Wednesday, June 24, 2009

News Clipping Archives

 

Maryland / Regional

Maryland reports first swine flu-related death (Baltimore Business Journal)

Woman is 1st in Md. to die of swine flu (Baltimore Sun)

Maryland Reports First H1N1 Flu-Related Death (WJZ-TV13)

County spent $114,000 in fight against swine flu (Frederick News-Post)

Restrictions lifted on assisted living facility (Frederick News-Post)

Baltimore foster care case nears end (Baltimore Sun)

CareFirst BlueCross BlueShield teams with MinuteClinic on health coverage (Baltimore Business Journal)

Anne Arundel Medical Center to put funds toward $424M expansion project (Baltimore Business Journal)

Md. colleges given $11M to combat nursing shortage (Baltimore Business Journal)

Officials gearing up for 2010 census (Frederick News-Post)

Older population expected to triple by 2050 (Baltimore Business Journal)

 

National / International

In New Theory, Swine Flu Started in Asia, Not Mexico (New York Times)

Most Want Health Reform But Fear Its Side Effects (Washington Post)

HHS secretary presses lawmakers on health care (Washington Post)

Authorities Indict 53 for Medicare Fraud (Wall Street Journal)

UN reports decline in cultivation of some drugs (Washington Post)

Is Our Doctors Learning? (Washington Post)

 

Opinion

Toys, Games Ease Kids Into the Dentist's Chair (Washington Post Commentary)

Butt Piracy (Washington Post Commentary)

Bringing Down the House (Washington Post Commentary)

 

 

Maryland / Regional

Maryland reports first swine flu-related death

 

By Julekha Dash Staff

Baltimore Business Journal

Tuesday, June 23, 2009

 

A Baltimore area resident has died of swine flu, the first Maryland resident associated with the flu to die.

 

The victim was an elderly Baltimore-area resident who had a serious underlying medical conditions, according to the Department of Health and Mental Hygiene. The state is not releasing details on the medical condition to protect the privacy of the family.

 

The Centers for Disease Control and Prevention reports that 87 people nationwide have died after contracting the H1N1 influenza virus. In the Mid-Atlantic region, Virginia has reported one H1N1 flu-related death and Pennsylvania has reported three.

 

Nationwide, the CDC reports more than 21,000 confirmed and probable cases of swine flu and 370 cases in Maryland.

 

Symptoms of influenza include fever, cough, and sore throat. Additional symptoms may include chills, headache, fatigue, vomiting, diarrhea or shortness of breath.

 

All contents of this site © American City Business Journals Inc. All rights reserved.

 

Woman is 1st in Md. to die of swine flu

Elderly Baltimore-area victim had other medical problems, officials say

 

By Stephanie Desmon

Baltimore Sun

Wednesday, June 24, 2009

 

An elderly woman from the Baltimore area is the first person in Maryland to die of swine flu, health officials said Tuesday.

 

Officials did not name the woman, who died Monday, or give her age or hometown. They did say she suffered from a serious underlying medical condition in addition to the H1N1 influenza virus.

 

The Centers for Disease Control and Prevention has reported 87 deaths nationwide of people who have contracted this strain of the flu, which started making people sick in Mexico this spring. More than 21,000 people across the United States have become ill with the flu, but most have had relatively mild cases.

 

"While hundreds of Marylanders have recovered from this relatively mild form of novel flu, this death illustrates how serious influenza can be, especially for persons with serious underlying health conditions," said John M. Colmers, the state's health secretary, in a statement.

 

To date, 370 cases of the swine flu have been confirmed in Maryland. That figure is likely a fraction of the total swine flu cases statewide. Many people who become ill with flulike symptoms are not tested and recover within a week's time, much like seasonal flu.

 

While most of the cases of swine flu have been fairly mild, the World Health Organization has declared it a pandemic, in response to the global spread of the virus. Meanwhile, the CDC expects that there will be more cases, hospitalizations and deaths associated with this pandemic in the coming days and weeks.

 

There is also fear that come fall and winter - the traditional flu season in the U.S. - the swine flu could cause even more serious illness than it has so far. That is how previous pandemics have behaved.

 

Scientists are at work on a vaccine that would protect against the swine flu strain, something human immune systems are susceptible to because it has not been seen before.

 

Based on CDC figures, health officials estimate that 1,000 Marylanders die every year from seasonal flu or its complications. Complications and death are more common among those with serious underlying health conditions.

 

Last week, three teenagers at the Baltimore City Juvenile Justice Center were diagnosed with the swine flu, prompting officials to separate them from the general population and hand out antiviral medication to many other inmates.

 

Copyright © 2009, The Baltimore Sun.

 

Maryland Reports First H1N1 Flu-Related Death

 

By Mary Bubala

WJZ TV13

Wednesday, June 24, 2009

 

Baltimore (WJZ) - The strand of flu virus that caused international panic has claimed its first life here in Maryland. State officials are confirming Maryland's first H1N1 flu related death.

 

Mary Bubala reports the victim's identity has not been released.

 

The person that died is from the Baltimore area and according to our media partners at the Baltimore Sun the victim is a woman.

 

The Department of Health and Mental Hygiene says the victim was an elderly Baltimore area resident, who had serious underlying medical conditions.

 

The news of the first Maryland death related to the H1N1 flu has some residents worried.

 

"That's the main question I ask, can you die from it? How do you cure it and everything like that? Is it curable? Cause I was not that sure about it, but now that I know it's deadly, it is a concern," said Jewel Mayfield.

 

Doctors say there is no reason to panic. Statewide there are 370 confirmed cases of the H1N1 virus, a small number compared to the number of cases usually reported with the regular flu.

 

"People are not nearly reactive about regular flu's like they are about swine flu. So could it be dangerous? Possibly, it's probably going to turn out to be less dangerous if not no more dangerous than the regular flu," said Dr. McRae Williams, GBMC Emergency Medicine.

 

The flu is spread by person to person contact or through droplets. People with compromised immune systems are most at risk. Doctors generally treat it with antibiotics.

 

Currently, scientists are working on a vaccine for the flu. The goal is to have it in place by the start of flu season this fall.

 

Nationwide 87 people have died from the H1N1 virus.

 

(© MMIX, CBS Broadcasting Inc. All Rights Reserved.)

 

County spent $114,000 in fight against swine flu

Focus now turns to seasonal variety, health officer says

 

By Janel Davis

Frederick News-Post

Wednesday, June 24, 2009

 

During the 12-day period in April and May in which health officials responded to local swine flu cases, the county spent about $114,500, with most of the money going toward personnel costs, according to a report by the county health officer Tuesday.

 

About $112,000 paid overtime costs for the county employees staffing the swine flu hot line that officials established for residents to receive the latest updates from state and federal authorities, said Ulder Tillman, who briefed the County Council about the flu.

 

At the height of the swine flu, or H1N1 virus, outbreak, Rockville High School was closed, as were schools in Anne Arundel, Baltimore and Prince George's counties.

 

In the county, more than 500 students from May 7 until the end of the school year had to be kept out of school for seven-day periods after coming into contact with the illness.

 

As of June 19, Montgomery County had 24 confirmed swine flu cases, including one that required hospitalization.

 

Tillman said the county's pandemic plan, which was used to handle the swine flu outbreak, was geared toward a worst-case scenario. But the flu turned out to be milder than expected, and health officials are working on a middle-ground approach for the future.

 

"The virus is impacting our summer and day camps, so monitoring continues," Tillman said.

 

In the meantime, the county is gearing up for the seasonal flu and expects to spend $250,000 so that all children, ages 5 to 11, can receive vaccinations, Tillman said.

 

"We have got to make sure that we have enough staff to be ready for any possible infections and to get the vaccine out," she said.

 

Copyright 2009 Frederick News-Post.

 

Restrictions lifted on assisted living facility

Summerville at Potomac no longer under ‘directed plan of correction'

 

By Erin Donaghue

Frederick News-Post

Wednesday, June 24, 2009

 

The Summerville at Potomac assisted living facility in Potomac is no longer operating under a "directed plan of correction" imposed by the state Department of Health and Mental Hygiene in December, according to DHMH officials.

 

The plan of correction, along with a $10,000 fine, was imposed after a routine survey uncovered problems at the facility that regulators said jeopardized resident safety and violated state regulations. In a December report, state health officials noted that a full-time delegating nurse — a registered nurse who routinely monitors each resident, acts as a "traffic controller" and issues directives to the staff regarding health care — had not visited the facility since August. Minimum state regulations require a delegating nurse to assess each resident every 45 days, according to the health department.

 

Rueben Rosenfeld, executive director of the facility, said that during the time the facility did not have a full-time delegating nurse, it was visited by other RNs and actively recruited for the delegating nurse position. But those nurses did not act as a "delegating nurse" by assessing every resident, said Wendy Kronmiller, director of the DHMH Office of Health Care Quality, in January. According to Kronmiller, the lack of a delegating nurse contributed to situations including improper treatment of pressure ulcers, some severe, and improper monitoring of residents prone to falls.

 

As of last month, however, the correction plan is no longer necessary after the assisted living facility responded to the concerns highlighted in the state's correction plan, Kronmiller said.

 

"[Summerville has] really accepted the challenges on their own volition," Kronmiller said. "We will continue to monitor Summerville, as we do other places, but we are pleased with the steps they've taken and the progress they've made."

 

The plan directed Summerville to appoint a full-time registered nurse; examine the skin of each patient and report the findings; enlist a wound care specialist to address ulcer concerns; operate under a monitor that will report to officials; and notify residents and their families about the survey. The plan also imposed an admission ban for residents with wound care concerns.

 

Summerville notified families of the plan, contracted with a wound care specialist and a monitor, and appointed a full-time delegating nurse in December.

 

The monitor was required to report to the state and the county about progress at the facility every 10 days, and the wound care specialist assessed each resident for wound care concerns and reported their findings to the state and the county every 10 days.

 

In March, the health department reduced the number of visits and reports required from the monitor to once a month, and also reduced the number of reports required from the wound care specialist to two times per month. Late last month, Kronmiller informed Rosenfeld that while the facility would continue to be evaluated as with other assisted living facilities in the state, the monitors were no longer necessary.

 

"[The monitor and wound care specialist] were for a significant amount of time required to be in the building and required to let us know what they found, and you saw a gradual arch of improvement over those months," Kronmiller said.

 

According to Terri Price, a regional director of sales and marketing Director of Sales and Marketing for Emeritus Assisted Living, the national network of assisted living facilities to which Summerville belongs, the facility now has two delegating nurses who complete an assessment of residents every 45 days. The facility has also hired a medical director.

 

"As a provider of services, you always want to exceed the expectations of your customers.  It has been our goal to work closely with our county and state surveyors to do just that. Summerville was very willing to put any measure in place to address their concerns as well as systems to prevent future concerns. We are very confident that we have done just that as a result of the most recent monitoring visit," Price wrote in an e-mail to The Gazette.

 

Kronmiller said to her knowledge there was no one currently at the facility with pressure ulcers or other wound care concerns except for one resident who is prone to pressure ulcers. Kronmiller said she was now confident that care could be coordinated to meet his needs.

 

"We will keep a steady eye on them to be sure this does not happen again, but I do think they've put a lot of energy and resources into fixing these problems," Kronmiller said.

 

Copyright 2009 Frederick News-Post.

 

Baltimore foster care case nears end

Lawyers for children file motion to end court role

 

By Julie Bykowicz

Baltimore Sun

Wednesday, June 24, 2009

 

For a quarter-century, lawyers for Baltimore foster children have been telling a judge horrific stories of abuse and neglect and indifference. The child welfare system itself, the attorneys said, failed these children time and again by shrugging off reforms it was ordered to make as a result of a federal lawsuit.

 

That has changed, the lawyers said Tuesday. Convinced that the state Department of Human Resources, which oversees child welfare and the city's more than 5,000 foster children, has finally made enough progress on changes first ordered by a judge in 1988, the lawyers on Monday filed a motion that could eventually end federal court oversight.

 

"This is a milestone," Human Resources Secretary Brenda Donald said.

 

Secretary since January 2007, Donald said she looked at the compliance requirements of the lawsuit she inherited and said, "These are the things we are supposed to be doing anyway."

 

The lawsuit was filed in 1984 on behalf of L.J., a boy who the lawyers said was beaten in his foster home until he had scars on "virtually every part of his body." His foster mother had been treated 41 times for alcoholism. Though L.J. is now in his mid-30s and Donald is more than half a dozen secretaries removed from Ruth Massinga, the case is known as L.J. vs. Massinga.

 

Over the decades, the suit expanded to include other children mistreated while under the state's care: Briana, a teen with learning disabilities, spent 42 nights in 2005 sleeping with other wards of the state at a Gay Street office building, with little access to showers or clean clothes. Stephen, a 14-year-old with untreated emotional problems, ran away from a group home to West Virgina in 2006, threatening suicide with his grandfather's gun.

 

The state entered a consent decree in 1988 and was supposed to be in compliance by September 1990. But the city's child welfare agency, the Department of Social Services, did not follow though on many of the court-ordered reforms, including reducing the staggering caseload of social services employees and conducting criminal background checks on foster parents.

 

A 2002 state legislative audit of foster care suggested the department simply ignored much of the consent decree. The audit of a sample 163 cases, most of them from Baltimore, found that children frequently were not receiving medical or dental care. Many were not enrolled in school. Case workers weren't visiting children as often as the law required to ensure their safety.

 

State officials promised change year after year, but shocking cases of children neglected by the state kept making headlines. In December 2002, Ciara Jobes, 15, was starved and tortured to death by her guardian, a mentally ill woman approved by city social services. Barely a month later, in January 2003, Travon Morris, 5, was fatally scalded in bath water by his mother, who regained custody after social services workers removed him from a safe foster home.

 

In November 2007, Mitchell Y. Mirviss, a lawyer for the foster children, asked the judge to hold the state in contempt of court, alleging 96 violations of the consent decree - everything from failing to train foster parents to neglecting children's dental needs. A 419-page memo accompanying the motion included stories of Briana, Stephen and a dozen other children under state supervision.

 

Mirviss has been involved in the case since 1985 and was skeptical anything would ever change. The system, he said in April 2008, has "a 20-year record of failure."

 

But Mirviss, an attorney with Venable who has largely worked pro bono on the case, and co-counsel Rhonda B. Lipkin of the Public Justice Center, say the system is on the road to recovery. That 2007 contempt motion eventually prompted the mediation that led to Monday's filing of the exit strategy.

 

A federal court hearing on the new filing will be held Aug. 5. U.S. District Judge J. Frederick Motz, who has overseen the case in recent years, must accept the plan that the plaintiffs' attorneys and the state have developed.

 

To end federal oversight, the state must comply for 18 months with 40 measurable "exit standards" that fulfill larger goals in areas such as family preservation, child healthcare and education. The plan calls for a renovation of case practice, meaning the workers in contact with children and families - as well as supervisors - will likely need new training and coaching.

 

Matthew Joseph, director of the Baltimore-based Advocates for Children and Youth, said the fact that Mirviss and Lipkin - longtime child advocates - signed onto the plan "tells us this is a good deal for children. They would not have agreed to anything less."

 

Joseph said improving the quality of work done by case workers and their supervisors will be the biggest challenge for the agency. He said that how quickly social services undertakes that particular reform will indicate its chances of getting out from federal compliance.

 

"That's what could lead to a transformation in the kinds of services families see," Joseph said.

 

Donald pointed to the department's recently implemented "Place Matters" strategy, which emphasizes moving children in need to permanent homes as quickly as possible, as evidence of commitment to change.

 

The plaintiffs' attorneys said their good relationship with Donald and her city social services director, Molly McGrath, motivated them to hammer out a deal in court. "They have a tremendous commitment to reform," Mirviss said. "That's something we have never seen before."

 

Donald said she looks forward to the day when L.J. v. Massinga is closed. "No secretary wants to have a lawsuit over her head," she said. "We want to prove we can do it, that we can be trusted. We should be able to manage our own child welfare system," without the federal courts keeping watch.

 

Mirviss said he, too, wants the department to succeed with the new plan. "No consent decree is permanent," he said. "They are supposed to be lifted."

 

L.J. v. Massinga

December 1984: Case filed in U.S. District Court.

 

September 1988: Department of Human Resources enters consent decree, agreeing to sweeping reforms.

 

May 2002: State legislative audit provides first reliable data showing ongoing problems with child welfare.

 

Nov. 5, 2007: Motion asks judge to hold DHR in contempt of court for failing to uphold consent decree.

 

September 2008: DHR and attorneys for foster children begin mediation on the contempt motion.

 

June 22, 2009: DHR and foster children's attorneys file motion asking for a new consent decree, which provides a road map to the end of federal oversight.

 

Copyright © 2009, The Baltimore Sun.

 

CareFirst BlueCross BlueShield teams with MinuteClinic on health coverage

 

By Julekha Dash Staff

Baltimore Business Journal

Wednesday, June 24, 2009

 

Members of CareFirst BlueCross BlueShield in Maryland, Northern Virginia and Washington, D.C., can now get health insurance coverage if they stop by MinuteClinic, the Minnesota retail health care clinic found in CVS stores.

 

Previously, MinuteClinic accepted CareFirst’s preferred provider and federal employee plans only in Maryland. The extension covers 3.4 million CareFirst members. CareFirst is the largest insurer in the mid-Atlantic.

 

MinuteClinic, a subsidiary of CVS Caremark Corp. (NYSE:CVS) based in Minneapolis, Minn., operates 500 clinics in 25 states, including 10 in Greater Baltimore.

 

MinuteClinic health care centers are staffed by nurse practitioners who specialize in family health care and treat and write prescriptions for common illnesses such as strep throat and eye, ear and bronchial infections. The clinics also provide flu, tetanus and Hepatitis A vaccines. The clinics do not require appointments.

 

Advocates of retail store health clinics say they are the future of basic medical care, particularly as the nation struggles to hold down the costs of its health system.

 

All contents of this site © American City Business Journals Inc. All rights reserved.

 

Anne Arundel Medical Center to put funds toward $424M expansion project

 

By Julekha Dash

Baltimore Business Journal

Tuesday, June 23, 2009

 

Anne Arundel Medical Center said it has raised $32 million to fund its $424 million expansion of the 100-acre medical campus.

 

It is the biggest fundraising project the Annapolis hospital has undertaken in its 107-year history. Doctors and other hospital staff contributed more than $5 million toward the capital campaign.

 

Anne Arundel Medical Center’s expansion includes an 8-story patient tower with 50 patient rooms, eight operating rooms, an expanded emergency department and a dedicated pediatric emergency department and inpatient unit. The project also includes three new garages and two pedestrian bridges.

 

The expansion also includes a 240,000-square-foot health sciences pavilion, which hospital officials unveiled June 18. The building houses physician offices, a breast treatment center and outpatient services. It also contains a health sciences institute that will provide medical and community education, a conference room and five classrooms with video-conferencing capabilities. One classroom will allow physicians-in-training to see AAMC surgeons perform live surgery.

 

All contents of this site © American City Business Journals Inc. All rights reserved.

 

Md. colleges given $11M to combat nursing shortage

 

By Ryan Sharrow Staff

Baltimore Business Journal

Tuesday, June 23, 2009

 

Leaders from Maryland’s health care industry Monday unveiled $11 million in grants to help state colleges close a widening shortage of nurses.

 

The grants, being divvied among 17 Maryland nursing schools, will be used to lure faculty and students, and improve technology at the universities.

 

Maryland’s nursing shortage is expected to reach 10,000 by 2016, according to the Maryland Hospital Association. The current vacancy rate of nurses at state hospitals is 8 percent. The economic downturn has helped the industry because many retired nurses have come back to work, but once the recession ends the shortage will worsen, said Carmela Coyle, CEO of the Maryland Hospital Association.

 

The first round of grants will increase the number of nurses graduating by 300 students and add 20 faculty positions at nursing programs across the state.

 

“The number of nurses graduating from Maryland schools are simply not enough,” said Ronald B. Peterson, president of Johns Hopkins Health System and co-chair of the “Who Will Care?” campaign at a press conference Monday. “We cannot take our eye off the nursing demand.”

 

The campaign’s goal is to add 1,500 new nursing students.

 

The program has raised $15.5 million to date through the state’s business community, including funds from the Baltimore construction form Whiting-Turner Contracting Co., MedStar Health, the region's largest hospital system, and CareFirst BlueCross BlueShield, the region's largest health insurer.

 

Greater Baltimore Medical Center, for example, gave $500,000.

 

The goal is to raise $20 million from the private sector by the end of the year, and then raise an addition $40 million in state, local and federal funds.

 

Among the local colleges receiving grants include:

 

• Anne Arundel Community College;

 

• Carroll Community College;

 

• Community College of Baltimore County;

 

• Coppin State University;

 

• Howard Community College;

 

• Johns Hopkins University School of Nursing;

 

• Stevenson University; and,

 

• Towson University.

 

All contents of this site © American City Business Journals Inc. All rights reserved.

 

Officials gearing up for 2010 census

Education campaign, job recruitment key to $14 billion effort

 

By Sean R. Sedam

Frederick News-Post

Wednesday, June 24, 2009

 

If the sparse attendance at a public forum in Olney on Thursday is any indication, U.S. Census Bureau officials have their work cut out for them as they embark on efforts to educate residents about the importance of the 2010 census.

 

Many "don't realize that in the U.S. the census represents political power, their representation [in Congress] and also means billions of dollars going back to the community," said Fernando Armstrong, Philadelphia regional director for the Census Bureau, during an hour-long presentation.

 

Government representatives outnumbered community members 4-1 among the 15 people in the William H. Farquhar Middle School gymnasium for the forum, organized by the office of U.S. Rep. Donna F. Edwards (D-Dist. 4) of Fort Washington, who represents part of Montgomery County.

 

In the months leading up to "Census Day" on April 1, officials are trying to create public awareness of what the census means and why it is important to be counted. Civic groups, churches and other community outreach efforts are eligible to receive up to $2,900 from the bureau to purchase materials such as fliers, banners or T-shirts to promote Census 2010 awareness.

 

Montgomery County has formed a "Complete Count Committee," an informal group composed of representatives of county municipalities, the school system and other county institutions, to get the message out that the census is "important, safe and easy," said Bruce Adams, director of the county's Office of Community Affairs.

 

"Just in a democratic view — small ‘D' — the census is very important," Adams said.

 

Census data is used to apportion representatives in Congress, the State House and the County Council and for identifying where social services and schools are needed. It is also used by businesses such as grocery stores in making decisions on where to open and what products to market to customers.

 

Officials hope the estimated $14 billion effort will reach undercounted populations, including black men ages 18 to 35, college students and immigrants.

 

Immigrants are particularly wary of the census and need to be educated by groups they trust, such as churches, that the census will not ask their legal status and can bring needed services, Armstrong said.

 

The Office of Community Partnerships oversees the county's six ethnic advisory groups.

 

The county has not set aside money in the budget for census efforts, but is hoping to get funding through the Census Bureau for promotional efforts, Adams said.

 

Questionnaires will be delivered or mailed to households in March.

 

Offices already have opened in Baltimore, Frederick and Laurel, and the bureau plans to open more this fall in Rockville, Anne Arundel County, Baltimore city, Baltimore County, on the Eastern Shore and in Southern Maryland.

 

The Census Bureau will need to hire an estimated 1.4 million workers for temporary jobs nationwide. The bureau has set up a toll-free jobs line at 866-861-2010 and a jobs Web site at http://2010.census.gov/2010censusjobs.

 

Copyright 2009 Frederick News-Post.

 

Older population expected to triple by 2050

 

Baltimore Business Journal

Wednesday, June 24, 2009

 

The world's 65-and-older population is projected to triple by mid-century, from 516 million in 2009 to 1.53 billion in 2050, according to the U.S. Census Bureau.

 

In contrast, the population under 15 is expected to increase by only 6 percent during the same period, from 1.83 billion to 1.93 billion.

 

The Census Bureau said that in the United States those 65 and older will more than double by 2050, rising from 39 million today to 89 million. While children are projected to still outnumber the older population worldwide in 2050, the under 15 population in the United States is expected to fall below the older population by that date, increasing from 62 million today to 85 million.

 

These figures come from the world population estimates and projections released today through the Census Bureau's International Data Base. This latest update includes projections by age, including people 100 and older, for 227 countries and areas.

 

Less than 8 percent of the world's population is 65 and older. By 2030, the world's population 65 and older is expected to reach 12 percent, and by 2050, that share is expected to grow to 16 percent.

 

"This shift in the age structure of the world's population poses challenges to society, families, businesses, health care providers and policymakers to meet the needs of aging individuals," said Wan He, demographer in the Census Bureau's Population Division.

 

Europe likely will continue to be the oldest region in the world: by 2050, 29 percent of its total population is projected to be 65 and older. On the other hand, sub-Saharan Africa is expected to remain the youngest region as a result of relatively higher fertility and, in some nations, the impact of HIV/AIDS. Only 5 percent of Africa's population is projected to be 65 and older in 2050.

 

Countries experiencing relatively rapid declines in fertility combined with longer life spans will face increasingly older populations. These countries will see the highest growth rates in their older populations over the next 40 years.

 

There are four countries with 20 percent or more of their population 65 and older: Germany, Italy, Japan and Monaco. By 2030, 55 countries are expected to have at least one-in-five of their total population in this age category; by 2050, the number of countries could rise to more than 100.

 

Although China and India are the world's most populous countries, their older populations do not represent large percentages of their total populations today. However, these countries do have the largest number of older people -- 109 million and 62 million, respectively. Both countries are projected to undergo more rapid aging, and by 2050, will have about 350 million and 240 million people 65 and older, respectively.

 

All contents of this site © American City Business Journals Inc. All rights reserved.

 

National / International

In New Theory, Swine Flu Started in Asia, Not Mexico

 

By Donald G. McNeil Jr.

New York Times

Wednesday, June 24, 2009

 

Contrary to the popular assumption that the new swine flu pandemic arose on factory farms in Mexico, federal agriculture officials now believe that it most likely emerged in pigs in Asia, but then traveled to North America in a human.

 

But they emphasized that there was no way to prove their theory and only sketchy data underpinning it.

 

There is no evidence that this new virus, which combines Eurasian and North American genes, has ever circulated in North American pigs, while there is tantalizing evidence that a closely related “sister virus” has circulated in Asia.

 

American breeding pigs, possibly carrying North American swine flu, are frequently exported to Asia, where the flu could have combined with Asian strains. But because of disease quarantines that make it hard to import Asian pigs, experts said, it is unlikely that a pig brought the new strain back West.

 

“The most likely scenario is that it came over in the mammalian species that moves most freely around the world,” said Dr. Amy L. Vincent, a swine flu specialist at the Agriculture Department’s laboratory in Ames, Iowa, referring, of course, to people.

 

The first person to carry the flu to North America from Asia, assuming that is what happened, has never been found and never will be, because people stop carrying the virus when they get better.

 

Moreover, the officials said, the chances of proving their theory are diminishing as the virus infects more people globally. It has now reached more than 90 countries, according to the World Health Organization. Since some of those people will inevitably spread it to pigs, its history will become impossible to trace.

 

“To tell whether a pig is newly infected by a human or had the virus before the human epidemic began really can’t be done,” said Dr. Kelly M. Lager, another Agriculture Department swine disease expert.

 

The highly unusual virus — which includes genetic bits of North American human, avian and swine flus and Eurasian swine flu — has not been detected in any pigs except those in a single herd in Canada that was found infected in late April.

 

A carpenter who worked on the farm after visiting Mexico had been thought to have infected the herd. But in mid-June, Canadian health agencies said he was not to blame. The whole herd was culled, and the virus has not been found elsewhere in Canada, as it would have been if it were endemic, since American and Canadian laboratories test thousands of flu samples to help the pork industry develop vaccines.

 

But a sample taken from a pig in Hong Kong in 2004 was recently found to have a virus nearly matching the new flu. That flu, which had seven of the new flu’s eight genome sequences, was noted in an article in Nature magazine on June 11, which called it a “sister virus.”

 

Scientists tracking the virus’s lineage have complained that there is far too little global surveillance of flu in swine. Public databases have 10 times as many human and avian flu sequences as they do porcine ones, said Dr. Michael W. Shaw, a scientist in the flu division of the Centers for Disease Control and Prevention, and there are far fewer pig flu sequences from Asia than from North America and Europe, and virtually none from South America or Africa. “Something could have been going on there for a long time and we wouldn’t know,” Dr. Shaw said.

 

But national veterinary officials said they knew of no close relatives of the new virus in the large private North American databases, either. That makes it most likely, they said, that it has been circulating in Asia.

 

The new virus was first isolated in late April by American and Canadian laboratories from samples taken from people with flu in Mexico, Southern California and Texas. Soon the earliest known human case was traced to a 5-year-old boy in La Gloria, Mexico, a rural town in Veracruz.

 

Because that area is home to hog-fattening operations with thousands of pigs in crowded barns near lagoons of manure, opponents of factory farming were quick to blame the industry.

 

In May, the Mexican government said it had tested pigs on the Veracruz farms and found them free of the virus. Smithfield Foods, an owner of the farms, and the National Pork Producers Council, the industry’s lobbying arm, were quick to publicize that announcement.

 

But outside veterinary experts still disagree on whether those tests proved anything.

 

According to Smithfield, Mexican government veterinarians tested snout swabs taken on April 30 and blood samples stored since January.

 

But since the human outbreak in Veracruz is believed to have started in February, many veterinary experts said testing pig snouts for live virus in April proved nothing. Any pig sick in February would have long since recovered and, since hogs are usually slaughtered at 6 months old, many of those alive in early February would be bacon by April.

 

But Dr. Greg Stevenson, an expert in swine diagnostics at Iowa State University, said that since flu could persist in a large herd for months, “if it had been there in February, it would probably still be there at the end of April.”

 

The blood tests — in which scientists look for antibodies formed in response to a previous infection — present a different set of problems. Antibodies are much harder to tell apart from one another than viruses are.

 

A pig that had the new H1N1 flu would come up positive on an antibody test. But so would a pig that had the regular H1N1 swine flu that has circulated since 1930, or even a pig that had been vaccinated against the earlier H1N1 flu — and all the Smithfield pigs routinely get flu shots.

 

The company said vaccinated pigs could be distinguished from previously ill pigs because illness produced more antibodies.

 

But outside experts were skeptical. An antibody test specific enough to identify only the new flu strain “would take months to develop, at a minimum, and would require considerable R & D expertise and technology,” said Dr. Christopher W. Olsen, a swine flu expert at the University of Wisconsin’s veterinary medical school.

 

The governor of Veracruz has asked the National Autonomous University of Mexico to do its own investigation of industrial hog farming in his state; the work is expected to take months. Carlos Arias, the biochemist leading the team, said he hoped to test all the swab and tissue samples stored by the farms and the national veterinary laboratory.

 

Copyright 2009 The New York Times Company.

 

Most Want Health Reform But Fear Its Side Effects

 

By Ceci Connolly and Jon Cohen

Washington Post

Wednesday, June 24, 2009

 

A majority of Americans see government action as critical to controlling runaway health-care costs, but there is broad public anxiety about the potential impact of reform legislation and conflicting views about the types of fixes being proposed on Capitol Hill, according to a new Washington Post-ABC News poll.

 

Most respondents are "very concerned" that health-care reform would lead to higher costs, lower quality, fewer choices, a bigger deficit, diminished insurance coverage and more government bureaucracy. About six in 10 are at least somewhat worried about all of these factors, underscoring the challenges for lawmakers as they attempt to restructure the nation's $2.3 trillion health-care system.

 

Part of the reason so many are nervous about future changes is a fear they may lose what they currently have. More than eight in 10 said they are satisfied with the quality of care they now receive and relatively content with their own current expenses, and worry about future rising costs cuts across party lines and is amplified in the weak economy.

 

President Obama, in a news conference yesterday, sought to leverage that apprehension.

 

"Premiums have been doubling every nine years, going up three times faster than wages," he said. "So the notion that somehow we can just keep on doing what we're doing, and that's okay, that's just not true."

 

Debra Matherne, a 43-year-old lawyer in Pennsylvania, agreed, saying she is contemplating leaving a job she loves because health insurance premiums for her family have jumped to $2,000 a month.

 

"That's just a crazy figure," she said.

 

The midday news conference was part of an orchestrated attempt by the White House to draw public attention to the need for landmark health legislation. Earlier in the day, Health and Human Services Secretary Kathleen Sebelius released a report documenting the growing financial burden that medical bills are placing on families.

 

On Wednesday, Obama will host a health-care meeting with a bipartisan group of governors and later participate in a televised town hall session dedicated to the issue.

 

Obama also used yesterday's news conference to rebut criticism of one of the more contentious ideas being considered: creation of a government-sponsored health insurance program that would compete with private firms.

 

Insurers and many Republicans warn that the "public option" included in bills filed in the House and Senate "would dismantle employer-based coverage, significantly increase costs" and add to the federal deficit.

 

"If private insurers say that the marketplace provides the best quality health care; if they tell us that they're offering a good deal, then why is it that the government, which they say can't run anything, suddenly is going to drive them out of business?" Obama said. "That's not logical."

 

After months of cordial relations between the industry and the White House, Obama's comments were the sharpest to date and come at a time when there is widespread debate and confusion over what the public wants. One of the reasons is the complexity of the issue, something not easily captured in a poll question.

 

Survey questions that equate the public option approach with the popular, patient-friendly Medicare system tend to get high approval, as do ones that emphasize the prospect of more choices. But when framed with an explicit counterargument, the idea receives a more tepid response. In the new Post-ABC poll, 62 percent support the general concept, but when respondents were told that meant some insurers would go out of business, support dropped sharply, to 37 percent.

 

Support for an "individual mandate," requiring every American to carry health insurance, ranges from 44 percent to 70 percent depending on the specific provisions.

 

"The president needs to understand that this is about patients and preserving their options," said Sen. Mike Enzi (R-Wyo.), a key player in bipartisan negotiations in the Senate. "Losing their health insurance is not the kind of change Americans were hoping for."

 

Even as Obama and the insurers ratcheted up the tenor of the discussion, both sides made clear there is still plenty of room for compromise.

 

"We are still early in this process, so we have not drawn lines in the sand," Obama said.

 

Karen Ignagni, head of America's Health Insurance Plans, said that she sensed an opening in the president's enthusiasm to create a government-sponsored plan modeled after the private-market plans from which federal workers choose.

 

In the poll, 58 percent said they see government reform as necessary to stall skyrocketing costs and expand coverage for the uninsured, while 39 percent said they fear any federal action would do more harm than good. The numbers split sharply along partisan and ideological lines: Ninety-two percent of liberal Democrats said they see government intervention as essential, compared with 19 percent of conservative Republicans.

 

Beyond general backing for governmental action, a few specific provisions under consideration on Capitol Hill receive significant levels of public support, including higher taxes on households with incomes above $250,000, a limit on medical malpractice amounts and, under certain conditions, a law requiring all Americans to carry health insurance. A large majority, 70 percent, opposes a new federal tax on employer-paid health insurance benefits that exceed $17,000 a year.

 

Majority support for certain new government action, however, does not come with high hopes: Half of all Americans said they think the quality of their health care will stay about the same if the system changes, and 31 percent expect it to deteriorate.

 

"We're spending a lot and not necessarily getting the bang for our buck," Philip Arms, 58, of Northwest Washington, said in a follow-up interview. Despite his desire for reform, "I'm not necessarily convinced it won't make things worse."

 

The poll was conducted by telephone June 18 to 21, among a national random sample of 1,001 adults; results have a margin of sampling error of plus or minus three percentage points.

 

Polling analyst Jennifer Agiesta contributed to this report.

 

Copyright 2009 Washington Post.

 

HHS secretary presses lawmakers on health care

 

Associated Press

By Ricardo Alonso-Zaldivar and David Espo

Washington Post

Wednesday, June 24, 2009

 

WASHINGTON -- Health and Human Services Secretary Kathleen Sebelius on Wednesday defended President Barack Obama's call for a new public health insurance plan in the face of strong opposition from Republicans and fresh criticism from a powerful business group.

 

Sebelius told the House Energy and Commerce Committee that a government-run option would increase choice and competition, but the U.S. Chamber of Commerce said in testimony that it would "gut the private market."

 

"Whether or not this proposal is a Trojan horse for single-payer health care, it is apparent that its cause is ideological, not pragmatic," the chamber said Wednesday.

 

Argued Sebelius: "If there is no choice in the market, cost regulation is almost irrelevant. It's a marketplace strategy that competition is often more effective than heavy-handed regulation."

 

Obama and his administration stepped up the campaign for comprehensive health care overhaul that would reduce costs and provide coverage to nearly 50 million uninsured Americans. The president planned a meeting with several governors Wednesday afternoon and a prime-time town hall to be broadcast on ABC.

 

In an interview with ABC News that aired Wednesday morning, Obama declined to say whether he was open to taxing health benefits. But he indicated there was a breaking point in the balance sheets where he would say that the cost of reforming the system is too great for the federal government to handle.

 

"I'm going to wait and see what ideas ultimately they (Congress) come up with," he said on ABC's "Good Morning America."

 

"I think that if any reform that we get is not driving down costs in a serious way," Obama added. "If people say, 'We're just going to add more people onto a hugely inefficient system,' then I will say no. Because ... we can't afford it."

 

Republicans and outside groups are making the public plan issue a focus of stepped-up television ad campaigns that warn of a government takeover of health care, contending the result would be rationing of care similar to Canada and other countries.

 

But Sebelius said that "rationing, frankly, is something that happens each and every day under our current system." It's done by private insurers, she said.

 

Sebelius also told lawmakers that Obama is willing to listen to suggestions on how to pay for a health care overhaul, as long as they don't increase the deficit. She testified as Democrats struggle with the $1 trillion-plus price tag over 10 years.

 

Obama's policies, including a stimulus package earlier this year designed to jump-start the economy, have added to the federal budget deficit, stirring public restiveness that could undermine his domestic agenda. About $1.3 trillion when Obama took office, this year's deficit is on track to soar to a record $1.85 trillion after his massive influx of federal spending to help struggling homeowners, stabilize frozen credit markets and bail out troubled banks, automakers and insurers.

 

Although lawmakers are considering an option Obama has opposed - taxing employer-provided benefits - Sebelius' testimony indicates that the administration is ready to be flexible if Congress can deliver a bill.

 

That has seemed uncertain, as cost concerns and partisan disputes have stalled progress. Sebelius used her testimony to encourage Democratic efforts - and to make clear that Obama expects lawmakers to deliver.

 

"Health reform constitutes our most important domestic priority," she said.

 

A new Washington Post-ABC poll found that most Americans are "very concerned" that a health care overhaul would lead to higher costs, lower quality, fewer choices, a bigger deficit, diminished insurance coverage and more government bureaucracy. About six in 10 are at least somewhat worried about all of these factors, the poll found.

 

More than eight in 10 said they were satisfied with the quality of care they now receive and were relatively content with their own current expenses.

 

Addressing that issue, Obama on Tuesday dismissed as "not logical" the insurance lobby's assertion that a new government health plan he backs would dismantle the employer-sponsored coverage most Americans now have. Yet, despite the harsh words from the president, senators attending a Tuesday evening meeting in the Capitol with White House Chief of Staff Rahm Emanuel said the administration was not ready to abandon the search for compromise.

 

That puts the spotlight on a small group of senators who are trying to find common ground on the issue of giving the middle class the option of joining a government health plan. Republicans are almost unanimously opposed, while Democrats insist it must be part of any final deal.

 

Dubbed "the coalition of the willing," the Senate group is focusing on nonprofit co-ops as an alternative both to private insurance and full-blown government intervention.

 

"The co-op proposal is alive and well, and negotiations are ongoing," said Sen. Kent Conrad, D-N.D., who proposed the idea, adding that it's the only version of a public plan that stands a chance of getting Republican support.

 

---

Associated Press writer Erica Werner contributed to this report.

 

© 2009 The Associated Press.

 

Authorities Indict 53 for Medicare Fraud

 

Associated Press

Wall Street Journal

Wednesday, June 24, 2009

 

WASHINGTON -- Authorities have indicted 53 people for schemes to cheat Medicare out of $50 million.

 

Suspects were arrested in Detroit, Miami, and Denver as part of a wide-ranging effort by the government to crack down on those allegedly defrauding the government-funded health care program for the elderly and disabled.

 

Attorney General Eric Holder, Health and Human Services Secretary Kathleen Sebelius, and FBI Director Robert Mueller announced the charges at a news conference in Washington.

 

Ms. Sebelius said the Obama administration is determined to crack down on Medicare fraud through new teams of investigators detecting patterns of false billing. Forty of the suspects have already been arrested, authorities said.

 

Copyright © 2009 Associated Press.

 

UN reports decline in cultivation of some drugs

 

Associated Press

By Barry Schweid

Washington Post

Wednesday, June 24, 2009

 

WASHINGTON -- In its annual report on world drug use, the United Nations concludes that global markets for cocaine, opiates and marijuana are holding steady or in decline.

 

Yet about 28 million people are heavy drug users likely to be physically or psychologically dependent on drugs, the report said.

 

Opium cultivation in Afghanistan, where 93 percent of the world's opium is grown, dropped by 19 percent last year, the Vienna-based U.N. Office on Drugs and Crime reported Wednesday.

 

And there was a 28 percent decline - the report called it staggering - in production of cocaine in Colombia, which produces half the world's cocaine, the report said.

 

Global production of coca hit a five-year low at 845 tons despite some increased cultivation in Peru and Bolivia.

 

Marijuana, or cannabis, remained the most widely used and cultivated drug in the world and it is more harmful than commonly believed, the report said.

 

As a result, the number of people seeking treatment is rising. Roughly 167 million people use marijuana at least occasionally.

 

Opiates and cocaine have about 18 million users a year each. And it is estimated that 11 million to 21 million people worldwide inject drugs.

 

Among synthetic drugs, 16 million to 50 million took amphetamines and related drugs and about 27 million took Ecstasy, the report said.

 

The estimated cost of the world's illicit drug market is about $320 billion, said Antonio Maria Costa, executive director of the U.N. office.

 

"This makes drugs one of the most valuable commodities in the world," he said in a telephone interview. "The proceeds of drug-related crime are of macro-economic proportions."

 

In a statement issued with the report, he called for treating drug use as an illness. "People who take drugs need medical help, not criminal retribution," Costa said. He appealed for universal access to drug treatment.

 

Among the striking findings in the report is the growth of what was once a cottage industry of industrial-sized laboratories in southeast Asia, particularly in the greater Mekong region of Vietnam, producing massive quantities of methamphetamine tablets and crystal meth.

 

Another is skyrocketing use of the amphetamine Captagon in the Near and Middle East.

 

"We are asking for increased investment in law enforcement and crime control," Costa said. "Organized crime related to drugs has become a threat to a number of countries."

 

The aim is to get governments worldwide to invest in public health and public security, he said. No specific amount was suggested.

 

Drug money perverts weak economies and corrupts weak officials, he said. And drugs are a source of revenue for insurgents, like the Taliban and FARC, the largest guerrilla group in Colombia, that control regions of illicit cultivation, he said.

 

© 2009 The Associated Press.

 

Is Our Doctors Learning?

Why aren't medical students taught about health care policy?

 

Slate Magazine

 

By Christopher Beam

Washington Post

Tuesday, June 23, 2009

 

When Daniel Henderson was a first-year medical student at the University of Connecticut, he wanted to take a class on health care policy. But between his core requirements and an elective in community-based research methods, he didn't have room in his schedule. His only encounter with policy was a pair of dull lectures in his second year. "Most people did work for other classes or played games on their computer," Henderson recalls.

 

For all the schooling future doctors undergo-as much as 11 years from pre-med through residencies-very little of it focuses on health care policy. That's understandable. Medicine is complicated enough without having to worry about who gets it or how we pay for it. But as a result, many students graduate with little understanding of how our health care system works. "People I graduated with couldn't tell you the difference between Medicare and Medicaid," says Jaclyn Albin, a recent grad of the George Washington University School of Medicine and Health Sciences.

 

The problem isn't always the classes. Most medical schools offer at least one elective that covers the basics of health care policy-how providers work, private vs. public insurance, drug legislation, etc. Many of them offer entire courses of study in policy.

 

The hard part is getting students to take them. Most first- and second-year students are so frazzled from their regular course work that they barely have time for sleep, let alone wonk out. "Things that are not required of med students, they're not going to do," Albin explained. Nor does it help that medical school is so competitive. "Everyone wants to be the best," says Henderson. Faced with a choice between learning about a high-paying specialty like radiology or gastroenterology or cardiology-all of which have limited residency slots-and public policy, there is no choice.

 

Some medical schools are trying to change that. Last year, all 170 third-year medical students at GWU spent a day on Capitol Hill listening to health experts-from congressional staffers to Medicare executives to pollsters-talk about health care policy and learning how they, as future doctors, could influence it. A few years ago, GWU added a health policy track-basically a minor-for students interested in learning about legislation. About a dozen students have enrolled every year-hardly a flood, but an improvement nonetheless. Some of them have written legislation by the time they graduate.

 

More drastic still are recent changes at Harvard Medical School. In 2006, HMS started requiring every student to take a semester-long class in health care policy. The series of 13 lectures covers the different types of managed care, entitlement programs, the economics of insurance, medical malpractice, and even health care reform. (See the syllabus here.) In smaller discussion sessions, students confront tough decisions. Say you've got a drug that may extend an elderly woman's life for a few months but costs thousands of dollars. Do you prescribe it? "We want them to understand the trade-off," says professor Haiden Huskamp, who co-teaches the class.

 

Meanwhile, both GWU and Harvard have begun incorporating policy into their standard curricula. If you're taking a cardiology class, for example, you'd learn not only about bypass surgery but about when it's covered and where you can send the patient once the procedure is done. Or say you're treating a hypothetical patient who has asthma. You might learn not just about which drugs are available but about health disparities-why asthma is so prevalent among urban minorities compared with other groups-and the policies that address them.

 

This kind of integration may seem obvious. But for decades, it was overlooked. "Ten or 15 years ago, most schools did not have anything involving health care policy," says professor Matthew Mintz of GWU. "Medicine was medicine and policy was policy and why would doctors want to learn anything about policy?"

 

Now, though, some schools are trying to teach doctors to think holistically about their profession. "You're trained in medical school to think about treating this one patient in a very narrow vision," says Huskamp. "But we want people to think at the societal level, the health system level." That means weighing the interests of the patient against the interests of the system as a whole.

 

The goal here is not to convince students that health care reform is necessary, says Huskamp: "We think about it more from an analytical point of view, than an opinion point of view." After all, students can agree that there's a problem but disagree about the solutions.

 

But sympathy for reform may well be the result. Refusal to think holistically about health care-to figure out why costlier care is often worse or which treatments work best-is largely what has driven costs up. "Doctors not being engaged in policy is a big problem, and one reason our health care system is in such bad shape," says Henderson, who now serves as health justice fellow for the American Medical Students Association.

 

Perhaps the first step in fixing the system, therefore, is for every medical school to require health policy classes. That might not make an activist of every doctor. But it would show students how influential they are-politicians love hearing from M.D.s-and inject more informed voices into the debate. "Health care professionals have not been traditionally involved [in policy debates]," says Albin. "It's something we've handed over to legislators and politicians." Educating med students about the system could also tip the debate in favor of reform. The American Medical Association may have come out against a public option. But the American Medical Students Association is pushing hard for it. Whoever wins, doctors-and aspiring doctors-should at least know what they're talking about.

 

Christopher Beam is a Slate political reporter.

 

Article URL: http://www.slate.com/id/2221157/

 

Copyright 2008 Washingtonpost.Newsweek Interactive Co. LLC.

 

Opinion

Toys, Games Ease Kids Into the Dentist's Chair

 

By Mark Trainer

Washington Post Commentary

Tuesday, June 23, 2009

 

Just the idea of the dentist turns many adults into petulant children. Reasonable grown-ups leave that reminder postcard pinned up on the bulletin board for months before shuffling to the telephone like a mopey teenager to make the appointment. Once there, leaned back and incapable of anything more than gurgling sounds, we might as well be infants again. And when the power of speech is returned to us, we're capable of transparent, juvenile lies. ("I can't imagine why that is, since I floss every day . . . really.")

 

But might our children be saved from lifelong dental anxiety? The business of looking after teeth has changed. Maybe dentists are tired of having their services be the go-to comparison for anything unpleasant ("about as much fun as having a tooth pulled"); maybe, thanks to all that fluoridation and improvements in preventive care, some other doctor can become the health-services bad guy.

 

Most adults I know had similar experiences to my own. The two dentists of my childhood worked out of their homes on leafy residential streets. You got a glimpse of their living rooms from the chair when they first entered the patient area. The first one spoke sternly about cavities and candy, then, paradoxically, gave you a stick of Juicy Fruit on the way out. The second would break off mid-procedure, raise the window that the chair faced, put out nuts for the squirrels, wash his hands and get back to work. The charm ended there. I had my share of cavities as a kid, and the allowance for my tender years boiled down to two utterances: "Hold still" and "We're almost finished." The first felt beyond my control to obey, and the second only served to illustrate the wide chasm that separated our concepts of time.

 

How things have changed. Any dentist who works with kids today is likely to have a waiting room stocked with toys and books, music, DVDs and other contraptions to distract from the unpleasant business of the chair and, for parting gifts, enough toys, stickers and balloons to make Bob Barker proud. Is this coddling? You bet. It turns a trip to the dentist into something like a visit to an overindulgent grandparent.

 

When should that first visit be? According to Sheila Samaddar, a family dentist on Capitol Hill, the American Academy of Pediatric Dentistry and the American Academy of Pediatrics are of different opinions on this. The AAP recommends the first visit at age 3, while the AAPD suggests a visit when the first tooth erupts, around six months after a baby is born.

 

Although Samaddar thinks most parents can see if something is amiss when babies are cutting their first teeth, she thinks waiting until age 3 is a little too long, saying most of her first-timers are between 18 months and 2 years old. Brian Brumbaugh, a pediatric dentist in Staunton, Va., prefers to see his patients on their first birthday. The idea, he explains, is establishing a "dental home," a place where parents can develop a relationship with the dentist, a place to bring their questions, and a place to call in an emergency. The thinking behind this is that the younger your child is when he first visits the dentist, the less likely he is to need an uncomfortable procedure that would trigger the bad associations many adults have with the dentist.

 

Whenever you begin your child's dental odyssey, you'll have the choice between a regular dentist and a pediatric dentist. Why choose a pediatric dentist? Children who have serious anxiety issues can benefit from the experience and training of a pediatric dentist. "I'm a little bit better able to handle a child with different abilities," says Dana Greenwald, whose practice is in Friendship Heights. "I'm more in tune with how to restore baby teeth," she says.

 

Any procedure that would require an anesthetic stronger than nitrous oxide will require a pediatric dentist. According to Greenwald, sedating children is challenging enough that many pediatric dentists will refer patients who need anesthesia to others with more experience in that field.

 

And there's the atmosphere. Whatever makes a family dentist kid-friendly is ramped up exponentially with a pediatric dentist. Brumbaugh's office boasts a 16-foot Thomas the Tank Engine play table in a large recreation area with a big-screen TV. Greenwald prefers to keep the toys low-tech ("Too many electronics can make kids zone out"), with stuffed animals, kid magazines and the house specialty: fingernail painting at the end of the visit.

 

My own children's first visits to the dentist were closer to age 3 -- up to 2 1/2 years late, depending on whom you ask. That means my wife and I join the 50 percent of the population Greenwald estimates wait until their children have a full set of baby teeth before making their way to the dentist. While it's possible that waiting until this age could leave some problems undetected, dentists told me it won't necessarily make the first visit more difficult.

 

"Three is a great age," Greenwald says. "They really want to please." We chose Tawann Jackson, a family dentist on Capitol Hill whose rapport with children was reported on a parents' e-mail discussion group.

 

I asked the dentists I spoke with what aspect of the first visit would be most likely to unsettle young patients. They all pointed to basic stranger anxiety. Chong Lee, who practices in Arlington, answered, perhaps most candidly, "It's the instruments." What with the goggles, gloves and the mask, the dentist has the potential to be one of the more unsettling strangers a child has ever encountered.

 

Jackson made a point of explaining to our daughter, Lela, why she was dressed this way. She asked Lela if she would be more comfortable in Mommy or Daddy's lap. (She was.) Jackson gave her an extensive tour of the tools -- well, not so extensive that it included the drill. She introduced her to the suction device, a.k.a. Mr. Thirsty (a name so ubiquitous in children's dentistry that it must be the answer to the first question on the comprehensive dental exam). She let Lela squirt some water and some air, and experience the giddy highs and lows of the chair's hydraulic system. Jackson seemed in no hurry about any of this; I soon realized that this first visit was going to be mostly an icebreaker.

 

When it came time to look at Lela's teeth, the doctor employed the approach at the heart of kids' dentistry: tell-show-do. She explained how she would be examining Lela's teeth and demonstrated on the tip of Lela's finger how she would use the instrument. Only then did she actually do the exam.

 

All of that thrilled Lela. It felt to her, I think, like a high-tech play date. As Lela was picking out toys and stickers in the outer office, Jackson told us what was going on behind the fun and games: A successful first visit includes an oral exam, counting of the teeth, soft tissue assessment (gum, tongue, lips), an oral cancer screening, an assessment of the child's bite, an evaluation of the teeth's spacing, a cleaning and a fluoride treatment. She discussed the family's dental habits. She wanted Lela's tooth-brushing to go on for two minutes and for us to do all we could to stop her thumb-sucking. The fun was over.

 

Twenty months later, my son, Finn, would have none of it. What had worked for Lela utterly failed to calm him. He screamed in a way that no ride in the chair or latex-glove balloon was going to silence. Jackson advised us to try again in a few months. She didn't want to do anything Finn didn't want to do. Hardly seems like the dentist, does it?

 

When interviewed for this article, my kids told me the dentist was fun. "It's good for your teeth," Lela, now almost 7, said. "And you get toys at the end," added Finn, now 5 and recovered from his first trip.

 

I asked which they preferred, the pediatrician or the dentist. "The dentist," Lela explained patiently. "The dentist doesn't give shots." "And," Finn reiterated, "you get toys at the end!"

 

I'm suddenly feeling like my own dentist isn't trying hard enough.

 

Mark Trainer is working on a story collection called "Bad Daddies." He lives on Capitol Hill. Comments: health@washpost.com.

 

Copyright 2009 Washington Post.

 

Butt Piracy

Why ban the tobacco industry when you can hijack it instead?

 

Slate Magazine

By William Saletan

Washington Post Commentary

Tuesday, June 23, 2009

 

"Today, despite decades of lobbying and advertising by the tobacco industry, we've passed a law to help protect the next generation of Americans," President Obama declared yesterday as he signed a new antismoking bill into law.

 

It's an uplifting tale of courage against evil. The truth, however, is more complicated. For all his rhetoric, Obama is still apparently a nicotine addict. And the country's biggest tobacco company, Altria, helped write the bill. These awkward facts don't make for a simple story about right and wrong. But they do help explain why, as a model of addiction control, the new tobacco law beats the war on drugs.

 

The law doesn't ban tobacco products. In fact, it bars the Food and Drug Administration from prohibiting them. It instead empowers the FDA to restrict "nicotine yields" and to require "the reduction or elimination of other constituents" that may be harmful. Lorillard, a major tobacco company, has complained that the bill "would allow the FDA to alter what occurs naturally in the leaf." That's true. To save lives, we're manipulating not just industry but nature.

 

Why is Altria going along with this crackdown? Because it sees the handwriting on the wall. The accumulating evidence of damage from firsthand and secondhand smoke has propelled a tide of smoking regulations, lawsuits, and tobacco taxes that are sweeping away the industry's old business model. Altria envisions a new business model: devising and selling less harmful tobacco products. Along with competitor R.J. Reynolds, it's test-marketing snus, a smokeless tobacco pouch. It's investing in research to limit carcinogens further. A third company, Star Scientific, is dedicated to "reducing toxins" through the development of "dissolvable smokeless products." It already sells tobacco tablets in two forms.

 

Don't kid yourself. These are still tobacco companies, and they'll give up their tobacco business when you pry it from their cold, dead hands. But their interest in making money by developing safer products can be put to good use. Two years ago, an Altria executive told Congress that "with clear guidelines and oversight, there should be an opportunity for increased competition as both new and existing manufacturers work to develop and commercialize products that could potentially reduce the harm caused by tobacco use." That's exactly right. The government's job is to set up the competition so that it genuinely serves public health.

 

Rules that serve the public won't please the industry. Tobacco companies wanted a rule that would let them market anything nominally safer than a conventional cigarette. The Senate rejected that idea. Instead, the law permits such marketing only if the FDA is convinced that the product, "as it is actually used," will "benefit the health of the population as a whole taking into account both users of tobacco products and persons who do not currently use tobacco products." So if smokers increase their consumption to compensate for a lower per-unit dose of nicotine, or if advertising the product's relative safety lures too many nonsmokers into using it, the FDA can forbid the product's sale.

 

Better yet, the law requires the agency to evaluate each product's risks and benefits "as compared to the use of products for smoking cessation." Doctors commonly prescribe nicotine inhalers, nasal sprays, and lozenges, and the government promotes such products, as long as they're designed to wean addicts off the drug gradually. By forcing tobacco products to compete on safety grounds with nicotine-replacement products, the law blurs the distinction. It pushes the industry to reduce harm and nicotine to levels from which smokers can quit altogether. In such a competition, if the industry can't adequately protect its customers' health, it will lose them.

 

Why not ban tobacco right away? Because too many people are hooked. If you think a ban will stop them, look at Obama. He needed to quit so he could run for president. He promised his wife he'd quit. He had access to every resource. And yet when a reporter asked yesterday whether he was still smoking, his press secretary could only answer, "He struggles with it every day."

 

If you ban tobacco products, some people will quit, but others will just buy them illegally. And the illegal products will come with none of harm reduction that regulation can provide. The FDA acknowledged this problem years ago. If tobacco were outlawed, the agency explained, black-market suppliers would move in with products "even more dangerous than those currently marketed, in that they could contain even higher levels of tar, nicotine, and toxic additives."

 

This is what drug warriors don't understand: There's always market competition, whether you like it or not. Prohibition just means that the competition is between legal and illegal products. To beat illegal products in an already-addicted market, you need sufficiently attractive legal alternatives. Then, by regulating and manipulating the legal products, you can ratchet down the harm and addiction. That's how you bring the market under control.

 

If you want to know what Obama really thinks about tobacco, don't read his lips. Read his teeth. To relieve his addiction and protect his health, he's been chewing nicotine gum. The law he just signed authorizes the FDA to expedite approval of nicotine lozenges, gum, and patches. It encourages the agency to broaden the grounds for prescribing such products and to authorize their "extended use." It puts regulators smack in the middle of the nicotine business so they can turn it to better use. If only all our drug policies were this rational.

 

(Now playing at the Human Nature blog: 1) Shrinking cows to fit the new economy. 2) The psychology of infanticide. 3) Are abortions for sex selection nobody's business?)

 

William Saletan is Slate's national correspondent and author of Bearing Right: How Conservatives Won the Abortion War.

 

Article URL: http://www.slate.com/id/2221147/

 

Copyright 2008 Washingtonpost.Newsweek Interactive Co. LLC.

 

Bringing Down the House

The sobering lessons of health reform in Massachusetts.

 

Slate Magazine

 

By Darshak Sanghavi

Washington Post  Commentary

Posted Tuesday, June 23, 2009

 

The debate over achieving universal health care can seem hopelessly confusing. But the issues are actually pretty simple when you consider the lessons of Massachusetts.

 

In 2006, state lawmakers seeking to broaden health coverage made it illegal to be uninsured. It works like this: Employers have to offer you a health plan. If you are jobless or don't like your employer's plan, you must buy your own. If you don't get one, you pay a stiff fine. This strategy-known as an employer and individual "mandate"-forms the backbone of the national health reform bills now making their way through Congress.

 

On paper, the experiment was a resounding success. According to an Urban Institute estimate, the number of uninsured residents quickly fell from 13 percent to 7 percent following the law's passage.

 

And yet, something strange happened. Despite having health insurance, roughly one in 10 state residents still failed to fill prescriptions, ended up with unpaid medical bills, or skipped needed medical care for financial reasons. Hundreds of millions of dollars were spent to insure more Massachusetts citizens, but many people still weren't getting necessary care. What happened?

 

Assume you're looking to buy insurance. The state has a handy Web site where you can find the cheapest plan. For a young family of four, that plan costs roughly $9,500 per year, which doesn't include a minimum annual deductible of $3,500 before many benefits kick in. (The state helps cover some of the premiums for those who make very little money, but many still have to pay the other fees.) And if anyone is hospitalized or needs a lot of specialized care, you also pay 20 percent of that bill. In this relatively cheap plan, the family can be liable for an extra $10,000 per year of medical costs. This sort of "high deductible" health plan is clearly structured to discourage medical care.

 

Imagine, for example, that your homeowner's insurance had a $1,000 deductible. If the faucet leaks, you'll try to fix it yourself instead of calling the plumber. The same thing applies to health care. If your newborn has a fever, you might give her Tylenol and just hope there's no serious infection rather than head to the emergency room and face a hefty co-pay.

 

Why does a progressive state like Massachusetts strong-arm many individuals and businesses into buying expensive insurance plans that don't encourage actual visits to the doctor and hospital? According to the Kaiser Family Foundation, the average person consumes more than $5,000 per year in health care resources. No matter how you slice it, some entity-government, business, or the individual-owes a boatload of cash for medical expenses. The annual costs for the 500,000 or so uninsured Massachusetts residents would run more than $2.5 billion, far in excess of the original state subsidy of $559 million.

 

That left billions to be paid by businesses and individuals. So for them, a high-deductible plan was a rational gamble. You (or your employer) front just enough money to get some coverage in case of catastrophe and then hope no one actually gets sick. But someone invariably does. As a result, out-of-pocket medical bills are the leading cause of bankruptcies-even though of most affected families actually have health insurance.

 

The expensive Massachusetts plan is not well-designed to systematically improve anyone's health. Instead, it's a superficial effort to clear the uninsured from the books and then clumsily limit further costs by discouraging care.

 

This brings us to the real task facing health reformers in our nation. Atul Gawande recently observed that for too long we've been "arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks." What's more important are the doctors who write the bills. The more procedures they do, the more money they make. To fix medicine, he argues, we have to create better incentives for doctors to do right by patients instead of their own bank accounts.

 

But that's not the whole story. Health care costs are rising everywhere, even in places like Minnesota, which Gawande cites as a prime example of low-cost, high-quality care that should be replicated nationwide. (Per capita health spending is actually 25 percent higher in Minnesota than in Texas, which has a hospital system that Gawande criticizes for profiteering.) In Massachusetts, some employers offering high-quality plans have annual rate increases of 10 percent to 15 percent. These jumps are certainly due to some overuse of services but also indicate increasingly high-technology care.

 

The lesson of Massachusetts is that really good health care is also really expensive. The concern isn't who writes the checks or who writes the bills. The real question is who makes the tough decisions about the limits of the checks and bills-in other words, who ultimately rations the money. Not everybody can have everything, and the sooner we admit that, the sooner our health care debate will get realistic.

 

In the haphazard Massachusetts plan, rationing fell to individuals, who then skimped on important prescriptions and routine visits. Gawande would leave rationing to properly incentivized doctors, but we have no data about whether this can be done widely. Others advocate for bodies like the Medicare Payment Advisory Commission (an impartial medical Federal Reserve Board), which can make the hard calls to promote and limit certain kinds of medical care. Britain, for example, has a national institute that makes precisely these decisions, like limiting drug-eluting stents for coronary artery disease and certain pricey drugs for kidney cancer. And health insurance executives here are again talking about "capitation," or fixed global budgets in which a group of health providers gets fixed monthly fees to handle all of a person's health needs.

 

In the meantime, one thing is sure: Without a smart plan to ration our resources well-that is, stick to a budget-and improve health, simply mandating that employers and individuals buy health insurance will only worsen the mess.

 

Darshak Sanghavi is a pediatric cardiologist and assistant professor of pediatrics at the University of Massachusetts Medical School. He is the author of A Map of the Child: A Pediatrician's Tour of the Body.

 

Article URL: http://www.slate.com/id/2221031/

 

Copyright 2008 Washingtonpost.Newsweek Interactive Co. LLC.

---

BACK TO TOP