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			Thursday, March 26, 2009 News Clipping Archives *Maryland / Regional* Students rally against tobacco use at Kick Butts Day (Frederick News-Post) Medicaid Fraud OK in Maryland! (Annapolis Anchor) Officials: Hospital deal could be reached by summer (Prince George’s County Gazette) Area Hospitals Feeling Pinch in Downturn (Washington Post) Stakeholders meet nursing home owners (Cumberland Times-News) City faces federal suit over group homes (Baltimore Sun) Police seek information after infant found dead in Berwyn Heights lake (Prince George’s County Gazette) Lawmaker pushes bill to study medical marijuana (Annapolis Capital) Federal programs gave addicts street drugs (dcexaminer.com) State's hospitals suffering amid recession (Daily Record) States consider drug tests for welfare recipients (Frederick News-Post) *National / International* A Vaccine Debate Once Focused on Sex Shifts as Boys Join the Target Market (Washington Post) Medical association sues WellPoint over database (Daily Record) Food Safety, Flesh-Eating Bacteria and an Insurance Lawsuit (New York Times) Head Injuries: Looking for Signs and Acting Quickly (New York Times) Florida Veterans Stream for Testing After H.I.V. Warning (New York Times) Circumcision helps prevent infection with two STDs, large study in Africa Finds (Baltimore Sun) U.S. Hospitals Slow to Adopt E-Records (Wall Street Journal) *Opinion* Relief for Patients (New York Times) Liability system is unreliable (Washington Times) Alcohol taxes encourage more spending (Washington Times) *Maryland / Regional* Students rally against tobacco use at Kick Butts Day By Nicholas C. Stern Frederick News-Post Thursday, March 26, 2009 Anthony Bejarano, 16, is chased by James Stevenson, 17, dressed as a cigarette, before a skit performed by area teens to encourage people not to smoke. The event was held outside Rita's Italian Ice on West South Street by a group called TRASH, or Teens Rejecting Abusive Smoking Habits. A dozen or more Frederick County middle and high school students gathered Wednesday afternoon to encourage their parents and peers to stop using tobacco products. The event, at Rita's Italian Ice shop on South Street, was supported in part by the Frederick County Teens Coalition Against Tobacco, and the Minority Outreach and Technical Assistance program of the Maryland Department of Health and Mental Hygiene. One skit featured an oversized cigarette that attempted to entice and ensnare a teenager in its grasp. Anti-tobacco pamphlets were among the promotional materials. Students also signed a poster pledging their eternal cessation from tobacco use in all of its forms on the day they designated Kick Butts Day. Frederick High School sophomore Chelsea Paul, 17, played both the victim and the aggressor in the skits. Paul has been a member of Teens Rejecting Abusive Smoking Habits for about a year. She participates in events designed to discourage teens and minorities -- often targets of tobacco company advertising -- from tobacco by, in part, showing them the effects its use may have on their bodies, she said. "We want to steer teens away from drugs and make them safe," she said. Robbie McLuckie, the youth program leader for TRASH at LIFE & Discovery, a local health and education nonprofit, spoke with some of the students about a possible internship opportunity at LIFE & Discovery for the next school year. McLuckie said LIFE & Discovery hopes to hire two or three interns from county schools who will work with him to promote similar anti-tobacco activities. The paid interns would also help gather donations, meet with local legislators and gain experience speaking in public. Copyright 2009 Frederick News-Post. Medicaid Fraud OK in Maryland! By Jesse Barron Annapolis Anchor Wednesday, March 26, 2009 Although I find it hard to side with Governor O’Malley on many things, one bill before the legislature that was introduced by him to investigate and recover damages from those who commit Medicaid fraud failed to get enough support. The lobbyists for hospitals, doctors, pharmaceutical companies and others were able to kill the bill. The bill, modeled on laws passed in nearly half the states, would have given Maryland officials and whistle-blowers greater latitude to pursue Medicaid fraud and collect damages. Opponents contended that the measure would have prompted frivolous lawsuits and would have added to administrative costs for health care providers, including physician practices and nursing homes. Those costs would then have been passed on to patients when rising medical costs have become a national crisis. The legislation failed by one vote. What I find disgusting is that Maryland hospitals have been suing uninsured patients left and right for payment of medical bills, even after the state reimburses them for their expenses. Essentially, in many cases they have been paid by the state and again later down the road by the patient. They do it because they have been able to get away with it and will continue to do so. The moral of the story is that dishonest hospitals, doctors and others can continue to double dip and rip off taxpayers with little fear. Source: Medicaid crackdown can’t beat industry opposition [Baltimore Sun] Copyright 2009 Annapolis Anchor. Officials: Hospital deal could be reached by summer Proposal to alter rules of sale not expected to delay effort beyond this year By Daniel Valentine Prince George’s County Gazette Thursday, March 26, 2009 State delegates and hospital union officials expressed optimism last week that the Prince George's County hospital system will be sold within the year - with the deal hammered out this summer - despite missing the previous deadline for the sale of the three medical centers. "We've made progress," said Del. James W. Hubbard (D-Dist. 23A) of Bowie. "We just need more time." Legislation sponsored by the county delegation would allow the Prince George's County Hospital Authority - a committee charged with selling the financially strapped hospital system - to have until May 2010 to work out details on how to sell off the hospitals in Cheverly, Laurel and Bowie. The hospital authority was convened in June 2008 with a goal of having a purchase in place by March 15 of this year. However, few bidders expressed interest in all three hospitals, and legislation has required that they be sold as a package. The county-owned hospitals have required financial bailouts over the past decade from the county and state due to a large number of uninsured patients. Officials estimate the hospitals, which serve 180,000 patients each year, lose about $12 million annually. Prince George's Hospital Center in Cheverly has been identified as the biggest financial burden, with half of its patients being uninsured. The proposed legislation, which met little resistance at a House Health and Government Matters Committee hearing last week, would allow the hospitals to be sold individually, but they must be sold at the same time. "It has to be all or none," said Del. Joanne C. Benson (D-Dist. 24) of Landover. "We have to be sure Prince George's County Hospital will not be standing alone." The deals would need to be reviewed by state and county officials before they could be finalized. Glover said he hopes to begin bringing in interested purchasers soon. Because the authority's current timeline is up, the extension bill must pass before the group can take official action. County Council members last month criticized the hospital progress for taking longer than expected and for possibly leaving parts unsold, but have not filed an objection to the current extension bill. Authority members said they will use the nine bids they have received on the individual hospitals as a starting point for further negotiations. "We will now work with these nine parties," said Kenneth Glover, authority chairman. "This gives a unique opportunity to negotiate the best deal possible." Glover would not provide information about the nine bids, which are under a nondisclosure agreement. Delegates and other officials said they did not know the identities, either. "I don't want to know that," Hubbard said. "I just want [the authority] to have the power to get this done." Glover and Hubbard said if all goes well, the deals could be reached by the summer. "It might not be the same buyer for all three," Glover said March 19. "But we will have someone for each location." Officials are also pursuing other options to aid the struggling hospital system. Gov. Martin O'Malley (D) has asked the federal government to give $156 million from the nation's Homeland Security budget to transform Prince George's Hospital Center into a regional trauma center by partnering with the military and a teaching hospital program from a local university. That proposal cannot be finalized until the federal budget passes in October. Stacy Mink, a spokeswoman for the union that represents hospital workers in Prince George's, said the union endorses the option of a joint partnership with a learning institution, which would provide stable funding and offset losses. "That kind of money cements the hospital's reputation as a first-class choice for emergency care in the capital area," Mink said. "We'll definitely be advocating that." Economic concerns are posing another hurdle in the deal. Last week, County Executive Jack B. Johnson (D) announced he is asking the state to pay the $12 million the county agreed to contribute to keeping the hospital afloat until a purchaser is found. Hubbard expressed concern about Johnson's proposal, which he said could give the appearance that the county is not fully supporting a hospital solution. "There needs to be that partnership between the county and state [on funding] to keep this hospital running," Hubbard said. Copyright 2009 Princes George’s County Gazette. Area Hospitals Feeling Pinch in Downturn By Lori Aratani Washington Post Thursday, March 26, 2009; B03 It might have a reputation as a growth industry in good times and bad, but that does not mean the health-care sector is immune to the economic troubles affecting other parts of the business world. In a report to be released today, the Maryland Hospital Association says that income is down and expenses have risen for many of the state's 58 hospitals. The report says 34 hospitals in the state lost a combined $466 million during the last quarter of 2008. Virginia hospitals are also reporting shortfalls. District hospitals have yet to report results for the final quarter of 2008, but Robert A. Malson, chief executive officer of the District of Columbia Hospital Association, said they, too, are affected by the downturn. Hospital officials in the three jurisdictions said they are looking closely at expenses and developing plans for cutting costs. Many have already made reductions. Maryland hospitals reported a 13.5 percent decline in total margins -- a measure of income from all sources, including investments -- for the last quarter of 2008. In Virginia, Chris Bailey, senior vice president at the Virginia Hospital and Healthcare Association, said income is down 24 percent, not counting investment losses. By comparison, hospitals nationally reported a 7.8 percent decline in total margins during the quarter, according to the American Hospital Association. "I do think there's a misperception that things are okay, when in fact they're not," said Carmela Coyle, president of the Maryland Hospital Association. In Maryland, the gap in operating expenses, the difference between what is spent and what is earned on patient care, narrowed to 1.5 percent in the fourth quarter, from 2.4 percent in the third. Coyle said the trend is troubling because it means hospitals' financial cushion is shrinking at a time when more people are turning to emergency rooms for care because they have lost their health insurance. In Virginia, Bailey said hospitals' "bad debts" -- owed by people who fail to pay their bills -- rose 20 percent in the fourth quarter from the same period in 2007. Copyright 2009 Washington Post. Stakeholders meet nursing home owners By Kevin Spradlin Cumberland Times-News Thursday, March 26, 2009 CUMBERLAND - Nearly three dozen stakeholders and supporters met the likely owners of the Allegany County Nursing Home and Rehabilitation Center. It was announced last week that Allegany County HealthCare Group LLC, a broad group of partners from Maryland and Rhode Island, had won the county commissioners’ approval as the final suitor for the Furnace Street facility. Allegany HealthCare Group includes Bill Freas of Rehab First, Cumberland attorney Paul Kelly, local orthopedic surgeons Gregg Wolff and Roy Carls, Mid-Atlantic Health Care LLC, owned by Dr. Scott Rifkin of Baltimore and Gilbane Development Company, headquartered in Providence, Rhode Island. At a news conference in downtown Cumberland on Wednesday, principals in the new ownership group thanked county decision-makers for choosing their proposal over apparent Florida-based runner-up North Bay Health Associates LLC. “Obviously, I think it’s a good one,” said Freas of the commissioners’ decision, made March 19 in executive session. Freas said it was clear the commissioners wanted a business group that is “interested in doing something for the community. In this area, that means a lot.” Freas said investors intend to improve the facility, which employs nearly 160 workers to care for about 140 residents at 701 Furnace St., a 61-year-old building situated on 2.74 acres. The land and building were assessed at a value of $2.2 million in July 2008. “We want to make it a real vital part to this community,” Freas said. Rifkin, of Owings Mills and Mid-Atlantic Health Care own a handful of nursing homes in Maryland and Delaware, including the Oakland Nursing and Rehabilitation Center, formerly Cuppett and Weeks Home Inc. About six years ago, Rifkin said his group bought its first nursing home in Berlin in southern Maryland. And two years after buying another facility in Annapolis, work was completed on a $2 million renovation, which added a modern gymnasium and other comforts for residents. “The county took its time and did this right,” Rifkin said. Rifkin said he couldn’t offer specifics on what, if any, physical changes there would be to the facility. He said some of the short-term changes, once the sale goes through, would involve programming. Rifkin said it was clear the county was concerned about the welfare of the employees and the residents. Local union representative Jim Bestpitch, who negotiated a three-year contract between the two leading candidates for the facility and the county, said workers are glad to know a decision has been made. Bestpitch said knowing who will be the boss lowers employees’ stress so they can better focus on their daily tasks. County Attorney Bill Rudd said the union contract essentially guarantees workers’ jobs. Civil service employees also are likely to be retained, he said, but they’re not guaranteed anything. “It’s hard to get people” to work in the industry, Rudd said. “My guess is, everybody’s going to keep their jobs.” Copyright © 1999-2008 cnhi, inc. City faces federal suit over group homes By Annie Linskey Baltimore Sun Wednesday, March 26, 2009 The U.S. Department of Justice says it will file a civil rights suit against Baltimore in early April, claiming the City Council approval process for starting group homes is discriminatory, according to a letter sent to the city Wednesday. Federal attorneys have, for years, been threatening such a lawsuit. But they were supportive of legislation introduced by Mayor Sheila Dixon that removed provisions allowing the Cty Council to veto those facilities. Late last year, City Council President Stephanie C. Rawlings-Blake withdrew her support from that measure, saying neighborhoods needed stronger protections. She and others worry that drug treatment facilities would be clustered in neighborhoods with large amounts of inexpensive housing. Copyright 2009 Baltimore Sun. Police seek information after infant found dead in Berwyn Heights lake Body discovered in bag in Lake Artemesia By Jordan Attebury Prince George’s County Gazette Thursday, March 26, 2009 An infant's body that had been stuffed into a bag and put in Lake Artemesia in Berwyn Heights was discovered by two fishermen Sunday around 3 p.m., according to the Prince George's County Police Department. Will Perdue and Joseph Dean were fishing and cleaning up trash at the lake when they saw a bag and fished it out of the water. They discovered the body of an infant inside and called the police. "At this point in the investigation we really don't know where to start," said police spokesman Cpl. Clinton Copeland. "We don't even know the sex of the child." The police are currently working with the medical examiner's office to discover the identity and cause of death. "I called this morning to make sure it was safe to go running," said Katya Sotris on Monday. Sortis, a Berwyn Heights resident, said she usually visits the lake three times a week, including Sunday when the body was found. "I'm guessing it is a teen that was just not prepared," Sotris said. The infant's discovery has led to more publicity for Maryland's "Safe Haven Law," established in 2002, allows a child's mother to relinquish an unharmed infant up to 10 days after birth at a designated safe haven such as hospitals and police stations without fear of repercussion, according to Ransom Washington Jr., public relations/community outreach and education manager at the Prince George's Department of Social Services. Prince George's County has six safe havens including one at the Prince George's County Police Department in Hyattsville and at the Beltsville Station in Beltsville. "It's always a heart-wrenching situation, especially because we have the safe haven law," Copeland said. "We haven't had any infants dropped off here [at the Prince George's County Police Department in Hyattsville] mostly they go to fire stations, hospitals or churches." County groups continue to stem the number of abandoned and deceased infants. The most recent cases include a baby found in Oxon Hill in 2004 and an infant found in Riverdale in 2006. In a third incident in October, Takoma Park resident Wendy Yanette Villatoro, 25, was charged with second-degree murder for placing her newborn daughter in a trash bag where she was discovered seven hours later and taken to a local hospital, where she died as a result of the exposure to the elements. "I'm just sad that they could not think that the baby could be taken care of by a loving family and that this was their last resort," said Lisa Wilder, a Washington, D.C., resident who was walking around Lake Artemesia on Monday. Copyright 2009 Prince George’s County Gazette. Lawmaker pushes bill to study medical marijuana Associated Press By Kathleen Miller Annapolis Capital Wednesday, March 25, 2009 ANNAPOLIS, Md. (AP) - Maryland advocates for medical marijuana say the state is sending mixed messages about using the drug to treat debilitating illnesses. They are hoping to persuade lawmakers to create a task force to study the issue. In 2003, the Maryland General Assembly approved less severe fines for people convicted of marijuana possession who can prove a medical necessity for the drug in court. Seriously ill people can still be arrested, however, and fined up to $100 if convicted of possession or use of marijuana or related paraphernalia, even if they prove in court they have a medical necessity. Otherwise, violators are subject to fines of up to $1,000 and can face up to a year in jail for simple possession or use of the drug. Delegate Henry Heller, D-Montgomery, said the 2003 law was "well-intentioned," but gives people a "false sense of security." Heller, who says he doesn't use medical marijuana himself, said he is sponsoring legislation to study the issue after some his neighbors in a Silver Spring senior community told him they wanted to use marijuana to treat severe illnesses but were afraid of running afoul of the law. Heller's proposal is to have a task force staffed by the Department of Health and Mental Hygiene study legal and feasibility issues related to the research, use and procurement of medical marijuana. The group would have to issue a recommendation to repeal or maintain the state's current policy for medical marijuana. Thirteen states have removed criminal penalties for patients who use and possess marijuana with their doctor's approval or certification, according to a Maryland Department of Legislative Services analysis. The task force would require additional general fund expenditures, however, to research and produce the report. A number of medical marijuana advocates told the House Judiciary Committee Tuesday that Maryland is sending mixed messages about using marijuana to provide relief from debilitating illnesses such as cancer or HIV. Howard County resident Suzi Rank told lawmakers she has used marijuana to battle the nausea that accompanied chemotherapy and steroid treatment for cancer and a blood disease. Rank said she tried eight different anti-nausea medications from her doctor and was hospitalized twice for dehydration before she tried marijuana and "it helped like nothing else had." "I have been a law-abiding citizen my whole life except for using marijuana," Rank said. "I feel like I am a typical medical marijuana patient, we are not out dealing drugs, we are your average person. I feel like I had to choose between my life, losing my life and breaking the law." On the Net: Read House Bill 1339: http://mlis.state.md.us/2009rs/fnotes/bil_0009/hb1339.pdf Copyright 2009 Annapolis Capital. Federal programs gave addicts street drugs By Bill Myers dcexaminer.com Thursday, March 26, 2009 The federal government is giving crack and powder cocaine, morphine, and other hard-core drugs to taxpayer-funded researchers for testing on addicts, The Examiner has learned. For decades, the government has authorized, funded and lobbied for studies in which otherwise illegal drugs were given to addicts in cities such as Washington, Bethesda, Baltimore, New York, Minneapolis and San Antonio. The studies continue today and have an array of aims, from documenting the ways cocaine warps the brain to the intensity of pain from morphine withdrawal. Government records obtained by The Examiner show that the researchers gave test subjects: * Morphine at the Veterans Administration in D.C. * Cocaine injections at the U.S. military’s Uniformed Services University in Bethesda. * Crack cocaine in several major cities. Most government officials are not aware of the experiments, even though they have been going on since at least the 1970s. But at least one former cabinet member found out about them and wants them stopped. John Walters, drug czar during both terms of George W. Bush’s administration, said he learned about the studies near the end of Bush’s term. “It’s not only questionable ethically, but probably — given the science — it may not be able to be defended at all,” Walters told The Examiner recently. In July 2008, Walters wrote a letter to Michael O. Leavitt, then secretary of health and human services. In that letter, obtained by The Examiner, Walters said that finding treatments for addictions was a “compelling” goal. “But what are their proper limits?” Walters wrote. He still hasn’t gotten a response. “Most people see the things that people will do to themselves when they’re addicted — what they’ll do to themselves, to their families, to their loved ones,” Walters told The Examiner. “I think that when you bring someone in and say, ‘Well, they’re not seeking treatment yet and therefore it’s OK to use them as an experimental subject’ — that’s not the understanding that the current science gives us about this disease.” The subjects of the tests signed consent forms before engaging in the studies and were paid. Most of the studies have been funded by the National Institute on Drug Abuse, a government agency based in Washington that is part of the National Institutes of Health. Officials there declined to be interviewed for this story and have not responded to requests for documents relating to the studies. Records show the studies date back to at least 1979. “NIDA issues grants to researchers all over the country and even many parts of the world,” spokeswoman Stephanie Older wrote in an e-mail. “Although all ... grantees must follow strict human subjects research guidelines, they do conduct their own independent research.” Critics such as Walters worry that scientists are victimizing people who can’t say no. Drug addiction is a powerful biochemical force. Studies have shown cocaine, for instance, can warp the brain’s prefrontal cortex, which governs a person’s reasoning and judgment. “What the critics seem to be implying is that because there’s addiction, there’s coercion,” said Kathleen Neill, a bioethicist with Georgetown University Medical Center. “This has brought up all kinds of ethical concerns, but that’s not to say there isn’t an answer to them.” Former drug addict Jesse Washington knows what his answer would be. Next month, he’ll have been clean and sober for 20 years. He still remembers acutely what it was like to wait eagerly for new kinds of cocaine, heroin and mescaline the way some collectors wait for “new cars off the line.” “I was always trying to find a safe way to do it. There’s not,” said Washington, who now counsels addicts at Samaritan Inns, a D.C. halfway house. “But [a study] would have given me an opportunity where I could have talked myself into it and said, ‘These people are trying to help me out. Maybe we can make it [drug abuse] work this time.’ ” Researchers interviewed by The Examiner say that their NIDA-funded work on drug addicts has yielded powerful insights into the disease. “Sometime in the fall we’re going to begin a clinical trial on a cocaine vaccine,” said Dr. Herbert Kleber, a Columbia University researcher. “It’s a fascinating kind of research.” Among the findings from clinical trials, for instance, were brain images taken by Johns Hopkins researchers that showed what cocaine can do to the brain. That’s led to new worlds of understanding on addiction, experts say. “The question is whether the results justify using these individuals as disposable subjects,” Walters said. Dr. Suena Massey is a professor of psychiatry at George Washington University who specializes in treating addiction. She says that research involving vulnerable people — such as the mentally ill or drug addicts — always challenges a scientist to find the ethical way of studying serious problems. “There’s definitely the potential of an ethical dilemma with doing a study that appeals to a vulnerability such as addiction,” Massey said. “Having said that, I think the capacity for informed consent can and should be made on a case-by-case basis.” Ex-drug czar Walters says he’s willing to be convinced. “I’m trying to listen to the best science possible. But I haven’t gotten an answer,” he said. “It’s all the bureaucracy protecting itself here on the grounds that the scientists know best. It’s not a trivial matter.” According to NIDA’s Web site, researchers in New York still are looking for “volunteers.” Copyright 2009 dcexaminer. State's hospitals suffering amid recession By Danielle Ulman Daily Record Thursday, March 26, 2009 Maryland’s hospitals are suffering in the economic crisis as costs rise, reporting losses of 13.5 percent in the fourth quarter of 2008, compared to profits of 2.2 percent in the corresponding period in 2007. In the fourth quarter, 34 out of 58 hospitals in the state lost a total of $466 million, according to the financial analysis completed by the Maryland Hospital Association. The state’s hospitals fared worse than their national counterparts at the end of 2008, with the nation’s hospitals ringing up losses of 7.8 percent. Losses stemmed from increased interest rates, smaller returns on investments and higher costs for upgrading or expanding programs and new technology. To help ease the burden of higher expenses, many hospitals have implemented hiring freezes, reduced administrative staff and curtailed spending on new technology upgrades, like moving medical records into electronic form, said Nancy Fiedler, senior vice president of communications for the hospital association. “There is a lot of belt tightening, and if these numbers continue it will probably lead to cutting beds and patient care staff at the very time when we’re seeing our emergency room admissions grow,” she said. The hospitals’ operating margins — a measure of revenue left over after bills are paid, but without taxes — were not as bad as profit margins, falling from 2.4 percent in the third quarter to 1.5 percent in the fourth quarter. Copyright 2009 Daily Record. States consider drug tests for welfare recipients By Tom Breen Frederick News Post Thursday, March 26, 2009 Want government assistance? Just say no to drugs. Lawmakers in at least eight states want recipients of food stamps, unemployment benefits or welfare to submit to random drug testing. The effort comes as more Americans turn to these safety nets to ride out the recession. Poverty and civil liberties advocates fear the strategy could backfire, discouraging some people from seeking financial aid and making already desperate situations worse. Those in favor of the drug tests say they are motivated out of a concern for their constituents' health and ability to put themselves on more solid financial footing once the economy rebounds. But proponents concede they also want to send a message: you don't get something for nothing. "Nobody's being forced into these assistance programs," said Craig Blair, a Republican in the West Virginia Legislature who has created a Web site — notwithmytaxdollars.com — that bears a bobble-headed likeness of himself advocating this position. "If so many jobs require random drug tests these days, why not these benefits?" Blair is proposing the most comprehensive measure in the country, as it would apply to anyone applying for food stamps, unemployment compensation or the federal programs usually known as "welfare": Temporary Assistance for Needy Families and Women, Infants and Children. Lawmakers in other states are offering similar, but more modest proposals. On Wednesday, the Kansas House of Representatives approved a measure mandating drug testing for the 14,000 or so people getting cash assistance from the state, which now goes before the state senate. In February, the Oklahoma Senate unanimously passed a measure that would require drug testing as a condition of receiving TANF benefits, and similar bills have been introduced in Missouri and Hawaii. A Florida senator has proposed a bill linking unemployment compensation to drug testing, and a member of Minnesota's House of Representatives has a bill requiring drug tests of people who get public assistance under a state program there. A January attempt in the Arizona Senate to establish such a law failed. In the past, such efforts have been stymied by legal and cost concerns, said Christine Nelson, a program manager with the National Conference of State Legislatures. But states' bigger fiscal crises, and the surging demand for public assistance, could change that. "It's an example of where you could cut costs at the expense of a segment of society that's least able to defend themselves," said Frank Crabtree, executive director of the West Virginia chapter of the American Civil Liberties Union. Drug testing is not the only restriction envisioned for people receiving public assistance: a bill in the Tennessee Legislature would cap lottery winnings for recipients at $600. There seems to be no coordinated move around the country to push these bills, and similar proposals have arisen periodically since federal welfare reform in the 1990s. But the appearance of a cluster of such proposals in the midst of the recession shows lawmakers are newly engaged about who is getting public assistance. Particularly troubling to some policy analysts is the drive to drug test people collecting unemployment insurance, whose numbers nationwide now exceed 5.4 million, the highest total on records dating back to 1967. "It doesn't seem like the kind of thing to bring up during a recession," said Ron Haskins, a senior fellow at the Brookings Institution. "People who are unemployed, who have lost their job, that's a sympathetic group. Americans are tuned into that, because they're worried they'll be next." Indeed, these proposals are coming at a time when more Americans find themselves in need of public assistance. Although the number of TANF recipients has stayed relatively stable at 3.8 million in the last year, claims for unemployment benefits and food stamps have soared. In December, more than 31.7 million Americans were receiving food stamp benefits, compared with 27.5 million the year before. The link between public assistance and drug testing stems from the Congressional overhaul of welfare in the 1990s, which allowed states to implement drug testing as a condition of receiving help. But a federal court struck down a Michigan law that would have allowed for "random, suspicionless" testing, saying it violated the 4th Amendment's protections against unreasonable search and seizure, said Liz Schott, a senior fellow at the Center on Budget and Policy Priorities. At least six states — Indiana, Massachusetts, Minnesota, New Jersey, Wisconsin and Virginia — tie eligibility for some public assistance to drug testing for convicted felons or parolees, according to the NCSL. Nelson said programs that screen welfare applicants by assigning them to case workers for interviews have shown some success without the need for drug tests. These alternative measures offer treatment, but can also threaten future benefits if drug problems persist, she said. They also cost less than the $400 or so needed for tests that can catch a sufficient range of illegal drugs, and rule out false positive results with a follow-up test, she said. Associated Press Writer Lawrence Messina in Charleston contributed to this report. Copyright 2009 Frederick News-Post. *National / International* A Vaccine Debate Once Focused on Sex Shifts as Boys Join the Target Market By Rob Stein Washington Post Thursday, March 26, 2009; A01 When a vaccine designed to protect girls against a sexually transmitted virus arrived three years ago, the debate centered on one question: Would the shots make young girls more likely to have sex? Now the vaccine's maker is trying to get approval to sell the vaccine for boys, and the debate is focusing on something else entirely: Is it worth the money, and is it safe and effective enough? "We are still more worried about the promiscuity of girls than the promiscuity of boys," said Susan M. Reverby, a professor of women's studies and medical history at Wellesley College. "There's still that double standard." The shift in the discussion about Gardasil illustrates the complex interplay of political, economic, scientific, regulatory and social factors that increasingly influence decisions about new types of medical care. For the vaccine, the new dynamic reflects a strategic tack by Gardasil's critics, growing concern about health-care costs, fears about whether medical treatments are being vetted adequately and stubborn biases about gender, experts say. "There is the cost, the safety, the boys versus girls," said Susan F. Wood, a professor of public health at George Washington University. "These are some of the complexities that are going to have to be addressed one way or the other with this vaccine." Gardasil protects against the human papillomavirus, the most common sexually transmitted infection. HPV causes genital warts and, in women, can lead to cervical cancer -- a disease that strikes about 10,000 American women a year and kills about 3,700. For males, the vaccine is aimed at protecting against genital warts and less common malignancies that HPV can cause, such as penile and anal cancer, as well as cancer of the mouth and throat. The virus causes at least 250,000 new cases of genital warts and an estimated 7,500 cancers in males each year, causing perhaps about 1,000 deaths. Vaccinating boys and men would also help prevent the spread of the virus to their sexual partners. "By vaccinating men as well as women, you reduce the amount of virus that is out there that can be transmitted back and forth," said Richard M. Haupt, who leads the HPV vaccine program at Merck & Co., which makes Gardasil. "Hopefully there will be a benefit not only to men themselves, but to their partners and future partners." After the Food and Drug Administration approved the vaccine in 2006 for girls as young as 9, medical authorities recommended that they receive it at age 11 or 12 to protect them before they start having sex. Critics worried that vaccinating children would send a subtle signal that their parents assumed they would become sexually active and that it would give youngsters a false sense of security. Merck also began an ambitious marketing campaign and lobbying push to persuade states to add the vaccine to the list of those required for children to attend school. But the company eventually abandoned the strategy in the face of an intense backlash from critics who argued that the decision should be left to parents. Although many states considered such mandates, so far only Virginia and the District have imposed one, and Haupt said the company has no plans to pursue that strategy again. But in December, Merck asked the FDA to approve the vaccine for males ages 9 to 26, and in February it presented the results of a large study that tested the vaccine in men to the federal Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, in the hopes of winning the panel's endorsement. The committee's recommendations influence which vaccines schools require and whether private insurance companies and state programs will pay. "There would be a tremendous public health benefit to vaccine 11- and 12-year-olds, both boys and girls," Haupt said. The Merck study, involving more than 4,000 boys and men ages 16 to 23, showed that the vaccine is about 90 percent effective in preventing infection with four HPV types, as well as genital warts and precancerous lesions, Haupt said. In preparation for a vote as soon as October, the CDC committee will meet again in June to consider cost-benefit analyses underway at the CDC and elsewhere. The relatively pricey vaccine costs about $500 for three shots and the associated office visits. "The cost-effectiveness data will be looked at very carefully," said Lauri Markowitz, who leads the HPV vaccine work group for the CDC. "There is increased interest in taking cost-effectiveness into consideration when considering prevention efforts." The American Academy of Pediatrics will also consider cost-effectiveness in deciding whether to endorse Gardasil for boys. Some question that focus. "The cost-effectiveness studies are really important, but I don't think they should be the sole driver of public health policy," said Gregory D. Zimet, a professor of pediatrics and psychology at Indiana University. "This is a vaccine that principally benefits women's health. I wonder if it was the reverse, and there was a vaccine for women that helped prevent prostate cancer in men, this would be as much of an issue." Groups that initially were critical when Gardasil was introduced for girls say they now want to make sure the decision is left up to parents. "We do not oppose the development or distribution of the vaccine," said Peter S. Sprigg of the Family Research Council. "The only concern we have is about proposals to make vaccination mandatory for school attendance. It's a parental rights issue." Little research has been done on parents' attitudes about vaccinating their sons, but several experts said it would probably be a harder sell. "For girls, you can go right to protection against cervical cancer. That's a powerful argument," said Zimet, who is studying the issue as part of his own research and in studies sponsored by Merck. "For boys, you have to make several arguments. Part of it is an altruistic argument. I think it's persuasive, but it's more complex." Debbie Stein of Bethesda, whose 15-year-old daughter, Sara, was vaccinated, thinks she would agree to have her 11-year-old son, Ben, get the shots if his pediatrician recommended them. "My feeling is it's a serious virus that causes cancer, and there's no reason not to vaccinate him," Stein said. "I think it will protect him and protect his wife in the future. I don't want to see him when he's 35 or 40 have a wife die of cancer." But Agustin Zamora, who lives in the District, worries that Gardasil has not been studied enough to know that it is safe and effective for his 9-year-old son, Marco, and his twin 2-year-olds, Antonio and Joaquin. "It's sort of like doing an experiment on people," Zamora said. "This is something you're giving to a lot of children. You need many years of study." Federal health officials, Merck and others say they are confident that the vaccine is safe. But some experts said they are concerned that there is insufficient evidence about how long Gardasil's protection will last, whether serious side effects will emerge and whether the relatively modest benefits for boys are worth even the small risks associated with any vaccine. "There are lots of things about this vaccine we do not know yet," said Karen K. Smith-McCune of the University of California at San Francisco. "I just want to be the voice in the room saying, 'What's the rush to vaccinate in the absence of the best available data?' " Some also question whether the reduction in infections will mean fewer cancers in the future. "There's probably enough data to say it probably is effective for the prevention of genital warts. They're not fun, but they're not at the same level as cancer or lethal infectious diseases," said Diane M. Harper, a professor of medicine at the University of Missouri at Kansas City who helped study the vaccine in women for Merck. "This may not be the best use of our resources at this time." Copyright 2009 Washington Post. Medical association sues WellPoint over database Associated Press Daily Record Thursday, March 26, 2009 LOS ANGELES — The American Medical Association is suing another large health insurer over what it claims was a scheme to underpay doctors for out-of-network medical claims. The AMA joined several medical societies in filing a lawsuit Wednesday in a Los Angeles federal court against Indianapolis-based WellPoint Inc. The lawsuit accuses the insurer of conspiring to use a much-maligned database maintained by Ingenix Inc. to set artificially low reimbursement rates. The association said in a statement that the underpayment created higher bills for patients. A statement from WellPoint said the insurer was reviewing the complaint and “unable to comment further at this time.” The case is similar to lawsuits filed last month against WellPoint competitors Hartford, Conn.-based Aetna Inc. and Philadelphia-based Cigna Corp. Earlier this year, Ingenix’s parent company, Minnetonka, Minn.-based UnitedHealth Group Inc., said it will pay $350 million to settle a long-standing AMA lawsuit over price-fixing and the out-of-network claims. That settlement awaits a judge’s approval. The database operated by Ingenix, a UnitedHealth subsidiary, also has attracted other lawsuits and an investigation by the New York attorney general’s office. UnitedHealth agreed in January to close the database and contribute $20 million toward the creation of a new one. Aetna has agreed to pay $20 million toward the database creation, and the attorney general’s office has said WellPoint will chip in $10 million. Insurers contributed claims information to the Ingenix databases, and then used those numbers to determine “usual and customary” payment rates for care patients seek outside their insurance network. But industry representatives have said they use more than the Ingenix database to figure out-of-network reimbursement, and doctor rates that vary widely across the country contribute to medical cost problems. Copyright 2009 Daily Record. Food Safety, Flesh-Eating Bacteria and an Insurance Lawsuit By Roni Caryn Rabin New York Times Morning Rounds Thursday, March 26, 2009 Lawsuit Filed Against Insurance Database Doctors groups in California are suing Wellpoint Inc., charging the insurer used a flawed database to fix prices and underpay them for care delivered out of a patient's network, The Los Angeles Times reports. Similar lawsuits over the Ingenix database have been filed against Aetna Inc. and Cigna Corp, and UnitedHealth, which owns Ingenix, has shut down the database as part of an agreement with New York Attorney General Andrew Cuomo. Food Safety in the White House Two advocacy groups say President Obama should appoint a single official within the Food and Drug Administration who is responsible for food safety. The recommendation comes from the Trust for America's Health and the Robert Wood Johnson Foundation. Right now responsibility for food safety is split between the F.D.A., the U.S. Department of Agriculture and the Centers for Disease Control and Prevention. Some British Therapists Still Offer Aversion Therapy to Homosexuals A small number of therapists in Britain still offer counseling and aversion therapy to gays and lesbians who want to be heterosexual, though there is no evidence it works, the Agence France-Presse reports. A survey of 1,400 psychologists and psychiatrists found that 17 percent said they had worked with at least one client to reduce homosexual feelings. Settlement Upheld in Flesh-Eating Bacteria Case A federal judge in Illinois has upheld most of an $8.5 million award to a woman who lost the use of most of her arm to flesh-eating bacteria after a Scott Air Force Base doctor dismissed her complaints, the Associated Press reports. When Jean Philips sought treatment in 2002, a doctor at the Illinois base thought she was an addict who abused prescription drugs. Copyright 2009 New York Times. Head Injuries: Looking for Signs and Acting Quickly By Liz Robbins New York Times Thursday, March 26, 2009 THE 18-year-old runner was rounding third base for home so fast that his batting helmet flew off. The infielder rifled the ball to the catcher, but it caught the runner instead, hitting his suddenly bare head. He scored, walked to the dugout, and five minutes later began to experience a violent headache. He had an epidural hematoma — the same bleeding in the brain that the 45-year-old actress Natasha Richardson fatally suffered last week after her innocent fall on a beginner ski slope in Quebec. And the circumstances seemed equally one in a million. But the young baseball player lived through his injury because the field was close to a hospital and he was taken there right away, and because Dr. Robert Cantu was able to operate quickly. “This kind of blood clot we’re dealing with here almost never happens in helmeted sports — unless the helmet comes off,” said Dr. Cantu, a director of the Neurological Sports Injury Center at Brigham and Women’s Hospital in Boston. Ms. Richardson was not wearing a helmet when she fell and she suffered what the New York medical examiner described last week as a “blunt trauma to the head.” She was initially lucid, the ski resort said, and declined treatment. Not until nearly four hours after the accident did her condition quickly deteriorate and Ms. Richardson was rushed to a local hospital hours outside Montreal. She died March 18 at Lenox Hill Hospital in Manhattan. With the public shock surrounding Ms. Richardson’s sudden death subsiding, the medical community, as well as parents and leaders of recreational, youth and college sports are taking harder looks at the inherent risks, and seeking lessons. Traumatic brain injury — a blow to the head that disrupts the normal function of the brain — occurs yearly in recreational and organized sports in the United States at a rate of about 207,830 a year, according to a 2007 study by the Centers for Disease Control and Prevention. The C.D.C. said the exact number of fatalities is unknown but Dr. Cantu said deaths represent less than 1 percent of total injuries. The agency said children in sports are more likely than adults to have head injuries. “Helmets, although they do not prevent concussion, have a virtually 100 percent record of preventing skull fractures,” Dr. Cantu said. “Had she been wearing a helmet,” he said of Ms. Richardson, “she would have been alive.” The type of fatal injury Ms. Richardson suffered is almost always caused by a fracture of the temporal bone, paper-thin compared to the rest of the skull, which in turn can cause an artery tear that sets up the possibility of rapid bleeding, Dr. Cantu said. While the medical examiner would not confirm a fracture, it is consistent with that kind of resulting hemorrhage. Last season, 43 percent of skiers and snowboarders wore helmets, according to the National Ski Areas Association, up from 25 percent in 2002. Seventy percent of children 9 or younger wore helmets. There was an equally important lesson from the Richardson tragedy. “Never, ever, after a head injury,” Dr. Cantu said, “should you not get checked out if the symptoms get worse.” The C.D.C. provides program tool kits, “Heads Up,” for high school coaches to identify symptoms of concussions, including dizziness, confusion and slow response. The slogan? “It’s better to miss one game than the season.” Michael Cott of Rosslyn, N.Y., missed six months of club soccer after his second concussion in one week at a summer camp in 2003. An opponent, trying to head the ball, slammed Michael’s forehead instead, knocking him unconscious. Michael returned to play only after his father, Noel Cott, mandated that he wear padded headgear, made by Full 90; Michael was teased, but he and his father became converts to the cause. Football and basketball lead the number of brain-injury-related emergency room visits, joining the recreational sports of skiing, bicycling, driving all-terrain vehicles, and playground activities, the C.D.C. reported. In collegiate sports, a new study shows a higher incidence of concussions for women than men, led by women’s ice hockey, said Dr. Margot Putukian, director of athletic medicine at Princeton University. Identifying a concussion, and soon, is key. “It’s so difficult when you have a mild injury, you might get fooled,” Dr. Putukian said. “It is not always the body-to-body contact, but often concussions are quite subtle.” Darcy Strain wishes he could have seen the signs when his son, Ethan, 11, was fiercely checked from behind by a much larger 12-year-old in an ice hockey tournament in Chicago in January. Ethan told his father he felt dizzy and had a headache after the game but felt well enough to play the next day. Mr. Strain, who lives in Houston and grew up in Manitoba playing on frozen ponds without a helmet, thought Ethan was fine. But days later, neurological tests showed that Ethan had a concussion. He suffered debilitating headaches and loss of short-term memory and has been unable to attend school in eight weeks. Mr. Strain bought Ethan a top-of-the-line helmet to wear after he is cleared to play again. And he urges friends to monitor their children’s injuries. “It brings it all close to home when that actress passed away with a little bump on the head from falling on a ski slope,” Mr. Strain said, his voice quavering in a phone interview. “There’s a reason why a little bump got her — everything went wrong that could have gone wrong. You don’t realize it could happen, until it happens to you.” Copyright 2009 The New York Times Company. Florida Veterans Stream for Testing After H.I.V. Warning By Damien Cave New York Times Thrusday, March 26, 2009 MIAMI — Hundreds of veterans, some in fatigues, others in wheelchairs, streamed into the Miami Veterans Hospital on Wednesday to be tested for H.I.V. and hepatitis after officials there announced that improperly cleaned colonoscopy equipment might have exposed them to infection. More than 3,200 veterans who had the procedure at Veterans Affairs clinics in South Florida from May 2004 to March 12, 2009, may be affected. “It’s mind-boggling,” said John, 58, a Vietnam veteran who asked that his full name not be used to protect his privacy. “You got to think about this: you’re going to get a procedure to help you live a better life. And now it turns out I may have sped up my system of dying.” John Vara, the Miami V.A.’s chief of staff, said 11 of 41 endoscopes at the Miami hospital were not sanitized in accordance with manufacturer guidelines. Medical experts said the risk of cross-contamination was low, “in the range of 1 in 1.8 million,” said Dr. Anthony Kaloo, chief of gastroenterology and hepatology at Johns Hopkins. Dr. Kaloo said that because the gastrointestinal tract was not a sterile area, the body of a healthy patient would probably eliminate whatever virus might be carried into their system by the endoscope. “The problem is with immune-suppressed patients, like cancer patients who are receiving chemotherapy,” Dr. Kaloo said. “They may be at higher risk.” The threat, however, appears to have caused a panic among a much larger swath of the veteran population. A hot line for South Florida veterans had received more than 3,400 calls as of Wednesday afternoon. This is not the first incident in which veterans may have been exposed to infection during colonoscopies. Last month, the Department of Veterans Affairs alerted about 6,400 patients in Tennessee that they might have been exposed to infectious body fluids during colonoscopies from 2003 to 2008. Another 1,100 veterans treated in Augusta, Ga., received a similar notification. Katie Roberts, a spokeswoman for the department in Washington, said initial test results showed that 10 people from Tennessee and 6 from Georgia had tested positive for infection. The Georgia results were still being evaluated, but in Tennessee, six people tested positive for hepatitis C and four for hepatitis B. Ms. Roberts emphasized that people might have gotten sick from other sources. “There is no way to determine if the positive test results are directly related to the endoscopies at each facility,” she said. That will bring little comfort to people like Steven Senzig, 62, a Vietnam veteran who came to the Miami V.A. Wednesday. He was one of 819 people to seek testing since Tuesday. Dr. Vara said 40 to 50 staff members had been assigned to deal with the problem, which he said was a measure of the desire to “get things right.” But like two local congressmen who have called for an inquiry by the V.A.’s inspector general, many veterans said they were frustrated that the V.A. still seemed to struggle with meeting basic standards of care. Mr. Senzig, pointing to two banners identifying the Miami hospital as an award winner for its services, said, “My question is, if it is happening here, what’s happening at the rest of the hospitals?” Carmen Gentile contributed reporting from Miami. Copyright 2009 The New York Times Company. Circumcision helps prevent infection with two STDs, large study in Africa finds Associated Press Baltimore Sun Thursday, March 26, 2009 LOS ANGELES - Circumcision not only protects against HIV in heterosexual men, but it also helps prevent two other sexually transmitted diseases, a large new study has found. Circumcised males reduced their risk of infection with HPV, or human papillomavirus, by 35 percent and herpes by 28 percent. However, researchers found circumcision had no effect on the transmission of syphilis. Landmark studies from three African countries, including Uganda, earlier found that circumcision lowered men's chance of catching the AIDS virus by up to 60 percent. The new study stems from the Uganda research and looked at protection against three other STDs. The findings are reported in Thursday's New England Journal of Medicine "Evidence now strongly suggests that circumcision offers an important prevention opportunity and should be widely available," Drs. Matthew Golden and Judith Wasserheit of the University of Washington wrote in an accompanying editorial. Worldwide, only about 30 percent of men are circumcised. The figure is higher in the United States, where about 79 percent of men are circumcised, according to surveys by the National Center for Health Statistics. HPV can cause cervical cancer and genital warts. Herpes greatly increases the chances of infection with HIV. The study was funded by the National Institutes of Health and the Bill and Melinda Gates Foundation. It was conducted by the Rakai Health Sciences Program and Makerere University in Uganda, the Johns Hopkins Bloomberg School of Public Health and a division of the National Institutes of Health. Copyright 2009 Baltimore Sun. U.S. Hospitals Slow to Adopt E-Records By Jacob Goldstein Wall Street Journal Thursday, March 26, 2009 Only 9% of U.S. hospitals have electronic health records, according to a new survey that reveals the gap between the present state of American health care and a high-tech future envisioned by policy makers. "We are at a very early stage in adoption, a very low stage compared to other countries," said David Blumenthal, a Harvard professor and an author of the survey. Last week, the Obama administration named Dr. Blumenthal National Coordinator for Health Information Technology. The survey, sent to hospitals in March 2008 and published online Wednesday by the New England Journal of Medicine, found that most institutions have some basic electronic systems, such as those for reporting patients' lab results. The electronic-record systems advocated by President Barack Obama and former President George W. Bush go further, however, often replacing paper records and including doctors' notes, treatment orders and automatic safety alerts. Cost was the most commonly mentioned barrier to adoption of such systems, cited in the survey by 74% of hospitals without electronic records. That suggests many facilities are likely to tap into federal incentives aimed at increasing the use of electronic records. The economic-stimulus package that Congress passed in February is likely to generate more than $20 billion in federal outlays for health-information technology, mostly between 2011 and 2015, according to the Congressional Budget Office. Costs for installing electronic records systems vary widely, but a midsize hospital might spend about $10 million over several years, said Erica Drazen, who runs the research group for the health-care division at Computer Sciences Corp. The stimulus incentives are likely to cover much, but not all, of the cost -- $6 million to $7 million for a midsize hospital, Ms. Drazen said. Only 1.5% of hospitals have adopted what the survey's authors define as a comprehensive, hospital-wide system. Another 7.6% of hospitals have adopted basic systems in at least one unit of the hospital, according to a less-rigorous definition that includes electronic physician notes, but not certain other features. Proponents of electronic records say they will improve patient safety, reduce unnecessary testing and create useful data to measure quality of care. But the push is controversial, as skeptics point to the cost and complexity of installing the systems and building data networks required to share information electronically between doctors' offices and hospitals. Some doctors argue that the systems are a distraction that takes away from patient care; more than a third of the hospitals that hadn't adopted electronic records cited resistance from physicians as one reason. The survey, based on responses from more than 2,900 U.S. hospitals, was funded by the federal government and the Robert Wood Johnson Foundation. The study excluded federal hospitals, such as those for veterans. Copyright 2008 Dow Jones & Company, Inc. All Rights Reserved. *Opinion* Relief for Patients New York Times Editorial Thursday, March 26, 2009 Attorney General Eric Holder announced last week that the federal government will no longer prosecute dispensers of medical marijuana if they comply with state law. That should bring relief to people who need marijuana for health reasons and free up law enforcement resources for more important work. There is considerable evidence that marijuana can be useful in treating pain, nausea, weight loss and other symptoms associated with chemotherapy and H.I.V. and other illnesses. Thirteen states, including California, have legalized marijuana for medical purposes, which remains illegal under federal law. The Bush administration was, nevertheless, intent on stopping the medical use of marijuana. It brought criminal charges against medical marijuana dispensaries, even ones in states that had made medical use of marijuana legal. Federal prosecutors treated their targets like common drug traffickers. In 2006, the Food and Drug Administration issued a poorly documented statement disputing marijuana’s therapeutic value. It was one of many cases in which the Bush team distorted science to justify its policies. Mr. Holder’s statement does not mean an end to all medical marijuana prosecutions. The Drug Enforcement Administration says it will continue to go after dispensaries that violate state and federal laws, like by operating as fronts for drug dealers or selling to minors. The Obama Justice Department has an enormous backlog of legal matters to work through, from enforcing long-ignored civil-rights laws to prosecuting white-collar criminals in the banking industry and on Wall Street. Mr. Holder deserves credit for recognizing that going after medical marijuana dispensers is not only bad policy, it is a distraction from work that really matters. Copyright 2009 The New York Times Company. Liability system is unreliable Washington Times Letter to the Editor Thursday, March 26, 2009 It is encouraging that President Obama and congressional leaders seem serious about reforming our nation's destructive medical-malpractice liability system ("Health debate could spur malpractice changes," Web, Metro, March 17). Such action would do wonders to lower health care costs and improve patient access to care. The threat of a debilitating medical-malpractice lawsuit causes 93 percent of all doctors to order more tests and procedures than are medically necessary, according to a survey. This wasteful practice of "defensive medicine" increases U.S. health care costs by more than $124 billion each year and adds 3.4 million Americans to the rolls of the uninsured. Any serious effort to fix our health care system must include a substantial dose of meaningful malpractice-liability reform. Lawrence J. McQuillan Director, business and economic studies Pacific Research Institute Sacramento Copyright 2009 Washington Times. Alcohol taxes encourage more spending Washington Times Letter to the Editor Thursday, March 26, 2009 Once again, the Maryland General Assembly is considering tax policy that would hurt businesses, take more money out of taxpayers' pockets and throw still more money into the state's seemingly bottomless pit ("Md. alcohol tax may quadruple," Saturday e-edition). The proposed 300 percent tax increase on alcohol has little to do with helping the disabled or addicted. It is merely a way for the legislature to tap yet another revenue source in order to increase spending and expand the burden on taxpayers. If the legislature truly thinks these programs are worthwhile, the state could have been funding them all along. In the past, however, they have chosen not to do so. Increasing alcohol taxes will further increase the cost of government. Legislators should instead be prioritizing and cutting their expenditures. John Nothdurft Legislative specialist, budget and tax policy The Heartland Institute Chicago Copyright 2009 Washington Times. BACK TO TOP


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