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			Tuesday, March 17, 2009 News Clipping Archives *Maryland / Regional* Raw Milk Sales to be Debated in Annapolis (ABC2 News) 'Scary Drug' Makes Comeback (Washington Post) Md. County Budget Blueprints Cut Jobs, Services (Washington Post) Weekly clinic helps uninsured (Annapolis Capital) Council backs $500 ambulance fee (Annapolis Capital) Nine interested in PG Hospital System (Daily Record) MARYLAND: House approves bills to strip abusers of guns (Carroll County Times) *National / International* Malpractice changes are a part of health debate (Washington Post) A Rise in Sexually Transmitted Diseases (New York Times) What the SCHIP Fight Means for Health Reform (Wall Street Journal) Stress So Bad It Hurts – Really (Wall Street Journal) *Opinion* Protect the poor as budget is cut (Baltimore Sun) Is it compassionate to prohibit suicide? (Baltimore Sun) Commentary: Let's not forget the human cost of health care reform (dcexaminer) Probably won't happen (Frederick News-Post) *Maryland / Regional* Raw Milk Sales to be Debated in Annapolis By: Christian Schaffer ABC2 News Tuesday, March 17, 2009 These days a lot of people are trying to find foods that are all natural. And some believe that includes ‘raw milk’ -- straight from the cow, unpasteurized. But it's illegal to buy raw milk in Maryland. So once a week, Liz Reitzig of Bowie makes a two-hour drive to a farm in Pennsylvania. She usually buys six to 10 gallons of raw milk for her family, averaging about $7.00 a gallon. Liz, her husband and their four children - ages six down to seven months - all drink the raw milk. ‘They love it,’ she said. I mean it's good. It tastes great, we make ice cream, all the fun stuff. Sometimes we even make butter -- if I have enough energy.’ Several of Liz’s family members are allergic to dairy products. When her oldest daughter started showing signs of that around age two, Liz gave the girl raw milk. ‘There was no reaction; she was fine,’ she said. She's never looked back. But by buying raw milk and bringing it to Maryland, Liz is skirting Maryland law. ‘I want to change the laws in Maryland so that we actually have access to fresh milk in Maryland,’ she said. In a statement, John Colmers, the Secretary of Maryland's Department of Health and Mental Hygiene said, ‘The science tells us there are real and measurable reasons to fear the sale of unpasteurized milk and milk products to the general public. The health hazards of raw, unpasteurized milk -- for children and adults -- are just too great and outweigh the so-called health benefits.’ Liz Reitzig swears by the health benefits the Secretary Colmers is downplaying. And she believes you can get sick from eating any food from spinach to peanut butter. ‘Taking one food item and saying this one has a risk so we have to ban it, that's taking it a bit too far and that's isolating that and putting it in a category that no other food item is in,’ she said. Tuesday in Annapolis, a house committee will hear testimony on a bill that would overturn Maryland's ban on the sale of raw milk. Copyright 2009 The E.W. Scripps Co. All rights reserved. 'Scary Drug' Makes Comeback As PCP Use Rebounds Among Suspects, D.C. Authorities Worry About Violent Incidents By Keith L. Alexander Washington Post Tuesday, March 17, 2009; A01 Damon D. Taylor had been smoking PCP before he walked into his mother's bedroom this month and shot her several times in the chest as she lay in bed, police say. Charlese J. Hall tested positive for PCP when she was arrested in the stabbing death of her 7-year-old daughter in December. Derek J. Green also had been using PCP in July before he drove his car onto a sidewalk along Alabama Avenue SE at more than 60 miles an hour, pinning a pedestrian against another car. D.C. police, prosecutors and drug testing agencies are bracing for more PCP-related violence. Ten percent of adult defendants now test positive for the drug, the highest rate in five years, according to D.C. Pretrial Services. The number of people with PCP in their system arrested on murder and sexual assault charges jumped to 12 last year, up from three in 2007. Police are concerned by the trend, because in several categories of crime -- assault, murder, robbery and burglary, for example -- the raw numbers, though small, have doubled or even tripled in the past year. "It's a very scary, scary drug for us," said D.C. Police Chief Cathy L. Lanier, who noticed the upward trend more than a year ago. "There's just so much violence surrounding it." The rise in PCP use comes as crack cocaine use by criminal defendants fell to its lowest level -- 30 percent -- since the District began keeping records in 1995. Crack pushed aside the market for PCP, or phencyclidine, which had been popular in the 1970s and 1980s. On the streets, it was known as "Love Boat" or "Buck Naked" because users often shed their clothes to cool off. Prosecutors in other jurisdictions are also seeing an increase. Glenn F. Ivey, the Prince George's County state's attorney, called current PCP-related violence "surprising" and said it is a reminder of his time as a prosecutor in the District during the crack years, when battles over turf and cash spun out of control. Ivey said defendants under the influence of PCP are now "routine." In November, a Montgomery County man was sentenced to 85 years in prison for stabbing one man to death, carjacking three others and wounding yet another during an eight-day rampage a year ago. At sentencing, Calvin Currica's attorney said Currica smoked PCP cigarettes and drank beer and cheap wine before the rampage. Last June, in the Port Republic area of Southern Maryland, a 49-year-old man was accused of fatally shooting his brother as they sat in a garage smoking marijuana cigarettes dipped in PCP. Most Virginia police departments do not separate PCP from other drugs in their statistics, so it is difficult to determine the extent of any problem in those jurisdictions. Officials in Fairfax and Arlington counties said they have seen no increase. In the District, the resurgence of PCP, like most drugs, is cyclical. Use of the drug dropped to a low of 6 percent among criminal defendants in 2004 from a high of 14 percent in 2002. During its peak, PCP users dipped marijuana cigarettes into a tiny bottle of PCP. Today, PCP users are dipping store-bought cigarettes into a bottle of PCP, or "making them wet," for $25 a dip, says Inspector Brian Bray, who heads the D.C. police narcotics unit. Police and drug counselors in the District said PCP resurfaced as cocaine users began looking for a stronger and longer high. PCP highs can last three to six hours. In comparison, a high from a $10 crack cocaine rock lasts five to 10 minutes, Bray said. PCP has varied effects on its users: It often increases aggression and perceived strength and numbs physical pain, Bray said. Other users hallucinate or seem incoherent. Ron Daniels, 61, hasn't smoked PCP in about 20 years but confronts addiction daily as a drug counselor for the Family Medical Counseling Services in Southeast Washington. For years, his clients were mainly heroin and crack addicts, but PCP users now show up regularly, he said. Unlike heroin and crack, Daniels said, PCP can impair physical and mental abilities within seconds after inhaling. "People don't realize what they did," Daniels said. "It's not until the high wears off when they are told what they did." Last month, D.C. police conducted one of their largest PCP busts in recent years when they recovered 178 ounces with a street value of $350,000 in Southeast Washington near the Condon Terrace neighborhood. Four suspects were arrested. In October, 32 people were arrested in the Clay Terrace section of Northeast Washington during a PCP sting when 10 ounces of PCP was seized along with $10,300 in cash and a handgun. Police are grappling with how to contain PCP's spread. Bray said much of the drug found in the District is shipped from California and Mexico. Recently, he seized a shipment that came in from New York. Sales of crack cocaine and PCP have some elderly D.C. residents afraid to leave home, said Advisory Neighborhood Commissioner Catherine Woods, who represents parts of Ward 7 near Clay Terrace. "This used to be a community where people could walk safely all day or night. Not anymore," Woods said." PCP use among juveniles is also a concern among D.C. officers and drug counselors. A 14-year-old was the youngest to test positive for PCP last year, according to Pretrial Services. In January 2008, 17-year-old Diedrick Johnson of Southeast was charged as an adult with shooting nine youths in two incidents, one of which occurred outside Ballou Senior High School. During a search of Johnson's home, police found a bottle containing a liquid, which they said was PCP. He pleaded guilty last month and will be sentenced in June. "This drug is hurting innocent people," said Lorraine Prophet, 50, who uses a wheelchair after she was injured when Derek Green, 31, ran her over in July on Alabama Avenue SE. It was Green's second arrest in two years involving a car crash while under the influence of PCP. He was sentenced to five years in prison after he pleaded guilty to aggravated assault. Ron Moten, co-founder of the anti-violence group Peaceoholics, said young people consider PCP "higher brow" and more "exclusive" than crack cocaine. He said its users often don't look as worn as crack addicts. "People know what crackheads look like," he said. "But PCP users can be anyone." At Margaret Ann Taylor's funeral Thursday, about 600 mourners at Matthews Memorial Baptist Church, near the Anacostia Metro stop, were in shock that her son apparently killed her. Damon Taylor was holding a .22-caliber semiautomatic handgun when police arrived. "I did something stupid. I just shot my mother," he told police, according to court records. Dorethea Billings, a longtime neighbor, said she knew Taylor, 25, as quiet and introverted. She said Taylor's father died last April and his daughter died a few months later after being born prematurely. Billings said the deaths sent Taylor into a drug-fueled downward spiral. "He's a victim, too," she said. "He didn't know what he was doing." Copyright 2009 Washington Post. Md. County Budget Blueprints Cut Jobs, Services Montgomery, Prince George's Union Officials Oppose Plans By Ann E. Marimow and Ovetta Wiggins Washington Post Tuesday, March 17, 2009; B01 Government officials in Maryland's two largest suburbs, faced with deep potential budget shortfalls, yesterday proposed eliminating more than 700 jobs, imposing an additional unpaid furlough in one county and making spending cuts that union officials in both counties pledged to resist. Montgomery County Executive Isiah Leggett (D) recommended shrinking the size of government by 400 jobs, scaling back bus service on more than 20 routes and raising community college tuition. In Prince George's, County Executive Jack B. Johnson (D) proposed getting rid of more than 300 jobs, forcing workers to take additional unpaid leave and cutting school funding. Governments throughout the region are contemplating deep cuts and tax increases as income and real estate tax revenue fall, a trend expected to persist into the next budget year. Leggett's $4.42 billion budget blueprint, which the County Council must vote on, would not raise property tax revenue above the local limit that ties increases to the rate of inflation. Leggett would provide a $690 tax credit for primary residences, but the bill for a median-priced home of $380,000 would still increase nearly 8 percent, or $200. In confronting a shortfall exceeding $500 million for fiscal 2010, Leggett said residents must adjust expectations for the level of services the county can afford. "It will not be easy, but better days are ahead," Leggett said. Overall spending would rise 1.9 percent, the smallest year-to-year increase in 18 years. For public schools and Montgomery College campuses, funding would increase 3 percent and 2.7 percent, respectively. To help fund the increase, tuition and fees for college students would rise $3 per credit hour for county residents, $6 for other Maryland residents and $9 for out-of-state students. Leggett's job-elimination plan would touch nearly every department, including part-time bus drivers, community health nurses and library staff. County workers would not receive planned cost-of-living raises, according to the proposal, although about two-thirds of all employees would still receive annual step raises based on years of service. Drivers on Montgomery's streets would see the number of stationary speed cameras increase to 60 under Leggett's plan. With the additional cameras, the program is projected to raise $15.7 million for the budget year that begins July 1. To help balance the books, Leggett would also seek a waiver from an annual state education funding obligation. The move would free up about $50 million while providing the school system with the same overall level of funding because of the federal stimulus package. Schools Superintendent Jerry D. Weast called the plan "the least painful of all the options for both our system and our taxpayers." Even before Leggett's announcement, the volunteer firefighters' organization scheduled a news conference to declare his budget "dead on arrival" because it relies on the creation of an ambulance transport fee, which would raise about $14 million. John Sparks, president of the union representing career firefighters, said he planned to challenge Leggett's decision not to fund pay raises without the union's blessing. Leggett is legally required to fund employee contracts unless the union renegotiates, but Leggett said he feared that the firefighters' position would unravel deals cut with other unions. Leggett's plan includes some new investments, such as providing health care for 3,000 uninsured residents and nearly $58 million for affordable housing. But the list of trims to health and human services programs is particularly long, with cuts in mental health care for children and some addiction services. Most council members have said they are not prepared to back the proposal. They gave mixed reviews as they thumbed through the four-pound budget book. Duchy Trachtenberg (D-At Large) called the package "sobering" and urged colleagues to "demonstrate real leadership and where necessary take a different path toward fiscal responsibility." Council member Michael Knapp (D-Upcounty) questioned some of Leggett's budget assumptions that he called "a lot of wishful thinking." In Prince George's, Johnson's $2.58 billion spending plan, which must also be voted on by the County Council, represents a 3.5 percent dip in spending from the current year. Faced with a $113 million gap, Johnson made cuts in nearly every department: He reduced school funding by 3.7 percent; the community college by 2 percent; human services by 11.5 percent; and public safety by 4.3 percent. With the deterioration of the real estate market, Johnson said, the county is near "rock bottom." "While we were able to benefit from a strong economy by investing in our communities for a number of years, it is clear to everyone that those times are over," Johnson said. For county workers, Johnson would maintain a hiring freeze, require an additional 10-day unpaid furlough on top of one earlier this year and eliminate cost-of-living and merit raises. Job reductions, he said, would save about $20 million. The second round of furloughs, which would begin July 1, would trim $17.5 million. Johnson's plan includes the elimination of 170 public safety jobs, which he said would mostly affect civilian positions. But Doug Bartholomew, president of the Prince George's County Professional Fire Fighters and Paramedics Association, said the loss of 25 employees from the department would put firefighters' lives in jeopardy. "It will affect the safety of our firefighters and the safety of our community," he said. Johnson said he hopes to avoid layoffs with additional revenue that could be raised if he is successful in pressing for legislation before the General Assembly. Prince George's is unable to ask residents to pay more in property taxes without help from state lawmakers because of a voter-imposed cap passed in 1978. A Johnson-backed measure would shift funding of school buses to the Washington Suburban Transit District and save the county about $30 million. Del. Aisha Braveboy (D-Prince George's) and Del. Justin Ross (D-Prince George's) have also introduced legislation that would allow the county to transfer to its budget about $30 million from the Maryland-National Capital Park and Planning Commission's surplus. "We'll only be successful if the members of the General Assembly approve these pieces of legislation," Johnson said. "We can't duck from this. We can't wish it away." Copyright 2009 Washington Post. Weekly clinic helps uninsured Nurse practitioner runs low-cost facility in city's Allen Apartments By Shantee Woodards Annapolis Capital Tuesday, March 17, 2009 Sandi Shanahan's patients call her doctor, since there seems to be no Spanish word for nurse practitioner. Paul W. Gillespie - The Capital Sandi Shanahan, a certified nurse practitioner, has been running a low-cost pediatric clinic at Allen Apartments since 2005. Roughly 400 patients come there each year, some from as far away as Baltimore. Each Tuesday, the certified nurse practitioner treats uninsured patients who are aged 19 and younger. But it's easy to understand the confusion. Shanahan carries a stethoscope around her neck and works with the sick. And she's been running a nonprofit clinic at an Allen Apartments community center each Tuesday since 2005. Shanahan offers low-cost services to uninsured patients up to age 19 and sees about 300 to 400 young patients a year. Because many are Hispanic, she has a bilingual volunteer on hand to schedule appointments and work with patients. Nearly 20,000 Hispanics live in Anne Arundel County, with about 2,300 living in Annapolis, according to the most recent Census figures. "We're not crazy busy, but we have definitely increased," Shanahan said. "There's still plenty of room for more people to come. I want it to continue to increase. The word needs to get out more. The people losing their jobs and losing their insurance - they've never had to look for anything like this before." Shanahan said she does what she can for advertising. Information has spread a great deal by word of mouth, and she advertises the clinic in her church newsletter. Shanahan said she spends about $28,000 a year on expenses; the facility is supported through grants, private donations and fundraisers. And times have been changing. With some of the families served by the clinic struggling in the current economy, many are able to contribute very little for the care they receive. A $35 donation is suggested, but lately parents have been forced to pay much less. Some people will donate $5 or $10, while others will pay nothing, she said. What's more, her clinic space was cut in half to accommodate an office for the city police's Hispanic liaison officer. At the same time, Shanahan is trying to do more. A Web site is being set up and should be online by the end of the month. She also is coordinating a June 20 fundraiser at the Baltimore & Annapolis Trail Park. The facility also has been able to receive client referrals from the county Health Department and the county Board of Education, since if offers lead testing. It is not uncommon for clients to come from Baltimore City or Baltimore County for the lead tests, Shanahan said. She also said she works with a network of area physicians and pharmacists who are willing to arrange services for discount prices. Annapolis resident Amanda Hernandez hadn't heard about the clinic until she called the Parole Health Center looking for services for those without insurance. Her 4-year-old daughter, Luz, had been suffering from a fever, cough and loss of appetite. The Hernandez family has been without health insurance for about three months because of a job change. Until her husband's insurance benefits kick in, Hernandez and her husband have tried to focus on Luz's health. They have been able to get by using discount programs at area pharmacies. "We didn't know we had an option for her," Hernandez said. "Until we found out about (Shanahan's clinic), we'd push it to the limit. We'd wait longer (to seek medical care) than we would have before." Volunteer Lee D. Wieland has been with the clinic since 2006. She speaks five languages, including Spanish, and often acts as an interpreter for the non-English speaking patients and their families. She answers the phones and collects the payments, so she hears all the stories. She knows about the families struggling to live off $200 a week, those with two children who couldn't afford to give a $70 donation, and those trying to manage bus fare with other expenses. "I say to them, 'This is what she asks from all patients. If you can't give this, give what you can, otherwise she won't be here,' " Wieland said. "You get more than you give (volunteering here). ... It's much more than health here. It's a little bit of 'How's life?' " The weekly clinic can be reached at 443-822-6851. The Web site www.shanahanchildrensclinic.com will be online by the end of March. Copyright 2009 Annapolis Capital. Council backs $500 ambulance fee But chides administration for not working out details By Erin Cox Annapolis Capital Tuesday, March 17, 2009 The County Council last night overwhelmingly voted to stick with the new $500 fee for ambulance rides, despite objections that the fee could scare cash-strapped senior citizens from calling for help. Although the council ultimately decided in a 5-2 vote to keep the fee, which isn't supposed to be billed to residents, most council members expressed concerns that the administration had not done enough public education about the fee nor ironed out the details of how the billing would work. Councilman Daryl Jones, who voted to repeal the fee, recounted a story of a sick person who took a taxicab to the hospital, believing it was a cheaper option than a $500 ambulance ride. That resident would not have been charged for an ambulance. "Here we sit, 14 days from when this is supposed to take effect, and we haven't had this public campaign," said Jones, D-Severn. "We don't even have a vendor who can tell us how the billing is going to work. ... If there's an education campaign that has occurred, I haven't seen it." Only Jones and Councilman Ed Middlebrooks, R-Severn voted to repeal the fee, which the council adopted last May as a way to balance the budget. The fee is expected to generate $2 million this year and another $8 million next year to help fill an ominous county budget hole. To make ends meet next year, the county has to slice nearly 20 percent of the money spent on county services, excluding schools. At least two councilman who voted to keep the fee in place said they did so in order to prevent a worse financial problem. "There's no bones about it," Council Chairman Ed Reilly, R-Crofton, said. "This is a way to make extra dollars. That's it." The council also asked the county administration to return when they could explain how the fee would work. County Fire Chief John Robert Ray told the council that no county resident would be expected to pay the fee. County Attorney Jonathan Hodgson said he expected it would be "months" before anyone saw a bill, and they would be sent only to insurance companies and non-county residents without insurance. Fire Battalion Chief Matthew Tobia defended his campaign to educate the public, saying he has already visited several senior centers, has others lined up, and just yesterday distributed information about the program to the county community associations. He also plans a segment on local radio stations and a public service announcement on the county's cable TV channel. Also at last night's council meeting, a bill to reform rules about predatory towing companies was withdrawn and a leaner, simpler version was be introduced in its place. That bill will be scheduled for a public hearing next month. <i>Residents with questions about the ambulance program can call 410-222-8200 or send an e-mail to fdemsbilling@aacounty.org.</i> Copyright 2009 Annapolis Capital. Nine interested in PG Hospital System Associated Press Daily Record Tuesday, March 17, 2009 ANNAPOLIS — The Chairman of the Prince George's County Hospital Authority says there are nine parties interested in buying at least parts of the hospital system. Authority Chairman Kenneth Glover declined to reveal the names of interested parties. Glover was in Annapolis Monday to urge a legislative panel to support a bill that would allow the seven-member hospital authority to sell the hospital and four other county health facilities, piecemeal, if need be. Donna Wilson, staff to the authority, confirmed there is at least one party interested in buying the entire system. The bill would also provide some flexibility in where services could be located after the system is sold. The health care system, owned by Prince George's County and managed by a not-for-profit company, has lost money for years. Copyright 2009 Daily Record. MARYLAND: House approves bills to strip abusers of guns Associated Press Carroll County Times Tuesday, March 17, 2009 ANNAPOLIS — The Maryland House of Delegates has approved two bills that make it easier for judges to take guns from domestic abusers. Delegates on Tuesday voted 92-45 in favor a bill that would allow judges to confiscate guns from people who have temporary protective orders filed against them. They also voted 98-38 to endorse a bill that requires judges to take firearms from the subjects of final protective orders. In addition, delegates voted 86-51 to kill a measure that would have required certain domestic violence victims be eligible for handgun permits. Gov. Martin O’Malley heavily backed both bills that can strip abusers of guns. Lt. Gov. Anthony Brown, whose cousin was shot to death last summer by an estranged boyfriend, also testified in support of the bills. The legislation will move to the Senate. Copyright 2009 Carroll County Times. *National / International* Malpractice changes are a part of health debate Associated Press By Erica Werner Washington Post Tuesday, March 17, 2009 WASHINGTON -- Medical malpractice overhauls have died many deaths in Congress over the years, often at the hands of Democratic lawmakers backed by trial lawyers. Attempts to change the system may be getting new life. As they search for savings to redo the nation's $2.4 trillion health system, key congressional Democrats and administration officials, from President Barack Obama on down, are indicating they're open to changing a system that's a burden for doctors but a boon to attorneys and some victims of medical error. "The cost issue is the thing that we actually think is the big driver in this whole debate," Obama told business leaders last week. Research, prevention and "medical liability issues _ I think all those things have to be on the table," the president said. A key Obama health adviser, Ezekiel Emanuel, went further recently at a meeting of the American Medical Association. "I'm not going to give you any details because I can't. I just can tell you I've been thinking long and hard about that," Emanuel, an oncologist and the brother of White House chief of staff Rahm Emanuel, told the doctors when asked about malpractice lawsuit reform. "It hasn't gone unnoticed. So stay tuned." Doctors' groups are heartened by such comments. "We're encouraged to see that lawmakers from both sides of the aisle and a growing number of key stake holders recognize the need for liability reform," said Nancy H. Nielsen, president of the AMA. But trial lawyers contend that medical malpractice amounts to a tiny portion of the overall cost of the medical system. They cite an oft-used 1999 statistic from the Institute of Medicine that as many as 98,000 deaths in the U.S. each year result from medical error. "Changing the legal system will not make anyone healthier or save one life," said Linda Lipsen, senior vice president of public affairs at the American Association for Justice. The differing viewpoints could foreshadow intractable debates to come. So key lawmakers are looking for a solution that both sides could live with. That's unlikely to include capping punitive and pain and suffering payments, as President George W. Bush unsuccessfully tried to get Congress to do. Democrats largely oppose such caps, which exist in a number of states, but they do see problems in fast-rising medical insurance premiums and so-called "defensive" medicine whereby doctors prescribe treatments that may be unnecessary to guard against getting sued if they don't. Senate Finance Committee Chairman Max Baucus, D-Mont., has proposed providing states grant money to develop alternate litigation models, such as encouraging disclosure and compensation in the case of error, or establishing a "health court" whose judges have health care expertise. Some ideas are similar to legislation that Obama co-sponsored with Hillary Rodham Clinton when both were in the Senate in 2005. Their bill would have created a program to allow patients to learn of medical errors and establish negotiated compensation with the offer of an apology. In an interview, Sen. Ron Wyden, D-Ore., who has a bipartisan health bill that includes incentives to get states to enact malpractice reforms, said changing medical malpractice is key to overhauling the health care system. "I think it's an essential piece for there to be enduring reform, reform that will stick and will get a significant bipartisan vote in the United States Senate," Wyden said. © 2009 The Associated Press. A Rise in Sexually Transmitted Diseases Vital Statistics By Nicholas Bakalar New York Times Tuesday, March 17, 2009 The latest data on the prevalence of chlamydia, gonorrhea and syphilis reveal a growing public health problem, with its severest effects on women, young people and members of minorities. All three diseases are preventable, treatable with antibiotics, and, at least in their early stages, completely curable. Yet they persist, partly because people can spread them without knowing they are infected. All three diseases are transmitted through vaginal, oral and anal sex. Untreated chlamydia or gonorrhea in women can lead to painful and long-lasting pelvic inflammatory disease, infertility and potentially fatal ectopic pregnancy; both can be transmitted to babies at birth. Syphilis has various severe symptoms depending on the stage of the disease, can be passed by pregnant women to their babies, and can persist for a lifetime in both men and women. “Condoms are a very good way to reduce the risk of getting infections,” said Dr. Stuart Berman, an epidemiologist with the Centers for Disease Control and Prevention, which issued the report. “If you use them all the time, and use them correctly, they work.” Screening is also helpful. “Pregnant women and men who have sex with men should be screened yearly for chlamydia, gonorrhea and syphilis,” Dr. Berman said. “And all sexually active women younger than 26 should be screened annually for chlamydia.” (Women’s rates of chlamydia are almost three times those of men.) These numbers, which were published in December, include only cases reported by local health departments, clinics and hospitals. The C.D.C. estimates that they account for less than half of the actual number of infections. Copyright 2009 The New York Times Company. What the SCHIP Fight Means for Health Reform Health Blog Wall Street Journal Tuesday, March 17, 2009 obamaOne of Barack Obama’s first moves on health-care as president was the long-awaited expansion of SCHIP, or the State Children’s Health Insurance Program. His signature on the bill came after two vetoes by former President Bush. The journal Health Affairs today takes a look at what SCHIP’s journey means for the chances of wider health reform. The program was first created in the wake of the Clintons’ busted broader health-reform effort: It was an incremental step to get at least one group — children — covered. The program “sought to fill in a coverage gap rather than to reengineer the entire system of coverage for all Americans,” write Jonathan Oberlander of the University of North Carolina and Barbara Lyons of the Kaiser Family Foundation. But the recent rub had to do in part with efforts to expand SCHIP to cover kids with higher incomes than were eligible originally. And the authors say the higher up the income ladder a government health-coverage program goes, “the more likely it is to encounter criticism that it will crowd out private insurance and that such subsidies are not necessary for higher-income Americans.” Meantime, kids are about as sympathetic as it gets. There are “limits” on the idea of insuring Americans group-by-group like that, they say. “To make significant progress toward covering all Americans, we will have to adopt insurance expansions that don’t simply target politically attractive populations. If the past decade has proved anything in American health policy, it is that incrementalism is not enough.” Health Blog Readers: How do you think health reform should happen? Is an incremental approach the practical way to go? Or is a major overhaul what’s needed by now? Copyright 2008 Dow Jones & Company, Inc. All Rights Reserved. Stress So Bad It Hurts -- Really HEALTH JOURNAL By Melinda Beck Wall Street Journal Tuesday, March 17, 2009 "I think your real problem is stress," the doctor said when I complained that the muscle injections he was giving me hadn't relieved my neck and shoulder pain. "You can't blame me for everything that's hard in your life," he said. My bursting into tears only seemed to confirm his diagnosis. It's not like I hadn't heard this before. During earlier bouts of low-back pain, irritable-bowel syndrome and temporomandibular joint disorder, plenty of doctors have used the stress word with me. And each time, I've become indignant. It sounded like "it's all in your head" or "you're malingering." That's an outdated view, says Christopher L. Edwards, director of the Behavioral Chronic Pain Management program at Duke University Medical Center. Decades ago, when doctors said a condition was psychosomatic, it was the equivalent of saying it wasn't real, since there was little evidence that the body and the brain were connected. "Now, we recognize that what happens in the brain affects the body and what happens in the body affects the brain," he says. That knowledge gives us the tools to try to manage the situation, he adds. Dr. Edwards says his pain-management program in Durham, N.C., is seeing a rise in patients amid the current economic crisis: "There's a very strong relationship between the economy and the number of out-of-control stress cases we see." From Stress to Pain Psychological stress can turn into physical pain and illness in a number of ways. One is the body's primitive "fight-or-flight" mechanism. When the brain senses a threat, it activates the sympathetic nervous system and signals the adrenal glands to pump out adrenaline, cortisol and other hormones that prime the body for action. Together, they make the muscles tense up, the digestive tract slow down, blood vessels constrict and the heart beat faster. That's all very useful for outrunning a mastodon. But when the threat is a tanking stock portfolio or an impending layoff, the state of alarm can last indefinitely. Muscles stay tense and contracted, which can make for migraine headaches, clenched jaws, knots in the neck and shoulders, and pangs in the lower back. Some of those body parts are already under pressure from long hours at the computer, restless sleep, grinding teeth and poor posture. The Gut Brain The digestive tract has its own extensive system of nerve cells lining the esophagus, stomach and intestines -- known as the gut brain -- that are extremely sensitive to thoughts and emotions. That's what creates the feeling of butterflies in the stomach. When anxiety persists, it can set off heartburn, indigestion and irritable-bowel syndrome, in which the normal movement of the colon gets out of rhythm, traps painful gas and alternates between diarrhea and constipation. "Stress does not necessarily cause pain, but it exacerbates the [physical] situation that may already be there. It diminishes your ability to cope," Dr. Edwards says. Stress also creates biochemical changes that can affect the immune system, making it underreact to viruses and bacterial infections, or overreact, which can set off allergies, asthma and skin disorders like psoriasis and eczema. And stress can raise the level of inflammation in the body, which has been associated with heart disease. A recent study in the journal Psychosomatic Medicine found that stressful conditions even in the teenage years can raise the level of C-reactive protein, a marker for inflammation that increases the likelihood of cardiovascular problems later. There are plenty of ways to short-circuit these harmful effects of stress. One of the best is physical exercise, which not only releases the feel-good neurotransmitters called endorphins, but also helps use up excess cortisol and adrenaline. Under stress, "there's a large amount of negative emotional energy in your system that is trying to find a way to discharge," says David Whitehouse, a psychiatrist and chief medical officer for OptumHealth Behavioral Solutions, a unit of UnitedHealth Group Inc. He adds that "stress kills brain cells. The body responds by making new ones, and exercise can help activate them and make new connections between them." Sleeping and Eating Many experts also recommend getting plenty of sleep, eating regular, balanced meals and keeping up social connections -- all things that people tend to forgo in times of stress. Biofeedback, once considered alternative medicine, is now accepted in mainstream medical circles as a way for people to reduce the impact of stress. Dr. Edwards runs a biofeedback laboratory at Duke, where patients monitor their heart rates, respiration, temperature and other vital signs and learn to control them with relaxation techniques. "The goal is that once we teach you to do that, you can use it the rest of your life," he says. Another form of biofeedback is called Heart Rate Variability Training, which teaches people to adjust their breathing to maintain an optimum interval between heart beats that induces a feeling of calm throughout the body. "It's probably similar to what happens in yoga and meditation," says Dr. Whitehouse. He adds that there is much new research going on in the field of "emotional resilience training" to help people learn to lower their anxiety levels and recover from setbacks. "People spend huge amounts of money, time and energy training their cognitive brains. What we now know is that the emotional brain can be trained as well to become more resilient," Dr. Whitehouse says. Emotions play a major role in how pain is perceived in the brain. In the 1960s, Ronald Melzack, a Canadian psychologist, and Patrick David Wall, a British physician, offered a groundbreaking theory after observing soldiers in World War II. "Two soldiers with nearly identical injuries from the same bomb blast would be sitting side by side in a hospital ward," Dr. Edwards explains. "One soldier would be saying, 'Hey doc, can you sew me up? I need to get back to my unit.' And the other would be crying, moaning and writhing in pain." Drs. Melzack and Wall determined that chemical gates in the spinal cord control pain signals from the body to the brain, depending largely on patients' emotional states. Positive emotions diminished the perception of pain, while negative emotions kept the gates open -- sometimes continuing the pain even after the initial cause had disappeared. Fear Versus Fact There's a growing consensus that cognitive behavioral therapy can be very effective at diffusing negative emotions. It works by examining, and challenging, the thoughts behind them. "We'd say, 'I understand your fear, but fear is not a fact. Let's look at the reality in your life,'" says Katherine Muller, a cognitive therapist and director of psychology training at Montefiore Medical Center in Bronx, N.Y. It's no surprise that being told that pain is stress related feels like an affront, Dr. Muller says. "There's this idea among high-functioning people that 'I'm a good coper,' and these symptoms suggest that you're not," she says. Indeed, many successful people find that low levels of stress and worry help them function. "But in periods of high stress, that worry takes over and becomes the dominant feeling. You're still going to work. You're still doing stuff for your family, but it's taking a toll. And suddenly your body is saying, 'Whoa -- I can't take the tension any more,'" Dr. Muller says. One technique she uses is to have patients keep a diary evaluating their stress level on a scale of zero to 10 several times a day and note what was happening at the time. Patterns may emerge -- that headache may set in every Thursday afternoon, after the staff meeting -- and there may be ways to change the situation. "The message I'm trying to send is that you are responsible for your own stress," says Dr. Muller. "The way you are looking at it and feeling about it is more up to you than you realize." So is stress-related pain all in your head after all? "All pain, and all human experience, is in your head," says Dr. Edwards. But that's a message of hope, he adds, since there are now ways that weren't available 60 years ago to ease pain by managing thoughts and emotions. All right. Sew me up, doc. I want to get back to my unit -- I think. Printed in The Wall Street Journal, page D1 Copyright 2008 Dow Jones & Company, Inc. All Rights Reserved. *Opinion* Protect the poor as budget is cut Baltimore Sun Commentary Tuesday, March 17, 2009 The state announced last week that its revenues will come in $1.1 billion below previous estimates over the next two years, and legislators must now find an additional $500 million in cuts to the state budget to restore balance, even after accounting for federal stimulus aid ("As revenues slip, O'Malley warns of fresh budget cuts," March 11). This means that devastating cuts could be in store for the programs and state workers that serve low-income Marylanders - the very programs and workers that are called on more and more as our economy declines. Maryland's safety net is already near the breaking point. A seven-year hiring freeze has resulted in a loss of 1,700 employees in the Department of Human Resources. Many of these employees worked in local social services departments, where their remaining colleagues now struggle to keep up with a flood of new applications for assistance. As more Marylanders find themselves in need because of job losses, foreclosures and high energy costs, more will seek assistance from the state. Others already living below the poverty line will see their situations become even direr. This is precisely the wrong time to cut the programs and state workers that provide vital assistance to Marylanders in need. Gov. Martin O'Malley and state lawmakers must work to ensure that Maryland's safety net is intact enough to support those it was created to assist.Julie VarnerAnnapolis The writer is the chairwoman of the Maryland Alliance for the Poor. Copyright © 2009, The Baltimore Sun. Is it compassionate to prohibit suicide? Baltimore Sun Commentary Tuesday, March 17, 2009 In his critique of assisted suicide, Paul Malley underestimates the degree to which other people's wishes may differ from his own ("Wrong solution," Commentary, March 10). Depression and hopelessness are not the only reasons terminally ill patients wish to end their lives. Many individuals see nothing undignified about choosing to end their lives at the time and manner of their choosing - and many view such a choice as the meaningful culmination of a good life. When I no longer can speak for myself, I would like my health care provider to end my life in as quick and painless a manner as possible. Unfortunately, even if I write that instruction in my living will and inform my health care proxy of my wishes, Maryland will not let me do so. How exactly is such a policy compassionate?Jacob M. AppelNew York The writer teaches bioethics at New York University. Copyright 2009 Baltimore Sun. Commentary: Let's not forget the human cost of health care reform By Sen. Jim DeMint dcexaminer Tuesday, March 17, 2009 In Great Britain last year, a 24-year old woman named Katie Hilliard was diagnosed with cervical cancer. The disease has since spread to her lungs and lymph nodes. In October, she took time off from her course of chemo and radiation therapy to marry her fiancée because, in her words, “We didn’t know how ill I would get.” The family of Claire Everett does know. She died in September, of the same disease, with her parents, husband, and two-year old son by her side. She was 23. Both could have been diagnosed early and possibly saved by a routine screening test. But the British National Health Service does not allow women under the age of 25 to receive that test. These kinds of stories are commonplace in nations with government-controlled health care, with good reason. As the miracle workers in the global medical research field develop treatments to keep us alive and healthy much longer than ever before, the costs of health care inevitably rise. Government health services looking to cut costs usually choose to ration coverage. In Great Britain, Canada, Sweden, and elsewhere, government bureaucrats decide which patients may receive which treatments based on how beneficial the treatment will be – beneficial to the government, that is, not the patient. The process by which government health departments decide who gets what is called “Comparative Effectiveness Research” (CER). And you might be surprised to know there was more than $1 billion allocated for CER in the so-called economic stimulus bill passed last month by Congress. The same research that countries with government-controlled care use to deny hip replacements to seniors with osteoporosis, let patients with macular degeneration go blind in one eye before treatment, and deny breakthrough drugs to patients with Alzheimer’s and multiple sclerosis, has now become part of American federal law. Americans should be shocked, but not surprised. CER is only one step in the Obama Administration’s insidious plan to take over American health care… for our own good. Consider the case of Tom Daschle, President Obama’s first choice for Secretary of Health and Human Services (HHS), and America’s leading cheerleader for CER. He wrote a book calling for federal bureaucrats to make “specific coverage decisions” for government-managed health care programs and to “exert tremendous influence on every … provider and payer, even those in the private sector” [emphasis added]. Consider the billions set aside in the stimulus bill to begin creating a national database of digitized medical records, Health IT. I have no problem with electronic medical records – they will probably reduce mistakes, lower costs, and even save lives. But I have a big problem with the government mandating the format of those records, fining any insurer who chooses alternative formats, and then using its massive database of confidential patient information to conduct its CER studies. But that’s exactly what the president’s 2010 budget advocates: “When [CER is] coupled with electronic health records, these findings can form the basis for clinical decision support tools.” And consider the expansion of the State Children’s Health Insurance Program (SCHIP), the first health care bill President Obama signed into law. Enacted in 1997 to provide health coverage for children of the working poor, the new SCHIP will cover children of parents who earn up to $106,000 per year. That is, children throughout the lower, middle, and upper-middle class will now grow up eligible for and accustomed to government-managed health care. Unless Americans act quickly, this health care nightmare could soon be reality: when “Generation SCHIP” reaches adulthood and risks losing its “free” health care, voters will finally allow Democrats to socialize medicine once and for all. Armed with its Health IT-based CER studies, the federal government can start rationing health care as it must to control the costs of a massive universal system. When that happens, the consequences here in America will be the same as they have been everywhere else socialized medicine has been tried. Sick patients will wait weeks to see a primary care physician. They will wait months to see a specialist. They will wait years to receive routine treatments. And they will be denied extraordinary treatments altogether. And before long, we’ll understand the true, human costs of a “free” system. If we do not act quickly to reject socialized medicine, the next Katie Hilliard or Claire Everett won’t be across an ocean, but across town, across the street, or maybe even across the kitchen table. Republican Sen. Jim DeMint is the junior senator from South Carolina. Copyright 2009 dcexaminer. Probably won't happen Frederick News-Post Letter to the Editor Tuesday, March 17, 2009 Commissioner David Gray is advocating more stringent European emission standards as a solution for the air pollution created by the proposed trash incinerator. However, even if Frederick County includes such standards in a contract, the commissioners must understand that neither they nor the State of Maryland have the legal authority to enforce standards more stringent than those authorized by the Clean Air Act. When Congress passed that legislation in 1970, national standards were included so that businesses would not move based on different pollution standards. Congress did grant one way to more stringent standards -- the California waiver. Because of California's pioneering work on air pollution, Congress allows them to apply for standards tighter than U.S. standards. Congress also allows other states to "opt in" to California standards. Just last week EPA held a hearing on a California request for a motor vehicle carbon dioxide waiver. Maryland is one of 14 states that wants to opt in if that waiver is granted. If Frederick County wants more stringent incinerator standards, they have two choices: Either get California to request a waiver and have Maryland opt in, or have Congress order EPA to change the national standard. I don't think either is going to happen soon. ROBERT KOZAK Frederick Copyright 1997-09 Randall Family, LLC. All rights reserved. BACK TO TOP


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