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			Tuesday, June 16, 2009 News Clipping Archives *Maryland / Regional* Rosewood relocation: Long-time resident of facility finds home in Manchester with help from The Arc (Carroll County Times) Service honors those who donated bodies to science (Carroll County Times) Records deadline a concern for MedChi (Daily Record) Report on risks to public criticized (Frederick News-Post) At Meade High, Anti-Terror 101 (Baltimore Sun) *National / International* Conmed Healthcare wins $2M contract from Oklahoma detention center (Baltimore Business Journal) Obama issues US doctors stern pitch for health fix (Annapolis Capital) More Problems Than Solutions in Medicare Report (Washington Post) Sebelius: Health care for all will take years (Washington Post) Obesity surgery thins bones, but enough to break? (Baltimore Sun) Backyard chickens on the rise, despite neighbors' clucks (Baltimore Sun) Flu pandemic deaths linked to poor public health (Washington Post) Flu Pandemic Spurs Queries About Vaccine (Wall Street Journal) China confirms 31 more cases of swine flu (USA Today) Philippines Reports New H1N1 Outbreak (Wall Street Journal) Study Shows Possible Link Between Deaths and ADHD Drugs (Washington Post) *Opinion* Cut drug copayments to bolster 'adherence' (Baltimore Sun Commentary) *Maryland / Regional* Rosewood relocation: Long-time resident of facility finds home in Manchester with help from The Arc By Erica Kritt Carroll County Times Tuesday, June 16, 2009 MANCHESTER - After getting home from her day of activities, Mary Francis Smith likes to sit in her room and look out her window onto Md. 30 in Manchester. She waves and even knocks on the window, shouting out “car” when she sees one passing by. “She likes to listen to the noise,” said Luke Pearson, a support service aide for The Arc of Carroll County. Smith, 58, is in her first apartment. On May 18 she moved here from her former home, the Rosewood Center in Owings Mills. Rosewood was a state-operated facility for residents with developmental disabilities. The facility was founded in 1888 and at its peak, housed more than 3,000 people. In January 2008, Governor Martin O’Malley and the Maryland Department of Health and Mental Hygiene announced that the facility would be closed by June 2009. The facility had numerous reports of abuse, neglect and mistreatment in the past, according to the Department of Health and Mental Hygiene, and it was decided that it would be better to close the facility and place the residents in other locations, including community placements, than to update the campus. Some of Rosewood’s residents who are deemed forensic patients, meaning those deemed incompetent to stand trial and therefore cannot be held criminally responsible for their actions, have moved into a facility at Springfield Hospital Center in Sykesville. Smith, who had been living in Rosewood since she was 9 years old, is developmentally disabled, has seizures and has microcephaly, which is a condition where the circumference of the head is smaller than normal because the brain has not developed properly or has stopped growing, according to the National Institute of Neurological Disorders and Strokes. When Smith’s parents learned she had to move, they were a little concerned. “I was very upset about it. We didn’t know where we were going to go,” said Margaret Smith, Mary’s mother. Margaret Smith said that despite the allegations about Rosewood, Mary Francis was always treated well and enjoyed living there. Smith said a lot of the problems with Rosewood were the buildings, which she said were in a sad state. Margaret Smith said originally she had hoped the state would just fix up the buildings and the residents could continue to live there, but she said that wasn’t what happened. So with the help of Mary Francis Smith’s service coordinator, the family found out about The Arc and, after several meetings, the Smith’s decided The Arc would be the organization to take over their daughter’s care. On May 18, Mary Francis Smith became the second to last resident to leave Rosewood for good. Becki Pearson, the program coordinator for support services for the ARC, was excited to take Mary from Rosewood and place her in the community Pearson said that while Mary Francis Smith was happy at Rosewood, most of the activities were done in a group and now there is a chance for her to be an individual and do what she wants to do. “She didn’t get that one-on-one attention,” Pearson said. With The Arc as her care provider, the Maryland Disabilities Administration pays for her 24-hour care and the Department of Housing and Urban Development and the Department of Human Services have helped the Smiths financially, so they can afford to put Mary in her very own apartment in Manchester. Pearson said the transition for Mary Francis Smith has been unexpectedly smooth. Already Mary has been to a carnival, a picnic and the mall. “She enjoys getting out,” Pearson. While Mary Francis Smith can’t hold a conversation, Luke Pearson, one of the many aides that assist her at home, and Becki Pearson are learning what her cues are. Luke Pearson said that she likes to watch TV, though she doesn’t understand it. She likes the noise and colors, and she also likes to listen to country music. Becki Pearson has learned that Mary Francis Smith will take off her shoes when she is comfortable, but put them back on when she is ready to go somewhere. Pearson also said that Mary Francis Smith is able to go visit her parents whenever she wants. “We’ll see her more,” Margaret Smith said. “We love her dearly.” Reach staff writer Erica Kritt at 410-857-7876 or erica.kritt@carrollcountytimes.com. Copyright 2009 Carroll County Times. Service honors those who donated bodies to science By Erica Kritt Carroll County Times Tuesday, June 16, 2009 SYKESVILLE - Virginia Clise, of Eldersburg, spent Monday afternoon honoring her late husband Joseph. But Clise was not at his funeral or memorial service, she was at a ceremony among many other people whose loved ones had donated their bodies to medicine. “I thought it was a wonderful [ceremony]. It was inspiring,” she said. The ceremony takes place annually on the grounds of Springfield Hospital Center in Sykesville. Clise said her husband decided to donate his body, after she made the decision to donate her body. She said as a retired nurse her body can be used to help others even after her death, and it also cuts down on the costs her children might have when she dies. Sandee Smith came out to say goodbye to her sister Delores Smith Bailey, of Baltimore. “I think [having the ceremony] is a good gesture to the family that they deserve appreciation,” she said. Smith, who lives in Richmond, Va., said she was hoping her sister as an African-American female could be of help to the medical society. According to the United States department of Health and Human Services, African-Americans have more disease, disability and early death than their white counterparts. “Maybe down the line someone can benefit from her,” Smith said. Norman Hoffheiser, of Ellicott City, came out with his wife Edith to honor his stepmother Bertha Hoffheiser. The couple was impressed by the location of the ceremony and graveyard, which is on a grassy hill under a collection of trees. “I think she’d be very happy here,” Norman Hoffheiser said. Ronn Wade, director of the State Anatomy Board, said the ceremony is held in honor and in gratitude of those who choose to give even after their death. The bodies are used for medical research, they are used as cadavers for paramedics to practice with and they also help medical students in their studies. “We’ll learn more from cadavers than any book,” Eliza Gordon-Lipkin, a medical student at the University of Maryland, said. Gordon-Lipkin said that in their first year of medical school students spend a lot of time with cadavers and are able to learn what organs look like, where things are in the body and see variations among people. Dr. Mark Teaford, of the Johns Hopkins University School of Medicine, said people who donate their bodies influence generations of people. The medical students who learn from them take their experience and pass it on to all of the patients and medical experiences they will have in their careers. This year 683 people were buried, and the state has 70,000 people on file as donating their bodies after death. Reach staff writer Erica Kritt at 410-857-7876 or erica.kritt@carrollcountytimes.com. Copyright 2009 Carroll County Times. Records deadline a concern for MedChi By Danielle Ulman Daily Record Tuesday, June 16, 2009 Maryland’s medical society is hoping the federal government will delay or eliminate financial penalties levied on doctors’ offices that do not computerize their records by 2015. The state’s doctors already suffer from some of the lowest insurance reimbursements for their services, and implementing expensive electronic medical record systems could prove too costly for them, said Gene Ransom III, executive director of the medical society, MedChi. “In Maryland, if we put more pressure on our providers you’ll find fewer physicians offering Medicare and Medicaid to patients,” he said. The American Medical Association is expected to hear MedChi’s concerns by Wednesday and decide whether to adopt a resolution offered by the organization as part of its legislative agenda, Ransom said Monday from Chicago, where he is attending the association’s meeting. “We support the idea of health information technology and we appreciate that money is coming from the federal government, it’s just the matter of these penalties that are difficult,” he said. In February, Congress passed President Barack Obama’s $787 billion federal stimulus package, which included about $19 billion to assist hospitals and physicians to move from paper to electronic medical records. A hospital or medical practice could receive up to $44,000 per doctor over a five-year period for implementing “meaningful” electronic medical record systems through Medicare and Medicaid payments beginning in 2011, but the government has yet to define which programs will qualify. Those that do not have computerized systems up and running by 2015 will have Medicare and Medicaid payments docked 1 percent; payments will drop an additional 1 percent each year that systems are not in place. In May, Maryland became the first state to require private insurance companies to offer incentives to medical practices that adopt electronic medical record systems. Rex Cowdry, executive director of the Maryland Health Care Commission, said moving medical records to an electronic format is “essential” to the coordinated care Maryland wants for its citizens. “There is a six-year period before any penalties start, so there’s time to reassess whether moving from incentives to penalties is the right move,” he said. “At this point having really substantial incentives available for adoption in 2011 followed by modest penalties in 2015 seems like a good way of getting people to adopt tools that we need.” Cowdry said he thinks Maryland’s doctors are very concerned about reimbursement levels. He said the state is looking at ways to reform the system to allow for better payment for better patient outcomes, like fewer hospital visits. “I think doctors are going to do the right thing, particularly now that there are substantial incentives available and really actively take up the best tools to do their job,” he said. “I understand why they don’t want to be penalized, but I think penalties help focus attention.” Children First Pediatrics, a practice with offices in Rockville and Silver Spring, changed over to electronic medical records in May. Rachel Bakersmith, the administrator, said the practice was only able to make the switch because Children's National Medical Center in Washington, D.C., got a group discount for offices that purchased the system through the hospital. The entire package, including training, computers, software, licensing and getting connected cost about $200,000, she said. The office will likely not see any stimulus money because it treats children, and they don’t see many Medicaid or Medicare patients. The practice could eventually see some higher reimbursements from private insurers. If her office did not choose to move its records to computers, Bakersmith said it would be difficult to swallow the penalty because pediatricians have one of the lowest reimbursements of all the specialties. “I understand the basis behind the penalty because electronic medical records are better for patient care,” she said. “I think at the very least it should be delayed until they get a handle on insurance companies and reimbursements.” Copyright 2009 Daily Record. Report on risks to public criticized By Pam Rigaux Frederick News-Post Tuesday, June 16, 2009 Frederick resident Joanne Ivancic shares her opposition to a proposed plan that would transport laboratory personnel who have been occupationally exposed to infectious agents to Bethesda. In the background is Mark Radtke, an NIH environmental protection specialist. A handful of people stood up to comment at a public hearing Monday evening, and all were critical of a report that analyzed environmental consequences of a proposal to transport personnel who were potentially exposed to infectious agents to Bethesda. The National Institutes of Health is proposing to transport laboratory personnel suspected of potentially having been occupationally exposed to infectious agents at the biodefense campus in Fort Detrick. They would be taken in a vehicle to a unit at the NIH Bethesda campus for observation and, if necessary, treatment, according to a copy of the Draft Environmental Impact Statement. Previously, personnel suspected of being infected were quarantined in a room on the Fort Detrick campus. According to the Draft Environmental Impact Statement published May 22, the potentially infected personnel would be transported on some of the area's busiest roads. That fact concerned Frederick resident Beth Willis. The roads from Frederick to NIH are among the most congested miles of highway in the nation, she said. Nowhere does the statement address the possibility of many workers being exposed to pathogens, she said. "How exactly would people be transported simultaneously?" The study's focus was not on public health and safety but rather the impact of having another car on the road. Frederick County Health Officer Barbara Brookmyer said the statement didn't address the communication failures within agencies involved in decisions critical to transport. She also wanted to know how and when local officials would be alerted to risk. Frederick resident Joanne Ivancic said she can't believe it is too inconvenient for medical personnel to drive to Frederick. "This could be a reasonable Plan B. It appears inappropriate for Plan A," she said. NIH officials observed the hearing and will answer questions in the final report, said Mark Radtke an NIH environmental protection specialist. Dr. James Lawler, chief medical officer of the Integrated Research Facility at Fort Detrick, spoke briefly about the risks involved prior to the public comment. He said potential exposures would be recognized and the only way for an employee to be exposed without it being known would be such a breach of multiple layers of security, the risk is negligible. The vast majority of exposures to pathogens have a five-day or longer incubation period, he said. Transporting someone potentially exposed under those circumstance poses minimal risk to public health. The hearing was in the C. Burr Artz Public Library. Please send comments to webmaster or contact us at 301-662-1177. Copyright 1997-09 Randall Family, LLC. All rights reserved. At Meade High, Anti-Terror 101 Schools in Maryland try preparing students to work in homeland security Los Angeles Times By Bob Drogin Baltimore Sun Tuesday, June 16, 2009 Flanked by hand-drawn posters about terrorist groups, from al-Qaida to the Ku Klux Klan, Tina Edler solemnly addressed her ninth-grade students. "One new vocabulary word today is 'agro-terrorism,' " she said. The meaning - deliberate sabotage of agriculture or food supplies - flashed on a screen behind her. Opening their school-issued laptops, the teens quickly found a possible example on the Internet. In 1989, a group calling itself the "Breeders" threatened to release thousands of crop-killing Mediterranean fruit flies in Southern California unless the government halted aerial pesticide spraying. The spraying continued, and scientists never could determine whether the group played a role in the Medfly infestation that year. Its members were never identified. "That counts," Edler said. "It's part of history." Meade High School, where Edler teaches, made its own history this year. The long-troubled public high school become one of the first in the nation to offer a four-year course in homeland security. The goal: to help graduates build careers in one of America's few growth industries. "This course will help me get a top secret security clearance," said Darryl Bagley, an eager 15-year-old. "That way I can always get a job." Meade offers its 2,150 students a standard high school curriculum, including electives such as advanced calculus and carpentry. But the 90 ninth-graders who chose the new homeland security program this past school year focused on topics torn from the headlines: Islamic jihadism, nuclear arms, cyber-crime, domestic militias and the like. New themes even were added to their science, social studies and English classes. "There's a lot of homeland security issues in Romeo and Juliet," said Bill Sheppard, the program coordinator. "Like, how do you deal with infiltration in your own family?" After two years, they can choose a related career track - such as law and public service or engineering - to prepare for college or a job. Joppatowne High School in Harford County started a similar program in 2007. And two more schools, one near Baltimore and the other in the state's western panhandle, will follow next fall, said Bill Reinhard, a spokesman for the education department. Schools in several other states are watching closely. So are critics. Mother Jones, the liberal magazine, has slammed Joppatowne High as a "black ops jungle" that is "dedicated to churning out would-be Jack Bauers." It warned of a "troubling landmark" in public education. But Jonathan Zimmerman, a New York University professor who studies the politics of education, said the courses were "a wonderful idea as long as they educate the kids and don't indoctrinate them. That's the only danger." Leah Skica, a science teacher who heads the Joppatowne program, said the curriculum presents an opportunity. Her school is near two Army facilities: the Aberdeen Proving Ground, a test site for munitions and equipment, and the Edgewood Chemical Biological Center. "High schools focus on traditional careers," she said. "We wanted to introduce students to what's going on in our local area, whether it's engineering for homeland security, computer security, or chemical and biological research." That thinking already has swept higher education. Since the Sept. 11, 2001, attacks, about 320 colleges and universities have begun awarding graduate or postgraduate certificates or degrees in emergency management, bio-defense and other security-related fields. Federal grants and a steady growth in jobs have driven the surge. "It's the fastest-growing field in academia," said Stan Supinski, who tracks education issues at the Center for Homeland Defense and Security at the Naval Postgraduate School in Monterey, Calif. High schools, he said, "may be the next trend." Meade hardly seems a cutting-edge school. It has struggled for years with low test scores, high dropout rates and a history of racial violence. A third of the students come from impoverished families. "In the past, if you read an article about Meade High School, it would have been about something bad happening," said Claire Louder, head of the Chamber of Commerce of West Anne Arundel County. "It had a very questionable reputation." County officials and Meade's energetic principal, Daryl Kennedy, were determined to improve the school's standing. Programs already catered to high-achieving students, and to those at risk of failure. They decided to excite what Kennedy called "average, B students" in the middle. "Homeland security was the obvious fit for us," Kennedy said. "It's in our backyard." The school lies just inside Fort George G. Meade, which has about 35,000 employees. A majority work at the National Security Agency, which eavesdrops on global communications and is America's largest intelligence organization. And more jobs are coming. Under plans announced in 2005, the Pentagon will shut or shrink dozens of military bases across the country and transfer thousands of families to the Fort Meade area over the next two years. The school began designing the program in 2006. Bill Sheppard, a genial, white-haired English teacher, was put in charge. Edler was hired as lead teacher. Now 31 and "a little overzealous," as she puts it, she has master's degrees in human resource management and business administration, and completed course work this year for a college certificate in homeland security. Creating a syllabus was the first challenge. No one has published a high school textbook on homeland security. "We were stabbing in the dark on the curriculum," Sheppard said. They appealed for help from parents, local businesses, Fort Meade officials and other federal and state agencies. Col. Daniel Thomas, the Fort Meade base commander, was skeptical at first. "It seemed like homeland security was so vague it was about everything," he said. "I said, 'Let's make this something real. With all the resources at my fingertips, I can fill your entire curriculum.' " For example, he arranged for students to watch emergency response drills for a chemical weapons attack and a school shooting. "Law enforcement, computer security, response to chemical and biological hazards, the study of intelligence applications, we could help with all that," he said. Other groups pitched in as well. Students went on at least eight field trips during the year, including to a Coast Guard station in Baltimore and the Marine base in Quantico, Va. Speakers from the FBI and the Food and Drug Administration came to class. A retired combat artist dropped in to discuss his work. "The reason it works is it's not just textbooks," said Carol Strudwick-Miller, secretary of the school's PTA. "They're getting out in the field. They're seeing things in the real world. The parents love it. So do the kids." Most of the students who took the classes this school year have signed up for the advanced course next fall. Another 106 teens have enrolled for the introductory class, which will be open to all grades. More teachers will be hired, and more courses are planned, including Arabic- and Chinese-language instruction. "We will expand from year to year," Sheppard said. "We want to give everyone in the school a chance to at least taste the program." Copyright © 2009, The Baltimore Sun. *National / International* Conmed Healthcare wins $2M contract from Oklahoma detention center By Julekha Dash Baltimore Business Journal Tuesday, June 16, 2009 Conmed Healthcare Management Inc. has been awarded a $2.2 million contract to provide health services to a county detention center in Oklahoma. The Hanover company was granted a one-year contract with four one-year renewal options. Conmed (OTCBB:CMHM) will provide a staff of nurses and physicians, as well as dental, mental and behavioral health services to 315 inmates. Conmed will also provide laboratory, pharmacy and radiology services to the Creek County jail. Conmed serves correctional facilities in Maryland, Washington, Oregon, Kansas, Virginia, and Arizona. All contents of this site © American City Business Journals Inc. All rights reserved. Obama issues US doctors stern pitch for health fix Associated Press By Steven R. Hurst Annapolis Capital Tuesday, June 16, 2009 WASHINGTON (AP) — President Barack Obama told a sometimes hostile audience of American doctors that they must join him in fixing a crumbling health care system, pitching an overhaul to a group deeply suspicious of government involvement. Advertisement The crowd of physicians from the powerful American Medical Association was uncharacteristically unreceptive to parts of the popular president's speech, an omen perhaps that his task in selling his plan to overhaul the U.S. health care system is going to get rockier. Boos erupted when Obama told the doctors in his speech in Chicago, Illinois, that he would not try to help them win their top legislative priority in Congress, to set limits on jury damages in medical malpractice lawsuits. To a degree, Obama's appearance Monday smacked of his having walked into the lion's den. While American physicians are discouraged and even angry about a system that overburdens them with paperwork and allows private insurance companies too much power to dictate treatment, many doctors worry even more about government involvement in their relationships with patients. Denying yet again that he wants to establish a government-run system of "socialized" medicine, Obama told the physicians to beware of "scare tactics and fear-mongering" from those with vested interests in the current system. "They'll give dire warnings about socialized medicine and government takeovers; long lines and rationed care; decisions made by bureaucrats and not doctors. We've heard it all before, and because these fear tactics have worked, things have kept getting worse," Obama said at the AMA gathering in Chicago. In one of his longest dissertations on the need for reform, Obama yet again promised Americans: "If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what." Aside from the extraordinary growth in health care costs in the United States, Obama again raised the needs of an estimated 50 million Americans who have no insurance to help with medical costs, creating a reality "where a single illness can wipe out a lifetime of savings." The United States spends about two-and-half times as much on health care as do other industrialized countries, but its citizens do not enjoy longer life expectancies than nations that spend far less. A 2003 study estimated that health care costs for the uninsured account for about 3 percent of health care spending, with taxpayers covering about 80 percent to 85 percent of the cost through a variety of government programs. With its multiple layers of private insurance companies and public health programs, administrative costs in the United States are higher than in other countries. A 2005 study estimated administrative costs in California, the most populous U.S. state, at about 20 percent, and a national study from the 1990s put the share at 25 percent. In a speech that stretched to nearly an hour, Obama made news when he recommended that all Americans, except those too poor to afford it, be required to have health insurance, whether through the private system or his proposal for creating a "government option." "Every American bears responsibility for owning health insurance," the president said, adding that the government would help those without the means to buy even the most inexpensive and bare-bones coverage. The somewhat muted response that greeted Obama applause lines from the gathered physicians turned outwardly negative when the president brought up the malpractice lawsuit tinderbox. Doctors complain that part of the big rise in the cost of health care grows out of the huge prices they must pay to insure themselves against lawsuits from patients who claim they were given improper care. While glancing off plans ranging from savings through computerized medical records to cutting the cost of medical education, Obama sought to drive home the need for an overhaul by telling the assembled physicians that the system is "a ticking bomb." Health care spending, Obama said, could force America to "go the way of GM — paying more, getting less, and going broke." General Motors Corp. is the American automaker that recently filed for bankruptcy in part because of the cost of insuring the health of its workers and retirees. While standing alone as the only major industrial nation without a government health care system, the issue has deep philosophical roots in the United States. Most Republican lawmakers, organizations in the health care industry, insurance companies and some conservative Democrats are balking at even modest government intervention in the system. Copyright 2009 Annapolis Capital. More Problems Than Solutions in Medicare Report By David S. Hilzenrath Washington Post Tuesday, June 16, 2009 Expanding access to Medicare will not solve the nation's health-care cost problem. That's the message of a report yesterday by a commission that advises Congress on the federal medical program for older Americans. To eliminate wasteful spending, policymakers must transform economic incentives for doctors, hospitals and other providers of medical services -- though it isn't clear how, according to the report. As Congress and the Obama administration seek to restrain potentially crushing increases in health-care spending, the report by the Medicare Payment Advisory Commission (MedPAC) is emblematic of the larger debate: long on problems and short on solutions. The commission has made specific recommendations in its past biannual reports, but identifying wasteful medical spending has proven a lot easier than rooting it out. To illustrate what it might take to save Medicare, the commission describes how primary-care doctors, specialists and hospitals could be reorganized into "accountable care organizations" whose members would receive bonuses if the organizations met quality and cost targets. To ratchet up the incentives, health-care providers that fail to meet cost and quality targets could be penalized, the report says. Even then, any projected savings would be highly uncertain, the report says. What is certain is that Medicare cannot maintain its current trajectory, it adds: "If current spending and utilization trends continue, the Medicare program is fiscally unsustainable. . . . Part of the problem is that Medicare's fee-for-service payment systems reward more care -- and more complex care -- without regard to the quality or value of that care." The report underscores the challenges facing President Obama and Congress as they seek to overhaul the health-care economy. The administration has put a spotlight on what it considers wasteful spending, but it has offered sparse details as to how it would change the incentives that produce the waste. The report identifies some areas that are ripe for savings. MedPAC estimates that the government is paying private Medicare health plans -- which were supposed to save the government money -- much more than it should. In addition, the government could save money by adopting a more streamlined approval process for "follow-on biologics" -- products that imitate biotech treatments already on the market. Getting doctors to join accountable care organizations may require pressure, MedPAC Executive Director Mark E. Miller told reporters: "If you want people to voluntarily organize, you may want to make sure that the current system isn't as pleasant a place to be." The model for accountable care organizations resembles that of large, tightly managed physician groups, practices that have been the subject of demonstration projects, and Medicare's experience with those offers limited encouragement, according to the report. Measurable quality improved in the areas of care monitored, such as for diabetes and congestive heart failure. But "whether the demonstration has actually generated savings for the Medicare program is debatable," the report says. Policymakers hope that money can be saved by better coordinating care. But, according to the MedPAC report, Medicare pilot programs intended to coordinate care for patients with chronic diseases -- programs that involved insurance companies and other private groups -- generally achieved modest quality improvements. Most of the programs cost Medicare more money than it would have spent without them, the report says. Copyright 2009 Washington Post. Sebelius: Health care for all will take years Associated Press Washington Post Tuesday, June 16, 2009 WASHINGTON -- HHS Secretary Kathleen Sebelius says covering the uninsured will take several years, even if Congress passes a bill and President Barack Obama signs it into law this fall. Sebelius said in a question-and-answer session with The Associated Press Tuesday that "it won't start the day after the bill passes." Nearly 50 million Americans are uninsured, and early cost estimates of congressional coverage plans have been disappointing. The $1 trillion over 10 years that the Obama administration wants to spend may not be enough. Sebelius said the first step would be to cover people who are eligible for existing government programs. She said after that, it could take until 2011 or 2012 to set up insurance purchasing pools and start covering the rest. © 2009 The Associated Press. Obesity surgery thins bones, but enough to break? Associated Press By Lauran Neergaard Baltimore Sun Tuesday, June 16, 2009 WASHINGTON - It isn't just the thunder thighs that shrink after obesity surgery. Melting fat somehow thins bones, too. Doctors don't yet know how likely patients' bones are to thin enough to break in the years after surgery. But one of the first attempts to tell suggests they might have twice the average person's risk, and be even more likely to break a hand or foot. The Mayo Clinic's finding is surprising, and further research is under way to see if the link is real. But with bariatric surgery booming and even teenagers in their key bone-building years increasingly trying it, specialists say uncovering long-term side effects and how to counter them takes on new urgency. Simply popping today's doses of calcium supplements may not be enough. "These procedures are now being sold as a panacea," Dr. Shonni Joy Silverberg of Columbia University told last week's annual meeting of The Endocrine Society, where the fat-and-bone relationship took center stage. "It is of heightened importance to find the answers to these questions." Here's the irony: Obesity actually is considered protective against bone-weakening osteoporosis, possibly the only positive thing you'll ever hear a doctor say about too much fat. "They're starting better than most of us," cautions Mayo bone-metabolism expert Dr. Jackie Clowes. So the big question is whether they really end up with worse bones, or just go through a transition period as their bones adjust to their new body size. About 15 million Americans are classified as extremely obese, 100 pounds or more overweight. Dieting alone doesn't make enough of a dent to fend off rampant diabetes and other health problems, so surgery is fast becoming the preferred treatment -- from the stomach stapling called gastric bypass to less invasive stomach banding. Patients tend to lose between 15 percent and 25 percent of their original weight, and diabetes dramatically improves. More than 1.2 million U.S. patients have undergone the surgery in the past decade, 220,000 in the last year alone, according to the American Society for Metabolic and Bariatric Surgery. There's little data on how patients fare many years later; large National Institutes of Health studies, on both adults and teens, are under way. But doctors have long noted that the radical weight loss can speed bone turnover until the breakdown of old bone outpaces the formation of new bone. Silverberg cites recent studies showing that a year after gastric bypass, adults' hip density drops as much as 10 percent, raising concern about a common fracture site of old age. (Stomach banding causes less thinning because it doesn't alter nutrient absorption as much.) No one knows if teen bones react similarly, but it's an important issue because almost half of peak bone mass develops during adolescence. To see if such changes translate into fractures, the Mayo team is comparing the medical records of nearly 300 adults who've had bariatric surgery with similarly aged Minnesotans who haven't. A quarter of the 142 surgery recipients studied so far experienced at least one fracture in the following years, Mayo's Dr. Elizabeth Haglind told the endocrinology meeting. Six years post-surgery, that group had twice the average risk. But in a puzzling finding, the surgery recipients had even more hand and foot fractures than their Minnesota neighbors, three times the risk. Those fractures aren't usually connected to osteoporosis. Did the once-obese merely start exercising and just fall down more? Clowes doubts it. "I was shocked" at the numbers, says Dr. Scott Shikora, president of the bariatric surgeons group, who says he hasn't seen a significant fracture problem in his own practice. Surgeons routinely tell patients to take some extra calcium and vitamin D. Shikora estimates about half follow that advice, and other research suggests higher doses may be needed anyway as the obese tend to start out deficient in vitamin D. A key next step will be to compare the patients who fracture with people of the same weight to see if their bone mass just had to adjust -- or if something about surgery alters the complex soup of hormones and other factors that keep bones strong, thus requiring more than extra calcium. Clowes' advice for now: Don't skip checkups, where doctors monitor bone health, and aggressively treat nutrient deficiencies. Copyright 2009 Associated Press. All rights reserved. Backyard chickens on the rise, despite neighbors' clucks Urban poultry farmers get a taste of rural life -- and a constant supply of eggs -- with their own coops. But not every city will run with the idea. Los Angeles Times By P.J. Huffstutter Baltimore Sun Tuesday, June 16, 2009 Reporting from Madison, Wis. — Jen Lynch and her family live in the heart of the city but roll out of bed to the sound of clucking chickens. Their day starts with cleaning coops, scooping out feed and hunting for eggs for morning omelets. Eight families in a three-block radius and an estimated 150 families citywide do the same. "It's our slice of rural life, minus the barns," said Jen Lynch, 35, as Flicka the chicken pecked at her backyard lawn. As the recession drags on, city dwellers and suburbanites alike are transforming their backyards into poultry farms. Victory gardens, proponents say, are not enough. Chickens are the next step. "People are turning to things that remind them of simpler times," said Ron Kean, a poultry specialist at the University of Wisconsin, Madison. "If you're smart, you can save money doing this." Growing interest in backyard chickens has fans rallying for change in dozens of cities, although the movement leaves some people squawking. "I moved to the city for a reason," said Evan Feinberg, 41, a technology consultant in Madison who said he grew up on a Midwest farm. "I never wanted to see another chicken, unless it's wrapped in plastic." Still, the idea of urban chickens is picking up steam. In Traverse City, Mich., officials are weighing the issue. In Iowa City, Iowa, chicken lovers have collected 600 signatures urging local officials to permit backyard chickens. Poultry fans in Madison persuaded the city's common council to reverse a ban on backyard hens about five years ago. The ordinance -- similar to regulations in Seattle, Los Angeles, Chicago and Baltimore -- allows up to four chickens per property. The animals are to be raised for eggs, and must be housed in a coop that is far separated from neighboring homes. (Roosters are typically banned in cities because of crowing.) The Lynches assembled their wire-and-wood coop, about the size of a big doghouse, with $40 worth of building supplies and wood salvaged from neighbors. Flicka and her sister, Lucy, were adopted from friends. In exchange, their hens give them 14 eggs a week, a bug-free backyard and manure for compost bins. "And they're cute," said Evie Lynch, 9, who takes the russet-hued Flicka for a walk each night before bedtime. "They like to snuggle in my arms." Chick hatcheries say they can't keep up with urban orders. Murray McMurray Hatchery, the world's largest supplier of rare-breed chicks, has sold out of its "Meat and Egg Combo" collection of meat birds and laying hens. Customers hungry for a standard hen must wait: There's a six-week backlog on orders. "I tell people we're getting out of the country livestock business, and getting into the city backyard pet business," said Bud Wood, president of the Webster City, Iowa, firm. Each animal typically lays one egg a day. Angelina Shell, who runs "City Chickens 101" classes at the Seattle Tilth Assn., an organic farming group, admits it can be exasperating trying to eat the 18 eggs her hens lay each week. "I bake constantly," said Shell, 36, whose refrigerator is crammed with bright yellow-tinged quiches. "I go over to friends' houses and they say: 'Oh, it's another egg dish. Great. Thanks.' " The cost of being an urban poultry farmer can rise quickly. Chicks can cost up to $20 each with shipping fees, and feed costs about $25 a bag. For those not content with a homemade coop, there's the $1,300, Amish-made "Egg Man." A popular coop design is by Dennis Harrison-Noonan, a handyman in Madison whose family chicken is named Fluffy. He built a 4-by-8-foot coop that looks like a child's playhouse -- complete with a window box of petunias -- to appease a neighbor. When a friend suggested he try selling the blueprints online, "I thought I might sell 10, 20 max," Harrison-Noonan said. He's sold 1,000 in the last year, at $35 each. His neighbor, however, is still unhappy and has stopped talking to him. Critics say the birds could be smelly, and have raised concerns over sanitation and public health. Property owners fret that coops will sour their real estate values. City leaders in New Haven, Conn., this month wrestled with the implications of legalizing backyard roosts at a contentious public hearing. Critics worried the urban homesteaders wouldn't stop at vegetable gardens and chicken coops. There are already rumblings that, in cities like Seattle, they have expanded into beekeeping and miniature-goat herding. "When you live with your food, you have issues," said Paul Kowalski, head of New Haven's environmental health program. "Raising your own food is cool, but not when you have yards that are 20 feet by 30 feet." Such fears were enough to quash pro-chicken legislative efforts in the village of Caledonia, Wis., about 30 miles south of Milwaukee. Patrick Flynn, who tried to keep his birds hidden from neighbors for years, was told to find a new home for his hens. Friends offered to take them. One person suggested a better hiding place; one option could be the "stealth coop," which is built to look like a trash can, from MyPetChicken.com. "I'm going to keep fighting," Flynn said. "I keep my family stocked with eggs. It's not much, but these days, every little bit helps." Copyright 2009 Baltimore Sun. Flu pandemic deaths linked to poor public health Associated Press By Edith M. Lederer Washington Post Tuesday, June 16, 2009 UNITED NATIONS -- The swine flu pandemic will demonstrate "in extremely tragic ways" the consequences of the failure to promote public health and ensure basic care during pregnancy and childbirth in developing countries, the head of the World Health Organization warned. Dr. Margaret Chan told a U.N. Forum on Advancing Global Health in the Face of Crises on Monday that developing countries are most vulnerable to the global H1N1 flu epidemic, the financial crisis, food shortages and climate change - and much more must be done to urgently strengthen their health care systems. "Because of the economic downturn, people in affluent societies are losing their jobs, their homes, and their savings, and this is tragic," she said. "In developing countries, they will lose their lives." Chan said present evidence indicates that "the main risk factors for severe or fatal H1N1 infection are two-fold: pregnancy, and underlying medical conditions, like asthma, cardiovascular disease, diabetes, and obesity." The WHO director-general said 99 percent of maternal deaths and 85 percent of the burden of chronic diseases are concentrated in low- and middle-income countries. "I firmly believe that this pandemic will reveal, in a highly visible, measurable and tragic way, exactly what it means, in life-and-death terms, when health needs and health systems have been neglected, for decades, in large parts of the world," Chan told ministers and health officials at the day-long forum. "We will see, in extremely tragic ways, the consequences of our longstanding failure to ensure basic care during pregnancy and childbirth," she said. U.N. Secretary-General Ban Ki-moon, who organized the forum, said he is "most troubled by the costs of failed maternal and child health." "The global impact of maternal and newborn deaths has been estimated at US$15 billion a year in lost productivity," he said. A woman dies every minute in childbirth, Ban said, which adds up to over half a million deaths a year, "nearly all of them preventable." According to the U.N. children's agency, UNICEF, 3.7 million babies under one month old die every year. "Experts warn that an additional 200,000 to 400,000 more babies could die annually if the (economic) crisis continues," Ban said. The secretary-general said the problems of poor maternal health, weak health care systems, and the flu pandemic demand stepped up global action to give priority to health issues "that remain relatively orphaned." "One billion people continue to suffer on a daily basis - and often die - of easy-to-control diseases that we continue to call `neglected tropical diseases.' These are in fact diseases of the world's poor," he said. As a result of the economic crisis, Ban said, "an additional 50 to 90 million people in developing countries will be plunged into absolute poverty this year ... (and) inequities between rich and poor countries in access to health care are likely to increase." A report by the Global Campaign for the Health Millennium Development Goals said recent actions from governments, international agencies and civil society have given hope for accelerating progress toward the goals of reducing child mortality by two-thirds and maternal mortality by three-quarters by 2015. But it said progress is now threatened by the economic crisis and new and innovative financing is needed. © 2009 The Associated Press. Flu Pandemic Spurs Queries About Vaccine By Jeanne Whalen Wall Street Journal Monday, June 15, 2009 Governments and drug companies ramping up production of a vaccine against the swine-flu virus are facing a tough question: Who really needs it? The world's biggest drug companies have started producing vaccines against the H1N1 virus and expect the first doses to be available by the fall. Many Western countries have ordered millions of doses, at a cost of more than $1 billion. But they have yet to figure out who should be first in line to get the shots, or to what extent they are even needed, given that the virus has so far proved less deadly than feared. "We hope that clarity will come from this fog in the next two to three months," said John Oxford, professor of virology at Queen Mary, University of London. On Sunday, a person with underlying health conditions died of swine flu in Scotland, health officials said, according to the Associated Press. It was the first reported death from the illness outside the Americas. The situation underscores the guessing game governments and drug companies must play when dealing with uncertain, high-risk health scares. If they move to produce too much vaccine, they could find themselves wasting taxpayer money and using up scarce capacity that could be producing other life-saving vaccines. But not getting enough vaccine -- or not vaccinating the right people -- could expose them to trouble if the pandemic worsens. Many countries "are still struggling about whom to vaccinate and how to prepare," said Andrin Oswald, head of vaccines and diagnostics at drug company Novartis AG. (Novartis's acquisition of eye-care company Alcon looks increasingly expensive. Please see article on page B2.) The World Health Organization, which formally declared swine flu a pandemic Thursday, has yet to offer guidelines on how many people should be vaccinated and who should be first. But some governments are moving ahead with their own plans. In the U.K., which has ordered enough vaccine to cover much of its population, health officials say health-care workers and children should be among those taking priority. U.S. officials are gathering more information on the virus and waiting to see the results of clinical trials on the safety and efficacy of the shots before making any decisions, according to a spokesman for the Centers for Disease Control and Prevention. Flu experts say the virus appears to be having the worst impact on people with other health problems, including diabetes and asthma. More than 70% of hospitalizations in the U.S. have been people with such conditions, according to the CDC. Pregnant women and people who are overweight also appear to be more vulnerable. The uncertainty about who will need the vaccine can be frustrating for drug companies trying to figure out how much to produce. After carrying out human trials this summer, GlaxoSmithKline PLC, Novartis and Sanofi-Aventis SA, three of the biggest vaccine makers, say they will focus first on filling orders they have received from governments. Novartis said more than 30 governments have so far asked it to supply them with vaccine or vaccine ingredients. Glaxo has pledged to donate 50 million doses to WHO for use in the developing world. Mike Esterl contributed to this article. Printed in The Wall Street Journal, page A10 Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved. China confirms 31 more cases of swine flu Associated Press USA Today Tuesday, June 16, 2009 BEIJING (AP) — China is now reporting 31 more cases of swine flu, bringing the total on the mainland Monday to 196. The Health Ministry said on its website late Sunday that the cities of Beijing and Shanghai have reported more cases, as did provinces in central, eastern and southern China. The world's most populous country has quarantined travelers — including New Orleans Mayor Ray Nagin — on the slightest suspicion of contact with an infected person, and has increased surveillance of the virus with temperature checks on incoming passengers at airports. There have been no reports of deaths. Hong Kong, which tallies swine flu cases separately, said late Saturday it had confirmed 11 more cases, bringing the Chinese territory's total to 84. Copyright 2009 The Associated Press. All rights reserved. Philippines Reports New H1N1 Outbreak Associated Press Wall Street Journal Tuesday, June 16, 2009 MANILA, Philippines -- The Philippines confirmed a flu outbreak in 20 people in a rural northern village Monday as the country's H1N1 infection tally neared 200, while Thailand reported its largest single-day jump in infections. "You can't stop the spread of this virus anymore," Philippine Health Secretary Francisco Duque III said. "The mitigation efforts are aimed at slowing it down, then working to help villagers address the infections." Mr. Duque said 46 new cases were reported Monday, bringing the number of infections in the country to 193. All of the cases are mild and 71 have fully recovered, he said. The World Health Organization said 74 countries reported 29,669 cases of the new flu, including 145 deaths, as of June 12. Thailand's Public Health Ministry on Monday confirmed 51 new cases of the flu commonly known as swine flu -- the largest jump in a single day since the country's first infection, which was confirmed in May. China reported 31 more cases of swine flu Monday, bringing the total on the mainland to 196. Hong Kong's swine flu cases hit 101 as nine more people were found to be infected. In New Zealand, authorities reported 15 new cases, bringing the South Pacific nation's total to 86. According to Reuters, many sick passengers who flew to Ho Chi Minh City in southern Vietnam took fever reducers to cheat temperature scanners at the airport, leading to the discovery of several infected cases later, state media reported over the weekend. Copyright © 2009 Associated Press. Study Shows Possible Link Between Deaths and ADHD Drugs By Shankar Vedantam Washington Post Tuesday, June 16, 2009 Children taking stimulant drugs such as Ritalin to treat attention-deficit hyperactivity disorder are several times as likely to suffer sudden, unexplained death as children who are not taking such drugs, according to a study published yesterday that was funded by the Food and Drug Administration and the National Institute of Mental Health. While the numbers involved in the study were very small and researchers stopped short of suggesting a cause and effect, the study is the first to rigorously demonstrate a rare but worrisome connection between ADHD drugs and sudden death among children. In doing so, the research adds to the evolving puzzle parents and doctors face in deciding whether to treat children with medication. Doctors have speculated about such a connection in the past because stimulants increase heart rate and have other cardiovascular effects. Physicians are currently advised to evaluate patients for cardiac risks before prescribing the drugs, and FDA officials said yesterday that those guidelines do not need strengthening in light of the new study. About 2.5 million children in the United States take ADHD medications such as Ritalin and Adderall. In a press briefing called on short notice yesterday, FDA officials said that given the seriousness of ADHD and the rarity of sudden death -- which strikes fewer than 1 in 10,000 children -- the benefits of the drugs outweigh their risks. Agency officials urged parents to discuss concerns with doctors rather than deciding on their own to discontinue a child's medication. The study's lead author, Madelyn Gould, a professor in child psychiatry and epidemiology at Columbia University, said she agreed with the FDA's advice. "This study reports a significant association or 'signal' between sudden unexplained death and the use of stimulant medication, specifically methylphenidate," the study researchers concluded, referring to the chemical name of Ritalin. "While the data have limitations that preclude a definitive conclusion, our findings draw attention to the potential risks of stimulant medications for children and adolescents." Since an experimental study comparing the risk of sudden death among children taking medications with those not taking medications would have had to include millions of children to generate a useful scientific result, Gould and a number of colleagues conducted what is known as a matched case-control study: They obtained information about 564 children in the United States who died suddenly and inexplicably between 1985 and 1996. The researchers evaluated how many of the children who died had been taking stimulant drugs by asking their parents and caregivers and by reviewing medical documents. For every child who died suddenly and inexplicably, the researchers then found another child closely matched in terms of age, sex and other variables who died in a traffic accident. Taking a stimulant drug is unlikely to have played any role in a child getting killed in an accident. If stimulant drugs had nothing to do with sudden, unexplained death, then the number of victims on stimulant drugs who suffered such deaths and the number of victims on stimulant drugs who died in traffic accidents ought to have been about the same. But Gould found that 10 children in the group that suffered sudden, unexplained death had been taking stimulant drugs, whereas only two children in the group killed in traffic accidents were taking such medications. Robert Temple, director of the Office of Drug Evaluation at the Center for Drug Evaluation and Research at the FDA, said that the study had been well conducted, but that he was concerned that not all parents may accurately recall whether children who died were taking stimulant drugs. When a child dies suddenly, he said, it is natural for a parent to pay close attention to all the medications the child was taking at the time and to report that to researchers. By contrast, he said, parents whose children die in traffic accidents may be less likely to note whether their children are taking medications -- and less able to report it years later. In an editorial accompanying the study, Benedetto Vitiello of the National Institute of Mental Health said that ADHD itself might have increased the risk for sudden, unexplained death. If that were the case, he said, it would explain why more children taking stimulant drugs were found in the group that suddenly died than among the children who died in traffic accidents. The researchers who conducted the peer-reviewed study acknowledged that its design precluded definitive answers, but they said that they had taken care to eliminate each of these potential confounders. They did not consider cases of sudden death in which children had asthma or cardiac abnormalities -- conditions known to be associated with ADHD -- because those factors might have independently raised the risk of sudden death. They also included one child who died in a traffic accident who seemed to have been abusing amphetamines, rather than taking an ADHD medication. Gould said she had her colleagues had compensated for biases not only on the part of parents, but in medical records -- medical examiners are more likely to conduct toxicology tests among children who die suddenly than among children who die in traffic accidents. The researchers first eliminated all records that relied on parental memories and looked only at medical records. They then eliminated all cases that had medical records and looked only at what parents reported. No matter how the data were sliced, Gould said, there were significantly more children taking stimulant drugs who suffered sudden, unexplained death than those were killed in traffic accidents. Vitiello said Gould's study underscores that ADHD drugs are not innocuous. Indiscriminate prescription of the drugs for general behavioral problems and the growing number of healthy teenagers and adults using the drugs to boost mental performance could have deadly consequences, he added. Copyright 2009 Washington Post. *Opinion* Cut drug copayments to bolster 'adherence' By Gary E. Applebaum Baltimore Sun Commentary Tuesday, June 16, 2009 President Barack Obama and congressional Democrats have promised to pass sweeping health reform legislation by year's end. But before they overhaul the entire U.S. health care system - and pledge trillions in spending - they ought to consider policies that transcend traditional political divides and have already proven successful. Here's one such policy: improve patient "adherence" to doctor-ordered courses of prescription drugs. In recent years, pharmaceuticals have been integral to improving Americans' health. Thanks to innovations in virtually all aspects of drug research, Americans are more productive, have lower mortality rates for many diseases and visit the hospital thousands of times less than they would otherwise. Unfortunately, millions of patients don't always follow the drug regimens prescribed by their doctors. This widespread "non-adherence" - which may involve skipping doses, taking less than the recommended amount of a drug or ceasing to take a drug before the supply has run out - makes Americans less healthy and ends up increasing the cost of health care. Three-quarters of adults prescribed drugs admit that non-adherence is a problem for them. Only half of those suffering from chronic diseases like diabetes and hypertension fully adhere to their medication regimens, according to an article in February's American Journal of Managed Care. A fifth of those with hypertension never bother to get their first refill, a 1997 study found. Of course, many patients may deviate from their prescribed treatments because they're concerned about the cost. Ignoring a doctor's orders, though, can result in even higher medical bills down the road. After all, it's far cheaper to take a daily cholesterol-lowering pill than it is to deal with a heart attack. Non-adherent patients with hypertension suffer 5.4 times as many poor clinical outcomes as those who take their medicines as prescribed. For non-adherent patients with heart disease, the likelihood of a poor outcome is 1.5 times higher. All told, non-adherence costs the U.S. health care system between $100 billion and $300 billion a year, studies have shown. About 125,000 people die each year because of complications brought on by non-adherence, according to a 1998 article in Business Health. These negative health consequences are tragic because they're so preventable. If we could simply improve patients' compliance with their doctors' orders, we could make significant gains in the overall health of the American public. Increased rates of adherence also have the potential to save us billions of dollars. If all patients suffering from elevated blood pressure received the appropriate drug treatment, the country could save $16.5 billion by avoiding nearly 90,000 deaths and 400,000 hospitalizations. Increasing drug adherence among workers with rheumatoid arthritis would diminish lost productivity by 25 percent, netting the economy an extra $4.4 billion. So, what's the best way to ensure that patients are taking the drugs they're supposed to? Lower insurance co-pays for drug purchases would certainly help. Forcing patients to bear the brunt of drug expenses often causes them to stop taking their meds. Insurance policies should cover more of the cost, particularly for medicines that treat chronic diseases. The long-term savings from such a change would be significant. Researchers recently found that eliminating co-payments for drugs called ACE inhibitors for diabetic Medicare patients would reduce spending by more than $1,600 per patient. One study determined that eliminating a $10 copayment for cholesterol-lowering statins for certain patients could result in 90,000 fewer hospitalizations and 36,000 fewer emergency room visits each year. Reducing use of such acute care could save more than $1 billion annually. A health reform initiative that advances patient health and saves money may sound too good to be true. But improved prescription-drug adherence can accomplish both. As lawmakers strive to implement common-sense health reform, improved adherence is just what the doctor ordered. Dr. Gary Applebaum, an Owings Mills resident, is a senior fellow at the Center for Medicine in the Public Interest. He is the former executive vice president and chief medical officer of Erickson Retirement Communities. His e-mail is gary.applebaum@cmpi.org. Copyright © 2009, The Baltimore Sun. BACK TO TOP


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