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			Friday, May 15, 2009 News Clipping Archives *Maryland / Regional* Maybe not so potent: Swine flu likely not as harmful as first feared (Carroll County Times) Maryland law will allow state to put stimulus cash toward electronic health Records (Baltimore Business Journal) $18.9 million awarded for stem cell research in Md. (Baltimore Sun) State Center future hinges on technicality (Daily Record) Emergency Workers Flex Political Muscle (Washington Post) *National / International* Obama Taps NYC Health Commissioner to Head CDC (Washington Post) NYC health commissioner Frieden to lead CDC (Baltimore Sun) NYC officials: Latest swine flu cases mostly mild (Hagerstown Herald-Mail) Texas reports state's 3rd death from swine flu (Hagerstown Herald-Mail) Finding Your Own Health Insurance (New York Times) Crews Scrub Queens Schools Hit by Flu Outbreak (New York Times) Food Companies Are Placing the Onus for Safety on Consumers (New York Times) Judge to decide if family can refuse chemo for boy (Daily Record) *Opinion* Health Costs Are the Real Deficit Threat (Wall Street Journal Commentary) Food Safety for People Who Don’t Cook (New York Times Commentary-3 total) *Maryland / Regional* Maybe not so potent: Swine flu likely not as harmful as first feared Associated Press Carroll County Times Friday, May 15, 2009 The swine flu outbreak that has alarmed the world for a week now appears less ominous, with the virus showing little staying power in the hardest-hit cities and scientists suggesting it lacks the genetic fortitude of past killer bugs. President Barack Obama even voiced hope Friday that it may turn out to be no more harmful than the average seasonal flu. In New York City, which has the most confirmed swine flu cases in the U.S. with 49, swine flu has not spread far beyond cases linked to one Catholic school. In Mexico, the epicenter of the outbreak, very few relatives of flu victims seem to have caught it. A flu expert said he sees no reason to believe the virus is particularly lethal. And a federal scientist said the germ’s genetic makeup lacks some traits seen in the deadly 1918 flu pandemic strain and the more recent killer bird flu. Still, it was too soon to be certain what the swine flu virus will do. Experts say the only wise course is to prepare for the worst. But in a world that’s been rattled by the specter of a global pandemic, glimmers of hope were more than welcome Friday. “It may turn out that H1N1 runs its course like ordinary flus, in which case we will have prepared and we won’t need all these preparations,” Obama said, using the flu’s scientific name. The president stressed the government was still taking the virus very seriously, adding that even if this round turns out to be mild, the bug could return in a deadlier form during the next flu season. New York officials said after a week of monitoring the disease that the city’s outbreak gives little sign of spreading beyond a few pockets or getting more dangerous. All but two of the city’s confirmed cases so far involve people associated with the high school where the local outbreak began and where several students had recently returned from Mexico. More than 1,000 students, parents and faculty there reported flu symptoms over just a few days last month. But since then, only a handful of new infections have been reported — only eight students since last Sunday. Almost everyone who became ill before then are either recovering or already well. The school, which was closed this past week, is scheduled to reopen Monday. No new confirmed cases were identified in the city on Friday, and Mayor Michael Bloomberg said the outbreak in New York had so far proved to be “a relatively minor annoyance.” In Mexico, where swine flu has killed at least 15 people and the confirmed case count has surpassed 300, the health secretary said few of the relatives of 86 suspected swine flu patients had caught the virus. Only four of the 219 relatives surveyed turned up as probable cases. As recently as Wednesday, Mexican authorities said there were 168 suspected swine flu deaths in the country and almost 2,500 suspected cases. The officials have stopped updating that number and say those totals may have even been inflated. Mexico shut down all but essential government services and private businesses Friday, the start of a five-day shutdown that includes a holiday weekend. Authorities there will use the break to determine whether emergency measures can be eased. In the Mexican capital, there were no reports of deaths overnight — the first time that has happened since the emergency was declared a week ago, said Mayor Marcelo Ebrard. “This isn’t to say we are lowering our guard or we think we no longer have problems,” Ebrard said. “But we’re moving in the right direction.” The U.S. case count rose to 155 on Friday, based on federal and state counts, although state laboratory operators believe the number is higher because they are not testing all suspected cases. Worldwide, the total confirmed cases neared 600, although that number is also believed to be much larger. Besides the U.S. and Mexico, the virus has been detected in Canada, New Zealand, China, Israel and eight European nations. There were still plenty of signs Friday of worldwide concern. China decided to suspend flights from Mexico to Shanghai because of a case of swine flu confirmed in a flight from Mexico, China’s state-run Xinhua News Agency reported. And in Hong Kong, hundreds of hotel guests and workers were quarantined after a tourist from Mexico tested positive for swine flu, Asia’s first confirmed case. Evoking the 2003 SARS outbreak, workers in protective suits and masks wiped down tables, floors and windows. Guests at the hotel waved to photographers from their windows. Scientists looking closely at the H1N1 virus itself have found some encouraging news, said Nancy Cox, flu chief at the federal Centers for Disease Control and Prevention. Its genetic makeup doesn’t show specific traits that showed up in the 1918 pandemic virus, which killed about 40 million to 50 million people worldwide. “However, we know that there is a great deal that we do not understand about the virulence of the 1918 virus or other influenza viruses” that caused serious illnesses, Cox said. “So we are continuing to learn.” She told The Associated Press that the swine flu virus also lacked genetic traits associated with the virulence of the bird flu virus, which grabbed headlines a few years ago and has killed 250 people, mostly in Asia. Researchers will get a better idea of how dangerous this virus is over the next week to 10 days, said Peter Palese, a leading flu researcher with Mount Sinai Medical School in New York. So far in the United States, he said, the virus appears to look and behave like the garden-variety flus that strike every winter. “There is no real reason to believe this is a more serious strain,” he said. Palese said many adults probably have immune systems primed to handle the virus because it is so similar to another common flu strain. As for why the illness has predominantly affected children and teenagers in New York, Palese said older people probably have more antibodies from exposure to similar types of flu that help them fight off infection. “The virus is so close,” he said. In the United States, most of the people with swine flu have been treated at home. Only nine people are known to have ended up in the hospital, though officials suspect there are more. In Mexico, officials have voiced optimism for two days that the worst may be over. But Dr. Scott F. Dowell of the CDC said it’s hard to know whether the outbreak is easing up in Mexico. “They’re still seeing plenty of cases,” Dowell said. He said outbreaks in any given area might be relatively brief, so that they may seem to be ending in some areas that had a lot of illness a few weeks ago. But cases are occurring elsewhere, and national numbers in Mexico are not abating, he said. A top Mexican medical officer questioned the World Health Organization’s handling of the early signs of the swine flu scare, suggesting Thursday that a regional arm of the WHO had taken too long to notify WHO headquarters of about a unusually late rash of flu cases in Mexico. The regional agency, however, provided a timeline to the AP suggesting it was Mexico that failed to respond to its request to alert other nations to the first hints of the outbreak. The Mexican official, chief epidemiologist Dr. Miguel Angel Lezana, backtracked Friday, telling Radio Formula: “There was no delay by the Mexican authorities, nor was there any by the World Health Organization.” In the U.S., Obama said efforts were focused on identifying people who have the flu, getting medical help to the right places and providing clear advice to state and local officials and the public. The president also said the U.S. government is working to produce a vaccine down the road, developing clear guidelines for school closings and trying to ensure businesses cooperate with workers who run out of sick leave. He pointed out that regular seasonal flus kill about 36,000 people in the United States in an average year and send 200,000 to the hospital. Copyright 2009 Carroll County Times. Maryland law will allow state to put stimulus cash toward electronic health records By Julekha Dash Baltimore Business Journal Friday, May 15, 2009 Gov. Martin O’Malley will sign legislation Tuesday that provides incentives for health care organizations to implement electronic health records. House Bill 706 allows the state to make use of federal stimulus dollars available for electronic health records and coordinate those efforts with the state’s own plan to create a state wide health information exchange. The federal stimulus money provided $19 billion toward electronic health records. State health officials do not know how much of that money will flow to Maryland. State and federal health officials are pushing electronic health records because they believe they will reduce medical errors and lower costs by eliminating the need for running multiple tests. The stimulus package enables physicians to receive incentives between $44,000 and $64,000 over the next five years through Medicare and Medicaid. It costs, on average, $50,000 for a physician practice to implement electronic health records. The incentive payments begin in 2011, and physicians who do not adopt an electronic health records will be penalized through lower Medicaid and Medicare payments starting in 2015. In the past, the biggest obstacle in getting physicians to install an electronic health record was cost. The federal stimulus money and the state’s health information exchange overcomes that obstacle by providing incentives to adopt health records. “It’s trying to create a business model to make [health IT] work,” Department of Health and Mental Hygiene Secretary John Colmers said. While the federal money provides payments to physician practices, the state is taking its own steps to ensure that hospitals can share electronic information. The legislation requires the Maryland Health Care Commission and the Health Services Cost Review Commission to designate a state health information exchange by Oct. 1. State health insurers will provide incentives to hospitals, which include a lump sum payment or increased reimbursement, to adopt electronic health records. Erickson Retirement Communities, Johns Hopkins Medicine, University of Maryland Medical System and more than a dozen companies and health care institutions have submitted their own plan to the state’s health care commission to create a health information exchange, known as the Chesapeake Regional Information System for our Patients. Copyright © American City Business Journals Inc. All rights reserved. $18.9 million awarded for stem cell research in Md. By Gus G. Sentementes Baltimore Sun Friday, May 15, 2009 The Maryland Technology Development Corp. this week awarded $18.9 million to dozens of researchers involved in stem cell research at private and public institutions across the state. The state has been formally funding stem cell research since legislators passed the Maryland Stem Cell Research Act of 2006. Stem cell research is widely regarded as having the potential to deliver groundbreaking cures to a broad range of health problems and help fuel the state's efforts to become a hub for the biotechnology industry. Fifty-nine projects received funding in the latest round of awards. The researchers work at numerous public and private organizations across Maryland, including the Johns Hopkins University, the University of Maryland, Hugo W. Moser Research Institute at Kennedy Krieger and GlobalStem. A complete list of awardees and their projects can be found at http://www.mscrf.org/content/awardees/2008.cfm. Copyright © 2009, The Baltimore Sun. State Center future hinges on technicality By Robbie Whelan Daily Record Friday, May 15, 2009 A technicality in the state’s accounting practices may spell doom for the proposed redevelopment of State Center, a massive, mixed-use project in Baltimore for which the state has yet to propose a viable financing plan. Maryland Treasurer Nancy K. Kopp is expected to release a report Friday produced by her office that will determine whether the project will be considered a capital expenditure or an operating expenditure under the state’s budgetary accounting definitions. If State Center is deemed a capital expense, the project will have to remain within the Maryland’s capital debt affordability limit, and funds for the redevelopment will have to come from the state’s already-stressed capital budget. The report was commissioned by state lawmakers in April, after the issue was brought up in budget discussions. “The office of the Treasury has a very specific mission to determine whether this is a capital or an operating lease,” said Howard S. Freedlander, deputy treasurer for external affairs with the state. “That mission is not to determine whether this is a good project or a bad project. It is to determine whether the state can afford it. The Department of General Services is suggesting that this is an operating lease, with no impact whatsoever on the state’s capital debt budget.” What’s the difference? A capital lease for State Center would put the office complex on the state’s books as an asset or a liability, and ownership of the project would transfer to the state at the end of a lease. If the state continued to use office space there under an operating lease, then lease payments would be listed as rental expenses, and would come from the state’s operating budget. Most capital expenditures, including land acquisition and the construction of schools, prisons and hospitals, are paid for by the issuance of general obligation bonds, which are guaranteed by the state. A city design panel gave the go-ahead to State Center’s master plan a year ago. The $1.6 billion design called for eight new buildings, 6 million square feet of new construction and a general overhaul of the existing cluster of state-owned office buildings at the corner of Howard Street and Martin Luther King Boulevard, just yards from a number of major public transit hubs, including light rail, metro and bus lines. Michael Gaines, the Department of General Services’ point-person on the project, declined to answer questions about the size of the state’s proposed investment in State Center’s makeover, or the state’s ability to pay for it, but did say the project has the potential to create 8,000 new jobs, double nearby transit ridership and generate $60 million in state taxes, annually. Gaines confirmed Thursday that DGS has proposed that State Center should be considered an operating expenditure. About 3,500 state employees from multiple state agencies work at State Center, but state officials have described the space as outdated and badly in need of renovation. The redevelopment was to be led by local developers Struever Bros. Eccles and Rouse and Doracon Contracting Inc., and also called for condominiums, 250,000 square feet of retail space, 250,000-300,000 square feet of public-use space and 2 million square feet for parking. St. Louis-based affordable housing builder McCormick Baron Salazar was slated to build dozens of mixed-income housing units. Freedlander added that the project “hasn’t even been discussed by the Capital Debt Affordability Committee as a priority.” “The critical question is going to be the actual expense to the state, regardless of how it is classified,” said Del. Murray D. Levy, a member of the state’s appropriations committee who sat on a task force regarding State Center. “There’s a debt affordability limit, but even if it fits into that, the question becomes, can we afford the payments on the debt also?” Since last year’s approval of the master plan, hard times have gotten worse. In addition to a weak housing market and a struggling national economy, the state legislature made deep cuts this year to deal with a projected $2 billion budget deficit. On Wednesday, the state comptroller reported that tax revenues were down nearly 17 percent, or lower than 2008 levels. In addition, the project’s lead developer, Struever Bros., this year defaulted on more than $6 million in loan obligations. On Thursday, Struever declined to answer specific questions about the project’s future, saying instead, “We remain very excited about State Center,” and announcing a community meeting on the development plan scheduled for Tuesday. The head of Doracon, the other main development partner at State Center, is Ronald Lipscomb, who is defending himself against allegations brought by the Office of the State Prosecutor concerning his alleged bribery of Baltimore City Councilwoman Helen Holton. “We have two choices,” Levy said. “We could increase the state property taxes, which I’m sure would be very popular with state elected officials — I’m sure they’d love to take credit for that, or fund it out of some other revenue source, some source of operating funds. And those operating funds are shedding money.… Where the hell are we going to get the money? We don’t have any right now.” Copyright 2009 Daily Record. Emergency Workers Flex Political Muscle By Jenna Johnson Washington Post Friday, May 15, 2009 The ballroom darkened, and the story unfolded: A teenager swerved to miss an oncoming car, crashed and was impaled on a fence post. He was lifted into a state police medevac helicopter and rushed to a hospital, where he was brought back from the brink. "It's only two miles to his house, but it will be months until he gets home," said Thomas M. Scalea, the physician-in-chief at Maryland Shock Trauma Center, narrating at the black-tie event on a recent Saturday. Scalea stood in a spotlight on a fabric-draped stage as photos from the accident scene flashed on a screen behind him. In the audience, doctors and volunteer firefighters sat beside dozens of current and former Maryland lawmakers, soaking in the show after a dinner of Stilton-Brioche-crusted sea bass and cheesecake drizzled with pomegranate syrup. Emergency workers, a powerful grass-roots lobby in almost every state, are a fearsome political force in Maryland, drawing their strength by deftly mobilizing a large network capable of conveying the emotionally charged message that their work means the difference between life and death. During the legislative session that ended last month, the emergency services community received almost everything it was seeking despite being under the shadow of a medevac crash that killed four and forced a review of possible overuse of the state-run helicopter service. A subsequent National Transportation Safety Board investigation made it clear that the medevac service adhered to some safety and flight standards that were less rigorous than industry norms. In a tight budget year, lawmakers gave the Maryland State Police $52.5 million to begin purchasing new medevac helicopters and $635,000 for safety upgrades to the current fleet. The Maryland Shock Trauma Center in Baltimore received $13.5 million for an ongoing renovation and a commitment of $50 million over the next five years for a seven-story addition. Emergency workers packed hearing rooms and other public events, often in uniform, fighting off one proposal that would have privatized the state police-run medical helicopter program, and another that would have replaced an independent agency that oversees emergency services with a department led by a political appointee. "How many people are we going to allow to die because we took the best system in the world and watered it down?" Scalea said at a news conference before the legislative session began. The independent agency, the Maryland Institute for Emergency Medical Services Systems, oversees and unifies every aspect of emergency services, including firefighters, dispatchers, medics, the state-run medevac helicopter program and the state's nine trauma centers. When a proposal affects any one component, the entire network mobilizes. "All you have to do is mention that you are going to mess with our program, and we show up in droves," said Frank Underwood, president of the Maryland State Fireman's Association. At a hearing in March, the mother of a paramedic killed in the September crash in Prince George's County sat beside the helicopter pilot's widow. Her son would have wanted her to fight for the state police aviation program, Wilma Lippy told lawmakers. "Keep the medevac program where it belongs: in the hands of the Maryland State Police," she said. Supporters of privatizing the medevac service argued that doing so would save money. Their proposal made it to a hearing before the Senate Finance Committee in part because analysts had predicted a budget shortfall of almost $2 billion. "I thought that it made sense to look at all of our options. During these hard times, I don't think there should be any sacred cows," said Sen. Thomas M. Middleton (D-Charles), who chaired the finance committee. Middleton, who opposes privatizing the medevac service, said his office was inundated with phone calls, e-mails and faxes from coalition members who didn't understand why he allowed the bills to be debated. "I heard from every fire and rescue chief in the state of Maryland," he said. "I got e-mails from people in my own county saying that you will let us down and embarrass us if you hear these bills." Sen. Robert J. Garagiola (D-Montgomery) said he was surprised by the reaction when he introduced a bill that would have delayed the purchase of new state police helicopters by one year so lawmakers could properly research the purchase. "That's not a lot to ask for," he said. "But they look at this one-year delay as an attack, so they mobilized against it." The bills to privatize the medevac service and create a new state-run department never made it out of the Senate Finance Committee. The bill to delay the helicopter purchase was overwhelmingly defeated on the Senate floor. At Shock Trauma's annual gala last month, former state Sen. Francis X. Kelly (D-Baltimore County) took the stage and celebrated the victory, recounting "the battle of a generation" that the EMS community fought this year as it struggled to cope with the helicopter crash and "opportunists" who tried to privatize the system. More than 50 past and present elected officials sat in the audience, including Gov. Martin O'Malley (D) and House Speaker Michael E. Busch (D-Anne Arundel). "Tonight, ladies and gentlemen, we celebrate. The storm has been weathered," Kelly said to a roaring audience. "Our magnificent coalition rallied as it has never rallied before." Staff researcher Meg Smith contributed to this report. Copyright 2009 Washington Post. *National / International* Obama Taps NYC Health Commissioner to Head CDC By Debbi Wilgoren and Michael Shear Washington Post Friday, May 15, 2009 New York City Health Commissioner Thomas R. Frieden, known for his aggressive and sometimes controversial efforts to limit smoking and consumption of trans fats in the nation's largest metropolis, has been chosen by President Obama to direct the Centers For Disease Control and Prevention, the White House said this morning. Acting CDC director Richard E. Besser, who steered the Atlanta-based agency through the first weeks of the global swine flu epidemic, will return to his previous role as head of the CDC's Coordinating Office for Terrorism Preparedness and Emergency Response. In a statement, Obama called Frieden "an expert in preparedness and response to health emergencies" who in seven years as New York City's health commissioner has "been at the forefront of the fight against heart disease, cancer and obesity, infectious diseases such as tuberculosis and AIDS, and in the establishment of electronic health records." "Dr. Frieden has been a leader in the fight for health care reform, and his experiences confronting public health challenges in our country and abroad will be essential" at the CDC, the statement said. Frieden will begin his work at the CDC in early June. In announcing the appointment, which does not require Senate confirmation, the White House said that Frieden's anti-cigarette campaign reduced the number of smokers in New York by 350,000 and "cut teen smoking in half." The city has increased cancer screenings, dramatically reduced deaths from the AIDS virus and "implemented the largest community electronic health records project in the country" under his tenure, the White House said. Frieden also oversaw New York's response to incidents of anthrax and drug-resistant tuberculosis. Frieden led efforts to ban smoking in New York bars and restaurants and to ban trans fats in food. He also pushed to require restaurants to post calorie information on their menus in an effort to reduce obesity. Those efforts sparked criticism from some groups that he was pushing government interference too far. Conservatives also balked at his creation of a program to pass out millions of condoms each year in an effort to slow the spread of AIDS. But others applauded his zeal, hailing him as an activist health care leader who was good for the city. "When it comes to aggressive, innovative and effective approaches to help people live better, longer lives, our Health Commissioner Tom Frieden really stands in a class by himself," New York Mayor Michael R. Bloomberg said in a statement. " . . . Because of Tom's leadership . . . New Yorkers are living longer." The CDC is the nation's lead agency to prevent and address health problems from infectious disease to unhealthy lifestyles to the threat of bioterrorism. Frieden could also play a central role as an adviser in Obama's efforts to reform the nation's health care system. The president has said he wants Congress to pass health care legislation by the time members leave for the August recess. In his own statement, Frieden said he was "sorry to be leaving one of the greatest jobs in the world," but "deeply honored and privileged to be selected for this position." Some had expected Obama to permanently name Besser to head the CDC. Besser has gotten high marks for his handling of the swine flu crisis, in particular his effective briefings at the height of the scare. But Besser, in an e-mail to the CDC community this morning, heaped praise on his successor. "Dr. Frieden is a consummate innovator. He's had dramatic success in New York City using policy approaches to reduce tobacco use and eliminate trans-fats in restaurant meals, to name just a couple of examples," Besser wrote. "I know CDC will be in great hands with Dr. Frieden; I look forward to working with him during this transition and welcoming him when he arrives in early June." In the e-mail, Besser thanked CDC employees for their dedication to public health. "What has impressed me most is your passion and commitment -- in every corner of CDC I have seen people passionate about their work and about what we are all here to do: improve and protect the health of the people everywhere," Besser wrote. Copyright 2009 Washington Post. NYC health commissioner Frieden to lead CDC Tribune Washington Bureau By Mark Silva Baltimore Sun Friday, May 15, 2009 President Barack Obama named on Friday Dr. Thomas Frieden, currently commissioner of the New York City Health Department, to serve as director of the federal Centers for Disease Control and Prevention. Dr. Rich Besser, who has served as an unusually high-profile acting CDC director throughout weeks of government response to the emergence of a new strain of flu, will stay to run the Office for Terrorism Preparedness and Emergency Response, which he has overseen for four years, the White House said Friday. "America relies on a strong public health system, and the work at the Centers for Disease Control and Prevention is critical to our mission to preserve and protect the health and safety of our citizens,'' Obama said in a statement issued Friday morning. Calling Frieden "an expert in preparedness and response to health emergencies,'' the president said that the New York health commissioner "has been at the forefront of the fight against heart disease, cancer and obesity, infectious diseases such as tuberculosis and AIDS, and in the establishment of electronic health records'' as well as a "leader'' care in health reform. "His experiences confronting public health challenges in our country and abroad will be essential in this new role,'' Obama said. Health and Human Services Secretary Kathleen Sebelius and the president also praised Besser for his handling of the H1N1 flu, which in several weeks has spread from 20 known cases inside the United States to Friday's CDC-reported count of 4,298 confirmed or probable cases in 46 states and the District of Columbia. Three deaths in the U.S. also have been attributed to the disease. Frieden will start in June, the White House said. Frieden has run one of the nation's largest public health agencies, in New York, since January 2002. He had served at the CDC from 1990 to 2002. In the early 1990s, as an epidemiologic intelligence service officer, he investigated issues such as a spread of drug-resistant tuberculosis, according to the White House. He holds medical and public health from Columbia University and completed infectious disease training at Yale University and has written more than 200 scientific articles. Copyright 2009 Baltimore Sun. NYC officials: Latest swine flu cases mostly mild Associated Press Writers By Marcus Franklin and Verena Dobnik Hagerstown Herald-Mail Friday, May 15, 2009 A day after a swine flu outbreak shut down three public schools in New York City, officials said Friday the virus is spreading faster than seasonal flu does, but the symptoms have generally been mild. Health Commissioner Dr. Thomas Frieden said the large clusters of cases at the three schools are "a little surprising," and officials don't know why the virus is spreading more rapidly than traditional influenza. Hundreds of schoolchildren were sent home sick this week and an assistant principal remains in critical condition. The schools were closed Thursday after four students and the assistant principal at the Susan B. Anthony middle school in Queens were confirmed to have swine flu. Mayor Michael Bloomberg said there were no immediate plans to close more schools. The Centers for Disease Control and Prevention has said repeatedly that there would be more deaths and new cases, and that the strain was still on the upswing in the U.S. Texas on Friday reported the nation's fifth swine flu death. The mayor said Thursday that the assistant principal, Mitch Wiener, may have had pre-existing health problems — but on Friday, Wiener's son Adam said his father had only suffered previously from gout, which he said was unrelated to his current condition. He said his 55-year-old father is now suffering from pneumonia, kidney failure, dehydration and a lung infection. "We're dealing with it the best way we can but it's obviously hard," said Adam Wiener, 23. "They say it's critical but not hopeless." It isn't unusual for flu cases to ebb and surge as the virus moves through a population during flu season. The virus tends to disappear as the weather gets warmer and more humid. Dr. Isaac Weisfuse, a deputy commissioner of the health department, said investigators are trying to learn more about why the disease has spread erratically. Schools are a good incubator for illness in general, he said, because space is tight and youngsters often don't practice the best hygiene. Adam Wiener said his father had been sick since at least last weekend with flu-like symptoms "but we didn't think anything of it." Then early Wednesday, he said, the family called 911 after his father began "hallucinating and wasn't coherent." Wiener's case is the most severe illness in the city since its first known cases of swine flu appeared in late April. At least five schools in the city were closed then, but all have since reopened. Frieden said Friday that officials look at a number of factors when deciding whether to close a school, including how many kids are out sick. "It has to be a school-by-school and day-by-day assessment," he said. Meanwhile, maintenance workers at the two middle schools and one elementary school scrubbed desks, floors and door handles Friday. At the shuttered Walter Crowley middle school in the Elmhurst section, a worker in a mask was seen mopping down the cafeteria on Friday. Police cars were parked outside the entrances, and a sign on the door said it was temporarily closed. At that school alone, 241 students were reported out sick with flulike symptoms. New York City's first outbreak occurred when hundreds of teenagers at a Roman Catholic high school in Queens began falling ill following the return of several students from vacations in Mexico, where the outbreak began. An estimated 1,000 students, their relatives and staff at the St. Francis Preparatory School fell ill in a matter of days. Additional sporadic cases continued to be diagnosed, but the symptoms were nearly all mild. The sick children recovered in short order and St. Francis reopened after being closed for a week. The middle school with the confirmed cases is two miles from St. Francis. Adam Wiener said his father has been mostly unconscious because of sedation since Wednesday evening, breathing with the help of a ventilator. One of Wiener's 18-year-old twin sons, Jordan, said his father had been awake briefly and asked him about his leg, which he had injured playing baseball. "He's always about his kids first," Jordan Wiener said Friday. "He was asking me how I was feeling and how my season's going." Associated Press Writer David B. Caruso contributed to this report. Copyright 2009 Hagerstown Herald-Mail. Texas reports state's 3rd death from swine flu Associated Press Hagerstown Herald-Mail Friday, May 15, 2009 Texas health officials say a 33-year-old Corpus Christi man died earlier this month of swine flu. Corpus Christi-Nueces County Health District's Dr. William Burgin Jr. said Friday that the man died May 5 or May 6 after becoming sick a few days earlier. He says the man preexisting medical conditions, including heart problems, that made it more difficult for him to survive any viral illness. Burgin did not identify the man but said he was a single parent of three children. He says one of the children contracted swine flu but was treated and is recovering. Burgin says county health officials received confirmation Friday morning that the man had died of swine flu. The death is the third from swine flu in Texas. Copyright 2009 Hagerstown Herald-Mail. Finding Your Own Health Insurance By Tara Parker-Pope New York Times Friday, May 15, 2009 While Washington is promising health care reform in the near future, people who are self-employed or unemployed can’t wait. They need health care coverage now. In today’s Patient Money column, Lesley Alderman explores the options for people who need to purchase their own health plans. It won’t be cheap, and deductibles are high, but at least your family will be covered in a medical emergency. The first step is to get informed about health insurance rules for your particular state. Then find out if a professional organization or local civic group offers plans that suit your needs. Health insurance brokers and Web sites can also be a resource. And for some people who are self-employed, a part-time job that offers benefits might be the most practical solution. To learn more, read the full story, “Buying Health Insurance Begins With Homework,” and then please join the discussion below. Are you self-employed? What affordable solutions have you found? Copyright 2009 New York Times. Crews Scrub Queens Schools Hit by Flu Outbreak By Anemona Hartocollis New York Times Friday, May 15, 2009 Three public schools in Queens were being disinfected Friday morning after the city closed them because of outbreaks of swine flu. An assistant principal was in critical condition with the city’s most serious case of swine flu since the virus turned up here more than three weeks ago. About two-dozen children who showed up at one of them, Public School 16 in Corona, at 7:30 a.m. were met by officials from the Department of Education and directed to return home. A note on the door of from the Department of Health and Mental Hygiene said that the school — along with two middle schools in Queens — would be closed for at least five days. “These schools have experienced unusually high levels of influenza-like illness in recent days,” the note read. “We are also seeing an increase in flu activity in Queens more generally. We hope that these temporary closures will prevent new infections and avoid unnecessary illness.” Just as many New Yorkers were beginning to forget the threat of swine flu, which surfaced last month and quickly spread around the globe, Mayor Michael R. Bloomberg confirmed at a hastily called news conference on Thursday evening that it had re-emerged. Colleagues identified the sick man as Mitchell Wiener, the assistant principal of Intermediate School 238 in Hollis, who on Friday was on a ventilator and being treated at Flushing Hospital Medical Center. His son, Adam Wiener, told The Associated Press on Friday that his father was suffering from kidney failure, dehydration and a lung infection. Mr. Bloomberg said on Thurssday night that Mr. Wiener appeared to have had some health problems that could have made him more susceptible to the virus, and colleagues and friends of the educator said said he had diabetes and sometimes walked with a cane. But on Friday morning, the younger Mr. Wiener told The A.P. that his father’s only pre-existing condition was “gout, which is unrelated to complications he’s experienced now." In addition to Mr. Wiener, who is in his 50s, four students at I.S. 238 have been confirmed as having swine flu, officials said. More than 50 students at the school have been sent home with influenza-like symptoms since May 6. The Education Department decided on Thursday to close I.S. 238 as well as P.S. 16 after 29 students went to the nurse’s office with flu-like symptoms, and I.S. 5 in Elmhurst, where 241 students were reported absent. Officials said the plan is to reopen those schools next Friday. There was some confusion outside P.S. 16 on Friday as parents and children who had apparently not heard about the closing began arriving. There are about 1,500 students at the school, according to the education department. "I didn’t know," said Susana Cruz, the mother of Madelyne Vaca,7, one of the people who were outside of the school.. "It’s a little scary because everything was O.K. yesterday." Ms. Cruz said she was unaware any children had become ill and said her daughter had no flu-like symptoms. Madeline Bono, who has been a crossing guard at the school for 11 years and learned about the swine flu cases on Thursday, said: "I’m surprised there’s so many of them coming today. They must not be listening to the news." Mr. Bloomberg said there was no clear connection among the three schools, which are, “reasonably far apart, five or six miles,” He said they were being closed because the flu, whose formal name is A(H1N1), appeared to spread very rapidly. The school closings came nearly a month after the first case of swine flu to surface in the United States was detected at St. Francis Preparatory School in Fresh Meadows, Queens, where several students had gone to Mexico on spring break. The flu spread rapidly there, infecting hundreds of students within days, though all have since recovered. Anxious New Yorkers, many without any symptoms, taxed hospital emergency rooms, and bought up supplies of hospital masks and Tamiflu from neighborhood pharmacies. The mayor — who was joined at the City Hall news conference on Thursday night by the city’s health commissioner, Dr. Thomas R. Frieden, and the schools chancellor, Joel I. Klein — began by acknowledging that the new outbreak was somewhat unexpected. “I am about to make an announcement that I had hoped we could avoid,” Mr. Bloomberg said. But he added the public health system had been effective in detecting the outbreak, and “we are acting as promptly as the evidence requires us to do.” Gov. David A. Paterson, who also joined the mayor Thursday night, urged the public “to remain alert rather than alarmed,” And said Mr. Wiener “is in our prayers.” Jessica Scaperotti, a spokeswoman for the health department, said that 178 New York City residents had tested positive for swine flu as of Thursday, but that the number was deceptive because the city had scaled down its testing efforts as the symptoms in most people turned out to be mild and not much different from seasonal flu. The city continued, however, to look for patterns. Teachers visited Mr. Wiener’s wife and three sons on Thursday night at the hospital’s intensive care unit. “He’s fighting for his life,” said one of Mr. Wiener’s sons, who declined to give his name. His colleagues said he was a popular and effective school administrator. A neighbor of Mr. Wiener said that his wife, Bonnie, had said her husband was sick as early as Tuesday. The neighbor, Donna Nieves, said she had seen Ms. Wiener in the laundry room Tuesday night, and quoted her as saying, “Oh, oh, Mitch is so sick with swine flu; half the school’s shut down because everyone’s getting sick.” Ms. Nieves said she returned to the laundry room with disinfectant wipes and began wiping down the washers and dryers, saying to Ms. Wiener, “I’m sorry, I just can’t afford to get sick.” She said that was the last time she saw her. On Wednesday morning, a neighbor told Ms. Nieves that Mr. Wiener, wearing a surgical mask, had been taken away by ambulance. Kvon Williams-Sparks, 13, an eighth grader at I.S. 238, said that he had noticed that janitors were cleaning the rest rooms more often, and that Mr. Wiener had not been at work since Monday. “On Monday, I found a notice in the library that said, ‘If you are sick, you should stay home,’ ” Kvon said. “But nobody has otherwise talked to us.” Asked if the city had let its guard down too soon, Mr. Bloomberg replied: “Most people haven’t come down with it. You’ve got to remember, we’re talking about 4,500 students here in a city of 8.4 million. It may very well be that a lot of people have it and the symptoms are so minor that they don’t even know it. That’s one of the things we’ll be studying.” Reporting was contributed by Sewell Chan, Javier C. Hernandez, Angela Macropoulos, Mick Meenan, Kenny Porpora and Liz Robbins Copyright 2009 New York Times. Food Companies Are Placing the Onus for Safety on Consumers By Michael Moss New York Times Friday, May 15, 2009 The frozen pot pies that sickened an estimated 15,000 people with salmonella in 2007 left federal inspectors mystified. At first they suspected the turkey. Then they considered the peas, carrots and potatoes. The pie maker, ConAgra Foods, began spot-checking the vegetables for pathogens, but could not find the culprit. It also tried cooking the vegetables at high temperatures, a strategy the industry calls a “kill step,” to wipe out any lingering microbes. But the vegetables turned to mush in the process. So ConAgra — which sold more than 100 million pot pies last year under its popular Banquet label — decided to make the consumer responsible for the kill step. The “food safety” instructions and four-step diagram on the 69-cent pies offer this guidance: “Internal temperature needs to reach 165° F as measured by a food thermometer in several spots.” Increasingly, the corporations that supply Americans with processed foods are unable to guarantee the safety of their ingredients. In this case, ConAgra could not pinpoint which of the more than 25 ingredients in its pies was carrying salmonella. Other companies do not even know who is supplying their ingredients, let alone if those suppliers are screening the items for microbes and other potential dangers, interviews and documents show. Yet the supply chain for ingredients in processed foods — from flavorings to flour to fruits and vegetables — is becoming more complex and global as the drive to keep food costs down intensifies. As a result, almost every element, not just red meat and poultry, is now a potential carrier of pathogens, government and industry officials concede. In addition to ConAgra, other food giants like Nestlé and the Blackstone Group, a New York firm that acquired the Swanson and Hungry-Man brands two years ago, concede that they cannot ensure the safety of items — from frozen vegetables to pizzas — and that they are shifting the burden to the consumer. General Mills, which recalled about five million frozen pizzas in 2007 after an E. coli outbreak, now advises consumers to avoid microwaves and cook only with conventional ovens. ConAgra has also added food safety instructions to its other frozen meals, including the Healthy Choice brand. Peanuts were considered unlikely culprits for pathogens until earlier this year when a processing plant in Georgia was blamed for salmonella poisoning that is estimated to have killed nine people and sickened 27,000. Now, white pepper is being blamed for dozens of salmonella illnesses on the West Coast, where a widening recall includes other spices and six tons of frozen egg rolls. The problem is particularly acute with frozen foods, in which unwitting consumers who buy these products for their convenience mistakenly think that their cooking is a matter of taste and not safety. Federal regulators have pushed companies to beef up their cooking instructions with the detailed “food safety” guides. But the response has been varied, as a review of packaging showed. Some manufacturers fail to list explicit instructions; others include abbreviated guidelines on the side of their boxes in tiny print. A Hungry-Man pot pie asks consumers to ensure that the pie reaches a temperature that is 11 degrees short of the government-established threshold for killing pathogens. Questioned about the discrepancy, Blackstone acknowledged it was using an older industry standard that it would rectify when it printed new cartons. Government food safety officials also point to efforts by the Partnership for Food Safety Education, a nonprofit group founded by the Clinton administration. But the partnership consists of a two-person staff and an annual budget of $300,000. Its director, Shelley Feist, said she has wanted to start a campaign to advise consumers about frozen foods, but lacks the money. Estimating the risk to consumers is difficult. The industry says that it is acting with an abundance of caution, and that big outbreaks of food-borne illness are rare. At the same time, a vast majority of the estimated 76 million cases of food-borne illness every year go unreported or are not traced to the source. Home Cooking Some food safety experts say they do not think the solution should rest with the consumer. Dr. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said companies like ConAgra were asking too much. “I do not believe that it is fair to put this responsibility on the back of the consumer, when there is substantial confusion about what it means to prepare that product,” Dr. Osterholm said. And the ingredient chain for frozen and other processed foods is poised to get more convoluted, industry insiders say. While the global market for ingredients is projected to reach $34 billion next year, the pressure to keep food prices down in a recession is forcing food companies to look for ways to cut costs. Ensuring the safety of ingredients has been further complicated as food companies subcontract processing work to save money: smaller companies prepare flavor mixes and dough that a big manufacturer then assembles. “There is talk of having passports for ingredients,” said Jamie Rice, the marketing director of RTS Resource, a research firm based in England. “At each stage they are signed off on for quality and safety. That would help companies, if there is a scare, in tracing back.” But government efforts to impose tougher trace-back requirements for ingredients have met with resistance from food industry groups including the Grocery Manufacturers Association, which complained to the Food and Drug Administration: “This information is not reasonably needed and it is often not practical or possible to provide it.” Now, in the wake of polls that show food poisoning incidents are shaking shopper confidence, the group is re-evaluating its position. A new industry guide produced by the group urges companies to test for salmonella and cites recent outbreaks from cereal, children’s snacks and other dry foods that companies have mistakenly considered immune to pathogens. Research on raw ingredients, the guide notes, has found salmonella in 0.14 percent to 1.3 percent of the wheat flour sampled, and up to 8 percent of the raw spices tested. ConAgra’s pot pie outbreak began on Feb. 20, 2007, and by the time it trailed off nine months later 401 cases of salmonella infection had been identified in 41 states, according to the Centers for Disease Control and Prevention, which estimates that for every reported case, an additional 38 are not detected or reported. It took until June 2007 for health officials to discover the illnesses were connected, and in October they traced the salmonella to Banquet pot pies made at ConAgra’s plant in Marshall, Mo. While investigators who went to the plant were never able to pinpoint the salmonella source, inspectors for the United States Department of Agriculture focused on the vegetables, a federal inspection document shows. ConAgra had not been requiring its suppliers to test the vegetables for pathogens, even though some were being shipped from Latin America. Nor was ConAgra conducting its own pathogen tests. The company says the outbreak and management changes prompted it to undertake a broad range of safety initiatives, including testing for microbes in all of the pie ingredients. ConAgra said it was also trying to apply the kill step to as many ingredients as possible, but had not yet found a way to accomplish it without making the pies “unpalatable.” Its Banquet pies now have some of the most graphic food safety instructions, complete with a depiction of a thermometer piercing the crust. Pressed to say whether the meals are safe to eat if consumers disregard the instructions or make an error, Stephanie Childs, a company spokeswoman, said, “Our goal is to provide the consumer with as safe a product as possible, and we are doing everything within our ability to provide a safe product to them.” “We are always improving food safety,” Ms. Childs said. “This is a long ongoing process.” The U.S.D.A. said it required companies to show that their cooking instructions, when properly followed, would kill any pathogens. ConAgra says it has done such testing to validate its instructions. Getting to ‘Kill Step’ But attempts by The New York Times to follow the directions on several brands of frozen meals, including ConAgra’s Banquet pot pies, failed to achieve the required 165-degree temperature. Some spots in the pies heated to only 140 degrees even as parts of the crust were burnt. A ConAgra consumer hotline operator said the claims by microwave-oven manufacturers about their wattage power could not be trusted, and that any pies not heated enough should not be eaten. “We definitely want it to reach that 165-degree temperature,” she said. “It’s a safety issue.” In 2007, the U.S.D.A.’s inspection of the ConAgra plant in Missouri found records that showed some of ConAgra’s own testing of its directions failed to achieve “an adequate lethality” in several products, including its Chicken Fried Beef Steak dinner. Even 18 minutes in a large conventional oven brought the pudding in a Kid Cuisine Chicken Breast Nuggets meal to only 142 degrees, the federal agency found. Besides improving its own cooking directions, ConAgra says it has alerted other frozen food manufacturers to the food safety issues. But in the absence of meaningful federal rules, other frozen-dinner makers that face the same problem with ingredients are taking varied steps, some less rigorous. Jim Seiple, a food safety official with the Blackstone unit that makes Swanson and Hungry-Man pot pies, said the company tested for pathogens, but only after preliminary tests for bacteria that were considered indicators of pathogens — a method that ConAgra abandoned after its salmonella outbreak. The pot pie instructions have built-in margins of error, Mr. Seiple said, and the risk to consumers depended on “how badly they followed our directions.” Some frozen food companies are taking different approaches to pathogens. Amy’s Kitchen, a California company that specializes in natural frozen foods, says it precooks its ingredients to kill any potential pathogens before its pot pies and other products leave the factory. Using a bacteriological testing laboratory, The Times checked several pot pies made by Amy’s and the three leading brands, and while none contained salmonella or E. coli, one pie each of two brands — Banquet, and the Stouffer’s brand made by Nestlé — had significant levels of T. coliform. These bacteria are common in many foods and are not considered harmful. But their presence in these products include raw ingredients and leave open “a potential for contamination,” said Harvey Klein, the director of Garden State Laboratories in New Jersey. A Nestlé spokeswoman said the company enhanced its food safety instructions in the wake of ConAgra’s salmonella outbreak. Danger in the Fridge ConAgra’s episode has raised its visibility among victims like Ryan Warren, a 25-year-old law school student in Washington. A Seattle lawyer, Bill Marler, brought suit against ConAgra on behalf of Mr. Warren’s daughter Zoë, who had just turned 1 year old when she was fed a pot pie that he says put her in the hospital for a terrifying weekend of high fever and racing pulse. “You don’t assume these dangers to be right in your freezer,” said Mr. Warren, who settled with ConAgra. He does not own a food thermometer and was not certain his microwave oven met the minimum 1,100-wattage requirement in the new pot pie instructions. “I do think that consumers bear responsibility to reasonably look out for their well-being, but the entire reason for this product to exist is for its convenience.” Public health officials who interviewed the Warrens and other victims of the pot-pie contamination found that fewer than one in three knew the wattage of their microwave ovens, according to the C.D.C. report on the outbreak. The report notes, however, that nearly one in four of the victims reported cooking their pies in conventional ovens. For more than a decade, the U.S.D.A. has also sought to encourage consumers to use food thermometers. But the agency’s statistics on how many Americans do so are discouraging. According to its Web site, not quite half the population has one, and only 3 percent use it when cooking high-risk foods like hamburgers. No data was available on how many people use thermometers on pot pies. Andrew Martin contributed reporting. Copyright 2009 The New York Times Company. Judge to decide if family can refuse chemo for boy Associated Press Daily Record Friday, May 15, 2009 MINNEAPOLIS — A Minnesota judge is expected to decide whether a family can refuse chemotherapy for a 13-year-boy's cancer and treat him with natural medicine, even though doctors say it's effectively a death sentence. With chemotherapy, Daniel Hauser has a 90 percent chance of surviving his Hodgkin's lymphoma, according to his cancer doctor. And without it? "It is almost certain that he will die," said Dr. Bruce Bostrom, a pediatric oncologist at Children's Hospital and Clinics of Minnesota. Bostrom, who diagnosed the disease, is an ally of the legal effort in southwestern Minnesota's Brown County to make Hauser submit to chemotherapy even though he and his parents believe it's potentially more harmful than the cancer itself. District Judge John Rodenberg was expected to rule Friday on Brown County's motion. Bostrom said Daniel's chance of survival without chemotherapy is about 5 percent. Nevertheless, parents Colleen and Anthony Hauser are supporting what they say is their son's decision to instead treat the disease with nutritional supplements and other alternative treatments favored by the Nemenhah Band. The Missouri-based religious group believes in natural healing methods advocated by some American Indians. "This is about the right of a 13-year-old young man to be free from acts of assault on his body," said the family's attorney, Calvin Johnson. The Hausers did not return several phone messages left at their home Thursday. Bostrom diagnosed Daniel Hauser with Hodgkin's lymphoma in January, and recommended he undergo chemotherapy treatments once a month for six months, followed by radiation. Daniel became gravely ill about a week later and was taken to an emergency room, Bostrom said, and the family consented to the first chemotherapy treatment. After that, Bostrom said, the family said they wanted a second opinion. They later informed him that Daniel would not undergo any more chemotherapy. Bostrom said Daniel's tumor shrunk after the first chemotherapy session. Two other doctors who examined Daniel backed up Bostrom's assessment at a court hearing last Friday. At that hearing, Colleen Hauser testified her son became sick and depressed after the first treatment, and said the family only would consent to traditional treatments in the case of a life-threatening illness. "My son is not in any medical danger at this point," Colleen Hauser testified. She also testified that Daniel was a medicine man and elder in the Nemenhah Band. The mother said her son made the decision himself to refuse chemotherapy: "I think he understands he has the right to choose healthier forms of dealing with this cancer." Brown County disagrees, and pressed the case after Bostrom notified child protection authorities. Daniel Hauser "does not have a complete understanding of what it means to be a medicine man or an elder," Brown County Attorney James Olson wrote in a legal filing. The Hausers, who are Roman Catholic, have eight children. Colleen Hauser told the New Ulm Journal newspaper that the family's Catholicism and adherence to the Nemenhah Band are not in conflict, and said she has treated illness with natural remedies her entire life. Nemenhah was founded in the 1990s by Philip Cloudpiler Landis, who said Thursday that he was one-fourth American Indian. Nemenhah adherents are asked to pay $250 to be members. "We're non-dogmatic, a very universal faith," Landis said. Landis said he founded the faith after facing his diagnosis of a cancer similar to Daniel Hauser. He said he treated it with diet choices, visits to a sweat lodge and other natural remedies. Landis also once served four months in prison in Idaho for fraud related to advocating natural remedies. "The issue is Danny's right to decide how he wants to live his life," Landis said. "What if they make him take chemotherapy and he dies from that? The band will mourn with the family if that's the case, but we'll rejoice that Danny had the opportunity to test the law of the land." Copyright 2009 Daily Record. *Opinion* Health Costs Are the Real Deficit Threat That's why President Obama is making health-care reform a priority. By Peter R. Orszag Wall Street Journal Commentary Friday, May 15, 2009 This week confirmed two important facts -- that health-care costs are the key to our fiscal future, and that even doctors and hospitals agree that substantial efficiency improvements are possible in how medicine is practiced. The numbers speak for themselves. The Medicare and Social Security trustees' reports released this week show that health-care costs drive our long-term entitlement problem. An example illustrates the point: If costs per enrollee in Medicare and Medicaid grow at the same rate over the next four decades as they have over the past four, those two programs will increase from 5% of GDP today to 20% by 2050. Despite the attention often paid to Social Security, spending on that program rises much more modestly -- from 5% to 6% of GDP -- over the same time period. Over the long run, the deficit impact of every other fiscal policy variable is swamped by the impact of health-care costs. Spiraling health-care costs are not just some future abstraction, however. Right now, families across America who have health insurance are seeing their take-home pay reduced and their household budgets strained by high costs and spiraling premiums. State and local governments also are feeling this pinch. And the growing weight of health costs on state budgets translates into an inability to make investments in areas such as education, hindering our overall economic growth. The good news is that there appear to be significant opportunities to reduce health-care costs over time without impairing the quality of care or outcomes. In health care, unlike in other sectors, higher quality currently seems to be associated with lower cost -- not the opposite. For example, health-care costs vary substantially across regions of the United States and across hospitals and doctors within a region -- even for patients with a similar diagnosis. Medicare spending in 2006 varied more than threefold across U.S. regions, mostly due to variation in the volume and intensity of services provided for similar types of patients. The kicker is that Medicare enrollees in areas with higher spending do not appear to have better health outcomes on average than those in areas with lower spending. We don't seem to be getting anything in exchange for the extra costs except more intensive tests and procedures, and additional days in the hospital -- and who would want any of that if the additional tests and procedures do not actually help to promote health? One study on inpatient knee replacements found three times as many were performed on Medicare beneficiaries in Milwaukee than in Manhattan. Expenditures in the last six months of life have been shown to be nearly twice as high for Medicare patients at certain leading academic medical centers than at others -- again, with no better medical outcomes. Uwe Reinhardt, the renowned Princeton economist, put it best: "How can it be that 'the best medical care in the world' costs twice as much as 'the best medical care in the world?'" The answer is it shouldn't. If we can move our nation toward the proven and successful practices adopted by lower-cost areas and hospitals, some economists believe health-care costs could be reduced by 30% -- or about $700 billion a year -- without compromising the quality of care. This may all seem academic, but this week a stunning thing happened: Representatives from some of the most important parts of the health-care sector -- doctors, pharmaceutical companies, hospitals, insurers and medical-device manufacturers -- confirmed that major efficiency improvements in health-care are possible. They met with the president and pledged to take aggressive steps to cut the currently projected growth rate of national health-care spending by an average of 1.5 percentage points in each of the next 10 years. By making this pledge, the providers and insurers made clear that they agreed the system could remove significant costs without harming quality. Health-care costs are already so high and the power of compound interest so strong that reducing the growth rate by 1.5 percentage points per year would save substantial sums. It would reduce national health expenditures by more than $2 trillion over the next decade -- and could help to put roughly $2,500 in the pockets of the average American family every year. A slower growth rate in overall health-care spending would help to promote and sustain a slowdown in Medicare and Medicaid spending, too. If cost growth slowed by that much in the future, Medicare and Medicaid spending would reach only about 10% of GDP by 2050 -- half the level than if historical growth rates continued. How can we move toward a high-quality, lower-cost system? There are four key steps: 1) health information technology, because we can't improve what we don't measure; 2) more research into what works and what doesn't, so doctors don't recommend treatments that don't improve health; 3) prevention and wellness, so that people do the things that keep them healthy and avoid costs associated with health risks such as smoking and obesity; and 4) changes in financial incentives for providers so that they are incentivized rather than penalized for delivering high-quality care. Already, the administration has taken important steps in all four of these areas. In February, the president signed the American Recovery and Reinvestment Act, which is providing resources for electronic medical records, patient-centered health research, and prevention and wellness interventions so that we have the infrastructure in place to lower health spending in the long run. The president's budget also put forward a set of quality-enhancing changes in incentives in Medicare and Medicaid, such as paying hospitals less when they don't get patient treatment right the first time so we can reduce the number of patients who have to endure readmission to a hospital. But more must be done. To transform our health-care system so that it improves efficiency and increases value, we need to undertake comprehensive health-care reform, and the president is committed to getting that done this year. Once we do, we will put the nation on a sustainable fiscal path and build a new foundation for our economy for generations to come. Mr. Orszag is director of the White House Office of Management and Budget. Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved. Food Safety for People Who Don’t Cook By The Editors New York Times Commentary – 3 total Friday, May 15, 2009 For most consumers, reheating a frozen pot pie or pizza is a matter of taste, not food safety. But with outbreaks of foodborne illnesses, makers of processed foods are now relying on consumers to follow specific, sometimes inconvenient instructions to kill pathogens in convenience foods. How much responsibility should consumers have to bear for the safety of the processed foods they eat? Should they assume the food is safe? ------------------------------------------------------------------------- Stop Blaming Consumers *Douglas Powell* is an associate professor of food safety at Kansas State University and the editor of barfblog.com. ConAgra Foods said on Nov. 14, 2007 when it reintroduced pot pies that, “… redesigned easy-to-follow cooking instructions are now in place to help eliminate any potential confusion regarding cooking times.” I tried them out out at the time and found the instructions inadequate. Iincreasingly, outbreaks in foods like peanut butter and tomatoes have little to do with how consumers handle the food. Were the new labels tested with consumers? Is there evidence from ConAgra that pot pie fans were actually following the instructions on the labels? If the company was serious about making sure the instructions worked, it should have tested the new labels with at least 100 teenagers in observational studies to prove that a target market could actually follow the instructions before introducing the product to the mass market. The instructions direct consumers to use a food thermometer to test the temperature. But it appears that bimetallic thermometers (traditional kitchen thermometers) are used on both the ConAgra label and in the Times video; these thermometers yield inaccurate readings. For a more accurate reading, consumers would have to use digital, tip-sensitive thermometers. Food safety isn’t simple – it’s hard. For decades, consumers have been blamed for foodborne illnesss – with unsubstantiated statements like, “the majority of foodborne illness happens in the home.” Yet increasingly the outbreaks in foods like peanut butter, pot pies, pet food, pizza, spinach and tomatoes have little to do with how consumers handle the food. Everyone from farm-to-fork has a food safety responsibility, but putting the onus on consumers for processed foods or fresh produce is disingenuous — especially for those who profit from the sale of these products. --------------------------------------------------- No Safety in Plastic *Ann Cooper,* a chef and school food advocate, is the founder of Lunch Lessons LLC and the Food Family Farming Foundation. She is co-author of “Lunch Lessons: Changing the Way We Feed Our Children.” Large multi-national corporations started taking over our food supply a generation ago, convincing consumers that processed food would be safer and easier. If we look at advertisements from the 1950s, the message was that processed food would help mothers get out of the kitchen while providing nutritional food to their kids. The notion that processed is safer has carried over to school food service administrators all across the country, causing them to switch from roasting fresh chicken to highly processed chicken nuggets, pizza pockets and burritos, all hermetically sealed. Food makers are trying to transfer responsibility back to consumers who no longer know how to cook. These plastic wrapped frozen lunch items are touted as safer because you heat them in the plastic, hold them in the plastic and serve them in the plastic, never needing to worry about contamination. In fact these companies have gotten so good at marketing the safety of these products that most schools in our country are truly afraid of cooking raw chicken –- as if it’s a foreign object from another planet –- as opposed to a food that families have been cooking for eons. And now, these food manufacturers — the ones that convinced us to stop cooking and that good food can come frozen in plastic -– have realized that mass production can lead to unsafe food, and so they are trying to transfer the responsibility back to consumers who no longer know how to cook. This is crazy. We now have a generation that doesn’t cook. If the companies are selling a fully cooked highly processed product, they — not the eater — should bear responsibility for its safety. If we want a safe, healthy and delicious food supply we need to cook. We need to realize that highly processed foods aren’t better and even the companies are realizing that they’re not safer. ---------------------------------------------------------- More Threats? Or Just More Reporting? *Walter Olson,* a senior fellow at the Manhattan Institute, is the author of “The Litigation Explosion” and other books. He edits Overlawyered.com. The Times article suggests that food safety has become more of a problem, as food processors have become less aware of where their ingredients come from. But a recent statement by the federal Centers for Disease Control, begins: “The incidence of the most common foodborne illnesses has changed very little over the past three years, according to a 10-state report released Thursday by the Centers for Disease Control and Prevention.” It adds that “there have been significant declines in the incidence of some foodborne infections since surveillance began in 1996.” If reheated pot pies pose a risk to consumers now, they were probably also a risk in 1979, 1989 and 1999. What worries C.D.C. experts is that the drop in illness numbers isn’t being sustained, but has instead plateaued. The apparent reason is that major safety gains in meat- and poultry-handling have not been matched by improvements in other areas. In all likelihood, innocent-seeming foods like sprouts, pistachios and green onions (to name a few recent high-profile examples of mass contamination) have been carriers of pathogens all along. Even if the uneven heating temperature achieved in frozen-then-microwaved pot pies is a risk to consumers today, it was probably also a risk in 1979, 1989 and 1999. In fact, what seems to be increasing is not so much food-borne illness itself as our ability to trace its origins accurately, and get the word out about it widely and quickly. As for why food processors are moving to more conservative (higher-temperature) cooking recommendations, wouldn’t you do that too if faced with mounting political pressure and lawsuit risk? I’m not convinced that the old days, when more business was done in spot sales at chaotic Hunts-Point-style food terminals, provided superior “traceability” as compared to today’s perhaps more circuitous, but much better electronically documentedtrade in ingredients. There has never been a guarantee that nasty bugs would not grow on food, and there isn’t one now. Copyright 2009 New York Times. BACK TO TOP


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