Monday, June 15, 2009

News Clipping Archives

 

Maryland / Regional

Lanham Hospital Fined for Not Reporting Errors (Washington Post)

State links billing rates to hospital performances (Annapolis Capital)

Local produce produces questions (Baltimore Sun)

Fighting food allergies (Washington Post)

An alternative approach to pain (Baltimore Sun)

Report: Single mothers struggle in Montgomery Co. (Daily Record)

 

National / International

Obama Is Pressed to Tax Health Benefits (Washington Post)

Obama Tries to Woo Doctors on Health Care Reform Plan (New York Times)

Hospital Industry Bristles at Cuts (Wall Street Journal)

PROMISES, PROMISES: Indian health care needs unmet (Washington Post)

Diabetes doctors debate the best diagnostic tests (Baltimore Sun)

H1N1 vaccine may not be ready in time for fall (Baltimore Sun)

Health Officials Struggle to Estimate Need for Flu Supplies (Wall Street Journal)

Momentum builds for broad debate on legalizing pot (Hagerstown Herald-Mail)

FDA Says Kids Shouldn't Stop Taking ADHD Medications (Wall Street Journal)

Fortified Foods: How Healthy Are They? (Wall Street Journal)

 

Opinion

Remembering when health care system was built on relationships (Baltimore Sun Commentary)

Swine Flu: Don't Panic (Wall Street Journal Commentary)

Health care reform needed (Carroll County Times Letter to the Editor)

 

 

Maryland / Regional

Lanham Hospital Fined for Not Reporting Errors

 

By Lisa Rein

Washington Post

Monday, June 15, 2009

 

Doctors Community Hospital in Prince George's County has been fined by Maryland health regulators after failing to notify them that a patient had died and that at least seven others suffered serious harm last year as a result of mistakes by the medical staff.

 

The 185-bed medical surgical hospital in Lanham paid the $30,000 fine last month for violating a Maryland law that requires hospitals to report serious medical errors. State officials agreed to reduce a proposed penalty of $95,000 as long as the hospital uses the remaining $65,000 to develop a patient safety program.

 

A top state regulator described Doctors' system of reporting errors as "seriously deficient" because of understaffing, a lack of attention to what caused patients to be injured or to die, and the absence of a system to prevent recurrences.

 

"We expect errors to occur," said Wendy Kronmiller, director of the state Office of Health Care Quality. "But we expect systems in place to catch them. What we found at Doctors is that the systems essentially didn't exist."

 

Administrators at Doctors have acknowledged their failure to comply with the law and called the state's action a wake-up call to sharpen the hospital's focus on patient safety.

 

"Our biggest challenge is making sure that someone is stepping back and saying, 'This isn't acceptable. I'm going to focus on dealing with this issue,' " Scott Gregerson, the hospital's vice president for strategy, said Friday. "Everybody in the institution needs a fundamental understanding of what is an error and what are the state's expectations for reporting."

 

The fine is the first in the five years that Maryland has required its 69 hospitals to make public any serious errors that affect patients during treatment. Hospitals are supposed to report such occurrences as surgery on the wrong limb, a patient's taking the wrong medication, a fall, an infection from an IV line and a delay in treatment.

 

The law, the result of a patient safety movement gaining steam in the Washington region and elsewhere, requires hospitals not only to report mistakes but also to analyze how and why the system broke down.

 

In some cases, state regulators found, Doctors did minimal investigations to determine what went wrong and did not classify the errors by their level of seriousness, as required by law. A few near misses, in which patients escaped serious harm, were never investigated, documents show. Those included a reported assault on one patient by another's visitor, an eight-day delay in getting medication to a 49-year-old man with a history of heart failure, and a case in which an antibiotic was given to a 65-year-old woman by a technician who mistook it for plain IV fluid.

 

Kronmiller said her staff will return to Doctors in a few months to make sure changes are being made. Gregerson said the hospital is looking to hire a registered nurse to lead patient safety efforts. I

 

In a letter to Kronmiller, Philip B. Down, the hospital president, said Doctors has seen a surge in indigent patients because of "deteriorating conditions" at the financially troubled Prince George's Hospital Center. Gregerson said Doctors expects 60,000 emergency room admissions this year.

 

"We are working very hard to make sure errors aren't repeated," he said. "But you have substantial demand. Care is not always predictable."

 

Gregerson said he is not sure whether the hospital charged insurance companies for the cost of dealing with the errors.

 

The state review early this year was triggered after Doctors reported just three errors since 2005. Health officials said they did a thorough review of 30 patient records.

 

A few other hospitals that were slow to submit paperwork -- including Prince George's and Laurel Regional Medical Center -- also attracted the state's attention and were subjected to reviews, but none of them was fined.

 

Maryland hospitals last year reported 182 "preventable" errors. Health experts have dubbed them "never events" because they are never supposed to happen. The state does not name individual hospitals or patients, but last year 15 hospitals with 100 to 200 beds, including Doctors, reported a total of 44 mistakes that led to death or serious injury, most from falls.

 

More than 20 states have passed laws requiring hospitals to report mistakes or preventable infections.

 

Mistakes are routine at almost every hospital. Some do not lead to serious harm, and some do, such as the 36-hour delay in giving fluids to a woman admitted to Doctors' emergency in February 2008 with uncontrollable nausea and vomiting. According to state records, the woman became so dehydrated that her blood pressure spiked, putting her at risk of a stroke. She was transferred to the intensive care unit, where she eventually recovered. The hospital did not identify the error internally and did no follow-up, records show.

 

The patient who died was a 46-year-old man who was admitted in January 2008 with a severe blood stream infection and liver disease that caused him to be confused, records show. A nurse's entry in the records says he was out of bed and sitting on the floor. The nurse put him back in bed, but he complained of a severe headache. Shortly after that, the nurse could not wake him. A CT scan revealed bleeding in his brain from a fall. He died the next morning. Records show the hospital failed to identify the fall, did not investigate and failed to report the death to the state.

 

"The patient fell at the hospital, exactly where medical attention should have been most available and where it did not occur," Kronmiller said.

 

In another case, records show, doctors did not properly perform a knee replacement on a 58-year-old woman admitted in June 2008. They realized the error and operated again to fix it. But the physician discharge summary indicated no complications, and nowhere was the second procedure noted or discussed, records show.

 

In March 2008, a man with dangerously low blood pressure and a low white blood cell count who was having trouble breathing was admitted to the intensive care unit at 10 p.m. But his blood pressure was not checked again for more than eight hours, at which point he was in acute distress. The nurse's overnight notes indicate only that at 2 a.m. the man was in "no acute distress," records show. The patient eventually recovered.

 

Copyright 2009 Washington Post.

 

State links billing rates to hospital performances

Incentives aim to reduce preventable complications

 

By Shantee Woodards

Annapolis Capital

Monday, June 15, 2009

 

On July 1, the state's hospitals will receive financial incentives based on the steps taken to prevent complications. The system will be based on a list of 64 preventable complications including collapsed lungs and infections of the urinary tract and in the blood.

 

Hospitals will be measured on how they address these complications, which patients develop during hospitalization. After a year, state regulators will give hospitals feedback on their performance, and that outcome will impact how much each hospital can charge patients.

 

During fiscal 2008, preventable complications were seen in 55,000 inpatient cases statewide, costing hospitals $522 million to treat. Officials said the new system will improve patient care in the state's 47 acute care hospitals.

 

"Maryland has long been a leader in the United States in the areas of hospital cost containment, access to care, equity in payment, financial stability and accountability," Robert Murray, executive director of the Health Services Cost Review Commission, said in a prepared statement. With this new system, "Maryland will distinguish itself as the leader in the nation in the area of clinical care quality as well."

 

The incentives likely won't have an impact on hospitals until 2011, said Mary Jozwik, vice president of Baltimore Washington Medical Center.

 

The changes come as both Anne Arundel Medical Center and Baltimore Washington Medical Center are dealing with financial losses. Both hospitals have cut back salaries and frozen wages.

 

At BWMC, new employees have to wait six months instead of three to enroll in disability plans. Available overtime and matching contributions to retirement plans are being reduced.

 

AAMC reduced salaries for managers and temporarily stopped the employer match in its retirement plans. The hospital also is in the midst of outsourcing its transcription department.

 

BWMC has measures in place to address patient complications. The hospital has an infection prevention program in which the staff monitors each infectious case. The hospital also has been making sure that staff members wash their hands often, since failure to do so can be a cause of infection.

 

This new methodology from the state can be beneficial as long as it's done fairly, officials said.

 

"Hospitals look at this as the necessary next step," Jozwik said. "There are some things that they have to be careful of whenever they get into doing this. When you choose an event that's potentially preventable, like an infection, you have to make sure that you're indeed coming up with a number of what you should have and what you have. (Officials have to make sure) that it is in fact a fair process and fair for every hospital."

 

AAMC officials called the changes a "great step for health care in Maryland," media coordinator Justin Paquette wrote in an e-mail. The hospital already has quality councils, which monitor each major clinical area. These councils, made up of physicians and nurses, report to officials going all the way up to AAMC's Board of Trustees' Quality and Patient Safety Committee.

 

This new initiative "confirms the benefits of the system our hospital already has in place in terms of monitoring, measuring and enhancing quality and patient safety in our hospital," Paquette wrote.

 

---

The state next month will impose a new payment system for hospitals, one that aims to cut down on health complications that can occur during a patient's hospital stay.

 

Copyright 2009 Annapolis Capital.

 

Local produce produces questions

Unfamiliar veggies from community farms stump cooks

 

By Laura Vozzella

Baltimore Sun

Monday, June 15, 2009

 

Bridget McMahon - former vegetarian and current foodie - took red chard home for the first time last week. The very same day, Kelly Barner - homeless and so new to veggies that she calls asparagus a "prickly thing" - got her first look at the chard, too.

 

The dark leafy greens with strawberry-red stems came to both women by way of a fast-growing program known as Community Supported Agriculture. CSAs, which number more than 12,500 nationwide, allow consumers to buy produce directly from local farms, and it's the farmer and the season that dictate which fruits and vegetables - and how much of them - are delivered each week.

 

Dinosaur kale, canary peppers and kohlrabi will make their way into area kitchens and stomachs from CSA farms, which grow lots of unfamiliar produce. Because a portion is donated to soup kitchens, some needy Baltimoreans are getting to know the unusual foods at the same time as gourmets. In city shelters and suburban kitchens, cooks are turning to the Internet, cookbooks and even strangers to identify these foods and figure out how to prepare them.

 

"Swiss chard, kale can be intimidating," said Joan Norman, whose family owns One Straw Farm in White Hall, which provided the red chard to both McMahon and Barner. "People are used to eating any vegetable they want, any day they want it, whatever the vegetable. If you're being forced into eating what's in season, it's not always comfortable."

 

Even for familiar foods, the volume of produce that arrives each week can be daunting, as it piles up on kitchen counters or jams refrigerator shelves.

 

But none of it goes to waste at the Mattie B. Uzzle Outreach Center, where Barner lives. The homeless shelter incorporates the produce not just into dinner, but also into nutrition classes.

 

Women learning the basics of label-reading and the food pyramid are also finding out how to prepare veggies that could stump accomplished home cooks.

 

"Some of them had never heard of eggplant or squash," said Jewel Gray, executive director of Collington Square Nonprofit Corp., which runs the East Baltimore shelter for about 55 women and children.

 

Produce provided by One Straw get much more exotic than that. Baby bok choy and garlic scapes may be freshly plucked from a local field, but they seem infinitely more foreign than Chilean grapes. And not just at the shelter, which is receiving food from the program for a second year.

 

Last week, when One Straw made its first deliveries of the season, women and children at Mattie B., as the shelter is known, also received strawberries, lettuce, kale and that mysterious red chard.

 

Not far away, doctors, nurses and other professionals at Johns Hopkins' Bloomberg School of Public Health picked up the same mix from One Straw. Some of them weren't sure what to do with the red chard either.

 

"It hasn't been in my house," said McMahon, a nurse at the school. The same was true for the kale she received.

 

McMahon and other Hopkins employees paid for their produce, buying what is known as a CSA "share" or "subscription." For $540, they will receive eight types of vegetables or fruit per week, from June to November.

 

CSA farms date to before 1990, when they numbered about 60 nationwide, according to a Rodale Institute report. Today, the number of CSA farms is up more than 200-fold and continues to grow, U.S. Department of Agriculture figures indicate.

 

One Straw alone has 1,500 CSA subscribers. For the past three years, Hopkins has been a stop on the farm's delivery route. Participation has grown from 25 in 2007 to 70 this year, says Brent Kim, a senior researcher at Hopkins' Center for a Livable Future who oversees the CSA program.

 

For every 10 shares, One Straw donates one to a community food organization. The Center for a Livable Future donates a couple more. That food goes to Mattie B. and a few other charities.

 

Eating locally grown food can lead to improved nutrition and a healthier planet by diversifying diets and cutting the distance that food travels, according to CSA advocates. But it's not easy eating green - not when the farmer gets to decide what's for dinner.

 

The typical CSA haul is a big box of roughage, lots of greens, lots of foods that are good for the body but rarely make it into the grocery cart. CSA farmers serve up what's in season and what grows well in the area. The globalized food-supply chain may have trained shoppers to grab the same things in the produce aisle week after week, month after month, but it can't coax tomatoes out of a Maryland field in June.

 

To help budding locavores along, One Straw posts recipes on its Web site. On a page called "Name That Vegetable," photos of individual veggies help customers know what's what.

 

"They get home, and they don't know what it is," Norman said. "So in the privacy of your own home you can secretly admit you do not know what arugula looks like in a bunch."

 

As McMahon picked up her veggies in Hopkins' parking garage last week, she chatted with a colleague about how she might prepare her first batch of chard.

 

"I think it's good with balsamic vinegar," McMahon theorized because she'd dressed beet greens that way.

 

Dr. Kawasar Talaat, a vaccine researcher, suggested adding frozen cherries and red onions, based on a recipe in her Moosewood cookbook, a classic vegetarian tome.

 

Diane Adams, a volunteer who coordinates the food program for Mattie B., also started her recipe research in the Hopkins garage, where she picks up produce for the shelter.

 

"How do you fix your kale?" she recalled asking one man. "He said, 'Oh, I just sauteed it for a few minutes and I ate it.' "

 

And that's where this unlikely cultural exchange reached its limit.

 

To Adams, greens are something to be boiled for half an hour or more, which is just what the shelter's paid cook, the Rev. Harrison Geter, wound up doing. A quick saute sounded "raw" to Adams.

 

"That's not something I'd do with kale," she said.

 

Copyright © 2009, The Baltimore Sun.

 

Fighting food allergies

Researchers at Hopkins and beyond working for breakthrough

 

By Rob Stein

Washington Post

Monday, June 15, 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."

 

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 Dr. 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. "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. No one should try the approach on his own, because the treatments can trigger potentially life-threatening reactions.

 

"It's still very investigational," said Dr. Wesley Burks, chief of the division of pediatric allergy and immunology at Duke University, who has produced promising results in children with peanut allergies.

 

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

 

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 Dr. 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.

 

The spike in research has been driven by 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. Some evidence suggests that the number of 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.

 

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.

 

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.

 

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.

 

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.

 

Copyright © 2009, The Baltimore Sun.

 

An alternative approach to pain

 

Expert advice

 

Ask The Expert Dr. Zhaoming Chen, St. Agnes Hospital

Baltimore Sun

Monday, June 15, 2009

 

Pain is the No. 1 reason people seek medical help. Acute-onset pain suggests a medical emergency and immediate medical assistance is necessary. Chronic pain has a significant impact on human life. According to Dr. Zhaoming Chen, the best way to control chronic pain is a multidisciplinary approach that includes complementary and alternative medicine.

 

Chen, chairman of the American Association of Integrative Medicine and a physician at St. Agnes Hospital, offers several easy ways to help people deal with pain.

 

•Regular exercise, 20 to 30 minutes daily, can relieve muscle cramping and stiffness, as stretching muscles can accelerate local blood circulation and remove metabolic products. Tai Chi is one of the appropriate exercises that will relieve muscle cramping.

 

•Eating healthy food can reduce the frequency of migraine headache attacks. The list of foods that trigger migraines is long. The simple way to find out whether or not a specific food triggers an attack is to check the food you ate before each pain attack. You may be able to identify the troublemaker.

 

•The brains of patients with chronic pain may misinterpret or amplify the pain signal from distant parts of the body. Qigong (a system of breathing and movement) and meditation can help people stay relaxed. Additionally, small doses of vitamin B complex are helpful to decrease stress associated with pain and discomfort.

 

•If you have to take pain medication, try to minimize the dose, minimizing side effects or drug interactions. Sticking to the schedule of pain medications may reduce rebounding pain.

 

•It is believed that people with chronic pain may have lower endorphin levels and cerebral spinal fluid, which can be elevated after acupuncture treatment - electrically or manually. Stimulation on special points throughout the body with fingertips is also effective to control headaches, neck pain, shoulder pain, lower back pain, abdominal pain, etc.

 

•High-quality sleep will reduce morning headaches. Go to bed at the same time every night. Watch your body weight closely. Acupuncture and qigong are very effective in helping people sleep.

 

More information about complementary and alternative medicine is available at the American Association of Integrative Medicine Web site: aaimedicine.com.

 

Copyright © 2009, The Baltimore Sun.

 

 

 

Report: Single mothers struggle in Montgomery Co.

 

Associated Press

Daily Record

Monday, June 15, 2009

 

A new report says nearly half of Montgomery County families living in poverty are led by single women.

 

The report released this week from the county's Commission for Women found that single mothers have daily challenges when it comes to being able to afford housing, food and health care.

 

The report says the median income for families in the county in 2007 was more than $100,000, while the median income for families headed by single women was about $45,000.

 

Officials with the commission say they hope the report triggers action from policymakers and advocates. They provide several recommendations on helping low-income women in areas such as education and child care.

 

Copyright 2009 Daily Record.

 

National / International

Obama Is Pressed to Tax Health Benefits

Seeking GOP Votes, Democrats Split Over Plan for New Levy

 

By Lori Montgomery and Ceci Connolly

Washington Post

Monday, June 15, 2009

 

The White House is caught in a battle within its own party over how to finance a comprehensive overhaul of America's health-care system, as key Democrats advocate a tax plan that could require President Obama to break his campaign pledge not to raise taxes on the middle class.

 

Sensitive to voter anxiety about a soaring federal deficit, Obama and congressional leaders have vowed to pay for a sweeping expansion of the health-care system -- expected to cost more than $1 trillion over the next decade -- without additional borrowing.

 

Much of the money is likely to come from reining in spending on federal health programs for the elderly and the poor. Obama has proposed trimming more than $600 billion from Medicare and Medicaid by 2019 -- including more than $300 billion in cuts unveiled in his Saturday radio and Internet address -- which could fulfill the promise to curb the growth of federal health spending.

 

The rest of the cash will probably come from new taxes. But Democrats are deeply divided over which taxes to raise, and the issue has become a central stumbling block in the push to enact legislation by fall.

 

In recent days, Obama has revived a tax plan he first offered in February: limiting itemized deductions for the nation's 3 million highest earners. Polls show that the idea is popular -- it was Obama's biggest applause line last week at an event in Wisconsin -- and it would enable him to abide by a campaign pledge to pay for coverage for the uninsured with new taxes on the rich.

 

"He believes this is the most equitable way to do this," said senior White House strategist David Axelrod. "It places the burden on people who can most afford it."

 

But many Democrats, particularly in the Senate, have balked at the idea, saying they prefer a tax that has some hope of winning Republican support. In legislation that could be unveiled as early as this week, Senate Finance Committee Chairman Max Baucus (D-Mont.) is expected to propose a new tax on the health benefits that millions of Americans currently receive tax-free through employers.

 

Economists say taxing employer-sponsored benefits would help trim runaway health costs and force society to broadly share the burdens of reform. The idea also has bipartisan appeal. Former president George W. Bush and Sen. John McCain (Ariz.), the 2008 GOP presidential candidate, championed a form of the tax; so did Obama advisers Jason Furman and Ezekiel Emanuel before they joined the administration.

 

"The Democrats are trying to figure out whether they can do health-care reform by themselves without Republicans, or whether they need to adopt some Republican ideas to get a health-care plan," said Chris Edwards, director of tax policy at the libertarian Cato Institute. Taxing health benefits "could be the center of a bipartisan agreement," he said.

 

But political analysts say the idea is treacherous, especially for Obama. Baucus is considering a tax on employer-sponsored premiums in excess of $15,000 a year, Senate aides said, a plan that would strike many of the very families Obama has vowed to protect from a tax increase. Yesterday, top administration officials pushed back forcefully against the tax, which Obama criticized during the campaign.

 

"The president starts with the premise that 180 million Americans have health coverage through their employer, that attacks on those benefits may dismantle that marketplace," Health and Human Services Secretary Kathleen Sebelius said on CNN.

 

Two-thirds of Americans under age 65 get coverage through an employer -- more than 158 million people, according to the Kaiser Family Foundation. In 2008, only about one in five employer-sponsored plans carried the high premiums likely to be hit by the tax.

 

But research shows that those people tend not to be wealthy highfliers with gold-plated insurance plans, as advocates assert, but those who have to pay high premiums just for basic coverage -- the old, the sick, women of childbearing age and residents of high-cost urban areas. Elise Gould, director of health policy research at the liberal Economic Policy Institute, found that a similar cap suggested by a 2005 tax reform panel would have raised taxes mainly on workers with family coverage, many of them in smaller firms with high concentrations of older, female or unionized workers.

 

Labor leaders, who have for years chosen better health benefits over higher wages in contract negotiations, call the tax a deal-killer. "It has the capacity to really undermine trust in a basic kind of way," said Gerald Shea, assistant to the president of the AFL-CIO. "If you say you really, really want to help out the middle class, what are you doing charging more for the health care that's already costing us an arm and a leg?"

 

It could also prove poisonous in the 2010 elections. In a recent survey for Health Care for America Now, a labor-backed reform advocacy group, Democratic pollster Celinda Lake found that 80 percent opposed a tax on benefits, compared with 63 percent support for limiting itemized deductions for high earners.

 

"Taxing benefits would be a disaster," Lake said. "You have no idea how strongly this is going to backfire if we do it."

 

Key lawmakers in the House don't particularly like either of the competing tax plans and may yet offer a third proposal. But in the Senate, the more important congressional battleground, taxing health premiums "has reached the level of a foregone conclusion," said Len Nichols, a health policy analyst at the nonpartisan New America Foundation.

 

Politics aside, the tax dwarfs all other current proposals as a potential cash cow. The tax-free treatment of employer-provided health insurance is the biggest loophole in the tax code and the second-largest federal health-care cost, after Medicare. Taxing half of all employer-sponsored premiums would generate nearly $1.2 trillion over the next decade, according to the nonpartisan Joint Committee on Taxation, compared with about $270 billion for new limits on itemized deductions for the rich.

 

Advocates say taxing benefits also makes good economic sense. The rewards of the current tax break fall heavily to the wealthy, and there is no similar tax break for workers who must buy insurance on their own. Many economists also dislike it because it encourages workers to take compensation in the form of health care instead of higher wages, pushing resources into the health system and increasing costs.

 

"Even in the absence of wanting the money, you'd want to do it," said MIT economist Jonathan Gruber.

 

Senate Democrats have been considering two options. The first would be to tax premiums above a certain level, such as the value of the standard family plan offered to federal employees, which will be about $15,000 in 2013, Senate aides said. That would raise about $420 billion over 10 years. The other option would be to apply the cap only to families earning more than $200,000 a year ($100,000 for individuals), which would raise about $160 billion over 10 years.

 

A senior Baucus aide said the committee is leaning toward the former option, which would do more to "bend the curve" of soaring health costs.

 

In either case, workers would see any insurance premiums in excess of the cap added to their wages and taxed as income. That could increase their tax bills by hundreds or thousands of dollars a year, said Paul Fronstin, director of health research at the nonprofit Employee Benefit Research Institute.

 

The Baucus aide stressed that the goal of reform is to lower premiums for everyone. But the White House is clearly not convinced.

 

"There is still a great deal of disagreement," Sebelius said, "on whether or not taxing benefits at any level of any kind really does put us a step forward or take us a step back."

 

Polling analyst Jennifer Agiesta contributed to this report.

 

Copyright 2009 Washington Post.

 

Obama Tries to Woo Doctors on Health Care Reform Plan

 

By Helene Cooper

New York Times

Monday, June 15, 2009

 

WASHINGTON — President Obama took his health care overhaul proposal to one of its more skeptical audiences, telling doctors at the American Medical Association conference in Chicago that the United States is “not a nation that accepts nearly 46 million uninsured men, women and children.”

 

Mr. Obama’s much-anticipated address appeared carefully calibrated to woo doctors to support — or at least, to not actively oppose — his sweeping health proposals. He also sought to reassure doctors who are skittish about his proposal for a government-run insurance plan as one option from which consumers could choose.

 

“I understand that you are concerned that today’s Medicare rates will be applied broadly in a way that means our cost savings are coming off your backs,” Mr. Obama said, in the keynote address at the A.M.A. annual meeting. “These are legitimate concerns, but ones, I believe, that can be overcome.”

 

Mr. Obama’s quick trip to Chicago to try to sell doctors on his health proposal is part of a wider White House effort to push what is a central tenet of Mr. Obama’s domestic policy program. He called health reform central to the American economy, and promised that he could enact his ambitious plan without burdening the budget deficit.

 

While he did not provide many specifics, Mr. Obama said that he wants to look into “a range of ideas” about how to put patient safety first, let doctors focus on practicing medicine, and encourage broader use of evidence-based guidelines for care. “That’s how we can scale back the excessive defensive medicine reinforcing our current system of more treatment rather than better care.”

 

Mr. Obama did not commit to specific limits on malpractice lawsuits, saying that would be unfair to patients. But he sought to address the concerns of many doctors who complain that malpractice litigation is part of the reason why health costs have soared.

 

At times, Mr. Obama struck a professorial note, lecturing Americans to stop smoking — without referencing his own battles to break the habit — and to seek mammograms and colon-cancer screening. Health care reform, he said, means going for a run, going to the gym, and staying away from video games. It also, he said, means laying off junk food.

 

“That’s a lesson Michelle and I have tried to instill in our daughters with the White House vegetable garden that Michelle planted,” Mr. Obama said.

 

He maintained his line that Americans will still be able to choose their own doctors. In fact, throughout much of his speech, he sought to empathize with doctors, and criticized a system which he said has created incentives to run more expensive tests than necessary and pushes doctors to see more patients in an effort to make more money.

 

“That is not why you became doctors,” Mr. Obama said. “That is not why you put in all those hours in the anatomy suite or the O.R. That is not what brings you back to a patient’s bedside to check in or make you call a loved one to say it’ll be fine. You did not enter this profession to be beancounters and paper-pushers.”

 

Mr. Obama drew cheers from his audience when he said, “I recognize that it will be hard to make some of these changes if doctors feel like they are constantly looking over their shoulder for fear of lawsuits.”

 

But it remains to be seen how far he will be willing to go on the malpractice issue. On Capitol Hill, Democrats drafting health legislation have so far shown little appetite for taking on the liability issue.

 

Mr. Obama’s ideas on health reform are facing mounting criticism — not only from the A.M.A. and from Republicans, who don’t like the public insurance program, but also from the hospital industry, which doesn’t like a proposal Mr. Obama announced on Saturday to pay for his health care overhaul in part by cutting certain hospital reimbursements.

 

In Washington, Representative Eric Cantor, a Republican from Virginia and the minority whip, issued a statement before Mr. Obama had completed his speech in Chicago.

 

“Democrats are touting a government-run health care option that creates an unlevel playing field leading to the destruction of the private market, reducing choice and putting Washington bureaucrats in charge of family health care decisions,” Mr. Cantor said. He added that “it’s time for the administration to end the happy talk and get down to the difficult decisions ahead.”

 

Copyright 2009 The New York Times Company.

 

Hospital Industry Bristles at Cuts

After Proposing $313 Billion Health-Spending Reduction, Obama Must Win Support

 

By Janet Adamy and Jonathan D. Rockoff

Wall Street Journal

Monday, June 15, 2009

 

Hospitals and other medical-industry groups are pushing back against President Barack Obama's proposal to cut $313 billion in government health spending as the White House intensifies its effort to revamp the nation's health system.

 

Mr. Obama will seek to build doctors' support for a health overhaul in a speech Monday to the influential American Medical Association in Chicago. He will make the case for controlling costs and expanding coverage, and he plans to detail more of what he wants to see in a government-run plan that would compete with private insurance companies, an administration official said Sunday.

 

Mr. Obama is pressing Congress to pass legislation to overhaul the country's health-care system by October. His plan would expand insurance coverage to the nation's 46 million uninsured, an effort estimated to cost at least $1 trillion over a decade.

 

Under pressure to amplify its payment plan, the White House on Saturday outlined $313 billion in additional spending cuts over that period to health-care providers paid through Medicare and Medicaid, the federal health programs for the elderly and poor. That would bring total cost savings and tax increases identified by the Obama administration to help pay for the overhaul to nearly $950 billion.

 

The sharp response from the hospital industry, which under the proposal faces reductions in subsidies exceeding $100 billion over 10 years, illustrates the administration's challenge in winning the deep concessions from industry needed to pay for the overhaul. After agreeing in May to contribute to a $2 trillion reduction in health spending over 10 years, the hospital industry is now bristling at the prospect of more givebacks -- this time, cuts that would be set in law.

 

"We're certainly disappointed," said Rich Umbdenstock, chief executive of the American Hospital Association, an industry group. "It will be very, very difficult for hospitals to live with cuts of that magnitude." He said what concerns the group is that the cuts were being laid out before lawmakers have agreed on concrete proposals for reducing the number of uninsured.

 

A spokeswoman for the White House Office of Health Reform said that as more Americans get insurance coverage, the need for the government to subsidize hospitals for covering the uninsured will decline.

 

The pharmaceutical industry recently has been negotiating with the White House and Congress over how much it would contribute to the cuts, said several people familiar with the negotiations. Drug companies were initially asked to contribute $100 billion over the next decade, but pressed for their contribution to be closer to $60 billion, they said. The industry argued that giving up too much in payments would cut into spending to develop new drugs.

 

"Otherwise we might all just become generic drug companies," said one industry official familiar with the talks. The White House on Saturday said it would save $75 billion over 10 years by paying better prices for drugs under the Medicare Part D prescription drug plan.

 

The Access to Medical Imaging Coalition, which represents makers of medical-imaging equipment, said the administration's proposed cuts "will impair access to diagnostic imaging services and result in patients' delaying or forgoing life-and-cost savings imaging procedures."

 

So far, the hospital association, as well as other major groups representing doctors, insurance companies and drug makers, support legislation aimed at expanding health-insurance coverage and putting the nation's health system on a more sustainable path. Such changes would benefit the industry by increasing their customer base through a fresh batch of insured Americans.

 

One hospital advocate said he saw the White House proposal as "trying to give cover to the Hill," as congressional committees work out final details of their health packages, including spending cuts to pay for it all.

 

"This takes some pressure off of them," the advocate said. If Congress were to propose less-severe reductions, interest groups could greet the plan with some relief, noting it could have been worse.

 

New York City offers a window into what could happen when payments to safety-net hospitals are cut. Already running at a deficit, the city's public hospital system is looking at $150 million in state Medicaid cuts for next year. Next month, it will close some outpatient services, such as community-based primary and preventive-care offices.

 

"We are in a position already where we are making painful decisions that require us to reduce access and services," said Alan D. Aviles, president and chief executive of the system, known as the Health and Hospitals Corp.

 

Laura Meckler and Barbara Martinez contributed to this article.

 

Printed in The Wall Street Journal, page A3

 

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

 

PROMISES, PROMISES: Indian health care needs unmet

 

Associated Press

BY Mary Clare Jalonick

Washington Post

Sunday, June 14, 2009

 

CROW AGENCY, Mont. -- Ta'Shon Rain Little Light, a happy little girl who loved to dance and dress up in traditional American Indian clothes, had stopped eating and walking. She complained constantly to her mother that her stomach hurt.

 

When Stephanie Little Light took her daughter to the Indian Health Service clinic in this wind-swept and remote corner of Montana, they told her the 5-year-old was depressed.

 

Ta'Shon's pain rapidly worsened and she visited the clinic about 10 more times over several months before her lung collapsed and she was airlifted to a children's hospital in Denver. There she was diagnosed with terminal cancer, confirming the suspicions of family members.

 

A few weeks later, a charity sent the whole family to Disney World so Ta'Shon could see Cinderella's Castle, her biggest dream. She never got to see the castle, though. She died in her hotel bed soon after the family arrived in Florida.

 

"Maybe it would have been treatable," says her great-aunt, Ada White, as she stoically recounts the last few months of Ta'Shon's short life. Stephanie Little Light cries as she recalls how she once forced her daughter to walk when she was in pain because the doctors told her it was all in the little girl's head.

 

Ta'Shon's story is not unique in the Indian Health Service system, which serves almost 2 million American Indians in 35 states.

 

On some reservations, the oft-quoted refrain is "don't get sick after June," when the federal dollars run out. It's a sick joke, and a sad one, because it's sometimes true, especially on the poorest reservations where residents cannot afford health insurance. Officials say they have about half of what they need to operate, and patients know they must be dying or about to lose a limb to get serious care.

 

Wealthier tribes can supplement the federal health service budget with their own money. But poorer tribes, often those on the most remote reservations, far away from city hospitals, are stuck with grossly substandard care. The agency itself describes a "rationed health care system."

 

The sad fact is an old fact, too.

 

The U.S. has an obligation, based on a 1787 agreement between tribes and the government, to provide American Indians with free health care on reservations. But that promise has not been kept. About one-third more is spent per capita on health care for felons in federal prison, according to 2005 data from the health service.

 

In Washington, a few lawmakers have tried to bring attention to the broken system as Congress attempts to improve health care for millions of other Americans. But tightening budgets and the relatively small size of the American Indian population have worked against them.

 

"It is heartbreaking to imagine that our leaders in Washington do not care, so I must believe that they do not know," Joe Garcia, president of the National Congress of American Indians, said in his annual state of Indian nations' address in February.

 

---

 

When it comes to health and disease in Indian country, the statistics are staggering.

 

American Indians have an infant death rate that is 40 percent higher than the rate for whites. They are twice as likely to die from diabetes, 60 percent more likely to have a stroke, 30 percent more likely to have high blood pressure and 20 percent more likely to have heart disease.

 

American Indians have disproportionately high death rates from unintentional injuries and suicide, and a high prevalence of risk factors for obesity, substance abuse, sudden infant death syndrome, teenage pregnancy, liver disease and hepatitis.

 

While campaigning on Indian reservations, presidential candidate Barack Obama cited this statistic: After Haiti, men on the impoverished Pine Ridge and Rosebud Reservations in South Dakota have the lowest life expectancy in the Western Hemisphere.

 

Those on reservations qualify for Medicare and Medicaid coverage. But a report by the Government Accountability Office last year found that many American Indians have not applied for those programs because of lack of access to the sign-up process; they often live far away or lack computers. The report said that some do not sign up because they believe the government already has a duty to provide them with health care.

 

The office of minority health at the U.S. Department of Health and Human Services, which oversees the Indian Health Service, notes on its Web site that American Indians "frequently contend with issues that prevent them from receiving quality medical care. These issues include cultural barriers, geographic isolation, inadequate sewage disposal and low income."

 

Indeed, Indian health clinics often are ill-equipped to deal with such high rates of disease, and poor clinics do not have enough money to focus on preventive care. The main problem is a lack of federal money. American Indian programs are not a priority for Congress, which provided the health service with $3.6 billion this budget year.

 

Officials at the health service say they can't legally comment on specific cases such as Ta'Shon's. But they say they are doing the best they can with the money they have - about 54 cents on the dollar they need.

 

One of the main problems is that many clinics must "buy" health care from larger medical facilities outside the health service because the clinics are not equipped to handle more serious medical conditions. The money that Congress provides for those contract health care services is rarely sufficient, forcing many clinics to make "life or limb" decisions that leave lower-priority patients out in the cold.

 

"The picture is much bigger than what the Indian Health Service can do," says Doni Wilder, an official at the agency's headquarters in Rockville, Md., and the former director of the agency's Northwestern region. "Doctors every day in our organization are making decisions about people not getting cataracts removed, gall bladders fixed."

 

On the Standing Rock Reservation in North Dakota, Indian Health Service staff say they are trying to improve conditions. They point out recent improvements to their clinic, including a new ambulance bay. But in interviews on the reservation, residents were eager to share stories about substandard care.

 

Rhonda Sandland says she couldn't get help for her advanced frostbite until she threatened to kill herself because of the pain - several months after her first appointment. She says she was exposed to temperatures at more than 50 below, and her hands turned purple. She eventually couldn't dress herself, she says, and she visited the clinic over and over again, sometimes in tears.

 

"They still wouldn't help with the pain so I just told them that I had a plan," she said. "I was going to sleep in my car in the garage."

 

She says the clinic then decided to remove five of her fingers, but a visiting doctor from Bismarck, N.D., intervened, giving her drugs instead. She says she eventually lost the tops of her fingers and the top layer of skin.

 

The same clinic failed to diagnose Victor Brave Thunder with congestive heart failure, giving him Tylenol and cough syrup when he told a doctor he was uncomfortable and had not slept for several days. He eventually went to a hospital in Bismarck, which immediately admitted him. But he had permanent damage to his heart, which he attributed to delays in treatment. Brave Thunder, 54, died in April while waiting for a heart transplant.

 

"You can talk to anyone on the reservation and they all have a story," says Tracey Castaway, whose sister, Marcella Buckley, said she was in $40,000 of debt because of treatment for stomach cancer.

 

Buckley says she visited the clinic for four years with stomach pains and was given a variety of diagnoses, including the possibility of a tapeworm and stress-related stomachaches. She was eventually told she had Stage 4 cancer that had spread throughout her body.

 

Ron His Horse is Thunder, chairman of the Standing Rock tribe, says his remote reservation on the border between North Dakota and South Dakota can't attract or maintain doctors who know what they are doing. Instead, he says, "We get old doctors that no one else wants or new doctors who need to be trained."

 

His Horse is Thunder often travels to Washington to lobby for more money and attention, but he acknowledges that improvements are tough to come by.

 

"We are not one congruent voting bloc in any one state or area," he said. "So we don't have the political clout."

 

---

 

On another reservation 200 miles north of Standing Rock, Ardel Baker, a member of North Dakota's Three Affiliated Tribes, knows all too well the truth behind the joke about money running out.

 

Baker went to her local clinic with severe chest pains and was sent by ambulance to a hospital more than an hour away. It wasn't until she got there that she noticed she had a note attached to her, written on U.S. Department of Health and Human Services letterhead.

 

"Understand that Priority 1 care cannot be paid for at this time due to funding issues," the letter read. "A formal denial letter has been issued."

 

She lived, but she says she later received a bill for more than $5,000.

 

"That really epitomizes the conflict that we have," says Robert McSwain, deputy director of the Indian Health Service. "We have to move the patient out, it's an emergency. We need to get them care."

 

It was too late for Harriet Archambault, according to the chairman of the Senate Indian Affairs Committee, Democratic Sen. Byron Dorgan of North Dakota, who has told her story more than once in the Senate.

 

Dorgan says Archambault died in 2007 after her medicine for hypertension ran out and she couldn't get an appointment to refill it at the nearest clinic, 18 miles away. She drove to the clinic five times and failed to get an appointment before she died.

 

Dorgan's swath of the country is the hardest hit in terms of Indian health care. Many reservations there are poor, isolated, devoid of economic development opportunities and subject to long, harsh winters - making it harder for the health service to recruit doctors to practice there.

 

While the agency overall has an 18 percent vacancy rate for doctors, that rate jumps to 38 percent for the region that includes the Dakotas. That region also has a 29 percent vacancy rate for dentists, and officials and patients report there is almost no preventive dental care. Routine procedures such as root canals are rarely seen here. If there's a problem with a tooth, it is simply pulled.

 

Dorgan has led efforts in Congress to bring attention to the issue. After many years of talking to frustrated patients at home in North Dakota, he says he believes the problems are systemic within the embattled agency: incompetent staffers are transferred instead of fired; there are few staff to handle complaints; and, in some cases, he says, there is a culture of intimidation within field offices charged with overseeing individual clinics.

 

The senator has also probed waste at the agency.

 

A 2008 GAO report, along with a follow-up report this year, accused the Indian Health Service of losing almost $20 million in equipment, including vehicles, X-ray and ultrasound equipment and numerous laptops. The agency says some of the items were later found.

 

Dorgan persuaded Senate Majority Leader Harry Reid, D-Nev., to consider an American Indian health improvement bill last year, and the bill passed in the Senate. It would have directed Congress to provide about $35 billion for health programs over the next 10 years, including better access to health care services, screening and mental health programs. A similar bill died in the House, though, after it became entangled in an abortion dispute.

 

The growing political clout of some remote reservations may bring some attention to health care woes. Last year's Democratic presidential primary played out in part in the Dakotas and Montana, where both Obama and Democrat Hillary Rodham Clinton became the first presidential candidates to aggressively campaign on American Indian reservations there. Both politicians promised better health care.

 

Obama's budget for 2010 includes an increase of $454 million, or about 13 percent, over this year. Also, the stimulus bill he signed this year provided for construction and improvements to clinics.

 

---

 

Back in Montana, Ta'Shon's parents are doing what they can to bring awareness to the issue. They have prepared a slideshow with pictures of her brief life; she is seen dressed up in traditional regalia she wore for dance competitions with a bright smile on her face. Family members approached Dorgan at a Senate field hearing on American Indian health care after her death in 2006, hoping to get the little girl's story out.

 

"She was a gift, so bright and comforting," says Ada White of her niece, whom she calls her granddaughter according to Crow tradition. "I figure she was brought here for a reason."

 

Nearby, the clinic on the Crow reservation seems mostly empty, aside from the crowded waiting room. The hospital is down several doctors, a shortage that management attributes recruitment difficulties and the remote location.

 

Diane Wetsit, a clinical coordinator, said she finds it difficult to think about the congressional bailout for Wall Street.

 

"I have a hard time with that when I walk down the hallway and see what happens here," she says.

 

---

On the Net:

 

Indian Health Service:http://www.ihs.gov/

 

U.S. Department of Health and Human Services Department's office of minority health:http://tinyurl.com/l9qzuq

 

National Congress of American Indians' health care issues:http://tinyurl.com/krs986

 

Senate Indian Affairs Committee:http://indian.senate.gov

 

GAO reports:http://tinyurl.com/ljq6fb,http://tinyurl.com/n7kdpa

 

© 2009 The Associated Press.

 

Diabetes doctors debate the best diagnostic tests

Controlling blood sugar is also discussed at their convention.

 

By Thomas H. Maugh II

Baltimore Sun

Monday, June 15, 2009

 

Diabetes rates have climbed steeply in this country in the last two decades. Fortunately, scientists' knowledge of how best to manage the disease is advancing as well. Researchers gathered at the American Diabetes Assn. meeting last week in New Orleans to consider the latest developments, including a new test for diagnosing the disease and a better understanding of the risks of aggressive control of blood sugar.

 

The current techniques for diagnosing Type 2 diabetes involve either a fasting plasma glucose test or, less commonly, an oral glucose tolerance test. In the former, the patient must fast for 12 to 14 hours before the physician measures the level of glucose in his or her blood. In the latter, the patient drinks a solution of concentrated sugar, and blood sugar levels are measured two hours later.

 

The first test can be affected by eating during the fast, and both can be affected by illness.

 

Many doctors now believe that a blood analysis for glycated hemoglobin, also known as hemoglobin A1c, is a better test. A1c is a measure of the patient's blood sugar levels for the two to three months preceding the test. The test requires only a sample of blood.

 

But diabetes groups have been reluctant to recommend wider use of it for diagnosis because only recently have most labs begun using a standardized test for A1c.

 

A 21-member committee including scientists from the American Diabetes Assn., the International Diabetes Federation and the European Assn. for the Study of Diabetes has been studying literature on the test for several months and, at the meeting, recommended that it be adopted as the primary diagnostic test.

 

"This is the first major departure from the way diabetes has been diagnosed in the past 30 years," Dr. David Nathan of Harvard Medical School, chairman of the committee, told a news conference.

 

The committee also concluded that the A1c test is a more accurate predictor of a diabetic's likelihood of developing complications of the disease. Healthy people have an A1c level of 6% or lower; diabetics typically have a level well above 7%. The committee recommended that a cutoff level of 6.5% be used for a diagnosis.

 

Assessing risks

 

A1c levels have also been a crucial end point in two large trials studying aggressive control of diabetes.

 

Doctors already knew that tight control of blood sugar levels is an effective method of preventing cardiovascular and other complications of Type 1 diabetes. But the situation is more complicated for Type 2, which affects the vast majority of the 24 million diabetics in the United States.

 

Researchers and clinicians had always believed that aggressively lowering sugar levels is beneficial, until two major studies released last year muddied the waters.

 

One of the trials, called Action to Control Cardiovascular Risk in Diabetes or ACCORD, suggested that aggressively lowering blood sugar caused a 20% increase in deaths, possibly from increased episodes of hypoglycemia, or subnormal blood sugar levels.

 

The second trial, the Veterans Affairs Diabetes Trial or VADT, found no increased risk of deaths, but no overall benefit from aggressive treatment.

 

New analyses of the data presented last week provide some insight into the differing findings but fail to answer the question of why some researchers saw increased risks while others didn't.

 

Two important conclusions they did reach, however, were that diabetics should avoid hypoglycemic episodes no matter what regimen is followed, and that aggressive treatment should begin as soon as possible after diagnosis.

 

The ACCORD trial enrolled 10,251 diabetics at 77 U.S. and Canadian clinics. Half received treatment to reduce A1c to between 7% and 7.9%, and half received aggressive treatment to try to reduce it to 6%.

 

Contrary to their initial speculation, the research team has now concluded that the excess deaths in the aggressive treatment arm were not caused by episodes of hypoglycemia, Dr. Matthew Riddle of the Oregon Health Science University in Portland told the meeting. Though severe hypoglycemia was associated with deaths, the risks were the same in both treatment groups.

 

The team did find a 20% increased risk of death for every 1% rise in A1c above 6%, Riddle said, "suggesting that lower blood glucose levels may be a worthy target." They also found that patients who were more easily able to reduce their A1c levels below 7% had a lower risk of death than those who struggled to do so.

 

And what caused the increased risk of death in the aggressive treatment group? "We don't know," Riddle said.

 

The VADT trial enrolled 1,791 patients from 20 VA medical centers, and had the same goals as ACCORD.

 

One new conclusion from the trial is that the time when treatment is begun is crucial, Dr. William C. Duckworth of the Carl T. Hayden VA Medical Center in Phoenix told the meeting. Aggressive treatment begun during the first 15 years after diagnosis is beneficial, while beginning such treatment between 15 and 20 years after diagnosis provides little or no benefit, the team found.

 

Surprisingly, beginning aggressive treatment 20 years after diagnosis was associated with a doubled risk of heart attacks and strokes, for reasons that are not clear.

 

Like ACCORD, the VADT team observed an association between hypoglycemic events and the risk of death. But they observed three times as many severe hypoglycemic events in the aggressive treatment arm, suggesting a need for careful control of medications to avoid such extremes.

 

Researchers are at a loss to explain the differences between the two studies. One possibility is that it is related to the drugs that were used. But physicians prescribed whatever medications they thought were appropriate, so teasing out effects will be difficult.

 

One conclusion comes out of both trials, however, Duckworth said: "We have to treat early and carefully."

 

Copyright © 2009, The Los Angeles Times.

 

H1N1 vaccine may not be ready in time for fall

 

Newsday

Baltimore Sun

Monday, June 15, 2009

 

As the World Health Organization declared a global flu pandemic last week, raising the alert to its highest level, federal health officials said it was unclear whether an effective vaccine would be available by fall. Federal and local health officials are eyeing the Southern Hemisphere, where the virus is already on an unstoppable course and where it's feared it might combine with the seasonal flu strain and develop drug resistance. The U.S. government has invested $1 billion toward vaccine production. But a vaccine must first be tested in a federally overseen clinical trial. No one knows whether the newly commissioned vaccine - in its earliest phases of development - will pass critical scientific testing. "Vaccines are not the only tools we have in the toolbox," said Dr. Anne Schuchat of the Centers for Disease Control and Prevention. "We have to be ready for the idea that we may not get a vaccine as soon as we'd like it, or we may not get a vaccine that works as well as we would like it. Or we might not get a vaccine."

 

Copyright © 2009, The Baltimore Sun.

 

Health Officials Struggle to Estimate Need for Flu Supplies

 

By Shirley S. Wang

Wall Street Journal

Monday, June 15, 2009

 

SyringeThe arrival of the H1N1 flu pandemic hasn’t overwhelmed the U.S. health-care system. But it has highlighted the difficulty for public-health agencies in determining whether drug and medical-products makers are producing enough supplies to satisfy demand, reports the Boston Globe.

 

Disease trackers are scrutinizing the response to the H1N1 virus so that they can prepare for the fall flu season, when the regular flu strain and the H1N1 virus are both expected to circulate.

 

“We really didn’t have a good handle on how much commercial supplies were out there, who had them, how rapidly were they being drawn down, and how to blend the public and private stockpiles so there would be no disruption of service,” James Blumenstock, chief program officer for public health practice at the Association of State and Territorial Health Officials, told the Globe.

 

For drug makers currently working on developing and manufacturing flu vaccine, the uncertainty of how much supply to manufacture is exacerbated because public-health officials don’t know yet who — if anyone — should get the vaccine first or to what extent vaccination should occur, notes the WSJ.

 

Accurate forecasts are important because companies want to provide enough vaccine to keep individuals’ healthy and the virus in check, but they don’t want to produce too much because it is a waste of money and also prevents them from making other important vaccines.

 

Demand for the H1N1 flu vaccine, expected to be ready for the fall, is high. So far, more than 30 governments have asked drug maker Novartis for vaccine or vaccine ingredients. GlaxoSmithKline has promised to donate 50 million doses to the World Health Organization, according to the WSJ.

 

Copyright 2008 Dow Jones & Company, Inc. All Rights Reserved.

 

Momentum builds for broad debate on legalizing pot

 

Aassociated Press National Writer

By David Crary

Hagerstown Herald-Mail

Monday, June 15, 2009

 

The savage drug war in Mexico. Crumbling state budgets. Weariness with current drug policy. The election of a president who said, "Yes - I inhaled."

 

These developments and others are kindling unprecedented optimism among the many Americans who want to see marijuana legalized.

 

Doing so, they contend to an ever-more-receptive audience, could weaken the Mexican cartels now profiting from U.S. pot sales, save billions in law enforcement costs, and generate billions more in tax revenue from one of the nation's biggest cash crops.

 

Said a veteran of the movement, Ethan Nadelmann of the Drug Policy Alliance: "This is the first time I feel like the wind is at my back and not in my face."

 

Foes of legalization argue that already-rampant pot use by adolescents would worsen if adults could smoke at will.

 

Even the most hopeful marijuana activists doubt nationwide decriminalization is imminent, but they see the debate evolving dramatically and anticipate fast-paced change on the state level.

 

"For the most part, what we've seen over the past 20 years has been incremental," said Norm Stamper, a former Seattle police chief now active with Law Enforcement Against Prohibition. "What we've seen in the past six months is an explosion of activity, fresh thinking, bold statements and penetrating questions."

 

Some examples:

 

*Numerous prominent political leaders, including California Gov. Arnold Schwarzenegger and former Mexican presidents, have suggested it is time for open debate on legalization.

 

*Lawmakers in at least three states are considering joining the 13 states that have legalized pot for medical purposes. Massachusetts voters last fall decided to decriminalize possession of an ounce or less of pot; there are now a dozen states that have taken such steps.

 

*In Congress, Rep. Dennis Kucinich, D-Ohio, and Sen. Jim Webb, D-Va., are among several lawmakers contending that marijuana decriminalization should be studied in re-examining what they deem to be failed U.S. drug policy. "Nothing should be off the table," Webb said.

 

*National polls show close to half of American adults are now open to legalizing pot - a constituency encompassing today's college students and the 60-something baby boomers who popularized the drug in their own youth. In California last month, a statewide Field Poll for the first time found 56 percent of voters supporting legalization.

 

That poll pleased California Assemblyman Tom Ammiano, a San Francisco Democrat who introduced a bill in February to legalize marijuana in a manner similar to alcohol - taxing sales to adults while barring possession by anyone under 21. Ammiano hopes for a vote by early next year and contends the bill would generate up to $1.3 billion in revenue for his deficit-plagued state.

 

Ammiano, 67, said he has been heartened by cross-generational and bipartisan support.

 

"People who initially were very skeptical - as the polls come in, as the budget situation gets worse - are having a second look," he said. "Maybe these issues that have been treated as wedge issues aren't anymore. People know the drug war has failed."

 

A new tone on drug reform also has sounded more frequently in Congress.

 

At a House hearing last month, Rep. Steve Cohen, D-Tenn., challenged FBI Director Robert Mueller when Mueller spoke of parents losing their lives to drugs.

 

"Name me a couple of parents who have lost their lives to marijuana," Cohen said.

 

"Can't," Mueller replied.

 

"Exactly. You can't, because that hasn't happened," Cohen said. "Is there some time we're going to see that we ought to prioritize meth, crack, cocaine and heroin, and deal with the drugs that the American culture is really being affected by?"

 

In a telephone interview, Kucinich noted that both Obama and former President Bill Clinton acknowledged trying marijuana.

 

"Apparently that didn't stop them from achieving their goals in life," Kucinich said. "We need to come at this from a point of science and research and not from mythologies or fears."

 

Gil Kerlikowske, chief of the Office of National Drug Control Policy, has not endorsed the idea of an all-options review of drug policy, but he has suggested scrapping the "war on drugs" label and placing more emphasis on treatment and prevention. Attorney General Eric Holder has said federal authorities will no longer raid medical marijuana facilities in California.

 

Nonetheless, many opponents of pot legalization remain firm in their convictions.

 

"We're opposed to legalization or decriminalization of marijuana. We think it's the wrong message to send our youth," said Russell Laine, police chief in Algonquin, Ill., and president of the International Association of Chiefs of Police.

 

Marijuana - though considered one of the least harmful illegal drugs - consumes a vast amount of time and money on the part of law enforcement, accounting for more than 40 percent of drug arrests nationally even though relatively few pot-only offenders go to prison.

 

According to estimates by Harvard University economist Jeffrey Miron, legalization of marijuana could save the country at least $7.7 billion in law enforcement costs and generate more than $6 billion in revenue if it were taxed like cigarettes and alcohol.

 

Pot usage is pervasive. The latest federal survey indicates that more than 100 million Americans have tried it at some point and more than 14 million used it in the previous month.

 

Testifying recently before Congress, Arizona Attorney General Terry Goddard said U.S. demand for pot is a key factor in the Mexican drug war.

 

"The violence that we see in Mexico is fueled 65 percent to 70 percent by the trade in one drug: marijuana," he said. "I've called for at least a rational discussion as to what our country can do to take the profit out of that."

 

The U.S. Drug Enforcement Agency remains on record against legalization and medical marijuana, which it contends has no scientific justification.

 

"Legalization of marijuana, no matter how it begins, will come at the expense of our children and public safety," says a DEA document. "It will create dependency and treatment issues, and open the door to use of other drugs, impaired health, delinquent behavior, and drugged drivers."

 

The DEA also says marijuana is now at its most potent, in part because of refinements in cultivation.

 

Even in liberal Vermont, with the nation's highest rates of marijuana usage, many substance-abuse specialists are wary of legalization.

 

Annie Ramniceanu, clinical director at Spectrum Youth and Family Services in Burlington, Vt., said her agency deals with scores of youths each year whose social development has been hurt by early and frequent pot smoking.

 

"They don't deal with anything," she said. "They never learned how to have fun without smoking pot, never learned how to deal with conflict."

 

Legalization proponents acknowledge that pot use by adolescents is a major problem, but contend that decriminalizing and regulating the drug would improve matters by shifting efforts away from criminal gangs.

 

"The notion that we have to keep something completely banned for adults to keep it away from kids doesn't hold up," said Bruce Mirken, communications director of the Marijuana Policy Project.

 

As for Obama, the activists don't expect him to embrace the cause at this point.

 

"Obama's got two wars, an economic disaster. We have to realize they're not going to put this on the front burner right now," said Allen St. Pierre, executive director of NORML, or the National Organization for the Reform of Marijuana Laws. "But every measurable metric out there is swinging our way."

___

On the Net:

 

Marijuana Policy Project: http://www.mpp.org

 

Drug Enforcement Agency: http://www.usdoj.gov/dea

Press Association

 

[iCopyright] © 2009 Associated Press.

 

FDA Says Kids Shouldn't Stop Taking ADHD Medications

 

By Jared A. Favole

Wall Street Journal

Monday, June 15, 2009

 

WASHINGTON -- The Food and Drug Administration on Monday said children shouldn't stop taking drugs that treat attention deficit hyperactivity disorder, or ADHD, despite a study showing the stimulants may be associated with sudden death.

 

A study released in the American Journal of Psychiatry found an association between the stimulants, which include drugs such as Ritalin, and sudden death in children who take the medicines.

 

The FDA, which partly funded the study, said there isn't enough evidence to conclude the drugs are dangerous and recommends people continue taking their medications. The study compared 564 healthy children who died suddenly to 564 who died in a motor vehicle accident. The study found that two patients in the motor vehicle group were taking stimulants, while 10 in the group of those who died suddenly were taking the medicines. The children died between 1985 and 1996, before certain stimulants, such as Adderall, became more commonly used.

 

"Given the limitations of this study's methodology, the FDA is unable to conclude that these data affect the overall risk and benefit profile of stimulant medications used to treat ADHD in children," FDA said.

 

One of the major limitations of the study, said FDA's Robert Temple, was that so few children who were studied were on stimulants.

 

These stimulants are aimed at helping kids and adults concentrate. Some leading ADHD drugs include Shire Pharmaceuticals Group PLC's Adderall, Johnson & Johnson's Concerta, Eli Lilly & Co.'s Strattera and Novartis AG's Ritalin.

 

Dr. Temple said the FDA has had its eye on whether ADHD medications cause heart problems and sudden death for years.

 

In 2006, the FDA required makers of ADHD drugs to update the drugs' labels to warn of rare but increased risks for psychiatric problems, heart attacks and strokes.

 

The FDA is conducting two more studies to determine the relation of ADHD medicines to death and stroke. One involves children and should be completed in the fall, while the other, in adults, likely won't be released until 2010.

 

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

 

Fortified Foods: How Healthy Are They?

Food companies are getting more creative with the products they're enhancing -- collagen-infused marshmallow, anyone? But can they really deliver on the health benefits they claim?

 

By Sara Reistad-Long

Wall Street Journal

Monday, June 15, 2009

 

Care for a dose of probiotics in your salsa? Or some omega-3 fatty acid -- derived from Peruvian sardines -- with your orange juice? In recent years there's been a boom in the number of foods enhanced to have health benefits, and consumers' appetite for the trend has been large.

 

Shoppers can now buy pasta that's enriched with calcium, ketchup that boasts probiotics for digestive wellness and soda that's host to an array of daily vitamins. Japanese exporter EIWA Confectionery is marketing marshmallows infused with skin-boosting collagen, and Canada Dry has introduced a heart-healthy ginger ale pumped with green tea, thought to reduce the incidence of heart disease. In development are even more combinations: cheese made with cholesterol-lowering plant sterols, a calorie-free probiotic sweetener and amino-acid energy drinks to target joint health.

 

In 2008, functional foods -- defined as foods believed to possess health benefits beyond the basic function of providing nutrients -- made up a $30.7 billion market, according to research firm Packaged Facts, and that figure is predicted to grow by 40% over the next five years. Between 2006 and 2008, the number of omega-3 fortified products alone increased by 68%, reported Mintel's Global New Products Database. The heart-healthy fatty acid found in fish turned up in well over 1,550 items, ranging from orange juice and cereal to bread and peanut butter. Consumers seem to be eating it up: 83% have expressed interest in products with added health benefits, according to a 2008 International Food Information Council survey.

 

But can these fortified Frankenfoods deliver on the health promises they claim? And can they compete with taking supplements or eating straight from the source?

 

Fortified foods are nothing new. Iodine was first added to salt in Michigan in 1924 in order to help reduce the prevalence of goiter, which had reached an alarming rate of 47% in that state. The measure worked so well that it led to the voluntary iodization of the product for the entire country. It also paved the way for a cascade of similar, mandatory approaches. Brain-and-skin degenerating pellagra was almost completely eradicated within about a decade after breads and grains were enriched with niacin, thiamin, riboflavin and iron in 1943.

 

In 1998, the U.S. Food and Drug Administration made it mandatory to add folic acid to enriched grains such as breads and cereals with the goal of reducing neural-tube defects in babies. Between then and 2004, the number of infants born with neural-tube defects went down by 25%, according a recent Centers for Disease Control and Prevention-sponsored study, which concluded that folic acid fortification was at least partially responsible for the drop.

 

"Nutritionally enhanced foods are essentially just a different way of getting some of the benefits of a vitamin supplement. Studies show both do the job," says Sheldon Hendler, M.D., Ph.D, co-author of "The Physician's Desk Reference for Nutritional Supplements."

 

Dr. Hendler says in some cases there can even be advantages to the fortified variant over a multivitamin: "Many of these ingredients are fat-soluble, so they're digested better when taken in food. They may also combine favorably with the food's existing components, increasing potency that way." Indeed, vitamin A's fat-solubility is precisely the reason many margarine brands now include the ingredient. The vitamin D that's routinely added to milk is often touted for aiding calcium absorption.

 

But enhanced foods aren't always as impressive as the label may suggest --especially when compared to whole foods. "Processing destroys nutrients, and the more processing there is, the more destruction you get," says Marion Nestle, author and professor of nutrition, food studies and public health at New York University. "Fortification adds back some nutrients, so overall you're better off with a processed fortified food than a processed unfortified one. But a whole food is always going to be superior."

 

For instance, while numerous brands of protein-fortified pastas can contain nearly as much protein as a serving of meat, the meat is usually the healthier choice because the pastas are made from processed grains and are thus high in simple carbohydrates. Another example: Since probiotics occur naturally in yogurts, consumers might be tempted to think that yogurts touting extra probiotics may escalate health benefits. But processing actually breaks down existing probiotic strains, and many of the lab-developed variants have little research to support their health claims.

 

Then one has to be mindful of serving size and strength. Hearts and Minds Peanut Butter with Omega-3 and Olive Oil has 100 mg of the fatty acid per two-tablespoon serving, but a 3.5 oz. portion of salmon, tuna or sardines has 1,500 mg of omega-3. One would have to eat 30 tablespoons of the peanut butter -- and 180 grams of fat -- to get the same amount of omega-3 present in a single serving of fish. Wonder Classic Calcium Fortified Enriched Bread may sound impressive, but one slice contains only 10% of the daily recommended value of the mineral -- a third of what's in a cup of low-fat milk.

 

Because of these inconsistencies, Ms. Nestle recommends taking a multivitamin, rather than relying on fortified foods, to cover one's nutritional bases. But the reality is that three out of four Americans don't consume the U.S. recommended daily allowance for vitamins and nutrients, according to a 2009 study in the Archives of Internal Medicine. So many nutritionists still advocate the consumption of fortified foods, no matter how potent -- or weak -- the product.

 

"By choosing food with a high nutrient content, you are [usually] satisfying real needs in your body," says Adam Drewnowski, Ph.D, a nutrition professor at the University of Washington. The bigger issue, according to Dr. Drewnowski, isn't so much whether these functional foods work, but how individuals respond to them. Since fortified foods tend to be less filling and more calorie-dense than whole ones, consumers who pass on something like a cup of broccoli (about 30 calories) in favor of a cup of fortified juice (often as much as four times the calories, but less fulfilling) might actually end up eating more -- and less healthily -- throughout the day.

 

"The trend is so new, we're waiting on this data, but because people assume their nutritional needs have been met, there's a chance they'll make poorer choices for the rest of their meal," says Dr. Drewnowski.

 

Lillian Cheung, Ph.D, a nutrition professor at the Harvard School of Public Health, also points out that adding nutrients to a food can encourage people to perceive it as unequivocally healthy, whether it's low-fat and fiber-rich oatmeal that's been fortified or a similarly enhanced bag of potato chips packed with fat and bereft of any naturally occurring nutrients that the oatmeal has. "The fact that brands have gone to the trouble to add this stuff sends an implicit message that the finished product is desirable, and that's just not always the case," she says. "Sports drinks are an example. The sugar they contain is so much worse than the added vitamins. But that information gets obscured."

 

Dr. Cheung says that boosting nutrients into such a wide variety of foods could also lead people to either over-consume vitamins and minerals that can be harmful in large amounts (too much folate, for instance, has recently been linked to some cancers), or under-consume others because they misapprehend how much of a given nutrient a food actually delivers.

 

Products with fortification mandates must adhere to a set minimum regulated by the government. But that almost always falls well below FDA recommendations. Moreover, companies are only required to list nutrition facts for substances with FDA daily values, such as vitamin A or calcium. Amounts of ingredients such as omega-3 fatty acid and probiotics are not regulated, meaning that not only do consumers not know how much they should be ingesting, but manufacturers are not required to disclose how much or little they are putting in their foods.

 

Says Dr. Lawrence Cheskin, associate professor of medicine and human nutrition at Johns Hopkins University: "A lot of this boils down to common sense. As with all foods, the key here is simply to get it from a good source and eat it in moderation."

 

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

 

Opinion

Remembering when health care system was built on relationships

 

By Susan Reimer

Baltimore Sun Commentary

Monday, June 15, 2009

 

I was sitting on an examining table, waiting to meet the new doctor my insurance company had assigned me to, when she blew in the door, offered her hand and shook mine energetically.

 

Then the new doc sat down on a chair in the corner of the room, put her feet up on the seat of another chair and clasped her hands behind her head like somebody who planned to be there for a while.

 

"Tell me about your life," she said, and suddenly a routine physical became a cross between a job interview and a high school reunion.

 

"Um. Aren't you kind of busy?" I asked.

 

No, she said, because whatever illness or physical complaint brought me into her office in the future would be a direct result of whatever kind of life I was living. She wanted to know what she was dealing with.

 

I started with the husband who traveled for work, the two small children, the full-time job, the hour commute and, oh, the fact that I worked until 1, 2 or 3 in the morning on a newspaper copy desk. Then I added the Step aerobics classes and the bad ankle.

 

And we were off.

 

That was some years ago, but I had found the kind of general practitioner they are saying we all need now.

 

One who listens. One who knows enough about us to understand the potential lifestyle origins of what ails us. One who is into preventing trouble. A physician for whom a shrinking compensation formula does not mean she has to see a patient every 15 minutes.

 

I bundled up my toddler daughter and rushed her to the pediatrician's office, the panic rising like bile in my throat. Her high chair had collapsed and, as she flew forward, she struck the bridge of her nose on the edge of the kitchen table.

 

There was blood everywhere. Stitches, I knew.

 

But that didn't scare me as much as the fact that this was the third time I had bundled her up with an injury. The first time, she'd scooted her walker down the basement steps and banged her head. The second time, she'd crawled up on the kitchen table for some crackers, fell off and broken her collarbone.

 

It was an alarming pattern, and one that might have brought me to the attention of social services.

 

"Why didn't you report me?" I asked my pediatrician weeks later when all the injuries had healed. "I mean, didn't you wonder about me?"

 

No, he said. "Your explanations were perfectly plausible. And besides, I know you."

 

Again, I had found myself in health-care heaven. Where the relationship between parent and pediatrician continues until the child's high school graduation picture is on the office bulletin board.

 

You can argue that this kind of care is a thing of the past. Like the time Dr. Kinsel came with his black bag to my mother's house (she had no car while my father worked) to give me an injection after an alarming allergic reaction to strawberries.

 

I have plenty of anecdotes like these. And I can gather plenty more with just a couple of phone calls. The kinds of doctor-patient relationships they describe are not a conceit. They are not a luxury or a throwback to another time or an example of pampering Western medicine.

 

They are an economy born of relationships.

 

My doctor rarely needs to send me to a specialist or for a battery of tests to figure out what is wrong with me. She knows me well enough. There is real savings there.

 

And my pediatrician knew me well enough to trust me.

 

We are beginning what they are calling "a historic, summerlong debate" on the reform of health care, a system lawmakers have been trying to fix since FDR failed to get health care included in his proposal for Social Security 70 years ago.

 

This time, unlike President Bill Clinton's attempt in 1993, all the players - hospitals, doctors, insurance companies, drug companies - are at the table because, as one wag said, they don't want to be on the menu.

 

On that table are proposals that each will find completely distasteful: mandated coverage, the federal government as insurance provider, cost controls, taxes on employee health benefits. To continue the food analogy, this is sausage no one wants to see being made.

 

People love to talk about their health problems, so one more story.

 

When yet another health insurance change required me to leave the doctor who knows me so well for a year, I found myself in the care of a health care giant and assigned to a doctor based on my home address.

 

During my time under her care, we communicated through the magic of e-mail. Appointment requests, referrals, medication refills, medical questions, test results. My records were at her fingertips - via the computer keyboard - when we "talked." The speed of her reassuring communication was a wonder.

 

Going back in time may not be the only way to improve health care.

 

Susan Reimer's column appears on Mondays.

 

Copyright © 2009, The Baltimore Sun.

 

Swine Flu: Don't Panic

'Pandemic' isn't a helpful designation.

 

By Daniel Henninger

Wall Street Journal Commentary

Monday, June 15, 2009

 

How perfect that New Orleans Mayor Ray Nagin should be quarantined for the past week in a Shanghai hotel because one person on his flight from the U.S. seemed to have the flu. This is swine-flu panic.

 

Among the legacies of Hurricane Katrina or the Sichuan earthquake is that politicians and public officials will forever overshoot in the face of any problem that rises to the level of a Media Code Red. Over the next year we'll learn whether our handling of the swine-flu threat is relatively rational or confused and destructive.

 

For example, there have been unconfirmed reports that the World Health Organization (WHO) in the next week will declare the swine-flu virus a full, Phase 6 pandemic. How about finding a less loaded word than "pandemic." "Pandemic" will instill a sense of panic that may impede the ability of public officials to assemble a rational response plan for this virus.

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Wonder Land columnist Daniel Henninger puts swine flu in perspective.

 

The WHO reports 141 deaths globally from swine flu, with 106 of those (75%) in Mexico and 27 in the U.S. Seasonal influenza kills 35,000 to 50,000 Americans each year. It is now evident that the current strain of the H1N1 swine-flu virus is a "mild" version rather than a pathogenic killer like the 1918 Spanish flu. In fact, seasonal flu kills 500,000 people annually world-wide, a staggering death toll that occurs with hardly any of the public losing a moment's sleep over it.

 

The WHO's classification system designates a virus as a pandemic based on geography -- the number of countries in which it has been found, not the fatalities produced. The WHO announcing "pandemic" will be like shouting "fire!" in a crowded theater. "Pandemic!" could be the title of an apocalyptic disaster movie.

 

When the media start chanting "pandemic" every 60 seconds, it will stampede public officials into school closings and traveler quarantines, as in Japan. The potential for needlessly disrupting work and production in an already staggered world economy could become significant. That would drain the already shallow reservoirs of political credibility we're going to need for a larger viral threat.

 

Virologists believe the odds are strong that in time some virus is going to be a virulent killer. This "mild" but unstable swine-flu virus could mutate (another charged word) into a mass killer, as happened in 1918. The WHO should reserve "pandemic" for that virus, and rummage the Greek dictionary of scientific terms for a word to describe what we've got now. Or at least call it a "geographic pandemic," which would force the media to define the distinction. This would help keep swine-flu anxiety at a manageable level.

 

We need to keep cool about this flu because there are opportunities to put in place a genuinely effective response for the big one in our future. Notably by building a new vaccine.

 

Washing your hands is nice, but specialists say that if one of these viruses goes pathogenic, the only thing that will reduce mortality is a good vaccine. And it almost certainly has to be a bioengineered vaccine.

 

Current manufacture, going back 60 years, uses one chicken egg to create one dose of vaccine. It works. That method will be used to create a swine-flu vaccine for this winter (though some experts worry it may pull production capacity from "flu shot" vaccine for the deadly seasonal influenza).

 

In a big mortality pandemic, the U.S. would need at least 300 million chicken eggs. Add in the population of Mexico or the world and -- no joke -- there won't be enough trustworthy chickens to produce eggs for that much vaccine.

 

After the onset of a genuine pandemic, new recombinant, or genetically engineered, vaccine production methods -- which use safe, dead virus -- could produce high volumes of vaccine in eight to 12 weeks, rather than the traditional 20 to 23 weeks. (There is only one egg-based vaccine manufacturer in the U.S.)

 

The Food and Drug Administration has approved several recombinant vaccines, such as for hepatitis-B. It is on track to approve a recombinant seasonal flu vaccine this fall. Adjuvants, which enhance the effectiveness and volume of swine-flu vaccines, are also in development. Other than tort lawyers, there is no serious political resistance to pursuing, and maybe achieving, a high-tech scientific response to swine flu. It's not a slam dunk but is within reach.

 

Notwithstanding the Katrina legacy, George W. Bush's administrators put in place good reforms after the outbreak of the SARS virus, such as stockpiling antiviral medicine and enhancing surveillance capabilities. What isn't known is whether the system is capable anymore of executing an effective, large-scale response. We're cooked if we let everyone with a headache overwhelm the nation's emergency rooms.

 

Public-health advocates are yelling they haven't been given enough money. Maybe. Last week the Obama White House asked to use $3 billion of stimulus funds for swine flu, prompting charges the stimulus was turning into a slush fund. Arguably it is, though there are worse walls to throw money at than a killer virus. Hospital respirators are expensive.

 

The good news is, if we don't panic and if we allow those vaccines to emerge, we can put up a respectable fight against a really lethal virus. The bad news is, we'll probably panic.

 

Printed in The Wall Street Journal, page A11

 

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

 

Health care reform needed

 

By Robert Wack, Other Voices

Carroll County Times Letter to the Editor

Monday, June 15, 2009

 

President Barack Obama’s interest in health care reform is provoking a variety of predictable responses.

 

From both ends of the political spectrum hyperbole and misinformation muddy the discussion. Here are two things to watch out for.

 

Back in the ‘90s, when President Bill Clinton took the last shot at meaningful health care reform, the insurance industry launched a devastatingly effective media campaign that came to be known as the Harry and Louise ads. An older couple sat at a kitchen table and worried about not getting the tests and medicine they need, not being able to choose their doctor and having to deal with bureaucrats. Along with other efforts to brand any change as socialized medicine, opponents of reform successfully derailed any attempts at change for more than a decade.

 

Meanwhile, all the scary things lamented in those ads came true any way, with or without reform. Denial of payment and denials of service occur routinely in our present system, and unless you can afford the premiums for the most generous plans, your choices are limited at every turn. If you don’t have health insurance, you don’t have any choices.

 

Socialized medicine is here already and is apparently so popular no politician dare touch it. It’s called Medicare, a government financed and administered health plan that makes up one of the largest portions of the health care economy. Everyone complains about how big and wasteful it is, but the only changes politicians have made recently are to make it bigger and more wasteful, because they are afraid of voters who love their government-sponsored health care.

 

On the left, the story to ignore is the utopian vision of a single payer system. The idea is that having one source for health care expenditures will solve everything that’s wrong with the system. Even if it was possible, politically or economically, it would not address the biggest problem we face: health cost inflation due to overutilization.

 

We consume health care excessively and inefficiently. Picture an all-you-can-eat buffet where someone else is paying the tab, and crowds of people jostle at the serving tables, loading their plates to overflowing, spilling food on the floor, leaving half-eaten food while they go for more and no one cares how much any of what they take actually costs.

 

Rising health care costs are limiting the people who can go to the buffet, but the sloppy behavior continues. While a growing number watch from the outside, the same waste and inefficiency occurs, at a higher price and for fewer people. Having a single payer won’t necessarily change that.

 

Things to pay attention to and support are initiatives that improve the amount and quality of information consumers can use to make health care consumption decisions. Data about outcomes are particularly important. How do we decide the best way to spend our health care dollars if we don’t know what works or doesn’t? Obama’s health IT initiatives are a step in the right direction.

 

We have big problems and desperately need reform, but don’t be blinded by preconceptions and fear mongering. The solutions to our present crisis will not be like anything we’ve tried before.

 

Robert Wack writes from Westminster, where he serves on the Common Council. E-mail him at rwack1@comcast.net.

 

Copyright 2009 Carroll County Times.

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