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			Friday, July 3, 2009 News Clipping Archives *Maryland / Regional* When to prescribe Tamiflu? (Baltimore Sun) Hospitals join University (The Aegis) Keep your cool to stay healthy at the beach (Baltimore Sun) Mercy Medical says new barcoding system will prevent mix-ups (Daily Record) *National / International* Study charts swine flu's spread through air travel (Baltimore Sun) Medicare Plans to Cut Specialists' Payments (Wall Street Journal) China Tries to Head Off Rural Flu Outbreak (Wall Street Journal) Warning over fake Tamiflu sales (BBC NEWS) *Opinion* Our Say: This time, county shouldn't be kept in dark on fly ash (Annapolis Capital Editorial) Drug safety (Cumberland Times-News Editorial) The myth of 'safe drugs' from abroad (Baltimore Sun Commentary) Union service fees and a drop in drug overdoses (Baltimore Sun Commentary) Death in the back seat: accident or a crime? (Baltimore Sun Letter to the Editor) *Maryland / Regional* When to prescribe Tamiflu? By Kelly Brewington Baltimore Sun Friday, July 3, 2009 Stephanie’s post below about making a vaccine for swine flu got me thinking about how the medical community is trying to treat this virus in the meantime. This week, Danish health officials reported the first case of Tamiflu-resistant swine flu. The World Health Organization called it an isolated incident and Roche, the company that makes the drug, said the medicine is still effective in treating the virus, known as H1N1. Still, the case begs an interesting question of state health officials and doctors everywhere: when is the right time to give someone Tamiflu? So far, Tamiflu is the most prescribed antiviral to help fight the symptoms of the virus. Medical experts agree prescribing Tamiflu to someone who tests positive for the H1N1 virus is a no brainer. It’s the best treatment out there. But whether to use the drug in an effort to prevent the virus is tricky. Giving Tamiflu as prevention doesn’t guarantee you won’t get the disease and it could make it more likely that the virus adapts and becomes resistant to drugs, said Dr. Clifford Mitchell, director of environmental health coordination for the Maryland health department. “When you give out a medicine, you run the risk that if you don’t kill every bug, the bugs that are able to survive are those that are able to resist that particular medication,” he said. “You don’t want to give this to everyone in the population.” Two weeks ago, when three teens were diagnosed with H1N1 at the Baltimore City Juvenile Justice Center, officials at the facility made prescriptions for antiviral medications available to any staff member who wanted one and even offered to pick up the tab. But typically, Tamiflu is recommended only for medical professionals who have had close unprotected contact with someone with the virus, and for people who have been exposed to the virus and are at risk for complications if they acquire it, such as pregnant women, the elderly and people with compromised immune systems. (See these guidelines from the Centers for Disease Control.) No cases of drug-resistant swine flu have been found in the U.S., but state health officials are paying close attention for possible drug-resistant samples when they do testing. Drug resistance has been found in other types of flu. The most common strain of flu that circulated over the winter was almost completely resistant to Tamiflu. Copyright 2009 Baltimore Sun. Hospitals join University Upper Chesapeake Medical, Harford Memorial to become part of Harford-based operation By Rachel Konopacki The Aegis Friday, July 3, 2009 The nonprofit company that owns Harford County’s two hospitals has agreed to be acquired by the larger University of Maryland Medical System. If the deal goes through as planned, local control of Harford County’s principal health care delivery system will end sometime in 2013, 101 years after the county’s first hospital opened its doors in Havre de Grace in 1912. A strategic affiliation between Bel Air-based Upper Chesapeake Health, or UCH, and University of Maryland Medical System, or UMMS, was announced by their boards of directors Tuesday. “This agreement expands on the current partnership that Upper Chesapeake Health has with UMMS and will most likely lead to a full merger infusing millions of health care related dollars into UCH and our service areas of Harford and western Cecil County,” according to an e-mail distributed Tuesday to elected officials and community leaders by Upper Chesapeake Health officials. While their initial affiliation is not expected to have a visible change on health care services in Harford County, officials at both nonprofit organizations said the arrangement will bring Upper Chesapeake Health greater access to capital for future expansion, including expanding clinical programs and services and developing ambulatory services, as well as access to a larger pool of primary care physicians and specialists, at a time when the state and region are facing a doctor shortage that may reach a crisis level. “This is very exciting; it’s a great opportunity for both of us,” Robert Chrencik, UMMS’s president and CEO, said Tuesday. “Upper Chesapeake is a very valuable addition to our system. It will be a very, very important part going forward.” Upper Chesapeake owns Upper Chesapeake Medical Center in Bel Air and Harford Memorial Hospital in Havre de Grace and is Harford County’s largest private employer. UMMS owns and operates nine hospitals around the state including its flagship University of Maryland Hospital in Baltimore, which is also home to the renowned Maryland Shock Trauma Center. University Hospital is also the teaching hospital for the University of Maryland’s medical and nursing schools. According to Upper Chesapeake, about six out of every 10 residents of Harford County and western Cecil County use its clinical and hospital services. The two organizations plan a full merger by 2013 through a three stage process over the next four years. At the end of those four years, the merger will be complete and UMMS will be in control of Harford County’s two hospitals. Upper Chesapeake Health’s board met June 23 and unanimously agreed to the merger. “We have had unanimity at every turn,” Roger Schneider, chairman of the Upper Chesapeake Health Board, said. Schneider and Upper Chesapeake President and CEO Lyle Sheldon met Tuesday with members of The Aegis Editorial Board and explained what led up to the affiliation and what Upper Chesapeake’s customers, employees and the community can expect in the future. Eighteen months ago, before the downturn in the economy, the board of UCH asked if it would be able to achieve everything it needed to do in all areas by itself — the answer to the question is what led to the discussion of the merger. “Realistically, we can’t do it on our own. We need a partner with a strategic vision,” Schneider said, adding that UMMS was selected for the merger because of its past success, excellent bond rating and access to capital. The primary advantage of the affiliation for Harford County residents will be they will not have to leave the county for the majority of their health care needs, as more clinical services will become available locally. Chrencik said UMMS favors a “decentralized” administrative structure, and Upper Chesapeake will continue to operate under its existing management, which is one of the reasons it agreed to the merger. “No one outside of this community will understand and protect better than the [UCH] board,” Schneider said, referring to the merger as a “cooperative type approach as opposed to command and control.” Three-step transaction Over the next three months, as part of the first phase of the transaction, Upper Chesapeake Health will end its financial agreement with St. Joseph Medical Center, which has held a minority ownership since 1998. UMMS will provide Upper Chesapeake Health with the capital to buy out St. Joseph, allowing UMMS to hold 20 percent minority ownership. Stage two of the planned Upper Chesapeake-UMMS merger, which will begin Oct. 1, calls for UMMS to provide Upper Chesapeake Health with financial resources to support clinical program growth and services. UMMS will provide up to 49 percent in capital infusion and will remain in the minority position in the merger until 2013. October will also mark the beginning of clarifying the business and facility plan for Upper Chesapeake Health, which will include discussion of whether upgrading and enhancing Harford Memorial Hospital, the emergency room in particular, is more cost effective than building a completely new facility. “The plan will clarify where it will make the most sense to put more money,” Sheldon said, adding the plan will take up to a year to complete. Upper Chesapeake Health’s change in ownership will be completed with stage three in 2013. Stage three will also solidify plans for a new Upper Chesapeake bed tower and Harford Memorial replacement or renovation. When the merger is complete, UMMS will have two directors on the 17-member board, replacing two St. Joseph directors. Chrencik said Upper Chesapeake will have one seat on the UMMS board. The two Upper Chesapeake hospitals have admitted nearly 8,500 patients from January to April in 2009. The company has had nearly 53,000 outpatient visits in 2009 so far, a 10.7 percent increase from the same four months in 2008, and about 87,000 emergency room visits. In 2008, Upper Chesapeake Health had gross revenues of $269.3 million, more than 280 hospital beds and more than 2,700 employees. According to its main web site, the UMMS system has 14,800 employees, more than 1,700 licensed hospital beds, handles 83,000 patient admissions annually and generates $2 billion in gross patient revenue. “This will be a great partnership for their organization, one that is beneficial for residents, for UMMS, for all of us,” Chrencik said. “Our hope is to use the assets of each other for a very successful plan, one that’s a win-win for everyone.” Aegis staff member Allan Vought contributed to this article. Copyright 2009 The Aegis. Keep your cool to stay healthy at the beach Take steps to avoid heat-related illness as you indulge in some fun in the sun Best of the Beach: A weekly series about good living by the shore By Kelly Brewington Baltimore Sun Friday, July 3, 2009 The water's lapping at your freshly manicured toes. The sun's shining down on your back and your Blackberry is most definitely turned off. It's a glorious beach moment. But sun seekers beware: A dazzling day at the shore can be the perfect summer escape, but don't let the relaxation put you off your guard. When it comes to sun, there can be too much of a good thing. Heat exhaustion and sunburn are not just minor annoyances; they can be harmful. Heat-related illness, ranging from cramps to life-threatening heatstroke, happens when the body struggles to cool itself. Heat cramps are muscle spasms, usually in the legs, arms and abdomen. With heat exhaustion, a loss of water and essential salts takes its toll on the body, resulting in dizziness, weakness, mild headache and vomiting. Heatstroke is the most severe illness and is accompanied by a higher body temperature and confusion. While the elderly, children and those with chronic illnesses are most at risk, young healthy people wind up in the emergency room with heatstroke just like everyone else, said Dr. Jeff Sternlicht, chairman of emergency medicine at Greater Baltimore Medical Center. "We'll see a young to middle-aged person who has a job where they tend to be outside somewhere in the heat," he said. "These are people who feel 'It's no big deal I can do it. I'm healthy, I'm young.'" People seem to have the most trouble with heat-related illness in early summer, usually those first couple of weeks of hot weather, Sternlicht said. "After a few weeks in the heat, the body physiologically controls itself to be in the heat." Sunburn, meanwhile, remains a threat no matter how warm, and even on cloudy days. In addition to using plenty of sunscreen, people should limit the amount of time they spend in the sun, especially during peak hours from 10 a.m. to 4 p.m., said Dr. Susan Kesmodel, a surgical oncologist at the University of Maryland Medical Center. Sun exposure injures the skin and enough injury over time can cause a mutation in cells that cause cancer, she said. "I know we're not going to make hermits out of everybody, but there are lots of people who think they if apply sunscreen they can stay out in the sun forever," she said. "But people are probably not using enough of it and are sitting out during peak sun hours." Even those with darker complexions should use sunscreen. While people with dark skin tones are better able to absorb the light, that doesn't mean they can't get melanomas or skin cancer - they just get them less frequently than people with lighter skin, Kesmodel said. Tips for avoiding heatstroke • Stay hydrated. Purists insist ice water is best. But sports drinks are just as good at replenishing fluids and have the added bonus of helping restore electrolytes - such as sodium and potassium, says Sternlicht. Skip the sugary sodas. Alcohol, which causes more fluid loss, speeds up dehydration and impairs judgment, is out. • Watch out for heat cramps. Tossing a Frisbee or a volleyball might seem low-exertion, especially for the young, but on days when the temperature soars and the air is thick with humidity, even a little exercise can slow you down. • Take it easy. Pace yourself and take a break from the heat. Go indoors and enjoy the comfort of your air-conditioned hotel room. And when you're out, try to stay under an umbrella, especially on the most sweltering of days. Tips for protecting the skin • Apply enough sunscreen. Use a sunscreen with SPF 15 or higher and slather it on. Most experts recommend an ounce to cover the body - about a palmful. Apply about every two hours, or more if you're swimming or sweating. Put some on your lips too, with a lip balm that has SPF built into it. • Seek shade. Wear a hat - one big enough to protect your neck, ears and nose. Don't forget your eyes; sun can damage more than your skin. Wear a pair of good wraparound sunglasses. Coolness factor aside, they'll block out damaging UV radiation. Copyright © 2009, The Baltimore Sun. Mercy Medical says new barcoding system will prevent mix-ups By Danielle Ulman Daily Record Friday, July 3, 2009 Mercy Medical Center has added breast milk to its bar-coding system to avoid milk swaps in vulnerable premature infants, which can result in transmitting disease. Babies that remain in the neonatal intensive care unit, or NICU, cannot breast feed, so their mothers often pump their breast milk at home and bring the containers to the hospital. Under the old system the labels on the bottles often fell off in the freezers or in warm water, causing the hospital to discard that milk. The recent addition of the bar-coding system means that the mother’s information is affixed to the containers with cryogenic labels that can withstand exposure to different temperatures. Ink also does not run on the labels so the information remains readable, and the bar codes reduce risk of milk switches that can cause disease transmission. “There’s a risk of passing on viruses or diseases if the mother is positive, so that’s why we put in the safety measures to avoid wrong administration of breast milk,” said Ann Johnson, a staff nurse at Mercy and the lead person on the NICU bar-coding program. The Baltimore hospital began administering medications with the help of a bar-coding system about three years ago in an effort to avoid human error. The new technology made it easier for its nurses to verify the “five rights of medication management” — right medication, right dose, right route, right patient, right time. Mercy tested the breast milk bar-coding program earlier this year with the same vendor that provides its medication verification system. In exchange for running a trial program, the hospital got the software for free when it fully implemented the breast milk program in April. While a medication mix-up for patients could have disastrous consequences, breast milk is a bodily fluid, so hospitals have to take the same precautions with it as they would with blood. A baby that received milk from a person other than his or her mother could contract diseases, such as HIV, hepatitis B, hepatitis C or cytomegalovirus, a family of herpes viruses, which can cause mental delays or learning disabilities. Under the new bar-coding system, the baby receives an anklet with a bar code and the mother takes home labels that include her information, the baby’s information and the bar code. The mother writes down the date and time the milk was pumped and drops off the milk at the hospital. The system is computerized, so there is an electronic record of the dates and times that the baby has been given breast milk. If the bar code on the baby’s bracelet does not match the bar code on the breast milk container, the system will alert the nurse that there is an error. Mercy did not have internal statistics for breast milk mismanagement. According to the American Journal of Nursing, Pennsylvania’s confidential reporting system that hospitals are required to report to found 20 cases of babies receiving the wrong breast milk from 2004 through 2007. Mary Covacevich, a nurse analyst in Mercy’s IT department, said cases are often not reported. “You just wouldn’t know because there was no untoward effect on the baby,” she said. Mercy’s bar-coding system has a reporting component that will record near-misses, but Covacevich said no numbers are available yet. The hospital has not had any mix-ups since it implemented the system. Mercy officials said they believe they are the first hospital in the region to use bar coding for both medication and breast milk. A spokeswoman for the Johns Hopkins Children’s Center said the NICU there has experimented with some bar-coding software for breast milk, but has not found a system that has the right features for the hospital. For example, one system would not allow triplets to have the same bar code, making it difficult to match the babies with their mothers’ milk. Copyright 2009 Daily Record. *National / International* Study charts swine flu's spread through air travel Associated Press By Mike Stobbe Baltimore Sun Thursday, July 2, 2009 ATLANTA - In a startling measure of just how widely a new disease can spread, researchers accurately plotted swine flu's course around the world by tracking air travel from Mexico. The research was based on an analysis of flight data from March and April last year, which showed more than 2 million people flew from Mexico to more than 1,000 cities worldwide. Researchers said patterns of departures from Mexico in those months varies little from year to year; swine flu began its spread in March and April this year. Passengers traveled to 164 countries, but four out of five of those went to the United States. That fits with the path of the epidemic a year later. The findings were reported Monday in the New England Journal of Medicine. The research shows promise in forecasting how a new contagion might unfold, indicated one government health official who praised the work. "We share a common interest in this issue: If we map the global airline distribution network, can we anticipate, once a virus emerges, where it is likely to show up next?" asked Dr. Martin Cetron of the U.S. Centers for Disease Control and Prevention. He leads CDC's division of global migration and quarantine. The new swine flu virus was first reported in the United States in mid-April, but the first large outbreak was in Mexico at about the same time. Health officials believe cases of the new virus were circulating in Mexico in March. Scientists have long assumed a relationship between air travel and spread of the virus. But the new research for the first time confirmed the relationship, said Dr. Kamran Khan, who led the study. He is a researcher at St. Michael's Hospital in Toronto. For years, Khan and his colleagues have been working on a system to use air travel information quickly to determine how a new contagion is likely to spread around the world. Their data sources include the International Air Transport Association, an international trade association representing 230 airlines and the vast majority of scheduled international air traffic. The study showed the majority of passengers flew to the United States, with Canada a distant second and France a more distant third. More than 90 percent of the time, Khan and his colleagues accurately matched air traffic volumes to which countries did and did not suffer swine flu outbreaks as a result of air traffic. The top 11 destination cities from Mexico were all in the United States. Los Angeles was the leader, receiving about 9 percent of all passengers from Mexico, and New York City was second, with about 5 percent. In contrast, the only South American entry in the top 40 destination cities was Buenos Aires, at No. 22. Passengers were even fewer when it came to cities in neighboring Guatemala and other Central American countries. The data show not only how disease spreads out of Mexico, but also that air travel is mainly among more industrialized countries, experts said. A second study released by the journal found a sharp rise in pneumonia cases in non-elderly Mexicans from late March to late April. Normally, only about a third of severe pneumonia cases in Mexico are in people ages 5 to 59. But during the recent swine flu outbreak, more than 70 percent were in that younger age group. The study seems to support plans to target swine flu prevention efforts to the young, experts said. __ On the Net: New England Journal: http://www.nejm.org Copyright 2009 Associated Press. All rights reserved. Medicare Plans to Cut Specialists' Payments By Jane Zhang Wall Street Journal Thursday, July 2, 2009 WASHINGTON -- The Obama administration said Wednesday that it plans to cut Medicare payments for imaging services and specialists, and will use the savings to increase payments to physicians providing primary care. Under the proposal, Medicare would put specialists' payments for evaluating and managing illnesses on par with those of primary-care physicians starting in January. That, combined with other changes, would boost payments to internists, family physicians, general practitioners and geriatric specialists by 6% to 8% next year, said the Centers for Medicare and Medicaid Services, the agency that manages Medicare, the federal insurance program for the elderly and disabled. Payments to cardiologists would be trimmed by 11% overall, but certain procedures they perform would see steeper reductions. Alfred Bove, president of the American College of Cardiology, figured that cardiologists would receive 42% less for an echocardiogram and 24% less for a cardiac catheterization. Radiologists would see an estimated cut of 20% for imaging services using expensive equipment such as MRI and CT scans, said Bibb Allen, chairman of the commission on economics at the American College of Radiology. That would be in addition to the cuts imposed on radiologists under a 2005 law, he said. The proposal, open for public comment until Aug. 31 and expected to be completed by Nov. 1, comes as the Obama administration seeks to boost the number of primary-care doctors to meet the needs of an aging population and care for the newly insured if legislation to overhaul the nation's health-care system is enacted. The administration is already spending $500 million in stimulus funds to train more primary-care physicians and repay the student loans of primary-care doctors who work in underserved areas. Legislation being debated in the House and the Senate also includes provisions intended to increase the number of primary-care physicians. Ted Epperly, president of the American Academy of Family Physicians, said the Medicare proposal would help reduce the income gap among doctors -- specialists make two to five times as much as primary-care physicians -- and attract more medical students to primary care. He called the change "long overdue." Groups representing cardiologists, radiologists and other specialists said they will lobby lawmakers to stop the cuts. Dr. Bove warned that "cutting back like this certainly threatens the successes we have had over the years with reducing heart disease." Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved. China Tries to Head Off Rural Flu Outbreak By Jeremy Chan Wall Street Journal Friday, July 3, 2009 BEIJING -- Faced with a rising number of homegrown new H1N1 flu cases, China is focusing prevention measures in urban areas to head off outbreaks in its vast rural population. Health Ministry officials said they are now paying particular attention to second-generation infections and severe cases of new H1N1 flu. Meanwhile, they have been continuing efforts to temporarily shut schools that have reported cases, as well as urging "social distancing" -- getting people with possible exposure to the flu to keep away from crowded public places or to stay at home if they feel ill. Elsewhere, cases of new H1N1, also known as swine flu, are continuing to rise around the globe. The U.K. government said Thursday their country could have more than 100,000 swine flu infections daily by the end of August, and that it now plans to focus on treating those with the illness rather than trying to contain it. U.K. Health Secretary Andy Burnham said the 100,000 figure was only a projection based on current trends. But the prediction and current rapid rise in number of cases in the U.K. illustrate how quickly and widely the new flu virus is spreading around the world. Government figures showed that the number of confirmed new H1N1 cases in the U.K. has more than tripled in the past week to 7,447. Although the majority of cases haven't been severe, the U.K. now accounts for at least three in every four of the confirmed cases in Europe. More than 100 countries have reported cases, and the flu is spreading particularly rapidly in the Southern hemisphere, where winter and regular flu season have set in. Large case counts have been reported in Argentina, Chile, and Australia. "As we see today, with well over 100 countries reporting cases, once a fully fit pandemic virus emerges, its further international spread is unstoppable," World Health Organization Director-General Margaret Chan said Thursday during opening remarks at for a two-day summit in Mexico to design strategies for battling the pandemic. In the U.S., the number of confirmed and probable H1N1 swine flu cases has climbed to nearly 34,000, and deaths have risen 34% in the past week to 170, according to the Centers for Disease Control and Prevention. But federal health officials believe more than one million people may have been sick with the disease, and even more may have been infected but not gotten sick. Separately, a study by researchers from the CDC and the Harvard-MIT Division of Health Sciences and Technology published in the journal Science found that the new virus lacks some genetic material that makes it as easily transmissible as some seasonal flu strains, a finding that helps explain why it is spreading mostly between people with close contact with one another. The researchers also found that the virus can thrive in the small intestine, possibly explaining why people have had more vomiting and diarrhea than is normal with seasonal flu. In Argentina, the government reported late Wednesday that the death toll from swine flu nearly doubled to at least 43 from 26. New Health Minister Juan Manzur said, "The swine flu situation is serious, difficult. We are tracking a curve that is still ascending." In Japan, the health ministry confirmed the country's first case of a genetic mutation of the new H1N1 influenza that shows resistance to Tamiflu, the main antiviral flu drug. The first case of H1N1 that didn't respond to Tamiflu was a patient in Denmark. In China, most H1N1 swine flu cases so far have been imported, and over the past several months hundreds of international travelers have been quarantined after arriving on flights with passengers found to be infected with the virus. But a recent spike in local transmissions has worried Chinese health officials. Beijing reported its first H1N1 swine outbreak Tuesday, shutting down a primary school in the eastern district of the city. Health authorities quarantined seven students who were reportedly infected, along with another 154 people-93 students, 20 teachers and 41 family members. In southern Guangdong province, which borders Hong Kong, a series of swine flu outbreaks last week closed several primary schools. China had a total of 866 confirmed cases of new H1N1 through the end of June, according to Health Ministry statistics. Most of those cases have been clustered in urban areas and along the coastline, with 240 cases confirmed in Guangdong and another 155 cases in Beijing. Although the flu so far hasn't proven as lethal in China as in Mexico or the U.S., a health-ministry official said on Monday it was only a matter of time before China recorded its first swine flu-related death. On Wednesday, a 34-year-old woman being treated for the new H1N1 flu was found dead in the bathroom of her hospital ward in Hangzhou, the capital of coastal Zhejiang Province. She had been admitted to the No.1 People's Hospital on June 23, but had shown no fever in the week leading up to her death and was reportedly recovering from the virus, according to an official at the Hangzhou Health Bureau. The reason for her death is still under investigation. Angry relatives of the patient stormed the hospital Thursday night, alleging that electric shock caused her death, the official Xinhua news agency reported. More than 20 relatives hurled rocks at an ambulance and smashed a hall near the hospital gates, the agency said. With fresh memories of its failed coverup of the SARS outbreak in 2002, China this time has been notably more open and aggressive in its response to the new H1N1. Some critics say the government's attempts to quarantine all arriving passengers suspected of carrying swine flu-and those seated around them on aircraft-have been overzealous. China has maintained its policy of quarantine at major ports, but with local outbreaks increasing, health experts say the country likely will be forced to reconsider its prevention strategy. The numbers of those infected in Guangdong have grown so large that the health ministry on Tuesday advised those suffering from "light symptoms" in the province to seek care at home rather than at hospitals. "Quarantine is most effective when there are sporadic cases," said Vivian Tam, an official for the World Health Organization in China. "But as numbers increase, it could become very resource-intensive and hard to sustain." China has increased its focus on preventing large-scale outbreaks. "If a large-scale outbreak occurs in a short amount of time, we will have a great amount of pressure on material resources as well as prevention and control," said Mao Qun'an, a spokesman for the Ministry of Health. Great discrepancies exist in China's health-care coverage between more-developed urban areas and the poorer countryside. That disparity, combined with a floating population of 150 million to 200 million migrant workers, who often have little or no access to medical care, mean health authorities worry that the new H1N1 virus could spread much farther and faster. China is already home to the much more lethal H5N1 avian flu virus, and health officials are worried that the H1N1 swine virus could mutate or recombine with other viruses if it spreads to the Chinese countryside. Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved. Warning over fake Tamiflu sales BBC NEWS Friday, July 3, 2009 People should not buy anti-flu drug Tamiflu over the internet without a prescription, experts have warned. The government's chief medical officer said Britain had a "massive" stockpile of genuine Tamiflu. The drug, used in suspected cases of swine flu, has now overtaken Viagra as the subject of the most junk e-mails, the Royal Pharmaceutical Society says. But the supplies offered are often fake, with buyers getting sugar or rat poison instead of the drug. Sir Liam Donaldson said in an interview with BBC Breakfast: "The whole field of counterfeit drugs is becoming a much bigger problem, not just with Tamiflu. "So my advice is don't buy it , you don't need to. We have got the biggest stockpile in the world and even worse than that you might end up with something that is poisonous and dangerous." He said the NHS was well prepared to treat the increasing number of swine flu cases that would come with the winter. "As we move towards the flu season we will see many more cases. That's what we expected. People should not be concerned." He said: "The NHS will be stretched, it will be under pressure. But we have good plans in place both locally and nationally to deal with this." Sir Liam confirmed a swine flu vaccine would be available towards the end of August and he said there would be enough for half of the population through the winter, up to Christmas. The Royal Pharmaceutical Society's research suggests more than two million people regularly buy medicine over the internet. However, much of that trade is legal. A spokesman, David Pruce, said: "We now think that Tamiflu is the most spammed medicine on the internet. It's taken over from Viagra. Most of that Tamiflu could well be fake. If it's fake it could range from simple sugar to rat poison." Meanwhile, the government says the rising numbers of swine flu cases mean trying to contain the virus is no longer an option. Ministers said the emergency response would now move to a new "treatment" phase across the UK as there may soon be 100,000 new cases a day. Consequently, anti-flu drugs will no longer be given to the close contacts of those infected nor will lab testing be done to confirm cases. Story from BBC NEWS: http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/8131911.stm © BBC MMIX. *Opinion* Our Say: This time, county shouldn't be kept in dark on fly ash Annapolis Capital Editorial Thursday, July 2, 2009 After the environmental mess Constellation Energy Group made in Gambrills, we hoped we had heard the last of the words "fly ash" for a while. We were much too optimistic. The energy-producing giant, the corporate parent of Baltimore Gas and Electric Co., ultimately deposited 2.4 million tons of fly ash - the powdery residue from the burning of coal - at a former sand and gravel mine in Gambrills. And the nearby groundwater was soon contaminated with carcinogens. Although it took years for the problem to become public knowledge, Constellation eventually paid a $1 million fine imposed by the state Department of the Environment, and spent an estimated $54 million to settle a class action lawsuit by Gambrills residents who wound up with unusable wells. The County Council banned fly ash dumping. The MDE imposed new regulations - ones that are too weak, environmentalists complained. And there was a heated argument between the MDE and the county over the way the agency kept county officials out of the loop for years, while it dickered with Constellation and the dump operator about fixing the problem with a pumping system - a system a state report says was inadequate. On top of that, the MDE refused to reimburse the county for $100,000 the county had to spend on testing and monitoring wells. And when legislation to reclaim that money skimmed through the General Assembly nearly unopposed, the governor vetoed it. Take that, Anne Arundel County. Safe disposal of fly ash is an unsolved national environmental problem. But we hoped that, with Constellation sending the ash from its Pasadena power plants to landfills in Virginia and Western Maryland, this county would have no further headaches of this type. Now we find out Constellation plans to buy a 65-acre industrial landfill in Curtis Bay, a stone's throw from the county line, for more fly ash disposal. The first informational meeting was scheduled for yesterday. In Baltimore. On an afternoon in the middle of the workweek. In the week before the Fourth of July holiday. (The MDE is saying that it's early yet and there will be public hearings - possibly in Anne Arundel.) No wonder county officials and area residents are complaining that they are again being kept out of the loop. It's just like old times. Perhaps this latest plan - for reasons of topography or the availability of public water - doesn't involve the hazards encountered at Gambrills. Perhaps. But this time around there's no excuse, outside of obstinacy or stupidity, for not keeping county residents and their government officials informed from the outset. It's the minimum they are owed by Constellation and the MDE. Copyright 2009 Annapolis Capital. Drug safety Cumberland Times-News Editorial Friday, July 3, 2009 A government panel’s recommendations that increased safety restrictions be placed on the maximum dosage of one of America’s most common painkillers and that certain prescription drugs be eliminated altogether is long overdue. For some users of these drugs, this action has come too late. It is estimated that 56,000 people require emergency treatment each year because they have overdosed on acetaminophen products — the basis for Tylenol — and about 200 die each year. Inadvertent overdosing on acetaminophen is the leading cause of liver failure in the U.S. The expert panel assembled by the Food and Drug Administration also rejected suggestions that over-the-counter cold medicines that combine acetaminophen be taken from the shelves. It is time for the FDA to take a good look at how Americans use both prescription and nonprescription medications. Possible overuse of prescription drugs is being considered as at least a contributor to the recent death of pop star Michael Jackson. Regardless of whether this is the case, it’s almost certain that abuse or misuse of pharmaceuticals has a hand in causing the deaths or onset of disability in many other less-famous people. Our human frailties often subject us to a variety of ailments that can include circulatory, digestive, mental health and joint problems, each of which may be controlled by medication. Taken individually, they may pose no problem — but when taken in combination, that may be a different story. If you have any questions about the medications you take, ask your physician. He should be glad to discuss it with you. Copyright © 1999-2008 cnhi, inc. The myth of 'safe drugs' from abroad By John Michael O'Brien Baltimore Sun Commentary Friday, July 3, 2009 More than 150 years ago, Baltimore's port inspector saw Europe's poorest-quality drugs being dumped on the United States. He knew substandard medicines hurt soldiers abroad and wanted to defend citizens at home. Port inspectors, doctors and pharmacists demanded higher standards for drug safety. As a result, the United States has the safest drug use system in the world. Sen. Barbara A. Mikulski and her colleagues on the Health, Education, Labor, and Pensions Committee recently defended drug safety and protected patients by demanding that any effort to obtain drugs from abroad have the secretary of health and human services' guarantee that it would protect patients and save money. Past Food and Drug Administration commissioners have claimed it can't be done, and state efforts to import drugs have failed to show savings while wasting millions of taxpayer dollars. Apparently, some in Congress believe that counterfeit drugs are not a real problem - despite the fact that numerous reports suggest that the worldwide counterfeit-drug epidemic is a threat to the health and security of American consumers. According to Customs and Border Protection officials, seizures of counterfeit imports coming into the U.S. rose by 22 percent (and by 141 percent in value) during the first half of 2007. It is impossible to know if a Web site with a Canadian flag links to a Middle Eastern pharmacist selling drugs from Turkey or even Iraq. It is downright scary to know drugs being made with cement mixers can look so real that not even scientists can correctly pick out the drug their company safely makes under strict FDA oversight. As a public health professional, I have seen the "laboratories" where chemicals stored in outdoor sheds are mixed in unsanitary conditions and made to look like drugs millions of Americans depend on to stay healthy. Organized criminals have discovered they can make more money selling counterfeit drugs than they can selling narcotics. As a pharmacist, I have talked to medical professionals and drug quality experts in Asia, the Middle East and Africa who explain that half of the drugs in their countries are fake. Their pharmacists often have to resort to cumbersome test kits to detect drugs that are either poisons that kill immediately or fakes that kill eventually. It is impossible to expect U.S. regulators to approve drugs from abroad, and it is impossible to expect pharmacists to be sure drugs that leave the FDA's system are indeed safe. Prescription drugs are the best value in health care, costing only 10 cents of every health care dollar. Unfortunately, the uninsured or even people with insurance have to pay full price or high co-payments out of their own pocket. The economic downturn has caused many Americans to skip preventive health services and not fill their prescriptions. The current effort to make affordable, quality health care accessible to all Americans offers new hope at the pharmacy counter. America's drug makers' offer to give 50 percent discounts to people in Medicare's "doughnut hole" as a part of comprehensive reform is even more encouraging. Senator Mikulski has become the Senate's voice on improving health quality through better medication use. She has supported helping vulnerable patients in Medicare and Medicaid work with a pharmacist to manage their medicines, avoid dangerous side effects and fight chronic diseases like high blood pressure, diabetes and asthma. She should be commended not only for these efforts but for her efforts to protect patients from dangerous imported drugs. John Michael O'Brien is assistant professor of clinical and administrative sciences at College of Notre Dame of Maryland School of Pharmacy. His e-mail is jobrien@ndm.edu. Copyright © 2009, The Baltimore Sun. Union service fees and a drop in drug overdoses By Andy Green Baltimore Sun Commentary Friday, July 3, 2009 Here are previews of editorials we're working on for tomorrow's paper. Let us know what you think. The best comments will run alongside the editorials in the print edition. -- In principle, the American Federation of State, County and Municipal Employees has an excellent argument for the so-called “fair share” law that went into effect in Maryland this week. It negotiates contracts for tens of thousands of state employees, whether they are members of the union or not. Conducting those negotiations costs money, and it isn’t right that non-members get the benefits without paying their share of the costs. But the potential side effects of the law are cause for concern. For one thing, employees who belong to other unions that aren’t recognized by the state as having bargaining rights would have to pay their union dues and the service fee. That will almost certainly endanger the existence of these smaller unions. And for another, the service fees would be a huge financial boon to AFSCME. The fees — which still must be negotiated with the state — will cover more than just the cost of negotiation. Non-members may end up paying as much as members or nearly so to pay for outreach, educating the public about the work state employees do and other activities they may not wish to support. -- A generation ago, former Baltimore Mayor Kurt Schmoke urged lawmakers to consider abandoning the criminal justice model for dealing with the country’s rampant drug problem and focus instead on treating people for their addictions. He was roundly criticized for the idea, and America went on to prosecute a fruitless “war on drugs” that two decades later it is still clearly losing. But last week, city health officials announced a small but significant victory in that struggle that may yet vindicate Mr. Schmoke’s more humanistic approach to the scourge of substance abuse. Officials reported that deaths from alcohol and drug overdoses declined for the second straight year in the city and are now at their lowest levels in more than a decade. The reason? Expanded treatment opportunities for heroin users and programs that teach addicts how to avoid life-threatening overdoses even if they aren’t able to completely break the cycle of dependence. With addiction at epidemic levels — nearly one in every six people in Baltimore struggles with a dependence on alcohol or drugs — there’s no way we’re going to make a dent in this problem simply by locking more people up. Copyright 2009 Baltimore Sun. Death in the back seat: accident or a crime? Baltimore Sun Letter to the Editor Friday, July 3, 2009 If a parent makes a foolish mistake and a child is killed as a result, what should the consequence be? This is the question facing authorities in Howard County, where a 23-month-old girl died after spending nine hours alone in a hot car. Every summer -- tragically and predictably -- a spate of such horrifying incidents is reported around the country. Such cases are deeply vexing because they stir conflicting responses. On the one hand, most people feel strongly that the death of an innocent child ought to be punished. And yet, the parent who is guilty not of cruel behavior but of a horrendous error has already suffered the worst kind of punishment imaginable, by causing the death or his or her own child. The response of Howard County officials to the case at hand is a bit curious. The mother who left the child in the car has not been charged, and a police spokeswoman said charges likely wouldn't be filed if the incident is "determined to be accidental." The state's attorney, Dario J. Broccolino, said his office would review the police findings, adding, "There are a million variables in these kinds of cases." "Determined to be accidental"? What other explanation could there for what happened here? Only a monstrous psychopath would intentionally leave a child to bake in a hot car. As for the "million variables," that just isn't the case. Rather, these kinds of incidents (15 children have died in locked cars this year, according to Safe Kids USA) are all depressingly similar: A distracted parent or guardian simply forgets that he or she has a small child in the back seat, parks the car and leaves. The legal responses to such cases seem to vary considerably, with little rhyme or reason to explain the variations. A Bowie woman was charged with reckless endangerment, although her 14-month-old survived. A Virginia man was charged with involuntary manslaughter when his toddler died. (Worth researching: Is the justice system less forgiving of men in such cases?). But our Ellicott City woman, apparently, is unlikely to face any charges at all. "I can't imagine that any judge can hand down any sentence that is worse than what the parents are doing to themselves," State's Attorney Broccolino said. That's no doubt true, but it accounts for only one aspect of our system of justice: the inflicting of punishment on the guilty. The system aspires to do other things, like giving a victim a kind of post-mortem justice by valuing the life that has been lost. And yet, society finds it difficult to do this when a death is accidental rather than intentional; just consider the often startlingly light sentences -- sometimes no jail time at all -- given to drivers guilty of vehicular homicides. Should the law, and society, be tougher on those who cause death through accident or negligence? And should it matter whether the culpable person is a parent of the victim? Michael Cross-Barnet Law and Criminal Justice Copyright 2009 Baltimore Sun. BACK TO TOP


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