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Wednesday, June 3, 2009

News Clipping Archives

Maryland / Regional
Drug program loses city funding July 1 (Baltimore Sun)
Man bitten by young rattlesnake in Poolesville (The Gazette)
Va. Woman Who Died Had Swine Flu, Other Illnesses (Washington Post)
Souring Economy Spurs A Surge at Free Clinics (Washington Post)
Advocates lay road map for facing special needs ‘crisis' (The Gazette)

National / International
Joint Chiefs chairman: Troops' mental health needs to be priority (CNN.com)
AstraZeneca, Merck collaborate on cancer treatment (Baltimore Sun)
Pharmacists may be switching your meds (MSNBC.com)
United Therapeutics ‘thrilled' with recent drug approval (The Gazette)
CDC says October soonest for swine flu shot availability (Baltimore Sun)
WHO considers move to pandemic phase 6 for H1N1 virus (CNN.com)
Prince George’s County Swine Flu Update (Baltimore Afro-American)
Study: Heat effective in treating throat condition (Baltimore Sun)
Psychiatrists see bitterness as an illness (Baltimore Sun)
On a Wing and a Prayer: Spirituality and Mental Health (Baltimore Afro-American)
Folic acid offers more protection than thought (Washington Post)

Opinion
A dangerous denial (Baltimore Sun Editorial)
Stem-Cell Guidelines Are a Good Start (Washington Post)


Maryland / Regional

Drug program loses city funding July 1
'Grave concerns' about I Can't We Can

By Julie Bykowicz
Baltimore Sun
Wednesday, June 3, 2009

I Can't We Can, a Northwest Baltimore-based drug treatment program founded 13 years ago by a former heroin addict, has lost its major source of funding because of "grave concerns" about the way it is being run, according to the agency that distributes the money.

Israel Cason, a popular community leader and vocal advocate of substance abuse treatment, estimates he has helped about 10,000 addicts over the years with housing, counseling and work training. A decade ago, city leaders were so enamored of the program that they declared Aug. 29 "I Can't We Can Day."

But Cason's program has struggled financially for years, and its only steady source of income - about $350,000 per year in public funds - will be cut off July 1.

Baltimore Substance Abuse Systems recently notified the program that it had failed to meet at least three major criteria for continued public funding. Its state license has lapsed, its financial books are in disarray and conditions at some of its properties are unsafe, said Greg Warren, president and chief executive officer of BSAS.

"It's with great pain that we had to make this decision," Warren said "Halfway houses are a scarce resource in Baltimore City, and to lose any of them is incredibly sad."

BSAS distributes about $54 million per year, mostly in state taxpayer money, and monitors the more than 70 local substance abuse programs it funds, Warren said. It has given money to I Can't We Can for at least four years, he said.

Cason said he depends upon the BSAS money, which pays for 30 of its 120 filled treatment beds and other programs. "We need that money to offset the people who come in without any money," he said.

Recovering addicts in the 30 publicly funded beds will be moved to other programs, Warren said.

Cason, who hosts a weekly radio program on 1010 WOLB AM and ran unsuccessfully for City Council in 2007, vowed to continue helping addicts, perhaps through less costly outpatient services. "We are in the business of saving lives," he said. "We'll make a way."

The biggest problem - the lapse in licensing from the state Department of Health and Mental Hygiene's Office of Health Care Quality - has been addressed, Cason said. He submitted the forms for renewal in mid-May, about a month late, and they are being processed.

Cason acknowledged continuing financial troubles, such as not filing I Can't We Can's 2008 tax forms. The program ran a network of businesses, including bakeries, a caterer and thrift stores, but recently has had to shutter most of them because of the economic downturn, he said.

Several of the program's halfway houses are in foreclosure, and Cason said he is still paying off a 48-unit apartment building that he constructed in Park Heights. About 70 percent of its occupants are I Can't We Can alumni, he said.

Money was so tight at the end of last year that the program couldn't replace a rooftop heating and air-conditioning unit stolen from its Park Heights Avenue headquarters, outpatient and counseling center. Anthony McCarthy, the chief administrative officer and a radio talk show host, went on a two-week hunger strike to raise money, generating about $5,000. The unit still hasn't been replaced.

Adding to the financial issues is what Warren called "ineffective" record-keeping. Two independent audits found "no standard practice as to how bills get paid," he said. "We can't determine if taxpayer money is being spent appropriately."

He also said BSAS found some properties unsafe - they had holes in the roofs and walls, exposed extension cords and other fire hazards.

Warren said BSAS has tried to work with I Can't We Can, but the group's plans to correct their problems have been "woefully deficient."

But Cason said BSAS didn't try hard enough to help. "They don't communicate," he said.

In a May 26 letter to BSAS asking them to reconsider funding for next year, Cason wrote, "Indeed, there were times when we have dropped the ball and not always performed up to your standards, nor ours. In the past we have been fortunate to be in partnership with city administrations that made it a priority to assist us in addressing those deficiencies ... that appears not to be your priority."

Copyright 2009 Baltimore Sun.

Man bitten by young rattlesnake in Poolesville
Two to six people annually are bitten by venomous snakes in Maryland

By Meghan Tierney
The Gazette
Wednesday, June 3, 2009

Sam Pettengill encountered his fair share of rattlers when he lived in Arizona, so he was unfazed when he found a small brown snake just inside the door of his Poolesville home Sunday.

Pettengill, a cook who lives and works at Kunzang Palyul Choling Buddhist temple on River Road, discovered the 7-inch snake around 11 p.m. after coming back from a walk with his dog. He tried pick up the snake to bring it outside when it bit him on the knuckle. Twice.

"It hurt like a bee sting, like something burning," Pettengill, 36, said from his room at Shady Grove Adventist Hospital on Tuesday.

An hour and a half later, his hand was swollen and the pain began traveling up his arm. Pettengill looked at pictures online to figure out what bit him — a timber rattlesnake, one of two venomous snake species found in the state, according to the Maryland Department of Natural Resources.

Timber rattlers live in rocky, forested areas and can grow up to 6 feet long but average 9-10 inches when they're born, according to the department. They generally avoid people but will venture inside to hibernate or follow mice.

Pettengill was treated with antivenin and will require some physical therapy to regain full use of his arm, he said. He moved to Poolesville in September from Arizona, where he occasionally had to relocate large rattlesnakes. He assumed the small snake was a more innocuous species and was shocked when it fought back.

"It was just five seconds of grabbing a snake," he said. "Poison control didn't even believe me."

Venomous snake bites are uncommon in Maryland, according to DNR — two to six people are bitten each year and fatalities are rare. About 8,000 people are bitten by venomous snakes in the U.S. each year and about five are killed, according to the Centers for Disease Control.

Doctors at Shady Grove see one to two venomous snake bites a year, mostly people who keep the animals as pets or have encountered them in the wild, according to emergency physician Dr. Joel Buzy.

"It's actually fairly rare," he said.

People who suspect they have been bitten by a venomous snake should remain calm, immobilize the bitten area and immediately seek medical attention, Buzy said. Remove tight jewelry or clothing from the bitten extremity and remember what the snake looked like so it can be identified. Do not ice or cool the bite, use a tourniquet, cut the skin or attempt to suck out the venom.

Copyright 2009 The Gazette.

Va. Woman Who Died Had Swine Flu, Other Illnesses

By Anita Kumar
Washington Post
Wednesday, June 3, 2009

RICHMOND, June 2 -- A woman from Chesapeake who had swine flu, among other illnesses, died Tuesday, state officials said.

It is the first publicly announced death in Virginia associated with swine flu, also called the H1N1 virus.

"The news today that the commonwealth has witnessed its first death associated with the H1N1 influenza virus is a sad and sharp reminder that Virginians must remain vigilant against the spread of this potentially fatal illness," Gov. Timothy M. Kaine (D) said.

The cause of death has not been confirmed, but officials say swine flu appears to have been a factor.

"The impact of this death is not lessened by the fact that the patient had preexisting medical conditions that increased the risk of complications from influenza," said Karen Remley, state health commissioner.

The woman lived at the Southeastern Virginia Training Center, a Chesapeake facility for people with mental retardation and related developmental disabilities.

The most recent statistics available indicate that, as of Friday, the state had confirmed 29 cases of swine flu. Six of them were in Northern Virginia counties: three in Fairfax, two in Arlington and one in Loudoun. At least two other cases involved residents from other parts of the state who had traveled to Mexico.

State officials would not release ages or other personal details about the patients in an effort to protect their privacy.

The Centers for Disease Control and Prevention has reported 17 deaths in the nation caused by swine flu. Health officials in Maryland and the District said Tuesday night that no swine flu deaths have been reported in those jurisdictions. A total of 115 deaths have been confirmed worldwide.

"It is important that all Virginians take the necessary steps to protect ourselves and our loved ones against spreading germs during the normal course of the flu season," Kaine said. "Individuals with symptoms should be particularly cautious and take proactive measures to prevent infection and spread of the disease."

The state has more than 1 million courses of antiviral drugs available.

Staff writer Martin Weil contributed to this report.

Copyright 2009 Washington Post.

Souring Economy Spurs A Surge at Free Clinics

By Chris L. Jenkins
Washington Post
Wednesday, June 3, 2009

At the Arlington Free Clinic, applications to see a doctor have more than doubled in a year. In Reston, a similar clinic has seen 40 percent more patients in 10 months.

Clinics across the region report similar increases, and the trend is expected to continue in the worsening economy.

In an effort to help expand such services, Dominion Resources donated $1 million yesterday to more than 100 free clinics nationwide, including about three dozen in Virginia and one in Maryland. The money will allow the clinics, which are staffed almost entirely by volunteers, to serve more people at a time when the number of uninsured nationwide is expected to increase by 30 percent.

"The current economic times have produced hardships not seen in several generations," said Thomas F. Farrell II, chairman, president and chief executive of Dominion. "We want to do our part to make sure medical services are available to those who are uninsured or can't afford to see a doctor."

Free clinics provide services to people who can't afford insurance or don't qualify for government health programs. They rely largely on donations and volunteer medical staff to care for 4 million patients a year, said Nicole Lamoureux, executive director of the National Association of Free Clinics.

Eligible patients, who generally make less than 200 percent of the federal poverty level ($44,000 for a family of four), pay only a yearly membership fee. Patients in Arlington, for instance, pay $15 annually and a small co-payment for their medications.

As the economy slumped last year, the percentage of U.S. residents who reported having trouble paying for health care or prescriptions during the previous 12 months rose from 18 percent in January 2008 to 21 percent in December, according to a Gallup poll released earlier this year. Each percentage point change represents about 2.2 million people.

The Arlington clinic has seen a 164 percent increase in people seeking its services over last year. Staff members hold a monthly lottery to determine which applicants will get one of about 40 slots that open up every 30 days.

In many cases, experts said, the increases at free clinics nationwide were driven by people whose incomes had been cut, making them eligible for the services.

Copyright 2009 Washington Post.

Advocates lay road map for facing special needs ‘crisis'
‘Milestone' report lays out strategy and steps to improve families dealing with developmental disabilities

By Sebastian Montes
The Gazette
Wednesday, June 3, 2009

Thousands of Montgomery County residents are in daily crisis as they struggle to support a loved one with developmental disabilities, according to a report from a work group of parents, care providers and county officials.

The first effort of its kind in the county, the May report provides dozens of measures that together would redefine the county's approach to autism and similar disabilities. It charts a course that would reach more families, create a more proactive support network, increase school and county staff focused on special needs, spur more and better job prospects for the developmentally delayed, and improve access to health care and recreation.

The report is the culmination of more than a year of study by the 18-member "Workgroup on the Future for People with Severe Developmental Disabilities, Including Autism," which County Executive Isiah Leggett backed soon after taking office.

The group is finishing its strategy for getting the report to families who would benefit and the policy makers who would have to buy in. The report marks "a real milestone" for advocates, providers, officials and families caught up in the crisis, said John Kenney, the group's co-chairman and chief of aging and disability services in the county's Department of Health and Human Services.

"We all do feel that progress has already been made," he said.

It will take no small commitment of government sympathy and funding to effect real change to services throughout a person's lifespan, said the group's co-chairwoman Lyda Astrove, whose 18-year-old son Scott has autism. To a large degree, it has to start by changing expectations, she said, from school officials to employers to the community-at-large.

"Even if it just starts the ball rolling," she said. "I'm not expecting that somehow policy makers are going to read this and go ‘Oh my goodness, let's do something!' It can start small and still become something."

Priorities, plans of action

First, the report seeks to "open eyes" and create a sense of urgency in breaking down barriers that families face when they try to access information, find support, put their children into meaningful jobs and provide the person with the range of services that the developmentally delayed need.

Those struggles trace to a bleak starting point: As the number of people with autism and other developmental disabilities grows, families languish sometimes for years on state waiting lists to get behavioral, medical and family services. Ninety-four percent of the more than 18,000 people on the state's Developmental Disabilities Administration waiting list in July 2008 needed services immediately, according to the report. More than 2,800 were Montgomery County residents.

From there, families find a system that many in the survey said was unresponsive and required navigating a complex web of paperwork and red tape while battling with health care providers over what services would be covered. Forty-one percent of the more than 200 families surveyed said they either could not find or could not afford a caregiver and spent on average $1,000 per month out-of-pocket for behavioral and therapeutic services.

Those pressures take a broad toll. One quarter of the survey's respondents said they had to leave their job, while more than a third said they had to cut their hours.

To help ease that burden, the report calls for a formalized family-to-family support network and more before- and after-school programs. The work group is calling on county officials to rework legislative language so that funding can be spent more flexibly to better meet widely diverging needs.

"There's no one-size-fits-all," Kenney said.

At work and at play

A fuller, more rewarding life for people with disabilities must also include social and recreational activities offered not in the confines of providers' facilities, but in the community at large. The group supports state passage of a law that would guarantee equal recreational access and boost funding for the county's therapeutic recreation programs.

Because of chronic problems in finding space and time through the county's recreational system, Community Support Services Inc. — a Gaithersburg-based provider that runs a school and has more than 30 assisted living homes in the county — built its own gym. In the years since, the benefits have been undeniable.

"We've proven it works. It's not a trial anymore," said Susan Ingram, CSS's executive director and member of the county work group. "What this would mean is the county taking more initiative instead of us having to run everything ourselves."

One of the fundamental — and increasingly bleak — challenges cited in the report is putting special needs people into meaningful and lasting jobs. A 2008 Cornell University study that showed a 42 percent unemployment rate among Maryland adults with developmental disabilities — "and some would say it's as high as 70 [percent]," Kenney said.

Boosting staff in the county school system and in the health and human services department, while ensuring close collaboration between the agencies, will bolster the anxious transition from school settings to adult life.

And so that those young adults enter a marketplace ripe with opportunity, the report urges the county to partner with employers to create "new avenues" for jobs and internships, while also calling on the county and municipal governments to do more hiring themselves.

Leggett is determining which of the recommendations "can be moved on now," and which may have to wait for county coffers to recover from the economic downturn, said his spokesman, Patrick K. Lacefield.

The state provides about 90 percent of government funds available for people with developmental disabilities.

In the fiscal year that ends this month, Montgomery County put $11 million toward residential and supportive services for people with developmental disabilities and their caregivers — by far the most of any county in Maryland, according to Kenney.

Copyright © 2009 Post-Newsweek Media, Inc./Gazette.Net.

National / International

Joint Chiefs chairman: Troops' mental health needs to be priority

By Greg Clary
CNN.com
Wednesday, June 3, 2009

WASHINGTON (CNN) -- America's highest ranking military officer said Tuesday the nation must do more for the mental health of American soldiers, warning statistics show "there are going to be more [troop] suicides this year than last."

The chairman of the Joint Chiefs of Staff, Adm. Michael G. Mullen, said the military lacks the number of mental health professionals necessary to help returning or soon-to-deploy troops deal with the high stress of war. He said he's working to get more money to increase the number of counselors so more soldiers can be helped.

Mullen made the comment to an audience of military families during a breakfast sponsored by The Hill newspaper at the Liaison Hotel in Washington.

"I think we need to get to a point where everyone is screened by a competent mental health professional," he said.

Officials say 64 soldiers have committed or are suspected of having committed suicide this year in the Army alone. That puts it on a grim pace to break last year's record of 133.

The issue came to a head last week as Fort Campbell in Kentucky stood down for a three-day suicide prevention event after 11 soldiers there committed suicide this year.

Suicides aren't the only result of stress on military personnel. The Army charged Sgt. John Russell with the murder of five fellow soldiers at a stress clinic in Baghdad's Camp Liberty last month. Russell's commander had referred him to counseling because of concern for his mental health.

But there are some strategies that seem to be helpful in treating stress, Mullen said. He singled out Fort Hood in Texas. saying that even though the facility has 30,000 more soldiers than Fort Campbell, there had been only one suicide at Fort Hood as of April.

"The general out there had essentially focused on relieving stress [and] not just attacking the suicide issue, and he'd done it very systematically," Mullen said. "It just shows that when leaders apply themselves, we can make a big difference there."

Attacking the overall stress level in soldiers may be more effective than just worrying about suicides, the admiral said, as troops face stress not just in war but in day-to-day life, as well.

"We are working hard to understand the underpinnings of this and, broadly, many of these suicides occur based on failed relationships, financial problems in a history too often discovered after the tragic event," Mullen said.

In fact, half of the suicides at Fort Campbell were committed by soldiers who had never deployed.

But Mullen said there is still a connection.

"I've heard people use that as a reason that would very possibly say the deployments don't have anything to do with it, and I just don't believe that," Mullen said. "I believe there is a relationship between those who haven't deployed but are going to deploy and all of the stress and hype that you hear as you get ready to go on your first deployment."

© 2009 Cable News Network. Turner Broadcasting System, Inc. All Rights Reserved.

AstraZeneca, Merck collaborate on cancer treatment

Associated Press
Baltimore Sun
Tuesday, June 2, 2009

Drug developers AstraZeneca PLC and Merck & Co. said Monday they will jointly develop a combination treatment for cancer.

The companies said they will combine efforts with Merck's MK-2206 and AstraZeneca's AZD6244, both of which are still in very early development.

They said in a statement that pre-clinical studies -- the laboratory phase of development -- indicate the combination has potential as an anticancer drug.

The drug candidates are currently in separate early-stage studies involving people. Under the deal, the companies will jointly evaluate the combination in a Phase I clinical trial. Development costs will be shared.

Decisions on further development will be based on the early-stage study.

The early stages of drug development focus mainly on whether the compound is safe and can reach its intended target. They normally only involve a small population of patients and are insufficient to determine whether a drug is effective. Results from later stages of development, involving a higher number of patients, are overwhelmingly used to determine whether a treatment actually works.

Copyright 2009 Associated Press. All rights reserved.

Pharmacists may be switching your meds
Laws allow substitution of generic drugs without patient knowledge

MSN Tracking Image
By Richard Laliberte
MSNBC.com
Wednesday, June 3, 2009

When you hand a pharmacist a prescription, you expect to get the medication your doctor ordered. But because of a perfectly legal loophole in rules that govern how drugs are dispensed, you may not - and the consequences can be dire.

Just ask Amy Detrick of Grove City, Ohio.

For months after the former social worker, 40, was diagnosed with epilepsy, her doctor fine-tuned the precise cocktail of meds that would keep her from having seizures - adding and subtracting drugs, calibrating doses, and carefully tracking how she responded. When her condition was finally under control, she filled a prescription for one of two drugs she took - Tegretol - and shortly afterward had a seizure while riding a bicycle. She fell off the bike, broke her leg, and had a hairline fracture in her left eye socket. While the doctors were treating her, they noticed the blood level of her medication had declined. Her pharmacist, she learned, had exchanged her Tegretol for a generic that worked a little differently. "Just imagine what could have happened had I been behind the wheel of a car," she says.

Detrick's story sounds like a medical mistake, but it wasn't. Instead, she experienced a potentially deadly consequence of a common practice called "therapeutic substitution," wherein her pharmacist legally switched a drug prescribed by her doc - but without telling her or her physician. Usually, pharmacists replace a brand-name drug with a generic formulation of the exact same medication. Therapeutic substitution is similar but with one crucial distinction: The new drug is in the same class as the old and treats the same condition, but it's not precisely the same medication.

To understand the nuance, think of statins. They constitute a single class of medication because they all lower cholesterol by reducing its production in the liver. But not every statin lowers cholesterol by the same amount or with the same balance of LDL to HDL. So if your doctor orders a brand-name drug but your pharmacist switches it for the cheaper version of a different medication (but still a statin), you may not get the precise benefit your doctor had in mind - and may, in fact, suffer unexpected side effects.

In one way, at least, patients can benefit from substitution - smaller co-pays. But two-thirds of people who reported having meds switched in a National Consumers League survey said they weren't consulted. Of those, 40 percent said the new drug was not as effective, and a third said it had more side effects. "It's not okay for your insurance company or pharmacist to change your drugs without your knowledge," says NCL Executive Director Sally Greenberg.

Unfortunately, therapeutic substitution is likely here to stay - meaning you need to be on the lookout to make sure you're not harmed by the practice. Here are three common reasons you could end up with a less effective drug and steps you can take to ensure you get the medication to treat your condition properly.

1. Your pharmacy misreads the law
After Tony Catizone of Chicago had a stroke while using a widely prescribed blood pressure medication, his doctor wrote a prescription for a new one, but a mail-order pharmacy changed the prescription back to the old drug. His son, Carmen, caught the substitution and called the pharmacy. "They told me that legally, they had to make the switch," says Carmen. Yet no state mandates therapeutic substitution, and even out-of-state mail-order houses must comply with the laws in your state. In Illinois, therapeutic substitution is allowed only in hospitals, where doctors control the process.

"The pharmacy was misinformed, evidently taking the insurer's list of covered drugs as the law," Carmen says. He knew this because he is executive director of the National Association of Boards of Pharmacy. "I told them I had a copy of the Illinois Practice Regulations and knew the law entitled my father to the right drug," he says. After transferring him from a customer service rep to a real pharmacist, the pharmacy corrected the switch.

Get the right drug: If your doctor believes her drug of choice should not be switched for another, ask her to write "medically necessary," "may not substitute," or "DAW" - for "dispense as written" - on the prescription. That obligates the pharmacist to check with you and your doctor before making any switches.

If a pharmacy tells you the law requires a substitution, find out which ones your state allows, and challenge the switch if the pharmacy has overstepped its authority. To get the information you need, contact your state's board of pharmacy; go to nabp.net and click on the Boards of Pharmacy button to bring up a contacts list for every state office.

Pick a pharmacy you like and stick with it. "That way, your pharmacy will have a long record of your prescription history and know if a drug didn't work for you," says Carmen Catizone, whose father had stopped going to a neighborhood drugstore when his insurance company changed to mail-order prescriptions only.

Ask your pharmacist to put a blanket statement in your records that you don't want any medications switched unless you and your doctor approve. "It's a way of getting your pharmacist's attention," says Catizone. "When pharmacists know more, they can do a better job of advocating for patients."

2. Your insurance company won't pay
Insurance plan formularies - the lists of drugs that insurers cover - are at the heart of most substitution battles. "The insurance company will tell me that the drug I prescribed for a patient is not approved or is at the higher co-pay, so I need to submit documentation justifying why insurance should cover it instead of making a substitution," says Lori Heim, MD, president-elect of the American Academy of Family Physicians.

If a doctor persuades the insurance company that a particular drug is medically necessary, the insurer may cover it after all. But the haggling, follow-ups, and appeals can be time-consuming - and infuriating. One frustrated Ohio doctor sued Medco, a large pharmacy benefits management company, asking to be compensated for time wasted on prescription hassles - and won a small award. Court testimony in the case revealed that the company sent 57 times more prescription-related inquiries to physicians in 2007 than it did 10 years earlier.

Meanwhile, as doctors deal with an ocean of paperwork and bicker with insurers, patients suffer. "I've had patients who did not have control of their allergy symptoms - sneezing and feeling miserable - while I jumped through hoops showing that these other drugs didn't work for them," says Heim.

Ask your doctor up front - before you fill your prescription - which generics, if any, are acceptable subs for the drug that she wants you to take: A switch at the pharmacy may be perfectly fine (and often cheaper for you). Write down the name of the prescribed medication and the approved subs on a piece of paper separate from the prescription slip, and then check the filled order against your list. If your pharmacist makes an unapproved switch, call your doctor right away so she can begin documenting why insurance should cover the original drug or an appropriate alternative.

If your doctor doesn't fight a substitution, make sure he isn't just taking the path of least resistance or losing your prescription in the shuffle. "Busy doctors sign papers quickly, so it's easy for a substitution to sneak through," says Robert Reneker, MD, urgent care physician at Spectrum Health, a hospital system in Grand Rapids, MI. Ask: Will the new drug work better? How will I know if it does or doesn't? Are side effects different from those associated with the original prescription? How will it interact with other medications or supplements I might be taking?

3. Your pharmacy cheats
You'd hope pharmacies are paragons of ethical behavior. "But they're not always aboveboard," says Reneker. Sometimes, he says, pharmacies make drug switches because profit margins are higher on cheaper substitutes. "Pharmacies are directly reimbursed by insurance companies and make more money from generics even though the sticker price for brand-name drugs is higher," says Reneker. "I've had pharmacies tell me a drug isn't on the formulary when I've already checked with the insurance company and know that it is. The switch to a cheaper substitute is motivated purely by profit."

Get the right drug: Shop for prescriptions at stores that have slashed prices on generics - a move that lowers profit margins and reduces the temptation for pharmacists to make sneak switches. Giant retailers like Wal-Mart and Target have led the way on price cuts, pressuring smaller pharmacies to match their discounts. "Drugs have become a way to attract people to stores so they'll spend money on other items," says Reneker.

Call your insurance provider to confirm whether a drug is really covered if your pharmacist says it isn't.

Fact file

Common prescription drug switches

Here are examples of cheaper therapeutic substitutions for brand-name drugs identified by the National Consumers League and how they may affect you.

If your doctor prescribes...

You may get...

The danger

Lipitor, a cholesterol-lowering statin	Simvastatin, the generic equivalent of Zocor, another statin	Lipitor does a better job of lowering LDL (bad) cholesterol and triglycerides, but simvastatin is better at raising HDL (good) cholesterol, so one drug may not treat your main problem as well as the other.
Lexapro, an antidepressant	Citalopram, a generic version of the antidepressant Celexa	You could experience more side effects with citalopram: Lexapro is more concentrated, so it's prescribed in smaller amounts.
Diovan, an angiotensin receptor blocker for lowering blood pressure	Lisinopril, the generic equivalent of Zestril, an ACE inhibitor for lowering blood pressure	Patients on Lisinopril sometimes develop a nagging cough.
Nexium, a proton pump inhibitor for heartburn	Omeprazole, the generic equivalent of Prilosec, an OTC proton pump inhibitor	Your body may respond better to one than the other; omeprazole may have more side effects.

Source: Prevention




United Therapeutics ‘thrilled' with recent drug approval
Adcirca could bring $300 million annually

By Robert Rand
The Gazette
Wednesday, June 3, 2009

United Therapeutics CEO Martine Rothblatt had one word, sort of, for analysts during last week's conference call announcing the U.S. Food and Drug Administration's approval of its oral treatment for pulmonary arterial hypertension: "Woo-woo-woo-woo-woo!"

The Silver Spring drugmaker, which already markets injectable Remodulin for the disorder, has high hopes for the new treatment, Adcirca. Rothblatt estimated annual revenues approaching $300 million.

"We are absolutely thrilled" to announce that the FDA has approved Adcirca, "thanks to the fantastic clinical development efforts led by Eli Lilly," Rothblatt said.

The FDA action came "seven years ago to the day that the FDA approved Remodulin," she said. "We at United Therapeutics definitely look at May 22 as being the luckiest day of the year for our company."

It turns out that the same compound — tadalafil — that can help men get an erection can also help pulmonary arterial hypertension patients exercise longer. Tadalafil is the active ingredient in both Eli Lilly's popular Cialis and United Therapeutics' Adcirca.

United Therapeutics licensed the rights to develop and market Adcirca for pulmonary hypertension in the U.S. from Eli Lilly in November. Rothblatt said upward of 40,000 U.S. patients have the disorder, and Adcirca has the potential to become the foundation for treating them.

Besides its efficacy, Adcirca's big advantage is that it is administered in one daily 40 mg oral dose, she said. It also has fewer side effects and is less expensive than other therapies.

United Therapeutics plans to distribute Adcirca through retail pharmacies, "leveraging Lilly's relationship with wholesalers," said Roger Jeffs, president and CEO.

The FDA's action now gives United Therapeutics a second drug on the market.

"It's a transformative event going from a one-medicine to a two-medicine" company, Rothblatt said.

This report originally appeared in The Business Gazette.


CDC says October soonest for swine flu shot availability

Associated Press
Baltimore Sun
Tuesday, June 2, 2009

A U.S. health official said a swine flu vaccine could be available as early as October, but only if vaccine production and testing run smoothly this summer. Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention said the agency began shipping virus samples to manufacturers in the past several days. The government will have to review the safety and effectiveness of what's produced, and decide if a vaccination campaign is warranted. October is about the time seasonal flu vaccine campaigns generally get rolling. CDC officials reported more than 8,500 probable and confirmed cases in the U.S., including 12 deaths and more than 500 hospitalizations.


WHO considers move to pandemic phase 6 for H1N1 virus

CNN Medical Producer
By Matt Sloane
CNN.com
Wednesday, June 3, 2009

(CNN) -- The World Health Organization announced Tuesday it is still considering increasing its pandemic alert level to phase 6 because of growing worldwide cases of the H1N1 virus, or swine flu.

"Globally, we are at phase 5, but we are nearing phase 6," said Dr. Keiji Fukuda, WHO's Assistant Director General. "As this continues to spread internationally, some countries are moving from isolated to sustained community spread."

Phase 6 is a declaration that many member countries have long feared could mean economic disaster. It is the highest on the WHO's pandemic alert system, and is described by the organization as a global pandemic.

Fukuda was quick to remind journalists that the designation does not reflect the severity of the disease, but how widespread it is.

"Our overall assessment of severity is moderate," he said, "because although the overall number of serious and fatal cases is relatively limited ... we really don't have a full handle on the number of people with serious illness."

Fukuda said nearly 19,000 cases of the H1N1 virus have been reported in 64 countries, resulting in 117 deaths.


Prince George’s County Swine Flu Update

HEALTH BRIEF
Baltimore Afro-American
Tuesday, June 02, 2009

Prince George's County now has a total of 17 confirmed cases of H1N1 Virus (swine flu). While the virus is not particularly virulent, it remains highly contagious, requiring appropriate personal and community mitigation efforts.

"The death of the New York school administrator reminds us all of the potential for this virus to infect individual's exposed." said Health Officer Donald Shell, M.D., M.A. "To avoid acquiring or transmitting this virus between individuals, we all must remain vigilant with our personal hygiene, including covering our coughs, cleaning our hand when they have been exposed to nasal secretions."

The Health Department offers these suggestions to protect the public's health:
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
• Avoid touching your eyes, nose or mouth
• Try to avoid close contact with sick people.
• If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.


Study: Heat effective in treating throat condition

Associated Press
Baltimore Sun
Tuesday, June 2, 2009

Zapping away abnormal, precancerous cells in the throat may lower the risk of later developing esophageal cancer, the first major study to test this technique finds. In a study of 127 people suffering from a heartburn-related problem known as Barrett's esophagus, only about 1 percent who had a procedure that uses heat to burn off precancerous spots went on to develop cancer over the next year. That's compared with more than 9 percent of those who got a fake treatment in which no cells were destroyed. Barrett's esophagus occurs when stomach acid backs up into the throat, causing the normal lining to be replaced by abnormal growth. Barrett's sufferers are 30 times more likely than others to develop esophageal cancer, one of the deadliest forms of the disease. Doctors typically perform down-the-throat exams and surgically remove the esophagus in severe cases of Barrett's. A less drastic alternative, which has been available since 2005, uses a device down the throat and radiofrequency energy to destroy precancerous cells. In the study published in Thursday's New England Journal of Medicine, Barrett's patients who had signs of precancerous cells were treated with the device or given a sham procedure that did not involve heat. After a year, 77 percent who had the procedure were free of precancerous spots compared with 2 percent who got the fake treatment. The study was led by Dr. Nicholas Shaheen of the University of North Carolina at Chapel Hill. Several researchers and Bergman have received grants from or have other financial ties to Sunnyvale, Calif.-based Barrx Medical Inc., which makes the device and paid for the research.


Psychiatrists see bitterness as an illness
Some people can't get over a feeling of being wronged

Los Angeles Times
By Shari Roan
Baltimore Sun
Tuesday, June 2, 2009

You know them. I know them. And, increasingly, psychiatrists know them. People who feel they have been wronged by someone and are so bitter they can barely function other than to ruminate about their circumstances. This behavior is so common - and so deeply destructive - that some psychiatrists are urging it be identified as a mental illness under the name post-traumatic embitterment disorder. The behavior was discussed before an enthusiastic audience recently at a meeting of the American Psychiatric Association in San Francisco.

The disorder is modeled after post-traumatic stress disorder because it too is a response to a trauma that endures. People with PTSD are left fearful and anxious. Embittered people are left seething for revenge.

"They feel the world has treated them unfairly. It's one step more complex than anger. They're angry plus helpless," says Dr. Michael Linden, a German psychiatrist who named the behavior. Embittered people are typically good people who have worked hard at something important, such as a job or relationship, Linden says. When something unexpectedly awful happens - they don't get the promotion, their spouse files for divorce - a profound sense of injustice overtakes them. Instead of dealing with the loss with the help of family and friends, they cannot let go of the feeling of being victimized. Almost immediately after the traumatic event, they become angry, pessimistic, aggressive, hopeless haters.

"Embitterment is a violation of basic beliefs," Linden says. "It causes a very severe emotional reaction. ... We are always coping with negative life events. It's the reaction that varies."

There are only a handful of studies on the condition, but psychiatrists at the meeting agreed that much more research is needed on identifying and helping these people.

One estimate is that 1 percent to 2 percent of the population is embittered, says Linden, who has published several studies on the condition.

"These people usually don't come to treatment because 'the world has to change, not me,' " Linden says. "They are almost treatment-resistant. ... Revenge is not a treatment."

Nevertheless, Linden suggests that people once known as loving and normal who suddenly snap and kill their family and themselves may have post-traumatic embitterment syndrome. That's reason enough for researchers to study how to treat the destructive emotion of bitterness.


On a Wing and a Prayer: Spirituality and Mental Health

NNPA Columnist
By Dr. Dan Collins
Baltimore Afro-American
Tuesday, June 2, 2009

(June 2, 2009) - Prayer is a cornerstone of good mental health because it immediately removes from our shoulders an unbearable burden - of being God.
When people function as if we were God, it makes us crazy.

Putting a God-sized burden on human sized shoulders is stressful. In a post-modern secular society, prayer is marginalized. Instead, we learn to rely on reason and hard work to influence the world.

The problem we have painfully discovered is that life is often unfair and unreasonable. And in those moments, when our humanity is stretched to its limits, intuitively we realize that there are some problems we just can’t fix by ourselves. It is at these times that it becomes crystal clear, we need to turn to a source greater than ourselves.

Having a connection with the divine is a refreshing fix for our trial and tribulation parched humanity. The divine connection bridges the gap between our best efforts and what still remains to be done.

Prayer is a stress buster because it pre-supposes that God will help us by making up the difference between what we have done and what is still needed. Prayer is a wonderful tool to help us manage the unmanageable aspects of our lives.

Prayer is good for our mental health because it humanizes us. A healthy prayer life invites each of us to look at ourselves and examine how we are affecting other people.

I’ll never forget a sermon a young preacher delivered in our church. His analogy was striking. He said he loved to go fishing because every now and then, he’d feel something tugging on the other end. Prayer, he said, is the same way: ''Every now and then, you feel something tugging on the other end.”

The preacher was right. Prayer is effective. If you continue to pray, you actually start to experience prayer outcomes. Here are at least three things that change inside of us that have a wonderful impact on our emotional health:

* Increase of love - Prayerfulness makes us more tuned into ourselves and each other. As we love, we are able to serve. In our current world, as the young folk are fond of saying, “I’m going to do me.” Love has a different script. Love instead asks a question: what is it that you want and need? And then love breaks it’s back trying to make that happen. Love heals, restores and reconciles.

* Increase of Patience - the word “wait” is a fighting word in many quarters. People don’t like to wait. But the idea of waiting can shift if we consider the benefits. Think of patience as being yoked to developing character. Remember either you will have character or be a character. Waiting helps us because we learn to face problems with greater determination. Patience helps us to make better decisions. And better decision making is at the heart of improved mental health.

*Increase of Vision - Prayerfulness gives us focus and direction. Developing a vision helps us to imagine the possible in the midst of the improbable. Vision empowers us to be bold--- to become more, to expect more and reach for more. A vision like this helps us to become more connected and resourceful. When we bring this type of vision into every aspect of our lives, we will have transformative mental health.


Folic acid offers more protection than thought

Associated Press
By Lauran Neergaard
Washington Post
Wednesday, June 3, 2009

WASHINGTON -- Baby-protecting folic acid is getting renewed attention: Not only does it fight spina bifida and some related abnormalities, new research shows it also may prevent premature birth and heart defects.

Now pregnancy specialists are asking if it's time for the government to boost the amount being added to certain foods to help ensure mothers-to-be get enough. But for older adults, there may be a down side to the nutrient: Extra-high levels late in life just might pose a cancer risk.

"Folate is assuming the role of a chameleon, if you will," says Dr. Joel Mason of Tufts University's nutrition research center, who is researching that possible risk.

Folic acid is an artificial version of folate, a B vitamin found in leafy green vegetables, citrus fruit and dried beans. Everyone needs regular folate because it's important for healthy cell growth yet the body doesn't store up enough of it.

And pregnant women need extra, even before they may know they've conceived. Enough folate in pregnancy's earliest days can prevent devastating birth defects of the spine and brain called neural tube defects, including spina bifida. Those defects have dropped by about a third since the U.S. mandated fortifying certain breads, cereals and pastas with folic acid in January 1998.

Two major studies in the past month suggest the vitamin may be even more protective.

First, Texas researchers analyzed nearly 35,000 pregnancies and found that women who reported taking folic acid supplements for at least a year before becoming pregnant cut in half their risk of having a premature baby. Their risk of having very early preemies, the babies least likely to survive, dropped even more.

Then Canadian researchers analyzed 1.3 million births in Quebec since 1990 to look for heart defects, the most common type of birth defect. They found the rate of serious heart defects has dropped 6 percent a year since Canada began its own food fortification in December 1998.

It's hard to get enough folate for pregnancy through an average diet. So health authorities have long advised that all women of childbearing age take a daily vitamin containing 400 micrograms of folic acid _ even if they're not trying to conceive, since half of pregnancies are unplanned. Last month, the U.S. Preventive Services Task Force went a little further, recommending that women take a daily supplement with 400 micrograms to 800 micrograms of folic acid daily.

But because only about a third of non-pregnant women take precautionary folic acid supplements, fortifying foods made with enriched flour ensures everyone gets a modest amount.

"We've seen in the U.S. and Canada dramatic changes in neural tube defects just with fortification. The question now is would a little more fortification, or even twice as much fortification, impact that bottom line, as well as those other potential benefits," says Dr. Alan Fleischman, medical director of the March of Dimes.

His group will call together pregnancy and folate specialists this summer to debate that. Also under way are deliberations by the European Union and Britain on whether to begin fortification there.

Complicating that issue is the question about cancer risk when older people _ women well beyond childbearing, and men _ take lots of folic acid.

Here's the quandary: Some research shows people who don't eat enough folate have a higher risk of colon and certain other cancers. On the other hand, animal studies show too much folic acid, the pill version, can spur some cancers. There's scant human evidence. But when researchers studied people prone to precancerous colon polyps, those who took high-dose folic acid _ 1,000 micrograms a day _ for three years had more new polyps than people given a dummy pill. And in March, researchers tracked 640 men from that earlier study and found that 10 years later, the folic acid users were more likely to have developed prostate cancer.

Why? While enough folate usually is protective, if people's bodies already harbor some precancerous or cancerous cells, too much may feed their growth, said Tufts' Mason. Older people are more likely to be brewing colon or prostate cancer.

Fortified foods alone wouldn't be enough to harm, stresses Fleischman: "I don't think it's going to end up being a generational argument."

But Mason worries that some people can rack up the dose with today's multiple sources: A multivitamin with 400 micrograms; some fortified cereals bring another 400 a bowl; many older people take special B-vitamin tablets with 400 more; another 200 or so from breads; more in vitamin-infused bottled water and energy bars.

Don't misunderstand: Everyone should eat enough leafy greens and citrus _ good folate from food is important at all ages. But until the issue's settled, Mason says older adults "really ought to think twice about whether you should take a vitamin supplement that contains folic acid."
___
EDITOR's NOTE _ Lauran Neergaard covers health and medical issues for The Associated Press in Washington.


Opinion

A dangerous denial
Our view: Parents who choose not to vaccinate are imperiling public health

Baltimore Sun Editorial
Wednesday, June 3, 2009

People believe all kinds of strange things, and most of the time it doesn't matter. Trouble arises, however, when their odd beliefs affect other people's health.

Such, unfortunately, is the case with parents who choose not to immunize their children against diseases that killed and crippled millions before vaccines were developed and made widely available. The anti-vaccine movement is driven largely by parents who believe that certain vaccines can cause autism, a suspicion that has been thoroughly investigated and authoritatively debunked.

A new study in the journal Pediatrics has found that children not vaccinated against pertussis are 23 times more likely to contract the disease, also known as whooping cough. This is hardly a surprise. What may be more alarming is that those who refuse to vaccinate are likely endangering the rest of us. Immunized children who are in contact with unvaccinated peers are at elevated risk of getting sick.

That's why, as Stephanie Desmon reported in The Baltimore Sun last week, at least one local doctor is refusing to treat children who haven't had their shots. Although fewer than 1 percent of children are not immunized, their numbers have doubled in recent years, a trend that worries Dr. Daniel Levy of Owings Mills: "We're going to start seeing the return of diseases we had almost gotten rid of."

Parents of autistic children deserve sympathy and support. There should be adequate services for these families, as well as more research into the steady rise over the last 20 years in diagnoses of "autism spectrum disorders," which describes an array of developmental, language and social difficulties.

But a dangerous ignorance should not be tolerated. As Dr. Timothy F. Doran, chairman of pediatrics at Greater Baltimore Medical Center, pointed out in these pages last year, the original study linking the MMR vaccine with autism was based on a mere 12 patients; the lead author was charged with misconduct, and his co-authors disavowed the work.

Further confusion was sown by the recent case of a Maryland-born girl who developed features of autism after receiving vaccinations, and whose family was compensated by the federal government. As Dr. Doran pointed out, this compensation fund is a "no-fault" program designed to avoid the tort process. The award was in no sense proof of a vaccine-autism link, and it did nothing to disprove the dozens of large-scale studies, from multiple countries, that have failed to demonstrate one.

Maryland law requires vaccinations against a dozen diseases from birth to age 5, but shockingly, any parent can send an unvaccinated child to school by simply signing a statement asserting that the vaccination is a violation of religious beliefs.

That's an unacceptable endangerment of public health. The number of definite pertussis cases in Maryland rose from 43 in 2007 to 64 last year. Before the next 50 percent increase, the state should seriously consider barring unvaccinated children from attending public schools. If parents want to make a risky decision regarding their children's health, perhaps they should have to make other arrangements for their education rather than endanger everyone else.


Stem-Cell Guidelines Are a Good Start

Washington Post Letter to the Editor
Wednesday, June 3, 2009

The storm raised by stem-cell scientists about the failure of the National Institutes of Health draft guidelines to grandfather in stem-cell lines already in use is overshadowing other important issues raised by these guidelines ["New Rules on Stem Cells Threaten Current Research," news story, May 25].

The guidelines admirably add certain protections for those who make the difficult decision to donate, for stem-cell research, embryos remaining after in vitro fertilization treatment. Such protections did not appear in the Bush-era guidelines. While the protections complicate the informed-consent process, the grandfathering issue they raise can be remedied by adopting sections of the National Academy of Sciences guidelines addressing it.

What has been lost in the grandfathering brouhaha is that the NIH draft guidelines do not provide for oversight of stem-cell research at the institutional or national levels.

In contrast, such oversight is called for by the National Academies, the 2000 NIH stem-cell task force and the 1999 report of the National Bioethics Advisory Commission. Oversight of stem-cell research has been generally appreciated by scientists in Canada (whose Stem Cell Oversight Committee I served on for three years), because it has enabled them to avoid ethical and policy pitfalls that could delay their research.

Although the NIH draft guidelines address the issue of informed consent in more detail than the guidelines in use up to now, they do not take into account recent studies showing that embryo donors want more opportunities during treatment to consider what to do with spare embryos and greater assurances that their decisions will not be subjected to undue influence by their doctors.

The NIH draft guidelines make a good first stab at developing more complete guidelines for stem-cell research, but these and other sorts of ethical and policy concerns will need to be addressed in the final NIH guidelines due to appear in July.

CYNTHIA B. COHEN
Faculty Affiliate
Kennedy Institute of Ethics
Georgetown University
Washington

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