Tuesday, June 2, 2009

News Clipping Archives

 

Maryland / Regional

Maryland swine flu cases rise to 61 (WMDT.com - WMDT 47 abc)

Bill pushes doctors to computerize records  (OmniMD)

High blood pressure often missed in kids (Baltimore Sun)

PharmAthene (Annapolis Capital)

Some drug patches raise safety concern (The Beacon)

 

National / International

Kids of parents with mental issues at greater risk; therapy helps (USA Today)

Depression diagnoses fell after FDA antidepressant warning (USA Today)

Study finds antidepressant doesn't help autistic children (Baltimore Sun)

Some Doctors Help With Bills As Well as Ills (Washington Post)

Health Groups Detail Plans to Reduce Costs (Wall Street Journal)

Cigarettes Without Smoke, or Regulation (New York Times)

SC funeral home license revoked for cutting corpse (Hagerstown Herald-Mail)

Sebelius, DeParle ready to tackle health care overhaul (USA Today)

The Deadly Toll of Abortion by Amateurs (New York Times)

Red Bull pulled from shelves in Hong Kong (USA Today)

 

Opinion

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Maryland / Regional

 

Maryland swine flu cases rise to 61

 

Associated Press

WMDT.com (WMDT 47 abc)

Tuesday, June 2, 2009

 

BALTIMORE (AP) - Maryland health officials say the number of confirmed swine flu cases has risen to 61.

 

Health Department spokesman David Paulson says 15 more cases have been confirmed over the past 10 days. Of the 61, the spokesman says five have been hospitalized, and all five have either recovered or are recovering.

 

Copyright © 2009  Delmarva 47 News  All rights reserved.

 

Bill pushes doctors to computerize records

 

EMR Specialists

OmniMD

Tuesday, June 2, 2009

 

O’Malley expected to sign bill that would aid in creating national health information network

 

Maryland is poised to jump ahead of the rest of the nation in health information technology on Tuesday when Gov. Martin O’Malley signs a bill intended to coax doctors into using electronic medical records.

 

The computerized files are seen as the foundation of a national health information network that proponents say will improve care, advance medical knowledge and save the country tens of billions of dollars annually. But with the startup costs to individual doctors in the tens of thousands of dollars, many smaller practices have been slow to move from clipboard to computer screen.

 

With today’s bill signing, Maryland will become the first state requiring private insurance companies to offer doctors financial incentives to adopt the technology, state officials say. Doctors who do not bring an electronic medical records system on line by 2015 could face penalties.

 

“This is where government and private health care providers can come together to really improve not only the quality of care but also, hopefully, create some costs savings as well,” O’Malley said. “Health IT is the future of health care in our country, and we want Maryland to lead the way.”

 

The bill also requires the state to develop a health information exchange, a computer network that would link all of Maryland’s physicians, hospitals, medical laboratories and pharmacies. It could be linked in turn with those of other states to create the national network envisioned by President George W. Bush and affirmed by President Barack Obama. O’Malley calls it “creating one common gauge of railroad track.”

 

Obama, who has promised to spend $50 billion on the effort over the next five years, set aside $17.2 billion in the economic stimulus package to encourage the adoption of electronic medical records - sophisticated computer programs that record a patient’s history, incorporate the latest medical research and propose appropriate treatments.

 

Privacy advocates warn that the features that make the computerized patient files attractive to health care providers - the wealth of personal information, and the ease with which it may be accessed and shared - also make them ripe for potential exploitation by employers, insurers and others. State and federal officials acknowledge such concerns and say safeguards will be incorporated into the new systems.

 

The stimulus money went to Medicare and Medicaid, which are to give it to doctors who adopt electronic medical records. But because Medicare and Medicaid account for less than half of payments to many providers, state Health Secretary John Colmers said, private insurers are now being enlisted to add incentive, beginning in 2011.

 

The bill allows insurers to choose among several forms of inducement - increased reimbursements, lump-sum payments or in-kind services - so long as it has a monetary value.

 

“The goal here in Maryland was to assure that all of the payers pull their oars in the same direction,” Colmers said. “There is a great promise in electronic health records, but the greatest promise comes when it’s done in a coordinated fashion, across all of the payers.”

 

Bush’s goal was to get all of the nation’s physicians using electronic medical records by 2014. The next year, insurers in Maryland may begin to reimburse holdouts at lower rates, according to the state measure.

 

Jeff Valentine, a spokesman for CareFirst Blue Cross Blue Shield, congratulated O’Malley and the state legislature on what he called “an important first step to maximize federal stimulus funding.”

 

The largest health insurer in the mid-Atlantic, CareFirst, already offers increased reimbursements to doctors who use electronic medical records, which Valentine said would lead to “improved patient outcomes and safety, lower costs associated with care delivery and an overall improved patient experience.”

 

The state began work on a health information exchange last summer, when the Maryland Health Care Commission asked two very different physicians groups to develop pilot programs and advise the state on how a statewide exchange should function.

 

The Chesapeake Regional Information System for our Patients, or CRISP, included several large Baltimore medical institutions, Johns Hopkins Medicine, MedStar Health and Erickson Retirement Communities among them. The Montgomery County Health Information Exchange Collaborative brought together community hospitals, the county health department and clinics that serve the poor and the uninsured.

 

“It’s a population that is, in many ways, invisible and not so well-connected to health care,” said Montgomery County group member Dr. Tom Lewis, who helped launch an electronic medical record initiative in a group of county clinics in 2003. “They may get care in emergency rooms and a web of free clinics, but we want to bring individual patients’ data together in one place.”

 

Because low-income patients tend to receive fragmented care, Lewis said, they have the most to gain from the sharing of electronic medical records among healthcare providers. For example, without such sharing between community clinics and hospitals, he said, emergency room doctors who provide much of the primary care for these patients may be unaware of their health histories, leaving the patients at risk of receiving unnecessary or unsafe procedures.

 

The group’s pilot project created a health information exchange that links 10 community clinics with Montgomery County General Hospital’s emergency room. So when a patient arrives at the ER, doctors can access an electronic synopsis of his or her medications, allergies, lab results and medical visits.

 

The emergency room can send discharge information directly to a patient’s clinic, which might not otherwise know about the visit. The group hopes the effort will cut down on unnecessary emergency room visits, by better connecting patients with clinics.

 

The pilot program is set to roll out in a few months, Lewis said. He said his group doesn’t plan to bid on a statewide information exchange, but has been eager to share its findings with the Maryland Health Care Commission.

 

Applications from groups hoping to design a statewide health information exchange are due to the commission by June 12. The commission is to award a contract in August. Startup costs are to be funded in part by stimulus money and in part by the rates that hospitals may charge.

 

The statewide network is likely to be phased in over time, said Colmers, the state health secretary, with the first elements coming on line as early as this fall.

 

“I expect fairly rapid adoption,” he said. “And with the incentives in the stimulus package and in this bill beginning to go into effect in ‘11, it will be important for it to be certainly ramped up and ready to operate by then.”

 

Above article published on

 

http://www.baltimoresun.com/health/bal-md.health19may19,0,6118960.story

 

Share your views and comments with OmniMD, a CCHIT & Surescripts® certified Electronic Medical Records Solution Providers.

 

Copyright © EMR Specialists. All rights reserved.

 

High blood pressure often missed in kids

Hopkins study finds higher percentage of ailment in African-American youth

 

By Kelly Brewington

Baltimore Sun

Tuesday, June 2, 2009

 

Va'Sean Duvall is a skinny 17-year-old who stays busy with an after-school job, choir rehearsals and school drama productions. On the surface, he doesn't fit the mold of someone - older, obese and inactive - who would be at risk for high blood pressure.

 

Yet he's among as many as 4 million children in the United States estimated to have hypertension, a figure that has grown fivefold in the past generation, according to Johns Hopkins researchers. It's a condition that doctors often fail to diagnose and one that leaves children - particularly African-Americans - at risk for serious heart problems, says a recent Hopkins study.

 

Doctors have known that a rising number of children are at risk for high blood pressure, and they think the nation's surging child obesity rate is a prime cause. But now, researchers are trying to learn more about the specific heart problems triggered by high blood pressure and hope to sound the alarm on the importance of catching hypertension early.

 

"We need to do a better job at increasing the public awareness, and we need to look at what are the barriers of physicians in recognizing high blood pressure in a clinical setting," said Dr. Tammy Brady, a pediatric nephrologist at the Johns Hopkins Children's Center and one of the study's authors.

 

Brady and other researchers found that black children with high blood pressure are more likely than other children to develop a thickening of the left chamber of the heart. Known as left ventricular hypertrophy, or LVH, the condition can lead to heart failure, rhythm abnormalities and death.

 

Of 139 hypertension patients ages 3 to 21 in the Hopkins study, 60 percent of the black subjects developed LVH, compared with 37 percent for those of other races.

 

"It's concerning that the prevalence is higher in the African-American population," said Dr. Cozumel Pruette, a kidney specialist at Hopkins Children's Center and the study's lead author. "Practitioners need to realize that and need to follow those children closely."

 

Researchers don't know why the disparity exists. Black children with LVH also tended to have higher cholesterol levels and a higher body mass index, putting them at greater cardiovascular risk, Pruette said. Since the study was among the first to look at racial differences and was done with a small sample, she said, more research is needed to understand why black children are especially vulnerable.

 

Still, Pruette stresses that all children with untreated hypertension could be at risk. Even those with mild hypertension can develop LVH.

 

Doctors are still learning the intricacies of the illness in children.

 

"It's been recognized in adults for several decades, but I think that our attention to LVH in children has probably lagged," said Dr. Susan Mendley, assistant professor and director of pediatric nephrology at the University of Maryland School of Medicine.

 

Brady, at Hopkins, recommends that when a doctor discovers one episode of elevated blood pressure, the child should be monitored and have further tests to determine if there are underlying causes of the hypertension. Children should have blood and urine tests to rule out kidney problems, which can cause hypertension. And doctors should do an eye exam to rule out eye problems that can trigger hypertension.

 

In addition, children should also receive an ultrasound of the heart, known as an echocardiogram, to check for LVH, she said. "It's a mistake not to do it," she said.

 

But some pediatricians say the extensive ultrasound may not be necessary for every child with elevated blood pressure. First, parents should be advised to encourage their child to exercise and limit salty foods, which can cause high blood pressure, said Dr. Charles Shubin, director of pediatrics at Mercy Medical Center in Baltimore.

 

"How much do you subject a larger population to get that if there is very low incidence of that problem?" he said. Of course, he said, if blood pressure is consistently high, doctors should order tests.

 

Brady says monitoring is critical because hypertension strikes some children who have no underlying health problems, making it difficult to detect without further tests. If the high blood pressure is severe, children can have symptoms such as bloody noses, headaches and shortness of breath.

 

"But often, hypertension is silent in kids," said Brady. "The kid looks fine; the kid seems healthy and has no complaints."

 

Pediatricians tend to carefully screen obese children and those with a family history of hypertension. But for other young patients, doctors may not do blood pressure readings at all, despite recommendations that screening begin at age 3, said Brady, who has researched why doctors miss high blood pressure. And some doctors do not take proper blood pressure readings, which is admittedly a tough task with a squirming child; Brady recommends taking three blood pressure readings during a visit and averaging them.

 

A 2007 study by Harvard researchers found that doctors fail to diagnose high blood pressure in more than three-quarters of children with the problem.

 

It can be difficult to spot kids with hypertension. Healthy pressure depends on a child's age, gender and height, so that "normal" is often a moving target.

 

"To a pediatrician in a busy clinic, there are so many things they are expected to do in a visit, so sometimes, they eyeball it," Brady said.

 

Many parents believe high blood pressure is an adult problem, and they are often shocked to learn their children have hypertension, Brady said.

 

Duvall's grandmother, Paula Duvall of Baltimore, had no idea children could struggle with high blood pressure. And when she learned of her grandson's diagnosis, she immediately began fretting about the child she has raised since he was a toddler.

 

She knows the risks of hypertension; she has the condition, and so does Duvall's grandfather. "That hurt me, because I know what it's like," she said.

 

Doctors detected Va'Sean Duvall's hypertension when he was admitted to the hospital this year for an asthma attack. Diagnosed with asthma at age 2, he's had attacks so severe he's been to the intensive-care unit more than a dozen times, and he takes numerous medications to keep the asthma controlled.

 

His lung doctor referred him to Brady after noticing the youth's blood pressure was consistently high. Other tests showed swelling of his heart muscle - an indicator of LVH. Brady put him on adult medicine, one pill a day.

 

"The high blood pressure medication, to add that on - that's really scary for me," Paula Duvall said. "Kids, they don't like taking medication, and it's hard for him sometimes, since he's been taking medication his whole life."

 

Va'Sean Duvall has taken the diagnosis in stride. His mind is set on studying math this fall at Coppin State University, with the ultimate goal of becoming a Broadway performer.

 

"It gets overwhelming sometimes," he said. "Sometimes taking medicine puts people down. But I say, 'Well, what can you do? Without medicine where would we all be?' "

 

Hypertension in children

•Affects as many as 4 million children in the U.S.

 

•More frequent and more severe in black families than in whites.

 

•If untreated, can lead to heart failure and death.

 

•Risk factors include obesity and having a parent with high blood pressure.

 

•All children age 3 and older should have annual blood pressure checks. Doctors should evaluate the readings with charts that indicate normal blood pressure by age, gender and height.

 

Sources: Johns Hopkins Children's Hospital researchers. American Heart Association

 

Copyright 2009 Baltimore Sun.

 

PharmAthene

Biodefense firm in running to develop anthrax vaccine

 

By Katie Arcieri

Annapolis Capital

Tuesday, May 2, 2009

 

An Annapolis biodefense firm said it is one of two companies left in the running for a government contract to develop 25 million doses of an anthrax vaccine.

 

Stacey Jurchison, spokeswoman for PharmAthene, said the only other firm competing for the U.S. Department of Health and Human Services contract is Emergent BioSolutions of Rockville.

 

PharmAthene officials said the deal could be worth up to $500 million and is part of the government's effort to procure an anthrax vaccine for the national stockpile.

 

Last month, the Annapolis company and Emergent pushed forward in their quest for the contract by submitting vaccine development plans to the U.S. Food and Drug Administration. The plans were required as part of recent contract amendments issued by Health and Human Services.

 

Both firms submitted their plans before the June 15 deadline. PharmAthene submitted plans for its SparVax second-generation vaccine, which has been tested on more than 700 people.

 

"We believe that it involves FDA in the process early," Jurchison said. "It enhances the opportunity for success for the contract."

 

The deal could be significant for PharmAthene, which currently has about 150 employees. About 50 employees work at the company's headquarters in the Park Place development on West Street.

 

PharmAthene was formed in 2001 by a group of doctors and investors. It focuses on developing biological and chemical-defense products.

 

In September, PharmAthene was notified by Health and Human Services that its proposal for SparVax was "technically acceptable" and within the competitive range for procurement. But the contract award has been delayed several times.

 

Jurchison said she expected the government to announce the award winner by the end of last year.

 

But the contract award wasdelayed after another bidder submitted a protest, said Gretchen Michael, Health and Human Services spokeswoman. It was delayed again this year after new requirements for development plans arose, she said.

 

Michael declined to say how many other firms are competing for the contract, but that she expects the contract to be awarded by the end of the year.

 

PharmAthene's quest for the contract comes as it reported a net loss of $6 million in the first quarter, compared to $4.7 million during that period a year ago.

 

The company's revenue dropped to $5.5 million in the first quarter of 2009 compared to $5.8 million in the same period last year.

 

PharmAthene trades on the American Stock Exchange under the ticker PIP.

 

Copyright © 2009 | Capital Gazette Communications, Inc., Annapolis, Maryland.

 

Some drug patches raise safety concern

 

Associated Press

The Beacon

Tuesday, June 2, 2009

 

Patients can risk a burn during an MRI (magnetic resonance imaging) scan if wearing a nicotine patch or any other med­ication patch.

 

Patches that ooze medication slowly through the skin are becoming more pop­ular — from over-the-counter nicotine patches, to prescription patches that deliv­er estrogen, pain medication, Alzheimer’s or Parkinson’s drugs, even an anti-nausea drug for chemotherapy recipients.

 

But the U.S. Food and Drug Administra­tion recently discovered that some are missing a key safety warning about MRI compatibility.

 

More than a quarter of the 60 different drug patches sold contain traces of alu­minum or other metals in their backing, the part that makes them stick to the skin, estimated Dr. Sandra Kweder, the FDA’s deputy drug director.

 

The metal may be invisible; the patch even may appear completely clear. But af­fected patches contain just enough metal to conduct electricity, meaning a patch worn during anMRI scan can overheat and cause a skin burn similar to a bad sunburn.

 

The FDA has issued a public health ad­visory: Tell your doctor about any medica­tion patches, so the professional can de­cide which should be removed before an MRI, how soon before the scan, and when it can be reapplied.

 

“If there’s any uncertainty, just don’t wear it in the machine,” Kweder said. “It’s just the smart thing to do.”

 

As for patch makers, FDA is reviewing every product’s label to be sure ones that are supposed to carry the safety warning do. Some may be missing because a patch was reformulated to add metal after its label was written; other times FDA ac­knowledged it just did not ensure the warning was present in the first place.

 

Now the agency is considering having an MRI warning somehow be put on the individual patch, not just the box it comes in.

 

Copyright (c)2009 The Beacon .

 

National / International

 

Kids of parents with mental issues at greater risk; therapy helps

 

By Liz Szabo

USA Today

Tuesday, June 2, 2009

 

Children of parents with anxiety disorders are up to seven times more likely than others to develop anxiety problems themselves, research shows, and kids of depressed parents are also at high risk for becoming depressed.

 

Two new studies suggest that talking to therapists can break this cycle, reducing the risk of mental health problems in children and teens.

 

Both studies released this week focused on "cognitive behavior therapy," in which patients learn to reframe the way they think about upsetting events to avoid falling into a depressive spiral.

 

Adolescence could be the best time to try to prevent depression, because most depressed adults say their problems started in their teen years, says Judy Garber of Nashville's Vanderbilt University, author of a study in today's Journal of the American Medical Association. About one in five teens experience depression by age 18.

 

Garber's study focused on high-risk teens whose parents had a history of depression. All 316 of the teens already had suffered from depression in the past or had some symptoms of depression when the study began. Half were randomly assigned to attend eight weekly group sessions with other teens.

 

After nine months, teens who attended group therapy were less likely to have had an episode of depression than teens who had their usual care, but didn't get therapy, the study shows.

 

The prevention program didn't help at all, however, for teens whose parents were currently depressed, Garber says.

 

Children of depressed adults may feel adrift because their parents aren't able to give them the support and encouragement they need, says Bryan King, director of child and adolescent psychiatry at Seattle Children's Hospital, who wasn't involved in the study.

 

And in addition to a genetic predisposition to depression, children may inherit their parent's negative attitudes.

 

"The children may be experiencing the negative thinking that their parents are wrestling with," King says. "The world at large is being viewed through the dark lenses of depression: everything is bad, everything is hopeless, there is no future."

 

Depressed kids are more likely to have trouble in school or with relationships and are at increased risk for suicide or substance abuse, Garber says.

 

Cognitive behavior therapy also aims to keep kids engaged in things that can make them happy, such as school, sports or social outings, King says. "They try to preempt this vicious spiral where if you feel bad, you pull back, you stop going to the football game or the movie or dance," King says. "Then, you get fewer opportunities for pleasure, which adds to your overall feelings of sadness and lack of worth."

 

The new study's results may have been modest, King says, because these teens were already at very high risk. He says this kind of therapy could have more success if used to treat high-risk kids who aren't yet depressed.

 

That was the focus of a small study from Johns Hopkins Children's Center, in which researchers tried to help children who weren't yet having anxiety problems. All 40 of the kids, ages 7 to 12, had parents with anxiety disorders.

 

Researchers offered half of youngsters and their parents an eight-week course of "cognitive behavioral therapy. In these hour-long sessions, parents learned how to recognize things they were doing that might make their children anxious — such as being overprotective or worrying out loud. Children also learned coping skills, according to the study, in the June issue of the Journal of Consulting and Clinical Psychology, released Monday.

 

After a year, none of the children in therapy had developed an anxiety disorder. But doctors diagnosed anxiety disorders in 30% of children in the comparison group, who were placed on a waiting list but didn't receive therapy during the clinical trial, says lead author Golda Ginsburg, a child psychologist.

 

Ginsburg says she is already planning a larger study with 100 children.

 

Although few insurers pay for cognitive behavioral therapy, Ginsburg says she hopes her study will provide evidence that it's worth the investment. Although it can be hard to find psychologists or psychiatrists who specialize in cognitive behavior therapy, Garber says that other professionals could also provide these services, such as school counselors, nurse practitioners or social workers.

 

Copyright 2009 USA Today.

 

Depression diagnoses fell after FDA antidepressant warning

 

Associated Press

By Carla K. Johnson

USA Today

Tuesday, June 2, 2009

 

CHICAGO — A persistent decline in the rate of Americans, especially children, newly diagnosed with depression followed the first federal warning on risks connected with antidepressant drugs, a study suggests.

 

In 2003, the Food and Drug Administration first warned about the risk of suicidal thoughts and behavior in young people taking the drugs. That action may have helped reverse a five-year trend of rising rates of diagnosis for depression, the researchers found.

 

The findings, published Monday in the Archives of General Psychiatry, are based on an analysis of eight years of data from nearly 100 managed care plans and more than 55 million patients.

 

It was already known that antidepressant use among young people had fallen since the drugs began carrying a so-called "black box" warning about risks. But the data showing an extended decline in the level of depression diagnoses are new.

 

In some cases, untreated depression can be more dangerous than suicidal feelings when starting antidepressants and a spike in teenage suicides in 2004 worried some experts that could be another unintended result of the FDA warnings. Then, teen suicides fell slightly the following year, offering hope that the suicide increase was just a blip.

 

The new research can't explain why diagnosis rates have declined, said lead author Anne Libby of the University of Colorado Denver. Diagnosis rates for anxiety and bipolar disorder, also sometimes treated with antidepressants, also fell.

 

"It could be that people who have depression aren't coming forth and getting diagnosed," Libby said. "It could be that providers are increasingly reluctant to diagnose cases of new mental health problems."

 

Libby said the FDA "should reopen its discussion about the boxed warning on antidepressants."

 

Only two antidepressants, Lexapro and Prozac, are approved for treating children and adolescents with depression, but doctors can legally prescribe others to young patients "off label." Prozac, Luvox and Zoloft are approved for pediatric obsessive compulsive disorder, said FDA spokeswoman Sandy Walsh.

 

Pinning the slumping diagnosis rates on the FDA warning is a leap, said Dr. Peter Lurie of Public Citizen's Health Research Group, which has warned of antidepressant risks in kids. There could be other explanations.

 

"It's possible that the drive toward more diagnosis and treatment had been nearing a point of exhaustion," Lurie said. "The data are interesting but the conclusion seems forced."

 

Lurie also questioned the authors' suggestion that the FDA overreacted.

 

"Is the implication that patients would be better off kept in the dark (about risks)?" he asked.

 

Dr. Gregory Simon, a psychiatrist and researcher at Group Health Center for Health Studies in Seattle, said the findings are "pretty convincing" evidence that the FDA's warning had unintended consequences.

 

"The warning appears to have scared people away from treatment; whether that's doctors or patients is unclear," Simon said.

 

Better follow-up care for patients on antidepressants is sorely needed, he said. Health plans consistently do poorly on quality measures of such follow-up visits, important for avoiding problems when people start taking antidepressants.

 

The study examined health claims data from July 1999 through June 2007.

 

For children, the rate of new depression diagnoses rose from 3.3 per 1,000 patients in 1999 to 5.2 in 2004. But by 2007, the rate had fallen to 3.5 per 1,000 patients.

 

A lesser downward shift was seen for adults, which the authors said could be a spillover effect of the FDA warnings.

 

The researchers obtained a license to use the health claims database through funding from Eli Lilly and Co., maker of Prozac, for an earlier study. Lilly paid for that license so the researchers could analyze use of another Lilly drug for European regulators.

 

Libby and her co-authors disclosed receiving past unrestricted research grants from other makers of antidepressants. But Libby said drug makers weren't involved in the design, analysis or conclusions of the current research.

 

Copyright 2009 The Associated Press. All rights reserved.

 

Copyright 2009 USA TODAY, a division of Gannett Co. Inc.

 

Study finds antidepressant doesn't help autistic children

 

Nationwide research finds that citalopram is no more effective than a placebo and that its side effects are twice as bad. About a third of autistic kids take the drug, known as Celexa in the U.S.

 

By Karen Kaplan

Baltimore Sun

Tuesday, June 2, 2009

 

An antidepressant commonly prescribed to help autistic children control their repetitive behaviors is actually no better than a placebo, according to a report published today.

 

Roughly a third of all children diagnosed with autism in the U.S. now take citalopram, the antidepressant examined in the study, or others that are closely related. The results of the nationwide trial, published in Archives of General Psychiatry, have some experts reconsidering the appropriateness of antidepressants and other mind-altering drugs used to treat children with autism spectrum disorders.

 

"There are tons of things being advocated as treatments for autism, some with appropriate caveats and careful explanations, others without any of that," said David Mandell, associate director of the Center for Autism Research at Children's Hospital of Philadelphia, who wasn't involved in the study.

 

An estimated 1.5 million Americans have autism, a group of poorly understood developmental disorders characterized by problems with communication and social interaction. One of the hallmarks of the disorder is obsessive, repetitive behavior such as flapping one's arms or hands or memorizing car makes and models. When those routines are interrupted, severe tantrums can result.

 

Only one medication -- the antipsychotic drug risperidone -- has been approved by the Food and Drug Administration for the treatment of irritability and aggression in children with autism. But doctors, frustrated by their limited options, haven't shied away from giving other pharmaceuticals a chance. Worldwide spending on drugs to treat autism is estimated to be $2.2 billion to $3.5 billion annually.

 

Because very few medications have been tested on autistic children in large, rigorous studies, doctors have looked to drugs that treat similar symptoms in other conditions, such as obsessive-compulsive disorder or attention-deficit hyperactivity disorder.

 

That's what led physicians to a class of antidepressants called selective serotonin reuptake inhibitors, or SSRIs, that help adults with obsessive-compulsive disorder. Their repetitive rituals, such as counting, cleaning or hand-washing, are reminiscent of the behaviors seen in autistic patients.

 

Doctors were also hopeful about SSRIs because the serotonin system is known to function improperly in people with autism.

 

But the medications will work only if the root causes of obsessive-compulsive disorder and autistic repetitive behavior involve the same biological pathways in the brain. The new study strongly suggests they do not.

 

"It just begs for a more careful understanding of the neurological underpinnings of the disorder," Mandell said.

 

Dr. Bryan King, director of psychiatry and behavioral medicine at Seattle Children's Hospital and leader of the study, said he was shocked to find that citalopram didn't help patients. Not only was the placebo slightly more effective, but the drug's side effects -- such as impulsivity and insomnia -- were at least twice as bad, the study found.

 

"I personally would have a healthy dose of skepticism about" prescribing citalopram or other SSRIs, King said. Citalopram is sold in the United States under the brand name Celexa.

 

In the study, King and his colleagues from six academic medical centers, including UCLA, enrolled 149 autistic children ages 5 to 17 whose compulsive behaviors were classified as moderate or worse. After 12 weeks, 33% of the 73 patients who took citalopram had improvements in repetitive behaviors as measured by clinicians and parents, versus 34% of the 76 patients who took a placebo.

 

If there hadn't been a control group for comparison, King said he would have been impressed by the improvement seen in the children who took the drug. "The decision would most definitely have been made to continue them," he said.

 

The study underscores the value of evaluating drugs in randomized, double-blind, placebo-controlled studies, which are considered the gold standard of medical research, Dr. Fred R. Volkmar, director of the Yale Child Study Center in New Haven, Conn., wrote in a commentary that accompanied the study. In such studies, neither patient nor doctor knows who is getting the drug and who is getting the placebo until all the results are in.

 

"We need more studies of this kind to advance research and guide clinical practice," Volkmar wrote.

 

Placebo-controlled studies are especially important in evaluating medications to treat behavior and mood because patients are typically in a crisis state when they enroll in a clinical trial and could improve on their own in time, Mandell said.

 

What's more, the attention focused on children when they are in a trial tends to improve their behavior all by itself, Volkmar said in an interview.

 

The study was funded by the National Institutes of Health. King and several of his colleagues have received research grants and other funding from pharmaceutical firms, including Forest Laboratories Inc. of New York, the maker of Celexa.

 

Copyright © 2009, The Los Angeles Times.

 

Some Doctors Help With Bills As Well as Ills

 

Kaiser Health News

By Sandra G. Boodman

Washington Post

Tuesday, June 2, 2009

 

Until recently, the sagging economy wasn't a subject Mary Newman routinely discussed during office visits. But after a steady stream of longtime patients confided that they had been laid off, were about to lose their health insurance or that their pay had been slashed, she added the recession to her standard checklist of questions.

 

"It's hitting people I hadn't expected," said Newman, an internist who practices in an affluent Baltimore suburb. "If a person is in financial hardship, we help them."

 

From Baltimore to Boise, doctors are encountering more patients struggling to pay for care. Some doctors have responded by selectively cutting their fees or devising novel payment arrangements; others have taken a harder line on billing and are sending more overdue accounts to bill collectors.

 

Although professional groups such as the American College of Physicians do not specify how much charity care their members should provide, many doctors say they feel a responsibility to help strapped patients, particularly those with whom they have long-standing relationships. Some say assisting patients pays dividends in the form of loyalty, which will benefit them once the economy recovers. For others, such efforts may stem an exodus of consumers at a time when elective procedures and visits to doctors' offices are down.

 

"You don't want people starting over with another doctor," says Alan Pocinki, a District internist who has been knocking 20 to 30 percent or more off his standard $145 office visit charge for longtime patients in financial straits.

 

A survey of nearly 1,100 hospitals released in April by the American Hospital Association found that 59 percent reported a moderate or significant decrease in non-emergency operations, such as knee replacements and hernia repairs. The Medical Group Management Association, which represents 22,500 medical practices across the country, has reported sharp increases in patients who fail to keep appointments and decreases in preventive-care visits in recent months.

 

These trends compound existing problems of rising overhead and static reimbursements. Whether the downturn will lower physicians' incomes this year remains to be seen. A survey by Sullivan, Cotter and Associates, a national firm that designs compensation plans, found that doctors' incomes increased an average of 4 percent last year, despite the souring economy.

 

Pocinki says he is working longer hours to maintain his income and to be able to offer discounts to existing patients experiencing financial problems. "Obviously there's only so much I can do and still pay my bills," he said.

 

Roughly 75 percent of his patients work for the World Bank or the federal government, and presumably have stable jobs with generous health benefits. For others not so fortunate, Pocinki has relaxed his policy of collecting the full fee at the time of the appointment. Now he tells some patients that they can pay a portion after seeing him and send him the rest later.

 

In the Minneapolis suburb of Edina, OB-GYN K. Anthony Shibley and his partners are offering one free visit and a Pap smear to existing patients who lose their insurance. Ten of the practice's 10,000 patients have taken advantage of the offer, said Shibley, whose staff verifies that patients have lost their coverage.

 

"I've gotten a letter of thanks from every single one of them," he said. "Our staff really feels good about this. They know these people."

 

Family physician H. Lee Adkins of Fort Myers, Fla., recently launched a novel plan to counter the growing no-show rate among patients with chronic illnesses: a $75-per-month fee that entitles patients to a basic package of services including more than a dozen office visits per year, simple lab tests and many vaccinations. Patients are required to sign a one-year contract.

 

Why $75? "That's the same amount people spend on a monthly cable bill," Adkins says.

 

He refers patients who need colonoscopies or mammograms to specialists who provide them at reduced cost. And he sends those who need medication to Wal-Mart, Target or other chain stores that offer steep discounts on certain drugs.

 

Jerry Staggs, 68, who has seen Adkins for 13 years, is among 30 patients who have signed up. Staggs, who sees Adkins monthly for high blood pressure and Type 2 diabetes, is worried about losing his job selling media advertising for a large national company. The unemployment rate in the Fort Myers area is above 12 percent, nearly double what it was last year.

 

"What would I do for medical care?" asked Staggs, who said he could not afford to replace his employer-subsidized insurance. "This is a fallback plan: Something could happen to my job at any moment."

 

Ted Epperly, president of the American Academy of Family Physicians, said his Boise practice is adjusting charges for patients in financial straits based on a sliding income scale. His practice has also been allowing patients to spread payments over several years. One young couple who just had a baby is paying the $1,500 physician's fee in monthly interest-free installments of $70.

 

"Many of our patients are not looking for a handout," Epperly said, "just something the physician can do with them. As long as they're paying in good faith, even if it's just $5 or $10 per month, we'll work with them."

 

Rochester, N.Y., pediatrician Anne Francis said parents in her practice are increasingly requesting services over the phone to avoid paying for an office visit. "I have been more apt to do a telephone conference for parents who I know are having significant financial problems," said Francis, who doesn't charge for telephone time, unlike some physicians.

 

In other cases she piggybacks visits to treat a chronic condition, such as asthma, onto a well-child visit, because the cost of the latter is fully covered by insurance. To accommodate parents worried about missing work in a precarious economy, Francis's practice is staying open into the evening.

 

Neurosurgeon Amiel Bethel said one or two patients each week tell him that they're too worried about their jobs to take time off to recuperate from surgery, or can't afford co-pays or other fees. That rarely happened a year ago.

 

"We can only do so much pro bono work," said Bethel, interim chair of the department of surgery at Greater Baltimore Medical Center in Towson. He refers patients to the hospital's billing office to work out a possible discount.

 

To compensate for a drop in procedures, Bethel said he has changed his schedule so he can see more patients, sometimes up to 15 more per week. "Medicine is not always recession-proof," Bethel said. "When the rest of the world is affected, we're affected as well."

 

Newman, the Baltimore internist, agrees, although her 14-doctor practice remains busy.

 

The downturn has hit home for Newman in a more personal way. Her banker husband, who is in his 50s, has been told he is being laid off this month. "I think a lot of people are worried about what happens if this goes on for three or six months longer," she said.

 

Copyright 2009 Washington Post.

 

Health Groups Detail Plans to Reduce Costs

 

By Janet Adamy

Wall Street Journal

Tuesday, June 2, 2009

 

WASHINGTON -- Health-care providers plan to help cut up to $1.7 trillion of costs over the next decade by improving care for chronic diseases, streamlining administrative tasks and reducing unnecessary care, major industry groups said Monday.

 

Their proposals offer the first detailed glimpse into how hospitals, doctors, pharmaceutical companies, health insurers, medical-device makers and a big labor union aim to make good on the cost-cutting promise they made to President Barack Obama last month. The savings are key to helping fund the Obama administration's plan to overhaul the nation's health system.

 

Under the groups' proposals, certain types of care could see cutbacks, potentially sparking concerns among consumers. For example, the American Medical Association, which represents doctors, is proposing to curb what it deems "overuse" in areas including Caesarean sections, back-pain management, antibiotic prescriptions for sinusitis and diagnostic imaging tests.

 

The White House on Monday released a study contending that fixing the nation's health-care system would increase the country's gross domestic product, lower unemployment and save families on average $2,600 in 2020.

 

The study estimated that without changes to the nation's health system, the number of uninsured Americans would grow to 72 million by 2040, up from at least 46 million now. Slowing the rate of health-care costs would prevent "disastrous" increases in the federal budget deficit, the report says.

 

Christina Romer, chairwoman of the president's Council of Economic Advisers, said, "The one thing that's happened relative to the 1990s is the nightmare scenario is getting closer."

 

Proposals from the groups involved include trying to reduce medical errors, switching to common insurance forms, improving measurements of physician performance, reducing the number of patients readmitted to hospitals, improving the efficiency of drug development, and expanding in-home care for patients with long-term illnesses.

 

Printed in The Wall Street Journal, page A3

 

Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved.

 

Cigarettes Without Smoke, or Regulation

 

By Katie Zezima

New York Times

Tuesday, June 2, 2009

 

FALL RIVER, Mass. — During 34 years of smoking, Carolyn Smeaton has tried countless ways to reduce her three-pack-a-day habit, including a nicotine patch, nicotine gum and a prescription drug. But stop-smoking aids always failed her.

 

Then, having watched a TV infomercial at her home here, Ms. Smeaton tried an electronic cigarette, which claimed to be a less dangerous way to feed her addiction. The battery-powered device she bought online delivered an odorless dose of nicotine and flavoring without cigarette tar or additives, and produced a vapor mist nearly identical in appearance to tobacco smoke.

 

“I feel like this could save my life,” said Ms. Smeaton, 47, who has cut her tobacco smoking to a pack and a half daily, supplemented by her e-cigarette.

 

That electronic cigarettes are unapproved by the government and virtually unstudied has not deterred thousands of smokers from flocking to mall kiosks and the Internet to buy them. And because they produce no smoke, they can be used in workplaces, restaurants and airports. One distributor is aptly named Smoking Everywhere.

 

The reaction of medical authorities and antismoking groups has ranged from calls for testing to skepticism to outright hostility. Opponents say the safety claims are more rumor than anything else, since the components of e-cigarettes have never been tested for safety.

 

In fact, the Food and Drug Administration has already refused entry to dozens of shipments of e-cigarettes coming into the country, mostly from China, the chief maker of them, where manufacture began about five years ago. The F.D.A. took similar action in 1989, refusing shipments of an earlier, less appealing version, Favor Smoke-Free Cigarettes.

 

“These appear to be unapproved drug device products,” said Karen Riley, a spokeswoman for the agency, “and as unapproved products they can’t enter the United States.”

 

But enough of the e-cigarettes have made their way into the country that they continue to proliferate online and in the malls.

 

For $100 to $150 or so, a user can buy a starter kit including a battery-powered cigarette and replaceable cartridges that typically contain nicotine (though cartridges can be bought without it), flavoring and propylene glycol, a liquid whose vaporizing produces the smokelike mist. When a user inhales, a sensor heats the cartridge. The flavorings include tobacco, menthol and cherry, and the levels of nicotine vary by cartridge.

 

Propylene glycol is used in antifreeze, and also to create artificial smoke or fog in theatrical productions. The F.D.A. has classified it as an additive that is “generally recognized as safe” for use in food. But when asked whether inhaling it was safe, Dr. Richard D. Hurt, director of the Nicotine Dependence Center at the Mayo Clinic, said, “I don’t think so, but I’m not sure anyone knows for sure.”

 

Of the e-cigarettes themselves, Dr. Hurt added: “We basically don’t know anything about them. They’ve never been tested for safety or efficacy to help people stop smoking.”

 

Public health officials also worry that the devices’ fruit flavors, novelty and ease of access may entice children.

 

“It looks like a cigarette and is marketed as a cigarette,” said Jonathan P. Winickoff, an associate professor at the Massachusetts General Hospital for Children and chairman of the American Academy of Pediatrics Tobacco Consortium. “There’s nothing that prevents youth from getting addicted to nicotine.”

 

Sales and use of electronic cigarettes are already illegal on safety grounds in Australia and Hong Kong, and some other countries regulate them as medicinal devices or forbid their advertising. So far the United States has focused only on stopping them at the border, although Senator Frank R. Lautenberg, Democrat of New Jersey, has asked the drug agency to take them off the market until they can be tested.

 

Distributors of electronic cigarettes fear that a bill making its way through Congress that would give the F.D.A. the authority to regulate tobacco could be used to put them out of business as well. The bill has passed the House and could be taken up by the Senate this week.

 

The only American study of electronic cigarettes, now under way at Virginia Commonwealth University and financed by the National Cancer Institute, deals not with the kind of safety questions raised by propylene glycol but rather with the amount of nicotine processed by the bodies of the products’ users.

 

Another study, conducted this year at the University of Auckland in New Zealand and financed by Ruyan, an electronic cigarette company, shows that users typically receive 10 percent to 18 percent of the nicotine delivered by a tobacco cigarette.

 

Smoking Everywhere, a Florida-based distributor of electronic cigarettes, sued the F.D.A on April 28, claiming that the agency did not have jurisdiction to refuse the imported devices.

 

“The F.D.A. has the power to regulate Nicorette gum and the like because it is marketed as a smoking cessation product,” said Kip Schwartz, a lawyer for Smoking Everywhere. But the company says its products are a cigarette alternative for adult enjoyment and make no claims to help smokers quit, Mr. Schwartz added.

 

Matt Salmon, a spokesman for the Electronic Cigarette Association, which represents six distributors, said e-cigarettes delivered nothing more than a mixture of nicotine and water vapor and emitted “no carcinogens.” The association declined to give sales figures, but said that “hundreds of thousands” of people used the products and that the average age of those users was the mid-40s.

 

“It’s a really good alternative for people who smoke tobacco,” Mr. Salmon said.

 

Edwin Schwab, who quit smoking regular cigarettes last year after trying e-cigarettes, likes them so much he has started selling them at a mall kiosk in Providence, R.I.

 

Mr. Schwab took his e-smoke along when he went out one night, he said, “and when everyone was smoking outside in the cold, I just stood in the warm bar, smoking.”

 

Copyright 2009 The New York Times Company.

 

SC funeral home license revoked for cutting corpse

 

Associated Press

Hagerstown Herald-Mail

Tuesday, June 2, 2009

 

The South Carolina funeral board has revoked the licenses of a funeral home and its director for cutting the legs of a 6-foot-7 man so his corpse would fit in a casket.

 

State licensing spokesman Jim Knight says the Board of Funeral Service voted Monday to revoke the funeral director license of Michael Cave and the license of Cave Funeral Services of Allendale.

 

Knight says the board also fined Cave the maximum $500 and ordered him to pay $1,500 for the investigation.

 

Cave did not immediately return messages left at his home and business Tuesday.

 

The body of James Hines was exhumed earlier this year because of rumors that circulated after he died in 2004. His widow said investigators told her his legs had been cut off between the ankle and calf to fit the coffin.

 

© 2009 The Associated Press. All rights reserved.

 

Sebelius, DeParle ready to tackle health care overhaul

 

By Richard Wolf

USA Today

Tuesday, June 2, 2009

 

WASHINGTON — Kathleen Sebelius and Nancy-Ann DeParle first met at the White House mess in 1997, during the battle for a patients' bill of rights to combat the constraints of managed care. The friendship they forged then could pay big dividends for President Obama now.

 

Sebelius and DeParle are the tag team for Obama's most ambitious domestic policy goal: an overhaul of the nation's health care system, which eluded President Clinton in 1994. The two "working moms," in Sebelius' words, are charged with chaperoning a measure through Congress that's likely to cost more than $1 trillion.

 

"There's a natural alliance," Sebelius says of their relationship, built over a dozen years on topics ranging from the children's health insurance program to raising their own children. She came to Washington in late April after serving as Kansas' governor and insurance commissioner.

 

DeParle has run Medicare and Medicaid, the mammoth government health programs for seniors, low- and middle-income families and people with disabilities.

 

With Sebelius as secretary of Health and Human Services and DeParle as director of the White House Office of Health Reform, Obama has two field generals where he originally envisioned one: former Senate majority leader Tom Daschle, whose nomination was withdrawn because of unpaid taxes.

 

"They have two people who not only are thoughtful emissaries but also are policy experts on health care," says Andy Stern, president of the Service Employees International Union.

 

No secret bill on hand

 

The president also has two pragmatists whose goal, like his, is to work with Congress rather than dictate to it, as the Clinton administration did. Given leeway, Congress is forging ahead with a goal of passing comprehensive legislation this year. "Nancy-Ann and the secretary are going to be pushing the ball up the hill, but they haven't designed the ball," says Chip Kahn, president of the Federation of American Hospitals.

 

That means Sebelius and DeParle will be spending more time consulting with lawmakers in June and July as the bill gets written and pushed through as many as five committees. Their goal is to get something passed that includes Obama's principles: expanded coverage, reduced costs, wider choice. Says former Health and Human Services secretary Donna Shalala, who introduced the pair over lunch in 1997: "They know where the tripwires are."

 

On the most controversial points, the two are willing to negotiate. They want a public insurance plan to compete with private insurers but say it doesn't need to be a rigid, Medicare-like model. They want more employers to offer health insurance but have not insisted on a mandate. They want to cover more uninsured but have not dictated how many. They want to pay for the expansion but aren't saying what taxes to raise or spending to cut.

 

"People still believe that either Nancy-Ann or I have the 1,000-page bill," Sebelius says in a joint interview in her office, during which the two occasionally finish each other's sentences.

 

"People comment on my handbag being so big," DeParle quips, as if the secret health care plan is inside. Instead, she says, Congress will write it by consensus. "It becomes retail politics now. It's member by member."

 

So far, many members are pleased with the tag team's light touch. Rep. Pete Stark, D-Calif., who chairs a key health subcommittee, calls DeParle "a quick study."

 

Sen. Bill Nelson, D-Fla., who was elected his state's insurance commissioner the same year as Sebelius, says she "knows the insurance industry backwards and forwards."

 

Other Democrats want the White House to take a firmer stand on behalf of a government insurance plan and other options favored by liberals. "It's about time for the Obama administration to begin to get more specific and begin to push," says Sen. Sherrod Brown, D-Ohio.

 

Republicans, including Senate Minority Leader Mitch McConnell, R-Ky., are concerned about the health care plan's likely cost and inclusion of a government insurance option. That will make it difficult for the administration to win their support.

 

"They're doing considerable outreach to members like me who want to help the administration shape a health care reform effort that could actually pass with significant support," says Sen. Susan Collins, R-Maine, one of three moderate Republicans who backed the administration's $787 billion economic stimulus plan in February.

 

Obama and his health care team also have cultivated relationships with doctors, hospitals, drug companies, insurers, businesses, labor unions and consumer groups, all of whom have embraced change — at least until the bill is unveiled. Some health care leaders have even promised to reduce health costs by $2 trillion over the next decade; details to come.

 

"They have a knowledge of the issue, they have political experience, and they know the data," says Karen Ignagni, president of America's Health Insurance Plans. "They're 24/7 workers."

 

Ron Pollack, head of the health care consumers group Families USA, says Sebelius and DeParle are not ideologues. "You can't find two people who are nicer to work with," he says. "So much of Washington depends on human contact."

 

'Close to home'

 

Sebelius, 61, and DeParle, 52, know the business of health care from personal experience. They each have two sons; Sebelius' are grown, DeParle's in grade school.

 

Sebelius helped her sons navigate the individual insurance market when their first jobs after college offered no coverage. DeParle advised her brother after he lost a job and couldn't afford to keep family coverage under the COBRA law, which gives workers and their families who lose employer-paid health benefits the right to stay covered temporarily if they pay the premiums.

 

Sebelius, the last member of Obama's Cabinet to be confirmed, says those experiences make both women keenly aware of the problems facing 46 million people in the USA without insurance and those who are in and out of coverage.

 

"It's something that a lot of families are struggling to try and figure out," she says. "If your child doesn't have a job, can you luck it out for a while or not? Can you take that risk or not? That's a difficult situation."

 

"It hits very close to home," DeParle says. "It's part of what makes this work so important and wonderful, I think, for both of us — being able to be involved in something that could really make a difference in people's lives."

 

Copyright 2008 USA TODAY, a division of Gannett Co. Inc.

 

The Deadly Toll of Abortion by Amateurs

 

By Denise Grady

New York Times

Tuesday, June 2, 2009

 

BEREGA, Tanzania — A handwritten ledger at the hospital tells a grim story. For the month of January, 17 of the 31 minor surgical procedures here were done to repair the results of “incomplete abortions.” A few may have been miscarriages, but most were botched operations by untrained, clumsy hands.

 

Abortion is illegal in Tanzania (except to save the mother’s life or health), so women and girls turn to amateurs, who may dose them with herbs or other concoctions, pummel their bellies or insert objects vaginally. Infections, bleeding and punctures of the uterus or bowel can result, and can be fatal. Doctors treating women after these bungled attempts sometimes have no choice but to remove the uterus.

 

Pregnancy and childbirth are among the greatest dangers that women face in Africa, which has the world’s highest rates of maternal mortality — at least 100 times those in developed countries. Abortion accounts for a significant part of the death toll.

 

Maternal mortality is high in Tanzania: for every 100,000 births, 950 women die. In the United States, the figure is 11, and it is even lower in other developed countries. But Tanzania’s record is neither the best nor the worst in Africa. Many other countries have similar statistics; quite a few do better and a handful do markedly worse.

 

Eighty percent of Tanzanians live in rural areas, and the hospital in Berega — miles from paved roads and electric poles — is a typical rural hospital, struggling to deal with the same problems faced by hospitals and clinics in much of the country. Abortion is a constant worry.

 

Worldwide, there are 19 million unsafe abortions a year, and they kill 70,000 women (accounting for 13 percent of maternal deaths), mostly in poor countries like Tanzania where abortion is illegal, according to the World Health Organization. More than two million women a year suffer serious complications. According to Unicef, unsafe abortions cause 4 percent of deaths among pregnant women in Africa, 6 percent in Asia and 12 percent in Latin America and the Caribbean.

 

Reliable figures on abortion in Tanzania are hard to come by, but the World Health Organization reports that its region, Eastern Africa, has the world’s second-highest rate of unsafe abortions (only South America is higher). And Africa as a whole has the highest proportion of teenagers — 25 percent — among women having unsafe abortions.

 

The 120-bed hospital in Berega depends on solar panels and a generator, which is run for only a few hours a day. Short on staff members, supplies and even water, the hospital puts a lot of its scarce resources into cleaning up after failed abortions.

 

The medical director, Dr. Paschal Mdoe, 30, said many patients who had had the unsafe abortions were 16 to 20 years old, and four months pregnant. He said there was a steady stream of cases, much as he had seen in hospitals in other parts of the country.

 

“It’s the same everywhere,” he said.

 

On a Friday in January, 6 of 20 patients in the women’s ward were recovering from attempted abortions. One, a 25-year-old schoolteacher, lay in bed moaning and writhing. She had been treated at the hospital a week earlier for an incomplete abortion and now was back, bleeding and in severe pain. She was taken to the operating room once again and anesthetized, and Emmanuel Makanza, who had treated her the first time, discovered that he had failed to remove all the membranes formed during the pregnancy. Once again, he scraped the inside of her womb with a curet, a metal instrument. It was a vigorous, bloody procedure. This time, he said, it was complete.

 

Mr. Makanza is an assistant medical officer, not a fully trained physician. Assistant medical officers have education similar to that of physician assistants in the United States, but with additional training in surgery. They are Tanzania’s solution to a severe shortage of doctors, and they perform many basic operations, like Caesareans and appendectomies. The hospital in Berega has two.

 

Abortions in Berega come in seasonal waves — March and April, August and September — in sync with planting and harvests, when a lot of socializing goes on, Dr. Mdoe said. He said rumor had it that many abortions were done by a man in Gairo, a town west of Berega. In some cases, he said, the abortionist only started the procedure, knowing that doctors would have to finish the job.

 

Dr. Mdoe said he suspected that some of the other illegal abortionists were hospital workers with delusions of surgical skill.

 

“They just poke, poke, poke,” he said. “And then the woman has to come here.” Sometimes the doctors find fragments of sticks left inside the uterus, an invitation to sepsis.

 

In the past some hospitals threatened to withhold care until a woman identified the abortionist (performing abortions can bring a 14-year prison term), but that practice was abandoned in favor of simply providing postabortal treatment. Still, women do not want to discuss what happened or even admit that they had anything other than a miscarriage, because in theory they can be prosecuted for having abortions. The law calls for seven years in prison for the woman. So doctors generally do not ask questions.

 

“They are supposed to be arrested,” Dr. Mdoe said. “Our work as physicians is just to help and make sure they get healed.”

 

He went on, “We as medical personnel think abortion should be legal so a qualified person can do it and you can have safe abortion.” There are no plans in Tanzania to change the law.

 

The steady stream of cases reflects widespread ignorance about contraception. Young people in the region do not seem to know much or care much about birth control or safe sex, Dr. Mdoe said.

 

In most countries the rates of abortion, whether legal or illegal — and abortion-related deaths — tend to decrease when the use of birth control increases. But only about a quarter of Tanzanians use contraception. In South Africa, the rate of contraception use is 60 percent, and in Kenya 39 percent. Both have lower rates of maternal mortality than does Tanzania. South Africa also allows abortion on request.

 

But in other African nations like Sierra Leone and Nigeria, abortion is not available on request, and the figures on contraceptive use are even lower than Tanzania’s and maternal mortality is higher. Nonprofit groups are working with the Tanzanian government to provide family planning, but the country is vast, and the widely distributed rural populations makes many people extremely hard to reach.

 

Geography is not the only obstacle. An assistant medical officer, Telesphory Kaneno, said: “Talking about sexuality and the sex organs is still a taboo in our community. For a woman, if it is known that she is taking contraceptives, there is a fear of being called promiscuous.”

 

In interviews, some young women from the area who had given birth as teenagers said they had not used birth control because they did not know about it or thought it was unsafe: they had heard that condoms were unsanitary and that birth control pills and other hormonal contraceptives could cause cancer.

 

Mr. Kaneno said the doctors were trying to dispel those taboos and convince women that it was a good thing to be able to choose whether and when to get pregnant.

 

“It is still a long way to go,” he said.

 

Copyright 2009 The New York Times Company.

 

Red Bull pulled from shelves in Hong Kong

 

By Anne Willette

USA Today

Tuesday, June 2, 2009

 

Red Bull is being pulled from supermarket shelves throughout Hong Kong after authorities said they found traces of cocaine in the popular energy drink, Agence France-Presse reports. The story is among the most e-mailed on Yahoo news.

 

A few days ago, Taiwanese authorities confiscated close to 18,000 cases imported from Austria for the same reason.

 

Hong Kong's Centre for Food Safety found traces of cocaine between 0.1 and 0.3 micrograms of the illegal drug per liter -- not enough to be a health danger. Commissioner of Narcotics Sally Wong said the government is exploring whether importers and retailers can be held liable.

 

A Red Bull official said the company's independent tests found no cocaine. "It would have been absolutely impossible for the Hong Kong or any other authorities to have found traces of cocaine in Red Bull Energy Drink," said Daniel Beatty, Asia Pacific marketing director. "We expect the Hong Kong authorities to recognize their error soon."

 

Beatty also said the firm's representatives were already meeting with Taiwanese authorities to point out the error.

 

Copyright 2009 USA Today.

 

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