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			Thursday, July 9, 2009 News Clipping Archives *Maryland / Regional* Health officials confirm second Md. H1N1 flu death (Washington Post) City moves to cut drug costs for residents (Baltimore Sun) Neighbors of Holy Cross hospital accept expansion, while residents near Suburban are fighting growth plan (Washington Post) Parents with autistic children reach out to help each other (Annapolis Capital) Families angry with hospital's patient care (Washington Post) Unwatched Boy Drowns in Pool In Apparent 'Tragic Accident' (Washington Post) GetWellNetwork in the loop (Daily Record) Fort Washington man shot, killed in Accokeek group home (The Gazette) *National / International* Administration Focuses on Swine Flu Preparedness (Washington Post) A growing problem: Children who need hormone injections to reach normal Height (Baltimore Sun) WHO approves cervical cancer vaccine Cervarix (Baltimore Sun) Experimental drug helps rabbits, monkeys survive anthrax infections; may aid people in attack (Baltimore Sun) Abortion pill used in a quarter of U.S. abortions (Baltimore Sun) Discord on Health Care Dulls Luster Of New Pacts (Washington Post) U.S. Prepared to Spend Billions on Swine Flu Vaccine (Washington Post) 'Double failure' at USA's hospitals (USA Today) Abortion Pill Study Suggests Way to Limit Infection (New York Times) The Caregiver’s Last Expense (New York Times) *Opinion* Food Fright (Washington Post Editorial) *Maryland / Regional* Health officials confirm second Md. H1N1 flu death By Stephanie Desmon Washington Post Thursday, July 9, 2009 A second Maryland death been linked to the H1N1 flu, state health officials said Wednesday. Officials would give very few details about the death, saying only that the person was younger than 65, a resident of the Baltimore metro area and had a serious underlying medical condition that contributed to the death. As of last week, the Centers for Disease Control and Prevention in Atlanta had reported 170 deaths from the swine flu nationwide, including the earlier death of an elderly woman from the Baltimore region. As of Wednesday, Maryland has 686 confirmed cases of the new flu virus, and officials have said that number is likely much higher because not everyone who gets sick goes to the doctor or is tested for the disease. The flu continues to spread in Maryland, even though flu season is long over. "Even though it's a time of year when we don't normally see much influenza, we know novel H1N1 will continue to be around through the summer and into the fall," health secretary John M. Colmers said in a statement. "Because of this, we want to make sure that people with underlying medical conditions who are more prone to complications check in with their healthcare providers if they develop influenza-like illnesses." Copyright © 2009, The Baltimore Sun. City moves to cut drug costs for residents Discount card adopted for uninsured By Angela J. Bass Baltimore Sun Thursday, July 9, 2009 Regardless of income, Baltimore residents can expect to start saving an average of 22 percent on their prescription drug costs, thanks to the city's newly adopted prescription drug discount card program sponsored by the National Association of Counties. Residents can pick up the card at local pharmacies, health clinics and libraries, and begin using it right away to reduce drug costs without filling out an application. An entire family can use a single card. "The discount card offers significant savings for the uninsured and underinsured residents of our city," said the city's interim health commissioner, Olivia Farrow. More than 100,000 Baltimoreans are uninsured, said Farrow, forcing many to pay steep prices for commonly prescribed drugs. "Even those fortunate to have prescription coverage can use the card to save money on drugs that are not covered by their health plan." Most pharmacies nationwide, including CVS, Rite Aid and Walgreens, accept the NACo card, which users need only present to the pharmacist behind the counter. Officials said supplies for vision, diabetes and hearing will not be discounted until next year. However, agency officials stressed that having full health coverage, something many low-income Baltimore City residents can get free of charge through several free Medicaid programs, is the best way to stay healthy. Participants interested in using the prescription card can look up the pre- and post-discount cost of prescriptions before going to the pharmacy by visiting caremark.com/naco or by calling 311. Nine out of 10 pharmacies nationwide accept the NACo card. Copyright © 2009, The Baltimore Sun. Neighbors of Holy Cross hospital accept expansion, while residents near Suburban are fighting growth plan By Andrew Ujifusa Washington Post Wednesday, July 8, 2009 Two expanding downcounty hospitals are having very different experiences trying to cooperate with adjacent neighborhoods. Officials at the Holy Cross Hospital in Silver Spring and nearby residents describe a collaborative design process that began almost two years ago and incorporated key residential suggestions. But for several years, Suburban Hospital in Bethesda and the adjacent Huntington Terrace Citizens Association have disagreed on a proposed expansion that will demolish 23 nearby hospital-owned homes and close one block of Lincoln Street, a residential thoroughfare. On June 22, County Hearing Examiner Martin Grossman recommended approval to the Board of Appeals of Holy Cross's expansion, which features a seven-story tower that will enable the hospital to utilize more single-patient rooms, and an extension of a parking lot to add 306 spaces. Both the tower and the parking facility will be built on the hospital's current 14.2 acre operating site on Forest Glen Road. Meanwhile, hearings about Suburban's expansion are entering their ninth month, with a hearing date scheduled on Monday before County Hearing Examiner Francoise Carrier. Suburban's proposed expansion, which would increase the hospital's operating site from 10 acres to 15.2 acres, would also add parking spaces and single-patient rooms, as well as new surgical suites and physician offices. Holy Cross has said it will not alter the current use of the 13 homes it owns in the nearby neighborhood that are used by nuns associated with the hospital or leased. Suburban has continued to buy homes not necessary to its current expansion plans, and closely considers homes up for sale in the block immediately north of its current facility on Old Georgetown Road. Neither expansion would add beds to the hospitals. Holy Cross currently has 454 licensed patient beds while Suburban is licensed for 228 beds. John Howley, a liaison to Holy Cross from the Forest Estates Community Association, said when the hospital first approached residents about expanding in September 2007, there were no drawings or blueprints. Instead, he said the hospital described its goals, and then asked how it could accommodate these needs while also respecting neighbors and their desires. Multiple meetings with both the architect and hospital CEO Kevin Sexton followed. "They came in with a concept and idea of what their needs were, and then we worked with them as they developed that," Howley said. As a result of the meetings, the 128-foot tower with the new single-patient rooms and enhanced surgical services was shifted from the northern to the southern part of the Holy Cross campus close to the Capital Beltway, so that it imposed less on residents. "The hospital adopted a plan that looked a whole lot like our recommendations," said Adam Pagnucco, a past president of Forest Estates. "We involved our community from the very beginning," said Holy Cross spokeswoman Yolanda Gaskins, noting that a similar process was used for a Holy Cross expansion finished in 2005. Huntington Terrace residents living near Suburban, however, describe a much less cooperative atmosphere. Amy Shiman of the neighborhood's citizens association said the neighborhood left the hospital's Community Panel for a Healthy Future, formed in 2005, because the hospital's expansion plans were set in stone before the panel began. "Our input was not sought out, it was not being even recorded, and we were the most relevant community because this is our neighborhood," Shiman said. Shiman noted that Suburban will continue to have significantly fewer patient beds than Holy Cross after the expansion. She criticized the hospital's desire to "sprawl" over the neighborhood rather than expand vertically as Holy Cross has proposed with the 128-foot tower. Holy Cross has requested a 17 percent increase in the ratio of its buildings' footprint to the campus size, while Suburban has not sought such a variance from county guidelines. Margaret Fitzwilliam, however, a planning director for capital projects with Suburban, said trying to link the number of beds to an appropriate density was misplaced, since the new surgical suites and other support facilities required additional space. Leslie Weber, a senior vice president with Suburban, said the hospital has tried to engage the neighborhood since 2001 in multiple discussions, but that the neighborhood simply did not accept "what the hospital defined as medical need." She did say that Suburban presented preliminary plans to Huntington Terrace in 2005 that were farther along than what Holy Cross presented nearby residents in 2007. Weber said multiple suggestions from members of the Community Panel resulted in changes to the parking structure and physician offices. She said building on its current operating site would force the hospital to shut down for periods of time, something the hospital would not contemplate. "We are dealing with a very tight, constrained campus," Weber said. Hospital officials said Carrier's recommendation to the county's Board of Appeals on Suburban may not be issued until the fall. Shiman said she hoped the recommendation would be issued by that time. Copyright 2009 Washington Post. Parents with autistic children reach out to help each other By Theresa Winslow Annapolis Capital Thursday, July 9, 2009 Six years ago, Alison Hamilton's life was in turmoil. Her oldest daughter, Leah, was just diagnosed with autism, and she'd just given birth to twin girls. "It was devastating," she said earlier this week. "And I couldn't help thinking, I had these two gorgeous new babies … what if it happens to them, too?" Luckily, her twins are OK, and Leah's made a lot of progress with the help of providers and advice from other parents with autistic children. And now Hamilton's trying to return the favor by helping to start a local chapter of the support group Talk About Curing Autism (TACA). The chapter, which is one of 24 throughout the country, serves both Anne Arundel and Montgomery counties, and has meetings in both regions. Since March, there have been two meetings in this area, and another is scheduled for 6:30 p.m. Aug. 30 at 130 Lubrano Drive in Annapolis. The group also holds more informal "coffee talk" sessions, one of which is set for 7 p.m. July 30 in the cafe at the new Whole Foods in the Annapolis Towne Centre. "I want to pay it forward," said Hamilton, 38, of Crofton. "There is no single road map, and that's where it can help to network with people. The networking has made a huge difference (for me)." The initial TACA meeting served as an introduction to the group, but some discussion of treatments also arose, she said. The second local meeting featured a physician who sees a lot of autistic children. About 30 people from throughout the region attended each gathering, Hamilton said. The interest didn't come as a total surprise, but she was pleased by the turnout. Hamilton said she was fairly certain there was a need in this area for TACA or something like it. "We've had some people say, 'I feel like I'm home. I found my group,' " she said. "We're thrilled. We're very pleased." Denice Rulo, of Severna Park, who has one son with autism and another with Asperger syndrome and also helped form the TACA chapter, said the group can help people navigate through what can be a daunting amount of information. "It's all about figuring out what's available out there," she said. "(Doctors) say that 'A' word. That's a huge bomb in front of you and early intervention is the key, but they don't tell you what that early intervention is." Like Hamilton, Rulo said she was helped by other parents and wants to repay their kindness. "He's come a long way," she said of her son, Jacob, 7, "and I owe it to the moms I've met along the way. We have each other." TACA members have other resources as well. Everyone who comes to a meeting gets a free copy of the organization's "Autism Journey Guide," said Rebecca Estepp, TACA's national manager. The 351-page guide is packed with all kinds of information about the disorder, as well as different therapies and diets. "TACA helps parents 'hands-on' through a variety of ways: support meetings, new parent seminars, parent mentors and a Web site with a live chat option," Estepp wrote in an e-mail. She added that parents also can call the main office in California for assistance. "TACA aims to give parents real, tangible help as quickly as possible," Estepp added. *Helping hand* It's hard to miss Hamilton's home, thanks to the large puzzle piece hanging from the front door. The puzzle piece is a symbol for autism, and serves as a kind of calling card for her involvement in the cause. She also has a couple autism stickers on the back of her minivan and an autism-related license plate holder as well. "It's part of our lives, you know," she said. "I believe in autism awareness, especially with the rising number of children with these diagnoses. It truly is a tidal wave." Jill Zaukus, of Pasadena, another parent who helped organize the chapter, said one of the most important things the group can provide to families is hope. She said hope is what keeps her going, too, as she faces the challenges of rasing her two autistic sons, Andy and Bradley, 8 and 7. Like Hamilton, Zaukus said life is a series of constant adjustments, with schedules built around therapy appointments. But both women are resolute in their determination to help their children and other families grappling with autism. "We keep trying," Zaukus said. "It's not that we don't accept our kids, but we're always striving for more - and that's our hope. There could always be some new therapy, some new treatment." For more information about the local TACA chapter, visit the Web site at meetup.talkaboutcuring autism.org/maryland/index.html. There's also a Yahoo group, which has 65 members and is available to parents and caregivers: health.groups.yahoo.com/group/TACAMarylandDC. For general information about TACA, visit the Web site at www.tacanow.org. Copyright © 2009 \| Capital Gazette Communications, Inc., Annapolis, Maryland. Families angry with hospital's patient care Doctors Community promises change after penalty for not reporting errors By Liz Skalski Washington Post Thursday, July 9, 2009 The families of several patients who have died or been injured while being treated at Doctors Community Hospital in Lanham say they are angry with the hospital's patient care and have considered suing for malpractice. The hospital received a steep fine in February from the state's Office of Health Care Quality for not notifying them as required that a patient had died and that at least seven other people suffered serious harm in 2008 from medical staff mistakes. A survey from the Maryland Department of Health and Mental Hygiene's Office of Health Care Quality completed Jan. 8, 2009, shows 14 different cases of patients at the hospital who were victims of medical malpractice from January to November 2008. Scott Gregerson, a Doctors Community Hospital spokesman, said the hospital paid the $30,000 fine in May and no lawsuits have been filed against the hospital as a result of the survey's findings. "We are in full compliance with the plan of correction submitted to [the] state, through educational efforts [which] will obviously be ongoing," Gregerson said. Gregerson said that the hospital and its staff can't comment on specific cases named in the Office of Health Care Quality survey or about patient care. Hospitals must periodically report to the office and are required to report errors, like surgery on the wrong limb, a patient taking the wrong medication or an infection from an IV line. The Office of Health Care Quality will follow up at Doctors in a few months to ensure the changes are being made. In a February letter to Wendy Kronmiller, the office's director, Doctors Community president Philip Down detailed the hospital's plan to improve its compliance and said hospital officials are "extremely concerned about the noted deficiencies. We immediately formulated a plan of action after meeting with our senior physician and administrative staff regarding oversight of adverse event reporting." Glenn Dale resident Peggy Terry, 73, said she believes her son, Mark Terry, is one of the patients described in the report and said recently she is considering suing the hospital for malpractice. The Office of Health Care Quality survey shows the patient was admitted to the hospital in January 2008 with a severe blood stream infection and liver disease, which sometimes made him confused. The survey also states that the patient was found by a nurse sitting on the floor, and later he complained of a severe headache and was given pain medication. The survey does not state that the patient was evaluated by a physician after the fall, only by a nurse. Peggy Terry says that later that day Mark Terry fell into unconsciousness and doctors performed a head scan that found a subdural hematoma - a collection of blood on the outer membrane of the brain, usually due to a head injury - on the left frontal lobe. The 46-year-old Glenn Dale resident died Feb. 10, 2008. Records show the hospital didn't investigate the fall or report the man's death to the state. Peggy Terry said the hospital won't say if her son fell out of bed. The death certificate cites Mark Terry's primary cause of death as respiratory failure, chronic obstruction and lung disease, although Peggy Terry said she believes his death was the direct result of the fall and intracranial bleeding reported in the death certificate. Dr. Robert Stevens, an assistant professor of anesthesiology and critical care medicine, neurology and neurosurgery at the Johns Hopkins University Hospital in Baltimore, said the procedure at the Johns Hopkins University Hospital in the event of a patient fall is for the on-call physician to assess the patient. "The standard of care would be that if a patient falls out of bed, the responsible physician will evaluate," he said. James O'Neil, 80, of Lanham was admitted to the hospital March 1 of this year and died of colon cancer on March 18. O'Neil's case is not listed in the survey because the state review included only 2008 cases. His widow, Phyllis O'Neil, 75, of Lanham said that while her husband being treated by the hospital, he was only bathed twice during his 17 days in the hospital, and she says a hospital room was so dirty she asked staff to clean it before her husband was moved to it. Other Doctors Community Hospital malpractice patient cases cited in the Office of Health Care Quality report include a patient who came to the hospital in March 2008 to have a cataract removed and a lens implanted. During the surgery, a lens with the wrong strength was implanted, and the hospital failed to follow up with an investigation. In another case, two patients were scheduled for cornea transplants in September 2008, and their eye tissue was accidently switched and transplanted into the other patient's eye. The survey states that no follow up was noted with the personnel involved and an investigation wasn't conducted into the prevalence of this event, which the state office said may help prevent the event from reoccurring. E-mail Liz Skalski at eskalski@gazette.net. Copyright 2009 The Gazette. Unwatched Boy Drowns in Pool In Apparent 'Tragic Accident' By Matt Zapotosky Washington Post Thursday, July 9, 2009 A 19-month-old boy left unattended in his mother's Charles County home Tuesday wandered into the back yard and apparently drowned in a pool, police said yesterday. Jason Daniel Burke Jr. was discovered by his mother just after 8:30 p.m. Tuesday lying unconscious in an aboveground pool in the 4300 block of Middletown Road in White Plains, said Diane Richardson, a spokeswoman for the Charles County Sheriff's Office. He was taken to a nearby hospital, where he was pronounced dead, authorities said. Richardson said the mother had left her house to run an errand, telling the toddler's 15-year-old cousin, who lives in the house, to watch the boy while she was gone. The cousin, Richardson said, left to go fishing. "We're still trying to determine whether the teen was aware that the child was still in the house," Richardson said. "All indications are that this is a tragic accident." Jason, who was asleep in a bedroom when the cousin went out, left the house through the back door, walked about 65 feet to the pool and climbed the steps to get in, Richardson said. The pool stands about four feet off the ground, she said. When the mother returned, no one was in the house and the baby gate was on the floor, Richardson said. The mother called police to report her son missing, Richardson said, then called back to say she had found him in the pool. A man who answered the door at the mother's home declined to comment. He said the mother was in the hospital because she was feeling "unstable" after the incident. The boy's body was sent to Maryland's Office of the Chief Medical Examiner in Baltimore for an autopsy, authorities said. Police said the death appeared to be accidental and didn't expect charges to be filed. Richardson declined to identify the child's mother. Copyright 2009 Washington Post. GetWellNetwork in the loop Staff and wire reports Daily Record Thursday, July 9, 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. Fort Washington man shot, killed in Accokeek group home Police Chief Hylton issues statement noting increased crime in group homes By Joshua Garner The Gazette Wednesday, July 8, 2009 A Fort Washington man was shot and killed early Tuesday morning at a group home in Accokeek, according to Prince George's County police. Stephone Robinson, 23, of the 12000 block of Langner Drive was found shortly after 1:30 a.m. in a home along a rural stretch of Accokeek Road in the 1500 block, suffering from a gunshot wound. He was pronounced dead at the scene, according to police. Police Chief Roberto L. Hylton issued a statement Tuesday noting the increased crime in group homes throughout the county. "The police department has noted a number of escalating crime issues involving group homes," he stated. "We need a process of registration in which police departments are notified in a timely manner about the status of group homes within their jurisdictions. Furthermore, a stringent inspection system is needed to ensure that these homes are following all state and local regulations to ensure their safe operation." Police say a second man also was found at the same location suffering from a gunshot wound. He was taken to a local hospital and listed in critical condition on Wednesday; his name has not been released. The investigation is continuing. Anyone with information about the case is asked to call the Prince George's County Police Department's Homicide Unit at 301-772-4925. Callers wishing to remain anonymous may call Crime Solvers at 1-866-411-8477. The Prince George's County Police Department is offering a cash reward of up to $25,000 for information that leads to an arrest and indictment. E-mail Joshua Garner at jgarner@gazette.net. Copyright 2009 The Gazette. *National / International* Administration Focuses on Swine Flu Preparedness By Spencer Hsu and Michael D. Shear Washington Post Thursday, July 9, 2009 The Obama administration today will try to restore a sense of urgency in combating the worldwide H1N1outbreak, known as swine flu, with an all-day summit that brings together federal and state health officials at the National Institutes of Health. Public and governmental awareness of the flu pandemic spiked this spring with fears that the new strain could resist treatment and ravage the population. That attention has faded as it became clear that most cases were mild and required no medical treatment. But the summit comes amid reports that infection rates have not subsided this summer as some experts had anticipated, forcing countries such as Britain to shift their response. The World Health Organization has said that 2 billion people could eventually be infected worldwide. "Scientists and public health experts forecast that the impact of H1N1 may well worsen in the fall -- when the regular flu season hits, or even earlier, when schools start to open -- which is only five or six weeks away in some cases," Health and Human Services Secretary Kathleen Sebelius said in announcing the summit on July 2. The all-day gathering in Bethesda will also be led by Homeland Security Secretary Janet Napolitano, Education Secretary Arne Duncan, and Homeland Security Advisor John Brennan. Some health officials have expressed concern that the country may not be ready to do battle if a more virulent form of the virus emerges this fall. Last spring, federal officials said some local communities were far more prepared than others to deal with a severe outbreak. And local officials have urged the federal government to take more action in coordinating the country's response. Robert M. "Bobby" Pestronk, executive director of the National Association of County and City Health Officials, said his group has encouraged the White House to engage and educate local and state elected officials about the central role they will play in a major health response, especially because scientific information is fast-changing. "It's especially important in a large-scale outbreak because the information that people get needs to be accurate and consistent," Pestronk said. "We're concerned and the situation is urgent." State and local officials say they expect the Obama administration to share in far more detail a national U.S. strategy to combat the pandemic, bringing together the three major agencies involved, the departments of Health and Human Services, Homeland Security and Education. They also are looking for money. Congress approved $350 million for state and local responders in a recent supplemental war funding bill, which the administration is set to distribute. Public health officials said they could need $3 billion if the H1N1 virus mutated into a more deadly form this fall. One key deadline is the opening of schools starting next month. While federal efforts have concentrated on development of a new vaccine, officials at all levels of government say they need a clearer understanding of what steps to take if it becomes necessary to limit public gatherings or other social contact. Last spring, federal health officials gave conflicting guidance to schools with suspected cases, initially recommending that that they close for 14 days, before judging based on additional information that it was enough for infected persons to stay home. Secretary of Education Arne Duncan, who will also attend the summit today, said in a statement last week that school systems "will continue following guidance from the Centers for Disease Control and Prevention and encouraging schools and districts to be in close communication with their local public health authorities and political leadership." Local health departments need guidance on such "community mitigation" measures as soon as possible, one non-federal official said, speaking on condition of anonymity, to begin preparing plans and to free up resources that can be devoted elsewhere. The official said it has been "slightly unclear" who at the federal level is making such decisions. Another non-federal health official said U.S. authorities have worked furiously since the outbreak was reported to April, and he expected new planning assumptions and strategies and tools to be laid out. Copyright 2009 Washington Post. A growing problem: Children who need hormone injections to reach normal height The Orlando Sentinel By Linda Shrieves Baltimore Sun Thursday, July 9, 2009 Madeline Truman Dang stands a few centimeters shy of 5 feet tall. Although she longs to be taller, the 12-year-old knows she's lucky to be as tall as she is -- doctors once warned her parents that Madeline might not grow more than 4 feet tall. But, thanks to eight years of daily growth-hormone injections, Madeline will now be able to drive a car without adding pedal extenders when she's 16. She may still need to use a step stool to reach high cabinets, but she will not need special accommodations throughout her life. "As a parent, it's a relief," says her mom, Melanie Truman of Orlando. "You want your child to live a normal life." Although many Americans are confused about human growth hormone -- thanks to news of athletes illegally using it to improve their performance -- there are thousands of parents around the country using the drug to help children who, without it, might not grow to a normal height. Endocrinologists estimate that 1 in 10,000 children may be growth-hormone deficient. "Heightism in America is a huge cult," says Dr. Paul Desrosiers, chief of pediatric endocrinology at Arnold Palmer Hospital for Children. "It's overwhelming, and kids end up at the behavioral pediatrician's office and psychologists' offices all the time." For years, short children were viewed as just that -- short people. But if a child's body isn't producing enough growth hormone, he or she could also have a weaker heart, less lung capacity and suffer from early osteoporosis. And that, for many parents, is more frightening than the prospect of a child who may be short. "People ask us if it's cosmetic [treatment]," Truman says. "And it's frustrating because I always have to explain that this is a medical condition. ... If your kid was diabetic, would you not give them insulin?" For Madeline's parents, the medical mysteries began at age 2. At first, doctors thought she wasn't growing because of a severe case of reflux, so they installed a feeding tube in the toddler. By age 4, Madeline's weight was normal for her age, but she wasn't getting taller. After a series of tests, doctors discovered that Madeline's body wasn't producing enough growth hormone, through the body's pituitary gland that regulates growth. For her parents, the news was both good and bad. Good, because they finally had found the problem. The bad news was soon obvious: Madeline would require daily shots of growth hormone for years, an expensive regimen for which many insurance companies refuse to pay. Madeline was lucky, however. At the time, her family was living in South Carolina, where she was added to the state's high-risk insurance pool for people who are uninsurable. And when Madeline and her mother moved to Florida in 2004, her ex-husband, who owns a small business, shopped around until he found an insurance plan that would cover Madeline's medication. The cost of treatment is prohibitive. Last year, Madeline's treatment cost $20,000, although her insurance picked up most of the cost. The treatment is not used to make NBA superstars out of children whose parents are short, Desrosiers says. "It's very hard to take a child and make them taller than their parents are," Desrosiers said. "Your goal is to get children to mid-parental height." During treatment, children often gain 4 to 6 inches in the first year -- which doctors call "catch-up growth" -- before slowing to an average of 4 inches a year. There can be complications, including headaches caused by intracranial pressure, which doctors treat by lowering the dose temporarily. Patients with scoliosis are not good candidates because their scoliosis will get worse. And though it's rare, the growth plates in the hips of some children have slipped, requiring surgery to screw them together. Doctors also screen carefully for patients who might have childhood diabetes in their family, or any family history of tumors and leukemia. Despite the small risk of side effects, many parents have mixed feelings about the treatment. Alyson Innes, of Orlando, is 5-foot-1 and her husband is 5-foot-8, so she wasn't concerned that her son, now 3, was the smallest kid in his preschool class. But when the doctor told her that his heart and lungs weren't growing either, she decided to try two therapies: a gluten-free diet (to treat his regular bouts of diarrhea) and growth-hormone therapy. Now he's growing and starting to catch up to his peers. Innes, however, hopes he can be weaned off the hormone. "I don't want to give him hormones until he's 15 or 16," Innes says. Yet many patients make peace with their daily hormone injections. Madeline, now 5 feet tall, isn't going to grow any taller -- according to X-rays, her growth plates have closed. She's thrilled that she no longer has daily injections. But deep down, Madeline wishes she could grow a little more. "Sometimes, you get tired," she says with a shrug, "of being the shortest person in the room." Copyright © 2009, South Florida Sun-Sentinel. WHO approves cervical cancer vaccine Cervarix The Associated Press Baltimore Sun Thursday, July 9, 2009 LONDON - The World Health Organization has approved a second cervical cancer vaccine, this one made by GlaxoSmithKline, meaning U.N. agencies and partners can now officially buy millions of doses of the vaccine for poor countries worldwide. GlaxoSmithKline PLC said in a statement Thursday the approval would help speed access to Cervarix globally. WHO had previously approved Gardasil, a competing cervical cancer vaccine made by Merck & Co. With two cervical cancer vaccines now ready to be bought by donor agencies, officials estimate that tens of thousands of lives might be saved. More than 80 percent of the estimated 280,000 cervical cancer deaths a year occur in developing countries. In the West, early diagnosis and treatment has slashed the disease's incidence. Last year, the global health association GAVI, formerly known as the Global Alliance for Vaccines and Immunization, prioritized the purchase of cervical cancer vaccines for the world's 73 poorest countries. GAVI includes U.N. agencies, the World Bank and the Bill & Melinda Gates foundation and is a major buyer of vaccines for the developing world. "We're very eager to offer women in developing countries these vaccines because without early screening, they are arguably more vulnerable to cervical cancer," said Dan Thomas, a GAVI spokesman. Thomas said the vaccine's price was essential to making it available to poor countries. In the West, the vaccines typically cost about $360 for a three-shot dose -- which is far too expensive for poor countries, Thomas said. Thomas said GAVI is in talks with drugmakers, but that it is still not clear whether either Merck & Co or GSK might sell their vaccines to donor agencies at a cheaper price. Cervarix has not been approved for use in the U.S. or Japan, but is available in 97 other countries. In the U.S., the cervical cancer vaccine market has been cornered by Gardasil since it was approved in 2006. The FDA is expected to decide within the next few months whether to approve Cervarix. Gardasil racked up $426 million in global sales in the most recent quarter, versus $69 million for Cervarix, which has won more contracts from government health programs beyond the United States. Copyright 2009 Associated Press. All rights reserved. Experimental drug helps rabbits, monkeys survive anthrax infections; may aid people in attack By Malcolm Ritter Baltimore Sun Thursday, July 9, 2009 NEW YORK (AP) - An experimental drug helped monkeys and rabbits survive anthrax in a series of studies, suggesting it could be useful in case of another anthrax attack. In 2001, five people died after inhaling anthrax germs they'd gotten through the U.S. mail. Doctors now use antibiotics to prevent or treat anthrax, and there is also an anthrax vaccine. The experimental drug works a different way - by blocking deadly anthrax toxin from entering cells. Researchers say it could be combined with antibiotics. The company that developed the experimental drug under federal contract has already delivered 20,000 doses to the government for emergency use. It has also asked the Food and Drug Administration to approve the drug - called ABthrax - under a rule that lets animal studies substitute for human studies when it's not feasible to test a drug in people. Results of the federally funded animal research are presented in Thursday's New England Journal of Medicine by researchers at Human Genome Sciences of Rockville, Md. In one experiment, monkeys got a single dose of a dummy injection or ABthrax two days before inhaling a lethal dose of anthrax. Those that got the placebo died within six days. But of those that got ABthrax, 7 of 10 in one group and 9 of 10 in a higher-dose group were still alive about a month later. In another experiment, monkeys inhaled anthrax and then were treated after showing signs of infection. Four weeks later, half of the 14 monkeys in one group and 9 of 14 in a higher-dose group had survived. Rabbit experiments also showed protection. When treated after signs of infection, for example, 8 of 18 rabbits remained alive two weeks later. In contrast, rabbits that had gotten a placebo all died within five days. The researchers also injected 333 people with ABthrax to check on safety. The only serious development possibly related to the drug was an inflamed gallbladder, which researchers said was probably due to an underlying medical condition. In an editorial accompanying the study, Dr. Gary Nabel, director of vaccine research at the National Institute of Allergy and Infectious Diseases, said results suggest ABthrax could provide "an important addition to the existing arsenal" that doctors have against anthrax. On the Net: New England Journal: http://www.nejm.org Anthrax information: http://www.bt.cdc.gov/agent/anthrax/basics/factsheets.asp Copyright 2009 Associated Press. All rights reserved. Abortion pill used in a quarter of U.S. abortions The Associated Press By Linda A. Johnson Baltimore Sun Thursday, July 8, 2009 TRENTON, New Jersey - Roughly a fourth of American women getting early abortions last year did so with drugs rather than surgery, statistics show, as a new study reported improved safety in using the so-called "abortion pill." Some experts predict the percentage of such "medical abortions," which offer more privacy than surgical termination at an abortion clinic or hospital, will rise even more due to the new study. The research, done at Planned Parenthood clinics across the country, shows that a new way of giving pills to induce abortion virtually eliminated the risk for a rare but dangerous infection. "This is the first really huge documentation of how safe and effective medical abortion is," said Dr. Beverly Winikoff, a professor of family health and population at Columbia University. "The technology is very good and very well used in this country, and probably will be used more and more." Two pills are used to induce an abortion. The primary drug, Mifeprex, was first approved in the U.S. in 2000. Use has risen steadily, even though manufacturer Danco Laboratories LLC of New York hasn't promoted it and the drug can only be obtained at a clinic or doctor's office, not through a pharmacy. Sales rose 16.5 percent last year, when about 184,000 American women used Mifeprex. Medical abortions now account for about a quarter of early abortions, according to company spokeswoman Abby Long. At Planned Parenthood, the biggest provider of medical abortions, they amount to 32 percent of early terminations. The group's study analyzed medical abortions at Planned Parenthood centers between 2005 and mid-2008 -- about 228,000 cases. It found the abortion pill was about 98.5 percent effective and that changes in how the drugs were given reduced risk of a serious infection from barely 1 in 1,000 cases to 0.06 in 1,000. The results are reported in Thursday's New England Journal of Medicine. The procedure, which works during the first nine weeks of pregnancy, involves swallowing Mifeprex, known chemically as mifepristone, at a doctor's office. Originally known as RU-486, the pill causes an embryo to detach from the uterine wall. A second pill, misoprostol, is used 24 to 48 hours later to cause contractions and push the embryo out of the uterus. These drugs are different from Plan B, which is taken within a couple days of contraceptive failure or unprotected sex to prevent pregnancy from occurring. Originally, the procedure involved inserting the misoprostol pill into the vagina where the medicine was absorbed. But by the end of 2005, four American women and one Canadian had died of a rare bacterial infection afterward, spurring concern among providers and criticism by abortion opponents. So in April 2006, Planned Parenthood told its 300 clinics offering the procedure to instead have patients put the misoprostol pill in their mouth and let it dissolve. Some clinics also began providing a week's course of antibiotics to avoid infection; the others tested women and treated any with sexually transmitted diseases. In 2008, all the clinics started giving patients antibiotics. "We decided we needed to make a safe procedure even safer," said the study's lead researcher, nurse practitioner Mary Fjerstad. By the study's last six months, serious infections had declined to one-16th of the original rate. "I think that providers are going to be pretty impressed with the data," said Dr. Beth Jordan, medical director of the Association of Reproductive Health Professionals, which plans to highlight the findings to doctors, nurse practitioners and pharmacists at its annual meeting in September. Given that 87 percent of U.S. counties have no abortion provider, Jordan said the findings might encourage some primary care doctors to offer abortion using the pills. "But I don't think it's going to open the floodgates," she said. In October, the National Abortion Federation, representing 400 centers that provide more than half of abortions in the U.S. and Canada, will review the findings and decide whether to make changes accordingly. Federation President Vicki Saporta said current guidelines allow putting misoprostol in the cheek to dissolve, swallowing it, or inserting it in the vagina, which more than a third of her member clinics do. Saporta said abortion opponents "have been misleading people into thinking that medical abortion is unsafe," but the study proves the procedure is safe. The cost is $400, only slightly less than the median cost for an early term surgical abortion. Since approval in 2000, there have been six deaths from sepsis, a bloodstream infection, among the more than 1.1 million American women who have used Mifeprex, most recently one in July 2007. That's a death rate of less than 1 in 167,000, according to the maker, and less than 0.1 percent of patients have needed transfusions. Misoprostol, which is officially approved in the U.S. for preventing stomach ulcers, is sold under the brand name Cytotec and made by Pfizer Inc. Winikoff and Saporta both raised concerns about giving a full course of antibiotic treatment to all women to prevent very few infections -- unlike the brief preventive dose given with surgical abortions. They said that could trigger a rare allergic reaction, add to the problem of antibiotic resistance and add to the cost of the procedure -- making it unaffordable in developing countries. Chris Gacek, a senior fellow at the anti-abortion Family Research Council, said he wasn't surprised by the increasing use of Mifeprex. "I don't think at this point we're going to do anything" to try to limit its use, he said. "It's hard to know whether this increases the (total) number of abortions." ___ On the Net: www.nejm.org Mifeprex site: www.earlyoptionpill.com Copyright 2009 Associated Press. All rights reserved. Discord on Health Care Dulls Luster Of New Pacts Allies Sour on Effort as Obama Woos Industry By Ceci Connolly and Michael D. Shear Washington Post Thursday, July 9, 2009 The Obama administration, hoping to boost its health-care reform effort with financial concessions from the hospital and pharmaceutical industries, is instead confronting deep dissension on several fronts within Democratic ranks and possible defections among key constituencies. Rep. Henry A. Waxman (D-Calif.), lead House architect of the landmark health legislation, warned yesterday that he is not obligated to abide by deals struck recently by the White House, Senate Finance Committee, industry executives and interest groups such as AARP. "The White House is not bound. They tell us they're not bound by that agreement," Waxman, the chairman of the House Energy and Commerce Committee, said at a National Journal breakfast. "We're certainly not bound by that agreement. The White House was involved, and we were not." Waxman's comments came amid several other warning signs for the administration, including a slipping timetable in the Senate, internal division in the hospital industry and mounting tensions between AARP and the pharmaceutical industry that threaten a temporary detente between the two negotiated last month by the White House. And a day earlier, President Obama took the unusual step of issuing a statement from Moscow correcting comments by White House Chief of Staff Rahm Emanuel that creation of a government-sponsored insurance program is "negotiable." No single development appeared likely to kill Obama's signature domestic agenda item, but the relentless barrage of challenges that seemed to hit hourly served to demonstrate why no president since Lyndon B. Johnson has been able to enact large-scale health legislation. From the outset, Obama has declined to dictate the details of a health-care bill to Congress, but he and his most trusted advisers have worked aggressively to shape its parameters and build political support. At the core of their strategy has been a series of side agreements aimed at extracting revenue, neutralizing potential adversaries and signaling to lawmakers that when the difficult votes come, they will have the political cover of industry support. "All the constituencies that have been the most vocal critics of any form of health reform in the past are now invested in its success," Emanuel said in an interview. Yesterday, Biden trumpeted an agreement by the nation's hospitals to contribute $155 billion to the cost of health reform, but it was quickly undermined by skepticism in the industry. Two public hospital systems left out of the talks suggested the reductions "could severely damage" hospitals that serve the poor. American Hospital Association representatives from Virginia, Wisconsin, Montana, Washington and Oregon also were raising objections internally to the deal's across-the-board Medicare cuts. "Everyone can say we need to reform the system," said one state hospital official, who requested anonymity to discuss the internal rift. "But when you start to look at the details of how you do that, that's when you get the rats scurrying off the ship. That's what's happening now." Senate Majority Leader Harry M. Reid (D-Nev.), after warning that some Democrats cannot tolerate taxes on employer-sponsored health benefits to finance comprehensive reform, met with four Republican senators in pursuit of a bipartisan approach. Reid assured the group that the Senate legislation would not be rushed, said Sen. Charles E. Grassley (R-Iowa). The White House campaign to disarm industry began two months ago with an announcement by six interest groups -- including doctors, insurers and organized labor -- that they would "do their part" to slow the rate of growth of health-care spending by 1.5 percentage points a year. "The quid pro quo is 'I'll give you savings if you let me play,' " said Dan Mendelson, president of the consulting firm Avalere Health. Next came a proffer of $80 billion by the drug industry's Pharmaceutical Research and Manufacturers Association, or PhRMA. Drug companies pledged to increase rebates to the federal government and provide 50 percent discounts on prescription medications for seniors who fall into Medicare's "doughnut hole." Once a senior passes his initial coverage limit, he must pay 100 percent of the cost of prescription drugs before he reaches the threshold of catastrophic coverage. Enticed by the savings for seniors, AARP, with its 40 million members, blessed the deal with the drug industry in a photo opportunity at the White House with Obama. "The most significant element of this was AARP," said one administration aide working on health policy. "The seniors were less than enchanted with the notion of health-care reform," said PhRMA chief W. J. "Billy" Tauzin. The deal "gave them a reason to be supportive." But both sides now make clear that the accord was on the single issue of the Medicare drug discount, and they remain far apart on several other potentially explosive issues. In a private meeting at the White House on Tuesday, the chief executives of five pharmaceutical companies informed Emanuel and White House health czar Nancy-Ann DeParle that they have serious concerns about proposals to allow the purchase of imported medications and on regulations on generic biologic drugs, Tauzin said. The Biotechnology Industry Organization, a trade group, and AARP sparred publicly over the generics issue and how many years of patent exclusivity should be given to those products. "Now one of the nation's largest health insurers, the AARP, says 'cheap and fast' should drive the biosimilars health-care debate," BIO charged in a radio spot. BIO, in pushing for a minimum of 12 years of patent protection, is "asking for a protection deal twice as sweet" as those given to traditional drugmakers 25 years ago, said AARP spokesman Jim Dau. "The real question is: How much more money do they think they can wring out of patients and taxpayers?" The administration had expected a good-news bump yesterday from Biden's event with the hospitals. But several state hospital lobbyists formed the "Value Coalition" to push back against a one-size-fits-all deal. In a document distributed to the 50 state associations that make up the American Hospital Association, the group argues for a different approach. "America's hospitals and the communities they serve are very concerned about any proposal that relies on payment cuts as the primary means by which to fund reform efforts," the document says. Instead, it argues for an "incentive" system that rewards -- not penalizes -- hospitals that have already cut costs. That proposal was hotly discussed by state association leaders during a 5 p.m. conference call on Tuesday, according to a participant. The coalition plans to go public with its objections soon. One state association member who helped draft the alternative proposal said the group is not trying to derail health-care reform legislation. "Much of the agreement . . . has merit, and we would support those provisions. Where we have a major problem is across the board Medicare cuts," the member said. "Such a move merely penalizes low-cost providers when our lower cost should be recognized and perhaps rewarded." Even if the side deals between the White House and industry hold, several House Democrats reiterated that they will have limited impact on them. "The people who write the legislation are the members of Congress," said Rep. Diana DeGette (D-Colo.). "We appreciate these discussions, but everybody is well aware legislation has to come through the House and Senate." Emanuel, however, thinks the desire for affordable health-care reform will trump concerns over specific legislative provisions. "It leaves those who oppose reform as the defenders of the status quo," he said. Staff writer Shailagh Murray contributed to this report. Copyright 2009 Washington Post. U.S. Prepared to Spend Billions on Swine Flu Vaccine Health Secretary Makes Announcement at All-Day Summit on H1N1 Flu Outbreak By Spencer Hsu and Michael D. Shear Washington Post Thursday, July 9, 2009 The Obama administration said today that it has billions of dollars available to help pay for a national H1N1 flu vaccine program this fall, if a vaccine is available. Health and Human Services Secretary Kathleen Sebelius made the announcement at an all-day summit on the outbreak of what is more commonly known as swine flu. One purpose of the gathering, officials have said, is to help restore a sense of urgency to the worldwide response to the epidemic. Sebelius said the government has "already appropriated about a billion dollars to buy the bulk ingredients" and has another $7.5 billion available in emergency preparedness funds. The summit of federal and state health officials opened with a satellite appearance by President Obama, who was beamed into the meeting room at the National Insitutes of Health from L'Aquila, Italy, where he is attending the Group of Eight summit. "Although we were fortunate not to see a more serious situation in the spring when we first got news of this outbreak . . . the potential for a significant outbreak in the fall is looming," Obama said. "We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation." Public and governmental awareness of the flu pandemic spiked this spring with fears that the new strain could resist treatment and ravage the population. That attention has faded as it became clear that most cases were mild and required no medical treatment. But the summit comes amid reports that infection rates have not subsided this summer as some experts had anticipated, forcing countries such as Britain to shift their response. The World Health Organization has said that 2 billion people could eventually be infected worldwide. "Scientists and public health experts forecast that the impact of H1N1 may well worsen in the fall -- when the regular flu season hits, or even earlier, when schools start to open -- which is only five or six weeks away in some cases," Sebelius said in announcing the summit on July 2. The gathering in Bethesda will also be led by Homeland Security Secretary Janet Napolitano, Education Secretary Arne Duncan and homeland security adviser John Brennan. Some health officials have expressed concern that the country may not be ready to do battle if a more virulent form of the virus emerges this fall. Last spring, federal officials said some local communities were far more prepared than others to deal with a severe outbreak. And local officials have urged the federal government to take more action in coordinating the country's response. Robert M. "Bobby" Pestronk, executive director of the National Association of County and City Health Officials, said his group has encouraged the White House to engage and educate local and state elected officials about the central role they will play in a major health response, especially because scientific information is fast-changing. "It's especially important in a large-scale outbreak because the information that people get needs to be accurate and consistent," Pestronk said. "We're concerned and the situation is urgent." State and local officials say they expect the Obama administration to share in far more detail a national U.S. strategy to combat the pandemic. They also came looking for money. Congress approved $350 million for state and local responders in a recent supplemental war funding bill, and the administration is set to distribute the funds. Public health officials said they could need $3 billion if the H1N1 virus mutates into a more deadly form this fall. One key deadline is the opening of schools starting next month. While federal efforts have concentrated on the development of a new vaccine, officials at all levels of government say they need a clearer understanding of what steps to take if it becomes necessary to limit public gatherings or other social contact. Last spring, federal health officials gave conflicting guidance to schools with suspected cases, initially recommending that that they close for 14 days, before judging based on additional information that it was enough for infected people to stay home. Duncan said in a statement last week that school systems "will continue following guidance from the Centers for Disease Control and Prevention and encouraging schools and districts to be in close communication with their local public health authorities and political leadership." Local health departments need guidance on such "community mitigation" measures as soon as possible, one non-federal official said, speaking on condition of anonymity, to begin preparing and to free up resources that can be devoted elsewhere. The official said it has been "slightly unclear" who at the federal level is making such decisions. Another non-federal health official said U.S. authorities have worked furiously since the outbreak was reported in April, and he expected new planning assumptions and strategies and tools to be laid out. Copyright 2009 Washington Post. 'Double failure' at USA's hospitals By Steve Sternberg and Jack Gillum USA Today Thursday, July 9, 2009 Too many people die needlessly at U.S. hospitals, according to a sweeping new Medicare analysis showing wide variation in death rates between the best hospitals and the worst. The analysis examined death rates for heart attacks, heart failure and pneumonia at more than 4,600 hospitals across the USA. At 5.9% of hospitals, patients with pneumonia died at rates significantly higher than the national average. With heart failure, 3.4% of hospitals had death rates higher than the average, and 1.2% of hospitals were higher when it came to heart attack. Researchers also found that the majority of U.S. hospitals operate the equivalent of revolving doors for their patients. One of every four heart failure patients and slightly less than one in five heart attack and pneumonia patients land back in the hospital within 30 days, data show. "We have double failure in our health system," says John Rumsfeld of the Denver VA Medical Center and chief science officer for the American College of Cardiology's National Data Registry. The analysis by U.S. Centers for Medicare and Medicaid Services (CMS) comes as the White House and Congress debate ways to cut costs and improve quality in the nation's health system. One idea on the table is to reward doctors and hospitals not just for how many procedures they perform but how well their patients fare. More than 200 hospitals have death rates better than the national average, and hundreds fare better on readmission rates. The findings are based on more than 1 million deaths and readmissions among Medicare patients from 2005 to 2008. A separate USA TODAY analysis of the data found that patients have higher death rates at hospitals in the nation's poorest and smallest counties, compared with those in larger, more affluent areas. Death rates in hospitals in counties with fewer than 50,000 people rank 1 to 2 percentage points higher than their most-populated counterparts, a significant difference. A similar pattern emerges at hospitals in counties where the median household income falls below $35,000 a year. Barry Straube, director of CMS' office of standards and quality, says the agency aims to intensify competition between hospitals by giving patients the information they need to seek out higher-quality care and by giving hospitals a way to measure their performance against their competitors. It also provides a tool that government and private health plans can use to determine which hospitals merit higher pay for better performance. "This kind of information is absolutely the backbone of many of our efforts to reform the health system," Janet Corrigan, head of the National Quality Forum, a consortium of government agencies, insurers, hospitals and doctors' groups that approved the methods used in the analysis. "Based on what we see here, we have our work cut out for us." Copyright 2009 USA Today. Abortion Pill Study Suggests Way to Limit Infection By Denise Grady New York Times Thursday, July 9, 2009 A large study of the pills used to induce abortion has found that infections are rare but can be made even less common if the pills are taken by mouth instead of vaginally, and with antibiotics. But it is not clear whether the findings will change medical practice. Abortion providers and other experts had different reactions to the study. Most agreed that it was reasonable to change to the oral route, but some hesitated at routinely prescribing antibiotics, which can have side effects, for a procedure with a very low infection rate. About 1.1 million women in the United States have used abortion pills since they were approved in 2000. Last year, 184,000 women took them, said a spokeswoman for Danco Laboratories, which markets the pills. They work only for early pregnancies, up to 63 days, and still account for a small proportion of the more than one million abortions performed every year in this country. The treatment consists of two drugs — first Mifeprex (formerly called RU-486) and then, two days later, misoprostol. The regimen approved by the Food and Drug Administration required that both drugs be swallowed. But later studies found that giving the second drug vaginally worked better, with smaller doses, and many providers switched to that method, an “off label” use, which is not illegal. Another method, the buccal route, in which the misoprostol pill is tucked between the gums and the cheek and allowed to dissolve, was also found to work better than swallowing. The new study was conducted and paid for by Planned Parenthood, the nation’s largest abortion provider. It analyzed the records of 227,823 women who had abortions at its clinics from January 2005 to June 2008. Of those, 92 had serious infections. The results are to be published on Thursday in The New England Journal of Medicine. The study is the first to gauge the effects of changes made by Planned Parenthood and some other abortion providers in 2006, when serious infections and a handful of deaths were linked to the pills. Researchers suspected that putting pills into the vagina was somehow contributing to infections. Planned Parenthood found that after the combined changes were made — switching from the vaginal to the buccal route and routinely giving antibiotics — infection rates dropped considerably, to 0.06 per 1,000 abortions, from 0.93 per 1,000. Mary Fjerstad, a nurse practitioner and the lead author of the study, said: “Our data show there was a reduction in serious infections when we switched to a nonvaginal route of misoprostol administration. But I don’t want to come down on the side of saying that everybody everywhere should give antibiotics with every medical abortion. Providers should decide that.” Abby Long, a spokeswoman for Danco Laboratories, which sells Mifeprex, said the company had not discussed the article with the Food and Drug Administration and was not planning any changes in the drug’s labeling or directions. Any proposed changes in the label would first have to be approved by the F.D.A. A spokeswoman for the drug agency said it was “carefully reviewing” the new information. Dr. Karen Loeb Lifford, director of family planning at Boston University School of Medicine, said she had already changed her clinic’s practice to use the buccal route and include antibiotics. “I do think the antibiotics will become the standard of care in the United States,” Dr. Lifford said, adding that Planned Parenthood had an enormous database of patients who were very much like other women seeking abortions, so the results would probably apply to most patients. Vicki Saporta, president of the National Abortion Federation, a professional group whose members provide more than half the abortions performed in the United States and Canada, said the group’s medical experts would evaluate the findings. The current guidelines allow oral, buccal and vaginal administration, but do not include routine antibiotics. Ms. Saporta estimated that about a third of the members gave the misoprostol vaginally. Dr. Paul D. Blumenthal, a professor of obstetrics and gynecology at Stanford, said that he would recommend the buccal route, but that in developing countries requiring antibiotics — which may be unavailable or unaffordable — could prevent women from obtaining the medical abortions he said they desperately needed. Copyright 2009 New York Times. The Caregiver’s Last Expense The New Old Age - Caring and Coping By Sarah Arnquist New York Times Thursday, July 9, 2009 Funerals mark a sad turning point in the emotional lives of families and, often, an end to years of caregiving. But they are also a major expense, often undertaken by stricken loved ones ill-prepared to make major financial decisions. The $11-billion funeral industry makes arrangements for most of the 2.4 million people who die each year in the United States. Many of the deceased have pre-planned their own funerals, but most have not. Planning is particularly difficult if families avoid talking about death beforehand, said Josh Slocum, executive director of the Funeral Consumers Alliance. The average funeral with a coffin, viewing and burial costs about $7,300, according to the National Funeral Directors Association. That includes a $1,595 basic services fee; $750 embalming and body preparation fees; $870 in facility and staff fees; $720 in transportation and other fees; and $3,400 for a casket and vault. The cemetery plot and burial fees are extra. Given the high costs, it’s not surprising that cremation is an increasingly popular option. And in these tough economic times, people are seeking out even thriftier alternatives. Simple Funerals, a Detroit business, offers entire funeral packages for $1,100, noted a recent article in Newsweek. In all but six states, family members are not legally required to consult a funeral director at all. Home funerals are therefore a legal and less expensive — but nearly forgotten — option. “There are practical reasons, commercial reasons and cultural reasons that we use funeral homes,” Mr. Slocum said. Not least among them: Home funerals require advanced planning, Mr. Slocum said. If you want a more traditional funeral, he recommends you talk with loved ones in detail about your wishes regarding a funeral. And shop around in advance. “The best thing to do is to get price lists from several funeral homes before death is looming and compare them,” Mr. Slocum said. “Prices can vary by thousands of dollars.” Also, he said, people should learn the rights guaranteed them by the Funeral Rule, a national regulation enforced by the Federal Trade Commission. The rights are described in detail on the commission’s Web site. Here is a quick overview. * Funeral directors must give customers itemized prices in person or over the phone. Customers do not have to accept a package of services that includes items they don’t want. “You have the right to pick any funeral you want item by item, and make a funeral that fits your taste and budget,” Mr. Slocum said. * Embalming is not necessary if the body is buried or cremated shortly after death. Funeral homes may require it, however, for a viewing or visitation. * The funeral home must allow you to use a casket you purchase elsewhere and cannot charge you an additional fee for doing so. You may order a discount casket online and have it shipped to the funeral home. * Caskets described as “gasketed,” “protective” or “sealed” do not prevent a body from decaying; they just cost more. * No state law requires you to purchase a casket for direct cremations. A funeral provider that offers cremations must also offer an inexpensive unfinished box or alternative cardboard or canvas container. Pre-paid funerals have been around for years, but both the AARP and the Funeral Consumers Alliance advise against them in nearly all cases. Mr. Slocum suggests people follow his group’s slogan: “It always pays to plan ahead. It rarely pays to pay ahead.” Many caregivers have already been down this road. What do you wish someone had told you before planning a funeral? Please share your advice below. Copyright 2009 New York Times. *Opinion* Food Fright The White House is doing its part to improve food safety. When will Congress? Washington Post Editorial Thursday, July 9, 2009 THE LIST OF FOODS that have made Americans sick is long and bound to get longer. Even cookie dough wasn't safe from contamination. But it was the massive peanut recall this year that spurred President Obama to establish the food safety working group to devise ways to make a relatively safe food supply safer. The proposals released Tuesday are sound within the confines of existing law. But Congress must move on legislation that would give the Food and Drug Administration increased authority to step in before and after the food supply is put at risk. The working group recommendations are aimed at reducing the prevalence of salmonella and E. coli contaminants that afflict more than 1.3 million Americans annually. The FDA soon will issue final rules to reduce the salmonella contamination of eggs. By the end of the month, the agency will release commodity-specific guidance to industry on how to prevent E. coli from spoiling leafy greens, melons and tomatoes. The Food Safety and Inspection Service plans to issue new standards by the end of the year to reduce salmonella in turkey and poultry. It will also release "improved instructions" to its workforce on how to ensure that businesses handling beef are doing so in a manner that reduces the chances of E. coli contamination. The FDA will publish draft guidance to the food industry on how to establish a food-tracing system. And a new "incident command system" will be created across all federal agencies to more quickly address outbreaks of food-borne illnesses. Overseeing all of these efforts will be a new FDA deputy commissioner for foods and a new chief medical officer at the Agriculture Department. After years of promises and false starts, these measures offer hope that inaction will give way to better prevention, enforcement and government response. But that hope is tempered by the fact that all of these rules and guidances are nonbinding. A comprehensive bill passed last month by the House Energy and Commerce Committee would give them the teeth they need to be effective. It would give the secretary of health and human services the authority to require facilities to have written food safety plans, to recall contaminated products and to establish a system to trace the origins of food from farm to fork. All Congress has to do is enact the bill into law. Copyright 2009 Washington Post. BACK TO TOP


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