Thursday, March 12, 2009

News Clipping Archives

 

Maryland / Regional

More furloughs debated in budget talks (Baltimore Sun)

City health official Sharfstein reported headed to FDA (Baltimore Sun)

Delegates do about-face on domestic violence bill (Baltimore Sun)

Infant's death is ruled a homicide (Eldersburg Eagle)

MedStar Health offers wireless Web at seven of its hospitals (Baltimore Business Journal)

National / International

Mental stress spirals with economy (USA Today)

Top Pain Scientist Fabricated Data in Studies, Hospital Says (Wall Street Journal)

A Reality Check (Baltimore Afro-American)

New Report Released: 1 in 50 children in America are homeless each year. (WBALTV 11)

Lack Of Vitamin D Linked To Teen Health Problems (WBALTV 11)

Opinion

Reinventing health care (Baltimore Sun)

In Columbia: Howard County's challenge is to persuade healthy uninsured residents to sign up for its low-cost plan (Baltimore Sun)

In Annapolis: Requiring people to be insured would help reform system (Baltimore Sun)

Medicare as solution (Baltimore Sun)

Health-care reform needed (Carroll County Times)

Maryland Food Bank needs continued Carroll County support (Eldersburg Eagle)

 

Maryland / Regional

 

More furloughs debated in budget talks

Local aid cuts also eyed to fill $516 million budget gap

 

By Laura Smitherman

Baltimore Sun

Thursday, March 12, 2009

 

Legislative leaders, saddled with a new budget hole of $516 million and a deadline for balancing the budget, said yesterday that they might resort to additional furloughs for state workers and slashing aid to local governments that have largely been spared in previous rounds of spending cuts.

 

Senate President Thomas V. Mike Miller and House Speaker Michael E. Busch laid out some budgetary options yesterday as the state's revenue forecasters officially reported that they now anticipate more than $1.1 billion less in tax revenue during the next 16 months. That means they will have to drastically cut a spending plan they had already begun to craft for next year.

 

Gov. Martin O'Malley pledged to work with the Democratic leaders to finish the budget before the General Assembly session ends in little more than a month. The governor, also a Democrat, interrupted a meeting at the State House with his budget team yesterday to hold a news conference but offered few clues as to how they would address the budget gap.

 

"We're right now going over the various options, none of them very good," O'Malley said. "It's all going to be very painful."

 

The worsening fiscal picture has forced the governor to abandon the rosy outlines of a budget plan he offered last month that included billions of dollars in federal aid from a stimulus package. At the time, he said he would be able to avoid some of the most painful cuts, such as a reduction in aid to school districts and plans to lay off 700 state workers.

 

But the latest revenue projections leave the governor and lawmakers with yet another gap to fill. The scenario is becoming familiar as state revenues have steadily deteriorated for the last several years.

 

The latest projections from the state Bureau of Revenue Estimates account for the impact of the deepening recession on income and sales tax collections, which have slowed with increasing unemployment and declining consumer confidence. There is no indication that the recession will end this year, and "tremendous uncertainty" regarding revenues remains, said David F. Roose, the bureau's director.

 

To keep the operating budget balanced during the current budget year, state officials plan to shift pots of money from other funds. But they must pare next year's budget more than they had expected.

 

While O'Malley has indicated layoffs might be revisited, legislative leaders have rejected the option. Miller said yesterday that an alternative is additional furloughs, and legislative analysts have suggested a 1 percent across-the-board pay cut.

 

Labor union leaders have balked at those proposals. They point out that state workers have already been asked to take up to five furlough days, which amounts to a pay cut, and are not getting pay raises next year.

 

"This is a time when the state has got to step up to the plate and be there for the people of Maryland, and this does not send the right message," said Patrick Moran, Maryland director for the American Federation of State, County and Municipal Employees. "At some point we have to say there are other places they need to look."

 

Legislative leaders also raised the possibility of cuts in aid to local governments, which accounts for about 40 percent of the state's operating budget.

 

They noted that few jurisdictions have imposed furloughs on government employees, and Miller said some counties continued to cut taxes while state lawmakers met in a special session two years ago to approve $1.3 billion in tax increases and a plan to legalize slot machine gambling.

 

"We're prepared to make the tough decisions, but the counties and beneficiaries of the state budget are going to have to bear their fair share of the costs," Miller said.

 

Local governments will be confronting difficult budget choices in the coming weeks as the economy weakens and they prepare for the state to make good on threats that aid will be cut, said Michael Sanderson, legislative director for the Maryland Association of Counties.

 

"It's always appealing to shift some cost or some responsibility to a different level of government and then at least in part declare victory with your budget problem," Sanderson said. "But the problem has not disappeared; it only landed in someone else's lap."

 

Another option lawmakers are exploring would alter so-called disparity grants intended to help less-wealthy jurisdictions such as Baltimore City. The proposal would shift the $120 million cost to localities, so that more affluent areas such as Montgomery County would essentially subsidize poorer areas, but with smaller amounts. Baltimore City, for instance, would get about $7 million less.

 

An additional option would force localities to reimburse about $30 million in education aid they mistakenly received because of a miscalculation by the state. O'Malley had said those jurisdictions would be able to keep that money, but Miller said yesterday that "perhaps we can not be so generous."

 

Lawmakers also might change the distribution formula for taxes that go to a transportation trust fund and reduce money sent to localities for maintaining highways and roads. That could yield about $80 million.

 

Other ideas would be to reject the governor's proposal to extend a tuition freeze at public universities for a fourth year, to cut aid to community colleges and to trim funding for preserving open spaces.

 

Two areas that Miller and Busch said would likely not be affected are education and Medicaid. Much of the federal stimulus money was earmarked for those purposes.

 

They also said it is unlikely that they would shift the cost of teacher pensions to local governments this year. Miller and Busch announced yesterday a joint work group that will meet after the session ends to examine local aid, including the state's more than $700 million yearly subsidy of pension costs.

 

Comptroller Peter Franchot, the state's chief tax collector, said he hopes O'Malley and the legislature examine the state's spending to "get ahead of the recession so we don't have to continually come back and make cuts."

 

Republicans lambasted the governor's fiscal stewardship.

 

"We saw this happening and we could have taken action before but we didn't," said Sen. David R. Brinkley, a Frederick County Republican and member of the Budget and Taxation Committee. "The squall that we saw coming is now a hurricane."

 

Ideas for cuts

General Assembly leaders offered several ideas yesterday for making $516 million in additional cuts to a state spending plan to be approved in the next few weeks:

 

•More furloughs for state employees, many of whom must take five unpaid days by the end of June.

 

•Asking counties to repay a combined $30 million in education aid mistakenly received through a state calculating error.

 

•Transferring the cost from the state to counties of $120 million in disparity grants received by poorer jurisdictions such as Baltimore.

 

•Shifting taxes from the transportation trust fund to general government operations.

 

Copyright 2009 Baltimore Sun.

 

City health official Sharfstein reported headed to FDA

Sharfstein said to be pick for deputy commissioner

 

By Matthew Hay Brown

Baltimore Sun

Thursday, March 12, 2009

 

The White House reportedly has tapped Baltimore health commissioner Dr. Joshua M. Sharfstein to be deputy commissioner of the Food and Drug Administration.

 

The Harvard-educated pediatrician would serve under Dr. Margaret A. "Peggy" Hamburg, the former New York City health chief who is to be nominated FDA commissioner, according to reports in The Wall Street Journal and The New York Times.

 

Sharfstein, the White House and the FDA all declined to comment. Sharfstein told The Baltimore Sun in December that he loved his job and was "looking forward to another year of public health progress in the city." President Barack Obama has yet to announce new leadership for the FDA, the nation's primary food and drug watchdog.

 

Sharfstein, 39, emerged as a candidate for a leadership post after leading an assessment of the FDA for the Obama transition team. The agency, based in Silver Spring, has been in the spotlight for what critics have called an inadequate response to the salmonella outbreak that contaminated the peanut butter in hundreds of products.

 

Since becoming Baltimore health commissioner in 2005, Sharfstein has taken on the manufacturers of cold and cough medicines, convincing the FDA there was little evidence the drugs worked in children younger than 4. He also targeted lead, banning use of the toxic metal in candy, cosmetics and jewelry sold in the city.

 

He also has championed the use of buprenorphine as a treatment for heroin addicts. His department says heroin overdoses have declined, though critics say addicts using "bupe" may be no better off than those who are on methadone.

 

Sharfstein, who grew up in Montgomery County, has been involved in health policy since his training at Harvard Medical School. He was 24 when he published an article on political contributions by the American Medical Association in the New England Journal of Medicine. He volunteered to write and edit portions of the FDA's legal argument to regulate tobacco as an addictive drug. As a health policy adviser on the staff of the House committee on government reform, he worked on several pieces of legislation relating to the FDA, including a bill to require the agency to regulate nonprescription colored contact lenses not as cosmetics but as medical devices.

 

Sharfstein is the son of two doctors, and he married a third. His father, Dr. Steven Sharfstein, is president and chief executive officer of the Sheppard Pratt Health System in Towson. His wife, Dr. Yngvild Olsen, is chief medical officer of the Harford County Health Department.

 

Copyright 2009 Baltimore Sun.

 

Delegates do about-face on domestic violence bill

 

By Julie Bykowicz

Baltimore Sun

Thursday, March 12, 2009

 

Maryland lawmakers reversed course yesterday on a controversial domestic violence records proposal that they had rejected a day earlier.

 

Del. Luiz R.S. Simmons, a Montgomery County Democrat, spearheaded the effort to revive his plan to allow subjects of protective orders to have their records expunged.

 

Under the proposal, records would be cleared if a judge denies an order after hearing from both the petitioner and respondent or if the accuser does not come to court.

 

On Tuesday, the bill died on the House of Delegates floor by five votes. Yesterday, it was resurrected when delegates voted to reconsider it and send it back to a committee for amendments. A similar measure on the Senate side, co-sponsored by President Thomas V. Mike Miller, a Democrat, is scheduled for a hearing this afternoon.

 

Simmons called the proposal "a matter of fairness," saying that when a judge has not determined that a person committed abuse, he or she "should not have to live with that taint." He said protective orders can be misused in divorce proceedings or if falsely filed out of malice. Yet the accused person's record remains available to the public and can be viewed by potential employers and landlords.

 

The state makes provisions for expungement of criminal records but has no mechanism for civil records such as protective orders.

 

Opponents, including the head of the Women's Caucus and domestic violence prevention experts, say the problem of dishonestly filed protective orders has been overstated and that alleged victims of abuse have many reasons to not follow through on protective orders - including intimidation.

 

Gov. Martin O'Malley's administration, which is pushing two measures to confiscate guns when protective orders are granted, also is concerned about the expungement proposal.

 

"We would have serious reservations about this legislation, given the psychology involved with domestic violence cases," said Rick Abbruzzese, a spokesman for O'Malley.

 

Copyright 2009 Baltimore Sun.

 

Infant's death is ruled a homicide

State police investigating death of Eldersburg child

 

By Charles Schelle

Eldersburg Eagle

Thursday, March 12, 2009

 

Maryland State Police are continuing their investigation into the Tuesday, March 3, death of an Eldersburg girl who passed away after being taken to the hospital with apparent breathing problems.

 

Ky'leigh M. Rogers, 8 months, of the 900 block of Caren Drive, Eldersburg, was pronounced dead at Carroll Hospital Center at about 4:30 p.m. on Tuesday.

 

The Office of the State Medical Examiner determined in an autopsy March 4 that Ky'leigh died from blunt force trauma and ruled the death a homicide, according to state police. No charges had been filed as of Tuesday morning, March 10, and police said the investigation is continuing.

 

"We are aggressively investigating this case," said state police spokesman Greg Shipley. The police are awaiting the results of forensic tests before charges will be made, he said.

 

State police at the Westminster Barrack were contacted by staff at the Carroll Hospital Center shortly before the baby died.

 

Troopers responding to the hospital learned that the Sykesville-Freedom Dist. Fire Department ambulance had transported the child earlier in the afternoon after responding to a 911 call from the child's home reporting the child was having trouble breathing.

 

Investigators from the Westminster Barracks and the Carroll County Child Advocacy Center began an initial investigation. The preliminary investigation led police to contact the Maryland State Police Homicide Unit.

 

As of Tuesday, homicide investigators were continuing the investigation, with assistance from the Westminster Barracks Criminal Investigation Section and the Carroll County State's Attorney's Office.

 

Copyright 2009 Eldersburg Eagle.

 

MedStar Health offers wireless Web at seven of its hospitals

 

By Julekha Dash

Baltimore Business Journal

Thursday, March 12, 2009

 

Patients at MedStar Health hospitals can now use their iPhone to surf the Internet from the emergency room or their hospital bed.

 

The Columbia-based health care system has rolled out wireless Internet networks at seven of its hospitals in Baltimore and Washington, D.C. MedStar is relying on technology from Aptilo Networks, a Swedish wireless network provider that has regional offices in Kuala Lumpur, Malaysia and Plano, Texas. Financial terms were not disclosed.

 

MedStar Health is providing wireless Internet access at seven of its eight hospitals. They are Georgetown University Hospital, National Rehabilitation Hospital and Washington Hospital Center in Washington, D.C., and Franklin Square Hospital Center, Good Samaritan Hospital, Harbor Hospital and Union Memorial Hospital in Greater Baltimore. Patients and their visitors as well as medical students will use the wireless Internet service.

 

MedStar Health is a $3.5 billion nonprofit that employs 25,000 and has 5,000 affiliated physicians.

 

American City Business Journals Inc. All rights reserved.

 

National / International

 

Mental stress spirals with economy

 

By Marilyn Elias

USA Today

Thursday, March 12, 2009

 

As the economic crisis gathered steam last year, Americans became increasingly stressed out and experienced worsened mental health — a trend that continues today, according to a landmark Gallup-Healthways poll out this week.

 

Done nearly every day in 2008 and still ongoing, the survey of 355,334 people is believed to be the largest, longest and most thorough poll showing how emotional well-being shifts with economic changes.

 

The survey produces a so-called Emotional Health Index (EHI) — a measure that weighs negatives such as depression, worry and stress against the positive feelings a person experienced the day before the survey.

 

Among highlights of the poll:

•Stress shot up over 2008, peaking in the fall and winter as the economic crisis deepened, then continuing high through February. The 10 least happy days of 2008 all were in the last quarter.

 

•Emotional well-being overall dropped, too, driven largely by declines in mental health for the poorest people.

 

•Americans' moods were ultra-sensitive to economic news. Well-being plunged on days when the Dow lost big and with reports of high jobless claims.

 

•A state's EHI correlated with high rates of death from ailments such as heart disease, says Gallup analyst Raksha Arora. States with a lot of open space or sunshine — Hawaii, Alaska, Wyoming — had some of the best emotional health even as the economy sank. Many poorer and Rust Belt states — West Virginia, Ohio, Kentucky — were worst off.

 

•There were few racial differences, but Hispanics, the nation's largest and fastest growing minority, had the worst emotional health all year long.

 

The poll was a joint effort between Gallup and Healthways, a disease-management company.

 

The poll findings are no surprise to anyone on the front lines of mental health care, says David Baron, chairman of the psychiatry department at Temple University School of Medicine in Philadelphia. "This recession has touched people in virtually every walk of life," Baron says.

 

The link between the EHI and illness makes sense, adds Stevan Hobfoll, a psychologist at Rush University Medical Center in Chicago. Depression increases smoking and drinking and discourages exercise; it also raises the risk of heart disease, he says.

 

The survey shows that those 30 to 55 years old, prime earning years, may be suffering most from the bad economic news, says Gallup's Arora.

 

And these are also prime-time decades for raising families. But that's getting harder in such a tough economic climate, says Julie Moghal, a psychologist based at CHOC Children's Hospital in Orange, Calif. "So many parents are feeling guilty and upset about how to handle economic reverses with their children," she says.

 

Hispanics take it hard

The particularly poor emotional health of Hispanics may be caused by cultural qualities as well as their economic roles, according to experts.

 

Although women overall have higher depression rates than men, Hispanic women have the highest rates of all women, says Caroline Clauss-Ehlers of Rutgers University, a bilingual psychologist who counsels many Hispanic families in New York. Latinos take great pride in caring well for their families, "and if you're the mother, and the family isn't doing well, a lot of the women feel they're to blame," she says.

 

Hispanic men and women feel shame if they can't take good care of their families — a hard act when the economy is nose-diving. This shame can prompt people to isolate themselves, keeping anguish private so they don't get the support they need, Clauss-Ehlers says.

 

Many Hispanic adults send money home regularly to even-poorer family members in other countries, she adds, so the recession has amplified pressure.

 

In the USA, a lot of Hispanics work as small-business owners dependent on Hispanic customers, who have lost work in this economic crisis as contractors, construction workers, painters or day laborers, according to Estuardo Rodriguez, spokesman for the Mexican American Legal Defense and Education Fund. With the building market collapsed, Hispanics have taken a hard hit in this recession, he says.

 

Someone who knows that too well is 35-year-old Raul DeAnda of Antioch, Calif. He had a good job in home construction, owned a house and supported three children with his wife expecting a fourth, when the unexpected slammed down on them in May: The company he worked for went out of business.

 

DeAnda spent nine months searching for work without success as savings dwindled and bills piled up. Now the family is facing foreclosure. Just last week, he latched onto another construction job, but he and his wife both fear it may be temporary and worry that they're so behind in mortgage payments they're going to lose their house, anyway.

 

He's a nervous wreck. And his wife, Lorena De La Cruz, minces no words on how she feels: "I'm very stressed, anxious, depressed and worried about our family." The longer it has gone on, the more worried she has become, De La Cruz says. With four children 2 months to 7 years old, she can't easily join the work force herself and prays her husband can keep this construction job.

 

Support system weakens

Even if lower-income people seek counseling for recession-related stress, they may have to wait a long time or never get help, says a report on public mental-health services out Wednesday that suggests one reason why poorer adults may be sinking in emotional well-being as the economy worsens.

 

The mental health system that serves them was on the economic chopping block all over the USA last year, with widespread slashes in services, says Michael Fitzpatrick, executive director of the National Alliance on Mental Illness, which put out the report.

 

Meanwhile, many therapists treating more upscale patients are hearing about more money-related traumas and pleas for reduced rates. As the Gallup-Healthways survey shows, stress has risen across the board.

 

Kathy Seus, 45, of Chicago was upbeat and fairly optimistic after losing her sales job in January. With experience in sales, marketing and management, plus an MBA from the University of Chicago, she hoped a strong effort would help her land another job. Two months later, optimism has waned and depression is setting in. There's no job in sight.

 

Meanwhile, her property taxes for March have gone unpaid. So has her mortgage, because she tried to negotiate a lower payment and says the bank wouldn't work with her until she stopped paying.

 

"For the first time in my life, I'm really scared and very worried about losing a house in which I've invested every cent I have and have lived in for 13 years," she says.

 

Many friends have slipped away as she has struggled to keep her head above water, Seus says. "They offer no comfort. I tell people I lost my job and am worried about losing my house, and they tell me how they've had to cut back on manicures."

 

She keenly appreciates those who have shown empathy. "The few that have been there for me have been absolute lifesavers," she says. "I hope that one day I can return the favor."

 

Supportive friends are vital for people facing economic crisis, says Lanny Berman, executive director of the American Association of Suicidology. A lack of supportive relationships is tied to higher suicide rates among the unemployed, Berman says. Unemployed adults have two to four times the suicide rates of employed people, but coping skills in hard times vary widely, he adds.

 

Suicides spiked during the Great Depression but didn't increase in later recessions lasting an average of 10 months, according to the suicidology group's website. The current recession is 15 months long and counting.

 

The Gallup-Healthways poll shows a lot of people are suffering in this scary economic crisis, "and we need to be more concerned about what happens with suicide now," Berman says. When someone is in despair over economic problems, "give them support and see that they get help for mental health problems," he says. "This is the time to be our brother's keeper."

 

 

Copyright 2009 USA Today.

 

Top Pain Scientist Fabricated Data in Studies, Hospital Says

 

By Keith J. Winstein and David Armstrong

Wall Street Journal

Thursday, March 12, 2009

 

A prominent Massachusetts anesthesiologist allegedly fabricated 21 medical studies that claimed to show benefits from painkillers like Vioxx and Celebrex, according to the hospital where he worked.

 

Baystate Medical Center, Springfield, Mass., said that its former chief of acute pain, Scott S. Reuben, had faked data used in the studies, which were published in several anesthesiology journals between 1996 and 2008.

[The anesthesiologist allegedly faked data in 21 studies on the use of various painkillers, including Vioxx.] Associated Press

 

The anesthesiologist allegedly faked data in 21 studies on the use of various painkillers, including Vioxx.

 

The hospital has asked the medical journals to retract the 21 studies, some of which reported favorable results from the use of painkillers like Pfizer Inc.'s Bextra and Merck & Co.'s Vioxx -- both since withdrawn -- as well as Pfizer's Celebrex and Lyrica. Dr. Reuben's research work also claimed positive findings for Wyeth's antidepressant Effexor XR as a pain killer. And he wrote to the Food and Drug Administration, urging the agency not to restrict the use of many of the painkillers he studied, citing his own data on their safety and effectiveness.

 

"Dr. Reuben deeply regrets that this happened," said the doctor's attorney, Ingrid Martin. "Dr. Reuben cooperated fully with the peer review committee. There were extenuating circumstances that the committee fairly and justly considered." She declined to explain the extenuating circumstances. Dr. Reuben didn't respond to requests for comment sent through Ms. Martin and left at his former office.

 

The retractions, first reported in Anesthesiology News, have caused anesthesiologists to reconsider the use of certain practices adopted as a result of Dr. Reuben's research, doctors said. His work is considered important in encouraging doctors to combine the use of painkillers like Celebrex and Lyrica for patients undergoing common procedures such as knee and hip replacements.

 

Last month, the journal Anesthesia & Analgesia retracted 10 of Dr. Reuben's studies and posted a list of the 11 published in other journals on its Web site. The journal Anesthesiology said it has retracted three of Dr. Reuben's articles.

 

Dr. Reuben had been a paid speaker on behalf of Pfizer's medicines, and it paid for some of his research. "It is very disappointing to learn about Dr. Scott Reuben's alleged actions," Pfizer said in a statement. "When we decided to support Dr. Reuben's research, he worked for a credible academic medical center and appeared to be a reputable investigator."

 

Wyeth said it isn't aware of any financial relationship between the company and Dr. Reuben.

 

An FDA spokeswoman said late Tuesday she wasn't aware of the matter. Merck had no immediate comment.

 

Hal Jenson, the chief academic officer at Baystate Medical, said a routine audit last spring flagged discrepancies in Dr. Reuben's work. That led to a larger investigation in which Dr. Reuben cooperated, Dr. Jenson said. "The conclusions are not in dispute," he added.

 

Dr. Reuben is on an indefinite leave from his post at Baystate, the hospital said. He no longer holds an appointment as a professor at Tufts University's medical school, according to the university.

 

Baystate concluded that "Dr. Reuben was solely responsible for the fabrication of data," Dr. Jenson said.

 

Jeffrey Kroin, who co-wrote four papers with Dr. Reuben, said he was dumbfounded to receive a letter earlier this year from Baystate, retracting the studies.

 

"We analyzed it and made figures and graphs, and sent it back, and wrote papers, and everything seemed fine," said Dr. Kroin of Rush University Medical Center in Chicago. "If someone has a good reputation, has 10 years of papers and has a very high position within their medical school, generally you assume they have a lot of integrity."

 

Jacques E. Chelly, the head of acute interventional postoperative pain service at the University of Pittsburgh Medical Center, said he was "shocked" by the news of the retractions. Dr. Reuben "was very well respected," Dr. Chelly said.

 

He added that the situation has prompted his hospital to review the protocols it uses to treat patients for pain, because Dr. Reuben's work was so influential in establishing them. He said the hospital was now conducting its own study to verify the efficacy of drugs that Dr. Reuben claimed were effective painkillers.

 

In an editorial in the journal Anesthesiology, editor James C. Eisenach warned that "these retractions clearly raise the possibility that we might be heading in wrong directions or toward blind ends in attempts to improve pain therapy."

 

The retracted studies aren't expected to affect the drugs' regulatory status because Dr. Reuben's studies weren't part of the packages that manufacturers submitted to the FDA or European authorities.

 

Write to Keith J. Winstein at keith.winstein@wsj.com and David Armstrong at david.armstrong@wsj.com

 

Printed in The Wall Street Journal, page A12

 

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

 

A Reality Check

 

By Lisa Fitzpatrick

Baltimore Afro-American

Wednesday, March 11, 2009

 

(March 11, 2009) - Earlier this week, the nation celebrated National Women and Girls HIV/AIDS Awareness Day. I generally shun set-aside days for a cause because awareness on a single day may cause many in society to fail to address the issue the remainder of the year. However, a recent experience in my clinic at the Center for Infectious Diseases Management and Research at Howard University Hospital painfully illustrates why it is necessary for us to honor this day.

Last week, I met a 24-year-old woman with AIDS whose story exemplifies a problem with the way the medical community and we as a nation are caring for HIV/AIDS patients. When I walked into the exam room, the first thing I noticed was her frail frame. She weighed less than 100 pounds and was literally skin and bones.

She clearly needed HIV/AIDS therapy, and she wasn’t receiving it. Instead, I learned to my alarm and distress that previous doctors had referred her to hospice care, which is most often a place for those who are dying. That’s where she was staying when she came to my office with a hospice caretaker.

Certainly there are cases for which hospice care is appropriate. But this case wasn’t one.

The woman before me could be treated, should be treated and was requesting medical treatment but it seemed medical professionals had sent her away to die. I realize that many Americans are not aware of the strides and advances realized in the field of HIV/AIDS medicine since the early 1990s, but I certainly would not expect such lack of awareness from medical providers.

Let’s be clear. HIV/AIDS is a treatable disease. We now have over 25 medications to effectively treat HIV. Further, in the District of Columbia, HIV treatment is free. I am appalled that even one provider would miss an opportunity to educate a patient about the availability of HIV treatment.

Under no circumstances should a young, Black woman in the nation's capital, or any woman, for that matter, be recommended to a service for the dying before she is offered treatment for HIV.

We can do better. We must do better. The circumstances of how this young woman came to be in my clinic are unacceptable. As I honored National Women and Girls HIV/AIDS Awareness Day this week, I was thankful and thrilled that this young woman made her way to our clinic.

But I shudder to think how many others nationwide are out there and are just like her.

Lisa K. Fitzpatrick, M.D., MPH, is the associate professor of medicine in infectious diseases at the Howard University College of Medicine.

 

Copyright 2009 Baltimore Afro-American.

 

New Report Released: 1 in 50 children in America are homeless each year.

 

National Center on Family Homelessness

WBALTV 11 News Link

Thursday, March 12, 2009

 

The National Center on Family Homelessness' new report, America’s Youngest Outcasts: State Report Card on Child Homelessness, offers comprehensive state-by-state data on the status of homeless children. The report documents the extent of child homelessness, describes the plight of these children, profiles and ranks the states, and proposes solutions. “Children without homes are on the frontline of the nation’s economic crisis. These numbers will grow as home foreclosures continue to rise,” said Ellen L. Bassuk, M.D., president of the National Center on Family Homelessness. “Our report underlines the need for every state-as well as the Obama Administration and Congress-to provide equal opportunities for all American children to grow and thrive in the safety and security of their own homes.”

 

To learn more, visit www.HomelessChildrenAmerica.org.

 

Copyright 2009 WBALTV 11.

 

Lack Of Vitamin D Linked To Teen Health Problems

 

WBALTV 11

Thursday, March 12, 2009

 

DALLAS -- New research involving teenagers links low levels of vitamin D to high blood pressure and high blood sugar.

 

The findings were being presented Wednesday at an American Heart Association conference in Palm Harbor, Fla. The association is based in Dallas.

 

The so-called "sunshine" vitamin is needed to keep bones strong, but recent research has linked vitamin D to other possible health benefits.

 

Teens in the study with the lowest vitamin D levels were more than twice as likely to have high blood pressure and high blood sugar.

 

Jared Reis, of the Johns Hopkins Bloomberg School of Public Health, said more research is needed to determine if vitamin D is really behind the health problems.

 

The body makes vitamin D when exposed to sunlight's ultraviolet rays. Vitamin D is also in fortified foods like milk and in salmon and other oily fish.

 

Copyright 2009 by The Associated Press. All rights reserved.

 

Opinion

 

Reinventing health care

In Washington: Presidential compromise and muscle will be needed

 

Baltimore Sun Editorial

Thursday, March 12, 2009

 

The White House called it a summit, but with reformers and one-time naysayers, industry execs and consumers, lawmakers and lobbyists in the room with President Barack Obama, the gathering last week had the feeling of a health care love-fest. Everybody was on their best behavior, and the goodwill generated over the president's push to reform America's ailing health care system this year was made for prime-time.

 

But Mr. Obama has set for himself and stakeholders an ambitious goal that won't be realized without his input and political capital.

 

The president's markers are his campaign talking points on health care reform: expanded access, affordability, a public program competitive with private insurance, a payment model that emphasizes primary care and wellness, mandatory coverage for children, employer contributions and incentives and protections for small businesses.

 

These are broad objectives that give room to devise a way to overhaul a system that is too costly and provides poor outcomes. But the competing interests could grind this process to a halt without leadership from Mr. Obama.

 

Nancy-Ann DeParle, the president's new health czar, reportedly has the smarts, credentials (on the local and national health care scene) and experience (on Medicare and Medicaid reform) to monitor and provide direction to this monumental undertaking, which could cost $1 trillion. Ms. DeParle must be ready to exert some presidential muscle when Mr. Obama's favored compromise and consensus are in short supply. Mr. Obama has set aside $634 billion in his new budget as a down payment on his commitment to pay for it.

 

It's going to be a long slog. With a national plan in doubt, state and local governments should keep up their efforts to expand access to quality health care and Americans should insist on reforms that will better serve them and their country's health.

 

Copyright 2009 Baltimore Sun.

 

In Columbia: Howard County's challenge is to persuade healthy uninsured residents to sign up for its low-cost plan

 

Baltimore Sun Editorial

Thursday, March 12, 2009

 

Officials in Howard County are showing that it is possible to significantly improve the quality of health care available to uninsured residents at a relatively low price - as little as $50 a month for a participant.

 

The county's new Healthy Howard experiment is not a Cadillac service. Care is available only within the county, and users can't pick who provides it. But the program does coach participants to lead healthier lifestyles and helps diagnose and treat medical issues before they lead to emergency room crises. Despite such obvious benefits, the program's managers have been surprised to discover that persuading relatively healthy residents to sign up for the innovative program is a challenge.

 

Lessons learned from the Howard program - positive and negative - should provide useful guidance for policymakers in Washington as they respond to the Obama administration's proposal to reform the system and provide health care for more than 45 million people who are uninsured.

 

One positive discovery by the Healthy Howard administrators was that most of the 3,000 uninsured county residents who first applied to participate in the program were already eligible for health care under a free federal program or relatively low-cost private health insurance. About 1,200 children were enrolled in the state's version of the federally funded Children's Health Insurance Program because of Healthy Howard's efforts. Dr. Peter Beilenson, the county health officer, credits an innovative electronic application process designed by a California nonprofit with helping to identify potentially available health insurance for uninsured residents. This technology could be a useful tool on the national level.

 

But despite its best efforts, Healthy Howard has yet to attract a significant portion of the estimated 13,000 uninsured county residents. One likely reason: In tough economic times, it is difficult to persuade healthy young people to part with even $50 a month for health insurance they don't think they need. That's something the national debate should take into account.

 

Healthy Howard is pursuing thousands of community college students and others to convince them that help in shaping a healthy lifestyle is worth the money. More applications from the growing ranks of the unemployed also are anticipated. The county's $500,000 investment in this program should be renewed for next year. It offers significant help for Howard's uninsured, regardless of the outcome of the national debate.

 

Copyright 2009 Baltimore Sun.

 

In Annapolis: Requiring people to be insured would help reform system

 

Baltimore Sun Editorial

Thursday, March 12, 2009

 

At the State House, enthusiasm for health care reform has been tempered by the realities of a recession and starkly declining tax revenues. A further expansion of Medicaid eligibility will likely be put on hold. Ditto for an ambitious plan to lower health care costs and extend insurance coverage through a fund financed by payroll and sin taxes.

 

But there is one idea that may advance despite the economic woes, and it could mean better health care for thousands of Marylanders without great cost to the average taxpayer. The concept is called individual mandate. Many recoil at the idea of government telling them to do anything, but with health care costs skyrocketing, expanding the numbers of insured Marylanders could work to everyone's advantage.

 

In laymen's terms, an individual mandate means people who earn enough to buy health care insurancewouldbe required to do so. While that doesn't necessarily solve the health care crisis, it should make a big dent - about 60 percent of Maryland's estimated 760,000 uninsured are employed adults.

 

One proposal offered by Baltimore Del. Peter A. Hammen would require individuals who earn 300 percent of the federal poverty guidelines ($66,150 for a family of four) to buy insurance. Those who don't would be subject to a tax. Employers who have at least nine full-time workers and do not provide health insurance also would be assessed a per-employee penalty. All revenue would be used to help pay for insurance for low-income individuals.

 

A much more modest proposal by Montgomery County Sen. Robert J. Garagiola would apply the mandate to children only. The program would last three years, and the penalty for failing to comply would be modest indeed: the loss of a $25 to $50 state income tax break equal to an out-of-pocket cost of about $2.38 a year, making the mandate symbolic at best.

 

In either case, the essential premise is the same: If the health care crisis is to be solved, everyone must be required to pay his or her fair share. Too often, those who choose not to buy insurance are a hidden cost for the rest of us - most commonly in the form of higher insurance rates to finance uncompensated care. Maryland now pays, on average, $1 billion a year to reimburse hospitals for such care.

 

In Massachusetts, the first state with an individual mandate, more than $4 million in tax penalties was collected last year from the uninsured. Businesses in the state have to make a "fair and reasonable contribution to coverage" or pay a $295 assessment per worker per year, a requirement expected to eventually generate $30 million annually.

 

An ill-timed financial burden on business? Perhaps for some. But the high cost of health insurance is the real back-breaker for employers, and extending the umbrella of insurance should make health care more affordable for all. As the nation's new president has pointed out, the current recession isn't a time to hide from health care costs, it's the overdue moment to confront them.

 

Copyright 2009 Baltimore Sun.

 

Medicare as solution

 

By Caroline Poplin

Baltimore Sun Commentary

Thursday, March 12, 2009

 

Medicare is one of the most popular and successful programs ever devised in this country. It has improved the length and quality of life for millions of our most vulnerable citizens - the elderly and disabled - while affording them dignity, choice and security in their medical care.

 

Despite the program's success, there are problems with the quality of care Medicare beneficiaries receive. Patients complain they have to wait weeks for an appointment with a primary care physician, if they can find one. When the doctor finally sees them, it may be for only a few minutes. Analysts, on the other hand, argue that doctors pile on useless services because they are paid a separate fee for each one. Everyone agrees that many Medicare patients see too many doctors, who don't always work together.

 

Reform is desperately needed - and if it's done right, it will entice more doctors into primary care, where the need is greatest. It could even begin to lead us in the direction of greater fiscal responsibility.

 

At President Barack Obama's health care summit last week, some participants called for radical changes in the health care delivery system. For example, analysts have proposed reducing or eliminating small, "inefficient" physician practices in favor of large "accountable health care organizations" with impossibly complex reimbursement schemes. Instead of choosing their doctors, patients would select a system. Many academics and insurers still believe in managed care, despite the public backlash of the 1990s.

 

Others put all their faith in the free market. Medicare dodged one bullet last year - the Republican solution to gradually turn the program over to the private insurance industry. That plan turned out to be even more expensive than traditional Medicare.

 

There is a simpler answer: We need to pay more for care we do want, and less for care we don't. The venerable fee-for-service system can still work, if we pay the right fees for the right services.

 

Right now, we don't. As Sen. Max Baucus, chairman of the Finance Committee, observed, physicians favor tests and procedures because they are far more profitable than office visits. Indeed, there are vital services Medicare doesn't pay for at all, such as making telephone calls, writing reports and coordinating care: These have all traditionally been "free." The result? Last year, only 2 percent of internal medicine residents chose careers in primary care; all the rest will become specialists.

 

The government now sets the fees Medicare pays physicians (they had skyrocketed under the original "customary" standard). But the government recognizes only the cost of services, as determined by a committee of private physicians in secret proceedings. Instead, Medicare needs to consider value along with cost - in open proceedings. And we need to pay physicians for coordinating care, especially for complicated patients. We need to pay doctors for the time they spend reading records and consulting, just as we pay lawyers. And we need to pay more for the time doctors spend talking with patients.

 

In the long run, a more rational fee structure could save money. Thoughtful discussions aren't just a nice thing for patients; sometimes they can prevent an unnecessary procedure. Doctors can substitute more convenient telephone calls for some office visits.

 

We can pay more for these "cognitive" services by reducing what we pay for procedures, tests and imaging. Over time, these reductions should focus innovators on techniques that improve care while lowering costs. More young physicians will choose primary care, particularly for the complex Medicare patients who need them most. Studies demonstrate that systems with more primary care physicians provide better care at lower cost than systems dominated by specialists.

 

Of course, this reform will not be simple. However, adding value and transparency to fee-for-service determinations has to be easier than pushing patients and doctors into a radically altered delivery system that many have rejected.

 

Dr. Caroline Poplin, a former general internist at Bethesda Naval Hospital, recently spent a year as a visiting scholar at the Georgetown University Law Center. Her e-mail is cp335@law.georgetown.edu.

 

Copyright 2009 Baltimore Sun.

 

Health-care reform needed

 

By John Culleton, Columnist

Carroll County Times Commentary

Thursday, March 12, 2009

 

Before we can approach any kind of government health insurance plan with some hope of success we must understand the parable of the left-handed shortstop.

 

Journalist Jack Germond can be credited with identifying the dilemma of the southpaw at the shortstop position. The geometry of that most geometric of games, baseball, dictates that a player who throws with his right hand has an overwhelming advantage over a left-hander when playing shortstop. As a result, there are no lefties playing shortstop in the majors. There may be one in Little League somewhere. Major League Baseball rules have no special provisions for left-handed shortstops. Congress would create a dozen.

 

For example, those few who worked for the railroads are covered by the Railroad Retirement Board, which is a separate agency providing essentially the same benefits as regular Social Security. Why don’t we just combine the two? Congress would find a way to make the combination more complicated than the current situation. There is a southpaw shortstop lurking somewhere that would have to be accommodated.

 

What is the problem with a separate RRB? Here’s an example from real life. An elderly relative had to be hauled off to the hospital by ambulance. The provider was a local volunteer fire company. The patient was drawing benefits from Railroad Retirement. The fire company had a vendor number for regular Medicare, but not for Railroad Retirement Medicare. The bookkeeping for the fire company was done by a private firm in Ohio. It took more than a year and endless phone calls and letters to get the fire company their compensation for this ill-fated trip. Actions have consequences. Inaction by Congress sometimes has worse consequences.

 

Here’s another example. A retired businessman had a cousin who took many expensive medicines and had to pick a Medicare Part D vendor to give him the best deal. It took the businessman (a computer whiz) five straight hours on the Internet to find the most advantageous vendor for the cousin. But that situation could change yearly.

 

In another example I heard about, a federal retiree chose a vendor for his health insurance, but in 2009 his co-pays for a required medication jumped 25 percent. A friend told him that the vendor had been taken over by another vendor, and the best deal overall was now with a third different vendor. It was too late for 2009, though, since the retiree was already locked in.

 

In another story I heard, a lady smashed her elbow. The surgeon did a bang up job of repair, but physical therapy and a brace were needed. The surgeon had a close working relationship with a physical therapy vendor, but the health insurer required that the work be done by a different vendor. That firm never could get the elbow brace right. Finally, a deal was worked out to use the first firm instead despite HMO rules. The false start caused more pain for the patient and ultimately more cost to the insurer.

 

There is a bottom line to all this. The recent health-care summit led by President Barack Obama was based the assumption that we need to have multiple private insurers involved in the solution. But a quick glance at the clerical workload in any doctor’s office will show that multiple insurers are not part of the solution, but instead a major part of the problem. And in some cases, multiple private insurers diminish freedom of choice of medical vendors. Each insurer has its own stable of mandatory providers.

 

A single-payer system is the solution. We don’t need an array of HMOs, PPOs and the like to choose from. Instead, we need free choice of medical vendors and one paying agency. The citizen gets better benefits at much lower administrative cost. But that is perhaps too simple for politicians to understand.

 

John Culleton writes from Eldersburg. His column appears every second Thursday. E-mail him at cct@wexfordpress.com.

 

Copyright 2009 Carroll County Times.

 

Maryland Food Bank needs continued Carroll County support

 

Eldersburg Eagle Letter to the Editor

Thursday, March 12, 2009

 

On the heels of the passage of the American Recovery and Reinvestment Act of 2009, our nation's governors, with limited optimism, stated that the country may be moving out of the recession by later this year or early next year. This means that in 2009 more Marylanders will need the help of the Maryland Food Bank.

 

I've been in the food banking industry for 12 years and I have never seen the need so great. Last year we distributed 14 million pounds of food, 188,000 pounds in Carroll County alone.

 

This year we have seen the demand increase by close to 50 percent from some of our partner agencies. Each day we are seeing more middle class families come to our network of soup kitchens, food pantries and emergency shelters.

 

I'm asking Carroll County residents to unite against hunger.

 

Last week you may have seen Boy Scouts collecting as part of the Scouting for Food Drive. Well, continuing through this week (March 14), the Maryland Food Bank has joined forces with Boy Scouts, Girl Scouts the United States Postal Service, Boy Scouts, and Girl Scouts to collect food.

 

It's easy to still participate -- residents leave a bag of food by their mailbox during the week or drop food off at their local post offices, Coldwell Banker Residential Brokerages or Safeway stores.

 

We need your help to feed all Marylanders in need. For more information regarding the Maryland Food Bank please go to mdfoodbank.org.

 

Deborah Flateman, CEO

Maryland Food Bank

 

Copyright 2009 Eldersburg Eagle.

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