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			Saturday, June 6, 2009 News Clipping Archives *Maryland / Regional* 2 swine flu cases reported (Salisbury Daily Times) Machine malfunction leads to job losses (Salisbury Daily Times) *National / International* City Reports Eighth Death Connected With Swine Flu (New York Times) New CDC chief to target smoking; led charge in NYC (New York Times) Some Doctors Question Safety Study on Glaxo's Avandia (Wall Street Journal) Tobacco Regulation Bill Is Expected to Pass Senate (New York Times) *Opinion* --- *Maryland / Regional* 2 swine flu cases reported Residents infected with virus have recovered By Brian Shane Salisbury Daily Times Saturday, June 6, 2009 SNOW HILL -- Two Worcester County residents have contracted, and since recovered from, the breakout strain of influenza commonly known as swine flu. "We anticipated that we would eventually see cases in our county," said Health Officer Debbie Goeller. Lab tests from the state's Department of Health and Mental Hygiene confirmed the two local cases of the H1N1 virus. Worcester health officials said one of the people diagnosed was an Ocean City Elementary School student. The child has been kept home since the diagnosis and will return to school when a doctor allows it, Goeller said. She said the school was sending information about the situation home to parents. Dr. Andrea Mathias, deputy health officer for Worcester County, said most cases seen in the U.S. have not been any more severe than the average seasonal flu. "It does depend on the health of the individual," she said. "It's something that may change; viruses do mutate and change over time. As the course of the virus goes on, and continues to make itself known in the population, we will have to see. But we have been very fortunate so far that it has been on the order of regular seasonal influenza." Mathias also said there isn't any single point of origin for this virus, and it's unclear where exactly the two Worcester County patients contracted H1N1. The average life of the virus is about two weeks, from infection to onset of symptoms to recovery. She also said "swine flu" is a term that some public health officials have discouraged and discontinued, mostly because upon genetic analysis, the virus was found to have swine, avian and human origins. It also has upset pig farmers. Maryland now has 83 confirmed swine flu cases, said DHMH spokeswoman Karen Black. She said Maryland's first cases were announced April 29. Prince George's County so far has the most confirmed cases, with 27. She said state health officials expect more confirmations of swine flu in the weeks and months to come. As of June 3, there are confirmed H1N1 cases in all 50 states, the District of Columbia, and Puerto Rico, according to the U.S. Centers for Disease Control and Prevention. The spread of the illness led to a federally declared public health emergency in April. Most people will have little or no immunity against it, and there is no vaccine to protect against it, though most patients have experienced typical flu symptoms and recovered without requiring medical treatment. The CDC also says an infected person should be assumed to be contagious from one day before symptoms start until they are symptom-free. And, even if symptoms improve rapidly, a person should be considered potentially contagious for up to seven days after the onset of symptoms. Young children may be contagious for longer periods. Health experts recommend that anyone experiencing flu-like symptoms -- fever, body aches, extreme fatigue, sore throats and dry cough -- stay home from work or school for at least 24 hours. If symptoms get worse, people should see a doctor. Copyright 2009 Salisbury Daily Times. Machine malfunction leads to job losses By Sharahn D. Boykin Salisbury Daily Times Saturday, June 6, 2009 SALISBURY -- Equipment failure at a state hospital facility has left 10 laundry room workers without jobs, according to the state's leading health agency. Advertisement Workers at Deer's Head Hospital Center, which provides chronic care and rehabilitative services, were given official notice on Monday that they were being laid off in 60 days after a presser that would cost more than $400,000 dollars to repair stopped working. "Because there is no money for repair or to replace that piece of machinery, that was the straw that broke the camel's back," said David Paulson, the Maryland Department of Health and Mental Hygiene director of communications. "The equipment that they use in the laundry room is failing. In these tough budgetary times there's no money to repair or replace the equipment that they use." Some of the employees are eligible for retirement because of the number of years they worked for the state, but they don't meet the age requirement. "They all want to continue working somewhere," Paulson said. "There's a number of opportunities they are investigating with other state facilities and agencies in the area." Laundry room workers did not return multiple phone calls from The Daily Times on Wednesday. The hospital plans to seek an outside vendor for its laundry services. A number of contractors are being considered including Eastern Correctional Institution; however, health officials said they are unsure if the correctional center can handle the additional work and it has not been determined whether the facility can meet the hospital's transportation needs. "It's sad for everybody involved," Paulson said. "And obviously sadder for those who lost their position." Copyright 2009 Salisbury Daily Times. *National / International* City Reports Eighth Death Connected With Swine Flu By Anemona Hartocollis New York Times Saturday, June 6, 2009 New York City’s Department of Health and Mental Hygiene has confirmed an eighth death linked to swine flu, the first of a person older than 65, officials said Friday. Jessica Scaperotti, a spokeswoman for the department, declined to release further identifying details, but she said the victim had underlying complications that increased the risk of death. Health officials have said such complications include being over 65 or under 2, having respiratory or immune system problems or being obese, among others. She said health officials were urging New Yorkers with flu who have underlying conditions or severe symptoms like shortness of breath to seek medical attention immediately. “While most of New York City’s H1N1 deaths involve people with established risk factors, influenza can be fatal in otherwise healthy people,” Ms. Scaperotti said. On Thursday, a spokesman for the Bronx district attorney’s office said four prosecutors were believed to be suffering from swine flu, prompting a thorough cleaning of the office. None have been hospitalized. About 1,000 New Yorkers die of flu in a normal flu season, health officials say. This virus is unusual in that it began in late April, later than the normal flu season, and has persisted well past the time when people no longer worry about flu in a normal year. There have been 29 new hospitalizations since Thursday, the health department said, for a total of 375 since the outbreak began. There have been 623 confirmed swine flu cases in New York City, though because testing is limited, that does not reflect the true spread of the virus. Copyright 2009 The New York Times Company. New CDC chief to target smoking; led charge in NYC City Reports Eighth Death Connected With Swine Flu Associated Press Medical Writer By Mike Stobbe New York Times Saturday, June 6, 2009 Dr. Thomas Frieden has swung a big stick as New York City's top health official, pushing through bans on smoking and artery-clogging trans fats. The New York Post called him "Dr. Buttinsky." Others attacked him as a wrong-headed crusader. But smoking plummeted and the city made admired inroads against cancer and other chronic diseases. On Sunday, he heads to Atlanta. And on Monday he takes over the federal government's top public health agency, the Centers for Disease Control and Prevention - where he's going to have to try a different approach. At the CDC, the 48-year-old physician will command a larger agency, but one with few regulatory powers and more political headaches. Any campaigns against smoking, obesity and other health dangers will have to be won more with carrots than sticks, public health experts say. "He can't walk across the hall and find a sympathetic mayor and get stuff through. It's a different playing field," said Dr. Jeff Koplan, a former CDC director who fell out of favor with the Bush administration. A key to succeeding in the CDC job will be whether Frieden can influence other federal agencies, state and local health departments, and health authorities around the world, experts said. In an interview this week with The Associated Press, Frieden acknowledged the challenge and said partnering with other agencies will be more crucial than it was in New York. "It's really very different," he said of his new job. He listed smoking as the nation's No. 1 health issue, and stressed the importance of fighting preventable illnesses. But in carefully worded responses, he did not reveal plans for any new campaigns, saying his initial goal is to work with CDC staff to build future plans. Was being head of CDC something he aspired to? "I've never really thought about the next job," he said. Until this week, Frieden ran the New York City Department of Health and Mental Hygiene, one of the nation's largest local health agencies, with an annual budget of $1.7 billion and a staff of more than 6,000. The CDC and its sister unit, the Agency for Toxic Substances and Disease Registry, have a combined budget of about $10.1 billion and more than 14,000 full-time, part-time and contract employees. The CDC is well regarded but has had its problems. The agency investigates disease outbreaks, researches health problems, and promotes illness prevention. CDC officials lead the federal response to threats like swine flu, SARS and food poisoning outbreaks. In a 2007 Harris Poll, the CDC was rated as the government agency that does the best job. But internally, the agency was demoralized. Employees complained about a reorganization that added new layers of bureaucracy, and knocked CDC brass for sometimes going along with Bush administration political positions at the sacrifice of science. Frieden arrives with a data-first reputation, earned partly through his decision at the start of his New York tenure in 2002, to survey the city to identify the most pressing health issues. He used the information powerfully, to set goals, clear away opposition and energize his staff. "He impresses upon people the importance of their work and the ideal of improving the public's health. He gets people whipped up," said David Vlahov, a member of the New York Board of Health. Colleagues describe him as smart, direct, a careful listener, a skilled communicator, a bit reserved with most people. Oh, and very determined. "He scares some people," Vlahov said. Frieden was a CDC disease investigator in 1990 when he was assigned to New York City and worked on a large outbreak of drug-resistant tuberculosis. He stayed there, taking a job heading the city's tuberculosis control. Cases of multidrug-resistant TB dropped by 80 percent. In 1996, he began working in India with the World Health Organization on tuberculosis control. "I hadn't planned on coming back. I sold my apartment in New York," he said. But New York Mayor Michael Bloomberg, elected in 2001, tapped him to be the city's health commissioner. Bloomberg is known as a political and philanthropic champion for public health and he firmly backed Frieden and his plans to attack chronic diseases. In 2003, the city banned ban smoking in almost all workplaces, a precedent-setting move that inspired other cities to do the same. New York also instituted cigarette tax hikes. Health officials estimate the city has 300,000 fewer smokers now than in 2002, which should translate to fewer cancer cases. In 2006, New York became the first U.S. city to ban restaurants from using artificial trans fats, and required hundreds of eateries to post calorie counts on their menus. The department's aggressive new efforts drew lawsuits and outrage from some quarters. Civil libertarians and some food industry representatives gagged on the city's attempts to force dietary changes and remain unhappy with the Obama administration's choice of Frieden to head the CDC. Some believe Frieden was chosen primarily for his work with New York doctors to expand the use of electronic medical records and systematically collect blood sugar tests from the city's patients in an effort to control the city's rampant diabetes. Those concepts fit with efforts to change the U.S. health system, not only to expand insurance coverage, but also to prevent disease, experts said. "I would argue that one of the reasons he was chosen was that he was able to make the case of how public health can play a vital role in a reformed health care system," said Jeff Levi, who heads Trust for America's Health, a research group. "It's that kind of vision that probably was most attractive to the administration." Of course, it didn't hurt that Frieden performed well during the recent swine flu outbreak, Levi said. New York was the scene of the first big U.S. outbreak. Some of Frieden's longtime colleagues say they're excited about what he may accomplish in his new job. Said New York Board of Health member Vlahov: "I'm very optimistic about the CDC having a new heyday." ___ On the Net: New York Health Department bio: http://www.nyc.gov/html/doh/html/commish/combio.shtml Copyright 2009 New York Times. Some Doctors Question Safety Study on Glaxo's Avandia By Jeanne Whalen Wall Street Journal Saturday, June 6, 2009 A large clinical study designed to test whether GlaxoSmithKline PLC's diabetes drug Avandia can be harmful to the heart appears to have raised more questions than it has answered, with some physicians calling the study flawed. Safety concerns have dogged Avandia since 2007, when an analysis of the drug suggested that people taking it had a higher chance of suffering a heart attack than people taking other diabetes pills. That analysis helped cut Avandia's sales in half, from £1.65 billion ($2.67 billion) in 2006 to £805 billion last year, and it sent researchers scrambling to scrutinize the drug. Avandia and other diabetes drugs are designed to control blood-sugar levels, which can reduce a person's risk for cardiovascular disease. But much is still unknown about the way diabetes drugs affect the heart. Results of a large, Glaxo-funded trial published in the medical journal The Lancet Friday showed that people taking Avandia didn't have a higher risk of being hospitalized or dying from cardiovascular problems than people taking other drugs for Type 2 diabetes, an outcome that Philip Home, chairman of the study's steering committee and a professor at Newcastle University, said "provides a robust assessment of [Avandia's] cardiovascular safety." [Avandia] Bloomberg News Safety concerns have dogged Avandia since 2007. The study "provides important and reassuring information about Avandia for physicians fighting diabetes," said Ellen Strahlman, Glaxo's chief medical officer. But a pair of doctors writing an editorial in the Lancet said "definitive conclusions" about Avandia's effects on the heart "remain elusive" because of the study's "limitations." The 4,447 patients in the study, called Record, were divided into groups. One group received Avandia plus one of two older diabetes drugs; the other received the two older drugs in combination. They were followed for 5µ years. In their editorial, the endocrinologists Ravi Retnakaran and Bernard Zinman of Mount Sinai Hospital in Toronto said the rate of cardiovascular problems in the trial was lower than expected, making it difficult to draw firm conclusions. One potential reason, they said, was that a significant number of people in the Avandia group took cholesterol-lowering statins, which are known to reduce a person's risk of heart attacks or other cardiovascular problems. A relatively high level of patients dropping out of the trial may also have compromised the results and led to a lower than expected number of cardiovascular problems, some physicians said. According to Glaxo, about 45% of participants dropped out of the trial at some point. Some physicians said this could have happened because of the negative publicity surrounding Avandia. A Glaxo spokeswoman said the dropout rate did not affect the primary aim of the study, which was to show that Avandia didn't increase the risk for death or hospitalization due to cardiovascular problems. Concerning heart attacks specifically, there were 60 cases in the Avandia group versus 52 in the other group, a difference that could have been due to chance, the study's authors said, calling the evidence about heart-attack risks "inconclusive." David Robbins, a professor of medicine at Kansas University School of Medicine, said the Record trial may have been too small to generate enough cardiovascular events to show for certain whether Avandia is riskier than other drugs. He also expressed disappointment that Avandia didn't improve cardiovascular outcomes. "What we really want in diabetes is that these drugs are reducing cardiovascular events," he said. "Lowering blood sugar is not enough." The study confirmed previously known risks related to Avandia that are already noted on the drug's prescribing label. The drug doubled patients' risk of developing heart failure. Avandia also increased the risk of patients, mostly women, developing bone fractures.. Printed in The Wall Street Journal, page B5 Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved. Tobacco Regulation Bill Is Expected to Pass Senate By Duff Wilson New York Times Saturday, June 6, 2009 WASHINGTON — Richard M. Burr, the Republican tobacco-state senator who tried a filibuster this week against a bill that would allow the Food and Drug Administration to regulate the cigarette industry, flew home to North Carolina for the weekend, conceding that the landmark legislation was likely to pass next week. Although a Senate filibuster killed a similar measure in 1998, times have apparently changed. Mr. Burr acknowledged Thursday that his effort would probably be blocked by a cloture vote that the Senate majority leader, Harry Reid of Nevada, has scheduled for Monday evening. “Clearly the cloture motion will pass,” Mr. Burr said in an interview. “Probably with flying colors,” David Ward, his press secretary, added. After that, a final vote on the tobacco control measure could come Wednesday, Senate staff members said. The House has already passed almost identical legislation, and President Obama has indicated he will sign the measure. Tobacco regulation used to be a fight to the death in Congress, but now Mr. Burr stood largely alone in the filibuster effort. “There’s been a fundamental change in the last 10 years,” Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, an advocacy group that has been a leading proponent of the legislation, said in an interview Friday. He noted the rising public concern about the effect of secondhand smoke on children and the trend toward smoke-free indoor air laws in most states — even, effective next year, in Mr. Burr’s home state. “There has been a change in attitudes about the need to act to reduce tobacco use and a condemnation of the tobacco industry’s continuing behavior,” Mr. Myers said. “I don’t predict Senate votes, but I think the debate this week showed extremely broad support.” The legislation, known as the Family Smoking Prevention and Tobacco Control Act, would for the first time empower the Food and Drug Administration to measure and restrict the harmful chemical components in tobacco and cigarette smoke. It would also require the agency to review new tobacco products; ban the use of terms like “light” and “low tar” that might misleadingly suggest those products were safer; require new, larger health warnings on cigarette packages; and tighten restrictions on marketing and advertising. The legislation is being shepherded through the Senate by Christopher J. Dodd, Democrat of Connecticut. Although the effort’s longtime champion, Edward M. Kennedy, Democrat of Massachusetts, was not present because he is battling brain cancer, Mr. Kennedy’s legacy was invoked often in the debate last week. But it was a Republican, John McCain of Arizona, who first brought comprehensive tobacco legislation to the Senate floor 11 years ago. Philip Morris, then and now the nation’s dominant cigarette maker with the Marlboro brand, initially supported it. But after Mr. McCain toughened the proposal, raising the financial liability for cigarette makers, Philip Morris led a $40 million industry lobbying and public relations campaign against the bill. It fell three votes short in a Senate filibuster. This year, Philip Morris has steadfastly endorsed the legislation, parts of which the company helped write. More than 1,000 health, medical and religious groups have endorsed it as the best chance to regulate tobacco. A smaller number of public health advocates are concerned about Philip Morris’s role. And the second- and third-largest tobacco companies, Reynolds America and Lorillard Tobacco, both based in North Carolina, are fighting the measure. They say it would lock in Philip Morris’s market dominance. Mr. Burr is a first-term senator from Winston-Salem, N.C., the home of Reynolds America, the maker of Camel cigarettes and newer, smokeless products, which he said would be banned by the F.D.A. requirements. The legislation would set tough standards for industry efforts to promote new products as lower risk. A company would have to show that new products not only reduced harm for current smokers, but also “benefit the health of the population as a whole, taking into account the impact on both users and nonusers of tobacco products.” The phrase encompasses nonsmokers and would-be quitters who might be tempted to try the new products rather than abstain. Mr. Burr said that was a nearly impossible standard even for lower-risk products like snus, a packaged, powdered tobacco developed in Sweden that is placed under the lip, and dissolvable smokeless tobacco products like pellets and filmlike strips. But Jeff Merkley, Democrat of Oregon, said in Senate debate that those products were intended to addict a new generation of children. He termed them “tobacco candy.” Richard J. Durbin, Democrat of Illinois, said, “The tobacco companies know that if they’re going to have 400,000 of their customers die each year, that they have to replace them with children.” An alternative proposal filed by Mr. Burr and Kay Hagan, Democrat of North Carolina, would set up a tobacco office in the Department of Health and Human Services to promote cessation and “reduced harm” products. Mr. Burr said Thursday evening that his alternative had about 45 supporters in the Senate. But the stricter F.D.A. bill had 58 co-sponsors. Copyright 2009 The New York Times Company. *Opinion* --- BACK TO TOP


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