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			Monday, July 13, 2009 News Clipping Archives *Maryland / Regional* Painkillers can kill (Baltimore Sun) Avascular necrosis can affect joints (Baltimore Sun) Number of rabid bats on the rise (Annapolis Capital) Annapolis teenager to be tried as adult (Annapolis Capital) Health care ideas targeted (Daily Record) Suffolk shelter reopens after parvo outbreak (USA Today) Del. gets federal grants to help fight flu (USA Today) *National / International* Swine Flu: Will You Vaccinate? (Washington Post) Health care likely to miss deadline (Baltimore Sun) Health in brief (Baltimore Sun) An Appetizing Reason to Take a Flexible Stance on Vegetarianism (Washington Post) Study: 1918 flu survivors seem immune to swine flu (Washington Post) Veterans Affairs Faces Surge of Disability Claims (New York Times) Alabama Physician Chosen as Surgeon General (New York Times) *Opinion* Racing to contain Swine Flu (Baltimore Sun Editorial) Health-Care Savings (Washington Post Editorial) Finding Health Care Waste (New York Times Letter to the Editor) *Maryland / Regional* Painkillers can kill With acetaminophen, less is more, doctors warn By Stephanie Desmon Baltimore Sun Monday, July 13, 2009 When a Food and Drug Administration panel took steps last month to reduce consumption of the popular painkiller acetaminophen, warning that too many people are inadvertently taking more than is safe and suffering liver damage and even death, Dr. David Maine's phones started ringing. And ringing. Patients wanted to know if taking Tylenol once a day is too much (it is not). They wanted to know if their prescriptions contain the drug (some do). "We've gotten a ton of calls," said Maine, a pain management specialist at Mercy Medical Center in Baltimore. Maine's message to his patients is clear: Know how much acetaminophen you are taking. The medical community has long known that people shouldn't take more than 4,000 milligrams a day (the equivalent of eight extra-strength Tylenol tablets in 24 hours). But with a proliferation of other medications on the market that include acetaminophen - from Nyquil to Excedrin - people aren't always aware of how much they are getting, and some take much more of the drug than they realize. Those combinations can push intake to dangerous levels. Maine has been telling his patients not to exceed 3,000 milligrams a day, partly to ensure they don't go overboard. "Often times, patients will take more than you're prescribing, which is where you get into trouble," he said. "With any drug, if you take too much, you can have a problem." Among the suggestions of the FDA panel - which would still need to be implemented by FDA officials - was to lower the recommended maximum daily dose from 4,000 milligrams, to remove two prescription painkillers (Vicodin and Percocet) from the market that contain acetaminophen, and to strengthen labeling to make it clearer when the compound is in combination medications. The strength of acetaminophen tablets has slowly crept up in recent years. Regular-strength Tylenol, at 325 milligrams per pill, used to be the norm. Now extra-strength is more common, whether brand-name or generic, at 500 milligrams per pill. With the FDA panel's recommendation, those larger pills would likely be eliminated, meaning people who are used to taking 1,000 milligrams at a time will have to adjust. And many won't be happy. "They use up to that 4 grams [4,000 milligrams] per day - cited as the previous maximum dose. That's not safe anymore to do," said pharmacist Cherokee Layson-Wolf, patient care program coordinator at NeighborCare Professional Pharmacies and an assistant professor at the University of Maryland School of Pharmacy. "It's going to be an issue," she said. "[People will say] if I can't take the doses I previously took, how am I going to get that relief? Copyright 2009 Baltimore Sun. Avascular necrosis can affect joints Expert advice Ask the expert: Marc W. Hungerford, Mercy Medical Center Baltimore Sun Monday, July 13, 2009 Avascular necrosis is a disorder of the bone. It affects the ends of long bones, primarily the hip, but the knee and shoulder and ankle can also be affected, says Dr. Marc W. Hungerford, director of joint replacement and reconstruction at Mercy Medical Center. In avascular necrosis the circulation in the bone is interrupted and dead spots can appear. If these dead spots are close enough to the joint, then the joint can collapse and the patient can develop arthritis of the involved joint. •In this country the top two risk categories for avascular necrosis are patients who take steroids for other conditions and patients who drink too much alcohol. Other patients at risk include those with blood clotting disorders, sickle cell, and a variety of other, rarer disease conditions. •Primarily the hip joints are affected. However, patients can also develop problems with the knees, the shoulders, and the ankles. In patients who have knee or shoulder pain first, it is worthwhile to evaluate the hips, since they are most commonly affected in patients with more than one affected joint. •The main symptom of avascular necrosis is generally a chronic aching pain, which is most commonly referred to as a toothache-type pain. The pain is generally not exacerbated by activity, but occasionally may be worsened with activity. The pain is also typically described as unrelenting and may be severe. •If the condition is caught at an early stage before the joint collapses, efforts to preserve the joint can be successful. These efforts include surgical options such as core decompression, which involves drilling a hole in the bone that is affected. This treatment helps to relieve the pressure inside the bone and prevent the joint from collapsing. It can be very effective if the disease is caught early enough. •If the joint has collapsed and has become arthritic, then the best option is a joint replacement. Even if one joint has collapsed and requires replacement, another joint may be affected and may have not collapsed yet. This less affected joint may be preserved if treated in time. Therefore, even in collapsed joints it is worthwhile to perform a detailed evaluation of the patient's other joints to try to prevent them from collapsing. Copyright © 2009, The Baltimore Sun. Number of rabid bats on the rise Infected bats found in 6 communities By Shantee Woodards Annapolis Capital Monday, July 13, 2009 The county Health Department is warning residents of an increasing number of rabid bats in the area. Since May, bats infected with rabies have been detected in six communities. Health officials issued notices to residents in those communities, advising them how to take precautions against rabies. Rabies fact sheets also have been issued at county libraries and community health fairs. Residents who come in contact with bats should call county Animal Control, which handles such reports 24 hours a day. The agency will attempt to capture the bat and get it tested. "This time of year, bats are actively coming to the area after hibernation," said Kyle Shannon, the health department's environmental sanitation specialist. "If a person has holes in their soffits or roofs, (bats) can get in," he added. "(With the area being the way it is), there's a much higher population of humans in the area. There's much less habitat for the bats and they've basically made houses and buildings their place to roost." From May 13 to June 11, seven rabid bats were found in Annapolis, Crofton, Glen Burnie, Millersville, Pasadena and Severna Park. Health officials said they are concerned because their active season isn't over yet and these levels already are exceeding previous years. There were five rabid bats detected in each of the past two summers, said Elin Jones, health department spokeswoman. The state has 10 species of bats. Those that typically form colonies on buildings are little brown bats, big brown bats, northern long-eared bats and evening bats, according to the Maryland Department of Natural Resources. Bats hibernate between November and February, and emerge between March and April. The babies are born in May and June, and begin to fly with their mothers by the end of the summer. They start searching for winter homes in September and October, the DNR Web site stated. The health department's reports come from a variety of sources, but mainly from Animal Control or from residents who have come in contact with a bat. Bat bites can easily go undetected, so anyone who isn't sure if they've been bitten should seek medical care as if they have been. In situations where bats are located in a home, the resident should try to trap it with a coffee can or bucket if that can be done with limited exposure to the bat, Shannon said. The most important thing is to contact Animal Control instead of releasing a possibly infected animal back into the environment, Shannon said. To report a bat to Animal Control, call 410-222-8900. Copyright 2009 Annapolis Capital. Annapolis teenager to be tried as adult Charged with brutal home invasion in city By Scott Daugherty Annapolis Capital Monday, July 13, 2009 A 17-year-old boy police said broke into a city apartment earlier this year armed with two knives and demanded sex from a woman will be tried as an adult, a county judge has ruled. Advertisement Attorneys for Juan C. Conseco-Figueroa, 17, of Carver Street, now plan to argue their client was insane and therefore not criminally responsible for what happened during the Feb. 16 home invasion. Conseco-Figueroa is charged with attempted first-degree rape, first-degree assault and numerous other charges in the attack, which left the 25-year-old woman seriously injured. He also is charged with kidnapping the woman's 6-year-old niece, whom he locked in a bedroom after her aunt escaped. The Capital does not name victims of alleged sexual assault. Richard Bittner, Conseco-Figueroa's attorney, said he was not surprised Circuit Court Judge Paul A. Hackner ordered his client to be tried as an adult on Friday. "I can't say it was unexpected," he said, noting that the state's Department of Juvenile Services interviewed his client and recommended he be tried as an adult. Bittner argued his client would be better served in the juvenile system, where he would have access to more services and treatment options. He said that Conseco-Figueroa was sexually abused for most of his life - from about the age of 6 until he emigrated from Mexico last year. At the time of the alleged attack, he was high on cocaine, paint fumes and alcohol, Bittner said. "He was self-medicating," he said. Assistant State's Attorney Kathy Rogers noted the vicious nature of the crime. She said if the Department of Juvenile Services doesn't think it can help Conseco-Figueroa, the court should not order the department to help him. "They really have no treatment to offer this defendant," she said. Police said Conseco-Figueroa was armed with two knives about 9:30 a.m. Feb. 16 as he forced his way into the victim's Carver Street apartment. The woman told detectives he wanted sex. When she refused, the man pulled off her shorts and his pants and held both knives to her throat. The man eventually cut the victim's neck, prompting the woman to try to protect herself with her hands. In the process, he severely cut her hand. The woman pleaded with the man not to kill her in front of her children and niece, who were in the apartment. When he tried to force her out of the apartment, she was able to break free and get help. After the woman left, Conseco-Figueroa approached the niece and pulled off her underwear, police said. He forced her into an upstairs bedroom, where she was later rescued by police. The woman suffered cuts on her chest, throat and neck. She was taken to Anne Arundel Medical Center, where she was treated and released. While police said in February the young girl was not harmed in the attack, Rogers said there were "signs of vaginal trauma." After the hearing, Bittner denied Conseco-Figueroa raped the girl; no new charges have been filed against his client. From the bench, Hackner explained the nature of the crime - coupled with the fact Conseco-Figueroa is just four months shy of his 18th birthday - led him to keep the case in the adult system. He questioned if any amount of treatment would be able to help a person who - when drunk and high - thinks it is a good idea to break into a house and try to rape a stranger. Hackner added that any such treatment plan would also be rather "academic," since federal immigration officials have expressed an interest in deporting Conseco-Figueroa back to Mexico. A trial is scheduled Nov. 17 in the county Circuit Court in Annapolis. If convicted, Conseco-Figueroa faces up to life in prison. Copyright 2009 Annapolis Capital. Health care ideas targeted Staff and wire reports Daily Record Monday, July 13, 2009 U.S. Sen. Barbara Mikulski, D-Md, said she wants to create a new Office of Patient Safety Research in the U.S. Department of Health and Human Services to make innovations like a checklist developed at Johns Hopkins Medicine widely available. The Provonost Checklist, named for the doctor at Johns Hopkins who developed it, is a 19-step list to guide health care teams in ensuring that all steps are covered in medical procedures. Mikulsi said she has inserted language in the Senate's health care reform bill to create such an agency to identify and disseminate best ideas and best practices, and make sure they are used in clinical training and practice. Copyright 2009 Daily Record. Suffolk shelter reopens after parvo outbreak Associated Press USA Today Monday, July 13, 2009 SUFFOLK, Va. (AP) — New policies are in place at Suffolk's animal shelter following an outbreak of parvovirus that resulted in 14 dogs being euthanized. The city closed the shelter June 27 after officials learned that a dog adopted from there died from the highly contagious virus. The shelter reopened Monday. Chief Animal Control Officer Meghan Chapin says the new policies include vaccination of all new arrivals and segregation of incoming animals for 10 days before they are put up for adoption. Puppies will be vaccinated at 6 weeks old and all litters will be placed into foster care outside the facility. Copyright 2009 The Associated Press. All rights reserved. Del. gets federal grants to help fight flu Associated Press USA Today Monday, July 13, 2009 DOVER, Del. (AP) — Delaware is slated to get nearly $1 million to prepare for the fight against influenza this fall, including funds targeted at swine flu. The $981,500 in grants comes from an appropriations bill signed into law last month by President Obama. More than $730,000 of the money Delaware will receive comes from Public Health Emergency Response grants earmarked for the state public health department. It includes funds for vaccination programs and efforts to reduce public exposure to swine flu. Hospitals and health care systems are eligible for more than $250,000 to prepare for possible flu outbreaks and their effect on the public health. Copyright 2009 The Associated Press. All rights reserved. *National / International* Swine Flu: Will You Vaccinate? On Parenting By Stacey Garfinkle Washington Post Monday, July 13, 2009 The swine flu vaccine may very well be coming to a school near you. The question is, will you vaccinate? The federal government plans to get 100 million doses of the vaccine in October, reports The Post's David Brown and Spencer S. Hsu. First in line for vaccinations: children. Education Secretary Arne Duncan says schools are "natural sites" to be the principal venues for delivering vaccines. Brown tells me that for the swine flu vaccine, people will probably need two shots at least a week apart. These will be separate shots from the seasonal flu vaccine that doctors already insist all children ages 6 months and older need. The medical community is still determining whether the seasonal flu vaccine needs to be given at a different time from either of the two swine flu shots. Thus, he reports, it is conceivable that people might need three separate shot visits. Studies on the H1N1 vaccine, its effectiveness and its interaction with the seasonal flu vaccine have just begun. At least some folks are expressing skepticism about the vaccination: Barbara Loe Fisher, the co-founder and president of the National Vaccine Information Center, has posted a video questioning whether we'll have a choice in vaccinating our children. And Non-Toxic Kids writer Katy Farber of Vermont says, "It feels rushed, and a little intimidating." Farber notes that she's not anti-vaccine but she does "like to take a minimalist approach to medication and intervention." As for my own kids, I don't yet know whether I'll have them vaccinated should it be available. I do know that my decision will come after doing a lot of research and talking it out with their doctors and my husband. How will you respond to calls to vaccinate your children? Copyright 2009 Baltimore Sun. Health care likely to miss deadline Democrats, GOP say overhaul moving ahead but don't want to rush it Baltimore Sun Monday, July 13, 2009 TEGUCIGALPATOKYO JERUSALEM - President Barack Obama's overhaul of the nation's health systems is unlikely to be completed by the White House's August deadline, lawmakers said Sunday as Congress turns its attention to other priorities. Democrats and Republicans alike said the administration's sweeping health care proposals are moving forward on Capitol Hill but cautioned against rushing into a spending plan that could cost trillions of dollars over the next decade. "I think everything is on the table and discussions are under way," said Health and Human Services Secretary Kathleen Sebelius, who said she's optimistic Congress will send the White House legislation before the year ends. But the White House's strategy to leave the legislative back-and-forth to Congress has produced varying and sometimes contradictory versions of health care legislation - along with delays. As the Senate turns its attention to Supreme Court nominee Sonia Sotomayor's confirmation hearings, the focus will turn away from Obama's top domestic priority. In the House, Democrats have proposed raising taxes on wealthy Americans to pay for the plan. Democratic leaders, meanwhile, have tried to calm moderate and conservative lawmakers about a proposal that could make their re-election bids more difficult. Republicans, seizing on an issue that affects all Americans and has shown a glimmer of hope for an out-of-power political party, have lambasted the proposal as rash and irresponsible. They also see the issue as a way to win House and Senate seats in the 2010 midterm elections. The delay in the legislation would be a blow to the White House and to Democrats' electoral prospects. Copyright 2009 Baltimore Sun. Health in brief Baltimore Sun - 2 total Monday, July 13, 2009 Lack of exercise can lead to diabetes Skip exercise now, pay later - that's the warning from a study that found that younger people who didn't exercise were more likely to develop diabetes in 20 years than those who stayed fit. Researchers examined data from the Coronary Artery Risk Development in Young Adults study, a longitudinal study of 5,115 adults initially ages 18 to 30 that looked at lifestyle and how cardiovascular disease risk factors changed over time. The participants were given a treadmill test at the beginning of the study, then at year seven and 20. They were also tested for diabetes. Body mass index was the strongest predictor of developing diabetes. And despite the fact that black men and white men started off on a fairly even BMI level at the beginning of the study, BMI was a bigger predictor of developing diabetes for black men. Researchers also found that the less fit people were, the higher the incidence of diabetes. Via a news release, lead author Mercedes Carnethon, assistant professor of preventive medicine at Northwestern University's Feinberg School of Medicine, said: "The overwhelming importance of a high BMI to the development of diabetes was somewhat unexpected, and leads us to think that activity levels need to be adequate not only to raise aerobic fitness, but also to maintain a healthy body weight." The study appears in the July issue of the journal Diabetes Care. - Los Angeles Times *** Fun in the sand? Stomach problems may follow** Reckless sand play, scientists have found, puts people at risk for subsequent stomach cramping and diarrhea courtesy of fecal bacteria on the shore. Safer to walk along the beach or (gulp) go in the water. In a survey of 27,000 visitors to ocean and freshwater beaches, 13 percent of those who said they had dug in sand during a visit to a beach reported gastrointestinal problems when interviewed 10 to 12 days later. As for those who allowed themselves to be buried in sand, their rate was even higher: 23 percent. The study, by scientists at the University of North Carolina at Chapel Hill and the Environmental Protection Agency, was published in the American Journal of Epidemiology. - Los Angeles Times Copyright © 2009, The Baltimore Sun. An Appetizing Reason to Take a Flexible Stance on Vegetarianism By Jennifer LaRue Huget Washington Post Tuesday, July 14, 2009 A Five Guys cheeseburger. That's about all that stands between me and a vegetarian diet. I could easily forgo meat -- most of the time. I rarely eat any during the day and have only small portions with dinner. I prefer vegetable-topped pizzas to meat-laden pies and have largely lost my taste for steak. Except for salmon and tuna, I could even live without fish. But the thought of never eating another perfect cheeseburger does me in every time. My interest in vegetarianism is piqued anew, though, by the American Dietetic Association's publication this month of an updated policy statement. The ADA, whose earlier position statements had supported vegetarian diets as healthful but relegated information about some of the age groups for which they're appropriate to the fine print, now states front and center that a properly planned and balanced diet can be healthful not only for adults but also for all children, from infants to teens. So can a vegan diet, with no animal products whatsover (including eggs, cheese and yogurt, for example). "This statement gets rid of the idea that grown-ups can be vegetarians, but maybe not kids," Ann Reed Mangel, co-author of the statement and accompanying paper, told me in an interview. The ADA even gives the vegetarian green light to pregnant and lactating women. (You can read a summary at http://www.adajournal.org/current -- look under the heading "From the Association.") The research paper accompanying the ADA's statement, written mostly for dietitians and health professionals, makes a good case for moving to such plant-based diets as the ovo-lacto vegetarian, incorporating eggs and dairy foods, and the pesco-vegetarian plan, which includes fish. The paper cites scientific evidence that these diets can help fight major diseases, such as Type 2 diabetes, cardiovascular disease and several kinds of cancer. It also provides guidance on how to orchestrate a healthful diet, focusing on key nutrients that can be hard for vegetarians to work into their meals. Chief among those is Vitamin B12, principally found in animal proteins. Susan Levin, a registered dietitian affiliated with the pro-vegetarian Physicians Committee for Responsible Medicine, explains that, gross as it sounds, vegetarians used to ingest more B12 when food wasn't as well washed as it is today; the vitamin existed in some of the manure residue left on plants. In addition, there was B12 in organisms found on plants in the days before widespread pesticide use. So vegans in particular need to take a multivitamin or supplement, or seek out foods that are fortified with it, Levin says: Because a B12 deficiency can cause irreversible neurological damage and other health problems, "it's not something you want to gamble with." Omnivores and vegetarians alike are hard-pressed to consume enough Vitamin D; Levin again suggests supplements. And while meat-eaters and ovo-lacto vegetarians get calcium from dairy products, vegans can turn to leafy greens, beans and even tofu, if it's the kind that's "set" in a calcium-based solution. Aside from that, the ADA's advice is simple: Eat a varied diet that includes whole grains, vegetables, fruit, legumes, nuts, seeds and, for non-vegans, lower-fat dairy products and eggs. Go easy on foods that are highly sweetened, high in sodium and high in fat, especially saturated fat and trans-fatty acids. Anyone can do that. Right? Levin thinks so. "Don't think about 'I can't be a vegetarian or vegan for my whole life,' " she suggests. "Try it wholesale for three weeks, and tell me after three weeks you don't feel and look better." By "wholesale," Levin means no cheating; she also warns against filling up on french fries and whole jars of peanut butter to get through the trial period. A vegan for 15 years, Levin is convinced I wouldn't crave that cheeseburger so much after three meatless weeks. "When people realize how much control they really have over their lives" -- including their health, general feeling of well-being, and even the way their skin looks -- through their diets, they find vegetarianism empowering, she says. Another option might be following the advice of Dawn Jackson Blatner, a spokeswoman for the ADA and author of "The Flexitarian Diet." She notes that meat-eaters don't have to go cold turkey: Just replacing some of the meat you currently eat with fruit, vegetables, nuts, whole grains, soy products and especially fiber can make you much healthier. But Blatner cautions against filling the place that meat once occupied on your plate with non-nutritious fare. "I have clients who call themselves vegetarians but who are cheese-aholics, carbo-holics -- eating too much pasta, rice and bread -- or processed-food-aholics," she says. "It's easy to do this wrong. But when it's done right, it's a very powerful and magical tool against just about every chronic illness," she says. So, under Blatner's scheme, I could still enjoy a cheeseburger now and then. And maybe, eventually, Five Guys will lose its hold over me. . . . Copyright 2009 Washington Post. Study: 1918 flu survivors seem immune to swine flu Associated Press By Seth Borenstein Washington Post Monday, July 13, 2009 WASHINGTON -- A new study finds that the way swine flu multiplies in the respiratory system is more severe than ordinary winter flu. Tests in monkeys, mice and ferrets show that the swine flu thrives in greater numbers all over the respiratory system, including the lungs, and causes lesions, instead of staying in the head like seasonal flu. In addition, blood tests show that many survivors of the 1918 flu pandemic seem to have immunity to the current swine flu, but not to the seasonal flu that hits every year. Those were findings from a study by a top University of Wisconsin flu researcher that was released Monday and will be published in the journal Nature. The researcher, Yoshishiro (yosh-ee-hero) Kawaoka (cow-a-woka), said he is more concerned about swine flu because of these results. © 2009 The Associated Press. Veterans Affairs Faces Surge of Disability Claims By James Dao New York Times Monday, July 13, 2009 He jumped at loud noises, had unpredictable flashes of anger and was constantly replaying battle scenes in his head. When Damian J. Todd, who served two tours in Iraq with the Marine Corps, described those symptoms to a psychiatrist in January 2008, the diagnosis was quick: he was suffering from post-traumatic stress disorder. Less swift was the government’s response when Mr. Todd submitted, a month later, a disability claim that would entitle him to a monthly benefit check. Nearly 18 months went by before the Department of Veterans Affairs granted his claim late last month, Mr. Todd said. Mr. Todd, 33, is part of a flood of veterans, young and old, seeking disability compensation from the department for psychological and physical injuries connected to their military service. The backlog of unprocessed claims for those disabilities is now over 400,000, up from 253,000 six years ago, the agency said. The department says its average time for processing those claims, 162 days, is better than it has been in at least eight years. But it does not deny that it has a major problem, with some claims languishing for many months in the department’s overtaxed bureaucracy. “There are some positive signs in terms of what we’re doing,” said Michael Walcoff, deputy under secretary for benefits in the Veterans Benefits Administration. “But we know that veterans deserve better.” Mr. Walcoff said the department recently finished hiring 4,200 claims processors, but many will not be fully trained for months. The Government Accountability Office reported last year that the Veterans Affairs Department had about 13,000 people processing disability claims. The larger significance of the backlog, veterans groups and officials said, is that resources for veterans are being stretched perilously thin by a confluence of factors beyond the influx of veterans from Iraq and Afghanistan. Aging Vietnam veterans with new or worsening ailments are requesting care. Layoffs are driving unemployed veterans into the department’s sprawling health system for the first time. Congress has expanded certain benefits. And improved outreach efforts by the department have encouraged more veterans to seek compensation or care. Mr. Walcoff said the vast majority of the 82,000 claims the department received each month were not from veterans returning from the current wars. “We’re still getting a lot of Vietnam vets,” he said. Veterans advocates say the actual backlog is nearing one million, if minor claims, educational programs and appeals of denied claims are factored in. They point to the discovery last year of benefits applications in disposal bins at several department offices as evidence of shoddy handling of claims. And they assert that they routinely see frustratingly long delays on what seem like straightforward claims. One group, Veterans for Common Sense, has obtained records showing that some veterans are calling suicide hotlines to talk about their delayed disability claims. The group has called on the department to replace processors who take exceedingly long to handle claims. “We’re not saying vets are threatening to commit suicide over the claims issues,” said Paul Sullivan, executive director of the group. “We’re saying V.A.’s claim situation is so bad that it is exacerbating veterans’ already difficult situations.” The sprawling veterans compensation and pension system is expected to pay $44 billion in benefits to about three million people this year, the largest group of whom served during the Vietnam War. Under the system, veterans who can demonstrate that a psychological or physical problem resulted from their military service are eligible for compensation and, if the injury is severe enough, free health care. (All new veterans are eligible for health care for five years after they leave service, regardless of whether they are injured.) Compensation is scaled by the severity of the disability: a veteran with dependents who is rated 100 percent disabled, and therefore unable to work, is eligible for more than $3,000 a month. Post-traumatic stress disorder, or PTSD, has emerged as one of the most prevalent disability claims, after ailments like back pain and knee injuries. Not only are many new veterans receiving a diagnosis of the disorder, but an increasing number of Vietnam veterans are also reporting symptoms for the first time, officials and advocates said. Delays in getting PTSD claims approved have prompted members of Congress to propose legislation that would reduce the documentation required to prove that a veteran’s disorder was caused by specific combat events. Finding such documentation can be difficult for Vietnam veterans, whose memories of events 40 years ago may have grown hazy. Records from that era are also often difficult to find, advocates said. Veterans who did not serve in combat units but who may have been in firefights or witnessed traumatic events like roadside bombings — common events in Iraq and Afghanistan — also report difficulties documenting the sources of their disorder. Those hurdles have added to the claims backlog, advocates said. Legislation proposed by Representative John Hall, Democrat of New York, would require the government to grant claims by veterans with the disorder once they demonstrated simply that they had served in a combat theater, which would include all of Afghanistan, Iraq and Vietnam. The projected cost of the legislation, $4.7 billion over 10 years, according to the Congressional Budget Office, has become a stumbling block. But Mr. Hall said the cost would be offset by the benefits of reducing the backlog, avoiding appeals of rejected claims and speeding compensation to veterans. “We’ve got veterans sleeping under bridges or struggling to fit back in with their families or looking for jobs,” Mr. Hall said. “It’s no time to be messing around with compensation that we probably owe them and will probably pay them anyway.” The legislation might have eased the process for Mr. Todd, who flew helicopters in Anbar Province for seven months in 2005 and then served 10 months with an infantry unit in Ramadi, an insurgent stronghold, in 2006 and 2007. He left the Marines in 2007 as a captain. Many months after Mr. Todd received the PTSD diagnosis and first submitted his claim, the department asked him to document two stressful events that might have caused his trauma. For one, he described driving a girl to the hospital after she was torn apart by a bomb. She survived, but the memory still brings him to tears. Now attempting to start his own business, Mr. Todd, who lives in Orange County, N.Y., said he would receive $770 a month for his disorder, as well as for shoulder, back, knee and hearing problems linked to his service. “There are a lot of other kids who need the money more,” he said. “I just want the process to change, because it is ridiculous.” Copyright 2009 The New York Times Company. Alabama Physician Chosen as Surgeon General By Gardiner Harris New York Times Monday, July 13, 2009 President Barack Obama has selected Dr. Regina Benjamin, an Alabama family physician, as the U.S. surgeon general, two administration officials said on Monday. Mr. Obama will announce his selection officially at a Rose Garden ceremony at 11:40 a.m. An African-American, Dr. Benjamin is nationally known for establishing a rural health clinic in Bayou La Batre, Ala. — a small, medically underserved shrimping village along the Gulf Coast. Hurricana Katrina destroyed the clinic in 2005, and then when it was rebuilt, the clinic burned down on the eve of re-opening. In 2002, she became the president of the Alabama Medical Association, making her the first African-American woman to be president of a state medical society in the United States. In September, she was one of 25 recipients of the $500,000 “genius awards,” awarded by the John D. and Catherine T. MacArthur Foundation. She completed her residency in family medicine at the Medical Center of Central Georgia. She is a graduate of Xavier University, Morehouse School of Medicine and the University of Alabama School of Medicine. The titular head of the U.S. Public Health Service, the surgeon general is a largely ceremonial post used by numerous administrations to communicate important health messages to the public. The office itself has only a handful of staff and must rely for research and support on the National Institutes of Health and the Centers for Disease Control and Prevention. But the uniform of the surgeon general invests its wearer with credibility in the public’s eyes and has often led the wearer to distance themselves from the political priorities of the administration. Copyright 2009 The New York Times Company. *Opinion* Racing to contain Swine Flu Baltimore Sun Editorial Monday, July 13, 2009 With cases of swine flu reported around the world - from Spain to New Zealand - public health officials are racing to take steps to avert a potential pandemic and avoid public panic. The swift action is important because nations that fail to take early action to meet the potential challenge could find it difficult to contain. That's why the United States declared a public health emergency on Sunday and President Barack Obama is set to address the health crisis Monday in remarks to a meeting of the nation's top scientists. The flu outbreak, which is suspected in as many as 103 deaths, most in Mexico- none in the U.S.- is a reminder of the importance of funding reporting systems that give medical authorities early and accurate information about the spread of disease. In the United States, concerns have been recently expressed about the adequacy of the reporting system leading to confusion about whether new numbers really mean ongoing infections — or just that health officials had missed something simmering for weeks or months. The emergency declaration allows the government to ship roughly 12 million doses of flu-fighting medications from a federal stockpile to states in case they eventually need them. A spokesman for the World Health Organization, Peter Cordingley, said the virus was spreading quickly in Mexico and the southern U.S. and has the potential to become a pandemic and a global threat. The Obama administration is seeking to strike a balance, informing Americans without panicking them. "We do think this will continue to spread but we are taking aggressive actions to minimize the impact on people's health," said Dr. Richard Besser, acting chief of the Centers for Disease Control and Prevention. Patients wait for care at Mexico City health center Mario Guzman / EPA Copyright 2009 Baltimore Sun. Health-Care Savings How Congress can help defuse the 'ticking time bomb' Washington Post Editorial Monday, July 13, 2009 THE RAPIDLY rising cost of health care, President Obama has said, is "a threat to our economy" and "a ticking time bomb for the federal budget." So a critical test of the health reform proposals lumbering through Congress is whether they defuse that bomb. The answer, so far, is no. That was the message, more tactfully delivered, of a letter budget director Peter Orszag sent to the chairs of three House committees that released a "discussion draft" of legislation last month. Controlling cost is a different question from the also crucial matter of how to pay to cover millions of uninsured Americans. Most of those pay-fors -- whether tax changes or spending cuts -- would not change the upward trajectory of health costs. As Mr. Orszag put it, "Adopting a deficit-neutral health reform that expands coverage . . . is not enough, because it would perpetuate a system in which best practices are far from universal and costs are too high." What would it take to fix that system? No one knows for certain, and any savings would take time to materialize, which is why the Congressional Budget Office appropriately declines to "score" the changes as cost-saving; in fact, some would cost money at first. But it would be crazy to squander this opportunity to bring costs under control. Two potential changes would require Congress to cede some control over Medicare, which may explain why they are not part of the House measure. Draining the politics out of Medicare payment policies could help create a more rational system. And because of the program's size, the way it pays for health care has implications for the whole system. Currently, doctors are paid for each office visit and every test, encouraging quantity of care over quality. Paying them, and hospitals, to manage the overall health of a patient might encourage more cooperation, lower costs and improve outcomes. Rather than have Medicare recipients bouncing among various specialists, it also makes sense to have a primary care physician, working with a team, responsible for overseeing treatment -- and compensated in part based on whether that is accomplished in a cost-effective way. The House takes baby steps in these directions, but it should give Medicare the flexibility to try them on a broader scale. As the Obama administration has suggested, it also would make sense to bolster the power of the Medicare Payment Advisory Commission (MedPAC). Every year, MedPAC submits recommendations to Congress to cut costs and improve care, and most of these -- the most politically sensitive, anyway -- are ignored. Turning MedPAC into something like a base-closure commission, with recommendations subject to an up-or-down congressional vote, would be another step toward controlling costs. Fortuitously, the most sensible way to pay for expanded coverage -- taxing employer-provided health insurance -- also would help control costs. Taxing wages but not health insurance encourages more generous insurance benefits. Costs go up because there is more demand for services. It's mind-boggling that lawmakers continue to resist tapping this ready source of financing -- and doing good at the same time. Finally, changes in the current, irrational system of medical malpractice litigation might help lower costs. The evidence that costs are driven up by doctors practicing defensive medicine to protect themselves from lawsuits is scant. But higher malpractice premiums are passed on to consumers. Steps to reduce the prevalence of medical errors and to lower the cost of adjudicating claims -- perhaps by finding ways to screen out frivolous claims -- could also help bend the current dangerous trajectory of health-care costs. Copyright 2009 Washington Post. Finding Health Care Waste New York Times Letter to the Editor Monday, July 13, 2009 To the Editor: In “Health Care’s Infectious Losses” (Op-Ed, July 6), Paul O’Neill significantly overstates the financial loss to the health care system that hospital infections and medical errors are responsible for. While their occurrence does waste money, and more important causes needless death and injury, it is not remotely possible that they could account for $1 trillion in health care spending out of a total of $2.2 trillion a year. The major areas of waste regarding health care costs are administrative expenditures and unnecessary care. The latter alone squanders as much as 30 percent a year ($700 billion or more) of America’s health care dollar, according to a report from the Congressional Budget Office in June 2008. While hospital infections and medical errors must be reduced, even more saving would come from attacking administrative costs and unnecessary care. Robert A. Levine Westport, Conn., July 7, 2009 The writer is a former chief of neurology at Norwalk Hospital and author of a coming book, “Shock Therapy for the American Health Care System.” Copyright 2009 The New York Times Company. BACK TO TOP


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