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			Wednesday, March 18, 2009 News Clipping Archives *Maryland / Regional* UM study: Hospitals lose $12B due to poor communications (The Gazette) Hospital to consolidate outpatient surgery center (Carroll County Times) Program helps close health care gap (Frederick News-Post) Bill would cover more autism therapies (Montgomery County Gazette) HIV/AIDS Continues Upward Spiral in District (Baltimore Afro-American) Local Honorees Gather to Support those living with HIV/AIDS (Washington Informer) In AIDS Crisis, Serious Times Call for Serious Measures (Washington Post) *National / International* Health care overhaul cost may reach $1.5 trillion (Washington Post) U.S. Births Reach Record Level (Wall Street Journal) A Silenced Drug Study Creates An Uproar (Washington Post) *Opinion* From Bad to Worse (Washington Post) *Maryland / Regional* UM study: Hospitals lose $12B due to poor communications Business Notes \| The Gazette Wednesday, March 18, 2009 U.S. hospitals are wasting $12 billion a year due to poor communications, say researchers at the University of Maryland's Robert H. Smith School of Business in College Park. The research, newly released from the Center for Health Information and Decision Systems, is the first to quantify the economic impact of a health care system "rife with communication delays and failures," according to a university statement. The loss equals about 2 percent of hospital revenues, and is more than half the average hospital margin of 3.6 percent, according to the study. One of the biggest wastes of money stems from unnecessarily long hospital stays, which account for 54 percent of total losses. The typical 500-bed hospital could recover $4 million a year with better communications, says the study. The release follows enactment of the new federal stimulus law, which earmarks $140 billion for health care, including $19 billion to modernize health information technology systems. The research center's corporate members include Cisco Systems, Johnson & Johnson and CNSI Inc. More information is available at www.rhsmith.umd.edu/CHIDS. Copyright 2009 The Gazette. Hospital to consolidate outpatient surgery center By Erica Kritt Carroll County Times Wednesday, March 18, 2009 In less than four months, Carroll Hospital Center will be moving all outpatient surgeries performed at the Dixon Ambulatory Care Center to the main hospital. Leslie Simmons, chief operating officer at the hospital, said the decision to consolidate was made based on health-care trends. According to the National Center for Health Statistics, 42 percent of surgeries take place at freestanding centers, which are separate from hospital-based centers like the surgical center in the Dixon building. The consolidation will also help control the cost of health care, Simmons said, though she did not know how much money the consolidation would save. The move will free up more space in the Dixon building. Simmons said that money is always considered, but the consolidation is not being done specifically for financial reasons. Carroll Hospital Center representatives were unable to say how much money the consolidation would save the hospital. Simmons said with the hospital’s newly renovated operating rooms, the move will not be a squeeze. “We can easily accommodate [the surgeries],” she said. About 77 surgeries are done each week at the surgery center in the Dixon building, said Teresa Fletcher, director of marketing and public relations for the hospital. Simmons said there are 10 operating rooms in the main hospital, and the only renovation necessary will be expanding the surgical waiting room. She said the hospital has been analyzing the option of consolidation, but the decision wasn’t made until this year. Simmons also noted that the equipment in the Dixon building’s four operating rooms and two minor procedure rooms will be used throughout the hospital after the move July 1. The Dixon Building is not closing, Simmons said. Only the outpatient surgeries that were provided there will be moving to the hospital’s main building. “We’re just moving down the hall,” she said. The Dixon Building is connected to the main hospital building. Fletcher said the move will free up 17,000 square feet in the Dixon building to provide more programs. Simmons said it is still unclear what will be done with the space because there are so many options available. New outpatient services could be added, or the hospital could expand current services. Cardiac and pulmonary rehabilitation, the wound care center and diabetes management services could be put in the space. Fletcher said The Women’s Place and the Imaging Center, both located in the Dixon building, will also be moving later this year. Those facilities will be relocated to the hospital’s new medical office building on the hospital’s campus that is set to be completed by the end of 2009. Reach staff writer Erica Kritt at 410-857-7876 or erica.kritt@carrollcountytimes.com. Copyright 2009 Carroll County Times. Program helps close health care gap By Ashley Andyshak Frederick News-Post Wednesday, March 18, 2009 BRUNSWICK-- Last year was hard for the Daytons. In February 2008, Albert Dayton lost his job at a plumbing and heating company where he worked for five years. In November, his wife, Donna, lost her housekeeping job and with it, the couple's health insurance. The Daytons said they have applied for hundreds of jobs both in person and on the Internet, but at age 62, they had no luck. Their applications to the Department of Social Services brought no relief either; Albert Dayton said he and his wife collected too much Social Security and unemployment compensation to qualify for any more assistance. The office determined their income was just $41 over the threshold, he said. The couple needed their health insurance back: He is diabetic and she has arthritis and is on cholesterol-lowering medication. Their coordinator at the Frederick County Business and Employment Center referred them to the Frederick County Health Access Program, where they found the help they had been looking for. The program was designed for people like the Daytons who do not qualify for state or federal programs but can't afford private health insurance. Since enrollment began six months ago, coordinator Leigh Joos has connected 140 people with participating primary care providers and specialists. The program is partnership between the Frederick County Health Care Coalition and the county health department. Those enrolled in the program pay $15 per office visit and are referred to specialists as needed. Most patients pay for their own prescriptions, taking advantage of generic drugs available for $4 at retail and grocery stores. Grants cover more expensive drugs and lab work. Kaiser Permanente Mid-Atlantic and the Community Foundation of Frederick County have funded more than $26,000 in laboratory and diagnostic tests and $4,000 in prescriptions for program participants, Joos said. Joos said the program is not accepting new applicants, but eligible residents can be put on a waiting list. The program will expand as more doctors get involved, she said. Nine primary care practices, 15 specialist practices and several physical therapists accept patients from the program. It does not include vision or dental care. Participating specialists said the program fills a major need. Dermatologist Matthew Bruntel started seeing program patients in January and doesn't charge them for visits. "It sounds like a really great way to close the gap with people who don't have insurance," he said. "I also believe that Frederick patients should be seen in Frederick County and not have to go somewhere else." Bruntel said the program is a stopgap measure that could work anywhere, but its effectiveness would be limited if doctors become overwhelmed with uninsured patients needing free care. "Most physicians are willing to donate at least some of their time to work with patients who can't afford care," he said. Dr. Jeffrey Cowen sees about two program patients per month at his Frederick cardiology practice. He said he charges a small fee or nothing at all. Cowen said the hardest part of the program is working with non-participating facilities and doctors, especially when a patient needs x-rays or cardiac studies, or needs to see another specialist. "I'll do what I need to do as best as I can get it arranged, but getting further care is difficult," he said. "Other people are not always as interested in doing these things." Please send comments to webmaster or contact us at 301-662-1177. DETAILS For details about the Frederick County Health Access Program, visit www.co.frederick.md.us/healthaccess or e-mail leigh.joos@hotmail.com. To donate, call the Community Foundation of Frederick County at 301-695-7660. Copyright 1997-09 Randall Family, LLC. All rights reserved. Bill would cover more autism therapies Health care providers question ‘Applied Behavioral Analysis' treatment By Sebastian Montes Montgomery County Gazette Wednesday, March 18, 2009 Some changes no mother would miss. The first that Maryam Muazu noticed was that her 2-year-old son had become more social. Not yet a month in, the cues were conspicuous when the 42-year-old would take Isma to their Montgomery Village home after his daily sessions at a preschool for autistic children. "He used to ignore everybody, usually he'd just stand apart in the corner," she said Friday, picking Isma up from the Brookeville campus of Community Services for Autistic Adults and Children. "But then he started throwing himself into the fray. Now he initiates play." Isma's older brother is also autistic. Muazu knew what small strides to look for, and she expects Isma to see the same kind of success. His brother is a student at Montgomery Village Middle School who is mainstreamed in three classes. And for both her children, she credits the progress to a one-on-one therapy called Applied Behavior Analysis. But her eldest son's success bore a heavy toll on the family. Her husband's insurance did not cover the treatment. Insurance companies say that the treatment is not evidence-based, and that it is an educational, not medical, program. Muazu, who no longer has insurance, was told that the decades-old methods are experimental. "In a year we spent I think $40,000," she said. Medicaid pays for Isma's treatment. Long waits, increased costs Maryland's Autism Waiver Program covers Medicaid-eligible families for a range of services and treatments, until the person turns 21. That leaves 2,700 people on a waiting list for the 900 slots. "If you were to sign up now, you probably wouldn't see services until about 2014," said Ian Paregol, CSAAC's executive director. "So if you have a child that's diagnosed with autism at about 18 months, well, you missed really an important window. That kid is going to be 7, and the window, really, for a best outcome is that 2 to 6 range." Thousands of families choose to pay for ABA therapy. Those stories are what prompted Del. Kirill Reznik to try to force insurers to cover the costs. Paired with a companion bill in the state senate, Kirill (D-Dist. 39) of Germantown is pushing a bill that would require insurers, nonprofit health service plans and HMO's to cover ABA and other early intervention therapies, up to $50,000 per year. "I've met parents who have mortgaged their homes and are facing foreclosure," he said. "I've met people who have gone into bankruptcy. And more and more people are beginning to really wonder whether they're going to stay in Maryland, or go somewhere like Pennsylvania, where it's covered." If passed, Maryland would be the eighth state to do so. Reznik and his fellow District 39 representatives — Sen. Nancy J. King and Dels. Saqib Ali and Charles E. Barkley — have authored or backed more than half of the two dozen autism-related bills introduced this year. Only a few of the bills are expected to pass. But the spotlight they have shone and the platform they have given advocates has marked a change in the state's approach to one of the world's fastest growing and least understood conditions. Already finding the axe is Reznik and King's attempt to make state health officials implement an "Adult Autism Care Training Program" that would standardize training and improve wages for caretakers. The bill's fiscal evaluation found that the program would cost the state $250,000 this year and $1.5 million the next. Reznik and King withdrew their bills last week. Far more momentous is the effort make insurers cover ABA treatment. Autism advocates such as CSAAC, the Kennedy Krieger Institute and Autism Speaks! rallied behind the bills, as did 54 legislators who signed on in support. But with a projected hit to state coffers upwards of $10 million per year, its backers admit the outlook is bleak. Opponents included Carefirst BlueCross BlueShield, Kaiser Permanente, Aetna, the Maryland Chamber of Commerce and the National Federation of Independent Business. In a letter to the legislature, the chamber wrote that requiring ABA coverage would "add a significant and uncontrollable increase in the cost of health insurance paid by employers." The state's Department of Legislative Services calculates that requiring coverage will add between $36 and $83 per year per employee in group plans. "It is not entirely clear what comprises the actual clinical or educational components of ABA," wrote William F. Casey, Carefirst BlueCross BlueShield's vice president of governmental affairs. More than just fiscal pressures, Reznik concedes that it may be too soon in lawmakers' autism learning curve. "If it doesn't pass, I'll bring it back next year, and the year after that, until it passes," he said. Partial solace could come in a pair of bills that would create a state commission on autism. Among its priorities would be to issue, by December, a report on the impacts of forcing insurers to cover ABA therapy. The hearing on the senate bill is set for Thursday. This year's session has wrought many of the small increments needed for broader change, CSAAC's Paregol said. "There's talk about autism now. Before, people would say, ‘Artism?' — they wouldn't necessarily know what it is. So I think it's getting there," he said. "I think that next year will be a very interesting year, because it's an election year. There's going to be a lot of promises made, and I hope there's going to be a lot of promises kept." More than 50 organizations and businesses will be on had at a county-hosted fair an autism services, to be held 3-7 p.m. April 29 at the Universities at Shady Grove (Building II), 9630 Gudelsky Drive, Rockville. Admission and parking are free. For more information, or for help in attending, call 240-777-1216, 240-777-1217 (TTY) or 711 (Maryland Relay) by April 10. Copyright 2009 Montgomery County Gazette. HIV/AIDS Continues Upward Spiral in District By Dorothy Rowley Baltimore Afro-American Wednesday, March 18, 2009 (March 18, 2009) - Despite a growing number of Washington, D.C. residents over age 13 diagnosed during the past year with HIV/AIDS, Mayor Adrian Fenty and his top two medical administrators say the city is not exactly in the throes of a Katrina-like emergency. Nevertheless, two updated 2008 reports – one on epidemiology and the other on heterosexual behavior — that were released on Monday indicate the District has the highest incidence of HIV/AIDS in the country. And the 3 percent of its 589,000 residents, who have been infected, already far exceeds the 1 percent threshold usually used to gauge the onset of an epidemic. The District’s current rate of infection also surpasses the HIV/AIDS outbreak in West Africa where two-thirds of its people are afflicted, and the D.C. cases have risen 22 percent since 2002. That was the same year when Baltimore health officials reported that city to be in a state of emergency over its outbreak of HIV/AIDS. Fenty’s comments on Monday during a press conference at a northeast health center did little to appease attendees, who queried the mayor at length on how his administration was dealing with the problem, which one attendee likened to the bubonic plague. Among their inquiries was why the rate had continued an upward spiral although more than $500 million dollars was earmarked in March 2006 for HIV/AIDS education and health programs. In this and other instances, Fenty deferred to Dr. Pierre Vigilance, who heads the city’s health department, and Dr. Shannon Hader, director of Washington’s HIV/AIDS Administration. Although high rates of HIV are found in just about every neighborhood in the District, most of the intervention-related projects have been needed in Wards 5, 6 and 8 where most of the city’s poor live and where the largest numbers of such cases have been reported. In addition, the rise in the number of infected persons has particularly escalated (currently 70 percent) among people ages 40 and over who, health officials say, tend to assume that HIV/AIDS is a young people’s disease. According to the reports, the highest rates of HIV are among residents of ages 40 to 49, and among Black males, who comprise 7 percent of the District’s adult population already diagnosed and living with HIV. On the other hand, medical experts contend that people infected early in their lives tend to live longer after being infected because they are also being treated for other afflictions that accompany aging, such as high blood pressure and diabetes. “…the rise in the number of infected persons has particularly escalated…among people age 40 and over who, health officials say, tend to assume that HIV/AIDS is a young people’s disease. “ Vigilance, who was with the Baltimore City Health Department during its HIV/AIDS state of emergency, said the District’s state of crisis is similar to that created by Hurricane Katrina in 2005. However, better testing has resulted in lowered infection rates as the city moves forward to reduce its cases of the disease. “It’s like a Katrina moment,” Vigilance said of the situation facing the city. Alluding to beefed-up programs and services geared at prevention and treatment, Vigilance added, “Clearly, this is a priority for us and an emergency everyday for us however, we’re doing things differently and better.” Vigilance said as they do more testing they are finding many more cases of the disease. “But the city’s investment in 2006 was not made in vain” because although “we now have a good snapshot story of where we are, it’s not the whole story and we want to drive down the rate of new cases.” At-large D.C. City Councilman David Cantania, who also attended the packed gathering of mostly media, noted that six years ago the District had neither a state of emergency nor an epidemiologist on hand to help tackle the problem. He said in more recent times the city’s HIV/AIDS program was largely looked upon as a joke, and that the city lacked the talent to provide a good response to the growing problem. As a result, Cantania said, the city had missed many opportunities for testing and now he’d like to see a more measured and thoughtful response to the issue. On the other hand, Hader, who heads the city’s AIDS Administration, described the situation as a long-term problem that needs a long-term solution. “We need an urgent long-term response where the bar isn’t set too low,” she said. In it efforts over the past two years to combat spread of the disease, the city has increased distribution of free condoms and offers of free HIV testing among other strategies that include more public service announcements. Hader said most people who transmit HIV don’t know they’re positive and that one of the city’s goals for reducing its spread is “to bring back into care people who’ve fallen out of care.” She also said the city’s prevention portfolio needs to have more community level interventions and programs that provide people the tools for protecting themselves while having sex. Hader said the heterosexual report surveyed people who had sex in the past 12 months and it found that fewer people than expected remain in the closet when it comes to their sexual preferences. “The study found that few men are on the down low,” said Hader. She also said opportunities for testing shouldn’t be missed because more people than previously believed have medical insurance. According to Hader, lack of testing has been the primary reason for ongoing transmissions of HIV/AIDS among heterosexuals -- which, she said, has driven up the numbers of infected people. Fenty added that the city held four HIV/AIDS conferences in the past year and that in tackling the problem, he has hired people like Hader and Vigilance who have “excellent strategies” for reducing outbreaks. Fenty said he has “demanded” that they follow through on those strategies to protect D.C. residents, adding that 40,000 more D.C. residents have been tested since 2007, when the city, because of is size and complexity, was described as having a modern epidemic. “…lack of testing has been the primary reason for ongoing transmissions of HIV/AIDS among heterosexuals…” “We’ve kind of done this knee-jerk thing,” Fenty said then added, “[But] in order to solve the problem, we have to face it head on.” Although the economic downturn has also affected HIV/AIDS programs and research funding, Vinog Mody, a Howard University professor of medicine, said President Obama’s stimulus package hasn’t been as much of a lifeline in his work as charitable giving. He said, however, that the lack of charitable contributions has been hampered by the slow economy. “As far as the District is concerned, I think that the AIDS Administration may take up the slack,” said Mody, who also serves chief of Howard’s infectious diseases division. The medical professional said the ability of HIV/AIDS patients to get better jobs and, therefore, properly house and feed themselves has always been a concern. He said that the lack of stimulus funding for high-priority needs among HIV/AIDS patients such as adequate jobs, housing and nutrition provisions will affect many of his patients who are 95 percent Black. “They are on the edge of society,” Mody said. “They can usually get their medications free but among our other concern for them is nutrition. If they have a job, then they can have money [for most of their needs].” Copyright 2009 Baltimore Afro-American. Local Honorees Gather to Support those living with HIV/AIDS By Carla Peay Washington Informer Thursday, 19 March 2009 Dr. Lonise Bias stood before several hundred guests and evoked the memory of her late sons, Len, and Jay, in a speech about courage, strength, and perseverance. “I stood on the grave of one son and buried another. Had God told me I would have to lose two sons before fulfilling my purpose, I would have told him to find another girl,” Bias said. But through adversity, Bias and her family prevailed, and she served as one of the most powerful reminders that triumph is possible after tragedy. Bias was one of 12 women and five men honored at the First Ladies Awards Brunch and Fashion Show, held at the Camelot in Upper Marlboro on Sat. March 14. The event was held in support of My Sister’s Keeper, whose mission is to provide affordable and supportive housing, educational opportunities and additional support services for single mothers living with HIV/AIDS and their children. My Sister’s Keeper is a program of the Harambee Community Development Corporation in partnership with Carolina Missionary Baptist Church. According to the Maryland State Department of Health, Maryland ranks ninth in the U.S. in total number of AIDS cases, and averages approximately 2,100 new cases per year. For the District of Columbia, the Centers for Disease Control reported more than 16,700 AIDS cases through 2007. African Americans, by percentage, make up the largest ethnic group to become infected with HIV/AIDS nationwide. “We must educated people, particularly our young people, that risky behavior leads to deadly consequences,” said Leslie Johnson, wife of Prince George’s County Executive Jack Johnson. Johnson spoke of family and friends who had died from the AIDS virus, and the importance of providing support for people living with HIV/AIDS. The event was hosted by Sheila Stewart and Jeannie Jones of Radio One, and included musical selections by Joe Coleman of the Platters and BET Gospel singer Andrea Holdclaw, a fashion show directed by Cynthia Ann Moore and featuring Jolie Models, and an awards presentation to 12 women and five men who have shown not only expertise in their fields, but a strong commitment to community service. Honorees: Denise Rolark Barnes, Publisher, The Washington Informer Newspaper – Media/Print Dr. Lonise Bias, Founder, the Len and Jay Bias Foundation – Anti-Violence Cynthia Brazelton, Pastor, Victory Christian Ministries International – Civic/Religion Shanise Craft, Vice President and GM, County Line Motors – Business/Philanthropy Dr. Charlene Dukes, President, Prince George’s Community College – Education Edura Govan, Executive Director, International Business Kids – Youth Entrepreneurship Trina Jenkins, Director of Family Life Ministries at the First Baptist Church of Glenarden – Women’s Empowerment/Religion Leslie Johnson, Co-Founder/Co-Chair, Sisters To Sister Program, Community Activist, First Lady of Prince George’s County – Public Service Mya, dancer, singer – Music/Entertainment Edith M. Johnson, Pastor, Miracle Temple P.H.C. – Religion/Social Nichole Thomas, Community Activist, wife of Washington Wizards center Etan Thomas Cynne Simpson, Anchor, WJLA-TV – Media/TV Michael Melton, attorney, businessman – Business/Civic Eugene Grant, Mayor of Seat Pleasant, Md. - Politics Kenneth Barnes, Founder, ROOT, Inc. - Social D.R. Cunningham, FBI – Community Youth Glenn Ivey, State’s Attorney for Prince George’s County - Legal Copyright 2009 Washington Informer. In AIDS Crisis, Serious Times Call for Serious Measures By Courtland Milloy Washington Post Wednesday, March 18, 2009; B01 In response to a report released Monday on the HIV/AIDS crisis in the District, city officials say they plan to develop a new and improved public awareness campaign. Such efforts will no doubt take time and involve focus groups and require lots of data and even more money. A person could contract AIDS and be dead by then. Perhaps I can help get the campaign going based on what we already know, starting with black women, who represent more than one-quarter of HIV cases in the District. Most of them -- about 58 percent -- have been infected through heterosexual sex. I propose a TV public service announcement that goes something like this: You see a man holding a gun to a woman's head and pulling the trigger while professing his love for her. Voiceover: "Is that any different from what a 'down-low brother' does when he has unprotected sex with other men, then comes home and has sex with his unwitting wife?" As a rule of thumb, marketing strategists told me, it is best to emphasize the positive -- say, remind the man of how good it feels to provide for and protect his family -- instead of denigrating him for immoral behavior. So I tweaked my ending. Voiceover: "Women, protect yourself. Men, it's bad enough being a liar and cheat, but don't go so low as to become a murderer, too." (If you have a better message, please let me know.) Asked in a telephone interview what she thought of my PSA, former surgeon general Joycelyn Elders said, "That would get my attention." And isn't that what public awareness is all about? In releasing the first report on the AIDS epidemic in 2007, city officials laid out an action agenda calling for a "modern response" to a "modern epidemic." Two years later, little has changed except the name of the problem -- which city officials now refer to as a "generalized and severe epidemic," and just in case you don't know the difference between the two, the latter involves infection rates "higher than West Africa." In other words, be afraid, D.C. Be very afraid. "You and I could go today from one end of the city to other and back again by different routes and not see a single HIV prevention message," D.C. Council member Jim Graham told me. "Why? Because there aren't the resources for those types of things." Not even a billboard. Gone are the "silence equals death" signs put up by ACT UP, the AIDS activist group that kept the issue in your face back in the '80s and '90s. You haven't seen that AIDS memorial quilt spread out on the Mall in quite a while, either. Red AIDS ribbons seemed to have faded to pink as breast cancer became the illness du jour. "If AIDS was an insect, it would be a cicada," Philip Pannell, a longtime Washington AIDS activist, told me. "AIDS is a cyclical issue, comes around every few years or so, makes some noise, then disappears until the next go-round. Every time an AIDS report comes out, Mayor Fenty talks about a wakeup call. But all we do is hit the snooze button." Meanwhile, the disease itself continues to incubate and spread in manners we have not yet even acknowledged. Look at the sexually transmitted disease chlamydia. As of 2007, there were 1,037 cases per 100,000 residents reported in the District, compared with a national rate of 370. We're talking about mostly black teenage girls and young women. With STDs such as chlamydia known to weaken the immune system and make HIV infection more likely, this epidemic is but an indicator of how vulnerable the population really is. I'd put Elders to work on PSAs for hip-hop radio stations immediately. Let her teach junior high school students about the ABCD's of STD prevention -- the same ones that got her drummed out of the Clinton administration: A) Abstinence is unrealistic; B) Be faithful to your partner; C) Condoms do work; D) Do other things. Student: "What other things, Dr. Elders?" Elders: ["The M-word."] Voiceover: "Nobody ever caught AIDS from themselves." Hey, don't go squeamish on me now -- not with 3 percent of the District population walking around radioactive. Culturally inappropriate, you say? Not in a culture where sex has become a weapon of mass destruction. Copyright 2009 Washington Post. *National / International* Health care overhaul cost may reach $1.5 trillion Associated Press By Ricardo Alonso-Zaldivar Washington Post Wednesday, March 18, 2009 WASHINGTON -- Your lungs may work just fine, but the estimated price for universal health care could take your breath away. Health policy experts say guaranteeing coverage for all Americans may cost about $1.5 trillion over the next decade. That would be more than double the $634 billion 'down payment' President Barack Obama set aside for health reform in his budget. About 48 million people are uninsured, and the problem is only expected to get worse because the cost of coverage keeps rising. Still, administration officials have pointedly avoided providing a ballpark estimate for Obama's fix, saying it depends on details to be worked out with Congress. "It's impossible to put a price tag on the plan before even the basics have been finalized," said White House spokesman Reid Cherlin. "Here's what we do know: The reserve fund in the president's budget is fully paid for and provides a substantial down payment on the cost of the reforming our health care system." The potential for runaway costs is raising concerns among Republicans and some Democrats as Congress prepares to draft next year's budget. The U.S. spends $2.4 trillion a year on health care, more than any other advanced country. And some experts estimate that a third or more of that goes for tests and procedures, rather than prevention and treatment. "We shouldn't just be throwing more money on top of the present system, because the present system is so wasteful," said Sen. Judd Gregg of New Hampshire, the ranking Republican on the Budget Committee. The health care plan Obama offered as a candidate would have cost nearly $1.2 trillion over ten years, according to a detailed estimate last fall by the Lewin Group, a leading consulting and policy analysis firm. The campaign plan would not have covered all the uninsured, as most Democrats in Congress want to do. But it is a starting point for lawmakers. John Sheils, a senior vice president of the Lewin Group, said about $1.5 trillion to $1.7 trillion would be a credible estimate for a plan that commits the nation to covering all its citizens. That would amount to around 4 percent of projected health care costs over the next 10 years, he added. The cost of covering the uninsured is "a difficult hurdle to get over," Sheils said in an interview. "I don't know where the rest of the money is going to come from," he added. Some of the leading advocates of coverage for all use cost estimates around $1.5 trillion. "Honestly ... we can't do it for the $634 billion the president put in the reserve fund," John Rother, public policy director for AARP, told an insurance industry meeting in Washington last week. "In all likelihood, it will be over $1 trillion," he added, citing his own estimate of $1.5 trillion. Economist Len Nichols, who heads the health policy project at the New America Foundation, said guaranteed coverage will cost $125 billion to $150 billion a year when fully phased in. White House budget director Peter Orszag told the House Budget Committee earlier this month that the president's $634 billion fund is "likely to be the majority of the cost." Roughly half of the money would come from spending cuts, and the other half from tax increases. But whether the $634 billion represents 50 percent, 60 percent or 70 percent of the cost "will depend on the details of whatever is finally done ... as we move through the legislative process," Orszag added. The overall cost matters because the expansion of health coverage is meant to be a permanent reform. That means future generations will have to bear the cost. "We are dealing with huge numbers," said David Walker, a former U.S. comptroller general and now head of the Peter G. Peterson Foundation, a group that promotes fiscal responsibility. "We need to have a much better sense of what we are talking about doing, and whether or not it's affordable and sustainable over time." © 2009 The Associated Press. U.S. Births Reach Record Level Associated Press Wall Street Journal Wednesday, March 18, 2009 ATLANTA -- More babies were born in the U.S. in 2007 than any year in the nation's history, topping the peak during the baby boom 50 years earlier, federal researchers reported Wednesday. There is both good and bad news from the more than 4.3 million births: The U.S. population is more than replacing itself, a healthy trend. However, the teen birth rate was up for the second year in a row. The birth rate rose slightly for women of all ages, and births to unwed mothers reached an all-time high of about 40%, continuing a trend begun years ago. More than three-quarters of these women were 20 or older. For a variety of reasons, it's become more acceptable for women to have babies without a husband, said Duke University's S. Philip Morgan, a leading fertility researcher. Even happy couples may be living together without getting married, experts say. And more women -- especially those in their 30s and 40s -- are choosing to have children despite their single status. The new numbers indicate the nation is experiencing a baby boomlet with fertility rates higher in every racial group. On average, a U.S. woman has 2.1 babies in her lifetime. The highest fertility rates were among Hispanics. But it's not clear the boomlet will last long. Some experts think birth rates are already declining because of the economic recession that began in late 2007. "I expect they'll go back down. The lowest birth rates recorded in the United States occurred during the Great Depression -- and that was before modern contraception," said Carol Hogue, an Emory University professor of maternal and child health. The 2007 statistical snapshot reflected a relatively good economy coupled with cultural trends that promoted childbirth, she and others noted. Meanwhile, U.S. abortions have been dropping to their lowest levels in decades, according to other reports. Some have attributed the abortion decline to better use of contraceptives, but other experts have wondered if the rise in births might indicate a failure in proper use of contraceptives. Some earlier studies have shown declining availability of abortions. Cultural attitudes may be a more likely explanation. Mr. Morgan noted the pregnancy of Bristol Palin, the unmarried teen daughter of former GOP vice presidential candidate Sarah Palin. The young woman had a baby boy in December, and plans for a wedding with the father, Levi Johnston, were scrapped. "She's the poster child for what you do when you get pregnant now," Mr. Morgan said. Teen women tend to follow what their older sisters do, so perhaps it's not surprising that teen births are going up just like births to older women, said Sarah Brown, the chief executive for the National Campaign to Prevent Teen and Unplanned Pregnancy. Indeed, it's harder to understand why teen births had been declining for about 15 years before the recent uptick, she said. It may have been due to a concentrated societal effort to reduce teen births in the 1990s that has waned in recent years, she said. The statistics are based on a review of most 2007 birth certificates by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. The numbers also showed: -Cesarean section deliveries continue to rise, now accounting for almost a third of all births. Health officials say that rate is much higher than is medically necessary. About 34% of births to black women were by C-section, more than any other racial group. But geographically, the percentages were highest in Puerto Rico, at 49%, and New Jersey, at 38%. -The pre-term birth rate, for infants delivered at less than 37 weeks of pregnancy, declined slightly. It had been generally increasing since the early 1980s. Experts said they aren't sure why it went down. -Among the states, Utah continued to have the highest birth rate and Vermont the lowest. CDC officials noted that despite the record number of births, this is nothing like what occurred in the 1950s, when a much smaller population of women were having nearly four children each, on average. That baby boom quickly transformed society, affecting everything from school construction to consumer culture. Today, U.S. women are averaging 2.1 children each. That's the highest level it's been since the early 1970s, but is a relatively small increase from the rate it had hovered at for more than 10 years and is hardly transforming. "It's the tiniest of baby booms," said Mr. Morgan in agreement. "This is not an earthquake; it's a slight tremor." Copyright © 2009 Associated Press. A Silenced Drug Study Creates An Uproar By Shankar Vedantam Washington Post Wednesday, March 18, 2009; A01 The study would come to be called "cursed," but it started out just as Study 15. It was a long-term trial of the antipsychotic drug Seroquel. The common wisdom in psychiatric circles was that newer drugs were far better than older drugs, but Study 15's results suggested otherwise. As a result, newly unearthed documents show, Study 15 suffered the same fate as many industry-sponsored trials that yield data drugmakers don't like: It got buried. It took eight years before a taxpayer-funded study rediscovered what Study 15 had found -- and raised serious concerns about an entire new class of expensive drugs. Study 15 was silenced in 1997, the same year Seroquel was approved by the Food and Drug Administration to treat schizophrenia. The drug went on to be prescribed to hundreds of thousands of patients around the world and has earned billions for London-based AstraZeneca International -- including nearly $12 billion in the past three years. The results of Study 15 were never published or shared with doctors, even as less rigorous studies that came up with positive results for Seroquel were published and used in marketing campaigns aimed at physicians and in television ads aimed at consumers. The results of Study 15 were provided only to the Food and Drug Administration -- and the agency has strenuously maintained that it does not have the authority to place such studies in the public domain. AstraZeneca spokesman Tony Jewell defended the Seroquel research and said the company had disclosed the drug's risks. Since 1997, the drug's labeling has noted that weight gain and diabetes were seen in study patients, although the company says the data are not definitive. The label states that the metabolic disorders may be related to patients' underlying diseases. The FDA, Jewell added, had access to Study 15 when it declared Seroquel safe and effective. The trial, which compared patients taking Seroquel and an older drug called Haldol, "did not identify any safety concerns," AstraZeneca said in an e-mail. Jewell added, "A large proportion of patients dropped out in both groups, which the company felt made the results difficult to interpret." The saga of Study 15 has become a case study in how drug companies can control the publicly available research about their products, along with other practices that recently have prompted hand-wringing at universities and scientific journals, remonstrations by medical groups about conflicts of interest, and threats of exposure by trial lawyers and congressional watchdogs. Even if most doctors are ethical, corporate grants, gifts and underwriting have compromised psychiatry, said an editorial this month in the American Journal of Psychiatry, the flagship journal of the American Psychiatric Association. "The public and private resources available for the care of our patients depend upon the public perception of the integrity of our profession as a whole," wrote Robert Freedman, the editor in chief, and others. "The subsidy that each of us has been receiving is part of what has fueled the excesses that are currently under investigation." Details of Study 15 have emerged through lawsuits now playing out in courtrooms nationwide alleging that Seroquel caused weight gain, hyperglycemia and diabetes in thousands of patients. The Houston-based law firm Blizzard, McCarthy & Nabers, one of several that have filed about 9,210 lawsuits over Seroquel, publicized the documents, which show that the patients taking Seroquel in Study 15 gained an average of 11 pounds in a year -- alarming company scientists and marketing executives. A Washington Post analysis found that about four out of five patients quit taking the drug in less than a year, raising pointed doubts about its effectiveness. An FDA report in 1997, moreover, said Study 15 did offer useful safety data. Mentioning few details, the FDA said the study showed that patients taking higher doses of the drug gained more weight. In approving Seroquel, the agency said 23 percent of patients taking the drug in all studies available up to that point experienced significant weight increases, compared with 6 percent of control-group patients taking sugar pills. In 2006, FDA warned AstraZeneca against minimizing metabolic problems in its sales pitches. In the years since, taxpayer-funded research has found that newer antipsychotic drugs such as Seroquel, which are 10 times as expensive, offer little advantage over older ones. The older drugs cause involuntary muscle movements known as tardive dyskinesia, and the newer ones have been linked to metabolic problems. Far from dismissing Study 15, internal documents show that company officials were worried because 45 percent of the Seroquel patients had experienced what AstraZeneca physician Lisa Arvanitis termed "clinically significant" weight gain. In an e-mail dated Aug. 13, 1997, Arvanitis reported that across all patient groups and treatment regimens, regardless of how numbers were crunched, patients taking Seroquel gained weight: "I'm not sure there is yet any type of competitive opportunity no matter how weak." In a separate note, company strategist Richard Lawrence praised AstraZeneca's efforts to put a "positive spin" on "this cursed study" and said of Arvanitis: "Lisa has done a great 'smoke and mirrors' job!" Two years after those exchanges, in 1999, the documents show that the company presented different data at an American Psychiatric Association conference and at a European meeting. The conclusion: Seroquel helped psychotic patients lose weight. The claim was based on a company-sponsored study by a Chicago psychiatrist, who reviewed the records of 65 patients who switched their medication to Seroquel. It found that patients lost an average of nine pounds over 10 months. Within the company, meanwhile, officials explicitly discussed misleading physicians. The chief of a team charged with getting articles published, John Tumas, defended "cherry-picking" data. "That does not mean we should continue to advocate" selective use of data, he wrote on Dec. 6, 1999, referring to a trial, called COSTAR, that also produced unfavorable results. But he added, "Thus far, we have buried Trials 15, 31, 56 and are now considering COSTAR." Although the company pushed the favorable study to physicians, the documents show that AstraZeneca held the psychiatrist in light regard and had concerns that he had modified study protocols and failed to get informed consent from patients. Company officials wrote that they did not trust the doctor with anything more complicated than chart reviews -- the basis of the 1999 study showing Seroquel helped patients lose weight. For practicing psychiatrists, Study 15 could have said a lot not just about safety but also effectiveness. Like all antipsychotics, Seroquel does not cure the diseases it has been approved to treat -- schizophrenia and bipolar disorder -- but controls symptoms such as agitation, hallucinations and delusions. When government scientists later decided to test the effectiveness of the class of drugs to which Seroquel belongs, they focused on a simple measure -- how long patients stayed on the drugs. Discontinuation rates, they decided, were the best measure of effectiveness. Study 15 had three groups of about 90 patients each taking different Seroquel doses, according to an FDA document. Approximately 31 patients were on Haldol. The study showed that Seroquel failed to outperform Haldol in preventing psychotic relapses. In disputing Study 15's weight-gain data, company officials said they were not reliable because only about 50 patients completed the year-long trial. But even without precise numbers, this suggests a high discontinuation rate among patients taking Seroquel. Even if every single patient taking Haldol dropped out, it appears that at a minimum about 220 patients -- or about 82 percent of patients on Seroquel -- dropped out. Eight years after Study 15 was buried, an expensive taxpayer-funded study pitted Seroquel and other new drugs against another older antipsychotic drug. The study found that most patients getting the new and supposedly safer drugs stopped taking them because of intolerable side effects. The study also found that the new drugs had few advantages. As with older drugs, the new medications had very high discontinuation rates. The results caused consternation among doctors, who had been kept in the dark about trials such as Study 15. The federal study also reported the number of Seroquel patients who discontinued the drug within 18 months: 82 percent. Jeffrey Lieberman, a Columbia University psychiatrist who led the federal study, said doctors missed clues in evaluating antipsychotics such as Seroquel. If a doctor had known about Study 15, he added, "it would raise your eyebrows." Copyright 2009 Washington Post. *Opinion* From Bad to Worse The HIV/AIDS epidemic is ravaging the District Washington Post Editorial Wednesday, March 18, 2009; A12 WE'VE LONG known that HIV and AIDS stalk the District. But the startling "District of Columbia HIV/AIDS Epidemiology Update 2008" released Monday shows the breathtaking devastation that the disease with no cure has unleashed on the District. According to the report, in defining an HIV epidemic as "generalized and severe," the Centers for Disease Control and Prevention and the United Nations Joint Program on HIV/AIDS have said that "the overall percentage of disease among residents of a specific geographic area exceeds 1 percent." It's 3 percent here. Every ward except Ward 3 is above the 1 percent threshold. And continuing a grim trend from the 2007 report, African Americans are bearing the brunt of this epidemic: 4.3 percent of African Americans in the District are living with HIV/AIDS; 6.5 percent of black men in the city have the disease, and African Americans account for 76 percent of HIV/AIDS cases in the District. But this is no more a black epidemic than it was a gay one when it roared to life in the 1980s. That 1 percent epidemic threshold is crossed by just about every racial group and age group. Three percent of Hispanic men, as well as 2.6 percent of white men and black women live with HIV/AIDS. The 40-to-49 age group has the highest proportion of those with the disease (7.2 percent) followed by 50- to 59-year-olds (5.2 percent) and 30- to 39-year-olds (3.4 percent). Men who have sex with men, heterosexual transmission and intravenous drug use are the top three ways the epidemic is spreading. Overall, the number of cases increased by 22 percent over 2006. In a separate study on heterosexual relationships and HIV released Monday, 5 percent of the 750 District residents surveyed tested HIV-positive. More than 70 percent of the study participants had not used condoms. A combination of factors allowed a bad situation to get worse. D.C. Council member David A. Catania (I-At Large), who chairs the council's health committee, told us that the District's HIV/AIDS Administration was rendered slow and ineffective by bureaucracy, patronage and a dearth of expertise. There have been 14 directors of that office since it was created in 1986. Shannon L. Hader has run the office since 2007 and is the third full-time director in the past five years. In addition, the city was prevented from spending its own funds on a needle-exchange program until the nearly 10-year-old ban was stripped from federal legislation authorizing the District's budget last year. Mr. Catania calls Ms. Hader "top drawer" and praises Mayor Adrian M. Fenty (D) for his commitment to fighting the epidemic. As horrifying as these latest statistics are, they offer a reason for hope. They reflect increased efforts by the District to get people tested and into treatment (i.e. making HIV testing a routine part of health care) and to educate them about staying uninfected (free condom distribution). More important, the data provide the most accurate picture to date of where and how the disease is being transmitted and who is becoming infected. With accurate data and an agency finally equipped with talent and resources, the District stands a chance of driving those numbers down in a sustained and targeted way to save lives. Copyright 2009 Washington Post. BACK TO TOP


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