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			Wednesday, July 22, 2009 News Clipping Archives *Maryland / Regional* O'Malley Budget Cuts Pass With Public Works Board (WJZ-TV13 online) O'Malley proposes $280 million in budget cuts (Baltimore Sun) O'Malley budget cuts: Look out, state workers and local governments (Baltimore Sun) State budget cuts hit health care, higher education (Annapolis Capital) Religions unite in AIDS fight (Baltimore Sun) University of Md. to test swine flu vaccine (Baltimore Sun) Most small firms lack health care (Baltimore Sun) Md. Cracks Down On Cigarette Smugglers (WJZ-TV13 online) Balto. Co. loan helps complete creamery (Baltimore Sun) Missing mental health records of Va. Tech gunman found at former university official's home (Baltimore Sun) Lyme disease a suburban threat (The Gazette) Eastern Panhandle Free Clinic gets new home (Hagerstown Herald-Mail) *National / International* Cancer awareness group sues in NJ to force food-makers to put warning labels on their hot dogs (Baltimore Sun) Prevention key to heart health (Baltimore Sun) Saying 'sorry' pays off for U. of Michigan doctors (Daily Record) Health-Care Reform Efforts Marred by Abortion Dispute (Washington Post) Sidney W. Bijou, Child Psychologist, Is Dead at 100 (New York Times) Are Indoor Pools Bad for Your Lungs? (New York Times) *Opinion* Managing the pain (Baltimore Sun Editorial) Health Insurance No One Needs (New York Times Commentary) *Maryland / Regional* O'Malley Budget Cuts Pass With Public Works Board By Ron Matz WJZ-TV13 online Wednesday, July 22, 2009 ANNAPOLIS, Md. (WJZ) ― Maryland's governor needed to chop up the state budget and he got it approved by the Board of Bulic Works. Governor Martin O'Malley came up with a plan to save a growing deficit. Ron Matz reports Wednesday the governor introduced his plan to the Board of Public Works and they all agreed on his plan. The governor will make up more than $280 million of a $700 million shortfall. Among the cuts: $34 million in reductions in Medicaid payments to hospitals, nursing homes, managed care organizations and other health care providers. The board, which is comprised of Gov. Martin O'Malley, Treasurer Nancy Kopp and Comptroller Peter Franchot, voted unanimously for the reductions. Maryland Health Secretary John Colmers says the department is "getting beat up pretty good." The state's Board of Regents has scheduled a meeting for Thursday to discuss how the cuts will affect the university system. More cuts will be announced by Labor Day. © MMIX, CBS Broadcasting Inc. All Rights Reserved. O'Malley proposes $280 million in budget cuts Up to $470 million in further reductions planned before Labor Day By Laura Smitherman Baltimore Sun Wednesday, July 22, 2009 Health care providers who serve Medicaid patients will get paid less, the University System of Maryland will hire fewer faculty members and 40 state workers will lose their jobs as part of $280 million in budget cuts proposed by Gov. Martin O'Malley. The Democratic governor has compiled a list of budget cuts to be presented today to the Board of Public Works, a three-member body that can approve midyear budget adjustments when the General Assembly is not in session. But the cutbacks won't end there: O'Malley plans up to $470 million in further budget cuts before Labor Day. The next round of spending reductions will target aid to local governments and state employee compensation, O'Malley said during a news conference. With tax revenues plummeting because of the recession, the governor has had to repeatedly cut spending to keep the state budget balanced, as required by law. The exercise has stirred criticism not only from those whose interests are affected but also from fiscal conservatives who say the budget is still too bloated. "It's been a seemingly never-ending effort to try to maintain fiscal responsibility," O'Malley said, while emphasizing that Maryland's finances are in better shape than many states'. Since taking office, O'Malley has reduced spending by more than $3 billion, but the state's operating budget has shrunk by a much smaller amount as spending on certain programs has increased. And the size of Maryland's overall budget, which includes federal funds such as the economic stimulus money received this year, has grown over the past three years. The governor is facing a shortfall of about $1.5 billion next year, though that could be less depending on how many long-term spending reductions O'Malley makes for the fiscal year that began this month. Of the $280 million in proposed budget cuts, about $130 million would be one-time savings. "The real problem is the gap between revenues and our commitments," said Warren G. Deschenaux, the legislature's chief fiscal analyst. Among the hardest hit in this round of proposed budget cuts would be Medicaid providers. The governor plans to save $24 million by paying only for hospital stays of a certain length under Medicaid, $23 million by reducing Medicaid rates for nursing homes and $13 million by taking away an inflation increase for providers of community mental health, substance abuse and other services. The limit on hospital payments would disproportionately hurt facilities that serve large numbers of poor patients, such as financially troubled Bon Secours Hospital in Baltimore, said Nancy Fiedler, a spokeswoman for the Maryland Hospital Association. Hospitals end up eating the cost to care for patients who stay longer than the Medicaid limit, she said. Another concern is that health care providers might drop Medicaid patients, said Gene M. Ransom, executive director for MedChi, the state medical society. "We have a network of community health facilities, doctors and other providers willing to take a loss and take Medicaid patients," he said. "But obviously at some point in time there's a breaking point, and people say they can't take it anymore." With federal funding cuts possible on top of state cuts, some nursing homes might be forced to close, said Joseph DeMattos, president of the Health Facilities Association of Maryland, whose members care for 20,000 residents in homes and assisted-living facilities. "The governor said these budget cuts would be difficult and unpopular, and they are," DeMattos said. The University System of Maryland would receive a cut of more than $17 million from operating expenses and $20 million that it must transfer from its fund balance. While the budget action does not jeopardize O'Malley's promise of extending a freeze on tuition for a fourth consecutive year, Chancellor William E. Kirwan said the system would not be able to hire as many adjunct or part-time faculty members or to offer as many courses, and that it would have to cut student services. "There's no doubt a cut of this magnitude will have a real impact on what we can do," Kirwan said. Other proposed budget reductions include the elimination of retention bonuses for nurses and correctional officers, a $3 million cut to funding for stem-cell research, a $2 million cut to a Chesapeake Bay cleanup fund, and a $5.5 million reduction in the Maryland Lottery's advertising budget. O'Malley said he wanted to shield K-12 education from budget cuts, pointing to a separate report Tuesday that Baltimore public schools showed remarkable gains in test scores over the past five years. He also said that he wanted to avoid the "mass layoffs" that other states have implemented. He told legislative leaders on Monday that he is considering furloughs for state employees. The governor also is considering cutting aid to counties and Baltimore City that is used to support police, health and other programs, though he said he wanted to sit down with local leaders before making those decisions, noting that they often have better ideas for where to trim. In expectation of future budget cuts, Baltimore Mayor Sheila Dixon has directed agency heads to identify 5 percent reductions to their spending plans for this year, said Scott Peterson, her spokesman. Peterson stressed that Dixon wants the agencies to "start looking and preparing" for cuts, but has not ordered any yet." Proposed reductions Gov. Martin O'Malley is proposing $280 million in budget cuts. They include: •Limiting how much Medicaid will pay for hospital stays over a certain length. Savings: $24 million •Reducing funding for operating expenses at the University System of Maryland. Savings: more than $17 million •Reducing the Maryland Lottery's advertising budget. Savings: $5.5 million •Cutting funding for stem-cell research and Chesapeake Bay cleanup. Savings: $5 million •Laying off 40 state workers Baltimore Sun reporter Annie Linskey contributed to this article. Copyright © 2009, The Baltimore Sun. O'Malley budget cuts: Look out, state workers and local governments By Andy Green Baltimore Sun Wednesday, July 22, 2009 Gov. Martin O'Malley unveiled about $280 million in budget cuts this afternoon that take big bites out of health care and higher education and lots of nibbles at just about everywhere else. But this looks like the appetizer course to a much bigger set of cuts that will be coming sometime before Labor Day. To keep the budget balanced, the administration needs to find about $420 million more, and the governor indicated that the savings are going to have to come from cuts to the state payroll and to aid to local governments. O'Malley, a former Baltimore mayor, has been loath to pass the state's budget problems on to the counties, but it seems like it comes to that eventually in every recession. There is virtue in the state picking up much of the tab for things like education in that it smooths out some of the big funding disparities between jurisdictions that you see in some states. But it also masks to an extent the true cost of local services. From a citizen's perspective, it doesn't matter much. The money comes out of your pocket one way or another. From a politician's perspective, it matters a great deal. Leaders on the state level see themselves making politically unpopular decisions while those on the county level have experienced less pain (though that is changing as the recession deepens). Bottom line, you-know-what flows downhill. As far as state workers go, the governor voiced a preference against the "massive layoffs" that other states have seen and hinted that he would prefer another round of furloughs instead. Furloughs are attractive in that they spread the pain and lessen the interruption of public services. The advantage of layoffs is that they provide ongoing cost reductions, which could be important since we don't appear to be dealing with a short-term problem. And the need for ongoing savings may soon become acute. Only $148 million of the cuts O'Malley is bringing before the Board of Public Works Wednesday represent ongoing savings. The rest are one-time reductions, raids on funds and accounting gimmicks. O'Malley is facing a budget shortfall of $1.5 billion or more in fiscal 2011, and the more he does now to find ongoing savings, the less he'll have to do later. Copyright 2009 Baltimore Sun. State budget cuts hit health care, higher education O'Malley unveils $280M in state reductions, but more hits on the way By Liam Farrell Annapolis Capital Wednesday, July 22, 2009 Gov. Martin O'Malley this morning presented more than $280 million in budget cuts to the Board of Public Works for approval, proposing spending reductions to higher education, health care and even the advertising budget for the state lottery. The cuts, which were expected to be approved, are just the first round in more than $700 million in reductions that O'Malley wants to make by Labor Day. Politically difficult actions, such as slashing local government aid and state employee compensation, will be part of the next wave, the governor said yesterday in a briefing in Baltimore. By the time the cuts are done, state general fund spending will be lower in fiscal 2010 than in fiscal 2007, according to the Department of Budget and Management. "We are going to have to make some painful and difficult decisions," O'Malley said. "We have to balance this budget. We have to maintain fiscal responsibility." The only measures the governor said he is resisting are large-scale layoffs and cuts to kindergarten through 12th-grade education. O'Malley declined to specify what local funding will be targeted and whether furloughs of state workers or just salary cuts will be used. Conversations will begin between the state and representatives of labor and county governments to see what options are available. "Employee compensation has to be a part of closing this gap," O'Malley said. "We are doing everything we can not to add to the economic stress." Cuts presented to the Board of Public Works today included: $40 million of higher education spending, including $17.7 million from University System of Maryland facilities renewal and operating expenses. $34 million in Medicaid payments to hospitals, nursing homes, managed care organizations and other health care providers. $3 million from stem-cell research. $2 million from the Chesapeake Bay 2010 Trust Fund. Eliminating a total of 39 filled and 18.5 vacant positions. The plan also accounted for an additional $75 million of federal Medicaid dollars because Maryland's unemployment rate is growing. Although lottery revenue has been robust in the recession, the plan also takes $5.5 million from the lottery agency's advertising budget. Eloise Foster, the budget secretary, said there has been little direct relationship between lottery revenues and advertisement spending. "This is a short-term cost-containment measure," she said. Standing firm The reductions come after the state's Department of Legislative Services estimated the deficit for the fiscal year that began July 1 already had widened to $700 million. Little optimism is found among the state's fiscal observers. Warren Deschenaux, the director of policy analysis for DLS, believes the state needs to start "ratcheting back expectations." Comptroller Peter Franchot has said "substantial" revenue writedowns are likely in September's long-term forecast. Latest reports have income tax collections alone at $300 million below expectations. "The national economic recession is still savaging our state economy and revenues," Franchot said in an online chat last week. Despite gloomy assessments, however, O'Malley said he is not ready to backtrack on the historic education spending that has been a central priority of his term. One chart distributed by his staff shows K-12 funding going up about $700 million since fiscal 2007 while the rest of the budget has fallen by more than $800 million. By September, total general fund spending for fiscal 2010 will be less than $13 billion. The governor admitted education "has been sustained in part" by cutting other areas of the budget, but he is resistant to stepping back now. "Maryland is part of that drive to transform America's economy," he said. "It is the right thing for all of us in terms of economic growth." O'Malley also resisted the notion that continuing to spend at such a pace will simply set education up for a fall in the near future. "Everything happens in cycles," he said. "There will be a recovery." Copyright 2009 Annapolis Capital. Religions unite in AIDS fight Faith-based groups provide city locations for HIV testing By Angela J. Bass Baltimore Sun Wednesady, July 22, 2009 Saying they have been too silent for too long in the fight against HIV and AIDS, leaders of several Baltimore faith-based groups converted nearly a dozen churches Tuesday into places where people could be tested for the virus without fear of being stigmatized. The JACQUES Initiative - a program at the Institute of Human Virology at the University of Maryland School of Medicine - launched Project SHALEM in partnership with the Maryland AIDS Administration and several local faith-based and community organizations. Shalem means "peace" or "a safe place" in the Christian, Islam and Jewish faiths. "The ultimate goal is to make churches, mosques and synagogues a safe place where people can receive HIV support," said Derek Spencer, the executive director of the JACQUES Initiative. "We are no longer going to wait for people to come into our academic centers for help," he said. For Tuesday's event, 11 religious churches across the city converted their basements, kitchens and event rooms into testing sites, where more than 40 trained volunteers from Baltimore and other East Coast cities administered swab tests, which don't require needles or blood and provide results within 20 minutes. Within the first hour, one of the testing sites had registered four positive tests, Spencer said, adding that organizers expected to reach their goal of testing 1,000 people. Dr. Angela Wakhweya, deputy director of the Maryland AIDS Administration, said Project SHALEM's goal is to eliminate new HIV cases in the state. "We're working with HIV-negative people to teach them how to stay negative," she said at a news conference at Bethel African Methodist Episcopal Church, one of Tuesday's testing sites. "[We're] encouraging those who are positive to get treatment and prevent the spread." Juan Christian, diagnosed with HIV in 2002, is convinced that the faith-based approach is the best way to encourage community members to get tested, especially after learning that it's the most effective approach in much of Africa. This observation inspired organizers to involve more churches in Baltimore, where Christian said there's a "church on every corner." Copyright © 2009, The Baltimore Sun. University of Md. to test swine flu vaccine Center for Vaccine Development will be one of 10 testing centers nationwide By Kelly Brewington Baltimore Sun Wednesday, July 22, 2009 The University of Maryland School of Medicine's Center for Vaccine Development will be one of 10 centers in the nation to test a swine flu vaccine on adults and children. The clinical trial, slated to begin next month, will enroll up to 1,000 adults and children to evaluate whether the vaccine is safe and effective in preventing the virus known as H1N1, which public health officials fear could mutate into a deadlier strain this fall. Health officials, infectious disease experts and vaccine makers have been scrambling for months to confront the swine flu pandemic, which has killed at least 263 people nationwide – including three in Maryland--and sickened as many as 1 million, according to estimates by the Centers for Disease Control and prevention. Most cases have been mild, however, and people who fall ill with flulike symptoms are not tested and usually recover within a week or so, much like the seasonal flu. Public health officials have been monitoring the virus' spread in the southern hemisphere, where flu season is now at its peak, paying close attention to any changes in the strain and bracing for a more severe version this fall. They hope to have a vaccine ready for distribution to the public by October. University of Maryland scientists plan to test the vaccine in healthy adults and elderly volunteers first before testing it on children, who are among the groups at greatest risk for contracting the virus. Copyright © 2009, The Baltimore Sun. Most small firms lack health care Surveys find many deterred by rising insurance cost Gus G. Sentementes Baltimore Sun Wednesday, July 22, 2009 Many small businesses are worried that rising health insurance costs are choking their growth and hindering the creation of new companies, and they fear health care reform plans being debated in Congress and by the Obama administration could end up costing them even more in taxes, according to business advocates. A survey of views on those costs released yesterday by the U.S. Public Interest Research Group, which includes its counterpart Maryland PIRG, found that 29 percent of the 343 small businesses they interviewed were able to offer insurance. Of the 21 businesses surveyed in Maryland, nine provided health coverage and nearly all said their insurance costs rose over the past year. A dozen Maryland small-business employers said difficulties with health care would prevent others from starting their own businesses in the future. Nicholas Green, a field organizer with Maryland PIRG, said the report was not scientific but intended to be a "real human snapshot" of the struggles that owners of small businesses and their employees face. "Rising health care costs are choking American small businesses just when we need them the most," Green said. Carma Halterman, a coffee shop owner in Charles Village, said the costs - around $300 a month per employee - are too prohibitive for her to offer insurance. "We go for days and weeks sometimes with a nagging medical condition, avoiding the cost of treatment, and that really affects my bottom line and productivity," said Halterman, 46, owner of Carma's Cafe, while joining Maryland PIRG officials in the report's release Tuesday outside her shop. The U.S. PIRG report comes as the debate on health care reform ramps up in Washington, with the Obama administration and congressional Democrats facing criticism from Republicans that their plans would be more costly to taxpayers. A Senate bill would put the cost of health care reform at about $600 billion. A House bill, which passed through the Ways and Means Committee on Friday, would allow the uninsured to get a public or private insurance plan, or keep the plan they currently use. An estimated 47 million people in the U.S. lack health insurance. About half of the House bill's $1 trillion price tag would come from Medicaid and Medicare changes, while the other half would come from a variable surcharge on 1.2 percent of the wealthiest Americans, those making $350,000 or more. Businesses with fewer than 25 employees would get a tax credit, but employers and individuals could face tax penalties if they don't offer and buy insurance under the House plan. In Maryland, the U.S. Small Business Administration's Office of Advocacy estimates that businesses with fewer than 500 employees - which they defined as a small business - numbered more than 112,000 in 2006, the most recently available data. Most of the businesses surveyed by U.S. PIRG were even smaller, with 50 employees or less. According to the U.S. PIRG survey, more than three-quarters of the small-business owners they surveyed who don't offer health care felt stymied in doing so due to high costs, complications and red tape.Of those businesses that could afford coverage, 55 percent indicated that they did so for business reasons - to attract competitive employees - and not altruistic ones, the survey found. Copyright © 2009, The Baltimore Sun. Md. Cracks Down On Cigarette Smugglers By Mike Schuh WJZ-TV 13 online Wednesday, July 22, 2009 ANNAPOLIS, Md. (AP) ― The state figures it's loosing a half million dollars a year in taxes, so they've stepped up their enforcement efforts to crack down on smugglers. Maryland has stepped up its efforts to catch cigarette smugglers avoiding state taxes. Mike Schuh reports, Maryland's efforts are being mirrored by other states that have substantial per pack taxes. Some of the cigarettes confiscated in Maryland are missing something that's very important to the taxman, a Maryland tax stamp. "Well for us it's a violation of the law. It has to be level, on all playing fields," said Peter Franchot, Maryland State Comptroller. Smugglers load up in low tax states, at $2 a pack. Maryland has the fourth highest tax per pack in the country, but nearby in Virginia it's only 30 cents. In South Carolina, it's just 7 cents for cigarette taxes. "The fact that there's a recession, there's a lot more smuggling of cigs, because the tax in our state is double the tax in Maryland," said Franchot. The state figures it's loosing a half million dollars a year in taxes, so they've stepped up their enforcement efforts to crack down on smugglers. "Now we've almost doubled the number of violations, I think we did 172,000 packs of cigs last year," said Franchot. So much money is out there to be made, that organized crime is in on the action. "This is just more illegal activity, they will smuggle another attractive illegal item that they can make money on," said Franchot. The highest tax per pack is New Jersey at $2.57, in New York City however the tax is above $4.50. © 2009 The Associated Press. All Rights Reserved. Balto. Co. loan helps complete creamery By Mary Gail Hare Baltimore Sun Wednesday, July 22, 2009 Bobby and Pam Prigel are moving forward with construction of a creamery on their Long Green Valley property, where they will sell organic dairy products made from milk produced by their herd at Bellevale Farms. A $250,000 low-interest loan from Baltimore County, announced Tuesday, will help them complete and equip a 10,000-square-foot pole barn on Long Green Road. "This puts the finishing touches on this project," Bobby Prigel told a gathering of officials and friends at the farm, promising to invite them back next spring for ice cream. "They will be pouring the concrete floor Friday." The Prigel family has lived and worked on the 260-acre farm since 1895 and began an organic operation there three years ago. In May, the Baltimore County Council passed a zoning regulation that would allow Bobby Prigel to sell organic products despite the objections of some land preservationists, who argued that the law would open the door to factory operations. The exterior of the creamery building resembles a farmhouse, with its wide front porch, stone facade and dormer windows. But until May, a shell was all the Prigels had to show for their $1 million investment. In announcing the loan, County Executive James T. Smith Jr. said the creamery "blends in perfectly with the county's commitment to agriculture," which he said must be "an ever-evolving industry." Rob Deford, owner of Boordy Vineyards and a longtime neighbor, said the creamery fits into the mix of residences, farms and businesses in the Long Green Valley, and he predicted its success. "Farms today have to put their label on something and manage their own destiny," Deford said. "An operation like this puts land to profitable use. Farms cannot be parks; they are working landscapes." Smith said that allowing the family farm to process and sell its own products directly to consumers will ensure its fiscal health and help the county in its efforts to safeguard farmland from development. The creamery, which will feature ice cream, yogurt, cheese and butter, will sell only organic and locally grown products. "I want to see the creamery happen for my husband and for the next generation of our family," said Pam Prigel, who treated her guests to homemade oatmeal cookies and iced tea Tuesday. "It means we will keep Bellevale Farms going into the future." Copyright © 2009, The Baltimore Sun. Missing mental health records of Va. Tech gunman found at former university official's home Associated Press By Bob Lewis, Sue Lindsey Baltimore Sun Wednesday, July 22, 2009 RICHMOND, Va. (AP) — Mental health records for Virginia Tech gunman Seung-Hui Cho that were missing for more than two years have been discovered in the home of the university clinic's former director, according to a state memo sent to victims' family members. Cho killed 32 people on April 16, 2007, then committed suicide as police closed in. His mental health treatment has been a major issue in the vast investigation of the shootings, yet the records' location had eluded authorities until they were uncovered by attorneys for some families of Cho's victims. A memo from Gov. Tim Kaine's chief legal counsel to victims' family members says Cho's records and those of several other Virginia Tech students were found last week in the home of Dr. Robert C. Miller. The memo was obtained by The Associated Press on Wednesday. The memo said Cho's records were removed from the Cook Counseling Center on the Virginia Tech campus more than a year before the shootings, when Miller transferred from his position at the clinic. Records for several other students were also at his home, the memo said. "I appreciate your call, but I'm not making comment at this time," Miller said when reached at a number for his private practice. Kaine said a Virginia State Police criminal investigation was under way into how the records disappeared from the center where Cho was ordered to undergo counseling. Removing records from the center is illegal, he said. Kaine said he was dismayed that it took two years before they were found by the attorneys. "That is part of the investigation that I am very interested in and, of course, I'm very concerned about that," Kaine said. The medical records are protected under state privacy laws. The state planned to release the records publicly as soon as possible, either by consent from Cho's estate or through a subpoena. The discovery calls into question the thoroughness of the criminal probe two years ago and the findings of a commission Kaine appointed to review the catastrophe, one victim's relative said. "Deception comes to my mind in my first response," said Suzanne Grimes, whose son Kevin Sterne was injured in the shootings. "To say it doesn't make sense is an injustice," she said. "It gives me the impression: 'What else are they hiding?'" She praised Kaine's willingness to investigate the disappearance of the records and have them released. "Until we get all the answers to what happened on that day and days prior, there's no sense of closure," Grimes said. Andrew Goddard, whose son, Colin, survived four gunshots, welcomed the new information. "We're not looking to hang people. We're looking for more of the truth about what happened," he said. While a large part of the shooting investigation focused on how university officials and law enforcement responded following the first reports of deaths in a Virginia Tech dormitory, family members of victims have also inquired how the troubled Cho slipped through the cracks at university counseling. In April, on the second anniversary of the shootings, families of two slain students sued the state, the school and its counseling center, several top university officials and a local mental health agency, claiming gross negligence in the chain of events that allowed Cho to commit his killing spree. The lawsuits also claim the local health center where Cho had gone to say he felt suicidal did not adequately treat or monitor him. The discovery shakes up that lawsuit, an attorney for the two families said. "Why would he (Miller) take any student mental health records to his home at any time, and why that student?" Robert T. Hall said. "It certainly is a question of whether there is more to the Seung-Hui Cho mental health history than we've been told," Hall said in a telephone interview from vacation in Vermont. Goddard, who was appointed last year to the state board of Mental Health, Mental Retardation and Substance Abuse Services, said he wasn't sure how helpful the records would be. But he said if they showed Cho was "anything other than this mildly upset student," that needed to come out. Associated Press Writer Dena Potter in Richmond contributed to this report. Lindsey reported from Roanoke. (This version CORRECTS the middle initial for the former clinic director to C., not H.) Copyright 2009 Associated Press. All rights reserved. Lyme disease a suburban threat Legislator organizes community forum in Potomac By Erin Donaghue The Gazette Wednesday, July 22, 2009 Even though he is an avid gardener, Potomac resident Hector Livingston is often afraid to venture into his own backyard. Livingston was infected with Lyme disease last summer and he knows at least six other families in his Lake Normandy Farms neighborhood that have contracted the disease locally. Another neighbor contracted it out of state. Livingston's symptoms included high temperature, chills, headaches and exhaustion, but he knows others in the county who were worse off. "It seems like everyone you talk to knows someone who has it," Livingston said. The number of cases of Lyme disease in Maryland doubled between 2006 and 2007, the most recent data available, according to the Centers for Disease Control. Though experts warn that increased reporting may play into the numbers, the disease is likely on the rise in Montgomery County, according to Bill Hamilton, an ecologist for Montgomery County Department of Parks. According to the Maryland Community Health Administration, Lyme disease is contracted through the bite of an infected black-legged tick, or Ixodes scapularis — often carried on hosts including deer and mice. The tiny ticks can be smaller than a sesame seed, and are most commonly found from April to October. Tick activity peaks in the summer. Early symptoms can include fever, headache, tiredness, stiff neck, joint pain, swollen lymph nodes, and sometimes a rash in the shape of a bulls-eye. Left untreated, however, the disease can become much more serious and can progress to arthritis, meningitis, facial nerve paralysis, or hearing abnormalities, according to the administration. Hamilton said the disease is a problem not only in rural areas, but is increasing in the suburbs as development encroaches upon wildlife habitat. "Wildlife has a host of diseases and issues that aren't necessarily compatible with humans, and whenever the two mix, there are going to be problems," Hamilton said. An increase in the deer population may also be contributing to the rise, and some have credited climate change to creating a more habitable environment for the black-legged tick, Hamilton said. Community concern about Lyme disease in the Bethesda and Potomac areas prompted an upcoming public forum on the growing problem. The forum was organized by State Del. Susan C. Lee (D-Dist. 16) of Bethesda, whose parents live in the Lake Normandy neighborhood, in an effort to get residents talking with officials about the problem. "This has gotten to be a really bad problem in both Potomac and Bethesda, and it's kind of a way to let people know what they can do and how they can be proactive about protecting themselves," Lee said. The disease can also be tricky to diagnose. "When I got sick, I had no idea what my problem was," said North Potomac resident Mimi Segal, who contracted the disease around 2000. She said she was so tired she would have to pull over to the side of the road to take a nap as she drove her daughter to her high school, and then nap again in the parking lot before she could muster up the energy to drive home. It took about a year for an infectious disease specialist to diagnose her with Lyme disease, after she suffered two kidney infections, a lung infection and Bell's palsy in the right side of her face. At the national level, debate is raging over guidelines used by doctors to diagnose the disease. After the Infectious Diseases Society of America developed guidelines in 2006 for diagnosing and treating the disease, an investigation by Connecticut Attorney General Richard Blumenthal last year determined that the ISDA didn't take into account evidence that suggests Lyme disease may become a chronic condition and require longer periods of treatment. Blumenthal's office and the ISDA agreed that the group would create an independent review panel to revisit how the disease is diagnosed and treated. The Lyme Disease Review Panel is scheduled for a public hearing July 30. Experts are preaching prevention strategies for the growing problem. Ticks are likely to be found in tall grass, shrubs, or weeds, according to Marilyn Piety, a special projects manager for Montgomery County Health and Human Services. When walking in the woods, stay on the path and don't venture into wooded areas, she suggests. Try to reduce the amount of skin that is exposed and tuck pants into socks. Always check for ticks after being outside, and if one is found, remove it and place it in a plastic bag with the date on it in the freezer. If you begin to experience symptoms, contact a doctor and let them know when the tick was found. Using a bug spray with the chemical DEET can also be effective. Copyright 2009 The Gazette. Eastern Panhandle Free Clinic gets new home By Richard F. Belisle Hagerstown Herald-Mail Wednesday, July 22, 2009 MARTINSBURG, W.Va. - It’s the dark blue tile floor that sets things apart in the new headquarters of the Eastern Panhandle Free Clinic. There are enough of the one-foot square tiles to cover 2,500 square feet of room, hallway and corridor space - slightly more than one third of the 6,600 square feet in the building that formerly was home to a satellite branch of East Ridge Health Systems in Martinsburg, W.Va. The tiles, with their porcelain finish, were bought at bargain-basement prices and obtained along with free cabinetry, desks, furniture and office equipment from the World Vision Center, a Mennonite-run facility in Philippi, W.Va. “We even got some medical equipment,” said Michele Goldman, executive director of the free clinic. “Everything has fallen into place.” The clinic moved to its new building July 13 from 11065 Middleway Pike in Charles Town, its home of 2,400 square feet for the last seven years. The monthly rent of $4,000 - up from $1,600 in the former building - will raise the clinic’s budget to $600,000. Panhandle residents between the ages of 19 years old and 65 years old with no health insurance who fall between the cracks for primary medical care rely on the clinic. Among the 2,400 clients the clinic sees each year are workers who lost their jobs and health insurance due to the economy, single working mothers and college students. Very poor children and adults have Medicaid and don’t use the clinic’s services, Goldman said. Goldman said the added space has enabled her to add two much-needed, full-time staff members - an administrative assistant and a medical assistant - bringing to 10 the number of full-time employees. Two employees work part time. The clinic handles 900 patient visits a month, “and it’s growing,” Goldman said. It operates with a physician who serves as medical director, two registered nurses, two nurse practitioners, two pharmacy technicians and volunteer counselors. More than 200 volunteers donate their time to the clinic, Goldman said. A major role for the clinic is providing hands-on training for nursing and social work students who are on degree tracks in area colleges and universities. There is a teaching room on the premises. The larger building provides space for a conference room, three administrative offices, eight examination rooms, a counseling office, offices for medical providers, a kitchen, adequate storage, and more admission and waiting room areas. Another plus, Goldman said, is that the new location will bring increased visibility to the clinic. Copyright 2009 Hagerstown Herald-Mail. *National / International* Cancer awareness group sues in NJ to force food-makers to put warning labels on their hot dogs By Associated Press Baltimore Sun Wednesday, July 22, 2009 NEWARK, N.J. (AP) — Hot dogs may be as American as baseball and apple pie, but a national cancer-awareness group says they're hazardous to your health and should carry warning labels. The Washington, D.C.-based Cancer Project wants to force hot dog makers to use warning labels. The group filed a lawsuit Wednesday in Superior Court in Newark on behalf of three New Jersey residents. The defendants are Kraft Foods, manufacturer of the Oscar Mayer brand; Sara Lee; Nathan's Famous; and the makers of the Hebrew National and Sabrett brands. The lawsuit cites a report by the American Institute for Cancer Research that concluded regular consumption of processed meat can increase the risk of colorectal and other forms of cancer. Copyright 2009 Associated Press. All rights reserved. Prevention key to heart health By Kelly Brewington Baltimore Sun Wednesday, July 22, 2009 Two new studies by Harvard researchers affirm what doctors have been trying to drill into us for years: adopt a healthy lifestyle and you'll keep your heart healthy. Sure, to all you diet and fitness buffs out there, this may not be earth shattering news. Still, the studies, which appear in this week's Journal of the American Medical Association drive home the link between behavior and health. In the first paper, researchers used the Nurses Health Study -- a long-running research project -- to examine the connection between lifestyle and the risk of developing high blood pressure in some 84,000 women between 1991 and 2005. They measured how well the nurses followed advice on six lifestyle factors such as exercising for 30 minutes a day, having a body mass index of less than 25 and even drinking moderate alcohol. Women who followed all six, had about an 80 percent lower risk of developing high blood pressure than those who did not. The second study, looked at heart failure in men by examining some 21,000 doctors in the Physicians' Health Study from 1982-2008. Men with normal body weight, who never smoked and exercised regularly had a 10 percent risk of developing heart failure, versus a 21 percent risk for men who didn't follow healthy behaviors. Of course, it may not be not surprising that a health study of doctors and nurses would reveal good results. (Better, than for say, reporters in an overworked newsroom.) Still, the authors note that their findings are similar to other studies that have found a link between healthy habits and prevention of cardiovascular disease. An accompanying editorial calls for greater public health efforts to help people ward off these preventable illnesses. "At this point, the national cost of treating cardiovascular diseases cannot be sustained, and prevention is urgent," said Dr. Veronique Roger of the Mayo Clinic. "These studies...underscore that healthy lifestyle will help prevent cardiovascular disease and greatly enhance health, which is a compelling reminder that health is a shared responsibility of individuals and communities." Copyright 2009 Baltimore Sun. Saying 'sorry' pays off for U. of Michigan doctors Associated Press Daily Record Wednesday, July 22, 2009 When a treatment goes wrong at a U.S. hospital, fear of a lawsuit usually means "never daring to say you're sorry." That's not the way it works at the University of Michigan Health System, where lawyers and doctors say admitting mistakes up front and offering compensation before being sued have brought about remarkable savings in money, time and feelings. "What we are doing is common decency," said Richard Boothman, a veteran malpractice defense lawyer and chief risk officer for a health system with 18,000 employees and a $1.5 billion annual budget. The estimated $5.8 billion annual cost of malpractice claims nationwide has drawn scrutiny as President Barack Obama and Congress plot an overhaul of the nation's $2.4 trillion health care system. So far, Obama has spoken in broad terms about shielding doctors from unwarranted lawsuits without capping damage awards, but medical malpractice is an issue that deeply divides. Doctors, hospitals, trial lawyers and patient advocates disagree not only on the solution but the problem itself. Is it the high price of malpractice insurance? The difficulty for victims of medical errors getting justice? The cost of unneeded tests ordered by lawsuit-wary doctors? The "burying" of medical errors that kill tens of thousands of Americans yearly? Officials at the University of Michigan say their approach addresses doctor, patient and public concerns. The willingness to admit mistakes goes well beyond decency and has proven a shrewd business strategy, according to a 2009 article in the "Journal of Health & Life Sciences Law" by Boothman and four colleagues at the Ann Arbor school. According to Boothman, malpractice claims against his health system fell from 121 in 2001 to 61 in 2006, while the backlog of open claims went from 262 in 2001 to 106 in 2006 and 83 in 2007. Between 2001 and 2007, the average time to process a claim fell from about 20 months to about eight months, costs per claim were halved and insurance reserves dropped by two-thirds. Boothman said the health system learns of possible medical errors from doctors themselves, as well as from patients or their lawyers. In any case, the university conducts a peer review to see if there was an error and if changes are needed to prevent a recurrence. Equally important, health system doctors and officials offer to meet with patients and their families, sometimes to explain that treatment was appropriate and sometimes to admit a mistake. "I do believe caregivers want to do this," said Boothman, whose second-floor office looks out on the University Hospital at the heart of the sprawling medical center, 35 miles west of Detroit. "It's not a hard sell at all, as long as you can reassure them it's OK." Malpractice lawyer Norman Tucker has several active cases against the University of Michigan and said the school is fair, though not an easy mark. Lawyers say because Michigan admits mistakes in some cases, it can signal a tough fight ahead in those cases where it denies error. "You should follow Mark Twain's advice: 'When in doubt, tell the truth,'" Tucker said. According to Harvard Medical School Dean Dr. Joan Reede, patients and their families can find great relief and comfort when a doctor promptly admits an error. She learned this personally when her mother nearly died from a medical error in 1998. Tommye Reede of Hull, Mass., spent eight weeks in a hospital after hip surgery when doctors at first failed to spot a severe allergic reaction despite warnings from her medically trained daughter. "There was an apology from the surgeon," Joan Reede said. "There was an acknowledgment that 'I did not pay attention.' ... At no point did I feel abandoned." "When you get what you consider to be a sincere apology, you always feel better," said her mother, now 79, who didn't sue. Mother and daughter talked about the experience in a 2006 doctor training DVD "When Things Go Wrong" by Dr. Tom Delbanco of the Harvard Medical School. They declined to name the hospital, saying they didn't want to single it out for attention. The openness approach is catching on at places from Boston Medical Center to the University of Illinois to California's Stanford University hospital. "Apologies for medical errors, along with upfront compensation, (reduces) anger of patients and families, which leads to a reduction in medical malpractice lawsuits and associated defense litigation expenses," according to Doug Wojieszak, spokesman for The Sorry Works! Coalition. The group includes doctors, lawyers, insurers and patient advocates. The "saying sorry" movement has its skeptics, even among those who agree it's the right thing to do. The right of injured patients to sue health care providers and force them to open up their internal records is a crucial part of reducing medical mistakes and improving care, said Matthew Gaier, co-chairman of the New York State Trial Lawyers Association's medical malpractice committee. Harvard University public health associate professor David Studdert says a review of published studies shows about 181,000 people are severely hurt each year as a result of mistakes at U.S. hospitals but only about 30,000 file legal claims. Many people don't sue because they don't discover they're victims of malpractice, Studdert and colleagues wrote in a 2007 article in the journal "Health Affairs." The spread of disclosure, the article said, could cause malpractice costs to rise from $5.8 billion now to between $7 billion and $11.3 billion a year. For "saying sorry" to work, doctors need protection from having their own honesty used against them in court, said Jim Copland, director of the Manhattan Institute's Center for Legal Policy and an advocate of curbs on damage suits. Protection could take the form of a shield law that would exclude an apology from admission as evidence in a malpractice suit. A number of states have or are considering such laws. "If you go out and say, 'Oh, we messed up, are you going to lose the lawsuit? You need to give them some protection," Copland said. Copyright 2009 Daily Record. Health-Care Reform Efforts Marred by Abortion Dispute By Dan Eggen and Rob Stein Washington Post Wednesday, July 22, 2009 President Obama, who has vowed to find common ground on culture-war issues, finds himself in the middle of a classic Washington dispute over abortion that is further undermining support among conservative Democrats for his ambitious health-care reform efforts. Abortion is not explicitly mentioned in any of the major health-care bills now under consideration in Congress. But abortion opponents charge that the legislation would make abortion both more widely available and more common by requiring insurance plans to pay for the procedures and providing government funding to subsidize plans that pay for them. White House press secretary Robert Gibbs said this week that decisions on specific benefits such as abortion coverage should be "left to medical experts in the field," referring to a proposed advisory board that would recommend minimum levels of coverage for private insurers. The dispute presents another unwelcome distraction for the White House and a political opportunity for Republicans, who are seizing on the issue as part of a broader attempt to kill health reform legislation that they believe is too intrusive and costly. A group of conservative Democrats led by Rep. Tim Ryan (Ohio) proposed a compromise Tuesday that would neither require nor bar private insurers from offering the procedure as long as no federal funding is used; another group of Democrats and Republicans is holding a news conference today to call for an explicit ban on funding. The conflict comes as two House Democrats on either side of the abortion divide prepare to introduce legislation later this week aimed at encouraging pregnancy prevention and greater government support for young mothers. The measure from Ryan, who opposes abortion, and Rep. Rosa DeLauro (D-Conn.), who supports abortion rights, has attracted an unusual array of supporters ranging from Planned Parenthood to evangelical leaders such as the Rev. Joel Hunter of Orlando. The developments underscore the emotional and often intractable nature of the abortion debate, which also flared during the confirmation hearings for Supreme Court nominee Sonia Sotomayor this month. Obama has repeatedly called for finding "common ground" between the two sides by advocating policies to reduce the number of abortions and unintended pregnancies, a message he amplified as part of a widely watched address at Notre Dame University and during a recent Vatican visit with Pope Benedict XVII. But the health-care reform legislation has reignited allegations from antiabortion groups that such pledges are an attempt by Obama and his allies to paper over their support for abortion rights with policies that will do little to reduce use of the procedure. "This is a president who says he wants to reduce abortions," said Douglas Johnson, legislative director for the National Right to Life Committee. "But the actual policies that this administration is promoting will result in massive public subsidies for abortion and result in a massive increase in the number of abortions." Democratic leaders and abortion rights groups say those concerns are exaggerated, and some accuse abortion opponents of attempting to use the health-care debate to further restrict legal access to abortion under private insurance plans. "This is the kind of divisiveness that the public has grown very tired of," said Nancy Keenan, president of NARAL Pro-Choice America, which has endorsed the Ryan-DeLauro bill. "We think those benefits should be decided by experts and not politicians." Rep. Bart Stupak (D-Mich.), who believes House legislation contains "a hidden abortion mandate," said he is in talks with House Energy and Commerce Chairman Henry A. Waxman (D-Calif.) in an attempt to find compromise language that will mollify him and other abortion opponents. He and other lawmakers are holding a news conference on the topic today. "It's been a long held conviction by many members that taxpayer dollars should not be used for abortion," Stupak said in an interview, referring to restrictions first enacted in 1976 for Medicaid funds. "They're open for discussions." In their separate proposal to House Speaker Nancy Pelosi (D-Calif.), Ryan and four other Democrats say that allowing insurers to chart their own abortion policies as long as taxpayer money isn't used for the procedure represents "a common ground solution" that effectively maintains current law on abortion funding. Their proposal would also stipulate that current state restrictions on the procedure would still apply. Adam Sonfield, a senior policy associate at the Guttmacher Institute, a nonpartisan reproductive health research group, said such a solution will "probably disappoint a lot of people on both sides, but it's probably something that people on both sides can live with." The prevention bill being proposed by Ryan and DeLauro would establish a series of new and expanded initiatives focused on contraceptives and other prevention measures, including restoration of Medicaid coverage for family planning services. The bill, to be announced formally on Thursday, also includes a series of grants and policies aimed at helping young mothers, including expanded maternity care options and more financial assistance for adoptions. Backers say the Ryan-DeLauro bill has been carefully scrubbed for months to remove policies that might alienate either side, such as eliminating financial support for the morning-after pill. Hunter, senior pastor of Orlando's Northland megachurch, said the proposal "isn't going to end the disagreement or the alarm that comes up on both sides. But I think it is the first of its kind to take such an incendiary culture-war issue and really make progress. It's a start." Ryan, who opposes abortion but has come under attack from some antiabortion groups for supporting the use of contraceptives, said he also believes the bill will help calm the current dispute over how to address the procedure in health-care legislation. "I'm hopeful this will spill over into the health-care debate and encourage both sides to find common ground there as well," Ryan said in an interview. The White House has not endorsed any specific legislation on reducing abortions. But Melody Barnes, Obama's domestic policy adviser, said in an interview that the Ryan-DeLauro proposal represents "a very positive development." She also said the administration, which has been holding meetings between advocates on both sides of the abortion debate throughout the summer, expects to issue its own package of proposals later in the year. "The president started this process with the desire to find common ground and to work with people across the political spectrum," Barnes said, adding: "The bottom line is to put concrete ideas on the table." Copyright 2009 Washington Post. Sidney W. Bijou, Child Psychologist, Is Dead at 100 By Benedict Carey New York Times Wednesday, July 22, 2009 Sidney W. Bijou, who adapted a set of simple reward-based psychological techniques to treat troubled children and in the process helped establish modern behavioral therapy for childhood disorders like autism and attention deficit disorder, died on June 11 at his home in Santa Barbara, Calif. He was 100. He collapsed and died while getting dressed, said his daughter, Jude Bijou, who had been caring for him. News of his death received only local coverage at the time but was widely discussed in professional circles. Dr. Bijou’s studies, showing that small rewards like a hug or piece of candy, given at the right times, could resolve large behavior problems, shook up the field of child psychology, which in the 1950s and 1960s was still dominated by Freudian thinking. Therapists had typically tried to understand a difficult child’s drives and motives, often in play therapy, by interpreting the small dramas in the dollhouse or between stuffed animals. Yet there was no good evidence that such approaches were effective, and Dr. Bijou, who had worked under the behavioral psychologist B. F. Skinner, decided to attack the bad behaviors directly, and by increments. A disruptive, defiant boy who struggled to hold his tongue earned instant praise; he might get a hug if he started his homework, and a piece of candy if he completed it. If a child became defiant, he would be ignored and perhaps removed from the group altogether for a time — given what parents today would call a “timeout.” “He was strongly opposed to the idea that punishment could have a positive effect,” said Susan O’Leary, a professor in the clinical psychology department at Stony Brook University, who worked with Dr. Bijou at an experimental preschool classroom at the University of Illinois. “The thinking behind the break, or the timeout, was that if good things were happening in the classroom, then the child would want to participate” and begin to behave more civilly. In a series of studies, first at the University of Washington and later at the University of Illinois, Dr. Bijou painstakingly documented children’s responses to such rewards, and how those responses could over time transform a child’s life. One of his most famous studies revealed the simple power of attention: By simply attending to a child when he or she was well behaved, teachers could quickly bring out more such behavior, even from habitually disruptive youngsters. Other researchers applied these techniques to specific diagnoses; one of them, O. Ivar Lovaas, conducted seminal studies at the University of California, Los Angeles, that found that simple rewards helped children with autism improve their social skills, among other things. The approach is now standard treatment for autism, backed by more evidence than any other therapy. “Dr. Bijou essentially helped lay the foundation of what now are viewed as standard behavioral interventions for children with a variety of behavior problems,” said William Pelham, a psychologist at the University of Buffalo. Sidney William Bijou was born Nov. 12, 1908, in Arlington, Md., to Leon Bijou, a tailor, and Lea, a homemaker, and moved with the family to Brooklyn when he was 10. He graduated from the University of Florida with a degree in business in 1933, and later studied psychology, first at Columbia in New York, and later at the University of Iowa, where he earned a Ph.D. After serving in the Army Air Corps, Dr. Bijou joined Dr. Skinner’s group at the Indiana University in 1946. In 1948 he moved to the University of Washington, where he ran the Institute of Child Development and put Dr. Skinner’s ideas to practical use with troubled youngsters, in experimental classrooms. With a colleague, Donald Baer, he wrote highly influential textbooks on the work, and later established similar behavior-based programs at the University of Illinois, the University of Arizona and the University of Nevada, Reno. Working in an era when most common childhood diagnoses, like A.D.H.D., were unheard of, Dr. Bijou took on children with all variety of problems, whether drooling, angry outbursts or a refusal to wear glasses. Each child was treated as an individual, his colleagues said; each learned at his or her own pace. Dr. Bijou’s wife of 67 years, Janet, died in 2000. In addition to his daughter, of Santa Barbara, he is survived by a son, Bob, of Mill Valley, Calif. The two siblings said their father had practiced at home what he documented in his classroom laboratories: catch children being good, let bad behavior be its own punishment. Once when his parents were out, 15-year-old Bob Bijou took his father’s car out with a friend for a spin and was arrested by the Bellevue, Wash., police. Father and son spent some time down at the station, where officers suggested several penalties, like delaying the boy’s opportunity to get a license. “My dad stood up and said, ‘I think he’s already had punishment enough,’ ” said Bob Bijou, who remembered his friend’s being grounded. “Sometimes it can pay off to have a psychologist for a father.” Copyright 2009 The New York Times Company. Are Indoor Pools Bad for Your Lungs? By Gretchen Reynolds New York Times Wednesday, July 22, 2009 A 2006 study of youth athletes in Quebec City turned up the provocative finding that young, high-level swimmers wheezed and coughed far more often than young, indoor soccer players. The swimmers, mostly 8-12 years old, reported in a questionnaire that they frequently suffered from upper and lower respiratory symptoms, lung congestion, breathing difficulties, and sneezing. More than 15 percent had asthma. To ensure that these self-reported symptoms were accurate, the scientists monitored 72 of the young swimmers and 73 of the soccer players over the course of five practices. They found that the swimmers definitely struggled with more breathing problems than the soccer players. Notably, the young swimmers’ difficulties were closely correlated to the levels of chlorine and chlorine byproducts in their pools. More chemicals meant more symptoms. Is swimming good or bad for the lungs? The question has particular relevance now, with the swimming World Championships getting underway this week in Rome, and the summertime, lazing-around-the-swimming-pool season reaching its zenith. Many doctors consider swimming an ideal sport for people with breathing problems. “The pool environment is humid, and your oxygen delivery system improves when you’re lying down,” says Dr. Jim Miller, one of the team physicians for USA Swimming. On the other hand, asthma and other severe breathing difficulties seem to be almost epidemic among competitive swimmers, with most of the problems developing after the athletes took up swimming, according to the latest research. In a study of 50 elite athletes published last year in the British Journal of Sports Medicine, almost all of the swimmers had inflamed lung tissue, with those who spent the most time at the pool showing the most changes. In another study, published earlier this year in the European Respiratory Journal, almost 70 percent of a group of 32 elite swimmers suffered from a condition known as airway hyper-responsiveness, in which the bronchial tubes twitch or spasm excessively in response to cold air and other stimuli. Airway hyper-responsiveness can be a precursor to asthma. Meanwhile, by some estimates, one-third of all elite swimmers have full-blown asthma, 80 percent of which began after they took up swimming. “The US National Team has a bunch of asthmatics on it,” says Miller. Is chlorine to blame? The chemical disinfectant, source of the distinctive, pungent, swimming-pool smell, is lethal in large amounts. But it’s not just chlorine “that is the issue,” says Dr. Louis-Philippe Boulet, a professor of medicine at the Quebec Heart & Lung Institute, and the author of multiple studies of swimmers’ lungs. Instead, problems arise when chlorine mixes with proteins in the water, such as shredded skin or hair, creating chloramines. The more chlorine and the more protein you have in a pool the more chloramines. These toxic byproducts tend to settle just above the water’s surface — where swimmers breathe — and are inhaled deep into the lungs. “There are increasing numbers of studies that suggest that exposure to chloramines may have a major effect on bronchial health,” Boulet says. Many of the affected swimmers have no idea that their lungs are unhealthy. Often, they have no symptoms or, as Boulet says, “they think that the symptoms”, such as coughing or tightness in the chest, “are a normal part of hard training.” Others realize that they have breathing problems when they try to exercise outside of the humid pool environment. In Boulet’s latest studies, elite swimmers with no symptoms of airway hyper-responsiveness in the pool were positive for the condition during testing on land. Casual swimmers don’t seem to face much risk. “The evidence so far leads me to think that recreational swimming is not detrimental,” Boulet says —especially if you swim outdoors. Although one study from last year found that asthma was more common among 847 European schoolchildren who’d frequented outdoor pools, Miller says that, in his work, “we hardly ever see problems among the swimmers at outdoor pools.” Anyone who trains several times a week or more at an indoor pool, however, might want to start “paying attention to chest health,” Miller says. If you often feel tightness or shortness of breath, in or out of the pool, “consider getting a pulmonary function test,” he says. This advice also holds true if you’re the parent of a young, competitive swimmer. In some studies, the youngest swimmers seemed to absorb the most chloramines. “If your child complains of a heavy chest or is often coughing, have him checked out,” Miller says. In addition, some emerging research suggests the possibility that babies and toddlers, with their rapidly developing lungs, shouldn’t be exposed to indoor swimming pools; in some small but intriguing studies toddlers who’d frequently been taken to indoor pools had lung damage “similar to that observed in current smokers,” a review by Boulet and others pointed out. But Boulet cautions that more testing is needed. In any case, if pulmonary testing shows airway hyper-responsiveness talk to your physician about treatments such as bronchial dilators, which helps to open the airway and “which are very effective for most swimmers” with breathing problems, Miller says. Though swimmers with existing allergies — who can have a more pronounced reaction to the chloramines — can be harder to treat, he adds. You might also look for a different pool. “When some of our high-school swimmers are going on college recruiting trips, we tell them to follow one simple rule,” Miller says. “If you walk into the building and can find your way to the pool without directions, don’t go to that school. A smelly pool is, chemically, way out of balance.” If your favorite pool is easy to find, blind-folded, talk to the manager about re-calibrating the amount of chlorine being used or improving the air flow in the facility to circulate the air above the surface of the water. In the meantime, if you sometimes wheeze, don’t panic. Active swimmers’ breathing problems “are probably not permanent,” Boulet says. In the largest study of its kind to date, the lungs of 26 elite swimmers from Finland were tested during and after their competitive careers. Twenty-three percent of them suffered from asthma while racing; only 4 percent still had the condition within five years after retirement. Overall, researchers say, the benefits of swimming for exercise outweigh the risks. As the authors of the Quebec City study of youthful swim racers were careful to point out, only one of the 72 swimmers they studied smoked and none were obese, making them statistical anomalies among the young. “Breathing problems do sometimes develop,” Miller says. “But with rare exceptions, they can be controlled. Swimming remains, in general, very good for you.” Copyright 2009 The New York Times Company. *Opinion* Managing the pain Our view: Gov. O'Malley is right to seek budget cuts that won't hamper the state's economic recovery; so far, he's made some good decisions and some bad ones Baltimore Sun Editorial Wednesday, July 22, 2009 Here's the good news: Gov. Martin O'Malley, after seemingly endless rounds of budget cutting, has still managed to find something we won't miss - $5.5 million in Lottery advertising. Here's the bad news: The rest of the $280 million in cuts Mr. O'Malley unveiled Tuesday afternoon aren't so painless, and they're only an appetizer for even worse reductions to come. The governor anticipates bringing about $420 million more in cuts to the Board of Public Works before Labor Day, and those, he hinted strongly, are going to come by reducing the state payroll and aid to local governments. What's more, only $148 million of the cuts he announced Tuesday represent ongoing savings, meaning the rest won't help solve the even bigger budget problems that loom next year, when expenses are projected to outpace revenues by $1.5 billion or more. Mr. O'Malley's foes will no doubt try to blame the state's financial woes on him - they'd probably pin the entire global financial meltdown on him if they could - but in truth, Maryland's troubles are no worse than those in other states. Hard though it may be to believe, our economy remains stronger and our state budget problems less severe than many others'. The question is how well Mr. O'Malley handles the situation. The standard he has set for himself, and it's a good one, is to manage the cuts in such a way that Maryland will be poised to recover more quickly from the recession than its peers. On that score, he makes some good decisions and some bad ones. At a news conference Tuesday, Mr. O'Malley repeatedly vowed to protect the state's investment in education, which he said would be the key to Maryland's future economic competitiveness. But when he talks about education, Mr. O'Malley means K-12 education and maintaining the huge ramp-up in spending Maryland has made in that area in the last several years. Indeed, as the state's standardized test scores for elementary and middle schools attested when they were released Tuesday, all those billions seem to be having an effect, especially in Baltimore City. A great K-12 education system is essential both to provide opportunities for children and to make the state an attractive place for people to live and raise families. But it doesn't even get you to first base when it comes to competing in the global economy. For that, you need excellence in higher education as well, both at the university and community college levels. Yet, Mr. O'Malley announced plans to cut funding for the University System of Maryland by some $37 million. That wouldn't necessarily be a problem except for his continued insistence that the system maintain, for a fourth year in a row, a freeze on undergraduate tuition. A modest tuition increase would allow the system to augment need-based financial aid and accommodate the growing demand for higher education. But as it is, quality higher education will be unavailable to some students not because they can't afford the tuition but because the system can't afford to provide them with seats in the classroom. When it comes to the immediate recovery from the recession, community colleges may be even more important because of their role in retraining workers. So far, Mr. O'Malley has avoided significant cuts to them, but that could change as he works in the coming weeks to cut aid to local governments. The state provides some $280 million in funding for community colleges, and reductions could hinder Maryland's economic recovery if they make tuition unaffordable, reduce support for students or hinder the colleges' ability to adapt their programs to the changing needs of the economy. Another problem that could hamper Maryland's recovery would be continued budget shortfalls at the state level. The last thing Maryland would need at the beginning of an upturn would be tax increases. Mr. O'Malley says he is determined to avoid them, and there appears to be no appetite in the General Assembly to raise taxes again. But if the state does not find significant ongoing savings, it could be in trouble. Maryland balanced its budget this year in part by using federal stimulus money to prop up its education spending and funding of teacher pensions, among other things. That cash runs out in two years. Tempting as it might be to put off worrying about that until after the 2010 election, when more cuts - and maybe even more tax increases - might seem politically palatable to our elected officials, the state will be stronger in the long run if it plans for the sunset of those funds now. Copyright © 2009, The Baltimore Sun. Health Insurance No One Needs By Matt Miller New York Times Commentary Wednesday, July 22, 2009 Los Angeles - EVERYONE who wants universal health coverage (me included) finds irresistible the rallying cry that all Americans should have the same health benefits that members of Congress have. But Congress’s health insurance — that is, the heavily subsidized preferred provider plan that most members have — is not an ideal model, because it is quite rich. As with other fee-for-service plans, it does little to encourage people to be smart health care shoppers. Congress’s health plan pays for routine expenses like office visits and vaccinations, for example, which is like auto insurance covering oil changes or new windshield wipers. As a result, the premiums are steep — upwards of $13,000 a year for a family (69 percent of which is paid by the government). To provide the 50 million Americans who are now uninsured with such a plan would require scary tax increases. When faced with staggering cost projections, advocates of universal coverage often suggest something less grand for the uninsured; after all, it’s better than the nothing they have now. But that approach violates the as-good-as-what-Congress-has standard. Plus, it makes uncomfortably explicit the dread possibility of a “two-tier” system in which influential or better-off Americans have lavish health insurance, and the less affluent make do with a slimmed-down plan. (To be sure, we now have multiple-tier care, but in a democracy we like to pretend that’s not the case.) The obvious answer — conveniently overlooked by the 535 well-insured members of Congress — is to stick with our rallying cry, but give Congress a more cost-effective plan. A new insurance plan for Congress would blend the sensible conservative desire to put a brake on costs with the equally sensible liberal goal to protect all Americans. Conservatives have proposed tax-sheltered health savings accounts paired with high-deductible insurance plans, but these are typically burdensome for the poor, who cannot afford a $5,000 (or higher) deductible. And by luring healthier people away from the broad insurance pool, such plans risk raising premiums for the sicker people who maintain traditional coverage. Liberals, meanwhile, champion Cadillac plans that provide no incentive for people to care about costs; whether the charge for a doctor visit is $150 or $400, the co-payment is the same. But the best of both sides’ impulses could be combined into a new basic health plan for Congress, and here’s how: First, make sure all members have primary and preventive care. This means regular checkups and health screenings, timely attention for injuries and other urgent medical problems and the kind of wellness coaching that can help people quit smoking, lose weight and reduce stress. If all Americans were provided such primary and preventive care, the country’s total medical bill would gradually come down. One approach would be to require senators and representatives, most of whom earn $174,000 a year, to maintain tax-sheltered health savings accounts, which they would use to finance their primary and preventive care. Today, families may put up to $5,950 annually in such an account — and any amount they don’t use on health care that year can remain in the account. To make such an approach work for all Americans, we’d need to supplement the accounts of people who couldn’t afford to save the full amount, and of less healthy people, whose costs are higher. An alternative strategy for Congress would be the new “fitness club” model offered by some doctors, in which members pay $65 a month for same-day or next-day access to primary care services. This would involve no insurance companies, so it would save administrative expenses. We could then pair one of these primary care plans with high-deductible insurance coverage for catastrophic care, but limit total annual out-of-pocket payments to, say, 15 percent of family income. For a member of Congress whose family had no other income, that limit would be $26,000. If this kind of plan were extended to other Americans, a family earning $25,000 a year would have a limit of $3,750. This kind of hybrid plan would honor the values of both parties even as it cut the cost of covering each politician by perhaps one-third. It would give members the incentive to shop for less expensive health services, thus encouraging doctors and other providers to compete to offer better value. At the same time, members would know they are protected in the event of a costly illness. Those who wanted greater coverage could pay for it out of their own pocket. If all Americans were to have such a hybrid plan, the nation would be healthier, costs would grow more slowly and medical bills would no longer be a leading cause of bankruptcy. Rarely do members of Congress get the chance to make a small change that can have such a big difference. Matt Miller, the host of the public radio program “Left, Right and Center,” is the author of “The Tyranny of Dead Ideas.” Copyright 2009 The New York Times Company. BACK TO TOP


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