Tuesday, June 23, 2009

News Clipping Archives

 

Maryland / Regional

Investigation of Go-Getters fire continues (Salisbury Daily Times)

Pregnant, addicted: Mothers battling heroin (Baltimore Sun)

Tanning restrictions get mixed reaction (Salisbury Daily Times)

New agreement reached in battle over foster care (Daily Record)

Del. hospital promoting cord blood donation (Salisbury Daily Times)

 

National / International

Where Can the Doctor Who’s Guided All the Others Go for Help? (New York Times)

Pharma’s Doughnut Deal Could Slow Seniors’ Shift to Generics (Wall Street Journal)

The ABCs of Vitamin D: What Are its Real Benefits? (Wall Street Journal)

HEALTHBEAT: Scientists studying possible protection for babies' brains when moms-to-be drink (Baltimore Sun)

Study: Bad test results often don't reach patients (Baltimore Sun)

Simple appendicitis test under development for children (Baltimore Sun)

Obama to push healthcare, energy reform (Washington Post)

Insurance Industry Warns on Health-Care Proposals (Wall Street Journal)

A Personal, Coordinated Approach to Care (New York Times)

What a Sweat I’m In (New York Times)

Obama, citing his smoking woes, signs tobacco law (Washington Post)

Occasional Smoker, 47, Signs Tobacco Bill (New York Times)

Federal Saving From Lowering of Drug Prices Is Unclear (New York Times)

Panel Sets Guidelines For Fighting Prison Rape (Washington Post)

Crowns Can Be a Royal Pain, Not to Mention a Sign of Aging (Washington Post)

Philly VA to research homelessness among vets (Washington Post)

AIDS: Discrimination in Visa Laws Poses Risk to Those With AIDS, Rights Group Says (New York Times)

 

Opinion

Healing the hospitals (Baltimore Sun Commentary)

Pandemic Reality Check (Washington Post  Commentary)

Safety first (Cumberland Times-News Editorial)

When Parents Need Help (Washington Post Letters to the Editor – 5 total)

A Puff of Fresh Air (Washington Post Letter to the Editor)

 

 

Maryland / Regional

Investigation of Go-Getters fire continues

 

By Earl Holland

Salisubury Daily Times

Tuesday, June 23, 2009

 

SALISBURY -- An investigation continues into the cause of a suspected arson at a psychiatric rehabilitation center over the weekend.

 

On Saturday at 7:43 p.m., members of the city fire department responded to an automatic fire alarm at the Go-Getters Center in the 400 block of East Main Street.

 

Assistant Chief Jim Gladwell of the Salisbury Fire Department, who was on the scene, said the nature of the fire was unknown until crews entered the building and encountered smoke.

 

"We when we arrived, we were unaware of a fire until we got inside the building," he said. "You don't know what's on fire until you actually see it."

 

Once inside, firefighters noticed the building had been ransacked and that gasoline had been poured inside, according to a Maryland State Fire Marshal's Office report.

 

Also during the blaze, firefighters reported there were several small fires set, but firefighters reported that those burned out without needing to be extinguished and before any extensive damage was caused.

 

The Main Street branch of Go-Getters provides day programs and classes on daily living to Wicomico County residents.

 

The Fire Marshal's Office reported that damages are estimated at $50,000.

 

Calls made to the Main Street location were not returned Monday, but an answering machine message said that the facility was open for regular business hours, which are from 8 a.m.-4 p.m.

 

Currently, no additional information was available regarding the status of the investigation.

 

Anyone with information is asked to call the Maryland State Fire Marshal's Office at 410-713-3780 or the Maryland Arson Hotline at 800-492-7529.

 

Copyright 2009 Salisbury Daily Times.

 

Pregnant, addicted: Mothers battling heroin

The effects of methadone on babies is not fully understood. But for expectant women who can't get clean without it, it might be their best hope

 

By Stephanie Desmon

Baltimore Sun

Tuesday, June 23, 2009

 

Lisa Pulley's fourth daughter was born last week. She put the first three up for adoption long ago because she couldn't -- really, wouldn't -- stop using crack cocaine and heroin long enough to focus on them.

 

The eighth-grade dropout has never held a job. She has been too busy selling sex for drugs, living on the street so she could afford drugs. There was no room in her life for children.

 

But this time, Pulley swears, she is ready. This time, she keeps telling herself, will be different. This time, she wants to keep the baby.

 

When the 37-year-old became pregnant, she enrolled in an intensive drug treatment program in Baltimore -- one where she has been getting methadone to help fight against her drug cravings.

 

In 40 years as a treatment for heroin addiction, methadone -- a synthetic opiate that satisfies the addict's physical hunger for the illicit drug -- remains the gold standard. But its effects on children born to women who take it still are not fully understood. The U.S. Food and Drug Administration has not approved its use in pregnant women, and about half of the babies will suffer a potentially harmful withdrawal after birth.

 

Still, addiction researchers say such babies are much better off than those whose mothers continued to shoot heroin. The greatest danger to the fetus of a heroin addict comes from the withdrawal the mother constantly cycles through as she searches for her next hit. And those who are prostituting themselves to procure the drug are exposed to the risk of contracting new infections, being raped or even killed in the process.

 

Yet the women still are taking a narcotic, at a time when many expectant mothers worry about having a sip of wine or drinking a cup of coffee.

 

"Most people, when you say 'methadone and pregnancy,' it's like, 'Oh my God, what are you doing?'" said Vickie L. Walters, program director at the Center for Addiction and Pregnancy at Johns Hopkins Bayview Medical Center.

 

"The ideal would be that she use nothing, that nothing gets into her system. But that's not the norm and that's the exception. It's better to have them on a safe, legal medication."

 

Dr. Christopher Welsh, an addictions psychiatrist at the University of Maryland Medical Center who treats pregnant women regularly, said "pregnancy just goes better" when addicts are on methadone. On methadone, they are not high, as the long-acting drug allows them a feeling of stability. Still, "methadone hasn't been studied as well as we would like," he said.

 

There is no direct evidence that babies are harmed over the long term by methadone. Often the children grow up in chaotic homes, where they may see violence, be exposed to lead paint and subpar schools or have mothers who return to hard drugs and the lifestyle that goes with them.

 

"It's hard to tease out how much is the drug specifically and how much is the environment," Welsh said. According to 2007 federal data, approximately 5 percent of pregnant women aged 15 to 44 years admitted to having used illegal drugs in the past month, significantly lower than the 9.7 percent of non-pregnant women in that age group. Many also use alcohol or use cigarettes while pregnant. They know the risks that drug use poses to their unborn children. But that doesn't mean they are ready to abandon habits that have become part the fabric of their lives.

 

"There's a tremendous amount of guilt and stigma that these women walk in the door with," said Hendrée Jones, research director at the Center for Addiction and Pregnancy. "They know putting a drug inside their body is harming them and the baby. They shoot up and they cry."

 

The Bayview center, which is also known as CAP, has been around for nearly 20 years. It was born out of a methadone clinic that in the mid-80s started seeing a handful of pregnant women at its doorstep. Women weren't its usual clients then, let alone those expecting children.

 

The director of the clinic wasn't comfortable giving methadone to pregnant women, Walters said. But he did want them to get prenatal care. The women weren't interested. So he brought in an obstetrician and made check-ups mandatory if they wanted methadone. He got 100 percent compliance.

 

In 1991, CAP opened its doors. The idea was a "one-stop shopping model," Jones said. There is methadone distribution, individual and group therapy, nutrition counseling, an obstetric clinic and a pediatric clinic. Most of the women are in extensive outpatient treatment, but many start out in the residential unit, which can be used for detox or as a timeout of up to 28 days from a drug-using life on the streets.

 

CAP used to offer more programs than it does now, but 98 percent of its patients are on medical assistance, and Medicaid doesn't pay for what it once did. Once the center sent vans into the neighborhoods to pick up the women; now staff give out bus fare. They used to treat women for two years following the birth of their babies. Now, they're covered only for a maximum of three months.

 

Time was, women could come in for counseling seven days a week. Now only the newer patients are allowed on the weekends.

 

On a recent morning in group therapy, crowded into a small room clearly too warm for them, the women complain about that.

 

Several say they would come on Saturdays or Sundays if they could. Many have lost custody of their children or are living away from home while they try to shed the drug life. They find themselves with little to do. "Having idle time on the weekends is dangerous," one says.

 

They are talking about success stories today, as they absently fidget in their uncomfortable seats. One chomps on Fritos from the vending machine. Another puts stickers on her painted toenails. Another is cleaning a spot off her T-shirt with a Tide pen. But they are all listening to the stories -- some familiar, some inspiring.

 

One woman, in a flowered tank top, proudly announces she is getting an unsupervised visit with her children in a few days, the first time they have all been together in two years. One is now healthy enough to start planning a birthday party for her two young sons -- a celebration she missed because of her addiction. The others applaud.

 

Another woman, though, is worried. Next week marks the anniversary of the death of another baby she had and she isn't sure she is strong enough to stay clean.

 

"You have come so far," one of the women tells her. The others nod. This is the only place where they get this kind of affirmation that yes, they are on the right track.

 

But a spirited debate soon erupts about whether they are technically clean. Many of the women are on methadone -- about half of the women are put on the drug at enrollment, Walters says, but the rate rises to 85 percent by the time of delivery. One says she went to a narcotics anonymous meeting where she took a key chain for being sober, only to be scolded by another participant who told her being on methadone is just like being on heroin as far as she was concerned. She was still using a narcotic as a crutch to get her through the day.

 

The women in CAP are a racially diverse group, with more white patients than black in recent years. The women typically are older and have been through drug treatment before. Still, a quarter will test positive for drugs beyond methadone when they give birth. Some of the women even return to the program when they are pregnant again.

 

Walters doesn't know the relapse rate. She doesn't have the funds to follow the women.

 

With so little known about methadone and its effects on moms and babies, research is a major component of CAP. A current study, being done at eight sites across the world, is comparing the outcomes of babies whose mothers have been on methadone versus those who have taken buprenorphine, a similar drug which comes in pill form, freeing users from daily trips to the methadone clinic.

 

A pilot study found the outcomes the same for mothers but babies spent an average of 13 fewer days in the hospital when they took bupe, Jones says. The positive trend, though not definitive, was for babies with birth weights and head sizes closer to the norm. Jones said she hopes her study will provide the data necessary to help get each drug FDA-approved for use by pregnant women.

 

Another study is looking at whether different doses of methadone have an impact on whether a baby suffers withdrawal -- called neonatal abstinence syndrome -- or how severe it is.

 

Juliann Mason, 28, was forced off drugs when she was in the city jail for three months last year. It was long enough for her to stop using the heroin she came to by way of Vicodin and OxyContin abuse.

 

But as soon as she was out the door she was using again. And then she got pregnant. Her daughter is due in August. Now she is on methadone and working hard at recovery. She doesn't want to live on the street anymore or dance on the Block. She wants to go to nursing school. She wants to be able to care for her 10-year-old daughter, who is in the custody of her parents.

 

But for her, that nine months isn't long enough to get well. So she will put her child up for adoption.

 

"I've made a lot of bad decisions in my life," she said. "I feel like this is the best decision I've made in my life."

 

When the baby is born, Mason plans to detox from methadone, too, a blind detox where the amount is slowly lowered and she won't know how much she is getting.

 

She wishes there was a way to not be taking methadone while she is pregnant, but she feels as though this is what is best for her now.

 

"Addiction is really a disease," she said. "It's like diabetes. When somebody gets pregnant they don't stop having diabetes."

 

Pulley, the woman who had her baby last week, says the program has given her new hope.

 

"I don't have to be miserable," the Baltimore woman said. "I don't have to live in abandoned homes. I don't have to have sex with strange men."

 

The way she sees it, this latest pregnancy "wasn't a bad thing."

 

"It was a beautiful thing -- or I'd probably still be out there."

 

Copyright © 2009, The Baltimore Sun.

 

Tanning restrictions get mixed reaction

New legislation, passed in Del. House, would limit the practice based on age

 

By Kristen Smith

Salisbury Daily Times

Tuesday, June 23, 2009

 

FENWICK ISLAND -- Legislation to limit the use of tanning beds by teenagers and children, which passed unanimously in the House on June 18, has garnered mixed reaction among advocates and salon owners.

 

Senate Bill 90 would ban anyone younger than 14 from using a tanning bed without a doctor's order and require children between the ages of 14 and 17 to get parental consent, signed in the presence of the tanning facility operator, before they are allowed to tan.

 

"This is a serious problem in Delaware, and you talk to any dermatologist and they'll tell you about that," said House Speaker Robert F. Gilligan, D-Sherwood Park. "Girls want to look real pretty and tan for their prom and then they find out they have melanoma."

 

The bill, sponsored by Sen. Bethany Hall-Long, D-Middletown, is named after Michelle Rigney, who died at the age of 22 last year from melanoma.

 

"Of course children are going to be at the pool and beach ... we're not banning that," Hall-Long said. "But this bill is about safer practices and education."

 

As a professor of nursing at the University of Delaware, Hall-Long knows a thing or two about melanoma.

 

"It's the No. 2 cause of cancer in the state of Delaware for people ages 15 to 29," she said. "And Delaware is the No. 1 state for melanoma deaths among men."

 

Rigney was a 22-year-old student at the University of Delaware. She was diagnosed at the age of 19 with Stage 1 melanoma. Sixteen months later, doctors found the melanoma had spread to both lungs.

 

After having a portion of one lung removed, she then found the melanoma had spread to her brain and other locations. Rigney underwent numerous treatments to stop the disease's progression, but her options were limited.

 

After learning she had cancer, Rigney became active in the fight against melanoma. She worked with lawmakers to push for laws that warn people about the potential dangers of tanning beds. She also helped found Miles for Melanoma of Delaware, a 5K walk and run to raise funds for research.

 

Serena Mennella, owner of Fenwick Island's Sunkissed Tanning, said although she understands the bill's purpose, it's definitely going to hurt business.

 

"Until now, Delaware had like zero regulations on tanning," she said. "I have a mix of younger and older clients, but certainly the prom-goers and June Bugs are my best customers in the spring and early summer. Now they'd need to run to mom or dad for permission."

 

Mennella, along with other local salon owners, is waiting on a cue from the state as to where she's going next.

 

"I don't know, for instance, if 17 year olds already in my system will be grandfathered in," she said. "No one's told me."

 

So what's the youngest tanner Mennella has seen?

 

"We have whole families come in. The other day, I had a mom with two little girls ... both probably no older than 13," she said. "Mom was with them, so I said OK, but that seemed young to me."

 

Carol Flatley, co-owner of I'd Rather Be Tanning in Ocean View, said with or without mom and dad's approval, she wouldn't allow anyone under 16 to tan.

 

"We don't go as far as to card our patrons, I'll say that much, but at least when you're tanning, you're not wearing makeup," she said. "That's a pretty good showing of age. If I see someone who looks 12 or 13 years old, they're not going to be tanning here."

 

Copyright 2009 Salisbury Daily Times.

 

New agreement reached in battle over foster care

 

By Caryn Tamber

Daily Record

Tuesday, June 23, 2009

 

The state and lawyers for Baltimore City children in foster care have reached a new agreement in their 25-year court battle over the care the children receive.

 

Lawyers for foster children filed suit in 1984 seeking better treatment for the children. In 1988, the two sides reached a consent decree, but that did not end the case. For the past 21 years, the state and the children’s advocates have argued over the extent of Maryland’s compliance with the decree, culminating in the advocates’ 2007 motion asking a judge to find the state in contempt and enforce compliance.

 

Today, parties are jointly filing a new consent decree, which includes provisions for an independent monitor for the foster care system. It also promises a host of specific changes, including keeping children under 13 out of group homes, giving children more health services when they enter the foster care system, and keeping caseworker client loads at 15 children or fewer.

 

“The fact is, we actually do all want the same thing,” said Molly McGrath, director of the Baltimore City Department of Social Services, which runs the foster care program.

 

Copyright 2009 Daily Record.

 

Del. hospital promoting cord blood donation

 

Associated Press

Salisbury Daily Times

Tuesday, June 23, 2009

 

WILMINGTON, Del. (AP) — A Wilmington hospital and two community organizations are promoting the donation of umbilical cord blood in hopes of advancing stem cell research.

 

St. Francis Hospital, Community Blood Services and the Brady Kohn Foundation announced a plan Monday for mothers to donate umbilical cord blood to the hospital.

 

Officials want to encourage more donations of umbilical cord blood, which is used to procure stem cells for research without the destruction of embryos.

 

The research is aimed at finding treatments for dozens of serious diseases.

 

Copyright 2009 The Associated Press. All rights reserved.

 

National / International

Where Can the Doctor Who’s Guided All the Others Go for Help?

 

By Elissa Ely, M.D.

New York Times

Tuesday, June 23, 2009

 

Psychiatry is a relatively safe profession, but it has a hazard that is not apparent at first glance: if you are in it long enough, there may be no one to talk to about your own problems.

 

It is not that way when you start out. Most psychiatric residents spend a good deal of time in therapy with a senior psychiatrist, for a number of reasons — not least, that it is the most intimate way to learn technical magic. Books teach the same thing to everyone who reads them. But no one forgets the crystalline remark their therapist made just to them, and how they viewed themselves differently ever after.

 

At a certain point, though, you stop being the student and become the teacher. You settle into the details of a career — hospital, research, private practice. Roots go down, time passes. Eventually, younger psychiatrists begin to approach you. Now you are the generation above, saving early-morning slots for residents before they head off to clinic and class. You lower fees and accommodate their hurtling, insane schedules. You remember how it was.

 

But no amount of wisdom prevents personal frailty. You are never too old for your own problems. Yet when you are the professional others go to, where do you bring your sorrows and secret pain?

 

Sometimes the situation is clear. During my training there was a formidable psychiatrist who disappeared periodically. Everyone knew she was being hospitalized for a recurrent manic psychosis, and that she would be back to intimidate the trainees as soon as medications had stabilized her.

 

There was an oddness about it, but no dishonor. Actually, her illness made her more impressive. We are taught to explain that mental illness has a biological component responsive to medical treatment, just like diabetes or heart disease. Her example brought conviction to our tone.

 

In my residency, I moonlighted in a medication clinic where an elderly psychiatrist was being treated for a dementia he did not recognize. He could not remember simple requests, raised his cane to strangers, screamed at family members; his wife met with me separately and told me she was ready to leave him.

 

Carefully writing “Dr.” on the top line of each of his prescriptions, I felt undersized and overregarded. Yet he took the pills without question and showed a fatherly interest in my career. Years later, I thought maybe his wife had chosen a student deliberately. My junior status allowed him to maintain his senior status.

 

Often, though, the situation is not straightforward, and medication is not the problem. Life is. Maybe we are overcome, maybe ashamed, maybe despairing. Self-revelation — the nakedness necessary in therapy — is hard when you have been a model to others.

 

“In my situation, it would be difficult to find someone,” Dr. Dan Buie, a beloved senior analyst in Boston, told me. It is not that psychiatrists aren’t waiting in wing chairs all over the city. It is that so many of them are former students and former patients. One generation of psychiatrists grows the next through teaching and treatment.

 

Surrendering that professional identity to become a patient reverses a kind of natural order. “You can’t be a simple patient,” Dr. Buie said. “Anyone I’d go to, I’ve known.” To avoid it, some travel to other cities for therapy (probably passing colleagues in trains heading in the other direction).

 

There is also the factor of experience. It is one thing if my internist is younger than I; she is closer to the bones of medicine, and with any luck we can get to know each other for years before serious illness requires more intimate contact. It is another thing if my therapist is younger than I.

 

“It would be a big mistake not to turn to someone,” Dr. Buie went on, “but I might have some trouble going to younger colleagues. It’s hard to understand the issues that come up in the course of a life cycle unless you’ve lived it yourself.”

 

Dr. Rachel Seidel, a psychoanalyst and psychiatrist in Cambridge, said that when people feel vulnerable, “we want someone with more insight than we have.”

 

“It’s a paradox,” she added. “Do I have to have gone through what you’ve gone through in order to be empathic to you? And yet, I’d have a preference for someone who’s been around longer.”

 

Some look laterally for help. Peer supervision is a well-known form of risk management; presenting troubling professional cases to colleagues prevents folly and mistakes at any age.

 

“I use a couple of peers,” said Dr. Thomas Gutheil, professor of psychiatry at Harvard Medical School. “Then they use me. It’s the reciprocity that’s key — you feel the comfort of telling everything about yourself when you know the reverse is also true.”

 

Other solutions are even closer. The playwright Edward Albee once wrote that it can be necessary to travel a long distance out of the way in order to come back a short distance correctly. The best source of help can be the nearest source of all. An elderly luminary at the Boston Psychoanalytic Society and Institute listened without comment when asked: Whom does he — the doctor others seek out for help — seek out for help himself? He wasted no words.

 

“My wife,” he said crisply.

 

Elissa Ely is a psychiatrist in Boston.

 

Copyright 2009 The New York Times Company.

 

Pharma’s Doughnut Deal Could Slow Seniors’ Shift to Generics

 

By Shirley S. Wang

Wall Street Journal

Tuesday, June 23, 2009

 

PharmaSeniors will be beneficiaries from the new $80 billion agreement of the drug industry to provide discounts for branded medicines to those in the Medicare doughnut hole, but there are a lot of unknowns about who will else will benefit from the deal. One question is how much will the government get from the deal to pay for covering the uninsured, the WSJ and the NY Times note this morning.

 

Further, pharmaceutical companies actually benefit from the agreement if more seniors decide to switch to or stay on brand-name drugs because of the discount coming from the industry. Scott Gottlieb, a former FDA official and adviser at the Centers for Medicaid and Medicare, told the WSJ that the proposal won’t affect the bottom line of drug companies because it “will ultimately discourage patients in the donut hole from switching to generics” because of decreased out-of-pocket costs for branded drugs.

 

Most consumers are price sensitive when it comes to medicine. A fraction will always choose to remain on branded medicines regardless of cost, but the vast majority eventually switch to cheaper generics once they are available. But as the deal announced yesterday will reduce seniors’ out-of-pocket costs for branded medicines closer to those of generics, many may stick with branded medicines rather than switch to generics.

 

And the deal could induce seniors to keep taking those branded meds. “Because of the discounts, Medicare beneficiaries are likely to continue filling prescriptions in the doughnut hole, whereas in the past many stopped taking their medications because the drugs were unaffordable to them,” Barclays analyst C. Anthony Butler told the Times.

 

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

 

The ABCs of Vitamin D: What Are its Real Benefits?

 

By Shirley S. Wang

Wall Street Journal

Tuesday, June 23, 2009

 

SunVitamin D has long been thought to be important to health. This past fall, national pediatric guidelines doubled the amount recommended for kids. And concern over vitamin D deficiency has increased the U.S. demand for testing by 80% to 90% last year, according to an executive quoted by the Financial Times.

 

Now, a large, $20 million government-funded trial is going to study whether vitamin D and fish oil lower the risk of cancer, heart disease or stroke in healthy individuals, reports the Boston Globe. The study will follow 20,000 healthy older adults for five years.

 

The study will also investigate whether vitamin D deficiency is one reason for higher rates of disease in African-Americans. The thought is that it is harder for people with darker skin to make vitamin D from sunlight, and perhaps taking supplements will reduce the risk of some diseases.

 

Researchers believe this to be the first known nutrient study that targets a particular population, according to the Globe. The goal is for 25% of the participants enrolled to be African-American.

 

The public should be cautious and wait for the findings “before jumping on the bandwagon to take megadoses of these supplements,” JoAnn Manson, at Brigham and Women’s Hospital in Boston, told the Associated Press. “We know from history that many of these nutrients that looked promising in observational studies didn’t pan out.”

 

However, “if something as simple as taking a vitamin D pill could help lower these risks and eliminate these health disparities, that would be extraordinarily exciting,” she said.

 

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

 

HEALTHBEAT: Scientists studying possible protection for babies' brains when moms-to-be drink

 

Associated Press

By Lauran Neergaard

Baltimore Sun

Tuesday, June 23, 2009

 

WASHINGTON (AP) - Drinking during pregnancy can seriously harm a baby's brain, yet thousands of mothers-to-be still do. Now scientists have begun testing whether a prenatal nutrient might offer those babies a little protection, part of a growing quest for ways to reverse the damage.

 

The only help today: intense behavioral or educational therapies once children with fetal alcohol-caused disabilities reach preschool or school age, says new research by the Centers for Disease Control and Prevention. The agency is spending $1.5 million this year to start spreading those programs so more youngsters can find care.

 

Better would be discovering a way to short-circuit what scientists now know is a complex chain reaction of toxicity that even moderate drinking during pregnancy - and especially a binge - can trigger in a baby's developing brain.

 

Don't misunderstand: This is not a hunt for a pill to allow women to drink. Even if scientists eventually find a treatment, one medication could never cover all the ways that alcohol harms.

 

"There's not going to be a single treatment that's going to be a panacea," cautions Dr. Jennifer Thomas of San Diego State University, whose animal research sparked interest in the nutrient choline, found in such foods as eggs and liver.

 

But, "there's heightened interest now since despite our best efforts, we haven't eliminated drinking in pregnancy and haven't made a huge dent in it," adds Dr. Christina Chambers of the University of California, San Diego. She is overseeing the first clinical trial - aiming to test 600 pregnant women in Ukraine - to see if prenatal choline might help.

 

About 12 percent of U.S. women drink at least some during pregnancy and 2 percent binge-drink. A CDC study last month concluded those numbers haven't substantially changed since 1991.

 

With 4 million annual births, that adds up. Full-blown fetal alcohol syndrome - a combination of brain, facial and growth abnormalities - is considered a leading preventable cause of mental retardation. There isn't a good count, but the CDC estimates that anywhere from 1,000 to 6,000 U.S. babies a year are born with it. CDC says at least three times as many have less severe alcohol-related neurodevelopmental problems, such as learning disabilities and speech delays.

 

In parts of the world like Ukraine, fetal alcohol syndrome is far more prevalent.

 

Chambers stresses that no one thinks the mom who has a glass of wine the week before learning she's pregnant needs to worry. But because doctors don't yet know the safe limit, health officials say to abstain during pregnancy. How much damage alcohol causes depends on how much the mother consumes, and at what point in gestation.

 

Nutrition plays a powerful role in proper development of the brain and nervous system: Getting enough folate during pregnancy, for example, can prevent spina bifida and related birth defects. And significant alcohol consumption interferes with mom's ability to absorb various nutrients, in turn affecting whether her fetus gets enough.

 

So Thomas' group tested choline, a precursor to a brain chemical that plays a key role in learning. She exposed pregnant rats to alcohol during a third-trimester spurt of brain growth. Giving the mother rats extra choline - or, importantly, giving newborn pups the nutrient - significantly improved the pups' later ability to learn.

 

On to humans: The study in Ukraine is recruiting women who acknowledge drinking while pregnant. They'll be counseled to stop, and then randomly assigned to take either a standard Ukrainian vitamin supplement every day, or that vitamin plus 750 milligrams of choline - more than the 450 mg pregnant women are advised to get from food. About 120 women have been enrolled so far, and researchers expect preliminary results within a year.

 

"Whether you'll be able to intervene when the woman's drinking is highly questionable," acknowledges Thomas, who says future work may need to examine newborn treatment.

 

The choline pathway isn't the only possible target:

 

*  Northwestern University researchers gave alcohol to rats in the equivalent of the second trimester and recorded a stunning alteration in the gene activity of their pups' brains - an alteration that in turn led to markedly lower levels of thyroid hormones in brain regions that control learning, memory and emotional behaviors. Children with fetal alcohol disorders also display abnormalities in thyroid hormones, which play a role in brain development, lead researcher Laura Sittig told a recent meeting of the nation's endocrinologists. The question is whether thyroid hormones might offer a treatment.

 

*  Australian researchers recently found dietary zinc played a role in protecting fetal mice exposed to alcohol even earlier in pregnancy.

 

This is very early stage science. For already affected children, the CDC advises families to seek behavioral training specifically targeted to fetal alcohol disorders - from the math trouble these youngsters frequently have to the common inability to learn through social experiences. Check CDC's Web site - http://www.cdc.gov/ncbddd/fas/intervening.htm - for a description of proven approaches.

___

EDITOR'S NOTE - Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

 

Copyright 2009 Associated Press. All rights reserved.

 

Study: Bad test results often don't reach patients

 

Associated Press

By Carla K. Johnson

Baltimore Sun

Tuesday, June 23, 2009

 

CHICAGO - No news isn't necessarily good news for patients waiting for the results of medical tests. The first study of its kind finds doctors failed to inform patients of abnormal cancer screenings and other test results 1 out of 14 times.

 

The failure rate was higher at some doctors' offices, as high as 26 percent at one office. Few medical practices had explicit methods for how to tell patients, leaving each doctor to come up with a system. In some offices, patients were told if they didn't hear anything, they could assume their test results were normal.

 

"It really does happen all too often," said lead author Dr. Lawrence Casalino of Weill Cornell Medical College. The findings are published in Monday's Archives of Internal Medicine.

 

"If you've had a test, whether it be blood test or some kind of X-ray or ultrasound, don't assume because you haven't heard from your physician that the result is normal," Casalino said.

 

Practices with electronic medical records systems did worse or no better than those with paper systems in the study of more than 5,000 patients.

 

"If you have bad processes in place, electronic medical records are not going to solve your problems," said study co-author Dr. Daniel Dunham of Northwestern University's Feinberg School of Medicine.

 

Dr. Harvey Murff, a patient safety researcher at Vanderbilt University Medical Center who wasn't involved in the study, said the researchers gave doctors "the benefit of the doubt" and still found a significant problem.

 

The researchers chose tests findings in which any doctor would agree patients should be informed. And they gave doctors a chance to explain when they found nothing in medical charts showing patients had been notified of bad test results.

 

The tests included cholesterol blood work, mammograms, Pap smears and screening tests for colon cancer.

 

Failing to inform patients can lead to malpractice lawsuits and increased medical costs, the researchers said.

 

"If bad things happen to patients that could have been prevented, that will lead to higher costs and in some cases considerably higher costs," Casalino said.

 

Researchers reviewed the medical records of more than 5,000 randomly selected patients, ages 50 to 69, in 23 primary care practices in the Midwest and on the West coast. They excluded dying patients and others with severe medical conditions where informing a patient would be redundant.

 

They surveyed doctors about how their offices manage test results. The offices that followed certain processes -- including asking patients to call if they don't hear any news -- were less likely to have high failure rates.

 

The study was funded by the California HealthCare Foundation.

 

"Our goal is not to indict physicians," Dunham said. "It's about working smarter and getting processes in place."

___

On the Net:

Archives: http://www.archinternmed.com

 

Copyright 2009 Associated Press. All rights reserved.

 

Simple appendicitis test under development for children

Researchers link a chemical in children's urine to appendicitis. Emergency rooms could test for it, preventing unnecessary surgery and increasing the chance of removing the appendix before it bursts.

 

By Thomas H. Maugh II

Baltimore Sun

Tuesday, June 23, 2009

 

Researchers have identified a chemical in urine that is closely associated with appendicitis in children and are working to develop a simple test that could be used to diagnose the condition -- a test that would both increase the likelihood of performing surgery before the appendix bursts and prevent unnecessary surgery.

 

Preliminary results show that the test is highly accurate, producing very few instances in which cases are missed (false negatives) or children are incorrectly diagnosed with the condition (false positives), a team from Children's Hospital Boston reported today in the Annals of Emergency Medicine.

 

Appendicitis is the most common childhood surgical emergency. The lifetime prevalence of appendicitis is 9% for males and 7% for females, but the bulk of the cases occur in childhood or adolescence. In the past, diagnosis was made simply from clinical symptoms, such as abdominal pain, and as many as 30% of cases in which surgery was performed revealed a healthy appendix.

 

Within the last few years, emergency room specialists have begun using CT scans for diagnosis, which reduces the number of unnecessary surgeries to as low as 5%. But in as many as 30% to 45% of those diagnosed with appendicitis, the organ has already ruptured at the time of surgery, leading to a variety of complications that lengthen hospital stays.

 

There has also been a growing reluctance to use CT scanners on children because of the risk that the radiation will trigger cancer later in life.

 

Dr. Richard Bachur and his colleagues studied urine from healthy children and those with surgically confirmed appendicitis, and concluded that high levels of one chemical, leucine-rich alpha-2-glycoprotein or LRG, correlated very closely with an inflamed appendix. Tests in 67 children showed that the amount in the urine was correlated to the severity of the inflammation, and the number of false positives and false negatives associated with its use were each less than 3%.

 

The team is now studying a larger number of urine samples and is working "feverishly" to develop a simple test for LRG that could be used in emergency rooms, Bachur said. "We could take urine and, in minutes, have an answer," he added.

 

He cautioned that the team has not yet studied potential markers in adults and they don't know whether the same test would work. "Adult diseases are a little different," Bachur said.

 

Copyright © 2009, The Los Angeles Times

 

Copyright 2009 Baltimore Sun.

 

Obama to push healthcare, energy reform

 

Reuters

By Jeff Mason

Washington Post

Tuesday, June 23, 2009

 

WASHINGTON (Reuters) - President Barack Obama will throw his weight behind legislative bids to reform healthcare and cut U.S. greenhouse gas emissions on Tuesday in his fourth White House press conference since taking office.

 

Obama, who has focused his first five months as president on trying to end the recession, is likely to discuss his plans to create jobs and stem unemployment, which economists expect will hit 10 percent in coming months.

 

The president will also be watched closely for further changes in his tone toward Iran following a contested presidential election that has sparked massive unrest.

 

Obama has sharpened his criticism of the Iranian government for cracking down on demonstrators while trying to avoid the appearance of meddling.

 

"The president wants to ensure that he doesn't become a political football that the regime uses against anybody that seeks justice in Iran," White House spokesman Robert Gibbs told NBC's "Today" show.

 

"I absolutely think we've seen the beginnings of change in Iran," he added.

 

On Monday Gibbs told reporters the president would touch on the economy, Iran, healthcare and energy at his news conference, which begins at 12:30 p.m. EDT (1630 GMT).

 

Legislation on two of Obama's signature issues -- covering 46 million Americans who do not have health insurance and capping carbon dioxide pollution from major industries -- is currently moving through the U.S. Congress.

 

But both bills face obstacles. Lawmakers are worried about the $1 trillion healthcare reform is expected to cost over the next 10 years, while the climate bill's chances of passage, though more positive in the House of Representatives, are less clear in the Senate.

 

Obama hopes to shore up support on both issues while addressing international crises including Iran and tension on the Korean peninsula.

 

He is scheduled to make an opening statement at the news conference, which will be held in the White House press room instead of the originally planned Rose Garden because of humidity, and then take questions for about an hour.

 

The news conference comes as Obama, who remains personally popular with a majority of the American public, has seen polls showing declining satisfaction with his policies.

 

A newly released Washington Post/ABC News poll showed only about half of Americans believe the president's $787 billion stimulus package will boost the economy.

 

Later in the afternoon Obama is scheduled to meet with Chilean President Michelle Bachelet.

 

(Editing by Vicki Allen)

 

© 2009 Reuters.

 

Insurance Industry Warns on Health-Care Proposals

 

Associated Press

Wall Street Journal

Tuesday, June 23, 2009

 

WASHINGTON -- The insurance industry Tuesday laid down a marker on health care, warning in stark terms that a proposed government insurance plan would dismantle the employer coverage Americans have relied on for a half century and overtake the system.

 

In a joint letter to senators, the two largest industry groups also said they don't believe it's possible to design a government plan that can compete fairly with private companies in a revamped health care market. That particular statement seemed to be aimed at lawmakers of both parties who are seeking a compromise on the contentious issue.

 

Release of the letter from America's Health Insurance Plans and the Blue Cross Blue Shield Association came as House Democrats pushed forward with a partisan health care bill. Meanwhile, key Senate Democrats were still laboring to achieve an elusive bipartisan compromise on President Barack Obama's top legislative priority of controlling costs and providing health coverage to 50 million uninsured Americans.

 

Recent media polls have found strong public support for the idea of a government plan. It would compete with private companies to offer coverage to individuals and small businesses, but eventually might be opened to large employers as well. The positive public reaction to the idea has emboldened liberals, who are arguing that Democrats shouldn't compromise.

 

The insurers suggested a government plan would run counter to Mr. Obama's promise that Americans can keep the coverage they have.

 

"A government-run plan no matter how it is initially structured would dismantle employer-based coverage, significantly increase costs for those who remain in private coverage, and add additional liabilities to the federal budget," said the letter from AHIP chief Karen Ignagni and Scott Serota, the head of Blue Cross.

 

Supporters of a public plan say just the opposite would happen -- that competition would force private insurers to cut administrative overhead and profits, putting a brake on costs all around.

 

"We do not believe that it is possible to create a government plan that could operate on a level playing field. Regardless of how it is initially structured, a government plan would use its built-in advantages to take over the health insurance market," added the industry letter.

 

Instead, the industry says it is ready to accept close government regulation to protect consumers. Dated June 19, the letter was addressed to Sen. Edward M. Kennedy (D., Mass.).

 

Sen. Kennedy's committee, the Health, Education, Labor and Pensions panel, has not yet finished its design for a government plan. Bogged down in delays and partisan strife, the panel jettisoned an end-of-week deadline for passing its bill.

 

Deliberations on both sides of the Capitol are continuing with lawmakers mindful of next week's July 4 congressional recess. Most will return home to face constituents with plenty of questions about their plans to overhaul the nation's costly health care system.

 

A sweeping bill unveiled in the Democratic-controlled House last week is being weighed in hearings that got under way Tuesday. The draft legislation, written without Republican help, would require all Americans to purchase health insurance and would put new requirements on employers, too.

 

First lady Michelle Obama, one of the administration voices seeking to rally support for health care overhaul, said "no system is going to be perfect." However, she argued the nation was ready for change.

 

"The country has moved to another point in time," she said on ABC's "Good Morning America." "It's not going to be easy, but you have more people who are ready to try to figure it out. And hopefully that will ultimately make the difference this time around. "

 

Mr. Obama's goal for signing a bill in October appears in doubt.

 

But Sen. Max Baucus (D., Mont.), chairman of the Senate Finance Committee, is doggedly pursuing a compromise. "We will get a bipartisan agreement," he insisted Monday.

 

Of the five House and Senate committees working on health care, Finance is the only one that appears to have a chance at a bipartisan agreement. Baucus planned to huddle behind closed doors Tuesday with a group of senators he's dubbed the "coalition of the willing." Others involved are top committee Republican Charles Grassley of Iowa; Republicans Mike Enzi of Wyoming, Orrin Hatch of Utah and Olympia Snowe of Maine; and Democrats Kent Conrad of North Dakota and Jeff Bingaman of New Mexico.

 

Looming large is the question of cost. Initial estimates had Senate plans topping $1.6 trillion over 10 years, and senators are working to scale back. Curbs on Medicare and Medicaid spending are assured, and a range of taxes are under consideration, along with the possibility of fees on employers who don't cover their employees.

 

The Senate's health committee is waiting for revenue estimates from the Congressional Budget Office on three scenarios for employer requirements, according to Sen. Chris Dodd (D., Conn.), who's leading the committee during Sen. Kennedy's treatment for brain cancer. They are a requirement that employers provide health coverage for employees or pay a fee; an approach requiring employers to chip in to the federal treasury for employees who are covered under public plans; and a scenario where employers who don't cover their employees would pay the government a set amount per employee.

 

Copyright © 2009 Associated Press

 

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

 

A Personal, Coordinated Approach to Care

 

Personal Health

 

By Jane E. Brody

New York Times

Tuesday, June 23, 2009

 

To the Odom family of Durham, N.C., Dr. Gloria M. Trujillo is a savior. Johnny Odom, at 57, has congestive heart failure, diabetes, kidney failure, high blood pressure, gout, high cholesterol and blindness in one eye. His daughter, Tonia, 35, has rheumatoid arthritis, and her 10-year-old son has asthma, a seizure disorder, high blood pressure, prediabetes and sleep apnea.

 

Dr. Trujillo, a primary care physician at the Family Medicine Center at Duke University, takes care of them all, coordinating the care they receive from various specialists via electronic records and e-mail. Ms. Odom uses the clinic’s online health portal to get the family’s medical information, make appointments and check the lab results Dr. Trujillo sends her.

 

Ms. Odom is especially pleased with the time the doctor takes to explain their medical problems and motivate her son to walk every day, which helps him maintain his weight and lower his blood pressure so he no longer needs medication.

 

At the same time, the extraordinary care the family receives, which is financed by Medicare and Medicaid, saves money by preventing medical complications and keeping the Odoms out of the hospital.

 

The Duke clinic represents a promising approach to delivering better health care: the so-called medical home. As President Obama and Congress try to create a national system that provides better care for more people at lower cost, you are likely to hear a lot more about this idea.

 

The term, coined by the American Academy of Pediatrics in 1967, is admittedly confusing. It does not mean a return to house calls. Nor need it apply only to people with complex health problems like those of the Odom family.

 

Rather, it is an approach in which each person has a primary care doctor who heads a team of professionals — perhaps including a physician assistant, a nurse practitioner, a dietitian, a social worker and a pharmacist — to provide round-the-clock access to care.

 

It is unlike managed care, in which primary doctors act as gatekeepers to specialists and the overriding goal is not managing care but managing costs. In a medical home, the family doctor helps patients get specialty care when they need it and, through electronic records, keeps careful track of treatments and informs specialists of the patients’ progress. The connections between the professionals who work on each case are seamless and convenient. Doctors and patients have easy access to medical information, and patients with chronic ailments are called regularly to reinforce treatment regimens and see how they are doing.

 

“I love this clinic,” Ms. Odom told me in an interview. “Everyone’s so friendly and knows you by your first name. I never have to wait more than a few minutes, and there’s a board that tells you how long the wait is.”

 

She added: “I feel really cared for. If my arthritis flares up, someone gets back to me the same day with the prescription I need. Dr. T taught us about heart failure and how to recognize danger signs so I know when to get my father to the emergency room.”

 

Focus on Prevention

 

There are now medical homes in more than a dozen states, many of them serving Medicaid patients. Their proponents say they save money because they focus on prevention and prompt attention to emerging problems, which can prevent costly complications. Some major health insurers are also testing patient-centered medical homes.

 

Medicare, until recently a holdout, now has a medical home demonstration project under way. If successful, it could have two huge benefits: it could help the Medicare system remain solvent as the older population grows, and it could result in coordinated care that emphasizes wellness rather than a fragmented, difficult-to-navigate system based on costly acute care.

 

An 81-year-old friend with multiple health problems complained recently that she was seeing an orthopedist, a rheumatologist, an oncologist, an ophthalmologist and an endocrinologist but had no doctor to oversee and coordinate her overall care.

 

The medical home concept has won the support of the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians and the American Osteopathic Association, among others. Bipartisan legislation in Congress would support medical homes in the Medicaid and children’s health insurance programs, which are jointly financed by the states and the federal government.

 

In The Journal of the American Medical Association last month, Dr. Diane R. Rittenhouse, a family and community medicine specialist at the University of California, San Francisco, and Stephen M. Shortell, dean of the School of Public Health at the University of California, Berkeley, wrote that in a patient-centered medical home, care was tailored “to meet the needs and preferences of patients.” Rather than passive recipients, patients would be “more active, prepared and knowledgeable participants in their care.”

 

Having a continuous healing relationship with a personal physician has been shown in a review of 40 studies to significantly improve health outcomes.

 

The Whole Patient

 

Another virtue of the medical home is an emphasis on the whole patient and the patient’s environment, rather than a specific disease or body part. Patients, doctors and families work together to make health care more effective and reduce its costs.

 

Dr. Atul Grover, an assistant vice president of the Association of American Medical Colleges, said in an interview that the medical home approach could revitalize student interest in primary care, which has been hemorrhaging doctors as their workloads increase and incomes and professional satisfaction shrink relative to those of specialists like cardiologists and orthopedists.

 

“The incentives in our current payment system are at odds with efforts to increase our focus on prevention, disease management and other aspects of patient-centered care,” Dr. Grover said. “Procedures are often reimbursed at a much higher level than cognitive services.

 

“If a physician spends 10 minutes intubating a patient in a hospital, that physician may be reimbursed more than a physician who spent twice as much time taking a patient history and creating a treatment plan.”

 

Dr. Shortell said the medical home concept required a new payment system, like “a single payment for both doctors and hospitals that gives them an incentive to work together to keep patients well.” Electronic health records, vital to the effectiveness of a medical home, are especially useful in rural areas where practitioners can be connected in a “virtual medical home,” Dr. Shortell said.

 

Dr. J. Lloyd Michener, chairman of community and family medicine at Duke, said that in the future, “we will have to train doctors to be members of teams — both within the office, where people are seen before they get sick, and within the community, to help create healthier environments.”

 

Copyright 2009 The New York Times Company.

 

What a Sweat I’m In

 

Q & A

 

By C. Claiborne Ray

New York Times

Tuesday, June 23, 2009

 

Q. How can you distinguish between night sweats that indicate a serious medical condition and those that don’t?

 

A. There is no easy way for a layperson to do so, but there are some clues, said Dr. Shari R. Midoneck, an internist at Iris Cantor Women’s Health Center in New York. Night sweats that are a matter of concern soak through your pajamas repeatedly, she said. And “if other symptoms are associated with them, like fever, weight loss, swollen lymph nodes and extreme fatigue, then this could be serious and you should see a doctor.”

 

Night sweats on a warm night are probably normal in those who feel fine otherwise, in younger women around their periods or in older women around menopause, Dr. Midoneck said.

 

Dr. Carla Boutin-Foster, who teaches at NewYork-Presbyterian/Weill Cornell Medical Center, narrowed the definition to drenching sweats when it is not too warm. Other symptoms that can indicate a severe problem, she said, include itching, cough, sputum production, shortness of breath, palpitations, chest pain and diarrhea.

 

Some possible causes of serious night sweats include acute or chronic infections, lymphoma and other tumors, low blood sugar in patients with diabetes, and some medications.

 

Anyone with night sweats plus other symptoms should be seen by a doctor, Dr. Boutin-Foster said, especially people with a known chronic medical condition. Even those with no other symptoms should monitor the sweats and keep a record of temperature, medications and foods, she said, and anyone with persistent sweats should also be evaluated.

 

Copyright 2009 The New York Times Company.

 

Obama, citing his smoking woes, signs tobacco law

 

Associated Press

By Philip Elliott

Washington Post

Monday, June 22, 2009

 

WASHINGTON -- Lamenting his first teenage cigarette, President Barack Obama ruefully admitted on Monday that he's spent his adult life fighting the habit. Then he signed the nation's toughest anti-smoking law, aiming to keep thousands of other teens from getting hooked.

 

Obama praised the historic legislation, which gives the Food and Drug Administration unprecedented authority to regulate what goes into tobacco products, to make public the ingredients and to prohibit marketing campaigns geared toward children.

 

But he didn't say how his own struggle was coming since he moved into the White House. And aides were no more forthcoming.

 

As senator, candidate and now president, Obama has veered between frank and cagey about his personal battle with smoking.

 

He promised his wife, Michelle, more than two years ago that he would quit if she let him seek the White House.

 

He has often acknowledged since that he has "fallen off the wagon." But he hardly ever provides specifics. And though White House aides pack nicotine gum in their jackets to help him resist, they also refuse to give a clear answer to the question of whether the president still sneaks a smoke now and again.

 

"I hate it," Michelle Obama told CBS' "60 Minutes" during the presidential campaign's early days. "That's why he doesn't do it anymore, I'm proud to say. I outed him - I'm the one who outed him on the smoking. That was one of my prerequisites for, you know, entering this race is that, you know, he couldn't be a smoking president."

 

Well, not exactly.

 

During Obama's two-year White House bid, he was known to occasionally bum a cigarette from a staff member - while also making sure to emphasize his efforts to stop for good and his progress from his onetime five-smoke-a-day average.

 

During Monday's bill signing, Obama focused on how the new law would help keep future generations of kids away from the dangerous habit. The president mentioned his own experience very briefly - just 30 words.

 

Almost 90 percent of people who smoke began at 18 or younger, he said.

 

"I know. I was one of these teenagers," he said. "And so I know how difficult it can be to break this habit when it's been with you for a long time."

 

And then he went back to the merits of the bill and the shortcomings of the tobacco industry, which he accused of targeting young people. One key provision in the new law bans candy-flavored cigarettes and the use of other flavored smokes that might appeal to teenagers. Ads aimed at young people also are banned.

 

Aides refused to elaborate on his own situation.

 

White House press secretary Robert Gibbs said he hadn't asked Obama about his smoking and made plain that he didn't plan to. The presidential spokesman stuck to vague language that left the impression Obama still occasionally falls off the wagon, but he did not say so directly.

 

"I don't, honestly, see the need to get a whole lot more specific than the fact that it's a continuing struggle," Gibbs said. "He struggles with it every day."

 

Still, it's not as if Obama was ever even a pack-a-day puffer.

 

"I've never been a heavy smoker," Obama told The Chicago Tribune in 2007. "I've quit periodically over the last several years. I've got an ironclad demand from my wife that in the stresses of the campaign I don't succumb. I've been chewing Nicorette strenuously."

 

© 2009 The Associated Press.

 

Occasional Smoker, 47, Signs Tobacco Bill

 

By Jeff Zeleny

New York Times

Tuesday, June 23, 2009

 

WASHINGTON — President Obama does not discuss the fact that he still occasionally smokes, a habit he very publicly tried to kick during his race for the White House.

 

But there he was on Monday, talking about cigarettes. As he signed legislation bringing tobacco products under federal control for the first time, the president conceded that the new law, aimed at keeping children from starting to smoke, could have helped him three decades ago.

 

Mr. Obama noted that 90 percent of smokers began on or before their 18th birthday.

 

“I know — I was one of those teenagers,” he said, standing beneath a punishing afternoon sun at a Rose Garden ceremony. “I know how difficult it can be to break this habit when it’s been with you for a long time.”

 

With that, Mr. Obama moved on. He did not mention whether he still smokes, a topic that has been a subject of considerable curiosity, and family drama, for years. Instead, he talked about the dangers of the addiction and its causes.

 

“Kids today don’t just start smoking for no reason,” he said. “They’re aggressively targeted as customers by the tobacco industry. They’re exposed to a constant and insidious barrage of advertising where they live, where they learn and where they play.”

 

The new law, the Family Smoking Prevention and Tobacco Control Act, allows the Food and Drug Administration not only to forbid advertising geared toward children but also to lower the amount of nicotine in tobacco products, ban sweetened cigarettes that appeal to young taste buds and prohibit labels like “light” and “low tar.”

 

When Mr. Obama entered the presidential race, he said his candidacy had been contingent on a deal with his wife, Michelle, that he quit smoking. The couple discussed his habit on “60 Minutes,” where Mrs. Obama declared, “I hate it.”

 

“That’s why he doesn’t do it anymore, I’m proud to say,” she continued. “I’m the one who outed him on the smoking. That was one of my prerequisites for, you know, entering this race, is that he couldn’t be a smoking president.”

 

Now there are few touchier questions inside the White House than whether Mr. Obama is still smoking. One senior administration official declined to answer, but pointed out that the president spoke Monday in the present tense, saying, “I know how difficult it can be to break this habit,” as opposed to “I know how difficult it was to break this habit.”

 

As Mr. Obama shook hands with some of the guests at the bill-signing ceremony, he wandered near a group of reporters. Dan Lothian, a correspondent for CNN, asked, “Mr. President, how difficult has your struggle been with smoking?”

 

The president, a mere few feet away, did not reply.

 

Several minutes later, the question came up at the daily White House press briefing. When asked directly if Mr. Obama was still smoking, Robert Gibbs, the president’s press secretary, replied: “He struggles with it every day. I don’t honestly see the need to get a whole lot more specific than the fact that it’s a continuing struggle.”

 

Copyright 2009 The New York Times Company.

 

Federal Saving From Lowering of Drug Prices Is Unclear

 

By Robert Pear

New York Times

Tuesday, June 23, 2009

 

WASHINGTON — The White House on Monday hailed what it described as a “historic agreement to lower drugs costs” for older Americans, but it was not immediately clear how much the government would reap in savings that could be used to pay for coverage of the uninsured.

 

As part of the agreement, pharmaceutical companies promised to help narrow a gap in Medicare coverage of prescription drugs that is known as the doughnut hole.

 

As Mr. Obama described the gap, “Medicare covers up to $2,700 in yearly prescription costs and then stops, and the coverage starts back up when the costs exceed $6,100.”

 

Drug companies said they would give most beneficiaries a 50 percent discount on brand-name medicines bought when they hit the gap in coverage.

 

This could be a boon to Medicare beneficiaries, and AARP praised the deal. But drug company lobbyists and Senate aides said that none of these savings would accrue to the government, which has no liability for a patient’s drug costs in the coverage gap. Indeed, that is the problem for beneficiaries: they are responsible for the entire cost of drugs in the gap.

 

Charles A. Butler, a pharmaceutical analyst at Barclays Capital, the investment bank, said the drug industry was offering an olive branch to Congress and the White House, in contrast to its “vociferous disagreement” with President Bill Clinton’s proposals in 1993-94.

 

In an interview, Mr. Butler said he did not think the latest concessions would have “a material adverse impact” on drug company earnings. “Because of the discounts,” he said, “Medicare beneficiaries are likely to continue filling prescriptions in the doughnut hole, whereas in the past many stopped taking their medications because the drugs were unaffordable to them.”

 

Congress and the White House are frantically seeking ways to help pay for legislation securing coverage for all Americans. The cost of the bill could top $1 trillion over 10 years.

 

The lobby for drug companies, the Pharmaceutical Research and Manufacturers of America, or PhRMA, said it had pledged $80 billion over 10 years to help “reform our troubled health care system.” The commitment came in a deal with the White House and Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee.

 

Mr. Obama described the agreement as a “significant breakthrough on the road to health care reform.”

 

But Senate aides and drug company lobbyists said the $80 billion reflected total projected savings to the health care system and included unspecified future concessions, besides the drug discounts in the coverage gap.

 

Some of the $80 billion reflects savings to the government. Some reflects savings to older Americans. But all the savings from closing the doughnut hole would go to beneficiaries, not the government, Senate aides said.

 

Reid H. Cherlin, a White House spokesman, said: “Of the $80 billion, we estimate that $30 billion could be used for the doughnut hole and passed on to seniors. The other $50 billion could go to health care reform, but these savings have not been identified at the moment.”

 

The House bill would go further. It would gradually eliminate the coverage gap and require drug companies to pay rebates to the government on drugs for low-income Medicare beneficiaries.

 

Ken Johnson, a spokesman for the drug manufacturers group, said the industry’s $80 billion commitment would include “significant scorable savings to the government,” though details were not available.

 

Steven D. Findlay, a health policy analyst at Consumers Union, said: “It’s great that PhRMA has stepped up to the plate with a proposal to help lower seniors’ drug costs. But this still leaves the doughnut hole in place and hundreds of thousands, perhaps millions, of seniors on the hook for drug costs they cannot afford. We hope Congress will eventually do away with the doughnut hole.”

 

Congressional reaction suggested that the industry’s voluntary price concessions had whetted the appetite of lawmakers for broader, deeper discounts.

 

Senator Olympia J. Snowe, Republican of Maine, said the $80 billion commitment amounted to “a modest percentage” of national spending on prescription drugs. The Department of Health and Human Services estimates that drug spending will total $3.3 trillion over 10 years.

 

Even as Mr. Obama welcomed the new agreement, drug companies opposed another significant part of his agenda: a proposal that would prohibit brand-name drug companies from paying generic drug makers to delay the marketing of generic products, which often cost much less.

 

In his budget, Mr. Obama said such “anticompetitive agreements” kept generic drugs off the market. Jon Leibowitz, chairman of the Federal Trade Commission, said these deals would cost consumers tens of billions of dollars in the next decade.

 

A House subcommittee has approved a bill to ban such “pay-for-delay settlements.” A Senate committee is poised to approve a similar bill this week.

 

Mr. Leibowitz said, “Drug companies are lobbying furiously against the legislation because they want to preserve their monopoly profits at the expense of consumers.”

 

But Diane E. Bieri, executive vice president of the drug manufacturers association, said the settlements sometimes benefited consumers because they avoided litigation and allowed generic drugs to enter the market before drug patents expired.

 

Copyright 2009 The New York Times Company.

 

Panel Sets Guidelines For Fighting Prison Rape

 

By Carrie Johnson

Washington Post

Tuesday, June 23, 2009

 

Nearly six years after President George W. Bush signed legislation to reduce prison rape, a blue-ribbon commission is calling on corrections officers to identify vulnerable inmates, offer better medical care and allow stricter monitoring of their facilities.

 

The National Prison Rape Elimination Commission, in a study to be released today, affirms that more than 7.3 million people in prisons, jails and halfway houses across the nation have "fundamental rights to safety, dignity and justice."

 

The number of rapes committed by detention staff members and other inmates remains a subject of intense scrutiny. A 2007 survey of state and federal prisoners estimated that 60,500 inmates had been abused the previous year. But experts say that the stigma of sexual assault often leads to underreporting of incidents and denial by many of the victims.

 

Too often, the report says, sexual abuse of prisoners is viewed as a source of jokes rather than a problem with destructive implications for public health, crime rates and successful reentry of prisoners into the community.

 

"If you have a zero-tolerance policy on prison rape and it is known from the highest ranks that this will not be tolerated and there will be consequences for it, that goes a long way in sending a message," said U.S District Judge Reggie B. Walton, the commission chairman. "Just because people have committed crimes and are in prison, that doesn't mean that part of their punishment is being sexually abused while in detention."

 

The panel hosted hearings and visited 11 corrections sites before issuing its report. Among the strongest recommendations: Staff members should be subject to robust background checks and given training, which could help victims of sexual assault secure emergency medical and mental health treatment.

 

Panel members are preparing to send their report to Attorney General Eric H. Holder Jr., who will have one year to prepare mandatory national standards. The recommendations will not bind state corrections officers, but states that do not adopt them will have their criminal justice funding cut, panel members said.

 

Jamie Fellner, senior counsel at Human Rights Watch, said the panel's recommendations are common-sense steps to prevent, detect and punish prison rape, not "pie in the sky" ideals. "This problem wouldn't exist with good prison management," Fellner said.

 

But the recommendations could pose a challenge for wardens who already battle crowding. Corrections officers, who according to inmate surveys commit a significant percentage of inmate assaults, also may protest more oversight.

 

Brenda V. Smith, an American University law professor who worked on the commission, said sexual abuse in prison "isn't just a random event that can happen to other bad people."

 

Instead, political protesters, people accused of driving under the influence of alcohol and substance abusers have shared harrowing incidents of rape while in custody, sometimes while spending only one night behind bars. "This is something that could happen to a kid who has no priors and who happens to make a mistake," Smith added.

 

Hope Hernandez said in an interview that she was raped multiple times by a corrections guard in the District years ago. She said she was suffering through withdrawal in a medical unit while she awaited sentencing on a drug-related charge. Hernandez said the guard led her to a secluded room while nurses slept.

 

Hernandez said she wanted to share her story to put a face on the problem of rape in detention facilities.

 

After her release on probation, she went on to earn a master's degree in social work. She said she remains unsettled that the guard's only punishment was a week-long suspension. But her work with foster children and substance abusers and her attendance at the White House signing ceremony for the prison rape bill brought her a measure of peace.

 

"I'm certainly not bitter over how long it's taken," Hernandez said of the panel report. "I think it's great that it's getting any attention at all."

 

Staff writer Del Quentin Wilber contributed to this report.

 

Copyright 2009 Washington Post.

 

Crowns Can Be a Royal Pain, Not to Mention a Sign of Aging

 

By Ibby Caputo

Washington Post

Tuesday, June 23, 2009

 

You probably don't feel like royalty when your dentist says you need a crown. Though you might feel as if you're paying a king's ransom.

 

Dental crowns, also called caps, are expensive, from several hundred to several thousand dollars, with insurance typically covering only part of the cost. The dental crown procedure can be temporarily painful and cause localized swelling. The crowns require multiple visits to the dentist. They can break or fall out. When done right, they can protect a smile for decades; when done wrong, they can be a real nightmare.

 

Take the story told by Jim Faherty, 74, a retired executive in Wellesley, Mass., who went to the dentist a few years ago because of a loose bridge that was replacing three of his upper front teeth.

 

Faherty said that he was sitting in the chair, expecting the dentist to begin preparation for bridgework, when she suggested crowns instead. He told her that other dentists had said crowns would not work because he had only a residual amount of natural tooth left in the front. But this dentist insisted otherwise.

 

"Here she is, a professional, graduated from one of the best dental schools, and [she said] crowns are better to keep the area clean," Faherty said. "She willy-nilly went ahead and did the crowns.

 

"And they all failed," he said. What followed, he said in a telephone interview, was a frustrating series of crowns that fell out, new temporary crowns, crooked crowns, surgical root extractions, evaluations, reevaluations, a change of dentist . . . . Two and a half years and more than 50 dental visits later, Faherty has two implants and a new crown -- and he's on a crusade. He's posted his story on a consumer-complaint site and willingly shares a thick file of his dental records.

 

He keeps the failed caps in a large saltshaker and rattles them into the phone. "That's my crowns," he said.

 

Faherty's is an extreme example, but many people are apprehensive about crowns. The more you know as a consumer, the better off you are, so . . . welcome to Dental Crown 101.

 

Crowns are used to protect weak teeth; to restore misshapen, discolored or broken ones; and to cap implants, root canals and the teeth that anchor either end of a bridge. They are used when a tooth has decayed and there is little natural tooth left to hold a filling. They're more likely to be needed by people who grind their teeth or clench their jaws, two common activities that lead to fractures and cracks. And in many cases they need to be replaced, sometimes more than once, over the course of a lifetime.

 

"It is not inevitable that everyone is going to get one," said Eugene Giannini, a District dentist and spokesman for the D.C. Dental Society. He said it depends on a variety of factors, including general health and lifestyle, genetics and what type of dental care you have received throughout your life.

 

Among people who do get crowns, the majority get their first in middle age, though sometimes even children need them. The procedure differs patient-by-patient and tooth-by-tooth, Giannini said. First, the dentist must drill away any existing filling and damaged portions of the tooth. Then the remaining tooth material must be reshaped to receive the crown. The amount of tooth that needs to be removed depends in part on the material of the crown.

 

Crowns made completely of metal are the strongest and require the least amount of tooth removal. They can be made of gold or other alloys including palladium, nickel and chromium.

 

Porcelain can be fused to metal so that the crown will blend in better with surrounding teeth, though sometimes the metal shows through, especially if the gums are receding. Crowns that are made completely of porcelain can be color-matched the best to surrounding teeth, though they are not as strong as metal models. Crowns made with porcelain require more tooth removal because their strength is dependent on their thickness.

 

After the drilling, the dentist will make a mold of what is left of the tooth. The mold is sent to a laboratory where the crown is made, and you will get a temporary crown to wear in the meantime. The permanent crown arrives within a few weeks.

 

But "permanent" is a term for discussion. There are no scientific data on the longevity of crowns, and some patients and insurers say dentists replace crowns more often than necessary.

 

Insurance plans vary, but in general most won't reimburse patients for a replacement until a crown is five years old.

 

And that doesn't mean every five-year-old crown should be replaced, said Doyle C. Williams, the chief dental officer for DentaQuest, a national dental benefits company.

 

"Ten to 20 years is the average lifetime of a real crown," Williams said, noting that he has had one crown in his mouth for 35 years. Williams, who also sits on the board of the National Association of Dental Plans, said he thinks the industry standard should be extended. "It should be changed, because it encourages people to change [a crown] every five years," he said.

 

Matthew Messina, a Cleveland dentist and a spokesman for the American Dental Association, disagreed with the assertion that dentists are too quick to replace crowns. "I haven't seen or heard anything of that sort," he said. "Based upon what I'm hearing and talking with other colleagues of mine about, there's nothing we are hearing in the dental association about trends towards that."

 

Measures to prevent the need for crowns start in childhood, when sealants can be placed on teeth to cut down on the chance of decay and the need for a large filling. Other measures include making sure your occlusion, or bite, is correct, and wearing a mouth guard when playing contact sports and a night guard to prevent clenching. It's also not advisable to chew a lot of ice.

 

And if you can, cut down on jaw-clenching stress. "That's a thing we see a lot in Washington: Patients are bruxers [teeth-grinders] and clenchers in this town," said Dennis Milliron, a dentist with a private practice in Foggy Bottom. He likened clenching and grinding to hitting a concrete block with a sledgehammer.

 

"The first and second time it might not break, but the 20th time? It will break."

 

Milliron said a patient's first crown can be traumatizing, especially for younger people. "It's the sense of mortality," Milliron said. "Patients think, 'Wow, I'm getting old.' " He described a professional in her early 30s who received her first crown a few weeks ago.

 

"She had apprehension, and some of it was about the procedure and some of it was a sense of feeling like she's falling apart," Milliron said. The patient, who works in a high-stress government job, had large fillings and a habit of jaw-clenching, he said. "We discussed why it was needed and [that] it wasn't a reflection of her personally," he said.

 

Copyright 2009 Washington Post.

 

Philly VA to research homelessness among vets

 

The Associated Press

Washington Post

Tuesday, June 23, 2009

 

PHILADELPHIA -- A new federal agency dedicated to eliminating homelessness among veterans has been established in Philadelphia.

 

The National Center on Homelessness Among Veterans plans to provide data, research and analysis to policymakers in hopes of ending the problem within five years.

 

Officials at the Department of Veterans Affairs say about 131,000 veterans have no permanent place to live. That's down from about 154,000 in 2007.

 

Center director Vincent Kane said last week the agency aims to make programs more effective and to help veterans live independently.

 

The $1.8 million initiative was announced in May by VA Secretary Eric Shinseki. It's headquartered at the VA Medical Center in Philadelphia with a secondary site in Tampa, Fla.

 

© 2009 The Associated Press.

 

AIDS: Discrimination in Visa Laws Poses Risk to Those With AIDS, Rights Group Says

 

Global Health

 

By Donald G. McNeil Jr.

New York Times

Tuesday, June 23, 2009

 

International migrant workers, foreign students and political refugees are often endangered by laws that discriminate against people with AIDS, the advocacy group Human Rights Watch reported last week.

 

About a third of the world’s countries limit the right of people with H.I.V. to enter or stay, even if their disease is under control with drugs. Some restrict their access to health care.

 

The report describes how guest workers from poor countries like the Philippines and Sri Lanka working in wealthy ones like Saudi Arabia may be given mandatory H.I.V. testing — sometimes without their knowledge — and deported, often without being able to claim back wages and sometimes after imprisonment without treatment.

 

The group said the visa restrictions had led people to commit fraud or stop treatment, risking their lives. The report detailed one study in which travelers from Britain stopped taking their AIDS pills or tried to mail them ahead, sometimes unsuccessfully, out of fear that they would be denied visas to the United States if they admitted being infected, or would be searched at the border.

 

Wealthy countries often deport people without considering whether they will have access to medical care elsewhere, the report said. South Korea, for example, has deported hundreds of foreign workers, and some deportees from the United States, especially those with criminal records, have been jailed without treatment and died in custody.

 

The International Organization for Migration estimates 3 percent of the world’s population — 192 million people — live outside the country where they were born.

 

Copyright 2009 New York Times.

 

Opinion

Healing the hospitals

 

By Michael Jhin

Baltimore Sun Commentary

Tuesday, June 23, 2009

 

Hospitals are the latest casualties of the economic crisis. As their investment incomes tumble, hospitals' already stretched operating budgets are being squeezed even further. At the same time, they must treat an increasing number of patients who are uninsured or cannot pay their medical bills; recent Obama administration estimates reveal that crushing health care costs trigger a personal bankruptcy every 30 seconds.

 

So it's not surprising that more than half of the nation's hospitals are operating in the red, according to a recent Thomson Reuters study. Credit rating agencies are downgrading hospitals. Moody's and Fitch recently changed the outlook for the not-for-profit hospital sector from stable to negative. And across the country, hospitals are cutting staff and services; many are being forced to close their doors.

 

Local hospitals are feeling the pinch. In March, the Maryland Hospital Association released a report that showed average revenue at 58 Maryland hospitals fell short of expenses by nearly 14 percent in the last quarter of 2008 - the worst profit margins reported by the state's hospitals to date.

 

While health care reform is a top priority for the Obama administration, hospitals need a remedy now. The federal government should step in to make sure that not one hospital fails in this country within the next two years. If some banks are too big to fail, then hospitals are far too critical to a community's health to fail.

 

But the government can and should only do so much. Hospitals themselves must change from the inside out to become well-run enterprises. By analyzing the millions of day-to-day processes and interactions - from patient admissions to Medicare billings - hospital staff can then implement the changes needed to make their facilities more efficient. Doing so will reduce costly medical errors, save time and, most important, save lives.

 

Improvements to the seemingly small stuff - the location of supplies, how patients are greeted, color-coding of lab sample containers - can make a huge difference. When everything and everyone are in the right places, then more time, the prized yet elusive asset at every hospital, becomes available for caregivers to really care for patients.

 

This transformation must take hold in teaching hospitals and medical schools. Nursing students and physician interns must be taught how to adopt the most efficient processes. We need "professors of process" to instill in students that in practicing health care, how is as important as what. The University of Maryland Medical Center (UMM) is an ideal example of a hospital doing just this. By implementing a more efficient process for the turnaround time in the operating room between surgical cases, the hospital was able to reduce patient wait time, decrease staff overtime and increase the number of patients seen during the day shift.

 

In this new efficiency-driven environment, government must also reward hospitals for being better businesses. Today, the government examines a number of metrics and standards when making Medicare or Medicaid reimbursement decisions. Sadly, how many procedures a hospital performs - not how well it operates - is the main criterion for reimbursement. Efficiency scores must become one of these key metrics. Private health insurers will then adopt similar standards to ensure a systemwide standard of rewarding efficiency.

 

Lastly, patients have a right to information that clearly tells them where the good hospitals are. We must make an industrywide commitment to complete transparency of hospital performance by posting hospital efficiency, cost and safety data online, for all to see. This can be achieved through required efficiency measurements from the Centers for Medicare and Medicaid Services and the Joint Commission, a nonprofit that accredits and certifies health care organizations. And we must go beyond simply reporting the information. It also has to be shared in a way that is useful so that patients will be better informed and hospitals that provide quality care will be recognized.

 

While all of this may sound ambitious, hospitals have an advantage over many other businesses: The people who work in them have a passion for care and a unique blend of skills. It is these people who can ensure that hospitals heal themselves and who will set the nation's hospital system on the road to recovery.

 

Michael Jhin is the CEO emeritus and former president and CEO of St. Luke's Episcopal Healthcare System in Houston. He is executive advisor to the health care practice of a Baltimore-based human performance and process improvement consulting firm. His e-mail is mjhin@rwd.com.

 

Copyright © 2009, The Baltimore Sun.

 

Pandemic Reality Check

What Can Be Done -- and What Can't -- To Protect Against H1N1

 

By John M. Barry

Washington Post Commentary

Tuesday, June 23, 2009

 

This month, the World Health Organization finally declared that the new H1N1 virus has become pandemic. Yesterday it reported a big jump in cases and fatalities since Friday. How many people this virus will sicken and kill depends, ultimately, on three things: the virus itself; the impact of what are known as "non-pharmaceutical interventions," or NPIs; and the availability and effectiveness of a vaccine.

 

The virus will be the most important factor. Influenza is one of the fastest-mutating organisms in existence, which makes it unpredictable, and a virus newly infecting the human population is likely to be even more unpredictable as it adapts to a new environment. There have been four pandemics that we know about in some detail: 1889-92, 1918-20, 1957-60 and 1968-70. All four followed similar patterns: initial sporadic activity with local instances of high attack rates -- just as H1N1 has behaved so far -- followed four to eight months later by waves of widespread illness with 20 to 40 percent of the population sickened. (In a normal influenza season about 10 percent of the population gets sick.) Subsequent waves followed as well.

 

In all four pandemics, lethality changed from wave to wave -- sometimes increasing, sometimes decreasing. It's impossible to know what will happen this time, but in 1999 the Centers for Disease Control and Prevention modeled a moderate pandemic in the United States, including a vaccine in its calculations, and concluded that the death toll would probably be 89,000 to 207,000. If the virulence of this virus does not significantly increase -- and right now there is no reason to think it will -- something close to the lower number looks probable.

 

What could help bring about such a best case? Again, the virus is the most important factor, and we have no control over it. But we do have non-pharmaceutical interventions and the possibility of a vaccine. Such interventions would come into play primarily in a moderate or severe pandemic. For a mild one, we may not need to take steps beyond washing hands, exercising "cough etiquette" and keeping the sick at home. But if the virus increases its virulence, other measures, such as closing schools, urging people to telecommute and even banning public meetings, could mitigate the impact.

 

However, the usefulness of non-pharmaceutical interventions is limited, and even if they work, their chief impact will be to flatten the pandemic's peak and stretch out the duration of a wave of illness to make it easier to handle. Consider: Those telecommuting are likely to run into Internet capacity problems, while the impact of closing schools -- aside from the burden that creates on working parents and their employers, or on children who get good meals only at school -- depends on how much kids congregate while out of school. And sustaining compliance will be both important and difficult. Scholars Bradley Condon and Tapen Sinha found that in Mexico City this spring, when the government advised wearing masks on public transportation, compliance peaked at 65 percent three days later -- but declined to 26 percent only five days after that. This decline came even as the government was taking the extreme measure of closing all nonessential services and businesses. Such behavior does not portend well for sustained compliance with any measure.

 

The most important human intervention is, of course, a vaccine. There are many unknowns: Because influenza mutates so rapidly, a new vaccine has to be made each year just for seasonal flu. Vaccines for most diseases approach 100 percent effectiveness, but a good flu vaccine is 70 percent effective; a great one is 90 percent effective. The vaccine in the 2007-08 flu season was only 44 percent effective. Hitting the "good" mark for a new virus that may be changing even more rapidly than seasonal flu will be difficult.

 

Supply is another problem. In a best case, enough vaccine for the entire U.S. population could be available by October as long as an adjuvant is used to simultaneously stimulate the immune system, which lessens the need for antigen from the virus itself. However, if the virus used to make vaccine grows slowly, or if a dose requires more antigen than seasonal flu, or if two doses are required to provide protection, producing that much vaccine could easily stretch deep into 2010. In addition, only about 30 percent of the supply will be made in the United States. The more virulent the virus, the more likely it is that foreign governments will refuse to allow export of the vaccine until their own populations are fully protected.

 

Meanwhile, the emergence of the H1N1 virus in no way lessens the threat from H5N1, more commonly known as bird flu. And the same day the World Health Organization declared H1N1 a pandemic, Egypt announced 25 new human cases of H5N1 -- the largest number yet identified in a single day.

 

The bottom line? Little can be done in the short term beyond exerting diplomatic pressure to guarantee that foreign governments allow manufacturers to honor contracts to export vaccine. In the medium term, sustained investment in vaccine production technologies -- especially recombinant ones -- could make it possible to produce massive amounts of vaccine in a few weeks. In the long term, we need a vaccine that works against all influenza viruses. Enough work has been done to suggest that this Holy Grail is achievable. Had influenza been taken seriously for the past 30 years, we would probably have one by now. No matter what happens over the next year or two, that's one history lesson we need to learn.

 

John M. Barry is a distinguished scholar at the Center for Bioenvironmental Research at Tulane and Xavier Universities and the author of "The Great Influenza: The Story of the Deadliest Pandemic in History."

 

Copyright 2009 Washington Post.

 

Safety first

 

Cumberland Times-News Editorial

Tuesday, June 23, 2009

 

Teen-aged drivers are under more scrutiny than ever these days. The latest changes for them will take place in West Virginia on July 10, when a new set of regulations takes effect.

 

Starting then, intermediate drivers can only drive unsupervised between 5 a.m. and 10 p.m., one hour earlier than the old rules allowed. They’ll also face new restrictions on driving with people under the age of 20.

 

The law banning intermediate drivers and those with instruction permits from using handheld cell phones will become a primary offense. That will allow police to ticket them even if they aren’t violating another traffic law.

 

In Maryland, a new driver’s education curriculum will soon be distributed to driving schools across the state. Based on a national curriculum developed by the American Drivers and Traffic Safety Education Association, the new curriculum will be taught in PowerPoint form. The higher-tech lessons are one way the Maryland Motor Vehicle Administration is trying to stay in tune with tech-savvy teens.

 

Allegany County has two driving schools and the majority of students are teen-agers. To get a license, students must complete six hours of behind-the wheel training and 30 hours of classroom lessons, including units on driving in adverse conditions, natural laws and car control, and negotiating intersections.

 

According to the National Highway Traffic Safety Administration (NHTSA), motor vehicle crashes are the leading cause of death for teen-agers in America. Teen-agers are involved in three times as many fatal crashes as all other drivers.

 

Imposing reasonable restrictions on cell phone use, when teens can drive and how many people may be in the car at any given time are prudent steps to cutting down accidents. So too are keeping driving curriculums up-to-date — so that teens learn about how to keep safe behind the wheel well before they ever put a foot on the gas pedal.

 

Copyright © 1999-2008 cnhi, inc.

 

When Parents Need Help

 

Your Views

Washington Post Letters to the Editor - 5 total

Tuesday, June 23, 2009

 

Gee, the writer Paula Span must run with a different crowd than I do, or else she is in La-La Land ["Their Parents' Keepers," June 16]. Most of my friends and I have not found the task of caring for an aging parent to be the rewarding experience she relates. Instead, it has been a battle between the generations over perceived vs. actual needs, money issues and outright refusal to accept necessary care.

 

Our parents, who are children of the Depression, refuse to pay for any services, even if they mitigate risk for illness or injury. Our relatives don't suck it up; they become more dysfunctional than usual.

 

Only after my mother suffered a life-threatening illness and was basically comatose was I able to change her solitary living situation and enroll her in an assisted living facility. I cannot tell you the immense relief I felt when I was no longer her sole social contact, cook, chauffeur, laundress, housekeeper, etc. I focus now on being just her daughter, and the time we now spend together is truly enjoyable, without the pressure on me to run two households.

 

Further, she's enjoyed some benefits; for example, her health has improved, and she socializes more. I highly recommend stressed caregivers look into assisted living.

 

Mary Zussman

Fairfax

 

**

 

I am currently not a keeper but a kept. I have multiple sclerosis and crippling depression. My family can't afford to support me, and there is no one who can look after me full time. For two years, I have been living in an independent living facility, which means I can take care of myself except for meals and medications, which I forget to take on my own because of MS-related short-term memory problems.

 

I don't qualify for assisted living or Medicaid, have only Social Security as income, and I can afford to stay here for only one more year. I'm only 60 now, yet my grandmother lived to be 99 and my mother is 87. What will happen to me for the next 30 years? There must be many others in my position, but we fall through the cracks. As my generation ages, I'm certain this will become a more common scenario.

 

Mary Lynch

Pennsauken, N.J.

 

**

 

I, too, was a caregiver for almost four years. My dad lived with me and my family, and what a challenging yet rewarding experience it was.

 

When Dad arrived from the hospital to move in, I was raising a family with four children ranging from ages 19 to 5 months and working part time as a nurse. With time and a multitude of medications and doctor visits, Dad seemed to thrive living with us. Down the road, I became pregnant with our last child and Dad went to a rehab facility after a few hospital stays to regain his ability to walk with his walker. This was to make my life easier, but he hated these short stays in those places. He said that he would rather die than ever go back to one.

 

Unfortunately, Dad passed away last summer, one month after we moved into a bigger home that would give him his own bedroom and bathroom. I feel like I lost my best friend, as we became very close over those years together. He was a wonderful, wise man, and I was honored to be his caregiver.

 

I commend anyone who takes on this responsibility, as caregivers go unnoticed most of the time. I don't think others realize the hard work that goes into caring for your parent until you face it yourself.

 

Margaret Conte

Warrenton

 

**

 

I read this article with great interest, but the writer didn't delve deeply into preventive measures people need to take prior to their aging process.

 

My wife and I are 71 and currently in good health. We recently moved into a retirement community, which offers independent living, assisted living and skilled nursing home care, if or when needed.

 

We are not wealthy people; however, during our working years we prepared for this time by purchasing long-term-care insurance. We definitely did not want to burden our children with the possibility of providing home care.

 

William G. Stoner

Harrisonburg

 

**

 

Paula Span's informative and sensitive article did not address the added challenges of long-distance care-giving. These issues arise for countless families, as more and more people move away from their home towns.

 

I struggle to balance caring for my parents with the demands of two children under age 5 and a full-time job. I know that I am not alone in this extra intense "sandwich." My mother was 40 years old when I was born, a rarity at the time. And while the advances in fertility medicine and adoption have created so many beautiful families later in life, I am profoundly afraid for what today's toddlers will face in 30 years, when they, too, are juggling sleepless nights with a newborn and calls from the assisted living facility or worse, the ICU.

 

Edna Friedberg

Washington

 

Copyright 2009 Washington Post.

 

A Puff of Fresh Air

 

Washington Post Letter to the Editor

Monday, June 22, 2009

 

George F. Will's broadside against the recently passed bill to allow the Food and Drug Administration to regulate tobacco products misfired and misled ["Burned by a Tobacco Bill," op-ed, June 18].

 

FDA regulation of tobacco products will begin to undo the damage caused by an unregulated marketplace. Without regulation, tobacco companies could continue to treat smokers like guinea pigs and target youth with products and promotions. Unfettered access to the marketplace allowed the industry to introduce filters made from asbestos, engineer the massive fraud known as "light" cigarettes and induce children to initiate use of cigarettes and smokeless tobacco.

 

A 1981 Philip Morris document says it all: "Today's teenager is tomorrow's potential regular customer . . . . The smoking patterns of teenagers are particularly important to Philip Morris."

 

Far from protecting the industry, the new legislation will ensure that sound science and public health considerations will control the behavior of the tobacco industry. Two federal courts have concluded that these companies are adjudicated racketeers. It's about time that regulation is used to help prevent kids from starting to smoke, oversee product design and help addicted smokers quit.

 

Mitchell Zeller

Olney

 

The writer is a consultant on issues relating to tobacco dependence. He was director of the FDA's Office of Tobacco Programs from 1997 to 2000.

 

Copyright 2009 Washington Post.

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