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			Wednesday, July 8, 2009 News Clipping Archives *Maryland / Regional* Look out, Baltimore, health care reform is on the way (Baltimore Sun) Police: Man fatally shot at Md. group home (Frederick News-Post) County receives domestic violence grant (Montgomery County Gazette) Rate of population growth lowest in decades (Carroll County Times) Cumberland toddler dies of apparent drowning (Frederick News-Post) Toddler drowns in backyard city pool (Cumberland Times-News) Toxins in bay threaten humans (Washington Post) *National / International* Swine flu resistance testing to grow after U.S. case (Baltimore Sun) Fort Jackson, state H1N1 flu cases still rising (The state.com) New H1N1 Flu Strain From Pig Farm Found in Canada (Bloomberg News) Smoking Cessation Harder For Women Than Men (Baltimore Sun) Food-safety fix starts at FDA (Baltimore Sun) Keepings teens safe from HIV (Baltimore Sun) Blacks With Equal Care Still More Likely to Die of Some Cancers (Washington Post) Study: Race gap in African-American cancer deaths may be partly biological (Baltimore Sun) GetWellNetwork in the loop (Daily Record) In Retooled Health-Care System, Who Will Say No? (Washington Post) Americans doubt insurance plans will cover cancer (Reuters) *Opinion* Change SSN assignment procedures (Carroll County Times Editorial) *Maryland / Regional* Look out, Baltimore, health care reform is on the way Cost-cutting will prick local economic bubble By Jay Hancock Baltimore Sun Wednesday, July 8, 2009 New York thrived during the housing-finance bubble. The health-care bubble is being very good to metro Baltimore. Hospital wings are rising. Hospitals and doctors are still hiring. Along with government and education, medicine is one of the few things keeping the area's recession from being much worse. Thanks to some of the highest bills and costliest care in the country, Baltimore's medical industry has accounted for more than half the metro region's job growth in the past five years. Health-care reform promises to stop all this, leaving Baltimore without an obvious engine to create employment. "The impact on a place like Baltimore, if we really stop doing procedures that the clinical trials show don't need to be done and should not be done, will be giant on the institutions and on the communities," says Dr. George D. Lundberg, former editor of the Journal of the American Medical Association as well as eMedicine and Medscape, online resources for doctors. Independent and outspoken, Lundberg is one of the few credible medical professionals talking about the damage runaway health spending is doing to the country. "I see a huge bubble," he says. "We're paying way more than we need to." He wants universal care. He just wants it to be affordable for everybody, including taxpayers. True reform, he believes, would shrink medical spending to 60 percent of its current level. Part of the savings could come from cutting administrative costs, lobbying and lawsuit abuse, he says. But much would be gained by eliminating unnecessary and exorbitant care, categories in which Baltimore seems to specialize. Johns Hopkins Hospital may be No. 1 in the U.S. News and World Report ratings. Baltimore may be one of the world's top destinations for medical treatment. But Cadillac care comes at a price taxpayers, employers (who cover most private health insurance) and patients can no longer afford. The average senior citizen treated in metro Baltimore costs Medicare 40 percent more than in Minneapolis/St. Paul, which sets the standard for efficient care, according to the Dartmouth Institute for Health Policy and Clinical Practice. Maryland has one of the highest concentrations of specialist doctors per resident in the country. It is one of four states where hospital spending on dying patients is more than 30 percent higher than the national average, according to Dartmouth research. But Baltimoreans and other Marylanders aren't any healthier. "There is a huge amount of care that is provided that is unnecessary," White House budget chief Peter Orszag told the blogger Ezra Klein a few months ago. "The Dartmouth folks say as much as 30 percent, others say between 15 percent or 10 percent, and fine, that's huge. The question is how we get out of that." However we get out, it won't be pretty. Even if payers limit care to what's scientifically proven to be effective, as Lundberg suggests, doctors and patients will scream "rationing." (His favorite example of a frequently unnecessary operation: extremely lucrative heart-artery bypass surgeries.) Even if reform fails in Congress (or delivers a generous plan that maintains spending at present rates), prospects for the medical industry look uncertain. The math is starting to catch up. "Health care costs have been growing for 30 years at a higher rate than the rate of income growth," says Richard Clinch, a University of Baltimore economist who has done consulting for Hopkins and the University of Maryland Medical Center. "Health care is going to hit a barrier like housing, where you can't pay for it any more. We have to rein this in." It's true that aging baby boomers are widely seen as a meal ticket for docs and hospitals in coming decades. But with medicine projected to siphon off a fifth of the national income by 2017, the country simply won't be able to afford today's kind of care no matter what the population looks like. For Baltimore that'll mean slower job growth for nurses and doctors. It'll put pressure on surgeons' incomes and hospital profits. Fabulous new cancer units and their accompanying construction jobs will go scarce or missing. Hospitals are figuring this out. They're about ready to agree to $150 billion in savings to help pay for a national medical plan, several newspapers reported Tuesday. The deal could be announced today. "We have too much money in the system already," says Lundberg, who just opened an eponymous think tank dedicated to improving communication on costs between doctors and patients. "To say we're going to throw more money at it - that's ridiculous. We need to squeeze what we need to squeeze and spend the money more wisely." The country will benefit. Providing basic care for millions of uninsured people is not only the right thing to do; it could temper expenses by keeping people from getting sick. Employers and employees are screaming about rising costs. Money not spent on excessive care can be invested in better cancer research. Or clean energy or cleaning up loose nukes. But for regions like Baltimore that have ridden the medical bubble to fame and fortune, health-care reform looks anything but healthy. Copyright © 2009, The Baltimore Sun. Police: Man fatally shot at Md. group home Associated Press Frederick News-Post Wednesday, July 8, 2009 ACCOKEEK (AP) — Prince George’s County Police say a Fort Washington man was shot to death at a group home in Accokeek. Officers were called to the home in the 1500 block of Accokeek Road around 1:30 a.m. Tuesday for the report of a shooting. Police say they found 23-year-old Stepfone Robinson on the ground suffering from a gunshot wound to the upper body and he was later pronounced dead on the scene. Police Chief Roberto Hylton says the department has noted “escalating crime issues” involving group homes. He is calling for a registration process to notify police departments of group homes in their jurisdictions. Copyright 2009 Frederick News-Post. County receives domestic violence grant Money to pay for some family justice center employees Montgomery County Gazette Wednesday, July 8, 2009 The county last week was awarded a grant of almost $1 million to cover the salaries of seven staff members working on domestic violence cases, including some at the county's Family Justice Center. The money was a continuation of a federal Department of Justice grant that the county has received since 2001, said Hannah Sassoon, domestic violence coordinator in the Sheriff's Office and leader of the justice center. The 24-hour county-funded center in Rockville opened for clients April 27. A grand opening was held May 18. The center is a one-stop location for domestic violence victims to receive a variety of services, ranging from legal advice to social service referrals and help with protection orders. Since the center's opening, about 230 clients have received services, Sassoon said. The most popular services have been counseling, legal aid and victim advocacy. U.S. Sen. Barbara A. Mikulski touted the grant award as part of her fight against domestic violence and sexual assault. "This grant will support the coordinated, community work being done by Montgomery County to combat domestic violence and sexual assault and help the victims of these terrible crimes rebuild their lives," Mikulski said in a statement. County receives 15 national awards The National Association of Counties awarded Montgomery County 15 awards for a variety of programs offered by county departments. Among the honors, County Executive Isiah Leggett's office received an award for CountyStat, the results-based data system; one for Health and Human Services, for an intern program for individuals with severe disabilities; and one for Consumer Protection for online training for police officers. The county received more awards than any other county in the state. Copyright 2009 Montgomery County Gazette. Rate of population growth lowest in decades By Adam Bednar Carroll County Times Wednesday, July 8, 2009 Carroll County’s population rose 12 percent since 2000, according to estimates released by the U.S. Census Bureau last week, although the percentage of growth has slowed to a trickle compared to what the county was experiencing at the start of the decade. The bureau estimates the county’s population reached 169,353 in 2008. That is up from 150,897 in 2000. Barring a mass migration to the county during the next year and a half, this will be the slowest rate of population growth by percentage during a decade since the 1940s, according to the county’s Web site. The county population grew less than 1 percent between 2006 and 2008, according to U.S. Census Bureau estimates. That is in contrast to the 7.5 percent in population growth between 2000 and 2003. The slowdown in growth roughly coincides with the Maryland Department of the Environment placing a development moratorium on several county municipalities because of a lack of water. In 2003, the county also issued a deferral on county building in order to stop some development on projects that had not reached the preliminary plan stage to allow the county to update its Concurrency Management Ordinance. By percentage, the fastest-growing municipality in the county is Mount Airy. The town’s population in Carroll County has increased by 43 percent since the last census. On the Frederick County side of the town, the population has increased by 30 percent. In total, the Town of Mount Airy has seen a 36 percent increase in population since 2000. Monika Weierbach, Mount Airy’s town administrator, said the town experienced rapid growth at the start of this decade but is starting to get its expansion back under control. She said the town is finally starting to catch up with services that were neglected while its population swelled. “It took us a little time to keep up with infrastructure,” she said. The town was subject to a building moratorium and has struggled to provide enough water for its expansion under the Maryland Department of Environment’s standards for ground water use. During the next decade, Weierback said she doesn’t expect growth in the town to be anything like it has been. She said restrictions on the amount of water the town can use as well as a slow economy will slow the town’s expansion. She said Mount Airy not issuing a new building permit since 2003 is proof of the town’s diminishing population growth. The largest increase in population has occurred outside municipalities. According to bureau figures, the number of people living in the county but not in a town or municipality grew by 14,913 people between 2000 and 2008. Population growth this decade peaked in the county in 2002, when the population grew 3 percent in one year. After that year, population growth began slowing. Between 2006 and 2008, population growth was less than 1 percent. Making sure this growth remains in designated growth areas is one of the county’s largest concerns, spokeswoman Vivian Laxton wrote in an e-mail. Officials in some towns like Hampstead, which saw its population grow 8 percent since 2000, said they’ve reached their limit and have nowhere else to grow. “We’re not likely to grow much more unless the town is inclined to annex more land, and we don’t really have the infrastructure to support that sort of thing,” said Mayor Haven Shoemaker Jr. He said that most of the large growth is behind the town and credited the adoption of its adequate facilities ordinance in 1995 for the slowdown. What population growth the town did see this decade Shoemaker attributed to a subdivision that had been planned prior to the facilities ordinance going into effect. Reach staff writer Adam Bednar at 410-751-5908 or adam.bednar@carrollcountytimes.com. Carroll County population estimates Population estimates from the U.S. Census Bureau for Carroll County and incorporated towns and cities for the past six years: CARROLL COUNTY Year Population Percentage 2003 162,229 + 2 2004 165,000 + 1.7 2005 166,820 + 1 2006 168,180 + .8 2007 168,786 + .3 2008 169,353 + .3 HAMPSTEAD Year Population Percentage 2003 5,352 + 1 2004 5,408 + 1 2005 5,433 + .4 2006 5,449 + .3 2007 5,455 + .1 2008 5,466 + .2 MANCHESTER Year Population Percentage 2003 3,479 + 1 2004 3,514 + 1 2005 3,529 + .4 2006 3,539 + .2 2007 3,541 + .05 2008 3,546 + .1 MOUNT AIRY (Carroll, Frederick counties) Year Population Percentage 2003 7,811 + 3 2004 8,118 + 3.9 2005 8,282 + 2 2006 8,603 + 3.8 2007 8,760 + 1.8 2008 8,761 + .01 NEW WINDSOR Year Population Percentage 2003 1,330 + 1 2004 1,342 + .9 2005 1,347 + .3 2006 1,350 + .2 2007 1,350 0 2008 1,352 + .1 SYKESVILLE Year Population Percentage 2003 4,339 + 1 2004 4,379 + .9 2005 4,395 + .3 2006 4,406 + .2 2007 4,412 + .1 2008 4,419 + .1 TANEYTOWN Year Population Percentage 2003 5,318 + 1 2004 5,373 + 1 2005 5,395 + .4 2006 5,410 + .2 2007 5,414 + .07 2008 5,422 + .1 UNION BRIDGE Year Population Percentage 2003 1,062 + .9 2004 1,071 + .6 2005 1,075 + .3 2006 1,077 + .1 2007 1,077 0 2008 1,077 0 WESTMINSTER Year Population Percentage 2003 17,438 + 1.5 2004 17,556 + .6 2005 17,647 + .5 2006 17,677 + .1 2007 17,668 - .05 2008 17,689 +.1 UNINCORPORATED CARROLL COUNTY Year Population Percentage 2003 120,175 + 2.5 2004 122,445 + 1.8 2005 123,992 + 1 2006 125,075 + .8 2007 125,589 + .4 2008 126,093 + .4 Copyright 2009 Carroll County Times. Cumberland toddler dies of apparent drowning Associated Press Frederick News-Post Wednesday, July 8, 2009 CUMBERLAND (AP) — Police in Cumberland say a 3-year-old boy has died from apparent drowning in his family’s backyard swimming pool. Authorities say Skyler Crowe was found unconscious in the water Tuesday evening and pronounced dead at the Western Maryland Health System’s Memorial Hospital campus. The boy’s father and grandmother told police he left their sight for a few minutes. When the grandmother went looking for him, she found him in the aboveground pool. The body is being sent to the state medical examiner’s office in Baltimore for determination of the cause of death. Police say foul play is not suspected. Copyright 2009 Frederick News-Post. Toddler drowns in backyard city pool By Staff Reports Cumberland Times-News Wednesday, July 8, 2009 CUMBERLAND — A 3-year-old boy died Tuesday evening after being found unconscious in his family’s backyard swimming pool. Skyler Lee Crowe was pronounced dead shortly after arriving at the Western Maryland Health System’s Memorial campus, according to the Cumberland Police Department. The city police and fire departments responded to the 100 block of Grand Avenue upon alert at 6:03 p.m. in reference to a small child who was pulled from the pool, the victim of an apparent drowning. Officers immediately started cardiopulmonary resuscitation until ambulance personnel from the fire department arrived and took over care of the youngster. C3I investigators and the Allegany County Department of Social Services were notified and arrived on the scene within minutes of the incident and assumed control of the investigation. The victim was at the residence with his father and grandmother when he left from their sight. Upon looking for the child a few minutes later, the grandmother located him in the above-ground pool that the family had in the backyard. The grandmother and a neighbor jumped into the pool and pulled the child out, according to police. The victim’s body will be taken to the Maryland State Medical Examiner’s Office in Baltimore for an autopsy to determine the official cause of death. The investigation is continuing, however no foul play is suspected, said police. Copyright © 1999-2008 cnhi, inc. Toxins in bay threaten humans The Associated Press By David A. Fahrenthold Washington Post Wednesday, July 8, 2009 ANNAPOLIS --The same pollution problems that afflict the Chesapeake Bay's fish and crabs -- high levels of mercury in fish, neon-colored algae blooms and voracious bacteria -- can also threaten the health of people who fish, boat and swim in the estuary, according to a new report. The report, released Tuesday by the nonprofit Chesapeake Bay Foundation, pointed out that the threat of infection from pollutants that wash into the bay from onshore is great enough that health authorities recommend not swimming until 48 hours after a significant rain. It says that many of the Chesapeake's problems have not improved significantly, despite a government-sponsored "save the bay" effort now 25 years old. And with climate change apparently warming the water to a more pathogen-friendly temperature, it says one of the scariest health threats -- a powerful strain of bacteria called Vibrio -- may become more common. "Clean water laws are not being enforced, and this is putting human health in danger," said William C. Baker, the foundation's president. Baker said the information about Vibrio was among the report's most disturbing conclusions: "I was surprised ... that there are very real, very severe risks in contact with the waters of Chesapeake Bay." Clifford S. Mitchell, director of environmental health coordination for Maryland's health department, downplayed the risks to swimmers, saying, "We're not seeing any kind of indication that it's not safe to go into the Chesapeake generally." He also said the agency had not recorded any cases of food poisoning related to Chesapeake shellfish between 2001 and 2007. He said he did not have the 2008 figures with him. Nevertheless, Mitchell acknowledged that swimmers should avoid water activities after a rain, which can sweep in animal manure and human waste from older sewage systems and leaky septic tanks. He also warned that people should not let cuts or open wounds contact the water; should avoid water that is unusually murky or discolored by algae, and should check official signs and Web sites for state water-quality warnings. "If the water looks good, if there are no postings (warning not to swim), if they've checked online ... they should feel pretty comfortable," Mitchell said. Maryland officials recommend that would-be bathers download a Google Earth program that notifies them about beach closures. It can be found at http://www.maryland healthybeaches.com . In Virginia, information about bay beaches can be found at http://www. vdh.state.va.us/epidemiology/DEE/BeachMonitor ing/beachadvisories. The bay foundation's report highlights several threats stemming from pollution: # Blooms of cyanobacteria, also known as blue-green algae, can cause liver disease, skin rashes, nausea and vomiting if ingested. The foundation's study said that, in 31 percent of tests on water contaminated with the algae, there was enough to make the water unsafe for children to swim. # A protozoan called Cryptosporidium, which washes into the bay in human and animal waste, can cause diarrhea and sometimes more serious illnesses if ingested. # Mercury, found in the smoke from coal-burning power plants, winds up in the water and accumulates up the food chain. People who consume enough of it can suffer neurological damage and an increased risk of heart disease. Mercury is the reason that state authorities warn against consuming too much of certain fish from lakes and streams in this region, and advise diners to limit their consumption of rockfish from the bay. # Vibrio, typically found in warmer waters to the south, seems to turn up more often now in the Chesapeake, the foundation's report said. The reason could be climate change and algae blooms that make the water more inviting for the bacteria. In Virginia, for instance, the report said, the number of cases of human infection jumped from 12 in 1999 to 30 in 2008. Vibrio can cause vomiting and diarrhea if ingested, and potentially serious skin infections if it is contracted through open wounds. But Mitchell, from the Maryland health department, said that there were not enough data to know if these infections really are more common than before. Among those who have been infected is Ken Smith, vice president of the Virginia Waterman's Association. Smith said that in June of last year, he had been removing big "Jimmy" crabs from his pots, then washed up with a bucket of water from Totuskey Creek, a tributary of the Rappahannock River. The next morning, he woke up and saw a bump on his forearm the size of a mosquito bite. "Went and drank a cup of coffee, and I looked back down and it was about the size of an egg," Smith said. In a few minutes, he was shaking violently, and drove himself to a hospital in Kilmarnock, Va. Smith said doctors there had seen enough cases to know it was Vibrio. But even with treatment, he endured several painful days, in which his infected arm swelled up twice the size of the other one. "It's got to be something ... in the water that (Vibrio) likes," Smith said. "It's just too much of it happening here." Additional Facts The Chesapeake Bay Foundation report noted that Pennsylvania, Maryland and Virginia issued 76 no-swimming advisories and beach closures last year because of unhealthy bacteria levels, typically after significant rainfall. Health officials in Virginia reported 30 infections from Vibrio bacteria last year, up from 12 in 1999, the report said. Reported cases also rose in Maryland, but a change in reporting requirements may have contributed to the increase. Copyright 2009 Salisbury Daily Times. *National / International* Swine flu resistance testing to grow after U.S. case Associated Press By Mike Stobbe Baltimore Sun Wednesday, July 8, 2009 ATLANTA - U.S. health officials are stepping up testing of swine flu cases for Tamiflu resistance, now that an American has come down with a resistant strain. A California teenager was diagnosed with swine flu last month after arriving in Hong Kong on June 11, and has since recovered. The 16-year-old is a San Francisco resident and likely was infected in the United States, health officials said Tuesday. Her illness was mild, but noteworthy. She's just the third person in the world to be diagnosed with a strain resistant to Tamiflu, the primary pharmaceutical weapon against the new virus. The other two resistant cases -- patients in Denmark and Japan -- had been taking Tamiflu as a preventive measure after coming into contact with someone with swine flu. The Californian girl had not taken Tamiflu, meaning she apparently was infected by an already-circulating resistant strain before she traveled to Hong Kong. "It's a little more concerning" than the two previous cases, said Dr. Tim Uyeki of the federal Centers for Disease Control and Prevention. Hong Kong health officials, known as aggressive about trying to detect and isolate swine flu cases, detected the resistant strain in the girl. Until an effective vaccine is developed, the drugs Tamiflu and Relenza are considered the best defense against the swine flu virus, which has caused nearly 34,000 reported illness in the United States, including at least 170 deaths. Health officials say they are not alarmed, and have been expecting to see some swine flu cases shrug off Tamiflu treatment. Such resistance has been seen in other types of flu. Late last year, CDC officials reported that the most common flu bug circulating at the time was overwhelmingly resistant to the drug. They also believe resistance is not a widespread problem. No resistance was seen in the CDC's analysis of about 200 U.S. swine flu samples. California officials say they have found no resistance in their tests of about 30 other samples in that state. Spread of a Tamiflu-resistant strain may not be ongoing, said Uyeki, a CDC flu expert. "These are likely to be sporadic cases, but it's very important to monitor" for them, he said. Health officials acknowledge they don't have a complete understanding of what's going on. The samples tested for resistance represent just a tiny fraction of the more than 1 million swine flu cases estimated to have occurred in the United States since the virus was first detected in April. The CDC is calling for health departments to send in more samples for testing Tamiflu resistance, Uyeki said. California is already stepping up such testing, said Ralph Montano, a spokesman for the California Department of Public Health. Health officials are continuing to recommend Tamiflu as a treatment for swine flu, Uyeki said. Copyright 2009 Associated Press. All rights reserved. Fort Jackson, state H1N1 flu cases still rising South Carolina By Kelly Davis The state.com Wednesday, July 8, 2009 A total of 32 Fort Jackson soldiers and personnel are now confirmed victims of H1N1, or "swine", flu, and there are 45 other patients positive for Type A flu waiting for test results to determine if they, too, have the H1N1 strain. According to a fort news report, the patients are in isolation at the Moncrief Army Community Hospital. Most fort personnel who have contracted the virus have already recovered. South Carolina has seen a total of 160 confirmed cases of H1N1 flu between May 16 and June 26, including 40 between June 19 and June 26, the last period for which data has been reported by the Department of Health and Environmental Control. Those figures include 27 total confirmed cases in Richland County (16 of which appeared in the most recent report period), 19 total confirmed cases in Lexington County and four in Kershaw County. Newberry County, where the first cases of the new flu were found in the state, has seen a total of 30 confirmed cases through June 26. The department has emphasized that the confirmed cases may not reflect total flu activity in the state, because not all cases are reported. The figures also do not indicate where the flu was contracted. Copyright 2009 The state.com - South Carolina. New H1N1 Flu Strain From Pig Farm Found in Canada By Tom Randall Bloomberg News Wednesday, July 8, 2009 July 7 (Bloomberg) -- A new strain of H1N1 flu sickened at least two workers at a pig farm in Saskatchewan, Canadian health officials said. Tests found the strain is different from the pandemic swine flu circulating the globe. The two people recovered from mild illness, and a third case is under investigation, according to a government statement. Pigs from the farm tested positive for a common version of swine flu and didn’t carry the new human version found in the workers. The risk of the virus is considered low, though disease trackers are testing other workers and continuing to monitor herds, the government said. Health officials worldwide are on heightened alert after a human swine flu virus, identified in April, flashed across the globe infecting at least 1 million people in the U.S. alone, according to the U.S. Centers for Disease Control and Prevention. “Preliminary results indicate the risk to public health is low,” said Leona Aglukkaq, Canada’s health minister, in the statement. “Canadians who have been vaccinated against the regular, seasonal flu should have some immunity to this new flu strain.” The new Canada strain is made up of genes from human seasonal flu and genes from swine flu viruses, according to the statement from the Public Health Agency of Canada. To contact the reporter on this story: Tom Randall in New York at trandall6@bloomberg.net. Copyright 2009 Bloomberg News. Smoking Cessation Harder For Women Than Men The Hartford Courant By Kathleen Megan Baltimore Sun Wednesday, July 8, 2009 Women appear to have a tougher time quitting smoking than men, according to researchers at Women's Health Research at Yale. While the percentage of men nationally who have given up cigarettes between 1965 and 2006 was 54.5 percent, the rate of decline among women was less steep, at 47.5 percent. Consequently, the gap in the percentages of male and female smokers has narrowed. In 1965, slightly more than half of all men smoked, while about a third of women did. Today 23.3 percent of men smoke, compared to 18.6 percent of women. Here we talked to Carolyn Mazure, Ph.D., a professor of psychiatry and director of the research program, about why women are not kicking the habit at the same rate as men. Q: So what does the research show? A: Well, the first thing I want to say is that smoking remains a serious public health issue. Smoking is the leading cause of preventable death and illness in the U.S. Those deaths and morbid occurrences are from cancers, respiratory illness, cardiovascular disease. Q: And why is it harder for women to quit smoking? A: That's a lot of interest to us. It appears as though when men quit smoking, the most prominent symptoms of withdrawal are biological symptoms of craving. However, we find women are more likely to use cigarettes to manage moods, to deal with stress and to control weight. In other words, women are smoking for different reasons, and if you're not helping with those particular reasons for smoking in your cessation treatment, you wouldn't necessarily expect your treatment to work. A good example is the nicotine patch, which often is considered the first line of treatment for smoking. The research data on the nicotine patch suggest that women do less well quitting smoking when using the patch than men do, probably because it targets symptoms of craving rather than the symptoms that are more prominent for women. So this begins to make an argument for gender-specific approaches to smoking cessation. ... With the medication, Zyban (the generic is bupropion), it appears that women do as well in quitting when using this treatment as men do. ... Zyban can help with mood symptoms. It was originally developed as an antidepressant drug, Wellbutrin. That's an important part of the story in that we do think there is a relationship between depressed mood and smoking. Q: Are women moodier than men or less good at managing stress? A: I wouldn't say that at all, but we clearly know that the rates of depression are higher in women than in men, not only in this country, but in the world. We find stress a pathway to depression in both men and women, although stress appears to be a more potent predictor of depression in women than men. Knowing that, we can understand how women would be attempting to use a variety of strategies to handle stress, including smoking. Nicotine can help someone reduce anxiety and modulate mood. It does have transient positive effects. But those positive effects are not worth the long-term health risk by any measure. Q: Cigarette smoking does affect weight, right? A: Yes, it can. When people quit smoking, it's not uncommon to gain a few pounds. Often this is a deterrent, particularly among women. I think it's very important that women know the truth of the matter: You have to deal with the fact that you may gain some weight and prepare for that, and really factor that into whatever cessation program you undertake. ... The main concept is to include some form of exercise and support. And the exercise should be something that is manageable and really fits into your day. Q: Does the menstrual cycle have any effect on attempts to quit smoking? A: There are data to suggest that the menstrual cycle may play a role in affecting one's ability to quit smoking. We tell women to think about the time within their menstrual cycle that is most difficult personally and advise them not to quit during that time because you are likely to have a harder time resisting cigarettes during that time. In addition, before you quit, prepare for that time in your cycle. What are you going to do when you feel badly? Call a [quit smoking hot line], take a walk, you have to have a plan. Q: Do you think there should be special cessation programs for women? A: I think in general we need to integrate the care for women into the mainstream of health care, but importantly, we have to be gender-sensitive in terms of what works for women and what works for men. •On the Web: www.women.smokefree.gov and Women's Health Research at Yale at www.yalewhr.org. Copyright © 2009, The Hartford Courant Copyright 2009 Baltimore Sun. Food-safety fix starts at FDA Agency to monitor egg production, add senior adviser Tribune Newspapers By Noam Levey Baltimore Sun Wednesday, July 8, 2009 WASHINGTON - The Obama administration took the first steps toward modernizing the nation's faltering system for protecting the food supply on Tuesday by announcing new regulations to curb the spread of salmonella in eggs and naming a new food watchdog at the Food and Drug Administration. Following up on President Barack Obama's pledge to improve a chronically underfunded and understaffed system that has repeatedly failed to control outbreaks of food-borne illnesses, the FDA for the first time will regulate how most eggs are produced on farms around the country. That was coupled with other steps that will give federal monitors more authority to prevent problems and more capacity to respond quickly when outbreaks occur. Q. What will egg producers be required to do? A. Nearly all egg producers with more than 3,000 laying hens-which account for the vast majority of eggs consumed by Americans-will be required to buy chicks from suppliers who monitor for salmonella bacteria. In addition, producers will be required to refrigerate eggs at 45 degrees no later than 36 hours after the eggs are laid. Q What will be the effect? A. The FDA estimates that the additional safety measures will cost the egg industry about $81 million a year, but provide $1.4 billion in public health benefits, driven by a projected 60 percent drop in the number of illnesses caused by contaminated eggs. That translates into 79,000 fewer illnesses annually, according to the agency. Q. Are there other food-safety steps in the works? A. The Department of Agriculture, which regulates most meat production, is expected to develop new standards by the end of the year to reduce salmonella in turkey and poultry. The agency is stepping up its beef inspections to reduce the danger of E. coli, particularly in ground beef, as well. The FDA also plans to issue draft guidelines for producers to reduce the risk of contamination in tomatoes, melons and leafy greens, along with developing a tracing system to make it easier to determine the source of a food-illness outbreak. Michael R. Taylor, a professor at George Washington University's School of Public Health and Health Services, will become a senior adviser to the agency commissioner, giving the food-safety unit a more prominent voice and greater access to senior agency officials. The administration also plans to create a new "unified incident command system" to coordinate a government response to future outbreaks of food-borne illnesses. Q. Why is this happening now? A. With recent food scares involving cookie dough, pistachios, peanut butter and peppers, there is growing consensus in Washington that major changes are needed in the way the federal government regulates foods. Particularly alarming to many policymakers and industry leaders were the weaknesses in the government's ability to identify the sources of contamination and to control them. That has helped build bipartisan support for legislation to give new regulatory powers to the FDA, which has little authority to mandate changes in the marketplace. And Obama in March created a Food Safety Working Group, which Tuesday announced the new egg rule and other steps by the FDA and Agriculture Department. Copyright © 2009, The Baltimore Sun. Keepings teens safe from HIV By Kelly Brewington Baltimore Sun Wednesday, July 8, 2009 HIV testWhen it comes to HIV/AIDS the mantra has always been: get tested. But some doctors warn that not all tests are created equal. Sometimes a negative test can give a false sense of security to both doctors and patients, particularly for risk-taking teenagers, said Dr. Allison Agwu, a pediatric infectious disease specialist at Johns Hopkins Children’s Center. Rapid HIV tests are designed to pick up antibodies to the virus, not the virus itself. It can take weeks or months for someone to produce antibodies. So a rapid test can come up negative the first time, but positive some weeks or months later. False negatives often happen during the earliest and most contagious stages of the infection. And with teens, those crucial months matter. “The test is only as good as when you get the test,” said Agwu. “I can’t tell you the number of times I spoke to a patient, and they say, ‘Well I’m negative. And they go on to doing whatever risky behaviors they’ve been doing.” Of the 53,000 new HIV infections diagnosed each year in the United States, 14 percent of those occurred in 13 to 25-year-olds, according to the Centers for Disease Control and Prevention. And the CDC reported last week that nearly half of all HIV positive teens don’t know they have the virus. Agwu thinks doctors need to look further, probe deeper about their patients’ risk behaviors and consider a test that detects the virus’ genetic markers rather than relying on antibodies to the virus. But testing is only part of the broader issue of getting teens to be aware of the dangers of HIV, said Agwu. Doctors and parents need to do a better job talking frankly to teens about sex and the risk for HIV, particularly in a city like Baltimore with higher than average rates of the disease, she said. There's no doubt that it's touchy territory for parents. Today, an AIDS daignosis is no longer a death sentence and teens are often desensitized to the dangers or think it will never happen to them, Agwu said. There's no easy way to combat this, Agwu admits. But engaging teens in a constant frank conversation about the disease is a start. Copyright 2009 Baltimore Sun. Blacks With Equal Care Still More Likely to Die of Some Cancers By Rob Stein Washington Post Wednesday, July 8, 2009 African Americans are less likely than whites to survive breast, prostate and ovarian cancer even when they receive equal treatment, according to a large study that offers provocative evidence that biological factors play a role in at least some racial disparities. The first-of-its-kind study, involving nearly 20,000 cancer patients nationwide, found that the gap in survival between blacks and whites disappeared for lung, colon and several other cancers when they received identical care as part of federally funded clinical trials. But disparities persisted for prostate, breast and ovarian cancer, suggesting that other factors must be playing a role in the tendency of blacks to fare more poorly. For decades, studies have shown that poor people and minorities are more likely to live shorter, sicker lives, and are less likely to survive a host of illnesses, including many cancers. Studies have indicated that the disparities were largely the result of poor people and minorities getting inferior care; they are less likely to have health insurance and receive routine preventive care, they frequently get diagnosed later, and they often undergo less aggressive treatment once they are diagnosed. The new study is another chance to weigh biology against disparities in the quality of care. "There is good news and puzzling news in our results," said Kathy S. Albain of Loyola University, whose findings were published online today by the Journal of the National Cancer Institute. "When there's a level playing field with the same quality of care, African Americans survive just as well as other races from some of our most common cancers, which is reassuring news and points us nationally toward a need to make sure there is quality of care and equal access to all," Albain said. "But for prostate, ovarian and breast [cancer], it's not access to care. There's something else. And we need to sort that out." Other researchers said the findings were groundbreaking. "I believe this is a landmark analysis," said Lisa A. Newman of the University of Michigan. "There seems to be something associated with racial and ethnic identity that seems to confer a worse survival rate for African Americans. I think it's likely to be hereditary and genetic factors." A growing body of evidence has suggested that biological factors may be playing a role in health disparities. Genetic variations, for example, appear to make some therapies more effective or less toxic for some people than others. That idea, however, has been controversial and has raised concern that it could distract from the major cause of disparities, such as poverty, prejudice and geographic variation in quality of care. Some experts cautioned that the study could not rule out the effects of socioeconomic and environmental factors earlier in life, and expressed worry that the findings could reinforce old prejudices. "When I hear scientists talking about racial differences, I worry that it starts to harken back to arguments about genetic inferiority," said Otis W. Brawley, chief medical officer of the American Cancer Society and an African American. In the new study, Albain and her colleagues used data collected from about 19,457 patients between 1974 and 2001 by the Southwest Oncology Group, a National Cancer Institute-funded national cooperative of clinical trials. Because all patients in the studies received the same treatment, if poverty and other socioeconomic factors were to blame, then differences in survival should remain constant across all cancers, the researchers reasoned. A detailed analysis of the data found no statistically significant association between race and survival for lung and colon cancer -- two of the most common forms of cancer -- or for leukemia, lymphoma and myeloma. But African Americans were still 49 percent more likely than whites to die from early-stage postmenopausal breast cancer, 41 percent more likely to die from early-stage premenopausal breast cancer, 61 percent more likely to die from advanced ovarian cancer and 21 percent more likely to die from advanced prostate cancer. Because all the cancers for which the disparity persisted were related to gender, the findings suggest that the survival gap may be the result of a complex interaction of differences in the biology of the tumors and inherited variations in genes that control metabolism of drugs and hormones, Albain said. Some of the difference in breast cancer survival could be explained by the fact that black women are more likely to get a more aggressive form of the disease that is more difficult to treat. But part of Albain's study and another analysis by researchers at the National Cancer Institute involving more than 244,000 cancer patients nationwide found that could not explain all the difference. "This is almost certainly related to a mix of factors across races pertaining to tumor biology and inherited factors," Albain said. Albain disputed suggestions the study could be used to support racial prejudices. "We certainly aren't talking about 'genetic inferiority' or stereotypes in our study (or implying it) and it would be a shame to have these results misinterpreted by someone in this way," Albain wrote in e-mail. "What we are saying is that there is something that 'tracks' with African ancestry only in these three diseases. . . . Once we discover the explanation for our findings, tailored treatments will benefit all races." But Brawley, who speaks widely on issues of racial disparity, and others argued that access to high-quality care remains the dominant problem. Socioeconomic factors that occur earlier in life may explain the findings, Brawley said. For example, poor people and minorities are more likely to grow up in polluted neighborhoods and have been hit hardest by the obesity epidemic, which could lead to more difficult-to-treat cancers, he said. "These differences are not due to inherent genetics. They are due to the effects of environmental factors like diet and exercise and obesity on biology," Brawley said. Copyright 2009 Washington Post. Study: Race gap in African-American cancer deaths may be partly biological Socioeconomic factors in black-white disparity still concern many experts despite findings in the Journal of the National Cancer Institute Tribune reporter By Deborah L. Shelton Baltimore Sun Wednesday, July 8, 2009 A new study led by a Chicago-area researcher is reigniting the debate over racial differences in cancer death rates. The research touches on a fundamental question in medicine: Do genetic and biological factors contribute to African-Americans dying of cancer at higher rates than other patients? Or are the racial disparities wholly explainable by socioeconomic and cultural differences, such as income, access to health care and diet? Published Tuesday in the Journal of the National Cancer Institute, the study found that African-Americans were more likely than others to die of three gender-related cancers -- breast, prostate and ovarian -- even when they received the same advanced care from the same doctors. The researchers say the survival disparity persisted after they controlled for factors such as education and income. This study found no statistical link between race and survival for lung cancer, colon cancer, lymphoma, leukemia or myeloma. The findings suggest that African-Americans' lower survival rates for certain cancers are not entirely due to factors such as poverty and poor health care, said lead author Dr. Kathy Albain, a breast and lung cancer specialist for Loyola University Health System in Maywood. Instead, she said, the new study indicates that interactions among hormones, tumor biology and inherited gene variations may play a significant role in the survival gap for breast, prostate and ovarian cancers by controlling the metabolism of drugs, toxins and hormones. "If you stir all that up in a pot," Albain said, "then I think we will have an answer as to why it is that those cancers still have the disparity but none of the other cancers do." But some researchers criticized the study's methodology and conclusions. Steve Whitman, director of the Sinai Urban Health Institute in Chicago, said the prevailing view in health disparities research is that socioeconomic factors play the dominant role. "What happens is, once again, [the study proposes] the problem is not with society, not with social issues, it's not with racism, but with the biology that lies within black people," he said. Whitman is founder of the Metropolitan Chicago Breast Cancer Task Force, a collaboration of health care organizations, physicians, researchers and advocates working to reduce an alarming disparity in mortality between black and white Chicagoans with breast cancer. In 2005, the last year for which data were available, the breast cancer death rate for African-American women in the city was 116 percent higher than that for white women, according to Whitman's research. Albain's study analyzed records of more than 19,000 adult cancer patients in the U.S. who participated in 35 randomized phase III clinical trials and were followed for at least 10 years. The trials were conducted from 1974 through 2001 by the Southwest Oncology Group, a national research collaborative funded by the National Cancer Institute. African-Americans' risk of dying during the study period was found to be 61 percent higher for advanced ovarian cancer, 49 percent higher for early post- menopausal breast cancer, 41 percent higher for early breast cancer before menopause, and 21 percent higher for advanced prostate cancer. Whitman argues that the researchers did not adequately control for the socioeconomic status of participants, leading to faulty conclusions. "They don't have actual measurements of the characteristics of the [study participants], but only of the ZIP codes that people live in, which is totally unacceptable," Whitman said. "There are still residual social variables in life that make black people different than white people, and they have totally ignored all of that," he added. But the study's findings made sense to prostate cancer researcher Dr. Rick Kittles, an associate professor of medicine at University of Chicago Medical Center. "I wasn't surprised that if you control for socioeconomics there was this residential difference [between races] for these hormone-related cancers," he said. "There's obviously some biology that needs to be further explored." At the same time, he said, researchers looking into biological causes need to work closely with social scientists. "I believe that you can't discount social determinants in this equation," he said. Carole Brown, 51, who is African-American and started chemotherapy for breast cancer Tuesday at U. of C. Medical Center, said she thinks blacks are more likely to get a diagnosis later and die of cancer because they don't have the financial resources to get care. "A lot of people aren't working and can't get the right insurance," said Brown, a Woodlawn resident who works at O'Hare International Airport as a security coordinator for a caterer but has private insurance. Brown, who found a lump about three months ago, said she did not have a doctor from October through April because she couldn't find a health provider who would accept her insurance. The new study contributes to a body of work on cancer disparities, said Adrienne White, vice president for health initiatives and advocacy for the American Cancer Society's Illinois chapter and a member of the society's new African-American Disparity Task Force. "We recognized that whenever you deal with cancer disparities, or any health care disparity, you have to take into account biologic factors, socioeconomic factors, social-cultural factors and access to care and information," White said. "First and foremost, there is no single simple answer to any of this." Dr. Otis Brawley, chief medical officer for the American Cancer Society's national office, said the key cause of racial disparities is lack of proper treatment. "To get rid of the black-white disparity we need to work on simple logistic issues: getting people adequate care," said Brawley, who wrote an editorial that accompanied the study. Copyright © 2009, Chicago Tribune Copyright 2009 Baltimore Sun. GetWellNetwork in the loop Staff and Wire Reports Daily Record Wednesday, July 8, 2009 GetWellNetwork Inc., of Bethesda, announced it has added five hospitals to its network, bringing to more than 10,000 the number of hospital beds around the country that are tied to its interactive health care service. The hospitals are the Adventist Health System, Florida Hospital East Orlando in Orlando, Fla.; Children's National Medical Center neonatal intensive care unit, Washington, D.C.; Henry Ford West Bloomfield Hospital, West Bloomfield, Mich.; Miami Children's Hospital, Miami, Fla.; and West Jefferson Medical Center, New Orleans, La. GetWellNetwork's PatientLife System uses a patient's in-room television as an interactive source of personalized information, education and communications tools. Copyright 2009 Daily Record. In Retooled Health-Care System, Who Will Say No? Questions About Cost And Limits Linger By Alec MacGillis Washington Post Wednesday, July 8, 2009 The question came from a Colorado neurologist. "Mr. President," he said at a recent forum, "what can you do to convince the American public that there actually are limits to what we can pay for with our American health-care system? And if there are going to be limits, who . . . is going to enforce the rules for a system like that?" President Obama called it the "right question" -- then failed to answer it. This was not surprising: The query is emerging as the ultimate challenge in reining in health-care costs that now consume $2.5 trillion per year, or 16 percent of the economy. How will tough decisions be made about what to spend money on? In a country where "rationing" is a dirty word, who will say no? The question permeates all levels of medicine: the use of tests that many argue are unnecessary (U.S. doctors order five times as many MRIs as doctors do in Germany); how early to intervene with common conditions such as heart disease and prostate cancer; how aggressively to treat patients nearing their life's end. Although Obama and his advisers have held up providers' spending patterns as the crux of the crisis, proposals in Washington go only so far in addressing the thorniest questions about who gets what care. Instead, cost-saving measures are focused on introducing a public insurance option to compete with private insurers, or on general cuts in Medicare and Medicaid payments to hospitals. The bills being written would put new emphasis on evaluating treatments according to their "comparative effectiveness," or weighing the risks and benefits of different types of treatment for the same illness, but the bills stop short of incorporating cost-benefit analyses into the findings or of requiring that providers abide by conclusions. Lawmakers are also considering ways to reform Medicare payments to emphasize the overall quality of care over the quantity of treatments. But lawmakers are not going as far as Massachusetts did; it is considering shifting entirely from a fee-for-service model to one where salaried physicians would be paid an overall annual price for covering a given person or family. Such a shift would probably be a shock to the system of many Americans, who have grown used to having any and all health-care options, regardless of cost, available to them. "The questions of who gets what, these difficult choices . . . really are not posed in the current health reform legislation," said Drew E. Altman, president of the Kaiser Family Foundation. "The challenge," he said, "is us, the American people: We want the latest and the best, and we want it now." The Democrats' caution has not kept Republicans from accusing them of embracing rationing. They raise the specter of the British agency, which goes by the acronym NICE, that decides whether that country's nationalized health-care system will pay for items such as costly cancer drugs that extend lives a few months on average. "You're going to be saying to people, 'We're not going to care for you, because we've decided it's too expensive to care for you,' " said Robert E. Moffit of the right-leaning Heritage Foundation. Others retort that the United States already has rationing: The uninsured and under-insured do not get the care they need. "We're already doing it," said Stanford University epidemiologist Randall Stafford. "We're just doing it in such way that it doesn't service societal interests." But reformers are clearly spooked by the notion that they could be accused of denying, for example, hip surgery to an 80-year-old. In recent months, a federal panel has held hearings on how to spend $1.1 billion in economic stimulus money allocated for comparative effectiveness research. At each hearing, representatives of providers, industry and patient groups praised the research -- but then demanded that cost not factor into the eventual findings. Scott Wallace, a Bush administration official who is now the Batten Fellow at University of Virginia's Darden School of Business, said factoring cost into treatment decisions would create the same backlash that HMOs encountered in the 1990s. "A mother of five with cancer wins against any rationing scheme ever created," he said. Many physicians and health care-experts argue, though, that it is precisely by marshaling better research data, partly with the help of electronic health records, that a case can be built for limiting certain treatments. If doctors were to demonstrate to heart disease patients how few advantages coronary artery bypass graft surgery has over less expensive treatments, for example, many patients probably would not elect to undergo the surgery. At Kaiser Permanente, the California-based health network that relies heavily on such research, Permanente Foundation Executive Director Jack Cochran said fears of treatment denials were exaggerated. Doctors, he said, need to be more realistic about not raising vain hopes about expensive, last-ditch treatments: "Comparative effectiveness is a hot-button issue because everyone sees their pieces of pie coming under scrutiny. But all of our pieces should be under scrutiny." All signs in Washington suggest that cost considerations will be kept at arm's length as health-care legislation moves forward. Carolyn M. Clancy, director of the Agency for Healthcare Research and Quality, said the emphasis will be on clinical outcomes alone. The draft legislation in the Senate Health and Education Committee, meanwhile, stresses that any research findings "shall not be construed as mandates for payments in coverage and treatment." A senior administration official who requested anonymity to speak candidly acknowledged that while research might point to obviously wasteful practices, the reform would for the time being not get at the "harder question" of what to do "if new technology does work better and reduces risks but costs a lot more, and how to evaluate that." The other half of the "saying no" challenge, reformers agree, is giving providers the right incentives and structures to deliver high-quality care as affordably as possible. The goal is to spread the "accountable care" models featured by the Mayo Clinic and others, where a network of providers works closely together to coordinate a patient's care, increasing the odds of keeping them healthy and decreasing unnecessary procedures. Massachusetts, which has achieved near-universal health coverage but is struggling with high costs, is considering major changes in this direction. A legislative commission is about to release a report recommending that the state goad providers into joining networks that would receive payments for each enrollee, rather than for each procedure delivered. Proponents say it would differ from the "capitation" approach -- fixed payments for each member -- used by the HMOs in the past because there would be more focus on performance and long-term value than on simply keeping costs down. Skeptics say such a system would force the state's many solo practitioners or small groups of physicians into big networks and would renew complaints from the HMO era about limiting patients' choice. In Massachusetts, for instance, most parents with a sick child would demand access to Children's Hospital; and most cancer patients would want to go to the Dana-Farber Cancer Institute, no matter what network those were in. The plans being considered in Washington do not go nearly as far in seeking to change providers' spending habits. They contemplate changing some Medicare payments from fee for service to a "bundling" system in which providers would be paid for an entire episode of care, giving them an incentive to reduce repeat hospital admissions. Another idea is to empower the Medicare advisory panel whose recommendations now tend to be ignored by Congress, or to create a separate, Federal Reserve-like entity to make tough decisions about federal health-care spending. John C. Goodman, president of the conservative-leaning National Center for Policy Analysis, questions this approach, citing new research by his group that shows that areas with high Medicare spending do not correlate with high medical spending overall, suggesting that fixing excesses in Medicare will not necessarily translate to the broader system. Henry J. Aaron of the Brookings Institution, who co-wrote a 2006 book called "Can We Say No?" said that real cost reform would mean giving all physicians incentives to leave behind the fee-for-service model for accountable care networks. The transition will take a long time, he said, and at first, people could still sign up for fee-for-service plans. But they would see their neighbors getting good care at a much lower price and hopefully switch over themselves. "We're just not going to be able to all have everything . . . regardless of cost," Aaron said. Copyright 2009 Washington Post. Americans doubt insurance plans will cover cancer By Maggie Fox Reuters Wednesday, July 8, 2009 WASHINGTON (Reuters) - Fewer than half of all Americans trust that their health insurance plans would pay for the full costs of cancer treatment and nearly two-thirds falsely believe Medicare would not pay anything, according to a survey released on Wednesday. Nearly 70 percent of more than 1,000 adults surveyed said they were "very concerned" about paying for cancer treatments if they were diagnosed and 59 percent fear they would leave their families in debt. The survey, published by the Community Oncology Alliance, suggests Americans are both worried and misinformed about the state of the U.S. healthcare system and changes that might be made as Congress and the White House work to reform the system. And people rightly fear the expense of paying to treat cancer, the second-leading killer of Americans after heart disease, said Dr. Patrick Cobb, president of the alliance and a managing partner of Hematology-Oncology Centers of the Northern Rockies in Billings, Montana. Few private insurance plans pay the full cost of cancer treatment, which can run $5,000 a month and more, and Medicare without supplemental coverage pays for 80 percent of the cost, leaving patients to cover the remaining 20 percent themselves or find other coverage. "Monthly out-of-pocket costs for cancer care and treatment, not covered by private insurance plans or Medicare, can easily run to $1,000 or more," Cobb said in a statement. "For many cancer patients, the costs of diagnostic imaging, surgery and expensive cancer medications, especially in the first few months of treatment, can add up to well beyond $2,500 per month." The telephone survey of 1,022 adults by Opinion Research Corporation found close to 80 percent said they had known a relative or friend with cancer. Just 45 percent said they believed their private insurance plans would cover the full cost of cancer treatment, while only 25 percent thought Medicare, the federal health insurance plan for the elderly, would cover the full treatment costs. Sixty-four percent wrongly said Medicare would not cover any costs. And 33 percent said they would stop cancer treatment if it started getting too expensive. "Though the U.S. has the best cancer care delivery system in the world, the system is now in first-stage crisis because Medicare has substantially cut payments for cancer drugs and essential services," Cobb said. "Oncologists are spending an inordinate amount of time dealing with patient financial issues, including trying to find ways of navigating the insurance maze and identifying drug and co-payment assistance for patients in need," he added. Most of those surveyed -- 85 percent -- said they believed a government-run health plan would have significant disadvantages for cancer care, compared to their own private insurance plans. Close to three-quarters said it would mean higher taxes, 62 percent worried about longer waits for care and 56 percent thought the quality of care in general would fall. President Barack Obama has started pressing for a public insurance option to be offered alongside traditional private, employer-sponsored insurance. But opponents, including many Republicans in Congress, say a public plan would undermine the private plans and some groups have been running advertising campaigns about the issue. © 2009 Reuters. *Opinion* Change SSN assignment procedures Carroll County Times Editorial Wednesday, July 8, 2009 Improvements need to be made to the government’s system of assigning Social Security numbers, which have become increasingly easy to predict, according to a report published in the latest edition of Proceedings of the National of Sciences. Social Security numbers are assigned to every American and document membership in the government’s backup retirement plan for U.S. workers and the Medicare health plan for elders. Researchers were able to predict Social Security numbers using information available in public records. For people born after 1988, the year in which the U.S. government began issuing numbers at birth, researchers were able to identify the first five Social Security numbers for a staggering 44 percent of individuals on the first try. Researchers were also able to predict the full nine numbers for 8.5 percent of those people in less than 1,000 tries. Information about an individual’s place and date of birth can be used to predict Social Security numbers, as well as personal information available from data brokers or social networking Web site profiles, according to an abstract of the report. The remaining numbers can be discovered using computer programs that plug-in the final four digits until the code is cracked. Authors of the report say that the ease with which the numbers could be predicted increases the risk of identity theft, which cost Americans about $50 billion in 2007, according to an Associated Press article. While a Social Security spokesperson said there is no reliably foolproof way to predict someone’s number, the report does raise some questions about just how secure Social Security numbers are. When the program was created in the 1930s, people hadn’t even heard of personal computers and identity theft. Over time, however, many businesses and schools have began using Social Security numbers or portions of the numbers as passwords, parts of e-mail addresses or other forms of authentication, making this information more easily available to potential identity thieves. Unrelated to the report, according to the AP article, Social Security officials said a system to randomly assign Social Security numbers will be put in place next year. This is good for people born after the new program is rolled out, but doesn’t do much good for Americans who already have an assigned number. Employers and colleges should quit using Social Security numbers as a form of identification for workers and students, and people will need to work harder to protect the details that could lead to identify theft from being posted online. Copyright 2009 Carroll County Times. BACK TO TOP


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