Maryland / Regional

State plans to close Baltimore's only public psychiatric center (Baltimore Sun)

CDC may join cancer cluster analysis (Montgomery Gazette)

Gude landfill is no go for bus depot (Montgomery Gazette)

Bill Proposed to Ban Hallucinogenic Herb Salvia Divinorum (Capital News Service)

Lawmakers seek to make hallucinogenic herb illegal (Baltimore Examiner)

Residents ask college to stop smokers to stop loitering (Montgomery Gazette)

Water quality getting worse in Clarksburg, report says (Montgomery Gazette)

New biosciences center in state capital budget (Montgomery Gazette)

Lead Probe Sought In D.C. (Washington Post)

National / International

Peanut Processor Knowingly Sold Tainted Products (Washington Post)

Study Refutes Claims on AIDS Drug Trials (New York Times)

Opinion

Caring for the Caregivers (New York Times Editorial)

Not What the Doctor Ordered (Washington Post Commentary)

In Dangerous Locales, HIV Discrimination Isn't an Open‑and‑Shut Case

(Washington Post Commentary)

Weasels vs. AIDS Relief (Washington Post Commentary)

Low nursing home ranking is difficult to understand (Salisbury Daily Times Letter to the Editor)

State plans to close Baltimore's only public psychiatric center

Proposal calls for shuttering inpatient facility at Walter P. Carter Center downtown.

By Kelly Brewington

Baltimore Sun

Wednesday, January 28, 2009

Maryland officials plan to close Baltimore's only public psychiatric hospital, relocating some patients to state facilities in Anne Arundel and Baltimore counties while forcing outpatient alcohol and drug treatment programs housed there to find new homes.

The plan, detailed in Gov. Martin O'Malley's budget for next year, calls for shuttering the 51‑bed in‑ patient facility at the Walter P. Carter Center downtown. Outpatient mental health programs, which serve thousands throughout the city, will have to move elsewhere by July 2010, when officials plan to close the center. Most of the 119 employees of the impatient hospital would be relocated to another mental health center, while state officials said they would work to try to find new state jobs for the rest.

John M. Colmers, the state health secretary, said the changes could save about $5 million in his agency's roughly $8 billion budget amid a time of severe belt‑tightening statewide. The agency is also moving to consolidate centers, reduce the size of state institutions and increase the number of community‑based programs.

"Our challenge is to find as many cuts as possible while continuing to meet our responsibility of protecting the health of the population," he said.

Mental health advocates said they do not object to the closure of the outdated building ‑ complete with peeling paint and small work spaces. But they said they fear that patients may be moved too far from their homes.

"We are not opposed to the state closing operations at the Carter Center. It's a very old facility with a lot of issues," said Kate Farinholt, Baltimore director of National Alliance on Mental Illness. "The concern is that you make sure there are still beds for these people, preferably within travel distance to their families and community supports."

Suzanne Harrison, director of psychiatry at LifeBridge Health, which operates Sinai Hospital in Baltimore and Northwest Hospital Center in Randallstown, said she fears the closure will put pressure on other hospitals and overburdened outpatient programs. "If we do this, what will be the impact on other aspects of the system?" she said.

The city health commissioner, Dr. Joshua M. Sharfstein, said he will be asking state officials for regular reports about the relocation of city residents and will push for more outpatient services in Baltimore. "There definitely needs to be a plan to sustain and ultimately grow the outpatient services for people with mental illness in Baltimore," he said.

Colmers said the agency is working on a program that will allow some psychiatric patients to be admitted to the private Bon Secours and Sheppard Pratt hospitals, at state cost. Patients who must be hospitalized because of a court order will be admitted to either Spring Grove Hospital in Catonsville or the Clifton T. Perkins Hospital Center in Jessup, where a new 44‑bed facility is to open.

Now, the inpatient facility at the Carter Center is using about 34 of its 51 beds. Last year, 328 patients were treated there, according to the state.

It is unclear where people now served by Carter's outpatient programs would go. The University of Maryland School of Medicine operates several of Carter's mental health and substance abuse programs. University officials said they are committed to keeping those services in the city and to keeping the Carter name.

Named after the late civil rights activist Walter P. Carter, the seven‑story center opened in 1976 to provide inpatient and community services in South and Southwest Baltimore. Del. Jill P. Carter, a Baltimore Democrat and Carter's daughter, said she believes a coalition that includes labor unions, mental health workers and other lawmakers would be able to derail closure of the facility.

"The center was built as a memorial to not only my father, but to the civil rights legacy he left, which was that this was a place people could go to get the services and help they needed to become productive members of society," Carter said.

Carter said that she plans to introduce two bills. One would prohibit the center's closure. The other bill would put into law certain requirements in case of closure, to ensure that the same level of services are offered elsewhere in the city.

Baltimore Sun reporter Laura Smitherman contributed to this article.

Copyright 2009, The Baltimore Sun

CDC may join cancer cluster analysis

Initial study shows further investigation needed in Poolesville

By Meghan Tierney

Montgomery Gazette

Wednesday, January 28, 2009

Initial analysis on whether there are an unusual number of cancer cases in Poolesville has "raised questions," and the U.S. Centers for Disease Control and Prevention is expected to help investigate further, according to a county health official.

The Montgomery County Department of Health and Human Services initiated a cancer cluster study in December after being contacted by a concerned resident. The first stages of the investigation, which involved comparing cancer rates in Poolesville to county and state rates, did not reveal unusual patterns, county health officer Dr. Ulder Tillman said during a presentation at Monday night's town commissioners meeting. However, the county received additional calls from Poolesville residents that warranted further study, she said.

"These have raised questions for us that we don't have complete data or information for," said Dr. Clifford Mitchell, director of environmental health coordination at the Maryland Department of Health and Mental Hygiene, which provided assistance to the county in its analysis. "...It really does suggest that further evaluation is warranted."

Tillman said that "some things may or may not be unusual" but would not elaborate, citing privacy concerns. After the meeting, she said questions had been raised about the number of cancer cases and the specific kinds of cancers reported.

Mary Anderson, a county spokeswoman, would not say how many people contacted the health department about cancers in Poolesville, also citing privacy concerns. She said she was not aware of any other times that the CDC participated in a cancer cluster study in Montgomery County.

More than 100 people attended the meeting at Poolesville's Town Hall, and residents lined the walls and spilled out into the foyer.

"I think we got their attention and got them looking at it," said resident Catherine Poss, who was diagnosed with a rare salivary gland cancer two years ago. "...We'll get an answer one way or another, and you can't ask for anything more than that."

Western upcounty residents have long discussed whether cancer rates in their communities are unusually high and wondered if environmental factors are to blame.

Resident Fred Kelly, whose wife was recently diagnosed with renal cancer, contacted the county in December after becoming concerned about high levels of naturally occurring alpha radiation‑emitting particles in the town's water supply, particularly radon. The town's water has never been out of compliance with federal and state standards.

There have been initial discussions with CDC officials about the agency participating with the study, Mitchell said. The county and state plan to formally ask for assistance and expect that the CDC will agree, he said.

"Looking at the questions that have been raised, we thought it was prudent to ask for outside assistance," Mitchell said. After the meeting, Tillman said she did not know how common it was for the CDC to participate in local cancer cluster studies.

A cancer cluster is a "greater than expected number of cases of similar cancers occurring in a short period of time among people who live or work near each other," according to documents provided by the county health department. The county will now look at whether there is an increased risk of cancer within the cluster and whether there is a common exposure. Only two out of every 1,000 suspected cancer cluster studies reach this stage, according to the documents.

Investigators are also waiting on Maryland Cancer Registry data from 2004‑06, which is expected to be finalized soon, Mitchell said. The study could take several weeks to several months to complete, he said.

The boundaries of the study area still need to be determined, Mitchell said.

To report a cancer case in Poolesville or find out if a specific case is in the state registry, contact the county health department at 240‑777‑1245.

Copyright 2009 Post‑Newsweek Media, Inc./Gazette.Net

Gude landfill is no go for bus depot

Residents seek more action on toxins leaching into water from former dump

By Melissa J. Brachfeld and Sebastian Montes

Montgomery Gazette

Wednesday, January 28, 2009

A closed landfill in Derwood has been dropped from a list of sites under consideration for a county school bus depot. The decision is a small victory for a group of area residents who are also ringing alarm bells over apparent contamination leaching from the 1960s‑era dump.

A report from the county's Department of Environmental Protection, featuring water sampling data taken from a ring of wells around the landfill between 2001 and September 2008, shows the groundwater contains more than two dozen toxic and cancer‑causing chemicals in amounts that exceed federal standards.

"Cyanide, lead, mercury, benzene and 24 other toxic substances are oozing from the landfill at levels so high, the EPA says they exceed the maximum contamination limits sometimes by tenfold," said Julia Tillery, a Derwood resident and member of Gude Landfill Concerned Citizens, citing standards from the U.S. Environmental Protection Agency.

Tillery, testifying at a County Council public hearing last week, said the results came as a "shock" to her group, which represents about 500 households in the nearby Derwood Station and Hollybrooke neighborhoods.

The county has been studying where to move a number of government operations along Crabbs Branch Way as part of a long‑term plan to develop 92 acres near the Shady Grove Metrorail station into a mix of houses, apartments and shops.

County Executive Isiah Leggett, citing cost, environmental and operations concerns, announced Monday that moving a bus lot to the approximately 100‑acre landfill site would be "harmful to the community," which for years also has been worried about leaking contaminants.

Tillery said while Leggett's decision is a relief, "there are still existing environmental issues at the landfill, so we're going to keep working."

"People get very alarmed when they see these numbers because no one likes to see any kind of contamination, but the question is is there any human exposure and is there a significant concentration in the surface water," said Peter Karasik, a section chief for the county Department of Environmental Protection's Division of Solid Waste Services said. "There are a wide range of chemical contaminants in the groundwater at that site because it was an unlined, unregulated landfill from the 1960s, which predates the [federal] Resource Conservation Recovery Act and the Clean Water Act."

Leggett's decision to not relocate the bus depot to the landfill site, located at 600 East Gude Drive, comes just days after a Thursday council hearing on Leggett's request for more than $46.6 million in planning and design funds to move and upgrade a dozen county operations and clear the way for redevelopment around the Metro station.

At a the hearing, Tillery told council members that the landfill is already in bad shape and placing a bus depot on top could only exacerbate the problem.

Her group has asked the Maryland Department of the Environment to declare the county in violation of its storm water discharge permit and to require a groundwater contamination survey and remediation plan.

"The county has watched these lab results come in year after year after year. Local officials say it's OK, as long as we don't drink it," Tillery said. "We actually have documents that say that. The creek near the landfill feeds Rock Creek; both are contaminated. Eventually, toxins flow into the Chesapeake, leaving our community."

"There's no question there's groundwater contamination," Karasik said. "The question is since everyone's on public drinking water should remediation efforts be made."

Word of the decision on Gude sparked worries in Montgomery Village that the Webb Tract could be revived as a candidate for the bus depot. Two years ago, Village residents won the assurance of the County Council that the bus depot would not move to the 130‑acre property off Snouffer School Road.

Under Leggett's "Smart Growth Initiative," the Webb Tract slated to become home to the county's police and fire rescue training facility and the county school system's food distribution warehouse.

While county officials recently determined that the bus depot will need to be broken up into smaller pieces, they have not discussed or identified possible locations.

On Tuesday, Patrick K. Lacefield, Leggett's spokesman, squashed the notion that the Webb Tract could see buses.

"Absolutely, positively not. It's not an option at all," he said.

Copyright 2009 Post‑Newsweek Media, Inc./Gazette.Net

Bill Proposed to Ban Hallucinogenic Herb Salvia Divinorum

By Michael Frost and Erich Wagner

Capital News Service

Wednesday, January 28, 2009

ANNAPOLIS ‑ Judicial committees in both houses heard arguments for a bill Tuesday that would outlaw Salvia Divinorum, a hallucinogenic plant native to Mexico.

"There's a herb right now that my daughter, your children and grandchildren can get their hands on in Maryland and get high and nothing can be done about it," said Sen. Richard Colburn, R‑ Caroline, who sponsored the bill in the Senate.

Salvia Divinorum was once used in healing ceremonies by the Mazotec Indians. According to Colburn, it is now available on the Internet for as little as $12 an ounce.

Currently legal under federal law, the new bill would make possession a misdemeanor in Maryland that would be punishable by up to four years imprisonment and/or a $25,000 fine, according to the Office of the Public Defender. Possessors of larger quantities could face felony charges and up to 20 years in prison.

Thirteen states, including Delaware, have enacted legislation regulating or banning the substance.

A federal survey conducted by the Substance Abuse and Mental Health Services Administration found that 1.8 million people aged 12 and over had used Salvia Divinorum as of 2006, including approximately 756,000 that year alone.

"Last year it grew considerably in popularity," said Capt. Robert Bokinsky of the Ocean City Police Department.

In Ocean City, it is sold in a number of boardwalk businesses without any age restrictions or attempts to educate the buyer, Bokinsky said. He added that a number of Delaware youth are simply crossing state lines to come to Ocean City and get it where it is still legal.

Bokinsky conducted 100 hours of research, during which he interviewed several users of the plant, many of whom had bad experiences, he said.

"Without exception, every user has said, `that stuff should not be legal,'" he said.

Some lawmakers were skeptical of the proposed legislation, saying the war on drugs is already failing.

"How are we going to win this one when we're miserably failing at the other ones?" said Sen. James Brochin, D‑ Baltimore County.

Naomi Long, director of the Drug Policy Alliance Metro Project, advocated a model along the lines of that used to reduce teen tobacco use. Such a strategy would favor strict age controls and restrictions on where it could be sold.

Making a drug illegal sends the market underground and takes away regulatory control, she said.

"Drug dealers do not card," Long said.

In the Senate, lawmakers also considered amendments to allow Salvia to continue to be researched for possible medical use, something some of those in favor of the bill seemed open to.

Delegate Todd Schuler, D‑Baltimore County, said he'd likely vote against the House bill because of the lack of evidence showing the drug to be dangerous.

"The witnesses provided no evidence that it was addictive, or that there were short‑term health effects or long‑term health effects," Schuler said. "They seem to want to make it illegal just because some people had a bizarre reaction to it."

For his part, Bokinsky felt the plant has lost its connection to its mystical past.

"The use that we're familiar with is far from the sacred experiences of the Mazotec shamans," he said.

Copyright 2008 University of Maryland Philip Merrill College of Journalism

Lawmakers seek to make hallucinogenic herb illegal

By Sara Michael

Baltimore Examiner

Wednesday, January 28, 2009

YouTube videos show young people laughing uncontrollably, slurring their words or hallucinating ‑‑ all after smoking an herb that's completely legal in Maryland.

But if state Sen. Richard Colburn has his way, Salvia divinorum ‑‑‑ also known as Sally D or Magic Mint, a herb widely available in smoke shops and on the Internet ‑‑ will be in the same category as heroin and LSD.

"It's pretty disturbing," Colburn, an Eastern Shore Republican, said of the hundreds of videos showing the affects of the herb.

"Just imagine if that was your child."

Colburn wants Maryland to join 13 other states that have laws or regulations against salvia. His measure would make it a Schedule 1 controlled dangerous substance, which are considered to have a high tendency for abuse and no medical purpose. Violators could face up to 20 years in prison.

Republican Dels. Jeannie Haddaway and Addie Eckardt introduced a similar measure in the House.

Opponents say outlawing salvia would prevent medical studies on possible benefits of the drug and create an underground market targeting youth.

The effects of salvia divinorum, a Mexican herb from the mint family that is smoked or chewed, last about a half‑hour.

The drug was blamed for the suicide of Delaware teen Brett Chidester. Delaware became the first state to outlaw salvia nearly three years ago under what was dubbed "Brett's Law," and his mother, Kathleen Chidester, has advocated for similar laws across the country.

"My hope and goal is to have salvia regulated across the U.S.," she said in written testimony in support of Colburn's bill.

"It's my son's legacy and I will not end my fight until this happens."

Ocean City police Capt. Robert Bokinsky said the herb is sold in shops along the boardwalk and he has arrested people for disorderly conduct who later disclosed they were on salvia.

"Without exception, every user has said, quote, 'That stuff should not be legal,' " he told lawmakers at a hearing Tuesday.

But some researchers, including Johns Hopkins scientists Matthew Johnson and Roland Griffiths, have opposed a ban, saying it would hamper research into its potential benefits such as treating Alzheimer's or pain management.

"They are afraid if we ban it they won't be able to" continue studying it, said Sen. Jamie Raskin, D‑Montgomery County, who questioned whether the bill should be amended to allow for research.

Naomi Long of the Drug Policy Alliance, which advocates for drug policy reform, likened salvia to marijuana, which teens have reported is easier to get than alcohol and cigarettes. Instead of making saliva a Schedule 1 drug, there should be education campaigns, age restrictions and regulations on who can sell it, she said.

"Our young people are able to access marijuana," she said, "exactly because it's out the realm of regulation."

baltimoreexaminer.com

Residents ask college to stop smokers to stop loitering

College officials say they will continue to work with community

By Nathan Carrick

Montgomery Gazette

Wednesday, January 28, 2009

Montgomery College's tobacco ban is making life miserable for the school's neighbors, they told college officials last week.

Residents living near Montgomery College's Rockville campus told the college's Board of Trustees at its monthly meeting that the school's ban on tobacco products is harmful to the community and has to be changed or eliminated completely.

The 10‑member panel listened to the complaints, but followed its own policy of not commenting on the public testimony at the meeting.

"We feel certain that the college will work very hard to continue the discussions with the community to resolve this issue," Chairwoman Roberta Shulman said after the testimony.

The college adopted the policy last August that prohibits all tobacco products on school property, effectively forcing smokers at the Rockville campus onto Hungerford Drive, Mannakee Street or the surrounding neighborhoods.

In 2001, the college received funding from the Maryland State Cigarette Restitution Fund to support the Healthy Campus Program. The program also receives grants from four other anti‑smoking groups, as well as funds for other health‑ and safety‑oriented programs.

"We call upon you to immediately rescind the smoking ban," said Elyse Gussow, president of the Plymouth Woods Homeowners Association. Plymouth Woods is a townhouse and condominium community immediately west of the college campus.

"The status quo is unacceptable because the ban forces students and faculty onto our property to smoke," she said.

The focus of most residents' ire is a break in the waist‑high fence that surrounds the college. The break opens onto Princeton Place, a cul‑de‑sac a few feet beyond the western‑most corner of campus. Residents complain that students flood through the fence and onto Princeton Place to smoke.

Aside from smoking, neighbors say students park on the street for easy access to campus, loiter, litter, abuse drugs and participate in sexual activity on or near their property.

In response to residents' complaints about litter, the college placed a trash can and smoking post‑style ashtray on the neighborhood side of the fence. Residents said this did little or nothing to stem the problem.

From the eight community members who spoke at the board meeting, three suggestions emerged. One was to close the gap in the fence and give smokers a designated spot on campus. Another was to close the fence between 9 a.m. and 5 p.m. on weekdays. A third was to leave the fence open and either rescind the ban altogether or give smokers a designated spot on campus.

"I can no longer let my children play on the front lawn," said Christina Borger, a Plymouth Woods resident. "There's just too much college‑level activity going on. Montgomery College needs to correct the wrong created by foisting its smoking problem off campus. I've come to ask you to close the opening from 9 a.m. to 5 p.m. Monday through Friday."

The gap in the fence is a popular and useful cut‑through for community members.

The Rockville Planning Commission in October made keeping the gap in the fence a provision for granting the school a use permit to build a new $58 million Science Center. College officials are now asking the planners to rescind that provision so they can close the fence if necessary.

Rockville City Council on Monday night heard testimony from many of the same community residents who spoke to the Board of Trustees. Council members seemed enthusiastic about seeing the problem resolved quickly.

The Board of Trustees' next scheduled meeting is Feb. 17.

"I think the neighbors described the situation well," Vice President and Provost Dr. Judy E. Ackerman said. She is confident the neighbors and the school can come to a solution.

"We've heard them and we're working toward a solution. I think they presented themselves well and did it in a very civil way. They made their point, and I think we can remedy this situation," she said.

Copyright 2009 Post‑Newsweek Media, Inc./Gazette.Net

Water quality getting worse in Clarksburg, report says

After months of delay, county releases 2007 report

By Margie Hyslop

Montgomery Gazette

Wednesday, Janaury 28, 2009

A report on stream quality in special protection areas calls for less dense development in environmentally sensitive areas of Clarksburg.

Monitoring in 2007 showed sedimentation and degradation that caused stream quality to decline from excellent or good to good or fair since intensive residential and commercial construction began in Clarksburg in 2002, according to the report.

The report, which county officials admit they held for months while they looked for solutions to announce along with the discouraging news, was posted on the Department of Environmental Protection Web site Monday.

Construction interruptions related to the suffering economy made matters worse as exposed soils have been stabilized more slowly and the building of permanent stormwater controls has been delayed, the report states.

The report calls for putting stormwater controls in place before or at the same time as roads and other impervious surfaces are built, using new curbs on changing natural drainage patterns and more use of grass buffers and rain gardens rather than drains and structures to control runoff.

It also recommends considering new limits on how much and how long erosion‑prone soils may be exposed.

The county monitors the water quality annually in four environmentally sensitive areas it has declared special protection areas.

Stream water quality in already developed special protection areas B Upper Rock Creek, Upper Paint Branch and Piney Branch B has changed little, the report said.

Piney Branch stream quality has been poor since 2003 and conditions in Upper Rock Creek have been good since 2004.

Indicators suggest that stream quality in Upper Paint Branch will recover "to near pre‑construction level," according to the report.

Copyright 2009 Post‑Newsweek Media, Inc./Gazette.Net

New biosciences center in state capital budget

School construction could reach $42 million

By Douglas Tallman

Montgomery Gazette

Wednesday, January 28, 2009

ANNAPOLIS C Montgomery College will be pushing forward with a new biosciences center at its Germantown campus as part of $87.2 million in county projects included in Gov. Martin O'Malley's capital budget.

O'Malley (D) slotted nearly $22 million in school construction for the county, although that number could increase with the passage of the federal stimulus bill making its way through Congress.

O'Malley's office Monday released information that showed Maryland receiving $191 million more for school construction projects statewide. And a spreadsheet from the House Committee on Education and Labor showed Montgomery County receiving an extra $20.4 million in 2009.

The governor said he has regular conversations with Maryland's congressional delegation about the status of the stimulus package, which is expected to send the state about $3.9 billion over two years.

"After reviewing it over the weekend, there are a number of really important investments that provide a way for states and cities in partnership with the federal government to get our economy moving again," O'Malley told reporters Monday.

Congress could vote on the plan today. The version being considered by the U.S. House of Representatives on Tuesday included $1 billion for infrastructure projects in Maryland, including $682.3 million for highway and transit projects and upgrades, $191 million for school construction and $174.5 million for clean water initiatives.

Before taking the federal money into account, O'Malley's capital budget totals $3.2 billion, including $1.6 billion for the Maryland Department of Transportation.

The capital budget schedules large government projects, such as schools, libraries and roads. Day‑to‑day services are funded through the state's operating budget, in which O'Malley has proposed spending $14.4 billion.

Taxes, fees and lottery revenue pay for the bulk of the operating budget. Nontransportation projects in the capital budget are financed largely through bonds. Transportation projects are funded through bonds, taxes and fees.

The biosciences center is an $82.5 million project that will receive $32.2 million from the state for planning and construction. The college could break ground by late 2009 or early 2010, and the work could be completed by late 2012 if all goes according to schedule, college spokeswoman Elizabeth Homan said.

A $4.3 million appropriation is expected in a future year to cover the cost of equipment.

The 125,685‑square‑foot center will house the Germantown campus' growing science programs, Homan said. She said the college is seeking Leadership in Energy and Environmental Design, or LEED, certification for the building.

Among the other Montgomery County projects is a new $75.2 million courthouse in Rockville. The budget sets aside nearly $18 million for the project, which already has had $57.6 million approved. The building will have nine courtrooms, four hearing rooms and encompass 159,725 gross square feet.

Frank Anastasi, who leads the group of opponents that calls itself the Move the Courthouse Steering Committee, said he was not surprised the budget included the courthouse.

"When it's built, it's going to be a monument to wasteful government spending. I wouldn't want my name attached to it," Anastasi said Monday.

The largest Montgomery school projects in the budget are the $13.6 million modernization effort at Walter Johnson High School in Bethesda and the $4.8 million modernization at Galway Elementary School in Silver Spring.

Copyright 2009 Post‑Newsweek Media, Inc./Gazette.Net

Lead Probe Sought In D.C.

Residents Fear Water Danger Was Downplayed

By Carol D. Leonnig and Bill Turque

Washington Post

Wednesday, January 28, 2009; B01

D.C. Council members asked the city's inspector general yesterday to investigate whether public health agencies and the water utility "negligently or intentionally" misled the public during the District's water crisis in 2004 and whether they should have looked harder for a correlation between high levels of lead in the water and health risks to children.

The request for a probe came as a new independent study was released that found that the number of toddlers and infants with dangerous blood‑lead concentrations ‑‑ those that can cause irreversible IQ loss and developmental delays ‑‑ more than doubled in neighborhoods that had the worst lead problems, starting in 2001.

D.C. parents and environmental activists expressed outrage at the findings, reported yesterday in The Washington Post, which showed that 42,000 fetuses and children younger than 2 during the city's lead problems were at high risk of irreversible damage. They accused government officials of downplaying the health risks at the time.

"They didn't want to find a problem, so they didn't," said Capitol Hill parent Satu Haase‑Webb. "They had the data. They chose to ignore it. What they did is bordering on gross criminal neglect."

The findings, based on blood tests available to health agencies, contradict public statements made by the D.C. Water and Sewer Authority, the D.C. Department of Health, the Atlanta‑based Centers for Disease Control and Prevention and the Environmental Protection Agency. Those agencies said there was no evidence that the city's lead crisis had affected residents' health.

"Specifically, we want to know if there is a correlation between elevated lead levels and lead‑poisoned children, and if so, whether District authorities negligently or intentionally misled the public," council members Jim Graham (D‑Ward 1) and Mary Cheh (D‑Ward 4) wrote to Inspector General Charles Willoughby.

Several parents said yesterday that the public health agencies and water utility underestimated possible harm to avoid blame. Dangerous concentrations of lead began showing up in the District's drinking water in 2001 because of a water treatment change, and the issue persisted for three years until a February 2004 Post article revealed the severity of the problem.

In 2003 and 2004, the tap water in some homes had hundreds and thousands of times the level of lead considered safe. WASA officials spotted the rising lead in 2001 but concealed it from authorities, a federal investigation found. The D.C. Department of Health and the EPA were made aware of the high levels in 2003 but did not warn residents of the risks or urge them to drink filtered or bottled water.

Two months after the problem was made public, the CDC released a report with the city health department that concluded that there was no measurable evidence that high lead levels in thousands of homes had caused individuals' blood‑lead levels to rise.

"If there is a report or study today that reaches conclusions different from those of local and federal health officials four or five years ago, it should be forwarded for their review and response," WASA General Manager Jerry Johnson said.

The CDC's director of lead poisoning prevention, Mary Jean Brown, said in a prepared statement yesterday that it was unfortunate that the CDC study was repeatedly cited by government officials as proof of no problem.

"It may have been helpful to more clearly state and explain the limitations of CDC's involvement, particularly the limitations of the health consultation," she said. "In retrospect, some people have misinterpreted the intent and scope of the health consultation, including characterizing it as a scientific study, which it clearly was not."

The District's attorney general, Peter J. Nickles, said yesterday he is still waiting to review a copy of the study, co‑authored by Virginia Tech and Children's National Medical Center, so that Mayor Adrian M. Fenty (D) can decide what steps his administration can take to protect public health. "If we see the data is qualified, and it shows we need to act, we will act," Nickles said.

Capitol Hill resident Andy Bressler said the study confirms what he and his wife suspected years ago when blood tests showed their twin boys, then 3, with elevated lead levels. The twins just turned 8, and the couple wonders whether one son's speech and balance problems are linked to lead.

"It kind of backs up everything we believed over the years ‑‑ that a lot of what happened was not fully investigated, either by D.C. or EPA," he said. "Our hope is that while a lot of this is somewhat water under the bridge, we hope it is a good signal to folks at WASA that they do a better job of investigating rather than cover things up."

Yanna Lambrinidou, president of Parents for Nontoxic Alternatives, a grass‑roots group, said she is devastated by the findings but also relieved that the information is out.

"The story, in my opinion, is alarming because of the no‑harm message from 2004 onward," she said. "The people responsible for the initial coverup in 2001‑04 were able to keep their positions and continue to run an agency [WASA] with the same troubling message and practices they had used before."

2009 The Washington Post Company

Peanut Processor Knowingly Sold Tainted Products

It Found Salmonella 12 Times

By Lyndsey Layton

Washington Post

Wednesday, January 28, 2009; A01

The Georgia peanut plant linked to a salmonella outbreak that has killed eight people and sickened 500 more across the country knowingly shipped out contaminated peanut butter 12 times in the past two years, federal officials said yesterday.

Officials at the Food and Drug Administration and the Centers for Disease Control and Prevention, which have been investigating the outbreak of salmonella illness, said yesterday that Peanut Corporation of America found salmonella in internal tests a dozen times in 2007 and 2008 but sold the products anyway, sometimes after getting a negative finding from a different laboratory.

Companies are not required to disclose their internal tests to either the FDA or state regulators, so health officials did not know of the problem.

The peanut butter and paste made at the company's Blakely, Ga., plant are not sold directly to stores but are used by manufacturers to make crackers, cookies, energy bars, cereal, ice cream, candies and even dog biscuits. Some of the country's biggest foodmakers, including Kellogg and McKee Foods, which produces Little Debbie brand snacks, have recalled more than 100 products made with the tainted ingredients, and the listkeeps growing.

Federal investigators also said yesterday that they had found four strains of salmonella at the Georgia plant, including one in a sample taken from the floor near a washroom. Only the Typhimurium strain of Salmonella enterica has been linked to the outbreak.

"There is a salmonella problem at the plant," said Robert Tauxe, deputy director of the CDC's division of food‑borne, bacterial and mycotic diseases.

The outbreak, which has spread to 43 states and Canada, is ongoing, but the pace has slowed "modestly," Tauxe said. Half the people made ill have been children.

Major‑label peanut butter is not suspected to be contaminated with salmonella and is considered safe to eat, according to the FDA. The makers of several major brands, including Peter Pan, Jif and Smuckers, are worried that panicky consumers will stop buying their products, and they have been taking pains to point out that their peanut butters are not part of the outbreak.

Though Peanut Corporation of America, based in Lynchburg, Va., was not required to inform regulators about its internal salmonella tests, Stephen Sundlof, director of the FDA's Center for Food Safety and Applied Nutrition, said it appears that the company violated federal law. "Foods are supposed to be produced under conditions that do not render them damaging to health," he said.

Sundlof said he could not say whether the company might face criminal charges.

Stewart Parnell, the company's owner and president, was not taking calls yesterday, and his spokesman did not return telephone messages.

The company e‑mailed a statement saying it "has cooperated fully with FDA from day one during the course of this investigation. We have shared with them every record that they have asked for that is in our possession and we will continue to do so."

The company halted production at the Blakely plant once the FDA confirmed it was the source of the outbreak. FDA officials said the company is free to restart production but will have to first address a list of manufacturing deficiencies, which federal officials intend to make public today.

FDA officials said they still do not know the how the plant was contaminated and how the bacteria got into the peanut products, although state inspection records show a pattern of unsanitary conditions over several years. In each case, inspectors flagged the problems but said they required routine follow‑up. There is no evidence that Peanut Corporation of America was ever closed by the state or otherwise penalized.

The FDA has never inspected the plant, instead delegating that duty under a contract to the Georgia Department of Agriculture. The federal agency has said it does not have enough inspectors to visit the country's 65,520 domestic food production facilities. In fiscal 2008, it inspected 5,930 plants.

State inspectors last visited the Georgia plant in October, while the contaminated products were being produced, according to inspection records first obtained by the Associated Press. But they did not test either the factory or the peanut products for salmonella. "We do pull product samples from time to time, but we can only run 4,500 samples in a year, and we have 16,000 food‑processing and food‑sales stores in the state," said Oscar Garrison, Georgia's assistant agriculture commissioner for consumer protection.

Michael Rogers, director of field investigations at the FDA, said that his agency is reviewing the state's inspection process and that it is unclear if Georgia officials would have found the salmonella if they had tested. "All inspections are a snapshot in time; they only reveal what is happening at the firm at that particular time," Rogers said.

But Jean Halloran, director of food safety for Consumers Union, said if the government was adequately protecting the food supply, the outbreak could have been minimized or even prevented, and lives could have been saved. Major reforms in inspections and regulations are past due, she said.

"The average plant is inspected once every 10 years," Halloran said. "This one was getting inspected a couple of times a year by Georgia, but neither they nor the FDA were taking enough enforcement action."

Salmonella is carried by animal feces. Foods can also become contaminated by infected handlers who do not wash their hands with soap after using the bathroom. The bacteria generally thrive in a wet environment, such as meat and eggs. But after a 2007 outbreak at a ConAgra facility in Georgia that makes Peter Pan peanut butter, food safety experts realized that salmonella can exist in a dormant state in peanut butter and then reproduce when ingested by humans.

Salmonella bacteria can cause an infection that often produces diarrhea, fever and abdominal cramps within 12 to 72 hours. The illness usually lasts four to seven days. While most people recover without treatment, infants, elderly people and those with compromised immune systems can develop severe illness that can be fatal if not promptly treated with antibiotics.

Staff researcher Julie Tate contributed to this report.

8 2009 The Washington Post Company

Study Refutes Claims on AIDS Drug Trials

By Lisa W. Foderaro

New York Times

Wednesday, January 28, 2009

An investigation into the participation of New York City foster children in clinical drug trials for H.I.V. and AIDS over a nearly 20‑year period has found no evidence that any children died as a result of the trials or that the foster children were selected because of their race.

In the late 1980s, as the AIDS epidemic intensified, the city's child‑welfare agency developed a policy to allow foster children to enroll in drug trials at a time when there were no approved treatments for children infected with H.I.V. and AIDS. Hundreds of children received medication in scores of trials conducted from the late 1980s to 2005.

But after charges by a freelance journalist that children were put in trials without their parents' knowledge and given medications known to cause death, some civil rights activists and City Council members expressed angry concern.

As a result, in 2005 the city commissioned the Vera Institute of Justice, an independent nonprofit group, to investigate the claims. That study, which is to be released on Wednesday, determined that city officials had acted in good faith and in the interests of the children, many of whom were seriously ill.

But it also found that the agency had not always followed its own protocols and kept poor records.

After interviewing dozens of people involved in the trials and reviewing hundreds of thousands of pages of case files, documents and correspondence, the Vera Institute concluded that none of the 532 children in the trials died as a direct result of the medications. (Twenty‑five children receiving treatment as part of the trials died during the trial years.)

The report also found that foster children were not removed from their families by the city because a parent had refused to consent to a child's treatment, as some had alleged.

In addition, the study said that researchers did not specifically select foster children for enrollment in the trials. And while the foster children were overwhelmingly black and Hispanic, as some critics emphasized, that profile mirrored the demographics of children with H.I.V. infection in the city at the time.

AWhen we read through an amazing volume of material, we found that Children's Services were aware that this was a very sensitive issue for a lot of important historic reasons,@ said Timothy A. Ross, the co‑director of the project at Vera.

AChildren's Services did research on the rules and regulations that applied, and developed a reasoned policy in the late 1980s,@ he added. AThe standard for enrolling kids in foster care that the child welfare agency used was higher than the federal standard.@

However, the institute also discovered problems. AThere were clearly breakdowns in the implementation of this policy,@ Dr. Ross said.

Sixty‑four children participated in 30 medication trials that were not reviewed by a special medical advisory panel, as the city's policy required. And 21 children participated in trials that the panel had reviewed but had not recommended. (In both cases, 13 of the enrollments occurred before the children were placed in foster care.)

Moreover, the informed consent forms from biological parents or guardians were missing from the child‑welfare files in 21 percent of cases, even though regulations and the city's own policies mandated that they be kept, Mr. Ross said. The state's Department of Health refused Vera's request to review medical records, which might have included some additional consents.

AWe found a disturbing lack of medical consent forms,@ he said. AIn some cases we found handwritten consents instead of the official consent forms. Mr. Ross added that such makeshift permissions violated both city policy and federal regulations.

The commissioner of the Administration for Children's Services, John B. Mattingly, said in an interview about the report: AIn very general terms, it puts to rest the most egregious charges that were being made by a few people three or four years ago. No children were yanked from their homes. That is all completely false.

Liam Scheff, the journalist in Boston who first made the alarming charges about the trials, questioned that finding.

ANow they admit that the children died, but, oh, it couldn't have been the drugs, Mr. Scheff said in an e‑mail message. AHow do they know? How do they tell the difference?

He said that the drugs in question had Food and Drug Administration warnings on them and that they had Acaused permanent injury and painful death in adults who have taken the exact same drugs at normal prescribed doses. These children died, and countless others were made sick while taking these drugs, because of a diagnosis that is itself overly harsh, overly deterministic and, he said, based on faulty H.I.V. testing technology.

Mr. Mattingly said the agency had already taken steps to ensure that policies are properly enforced in any future clinical trials involving foster children. Today, no children are involved in medication trials.

One change involved the revamping of the way the agency catalogues and maintains archived case records; an electronic system established in 2004 allows for prompt retrieval of all case files. Another new policy calls for more review by Family Court when a parent is not available to provide consent.

Copyright 2009 The New York Times Company

Caring for the Caregivers

New York Times Editorial

Wednesday, January 28, 2009

With more jobs being lost all the time across the board C more than 71,000 layoffs in the United States were announced on Monday and Tuesday alone C there should be comfort in the fact that one sector, health care, continues to add jobs. In December, employers added 32,000 health‑related positions.

Unfortunately, one of the fastest‑growing areas within the health care field C home care for the elderly C also is one of the lowest paid and most exploitable.

Outdated labor rules from 1975 allow home care aides to be defined as companions, which exempts their employers, usually private agencies, from federal standards governing overtime and minimum wages. As the population has aged, however, demand for home care has grown and the work has evolved far beyond companionship. It is not uncommon for home care workers to perform significant housekeeping chores and to help their elderly clients move, dress and eat, make sure they take their medicines and go to doctors' appointments.

In its last days in office in 2001, the Clinton administration proposed a revision to the labor rules to allow federal protections to apply to personal home care aides, but the Bush administration promptly threw that out and reasserted the status quo. A 2007 Supreme Court ruling upheld the rules, and a push that year by House and Senate Democrats to pass a bill to update the law went nowhere.

According to the Labor Department, personal and home care aides are expected to be the second fastest‑growing occupation in the United States from 2006‑2016, increasing by 51 percent, slightly behind the expected growth in systems and data communications analysts.

Most home care aides are women, low income and minority, and many of them are immigrants. Some states have taken steps to provide them with basic labor protections. Efforts to unionize home care workers in some states also has led to wage gains and better conditions. But the progress is incomplete without a federal law to recognize and protect the home care work force. It is unconscionable that workers who are entrusted with the care of some of the nation's most vulnerable citizens are themselves unprotected by basic labor standards.

It is also unwise, because poor pay for long hours leads to high turnover, which undermines the quality of care. Turnover also drives up the cost of providing home care C a needless drain on Medicaid, which pays for many home care services. And that is not the only way that poor quality home care jobs end up costing taxpayers. Nearly half of home care workers rely on food stamps or other public assistance, so taxpayers ultimately compensate for their low pay and inadequate benefits.

Of necessity, job creation and job quality will be the focus of the Obama administration in 2009, and, most likely, for many years. The Department of Labor could rewrite the rules to extend federal protections to home care workers. Or Congress and the White House could work together to pass a law granting those protections. Either way, the point is to ensure that home care, a 21st‑century growth industry, creates good jobs.

Copyright 2009 The New York Times Company

Not What the Doctor Ordered

By Steven Pearlstein

Washington Post Commentary

Wednesday, January 28, 2009; D01

Three things are indisputably true about the pharmaceutical industry:

Over the past decade, there has been significant cross‑border consolidation, involving major pharmaceutical companies and promising biotech firms.

Whatever operating efficiencies that consolidation may have generated, none of it was passed on to consumers in the form of lower prices.

During the same period, there has been a steady decline in the number of important new drugs flowing from company research labs.

All of which ought to raise serious questions about why the government's antitrust regulators should approve the latest industry mega‑merger in which No. 2 Pfizer proposes to buy No. 11 Wyeth in a deal valued at $68 billion.

The impetus for this merger couldn't have been clearer: In 2011, the patent will expire on Pfizer's blockbuster cholesterol‑lowering drug, Lipitor, which now accounts for a quarter of the company's revenue, and there is little in Pfizer's development pipeline to replace it.

Unable to stop the slide in its stock price by creating new drugs, Pfizer has concluded that the next best way to keep shareholders happy is through financial engineering. The company will borrow $22 billion at steep interest rates and pay a 29 percent premium to pick up Wyeth, which has been more successful moving from chemical compounds into biotech products and has a few high‑potential products in development.

As they always do, the companies argue that the deal should sail through antitrust review. Using traditional antitrust analysis, that's exactly what would happen. The two companies have few, if any, overlapping products and the combination is expected to generate $4 billion in savings over the next three years. Even after the merger, there will be at least 10 large global players in the industry.

But pharmaceuticals is an industry that doesn't lend itself to traditional market analysis. Because the bulk of profits in the industry come from temporary monopolies ‑‑ government‑

granted patents ‑‑ the current marketplace is not where the important competition takes place. Rather, the real rivalry takes place "upstream," as companies compete to innovate, either by developing medicines in their labs or by buying up promising patents and biotech start‑ups. And in that "market for innovation," it is hard to see how further consolidation would be good for consumers.

It is important to remember that, like many industries, the pharmaceutical industry divides itself into sub‑markets ‑‑ cancer drugs, heart drugs, painkillers, vaccines ‑‑ and that because not all companies compete in all markets, there are only a few players in each. Eliminating one of the global players, therefore, risks reducing to a handful the number of players in each sub‑market.

It is also important to remember that this is an industry that deserves to be treated with deep suspicion by antitrust regulators because of its congenital distaste for competition.

It is an industry that spends lavishly on lawyers and lobbyists to protect and extend its patents and throw up endless challenges to approvals of competitive drugs.

It is an industry in which companies rarely compete on the basis of price, both because its patents give it near‑monopoly pricing power and because the people who decide which drug to use (doctors) are not the ones who pay the bills (insurers and consumers).

It is an industry in which companies facing expiration of lucrative patents routinely pay millions of dollars to potential rivals to delay the introduction of lower‑priced generic drugs under the guise of "joint ventures"‑‑ payments that the Federal Trade Commission has described as kickbacks designed to lessen competition.

And it is an industry that, when all else fails, would always rather buy a rival than compete against it.

Consider Ovation Pharmaceuticals of Deerfield, Ill. Back in August 2005, Ovation bought from Merck a drug called Indocin IV, which at the time was the only approved product to treat a life‑threatening heart condition in prematurely born infants. Unfortunately for Ovation, Abbott Laboratories was in the process of winning approval from the Food and Drug Administration of a product that would compete with Indocin. So in January 2006, Ovation purchased the rights for the second drug, NeoProfen. According to a complaint filed in December by the FTC, Ovation then raised the price of Indocin by nearly 1,300 percent, from $36 per vial to nearly $500. When NeoProfen eventually hit the market, it was priced at roughly the same level.

(For the record, Ovation says it has done nothing wrong and that it priced its drugs appropriately.)

Ovation is not some rogue drug company. Its slimy behavior reflects the way the industry thinks, the way it behaves and the way it prefers to "compete." Which is why it is crucial for the government to bring closer scrutiny to industry mega‑mergers.

There is nothing in the various pronouncements this week by Pfizer executives, or in the projections of industry analysts, to credibly suggest that the combined company will suddenly become more innovative, or that it will resist the temptation to cut back on the $10 billion now spent on research and development. Nor is there anything in the company statements, or the history of recent drug company mergers, to suggest the $4 billion in operating savings will translate into lower drug prices.

Indeed, even shareholders should be worried. Pfizer's overpriced purchases of Warner Lambert in 2000 and Pharmacia in 2003 have done little to boost either its stock price or its pace of innovation. And a recent study of industry mergers by Harvard Business School professor Gary Pisano suggests that most drug industry mega‑mergers have destroyed shareholder value, not enhanced it.

What we do know, however, is that because of the herd‑like behavior of corporate titans and industry analysts, and the prodding of Wall Street's fee‑grubbing investment bankers, the Pfizer‑Wyeth deal will almost surely be followed by other mega‑mergers. And we know that, in an industry with high barriers to new entrants, each of these mergers will result in one fewer company competing, or potentially competing, to develop new drugs.

The Pfizer‑Wyeth deal offers a wonderful opportunity for a new administration in Washington to signal the end of the era of anything‑goes mergers, and to apply the antitrust laws in creative new ways to innovative high‑tech industries that are the key to America's economic future.

8 2009 The Washington Post Company

In Dangerous Locales, HIV Discrimination Isn't an Open‑and‑Shut Case

By Joe Davidson

Washington Post Commentary

Wednesday, January 28, 2009; D01

Should an employer be required to hire an applicant who has HIV for work that could become bloody in a place where there is poor medical care?

Suppose the job is protecting diplomats in dangerous places. The employee would carry a gun, probably a big one, and would be trained to expect attacks. The result of an assault, of course, could be a bloody mess.

The answer is not an easy one, which is why the U.S. District Court for the District of Columbia has been asked to sort it out.

The case involves a 46‑year‑old former Green Beret, who received numerous decorations during his 20 years in the service. Shortly before the Obama administration took office, he sued the State Department and a private security firm, Triple Canopy, because he was pushed out of its training program. He was told the company's government contract requires that employees have no contagious illness.

Court documents refer to the plaintiff as John Doe. Journalists don't like to use pseudonyms, but exceptions are sometimes made. In this case Doe, who did tell me his real name, says he fears further discrimination. "I have a family and I want to protect my kids," he said in a telephone interview.

In November 2005, Doe was at the end of his training with Herndon‑based Triple Canopy when a supervisor pulled him from a session to say Doe would not be sent to protect diplomats in Haiti as planned.

According to Doe's court brief, the supervisor cited paragraph C5 of the company's contract with State, which says, "all contractor employees working under this contract should . . . be free from communicable disease." Doe was told that provision is mandatory and includes HIV.

Now, instead of the $545 a day he would have made with Triple Canopy, he says he gets $12 an hour doing construction work.

Through his attorneys with the American Civil Liberties Union Foundation and the firm of Paul, Weiss, Rifkind, Wharton & Garrison in New York, Doe argues that the federal Rehabilitation Act and the Americans with Disabilities Act prohibits discrimination based on disabilities, including HIV.

"Despite these mandated protections, the State Department required certain of its contractors to terminate, or deem ineligible for employment, all individuals with HIV regardless of their ability to perform the essential functions of the job," Doe's brief states.

He doesn't have any symptoms. And after Special Forces service and having already done similar work in Iraq, he has no doubt that he can do the job.

"There is not too many Americans that are as qualified as I am doing this kind of work" he told me. "I am a professional at what I do, and I've never had any problems doing my job."

While in the Army, he worked as a Special Forces engineer, intelligence officer and a team sergeant in far‑flung places like Haiti, Kenya, Kuwait and Pakistan.

He tested positive while in the Army but continued to serve until his normal retirement date.

After retiring from the Army in September 2001, Doe wanted to continue doing "basically what I've done my whole life."

He was a Defense Department security contractor with two companies in Iraq, doing essentially the same type of work he planned to do for Triple Canopy in Haiti.

His HIV status was known to his employers while in Iraq, and that "did not impede his two years of employment for these contractors in any way," his brief says. But when he went to work for Triple Canopy, it terminated him "because the State Department barred Triple Canopy from hiring anyone with HIV" for work under its World Personal Protective Services Contract.

The State Department denies that assertion without elaboration in its brief. While the government's document is short on information, Triple Canopy's brief does provide a rationale for giving Doe the boot.

With the hazardous conditions, the danger of bloodshed "and the consequent threat to the safety and health of other individuals, the deployment of John Doe . . . would pose a direct threat to other individuals (as well as to himself)," Triple Canopy argues.

If Doe were wounded, "his colleagues would face the choice of either refusing to render aid to him or doing so without the ability to comply" with proper procedures for treating those with HIV, meaning they wouldn't have protective clothing such as masks or rubber gloves.

Triple Canopy acknowledges that "it is well‑established that HIV‑positive status does not present a direct threat to the safety and health of others in a normal working environment."

But it also says federal law promoting employment for those with disabilities "is not intended to do so at the risk of their own health or safety or that of others."

Banning discrimination against those living with HIV in a normal workplace is a no‑brainer. But it's a more difficult question if the workplace could become soaked with the employees' own blood.

8 2009 The Washington Post Company

Weasels vs. AIDS Relief

By Michael Gerson

Washington Post Commentary

Wednesday, January 28, 2009; A15

Some of the personnel stumbles of the Obama administration ‑‑ including the abortive nomination of Bill Richardson as commerce secretary ‑‑ resulted from incompetent vetting. William Lynn's reception as deputy secretary of defense has been complicated by hypocrisy ‑‑ the administration's attempt to gain political credit for a restrictive lobbying ban it swiftly violated to get a qualified appointee.

But one major personnel error was made from malice. And it calls into question the depth and duration of President Obama's "new politics."

During Obama's transition, Dr. Mark Dybul was initially asked to stay on as the coordinator of the President's Emergency Plan for AIDS Relief (PEPFAR) for several months until a replacement could be found and confirmed. Because Dybul was the main architect of the program and one of its guiding visionaries, few were surprised by the offer. With Ambassador Randall Tobias, Dybul organized the most staggeringly successful foreign assistance effort since the Marshall Plan ‑‑ eventually helping support lifesaving AIDS therapy for more than 2 million people.

While I worked at the White House ‑‑ from 2001 to 2006 ‑‑ I saw Dybul combine the ability to build bipartisan consensus for PEPFAR on Capitol Hill with exceptional compassion for the victims of a cruel and wasting sickness. It mattered little to the Bush administration that Dybul was openly gay or that he had contributed to Democratic candidates in the past. He was recognized as a great humanitarian physician ‑‑ a man of faith and conscience ‑‑ almost universally respected among legislators, AIDS activists, foreign leaders and health experts. Almost.

A few radical "reproductive rights" groups ‑‑ the fringe of a fringe ‑‑ accused Dybul of advocating "abstinence only" programs in AIDS prevention. It was always a lie. Dybul consistently supported comprehensive prevention efforts that include abstinence, faithfulness and condom use ‑‑ the approach that African governments themselves developed. In fact, Dybul was sometimes attacked from the right for defending a broad definition of AIDS prevention, including programs to address prostitution and transgenerational sex. Over the years, PEPFAR distributed 2.2 billion condoms ‑‑ hardly an "abstinence only" approach.

By encouraging Dybul to stay until his successor was in place, the Obama administration displayed a generous spirit, as well as a practical concern for continuity in a vital program.

Then, the day after the inauguration, Dybul received a call asking him to submit his resignation and to leave by the end of the day. There was no chance to reassure demoralized staffers, or PEPFAR teams abroad, or the confused health ministers of other nations. The only people who seemed pleased were a few blogging extremists, one declaring, "Dybul Out: Thank you, Hillary!!!"

As in most political hit‑and‑run attacks, the perpetrator was not anxious to take credit. It seems unlikely to be Hillary Clinton herself ‑‑ Dybul's ultimate boss at the State Department ‑‑ who had not even been confirmed when Dybul received his call. But someone at State or the White House determined that sacrificing Dybul would appease a few vocal, liberal interest groups. One high‑ranking Obama official admitted that the decision was "political." Yet the AIDS coordinator is not a typical political job, distributed as spoils, like some deputy assistant position at the Commerce Department. It involves directing a massive emergency operation to provide lifesaving drugs, through complex logistics, to some of the most distant places on Earth. And now that operation may be months without effective leadership ‑‑ undermining morale, complicating interagency cooperation, delaying new prevention initiatives and postponing budget decisions.

It is difficult to imagine what vision of public service could cause any Obama official to celebrate a victory by sabotaging a good man and a good cause. And it is difficult to conceive what political gain Obama has achieved. This type of captivity to extreme interests is precisely what has discredited Democrats so often in the past. It is a kind of politics with all the "newness" of a purge, all the "freshness" of a mugging.

Governing, admittedly, is not badminton. But it costs little to be graceful. And pettiness, in this case, may impose a cost on the world's most vulnerable people.

"We, who seven years ago," wrote William Butler Yeats, "Talked of honour and of truth,/Shriek with pleasure if we show/The weasel's twist, the weasel's tooth." For some in the Obama administration, the baring of the weasel's tooth took merely a day.

But none of this should bother Mark Dybul, who sleeps well in the knowledge that he helped save millions of lives ‑‑ an experience his critics will never share.

8 2009 The Washington Post Company