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			Monday, July 20, 2009 News Clipping Archives *Maryland / Regional* Tracking environmental health (Baltimore Sun) Report criticizes juvenile center where 14 youths escaped (Baltimore Sun) 12 in area treated for carbon monoxide poisoning (Baltimore Sun) *National / International* Bad news, good news on circumcision and HIV (Baltimore Sun) With Health Reform, Waxman Takes On Another Tall Order (Washington Post) Governors Fear Medicaid Costs in Health Plan (New York Times) Swine Flu Vaccine on Track for Fall: CDC (MSNBC) Americans Worried About Flu’s Impact on Finances (New York Times) New Push in H1N1 Flu Fight Set for Start of School (Wall Street Journal) Sobering statistics on teen pregnancy and STDs (Baltimore Sun) Diprivan, the drug found in Michael Jackson's home, may be more tightly Restricted (Baltimore Sun) Preventing delirium in older hospital patients: what families can do (Baltimore Sun) HGS's Lupus Drug Shows Promise in Latest Trials (Washington Post) SAfrica stops funding for AIDS vaccine research (Washington Post) *Opinion* Costs and Benefits (New York Times Editorial) The color of complacency (Carroll County Times Commentary) Gone but not forgotten (Carroll County Times Commentary) *Maryland / Regional* Tracking environmental health By Kelly Brewington Baltimore Sun Monday, July 20, 2009 A fancy new tool from the Centers for Disease Control and Prevention enables users to track environmental health hazards across the country. ( http://ephtracking.cdc.gov/showHome.action ) The National Environmental Public Health Tracking Network collects information on environmental hazards, how people are exposed to them and if they lead to serious illnesses. The goal is to help people understand how the environment may play a roll in their health. Scientists have known that air pollution and lead can contribute to illness, but many other evironmental and health connections remain unproven. This site attempts to gather more information to better understand the possible connections. The site collects information from state and local agencies and breaks them down into various topics. For instance, you can learn about how the CDC tracks lead poisoning (http://ephtracking.cdc.gov/showChildhoodLeadPoisoning.action), its effect on health and efforts to combat it. You can learn more about air quality status, details on arsenic in water and their links to health outcomes. You can also run individual "reports" on the impact of certain health problems in your area. After a bit of clicking, I learned there were 8,724 hospitalizations for asthma in Maryland in 2006. There's also a link to Maryland's own tracking network ( http://eh.dhmh.md.gov/tracking/ ), where you can get even more detailed information as well as tables, maps and downloads. Maryland is one of 16 states selected by the CDC in this effort. “For the first time, the members of the public can be active and informed participants,” said John M. Colmers, Maryland's health secretary. “Anyone will have access to the same information that policy makers and public health professionals use to better understand the complex relationships between our health and our environment and rely on that information to make informed decisions.” Copyright 2009 Baltimore Sun. Report criticizes juvenile center where 14 youths escaped Associated Press By Brian Witte Baltimore Sun Monday, July 20, 2009 Maryland's juvenile justice monitor on Monday outlined widespread problems at the state's secure treatment center for troubled youths and said staff at the center's oversight department "hampered" an investigation into a violent escape of 14 youths in May. The Maryland Department of Juvenile Services disputed findings in the extremely critical report, which is being released Monday. Copies of the report by the monitor, which is a division of the attorney general's office, and the department's four-page response were obtained by the Associated Press. The Maryland Juvenile Justice Monitoring Unit report noted that staff and youths at the facility feared for their lives during the outbreak of violence. It also raised questions about whether the 48-bed Victor Cullen Center in Sabillasville is capable of handling some of the youths under its charge. "In the two years since its opening, Victor Cullen has been unable to establish a positive therapeutic culture," the report said. "Many factors, including multiple leadership changes, staff shortages, lack of clinical staff, and staff failure to understand the rehabilitative model, have contributed to the difficulties." For example, many youths confined at the facility do not meet criteria for responding to the center's peer-oriented treatment program, the monitor found. That's because they have histories of violent crime or have cognitive difficulties creating hurdles to responding to treatment, the report said. While Maryland's juvenile justice system has had serious problems for years, the monitor's report is notable for its pointed criticism of the facility's management and the department's lack of cooperation. While the report says department staff "made it difficult for monitors to gain access to evidence and to interview youth on the campus," the department denies hampering the investigation. In its response, the department claims monitors had access to Victor Cullen "on every day that they arrived at the facility." The department also said youths involved in the incident had to be interviewed first by investigating police. The department also said some of the more serious offenses by youths identified by the monitor, such as arson and assault on police that would make them ineligible for treatment at the facility, were allegations that were not sustained in court. Nevertheless, Marlana Valdez, Maryland's independent juvenile justice monitor, said the monitor isn't changing its position. "In this case, we reviewed their comments and do not agree with them and stand by the report and the report speaks for itself," Valdez said. The report also notes the facility's staff members "consistently remarked that they do not have the tools to do their jobs." "They said the program continues to be short-staffed, and that too many lack experience working with youth," the report said. Six staff members were disciplined after the escape -- another point the monitor takes issue with, because it has worsened staff morale. The report also criticized the department for being too slow to warn members of the community nearby about the breakout, criticism the department rejected as "erroneous." The monitor's report also provides more details on the chaotic May 27 breakout, when the 14 youths escaped after hard-punching melees resulted in six staff members seeking medical attention. The incident was set off after a youth stayed on the telephone too long around 6:45 p.m. and elbowed a staff member in the face after the phone was disconnected. What happened after that is described as a fast-moving chain reaction of youths beating up staff in two separate cottages. When one or two staff members left one cottage to help with the initial disturbance, 11 youths and one staff member remained in the cottage next door. One of those youths then attacked the lone staff member, the report said. That staff member ended up with "a broken nose, a black eye, and a head contusion." The department, however, disputes that the employee's nose was broken, citing medical documentation the department received. Staff members also told the monitor that the department "minimized the extent of injuries to staff by making public statements that injuries were limited to bruises and cuts when they were more serious." The report also criticizes the department for not dealing "with the traumatic effects of this event on both staff and youth." "Even the ambulance drivers were so afraid that they fled the facility," the report said. The department said it's "simply incorrect" to say action hasn't been taken, because it arranged for a staff psychologist and a private mental health provider to meet with staff soon after the incident. Staff members also were given an opportunity to seek assistance from an employee assistance program. The report details how gang issues played a role in the violence, in which youths took control of two buildings. Youth witnesses interviewed by the monitor said one of the boys spoke of what was happening to his "crew members" in another cottage at the facility before punching a staff member in the face. The report said the boy then grabbed the injured staff member's radio and, in a defiant effort to communicate with a staff member on the other end, shouted: "You got our youth and we got your staff!" Copyright 2009 Associated Press. All rights reserved. 12 in area treated for carbon monoxide poisoning By Richard Irwin and Brent Jones Baltimore Sun Monday, July 20, 2009 Nine people, including seven children, were treated at two separate medical facilities Sunday afternoon for the nonlife-threatening effects of a natural gas leak in a Northeast Baltimore apartment, said a spokesman for the city Fire Department. Hours later, three others were treated for another carbon monoxide leak in Howard County. Chief Kevin Cartwright said when firefighters and medics arrived at a two-story apartment in the 6900 block of McClean Blvd. near Perring Parkway shortly after 3 p.m., they found seven children and two adults complaining of feeling ill. Cartwright said the children, the youngest 18 months, were taken by ambulances to the University of Maryland Medical Center and the adults to Maryland Shock Trauma Center. He said firefighters and a Baltimore Gas and Electric Co. crew traced the leaking carbon monoxide to a malfunctioning gas-operated water heater on the first floor and shut it down. Fans were used to ventilate the apartment. Cartwright said low levels of the gas also were found in two adjacent vacant apartments. The apartment complex is owned by Sawyer Realty Holdings LLC, a College Park-based company that manages dozens of other housing communities in Baltimore and Prince George's counties. One complex, Cove Village in Essex, has a history of carbon monoxide problems, including two incidents that sent eight people to the hospital last month. In Howard County, firefighters responded Monday morning to a call for carbon monoxide in the 10300 block of Twin Rivers Road that sent three people to Howard County General Hospital. Fire officials said the leak displaced a family of five, and crews were attempting to find the source of the leak. Copyright © 2009, The Baltimore Sun. *National / International* Bad news, good news on circumcision and HIV Picture of Health Baltimore Sun Monday, July 20, 2009 In recent years, research studies done in three African countries have conclusively showed that being circumcised reduces a man's risk of acquiring HIV by roughly 50 percent. Could a man's circumcision also protect his partner from getting infected? The answer appears to be no. A Ugandan study, led by Dr. Maria J. Wawer from Johns Hopkins Bloomberg School of Public Health and published in this week's issue of The Lancet, was stopped short after 2 years when it was determined that HIV-infected men who were newly circumcised were just as likely to spread the disease to their partners as those who remained uncircumcised. ... Circumcision is catching on in Africa as a way to keep HIV transmission in check, promoted by the World Health Organization and other public health groups. Anecdotal reports from the continent, according to The Lancet, say interest in circumcision from young men is being driven by women who want circumcised partners. Is the news all bad news for women? Not according to the study's authors. They say that more circumcision (accompanied by HIV counseling, condoms and education on HIV prevention) will mean fewer men with HIV -- fewer men to spread HIV to their women. Copyright 2009 Baltimore Sun. With Health Reform, Waxman Takes On Another Tall Order By Ceci Connolly Washington Post Monday, July 20, 2009 For his first feat this legislative session, Rep. Henry A. Waxman (D-Calif.) staged a coup and deposed a sitting chairman and dean of the House. He followed that up with a nail-biter victory in the House for his beloved climate change bill. But on Monday, the hard work will begin for the chairman of the House Energy and Commerce Committee as he labors to advance President Obama's endangered health-reform agenda. If Obama is to succeed, he will need the 5-foot-5 Los Angeles liberal to quell an uprising by conservative Democrats, overcome a budget gap in excess of $240 billion and possibly swallow compromises on pet issues such as biogenerics and a new government-sponsored health program. Legislation aimed at overhauling the nation's $2.3 trillion health-care system is so complex that it requires the blessing of three House committees. Last week, two panels approved the bill in little more than a day. Waxman, though widely considered one of the most tenacious dealmakers in Congress, will have no such luxury. He and his veteran staff are bracing for up to a week of marathon sessions, with the outcome still in doubt. Already, a faction known as the Blue Dog Coalition is saying it has the votes to stop him. "Henry has the biggest challenge," said House Majority Leader Steny H. Hoyer (D-Md.). In addition to dealing with "some of the most controversial policies" in the sprawling health bill, the committee "has the most diverse representation in the caucus," Hoyer said, which means Waxman must juggle many competing interests within his party. Elected in 1974 in the class of post-Watergate reformers, Waxman built a reputation as a ferocious investigator, particularly under Republican presidents. After Obama's election, Waxman took on -- and defeated -- Rep. John D. Dingell (D-Mich.) for the top spot on a committee known for its clout. The hurdles arrayed before Waxman, 69, speak to a more fundamental reality replayed each time Congress attempts to enact universal health care: Dramatically changing an industry that touches every American personally and every business financially is treacherous politics. "A health-care bill is, under any circumstance, going to be difficult," Waxman said in typical understatement. "If it had been easy, we would have done it a long time ago. But I'm optimistic." To win passage of a bill that could cost $1.2 trillion over the next decade, House Democratic leaders must hold together an eclectic coalition that includes family farmers, coastal liberals, civil rights heroes and antiabortion Midwesterners. Many of the tensions arise over government spending. In a response similar to their discomfort over climate change, many of the conservative Democrats threatening to derail health reform say they are worried about the price tag. "We cannot continue to throw money into a broken system, and I will continue working constructively with the leadership and the administration to address the Blue Dogs' concerns in the days ahead," said Rep. Mike Ross (D-Ark.), chairman of the Blue Dog Health Care Task Force. The case was bolstered last week by the nonpartisan Congressional Budget Office, which concluded that the bills under consideration do not accomplish Obama's goal of slowing long term the rate of growth in health care. After 34 years in Congress, Waxman is sensitive to members' "unease about having to answer back home," particularly in swing districts. But he also said he believes that many are falling prey to "misleading" talk on "right-wing radio." "They are using the rhetoric they used successfully in 1993 and '94," he said, recalling the defeat of President Bill Clinton's health-care bill. "We've learned our lessons." In a weekend interview, Waxman praised Obama for striking deals with many of the large industries that blocked health reform 16 years ago. But he also made clear that he is not entirely satisfied with the concessions the young president won, particularly from drug companies. Waxman is girding for two battles involving the pharmaceutical industry. First, he is vowing to recoup the "windfall" the industry made when it stopped paying the government rebates on medicines purchased for people who switched from Medicaid to a new Medicare drug program. The second and more difficult struggle centers on market protections for companies that produce therapies known as biologics. Derived from living cells instead of the chemical compounds used to make traditional medications, biologics are widely considered the future of the pharmaceutical industry. But the treatments can be exorbitantly expensive. A one-year course of the breast cancer biologic Herceptin costs about $48,000. For that reason, consumer groups such as AARP are eager to create an approval path for cheaper generic versions. "These aren't going to benefit people if they can't afford them," said John Rother, AARP's director of public policy. The industry, backed by Rep. Anna G. Eshoo (D-Calif.), wants 12 to 14 years of market protection called data exclusivity. "We think that's the right balance between expanding competition without undermining the incentives industry needs to innovate," said Jeff Joseph, a spokesman for the trade group BIO. Investing in biologics is a financially risky business, he said, in which it takes an average of 13 to 16 years to break even. But the Federal Trade Commission released a report last month saying extra protection was unnecessary because the industry already enjoys the benefits of standard patent protections and the high prices. Waxman proposed granting biologics five years of data exclusivity, while the Obama administration proposed seven years as a "generous compromise." Lined up with Waxman are many consumer groups, health insurers, pharmacies and major corporations that bear the brunt of soaring medical bills. But Eshoo spokesman Jason Mahler said that with 135 co-sponsors on her bill, Eshoo expects to prevail. Shortly after Waxman helped push the climate change bill through the House on a 219 to 212 vote, he fainted in his office and was briefly hospitalized. Still, compared with the eight years he spent keeping tabs on a Republican president, the high-wire legislating is energizing, Waxman said. "President Obama is not working around the edges. He is taking on big issues, and that leaves many members feeling anxious," he said. "I'm excited by it." Copyright 2009 Washington Post. Governors Fear Medicaid Costs in Health Plan By Kevin Sack and Robert Pear New York Times Monday, July 20, 2009 BILOXI, Miss. — The nation’s governors, Democrats as well as Republicans, voiced deep concern Sunday about the shape of the health care plan emerging from Congress, fearing that Washington was about to hand them expensive new Medicaid obligations without money to pay for them. The role of the states in a restructured health care system dominated the summer meeting of the National Governors Association here this weekend — with bipartisan animosity voiced against the plan during a closed-door luncheon on Saturday and in a private meeting on Sunday with the health and human services secretary, Kathleen Sebelius. “I think the governors would all agree that what we don’t want from the federal government is unfunded mandates,” said Gov. Jim Douglas of Vermont, a Republican, the group’s incoming chairman. “We can’t have the Congress impose requirements that we are forced to absorb beyond our capacity to do so.” The governors’ backlash creates yet another health care headache for the Obama administration, which has tried to recruit state leaders to pressure members of Congress to wrap up their fitful negotiations. Both Ms. Sebelius, who was Kansas’ governor before she joined the cabinet in April, and the federal Medicaid chief, Cindy Mann, made appearances at the meeting on Sunday. Meanwhile, other administration officials spent the day pushing President Obama’s proposal on television talk shows. Mr. Obama also plans to address questions about his health plan at a news conference on Wednesday evening. Ms. Sebelius emerged from her hour-long meeting with the governors saying that “there’s a recognition that states don’t have cash right now” and that “it’s difficult to send states the bill if they don’t have the money.” Although many governors said significant change in how the nation handles health care was needed, they said their deep-seated fiscal troubles made it a terrible time to shift costs to the states. With the recession draining states of tax revenues even as their Medicaid rolls are surging, the National Governors Association projects that states will face aggregate deficits of $200 billion over the next three years. Each of several health care bills coursing through Congress relies on a large increase in eligibility for Medicaid, the state and federal insurance program for the poor, as one means of moving toward universal coverage. Because the states and the federal government share the cost, any increase in eligibility levels, benefits or payments to doctors would impose new burdens on the states unless Washington absorbs them. In at least one of several bills circulating in Congress, the states would eventually pick up a share of the new costs, and the governors fear they cannot count on provisions in other bills that they will not bear costs. It was unclear whether the governors would draft a statement expressing their dismay, at least partly because half of them did not attend. Many, including the group’s chairman, Gov. Edward G. Rendell of Pennsylvania, a Democrat, stayed home to deal with budget crises. Some of the group’s most notable names — Arnold Schwarzenegger of California, Sarah Palin of Alaska, Tim Pawlenty of Minnesota and Bobby Jindal of Louisiana — were not here. But the sentiment among those who were could not have been more consistent, regardless of political party. The governors said in interviews and public sessions that the bills being drafted in Congress would not do enough to curb the growth in health spending. And they said they were convinced that a major expansion of Medicaid would leave them with heavy costs. They are already anticipating large gaps in Medicaid financing after 2010, when stimulus money dries up. And they pointed out that Medicaid already suffered from low payment rates to health care providers, discouraging some doctors and hospitals from accepting beneficiaries. If Medicaid is expanded, states will almost surely have to increase payments to doctors to encourage more of them to participate. Gov. Phil Bredesen of Tennessee, a Democrat, said he feared Congress was about to bestow “the mother of all unfunded mandates.” “Medicaid is a poor vehicle for expanding coverage,” added Mr. Bredesen, a former health care executive. “It’s a 45-year-old system originally designed for poor women and their children. It’s not health care reform to dump more money into Medicaid.” Mr. Bredesen was far from alone in his concern. “As a governor, my concern is that if we try to cost-shift to the states we’re not going to be in a position to pick up the tab,” said Gov. Christine Gregoire of Washington, also a Democrat. “I’m personally very concerned about the cost issue, particularly the $1 trillion figures being batted around,” said Gov. Bill Richardson, the New Mexico Democrat who served in the Clinton cabinet and ran for president against Mr. Obama. Asked about the concerns, Peter R. Orszag, director of the White House Office of Management and Budget, made two points. First, he said, one of Mr. Obama’s overriding goals was to reduce the rate of growth of health costs, and that would benefit states by relieving pressure on their budgets. In addition, he said, some versions of the legislation, including the House bill, could slightly reduce state spending on Medicaid and the Children’s Health Insurance Program over the next 10 years. Many governors expressed frustration that the prolonged negotiations in Washington had made it difficult to gauge the potential impact on their budgets. “There’s a concern about whether they have fully figured out a revenue stream that would cover the costs, and that if they don’t have all the dollars accounted for it will fall on the states,” said Gov. Bill Ritter Jr. of Colorado, a Democrat. Under the health care proposals before Congress, Medicaid eligibility would be based solely on income, without regard to factors that have historically been used to decide who qualifies. In the House bill, Medicaid would be expanded to cover all nonelderly people with incomes at or below 133 percent of the poverty level, or $29,300 for a family of four. The federal government would pay all the costs for those who were newly eligible. Medicaid would also cover newborns, for up to 60 days after birth, if they did not have insurance from other sources. The Congressional Budget Office projects that 11 million more people would receive coverage through Medicaid under the House bill, and that it would increase federal Medicaid spending by $438 billion over 10 years. Medicaid thus accounts for about 40 percent of the cost and 30 percent of those who gain coverage. In a draft of the bill in the Senate Finance Committee, the federal government would pick up the extra costs for perhaps five years, but states would eventually have to pay their normal share. On average, the federal government pays 57 percent. One of the proposals being considered by the Finance Committee would encourage states to issue bonds to cover the costs of expanding Medicaid. Governors in both parties revolted, trumpeting their opposition in a conference call last week with Senator Max Baucus, the Montana Democrat who leads the committee. “There is strong bipartisan opposition to the idea of the states’ issuing bonds to pay for operational expenses,” said Gov. Haley Barbour of Mississippi, chairman of the Republican Governors Association. “One governor said it would be like taking out a mortgage to pay the grocery bill.” Copyright 2009 The New York Times Company. Swine Flu Vaccine on Track for Fall: CDC New U.S. outbreak likely in coming months; children and young adults still primary targets HealthDay Reporter By Steven Reinberg MSNBC Friday, July 17, 2009 FRIDAY, July 17 (HealthDay News) -- U.S. health officials said Friday that development of a vaccine for the H1N1 swine flu is on track, with the first doses possibly ready by the fall. Initial tests of a vaccine are expected to start soon, possibly within weeks, although results about its safety and effectiveness won't be known for about month after that, officials said. Secretary of Health and Human Services Kathleen Sebelius has announced plans for a voluntary vaccination program in the fall, "assuming availability of a safe and effective vaccine," Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the U.S. Centers for Disease Control and Prevention, said during a midday press conference. Schuchat said the CDC is working with states and local governments to develop vaccination programs. On July 29, the CDC's advisory committee for immunization practices will meet to discuss who should receive the H1N1 vaccine. The committee also will look at who should be vaccinated first -- for example, health-care workers -- if the vaccine is in short supply. "We think things are proceeding well," Dr. Jesse Goodman, the U.S. Food and Drug Administration's acting chief scientist and deputy commissioner, said during the press conference. "We expect initial trials to be starting very shortly." As vaccine development continues, the H1N1 swine flu virus continues to sweep around the world. "This virus is not going away," Schuchat said, adding that it's still causing infections in the United States in the summer, "in temperature and humidity conditions that are not very favorable to seasonal influenza virus transmission." On Friday, the CDC was reporting 40,617 confirmed cases of H1N1 infection and 263 deaths, although officials believe more than 1 million Americans have been stricken with the swine flu. The reason for the disparity: The virus continues to produce mild symptoms and patients typically recover quickly. Schuchat said she expects to see a new outbreak of H1N1 swine flu in the United States in the fall. It will most likely start earlier than seasonal flu, she said. Seasonal flu typically surfaces in late fall. Unlike seasonal flu, the H1N1 flu continues to pose more problems for younger people, Schuchat added. "There are a higher attack rates and hospitalizations in younger adults and children," she said. In the Southern Hemisphere, where the winter flu season is under way, cases of H1N1 virus infection are being reported, along with cases of seasonal flu, Schuchat said. "In the reports we have, the virus continues to affect generally younger people, sparing the elderly to a great extent," she said. And, as in the United States, the H1N1 virus is causing severe respiratory problems in the Southern Hemisphere, a trend that's unique to the new strain of flu and not seen in seasonal flu, Schuchat noted. "We've heard of intensive-care units with many younger people who have this new H1N1 virus." Last month, researchers reported in the New England Journal of Medicine that, unlike seasonal flu, the new H1N1 flu strain attacks younger people and can be more severe and deadly in that group. One report focused on the initial flu outbreak last spring in Mexico that included 2,155 cases of swine flu reported by the end of April. Researchers zeroed in on the 100 people who died and what caused those deaths. They found that 87 percent of the deaths and 71 percent of the cases of pneumonia were seen in people aged 5 to 59. That's unlike what is seen with seasonal flu epidemics, in which, on average, 17 percent of those in that age range who are seriously ill die and 32 percent develop severe pneumonia, the researchers said. Also Friday, the World Health Organization said it would no longer keep a global tally of individual cases of H1N1 swine flu. The reason: The pandemic is circling the globe at an "unprecedented" speed, and keeping a count no longer serves a valuable purpose. Instead, the agency said it would focus on new countries experiencing infections, with an eye out for genetic mutations that could mean the virus is becoming more virulent and potentially more dangerous. Before it stopped reporting individual cases, the WHO had listed almost 95,000 cases and 429 deaths worldwide. Copyright 2009 MSNBC. Americans Worried About Flu’s Impact on Finances By Roni Caryn Rabin New York Times Monday, July 20, 2009 Most Americans think swine flu will be back with a vengeance in the fall, with almost 6 in 10 saying they believe a serious outbreak of influenza A (H1N1) is likely, a new survey has found. But while most adults are not overly concerned about their own health or that of their families, they are worried about the financial hit they will take if illness or school closings keep them home from work, according to the survey by researchers at the Harvard School of Public Health. Some 44 percent of those surveyed said they would lose income if they missed work for a week to 10 days due to illness, and a quarter said they could lose their jobs or businesses altogether. Parents with children in school and day care were similarly concerned about the impact of extended school closings. More than half said they or another member of the household would have to miss work to care for children if schools or day care centers were closed for two weeks. Some 43 percent of parents said the loss of income would cause financial hardship, and 26 percent said it could cost them their jobs. Dr. Robert Blendon, a professor of health policy and political analysis at the school, said the findings are a “wake-up call” to businesses that they need to reexamine their sick leave policies. “It’s really clear: we live in a country where parents work. It’s not 1918 anymore, where most families had someone who stayed at home,” Dr. Blendon said. “Unless we have some general leave polices that are supportive of people, we’re going to have a lot of families in very difficult economic circumstances very quickly.” The survey was the third Harvard evaluation of perceptions of the flu outbreak and included the responses of 1,823 adults ages 18 and older. It was conducted in June of this year. Copyright 2009 The New York Times Company. New Push in H1N1 Flu Fight Set for Start of School By Betsy Mckay Wall Street Journal Monday, July 20, 2009 U.S. health officials are preparing intensively to combat an anticipated wave of outbreaks of the new H1N1 flu when children return to school and the pace of cases picks up. Identified by scientists just three months ago, the new swine-flu virus has reached nearly every country, spreading tenaciously with what the World Health Organization this week called "unprecedented speed." Rather than die down in the summer as some experts initially expected, it is continuing to proliferate even in countries like the U.S. and U.K. that are in the full bloom of summer, when the march of influenza normally slows down. It is also spreading rapidly in the Southern Hemisphere. Anne Schuchat, chief of immunization and respiratory diseases at the U.S. Centers for Disease Control and Prevention, said Friday that the agency expects an increase in cases before the normal start of the flu season in mid-autumn, because children are likely to spread it to one another once they go back to school. Infectious diseases normally spread readily among children, and this virus has hit children and young adults harder than the elderly, who normally suffer the heaviest toll from flu. "We've seen it in camps and military units," Dr. Schuchat said. "I'm expecting when school reopens and kids are all back together, in some communities at least we may see an increase." The number of confirmed U.S. infections is now 40,617, with 263 deaths, the CDC said Friday. But the agency believes that more than one million people have been infected and weren't tested for the virus or didn't visit a doctor. The disease has become so widespread that the agency will probably suspend tallying individual case counts within the next few weeks and focus instead on tracking clusters, severe cases, deaths and other unusual events -- a more traditional approach to tracking diseases, Dr. Schuchat said. [flu] The CDC would be following the WHO, which said on Thursday that it is abandoning individual case counts. Most of those who have the new flu get only mildly ill for a few days and don't need treatment. But officials are concerned about the virus because it is new and could easily mutate and become more virulent as it spreads through the population. Argentina declared a nationwide animal-health emergency Friday after finding the virus possibly jumped from humans to two pig herds, a development that flu experts say could potentially spur mutations. The country's death toll from the virus stands at 137. Global officials are also concerned because the new H1N1 virus has caused severe illness in some children and young people. Some recently published studies suggest it can cause more severe illness than seasonal flu. Deaths from flu are normally rare among children and young adults, who account for the bulk of the U.S. deaths from the pandemic strain. Nor is it clear why the virus is striking pregnant women, as well as people with asthma, diabetes and other conditions hard. To combat the virus, federal officials are preparing to mount a massive immunization campaign, and are also urging communities, businesses and individuals to make contingency plans for possible school closures, multiple employee absences for illness, surges of patients in hospitals and other effects of potentially widespread outbreaks. Clinical trials are expected to begin later this month to test whether a vaccine developed to combat the virus is safe and effective, and the CDC is working with state and local public-health authorities to figure out how to get as many as 600 million doses, or two for every U.S. resident, into people's arms. Results of the trials aren't expected until early October, but officials say they expect to have the first 100 million doses of vaccine ready by mid-October. The WHO and some vaccine manufacturers reported this week that the vaccine was proving difficult to manufacture because the viruses used to make the shots are yielding only 25% to 50% of the active ingredient they normally get for flu vaccines. But Dr. Schuchat said that wasn't affecting the U.S. government's plans. "We haven't heard news that has changed our expectations for vaccine availability in the fall," she said. "Based on what has been described to us so far, it's within the range of our planning assumptions, but that doesn't mean we won't have more surprises." Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved. Sobering statistics on teen pregnancy and STDs By Kelly Brewington Baltimore Sun Monday, July 20, 2009 The teen pregnancy rate increased in 2006 and again in 2007, after 14 years of declines, according to a report released today from the Centers for Disease Control and Prevention. It's among a string of worrisome statistics released today that indicate after recent years of improvements, some trends are getting worse. Among the findings in the CDC's analysis of youth sexual and reproductive health: * The rate of AIDS diagnoses in young men (15-19 years old) is on the rise, nearly doubling from 1.3 cases per 100,000 population in 1997 to 2.5 cases per 100,000 population in 2006. * In 2006, about 1 million teens and young adults had chlamydia, gonorrhea or syphilis. And the rates of syphillis, for men and women, are on the rise. The humanpapillomavirus, or HPV, is widespread. Between 2003 and 2006, nearly a quarter of girls 15-19 years old had an HPV infection. That figure was 45 percent for young women ages 20-24. Now the big question is why? "It is imperative that all of us at the national and community level work together to ensure STD and HIV prevention programs are reaching young people, particularly in communities with the greatest burden of disease," said Dr. Kevin Fenton with the CDC. Copyright 2009 Baltimore Sun. Diprivan, the drug found in Michael Jackson's home, may be more tightly restricted The widely used anesthetic can be dangerous, but supplies are not always closely monitored. The Los Angeles Times By Jeff Gottlieb and Rong-Gong Lin II Baltimore Sun Monday, July 20, 2009 Even before Michael Jackson's death, federal regulators had become concerned about Diprivan, the anesthetic that police found at the pop star's home. The attention Jackson's death has attracted to the drug could lead to its becoming a controlled substance. Also known by the generic name propofol, the drug is among the most widely used general anesthetics in the U.S. Its purpose is to quickly knock out patients or make them semi-conscious during uncomfortable procedures, such as colonoscopies. The drug can be so dangerous that the U.S. Food and Drug Administration says only those trained in general anesthesia should administer it. "Me administering this to you at home, I'm fairly likely to hurt you," said Dr. Paul Wischmeyer, an anesthesiologist at the University of Colorado. "You'd need to have a surgery center at your house." Nearly all of the small but growing number of abuse cases involve doctors and other medical personnel. Because a dose lasts just a few minutes, it's not uncommon for users to inject themselves 80 times a day as they search for a brief high or the sensation of slipping into unconsciousness, according to physicians who have studied Diprivan abuse. "We're used to administering what's usually a lethal dose if we weren't sitting there," said Dr. Ethan Bryson, an assistant professor of anesthesiology at Mt. Sinai School of Medicine in New York. "But when you're doing it to yourself and injecting it in the arm, you can make yourself stop breathing, and if there's no one there to breathe for you, you'll die." If Jackson was using Diprivan, he would have been one of the rare known cases of nonmedical personnel abusing it. In two such cases, the people using the drug died. At many hospitals, Diprivan is given the same casual oversight as Tylenol, said Lisa Thiemann, senior director of professional practice for the American Assn. of Nurse Anesthetists. Three days before Jackson died, the group recommended the drug be placed in secure environments in medical facilities. A 2007 survey by Wischmeyer found that 71% of the 126 anesthesiology departments he polled had no system to monitor Diprivan. Hospitals are required to monitor narcotics, including Demerol and morphine. Wischmeyer found that the anesthesiology programs whose doctors had died from Diprivan abuse were among those that did not keep track of the drug. The FDA and the Drug Enforcement Administration said they were considering making it a controlled drug even before Jackson's death. Now, that push has received renewed attention. Local hospitals are also reviewing whether they should increase oversight, among them Ronald Reagan UCLA Medical Center. At Los Angeles County-USC Medical Center, where Diprivan is kept in locked anesthesia carts, officials are planning to track the drug as if it were a controlled narcotic, requiring it to be locked up and monitored. Sources have told The Times that detectives found a large quantity of Diprivan in Jackson's rented Holmby Hills mansion. Teva Pharmaceuticals, a maker of the drug, said the DEA contacted the firm about a lot number stamped on the drug's packaging. The identification could help trace how the drug was obtained. Dr. Arnold Klein, a Beverly Hills dermatologist who treated Jackson for 25 years, told CNN's Larry King that the singer was using the drug with an anesthesiologist "to go to sleep at night" while touring Germany. The last time Jackson toured there was 1997. Dr. Omar Manejwala, associate medical director at the William J. Farley Center at Williamsburg Place in Williamsburg, Va., an addiction treatment center that focuses on physicians, said nearly all Diprivan abusers started using the drug to overcome insomnia, even though injecting it would knock them out only for a few minutes. "They describe a transient feeling of pleasure and a relief from the experience of sleep deprivation," he said. They want to do "anything to avoid being awake." Doctors said that going under with Diprivan, even for several hours, is not the same as sleeping. "You never use propofol for insomnia treatment," Wischmeyer said. "Never, ever." Manejwala and others who have treated substance-abusing physicians also said that Diprivan users seem to have experienced abuse and trauma at a young age.Doctors said people taking Diprivan sometimes report hallucinations and sexual dreams. "They'll inject the drug and get a tiny moment, 10 seconds of this euphoric floating, disconnected from the troubles of world, almost out of body, feel at peace, wonderfully floating, and then get unconscious, so they never have enormous periods of euphoria or wonderment," said Dr. Paul Earley, medical director at Talbott Recovery Campus in Atlanta, which also specializes in treating drug and alcohol abusing doctors. Other abusers, doctors said, simply find the world or their problems so difficult and overwhelming that they just want to escape, even if only briefly. "Most just want to go blotto," Manejwala said. Diprivan is not a drug people can buy on the street. Someone would have to take it from a hospital, surgery center or other medical facility or somehow obtain it from a distributor or manufacturer. If Jackson did indeed use it, "there is no way he did it by himself," said Dr. Zeev Kain, chairman of the anesthesiology department at UC Irvine Medical Center. "Somebody needed to steal or take it, and somebody needed to inject it in him." FDA spokeswoman Karen Riley said Diprivan was not controlled when it was introduced in 1989 because there was no evidence it could be abused. Even today, many doctors are surprised by reports of abuse. "When I talk to colleagues who haven't heard of Diprivan abuse, they will say, 'You're kidding? What's the point?' " Manejwala said. There is evidence the abuse is increasing. Wischmeyer said his research shows use among healthcare professionals was up five times from 1997 to 2007. Earley said that in 2007, his center treated 12 people who had used Diprivan. A year later, the number nearly doubled, to 22. Although he didn't have numbers, Manejwala said there is no question the number of cases his center has treated has increased. Doctors like using Diprivan in medical procedures because it acts quickly -- it can sedate a person in less than a minute -- and puts anxious patients at ease during uncomfortable procedures. Once the patient is anesthetized, doctors can continue using Diprivan intravenously to keep them sedated or substitute another anesthetic. Diprivan has fewer side effects after patients awaken, such as nausea, and leaves them more clear-headed. "It's a really good drug in the domain of anesthesia," Kain said. "It's very bad it's gotten this bad rap right now." Copyright 2009 Los Angeles Times. Preventing delirium in older hospital patients: what families can do Baltimore Sun Monday, July 20, 2009 Hospitals need to do more to prevent older patients from becoming delirious – a condition characterized by confusion, disorientation, sudden lapses in memory or attention, and sometimes agitation. Delirium is a medical problem in its own right. When an elderly patient develops this condition, he or she is much more likely to be placed in a nursing home after a hospitalization. Also, patients with delirium are more likely to deteriorate physically or mentally and to die. It's a surprisingly common problem: as many as one out of every five seniors who are hospitalized become delirious, research shows. Depending on the circumstances – whether the patient has underlying dementia, whether they end up in intensive care – the numbers can be much higher. Hospital procedures can foster delirium in frail older people by disrupting their routines, exposing them to new medications, interfering with their their sleep and making them feel out of control. Studies have shown that several interventions can make a difference, such as putting clocks in rooms so someone can tell what time it is, minimizing the use of restraints, keeping rooms quiet and dark at night, and carefully managing medication. There's also a role for families. Dr. Malaz Boustani, an associate professor of medicine at Indiana University School of Medicine, suggests the first step is awareness: recognize that your older parent or uncle is at higher risk of delirium if he has cognitive impairments or is over 75 years old or has multiple chronic illnesses. If your loved-one is vulnerable, "work with their doctor," Boustani says. "Tell them that my mom or dad is scheduled for a hip replacement and I hear they could develop dementia after surgery. Can you tell me how you would assess their risk? Are they taking any medications that could increase that vulnerability? Could we hold off on that medication until after the surgery?" In the hospital, stay tuned to abrupt mental changes in a loved-one. "If they're more confused, if their attention is really bad, they might have delirium," Boustani says. "Tell the nurse you're worried and ask for an assessment. Also, ask for a consultation with a geriatrician." Don't let hospital staff minimize your concerns. "Family members are usually the first ones to pick up that something is wrong. If you know that mom or dad is just not right, not themselves, don't let the doctors or nurses pooh pooh it," said Dr. Sharon Inouye, a professor at Harvard Medical School and director of the Institute for Aging Research at Hebrew SeniorLife in Boston. Make sure you monitor your loved-one's condition in the hospital and are there as much as possible. "Are they eating and maintaining hydration?," Inouye says. "Are they sleeping much more? Are there personality or behavior changes?" It's very important for family members to be around as much as possible to provide comfort and a sense of connection and orientation to an older patient, Inouye says. Economic pressures on hospitals make it hard for even the best-intentioned staff to do everything they should, so help out when you can, Inouye says. Make sure the call button is where your loved-one can reach it (often it's not) and that a water jug is within reach. If side rails are up, take them down and help your relative get out of bed and walk around the floor. Have an intelligent conversation with your older parent or spouse several times a day; human interaction is crucial, Inouye says. Useful materials on this topic are available from the Hospital Elder Life Program, which promotes the delirium prevention programs across the country. Inouye founded the organization and is closely involved in its work. I reprint a section from their Web site below: Avoid Confusion in the Hospital – Ten Tips By taking these ten steps, you may be able to reduce the risk of delirium: 1. Bring to the hospital a complete list of all medications (with their dosages), as well as over-the-counter medicines. It may help to bring the medication bottles as well. 2. Prepare a "medical information sheet" listing all allergies, names and phone numbers of physicians, the name of the patient's usual pharmacy and all known medical conditions. Also, be sure all pertinent medical records have been forwarded to the doctors who will be caring for the patient. 3. Bring glasses, hearing aids (with fresh batteries), and dentures to the hospital. Older persons do better if they can see, hear and eat. 4. Bring in a few familiar objects from home. Things such as family photos, a favorite comforter or blanket for the bed, rosary beads, a beloved book and relaxation tapes can be quite comforting. 5. Help orient the patient throughout the day. Speak in a calm, reassuring tone of voice and tell the patient where he is and why he is there. 6. When giving instructions, state one fact or simple task at a time. Do not overwhelm or over stimulate the patient. 7. Massage can be soothing for some patients. 8. Stay with the hospitalized patient as much as possible. During an acute episode of delirium, relatives should try to arrange shifts so someone can be present around the clock. 9. If you detect new signs that could indicate delirium -- confusion, memory problems, personality changes -- it is important to discuss these with the nurses or physicians as soon as you can. Family members are often the first to notice subtle changes. 10. Find out more about delirium. The American Psychiatric Association's "Patient and Family Guide to Understanding an Identifying Delirium" is available on line. For a copy, click here. Copyright 2009 Baltimore Sun. HGS's Lupus Drug Shows Promise in Latest Trials Md. Firm Gets Step Closer to Applying For FDA Approval By Mike Musgrove Washington Post Monday, July 20, 2009 An experimental drug that aims to treat people afflicted with the autoimmune disease lupus showed promising results in its latest round of tests, giving its Rockville-based developer hope that it may have a financial success on its hands. Human Genome Sciences is set to report the new results on Monday. The drug, called Benlysta, is the first new treatment for lupus in decades to show potential this far into tests with human patients. "This is just a wonderful outcome, we're delighted," said David C. Stump, HGS's head of drug development. "Patients have been looking for a new medication for 50 years." If the next round of tests go well, HGS plans to file for Food and Drug Administration approval early next year. The drug could become available late in 2010. The company has not determined how much it will charge for the treatment. Wall Street analysts believe the drug could be worth billions of dollars for the firm and its partner in developing it, GlaxoSmithKline, if Benlysta makes it to the market. Given a history of failure in developing drugs for lupus, many Wall Street analysts did not anticipate favorable news. "We believe odds are against a robust data set," wrote analyst Jason Kolbert of ThinkEquity in a note to investors last week. Kolbert predicted that an unlikely positive announcement from HGS could eventually send the company's stock, which had been trading at under $3 for much of the year, to over $15. Even facing widespread skepticism, HGS shares rose Friday in anticipation of Monday morning's announcement. After spending the week priced at around $2.50 per share, the stock shot up to $3.63 before closing at $3.32. The Lupus Foundation of America estimates that about 1.5 million Americans have some form of the disease. Currently, doctors typically use chemotherapy and steroids for lupus, treatments that can have harsh side effects. "This is a big deal for a lot of people," said Sandra C. Raymond, the organization's chief executive, speaking before the results of the tests were known. In just the past year, lupus victims have seen their hopes dashed three times as other experimental drugs failed to pass their testing processes. Lupus is a disease that waxes and wanes unpredictably, making drug testing particularly difficult, said Dr. Gary S. Gilkeson, professor of medicine at the Medical University of South Carolina. "It's not like cholesterol, cancer or diabetes, where there's something easy to measure," he said. Gilkeson, who participated in previous failed trials for experimental drugs designed to treat the disease, said there was concern in the lupus community that another failure or two in this area could discourage drugmakers from trying to develop medicines to treat the disease. Though the disease's causes are still not entirely understood, the HGS drug is designed to target a protein that becomes overactive in lupus patients and can cause the body to attack its own organs. For its latest round of testing, 865 patients located in 13 countries outside the United States were given different doses of the drug, or a placebo, for a one-year period. Among those given the placebo, 44 percent experienced meaningful improvement in their symptoms. But among those who took a high dose of Benlysta, 58 percent saw improvement. Fifty-two percent of those who took a low dose improved. The results were positive enough to meet guidelines for success that HGS had established with the FDA. HGS's president and chief executive, H. Thomas Watkins, said he is optimistic about the drug's chances in the next round of tests, which will involve a similar number of patients in the United States and Western Europe. The company has spent hundreds of millions of dollars to develop the drug over the past several years. "It's a big wager, with no guarantee of success," he said. "We're happy to make those investments, particularly when you get results like this." One press account earlier this year likened the fight against lupus to cornering a hyperactive cat, a description Watkins and Stump recalled at the end of a phone interview Friday afternoon. "The cat has been cornered," Watkins said. Copyright 2009 Washington Post. SAfrica stops funding for AIDS vaccine research Associated Press By Michelle Faul Washington Post Monday, July 20, 2009 CAPE TOWN, South Africa -- South Africa has stopped funding research on an AIDS vaccine, a leading scientist said Monday, even as a major vaccine trial on humans began in the country ravaged by the world's worst AIDS epidemic. Anna-Lise Williamson, an AIDS researcher at the University of Cape Town, told The Associated Press that the clinical vaccine trial that began Monday would continue with U.S. money. But she said South Africa's Department of Science and Technology had stopped funding her research this year and the utility Eskom's contract for funding ended last year and was not renewed. Even though South Africa's science minister appeared at a ceremony launching the vaccine trial with Williamson and lauded her research, neither he nor Eskom immediately returned calls seeking comment about funding. At the ceremony, one of 36 healthy volunteers was injected Monday before officials and journalists in Cape Town's Crossroads shantytown. The event was also attended by American health officials who gave technical help and manufactured the vaccine at the U.S. National Institutes of Health. "For vaccine development presently, the South African AIDS Vaccine initiative has no money," Williamson said. "If we do not continue working on this, we will never have a vaccine... it's incredibly important that we keep working." The South African vaccine, developed at the University of Cape Town, targets the specific HIV strain that has ravaged South Africa. During nearly 10 years of government denial and neglect, South Africa developed a staggering AIDS crisis. Around 5.2 million South Africans were living with HIV last year - the highest number of any country in the world. Young women are hardest hit, with one-third of those aged 20-to-34 infected with the virus. AIDS vaccine researchers have met so many disappointments some activists are questioning the wisdom of continuing such expensive investments, saying the money might be better spent on prevention and education. A new report says HIV vaccine research funding worldwide decreased for the first time since 2000, with investments of almost $1.2 billion in 2008, down 10 percent from 2007. South Africa was also the site of the biggest setback to AIDS vaccine research, when the most promising vaccine ever, produced by Merck & Co. and tested here in 2007, found that people who got the vaccine were more likely to contract HIV than those who did not. South African scientists working on the latest vaccine had to overcome deep skepticism from their political leaders, who had shocked the world with their unscientific pronouncements about the disease. Williamson said South Africa, at the heart of the epidemic, must press ahead with trials to test the safety of the vaccine. "We have got the biggest ARV (anti-retroviral) rollout in the world and still hundreds of people are dying every day and getting infected everyday," she said. Williamson's vaccine also is being tested at a trial of 12 volunteers in Boston that began earlier this year, said Anthony Mbewu, president of South Africa's government-supported Medical Research Council that shepherded the project. "It is being very well tolerated, no adverse events, so it is going very well," Williamson said Monday. The trial started in the U.S., partly to allay any criticism that the United States was collaborating in an AIDS vaccine that would use Africans as guinea pigs. The government decided it was important to develop a vaccine specifically for the HIV subtype C strain that is prevalent in southern Africa "and to ensure that once developed, it would be available at an affordable price," Mbewu said. Some 250 scientists and technicians worked on the latest vaccine project. Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Disease and a leading AIDS researcher, said the South African scientists received more money from his institute's research fund than any others in the world except the U.S. The U.S. had paid to produce the vaccine. He called it "the most important AIDS research partnership in the world." But he warned "There are extraordinary challenges ahead," referring to the years of testing needed now that South Africa has reached the clinical trial stage. At an international AIDS conference in Cape Town, Vice President Kgalema Motlanthe emphasized Sunday night that the clinical trials were being held "under strict ethical rules." Mbewu said the crisis in South Africa more than justifies the expenditure on AIDS research. AIDS strikes men and women alike in Africa, where the epidemic is fueled by the many people who have sex with several people at the same time. In the 1990s, South Africa's then-President Thabo Mbeki denied the link between HIV and AIDS, and his health minister, Manto Tshabalala-Msimang, mistrusted conventional anti-AIDS drugs and made the country a laughing stock trying to promote beets and lemon as AIDS remedies. Williamson, a virologist, said the scientists had to fight constant controversy, including international organizations that tried to stop the state utility Eskom from funding the project. Eskom gave "huge amounts" regardless, she said. "International organizations told Eskom that this was a terrible waste of money, that putting money into South African scientists was like backing the cart horse when they need to be backing the race horse," she said. Even her research director told her she was wasting her time. "Most of them just made us more determined to prove them wrong," Williamson said. On the Web: http://www.saavi.org.za, the South African AIDS Vaccine Initiative http://www.hivresourcetracking.org. © 2009 The Associated Press. *Opinion* Costs and Benefits New York Times Editorial Monday, July 20, 2009 Democrats pushing for health care reform got serious jolts last week from critics who warned that their proposed legislation would do little to slow spiraling health care costs. A group of conservative Democrats vowed that they would join Republicans to block action in a crucial House committee unless more cost restraint was imposed. And Douglas Elmendorf, the respected head of the Congressional Budget Office, warned that none of the bills he has seen impose fundamental changes in how medical care is delivered and paid for. Health care reform is vitally important both to cover tens of millions of uninsured Americans — a moral imperative — and to bring down the relentlessly rising costs of care. Those costs are straining not only the government’s budgets for Medicare and Medicaid. American businesses are struggling to provide insurance for their employees. Millions of Americans are struggling to pay high medical bills and rising premiums; many are just a pink slip away from being uninsured. Mr. Elmendorf’s testimony should prod Democratic leaders to come up with more and better ways to restrain costs for federal programs and the health care system as a whole. The White House was certainly paying attention. It called for the creation of an independent expert body to propose fair payment rates and other cost-saving reforms for Medicare. That is a sound idea that could lessen the influence of high-pressure lobbying — by drug companies, insurers, hospitals and doctors — that inevitably drives up costs. The pending bills do an excellent job of providing health insurance for millions of uninsured Americans at a cost of roughly $1 trillion over the next decade — mostly for subsidies to low- and middle-income people and expansion of the Medicaid program for the poor. President Obama has rightly insisted — and Congressional leaders have agreed — that this expansion of coverage must not drive up the deficit over the next 10 years. It has to be fully paid for by new taxes or big savings in Medicare and other federal programs. Whatever legislation emerges from Congress is expected to do so — or face a veto. The knottier problem is how to slow the rate of increase in health care costs. Those costs are growing faster than inflation, wages and the overall economy. This is the issue that Mr. Elmendorf was addressing, and he seemed to be thinking beyond the 10-year budget window to the likely impact on future deficits. He is right to be concerned. If the government simply extends subsidized insurance to millions of uninsured people but fails to force fundamental changes in the delivery or financing of health care, then federal health care costs will keep escalating at excessive rates. That will drive up deficits in subsequent decades unless new taxes are imposed or new savings found. The budget office is concerned only with impacts on federal spending and the deficit. But any changes to Medicare’s policies would reverberate through the whole health care system as health care providers changed their practices and private insurers followed Medicare’s lead. The House bill makes a good start in the right direction by proposing changes in Medicare reimbursement rates and various pilot programs to encourage greater productivity and less costly forms of care. But more could and should be done. Medicare ought to be empowered, for example, to reduce its payment rates to the highest-cost hospitals and most inefficient doctors. That is probably the best way to get them to stop providing needless tests and treatments that don’t improve the health of the patient. Medicare should also be allowed to use the results of comparative effectiveness research to set reimbursement policies favoring the best treatments. Unfortunately, as currently written, the House bill calls for that research but prohibits Medicare from using it to set rates. All of these ideas seem well worth trying. The long-run solution is to move away from Medicare’s fee-for-service system that rewards doctors and hospitals for each additional service they provide and move into a new system where doctors and hospitals are organized and rewarded in ways that encourage both low-cost and high-quality care. The problem is that nobody is sure of the best way to do that. The House bill is right to set up pilot programs to test some approaches. But more ideas should be developed and tested. Much to the anger of leading Democrats, Mr. Elmendorf also suggested that Congress might consider taxing employer-provided health benefits. He seemed to mean the most generous policies that many economists think encourage excessive use of medical care. That could raise several hundred billion dollars to pay for the expansion of coverage and, unlike the taxes on wealthy Americans proposed in the House bill, is likely to keep pace with future increases in health care costs. A tax on employer-provided benefits would probably also encourage workers to choose lower-cost policies and use health care more sparingly. But it is politically risky and it could turn many Americans away from supporting health care reform. It might best be considered as a last resort. Copyright 2009 The New York Times Company. The color of complacency By Hugh McLaurin Carroll County Times Commentary Monday, July 20, 2009 The Department of Homeland Security has raised the terror alert level from yellow to orange for readers of this column, indicating a heightened probability that you will feel terrorized and in need of medical attention should you choose to proceed. Don’t say you weren’t warned. I assume you know exactly what to do now, having checked the Homeland Security Advisory System every day for the past seven years and prepared yourself accordingly. Maybe you typically pick an outfit or accessory to match the color of the threat level, or use it to decide whether to wear body armor that day. Perhaps you weave erratically through traffic on your commute when the threat level goes up to reduce the likelihood of a direct hit. That would explain a lot of the driving I see on my commute. Or just maybe, like me, you have become complacent and forget there even is a warning system until you hear about the color changing, at which point you promptly forget about it again. It’s because of that possibility that the Obama administration has formed a bipartisan task force to take a close look at the way the government alerts citizens to the threat of terrorist activity. While the color-coded system of alerts isn’t necessarily a bad idea, it has often been viewed as something of a joke and, at best, a flawed system with limited effect. It’s probably harmless, but is it really helpful? Since the system was introduced in the aftermath of 9/11, the threat level has oscillated between yellow and orange, settling in at yellow most of the time. It hasn’t moved at all since 2006. Since then, the general threat level has been yellow, while the airlines remain at the higher alert level of orange. After being stuck in one spot for three years, it has little meaning anymore. I venture to guess that the whole thing has no impact on the daily lives of most of us, and few of us pay it any mind at all. Worse, it was thought to have been used at times for political purposes during the Bush administration to show toughness on security matters or to rally the citizenry behind administration policies. I can’t say for sure that occurred, but if so, it further dilutes the purpose. I’m glad to see this task force at work, because the fact of the matter is we do need something to tell us whether we should be worried about terrorist activities. We need to keep a few things in mind. For one thing, the era of terrorism is not over and we remain at varying levels of risk. A lot of dedicated people do a great job of protecting us, allowing us to pretend as we do that there is no threat at all. There is. Also, the government has information about terrorist activities that we don’t have and it can’t tell us about. So it’s important to at least have some way for them to rub it in that they know something we don’t and we better watch out. Plus it would be irresponsible for them to be aware of a threat without alerting us so we could decide what to do. What we need is some reliable way of alerting people to genuine threats in a way that grabs their attention and leaves them with practical options, depending on their individual circumstances. That’s a tall order, and I’m afraid the current system of colors doesn’t cut it. I’ll be interested to see what the task force recommends once their 60-day review is complete. Will it involve personal wake-up calls to citizens every morning, or electric shocks? That would get my attention. And attention is what we need, before complacency leaves us in a very bad place when the next terrorist incident occurs. Hugh McLaurin writes from Westminster. His column appears Sundays. E-mail him at hmclaurin@comcast.net. Copyright 2009 Carroll County Times. Gone but not forgotten By Tom Zirpoli Carroll County Times Commentary Monday, July 20, 2009 The recent closing of the Rosewood Center in Owings Mills, where at least 13,000 individuals with developmental disabilities have been housed during a span of a hundred years, is cause for celebration. But closing a facility and securing community-based placements does not guarantee a safer or improved quality of life for Marylanders with disabilities. In 1975, Congress passed the first national law mandating a public education for children with developmental disabilities. Thus, school-aged children were provided with significantly better options than staying at home or being placed in a state residential setting. Mandating that all children had a fundamental right to attend school, regardless of their ability, was the right thing to do. As a result of mandatory education, many of these children were found to be wrongly diagnosed. And through the miracle of an education, many overcame their disabilities and went on to live healthy and productive lives. At about the same time, the horrible conditions for people with disabilities living in some of our nation’s large institutions were starting to come to light. Finally, the 250,000 children and adults, many living in squalor conditions in state institutions, with some housing up to 5,000 individuals, were getting long-overdue attention. As a result, the deinstitutionalization movement encouraged states to move adults with disabilities from large residential institutions to smaller community placements such as group homes, alternative living units (small group homes) or even into their own apartments and homes. Almost 40 years of research has demonstrated that the simple act of changing a person’s environment can make a significant and positive change in their development and behavior. For the majority of individuals with disabilities, the transition from institution to community-based homes has been nothing short of life-changing. However, doing the right thing does not always produce the right result; at least not for everyone. And doing the right thing without proper monitoring and support can lead to negative results. As I wrote in an article in 1986, moving adults with disabilities from large state residential facilities to community homes is doomed to fail without the proper long-term supports and funding. As previously stated, placement is an important variable related to quality care for individuals with disabilities. But placement is not the only variable; it is merely the first step in a process of community integration. Having observed the conditions in many state-operated facilities and community-based programs, I would argue, in fact, that placement is not even the most important variable when it comes to safety and quality of care of individuals with developmental disabilities. Rosewood may be closed, but more than 18,000 adults with developmental disabilities in Maryland are on waiting lists for services. At the same time, some individuals who have secured community placements are not any safer or happier than they were in state-operated facilities. While we should certainly celebrate the closing of Rosewood and other state institutions for people with developmental disabilities, we must be diligent and ensure that we are not replacing them in underfunded community placements. The result is the same or, in some cases, worse. Tom Zirpoli writes from Westminster. His column appears on Wednesdays. E-mail him at tzirpoli@mcdaniel.edu. Copyright 2009 Carroll County Times. BACK TO TOP


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