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			Thursday, July 16, 2009 News Clipping Archives *Maryland / Regional* Third swine flu death reported in Maryland (Baltimore Sun) Third Swine Flu-Related Death Reported in Maryland (Washington Post) Rising costs leave more Marylanders, Americans without health insurance (Baltimore Sun) Good reviews for hospital deal (The Aegis) O'Malley plans disaster response (Baltimore Sun) Hopkins ranked best hospital again (Baltimore Sun) Howard Co. officials warn about water quality scam (Baltimore Sun) Victims of Abuse, and the Economy (Washington Post) Va naval lab to test for swine flu (USA Today) *National / International* Congress considers banning antibiotics in livestock (Baltimore Sun) In Good Health — Use common sense with Tylenol (Frederick News-Post) Study Cites Hormones as Cancer Risk (New York Times) Behaving badly at the beach (Baltimore Sun) U.S. to Buy H1N1 Vaccine Components From Four Firms (Wall Street Journal) Obama Eyes The Purse Strings for Medicare (Washington Post) Fight for swine flu vaccine could get ugly (Washington Post) *Opinion* A healthy beginning (Baltimore Sun Editorial) The next course (Baltimore Sun Editorial) A Strong Health Reform Bill (New York Times Editorial) Hamstringing hospitals won't cut costs (Baltimore Sun Commentary) Despite chemical hazards, spraying still best option (Salisbury Daily Times Letter to the Editor) *Maryland / Regional* Third swine flu death reported in Maryland By Brent Jones Baltimore Sun Thursday, July 16, 2009 A third person in Maryland has died from swine flu, health officials said. Officials did not name the person, or give a gender, age or hometown. The person was an adult from the Eastern Shore who health officials said had a serious underlying medical condition in addition to the H1N1 influenza virus. Although the person died in June, the final cause of the death was recently determined to be associated with the virus, officials said. The Centers for Disease Control and Prevention has confirmed 732 swine flu cases statewide as of last week, although that may be only a fracture of those infected with the virus. Many people who become ill with flu-like symptoms are not tested and recover within a week's time, much like seasonal flu. Nationally, 211 people have died from complications associated with swine flu as of July 10. The CDC reports 37,246 confirmed and probable cases. Copyright © 2009, The Baltimore Sun. Third Swine Flu-Related Death Reported in Maryland By Lori Aratani Washington Post Thursday, July 16, 2009 Maryland state health officials said yesterday that a third person has died of H1N1 flu-related illness. Health officials said the person lived on the Eastern Shore and had underlying health issues. Further information about the person is not being released due to privacy restrictions. Two other Maryland residents whose deaths have been attributed to the H1N1 virus, more commonly known as swine flu, also had underlying health conditions. The Centers for Disease Control and Prevention report as of July 10 that 211 people nationwide have died after contracting novel H1N1 influenza. In the mid-Atlantic region, Virginia has reported two H1N1 flu-related deaths and Pennsylvania has reported six. Nationwide, as of July 10, there have been 37,246 confirmed and probable cases of H1N1 influenza. To date, 732 cases have been confirmed in Maryland. That figure, however, is likely a fraction of the total H1N1 flu cases statewide. Many people who become ill with flu-like symptoms are not tested and recover within a week's time, much like seasonal flu. Flu symptoms include fever, cough and sore throat. Other symptoms may include chills, headache, fatigue, vomiting, diarrhea or shortness of breath. Copyright 2009 Washington Post. Rising costs leave more Marylanders, Americans without health insurance By Kelly Brewington Baltimore Sun Thursday, July 16, 2009 As members of Congress duke it out in the health care reform debate, a national consumer advocacy group releases this sobering statistic: an average of 740 Marylanders lose their health insurance every week, according to a new study by Families USA. By the group's estimates, 114,780 people will lose health coverage in Maryland from 2008 through December 2010. Nationwide, that figure could climb to 6.9 million, according to the organization, which if you haven't noticed, is lobbying bigtime for Congress to hurry and pass a bill that will expand coverage to those without. In fact, just an hour ago, a Senate committee made a first step to do just that. Rising premiums -- up 119 percent from 1999 to 2008 -- are causing more families to go without coverage, both in Maryland and nationwide, according to the report "The Clock is Ticking: More Americans Losing Health Insurance. Copyright 2009 Baltimore Sun. Good reviews for hospital deal Local politicians support Upper Chesapeake Health merger with UMMS BY Rachel Konopacki The Aegis Wednesday, July 15, 2009 Local elected officials seem to be in full support of the recently announced merger between the nonprofit company that owns Harford County’s two hospitals and University of Maryland Medical System. A strategic affiliation between Bel Air-based Upper Chesapeake Health, or UCH, and University of Maryland Medical System, or UMMS, was announced by their boards of directors on June 30. The two organizations plan a full merger by 2013 through a three-stage process over the next four years, which will ultimately bring Upper Chesapeake Health greater access to capital for future expansion, as well as access to a larger pool of primary care physicians and specialists. The primary advantage of the affiliation for Harford County residents will be they will not have to leave the county for the majority of their health-care needs, as more clinical services will become available locally, something Harford County Council President Billy Boniface sees as a major advantage. “I think anytime you can provide more resources and put more in the county is good,” he said. Although Boniface, who had yet to meet with Upper Chespeake’s CEO Lyle Sheldon when the council president was interviewed, sees the added services as a plus, he still remains uncertain about the specifics of the merger. “It looks like a good idea just on the surface,” he said. “We need to get some more specifics.” Upper Chesapeake owns Upper Chesapeake Medical Center in Bel Air and Harford Memorial Hospital, and with this merger, those two municipalities will be most affected. “I was optimistic when they announced the merger,” Robert Preston, Bel Air town commissioner and mayor, said. “I think Bel Air has been on a road to becoming a world-class health facility and they are certainly moving in the right direction in what they are trying to accomplish.” Preston said the Bel Air town commissioners had a briefing with Sheldon a few weeks ago about the future of Upper Chesapeake. “I was very impressed,” he said. Bel Air Town Commissioner Terry Hanley agrees with Preston. “I think it could be a very positive thing for the citizens,” he said. “Upper Chesapeake has made great strides over the last few years and I am sure it will continue.” The only downside to the merger, according to Hanley, would be the potential layoff of employees, but Hanley said the town commissioners were told that won’t happen. With the possible expansion of Upper Chesapeake Medical Center in the future, Preston said the town is prepared to help. “The town is doing everything we can to support the hospital,” he said, adding that the town plans to handle any issues that involve town planning. While Bel Air’s Upper Chesapeake may be expanded, there is the potential for Harford Memorial to be rebuilt. The future of Harford Memorial’s facility, whether it will be upgraded or completely rebuilt, will be discussed this October when UCH begins to clarify its business and facility master plan. Havre de Grace Mayor Wayne Dougherty said Harford Memorial is limited on the expansion it can undergo because of land space, which means the land UHC owns in Bulle Rock may be the future site of a hospital. “It’s still in city limits and it’s better than losing the hospital completely,” Dougherty said, adding that if the hospital does move, he would like to see if the current facility can be retrofitted for a professional complex to get it back on the tax rolls. Havre de Grace City Council President Randy Craig is also interested in what would happen with Harford Memorial’s current facility if it is rebuilt. “One of the important things to look at is what the property would be used for,” he said. “It needs to be compatible with the economic needs of the city.” Craig said he would also want to know what would happen with the houses on Union Avenue that are currently doctor’s offices. “It would be nice to see that turned back into a residential area,” he said. Although Craig sees the overall merger of the two entities as a positive, he is still concerned about the specifics. “Details are important to examine as this thing moves forward,” he said, adding that it is critically important to keep a hospital in Havre de Grace. Dougherty, on the other hand, is focusing on the positives of the merger. He said the merger will allow Upper Chesapeake Health to expand its services and bed space, which will benefit the citizens of the county. “The demand for medical service in and around Havre de Grace are becoming more and more,” he said. “I think it’s just a win-win situation, not just for Havre de Grace, but for Harford County.” Discussion of the merger began 18 months ago, before the downturn in the economy, when the board of UCH recognized it would be unable to achieve everything it needed to do in all areas by itself. On June 23, the merger became a reality when Upper Chesapeake Health’s board unanimously agreed to the strategic affiliation. “Having been born and raised here in Harford County and seen how health care has developed since I was born, I think its one of the best things for Harford County,” Richard Streett Jr., who has been on Upper Chesapeake’s board of directors for seven years, said. “It’s a win-win situation.” Streett said it was a unanimous decision among the board members that UMMS is the best fit for the merger, considering its track record and the fact that it was already a partner with Upper Chesapeake Health. “This just takes us to a whole different level,” he said. “I don’t think there are any negatives for the state, Harford County or the citizens.” In addition to serving on Upper Chesapeake’s board, Streett is also the chairman of the Upper Chesapeake Health Foundation. “We raise a lot of money for Upper Chesapeake,” Streett said, adding that even with the merger, all of the money raised by the foundation will stay in Harford County. Randy Worthington, who served on Upper Chesapeake’s board for 30 years before recently resigning to become a member of the Maryland Health Care Commission, sees this merger as something similar to what is occurring all over the nation. The health care commission regulates the state’s hospitals. “I think that around the country health systems are consolidating and I think Maryland is no exception,” Worthington, who was involved with the discussion of the merger when he was on the Upper Chesapeake board, said. “I think it’s a very positive thing for Harford County. I think it’s a good thing and I am all for it.” Worthington said Upper Chesapeake will need access to physicians, capital and downstream tertiary care, although he also sees losing local control over the hospitals as the number one potential disadvantage. When the merger is completed in 2013, Worthington said there will be a loss of local control, but he also said that at least the merger involves a Maryland organization and UMMS is invested in the state. “If citizens are not satisfied, they always have the right to political intervention,” he said. “There is that versus merging in Colorado.” Worthington said St. Joseph Medical Center, which owned 20 percent of UCH before being bought out by UMMS, is part of Catholic Health Initiatives which has its headquarters in Colorado. He said a merger with a Colorado company would have had a different effect than one with a company in Maryland. Copyright 2009 The Aegis. O'Malley plans disaster response 'Civic Guard' would coordinate public, private actions in emergency By Laura Smitherman Baltimore Sun Thursday, July 16, 2009 When disaster strikes, a swift response from the private sector can be just as crucial as the government's response. Wal-Mart Stores Inc. famously sent water and other necessities after Hurricane Katrina in 2005, often before federal emergency workers arrived. And in Baltimore two years before then, amphibious Duck tour boats evacuated residents from flooded coastal areas after Hurricane Isabel. To make the most of such charitable outpourings, Gov. Martin O'Malley plans to announce Thursday the creation of a "Civic Guard" to better connect disaster victims and first responders with businesses and nonprofit organizations that might be able to help with extra manpower or resources such as shovels and medical supplies. The initiative allows private-sector volunteers to log on to Maryland Emergency Management Agency's Web site to submit information about what they may be able to offer during an emergency. While such public-private partnerships have proven invaluable in the past, this is the first time the state has formalized them in advance. "This allows us to make these connections ahead of time rather than afterward when you have a lot of chaos," said Richard Muth, MEMA's director. In prepared remarks for a speech before a summit in Baltimore on preparing for public health and safety crises, O'Malley, a Democrat, said the Civic Guard program "seeks to involve every citizen in the safety, security, and preparedness of the broader community." Businesses and other organizations want to lend a hand, but often don't know whom in government to approach, said Lori Romer Stone, a coordinator with the University of Maryland's Center for Health and Homeland Security that helped developed the initiative. She said one model for the Civic Guard was an agreement between construction unions and O'Malley when he was Baltimore's mayor. That allowed heavy equipment operators to be pre-qualified to work at disaster sites, thus avoiding delays. A system for credentialing Civic Guard volunteers has not been established, Muth said. But once businesses and nonprofits register, he plans to provide training opportunities. The program will be initially funded through a $2.7 million federal grant that is intended to support coordination of regional planning for catastrophic events, according to the governor's office. Copyright © 2009, The Baltimore Sun. Hopkins ranked best hospital again Tops U.S. News ratings for 19th straight year By a Baltimore Sun Reporter Baltimore Sun Thursday, July 16, 2009 The Johns Hopkins Hospital - for the 19th consecutive year - is America's best hospital, according to the annual rankings of 4,800 hospitals published today by U.S. News & World Report. The magazine ranked Hopkins first in the nation in ear, nose and throat, rheumatology and urology; second in geriatric care, gynecology, neurology and neurosurgery, ophthalmology and psychiatry; and third in cancer, diabetes and endocrine disorders, digestive disorders, heart and heart surgery, and respiratory disorders. The hospital ranked fifth in orthopedics, sixth in kidney disorders and 16th in rehabilitation medicine. Other area hospitals ranked well in some areas. The University of Maryland Medical Center ranked 33rd in cancer, 32nd in kidney disorders, 34th in respiratory disorders and 28th in urology. Franklin Square Hospital Center is 31st in digestive disorders, 33rd in diabetes, 39th in geriatrics and 31st in respiratory disorders. Baltimore-Washington Medical Center ranked 43rd in digestive disorders. Union Memorial Hospital ranked 36th in diabetes, 42nd in geriatrics, 42nd in heart and heart surgery and 28th in orthopedics. Johns Hopkins Bayview Medical Center ranked 44th in diabetes, 11th in geriatrics and 47th in respiratory disorders. Good Samaritan Hospital ranked 48th in diabetes and 50th in orthopedics. Sinai Hospital ranked 38th in neurology and neurosurgery. Sheppard Pratt Health System ranked sixth in psychiatry. Copyright © 2009, The Baltimore Sun. Howard Co. officials warn about water quality scam By Larry Carson Baltimore Sun Thursday, July 16, 2009 Howard County consumer officials are warning residents about a water quality sales scam being promoted by door-to-door promoters. According to Rebecca Bowman, administrator of the county's Consumer Affairs Office, some residents have been finding "notices" hung on their front doors offering free water testing. Those who accept and leave a water sample along with a completed questionnaire are later told the test revealed the need for purification equipment, which the person then tries to sell them, Bowman said. The name of a testing company is not provided. County officials said piped drinking water is thoroughly tested by the county's two public water suppliers, Baltimore City and the Washington Suburban Sanitary Commission. The county also lists specific quality test results here. Bowman said people selling door to door must obtain a peddler's license from the county, are to limit their activities from 9 a.m. to 8 p.m. and must show their license upon request. Residents may call the Consumer Affairs Office at 410-313-6420 to report suspicious behavior. Copyright © 2009, The Baltimore Sun. Victims of Abuse, and the Economy Rise in Domestic Violence Cases Strains Fairfax's Services By Chris L. Jenkins Washington Post Thursday, July 16, 2009 The calls seeking help have come in each month by the dozens, sometimes nearly double the number from a year before. A woman, concerned about her recently unemployed husband's continued abuse, is looking for a haven. A relative, worried about a sister, mother or daughter, wants to know how and where to refer her for help. In Fairfax County, job losses have led to longer lines at food pantries and unemployment insurance and social services offices. Now there is another effect of a continued wilting economy: a steady rise in domestic violence calls because of mounting stress among families pinched at every turn, county officials said. The increased search for help, largely among women with children, has stretched the county's one publicly financed shelter and led to waiting lists for counselors and therapists. "Economic stress is often not the sole cause but a major contributing factor for families already in distress," said Ina Fernandez, director of the Fairfax County Office for Women and Domestic and Sexual Violence Services. "If there's already stress in the family and if one person loses a job, it's almost like the straw that breaks the camel's back. It's not a causal factor but a contributing one." Officials said much of the marked increase has come in domestic violence calls to the county's Victim Assistance Network. Requests for assistance were up 23 percent during the first half of the year over the same period last year. In some months, the year-to-year increases were striking. For instance, in March 2008, the hotline received 44 domestic violence calls; a year later, it received 91. "When you are losing control of everything, you try to control anything you can," Fernandez said. She said requests for domestic violence counselors has risen so quickly that her office had a 24-person waiting list in April, leading to a three-week wait for support. Often there are not delays for such services, she said. The impact is also showing up at Artemis House, the county's domestic violence shelter. Clients can stay up to 45 days in the 35-bed facility. Although there has always been a demand for services, the shelter has been consistently full over the past year, reflecting a need for more county-sponsored services, said Debra Ranf, the shelter's coordinator. Ranf said the economy is making it hard for women, who report 90 percent of the domestic violence cases in the county, to break away from their abusive relationships. "Forty-five days really is a short period of time," Ranf said. "And in this economy, it makes it hard for our clients to remain independent because they can't find the jobs they need to survive on their own." Counselors across Northern Virginia said they have seen many of their clients, mostly women, return to their partners' home faster than usual because they have been unable to support themselves on one salary. In some cases, the women return to the shelter within the month because they were abused again. Domestic violence calls increase and requests for shelter beds often swell during economic downturns, according to recent national research. Studies by the National Institute of Justice have consistently found that domestic violence is more likely to occur when couples are worried about or under financial strain. In a 2004 survey, 2.7 percent of couples reported domestic violence issues while experiencing low levels of "subjective financial strain." Meanwhile, 9.5 percent of couples experiencing high levels of financial strain reported domestic violence issues. A government study found that when men were always employed, the rate of intimate partner violence was 4.7 percent. When men experienced one period of unemployment, the rate rose to 7.5 percent. And when men experienced two or more periods of unemployment, the rate climbed to 12.3 percent. Locally, the increases are not just in Fairfax. This spring at Doorways for Women and Children in Arlington County, calls were up 35 percent from last year, although requests for rooms have remained consistent at the shelter. In addition, the number of people seeking court services related to abuse doubled in Arlington over the last year. Catholic Charities, which runs a national network of social service agencies, has reported a spike in domestic violence in many parts of the country. Copyright 2009 Washington Post. Va naval lab to test for swine flu Associated Press USA Today Thursday, July 17, 2009 NORFOLK, Va. (AP) — A Navy lab in Virginia soon will begin testing for swine flu. The Navy says the lab at the Norfolk Naval Station is the first on the East Coast to get equipment capable of testing for the virus, officially known as H1N1. Navy officials will show off the new equipment at the Naval Environmental and Preventive Unit on Thursday. The lab will work with the Naval Health Research Center in San Diego, state health departments and the Centers for Disease Control and Prevention to help confirm cases of swine flu. The Navy said the facility is in the final phase of evaluating its new processes before it can begin testing. There have been more than 37,000 confirmed or probable cases and 211 deaths from swine flu in the U.S. Copyright 2009 The Associated Press. All rights reserved. *National / International* Congress considers banning antibiotics in livestock By Meredith Cohn Baltimore Sun Thursday, July 16, 2009 The New York Times is reporting that Baltimore's own Dr. Joshua Sharfstein, now the principal deputy commissioner of food and drugs, is pushing to tack onto the health bill in Congress a provision to restrict antibiotics in livestock. Antibiotic is used commonly in livestock to promote growth and cut down on illnesses. But Sharfstein says the use in cows, pigs and chickens leads to treatment resistent bacteria in humans. Farmers shouldn't be able to use them without supervision from a veterinarian, he said. There was a hearing yesterday on the proposal by Rep. Louise M. Slaughter, D-N.Y., and chairwoman of the Rules Committee. Her measure would ban seven classes of antibiotics important to human health from being used in animals, according to the Times. Other antibiotics would be resticted to therapeutic uses and some prevention uses. Prospects for the proposal weren't totally clear. Though some supporters, including the American Medical Association and the Pew Environment Group, say they are improving. Seem like a good move? Copyright 2009 Baltimore Sun. In Good Health — Use common sense with Tylenol By Karen Gardner Frederick News-Post Tuesday, July 14, 2009 There's been a lot in the news lately about acetaminophen, the main ingredient in Tylenol. Most of it is bad, but that doesn't mean you can't, or shouldn't, take Tylenol or equivalents. Taking too much, however, can mean liver damage. Taking too many Tylenol pills combined with drinking alcohol or taking other prescription drugs can be especially hard on the liver. That's where you should be careful. Acetaminophen is a popular substitute for aspirin or ibuprofen, the main ingredient in Advil and Motrin. Ibuprofen and aspirin can be hard on the stomach. Pain relief comes, but it comes at a price. There's usually an organ that's affected. But experts say that alternating the two may be a good plan, if pain relief is needed. According to Rodale, the publisher of many health and fitness oriented magazines, too much acetaminophen can cause the liver to produce a toxic metabolite that binds to liver proteins and damages cells. If you take prescription drugs and have a headache, check to see if acetaminophen is in any of the drugs you are already taking. If it is, you should probably talk to your health care provider about another type of pain relief. The best thing you can do is read labels and know what you're taking, for both prescription and over-the-counter drugs. And don't take more than the recommended dose. Acetaminophen is also an ingredient in some over-the-counter pain relievers like Excedrin Migraine, and some cold medicines. Copyright 2009 Frederick News-Post. Study Cites Hormones as Cancer Risk By Reuters New York Times Thursday, July 16, 2009 CHICAGO (Reuters) — Women who took hormone replacement therapy after menopause had a sharply increased risk of ovarian cancer, researchers in Denmark are reporting. In a study of more than 900,000 Danish women ages 50 to 79, the scientists found 140 extra cases of ovarian cancer linked to hormone treatment over eight years. That translated to a 38 percent greater risk of contracting the disease, compared with women who did not receive the therapy. Hormone therapy accounted for 5 percent of the cases of ovarian cancer in the study period, the researchers reported in The Journal of the American Medical Association. “Even though this share seems low, ovarian cancer remains highly fatal, so accordingly this risk warrants consideration,” wrote the researchers, led by Lina Steinrud Morch of Copenhagen University. The findings were similar to those in the 2002 Women’s Health Initiative study, which was stopped early because it found an increased risk of ovarian cancer, breast cancer, strokes and other health problems from hormone therapy. Use of the treatment plunged after those findings were reported, and sales of Prempro, the combined estrogen-progestin therapy sold by Wyeth, have fallen 50 percent since 2001, to around $1 billion a year. Wyeth’s director of global medical affairs, Dr. Corrado Altomare, who was not involved in the Danish study, said that for women considering hormone therapy, family history and personal medical history “certainly” come into play. The risks of ovarian cancer were about the same from hormone therapy regardless of the duration of use, the formulation of the hormones, the estrogen dose or how it was administered, according to the study. As in earlier studies, the recent one found that the cancer risk diminished about two years after therapy was stopped. Ovarian cancer is diagnosed in roughly 18 out of 100,000 women in the United States each year, according to government statistics, and it killed 15,000 Americans in 2007. Copyright 2009 The New York Times Company. Behaving badly at the beach By Michelle Deal-Zimmerman Baltimore Sun Thursday, July 16, 2009 How do you behave at the beach? Do you go for the land grab - staking your claim to large portions of the sand? Do you smoke even though you're sitting near kids building a sandcastle? Do you toss your used beer cans at fast-moving crabs? Do you - heaven forbid - take a whiz in the water? You? Never, right? But according to TripAdvisor.com, 82 percent of travelers believe their fellow beachgoers are violating some form of beach etiquette or pool etiquette. The popular online traveler community surveyed more than 3,800 Americans and came up with a list of beach habits that irk us. The most common violations are beach chair hogging, urinating in the water and littering. But the most annoying ones are blasting loud music, smoking and - you guessed it - urinating in the water. Here are some more results from the TripAdvisor.com survey released earlier this month: * Eighty-four percent of travelers agree that people should not be allowed to "save" beachside or poolside chairs by getting up early and leaving their stuff on the chairs for hours. * It seems that some travelers don't practice what they pee: 53 percent of travelers admit to finding it acceptable to urinate in the ocean if other swimmers aren't near. * At an uncrowded beach, the majority of travelers (38 percent) believe that you should sit no closer than 20 feet away from another stranger. Twenty-two percent say 7-10 feet away is sufficient. * Is this a bath? Thirty-seven percent of travelers rarely shower before going in to the pool, and 14 percent admit to never washing off before hitting the pool. * Fifty-five percent of travelers think it violates etiquette for parents to change their children's diapers in public at the pool or beach, and 73 percent even think the beach should be separated into kid-friendly and pet-friendly areas. * Twenty-four percent of travelers think that it violates beach and pool etiquette for women to wear revealing bikinis, while 35 percent of travelers think it violates etiquette for men to wear speedos. * When asked which U.S. state's travelers were the worst beach and pool offenders, those surveyed awarded New York the honor, which came in at 11 percent of the vote, followed by Florida with seven percent and California with five percent. Copyright © 2009, The Baltimore Sun. U.S. to Buy H1N1 Vaccine Components From Four Firms By Jennifer Corbett Dooren Wall Street Journal Thursday, July 16, 2009 The U.S. government signed contracts with four companies worth a total of almost $1 billion to purchase ingredients used to make vaccines against the new H1N1 influenza virus. Health and Human Services Secretary Kathleen Sebelius said Monday that the department will commit $884 million to buy supplies of two key ingredients for a potential H1N1 vaccine. The funds will be used to place additional orders for bulk H1N1 antigen and adjuvant on existing contracts with U.S. units of Sanofi-Aventis SA and AstraZeneca PlC, along with GlaxoSmithKline PlC and Novartis AG. In May, the government earmarked $1 billion to spend on vaccine development. The bulk of the additional contracts announced Monday went to Novartis, with a contract worth about $690 million. Sanofi’s contract is worth about $61.4 million; Glaxo’s totaled $71.4 million, while a contract signed with AstraZeneca’s MedImmune unit totals about $61 million. Antigen is the active ingredient in a vaccine that causes the human body’s immune system to develop antibodies that help fight an invading virus. An adjuvant boosts the body’s response to a vaccine and could potentially reduce the amount of antigen necessary for the body to recognize and fight a virus. The government said vaccine ingredients will become a part of the pandemic stockpile, for use if a vaccination campaign is necessary. Last week, federal officials said they were planning for a vaccination campaign aimed, in part, at school-age children, the age group among the hardest hit by the new virus that was first detected in April. Any H1N1 vaccines would be administered separately from seasonal influenza vaccines because production is almost complete for seasonal vaccines. Vaccine makers are currently developing H1N1 influenza vaccine pilot lots that would be used for tests that are expected to start next month. The Food and Drug Administration is planning a meeting next week to discuss the clinical trials. The earliest doses of an H1N1 vaccine wouldn’t be available until mid-October, assuming tests show the vaccines are safe and likely to be effective. Federal officials have said they expect tests and the manufacturing process of H1N1 vaccines would be similar to the process for seasonal vaccines. Any H1N1 vaccine campaign would likely be carried out over a several-week period as additional vaccine becomes available. Separately, a new study published online Monday in the journal Nature suggests the H1N1 virus is stronger than previously believed. Research led by Yoshihiro Kawaoka of the University of Wisconsin in Madison, showed the H1N1 virus infects the lungs of mice, ferrets and monkeys, making the virus more likely to cause pneumonia compared to seasonal flu, which typically infects cells in the sinuses and throat. Researchers said tests of antiviral drugs in mice showed the drugs worked and suggested the drugs will be effective at combating H1N1 infections in humans. Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved. Obama Eyes The Purse Strings for Medicare Lawmakers Now Win Friends at Home by Setting Payout Rates By Shailagh Murray Washington Post Thursday, July 16, 2009 At the same time President Obama is asking members of Congress to take one of the most politically difficult votes of their careers, he is also pressing lawmakers to give up one of their most valued perks of office: boosting Medicare payments to benefit hometown providers. Setting reimbursement rates for local hospitals, doctors, home health-care centers and other providers is a legislative ritual that amounts to one of the most effective and lucrative forms of constituent service. Delivering federal money through Medicare, the country's largest insurance program, can be a powerful tool on the campaign trail, allowing lawmakers to argue that they are creating jobs and improving the quality of health care for voters. Longtime members of Congress have become masters at dominating the tug of war between keeping providers flush and trying to rein in the entitlement program's dramatic growth. House Ways and Means Chairman Charles B. Rangel (D-N.Y.) champions New York City's teaching hospitals. Charles E. Grassley (Iowa), the Senate Finance Committee's ranking Republican, makes sure rural health-care services are amply funded. Months before Sen. Ted Stevens (R-Alaska) left office, he secured a permanent 35 percent increase in Medicare payments for Alaska physicians. Obama administration officials say they are determined to stem soaring Medicare spending, arguing that it is a root cause of the broader health-care crisis that they are trying to address with Congress. Behind the scenes, Obama is pushing for a mechanism that would take Medicare payment authority out of the hands of politicians and invest it in a separate entity, possibly under the executive branch. "Structures that fundamentally alter the long-term costs are a must for real health-care reform," said White House Chief of Staff Rahm Emanuel. He called the Medicare payment debate "the least talked-about, most important issue on the table." House Democrats' health-care proposal, released Tuesday, includes no measures aimed at reversing the long-term cost trajectory of Medicare, a fact that spurred a rebellion among conservative Blue Dog Democrats on the Energy and Commerce Committee, which will begin debate on the House bill today. Rep. Mike Ross (Ark.), a Blue Dog leader and panel member, told reporters yesterday that he has the votes to defeat the package unless it is "substantially amended" to address long-term cost concerns. The Senate health committee approved its own bill yesterday on a party-line vote; that package also was silent on the issue of Medicare's growth. "We need to make it happen," Senate Finance Committee Chairman Max Baucus (D-Mont.), whose panel has jurisdiction over Medicare, said of payment reform. Baucus is crafting a separate proposal to pay for expanded health-care coverage, but that task is complicated by the fact that he is also attempting to win the backing of lawmakers such as Sen. Olympia Snowe (R-Maine), a crucial swing voter who opposes White House efforts to shift control of the Medicare payment equation. Snowe said Finance Committee members have debated payment reform at length in recent closed-door meetings, but did not reach a consensus. She said her chief worry is that providers would continue to look to lawmakers to protect their interests but that under a new system, she and others would be unable to respond to their concerns. Congress must retain the ability to "shape and influence" Medicare rates, Snowe said. "We're still going to be held accountable." Obama urged House and Senate leaders to action during a White House meeting this week, and at the request of committee chairmen, administration officials yesterday sent two proposals to Capitol Hill aimed at addressing the problem. One would empower the Medicare Payment Advisory Commission (MedPAC), a nonpartisan body of health-care experts that serves Congress in an advisory role, to determine cuts and changes to Medicare, akin to the Federal Reserve Board. "It's not perfect, but it does a lot better job than what Congress is doing," Rep. Jim Cooper (Tenn.) said of the commission. Cooper, a Blue Dog, co-sponsored the proposal with Sen. John D. Rockefeller IV (D-W.Va.), a senior Finance Committee member. The second proposal would create a similar entity, called the Independent Medicare Advisory Council, to make Medicare recommendations to the president. Lawmakers could vote to overturn decisions with which they disagreed but could no longer tailor Medicare spending to address local concerns. Medicare and Medicaid spending now accounts for 5 percent of gross domestic product, and if both programs grow at the same rate over the next 40 years as they have for the past four decades, they will eventually hit 20 percent of GDP, according to estimates. Congress is attempting to extract as much as $500 billion in Medicare cost savings to pay for health-care reform, but Obama administration officials are concerned that those savings would not result in the transformative fixes the system needs to be stabilized for the long term. White House officials say their own proposals for payment reform would make the system more flexible, allowing it to respond to developments such as breakthroughs in treatment. "We're trying to create a structure where that would be easier to reorient the system towards higher value and lower cost in the future," said White House budget director Peter Orszag. The long-term cost challenge has emerged as a major point of contention as new health-care legislation creeps closer to becoming a reality. White House officials and Democratic fiscal hawks worry that Congress could provide coverage to millions of uninsured people, expand the government's role in health care, and yet fail to "bend the cost curve," creating a fiscal disaster for the nation and a political disaster for their party. Republicans are warning that Democrats are charting a ruinous path, and those criticisms are beginning to resonate. Senate Finance Committee member Ron Wyden (D-Ore.) said such concerns have elevated the Rockefeller-Cooper proposal from a nonstarter to an idea that is gaining traction. "That's getting a very serious look right now," Wyden said. MedPAC was created in 1997 to address Medicare's grim prospects as health-care costs outpaced inflation and retiring baby boomers caused the program's ranks to swell. As the country's largest health-insurance program, covering nearly 40 million of the most expensive patients, the entitlement program also holds extraordinary influence over the health-care marketplace. A flood of carefully researched MedPAC reports set forth specific ideas for addressing Medicare's many deficiencies. In testimony before the House in late June, MedPAC Chairman Glenn M. Hackbarth summed up his view of the problems. "The health-care delivery system we see today is not a true system: Care coordination is rare, specialist care is favored over primary care, quality of care is often poor, and costs are high and increasing at an unsustainable rate," Hackbarth told Energy and Commerce Committee members. But for most lawmakers, resisting the armies of health-care lobbyists who are deployed to protect industry interests has proved difficult. "Basically, the cards are stacked against the member who has to confront these groups," said George F. Grob, who conducted numerous Medicare reviews through the Department of Health and Human Services' inspector general's office. "Look at who they're confronting -- the cancer doctors. Drug companies saying, 'We're the ones saving lives out there.' Hospitals saying, 'We're going to have to shut down.' " Such concerns are often conveyed to politicians by former colleagues or aides who have joined industry ranks. "They're talking to their friends," Grob said. But also, he said, the lobbyists "make really good arguments. They really know their stuff, and they understand the process. They know what the life cycle of a bill is, they know who to talk to, they know what they're talking about -- and they reach everybody." Copyright 2009 Washington Post. Fight for swine flu vaccine could get ugly Associated Press By Maria Cheng Washington Post Thursday, July 16, 2009 LONDON -- An ugly scramble is brewing over the swine flu vaccine - and when it becomes available, Britain, the United States and other nations could find that the contracts they signed with pharmaceutical companies are easily broken. Experts warn that during a global epidemic, which the world is in now, governments may be under tremendous pressure to protect their own citizens first before allowing companies to ship doses of vaccine out of the country. That does not bode well for many countries, including the United States, which makes only 20 percent of the flu vaccines it uses, or Britain, where all of its flu vaccines are produced abroad. "This isn't rocket science," said Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota. "If there is severe disease, countries will want to hang onto the vaccine for their own citizens." Experts say politicians would not be able to withstand the pressure. "The consequences of shipping vaccine to another country when your own people don't have it would be devastating," added David Fedson, a retired vaccine industry executive. About 70 percent of the world's flu vaccines are made in Europe, and only a handful of countries are self-sufficient in vaccines. The U.S. has limited flu vaccine facilities, and because factories can't be built overnight, there is no quick fix to boost vaccine supplies. Last week, the World Health Organization reported nearly 95,000 cases of swine flu including 429 deaths worldwide. If swine flu turns deadlier in the winter, the main flu season in the Northern Hemisphere, countries will likely be clamoring for any available vaccines. "Pandemic vaccine will be a valuable and scarce resource, like oil or food during a famine," said David Fidler, a professor of law at Indiana University who has consulted for WHO. "We've seen how countries behave in those situations, and it's not encouraging." Britain claims it will start vaccinating people in August, Italy says it will begin by the end of the year, and many other countries have similar strategies. Those mass vaccination plans could be derailed by problems making the vaccine and by other countries' refusal to ship it abroad. If the virus remains mild, this could all be moot. Experts estimate swine flu to be about as dangerous as seasonal flu, and there usually isn't a high demand for those vaccines. Still, regular flu kills up to 500,000 people a year. In past pandemics, or global epidemics, vaccines were never exported before the country that produced them got enough for its own population first. Unlike the last two pandemics in 1957 and 1968, however, many more countries this time around have struck deals with companies which they say guarantees them first access to vaccine. Yet in a global health emergency, those contracts may ultimately be meaningless. Countries with flu vaccine plants might decide to seize all vaccines and ban their export, thus breaking the pharmaceutical contracts promising other countries vaccine supplies. These private contracts are not binding international law between two countries, according to Fidler. He said most vaccine contracts include a clause allowing them to be broken under extraordinary circumstances, such as a health emergency. That would leave the countries who had brokered such deals not only without vaccine, but without legal recourse. "There's nothing in international law that helps you resolve this, it's just a political nightmare happening in the midst of an epidemiological nightmare," Fidler said. Britain has ordered 60 million doses, enough to cover its entire population. But those doses are being manufactured by GlaxoSmithKline PLC and Baxter International Inc., whose production plants are in Germany, Austria and the Czech Republic. Neither Britain's department of health or the vaccine manufacturers would comment on delivery plans. Osterholm said about 80 percent of the United States' pandemic vaccine supply will be coming from abroad and he is very concerned about when it might arrive. Timing could be everything to avoid a vaccine spat. "It's easy to move vaccine around if the disease is relatively mild. But if it is more severe, countries may not be willing to let it go," he said. So far, swine flu remains a relatively mild disease, and most people don't need medical treatment to get better. But experts fear the virus could mutate into a more dangerous form. And during the flu season, when the virus spreads more easily, more people will probably fall sick and die. Public health officials are aware that so-called "vaccine wars" might break out if the swine flu outbreak worsens, but are loathe to even discuss the topic. The European Centre for Disease Prevention and Control, an agency of the European Union, said it had no mandate to advise countries in such circumstances. WHO said it was not aware of any countries planning to block the shipment of vaccines and said they would work to ensure all countries get enough doses to protect their health workers. Questions also remain about when a swine flu vaccine will even be available, as WHO reported this week that a fully licensed vaccine might not be ready until the end of the year. With little or no safety data about a swine flu vaccine, governments that are planning to roll out mass campaigns are taking a gamble, since any rare side effects won't show up until millions of people start getting the shots. Experts say government promises about when vaccines will arrive should be taken with a huge grain of salt. "Many pieces of the puzzle are missing," Osterholm said. "Anyone who pretends to have a well-defined schedule of vaccine delivery is obviously very poorly informed." © 2009 The Associated Press. *Opinion* A healthy beginning Our view: The health care expansion plans being developed in Congress are a good start, but more work needs to be done on how to fund reform and hold down costs Baltimore Sun Editorial Thursday, July 16, 2009 The health care reform plans moving through the House of Representatives and U.S. Senate this week appear to be an excellent starting point for an ambitious effort to cover virtually everyone in the nation. They would: ensure that about 94 percent of Americans have coverage; provide for a government-run health plan that would compete with private insurers and drive down costs; require that individuals have coverage and that employers provide it; forbid private insurers from denying coverage because of pre-existing conditions; expand Medicaid to people making up to 133 percent of the poverty level and provide subsidies to those making up to 400 percent of poverty ($88,000 for a family of four); establish insurance exchanges so that individuals could more easily buy coverage; and invest in primary care. One little problem: How do we pay for it? The plan unveiled by House Democrats would cover the price tag - estimated at $1 trillion or more over 10 years - through a variety of cost-saving measures and a $540 billion increase in taxes for the top 2 percent of earners. (That's individuals making more than $280,000 a year and families making more than $350,000.) The Senate Finance Committee is working to find some bipartisan compromise on funding, if that's possible, and is considering paying for the plan through a variety of smaller measures, such as efforts to close corporate tax loopholes, fees on pharmaceutical and health insurance companies and perhaps even taxes on some health benefits. Shouldering some of the cost through an income tax surcharge on the wealthy isn't a bad idea, but making it the primary funding source would be a mistake. As Maryland has learned after raising marginal income tax rates on the wealthy, such levies are extremely sensitive to the economy and can drop off quickly during bad economic times as capital gains evaporate. Putting all our eggs in that basket seems like a bad idea. And politically, it would provide an inviting target. Political considerations are already driving the pace of the reform effort. President Barack Obama has been pressuring lawmakers to pass a plan before the August recess. Why the rush? Democrats are afraid that the longer the proposals linger, the more time well-funded opponents with a tremendous stake in preserving the status quo will have to torpedo reforms, as they did during the Clinton administration. But Mr. Obama and congressional leaders shouldn't be in such a hurry. Sixteen more years of a dysfunctional health care system have made the public more eager for reform, not less. The advocacy ads now running on cable channels show a government bureaucrat standing between a patient and a doctor; that's probably not so scary for people who have spent the last decade grappling with profit-minded insurance company bureaucrats standing between them and their doctors. But the recession and mounting budget deficit have made voters scared of the pricetag. Finding a palatable way to pay for health care expansion is crucial. So is reforming the economics of health care to stop the unsustainable growth in costs. If it takes longer than the next three weeks to develop a plan that gives incentives for doctors, hospitals and insurance companies to provide better care rather than more care, Congress shouldn't be afraid to take it. Copyright © 2009, The Baltimore Sun. The next course Our view: Buying food locally is a sound policy but requires consumers to act Baltimore Sun Editorial Thursday, July 16, 2009 When we run an item past the supermarket scanner, we're voting for local or not, organic or not." That's one of the more critical observations made in the scathing new documentary film, Food, Inc., that raises important questions about the nation's food supply, its impact on health and safety and the big business the production of food has become over the last half-century. Not only is it true that we are what we eat, but, increasingly, what we eat is having an extraordinarily adverse impact on ourselves and our environment. Growing incidences of food-borne illnesses, diabetes, obesity and cancer (and many other human disorders related to pesticides) can be directly traced, at least in part, to the unsustainable and unhealthy ways we grow, process and distribute our food. Consumers may be attracted to having seasonal fruits and vegetables available in their grocery stores year-round, but the environmental consequences of shipping produce halfway around the world are considerable in the wasting of fossil fuel and the resulting release of harmful greenhouse gases into the atmosphere. The alternative is to buy local - and preferably organic. But as Baltimore Sun reporter Laura Vozzella recently chronicled, what chain grocery stores advertise as local could hail from as far away as Chile and New Zealand. Maryland law does not require stores to adhere to any particular standard. That ought to change, but such a law would be only a small part of a solution. The real burden lies with food shoppers who face the choice of buying local or not, and organic or not, every time they shop for their next meal. Until they insist on more healthful options, all the grocery stores, markets and restaurants that have grown accustomed to the reliability and convenience of large-scale providers supplying faster, fatter, bigger and cheaper foods on demand are unlikely to change their policies. This afternoon, Gov. Martin O'Malley is scheduled to host a backyard cookout with Maryland producers and chefs at Government House in Annapolis to showcase the variety of fresh products available locally. The event launches the state's annual "buy local challenge," which asks residents to eat at least one locally grown item each day for seven days, beginning this weekend. Eating locally would not seem so difficult a chore in mid-July, when Maryland farmer's markets are loaded with fresh corn, tomatoes, melons, cucumbers and other fare. Still, it requires more consumers to become better educated about what's available and how to find it and prepare it. People must also be made more aware of the many health and environmental benefits of buying locally. State agriculture officials say the "buy local" movement is already having an impact. The number of small-scale farms providing fresh fruits, vegetables, dairy, eggs, meat and wine to the marketplace is growing. But it can (and must) grow much further still - if the public is willing to "vote" for it at the grocery checkout. Copyright © 2009, The Baltimore Sun. A Strong Health Reform Bill New York Times Editorial Thursday, July 16, 2009 While the Senate continues to struggle over its approach to health care reform, House Democratic leaders have unveiled a bill that would go a long way toward solving the nation’s health insurance problems without driving up the deficit. It is already drawing fierce opposition from business groups and many Republicans. This is a bill worth fighting for. The bill would require virtually all Americans to carry health insurance or pay a penalty. And it would require all but the smallest businesses to provide health insurance for their workers or pay a substantial fee. It would also expand Medicaid to cover many more poor people, and it would create new exchanges through which millions of middle-class Americans could buy health insurance with the help of government subsidies. The result would be near-universal coverage at a surprisingly manageable cost to the federal government. The nonpartisan Congressional Budget Office estimates that by 2015, 97 percent of all residents, excluding illegal immigrants, would have health insurance. The price tag for this near-universal coverage was pegged by the budget office at just more than $1 trillion over 10 years — at the low-end of the estimates we’ve heard in recent weeks. The legislation would pay for half that cost by reducing spending on Medicare, a staple of all reform plans. It would pay for the other half by raising $544 billion over the next decade with a graduated income surtax on the wealthiest Americans: families with adjusted gross incomes exceeding $350,000 and individuals making more than $280,000. Predictably, the idea of raising taxes this way has critics outraged, with some charging that it is unfair to require a small sliver of the population to bear the brunt of the cost. The wealthy have benefited greatly from Bush-era tax cuts, and their incomes have risen disproportionately in recent years. It seems proper that they should contribute heavily to an effort that is vital to hard-pressed Americans and to the long-term health of the economy. The legislation also includes some sound ideas for slowing the inexorable rise in health care costs. Such savings are also essential for the nation’s economic health. It adjusts Medicare reimbursements to encourage health care providers to improve productivity, reduce costly hospital readmissions and spend more time on primary care that can head off the need for costly specialists. It expands prevention and wellness activities. And it establishes a center to compare the effectiveness of various drugs, devices and procedures. Unfortunately, it prohibits the government from requiring public or private insurers to set reimbursement policies based on the findings. These steps may not produce big savings quickly but could lower costs in future years. The bill makes a mockery of Republican claims that the Democrats are pushing a hugely costly government takeover of medicine. This bill is clearly not hugely costly. It would expand the government’s role in financing and regulating coverage but would also bolster private coverage. It would increase employer-based coverage, mostly by requiring employers to participate. And it would send more clients to the private insurance industry. The Congressional Budget Office estimates that perhaps 10 million people might enroll in a new public plan, while twice that number might enroll in competing private policies. The Senate health committee has approved, by a party-line vote, a bill that in many respects parallels the House bill. The Senate Finance Committee, hoping to win over Republicans and conservative Democrats, is balking at a public plan and raising taxes on the wealthy. If there is a deal to be had, it is worth discussing. But the House has set a clear standard for health care reform: It must cover all Americans without driving up the deficit. Copyright 2009 The New York Times Company. Hamstringing hospitals won't cut costs By Chet Burrell and Carmela Coyle Baltimore Sun Commentary Thursday, July 16, 2009 If there's one thing everyone in the health care debate agrees on, it's that whatever reforms we embrace have to lead to more affordable health care. Businesses, individuals, hospitals and insurers face the same problem: how to moderate ever-higher health care expenses. Stemming these rising costs was the primary reason given recently when the Maryland Health Services Cost Review Commission set hospital rates at a below-inflation rate of increase for the coming year. Unfortunately, the commission's action to limit the increase in hospitals' charges to 1.49 percent could harm health care delivery in Maryland. Moreover, it is unlikely to stem the rise in health insurance premiums. Hospitals have been hammered by the recession. The commission's decision further stresses hospitals financially and may drain resources from needed health care programs and community services. Hospitals are concerned that vital care professionals could face layoffs at the very time the state is looking to health care to help lead us out of the recession. Despite restraint in the rise of hospital rate increases, insurance premiums have consistently risen faster than inflation. Employers have reacted by decreasing coverage and shifting costs to employees. In the long term, these moves, which are driven out of economic necessity, will likely harm the health of the whole community. So, what is driving costs up? And what can be done about it? One cause is that we are overusing our health care resources. Needless duplication of tests, diverging incentives for hospitals and physicians, preventable hospital readmissions, a failure to recognize the value of primary care, and a lack of care coordination especially for the chronically ill - all of these things waste resources. In Maryland, we are beginning to attack health care's true cost drivers. Maryland hospitals are working on a number of fronts to reduce complications and associated costs. The Anne Arundel Medical Center used a multidisciplinary team approach to produce drastic reductions in preventing ventilator-associated pneumonias. At Johns Hopkins Bayview Medical Center, careful coordination has resulted in the elimination of all bloodstream infections for more than one year. Another approach that is catching on involves coordinating treatment through "patient centered medical homes." A primary care physician is compensated to act as the "quarterback" of a provider team for patients with chronic diseases such as diabetes, asthma or hypertension. Such diseases require constant attention and treatment modifications. Members of the team work together to deliver the full spectrum of care - primary, preventive or acute - to keep the patient healthy. They are rewarded for good performance and good outcomes overall, not just for hospital-based services. This comprehensive approach zeros in on what these patients really need to stay healthy and seeks to avoid expensive hospitalizations. And since 80 percent of health care dollars are spent treating only 20 percent of all people - usually those with chronic conditions - the savings from better coordination and more personalized care can be substantial. These types of steps can bring down health care costs. To achieve this, working partnerships between those who provide care and those who pay for it are necessary. Simply focusing on inpatient reimbursement rates is not reform. But if hospitals and insurers work together to reform the payment system so it rewards quality health care, we can bring down costs and improve health outcomes. Chet Burrell is CEO of CareFirst BlueCross BlueShield. Carmela Coyle is President and CEO of the Maryland Hospital Association. Her e-mail is ccoyle@mhaonline.org. Copyright © 2009, The Baltimore Sun. Despite chemical hazards, spraying still best option Salisbury Daily Times Letter to the Editor Thursday, July 16, 2009 RE: "'No mosquito spraying' request upsets neighbors," July 9 As an addendum to my previous letter, I would like to say that I have become more "educated" on the chemical used in Snow Hill to treat mosquitoes. It is not organic; however, considering more than 1 million deaths occur every year as a result of mosquito-borne illnesses -- and there are no known linked deaths related to the chemical used -- my choice remains the same. The chemical is diluted and used in low volumes, so as to cause as little harm as possible. A person would have to experience long-term, direct and concentrated exposure to be affected -- whereas it only takes one mosquito bite to transmit West Nile virus and/or encephalitis. The benefits still outweigh the risks. I appreciate the positive support I have received from my neighbors, as well as many others who live in the town of Snow Hill. Lisa Moyer Snow Hill Copyright 2009 Salisbury Daily Times. BACK TO TOP


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