Wednesday, June 17, 2009

News Clipping Archives

 

Maryland / Regional

Single mothers face high obstacles, study finds (Montgomery County Gazette)

Md. firm receives Creek County jail care contract (Daily Record)

Mentally ill inmates struggle with inadequate treatment (Montgomery County Gazette)

HIV/AIDS walk to be held (Frederick News Post)

Wicomico will buy swine flu antivirals (Salisbury Daily Times)

Stimulus funds available for Carroll aid agencies (Carroll County Times)

Milk is an important commodity in county (Hagerstown Herald-Mail)

 

National / International

FDA tells parents to keep children on ADHD drugs, despite new evidence of sudden death risks (Baltimore Sun)

Obama's Health Plan Needs Spending Controls, CBO Says (Washington Post)

FDA Commissioner Faces Formidable To-Do List (Washington Post)

Obesity a disability? AMA says no (Baltimore Sun)

House Committee Approves Sweeping Food-Safety Bill (Wall Street Journal)

Children Suffer as States Cut Health Budgets (Wall Street Journal)

7 More With Swine Flu Die, Raising the City’s Total to 23 (New York Times)

FDA says Zicam nasal spray can cause loss of smell (Washington Post)

E.P.A. to Review Safety of Pet Flea and Tick Products (New York Times)

 

Opinion

Malpractice and Health Care Reform (New York Times Editorial)

Reducing Medicare readmissions will keep down costs, help patients (Baltimore Sun  Commentary)

A judgment against health-related bias (Baltimore Sun  Commentary)

Dangerous times (Baltimore Sun  Commentary)

When the Other Guy Doesn't Wash His Hands (Washington Post Letter to the Editor)

 

 

Maryland / Regional

Single mothers face high obstacles, study finds

Six-item agenda outlines recommendations at all government levels

 

By Janel Davis

Montgomery County Gazette

Wednesday, June 17, 2009

 

Nicole Swinson knew things were difficult for single mothers, but she didn't know just how difficult until she saw the numbers in black and white.

 

Families headed by a single woman make up 15 percent of county families, but they account for 47 percent of the county's families with incomes below the federal poverty line.

 

In 2007, about 13 percent of the 38,889 single mothers in the county lived in poverty.

 

"I was alarmed at the study. The truth was we were one paycheck away from poverty. We think we're making it, but we're really not," Swinson said about herself and the county's other single mothers. "I didn't feel like it as I was going along and taking care of my children, but when I saw the numbers, it motivated me to do more."

 

Last week, the county's Commission for Women released the statistics as part of its "Single Mothers and Poverty" study, focusing on the challenges confronting single mothers in the county.

 

The study is a compilation of existing data from the county, state and federal government and Census figures. From the data, the commission developed an agenda of recommendations in six categories: education, employment, child care, income supports (including child-support payments), health care and housing.

 

The county's high cost of living, coupled with disparities in pay, mean Montgomery County can be a difficult place for single mothers despite the numerous assistance programs, said Tedi S. Osias, chairwoman of the commission's Mothers and Poverty Committee, which conducted the two-year survey and made the recommendations.

 

"The face of poverty is a woman's face, and much of the time it is a mother's face," says the first line of the study.

 

Swinson's youthful face belies the tough times she can recant during her 10 years in the county.

 

A former Washington, D.C., resident, Swinson, 39, came to the county to care for her three children — including two with disabilities — after her husband left her. In the process, the children got dropped from his health insurance. After losing her job at Reagan National Airport after the Sept. 11 attacks, Swinson also lost her health insurance.

 

"That was one of the most memorable moments after losing my job," she said. "Most disappointing to me was that I had worked, and I knew there were programs out there to help me, but it took a long time to get help."

 

The family went without health care for a year before receiving government-funded health care.

 

"I had to keep it together," she said, "because if the kids saw that I was breaking, they would break, too."

 

Swinson's story is indicative of the single mothers represented in the commission's study, including the 21 percent of unmarried women with no health insurance, the 72 percent of single-mother households that apply for public housing and those who earn almost 60 percent less than the county's median income.

 

The most difficult part of being a single mother is "not having enough money to do the things that I need to do or even some things that I want to do," Allison Kemp said.

 

Kemp, a self-professed "late-age" mother, had her second child at 41; at the same time, her son turned 18.

 

"[Parenting] takes up all of my time. If I had someone else there to help they could do some of those things that need to be done," she said.

 

Instead, she begins her day at 6:30 a.m. and squeezes in work, household chores, errands, meals and playtime with her 5-year-old daughter before repeating the routine the next day.

 

At the same time, the Silver Spring resident is trying to improve her credit, pay down debt and pay child care.

 

"Child care is expensive, and with that and other [necessities], they take up any savings you try to have," said Kemp, 46. "So a chance for getting ahead is hard."

 

Aside from just presenting the statistics, the commission's ultimate goal is to help the county's single mothers get ahead. Each of the six categories highlighted in the study includes policy recommendations, ranging from lobbying for changes in laws affecting women to streamlining the county's many and varied assistance programs.

 

"It is important to connect the study with priorities for women in Montgomery County," said Councilwoman Duchy Trachtenberg, who has successfully lobbied to expand many of the assistance programs aimed at the county's neediest residents — including single mothers.

 

"We have to push this agenda on the state level and keep talking about this information," Trachtenberg said. "Together, we can make a difference."

 

Trachtenberg (D-At large) of North Bethesda has had help on the council from Valerie Ervin, the council's only single mother.

 

Ervin (D-Dist. 5) of Silver Spring frequently tells her story of raising two sons alone while going to college and working as a Safeway grocery store checker years ago. Her sons are now 27 and 21, but her past struggles motivate her commitment to help other single mothers, she said.

 

During her tenure as a school board member, and now as a council member, Ervin has pushed for universal pre-kindergarten throughout the county.

 

"My advice for single mothers is to stay in school or go back to school because the trajectory for single moms should be the same as everyone else," Ervin said. "Your children's success is similar to your attainment. It shouldn't be any different for a single mother."

 

For Swinson and Kemp, two of the county's single mothers fortunate enough to participate in a five- to seven-year county self-sufficiency program run by the Housing Opportunities Commission for the past 11 years, the difference lies in the partially subsidized housing they receive and an escrow account due to them at the end of the program.

 

"The whole point of housing is stability," said Nancy Scull, director of the comprehensive Self-Sufficiency Program. "If you don't know where you're sleeping at night, don't have a place to go, you can't have children who go to school and be successful, parents can't apply for jobs. You're much too stressed."

 

About 90 percent of the clients in the program are single parents, and 96 percent of those are single mothers.

 

"The stability of subsidized housing, which is what we provide, is critical to anybody's success, especially single parents," Scull said.

 

As a single mother, you have to set a goal for yourself and stick to it, Swinson said. "I love to share my story, because people don't know what I've been through."

 

-15% of county families headed by single women

 

-47% of single-woman families have incomes below federal poverty line

 

-Maryland one of 14 states requiring women to apply for child support before receiving child-care subsidies

 

-33.5% ($25m) of child support in the county went uncollected in fiscal 2008

 

-21% of single women in the county have no health insurance

 

-72% of households applying for public housing in 2008 in county headed by single women

 

-$52,960 average annual income needed in 2008 to pay market rent for two-bedroom housing

 

-$45,022 median income for female-headed county households

 

Copyright 2008 Montgomery County Gazette.

 

Md. firm receives Creek County jail care contract

 

Associated Press

Daily Record

Wednesday, June 17, 2009

 

A Maryland firm says it has agreed to a $2.2 million contract to provide health care services for Creek County jail inmates.

 

Conmed Healthcare Management Inc. CEO Richard Turner said Tuesday that the contract was its first in Oklahoma. The contract consists of a one-year initial deal with four one-year renewal options. It will take effect on July 1.

 

The company says the initial contract will cover about 315 inmates. Under the agreement, Conmed will provide services including staffing of nurses, physicians and clerical personnel.

 

The company also will offer dental, mental, behavioral health, laboratory and diagnostic X-ray services.

 

Copyright 2009 Daily Record.

 

Mentally ill inmates struggle with inadequate treatment

 

By C. Benjamin Ford

Montgomery County Gazette

Wednesday, June 17, 2009

 

Victoria Shaffer never sees her work when it is successful, but she often does when it is not.

 

As a therapist at the Montgomery County Correctional Facility, she deals with a steadily growing stream of inmates with mental health issues.

 

In some cases, the facility is like a revolving door. When inmates with mental illnesses are released back into the community, there often is not a strong support system of family or public programs to help them, and they revert to their prior behavior, she said.

 

The ones where treatment works are not likely to return.

 

"This is not the most cost-effective way to treat mental illness, and it also is not the most humane," Shaffer said. "This is a jail environment and not a mental hospital."

 

A new study released earlier this month showed that a growing number of inmates in jails nationwide have serious mental health problems. The study of more than 20,000 men and women inmates by the nonpartisan Council of State Governments' Justice Center and Policy Research Associates found that 14.5 percent of men and 31 percent of the women in jails suffered from serious mental illnesses such as schizophrenia.

 

"I don't feel overwhelmed, but it saddens me," Shaffer said. "It's not the way we want to treat those with an illness."

 

The study showed that people in jail were more than three to six times likely than people in general society to have a serious mental illness.

 

Corrections officials said the percentage of inmates with mental health issues has grown dramatically in recent years, as the federal and state governments — and more recently, strapped counties — have cut funding for mental health services.

 

For example, in Montgomery County, the county's outpatient mental health clinics served 1,583 clients in fiscal 2009, but the number is expected to decline to 1,403 in fiscal 2010 because of program cuts.

 

At least 19 states have enacted public health cuts this year, according to the Center on Budget and Policy Priorities, which works at the federal and state levels on fiscal policy and public programs that affect low- and moderate-income families and individuals.

 

Mental health grows as a jail issue

 

Washington County Sheriff Douglas Mullendore, who oversees his county's jail as well as the patrols by deputies, said that police encounter more people than in the past with mental health issues that cause them to commit crimes. The crimes often are minor, such as disturbing the peace by shouting or trespassing, Mullendore said.

 

"It's the same old thing," he said. "When money gets tight for public services, one of the first things cut is mental health. They don't get their medications or services, the police get called, and they get locked up."

 

In some cases, the mentally ill inmates are more dangerous than the inmates in the general population because of their erratic behavior, he said.

 

But the correctional deputies are not trained in psychiatric counseling, which makes working with the mentally ill more stressful, said Maj. Van Evans, warden of the Washington County Detention Center.

 

Because the police do not have anywhere else to take the seriously mentally ill after they commit even minor crimes, they end up in jail, Shaffer said.

 

Services at jails across Maryland vary considerably. While Montgomery County has its own staff of therapists to provide mental health services, jails such as in Washington County contract them out. Montgomery County has a mental health wing called the Critical Incident Unit with full-time staff, while Washington County's incarcerated mentally ill can see a therapist twice a week.

 

"Jails at the county and municipal level were never intended to replace the need for a strong, community-based mental health system," said Art Wallenstein, director of the Montgomery County Department of Correction and Rehabilitation. "Better alternatives exist, and they must be encouraged and supported. Jail is not the answer for addressing mental illness in this country."

 

The Montgomery County mental health wing holds 40 inmates and generally is at or near capacity all the time, Wallenstein said.

 

"This is a public policy issue of growing importance because the jails have become the major mental health provider in the country," Wallenstein said. "That's totally wrong. The goal is to use incarceration in appropriate cases and use community-based mental health treatment when appropriate."

 

The Montgomery County budget for psychotropic medications exceeds $300,000 a year to meet the needs of inmates, he said. The drugs help treat people with mental illnesses by altering their behavior and stabilizing their moods.

 

A jail setting is not the best for providing the counseling services the mentally ill need, Shaffer said.

 

"If you have an inmate who is paranoid and is already locked up, he is going to be more of a challenge to treat because of the environment," she said.

 

When they are released into the community, the support system isn't in place to make certain they are obtaining their medications or taking them when they do get them, she said.

 

"The reality is many of them are homeless," she said.

 

That often results in the mentally ill returning to jail when they commit new offenses.

 

"If they're doing better, we usually don't hear about them," she said.

 

Del. Galen Clagett (D-Dist. 3A) of Frederick, who worked in prisons in the 1960s and is chairman of a House appropriations subcommittee on prisons, said some of the problem can be traced to the movement to get the seriously mentally ill out of a residential setting and back into the community.

 

"When they deinstitutionalized these facilities, all of these people were dumped back into the communities," Clagett said. "It's a really complicated issue and is a real sticky wicket."

 

At the federal level, Senate Judiciary Committee Chairman Patrick Leahy (D-Vermont) has sponsored the Mentally Ill Offender Treatment and Reduction Act to authorize federal grants to help state and county governments offer treatment to mentally ill inmates and to train police to react to situations involving the mentally ill.

 

But Shaffer said the needs of the mentally ill often are not on the radar.

 

"You very seldom hear a politician run on the issue of what they'll do in office for the mentally ill," she said.

 

Copyright 2009 Montgomery County Gazette.

 

HIV/AIDS walk to be held

 

By Adrienne Lawrence

Frederick News-Post  

Tuesday, June 16, 2009

 

The first HIV or AIDS walk in recent history will be held June 27. The Frederick AIDS Awareness 5K Walk is expected to become an annual event in Frederick.

 

The Frederick County Health Department, Frederick Church of the Brethren and Positive Influence Inc. chose the day because it is National HIV Testing Day.

 

"It's time to get people thinking about it again," said Debbie Anne, AIDS certified registered nurse and HIV Program supervisor with the Frederick County Health Department. "Every nine and a half minutes someone contracts HIV (in the U.S.)."

 

Registration begins at 10 a.m. and the 5K walk will begin at 10:30 a.m. at the church on Fairview Avenue, across from Schifferstadt Architectural Museum.

 

All funds will go to education, support and awareness programs for HIV and AIDS in Frederick County.

 

Free, confidential and private HIV testing will take place from 10 a.m. to 2 p.m. with trained staff, who can answer questions and provide information and education.

 

In addition, volunteers will collect horizontal 12 by 18 inch (with an additional 1 inch border) panels for a Frederick community AIDS quilt. The quilt is fashioned after the National AIDS Quilt, but this one will stay in Frederick and be available to the community for education and awareness purposes.

 

Each panel usually represents a person who died with HIV or AIDS. For details, e-mail info@fcob.net.

 

A year ago, Bob Rice, HIV/AIDS Ministry chairman with Frederick Church of the Brethren, found a place he could serve, not only with the upcoming walk, but also to help people affected by the disease. As a ministry, FCB is raising awareness and removing the stigma of HIV through education beginning with the church and then throughout the community.

 

"We offer care and support to those infected and affected by HIV and AIDS. This is a place where they can come, worship and know they are home," Rice said.

 

"It's something that I've felt strongly about for a longtime," he said. "I have the time and interest to make an impact."

 

"It's not the end of the world," Rice said.

 

"There's lots of hope," Anne chimed in.

 

DETAILS Frederick AIDS Awareness 5K Walk, Time: 10 a.m. to noon, When: June 27, Where: Frederick Church of the Brethren 201 Fairview Ave., To register: E-mail: info@fcob.net Call: 301-241-3208 (Robert) 301-662-8496 (Bob)

 

Copyright 1997-09 Randall Family, LLC. All rights reserved.

 

Wicomico will buy swine flu antivirals

Council members play down their concerns about pandemic

 

By Laura D'Alessandro

Salisbury Daily Times

Wednesday, June 17, 2009

 

SALISBURY -- If the swine flu pandemic creates an emergency situation on the Eastern Shore, Wicomico County will be prepared to treat half of its employees after the County Council approved spending $20,5000 Tuesday to stockpile antiviral medication.

 

The purchase will allow Wicomico County Health Department to acquire 343 doses of Tamiflu and Relenza, medications to speed flu recovery with a shelf life of close to 10 years, according to Brandy Wink, deputy health officer. Wink said the medicine will be stored at the health department and only used if a state of emergency is declared by Gov. Martin O'Malley, at which time treatment would be made available to county employees.

 

Wink originally approached the council seeking 686 doses to cover all county employees, but the amount was reduced to half by the council, who felt the cautionary expenditure was unnecessary.

 

"Even though it may be a pandemic --I'm not so sure --is it overkill to have a stockpile of these for everybody," said County Council President John Cannon, "especially if it turns out to be isolated incidents. I don't think we've ever had a pandemic on the Eastern Shore."

 

In Worcester County, commissioners recently approved a $10,000 expenditure to purchase a stockpile and Ocean City chose to only purchase enough medication to cover fire and emergency medical employees.

 

Wink said in the case that widespread antiviral treatment is needed, hospitals and pharmacies are also prepared with stockpiles of the drugs for the general public.

 

Though the council was reluctant, a local doctor said the purchase was a smart move. Dr. Victor Gong, owner of the 75th Street Medical Center in Ocean City said health officials are predicting the worst is yet to come with the disease.

 

"It has spread to about 70 countries and is only going to get worse," Gong said. "Health officials expect it to blossom more in the fall even though it may have tapered down now."

 

Copyright 2009 Salisbury Daily Times.

 

Stimulus funds available for Carroll aid agencies

 

By Erica Kritt

Carroll County Times

Wednesday, June 17, 2009

 

Carroll’s needy will be getting their hands on some of the $787 billion allocated in the American Recovery and Reinvestment Act later this summer.

 

The federal government has allocated stimulus funds to go to emergency food and shelter programs across the country.

 

Carroll’s local board will receive $37,695.

 

Janet Boyd, chairwoman of the local emergency food and shelter program, said the money will be divided among selected agencies that apply for the funds by June 26.

 

The organizations must be private nonprofits or government agencies, have an accounting system, observe nondiscrimination policies and have experience administering emergency food and shelter programs. Private voluntary organizations must have a voluntary board to qualify for funds.

 

Boyd said within 25 business days of receiving the funding notice, the local board has to ask for and receive applications and make a decision on which organizations are getting the money and how much each will receive.

 

The process is not something Boyd is unfamiliar with. Since 1996, Carroll County has received yearly funds from the federal government for emergency food and shelter programs.

 

So far in 2009, Carroll County received $41,851, which was divided among Carroll County Food Sunday, Human Services Programs of Carroll County, Meals on Wheels, Family and Children Services and the Church of the Ascension.

 

Boyd said the process for using the funds from the American Recovery and Reinvestment Act is the same as the normal yearly process.

 

Boyd said the Emergency Food and Shelter National Board Program has stressed that it wants to get agencies that have never applied for money from the emergency food and shelter program to apply.

 

“A lot of soup kitchens and food pantries are anxious to apply,” Boyd said.

 

So far, Boyd said there is a good amount of interest and she said she expects that to continue until the deadline.

 

Jeanette McLernon, associate director at HSP, said this stimulus money will help.

 

“We’ve seen a drastic increase of individuals and families who have never used our services before,” McLernon said.

 

Agencies receiving funds will have until Dec. 31 to use them. Any money not used within that time period is given back to the government.

 

Reach staff writer Erica Kritt at 410-857-7876 or erica.kritt@carrollcountytimes.com.

 

Allocation amount for nearby county

 

American Recovery and Reinvestment Act Funds through Emergency Food and Shelter Programs for Carroll and nearby counties

 

Carroll County: $37,695

 

Howard County: $43,422

 

Frederick County: $54,418

 

Montgomery County: $181,620

 

Baltimore County: $200,155

 

Source: Emergency Food and Shelter National Board Program

 

To apply

 

Agencies can find an application at http://ccgovernment.carr.org/ccg/housing/default.asp" target="_blank">http://ccgovernment.carr.org/ccg/housing/default.asp.

 

Completed applications must be submitted to Janet Boyd at Carroll County Department of Citizen Services, 10 Distillery Drive, Suite 101, Westminster, MD 21157. All applications must be received no later than 4:30 p.m. June 26. Applicants will present proposals July 1. Boyd can be contacted with any questions at 410-386-3600.

 

Copyright 2009 Carroll County Times.

 

Milk is an important commodity in county

 

By Jeff Semler

Hagerstown Herald-Mail

Tuesday, June 16, 2009

 

June is National Dairy Month and is widely celebrated nationally.

 

It is the reason you see displays and promotions in your grocer's aisle for such things as cheese and ice cream.

 

As I have stated on many occasions in this column, Washington County is home to some 11,000 dairy cows, ranking it second in the state, and 150 dairy farms, ranking it first in the state.

 

At one point in our history, every farm had a few milk cows whose milk would be consumed by the family, with a portion processed on the farm into butter or cheese as cash crops to add to the farm's bottom line.

 

Today, however, most of the milk produced in the county is shipped over the mountain to be processed and jugged and shipped to supermarkets.

 

When you think about the dairy products that grace your table, such as cheese, yogurt, milk and ice cream, do you ever wonder about the size and scope of the dairy industry? Here are but a few examples:

 

• More than 10 pounds of milk go into one pound of cheese.

 

• U.S. cheese consumption is 31.3 pounds per capita.

 

• Cheddar is the most popular natural cheese in the U.S. (cheddar accounts for 9.39 pounds per capita or 27 percent pound share.)

 

• Super Bowl Sunday rates as the No. 1 day for pizza consumption. In second place, using huge amounts of cheese, is the Wednesday before Thanksgiving.

 

• The average buyer purchases cheese 15 times a year at retail.

 

• More than one-third of all milk produced each year in the U.S. is used to manufacture cheese.

 

• About 300 varieties of cheese are sold in the United States.

 

• Ice cream lovers drive U.S. production to 1.6 billion gallons of ice cream, frozen yogurt, sherbet and other related products.

 

In the U.S., the major dairy animal is the cow, but the goat is the major dairy animal worldwide. In other countries, yaks, camels, horses, water buffalo and sheep are milked. Most of the milk from these animals is made into cheese or cultured products similar to yogurt, since most of these regions are also short on refrigeration.

 

So what about our friend the cow? The two most popular breeds in the U.S. are the Holstein (black and white) and the Jersey (brown). The rest of the major dairy breeds are Ayrshire, Brown Swiss, Guernsey and Milking Shorthorn. A cow will weigh 1,000 to 1,400 pounds and produce 90 to 135 cups of milk per day. She has a four-part stomach that allows her to eat food that humans would be unable to digest. She will consume nearly 100 pounds of feed and 50 gallons of water per day.

 

Now to the dairy farmer. He milks his cows every day. Neither cows nor farmers take weekends or holidays off. As many farmers will tell you, it's not a job, but a way of life. However, it is also a business or the farming enterprise does not survive. As I write, farm gate milk prices are about the same as they were in 1976. I cannot think of one person that would stand still if they were paid what they were in 1976.

 

To help put this in perspective, in 1976, the minimum wage was $2.30 per hour and today it is $6.55, with a scheduled boost to $7.25 in July. One gallon of regular gasoline was 59 cents per gallon and now it is about $2.55. Milk in stores was $1.65 per gallon; today it is $3.49. You are probably asking yourself how a dairy farmer is to survive. Excellent question, for which there is no easy answer other than to hang on and wait for the market to rebound. The question is when will the market rebound and will anybody still be hanging on at that point?

 

The farm gate price of milk has literally dropped by half since last year, yet the price of milk in the store has not, so the question begs, do we truly operate in a free economy? These are the kinds of questions that make economists scratch their heads, too, I am sure.

 

With that said, in honor of Dairy Month and those folks who toil every day to bring you those delicious products, have a bowl of ice cream or strawberries and cream.

 

Jeff Semler is an Extension educator, specializing in agriculture and natural resources, for the University of Maryland Cooperative Extension. He is based in Washington County. He can be reached weekdays by telephone at 301-791-1404, ext. 25, or by e-mail at jsemler@umd.edu

 

Copyright 2009 Hagerstown Herald-Mail.

 

National / International

FDA tells parents to keep children on ADHD drugs, despite new evidence of sudden death risks

 

Associated Press

By Matthew Perrone

Baltimore Sun

Wednesday, June 17, 2009

 

WASHINGTON - Federal health regulators are urging parents to keep their children on attention deficit drugs like Ritalin and Adderall, despite new evidence from a government-backed study that the stimulants can increase the risk of sudden death.

 

Published Monday in the American Journal of Psychiatry, the study suggests a link between use of the stimulant drugs and sudden death in children and adolescents. The drugs, used to treat attention deficit and hyperactivity disorder, already carry warnings about risks of heart attack and stroke in children with underlying heart conditions, but researchers have questioned whether they pose the same risks to children without those problems.

 

Healthy children taking the medications were six to seven times more likely to die suddenly for unexplained reasons than those not taking the drugs, according to the study from the National Institute of Mental Health.

 

The study was partially funded by the Food and Drug Administration, but agency experts said its methods — which relied on interviews with parents and physicians years after the children's deaths — may have caused errors.

 

"Since the deaths occurred a long time ago, all of this depended on the memory of people — relatives and physicians — involved with the victims," said Dr. Robert Temple, the FDA's director of drug review.

 

The agency urges parents to discuss safety concerns with their doctor, but to keep children on the treatments.

 

The study compared a sample of 564 children who died of unexplained causes to 564 children who were killed in car accidents. Among the unexplained deaths, 10 children were taking an ADHD drug compared with two of the patients killed in car accidents.

 

The researchers used car accident victims as a comparison group because sudden childhood deaths are rare and difficult to track.

 

"We're confident that the association is real and that that's never been shown before," said Dr. Madelyn Gould, a professor of psychiatry at Columbia University. "But given the limitations, we wanted any ramifications from the paper to be conservative."

 

The FDA said it is collecting data for a larger, more in-depth study of the drugs that should be completed by the fall.

 

"We're not sure this study tells us something we didn't know," Temple said of Monday's publication. "We didn't think it gave an unequivocal answer as to whether there is such a risk."

 

About 2.5 million U.S. children currently take drugs for ADHD, according to government researchers. The American Heart Association recommends doctors consider giving children echocardiograms before starting them on ADHD drugs, though experts stress there is little hard data about the drugs' risks.

 

Sales of the drugs topped $4.8 billion last year, according to health care analysis firm IMS Health. The most popular brands include Shire's Adderall, Johnson & Johnson's Concerta and Novartis' Ritalin.

 

Copyright 2009 Associated Press. All rights reserved.

 

Obama's Health Plan Needs Spending Controls, CBO Says

 

By Lori Montgomery, Shailagh Murray and Ceci Connolly

Washington Post

Wednesday, June 17, 2009

 

President Obama's plan to expand health coverage to the uninsured is likely to dig the nation deeper into debt unless policymakers adopt politically painful controls on spending, such as sharp reductions in payments to doctors, hospitals and other providers, congressional budget analysts said yesterday.

 

While popular measures such as increasing preventive care, expanding the use of electronic medical records and rewarding doctors for choosing more effective treatments have the potential to lower costs, "little reliable evidence exists about exactly how to implement those types of changes," Congressional Budget Office Director Douglas W. Elmendorf said in a letter to Senate budget leaders.

 

"Without meaningful reforms, the substantial costs of many current proposals . . . would be much more likely to worsen the long-run budget outlook than to improve it," he said.

 

The pronouncement from the influential budget office is likely to complicate the arduous task of enacting comprehensive changes this year. Democratic lawmakers, struggling to reach consensus, will lose support unless they produce a package that has the potential to lower the nation's spiraling debt. But hospitals and drugmakers already are balking at proposals that would cut their federal payments, including a plan Obama unveiled last weekend to trim more than $300 billion from Medicare and Medicaid.

 

In recent days, Obama has embraced some of the very ideas the CBO advocates, including the proposal to reduce Medicare payments to spur hospitals and other providers to be more efficient. Obama also has said he is open to empowering a body outside Congress to slash payments to providers if they cannot cut costs on their own.

 

Both ideas could produce long-term savings, CBO said yesterday, and administration officials welcomed the report. "Many of the policies CBO believes could reduce costs in the long term have been proposed by the administration," said Kenneth Baer, spokesman for White House budget director Peter Orszag.

 

But those ideas have yet to gain traction on Capitol Hill, where some influential Democrats have ruled out the notion of giving up control over Medicare payments.

 

Cutting costs will require "real action," said Sen. Judd Gregg (R-N.H.), the senior Republican on the Senate Budget Committee. The CBO report "strips away the political posturing and gets down to the basic fact that it will require alternatives that are generally unacceptable to the people who have been putting forward health-care plans."

 

In addition to pressuring hospitals and doctors to reduce costs, Elmendorf suggested "significantly limiting" the tax-free treatment of health coverage that millions of Americans obtain through employers. Both "approaches could directly lower federal spending on health care and indirectly lower private spending on it as well," he wrote.

 

Key Democrats in the Senate, including Finance Committee Chairman Max Baucus (D-Mont.), are advocating a new tax on the most generous employer-sponsored health benefits. But the White House is opposed to the idea, which has the potential to ensnare the middle-class workers Obama vowed to protect from tax increases.

 

Yesterday, Baucus said committee members have resisted tax increases that are unrelated to health care. Aides said Baucus is trying to keep the 10-year cost of his reform package under $1 trillion, and to cover the cost primarily with spending cuts rather than tax increases.

 

"This process is hard. . . . You submit something to CBO, you get a score back, and then you've got to go talk to everybody about what the changes are that you might want to make to get the cost down, and that's really what's going on," said Sen. Kent Conrad (D-N.D.), chairman of the Senate Budget Committee.

 

Senate aides said Baucus had been looking at options that could push the price past $1.6 trillion over 10 years, a figure that startled some Democrats on the Senate Finance Committee, who met yesterday to discuss their options.

 

"It is clear there have got to be changes made to make the whole package affordable," Conrad said.

 

As lawmakers grappled with the challenge of paying for a major expansion of coverage, three of their former colleagues -- all former Senate majority leaders -- finalized what they say is a blueprint for how to achieve the goal without busting the budget. Democrat Thomas A. Daschle and Republicans Robert Dole and Howard Baker will release a comprehensive proposal today for covering every American without putting the federal government deeper in debt.

 

The three advocate a mix of tax increases, spending cuts and new mandates guaranteed to annoy nearly every major player in the health-care debate, including a mandate on businesses to contribute to health insurance costs and a tax on some benefits provided through the workplace.

 

"We came up with common ground on all of these issues," said Daschle, who was Obama's first choice to lead this year's health-reform effort. "We stayed at the table until we found agreement, as painful as it was."

 

Copyright 2009 Washington Post.

 

FDA Commissioner Faces Formidable To-Do List

 

By Lyndsey Layton

Washington Post

Wednesday, June 17, 2009

 

Margaret A. Hamburg, the new commissioner of the Food and Drug Administration, wants to reorient the sprawling bureaucracy and remake it into the key federal agency that protects public health.

 

"It really goes back to what the FDA was about from the very beginning: a very clear public health mission but with a regulatory framework for action," Hamburg said yesterday, adding that she wants to increase transparency and pump up enforcement.

 

"The FDA has been seen as a cold regulatory agency and also something of a black box," she said. "We have a chance to open it up and make sure the American people have the safe, high-quality foods they need, the safe and high-quality drugs and medical equipment they need."

 

With nearly 11,000 employees, the FDA is charged with overseeing products that account for a quarter of consumer spending in the United States, including over-the-counter and prescription medications, food and medical devices such as heart valves and artificial hips.

 

During the Bush administration, consumer groups charged that the FDA was making decisions on the basis of political ideology and not science. The agency was lambasted on Capitol Hill for a series of food-borne illnesses, the most recent of which was a salmonella outbreak that sickened 700 people, killed nine and prompted the largest recall in U.S. history.

 

The FDA also has been slammed by its own scientists for approving medical devices without proper vetting. And it has been unable to ensure the safety of imported goods pouring into the United States from around the world, including food, drugs and raw materials.

 

"When I was first talking to the administration and the vetting process was going on, suddenly I realized that every day there was some story about a really bad situation and the FDA, and I thought, 'Do I really want this job'?" she said.

 

She decided yes, and started work four weeks ago, after her Senate confirmation. "I've been really impressed by the dedicated staff," she said. "There's a lot to be done, but I don't think it's a patient in crisis. I think it's really important to restore confidence, to restore faith that the FDA is going to use the best available science and has real integrity."

 

Hamburg, a Harvard-trained physician, is a former health commissioner of New York City and was an assistant secretary at Health and Human Services during the Clinton administration. Most recently, she was vice president for biological programs at the Nuclear Threat Initiative, a think tank.

 

In the short time that Hamburg and her principal deputy, Joshua Sharfstein, have been running the agency, the FDA has announced nearly daily warnings about various consumer products. Yesterday, the agency warned the public not to use three Zicam brand over-the-counter cold remedies because they have caused some people to lose their sense of smell.

 

"We've changed our posture to one that is more aggressive and forward leaning," Hamburg said.

 

At her direction, Sharfstein is chairing an internal task force to recommend ways to release more information about FDA decisions and policies. The agency has long been criticized for keeping private information about drugs or devices under study, even when the products are linked to serious health problems or deaths.

 

Hamburg's to-do list goes beyond reorienting and restoring public confidence in the FDA. Last week, Congress passed historic legislation that gives significant new authority and responsibility to the FDA to regulate tobacco for the first time. That means Hamburg must create a new center within her agency to handle oversight of the manufacturing, marketing and sale of cigarettes, cigars and other tobacco products.

 

And today a House committee takes up legislation that would give FDA broad new powers to regulate food safety -- a bill that House leaders are determined to pass this year. The bill would place greater responsibility on the food industry to prevent food-borne illnesses and would require the FDA to significantly expand its inspection and oversight of the industry.

 

Hamburg's days are jammed; she conducted an interview while being driven from Health and Human Services headquarters across town to the Brookings Institution. She says she is determined not to let the work overwhelm her life and makes it a point to try to eat dinner with her husband and two teenage children, toting home a briefcase filled with 10 pounds of work each night. She falls asleep reading briefing books.

 

"The first weeks have been very full," she said. "And my learning curve is extremely steep."

 

Copyright 2009 Washington Post.

 

Obesity a disability? AMA says no

 

Associated Press

Baltimore Sun

Wednesday, June 17, 2009

 

CHICAGO - The American Medical Association has taken action to support doctors' ability to discuss obesity with their overweight patients.

 

Under a new policy adopted Tuesday, the AMA formally opposes efforts by advocacy groups to define obesity as a disability.

 

Doctors fear using that definition makes them vulnerable under disability laws to lawsuits from obese patients who don't want their doctors to discuss their weight.

 

Doctors took the action at their annual meeting in Chicago.

 

In other action Tuesday, the AMA agreed to lobby for legislation to ban selling tobacco in pharmacies.

 

Health care reform issues are slated to come up later at the meeting, which ends Wednesday.

 

Copyright 2009 Associated Press. All rights reserved.

 

House Committee Approves Sweeping Food-Safety Bill

 

By Jane Zhang

Wall Street Journal

Wednesday, June 17, 2009

 

WASHINGTON -- The House Energy and Commerce Committee approved sweeping food-safety legislation Wednesday aimed at giving the Food and Drug Administration more power while requiring the food industry to do more to prevent contamination.

 

The legislation, which follows a raft of outbreaks linked to tainted spinach, sprouts, peanuts, hot peppers and other foods, would give the FDA authority to order food recalls, impose new civil penalties on violators and require foreign and domestic food companies to follow food-safety standards to prevent food contaminations. The bill also requires that the FDA inspect high-risk food facilities more frequently, at least once a year.

 

The bill would significantly boost the FDA's funding for food-safety activities by requiring food facilities to pay an annual registration fee of $500 per facility. And food companies would be required to keep detailed records so the FDA more quickly trace tainted foods and track the contamination back to the source. The legislation exempted meat, poultry and other farms that are already regulated by the U.S. Department of Agriculture.

 

The committee's unanimous vote followed nearly two weeks of negotiations involving committee Democrats, Republicans and food-industry representatives. The House hasn't scheduled a vote on the legislation. In the Senate, Illinois Democrat Dick Durbin has introduced food-safety legislation, but it's unclear when that legislation will begin moving because the chamber's health committee is preoccupied with legislation to overhaul the health-care system.

 

Copyright 2009 Wall Street Journal.

 

Children Suffer as States Cut Health Budgets

 

By Vanessa Fuhrmans

Wall Street Journal

Wednesday, June 17, 2009

 

As the recession forces more hospitals and doctors to pare costs and services, the cutbacks are hitting one group of patients especially hard: children.

 

The Grabo family of Las Vegas learned this firsthand in December, weeks after a state budget crisis prompted Nevada lawmakers to cut Medicaid payments to health-care providers, some by as much as 40%. Two of the Grabos' four children receive Medicaid benefits to treat their disabilities. But the day before their son Tyler, 10 years old, was scheduled to see his pediatric endocrinologist, the doctor's staff called and said he no longer accepted patients with Medicaid.

 

Elizabeth Grabo says she was able to find just one other local endocrinologist who still saw children covered by the government program for the poor or disabled, but she couldn't get an appointment before March. Without a doctor's supervision, Tyler, who has suffered from muscle and joint problems since birth, had to stop a growth-hormone regimen he had started just a few months before.

 

"It's not the fault of the physicians. They're actually losing money to see these patients," Mrs. Grabo says. "But to know we have no options is the scariest thing."

[Kid Care]

 

The economic slump is hitting many medical centers and practices in a variety of ways. Credit remains tough to come by, revenue is down as some patients forgo care, and the number of uninsured is ticking higher as more people lose their jobs. On top of that, some two dozen states around the country have enacted or proposed steep cuts to Medicaid payments because of severe fiscal crunches.

 

Children's hospitals and pediatricians are among the hardest hit by state cuts. That's because, while children have always made up about half of Medicaid's rolls, their numbers have swelled in recent years to the point that at least 22 million, or one in four, U.S. kids now get their health coverage through Medicaid or a state Children's Health Insurance Program. States often administer CHIP, which is aimed at families with more income than Medicaid participants, as part of their Medicaid programs. Both Medicaid and CHIP are jointly funded by state and federal governments.

 

It's becoming increasingly difficult to find a doctor, particularly a specialist, who takes Medicaid. In a recent survey by the Medical Group Management Association, a trade group, 18% of 1,850 practices polled said they no longer took new Medicaid patients, while an additional 11% said they were likely to stop in response to the recession.

 

More children may have Medicaid cards, but "a lot of them are being turned away at the doctor's," says Edwin Suarez, a Las Vegas physical therapist whose pediatric caseload had been 70% Medicaid patients. But after state cutbacks, Mr. Suarez is having to turn away some children. "Otherwise I just can't meet my overhead," he says.

 

Medicaid cutbacks also affect services for privately insured kids, as children's hospitals cut staff and programs to make up the revenue shortfalls.

 

In Minneapolis, for instance, Children's Hospitals and Clinics of Minnesota depends on Medicaid for 40% of its revenue, compared with 10% on average at most traditional hospitals. Following state budget cuts in recent years, the hospital closed an exercise-therapy program for children with chronic illnesses and school-based health programs, and is weighing other cuts.

 

States also are cutting other programs that affect children. Funding cuts have prompted the operator of Helen DeVos Children's Hospital in Grand Rapids, Mich., to close one of the state's two regional poison-control call centers, a majority of whose cases involve young children. Funding also has been eliminated for California's four state poison call centers.

 

In a recent survey by the National Association of Children's Hospitals, about 20% of the 42 hospitals responding reported they had cut or were considering reducing clinical services because of the downturn. Others, like Seattle Children's Hospital, say they haven't cut programs or jobs outright, but patient wait times have climbed as they have pared employees' hours and not replaced departing staff.

 

State cutbacks come even though Congress in February approved $87 billion in additional Medicaid funds to states as part of the economic stimulus package. Medicaid, with a total budget last year of about $330 billion, swallows about 7% of the federal budget and constitutes one of the biggest chunks of state budgets. Congress also appropriated $33 billion to expand CHIP coverage.

 

Cindy Mann, director of the federal Center for Medicaid and State Operations, said reduced reimbursements "are an area of concern to the extent that they are translating into reduced access to care." She added that part of the recent federal legislation provides for establishing a commission to monitor problems enrollees might have in getting care.

 

States say the new money isn't enough to make up for dwindling tax revenues and the growing ranks of Medicaid participants. Nevada, for instance, whose Medicaid program was already thinly funded, cut hospital reimbursements by 5% and some pediatric specialists' reimbursements by more than 40% last fall. Almost overnight, many specialists in the state closed their doors to new Medicaid patients.

 

Mr. Suarez, the Las Vegas physical therapist, says his Medicaid reimbursement rates were cut by a third. He still takes as new Medicaid patients children with emergencies and newborns with congenital disorders or injuries that occurred during delivery, "since these are the kids with just a small window of opportunity to get better," he says. "But I have to put older kids on a waiting list."

 

Ben Spitalnick, a general pediatrician in Savannah, Ga., where some 60% of the city's children are on Medicaid, says he recently had a young Medicaid patient with a broken arm but couldn't get any local orthopedic specialist to take him. Ultimately, Dr. Spitalnick had to send him to the emergency room, where the boy was referred to a specialist on call. "But that's a couple hours while a patient is in great discomfort and at a much greater cost to the system," Dr. Spitalnick says. "Who does that help?"

 

Some pediatric hospitals that don't rely on Medicaid are hurting, too. The board of Shriners Hospitals for Children, which provides free care, particularly in burn treatment, orthopedics and other pediatric specialties in short supply, will vote in July on whether to close six of its 22 hospitals nationwide. The hospitals operate on returns from their endowment and philanthropy, but plunging financial markets have shrunk the endowment to $5 billion from $8.3 billion just a year ago and stagnating donations haven't made up the shortfall.

 

One hospital in danger is the Shriners in Springfield, Mass., where doctors have treated 8-year-old Gabrielle Zeller's rheumatoid arthritis ever since her joints swelled and she began to have trouble walking as a toddler. Though the Zellers, who live in nearby Suffield, Conn., are privately insured, the pediatric rheumatologist at Shriners was the only one in practice for miles around. Without the hospital, the family will have to travel a couple of hours to Boston for care.

 

"But at least we have insurance," says Gabrielle's mother, Andrea. "What about all of the families that don't?"

 

Write to Vanessa Fuhrmans at vanessa.fuhrmans@wsj.com Printed in The Wall Street Journal, page D1

 

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

 

7 More With Swine Flu Die, Raising the City’s Total to 23

 

By James Barron

New York Times

Wednesday, June 17, 2009

 

New York City officials reported Tuesday that seven more people with the swine flu virus had died, lifting the city’s total to 23.

 

The city’s health department also said that the number of confirmed cases of the virus had climbed to 1,032. The department estimated last week that more than half a million New Yorkers may have become sick from the virus since the outbreak began in late April.

 

In reporting the seven new deaths, the department did not say exactly when the victims died — or when they contracted the virus.

 

But the department announced the deaths in a posting on its Web site that covered the days from last Friday through Monday, a period in which it said 142 people in the city had been hospitalized for swine flu. The department said that in all, 709 people had been admitted to hospitals with the virus.

 

The posting did not identify the seven victims. It provided few other details, except to say that all seven had been between the ages of 25 and 64 and that most of them had been hospitalized late last month, at the height of the outbreak. It also said that 16 had an “established underlying risk factor” for severe influenza or complications.

 

On Tuesday, Nassau County also reported a swine flu death, a woman in her 20s who had given birth 10 days earlier. The county’s health department said Nassau had 74 confirmed cases of swine flu.

 

In New York City, the number of emergency room visits by people complaining of flulike symptoms decreased in June, and by June 9 it was roughly a third of the peak number recorded on May 25.

 

The number of patients admitted with confirmed swine flu was also down, although because of testing delays, the data that the health department posted on Tuesday was almost two weeks old. The department said the statistics were based on information from 50 hospitals in the city.

 

Copyright 2009 The New York Times Company.

 

FDA says Zicam nasal spray can cause loss of smell

 

Associated Press

By Matthew Perrone

Washington Post

Wednesday, June 17, 2009

 

WASHINGTON -- Consumers should stop using Zicam Cold Remedy nasal gel and related products because they can permanently damage the sense of smell, federal health regulators said.

 

The over-the-counter products contain zinc, an ingredient scientists say may damage nerves in the nose needed for smell. The other products affected by the Food and Drug Administration's announcement Tuesday are adult and kid-size Zicam Cold Remedy Nasal Swabs.

 

The FDA says about 130 consumers have reported a loss of smell after using Matrixx Initiatives' Zicam products since 1999. Shares of the Scottsdale, Ariz.-based company plunged to a 52-week low after the FDA announcement, losing more than half their value.

 

"Loss of the sense of smell is potentially life threatening and may be permanent," said Dr. Charles Lee, of FDA's compliance division. "People without the sense of smell may not be able to detect dangerous life situations, such as gas leaks or something burning in the house."

 

Matrixx defended the safety of its products, but said late Tuesday it will withdraw Zicam Cold Remedy Swabs and Zicam Cold Remedy Gel from the market.

 

The FDA said Zicam Cold Remedy was never formally approved because it is part of a small group of remedies that are not required to undergo federal review before launching. Known as homeopathic products, the formulations often contain herbs, minerals and flowers.

 

A warning letter issued to Matrixx on Tuesday asked the company to stop marketing its zinc-based products, but the agency did not issue a formal recall. Instead, regulators said Matrixx would have to submit safety and effectiveness data on the drug.

 

"The next step, if they wish to continue marketing Zicam intranasal zinc products, is for them to come in and seek FDA approval," said Deborah Autor, director of FDA's drug compliance division.

 

The agency is requiring formal approval now because of the product's safety issues, she added.

 

"It won't bring my smell back, but at least I feel like there's some justice that's starting to take place," said David Richardson, of Greensboro, N.C., who lost his sense of smell after taking Zicam for a cold in 2005. He said he hopes the product will be formally banned.

 

Medical records appear to support Richardson's claim that his lost sense of smell was linked to using Zicam.

 

The global market for homeopathic drugs is about $200 million per year, according to the American Association of Homeopathic Pharmacists. The group's members include companies like Nutraceutical International Corp. and Natural Health Supply.

 

Matrixx has settled hundreds of lawsuits connected with Zicam in recent years, but says on its Web site: "No plaintiff has ever won a court case, because there is no known causal link between the use of Zicam Cold Remedy nasal gel and impairment of smell."

 

The company said in a statement Tuesday that the safety of Zicam Cold Remedy is "supported by the cumulative science and has been confirmed by a multidisciplinary panel of scientists." Matrixx said it will comply with the FDA's requirements, but will seek a meeting with the agency to "vigorously defend its scientific data."

 

But government scientists say they are unaware of any data supporting Zicam's labeling, which claims the drug reduces cold symptoms, including "sore throat, stuffy nose, sneezing, coughing and congestion."

 

The products accounted for about 40 percent of Matrixx's $111.6 million in sales last year.

 

Health officials said they have asked Matrixx executives to turn over more than 800 consumer complaints concerning lost smell that the company has on file. A 2007 law began requiring manufacturers to report such problems, but FDA regulators declined to say Tuesday whether the company broke the law.

 

The 130 reports received by the FDA came entirely from physicians and patients, not the manufacturer.

 

Regulators said the relatively small number of complaints accounted for the agency's lengthy investigation.

 

"FDA doesn't take action against drug products without evaluating all of the circumstances surrounding the issues with the product," Lee said.

 

Shares of Matrixx Initiatives Inc. plummeted $13.46, or 70 percent, to $5.78 Tuesday. The company said based on the FDA's recommendation, consumers should discard any unused product or contact Zicam at 1-877-942-2626 orhttp://www.zicam.comto request a refund.

 

-------

AP National Writer Jeff Donn in Boston contributed to this report.

 

© 2009 The Associated Press.

 

E.P.A. to Review Safety of Pet Flea and Tick Products

 

By Nicholas Bakalar

New York Times

Wednesday, June 17, 2009

 

Liquid flea and tick treatments for dogs and cats have been on the market for more than a decade. But following a recent increase in reports of adverse reactions among pets, the Environmental Protection Agency has intensified its scrutiny of the products, warning pet owners that the treatments may have serious, even fatal, side effects.

 

Spot-on flea and tick treatments are applied topically, usually between the animal’s shoulder blades or along the spine. There have been no recalls of the products, and the agency said in May that there is no reason to avoid them.

 

But the E.P.A. is investigating a large number of anecdotal reports involving both cats and dogs who received spot-on treatments and suffered problems like skin irritations, hair loss and tremors, according to agency spokesman Dale Kemery. The initial reports were not verified by veterinarians.

 

The agency now is evaluating all available data on the pesticides, including reports of adverse reactions, the clarity of the directions and label warnings, and the pre-market safety data submitted in support of the products.

 

The E.P.A.’s report on liquid flea and tick treatments is expected by October and will be published on the agency’s Web site, Mr. Kemery said.

 

In the meantime, Mr. Kemery suggested that pet owners read the directions on any veterinary medicine they use. “Don’t use dog products on cats and vice versa,” he added. “If you detect negative reactions, the vet is the first stop.”

 

Most of the spot-on products are intended for dogs only, but there are more than 25 labeled for cats and at least two for use on both cats and ferrets.

 

Cats are particularly sensitive to an insecticide called permethrin, the active ingredient in some spot-on flea and tick treatments. According to a study published online in The Veterinary Journal, cats overdosed with permethrin insecticides can suffer tremors, seizures, excess salivation, vomiting, loss of appetite and death. Steven R. Hansen, a veterinary toxicologist with the ASPCA Animal Poison Control Center, said there have been cases in which a cat has been poisoned by grooming a dog that had been treated with a permethrin pesticide, but such events, he said, are "extremely rare."

 

Not all pet pesticides contain permethrin. Bob Walker, a spokesman for Bayer, which manufactures Advantage and Advantix flea and tick products, said that the company’s dog medicines contain permethrin but its cat medicines do not.

 

The appearance of counterfeit pesticide products for dogs and cats has further complicated the picture. On April 28, the E.P.A. warned distributors and retailers to stop selling counterfeit products with the brand names Advantage and Frontline, and to recall those already sold.

 

It is unclear why reports of adverse reactions have increased in recent years. Natasha Joseph, a spokeswoman for Mariel, the manufacturer of Frontline flea and tick treatments, suggested that the appearance of new products on the market or improved reporting might help explain the increase.

 

“We reported to the E.P.A. that events for Frontline have been consistently low,” she said. “Frontline is not part of the problem.” Frontline products for both dogs and cats contain a broad-spectrum pesticide called fipronil.

 

A list of more than 200 brand names of registered spot-on repellents was updated on May 15 and appears on the E.P.A. Web site (PDF). Consumers may call the National Pesticide Information Center at (800) 858-7378 to report a problem with the products.

 

The agency has also advised veterinarians to report adverse reactions at the center’s Veterinary Pesticide Adverse Effects reporting portal.

 

Ultimately, the E.P.A. analysis may lead to changes in regulations. “It could be that we’ll require changes in labeling or formulaic changes,” Mr. Kemery said. “And it could go as far as canceling a product.”

 

Copyright 2009 The New York Times Company.

 

Opinion

Malpractice and Health Care Reform

 

New York Times Editorial

Wednesday, June 17, 2009

 

Hoping to enlist support for his campaign for health care reform, President Obama told the American Medical Association this week that he would work with doctors to limit their vulnerability to malpractice lawsuits. That was a reasonable offer — provided any malpractice reform is done carefully.

 

The current medical liability system, based heavily on litigation, has a spotty record. It fails to compensate most victims of malpractice because most never file suit. When cases reach the courts, some juries do a decent job of sorting out whether there was negligence or preventable error; others are swayed to grant large damage awards based more on the severity of a patient’s injuries than on clear evidence of negligence.

 

Mr. Obama did not specify which malpractice reforms he favors, but he wisely rejected placing caps on malpractice awards, the preferred solution of Republican tort reformers. Such caps would be unfair to people grievously harmed by physician errors who need substantial compensation to live with their injuries.

 

There is a variety of ideas worth exploring. Some analysts have called for setting up tribunals of neutral experts to hear malpractice claims. Others suggest requiring mediation, or granting doctors presumptive protection in malpractice lawsuits if they have followed recommended clinical practice guidelines, or encouraging doctors to confess error promptly, apologize to patients forthrightly, and offer them fair compensation for their injuries.

 

Whether malpractice reform would save much money is unclear. Malpractice claims do drive up insurance premiums paid by doctors in some high-risk specialties, such as obstetrics and neurosurgery. Those costs are presumably passed on to patients. There is also concern that doctors may overprescribe costly tests and treatments to avoid possible lawsuits. But the evidence is inconclusive, according to the Congressional Budget Office, that doctors engage in enough “defensive medicine” to have a significant impact on costs.

 

The office estimates that caps on damages would ultimately reduce malpractice premiums for medical providers but would have a “relatively small” impact on total health spending, reducing it by less than half a percent. Even that could save billions of dollars a year, which is not trivial. But malpractice claims are probably not a major cost driver.

 

Still, most doctors are convinced that malpractice suits are unfair and burdensome, so it is worth exploring the issue, if only to gain their help in reforming the health care system. Whatever the alternative — tribunals, mediation — patients must retain the right to go to court and seek higher damages than they have been offered. That is the only way to deter negligence by doctors, hospitals and other health care providers.

 

Copyright 2009 The New York Times Company.

 

Reducing Medicare readmissions will keep down costs, help patients

 

By Tiffany M. Lundquist

Baltimore Sun Commentary

Tuesday, June 16, 2009

 

Maryland is a recognized leader among the states when it comes to health care. The excellence of care provided in Maryland institutions brings national prominence and economic strength to the state, and Marylanders have better access to primary care than residents of almost every other state in the nation, according to "America's Health Rankings, 2008."

 

But Maryland also leads the country in the rate of hospital readmissions among Medicare patients. According to a study recently published in the New England Journal of Medicine, 22 percent of Medicare patients in Maryland - more than one in five - are readmitted to the hospital within 30 days of being discharged.

 

Transitions from hospital to home can be complicated and risky, especially for individuals with multiple chronic illnesses. Faced with complex, costly treatments - and often conflicting instructions from different health care providers - people with chronic conditions and their family members often struggle to coordinate care and get appropriate help. This lack of coordination can lead to medical errors, unnecessary tests, avoidable hospital stays, and stress for patients and their families.

 

It also drives up Medicare costs. In 2004, Medicare spent an estimated $17.4 billion on potentially avoidable re-hospitalizations nationwide.

 

Too many people are leaving the hospital with a handful of prescriptions and little else. It's weighing on our health and driving up the cost of health care for all Americans.

 

One way to improve outcomes while reducing costs is to establish a Medicare follow-up care benefit. This benefit would support patients as they transition from the hospital to their own home or another setting, such as a skilled nursing facility or rehabilitation center.

 

Under a follow-up benefit, a team of professionals working with patients and their family members could provide transitional care services including: a comprehensive assessment of the individual's needs (and the primary caregiver's needs); development of a care plan; a visit in the next care setting shortly after hospital discharge; home visits; help with medication management; arranging and coordinating community resources and support services; and accompanying the individual on follow-up physician visits.

 

Multiple clinical studies - including the Guided Care Model pioneered at the Johns Hopkins University - have shown that transitional care services not only reduce readmissions but improve patient outcomes and satisfaction. As Congress debates overdue reform of the nation's health care system, AARP has urged lawmakers to ensure that comprehensive reform includes a Medicare follow-up care benefit.

 

We enthusiastically endorse the Medicare Transitional Care Act, introduced in the House last week by Rep. Earl Blumenauer, Democrat of Oregon, and Rep. Charles Boustany, Republican of Louisiana, which would ensure that Medicare beneficiaries leaving the hospital and their caregivers get the support they need for up to 90 days after being discharged.

 

Transitional care services would be provided through hospitals, home health agencies and primary care practices by nurses or other health professionals. The Transitional Care Act includes provisions to phase in the benefit as well as payment incentives that will help with the issue of increased workload.

 

As representatives of the state with the highest re-admission rate in the country, members of Maryland's congressional delegation should likewise support this legislation with enthusiasm.

 

Keeping people healthy and out of the hospital benefits everyone. We can improve the quality of our health care and at the same time contain rising health care costs with a follow-up care benefit in Medicare. As a common-sense approach to stop avoidable hospital readmissions, ease pressure on caregivers and save money, it's a crucial piece of the health reform puzzle.

 

Tiffany M. Lundquist is acting state director for AARP in Maryland. Her e-mail is tlundquist@aarp.org.

 

Copyright © 2009, The Baltimore Sun.

 

A judgment against health-related bias

 

By Christopher D. Saudek

Baltimore Sun Commentary

Wednesday, June 17, 2009

 

One hundred years ago, Judge Sonia Sotomayor would not have reached her 10th birthday. Now she is nominated to sit on the Supreme Court of the United States, with every expectation that she will influence the court for decades to come. Her life with type 1 diabetes is an under-told story, not only for the medical advances that made it possible but also for what it says about our society's approach to disabilities.

 

Since the discovery of insulin in 1921, diabetes is no longer fatal. It is, instead, an incurable but manageable chronic disease. Judge Sotomayor proves that people with diabetes can now contribute and excel in the workplace.

 

As a child she loved Nancy Drew mysteries, only to be counseled against pursuing a career in law enforcement. Not bad advice at the time, since in the 1950s and far beyond, police forces, fire departments, the military and other major employers would not hire a person with diabetes or keep employees who developed diabetes. Today, employment opportunities for people with diabetes are not so bleak. Last week, the FBI was successfully challenged in federal court for its policy against hiring people who take insulin.

 

To be clear, there is a vast difference between employment policies that consider the individual versus those that categorically exclude people. Individual consideration looks at each person, their strengths and limitations. It recognizes that not everyone, with diabetes or not, is suited to every job, any more than each of us can play in the National Football League, perform surgery, or be a judge. In fact, people with type 1 diabetes have performed successfully in any number of demanding professions, including, incidentally, professional football and surgery.

 

Progress against discrimination based solely on the presence of diabetes has been a long, hard-fought battle. In recent years, lawsuits successfully challenged discrimination not only in the FBI but in factories, trucking, police forces, school systems and the military. The issue is that each person is entitled to individual consideration and reasonable accommodation.

 

This is the whole point of the Americans with Disabilities Act. Ironically, the Supreme Court wrote an opinion in 1999 that limited the definition of a disability, somehow likening the management of diabetes to the correction of nearsightedness with glasses. People with diabetes were, as a result, subject to discrimination by employers, who admitted rejecting them explicitly because of their diabetes - even as courts could declare that they were not disabled and not protected by the Americans with Disabilities Act. Last year this injustice was corrected with passage of the Americans with Disabilities Act Amendments Act.

 

Many other disability rights issues are working their way through our courts. There is no predicting, of course, how a Justice Sotomayor would rule on issues that are not yet before the court, but at least we know that she would have a life with diabetes to inform her decisions.

 

Much is being written about Judge Sotomayor's legal prowess, her ethnicity and her gender, but the other story is at least as big. It is the story of medical progress that allows people with diabetes to lead full, healthy lives. It is the story of how some 24 million Americans with diabetes, more than 2 million with type 1 diabetes, are increasingly contributing in the mainstream of American life. And it is the story of the ongoing effort to snuff out the remnants of discrimination against people with chronic diseases like diabetes.

 

Dr. Christopher D. Saudek is a professor of medicine at the Johns Hopkins University School of Medicine and director of the Johns Hopkins Diabetes Center. His e-mail is csaudek@jhu.edu.

 

Copyright © 2009, The Baltimore Sun.

 

Dangerous times

In economic downturn, the risk of domestic violence grows while services shrink

 

By Jacquelyn Campbell

Baltimore Sun Commentary

Thursday, June 14, 2009

 

As a researcher of domestic abuse against women in the U.S. and globally, I wasn't surprised when a survey last week linked the economic downturn to an upswing in domestic violence. I've seen time and again the brutal connection between financial stress and violence against women. Financial stress does not cause domestic violence, but can make a bad situation worse. And the new report highlights the ongoing, and largely ignored, problem of domestic abuse, a major public health problem for women everywhere.

 

Each year, U.S. women are the victims of 4.8 million physical assaults and rapes by intimate partners. In Maryland, one person every five days dies of domestic abuse, according to the Maryland Network Against Domestic Violence. And even as the recession exacerbates the problem, it simultaneously threatens the financial viability of critical services for women escaping violence, such as the House of Ruth Maryland ( www.hruth.org).

 

I've devoted my career to the prevention of violence against women. Formerly a school and community health nurse, who was a witness to a high incidence of abuse among women of all ages, I chose to study this issue during graduate school.

 

I discovered that homicide was the leading cause of death for young African-American women and the seventh leading cause of premature death for U.S. women overall. I found that the killer generally was not a stranger, but rather an intimate partner.

 

According to the World Health Organization, at least one third of women worldwide have been beaten, coerced into sex or otherwise abused in their lifetimes, and most of the time the women know their abusers. The rate approaches 70 percent in some countries.

 

But domestic abuse, both in the United States and abroad, is too often hidden, ignored and wrapped in needless shame and guilt. Friends, neighbors and even family members don't want to get involved. Even the police may be reluctant to intervene in a domestic fight.

 

A health care provider can make the difference between life and death for an abused woman, provided they recognize the abuse. But too often health care providers are not taught to identify the signs of domestic abuse, like a history of broken bones or string of suspicious accidents or being depressed.

 

Doctors and nurses are a solution, already in place, to reducing homicide rates from violence against women, but they don't always have the training they need to accurately identify signs of abuse. I have used my research to help health care workers quickly and accurately identify abused women at high risk by developing the "Danger Assessment," a brief tool to help women accurately assess their risk of being killed or seriously abused by a partner. This is being used in several countries around the world, as well as by some local health care professionals and the House of Ruth.

 

As we look for the solution to this deadly problem here in the U.S., let's use some of the lessons we've learned globally about this epidemic.

 

In South Africa, women are getting advice about partner violence prevention with measurable success. In New Zealand, both Maori women and Pakiha (white) women are being assessed for partner violence during prenatal visits and then given the interventions they need in order to stay safe. We should support those programs internationally through the U.N. and the World Bank and then put them in place here in the United States so that more women can lead lives that are both physically safe and financially secure.

 

Women are dying from domestic homicide at alarming rates, whether in Botswana or Baltimore. We can prevent this. Investing in U.S. global health research affords us the opportunity to do just that and save the lives of women everywhere. It is the right thing to do, the smart thing to do - and as economic stress affects more and more families, the absolutely necessary thing to do.

 

Jacquelyn Campbell is the Anna D. Wolf chair and a professor at the Johns Hopkins University School of Nursing, with a joint appointment in the Bloomberg School of Public Health. She is a Paul G. Rogers Society for Global Health Research Ambassador. Her e-mail is jcampbel@son.jhmi.edu.

 

Copyright © 2009, The Baltimore Sun.

 

When the Other Guy Doesn't Wash His Hands

 

Washington Post Letter to the Editor

Wednesday, June 17, 2009

 

Regarding the June 9 Health article "Coming Clean About Risk of Finger Food":

 

This article brings up some good points about matters of hygiene that we can all do something about. But a problem exists at many restaurant and public restrooms that one has no control over: hot-air hand dryers.

 

While I applaud the effort to find an environmentally friendly approach to hygiene, not having disposable paper towels as an option puts those of us who wash their hands at risk from those who do not when we must use a door handle to exit a restroom.

 

To safeguard against people who don't wash after using the facilities, I clean my hands, then use the paper towel I dried them with to grab the door handle upon exiting. I then dispose of the towel at my first opportunity. As there are plenty of patrons who don't wash before touching the door handle, if an air dryer is your only option, you're trapped -- with no choice but to grab the handle with your clean hands.

 

I'm no germaphobe. But I don't enjoy touching surfaces that have been touched by another bathroom patron who didn't have the decency to wash his hands. Perhaps establishments should give some thought to this problem and provide either towels or both options in their restrooms. Or place a hand sanitizer dispenser immediately outside of the door.

 

CRAIG BOZMAN

Vienna

 

Copyright 2009 Washington Post.

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