Tuesday, June 9, 2009

News Clipping Archives

 

Maryland / Regional

More people homeless in Baltimore (Baltimore Sun)

Homeless shelter loses United Way funding (Baltimore Sun)

Today, multiple answers to the familiar question: Got milk? (Baltimore Sun)

Exercise can reduce scoliosis symptoms (Baltimore Sun)

MARYLAND Lawmakers request $30M for emergency preparedness (Salisbury Daily Times)

Funds Sought for Preparedness Partnership (Washington Post)

State, county officials take the heat at Ridgely Middle (Catonsville Times)

Maryland Department of Environment issues 80 enforcement actions (Baltimore Business Journal)

Alternative medicine meets mainstream hospitals (USA Today)

 

National / International

House Democrats to consider taxing health benefits (Baltimore Sun)

Exercising for back  pain relief (Baltimore Sun)

Body of lies: Patients aren't 100% honest with doctors (Baltimore Sun)

How to treat a sunburn (Baltimore Sun)

Peanuts, Anyone? (Washington Post)

Coming Clean About Risk of Finger Food (Washington Post)

Decision Makers Differ on How To Mend Broken Health System (Washington Post)

What to know before buying supplements (Washington Post)

At Last, Facing Down Bullies (and Their Enablers) (New York Times)

Tests show many supplements have quality problems (Washington Post)

Roche Makes Headway on New Diabetes Drug (Wall Street Journal)

HIV rate among South African teens has dropped (Washington Post)

Is This a Pandemic? Define ‘Pandemic’ (Washington Post)

Navy reports 21 swine flu cases on USS Iwo Jima (Salisbury Daily Times)

Egypt: Five more Americans test positive for swine flu (USA Today)

WHO may soon raise swine flu alert to pandemic level (USA Today)

 

Opinion

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Maryland / Regional

More people homeless in Baltimore

Census shows 12% increase, underscores mayor's goal of getting people off streets

 

By Julie Bykowicz

Baltimore Sun

Tuesday, June 9, 2009

 

Baltimore's homeless population is on the rise, a study released Monday shows, bolstering Mayor Sheila Dixon's case for spending millions on year-round emergency shelters and the construction of a proposed permanent facility.

 

The census, conducted Jan. 22, found 3,419 homeless people, including those who live in shelters as well as more than 1,000 street dwellers.

 

The total was up 12 percent from two years ago, and nearly 28 percent since the census began in 2003. The U.S. Department of Housing and Urban Development requires the biannual survey for federal funding.

 

Early last year, Dixon announced a 10-year plan to end homelessness in Baltimore. A 275-bed, $8.2 million emergency facility on the Fallsway could open next spring, though the city is still reviewing proposals. Dixon has also used federal low-income housing vouchers to move about 150 homeless families and individuals into permanent residences over the past 18 months.

 

Diane Glauber, director of Baltimore Homeless Services, said the census provides a rare snapshot of homelessness and helps to show where to deploy resources for maximum impact. Federal officials use the figures for some formula-based grants, including money for emergency shelters.

 

Some of the key findings this year include:

 

•About 85 percent of the overall homeless population was African-American.

 

•About 23 percent of the 2,265 shelter occupants were children.

 

•Most of the street dwellers were men, and nearly half of them were between ages 45 and 60.

 

•More than 30 percent of the people in shelters were chronically homeless with substance abuse and mental health problems.

 

Reaching out to the street population has proven difficult for those trying to assist them.

 

On a recent afternoon, Achike Oranye, an outreach worker with People Encouraging People, and Gregory Sileo, the city's homeless outreach coordinator, walked through downtown to talk to some of the people who have been living on the streets for years.

 

Oranye and Sileo approached a pair of men at the mouth of a dingy alley on Baltimore Street. The two showed the effects of the alcohol they said they had been drinking all afternoon. A 57-year-old in a wheelchair, who has been homeless in the area for as long as anyone can remember (he says 35 years), said drinking is his way of coping.

 

Asked why he hadn't taken the city's offers of help, he said, "I'm a survivor," and turned away. Sileo was visibly frustrated.

 

"At some point, it's like, 'What more can we do?' " Sileo said. "We keep trying every day and hoping eventually there will be a breakthrough."

 

Baltimore's unsheltered homeless population ballooned from 242 in 2005 to 1,154 this year, according to the census, but officials attribute much of that increase to better counting methods. About 75 volunteers flooded the downtown area for the street count this year, compared to fewer than a dozen in 2005.

 

"The complexity of counting the homeless is a real challenge," said Mary Anne Akers, dean of Morgan State University's School of Architecture and Planning, which tallied the numbers. "I don't think any city can say it is 100 percent accurate, but we are as close as we can be."

 

National experts say undercounting is a problem with almost any homeless population census. And every city counts differently, making comparisons difficult.

 

Philadelphia, which has about twice as many residents as Baltimore, reports a shelter population of about 2,600 and a street population of about 550. Washington, a slightly smaller city, counted more than 6,000 homeless people, including 378 on the streets, last year.

 

Locally, Baltimore County also saw an increase in its latest homeless census, counting 692 this year. Mary Harvey, director of the Office of Community Conservation, said better methodology accounts for some, but not all, of the rise.

 

Dixon said the city's census numbers came as no surprise, given the national economic downturn and scant resources for people with mental illness and substance abuse.

 

Baltimore is to receive about $10 million in federal stimulus money to move homeless people into permanent housing and to prevent homelessness by addressing foreclosures.

 

This winter, the Harry and Jeannette Weinberg Foundation pledged $1.8 million to the proposed emergency shelter at 620 Fallsway.

 

Dixon said she has been particularly focused on moving chronically homeless street-dwellers into permanent housing. Many of the housing vouchers for the homeless have gone to people living in encampments under the Jones Falls Expressway and on the grounds of St. Vincent de Paul Church at the end of the expressway.

 

While the emergency facility is being built, Dixon has kept shelters open 24 hours a day throughout the year, parting with the city's tradition of "code blue" shelters open on only the most frigid of winter nights. Single men and women stay at the former Health Department building on Guilford Avenue - which battled a flea infestation a month ago - and women with children stay at a facility on Mount Street.

 

"You definitely see less people on the streets because of the shelters," Dixon said. "But they're still out there."

 

The mayor says she frequently alerts Glauber and Sileo to homeless people she sees on the streets day after day.

 

Just two blocks from City Hall, Richard Crews, 54, has been sitting in a blue camping chair, jangling a change cup, for more than three years.

 

Crews has received a federal housing voucher from Dixon's homeless workers and been approved for a place on Washington Boulevard, the outreach workers said. Yet Crews hasn't left his spot.

 

Oranye, a licensed counselor who has worked in Baltimore for more than five years, said some of the veteran street dwellers are loath to leave their downtown perches - places that have become comfortable to them.

 

Copyright 2009 Baltimore Sun.

 

Homeless shelter loses United Way funding

Agency blames faulty funds application

 

By Larry Carson

Baltimore Sun

Monday, June 8, 2009

 

At a time when charitable giving is down because of the national recession, United Way of Central Maryland will stop funding for Howard County's main homeless shelter for the first time since 1978.

 

The action threatens to renew a 2007 rift over United Way funding cuts to groups across the region. During that dispute, Howard County Executive Ken Ulman threatened to create a rival charitable organization or end county government participation in United Way, but the dispute ended with an agreement to allow more local influence over the regional agency's funding grants.

 

Despite that, Howard's Grassroots Crisis Intervention Center was denied any money for the fiscal year starting July 1. Grassroots, which last spring opened an enlarged, $5.5 million homeless shelter in Columbia, had applied for $77,950 to help fund its $2.4 million annual budget.

 

By contrast, United Way doubled its contribution to $61,000 for Congregations Concerned for the Homeless, another Howard-based group, to provide transitional housing for eight families. Howard-based Domestic Violence Center is to get $25,000, the same amount as this year.

 

The reason for halting funding for Grassroots is unclear, with different accounts coming from the two sides.

 

Andrea Ingram, Grassroots' executive director, said she had no advance inkling of what was coming and is mystified by the denial.

 

"With our new facility, we've experienced an explosion of need," she said. "This is huge for us," she said about the loss of United Way support. Grassroots has had a committee working since January to identify new sources of money to combat funding problems, Ingram said. The United Way money would have paid for two case managers to teach financial literacy and to run emergency programs like the new day center Grassroots opened along U.S. 1 last year to provide showers, laundering services and food to a group of chronically homeless people in North Laurel.

 

"Our opinion is that they should have gotten this funding," said Susan Rosenbaum, who as director of the county's Department of Citizen Services reviewed Grassroots' application. "We don't understand this decision."

 

Ulman said he was "very disappointed" and expressed that to Larry E. Walton, a county resident who is president and chief professional officer for United Way of Central Maryland.

 

"Grassroots is one of the few organizations we increased funding to," Ulman said about the county's grants to nonprofits. "Arguably, it's the most important nonprofit in our county."

 

Walton said United Way's donations are projected to drop $3 million under the goal for fiscal 2010. In response, the group shortened its normal 30-month budgeting period to one year in hopes that conditions will improve. United Way awarded $2.6 million for the next fiscal year to 40 organizations across Central Maryland, compared to $4.2 million annually over the past several years. He said United Way had 120 applications for requests totaling $10 million.

 

The lowered funding combined with heightened needs, he said, forced the organization to concentrate on "basic needs," and stop funding youth agencies that were traditional recipients such as the Boy Scouts and Girl Scouts of Maryland, Big Brother and Big Sisters of Maryland and the Boys and Girls Clubs of Harford County.

 

In a letter to Ulman, Walton said six agencies serving Howard would get $291,000 in fiscal 2010, plus $1.3 million more designated by donors to go to nonprofits that serve or are in the county. United Way allows contributors to choose specific destinations for their gifts.

 

Walton said he was surprised, however, when he saw Grassroots was missing from the list, but added that the application was faulty, a statement Howard County and Grassroots officials contend isn't true.

 

"They took themselves out of the race before the race even started," Walton said, by "applying for programs we weren't funding." Walton said he hopes Grassroots can qualify next year, but in the interim may be able to get some money from a $31,000 discretionary fund available for Howard organizations.

 

"They're a good agency," he said.

 

Sandy Monck, United Way's senior vice president for community impact strategies, said "they may have followed the instructions of the Request for Proposals" , but "did not meet the review criteria" when volunteers evaluating all the requests applied United Way's four standards; limited funding, alignment with United Way's priorities, demonstrated capacity to provide services and good ways to measure performance and do budgeting. She refused to say specifically why Grassroots failed to qualify, adding that United Way officials will meet with Ingram and her staff soon to explain further.

 

Ingram said Grassroots also lost $6,500 in other grants, though Howard County pitched in an extra $11,000 for fiscal 2010. The county provides about $1 million of Grassroots' annual budget, she said.

 

Ulman said the May 21 decision to deny funding to Grassroots seems to reverse the progress made after the last dispute.

 

"I had felt we were working much better together," he said.

 

He said he asked Walton to look for other funding sources for Grassroots, and offered a new warning.

 

"If this is more than a one-time issue, we may have to look at our relationship with United Way," he said.

 

Copyright 2009 Baltimore Sun.

 

Today, multiple answers to the familiar question: Got milk?

 

By Laura Vozzella

Baltimore Sun

Monday, June 8, 2009

 

Patty Sullivan of Catonsville is stumped by the dairy case. One kind of milk promises to make her children smarter. Another claims to come from healthier cows. Unable to sort all that out, she reaches for good old, conventional Costco milk."I find it very confusing," said Sullivan, who picks up five gallons a week for the Burtonsville preschool she runs. "You need a research degree to find out the differences. And is it really that much better for you?"

 

Not long ago, consumers only had to ponder one thing before hefting a gallon jug into the shopping cart: How much fat did they want? Then, more than a decade ago, organic started showing up in ordinary supermarkets.

 

Today, the world of milk is even more rarefied - and more confusing, because the milk trucks are moving more quickly than the science. Researchers can't even agree if milk "does a body good," much less which kind is best. While consumers can have their pick of more milk varieties than ever before, they also have more questions about a product considered to be a cornerstone of childhood nutrition - one that each American, on average, slurps down at a rate of 24 gallons a year.

 

There's milk from grass-fed cows, said to be more nutritious and better for the environment. Milk with added omega-3 fatty acids, touted as boosting brain function. Nonhomogenized milk that fans are willing to shake before drinking - in glass bottles, no less - on the premise that their bodies won't absorb as much fat if it hasn't been blasted into tiny bits.

 

Ultra-pasteurized. Low-pasteurized. And unpasteurized "raw" milk, whose devotees are so convinced of its superior health benefits that they'll travel from Maryland, where sales are outlawed, to Pennsylvania, where it's legit.

 

With soy, rice and almond milks suddenly mainstream fare, the dairy case has become more crowded than a feedlot. The grocer's got milk, all right, even in a troubled economy that reportedly has milk sales slumping.

 

None of it is cheap.

 

While Sullivan spent about $2.25 a gallon for that conventional milk at Costco, Wendy Johnson, a special-education teacher from Hanover, pays more than twice as much for organic. She shells out even more - about $14 a gallon - for individual, juice box-like containers of organic milk for when the family's on the go.

 

Johnson figures organic is best for her 5-year-old daughter, but she has some doubts, precisely because of those handy little "shelf-stable" boxes that don't need refrigeration.

 

"If you can put it on the shelf, what's left in it?" Johnson wonders.

 

Not that Johnson can take it as a given that milk is good for her daughter in the first place.

 

Just last month in the American Journal of Clinical Nutrition, Purdue University foods and nutrition professor Connie Weaver wrote that milk is an important source of calcium and other nutrients, improves bone health and reduces the risk of stroke and some cancers. Research has put to rest concerns that it might increase prostate cancer, she noted. But in the same issue, University of North Carolina nutrition scientist Amy Joy Lanou argued that milk increases prostate and ovarian cancers. Her advice: Stay away from the stuff.

 

Even the experts who think milk is healthful don't agree on much else.

 

The National Dairy Council and other industry groups contend that all milks are created equal. The U.S. Food and Drug Administration agrees, finding "no significant difference" between organic milk and what flows from cows given synthetic growth hormones to boost production.

 

"We wouldn't favor one type of milk over another," said Michael Herndon, an FDA spokesman. Like the Dairy Council, Herndon dismissed the various milk varieties as pure "marketing."

 

But food-safety and sustainable-farming advocates maintain that organic milk is safer. Even if the synthetic hormones, approved by the FDA in 1994, do not show up in conventional milk, they say, they seem to raise the level of other, naturally occurring hormones in the milk that could pose problems for humans. They also contend that artificial hormones are rough on the cows, causing more infections that, in turn, lead to more antibiotic use on the farm.

 

In any case, these advocates say, there are too many unknowns.

 

"I think there's a real void in the science," said Patty Lovera, assistant director of Food and Water Watch, a consumer group based in Washington. "That just wasn't where the [agricultural research] focus was. It was how to be bigger, how to get faster."

 

There is one point of consensus: Cows that feed on grass produce milk that's higher in omega-3 fatty acids, vitamin E, beta-carotene and an antioxidant called conjugated linoleic acid - all good stuff for the body.

 

But there's no way, short of farm surveillance, for consumers to know if Bessie is really munching much green.

 

To make milk worthy of the U.S. Department of Agriculture organic label, cows cannot be treated with antibiotics or synthetic growth hormones. The animals must be given feed produced without chemical fertilizers and pesticides. And the cows must have "access to pasture."

 

The pasture part is problematic because the government has not spelled out what "access to pasture" means. As for milk marketed as "grass-fed," the FDA has not defined the term at all.

 

On this point alone, Big Dairy and food activists find common ground.

 

"Grazing is the key," wrote Rusty Bishop, director of the Center for Dairy Research at the University of Wisconsin in Madison. "The problem is that the majority of organic fluid milk on the market is from cows on pasture an average of 60 partial days, and pasture grasses make up less than 5 percent of their dryweight feed intake."

 

Bishop's research center bills itself as independent but receives substantial funding from the milk industry. His comments about grazing are part of a June 2007 study that otherwise pooh-poohs the purported advantages of organic milk.

 

But his grazing gripe could have easily come out of the mouth of John Peck, who hails from way on the other side of the milk debate. The executive director of the Madison, Wis.-based Family Farm Defenders worries about factory farms co-opting the organic label and wants the government to establish grazing standards.

 

So while he agrees with Bishop on grazing, Peck's milk mantra couldn't be more different. "The best milk is milk that's unhomogenized, unpasteurized, grass-fed, in a glass bottle, from a farm within 20, 30 miles of you," Peck said.

 

That sort of certainty is harder to come by in the supermarket aisles, even for consumers up on the latest nutrition news.

 

Greg Resch, general manager of David's Natural Market in Columbia, buys Horizon Organic Milk Plus DHA Omega-3 Whole Milk Ultra Pasteurized for his family. The milk costs a whopping $4.99 for a half-gallon at David's, a small store that devotes an entire four-door refrigerated case to milk.

 

Resch chooses that particular milk because it is supplemented with docosahexaenoic acid or DHA, an omega-3 fatty acid that's derived from algae and thought to promote brain development. His kids aren't big on fish, another source of the nutrient, so the milk is his way of slipping a little brain food into their diet.

 

Resch isn't thrilled that the milk is ultra-pasteurized, heated to a temperature higher than what's necessary for normal pasteurization. That's done to extend the shelf life for many brands of organic milk, which tend to sit longer in the store because they're pricey.

 

Some suspect the high heat - the same thing that keeps those little "shelf-stable" milk boxes fresh outside the fridge - zaps all the good stuff out of milk.

 

Resch just weighs the pros and cons, tries to make the best choice, and accepts the fact that nothing's perfect.

 

"It can get almost crazy sometimes," he said. "You can only do so much to Mother Nature."

 

deciphering the dairy case

Milk: Conventional milk comes from cows that may have been treated with antibiotics and injected with synthetic growth hormone. The animals also may eat feed treated with chemical pesticides.

 

No added hormones: Milk from cows not treated with synthetic bovine growth hormones (called rBGH and BST on some labels). Sometimes billed as "hormone-free," but that's a misnomer, since all milk has naturally occurring hormones.

 

Organic: From cows not treated with antibiotics or artificial growth hormones. The animals also eat feed raised without chemical fertilizers or pesticides and must have "access to pasture." How often do the cows have grass under hoof? No telling. The government has not defined "access to pasture."

 

Grass-fed: Milk from cows that spend at least some of their time grazing. How much of their diet is grass? Another undefined term, another unknown.

 

Plus DHA: Milk supplemented with a supposedly brain-boosting omega-3 fatty acid derived from algae.

 

Homogenized: Milk that has been pressurized to evenly distribute the fat, so the cream doesn't rise to the top. Almost all of the milk on the market fits this description.

 

Nonhomogenized: The fat is not blasted into tiny bits in this variety, produced by some niche dairies. Before pouring, shake the bottle to mix in the cream or scoop it off for your coffee.

 

Pasteurized: Milk heated to 161 degrees to kill off potentially harmful bacteria.

 

Ultra-pasteurized: Milk heated to 280 degrees, a temperature higher than what's needed for pasteurization, to extend its shelf life.

 

Raw or unpasteurized: From the cow's udder to your lips. Because the milk's not heated, no nutrients are lost, devotees claim. But drinkers risk illness - and arrest if they buy it in Maryland, where sales are illegal.

 

Copyright 2009 Baltimore Sun.

 

Exercise can reduce scoliosis symptoms

 

Ask the expert: Charles Edwards II, Mercy Medical Center

Baltimore Sun

Tuesday, June 9, 2009

 

Scoliosis, an abnormal curvature of the spine, affects roughly 2 percent of the population, according to the American Academy of Orthopaedic Surgeons. For National Scoliosis Awareness Month, Dr. Charles Edwards II of the Maryland Spine Center at Mercy Medical Center offers five things you should know about the disease.

 

•Abnormal curvature of the spine is termed scoliosis. It typically increases in size during the years of most rapid growth. Children with scoliosis are evaluated with spine X-rays every six to 12 months.

 

•For children and adolescents with moderate curves, rigid bracing of the spine can help prevent worsening of the deformity. For larger curves, surgery is often recommended to prevent further worsening during adulthood and to improve the appearance of the deformity.

 

•Scoliosis can develop or worsen as the cushions within the spine (disks) age and flatten. Adults with mild scoliosis are typically asymptomatic. Adults with larger scoliosis curves often experience increasing back pain and compression of the nerves within the spine. Such compression, called sciatica, can cause pain, numbness and weakness in the legs.

 

•Regular exercise, smoking avoidance and anti-inflammatory medications are useful for preventing and minimizing symptoms. If the deformity becomes severe or the symptoms debilitating, then surgery may be advisable.

 

•Surgery typically involves straightening of the deformity, opening up the space for the nerves and placement of metal implants to stabilize the spine. A spinal deformity surgeon helps determine whether a limited minimally invasive procedure is appropriate or if a larger, more comprehensive surgery is required.

 

Copyright 2009 Baltimore Sun.

 

MARYLAND Lawmakers request $30M for emergency preparedness

 

Delmarva Media Group

Salisbury Daily Times

Tuesday, June 9, 2009

 

CHEVERLY, Md. — Two Maryland lawmakers are asking for $30 million in federal funding to create the Maryland/National Capital Region Emergency Preparedness Partnership.

 

Democrats Sen. Barbara Mikulski and Rep. Donna Edwards visited Prince George's Hospital Center on Monday to announce their requests that would make the hospital a key player in the region's emergency preparedness efforts.

 

The lawmakers say the partnership would coordinate the region's response in a large-scale emergency and could go toward hospital response to pandemics and other disasters.

 

The partnership would also include Malcolm Grow Medical Center at Andrews Air Force Base and the University of Maryland Medical System.

 

Mikulski has requested $5 million and Edwards has requested $25 million. Their requests must go through the appropriations process.

 

Copyright 2009 Salisbury Daily Times.

 

Funds Sought for Preparedness Partnership

 

By Lori Aratani

Washington Post

Tuesday, June 9, 2009

 

Two Maryland lawmakers are asking for $30 million in federal funding to make Prince George's Hospital Center a key player in efforts to boost the region's emergency preparedness.

 

At a news conference at the hospital yesterday, Sen. Barbara A. Mikulski (D) and Rep. Donna F. Edwards (D-Prince George's) said the money would fund the creation of the Maryland-National Capital Region Emergency Preparedness Partnership. Edwards asked for $25 million in federal funds for fiscal 2010, and Mikulski asked for $5 million.

 

The lawmakers said the partnership would coordinate the response to a large-scale medical emergency caused by a biological, chemical or nuclear attack. The money could also fund the hospital's response to pandemics and other disasters that could cause significant casualties.

 

The partnership would include Malcolm Grow Medical Center at Andrews Air Force Base and the University of Maryland Medical Systems. Prince George's Hospital Center would serve as the central facility for training and trauma surge capacity, the lawmakers said.

 

Copyright 2009 Washington Post.

 

State, county officials take the heat at Ridgely Middle

 

Catonsville Times

Tuesday, June 9, 2009

 

Parents say heat inside school makes for poor learning environment

 

Elected officials and parents of children who attend Ridgely Middle School in Lutherville toured the school Monday to express concern about what parents say is excessive heat in school building.

 

Parents and teachers say some parts of the school are so hot they create an inhospitable learning environment and are even causing health problems for students.

 

In Stephanie Strayers second floor classroom, it was 87 degrees on Monday, with nearly 60 percent humidity, according to a digital weather station in her room.

 

Thats a heat index of 90 degrees, Julie Sugar said after checking a temperature chart.

 

Strayer said she typically has up to 35 students in her room. A full room can make her sixth grade world cultures class even hotter.

 

Last week, it was 94 degrees in here while the students were taking their final exams, Strayer said.

 

Ridgely Middle, built in the mid-1960s, underwent about $14 million in renovations nearly two years ago. The renovations included energy-efficient windows, which dont let in as much air as the old windows did. A chiller unit that would have cooled the school was part of the original plans, but was never installed.

 

The chiller could still be added to the school at a cost of about $966,000, according to Sen. Jim Brochin, a Democrat who represents the 42nd District, which includes Towson, Timonium and part of Pikesville.

 

The new windows open inside and only at a 30-degree angle. The old windows opened outward and at a 90-degree angle.

 

The school system faced criticism from the County Council during last months budget hearings. The councils budget message asked the school to provide a report on how it is addressing the concerns of parents as well as information on other schools that are in a similar condition. The school system has until June 30 to respond.

 

What other schools have similar situations? Councilman Kevin Kamenetz asked after the tour. If its just Ridgely, then fix it.

 

Copyright 2009 Catonsville Times.

 

 

 

Maryland Department of Environment issues 80 enforcement actions

 

By Scott Dance

Baltimore Business Journal

Tuesday, June 9, 2009

 

The Maryland Department of Environment has fined more than two dozen Baltimore-area businesses for pollution violations.

 

The department issued 80 enforcement actions in total Tuesday, seeking penalties of $576,000.

 

The violations included:

 

• A lack of air quality permits at a crushing plant owned by P&J Contracting of Baltimore, for a $31,000 fine;

 

• An emergency discharge of air emissions at Air Products in Sparrows Point, for a $25,000 fine;

 

• Failure to meet air quality permit standards at Sunoco Partners Marketing and Terminals LP in Baltimore County;

 

• Improper protection for workers of Southern Insulation during asbestos removal at the Sparrows Point Steel Mill;

 

• Lead paint at properties owned by Charm City Housing Associates Inc., Rent Man Limited, 3401 Woodbrook LLC, 1645 N. Calhoun Holdings LLC, and Mortgage Solutions Consulting Group LLC;

 

• Improper patient exposure to X-ray radiation at Johns Hopkins Hospital, with a $7,500 fine.

 

Other settlements for radiation exposure were made with:

 

• Dentist Mark S. Blank in Reisterstown,

 

• Dentist Edward J. Sattler in Baltimore,

 

• Arbutus Veterinary Hospital,

 

• H.M. Dunstan & Associates PA in Baltimore,

 

• Edmondson Family Dental Care in Baltimore,

 

• SurgiCenter of Baltimore in Owings Mills,

 

• Dentist Lincoln O. Frank in Baltimore,

 

• Dentist Paul E. Freed in Towson,

 

• Seton Imaging Center in Baltimore,

 

• Dentist Garry D. Snydman in Owings Mills,

 

• Dentist Karl J. Zeren in Timonium,

 

• Chase Brexton Health Services Inc. in Baltimore,

 

• Mandel Keiser & Joseph LLP in Owings Mills,

 

• Dentist Thomas F. Menton in Ellicott City,

 

• Dentist Michael L. DiPaula in Baltimore,

 

• Dundalk Cosmetic and Family Dental Center,

 

• Sarubin Family Dental Associates in Baltimore,

 

• Dentist Lynn R. Chincheck in Timonium, and,

 

• Dentist Richard N. Lamb in Baltimore.

 

Radiation fines ranged from $250 to $1,000.

 

All contents of this site © American City Business Journals Inc. All rights reserved.

 

Alternative medicine meets mainstream hospitals

 

Associated Press

By Marilynn Marchione

USA Today

Tuesday, June 6, 2009

 

BALTIMORE — At one of the nation's top trauma hospitals, a nurse circles a patient's bed, humming and waving her arms as if shooing evil spirits. Another woman rubs a quartz bowl with a wand, making tunes that mix with the beeping monitors and hissing respirator keeping the man alive.

 

They are doing Reiki therapy, which claims to heal through invisible energy fields. The anesthesia chief, Dr. Richard Dutton, calls it "mystical mumbo jumbo." Still, he's a fan.

 

"It's self-hypnosis" that can help patients relax, he said. "If you tell yourself you have less pain, you actually do have less pain."

 

Alternative medicine has become mainstream. It is finding wider acceptance by doctors, insurers and hospitals like the shock trauma center at the University of Maryland Medical Center. Consumer spending on it in some cases rivals that of traditional health care.

 

People turn to unconventional therapies and herbal remedies for everything from hot flashes and trouble sleeping to cancer and heart disease. They crave more "care" in their health care. They distrust drug companies and the government. They want natural, safer remedies.

 

But often, that is not what they get. Government actions and powerful interest groups have left consumers vulnerable to flawed products and misleading marketing.

 

Dietary supplements do not have to be proved safe or effective before they can be sold. Some contain natural things you might not want, such as lead and arsenic. Some interfere with other things you may be taking, such as birth control pills.

 

"Herbals are medicines," with good and bad effects, said Bruce Silverglade of the consumer group Center for Science in the Public Interest.

 

Contrary to their little-guy image, many of these products are made by big businesses.

 

Ingredients and their countries of origin are a mystery to consumers. They are marketed in ways that manipulate emotions, just like ads for hot cars and cool clothes. Some make claims that average people can't parse as proof of effectiveness or blather, like "restores cell-to-cell communication."

 

Even therapies that may help certain conditions, such as acupuncture, are being touted for uses beyond their evidence.

 

An Associated Press review of dozens of studies and interviews with more than 100 sources found an underground medical system operating in plain sight, with a different standard than the rest of medical care, and millions of people using it on blind faith.

 

How did things get this way?

 

Fifteen years ago, Congress decided to allow dietary and herbal supplements to be sold without federal Food and Drug Administration approval. The number of products soared, from about 4,000 then to well over 40,000 now.

 

Ten years ago, Congress created a new federal agency to study supplements and unconventional therapies. But more than $2.5 billion of tax-financed research has not found any cures or major treatment advances, aside from certain uses for acupuncture and ginger for chemotherapy-related nausea. If anything, evidence has mounted that many of these pills and therapies lack value.

 

Yet they are finding ever-wider use:

 

•Big hospitals and clinics increasingly offer alternative therapies. Many just offer stress reducers like meditation, yoga and massage. But some offer treatments with little or no scientific basis, to patients who are emotionally vulnerable and gravely ill. The Baltimore hospital, for example, is not charging for Reiki but wants to if it can be shown to help. Other hospitals earn fees from treatments such as acupuncture, which insurance does not always cover if the purpose is not sufficiently proven. The giant HMO Kaiser Permanente pays for members to go to a Portland, Ore., doctor who prescribes ayurvedics — traditional herbal remedies from India.

 

•Some medical schools are teaching future doctors about alternative medicine, sometimes with federal grants. The goal is educating them about what patients are using so they can give evidence-based, nonjudgmental care. But some schools have ties to alternative medicine practitioners and advocates. A University of Minnesota program lets students study nontraditional healing methods at a center in Hawaii supported by a philanthropist fan of such care, though students pay their own travel and living expenses. A private foundation that wants wider inclusion of nontraditional methods sponsors fellowships for hands-on experience at the University of Arizona's Program in Integrative Medicine, headed by well-known advocate Dr. Andrew Weil.

 

•Health insurers are cutting deals to let alternative medicine providers market supplements and services directly to members. At least one insurer promotes these to members with a discount, perhaps leaving an incorrect impression they are covered services and medically sound. Some insurers steer patients to Internet sellers of supplements, even though patients must pay for these out of pocket. There are networks of alternative medicine providers that contract with big employers, just like HMOs.

 

A few herbal supplements can directly threaten health. A surprising number do not supply what their labels claim, contain potentially harmful substances like lead, or are laced with hidden versions of prescription drugs.

 

"In testing, one out of four supplements has a problem," said Dr. Tod Cooperman, president of ConsumerLab.com, an independent company that rates such products.

 

Even when the ingredients aren't risky, spending money for a product with no proven benefit is no small harm when the economy is bad and people can't afford health insurance or healthy food.

 

But sometimes the cost is far greater. Cancer patients can lose their only chance of beating the disease by gambling on unproven treatments. People with clogged arteries can suffer a heart attack. Children can be harmed by unproven therapies forced on them by parents who distrust conventional medicine.

 

Mainstream medicine and prescription drugs have problems, too. Popular drugs such as the painkillers Vioxx and Bextra have been pulled from the market after serious side effects emerged once they were widely used by consumers. But at least there are regulatory systems, guideline-setting groups and watchdog agencies helping to keep traditional medicine in line.

 

The safety net for alternative medicine is far flimsier.

 

The latest government survey shows the magnitude of risk: More than a third of Americans use unconventional therapies, including acupuncture, homeopathy, chiropractic, and native or traditional healing methods. These practitioners are largely self-policing, with their own schools and accreditation groups. Some states license certain types, like acupuncturists; others do not.

 

Tens of millions of Americans take dietary supplements — vitamins, minerals and herbs, ranging from ginseng and selenium to fish oil and zinc, said Steven Mister, president of the Council for Responsible Nutrition, an industry trade group.

 

"We bristle when people talk about us as if we're just fringe," he said. Supplements are "an insurance policy" if someone doesn't always eat right, he said.

 

In fact, some are widely recommended by doctors — prenatal vitamins for pregnant women, calcium for older women at risk of osteoporosis, and fish oil for some heart patients, for example. These uses are generally thought to be safe, although independent testing has found quality problems and occasional safety concerns with specific products, such as too much or too little of a vitamin.

 

Some studies suggest that vitamin deficiencies can raise the risk of disease. But it is not clear that taking supplements will fix that, and research has found hints of harm, said Dr. Jeffrey White, complementary and alternative medicine chief at the National Cancer Institute. A doctor with a big interest in nutrition, he sees the field as "an area of opportunity" that deserves serious study.

 

So does Dr. Josephine Briggs, director of the National Center for Complementary and Alternative Medicine, the federal agency Congress created a decade ago.

 

"Most patients are not treated very satisfactorily," Briggs said. "If we had highly effective, satisfactory conventional treatment we probably wouldn't have as much need for these other strategies and as much public interest in them."

 

Even critics of alternative medicine providers understand their appeal.

 

"They give you a lot of time. They treat you like someone special," said R. Barker Bausell, a University of Maryland biostatistician who wrote "Snake Oil Science," a book about flawed research in the field.

 

That is why Dr. Mitchell Gaynor, a cancer specialist at the Weill-Cornell Medical Center in New York, said he includes nutrition testing and counseling, meditation and relaxation techniques in his treatment, though not everyone would agree with some of the things he recommends.

 

"You do have people who will say 'chemotherapy is just poison,'" said Gaynor, who tells them he doesn't agree. He'll say: "Cancer takes decades to develop, so you're not going to be able to think that all of a sudden you're going to change your diet or do meditation (and cure it). You need to treat it medically. You can still do things to make your diet better. You can still do meditation to reduce your stress."

 

Once their fears and feelings are acknowledged, most patients "will do the right thing, do everything they can to save their life," Gaynor said.

 

Many people buy supplements to treat life's little miseries — trouble falling asleep, menopausal hot flashes, memory lapses, the need to lose weight, sexual problems.

 

The Dietary Supplement and Health Education Act of 1994 exempted such products from needing FDA approval or proof of safety or effectiveness before they go on sale.

 

"That has resulted in consumers wasting billions of dollars on products of either no or dubious benefit," said Silverglade of the public interest group.

 

Many hope that President Barack Obama's administration will take a new look. In the meantime, some outlandish claims are drawing a backlash. The industry has stepped up self-policing — the Council for Responsible Nutrition hired a lawyer to work with the Council of Better Business Bureaus and file complaints against problem sellers.

 

"We certainly don't think this is a huge problem in the industry," Mister said, but he acknowledges occasionally seeing infomercials "that promise the world."

 

"The outliers were making the public feel that this entire industry was just snake oil and that there weren't any legitimate products," said Andrea Levine, ad division chief for the business bureaus.

 

The FDA just issued its first guidelines for good manufacturing practices, aimed at improving supplement safety. Consumer groups say the rules don't go far enough — for example, they don't set limits on contaminants like lead and arsenic — but they do give the FDA more leverage after problems come to light.

 

The Federal Trade Commission is filing more complaints about deceptive marketing. One of the largest settlements occurred last August — $30 million from the makers of Airborne, a product marketed with a folksy "invented by a teacher" slogan that claimed to ward off germs spread through the air.

 

People need to keep a healthy skepticism about that magical marketing term "natural," said Kathy Allen, a dietitian at Moffitt Cancer Center in Tampa

 

The truth is, supplements lack proof of safety or benefit. Asked to take a drug under those terms, "most of us would say 'no,'" Allen said. "When it says 'natural,' the perception is there is no harm. And that is just not true."

 

Copyright 2009 The Associated Press. All rights reserved.

 

National / International

House Democrats to consider taxing health benefits

 

Associated Press

By David Espo

Baltimore Sun

Tuesday, June 9, 2009

 

WASHINGTON - Despite a less-than-rousing reaction from the Obama administration, House Democrats are considering a new tax on employer-provided health benefits to help pay for expanding coverage to the uninsured.

 

Several officials also said an outline of emerging legislation envisions a requirement for all individuals to purchase affordable coverage, with an unspecified penalty for those who refuse and a waiver for those who cannot cover the cost.

 

"There's no sense having a mandate unless you have a contribution," Rep. Charles Rangel, D-N.Y., chairman of the House Ways and Means Committee, said Monday. He referred to the suggestion as "play or pay."

 

Rangel and other senior Democrats arranged to bring members of the party's rank and file up to date at a midday session Tuesday on the effort to draft health care legislation at the top of President Barack Obama's agenda.

 

No details were available on the possible tax on health benefits, and several officials stressed that no final decisions would be made for several days.

 

The idea has been gaining currency in recent weeks as Congress intensifies its search for more than $1 trillion to help pay for a health care overhaul.

 

Sen. Max Baucus, D-Mont., first floated the idea several weeks ago, and emerged from a White House meeting last week saying Obama was open to it.

 

Obama's top aides did not disagree, even though the president attacked the idea lustily last year when campaign rival John McCain proposed it. Instead, White House officials say Obama prefers his own suggestions: cuts in projected Medicare spending and tax increases on the wealthy that thus far have gained little favor among Democrats in Congress.

 

Several officials said the House legislation will include a government-run insurance option as well as plans offered by private companies. The government option draws near-unanimous opposition from Republicans and provokes concerns among many Democrats as well, although Obama has spoken out in favor of it.

 

The officials spoke on condition of anonymity, saying they did not want to pre-empt the presentation to rank-and-file Democrats on Tuesday.

 

Under the House Democratic plan, individuals and small businesses would be able to purchase coverage from a "health exchange" and the government would require all plans to contain a minimum benefit, these officials added. No applicant could be rejected for pre-existing conditions, nor could one be charged a higher premium, they said.

 

House Democrats also are considering a wide-ranging change for Medicaid that would provide a uniform benefit across all 50 states and increase payments to providers, according to several officials. Medicaid is a joint state-federal program of health coverage for the poor.

 

The disclosures came as the pace of activity quickened in both the House and Senate on health insurance legislation. Obama scheduled a meeting Tuesday at the White House with several Democrats.

 

Party leaders hope to pass legislation in both houses by early August and complete work on a compromise measure in the fall for Obama's signature.

 

The president has stepped up his own involvement in the issue in recent days, and there has been a flurry of negotiations involving outside interest groups who have pledged to take steps to achieve savings within the private insurance market.

 

Alongside those efforts, financing Obama's plan to spread coverage more widely carries a price tag estimated at more than $1 trillion over a decade. House Democrats are considering cutting projected Medicare payments to home health care, pharmaceutical companies, insurance companies, hospitals and others to cover costs, but not on the scale that the president proposed last winter.

 

The option for taxing insurance benefits is also under consideration as part of legislation taking shape across the Capitol in the Senate Finance Committee.

 

Numerous options are possible, many of which involve either a tax levied according to the value of an individual's employer-provided health plan or on the benefits received by upper-income taxpayers.

 

The issue poses multiple potential problems for Obama, who has pledged not to raise taxes on individuals making less than $250,000 and also ran commercials criticizing McCain's call for a tax on health benefits in last fall's campaign.

 

In recent weeks, the president and his aides have sought to straddle the issue, neither accepting it nor ruling it out.

 

Associated Press writer Ricardo Alonso-Zaldivar contributed to this report.

 

Copyright 2009 Baltimore Sun.

 

Exercising for back  pain relief

A strength-training program in a recent study reduced back pain and improved quality of life for participants.

 

From the Los Angeles Times

By Jeannine Stein

Baltimore Sun

Tuesday, June 9, 2009

 

More is better when it comes to alleviating lower back pain -- more exercise, that is.

 

Although many people who suffer from back pain don't exercise, fearing it will exacerbate the problem, a recent study found that exercising four days a week gave people greater relief from back pain than working out fewer times per week or not at all.

 

In the study, 120 people were randomly assigned to one of four groups for 12 weeks: One did a strength-training program two days a week, one did it three days a week, and one did it four days a week. A control group did no exercise but participated in a two-week exercise familiarization program. Exercises in the program included bench presses, lat pull downs and leg presses.

 

Those in the four-day-a-week program had the most reduction in pain -- 28% -- compared with 14% for those who exercised two days a week. The four-day group also reported having a better quality of life and less disability than those who exercised less. In addition, it showed the greatest strength gains. The control group showed insignificant change in all areas.

 

The study was presented recently at the annual meeting of the American College of Sports Medicine in Seattle.

 

Copyright 2009 Baltimore Sun.

 

Body of lies: Patients aren't 100% honest with doctors

When patients aren't truthful, misled doctors may give a wrong diagnosis or treatment.

 

By Karen Ravn

Baltimore Sun

Tuesday, June 9, 2009

 

Bill Moore of Pacific Grove was barely in his 20s when he found out he had cholesterol trouble.

 

This was bad news for Moore because his father had died of a heart attack at 45 and because, as he told his doctor, Moore was eating all the right stuff.

 

The doctor prescribed cholesterol-lowering medication, and a subsequent test showed the drug was working very well. Too well.

 

His doctor was very surprised, Moore says. "I told him I must be unique. I must have a unique body composition." But the truth was Moore had fed his doctor a false written record of his eating habits before beginning the drug -- reporting vegetables and salads that had never been on his menu, and not reporting all the hamburgers and pizzas that had.

 

Only when he started on the cholesterol drug did he finally begin eating the way he'd been claiming to eat all along. It was that change combined with the drug that made his cholesterol levels plunge.

 

Inaccurate information can do more than confuse a doctor. It can lead to misinterpreted symptoms, overlooked warning signs, flawed diagnoses and treatments -- potentially endangering a patient's health, even life.

 

Still, doctors know that at least some of the time, at least some of their patients overstate, understate, embellish, omit, or otherwise stray from a straight and thorough reporting.

 

"Everybody lies at some point," says Dr. Sharon Parish, a professor of clinical medicine at Albert Einstein College of Medicine in New York City who practices at Montefiore Medical Center. They do it out of embarrassment, to please the doctor, to avoid a lecture.

 

But doctors and patient advocates agree that in most cases, when patients lie, they're pretty much asking for trouble. Even when telling the truth is unappealing, "getting into a lying relationship with your physician is really far more perilous," says Peter Clarke, director of the Center for Health and Medical Communication at USC and co-author of the 1998 book "Surviving Modern Medicine."

 

An early lesson

That patients lie is one of the basics doctors learn in medical school. Of 1,500 responders to a 2004 online survey by WebMD, 45% admitted they hadn't always told it exactly like it was -- with 13% saying they had "lied," and 32% saying they had "stretched the truth."

 

Not included in those figures would be patients who "lie" without knowing they do so by withholding information because it slips their mind or they have no idea it could be useful. (Maybe Aunt Agnes would gladly tell about the time she snored so loud she woke the neighbors if she knew that a diagnosis of sleep apnea could depend on it.)

 

In the WebMD survey, 38% of respondents said they lied about following doctors' orders and 32% about diet or exercise. Doctor reports bear this out.

 

"Patients are strongly motivated to have their doctors think they're good patients," says Dr. Steven Hahn, professor of clinical medicine at Albert Einstein College and an internist at Jacobi Medical Center in New York City.

 

It's hard to make a good impression when you're on an examining table in a flimsy, open-backed gown -- a fact that might make lying that much more tempting. But even fully clothed, talking face to face across a desk, a patient cedes authority to the doctor. And people generally like to please those in authority, says Emanuel Maidenberg, clinical professor of psychiatry at UCLA.

 

Patients also are prone to lying about the fact that they engage in social taboos, things their doctor might not approve of. In the WebMD survey, 22% lied about smoking, 17% about sex, 16% about drinking and 12% about recreational drug use.

 

"When you're studying psychiatry, you're taught that if a patient says, 'I use cocaine once a month,' you figure it's twice a month," says Dr. Robert Klitzman, professor of clinical psychiatry at Columbia University. "We were taught to double."

 

Patients lie because they don't want to be judged, embarrassed or misunderstood. They lie about pursuing alternative health remedies because they disagree with their doctor or because they think an item is none of their doctor's business.

 

Doctors, of course, make the case that even deeply personal matters such as sexual orientation or having an extramarital affair can affect the care doctors give (how to interpret symptoms, what tests to order, exams that might be important). Patients may see only unpleasant invasions of their privacy -- and a risk that somehow their co-workers, parents or spouses will find out too.

 

"We live in complex social webs," Klitzman says. "Someone will see the forms. . . . People talk."

 

But co-workers, parents and spouses aren't the only threats hanging over a patient's head. Health insurance is another. And so -- not surprisingly -- sometimes people lie in order to keep something out of their medical records or out of the hands of their insurance companies.

 

That can be of genuine concern, say doctors and patient advocates. What happens in the doctor's office doesn't always stay in the doctor's office.

 

Anything and everything health-related that patients tell their doctors is supposed to go into their medical records. That information is confidential, protected under the federal Health Insurance Portability and Accountability Act.

 

But in fact, it's only confidential until it isn't.

 

Whenever patients apply to buy individual insurance policies, and whenever they file claims under policies they own, the insurance company can request their medical records.

 

Patients can refuse to release the records, but if they do, the company can refuse to sell them a policy or refuse to pay claims. This is part of the deal patients agree to by signing on to the insurance contract.

 

And it doesn't take much in a patient's records to nix the sale of a policy. "A case of acne can do it," says Jerry Flanagan, an advocate with the Foundation for Taxpayer and Consumer Rights.

 

And there are other insurance complications. If, when processing a claim, the insurance company finds something in a patient's records that contradicts something the patient said when purchasing the policy, the company can retroactively cancel the policy, Flanagan says. Then it can demand reimbursement for any claims it has already paid -- even if those claims had nothing to do with the reason for canceling the policy.

 

"I would never advocate lying to your doctor," Flanagan says, "but I can definitely understand why someone might."

 

Dr. Ken Duckworth, medical director of the National Alliance on Mental Illness, suggests one scenario in which it might be tempting to lie. Say someone learns from a gene testing company that she is carrying a gene that puts her at risk for a disease for which there is no treatment or prevention. Then, he says, "it could be in a patient's interest to conceal that information."

 

Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia, cites yet another hypothetical: Say a patient feels deserving of coverage for a certain condition or treatment, but his symptoms don't quite fit the insurance company's requirements. The patient might adapt the description of his symptoms to qualify for coverage, "and that might arguably be defensible or excusable."

 

Accuracy is vital

Sometimes, a doctor may be willing to help by overstating a patient's case.

 

In 1997, Dr. Victor Freeman, then a primary care research fellow at Georgetown University Medical Center, asked 167 internists across the country what doctors should do if one of their patients was at first turned down for coverage of a treatment that was medically indicated.

 

Almost half -- 45% -- said it was ethical to lie in order to get coverage for the patient. The more serious the condition, the more doctors said lying was appropriate: 57% when bypass surgery was at stake for a patient with severe angina or chronic atherosclerosis; 47% when the issue was comfort care for a patient with terminal ovarian cancer causing abdominal pain and extreme nausea; 32% when a patient with severe depression was seeking a psychiatric referral.

 

At other times, a doctor may be willing to help by leaving things out of a patient's record.

 

Dr. Howard Brody, director of the Institute for the Medical Humanities at the University of Texas Medical Branch in Galveston, Texas, suggests patients talk to their doctors if they have symptoms or conditions they fear could disqualify them for insurance coverage.

 

"There may be times when a doctor will agree to not put it on [record]," he says.

 

"But that's very iffy. It's not good medical practice as a rule."

 

Clarke suggests patients have two sets of medical records, a private one between patient and doctor and another for sharing with others.

 

"The solution is not to lie to your physician but to establish private records that won't be released to third parties," he says. "If your physician won't do that, it's reason enough to leave the physician."

 

Short of changing to a healthcare system where insurance companies can't refuse to sell anyone a policy because of a health condition -- which he favors -- Flanagan says there's no ideal solution for some patients.

 

Even so, most doctors, ethicists and patient advocates think it's a bad idea to lie to a doctor, although they all see reasons why patients might want to -- and even scenarios where a lie might be justified.

 

Some ethicists consider it a moral obligation for patients to tell the truth to their doctors, Brody says. In establishing a patient-doctor relationship, the first step is to take a thorough medical history.

 

"None of the rest makes any sense without an accurate history to guide you," he says.

 

Lying about what you eat, how much exercise you get or whether you're taking your medication as prescribed may seem benign but can be hazardous. If it seems you've been doing everything right, and your condition still isn't improving, the doctor could change your current treatment plan to something more serious and invasive -- and unnecessary.

 

As for embarrassment, perhaps patients worry too much about what their doctors think of them.

 

"Doctors have heard it all," Klitzman says. "They've seen it all."

 

In other words: Get over yourself.

 

Copyright © 2009, The Los Angeles Times.

 

How to treat a sunburn

 

Daily Press (Newport News, Va.)

By Alison Johnson

Baltimore Sun

Friday, May 29, 2009

 

While the best way to deal with sunburn is not to get one - think sunscreen, limited midday exposure and hats - here's what to do if you get baked:

 

Cool it down. Soak a cloth with cool water and rest it on burns for about 20 minutes. Then apply a balm such as aloe vera. You also can use a mild lotion - aim for one without perfume or dye - to help keep skin moisturized.

 

Bathe with cool water. Don't take hot showers or baths and avoid cleaning burned areas with soap, which can be an irritant. Pat your skin dry with a towel instead of rubbing.

 

Wear comfortable clothes. Choose loose-fitting cotton; wool and man-made materials such as polyester may chafe against a burn. You also can lie down a soft cotton blanket on couches, chairs and beds.

 

Don't peel your skin. Picking at a burned spot will irritate it and slow healing.

 

Stay out of the sun. Some people think that if they're already burned, it can't get worse. Not true. Wait until your skin has healed or cover up as much as possible.

 

Drink lots of water. You can dehydrate more quickly if you are sunburned.

 

Take painkillers. If your burns bother you, get an over-the-counter medicine with acetaminophen or ibuprofen, such as Tylenol, Advil or Motrin.

 

Try natural remedies. Some people have had luck with putting cold, wet teabags on burns or adding a half cup of baking soda or oatmeal to a cool bath.

 

See a doctor if needed. Call if your skin blisters or peels severely. You could be at risk for an infection and may need medication.

 

(c) 2009, Daily Press ( Newport News, Va.).

 

Visit dailypress.com, the World Wide Web site of the Daily Press at http://dailypress.com and on America Online at keyword "dailypress."

 

Distributed by McClatchy-Tribune Information Services.

 

Copyright © 2009, Tribune Media Services.

 

Peanuts, Anyone?

Researchers Expose Kids to Risky Foods In Order to Cure Them

 

By Rob Stein

Washington Post

Tuesday, June 9, 2009

 

Ever since she was an infant, Reagan Roberts could not tolerate being anywhere near cow's milk. A mere sip would leave her vomiting and gasping for breath. If she were even touched by someone with milk on their hands, she would break out in hives and a bright red rash.

 

"We just had to keep her away from milk," said Reagan's mother, Lissa. "We couldn't have it around the house. At preschool she had to sit by herself. We brought her food to birthday parties. We couldn't go to restaurants. It was very hard."

 

Today, however, Reagan, 9, of Ellicott City, can drink as much milk as she wants and eat anything.

 

"She eats ice cream. She eats cheese. She eats yogurt. She drinks chocolate milk. She eats any food anybody else can," Lissa Roberts said. "It's a miracle."

 

Reagan is one of a small number of children who have undergone an experimental treatment that is showing promise for treating milk, peanut and other food allergies. The approach, known as oral immunotherapy, involves slowly desensitizing the immune system by painstakingly ingesting increasing amounts of whatever triggers the reaction.

 

"It's pretty encouraging," said Robert A. Wood, chief of pediatric allergy and immunology at Johns Hopkins, who led the study that Reagan participated in at the Hopkins Children's Center in Baltimore. "We've still got a long way to go, but I never thought we'd get this far."

 

Although the approach appears to be highly effective for some children with milk and peanut allergies, the researchers conducting the studies and others caution that much more research is needed to prove and perfect the approach and that it is far from ready for widespread use. No one should try the approach on his own, because the treatments themselves can trigger potentially life-threatening reactions.

 

"It's still very investigational," said Wesley Burks, chief of the division of pediatric allergy and immunology at Duke University, who has produced promising results in children with peanut allergies. "We're very hopeful. But there are lot of things we need to do to understand it better, make it more effective and make sure it's safe."

 

The strategy is being tested in a handful of small studies that are part of a surge of research in a field that for years showed little progress.

 

"There's been a substantial uptick in the amount of research," said Marshall Plaut of the National Institute of Allergy and Infectious Diseases, which has more than doubled the funding for food-allergy research since 2007. "I think it's time to be cautiously optimistic."

 

In addition to the oral immunotherapy studies, scientists are in the early stages of testing an experimental suppository, a Chinese herbal remedy and variations of oral immunotherapy that might be safer and more effective.

 

"There's definitely been a spike in the amount of work going on," said Hugh A. Sampson, a professor of pediatrics, allergy and immunology at the Mount Sinai School of Medicine in New York who leads a federally funded consortium studying food allergies. "Five years ago there was almost nothing going on in people with respect to therapies, whereas now there are a variety of different therapies being looked at."

 

Why the Increase?

The spike in research has been driven by increasing evidence that food allergies are becoming more common, occurring earlier in life and lasting longer. About 12 million Americans are estimated to suffer from food allergies, including about 3 million children. Some evidence suggests that peanut allergies may have doubled in children in the past decade.

 

The reason for the trend is the subject of intense research and debate. There are several theories, including changes in how food is processed and children's not being exposed to certain foods early in life. Evidence has also been mounting for the "hygiene hypothesis," which blames growing up in increasingly sterile homes, making the immune system overreact to ordinarily harmless substances, including food.

 

Whatever the cause, researchers have long struggled to develop therapies. Food allergies can trigger symptoms ranging from rashes and hives to responses believed to cause perhaps 200 deaths each year in the United States. Currently, food-allergic people have only two options: to avoid the substance that causes their reaction or to try to stop a reaction with an injection of epinephrine.

 

That leaves parents of allergic children scouring food labels, avoiding restaurants, sending their children to school and parties with specially made food and snacks, and still worrying about inadvertent contact with peanuts, milk, eggs and other ubiquitous foods.

 

"It's hard to live," said Angie Duty of Durham, N.C., whose 9-year-old son, Sam, was intensely allergic to peanuts before undergoing the therapy as part of one Burks's studies. "Sam doesn't like to be different, but of course he is different and we have to explain that to him."

 

Although doctors have long used shots to desensitize people allergic to pollen and other substances, early attempts to do the same for food allergies ended in failure.

 

"The side effects were so great that they were as bad if not worse than the disease itself," Burks said.

 

But a small number of researchers in recent years have begun trying the approach again, this time by orally administering the protein in the food that triggers the allergic reaction.

 

With doctors standing by in case of a severe reaction, each study subject undergoes careful testing to determine the maximum dose he or she can safely tolerate. Once that is established, the participants are sent home to sprinkle that amount of purified protein on their food for a week or two; then they return to the research center in to see if the dose can be increased. The procedure is repeated for months or even years to slowly raise the amount they can safely consume.

 

"It's a way of sort of rerouting or tricking the immune system to no longer be allergic to that food," said Stacie Jones, chief of allergy and immunology at the Arkansas Children's Hospital, who has been working Burks to test the approach for peanut allergies.

 

In a study involving 19 children who were severely allergic to milk, Wood found that within four to six months most of the children significantly increased the amount of milk protein they could tolerate. After between about nine months and two years, about half of the children could safely consume as much milk or food containing milk as they wanted.

 

"These are children who could have died from a teaspoon of milk before," Wood said.

 

No More Reactions

In March, Burks and Jones reported the results of a pilot study involving 33 children with peanut allergies. The children started by ingesting peanut protein powder equivalent to one one-thousandth of a peanut. Four of the children had to drop out because of allergic reactions, but six of nine children who underwent the treatment for 2 1/2 years have been able to stop the peanut powder and have now gone six to eight months without reacting to eating peanuts. "It's fabulous," said Janet Vande Berg of Durham, N.C., whose 9-year-old daughter, Caroline, can eat peanuts for the first time in her life. "It makes a huge, huge difference in the quality of life for both the kids and the families. It just takes the stress away."

 

The researchers are tracking the remaining children in the study to see if any others achieve similar results and have followed up with a more stringent study in which 13 children received a similar treatment and seven received a placebo.

 

After about 10 months, all seven children on the placebo were still allergic, whereas none of the 13 on the peanut powder had reactions when they were challenged. All the children are now receiving the treatment and are being followed to see if they remain desensitized and perhaps become "tolerant," meaning they no longer need to consume daily doses of peanuts or peanut protein to maintain their ability to eat peanuts freely.

 

"I think it's an important advance in the field," said the NIH's Plaut. "It's a small number of subjects, so it's hard to draw full-blown conclusions. But it's the first data that suggest you may be able to achieve something like this in food allergies."

 

It remains far from clear, however, what proportion of children will benefit, how long the benefit might last and what proportion will need to continue to consume at least some milk or peanuts every day to maintain their protection. While some children, such as Vande Berg, appear to completely lose their allergies, others seem to just be able to eat more of the milk or food before reacting. But even that can be helpful.

 

"We know this therapy at least protects them from accidental ingestion so they won't have a life-threatening reaction," said Jones, the Arkansas researcher. "At the very least it's providing some security for these families."

 

Burks and Jones are part of the federal consortium, which is studying the same approach for eggs at research institutions across the country, including Johns Hopkins, and conducting detailed immunological studies to try to get a better understanding of how the treatment works.

 

Meanwhile, researchers in London are studying 640 babies at high risk for food allergies to see if exposing them to peanuts early in life reduces their chances of developing the allergy in the first place.

 

"There are a lot of people putting ideas out there and producing some promising preliminary data," Plaut said. "That makes me think there will be some important developments in the future."

 

Copyright 2009 Washington Post.

 

Coming Clean About Risk of Finger Food

 

By Sindya N. Bhanoo

Washington Post

Tuesday, June 9, 2009

 

Come lunchtime, Washingtonians step out of their germ-laden offices to grab a bite to eat. And likely as not, they'll be eating with their fingers.

 

There are Indian restaurants, with naan that spice lovers dip into curry. And Ethiopian, with injera, the crepe broken off with the fingers and eaten with vegetable and meat stews.

 

At Nando's Peri-Peri, which opened in Washington's Chinatown last summer, the juicy chicken is finger-licking good, as many customers prove while enjoying their meals.

 

But all this food touching means the germs from our hands are also touching our food.

 

With the wide variety of ethnic finger foods available today, along with classics such as french fries and nachos, should more of us be washing our hands before sitting down to eat at restaurants?

 

Yes, says Charles Gerba, a microbiologist at the University of Arizona. Especially at lunchtime.

 

Gerba is the germ guy. He has spent years swiping cotton swabs across the floors of bathrooms, counters, tables and door handles, trying to figure out where the ickiest of germs live.

 

"Eighty percent of us work indoors; we're sharing more spaces with more people than ever before," he said.

 

The work environment is crawling with bacteria, he has found.

 

"Our offices -- our desktops, our keyboards, our phones -- these are among the worst places for germs," he said. "There are 400 times more viruses on the average desktop than the average toilet, for instance."

 

Yuck.

 

The Centers for Disease Control and Prevention recommends that we always wash our hands in warm water with soap before eating.

 

But 35 percent of Americans don't always wash their hands before lunch, according to a 2008 survey conducted for the Soap and Detergent Association, a trade group.

 

I began thinking about hand-washing because my parents are from India, and I grew up eating Indian food almost every day. We ate it with our hands -- after washing them.

 

But at Indian restaurants, I rarely see patrons making their way to the restroom to wash up before dipping their fingers into a plate of samosas or tearing a piece of naan in half to scoop up some chicken tikka masala.

 

In India, it is common to see sinks with running water and soap in the seating area of restaurants, so customers can wash up before and after eating. A few years ago when I was visiting India, I thought to myself, why not do this in America?

 

Some restaurants do. Nando's has sinks in the seating area. The question is whether patrons use them.

 

I stood in a corner of the restaurant during lunch one day (shortly after the swine flu outbreak began, in fact) and started counting.

 

One, two, three, four, five . . . six . . . all the way up to 58, in a half-hour.

 

That was my count of how many people walked by the very prominently located sink and didn't wash their hands. They did stop, though, to pick up dipping sauce and napkins, which were located right next to the sink.

 

I counted three, yes three, people who did wash their hands: two middle-aged men and one young woman.

 

The two men were together, so I joined them in their lunch booth to find out what inspired them to wash.

 

"I always wash my hands before I eat," said Mark Raby, 48. "And I like the sink out here; in fact, maybe this will encourage more people to wash."

 

His lunch companion, Jamie MacAyeal, is not always so diligent.

 

"At home, in general I do," said Mac-Ayeal, 52. "But not always when I eat out. Our bodies can fight germs."

 

Raby disagreed.

 

"Your skin comes into contact with all kinds of pathogens, and why ingest these?" he asked.

 

"It's like how there's two schools of thought for infants," MacAyeal said, explaining that some pediatricians say that kids should be kept away from germs, while others say exposure to germs builds immunity.

 

"My dad was a pediatrician," Raby said, eyeing his friend with skepticism. "And he taught me to wash my hands."

 

Other restaurants offer different solutions.

 

At Zed's, a popular Ethiopian restaurant in Georgetown, waiters bring every customer a disposable hand wipe before and after they eat.

 

And at Marrakesh, a Moroccan restaurant neat the convention center, waiters pour warm rose water on customers' hands over a brass bowl and then hand them small towels.

 

"This is customary in Morocco because we eat with our hands," said Andre Helou, the restaurant's manager. "Everyone is clean before they eat; it gives a good feeling."

 

Though most customers at Marrakesh do eat with their hands, the restaurant also provides silverware. "Couscous can be hard to eat with your fingers," Helou said, "though traditionally, we form it into small balls with our fingers and place it our mouth."

 

Until eight years ago, at Meskerem, an Ethiopian restaurant in Adams Morgan, waiters took soap, a pitcher of warm water and bowls to pour water over people's hands. "We tried to show people the traditional way, but everything costs money," said manager Mohaba Mohaba.

 

Many Americans today are familiar with how Ethiopian food is eaten anyway, he added. "And when we have newcomers we tell them they might like to wash their hands before eating."

 

Gerba, who has been to Marrakesh when visiting Washington, says restaurants should encourage hand-washing.

 

"When possible, you should be using soap," he said. "Hands are pretty efficient at picking up viruses."

 

Does the germ doctor wash his hands every time he eats?

 

"I sure do," Gerba said. "It's probably always a good idea. But if you're not touching the food and you're using knives and forks, it's not as a critical."

 

Copyright 2009 Washington Post.

 

Decision Makers Differ on How To Mend Broken Health System

 

By Ceci Connolly

Washington Post

Tuesday, June 9, 2009

 

Nowhere else in the world is so much money spent with such poor results.

 

On that point there is rare unanimity among Washington decision makers: The U.S. health system needs a major overhaul.

 

For more than a decade, researchers have documented the inequities, shortcomings, waste and even dangers in the hodgepodge of uncoordinated medical services that consume nearly one-fifth of the nation's economy. Exorbitant medical bills thrust too many families into bankruptcy, hinder the global competitiveness of U.S. companies and threaten the government's long-term solvency.

 

But the consensus breaks down on the question of how best to create a coordinated, high-performing, evidence-based system that provides the right care at the right time to the right people.

 

During eight years in office, President George W. Bush took an incremental approach, adding prescription drug benefits to the Medicare program for seniors and the disabled and expanding the number of community clinics nationwide. President Obama, like the last Democrat to occupy the White House, contends that was insufficient and is pushing for an ambitious reworking of the entire $2.3 trillion system.

 

Framed by President Bill Clinton 16 years ago as a moral imperative to deliver health care to all, this summer's historic debate comes against a more urgent backdrop. As the national unemployment rate nears 10 percent and giants such as General Motors crumble, the expensive, inefficient health system has deepened the country's economic woes.

 

By virtually every measure, the situation has worsened.

 

Today, about 46 million Americans have no health insurance, so they go without or wait in emergency rooms for expensive, belated care. Everyone else helps pay for that Band-Aid fix in the form of higher taxes and an extra $1,000 a year in insurance premiums.

 

Pockets of medical excellence dot the landscape, but at least 100,000 people die each year from infections they acquired in the hospital, while 1.5 million are harmed by medication errors. Of 37 industrialized nations, the United States ranks 29th in infant mortality and among the world's worst on measures such as obesity, heart disease and preventable deaths.

 

Bright young physicians trained at prestigious and expensive universities enter a profession built on perverse financial rewards. They, like assembly-line workers of the past, are paid on a piecemeal basis, earning more money not by doing better but simply by doing more.

 

Yet more care rarely translates into better health. Extensive research by Dartmouth College has found the exact opposite: Health outcomes are often best in communities that spend less compared with cities such as Boston and Miami where the medical arms race of specialists and high-tech gadgets often leads to greater risks and injuries.

 

The Institute of Medicine estimates that one-third of all medical care is pure waste, such as duplicate X-rays, repeat lab tests and procedures to fix mistakes.

 

"Most Americans don't understand how bad health care in the United States is," said Michael F. Cannon, head of health policy at the libertarian Cato Institute. "We need big reforms."

 

Across the ideological spectrum, the diagnosis is remarkably consistent.

 

"Sure, some people here have the best health care in the world, but the average American is paying too much and not getting enough in return," said John D. Podesta, who led Obama's transition team and heads the Center for American Progress, a think tank.

 

Said Sen. Judd Gregg (R-N.H.): "What's tragic is that so much of this spending is on duplicative or unnecessary care that doesn't improve health outcomes."

 

Simply put, the goal of health reform is to finally get our money's worth, say industry leaders, policymakers, consumers and business executives.

 

They envision a health-care system that guarantees a basic level of care for everyone, shifts the emphasis to wellness and prevention, minimizes errors, and reduces unnecessary and unproved treatment. Such a system would coordinate care, track patients and doctor performance electronically, and reward good results. The high-value system of the future would be organized "so that people get the care they need and need the care they get," said Elizabeth A. McGlynn, associate director of the health research division of Rand Corp.

 

Nowadays, that is often not the case.

 

On average, Americans receive the recommended, proven care 55 percent of the time, according to Rand studies. Sometimes, doctors or nurses overlook a basic but critical step, such as prescribing a beta blocker medication to patients after a heart attack, a therapy shown to significantly reduce the risk of a fatal attack. At other times, patients undergo procedures when there is no evidence that they are any better than a simpler, cheaper alternative.

 

Ten years ago, in its landmark report "To Err is Human," the Institute of Medicine estimated that 44,000 to 98,000 people die each year from medical mistakes, highlighting the need for improvement. Since then, the tally has risen, said Janet Corrigan, president of the National Quality Forum, a nonprofit membership organization that promotes quality standards.

 

"We now know estimates of those who die from hospital-acquired infections is upwards of 100,000," she said. "Many of those, if not most, are avoidable and preventable."

 

Sen. Robert C. Byrd's recent hospital stay, for example, has been extended because the West Virginia Democrat developed a staph infection.

 

"Everyone agrees that hospitals are hazardous to your health," said Mitchell Seltzer, a consultant who advises large medical institutions. "For every day a patient is in a bed, they are subjected to a higher probability of medical errors, hospital-acquired infections, inappropriate tests that do not have a direct bearing on the medical condition being treated."

 

Part of the problem is cultural, said Rand's McGlynn.

 

"People tend to demand the new thing even if there's not much evidence it will make a difference in the length or quality of life," she said.

 

Few patients or physicians have any idea who delivers good, or bad, care, because few organizations track results. Consumers have more information to evaluate their cars than they do their surgeons.

 

"It's like a doctor flying the plane without instruments," said James N. Weinstein, a spine surgeon who directs the Dartmouth Institute for Health Policy and Clinical Practice.

 

Obama set aside $19 billion in his economic stimulus package to promote the use of digital records, on the belief that they reduce duplication, produce more consistent care and cut down on errors.

 

Because the fee-for-service payment system rewards quantity over quality, there is little incentive -- and there are even disincentives -- for doctors, nurses and hospitals to improve, Corrigan said.

 

"Is it a surprise we have lots of extra imaging tests and lab tests?" she said. "Not at all."

 

The consequences are especially glaring in regions with larger numbers of specialists and pricey technology, the Dartmouth data show.

 

Take the case of Miami vs. La Crosse, Wis. In 2006, using inflation-adjusted figures, Medicare spent $5,812 on the average beneficiary in La Crosse, compared with $16,351 in Miami. Yet an examination of health status in both places, adjusted for age, finds no evidence that the extra spending resulted in better care, Weinstein said.

 

"That's the enigma here," he said. "Less is more, and more isn't better."

 

Physician behavior and spending patterns in Medicare have been good indicators of broader trends across the nation, Dartmouth has found.

 

Even the best physicians cannot stay current with all of the drugs, tests and treatments available today -- another reason to digitize modern medicine, Corrigan said.

 

Many fear that the push to contain costs will result in rationing.

 

In today's system, "we don't ration care, we ration people," said Donald M. Berwick, president of the independent Massachusetts-based Institute for Healthcare Improvement. "We know that if you are black and poor or a woman, there are all sorts of effective interventions you are not going to get."

 

Though the transition would be painful and the politics treacherous, Berwick said it is possible to spend less on medical care and have a healthier nation.

 

"If we could just become La Crosse, think of how much better off we would be," he said.

 

 

Copyright 2009 Washington Post.

 

What to know before buying supplements

 

By The Associated Press

Washington Post

Tuesday, June 9, 2009

 

-- The federal Food and Drug Administration does not analyze the content of dietary supplements, which do not need proof of safety or effectiveness before they go on sale. Here are tips from the government on their use:

 

-Don't self-diagnose a health condition or substitute a supplement for medicine.

 

-Ask your doctor before taking a supplement, especially if you are pregnant, taking other medicines or are having surgery soon.

 

-Request proof from the manufacturer or distributor to back up any claims.

 

-Ask the seller or manufacturer for information on tests showing safety or effectiveness of ingredients, and whether consumers have complained of adverse events.

 

-Look for "seals of approval" from independent groups that have standards to help ensure the product was properly made, contains what the label says, and is free of contaminants. These groups include Consumerlab.com, NSF and the U.S. Pharmacopeia.

 

---

On the Net:

 

Tips from FDA:http://www.fda.gov/Food/DietarySupplements/ConsumerInformation/ucm110567.htm

 

ConsumerLab.com quality seal:http://www.consumerlab.com/seal.asp

 

NSF certification:http://tinyurl.com/d3e3k7

 

U.S. Pharmacopeia verification program:http://www.usp.org/USPVerified/dietarySupplements/

 

© 2009 The Associated Press.

 

Tests show many supplements have quality problems

 

Associated Press

By Marilynn Marchione

Washington Post

Tuesday, June 9, 2009

 

Lead in ginkgo pills. Arsenic in herbals. Bugs in a baby's colic and teething syrup. Toxic metals and parasites are part of nature, and all of these have been found in "natural" products and dietary supplements in recent years.

 

Set aside the issue of whether vitamin and herbal supplements do any good.

 

Are they safe? Is what's on the label really what's in the bottle? Tests by researchers and private labs suggest the answer sometimes is no.

 

One quarter of supplements tested by an independent company over the last decade have had some sort of problem. Some contained contaminants. Others had contents that did not match label claims. Some had ingredients that exceeded safe limits. Some contained real drugs masquerading as natural supplements.

 

"We buy it just as the consumer buys it" from stores, said Dr. Tod Cooperman, president of ConsumerLab.com. The company tests pills for makers that want its seal of approval, and publishes ratings for subscribers, much as Consumer Reports does with household goods.

 

Other tests, reported in scientific journals, found prenatal vitamins lacking claimed amounts of iodine, and supplements short on ginseng and hoodia - an African plant sparking the latest diet craze.

 

"There's at least 10 times more hoodia sold in this country than made in the world, so people are not getting hoodia," said Dr. Mehmet Oz, a heart surgeon and frequent Oprah Winfrey guest who occasionally has touted the stuff.

 

Industry groups say that quality problems are the exception rather than the rule.

 

"I believe that the problem is narrow, that the well-established and reputable brands deserve their reputations," said Michael McGuffin, president of the American Herbal Products Association.

 

Of course, prescription drugs have had problems, too. Dozens of deaths were linked last year to tainted heparin, a blood thinner produced in China, for example. However, pharmaceutical drugs must show evidence to the government of safety and effectiveness before they go on sale. Not so for dietary supplements.

 

Fifteen years ago, Congress passed a law that treats supplements like food and allows them to go straight to market without federal Food and Drug Administration approval. The FDA can act only after consumers get sick or a safety issue comes to light.

 

"We called it 'the body rule,'" said William Obermeyer, a chemist who left the FDA to found ConsumerLab.com with Cooperman. If a supplement was harmful, "we had to have so many adverse events before we could make a move on it. It was really like closing the barn door after all the animals left."

 

The law said the FDA could write quality control rules for products sold in the U.S. It took the FDA 13 years to adopt these, and they are just now taking effect. But the rules do not say what tests companies must do to prove what is in their products, and some tests can be fooled by subbing other ingredients. The rules also set no limits on toxins such as lead; nor do they change the fundamental way these products are sold to the public.

 

"It leaves the level of quality up to the manufacturer," Cooperman said.

 

In a written statement, FDA spokeswoman Susan Cruzan said the new rules contain what is "needed to ensure quality," and that products that contain contaminants or whose labels do not honestly describe their contents, are considered adulterated and subject to further action by the agency. But she conceded that the agency is spread thin.

 

"In that FDA has limited resources to analyze the composition of food products, including dietary supplements, it focuses these resources first on public health emergencies and products that may have caused injury or illness," she wrote.

 

Millions of Americans take vitamin, herbal or other dietary supplements. Annual sales exceed $23 billion, and more than 40,000 products are on the market. Tens of thousands of supplement-related health problems are handled by U.S. poison control centers each year, according to a report in the New England Journal of Medicine in 2002.

 

Until last year, supplement makers were not required to report problems to the FDA, and even now they must report only serious ones. The agency estimates that more than 50,000 safety problems a year are related to supplement use.

 

The Institute of Medicine, an independent science panel that advises the government, studied the situation in 2005.

 

"The committee is concerned about the quality of dietary supplements in the United States. Product reliability is low," says its report, which urged amending the 1994 law to tighten consumer protections.

 

Trade associations say the FDA's new rules do that.

 

"We are FDA-regulated products," though not in the same way as prescription or over-the-counter drugs, said Steven Mister, president of the Council for Responsible Nutrition.

 

The FDA can ask law enforcement to act against any company selling an adulterated product, said McGuffin of the herbal products association. "You can go to jail, you can have your company seized," he said.

 

"We represent companies that we consider the responsible center of the industry," who are working to comply with the new rules, he said.

 

But his group only represents 250 of the 1,500 companies selling such products. And even though millions of people take supplements with no apparent ill effects, there have been many quality problems that a consumer might never realize because they don't always produce symptoms:

 

-CONTAMINANTS

 

ConsumerLab.com found lead in at least one brand each of zinc, black cohosh and ginkgo products tested in recent years. Lead can accumulate and cause many health problems, and the testing company wants a national limit of 0.5 micrograms per day - a level that in California requires a warning on the label.

 

A fungal toxin was found in four red yeast rice products in March 2008. And in 2007, federal officials warned about a liquid herbal supplement sold for colic and teething pain after finding cryptosporidium, a waterborne parasite that causes severe diarrhea.

 

Ayurvedics - popular herbals used in traditional medicines from India - often contain hazardous metals, studies in medical journals report. In 2004, researchers tested 70 ayurvedic remedies in the Boston area and found that one in five had potentially harmful levels of lead, mercury or arsenic. Tests in Houston, Chicago, San Francisco and New York City turned up similar results.

 

Metals naturally accumulate in certain herbs and come from the soil they are grown in. Many supplement ingredients come from Europe, India and China.

 

"We don't know how much of the ingredients are imported - whether they're coming from across town or across the world," Mister of the trade association conceded.

 

But even manufacturers get duped, said Jana Hildreth of the Analytical Research Collective, a group of scientists advocating better supplement testing.

 

"Companies started going to China and demanding lower prices," and unscrupulous suppliers sometimes spiked products with cheap ingredients that can trick lab tests, she said. An example: a buckwheat derivative, rutin, in place of pricier ginkgo.

 

-POTENCY PROBLEMS

 

In ConsumerLab.com testing last November, four out of seven supplements contained less ginkgo than claimed on their labels, and one failed to break apart properly to release its ingredients. Seven out of nine failed in tests in 2003, as did six out of 13 in 2005.

 

"It is now believed that ginkgo is among the most adulterated herbs," the company reports.

 

Tests by California scientists of two dozen ginseng supplements, reported in a nutrition journal in 2001, found that many differed from their labels. The concentrations of some ginseng compounds varied by up to 200-fold from product to product.

 

In ConsumerLab.com tests, six out of nine chondroitin supplements failed testing in April 2007. One had only 8 percent of what it claimed to contain, and one "maximum strength" product had none.

 

Vitamins and minerals had problems, too. A "high potency" iron supplement contained less than half the amount claimed. Of 23 top-selling vitamin C pills, one provided less than half the amount promised; the suggested dosages of some others were beyond recommended safe levels. Of 10 vitamin A supplements, one provided twice its stated amount, raising concern about toxic side effects.

 

Last year, nearly 200 people were sickened by supplements containing up to 200 times the amount of selenium stated on the label. Symptoms included hair loss, discolored and painful fingernails, muscle cramps, joint pain, diarrhea and fatigue.

 

-HIDDEN PRESCRIPTION DRUGS

 

The FDA has repeatedly warned about herbal pills found to contain versions of Viagra and similar drugs to help men get an erection. These can pose a heart hazard, especially when taken with certain medications.

 

In December, the FDA expanded warnings about dozens of brands of weight loss pills. Though the labels did not say so, some contained sibutramine, a controlled substance that poses heart risks; rimonabant, a drug not approved in the United States; a seizure medicine, and a diuretic.

 

Red yeast rice, a traditional Chinese medicine, has compounds that may block cholesterol in a way similar to statin drugs. Some red yeast rice products have been found to contain lovastatin, the active ingredient in the drug Mevacor. Problems can occur at high doses or with other medicines.

 

-OTHER RISKS

 

Even "safe" supplements can be harmful. Beta-carotene takers still had increased rates of lung cancer six years after one study was stopped. These supplements "appear to increase rates of the disease, particularly among smokers," the National Cancer Institute warns.

 

In another study, men taking vitamin E were slightly more likely to get prostate cancer, and those taking selenium were a little more likely to develop diabetes. The results could have been due to chance, but federal officials were taking no chances and stopped the study last October.

 

Other studies suggest that high doses of vitamin C may help shield cancer cells from treatments designed to kill the cancer.

 

"Antioxidants are not the magic bullets that the supplement industry would like consumers to believe," said David Schardt, a nutrition expert with the consumer advocacy group, the Center for Science in the Public Interest. "They're not even necessarily benign."

 

Herbal sex pills containing the African tree bark extract yohimbe have landed men in hospitals with heart rhythm problems. This herb can cause high blood pressure, increased heart rate and other symptoms, the government warns.

 

The most serious side effects occurred with diet pills containing ephedra - heart problems, seizures and even deaths. The FDA banned it in 2004. The battle started in 1997, when the agency wanted strong warnings on labels, and it became a test case of FDA authority that went all the way to the U.S. Supreme Court, where the FDA ultimately prevailed.

 

-DRUG INTERACTIONS

 

Ginkgo, vitamin K, garlic, ginseng and other herbals can cause bleeding or clotting problems if taken with certain medications or before surgery. St. John's wort, promoted for depression, affects metabolism of more than half of all prescription drugs and can undermine birth control pills. Other supplements that can interfere with medicines include glucosamine, saw palmetto, soy and valerian.

 

-OVERSTATED HEALTH CLAIMS

 

Makers can say a supplement addresses a nutrient deficiency, supports health, or reduces the risk of developing a problem, but then must say the product "is not intended to diagnose, treat, cure, or prevent any disease."

 

So consumers will see vague claims, such as "promotes healthy immune system function." The immune system has dozens of parts, and modifying one can be helpful or harmful, so "it's a quack concept," said Dr. Stephen Barrett, a retired physician who runs Quackwatch, a Web site on medical scams.

 

The Federal Trade Commission has stepped up actions against deceptive ads, said commission lawyer Rich Cleland.

 

"It is a little like playing Whack-A-Mole," because each time one problem is resolved, more seem to pop up, he said.

 

Last year, his agency reached a settlement against the makers of Airborne, a supplement aimed at people in crowded places such as airplanes, offices and schools. Company founders "made false claims that Airborne products are clinically proven to treat colds," and there is also no evidence the products can prevent colds, the FTC complaint says.

 

Airborne's makers agreed to add $6.5 million to the $23.5 million they had already agreed to pay to settle a related private class-action lawsuit, bringing the total settlement fund to $30 million.

 

Industry also has stepped up self-policing. The Council for Responsible Nutrition gave money to the Council of Better Business Bureaus so it could hire a lawyer to investigate some supplement sellers' sketchy claims.

 

"There were cancer cures and 'blast off 29 pounds in 39 days' - really the Wild West of advertising. It was totally out of control," said the BBB's advertising division director, Andrea Levine.

 

The BBB council targets the worst claims in popular categories, such as diet, cold and flu, menopause, joint problems and sleep aids.

 

"We can't do them all," but want to send a broad signal about what kinds of claims are over the line for each type of product, she said.

 

---

On the Net:

 

FDA: http://www.fda.gov/consumer/updates/supplements080408.html

 

Government supplement advice: http://tinyurl.com/alpr98

 

and http://tinyurl.com/kngv35

 

© 2009 The Associated Press.

 

At Last, Facing Down Bullies (and Their Enablers)

 

18 and Under

 

By Perri Klass, M.D.

New York Times

Tuesday, June 9, 2009

 

Back in the 1990s, I did a physical on a boy in fifth or sixth grade at a Boston public school. I asked him his favorite subject: definitely science; he had won a prize in a science fair, and was to go on and compete in a multischool fair.

 

The problem was, there were some kids at school who were picking on him every day about winning the science fair; he was getting teased and jostled and even, occasionally, beaten up. His mother shook her head and wondered aloud whether life would be easier if he just let the science fair thing drop.

 

Bullying elicits strong and highly personal reactions; I remember my own sense of outrage and identification. Here was a highly intelligent child, a lover of science, possibly a future (fill in your favorite genius), tormented by brutes. Here’s what I did for my patient: I advised his mother to call the teacher and complain, and I encouraged him to pursue his love of science.

 

And here are three things I now know I should have done: I didn’t tell the mother that bullying can be prevented, and that it’s up to the school. I didn’t call the principal or suggest that the mother do so. And I didn’t give even a moment’s thought to the bullies, and what their lifetime prognosis might be.

 

In recent years, pediatricians and researchers in this country have been giving bullies and their victims the attention they have long deserved — and have long received in Europe. We’ve gotten past the “kids will be kids” notion that bullying is a normal part of childhood or the prelude to a successful life strategy. Research has described long-term risks — not just to victims, who may be more likely than their peers to experience depression and suicidal thoughts, but to the bullies themselves, who are less likely to finish school or hold down a job.

 

Next month, the American Academy of Pediatrics will publish the new version of an official policy statement on the pediatrician’s role in preventing youth violence. For the first time, it will have a section on bullying — including a recommendation that schools adopt a prevention model developed by Dan Olweus, a research professor of psychology at the University of Bergen, Norway, who first began studying the phenomenon of school bullying in Scandinavia in the 1970s. The programs, he said, “work at the school level and the classroom level and at the individual level; they combine preventive programs and directly addressing children who are involved or identified as bullies or victims or both.”

 

Dr. Robert Sege, chief of ambulatory pediatrics at Boston Medical Center and a lead author of the new policy statement, says the Olweus approach focuses attention on the largest group of children, the bystanders. “Olweus’s genius,” he said, “is that he manages to turn the school situation around so the other kids realize that the bully is someone who has a problem managing his or her behavior, and the victim is someone they can protect.”

 

The other lead author, Dr. Joseph Wright, senior vice president at Children’s National Medical Center in Washington and the chairman of the pediatrics academy’s committee on violence prevention, notes that a quarter of all children report that they have been involved in bullying, either as bullies or as victims. Protecting children from intentional injury is a central task of pediatricians, he said, and “bullying prevention is a subset of that activity.”

 

By definition, bullying involves repetition; a child is repeatedly the target of taunts or physical attacks — or, in the case of so-called indirect bullying (more common among girls), rumors and social exclusion. For a successful anti-bullying program, the school needs to survey the children and find out the details — where it happens, when it happens.

 

Structural changes can address those vulnerable places — the out-of-sight corner of the playground, the entrance hallway at dismissal time.

 

Then, Dr. Sege said, “activating the bystanders” means changing the culture of the school; through class discussions, parent meetings and consistent responses to every incident, the school must put out the message that bullying will not be tolerated.

 

So what should I ask at a checkup? How’s school, who are your friends, what do you usually do at recess? It’s important to open the door, especially with children in the most likely age groups, so that victims and bystanders won’t be afraid to speak up. Parents of these children need to be encouraged to demand that schools take action, and pediatricians probably need to be ready to talk to the principal. And we need to follow up with the children to make sure the situation gets better, and to check in on their emotional health and get them help if they need it.

 

How about helping the bullies, who are, after all, also pediatric patients? Some experts worry that schools simply suspend or expel the offenders without paying attention to helping them and their families learn to function in a different way.

 

“Zero-tolerance policies that school districts have are basically pushing the debt forward,” Dr. Sege said. “We need to be more sophisticated.”

 

The way we understand bullying has changed, and it’s probably going to change even more. (I haven’t even talked about cyberbullying, for example.) But anyone working with children needs to start from the idea that bullying has long-term consequences and that it is preventable.

 

I would still feel that same anger on my science-fair-winning patient’s behalf, but I would now see his problem as a pediatric issue — and I hope I would be able to offer a little more help, and a little more follow-up, appropriately based in scientific research.

 

Copyright 2009 The New York Times Company.

 

Roche Makes Headway on New Diabetes Drug

 

By Anita Greil

Wall Street Journal

Tuesday, June 9, 2009

 

ZURICH -- Roche Holding AG said Tuesday it is moving a new potential blockbuster diabetes drug into late-stage testing, paving the way for a possible launch in 2014.

 

The drug belongs to a class of medicines called PPAR agonists that has proved a big disappointment for many pharmaceutical companies. GlaxoSmithKline PLC's Avandia suffered a sharp drop in sales after it was tied to a possible increase in the risk of heart problems. AstraZeneca Plc terminated development of a similar drug called Galida in 2006, and Bristol-Myers Squibb Co. halted development of Pargluva in 2005, also citing safety concerns.

 

Roche is hoping to avoid such problems by developing the drug as something that can help diabetes patients who already face a high risk of heart-attack or stroke.

 

Roche estimates that in the U.S. and the three biggest European countries there are around 500,000 diabetes patients who suffered a heart attack, out of around 3 million people who suffer a heart attack each year.

 

Roche's experimental medicine, called aleglitazar, was shown to be as good as or better at lowering blood sugar and certain blood fats in patients with type 2 diabetes as the market leader Actos, made by Japan's Takeda Pharmaceutical Co. There were no major unwanted side effects observed in the study.

 

Should the drug win regulatory approval, albeit unlikely before 2015, it has the potential to eventually generate annual sales of $1 billion or more.

 

"The reason why so many drugs of this class have failed is that you already have very good diabetes drugs out there, which is creating high hurdles for new entrants," said Luke Miels, Roche's head of strategic marketing for metabolic diseases.

 

First results from the late-stage study should be available in 2013, which would allow for filing the drug for regulatory approval in 2014, Mr. Miels said.

 

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

 

HIV rate among South African teens has dropped

 

Associated Press

By Clare Nullis

Washington Post

Tuesday, June 9, 2009

 

CAPE TOWN, South Africa -- The number of new HIV infections among South African teens has dropped significantly, prompting hope that national efforts to tackle the epidemic have finally turned a corner after years of denial and delay.

 

A report by the Human Sciences Research Council released Tuesday said that although young people continue to have multiple sexual partners - which drives South Africa's epidemic - they are increasingly heeding advice to use a condom.

 

"There is clearly light at the end of the tunnel," said Health Minister Dr Aaron Motsoaledi. "There is real light."

 

Motsoaledi, a respected medical doctor, became health minister last month. He must overcome the legacy of former President Thabo Mbeki, who denied the link between HIV and AIDS, and his health minister Manto Tshabalala-Msimang, who mistrusted conventional anti-AIDS drugs and promoted beetroot and lemon.

 

"Unfortunately we spent a lot of time fighting each other. I am quite sure that we are going to stop fighting each other and start fighting the disease," said Motsoaledi. "I am hoping that in the next few years the results will be much more encouraging than this," he said.

 

During nearly 10 years of neglect, new HIV infections reached a peak of 1,000, with nearly 1,000 deaths from AIDS every day. The council's report estimated that around 5.2 million South Africans were living with HIV last year - the highest number of any country in the world.

 

The report said that HIV prevalence in children between 2 and 14 fell from 5.6 percent in 2002 to 2.5 percent last year, mainly thanks to the spread of drugs to prevent women passing on the virus to their children.

 

Young women continue to bear the brunt of the epidemic; nearly one third of women aged 20 to 34 are infected with the virus, the report said. Infection rates peak later in men.

 

The survey of more than 23,000 people was entitled "A Turning Tide Among Teenagers?" In rare good news, it said that HIV incidence - the number of new infections - among teens was falling. For instance, incidence among 18-year-olds halved between 2005 and 2008 to 0.8 percent. In 20-year-olds it decreased from 2.2 percent to 1.7 percent.

 

Olive Shisana, head of the research council and one of the report's authors, said this was because of an increase in condom use among young males aged between 15 and 24, from 57 percent in 2002 to 87 percent in 2008. In females of the same age, there was also an increase of condom use, from 46 percent to 73 percent. Condom use among males aged 25 to 49 doubled and among women it tripled.

 

"Young men have made a decision that they are going to run around, but they are going to use a condom. They have made a decision that they will have a lot of sex with a lot of different people, but they are going ... to make sure they are protected," she said.

 

Every year the government distributes many millions of condoms free of charge as part of its anti-AIDS campaign and - to loud applause - health minister Motsoaledi indicated he would be willing to increase the condom budget further.

 

But on the downside, the survey showed that messages that young people should abstain, delay their first sexual encounter and have only one partner, were falling largely on deaf ears. This was the approach traditionally promoted by the U.S. President's Emergency Plan for AIDS Relief, which is the biggest foreign donor of South Africa's anti-AIDS drive.

 

Funding from that plan paid for the survey, the third conducted since 2002.

 

It said the percentage of 15-59-year-old males who had more than one partner in the past year increased from 9.4 percent in 2002 to 19.3 percent in 2008.

 

It said there was an increase in the problem of teens having older partners who would buy them food, clothes and pay for transport. This is particularly risky because older men have a higher HIV rate than teenage boys, and often the teenage girls do not have the bargaining power to insist that they wear a condom.

 

Shisana said that in poor areas, girls came under pressure from their families to stay in such relationships despite the risk.

 

Even more worryingly, the survey showed a decrease in the proportion of people who understood about HIV prevention from 66.4 percent in 2005 to 44.8 percent in 2008. More people understood the need for condoms and the need to dispel previously widespread myths that sex with babies cured AIDS, but this was offset by a big increase in the people who thought there was no risk in having multiple partners.

 

Motsoaledi said the government would try to strengthen its AIDS prevention campaigns - long weakened because of bureaucracy and mixed messages in the health department.

 

"It is clear our work is well cut. We can't pretend that we don't know what to do," he said.

 

© 2009 The Associated Press.

 

Is This a Pandemic? Define ‘Pandemic’

 

The Doctor’s World

 

By Lawrence K. Altman, M.D.

Washington Post

Tuesday, June 9, 2009

 

After decades of warnings about the inevitability of another pandemic of influenza, it is astonishing that health officials have failed to make clear to the public, even to many colleagues, what they mean by the word pandemic.

 

Generations of people have used the term to describe widespread epidemics of influenza, cholera and other diseases. But as the new H1N1 swine influenza virus spreads from continent to continent, it is clear that a useful definition is far more complicated and elusive than officials had thought.

 

And what is at stake is far more than an exercise in semantics. A clear understanding of the term is central to the World Health Organization’s six-level staging system for declaring a pandemic, which in turn informs countries when to set their control efforts in motion.

 

Dictionaries and medical journals offer little guidance. Their definitions can be too vague or too narrow, contradictory and clouded by jargon.

 

“There is a lot of misinformation in the medical literature, and it is really quite hard to figure out what is and what is not a pandemic,” said Dr. David M. Morens, an epidemiologist at the National Institute of Allergy and Infectious Diseases who has been studying the history of pandemics.

 

The word implies the rapid spread of an infectious disease to many countries in different regions, hitting each with more or less the same severity. But in fact, severity varies — not all people are infected at the same time, and not every country need be affected.

 

And there can be many other factors, including the numbers and percentages of people falling ill and dying; a population’s vulnerability to the disease, based on previous rates of infection; and the quality of health care facilities and disease monitoring systems.

 

Not least is that scientists do not know precisely how pandemics arise, what fuels them, why they vary in their lethality, why some occur in waves and why they stop.

 

Health officials have long preached that with influenza, the only sure bet is to expect the unexpected. The new swine influenza virus, which appeared suddenly after years of warning about a potential pandemic of avian influenza, upset the W.H.O.’s assumptions that most people have the same understanding of the word pandemic.

 

For years, the organization’s Web site defined an influenza pandemic as causing “enormous numbers of deaths and illness.” But the agency recently pulled the definition, apologizing for causing confusion and anxiety.

 

One of the biggest problems in public health is communicating risk assessment.

 

United States and W.H.O. officials say their preparedness plans are intended for governments, not people in the street. Officials bristle at criticism that their messages and plans have led the public to equate the word pandemic with the Spanish influenza of 1918-19, the worst recorded pandemic in history, killing 20 million to 100 million people.

 

In preparing for the worst, officials have considered milder pandemics, said Dr. Nancy J. Cox, chief of the influenza division at the Centers for Disease Control and Prevention in Atlanta.

 

But Dr. William Schaffner, the chairman of preventive medicine at Vanderbilt University, said that “we, the public health community, deserve to be chided” about the confusion.

 

“We ought to be able to do a better job in communicating in an understandable way,” he said in an interview.

 

Scientists like to assert that theirs is an exact discipline. But like the terms “evidence -based medicine” and “peer review,” pandemic turns out to be another example of imprecise vocabulary that doctors use every day, assuming everyone understands their meaning.

 

Journals, textbooks and reference works use pandemic in discussing certain diseases, but rarely define the word.

 

For example, the definition section of the Control of Communicable Diseases Manual, a standard reference work, includes “endemic” (said of a disease that is usually present in an area or a population group) and “epidemic” (more cases of an illness than would normally be expected) but not “pandemic.”

 

The disease manual’s editor, Dr. David L. Heymann, a retired assistant director-general of the W.H.O., said the term had not caused confusion in the past, but assured me in an interview that “pandemic will be defined in the next edition.”

 

Even the indexes of most major medical textbooks do not list pandemic. One is Harrison’s Principles of Internal Medicine, of which Dr. Anthony S. Fauci, who directs the National Institute of Allergy and Infectious Diseases, is a main editor.

 

“It’s a mistake, and I’m surprised it’s not there because it should have been,” Dr. Fauci said in an interview.

 

Government agencies do not have official lists of pandemics. Textbooks cite many recent and old ones, including these:

 

¶AIDS. Many experts have called H.I.V. a pandemic. Others disagree, saying the virus is pandemic only in Africa.

 

¶Cholera. Since 1817, most experts agree, the world has had seven pandemics of this bacterial illness, which causes severe diarrhea and dehydration. ¶Acute hemorrhagic conjunctivitis. Beginning in 1969, an enterovirus has caused tens of millions of cases of a highly contagious, acute, painful, but rarely blinding, form of hemorrhagic eye inflammation.

 

¶Dengue. Since World War II, this mosquito-borne viral disease has spread widely in Asia and Latin America.

 

¶Syphilis. A pandemic of the bacterial disease raced through Europe and Asia after Columbus’s return from America and during mass movements of armies in Europe.

 

Although pandemics have been classically limited to infectious diseases, the term has spread to noninfectious, chronic ones. For example, many health officials now speak of pandemics of obesity and heart disease.

 

Knowledge about past pandemics is necessarily incomplete; historical accounts cannot make up for the absence of modern disease monitoring and laboratory tests.

 

About 14 pandemics of influenza have been described since the 16th century, with the first indisputable one occurring in 1889.

 

In 1580, an influenza pandemic swept through Asia into Europe within six weeks, and at least 10 percent of Rome’s 81,000 residents died in the first week, said Dr. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Some Spanish cities were almost totally depopulated.

 

Dr. Morens, of the infectious diseases institute, said his studies of influenza pandemics left a confusing track record and “are rewiring our brains about thinking about influenza.”

 

“The medical literature will tell you there were three pandemics in the 1830s,” he said — “one from 1830 to 1832, a second in 1833 to 1834 and a third in 1836 to 1837. But I am beginning to think they were all one pandemic.”

 

Dr. Morens said he was puzzled as to why no influenza pandemics were recorded for nearly 150 years after the one in 1580, although there were some severe localized epidemics.

 

“A period of pandemic stability makes us wonder whether a pandemic comes at any time by chance,” he said, “or whether something about epidemic situations prevents pandemics,” or at least delays them.

 

The W.H.O.’s staging system has long been part of its plan for an influenza pandemic. Deep concern about a potential pandemic of the H5N1 avian influenza virus led the organization to convene a large meeting of experts in 2005. Among other things, the experts recommended simplifying the staging system.

 

A number of doctors ask why health agencies do not declare seasonal influenza a pandemic when it spreads around the world.

 

But Dr. Osterholm, the Minnesota expert, said that “you can’t use the terminology for just worldwide transmission, because if you did that, you would say every seasonal flu year is a pandemic.”

 

“To me,” he continued, “a pandemic is basically a new or novel agent emerging with worldwide transmission.”

 

Dr. Keiji Fukuda, an influenza expert who is an assistant director-general at the W.H.O., said in an interview that “as difficult as things are right now,” the problem of defining a pandemic and communicating risk “would be magnitudes worse and more confusing” if the agency had not dealt with AIDS, SARS and avian influenza.

 

Those experiences prompted new international health regulations and pandemic plans, and allowed critical scientific information to be disseminated quickly, he said.

 

The process was “painful, sure,” he said. “But you can’t really do anything like this without having some amount of pain.”

 

Copyright 2009 The New York Times Company.

 

Navy reports 21 swine flu cases on USS Iwo Jima

 

Associated Press

Salisbury Daily Times

Tuesday, June 9, 2009

 

NORFOLK, Va. (AP) — The Navy is reporting 21 cases of swine flu onboard the USS Iwo Jima.

 

Navy spokesman Cmd. Cappy Surette says the Centers for Disease Control and and Prevention confirmed the first case on May 27. The amphibious assault ship left New York on May 26 after participating in Fleet Week.

 

Surette says the cases were mild. All 21 sailors and Marines were treated in New York and have since returned to duty.

 

Several other people have been isolated in the ship's medical ward after developing flu-like symptoms.

 

The Iwo Jima is scheduled to return to Norfolk later this week.

 

Surette says the Navy has had 147 confirmed cases of H1N1, and 137 of those people have returned to work.

 

Copyright 2009 The Associated Press. All rights reserved.

 

Egypt: Five more Americans test positive for swine flu

 

Associated Press

USA Today

Tuesday, June 9, 2009

 

CAIRO (AP) — Another four students and a faculty member at the American University in Cairo have contracted swine flu, said Egypt's health minister, bringing the total number of those infected at the school to seven.

 

The five cases were discovered when tests were carried out at a dormitory after two students from the United States were diagnosed with swine flu, Hatem el-Gabali told reporters Tuesday. He did not disclose the nationalities of the five new cases.

 

AUC Communications Manager, Doaa Farag confirmed that the five new cases are all Americans, and consist of four students and a faculty member.

 

The dorm, which the ministry said houses 234 people including 110 students from 10 different countries, is under quarantine for seven days. AUC officials said Tuesday they were waiting for confirmation of the test results.

 

The Health Ministry said the rest of the dorm dwellers tested negative, but the dormitory will remain under quarantine.

 

Every year hundreds of foreign students take classes at AUC, which has a 5,500 person student body, 81% of whom are Egyptians.

 

The dormitory is located in Zamalek, an upper class neighborhood of Cairo and home to many foreigners and embassies. The university itself recently relocated to the desert outskirts of the capital.

 

The two swine flu cases were discovered Sunday night after the students exhibited flu-like symptoms and tested positive for the virus. El-Gabali said Monday that they were recovering and would be released from the hospital in 48 hours.

 

The 23-year-old students who contracted the flu, a male from New Jersey and a female from Florida, arrived from the United States on May 28 for a summer program at the university, but did not exhibit symptoms until Friday.

 

Travelers arriving in Egypt are photographed, their body temperature scanned and addresses taken down in case follow up is necessary.

 

Egypt's government has come under criticism from international animal rights groups for its decision to slaughter the nation's 300,000 pigs in response to the swine flu problem.

 

Copyright 2009 The Associated Press. All rights reserved.

 

WHO may soon raise swine flu alert to pandemic level

 

Associated Press

USA Today

Tuesday, June 9, 2009

 

GENEVA (AP) — The World Health Organization said Tuesday a spike in swine flu cases in Australia may push it to finally announce the first flu pandemic in 41 years. It also expressed concern about an unusual rise in severe illness from the disease in Canada.

 

WHO's flu chief Keiji Fukuda said the agency wanted to avoid "adverse effects" if it announces a global outbreak of swine flu. Fukuda said people might panic or that governments might take inappropriate actions if WHO declares a pandemic.

 

Some flu experts think the world already is in a pandemic and that WHO has caved in to country requests that a declaration be postponed.

 

"On the surface of it, I think we are in phase 6," or a pandemic, said Margaret Chan, WHO's director-general.

 

Chan said it was important to verify the reports that the virus is becoming established outside North America before declaring a pandemic. "The decision to make a phase 6 announcement is a heavy responsibility, a responsibility that I will take very seriously, and I need to be convinced that I have indisputable evidence," she said.

 

Chan said she will hold a conference call with governments Wednesday in order to verify some of the reports she has received before making a formal announcement. "Once I get indisputable evidence, I will make the announcement," she told reporters in Geneva.

 

WHO said the virus has infected 26,563 people in 73 countries and caused 140 deaths. Most of the cases have been in North America, but Australia also has seen a sharp increase in recent days.

 

In most of the 73 countries, the new H1N1 virus has triggered only mild illness. But the fact that some of the deaths have occurred in otherwise healthy adults has prompted WHO to classify the outbreak as "moderate" for the time being.

 

"Approximately half the people who have died from this H1N1 infection have been previously healthy people," Fukuda said, adding that this was "one of the observations which has given us the most concern."

 

Wealthy countries such as the U.S., Canada and Britain already have large stockpiles of antivirals used to treat swine flu, but many developing countries have no supplies of the drugs and could be more vulnerable to the virus, given their struggle with widespread problems such as AIDS, malnutrition and malaria.

 

Some pharmaceutical companies are preparing to make a swine flu vaccine, if WHO declares a pandemic.

 

The number of cases in Australia jumped to more than 1,000 by Monday, with the vast majority reported from the southern state of Victoria.

 

If the swine flu virus were to be shown to be spreading rapidly from person to person in another world region beyond North America, such as Australia or Europe, that should trigger the conditions for WHO to declare a pandemic, meaning the outbreak has gone global.

 

"We are getting really very close to knowing that we are in a pandemic situation," Fukuda said.

 

He also said it was more important that countries take "the right actions" than that they accurately report the extent of their outbreaks.

 

With 675 reported swine flu cases in Britain, some experts suspect the virus already is entrenched in communities, but that U.K. health authorities are deliberately not testing for the virus and not reporting cases.

 

In recent weeks, two Greek students caught swine flu in Scotland — who had no history of contact with any confirmed cases, a clear sign the virus is spreading in British communities.

 

"Our primary concern is not so much the numbers that are being reported," Fukuda said. He said countries simply needed to take appropriate actions to handle their outbreaks.

 

In his weekly update on the outbreak, Fukuda also addressed reports that an unusually large number of severe cases have occurred among Canada's Inuit population.

 

"There are reports of infections occurring in Inuit communities with a disproportionate number of serious cases," he said. "These are observations of concern to us."

 

Copyright 2009 The Associated Press. All rights reserved.

 

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