Thursday, June 18, 2009

News Clipping Archives

 

Maryland / Regional

Md. health officials probe flu outbreak at city juvenile center (Baltimore Sun)

$788,000 Paid to Doctor Accused of Faking Study (New York Times)

9,200 uncounted vials found at Army biodefense lab (Daily Record)

Police probe infant's death at Citicorp daycare (USA Today)

Lt. gov. makes his case for new domestic violence legislation (The Gazette)

 

National / International

Health-Care Cuts Could Shift Costs (Washington Post)

Health workers didn't take swine flu precautions (Washington Post)

Whiff of homeopathic gel Zicam forever changes patient's trust in alternative Treatments (Baltimore Sun)

EPA to Pay Medical Bills for People Sickened by Asbestos From Montana Mine (Washington Post)

Bill Boosting FDA Oversight Of Food Wins Panel Approval (Wall Street Journal)

Kidney Stones Common After Weight Loss Surgery (New York Times)

 

Opinion

Teenagers and Pregnancy (New York Times Editorial)

Burned by a Tobacco Bill (Washington Post Commentary)

 

 

Maryland / Regional

Md. health officials probe flu outbreak at city juvenile center

There have been more than 250 confirmed cases of swine flu in Md., spokesman says

 

By Jacques Kelly

Baltimore Sun

Thursday, June 18, 2009

 

State health officials reported a flu outbreak at the Baltimore City Juvenile Justice Center in Baltimore on Wednesday evening and are conducting tests to determine if six youths have swine flu.

 

"We have six confirmed cases of flu — confirmed by rapid testing," said David Paulson, spokesman for state's Department of Health and Mental Hygiene. "We do not know if it is seasonal flu or the H1N1 (swine flu) variety."

 

He said results of further testing would be known by Thursday.

 

Tammy Brown, spokeswoman for the center, said that none of the youths — whose ages range from 14 to 18 — had been hospitalized.

 

"We are taking precautions and limiting visitors," she said.

 

Paulson said that as of Wednesday, Maryland had more than 250 confirmed cases of swine flu.

 

Copyright © 2009, The Baltimore Sun.

 

$788,000 Paid to Doctor Accused of Faking Study

 

By Barry Meier

New York Times

Thursday, June 18, 2009

 

Medtronic said on Wednesday that it had paid nearly $800,000 over an eight-year period to a former military surgeon who has been accused by the Army of falsifying a medical journal study involving one of the company’s products.

 

The surgeon, Dr. Timothy R. Kuklo, claimed in the study that the use of a Medtronic bone growth product called Infuse had proved highly beneficial in treating leg injuries suffered by American soldiers in Iraq.

 

The British medical journal that published the article retracted it this year after an internal Army investigation found that Dr. Kuklo had forged the names of four other doctors on the study and had cited data that did not match military records.

 

Other doctors at Walter Reed Army Medical Center, where Dr. Kuklo worked until August 2006, said that he had also overstated the benefits of the Medtronic product.

 

Dr. Kuklo, who now works as an assistant medical professor at Washington University in St. Louis, has repeatedly declined to comment on the situation.

 

Medtronic has said it was not involved in any way with the challenged report.

 

The company is under investigation by the Justice Department and Senator Charles E. Grassley, Republican of Iowa, in connection with possibly illegally marketing of Infuse through outside physicians like Dr. Kuklo who work for it as consultants. The company has denied doing so. Last month, it suspended Dr. Kuklo’s consulting contract.

 

In the last few weeks, Medtronic, which initially declined to say what it had paid Dr. Kuklo or even when it had hired him, has been under growing pressure from Senator Grassley to disclose its financial ties to Dr. Kuklo.

 

In information released on Wednesday, Medtronic said that it made about $788,280 in direct payments to Dr. Kuklo between 2001 and 2009.

 

It described those funds as either reimbursement for travel expenses, or payments for speaking or training other doctors on Medtronic’s behalf, or for consulting. The company said that those consulting services included working on the design of new or existing orthopedic products and surgical instruments.

 

The company also said that from 2001 to 2007, it made about $64,000 in indirect payments to Dr. Kuklo in connection with attendance at medical meetings and other events.

 

It is legal for military doctors to receive payments from medical products companies, but they are supposed to seek permission from officials. Army officials have said they have not found records to indicate that Dr. Kuklo sought or received such clearance.

 

Copyright 2009 The New York Times Company.

 

9,200 uncounted vials found at Army biodefense lab

 

Associated Press

Daily Record

Thursday, June 18, 2009

 

HAGERSTOWN — An inventory of deadly germs and toxins at an Army biodefense lab in Frederick found more than 9,200 vials of material that was unaccounted for in laboratory records, Fort Detrick officials said Wednesday.

 

The 13 percent overage mainly reflects stocks left behind in freezers by researchers who retired or left Fort Detrick since the biological warfare defense program was established there in 1943, said Col. Mark Kortepeter, deputy commander of the U.S. Army Medical Research Institute of Infectious Diseases.

 

He said the found material included Korean War-era serum samples from patients with Korean hemorrhagic fever, a disease still of interest to researchers pursuing a vaccine. Other vials contained viruses and microbes responsible for Ebola, plague, anthrax, botulism and a host of other ailments, Kortepeter said in a teleconference with reporters.

 

"What happens over time, these get moved from one freezer to another, historically. Now we have much better tracking of where they are," Kortepeter said.

 

About half of the found material has been destroyed, Kortepeter said. Samples deemed potentially useful were saved and entered into a laboratory database, he said.

 

The material was in tiny, 1mm vials that could easily be overlooked in the 25-cubic-foot freezers or even covered by clumps of minus-80-degree ice, said Sam Edwin, the institute's inventory control officer.

 

Kortepeter said the inventory found nothing missing from about 70,000 items the institute began cataloging in 2005. He said Army criminal investigators have concluded that three vials of Venezuelan equine encephalitis that were discovered missing last year "were likely used up but for some reason were never recorded with the database."

 

The separate search of the institute's 335 freezers and refrigerators began Feb. 4 and ended May 27. Kortepeter said it was prompted by the discovery during a spot check in January of 20 samples of Venezuelan equine encephalitis in a box listed as containing 16.

 

He said the review was ordered by the institute's commander, not by higher officials.

 

However, the spot check that led to the inventory was part of a tightened security program the Army implemented at all five of its biological and chemical research centers in December in response to an FBI finding that a Fort Detrick scientist was responsible for deadly 2001 anthrax attacks, said Michael Brady, special assistant to Army Secretary Pete Geren.

 

Brady said the other labs found no discrepancies, so they did not need inventory reviews.

 

The new security measures also include an annual check to ensure that all material in the database is accounted for, Brady said.

 

"This is not going to be a once-in-a-while thing," he said. "This is going to be a regular, aggressive inventory accountability program to make sure we don't have the problems we've seen in the past."

 

After Fort Detrick anthrax researcher Bruce E. Ivins killed himself in July, the FBI announced that he alone was responsible for the anthrax mailings that killed five people and sickened 17 others in 2001. Ivins committed suicide after learning he would be charged in the attacks. His attorney maintains he was innocent.

 

Copyright 2009 Daily Record.

 

Police probe infant's death at Citicorp daycare

 

Associated Press

USA Today

Thursday, June 18, 2009

 

HAGERSTOWN, Md. (AP) — Police say an autopsy is planned for a 5-month-old boy who died at the Citicorp daycare center near Hagerstown.

 

Washington County Sheriff's Maj. Sam Billotti told The (Hagerstown) Herald-Mail Thursday that autopsies are routinely conducted when someone dies while not under a doctor's care.

 

Citicorp said in a statement that it is working with daycare contractor Bright Horizons to understand what happened to the boy at the company's credit services complex.

 

Police say ambulance workers found the child in cardiac arrest when they responded around 3 p.m. Wednesday to a 911 call that the infant wasn't breathing.

 

Police say attempts to resuscitate the child in the ambulance and at Washington County Hospital failed.

 

Copyright 2009 The Associated Press. All rights reserved.

 

Lt. gov. makes his case for new domestic violence legislation

Brown says deputies can handle guns confiscated under laws

 

By Greg Holzheimer

The Gazette

Thursday, June 18, 2009

 

Maryland's lieutenant governor touted new laws aimed at keeping guns out of the hands of domestic abusers and praised the Prince George's County Sheriff's Office for its efforts against domestic violence at a June 11 morning tour of the sheriff's office in Upper Marlboro.

 

Lt. Gov. Anthony G. Brown (D) said he came to Prince George's largely because of its high population of African Americans. Homicides related to domestic violence are the leading cause of unnatural deaths for black women between the ages of 15 and 45, he said.

 

"Today's a significant day for not only protecting African-American women who are victims of domestic violence but all women who are victims of domestic violence," he said.

 

The two laws, both of which were signed by Gov. Martin O'Malley (D) on May 19, give judges the option of confiscating guns when they issue temporary protective orders against people suspected of domestic violence and require judges to confiscate guns when they issue final protective orders. Both laws will go into effect Oct. 1.

 

According to Brown's office, more than half of the 75 Maryland residents and 11 county residents who were killed in 2008 as a result of domestic violence were shot to death.

 

The sheriff's department has taken the lead in domestic violence cases in Capitol Heights, Suitland, Seat Pleasant and surrounding areas since 2006, when Jackson launched the Domestic Violence Unit, a 65-member group that includes sheriff's deputies, counselors and court advocates who focus on domestic violence cases. Those advocates worked with 2,820 domestic violence victims in 2008, said Norma Harley, who manages the unit's victim assistance coordinators.

 

But sheriff's deputies are confiscating fewer weapons from people suspected of domestic violence, taking in 50 percent fewer guns in 2008 than they did in 2007, according to Lt. Col. Robert Kiker, commander of field operations for the department. Jackson said the laws will give judges the authority to confiscate firearms from people who do not have them out in the open when sheriff's deputies arrive.

 

"Prince George's County and the rest of the state of Maryland is committed to eradicating domestic violence," Jackson said. "We are no longer going to remain silent."

 

Elissa Levine, the program manager for counseling and outreach for House of Ruth, a nonprofit that works with abuse victims, said she is worried the sheriff's department does not have the resources to handle cases in the rest of the county.

 

"They're very collaborative with people in the community," said Levine, who said she supports the new laws. "They're also strapped for funding … I would like them to spread out to other parts of the county."

 

Cpt. Thomas Lay, the commander of the domestic violence unit, said the sheriff's office focuses on Suitland, Capitol Heights and Seat Pleasant but is also active in other areas. He said he hopes his group will eventually handle domestic violence cases across the county.

 

There have been about 10,000 reports of domestic violence in the county since the beginning of the year, according to Vernon Herron, the county's director of homeland security. Sheriff's deputies responded to 2,000 of those calls, and 435 of them required emergency medical services, he said.

 

Copyright 2009 The Gazette.

 

National / International

Health-Care Cuts Could Shift Costs

Private Sector May Face Greater Burden, Economists Say

 

By David S. Hilzenrath

Washington Post

Thursday, June 18, 2009

 

President Obama's plan to rein in federal spending on health care could end up shifting costs to the private sector, economists say.

 

Unless doctors and hospitals are able to respond to the government cuts by becoming more efficient, the result could be higher costs for insurers, employers, and people with private medical coverage, they say.

 

Historically, health-care spending has been a bit like a balloon: If it is squeezed in one place, it tends to bulge in another.

 

"I think there's definitely risk that a portion of the reduction in hospital payments from Medicare will wind up as increased payments by private insurers," said Paul B. Ginsburg, president of the Center for Studying Health System Change.

 

Depending on the circumstances, hospitals may have the motive and means to "transfer those charges to somebody else," and "we'll see costs increasing on the private side and not necessarily falling everywhere," said Harold S. Luft, director of the Palo Alto Medical Foundation Research Institute.

 

The biggest health-care proposal that Obama announced last weekend is especially likely to move costs to the private sector, because it would cut Medicare payments without giving hospitals the tools to deliver care more cost-effectively, Luft said. The administration predicts that measure -- adjusting Medicare payments to reflect productivity changes in the overall economy -- would save the government $110 billion over 10 years.

 

Squeezing from the government's end could make health care more efficient for everybody. "If you push on one side, you're actually pushing on the whole thing," said Kenneth Baer, a spokesman for the Office of Management and Budget.

 

But a report issued Tuesday by the Congressional Budget Office portrayed that outcome as speculative. There is no guarantee that the health-care system's response to pressure would be greater quality or efficiency, according to the CBO analysis.

 

Throwing cold water on hopes for effective health-care reform, the CBO described a variety of problems that could make it hard to slow federal spending on care -- and to do so without putting quality at risk.

 

"At this point, experts do not know exactly how to structure such reforms so as to reduce federal spending on health care significantly in the long run without harming people's health," the CBO said.

 

"Examples of efficient care certainly exist today. . . . Yet applying the methods of those efficient providers throughout the health-care system cannot be accomplished through fiat or good intentions," it added.

 

The challenge is that the administration and Congress are trying to extend medical coverage to the uninsured without increasing the federal budget deficit over the next decade. As a result, they are bound by the budgetary scoring process -- meaning they must come up with solutions that can predictably and measurably reduce federal outlays.

 

Some steps that might prove cost-effective over the long run do not necessarily mean savings for the federal budget.

 

Conversely, some steps that save the government money would not necessarily translate into overall reductions in national health-care spending.

 

If Medicare cuts payments to hospitals but the costs of treating patients stay the same, "then you have the potential for cost-shifting," said Kenneth E. Thorpe, a professor of health policy at Emory University. But Obama is trying to implement policies "that would lead to hospitals reducing their expenditures," he said.

 

One of the president's signature proposals would reward hospitals for reducing readmission rates and penalize hospitals whose patients must return for another stay because they did not receive adequate treatment the first time. That proposal is unlikely to create a bulge in private medical costs, because it would lead hospitals to change the way they function, Thorpe said. The administration is counting on improved readmission rates to save the government $25 billion over 10 years.

 

Not all hospitals would have the ability to foist additional costs onto the private sector. Those most likely to make up elsewhere for cuts in government payments are major hospitals that are essential to local health networks and therefore able to wield more market clout, Ginsburg said.

 

The consolidation of hospitals in many communities limits private insurers' ability to push back.

 

Cutting payments by Medicare, the federal program for the elderly, is a relatively blunt instrument of reform.

 

"Imposing slower growth in [Medicare] payments would create ongoing pressure on providers to identify and adopt efficiencies; it would also, however, create risks for providers and patients if the efficiency gains were not achieved," the CBO said.

 

Part of the problem is what the CBO described as the difficulty in measuring the quality of care. If quality cannot be gauged, it is hard to reward doctors and hospitals for delivering it -- and it is hard to penalize them for not doing so.

 

Various popular ideas about how to save money have limitations and downsides, the CBO reported.

 

Increasing access to preventive care, for example, is widely considered a powerful way to reduce spending, but "one study of health and economic effects of preventive services found that only 20 percent of the services that were assessed yielded net financial savings," it said. In some instances, the cost of delivering preventive care to a large population would actually exceed the savings on the relatively few people who avoided illness as a result, CBO said.

 

Similarly, improving public health can reduce Medicare spending on particular problems. However, helping people live longer and healthier lives can increase the burden they put on the federal government, partly because they will spend more time collecting Medicare and Social Security benefits, the CBO reported.

 

Copyright 2009 Washington Post.

 

Health workers didn't take swine flu precautions

 

Associated Press

By Mike Stobbe

Washington Post

Thursday, June 18, 2009

 

ATLANTA -- The first study of U.S. health care workers with swine flu found many didn't do enough to protect themselves against the virus.

 

Researchers focused on 13 nurses and other health care workers who were likely infected at work. Only half always wore gloves. Even fewer routinely wore other protection around patients who might have the virus.

 

Early in the pandemic, the Centers for Disease Control and Prevention said health care workers should wear gloves, gowns, eye protection and respirator masks when dealing with patients suspected of having swine flu. The CDC also advised sick workers to stay home.

 

© 2009 The Associated Press.

 

Whiff of homeopathic gel Zicam forever changes patient's trust in alternative treatments

 

Associated Press

By Jeff Donn

Baltimore Sun

Thursday, June 17, 2009

 

He was like millions of other consumers who sometimes take vitamins or echinacea, hoping to build up his immunity or ward off a cold. He figured alternative remedies were as safe as a spoonful of honey.

 

But that notion washed away with one squirt of a homeopathic cold gel.

 

David Richardson, of Greensboro, N.C., is one of hundreds of patients across the country who have lodged complaints about Zicam Cold Remedy, saying it destroyed their sense of smell.

 

"It's like watching a sunset in black and white. The things that you take for granted, not only smelling fresh-cut grass or bread in the oven ... you miss those parts of your life," he says. "There's not a day that goes by that you're not reminded of it."

 

The U.S. Food and Drug Administration says that people who can't smell may also miss danger signs in their daily lives like smoke or gas. It moved to force three Zicam products — Zicam Cold Remedy Nasal Gel, Nasal Swabs and discontinued Swabs in Kids' Size — off the market Tuesday and told consumers not to take them anymore.

 

Zicam belongs to an under-the-radar but legal sector of the drug industry called homeopathic remedies. They hold a unique legal status: They are mainly sold without prescription as legal drugs claiming to treat specific ailments, yet they are not routinely reviewed for safety or benefit by the FDA. The agency rarely acts unless safety questions arise after marketing.

 

Most scientists say homeopathic remedies contain active ingredients in such low concentrations — often 1 part per million or less — that they are usually safe.

 

But FDA spokesman Sandy Walsh says that "consumers purchasing homeopathic products should be aware that they have not been reviewed by the FDA."

 

Zicam's maker, Matrixx Initiatives, of Scottsdale, Ariz., contends Zicam is safe. It blames the apparent side effects on the colds and infections that people were treating, not on the treatment. However, the company agreed to suspend shipments and reimburse customers who want refunds.

 

It already agreed to settle about 340 Zicam claims for $12 million in 2006. It was still dealing with 17 lawsuits earlier this year, as well as more than 500 more patients who may sue in the future, according to its filings to the U.S. Securities and Exchange Commission.

 

Richardson, 46, says he used Zicam just once. His mother, a retired nurse, offered him some for his stuffy nose. He had just started a new job as a salesman and wanted to work at his best.

 

So he held the nasal gel to his nose, pumped and inhaled. He immediately felt a burning sensation but acknowledges that his sense of smell was already diminished by the cold. It was only when health returned — but not sense of smell — that he began to worry.

 

He went to the doctor and had an MRI, but nobody could figure out what was wrong. It was only when he did an Internet search for Zicam and saw all the lawsuits that he began to feel suspicious. One doctor has now tested his sense of smell and tentatively linked the problem to Zicam.

 

With months of medical care, Richardson says he has regained about 20 percent of his sense of smell.

 

He has complained to the FDA and engaged a personal injury lawyer but hasn't yet sued. "It finally feels good to feel like we're being heard," he said of the FDA's action.

 

Copyright 2009 Associated Press. All rights reserved.

 

EPA to Pay Medical Bills for People Sickened by Asbestos From Montana Mine

 

By David A. Fahrenthold

Washington Post

Thursday, June 18, 2009

 

The Environmental Protection Agency yesterday declared its first-ever "public health emergency," saying the federal government will funnel $6 million to provide medical care for people sickened by asbestos from a mine in northwest Montana.

 

The declaration applies to the towns of Libby and Troy, where for decades workers dug for vermiculite, a mineral used in insulation. They were unknowingly poisoning themselves: The vermiculite was contaminated with a toxic form of asbestos, which workers carried home on their clothes.

 

The Department of Health and Human Services estimates that there are 500 people with asbestos-related illnesses such as lung cancer and asbestosis in the two towns, whose populations total about 3,900.

 

A spokeswoman for the department said 50 new cases are diagnosed every year, including some in workers' relatives and children who never set foot in a mine.

 

Yesterday, the department announced that it will grant $6 million to the health authority in Lincoln County, Mont., where the towns are located. That money is intended to pay for residents' health care, officials said; it will pay what insurance won't, and cover the full medical tabs for those without insurance.

 

"For way too long, many here in Washington have turned a blind eye to the needs of the residents in Libby," said Health and Human Services Secretary Kathleen Sebelius. "Those days are over."

 

The EPA has had the power to declare a public health emergency since 1980. But agency officials said the law includes no specific criteria about what constitutes an emergency. Its main legal importance was to give the EPA power to remove materials such as insulation from buildings, they said.

 

The announcement comes about six weeks after a Montana jury acquitted chemical company W.R. Grace and three of its executives on charges that they withheld information about the mine's dangers. W.R. Grace ran the mine from 1963 until it closed in 1990. Vermiculite had been extracted from the site since the early 20th century, according to the EPA.

 

At yesterday's announcement, Sen. Max Baucus (D-Mont.) told the story of a longtime mine worker from the region who died of asbestos-related problems and carried home asbestos-laden dust that sickened his wife and two children. Last fall, Baucus slammed the Bush administration for not declaring a public health emergency in the region earlier.

 

"I don't think anybody escaped from the exposure," Montana's other senator, Jon Tester (D), said in an interview. "Nearly every family, if not every family, that was exposed to it has some health issues."

 

The Department of Health and Human Services has spent $46 million in the area in the past 10 years funding diagnostic screening programs and paying to improve local health care. An agency spokeswoman said the new $6 million is intended to be funneled directly to patients.

 

"If something's not covered, there's a place you can go where it can be," said department spokeswoman Jenny Backus. She said it is not clear what funding would be given to the program after this year.

 

Copyright 2009 Washington Post.

 

Bill Boosting FDA Oversight Of Food Wins Panel Approval

 

By Jane Zhang

Wall Street Journal

Thursday, June 18, 2009

 

WASHINGTON -- The House Energy and Commerce Committee on Wednesday approved legislation that would give the Food and Drug Administration significantly more funding and power to police food safety.

 

The bill comes in response to deadly outbreaks of illnesses traced to tainted spinach, peanuts, hot peppers and other foods. It is designed to plug holes in the regulation of most food items other than meat.

 

The FDA has been under fire for its inability to prevent food-poisoning cases, quickly trace them to their source or find the causes.

 

The legislation would give the FDA authority to order food recalls, impose new civil penalties and require companies to follow food-safety standards. It also would require the agency to inspect so-called high-risk food facilities at least once a year and make companies keep detailed records to help the FDA more quickly trace the distribution of tainted foods and track the course of the contamination.

 

To help fund the work, the bill would require some 378,000 food facilities, including 223,000 overseas, to pay an annual registration fee of $500. The legislation exempts farms that raise meat and poultry and other facilities regulated by the U.S. Department of Agriculture.

 

The unanimous voice vote for a version of the bill offered by committee Chairman Henry Waxman (D., Calif.) followed more than a week of negotiations between Democrats and Republicans.

 

In recent months, industry groups met with all members of the committee and enlisted farmers and producers to call and visit with the lawmakers. Consumer advocates flew in families of food-poisoning victims and bombarded congressional offices with faxes, emails and phone calls.

 

The Grocery Manufacturers Association said it was largely pleased with the bill after Democrats agreed to a number of changes. They halved the registration fee to $500 and added a cap so no company would be charged more than $175,000. The legislation would give companies flexibility in developing anti-contamination programs in lieu of strictly following FDA directives.

 

Consumer groups say they are pleased the bill would require more frequent FDA inspections -- every six to 12 months in the case of high-risk facilities. There is currently no set schedule. But Donna Rosenbaum, executive director of Safe Tables Our Priority, said the public-health group will continue lobbying to require companies to report positive lab tests for pathogens and for more precise language, including a definition of high-risk facilities.

 

Several groups representing pork, beef, poultry and other agricultural interests claimed victory. They enlisted lawmakers on the House Agriculture Committee to help make the case that they should be exempt from FDA food-safety rules since they are already regulated by the USDA.

 

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 it will begin considered.

 

Printed in The Wall Street Journal, page A4

 

Copyright 2009 Wall Street Journal.

 

Kidney Stones Common After Weight Loss Surgery

 

By Roni Caryn Rabin

New York Times

Thursday, June 18, 2009

 

Patients who underwent a popular form of weight loss surgery developed kidney stones, a painful and recurring condition, at almost double the rate of obese patients who didn’t have the operation, according to one of the largest studies to examine the rate of complications from bariatric surgery.

 

Almost 8 percent of obese patients who underwent the gastric bypass procedure known as Roux-en-Y (pronounced ROO-on-why) had kidney stones within two years of the operation. In comparison, kidney stones developed in just under 5 percent of similar patients who did not undergo surgery, according to the study, published in the June issue of The Journal of Urology.

 

But the authors of the study cautioned that the findings should not be considered “an indictment” of the Roux-en-Y procedure, because the long-term health benefits for obese patients are significant. Weight-loss surgery can reduce their risk for heart disease, diabetes and other life-threatening diseases.

 

“The takeaway message is not that bariatric surgery is a bad thing because patients are twice as likely to get a kidney stone, but to recognize they’re at increased risk and give them appropriate counseling,” said Dr. Brian R. Matlaga, an assistant professor of urology at Johns Hopkins University School of Medicine and first author of the study. “You’re saving a patient from all the things we know are associated with obesity: diabetes, high blood pressure, heart disease, sleep apnea, pregnancy complications.”

 

Dr. Matlaga and his colleagues used a health insurance database to identify 4,639 patients who underwent Roux-en-Y surgery between 2002 and 2006, and compared them with a similar group of obese patients who did not undergo the surgery. They used claims data to see which patients were diagnosed with or treated for kidney stones.

 

Some 7.65 percent of the surgery patients were diagnosed with kidney stones, compared with 4.63 percent of the comparison group. The researchers calculated that surgery increased the risk of developing the painful, chronic condition by 71 percent.

 

Kidney stones were one of the well known complications of an earlier type of gastric bypass surgery, the Jejunoileal bypass procedure, which was associated with so many health problems that it has been abandoned.

 

Most people who suffer from kidney stones have recurring problems that send them to the emergency room doubled over in pain. To reduce the risk, Dr. Matlaga suggested patients drink at least six to eight glasses of fluids a day, cut down on salt and animal protein and reduce consumption of foods like black tea, nuts, okra and some leafy vegetables that are high in oxalates, which can form into kidney stones. They should not reduce their calcium intake, since calcium binds with oxalate and flushes it from the body, he said.

 

Copyright 2009 The New York Times Company.

 

Opinion

Teenagers and Pregnancy

 

New York Times Editorial

Thursday, June 18, 2009

 

Between 1991 and 2003, increased contraceptive use among sexually active teenagers played an important role in driving down teenage pregnancy rates. Since then, according to a new report from Columbia University’s Mailman School of Public Health, contraceptive use by teens has declined while their sexual activity has remained unchanged. This is a worrisome shift — and it has bearing on the coming budget battle in Congress.

 

The report’s authors, Dr. John Santelli, Mark Orr, Laura Lindberg and Daniela Diaz, said they found a decrease of about 10 percent in contraception use that is consistent with recent gains in the teenage birth rate.

 

They suggest, not unreasonably, a link between the shift in use of contraception and one of former President George W. Bush’s great social-policy follies: highly restrictive abstinence-only sex education programs that deny young people information about sexually transmitted diseases, contraceptives and pregnancy. To the extent these programs even mention condoms, typically it is to disparage their effectiveness.

 

Responding to mounting evidence of the program’s danger as a public health strategy, many states now decline to participate, forgoing federal money.

 

To President Obama’s credit, his budget plan would direct current funds now devoted to the abstinence-only programs, along with some additional money, to a new teenage pregnancy prevention initiative, with an emphasis on comprehensive sex education.

 

This science-based effort to protect the health of young people and reduce the number of unwanted pregnancies should win support from lawmakers on both sides of the aisle — and both sides of the abortion divide.

 

Copyright 2009 The New York Times Company.

 

Burned by a Tobacco Bill

 

By George F. Will

Washington Post Commentary

Thursday, June 18, 2009

 

Politicians have extraordinary shoulder joints that enable them to pat themselves on the back, and last week the president, a master of that calisthenic, performed it in the Rose Garden. His subject -- aside from himself, as usual -- was the bill by which Congress authorized the Food and Drug Administration to regulate tobacco. The president called this "a bill that truly defines change in Washington" and "changes the way Washington works and who Washington works for."

 

Our leaders are often wrong but rarely so precisely wrong. In two important particulars, the bill is a crystalline example of Washington business as usual -- the protection of the strong. The bill was supported by America's biggest tobacco company and by the Democratic Party's fountain of funds, the trial bar.

 

Congress could ban cigarettes; therefore it could ban tobacco advertising. Instead, tobacco advertising and promotions will be even more severely curtailed. These restrictions merit a constitutional challenge. Although commercial speech does not receive full First Amendment protection, Congress should not be allowed to effectively prohibit truthful communication about a legal product. Philip Morris, however, can live -- indeed, can flourish -- with the new restrictions on the marketing measures by which less powerful companies might threaten its dominance. And lest courts conclude that companies cannot be sued for behavior (selling cigarettes) governed, hence authorized, by a regulatory body, the bill stipulates that it shall not be construed to limit "the liability of any person under the product liability law of any state."

 

Government policy regarding tobacco, as regarding so much else, is contradictory and unlovely. Nevertheless, it has been, on balance, a success: Americans are behaving much more sensibly.

 

Before the surgeon general declared tobacco addictive (1988) and carcinogenic (1964), before a character in a 1906 O. Henry story asked, "Say, sport, have you got a coffin nail on you?" people intuitively understood that inhaling smoke is unhealthy. Smoking is addictive (although there are about as many ex-smokers as smokers), sickening, often fatal and usually childish: Ninety percent of all smokers start by age 18; few start after 21. But death and intelligence cost the companies 6,000 customers a day, so that many new smokers must be made daily just to keep up.

 

Ironies abound. The February expansion of the State Children's Health Insurance Program is supposed to be financed by increased tobacco taxes, so this health care depends on an ample and renewable supply of smokers. State governments, increasingly addicted to tobacco tax revenue, face delicate price calculations: They want to raise their regressive tobacco taxes (smokers are disproportionately low income and poorly educated) to just below where smokers are driven to quit.

 

Governments cannot loot tobacco companies that do not flourish. In a 1998 settlement, 46 states conspired to seize $206 billion from companies selling legal tobacco products made from a commodity subsidized by the governments that subsidize treatment of tobacco-related illnesses. The dubious premise of the settlement was that smoking costs governments substantial sums. Actually, tobacco is the most heavily taxed consumer good (Rhode Island's tax is $3.46 per pack) and the accurate actuarial assumptions of public and private pension plans are that premature deaths of smokers will save billions in payments.

 

In the early 1950s, the sponsor of anchorman John Cameron Swayze's "Camel News Caravan" on NBC television required him to have a lit cigarette constantly visible. Today smokers are pariahs in a country the Father of which was a tobacco farmer. Someday the ashtray may be as anachronistic as the spittoon, but fear of death may be a milder deterrent to smoking than is the fact that smoking is dumb and déclassé. Dumb? Would you hire a smoker, who must be either weak-willed or impervious to evidence? Déclassé? Twenty years ago, California cut smoking 17 percent with commercials such as: "I tried it twice and I, ah, got all red in the face and I couldn't inhale and I felt like a jerk and, ah, never tried it again, which is the same as what happened to me with sex."

 

Three decades ago, public outrage killed an automobile model (Ford's Pinto) whose design defects allegedly caused 59 deaths. Yet every year tobacco kills more Americans than did World War II -- more than AIDS, cocaine, heroin, alcohol, vehicular accidents, homicide and suicide combined.

 

In the time it takes to read this column, three Americans will die of smoking-related illnesses. If you tarry to savor the column's lovely prose, four will die, so read fast.

 

Copyright 2009 Wasington Post.

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