-
- Copyright 2008 Washington Post.
-
-
- By Rosalind S. Helderman and Nelson Hernandez
- Washington Post
- Thursday, January 8, 2009; PG03
-
- Prince George's County health authorities have
quietly moved toward a solution to what was once one of
the public school system's most alarming problems: the
large number of students who were being barred from
school because they had not received state-mandated
vaccinations.
-
- John White, spokesman for the Prince George's school
system, said a campaign to get kids to clinics for their
chickenpox and hepatitis B shots had reduced the number
of students who lacked immunizations from more than
2,300 a year ago to 268 as of mid-December, before the
winter break.
-
- School officials celebrated the decline then, saying
they hoped to take care of the remaining few over the
break and this month.
-
- "It's amazing," said Betty Despenza-Green, the
school system's chief of student services, who credited
the decline to "a lot of pressure" and "nurses being
very, very strategic" in their targeting of students who
needed the vaccinations. There was a change in the
attitude of parents and students as well.
-
- "People didn't think we were taking this seriously
and therefore they didn't comply," said Karen Bates, the
school system's health services supervisor. "Now they
think we are taking this seriously."
-
- The public snapped to attention in November 2007,
when R. Owen Johnson Jr. (District 5), then chairman of
the school board, called the issue an "educational
crisis" and State's Attorney Glenn F. Ivey (D) said he
would prosecute parents who allowed their children to
remain out of compliance, offenses that carry fines of
$50 a day or up to 10 days in jail.
-
- In practice, the court did not throw people in jail
over the immunizations, but the legal threat briefly
gained national news coverage and helped persuade
parents in the county to cooperate, school officials
said.
-
- "I think certainly that contributed to it," Bates
said of the turnaround. "It served to send a message
that everyone in the county was connected and
collaborative around this issue of immunization. . . .
This [school] year we haven't even had to talk about
taking those kinds of measures. I think every year it's
going to become easier and easier."
-
- Copyright 2008 Washington Post.
-
-
- By Jane Gross
- New York Times
Thursday, January 8, 2009
-
- Hardly anyone has a good word to say about this
country’s fragmented system for delivering and paying
for long-term care, with one exception: the P.A.C.E.
program, which many experts laud as long-term care done
right.
-
- P.A.C.E., an acronym for “program of all-inclusive
care for the elderly,” provides anything and everything
a frail elderly person and her family might need,
coordinated by a team of medical and social service
providers, for an annual fee generally paid by Medicare
and Medicaid. The care can be delivered at home, a
P.A.C.E. center, a hospital or a long-term care facility
— seamlessly moving back and forth under the supervision
of one interdisciplinary team for a fixed cost.
-
- The model for P.A.C.E. was developed 27 years ago in
San Francisco’s Chinatown/North Beach area by a
community center called On Lok (Cantonese for “peaceful,
happy abode”). The On Lok approach was replicated
elsewhere using foundation grants and gradually embraced
by Congress, which eventually authorized all P.A.C.E.
programs as Medicare providers.
-
- The formula is hard to quarrel with. According to
several studies, P.A.C.E. clients, while far more frail
than the average Medicare recipient, cost taxpayers less
money in government-funded medical care, have fewer and
shorter hospital stays, rarely wind up in nursing homes
(even though they must be eligible to enroll in one),
and report satisfaction rates close to 100 percent.
-
- Readers of this blog, physicians, researchers in
geriatrics and gerontology, clients and family members —
all have urged that I visit to a P.A.C.E. center, and so
recently I did.
-
- The nation’s largest P.A.C.E. provider is the
Comprehensive Care Management Corporation in the Bronx.
What I found there is a model that bridges the customary
divide between acute and chronic care, and assigns each
client to an interdisciplinary team that coordinates
care across different settings. The program pays for
coverage as a H.M.O. would, with a fixed annual cost per
patient rather than a fee-for-service set-up.
-
- But unlike many H.M.O.’s, the program doesn’t
operate as a faceless bureaucracy serving as gatekeeper
to all but primary care physicians, and granting and
denying services or procedures. Rather, at 40-odd
locations in 22 states, P.A.C.E. means care by an
interdisciplinary team that knows the patient and
family, their histories, strengths, limitations and
goals. Team members decide the care plan with each
member, tweak it as things change, and rarely say ‘no’
to anything that will sustain quality of life.
-
- P.A.C.E. offers its members access to primary care
physicians, specialists, home health aides,
transportation, recreation and companionship at a day
center, meals (at the center or delivered to home),
medical assistance on call 24-hours-a-day — and just
about anything else that will make it possible for
extremely frail and cognitively impaired elders to
remain at home.
-
- The breadth and flexibility of P.A.C.E.’s services
were apparent during a daily team meeting in late
December, on the eve of a snow storm. First the
assembled doctors, nurses, social workers,
rehabilitation and recreation specialists,
transportation coordinators, clinic schedulers and
office managers reviewed the overnight emergency calls.
These had been answered by a real person who had
assessed whether a trip to the emergency room was needed
or the problem could be handled by phone or with a home
visit, always the goal. One person hospitalized
overnight because of seizures had already received a
dawn visit from her regular P.A.C.E. doctor, with
reassurance that her home health aide was on standby for
her return and that her missing coat had been located.
-
- The team then discussed new clients and those
needing changes in their care plan: a woman who felt
well enough to come to the center five days a week and
thus required a new transportation schedule; a
hospitalized patient ready for discharge whom they hoped
to keep to keep longer, since his wife needed a break
from caregiving; a new member who’d asked for more fresh
fruits and vegetables among the daily lunch choices.
-
- Next came a review of everyone who had been expected
that day at the center on Allerton Avenue — one of seven
run by C.C.M. in the New York metropolitan area — but
had not shown up yet. Some were out of town visiting
relatives, others at outside medical appointments or
under the weather. A few had been stranded by
transportation glitches. Anyone unaccounted for — and
there were only a few — would be called or visited
immediately, especially with the storm bearing down.
-
- All P.A.C.E. members are ranked by priority. Level 1
means they can’t be alone at home without an aide. Level
2 means they need someone to shop, organize medications
or otherwise make a short home visit every day. And
level 3 means they are either safe alone or have family
or neighbors for back-up support. Since weather reports
suggested the center might have only a skeleton staff
the next day, arrangements were made to get aides, food,
backup oxygen tanks and whatever was needed to each of
300 clients classified at levels 1 or 2. For level 3
clients, staff would doublecheck that relatives and
friends hadn’t all decamped for the holidays.
-
- Outside the meeting room, three staff physicians
were seeing patients. On certain days, they are joined
by a wound care expert, since pressure sores are an
abiding problem for those who spend all their time in
bed or in a wheelchair. Also available are two
psychiatrists specializing in depression, anxiety and
dementia-related agitation; an opthalmologist and
optometrist to treat the myriad of vision problems
associated with age; and a podiatrist, because many
older people cannot cut their own toenails and risk
infection or diabetic complications if the job is not
done regularly and carefully.
-
- Other specialists, on contract from a local
hospital, see patients in their own offices, with
transportation and translation provided by P.A.C.E., as
well as immediate consultation between the primary care
doctor and the specialist.
-
- In the recreation and dining areas, members are
welcome for breakfast and lunch and sent home with
dinner. At the Allerton Ave. center, located in an area
with a large Latino population, someone reads newspapers
aloud in Spanish every day, down to the horoscopes and
the box scores.
-
- Staff members take notice if anyone is making
frequent trips to the bathroom, and a nurse is on hand
to check for a urinary tract infection, another
condition especially dangerous for the elderly. The
center has handicapped-accessible showers for those who
can’t use the ones they have at home, as well as washing
machines and dryers. Some clients manage but one visit a
week; others come daily. All are provided free
transport, with an aide if necessary, but also have the
option of many of the same services at home.
-
- All P.A.C.E. members nationwide must be 55 or older
and eligible under state regulations for nursing home
placement, which generally means they require assistance
or supervision with basic tasks like bathing, dressing,
walking or getting from bed to a wheelchair. Medicare,
which provides health coverage for all Americans over
the age of 65, pays a share of the “capitated” annual
free per member. Medicaid pays the remainder for those
who qualify on grounds of low income.
-
- Anyone otherwise eligible for P.A.C.E. but not
covered by Medicaid can make up the difference
out-of-pocket, which in New York State would be around
$3,500 a month — a tidy sum but far less than the cost
of home health aides, assisted living with the enhanced
services people this frail would need, or placement in a
skilled nursing facility. In other words, this excellent
care is not limited to the indigent, as it is in many
other pilot programs run by Medicaid.
-
- Each P.A.C.E. program must manage its funds wisely,
lest the cost of services exceeds the fixed fees. That
encourages preventive care that members might not
receive otherwise. For instance, government
reimbursement and most private insurance will not pay
for ongoing physical therapy once a patient has
“plateaued,” and so often treatment stops, which can
lead to further loss of mobility. But since physical
therapy is cheaper than repairing a broken hip or
providing round-the-clock care for someone who is
bed-bound, P.A.C.E. does pay for ongoing physical
therapy, an approach that is cost-effective to the
taxpayer, according to several studies, and leads to
better outcomes.
-
- After a day at the P.A.C.E. center, my only
reservation is whether a middle-class person — say, my
mother — would have given a program like this a chance
or been put off by the race, ethnicity or cultural
differences of the other clients. She was by no means a
prejudiced woman, but the older she got the more her
comfort level depended on being among people of similar
background.
-
- I was embarrassed to raise this question. But,
P.A.C.E. officials told me, my mother’s resistance would
not have been unusual or viewed as a sign of bad
character. Shared experience matters at this time of
life, and P.A.C.E. centers tend to reflect the
neighborhoods where they are located. My mother might
have done well at C.C.M.’s Westchester County center, in
White Plains, N.Y., or a center in Amityville on Long
Island that is soon to open.
-
- P.A.C.E. centers around the country are listed on
the Web site of the National P.A.C.E. Association, along
with program details. Further information is available
through the Centers for Medicare & Medicaid Services. My
thanks to all of you who told me to go take a look.
-
- Copyright 2008 New York Times.
-
-
- By Sara Michael
- Baltimore Examiner
- Thursday, January 8, 2008
-
- Research by Greater Baltimore Medical Center
clinicians has prompted changes in delivery room
practices that could help many low-weight babies avoid
lung disease.
-
- Babies weighing less than 5.5 pounds can suffer from
chronic lung disease, which can lead to long hospital
stays, frequent readmission to the hospital and a risk
of neurodevelopmental delays.
-
- Dr. Howard Birenbaum, GBMC's director of
neonatology, and other researchers studied practices
that would reduce chronic lung disease cases. The
findings were reported in this month's edition of the
journal Pediatrics.
-
- The changes include avoiding endotracheal intubation
in the delivery room and using continuous positive
airway pressure machines in the delivery room to help
the babies breathe.
-
- Birenbaum noticed an increase in the incidence of
chronic lung disease between 1997 and 2002, and in 2003,
implemented this initiative. By 2005, lung disease cases
decreased to 20.5 percent, down from 46.5 percent in
2002.
-
- Copyright 2008 Baltimore Examiner.
-
-
- By Donald G. McNeil Jr.
- New York Times
- Thursday, January 8, 2009
-
- Virtually all the flu in the United States this
season is resistant to the leading antiviral drug
Tamiflu, and scientists and health officials are trying
to figure out why.
-
- The problem is not yet a public health crisis
because this is a below-average flu season so far and
the chief strain circulating is still susceptible to
other drugs — but infectious disease specialists are
nonetheless worried.
-
- Last winter, about 11 percent of the throat swabs
from patients with the most common type of flu that were
sent to the Centers for Disease Control and Prevention
for genetic typing showed a Tamiflu-resistant strain.
This season, 99 percent do.
-
- “It’s quite shocking,” said Dr. Kent A. Sepkowitz,
director of infection control at the Memorial
Sloan-Kettering Cancer Center. “We’ve never lost an
antibiotic this fast. It blew me away.”
-
- The single mutation that creates Tamiflu resistance
appears to be spontaneous, and not a reaction to overuse
of the drug. It may have occurred in Asia, and it was
widespread in Europe last year.
-
- In response, the C.D.C. issued new guidelines two
weeks ago. They urged doctors to test suspected flu
cases as quickly as possible to see if they are
influenza A or influenza B and then, if they are A,
whether they are H1 or H3 viruses.
-
- The only Tamiflu-resistant strain is an H1N1. Its
resistance mutation could fade out, a C.D.C. scientist
said, or a different flu strain could overtake H1N1 in
importance, but right now it causes almost all flu cases
in the country, except in a few mountain states, where
H3N2 is prevalent.
-
- Complicating the problem, antiviral drugs work only
if they are taken within 48 hours. A patient with severe
flu could be given the wrong drug and die of pneumonia
before test results come in. So the new guidelines
suggest that doctors check with their state health
departments to see which strains are most common locally
and treat for them.
-
- “We’re a fancy hospital and we can’t even do the A
versus B test in a timely fashion,” Dr. Sepkowitz said.
“I have no idea what a doctor in an unfancy office
without that lab backup can do.”
-
- If a Tamiflu-resistant strain is suspected, the
disease control agency suggests using Relenza. But it is
harder to take — it is a powder that must be inhaled and
can cause lung spasms, and it is not recommended for
children under age 7.
-
- Relenza, made by GlaxoSmithKline, is known
generically as zanamivir. Tamiflu, made by Roche, is
known generically as oseltamivir.
-
- Alternatively, patients who have trouble inhaling
Relenza can take a mixture of Tamiflu and rimantadine,
an older generic drug that the agency stopped
recommending two years ago because so many flu strains
were resistant to it. By chance, the new Tamiflu-resistant
H1N1 strain is not.
-
- “The bottom line is that we should have more
antiviral drugs,” said Dr. Arnold S. Monto, a flu expert
at the University of Michigan’s School of Public Health.
“And we should be looking into multidrug combinations.”
-
- New York City had tested only two flu samples as of
Jan. 6, and both were Tamiflu-resistant, said Dr. Annie
Fine, an epidemiologist at the city’s health department.
Flu cases in the city are only “here and there,” she
said, and there have been no outbreaks in nursing homes.
Elderly patients, and those with the AIDS virus or on
cancer therapy are most at risk.
-
- But, she added, because of the resistance problem,
the city is speeding up its laboratory procedures so it
can do both crucial tests within one day.
-
- “And we strongly suggest that people get a flu
shot,” she said. “There’s plenty of time and plenty of
vaccine.” Exactly how the Tamiflu-resistant strain
emerged is a mystery, several experts said.
-
- Resistance appeared several years ago in Japan,
which uses more Tamiflu than any other country, and
experts feared it would spread.
-
- But the Japanese strains were found only in patients
already treated with Tamiflu, and they were “weak” —
that is, they did not transmit to other people.
-
- “This looks like a spontaneous development of
resistance in the most unlikely places — possibly in
Norway, which doesn’t use antivirals at all,” Dr. Monto
said.
-
- Dr. Henry L. Niman, a biochemist in Pittsburgh who
runs recombinomics.com, a Web site tracking the genetics
of flu cases around the world, has been warning for
months that Tamiflu resistance in H1N1 was spreading.
-
- He argues that it started in China, where Tamiflu
use is rare, then was seen last year in Norway, France
and Russia, then moved to South Africa, where winter is
June to September, and then back to the northern
hemisphere in November.
-
- The mutation conferring resistance to Tamiflu, known
in the shorthand of genetics as H274Y on the N gene, was
actually, he said “just a passenger, totally unrelated
to Tamiflu usage, but hitchhiking on another change.”
-
- The other mutation, he said, known as A193T on the H
gene, made the virus better at infecting people.
-
- Furthermore, he blamed mismatched flu vaccines for
helping the A193T mutation spread. Flu vaccines
typically protect against three flu strains, but none
have contained protections against the A193T mutation.
-
- Dr. Joseph S. Bresee, the C.D.C.’s chief of flu
prevention, said he thought Dr. Niman was “probably
right” about the resistance having innocently
piggy-backed on a mutation on the H gene — which creates
the spike on the outside of the virus that lets it break
into human cells. But he doubted that last year’s flu
vaccine was to blame, since the H1 strain in it
protected “not perfectly, but relatively well” against
H1N1 infection, he said.
-
- Dr. Niman said he worried about two aspects of the
new resistance to Tamiflu. Preliminary data out of
Norway, he said, suggested that the new strain was more
likely to cause pneumonia.
-
- Flu typically kills about 36,000 Americans a year,
the C.D.C. estimates, most of them elderly, very young
or with problems like asthma or heart disease, and
pneumonia is usually the fatal complication.
-
- And while seasonal flu is relatively mild, the
Tamiflu resistance could transfer onto H5N1 bird flu
circulating in Asia and Egypt, which has killed millions
of birds and about 250 people since 2003. Although H5N1
has not turned into a pandemic strain, as many experts
recently feared it would, it still could — and Tamiflu
resistance in that case would be a disaster.
-
- Copyright 2008 New York Times.
-
- Bacteria on doctor uniforms can kill you.
-
- By Betsy McCaughey
- Wall Street Journal Commentary
- Thursday, January 8, 2008
-
- You see them everywhere -- nurses, doctors and
medical technicians in scrubs or lab coats. They shop in
them, take buses and trains in them, go to restaurants
in them, and wear them home. What you can't see on these
garments are the bacteria that could kill you.
-
- Dirty scrubs spread bacteria to patients in the
hospital and allow hospital superbugs to escape into
public places such as restaurants. Some hospitals now
prohibit wearing scrubs outside the building, partly in
response to the rapid increase in an infection called
"C. diff." A national hospital survey released last
November warns that Clostridium difficile (C. diff)
infections are sickening nearly half a million people a
year in the U.S., more than six times previous
estimates.
-
- The problem is that some medical personnel wear the
same unlaundered uniforms to work day after day. They
start their shift already carrying germs such as C.diff,
drug-resistant enterococcus or staphylococcus. Doctors'
lab coats are probably the dirtiest. At the University
of Maryland, 65% of medical personnel confess they
change their lab coat less than once a week, though they
know it's contaminated. Fifteen percent admit they
change it less than once a month. Superbugs such as
staph can live on these polyester coats for up to 56
days.
-
- Do unclean uniforms endanger patients? Absolutely.
Health-care workers habitually touch their own uniforms.
Studies confirm that the more bacteria found on surfaces
touched often by doctors and nurses, the higher the risk
that these bacteria will be carried to the patient and
cause infection.
-
- Until about 20 years ago, nearly all hospitals
laundered scrubs for their staff. A few hospitals are
returning to that policy. St. Mary's Health Center in
St. Louis, Mo., reduced infections after cesarean births
by more than 50% by giving all caregivers
hospital-laundered scrubs, as well as requiring them to
wear two layers of gloves. Monroe Hospital in
Bloomington, Ind., which has a near-zero rate of
hospital-acquired infections, provides laundered scrubs
for all staff and prohibits them from wearing scrubs
outside the building. Stamford Hospital in Connecticut
recently banned wearing scrubs outside the hospital.
-
- Across the pond, a British study found that
one-third of medical personnel did not launder their
uniforms before coming to work. One British surgeon who
specializes in hip and knee replacements reduced
postoperative infections by two-thirds at her hospital
by protecting patients from contaminated uniforms.
Before approaching any patient's bed, nurses put on
disposable, clear plastic aprons that were pulled off
rolls like dry cleaning bags. Each one costs a nickel.
-
- In response to this evidence and public outrage over
infections, the cash-strapped British National Health
Service is providing nurses with hospital-laundered
"smart scrubs." The smart design includes short sleeves,
because long sleeves spread germs from patient to
patient.
-
- The new British policy will protect patients and
prevent superbugs from being carried outside hospitals.
In one study, more than 20% of nurses' uniforms had C.
diff on them at the end of a shift. The germ can cause
extreme diarrhea, dehydration, inflammation of the
colon, and even death.
-
- In a hospital, C. diff contaminates virtually every
surface. It spreads when traces of an infected person's
feces get in another person's mouth. Patients who touch
objects in their room and then eat without washing their
hands unknowingly swallow the germ. Many otherwise
healthy patients who go into the hospital for elective
surgery, such as hip replacement, have contracted C.
diff and died.
-
- Outside the hospital, C. diff is also difficult to
control. It isn't killed by laundry detergents or most
cleaners. Researchers at Case Western Reserve and the
Cleveland Veterans Administration Medical Center found
that even after routine cleaning, 78% of surfaces still
had C. diff. Only scrubbing with bleach removed it.
That's not the kind of cleaning restaurants are prepared
to do after serving hospital workers.
-
- Imagine sliding into a restaurant booth after a
nurse has left the germ on the table or seat. You could
easily pick it up on your hands and then swallow it with
your sandwich. Hospitals should provide workers with
clean uniforms and prohibit wearing them in public.
-
- Ms. McCaughey, former lieutenant governor of New
York state, is a fellow at the Hudson Institute and
chair of the Committee to Reduce Infection Deaths.
-
- Copyright 2008 Dow Jones & Company, Inc. All
Rights Reserved.
