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			Friday, June 19, 2009 News Clipping Archives *Maryland / Regional* Three cases of swine flu confirmed at city juvenile center (Baltimore Sun) Md. confirms 305 cases of swine flu (Frederick News-Post) Baltimore could attract medical data centers (Baltimore Sun) Shifting drug trade is reflected in report (Baltimore Sun) Sheriff meets with staff following suicide at jail (Frederick County Gazette) WSSC Picks Manager at D.C. Agency For Top Post (Washington Post) Research center showcases advances in telemedicine (Frederick News-Post) *National / International* FOOD: Nestle recalls Toll House cookie dough products (Carroll County Times) Study finds maternal screening campaign, though successful, has unexplained false test results (Baltimore Sun) Just how friendly are those probiotics in your food? (Baltimore Sun) Number of patients who die awaiting kidney reaches new high (Baltimore Sun) Health-Care Cuts Could Shift Costs (Washington Post) EPA to Pay Medical Bills for People Sickened by Asbestos From Montana Mine (Washington Post) House eyes new taxes as senators pare health bill (Washington Post) Fits and starts on health care slow down bill (Annapolis Capital) Camps Seeing Outbreaks of Swine Flu, Agency Says (Washington Post) Man who lost sense of smell assumed Zicam safe (Daily Record) *Opinion* Fixing a Sick Health Care System (Baltimore Afro-American) Viewpoint: Can medicine again be a 'calling'? (Baltimore Sun Commentary) The Rationing of U.S. Medical Care (New York Times Letters to the Editorial-6 total) *Maryland / Regional* Three cases of swine flu confirmed at city juvenile center Another 18 youths, two staff members reporting symptoms of virus By Kelly Brewington Baltimore Sun Friday, June 18, 2009 Three teenagers at the Baltimore City Juvenile Justice Center have swine flu, state health officials confirmed Thursday afternoon. Another 18 youths at the facility are reporting flu-like symptoms. All 21 are being treated and have been separated from the rest of the institution's population, said David Paulson, a spokesman for the Maryland Department of Health and Mental Hygiene. In addition, two staff members at the facility have complained of flu-like symptoms and have been told by officials to stay home. Confirmation of the outbreak comes a day after tests revealed six cases of the flu and reports from other youths of flu-like symptoms. Officials have confirmed 305 cases of the virus, known as H1N1, since the outbreak hit the United States in April. Tammy Brown, spokeswoman for the juvenile 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. Copyright © 2009, The Baltimore Sun. Md. confirms 305 cases of swine flu By Associate Press Frederick News-Post Friday, June 19, 2009 BALTIMORE — Maryland health officials say they’ve confirmed 305 cases of swine flu in the state. Department of Health and Mental Hygiene spokesman David Paulson said today that this number likely represents just a fraction of cases since not everyone with flu-like symptoms is being tested anymore. Paulson says the number of confirmed cases has risen steadily. He says the illness is behaving like seasonal flu, although it is highly contagious since people have a less resistance to it than they would to seasonal flu. Please send comments to webmaster or contact us at 301-662-1177. Copyright 1997-09 Randall Family, LLC. All rights reserved. Baltimore could attract medical data centers Compared to other cities on East Coast, Baltimore has lower operating costs for facilities to store electronic medical records By Gus Sentementes Baltimore Sun Friday, June 19, 2009 Baltimore has the potential to be a prime destination for health care data centers -- an industry that's expected to grow rapidly in the coming years as the Obama administration pushes for hospitals and doctors to adopt new electronic medical records systems, according to a report released Thursday by a New Jersey location consulting company. The Baltimore area stacks up very well against other competing regions on the East Coast, such as New York and Boston, because of lower operating costs and the existence of a well-trained technology work force, according to John Boyd Jr., a consultant with The Boyd Co. in Princeton, N.J. With the Obama administration poised to make $20 billion available to help upgrade paper-based records to electronic formats, Boyd said that states will likely be vying for companies seeking to open new data centers to store a flood of new digital medical records. "Baltimore is in the game," Boyd said. "This is the growth industry right now, and it's because of this money coming from Washington." According to The Boyd Co.'s study, which is updated every 18 months, a data center with 150 employees in a newly-constructed 150,000-square-foot building would cost $21.4 million a year to operate in Baltimore. Centers of similar size would cost $36.8 million in New York City; $27.7 million in Boston; and $24.3 million in Philadelphia. The cheapest place in the country to run a data center is in Sioux Falls, S.D., with annual operating costs as low as $17.5 million. The study included such factors as labor, energy, tax and travel costs. Meanwhile, salaries for information technology workers who would operate the data centers are competitive with other metropolitan regions. A lower-paying job, such as a medical records technician, would earn $30,000 in Baltimore, compared with $35,000 in New York City. On the high end, a web security manager would earn $140,000 in Baltimore, compared with $159,000 in New York City, the study found. Baltimore Technology Park, a data center based in downtown Baltimore, already has several health care industry clients and expects to see more business as medical records increasingly go digital, according to James Gohng, business development director for the privately held company. The company’s 12 employees work in a secure, 30,000-square-foot facility near M&T Bank Stadium. Their clients include health care companies and hospitals, law and financial firms, and mortgage companies and education institutions. “Health care is a great prospect for us,” said Gohng. “It will mean more work.” Copyright © 2009, The Baltimore Sun. Shifting drug trade is reflected in report Price of cocaine is up, dealers are outsourcing, and smuggling is changing By Peter Hermann Baltimore Sun Friday, June 19, 2009 Here's some new news about drugs in Baltimore: •A kilo of cocaine now costs $32,000, up a full $10,000 from 2006. Bulk quantities of the drug are more expensive here than in Washington, where a kilo costs $30,000, and in Richmond, Va., where it goes for $26,000. •Local drug dealers outsource even the final stages of turning powder cocaine into crack. •Dealers are increasingly steering away from highways to smuggle drugs, preferring package delivery services so they can track their shipments on the Internet. It's hardly a revelation that the drug business is big business in Baltimore. Mayor Sheila Dixon estimated a few months ago that dealers on one city street, Pennsylvania Avenue, rake in $10 million a year. And just like annual reports measuring the economic ups and downs of business ventures, experts measure the vitality of distributors in the lucrative cocaine and heroin trade. The experts in this case are from the U.S. Department of Justice's Washington-Baltimore High-Intensity Drug Trafficking Area, part of the National Drug Intelligence Center. Their 15-page report, "Drug Market Analysis 2009," looks at drug dealing from a macro level, a panoramic portrait of how drugs are distributed in the Washington and Baltimore area. In many ways, the report concludes that not much has changed: Baltimoreans continue to abuse heroin, die after overdosing on it and keep killing for it at an alarming rate. The federal report notes some new threats - traffickers from the Dominican Republic who are typically supplied by Colombians are dealing in even larger amounts of drugs because they've found "new suppliers in the Caribbean, Puerto Rico and Mexico." Meanwhile, Mexican traffickers have moved into Virginia's Shenandoah Valley, using Georgia and North Carolina as shipment hubs. And, the report states, West African criminal groups are moving in on the Baltimore trade, threatening the growing West Coast-based Bloods and Crips gangs, importing heroin not only from New York City but also "directly from Afghanistan." In some cases, the report says, drugs are simply mailed "directly from Pakistan." The good news is that authorities attribute the jump in price for bulk cocaine in Baltimore to a crackdown by police that has "disrupted the cocaine supply in the region, making it difficult for lower-level dealers to obtain the drug." They are being forced to look to Pennsylvania and Michigan for supplies, thus driving up the price. And while the report says that manufacturing jobs in the drug business are in short supply in Baltimore, this city remains one of the biggest and most important transportation hubs for drugs in the country. The area's "extensive and diverse transportation infrastructure" connects the entire East Coast and leads out west, providing "drug traffickers with ready access to wholesale drug markets." The report says that because police are targeting highways, dealers are using navigational devices to traverse "unfamiliar routes" or are simply sending boxes of drugs with delivery services. Not only can they watch the progress of their packages on the Internet; the report says that "if a shipment is delayed, they assume that law enforcement has intercepted it, and they refuse delivery to avoid arrest." Like a business, the operators change tactics to meet new demands, satisfy the changing habits of consumers and counter new tactics by competitors. For example, the federal report says methadone overdoses are increasing in Baltimore from people abusing the drug designed to wean them off heroin, while the party drug Ecstasy, which used to be limited to teenage parties in the suburbs, is now being sold at "open-air drug markets" in Washington. Copyright © 2009, The Baltimore Sun. Sheriff meets with staff following suicide at jail Rope marks on man's neck can be seen in arrest photo prior to his death By Sherry Greenfield Frederick County Gazette Thursday, June 18, 2009 Frederick County Sheriff Chuck Jenkins was slated to meet with command staff at the county's adult detention center Wednesday regarding the apparent suicide of a Sabillasville man at the jail on June 10. Justin M. Lihvarchik, 26, was found hanging from his cell's top bunk by a noose made out of his shoelaces. He could not be revived. Cpl. Jennifer Bailey, spokeswoman for the Sheriff's Office, said that an investigation into Lihvarchik's death includes whether deputies noticed apparent rope marks on the man's neck, which can be seen in his arrest photo. "Officers said he made those marks on himself prior to being arrested," Bailey said. Autopsy results are not yet complete, Bailey said Wednesday. Two officers on duty at the detention center at the time of the death have been placed on administrative leave during the investigation. The deputies' names are not being released, Bailey said. Bailey gave the following account of the timeline leading up to Lihvarchik's death: Police were called to a residence on Harbaugh Valley Road in Thurmont at about 1:14 a.m., June 10, regarding a domestic dispute. Deputies found that Lihvarchik had allegedly assaulted his 26-year-old girlfriend, and threatened to harm her further. He had been drinking alcohol at the time. Lihvarchik was arrested at about 1:33 a.m., taken to the Frederick County Adult Detention Center's central booking unit, and charged with second-degree assault. At 2:37 a.m., he was transferred to a cell in the holding unit. Lihvarchik was alone in the two-person cell. At 5:30 a.m., an on-duty supervisor found his body hanging from the top bunk. Correctional officers and medical staff at the jail administered CPR until emergency medical units arrived. Lihvarchik could not be revived. His body was transported to the Office of the Chief of the Medical Examiner in Baltimore. Detention center policy requires that correctional officers check on inmates every 20 minutes, Bailey said. It is unclear whether the two officers on duty June 10 checked on Lihvarchik every 20 minutes. "That will be part of the investigation," Bailey said. Inmates are not stripped of their clothes and shoes until they are transferred into the general population, Bailey said. E-mail Sherry Greenfield at sgreenfield@gazette.net. Copyright 2009 Frederick County Gazette. WSSC Picks Manager at D.C. Agency For Top Post By Katherine Shaver and Carol D. Leonnig Washington Post Friday, June 19, 2009 Jerry N. Johnson, who oversaw the D.C. Water and Sewer Authority when high levels of lead were found in the city's tap water, was chosen yesterday for the top post at the Washington Suburban Sanitary Commission, the troubled Maryland utility whose underground water pipes have been breaking in record numbers. The six-member board of the WSSC, which supplies water and sewer service to 1.8 million people in Montgomery and Prince George's counties, voted unanimously to offer Johnson the job of general manager, pending a background check and contract negotiations that must be completed by July 8, county officials said. Johnson has accepted the job. Johnson, WASA's general manager for 12 years, is set to resign from that agency July 2. WASA's board of directors voted in April to buy him out of his $230,000 annual contract a year early, a decision that one D.C. Council member said was aimed at restoring public confidence after the way the lead discovery was handled five years ago. Gene W. Counihan, vice chair of the WSSC board and a Montgomery commissioner, said Johnson is "a known quantity with an outstanding record as an effective manager. . . . He's put [WASA] in better financial shape and really streamlined and effectively managed that organization." Juanita D. Miller, a Prince George's commissioner, said in an interview that the board "was satisfied" with Johnson's explanation of the lead problem. "This brings closure to this long-standing need to bring leadership to our agency," Miller said. Counihan noted that a scientific journal announced this week that it found no evidence that WASA officials tried to influence the outcome of a 2007 research paper on lead in the District's water supply. Johnson, 61, said he sought the "challenge" of helping the WSSC find money to replace its aging underground pipes, nearly 4,000 of which have burst in the past two years. "The WSSC had been a model utility in the country, and I think the star might need to be polished a bit," Johnson said in an interview. "I think I can help do that." If formally approved at the WSSC's July board meeting, he will probably start in September, he said. Johnson's hiring marks the second time that Montgomery and Prince George's leaders have tried to break a 15-month stalemate among the agency's six commissioners over a successor to former general manager Andrew D. Brunhart. Prince George's County Executive Jack B. Johnson (D) backed away from the first nominee, former Texas utility leader David E. Chardavoyne, in April after news accounts showed he had been targeted in a racial discrimination complaint by an African American employee. Jack Johnson and Montgomery County Executive Isiah Leggett (D) issued a joint statement saying Jerry Johnson "is nationally known as a turnaround specialist." As the first WASA general manager, they said, he guided the agency "from an unrated agency, with a projected $8 million deficit, to one with an A-plus credit rating and $170 million reserve in just two years." Jerry Johnson came to personify WASA's failure to alert customers to the lead risk in tap water from 2001 to 2004. Most D.C residents learned that levels of the substance were dangerously high from a front-page Washington Post article in January 2004. An investigation found that Johnson was personally involved in decisions to avoid sounding the alarm, even after federal law required the utility to issue specific warnings about health risks from rising lead levels. WASA officials knew in summer 2001 that the water contained unsafe lead levels but withheld six high test results from federal regulators and said the water was acceptable, records show. When WASA tested its water during the next two years, records show, the utility dropped half the homes that previously had been shown to have high lead levels and avoided testing high-risk homes, a violation of federal rules. The Environmental Protection Agency, which cited WASA for violations in June 2004, called the utility's practices unprecedented and a "serious breach" of the law. Johnson said he "takes responsibility for the organization's actions." But, he added, "I reject the notion that we failed to advise [the public]. Certainly we could have been more proactive, and certainly there could have been better public relations efforts, but there was certainly no intent by this organization to mislead the public." Yanna Lambrinidou, president of Parents for Nontoxic Alternatives, a grass-roots organization, said, "Jerry Johnson has proven he's not the right person to be handling drinking water issues and protecting the public health." Staff writer John Wagner contributed to this report. Copyright 2009 Washington Post. Research center showcases advances in telemedicine By Justin M. Palk Frederick News-Post Friday, June 19, 2009 FORT DETRICK -- The Telemedicine and Advanced Technology Research Center works on science and engineering ahead of programmed research projects. In practical terms, that means virtual-reality rigs for training surgeons, chemical, biological and explosive agent detectors, and robots capable of identifying and diagnosing battlefield casualties. Those technologies were on display Thursday at the center's Advanced Medical Technology Expo. The center's mission is "to come up with solutions for the warfighter and then get them into the hands of the warfighter," said Col. Ron Poropatich, the center's deputy commander. It mainly oversees projects funded through congressional earmarks -- some $400 million this year. Two of the areas it's focusing on are improving training for doctors and advanced robotics for telemedicine and field support. The Army needs to train or retrain 100,000 personnel in trauma medicine a year, said J. Harvey Magee, technical director of the center's Medical Simulation and Training Technologies group. The center's goal is to create ways to train doctors in simulated situations -- either on models or mannequins, or in virtual reality -- and ways to objectively measure whether the students are learning the skills they needs. Magee likened it to the simulator training that allows pilots to practice water landings without actually ditching a plane. "The idea is: No surprises, Doc." The center has ongoing projects in robotics, to develop self-guiding helicopters for carrying supplies to and wounded soldiers from the battlefield, improved hydrogen fuel cells, and improved telemedicine equipment. But in keeping with the center's mission, it's all still five to 15 years away from being fielded, said Gary Gilbert, chief of the center's Knowledge Engineering Group. "We kind of take it to the point where it's ready for final development," Gilbert said. Please send comments to webmaster or contact us at 301-662-1177. Copyright 1997-09 Randall Family, LLC. All rights reserved. *National / International* FOOD: Nestle recalls Toll House cookie dough products By The Associated Press Carroll County Times Friday, June 19, 2009 NEW YORK — Nestle USA on Friday voluntarily recalled its Toll House refrigerated cookie dough products after a number of illnesses were reported by those who ate the dough raw. The company said the Food and Drug Administration and the Centers for Disease Control are investigating reported E. coli illnesses that might be related eating the dough. In a statement, the FDA said there have been 66 reports of illness across 28 states since March. About 25 people have been hospitalized, but no one has died. The FDA advised consumers to throw away any prepackaged, refrigerated Nestle Toll House cookie dough products in their homes. Retailers, restauranteurs and employees at other food-service operations should also not sell or serve any of the products. Nestle spokeswoman Roz O’Hearn said “this has been a very quickly moving situation,” adding the company took action less than 24 hours after hearing of the problem. O’Hearn said the company will “cooperate fully” with the FDA’s investigation. The recall includes refrigerated cookie bar dough, cookie dough tub, cookie dough tubes, limited edition cookie dough items, seasonal cookie dough and Ultimates cookie bar dough. It extends to chocolate chip dough and other varieties, including gingerbread, sugar and peanut butter cookie dough. It does not affect any other Toll House products, including ice cream that contains Toll House raw cookie dough. The FDA also said consumers should not try to cook the dough, even though eating cooked dough would be safe, because consumers might get bacteria on their hands and on counters and other cooking surfaces. E. coli is a potentially deadly bacterium that can cause bloody diarrhea, dehydration and, in the most severe cases, kidney failure. Copyright 2009 Carroll County Times. Study finds maternal screening campaign, though successful, has unexplained false test results Associated Press By Mike Stobbe Baltimore Sun Thursday, June 18, 2009 ATLANTA (AP) - A massive effort to test pregnant women for a deadly germ they can spread to their babies has yielded a bad surprise - a high rate of wrong test results that led some infants to miss out on treatment. A study found the test missed more of the infections than would normally be expected. If the mothers had tested positive for the Group B strep bacteria, they would have been given antibiotics during labor to cut the chances of infecting their infants. Group B strep is a common bacteria carried in the intestines or lower genital tract, and can be spread to babies during delivery. It's harmless to most adults but in newborns can lead to blood infections, pneumonia, meningitis, mental retardation or hearing and vision loss, and death. It is a rare problem which occurs in less than 1 in 3,000 births, but the infection's terrible risks drove the Centers for Disease Control and Prevention and doctor groups in 2002 to recommend routine tests of all pregnant women. The study, led by the CDC, is the first large national study of the screening program. The CDC is planning follow-up research to pin down what caused the false negative test results. Possible explanations include problems with the collection of samples or the accuracy of the standard lab test used to check for the germ, experts said. Or perhaps the mother was infected after getting the test. "There are a lot of unknowns here," said Dr. Diane Ashton, deputy medical director for the March of Dimes. No one is suggesting the screening program is a failure. The study found that screenings nearly doubled in only a few years. And infant infections from Group B strep, which were already dropping because of earlier prevention efforts, dipped another 27 percent. "The guidelines have been an unabashed success," said Dr. Barbara Stoll, pediatrics chair at Emory University's medical school. She was not involved in the study, which is being published in Thursday's New England Journal of Medicine. The new study is based on a database that tracks cases of Group B strep disease in 10 states. Over two years, 250 infants out of nearly 7,700 were born with the infection. The researchers also compared the results to a similar study done in the late 1990s, before the screening recommendations were in place. The good news: The screening rate rose from 48 percent to 85 percent of pregnant women. And the antibiotics seemed to be very effective, said the CDC's Stephanie Schrag, a study co-author. But Schrag and others acknowledged that the false negatives were a disappointing surprise. Based on previous studies, the researchers calculated that they would see 44 to 86 cases of false negatives involving full-term infants. But the final study showed 116 cases - or about 60 percent of the infected full-term infants in the study were born to mothers who had been tested and mistakenly found clear of the infection. The rest of the infected full-term babies were either not screened or were born to mothers who tested positive. Timing may be an issue. It's recommended that doctors test moms for the germ at 35 to 37 weeks into the pregnancy, by swabbing the vagina and rectum. But Group B strep infections can come quickly, and some tests might have been done before the bacteria appeared. "Maybe it was a true negative test, and the mother later became colonized" with the bacteria, she said. The study's authors said more rapid tests could make a difference, and development of a new vaccine against Group B strep could be an even better solution. ___ On the Net: New England Journal: http://www.nejm.org March of Dimes: http://tinyurl.com/bgqee3 Copyright 2009 Associated Press. All rights reserved. Just how friendly are those probiotics in your food? Helpful bacteria are being added to a growing number of products, but scientists say the industry's claims can mislead and confuse consumers By Julie Deardorff Baltimore Sun Friday, June 19, 2009 Ready for some live, active cultures in your chocolate-- How about your breakfast cereal-- Probiotics, the so-called friendly bacteria with health benefits, have broken out of the dairy case and are colonizing other areas of the supermarket. The bacteria, which occur naturally in fermented foods such as yogurt, kefir and miso, are thought to aid digestion and support the immune system by balancing the intestinal ecosystem. But as manufacturers add the microbes to everything from infant formula and fruit juice to pizza, muffins and granola bars, experts caution that the word "probiotic" is widely misused by the industry and misunderstood by consumers. While there are thousands of bacterial strains, only a few dozen have been tested for health benefits. Studies suggest some products may offer relief for digestive issues, but it's not known whether healthy people benefit from snacking on live "bugs." The European Union Food Safety Authority this week started a process to regulate health claims on products, including probiotics. And a pending class-action lawsuit alleges that Dannon misled consumers about the benefits of Activia and DanActive, both marketed as probiotics. Dannon denies using deceptive advertising and is standing by the claims and the studies that supported them. But a spokesman agreed it's buyer beware at the market. "We're on the front lines; we see a lot of confusion," said Dannon's Michael Newirth. There is no standard definition of probiotics, according to the Food and Drug Administration, but scientists generally say the term refers to foods, beverages or supplements containing live microorganisms that studies show promote health when people take enough of them. Without studies, products shouldn't be called probiotic, scientists say. "Sadly, of the hundreds of new products launched in recent years, very few have been shown to be probiotic," said probiotic researcher Gregor Reid, a microbiologist at the University of Western Ontario and the president of the International Scientific Association for Probiotics and Prebiotics. Though probiotics are not a new invention -- they also are found in breast milk -- researchers are just beginning to understand the role they can play in regulating the immune system and managing disease. Scientists cannot yet explain exactly how probiotics work, but it's thought they can help restore beneficial bacteria in the intestinal tract. "Some [bacteria] can produce enzymes that help digest food, while others can synthesize vitamin K in the gut or even help stimulate the immune system," Joe Schwarcz wrote in "An Apple a Day: The Myths, Misconceptions and Truths About the Food We Eat." The bacteria may produce antibodies for certain viruses, produce substances that prevent infection or prevent harmful bacteria from attaching to the gut wall and growing there, according to the American Gastroenterological Association. But if those bacteria are wiped out by disease or medication, potentially harmful microbes may flourish. The strongest studies have found that a few probiotics (Lactobacillus GG and the yeast Saccharomyces boulardii) can help with common gastrointestinal disorders that may involve an imbalance of gut bacteria. "They are most effective for diarrhea due to rotavirus, and if given early in the course of the illness," said Stefano Guandalini, professor of pediatrics and chief of the gastroenterology section at the University of Chicago Comer Children's Hospital. "They've been also shown to reduce the incidence of postantibiotic diarrhea -- which occurs in up to 40 percent of children taking antibiotics." There's also growing evidence that children with ulcerative colitis can benefit from a proprietary mixture of eight strains called "VSL #3," Guandalini said. And certain probiotics have been shown to reduce symptoms of irritable bowel syndrome. But more research is needed for probiotic effects on almost all other conditions, including cancer, oral health, allergies, skin conditions and obesity. For the consumer, finding the right probiotic can be vexing. Labels can't legally declare that the probiotic can cure, treat or prevent disease. So health claims, which don't require FDA approval, are often vague. For example, Kashi's Vive is called a "probiotic digestive wellness cereal," one that "may restore your digestive balance." And it may -- each serving contains a whopping 12 grams of fiber. But the probiotic used -- Lactobacillus paracasei ssp paracasei F19 -- has not been tested in humans eating Kashi Vive. And there's no guarantee that the microbes in the dry cereal are alive. To make things more complicated, probiotics interact with bacteria already in the body, and everyone has slightly different microflora, said probiotic expert Gary Huffnagle, a professor of internal medicine and microbiology at the University of Michigan Medical School. So a product that works for one person might not be right for another. Still, Huffnagle says one of the best things about probiotics is they're safe and your own trials should yield answers in a few weeks. Bonnie Thompson, 43, of Fort Collins, Colo., who suffered from irritable bowel syndrome for decades, tried several brands before finding one that worked: the Garden of Life supplement called Primal Defense. Ultimately, the most effective probiotic was her own homemade kefir. "I credit it with normalizing my bowel function," she said. NAVIGATING THE LABEL Just because a food product says “probiotic” doesn’t mean it’s a probiotic. Even more aggravating, manufacturers often leave important information off the label, such as whether the product contains live organisms or the full name of the bacterial strain. Some advice: Watch the dates: The organisms can die off while the product is sitting on the shelf. The best way to ensure it has an effective number of live bacteria is to look at the “best by” or expiration date. Get enough microbes. Easier said than done. There is no single dosage for probiotics; studies have documented health benefits for products ranging from 50 million to more than 1 trillion colony-forming units (the measure of live microbes) per day. The amount you need is the amount that the study on your product showed was effective. There is a clinical study, right-- Scour yogurt labels. Look for yogurt products with “live and active cultures” and avoid the ones that say “made with active cultures.” Those may have been heat-treated after fermentation, which kills the bacteria. Also, Acidophilus and Bifidobacteria are less sensitive to stomach acid and more likely to make it into the colon alive than other names you might see on the label, such as Lactobacillus bulgaricus and Streptococcus thermophilis. Scour yogurt labels, Part II. Remember that even “live, active cultures” aren’t necessarily probiotics, meaning they may not have been tested for health benefits. Speak the lingo. A probiotic is defined by its genus (e.g. Lactobacillus), species (e.g. rhamnosus) and strain (a series of letters or numbers). “Products that list the genus and species and also the strain tend to have inherently better quality control and products,” said probiotics expert Gary Huffnagle. Watch for too-perfect names. Dannon calls its bacterial strains Bifidus Regularis (in Activia) and L. casei Defensis (in DanActive)-for marketing purposes. These are made-up, consumer-friendly, trademarked names. Copyright © 2009, Chicago Tribune. Number of patients who die awaiting kidney reaches new high Los Angeles Times By Shari Roan Baltimore Sun Thursday, June 18, 2009 The shortage of donor organs has been a problem for many years, and it isn't getting any better. A study published today found that 46% of patients age 60 and older currently on the waiting list for a kidney transplant will die before receiving an organ from a deceased donor. The study is published in the Clinical Journal of the American Society of Nephrology. People in search of a kidney may have better luck trying to find a living donor -- someone who will give up one of their two kidneys. Kidney "We have now reached a notable benchmark in which nearly half of newly listed older candidates will not survive the interval to receive a deceased donor transplant," the lead author of the study, Jesse D. Schold, said in a news release. "Our results emphasize the particular need to consider living donation as an alternative source for some older patients -- or alternatively, the critical importance of navigating the steps to receive a deceased donor transplant as rapidly as possible." Schold, an associate instructor of medicine at the University of Florida, analyzed data on nearly 55,000 patients over age 60 who were on the U.S. waiting list for a kidney transplant from 1995 to 2007. Patients age 70 and older and African Americans were even more likely to die before receiving a kidney. Besides age, factors such as blood type and being on dialysis at the time of listing also affected the odds of receiving a transplant. The study also found wide variations in regions of the country. The number of people who need kidneys is increasing while the number of donors has remained stable. That means time on the waiting list has grown and more people die. Only certain patients are viable organ donors at the time of death. While many family members consent to donation, an astonishing number of Americans refuse to offer what has been called "the gift of life." Information on organ transplantation, donation and procurement can be found on the websites of the United Network for Organ Sharing and Donate Life America. Copyright 2009 Baltimore Sun. 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. 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. House eyes new taxes as senators pare health bill Associated Press By Erica Werner Washington Post Friday, June 19, 2009 WASHINGTON -- Early work on the ambitious health care overhaul the Obama administration is seeking has exposed the kinds of in-house fights that typify just how hard it will be to get meaningful legislation this year. Case in point: A proposal to help bankroll universal health coverage with a dime-a-can increase in the price of soft drinks. House Democrats have lots of potential targets for higher taxes as they aim to expand health care coverage to reach the roughly 50 million that experts say are uninsured. Also under consideration are higher alcohol taxes, increases to the Medicare payroll tax and a value-added tax, a sort of national sales tax, of up to 1.5 percent or more. The list of options being weighed by the tax-writing House Ways and Means Committee, and obtained Thursday by The Associated Press, aims to raise some $600 billion over 10 years to partially pay for President Barack Obama's goal of overhauling the nation's health care system to tame costs and cover the 50 million uninsured. The final price tag for that effort could top $1 trillion, with cuts to Medicare and Medicaid covering the rest of the cost. The tax options include: - Increasing the price of soda and other sugary drinks by 10 cents a can. - Applying a potential 2 percent income tax increase to single taxpayers earning more than $200,000 a year and households earning more than $250,000. - A new employer payroll tax could target 3 percent of employers' health care expenditures. - Taxing employer-provided health insurance benefits above certain levels - a less likely option but one that still is in the running. House Democrats planned to unveil a draft of their sweeping health care bill Friday. It would require all individuals to obtain health insurance and force employers to offer health care to their workers, with exemptions for small businesses. A new public health insurance plan, strongly opposed by Republicans, would compete with private companies within a new health care purchasing "exchange" where Americans could shop for coverage. Government subsidies would help the poor buy care. The draft, being released at a news conference of the chairmen of the three committees with jurisdiction - Ways and Means, Energy and Commerce, and Education and Labor - was not expected to mention the potentially unpopular tax options. On the other side of the Capitol, two Senate committees were going in separate directions on their health care bills. The Health, Education, Labor and Pensions Committee spent a second full day working on an expansive bill reflecting Democratic priorities, while members of the Finance Committee were laboring to produce legislation that could attract Republican support. To that end Finance Committee senators were looking at leaving a new public insurance plan out of their bill, instead creating nonprofit co-ops to offer insurance in competition with private companies, according to an outline obtained by The Associated Press. The co-ops could accept federal loans for startup operations, but would have to repay the money. Struggling to pare their bill from an earlier $1.6 trillion cost estimate to about $1 trillion over 10 years, Finance Committee members also were looking at making federal subsidies available to help families with incomes of up to 300 percent of poverty, or $66,000, purchase insurance. An earlier proposal set the level at 400 percent of poverty, or $88,000. Finance Committee Chairman Max Baucus, D-Mont., reviewed the plans behind closed doors Thursday with a group of senators he deemed "the coalition of the willing." Republicans present were top committee Republican Charles Grassley of Iowa, Orrin Hatch of Utah and Olympia Snowe of Maine. "We're getting closer and closer," Baucus said during a break in the meeting. "There's no doubt in my mind we're going to have a bipartisan bill." Sen. Christopher Dodd, D-Conn., who's presiding over the Health Committee work session, dismissed bipartisanship as an end in itself. "My goal here is to write a good bill. My goal is not bipartisanship," said Dodd, who has taken the committee reins in the absence of Sen. Edward M. Kennedy, D-Mass., who's being treated for brain cancer. --- AP Special Correspondent David Espo contributed to this report. © 2009 The Associated Press. Fits and starts on health care slow down bill Associated Press By Erica Werner Annapolis Capital Friday, June 19, 2009 WASHINGTON (AP) — Delays and disputes bogged down a Senate panel considering the details of remaking the nation's $2.5 trillion health care system. Advertisement The first formal drafting and voting session on Sen. Edward M. Kennedy's sweeping legislation was given over Wednesday to six hours of speechmaking by senators. Nothing was accomplished on the bill itself, and there were suggestions that a goal of completing committee action before the congressional recess July 4 might not be met. A separate and even more critical Senate committee delayed its own voting timeline as lawmakers struggled to slash costs to under $1 trillion over 10 years. If things keep going the way they did Wednesday, it doesn't bode well for President Barack Obama's goal of signing legislation this fall to rein in spiraling health costs and extend care to 50 million uninsured Americans. "This is the first time that I had to kind of say we haven't met a deadline," said Sen. Chuck Grassley of Iowa, top Republican on the key Senate Finance Committee. The Finance Committee was supposed to release draft legislation Wednesday and begin voting on it next week. But the committee announced that votes would wait, possibly until after July 4, as senators sought to retool their proposals to cut the cost by more than one-third, from an initial $1.6 trillion to less than $1 trillion. Of the five major panels, including Kennedy's, working on health care, Finance has the best odds of coming up with a bipartisan proposal that could overcome gathering opposition. "We'll be ready when we're ready, but we're not there yet," said Finance Chairman Max Baucus, D-Mont. With Kennedy absent from the Capitol after a diagnosis of brain cancer, his Health, Education, Labor and Pensions Committee met under the leadership of Sen. Chris Dodd, D-Conn. Senators were considering a bill topping 600 pages, plus 388 amendments, but with the most contentious issues — whether to create a new public plan to compete with the private market, and whether to require employers to cover their workers — still unwritten. The legislation would create a new insurance marketplace where people could shop for coverage plans with help from government subsidies. As written, it costs some $1 trillion but still leaves 37 million people uninsured, and Republicans are deeply skeptical. The health committee is scheduled to meet daily and was supposed to finalize the bill by the end of next week, but after Wednesday's session Dodd backed away from that deadline. "We'll see how it goes. I'm interested in getting this done but I'm interested in getting it right," Dodd said. "I'm not time-driven to the point where at all cost that has to be done that day." Committee hearings in the House are set to begin next week. __ Associated Press writer Ricardo Alonso-Zaldivar contributed to this report. Copyright 2009 Annapolis Capital. Camps Seeing Outbreaks of Swine Flu, Agency Says By Donald G. McNeil Jr. Washington Post Friday, June 19, 2009 Although it is fading in much of the nation as warmer weather comes on, swine flu is causing outbreaks in summer camps just as it has in schools, federal officials said Thursday. The illness has hospitalized 1,600 Americans, most of them young, and is blamed in 44 deaths, the officials said. It is most persistent in the Northeast, and nearly 90 percent of the flu cases that are tested nationally are the new swine H1N1, not seasonal flu. The advice to camp administrators and parents is basically the same as for schools, said Dr. Daniel B. Jernigan, deputy director of the flu division of the Centers for Disease Control and Prevention: Camps should be on the alert for sick children, who should be kept home for a week or until 24 hours after symptoms have finished. (Not all camps offer refunds, the American Camp Association noted.) Parents should be prepared to take sick children home on short notice. Religious camps in Clayton, Ga.; Santa Rosa, Calif.; and Cleveland, Ga., and a Boy Scout camp near Asheville, N.C., all reported probable swine flu cases in local newspapers this week. The C.D.C. also said that many hospitals and clinics were not doing enough to prevent the spread of flu within their walls. Preliminary analysis of 26 cases of swine flu among health care workers in April and May showed that too few hospital staff members wore masks and other protection, and that patients with the flu were not being identified quickly enough. “Infectious patients should be identified at the front door,” said Dr. Michael Bell, chief of infection control for the agency. “Identifying them up front is essential.” When that is done correctly, Dr. Bell said, hospitals act appropriately by putting infectious patients in single rooms, covering their mouth and nose with masks, alerting staff members to wear protection and wash their hands, and doing some procedures in rooms pressurized to make sure no air escapes into corridors. As if to emphasize the potential risks in hospitals, The Associated Press reported Thursday that 33 premature infants in a hospital in Greensboro, N.C., were getting precautionary flu treatment because a respiratory therapist had worked in the neonatal intensive-care unit after treating an older patient who later tested positive for the virus. None of the children had flu symptoms, a hospital administrator said. Copyright 2009 New York Times. Man who lost sense of smell assumed Zicam safe Associated Press Daily Record Friday, June 19, 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 Daily Record. *Opinion* Fixing a Sick Health Care System By George Curry Baltimore Afro-American Commentary Thursday, June 18, 2009 (June 18, 2009) - The debate over universal health care heats up this week amid false charges that President Obama wants to institute “socialized medicine” and health reform hurts those already covered by private insurers. One of the most important facts to keep in mind is that although the United States spends twice as much as other industrialized nations on healthcare ($7,129 per capita, it is at or near the bottom when it comes to such indicators as infant mortality and life expectancy. If providing free, universal health care to all citizens is such a bad idea, why has it been adopted in England, Canada, Brazil, Israel, Germany, Australia and Scotland? In fact, the United States is the only industrialized nation in the world that does not provide universal health care for its citizens. Consequently, at least 43 million Americans are without health insurance and that figure is certain to grow with rising unemployment. “The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers,” Physicians for a National Health Program noted on its Web site. “Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sale and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. “Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.” By switching to a single-payer system that covers all medical necessities, it is estimated that savings will amount to more than $350 billion per year. Obama has made health reform one of his top priorities. Not unexpectedly, some leading Republicans are accusing him of favoring socialized medicine and urging the government to not meddle in affairs that should be handled by the private sector.A group calling itself Conservatives for Patients’ Rights has already begun running spots on CNN designed to scare the public: Narrator: There are hundreds of choices in health care plans today. But imagine this is the massive, government-run insurance plan some in Congress want. This government-run plan could crush all of your other choices, driving them out of existence, resulting in 119 million off their current insurance coverage, leaving no choices in health insurance and government in control of your health care. CPR Chairman Rick Scott: It’s not too late. Protect your health care choice. Tell Congress to say no to a government-run plan. Factcheck.org notes, “That’s not the type of public plan President Obama has proposed. Nor is such a plan gaining acceptance on Capitol Hill.” A House summary of the United States National Health Care Act (H.R. 676) introduced by Rep. John Conyers and making its way through Congress states, “The bill would create a publicly financed, privately delivered healthcare system that uses the already existing Medicare program by expanding and improving it to all U.S. residents and all residents living in U.S. territories. The goal of this legislation is to ensure that all Americans will have access, guaranteed by law, to the highest quality and most cost effective healthcare services regardless of their employment, income, or healthcare status. With over 45-75 million uninsured Americans, and another 50 million under-insured, the time has come to change our inefficient and costly fragmented non-healthcare system.” The summary continues, “The program will cover all medically necessary services, including primary care, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, long term care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics, and practices. No co-pays or deductibles are permissible under this act.” A recent poll by the New York Times and CBS News found that 57 percent of Americans would be willing to pay higher taxes if it meant universal coverage for all Americans. Thirty-eight percent opposed the idea.Not only is universal health care sound public policy, it can provide an economic advantage as well. Writing in Canada’s Financial Post, Diane Francis said: “Universal health care is a cornerstone of smart economic policy. Take, for example, the effect of guaranteed health care on economic activity, business expansion or the public’s sense of wellbeing. If a worker in Canada or Europe or Japan loses his or her job this recession, it’s a psychological and financial blow. But if an American loses his or her job, the family faces financial ruin if sickness strikes any member because they are without healthcare coverage.” She continued, “Bridge coverage is available but unaffordable for anyone but the wealthy. Worse yet, if a major illness is diagnosed during unemployment, a worker becomes unemployable, bringing about a life sentence of poverty. “Little wonder, then, that consumer spending has ground to a halt in the United States, which makes the economic meltdown that much harder to combat or ever solve.”It’s time for the United States to catch up with the rest of the industrialized world by providing universal health care. George E. Curry, former editor-in-chief of “Emerge” magazine and the NNPA News Service, is a keynote speaker, moderator, and media coach. He can be reached through his Web site, www.georgecurry.com. Copyright 2009 Baltimore Afro-American. Viewpoint: Can medicine again be a 'calling'? By Ellen Goodman Baltimore Sun Commentary Friday, June 19, 2009 BOSTON - There will be time to talk about costs and coverage, about public and private plans, about reasoning and rationing in health care reform. So the president began this week speaking to the workers in the system: doctors. At the meeting of the American Medical Association, Barack Obama tackled the model "that has taken the pursuit of medicine from a profession - a calling - to a business." He reminded doctors: "You didn't enter this profession to become bean counters and paper pushers. You entered this profession to be healers. And that's what our health care system should let you be." Listening to him, I thought of one small tale from the annals of medicine. A few days earlier, a friend had an appointment to consider a rather serious heart procedure. After 15 minutes, the cardiologist stood up to leave. My friend was startled. "I have more questions," she said. He answered, "I have another patient," and walked away. I am sure that he didn't become a cardiologist to treat patients like travelers in a revolving door. I am also sure that no rational system would allot minimum time and payment for an office visit to decide on a procedure that will cost, on average, $35,000. But there we are. Somewhere along the way, with the help of insurers and incentives, by paying for procedures rather than patient care, we have created a culture of medicine that pushes doctors away from the "calling." In his speech, Mr. Obama mentioned McAllen, Texas. This little-known city has become the infamous poster town for runaway health care costs since Atul Gawande wrote about it in The New Yorker. McAllen has the second-highest per capita health care costs in the nation, a fact it doesn't post on its Web site. Costs are twice as high as those in its demographic twin, El Paso. Not because the people are sicker. Not because they are kept healthier. And not because of malpractice suits. "The primary cause of McAllen's extreme costs was, very simply, the across-the-board overuse of medicine," wrote Mr. Gawande. It was reminiscent of other high-cost areas where people "got more of the stuff that cost more, but not more of what they needed." In McAllen, Mr. Gawande unhappily concluded that this overuse came because too many doctors saw their practice "primarily as a revenue stream." It wasn't just some aberrant character, it was the system that pays doctors for quantity, not quality - and pays them as individuals rather than as members of a team. He compares this failure to the success of places such as the Mayo Clinic, with lower costs and higher quality. When my friend, the patient of the 15-minute consult, sent The New Yorker piece to her daughter, one of the most dedicated primary care doctors I know, she got this e-mail in return: "I can only speak for my friends/partners over the years. I think all of us hate money being part of any decision-making process. We love tight, up-to-date, data-driven, life-saving, critical thinking. We love talking to people, touching them (literally and figuratively) and feeling useful/important in our communities. We all hate figuring out what drug is on the formulary, appealing a refused claim ... seeing problems get worse because the patient decides they cannot afford a medication." She also hates thinking about medical school debts, not to mention an income that has been flat for the last 10 years, while the public thinks doctors are money-grubbing. "It's hard to keep up an altruistic head of steam," she continued. "The truth is, I'm not encouraging my kids to go into medicine. ... That feels sad and ominous." Ominous indeed. Doctors are sick of hoops and hurdles, wary of more regulations saying which procedures are useful and which are "overuse." But the message from McAllen is that doctors need to reform their culture in tune with their calling. At the recent Harvard Medical School commencement, Steve Bergman - known to generations of medical students as Samuel Shem, author of The House of God, the satirical novel about medical training - told the new doctors: "Has anyone ever heard, in a crowded theater when someone collapses, the call go out: 'Is there an insurance executive in the house?' We do the work. We have the power. Without us, there's no health care. If we stick together, we can take action and change things." That's something to be written - legibly, please - on the prescription pad for health care reform. Ellen Goodman is a columnist for The Boston Globe. Her e-mail is ellengoodman1@me.com. Copyright © 2009, The Baltimore Sun. The Rationing of U.S. Medical Care Washington Post Letters to the Editor - 6 total Friday, June 19, 2009 To the Editor: David Leonhardt (“Limits in a System That’s Sick,” Economic Scene, June 17) makes no mention of the most egregious form of medical care rationing — the decisions by insurance companies to pay or not to pay for medical procedures, decisions that are routinely based on cost rather than on sound medical practice. Health care reform will get nowhere until the public understands that the insurance companies are the ones currently making the rationing decisions. The objection to a government-run plan — that it would compromise the relationship of doctor and patient — overlooks the fact that the relationship is already severely compromised by the insurance companies. Howard Nenner Whately, Mass., June 17, 2009 • To the Editor: Let’s not forget that health care is also already rationed by socioeconomic status: the very poor are covered by government plans, and the very rich can afford whatever treatment they want. It’s we folks in the middle who are left holding the bag. Ted Claire Berkeley, Calif., June 17, 2009 • To the Editor: David Leonhardt is correct that health care in the United States is rationed. Our present system reflects a flawed value system of society that does not recognize the value of the time, judgment and advice of a fully trained primary-care physician. Payment is for actions taken. This is different from the other learned professions. Thoughtful, conscientious evaluation and management require more time and fewer actions than third parties pay for. This changes good primary-care doctors into referral centers to specialists. Paying for time and not just actions is a prerequisite for meaningful reform. The cultural desire to know what is wrong immediately is another cause of higher costs. Immediacy requires myriad tests and imaging done quickly. Careful observation for a time can be just as effective, safer and less costly. Another prerequisite for lowering costs is for our national culture to develop some patience. Marcus M. Reidenberg New York, June 17, 2009 The writer, a medical doctor, is a professor of pharmacology, medicine and public health at Weill Cornell Medical College. • To the Editor: “Doctors and the Cost of Care” (editorial, June 14) unfairly blames “profligate physician behavior” for high medical spending in the United States. Contrary to what the Dartmouth researchers claimed, regions with high Medicare per capita spending are not necessarily wasting money. Medicare spending per capita is an inaccurate proxy for overall medical spending. Atul Gawande, in his New Yorker article cited in the editorial, relies on the Dartmouth Medicare data to identify McAllen, Tex., as the town with the highest per capita medical spending next to Miami. But there are reasons other than physician behavior that explain Medicare costs in McAllen. It is a border town and cares for many newcomers who are uninsured and can’t pay. Therefore costs are shifted to insurance programs like Medicare. In addition, to the extent actual medical spending per capita is high in McAllen, Dr. Gawande points out other reasons. McAllen’s population drinks 60 percent more than average and has a 38 percent obesity rate. Most doctors put their patients first, and many doctors provide free treatment when a patient cannot pay. What a shame doctors are being vilified in the name of reform. Betsy McCaughey New York, June 15, 2009 The writer is chairwoman of the Committee to Reduce Infection Deaths and a former lieutenant governor of New York State. • To the Editor: I was disturbed to see your editorial suggest that the blame for “ever rising premiums” falls primarily on physicians. Let’s give credit where credit is due. Between 2000 and 2007, the 10 largest publicly traded insurance companies increased their profits 428 percent, from $2.4 billion to $12.9 billion, according to Securities and Exchange Commission filings. During the same period, the number of insurers fell by nearly 20 percent, largely because of a huge wave of mergers that led to stunning consolidation. And premiums increased by more than 87 percent, rising four times faster than the average American’s wages. Today, 95 percent of American insurance markets qualify as tight oligopolies. As in so many industries, blind reliance on free-market forces has failed the American public. Clearly, doctors bear a responsibility to curb costs. But the real culprits are the middlemen who, after years of lax regulation, now have such a tight grip on the market that they can — and do — charge whatever they want. David A. Balto Washington, June 14, 2009 The writer is a senior fellow with the Center for American Progress. • To the Editor: Since its founding, Mayo Clinic has paid physicians with salaries to avoid financial conflicts of interest in clinical decision-making, and to promote multi-disciplinary coordination of care. Less well known, but important to Mayo’s early growth, was its principle of billing based on patients’ means. Using a sliding scale, wealthier patients paid more than poorer patients did for the same care. Such means adjustment increased patient volumes, which strengthened Mayo’s expertise and efficiency, benefiting rich and poor alike. Health reform warrants similar means-adjustment principles. Consumer-owned cooperatives could buy high-deductible, low-premium insurance policies, and pay below-deductible bills, using means-adjusted withdrawals from participants’ health savings accounts. Such a plan would improve outcomes and value more effectively than bureaucratic price-setting would. Randall C. Walker Rochester, Minn., June 15, 2009 The writer is a medical doctor at the Division of Infectious Diseases, Mayo Clinic College of Medicine. Copyright 2009 The New York Times Company. BACK TO TOP


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