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			Monday, May 18, 2009 News Clipping Archives *Maryland / Regional* Maryland law will allow state to put stimulus cash toward electronic health records (Washington Business Journal) Md. has 33 confirmed swine flu cases, health officials say (Baltimore Sun) Lieutenant governor calls for coordination of efforts (Cumberland Times-News) Arundel hones suburban strategy on HIV/AIDS (Baltimore Sun) Howard program for uninsured sees low enrollment (Daily Record) *National / International* Children's Use Of Psychiatric Drugs Begins To Decelerate (Wall Street Journal) Rare anal cancer in national spotlight (Baltimore Sun) Study says changes in cigarettes over the years may have made smoking riskier to the lungs (Baltimore Sun) Washing kids' hands can keep everyone healthy (Baltimore Sun) New Drugs Have Allure, Not Track Record (New York Times) New swine flu outbreak hits Japan (Baltimore Sun) *Opinion* Healthcare reform won’t be easy (Carroll County Times Editorial) *Maryland / Regional* Maryland law will allow state to put stimulus cash toward electronic health records By Julekha Dash Washington Business Journal Monday, May 18, 2009 Maryland 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 2009 Baltimore Sun. Md. has 33 confirmed swine flu cases, health officials say The Associated Press Baltimore Sun Monday, May 18, 2009 Maryland health officials said Monday that the number of confirmed swine flu cases in the state has risen to 33. Karen Black, a spokeswoman for the Maryland Department of Health and Mental Hygiene, said all 33 people have recovered, or are recovering. Worldwide, the swine flu virus has sickened more than 8,800 people in 40 countries, including 76 deaths, as of Monday. In the United States, the federal Centers for Disease Control and Prevention in Atlanta said 46 states have reported more than 4,700 confirmed and probable cases. Copyright 2009 Associated Press. All rights reserved. Lieutenant governor calls for coordination of efforts By Tess Hill Cumberland Times-News Monday, May 18, 2009 FROSTBURG - Lt. Gov. Anthony Brown called for coordination between local, state and federal governments to provide veterans and deployed service members with better access to mental and behavioral health services during a press conference Monday at Frostburg State University. Brown was at FSU to attend a meeting of the Maryland Veterans Behavioral Health Advisory Board. “Last Monday, five American soldiers, including one of our neighbors, were killed during a shooting at Camp Liberty clinic in Baghdad,” Brown said. “This tragedy is an eye-opener, a sad eye-opening. I think the important lesson here is that we continually work across all levels of governments to ensure we’re providing our veterans, their families, soldiers currently deployed, with quality mental and behavioral health treatment.” Brown said suicide attempts of active personnel have increased 600 percent since the war in Iraq began. He said everyone in government has an obligation to improve treatment and expand access for behavioral health services for veterans. “We need to get to them early; get them the care that they need. This is one of the most basic obligations we have at any level of government,” he said. “So today we are calling on all levels of government, local, state and federal, to better coordinate, better cooperate and strike existing and creating new partnerships with one goal in mind, providing our veterans with immediate access to behavioral health services upon conclusion of a tour of duty, including mandatory mental health screening.” Brown said that Maryland has taken many steps to expand mental and behavioral health services to veterans. During the 2008 session of the Maryland General Assembly, Brown led efforts to pass the Veterans Behavioral Health Act. This act set aside $2.3 million for behavioral health services for veterans, he said. The Department of Health and Mental Hygiene has launched the Maryland Commitment to Veterans campaign. The campaign will help educate veterans about available services and help returning service members transition back to civilian life. “Our goal is for all veterans to get the needed behavioral health services when and where they need it, no questions asked,” department Secretary John Colmers said. “We have created the Veterans Behavioral Health Advisory Board in order to get input from all across the state.” Colmers said to obtain this goal local, state and federal government needs to cooperate with each other. “We are busting through the lines that separate local, state and federal governments,” he said. Wilbert Forbes, deputy secretary of the Maryland Department of Veterans Affairs, said the state is also engaged in expanding and widening veteran outreach. “We need to reach out to all veterans, in every corner of the state and nation, and give them the help they need,” he said. “We found out we can do this through social networks like MySpace and Twitter. So we developed the Network of Care.” This Web site provides veterans with basic information and knowledge they should have in assisting with health care when they return from service. “It is helpful in getting them the care they need,” he said. For more information about the Maryland Commitment to Veterans campaign, visit www.veterans.maryland.gov. To visit Network of Care, visit www.networkofcare.org. Contact Tess Hill at thill@times-news.com. Copyright © 1999-2008 cnhi, inc. Arundel hones suburban strategy on HIV/AIDS Panel's goals: prevention, education and acceptance By Tyeesha Dixon Baltimore Sun Monday, May 18, 2009 It was November 1994 when Carolyn Massey suffered a horrible cold that brought her to a doctor. She was shocked to learn that she had been infected with HIV, the same virus that had led to her 35-year-old brother's death a year earlier. As the 52-year-old mother of two sat recently at the kitchen table of her Laurel home, she described the pain and frustration after learning that she had contracted the virus from the man she had been in relationship with for a decade. "I was in denial and angry and ignorant for about a year," she said. "Back then it was considered to be a gay white man's disease." Some 15 years later, Massey is using her experience to educate others about the virus that has touched her life so intimately. Massey, along with 19 other community leaders, government officials and health professionals, was appointed recently by Anne Arundel County Executive John R. Leopold to serve on the county's first HIV/AIDS Commission - a board charged with examining the disease and brainstorming ways to combat it. "HIV and AIDS is still a serious matter that we're going to continue to address," Leopold said. The commission, which held its first meeting last month, is thought to be the first of its kind in a suburban Maryland county. Baltimore City has a similar organization. Anne Arundel County Councilman Daryl Jones introduced legislation late last year to form the board. Jones said the district he represents, in the northern part of the county, has become highly affected by the disease, in part because of its proximity to Baltimore. In 2006, the most recent year for which figures are available, there were 56 new cases of HIV reported in Anne Arundel County, and 40 new AIDS cases. That same year, almost 1,000 people in the county reported living with either HIV or AIDS, according to the latest statistics from the Maryland AIDS Administration. Maryland, which ranks 19th in the country in population, has the ninth highest number of cumulative AIDS cases (more than 20,000 through 2006), according to the Maryland AIDS Administration. The state sees about 2,100 new infections each year. "It's pretty much what I would classify as having the potential to reach epidemic proportions," Jones said, noting that Baltimore has the second highest AIDS case report rate of any major metropolitan area in the United States. The commission has several goals, Jones said: to find available funds for testing and outreach, erase some of the stigma associated with the disease and widen the knowledge pool for county residents. He said the commission will compile a yearly report to advise the county council on issues related to the virus. Dr. Kelly Sipe Russo, physician clinical specialist for the Anne Arundel County Health Department's division of community health, said the department has identified "hot spots" in the county with higher rates of infection: the northern area and Annapolis. Russo said although infections in the county aren't necessarily rising, they're not decreasing either, which is why the county is taking action. The county already had several programs in place to help those people living with HIV or AIDS, and to increase awareness in the community. Sisters Informing Sisters on Topics about AIDS, or SISTA, for example, is a series of peer-led group sessions targeting African-American women, a community that historically has seen high rates of infection. Another program is geared toward educating intravenous drug users of the risks of needle-sharing. But staffing is thin. James Leber, an education supervisor with the health department focusing on HIV and other sexually transmitted diseases, is one of two people who use funds from a federal outreach grant to identify people infected with HIV and link them to primary care physicians. "We're out in the community," he said. "We're knocking on doors." Health department officials are optimistic and encouraged that the programs in place are working, if slowly, and that more outreach and education will lead more people to get tested and treated if infected. Addressing the risk of infection is also urgent, Jones says. As people increasingly turn to alcohol and drugs because of emotional problems that often stem from financial issues in the economic downturn, some may practice unsafe sex. Stigma is another reason Jones felt the commission was so important to create. "It's a topic that people were quiet about," he said. "Part of what the commission will address is figuring out ways to take away some of the fear factor" in getting tested. Massey, the HIV advocate, said that through her outreach work, she also hopes to break that stigma, especially among black women. "The stigma is still there, but I feel we're doing some of the right things the right way," she said. "HIV infection is something that does not have to happen." For more information about HIV/AIDS services in Anne Arundel County, visit www.aahealth.org or call 410-222-7108. Copyright 2009 Baltimore Sun. Howard program for uninsured sees low enrollment Associated Press Daily Record Monday, May 18, 2009 ELLICOTT CITY — Howard County officials hoped to sign up 2,000 people in the first year of an effort to provide low-cost, preventive medical care for uninsured residents. But only about 200 people have joined in the more than seven months since enrollment began. At a recent county council budget hearing, county health officer Dr. Peter Beilenson acknowledged that enrollment is not where he hoped it would be. Officials say many people don't know the program exists and some people are reluctant to pay even a small monthly charge in uncertain economic times. The slow start has prompted County Councilman Greg Fox, a critic of the program, to push cutting the county's $500,000 contribution in half in the fiscal 2010 budget, which the council will vote on Wednesday. Copyright 2009 Daily Record. *National / International* Children's Use Of Psychiatric Drugs Begins To Decelerate By David Armstrong Wall Street Journal Monday, MAY 18, 2009 The growth in antipsychotic-drug prescriptions for children is slowing as state Medicaid agencies heighten their scrutiny of usage and doctors grow more wary of the powerful medications. The softening in sales for children is the first sign that litigation, reaction to improper marketing tactics, and concern about side effects may be affecting what had been a fast-growing children's drug segment. The six so-called atypical antipsychotics that dominate the market have limited approval from the FDA to treat patients under 18 years of age. Only one is cleared for children under age 10 -- risperidone, branded by Johnson & Johnson as Risperdal -- to treat irritability associated with autism. But doctors can prescribe drugs as they see fit, and many have turned to the atypicals to treat serious mental conditions in children, including schizophrenia and bipolar disorder. Use of Risperidone by those 18 and under accounts for about 25% of the drug's sales, while SDI Health, a medical market-research company that gathers sales information from drugstores, estimates that sales of all antipsychotics to that age group account for 15% of the drugs' sales, or $2.18 billion. Data on use among children are hard to come by, but SDI's figures show that antipsychotic prescriptions for children under 18 rose 5.2% between 2007 and 2008, compared with an increase of 8.73% in the year-earlier period. The slowdown is more pronounced among younger children. The nation's second largest pharmacy-benefits manager, Medco Health Solutions Inc., which handles 586 million prescriptions a year, estimates that prescriptions for antipsychotics for patients under 10 fell 4% last year. From 2001 through 2007, use in that age group increased 85%, Medco says. SDI Health estimates that prescriptions for psychiatric drugs for children under 10 increased 3.5% last year. In contrast, between 2002 and 2007, such prescriptions rose 44.6%, it says. SDI also says it saw a 1% drop in prescriptions for those under seven last year. "I was never a big prescriber to begin with, but I have definitely been more careful as information has come to light about the serious side effects being downplayed in the marketing of these drugs," says Michael Houston, a child psychiatrist in Chevy Chase, Md. Others who treat children with serious and dangerous behavioral problems worry that misconceptions about the drugs will prompt some parents or doctors to balk at their use. "For those children who are seriously mentally ill, although these side effects can be potentially significant, the benefits far outweigh the side effects," says Louis Kraus, the chief of child psychiatry at Rush University Medical Center in Chicago. Antipsychotics have faced heightened scrutiny and investigation over the past year. In November, a Food and Drug Administration advisory committee asked the FDA to research children's use of the drugs and expressed concern about possible side effects such as weight gain and increased diabetes risk. And 11 state attorneys general are investigating alleged marketing of Eli Lilly & Co.'s antipsychotic Zyprexa for uses the FDA hasn't approved. In January, Eli Lilly agreed to pay $1.4 billion to settle allegations it improperly marketed Zyprexa. The company also agreed to plead guilty to a criminal charge of promoting the drug for unapproved uses. A Lilly spokesman declined to comment on ongoing litigation and said the company doesn't track the drug's use in children. Bristol-Myers Squibb Co. agreed to pay $515 million in September 2007 to settle allegations it promoted Abilify for use in children. The FDA didn't approve of the use of the drug in children older than 10 until 2008. State Medicaid agencies began to question "off label" use of antipsychotics after the December 2006 death of Rebecca Riley, a four-year-old Massachusetts girl whose family received Medicaid benefits. After being diagnosed with bipolar disorder at age two, she was prescribed a cocktail of drugs, includingan antipsychotic, court records show. Some states began moving to require special approval before they would cover a claim for an antipsychotic. A group of 16 states started studying the use of psychiatric medication in children in 2007 in an effort they dubbed "too many, too much, too young," says Jeffrey Thompson, the medical director of the Washington state Medicaid program. In California, the number of children six and under using psychiatric medications has fallen to 4,200 from 5,686 since a 2006 prior-authorization plan was put in place, the state's top Medicaid official says. Florida's state Medicaid agency says the number of prescriptions for atypical antipsychotics written for children under age six in the second half of last year dropped to 1,137 from 3,167 a year earlier. The agency says the decline was the result of a state program started last year under which prescriptions for children under six are reviewed for appropriateness by state-hired psychiatric consultants before Medicaid will cover them. Washington has created a system to flag the use of psychiatric drugs that may contain too high a dose for young children or have side effects that it regards as particularly dangerous. From May 2006 to April 2008, the system flagged 1,032 cases for review by outside consultants. Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved. Rare anal cancer in national spotlight Expert advice Baltimore Sun Monday, May 18, 2009 Actress Farrah Fawcett's battle with anal cancer, featured last week in a television special, has brought the rare disease into the national spotlight. According the National Cancer Institute, there were an estimated 5,000 new cases of anal cancer in 2008. The number of new colon cancer cases was 106,100 for the same year. While the details of Fawcett's case are not known, Dr. Petr Hausner, an oncologist at the University of Maryland Greenebaum Cancer Center who specializes in gastrointestinal and thoracic cancers, offers five things people should know about the disease: •Anal cancer is a rare cancer. Many cases are linked to infection with a certain type of human papilloma virus (HPV). It can also be caused through unprotected anal intercourse, in particular with a person who has genital warts. However, not all people who have HPV will develop anal cancer. •In 2008, Harald zur Hausen won the Nobel Prize in physiology or medicine for his discovery of the link between certain variants of HPV and cervical cancer, which led to the creation of HPV vaccines. The same type of HPV virus that causes cervical cancer in women can cause anal cancer in women and men, thus HPV vaccination might protect from cervical and anal cancer. •Because of the suppression of the immune system, anal cancer is 10 times more common in patients who are HIV-positive. •The early symptoms of anal cancer are the feeling of a foreign body in the anus, bleeding and pain with bowel movements. Cancers causing such problems can be easily found by a rectal exam, identified by histology and treated by a combination of chemotherapy and radiation. Early detection is key. •Researchers are studying more effective treatment options. For example, at the University of Maryland Medical Center, we are testing a way to deliver radiation to patients with this cancer so as to spare healthy tissue. Copyright © 2009, The Baltimore Sun. Study says changes in cigarettes over the years may have made smoking riskier to the lungs By Lauran Neergaard Baltimore Sun Monday, May 18, 2009 WASHINGTON (AP) — It may be riskier on the lungs to smoke cigarettes today than it was a few decades ago — at least in the U.S., says new research that blames changes in cigarette design for fueling a certain type of lung cancer. Up to half of the nation's lung cancer cases may be due to those changes, Dr. David Burns of the University of California, San Diego, told a recent meeting of tobacco researchers. It's not the first time that scientists have concluded the 1960s movement for lower-tar cigarettes brought some unexpected consequences. But this study, while preliminary, is among the most in-depth looks. And intriguingly it found the increase in a kind of lung tumor called adenocarcinoma was higher in the U.S. than in Australia even though both countries switched to so-called milder cigarettes at the same time. "The most likely explanation for it is a change in the cigarette," Burns said in an interview — and he cited a difference: Cigarettes sold in Australia contain lower levels of nitrosamines, a known carcinogen, than those sold in the U.S. That's circumstantial evidence that requires more research, he acknowledged. But anti-smoking advocates are citing the study as Congress considers whether the Food and Drug Administration should regulate tobacco, legislation that would give the agency power to decide such things as whether to set caps on certain chemicals in tobacco smoke. Smokers once tended to get lung cancer in larger air tubes, particularly a type named "squamous cell carcinoma." Then doctors noticed a jump in adenocarcinoma, which grows in small air sacs far deeper in the lung. Initial studies blamed introduction of filtered, lower-tar cigarettes. When smokers switched, they began inhaling more deeply to get their nicotine jolt, pushing cancer-causing smoke deeper than before. Burns' study, presented at a meeting of the Society for Research on Nicotine and Tobacco, took a closer look. He compared smoking behaviors of different age groups over four decades — how much they smoked, when they started, when they quit — and how cancer-risk changed. The risk of squamous cell carcinoma stayed about the same over those years, Burns found. But adenocarcinoma rose. It makes up 65 percent to 70 percent of newly occurring U.S. lung cancer cases, but no more than 40 percent of Australia's lung cancer, he said. While the nation's total lung cancer cases have inched down as the number of smokers has dropped in recent years, the study suggests an individual smoker's risk of getting cancer is higher. It's well known that cigarettes differ from country to country, because of different tobacco crops grown locally and smokers' varying tastes. Nitrosamines are a byproduct of tobacco processing and levels vary for several reasons, including differences in curing practices. Australian cigarettes contain about 20 percent of the nitrosamine content of U.S. cigarettes, making the chemical a prime suspect, concluded Burns, who has been scientific editor of several surgeon general reports on tobacco. That doesn't rule out a role for deeper inhaling, cautioned Dr. Michael Thun of the American Cancer Society: "There's several strong suspects in the lineup. They may have acted in combination." Philip Morris USA spokesman David Sutton called the study speculative and hard to evaluate until it's published in a medical journal, something Burns plans to do. Still, Philip Morris, which supports FDA tobacco regulation, began taking steps with its growers in 2000 that have yielded "significantly lower" nitrosamine levels in recent years' supplies, Sutton said. Be careful in assuming lower-nitrosamine cigarettes are less lethal, said Dr. Neal Benowitz of the University of California, San Francisco, a well-known tobacco expert. Lung cancer is only one of tobacco's many risks — it causes heart disease and other killer diseases, too. "If you reduce someone's (lung cancer) risk by 10 percent, that's not really meaningful for an individual," he said. "The goal still is to get them to stop." Copyright 2009 Associated Press. All rights reserved. Washing kids' hands can keep everyone healthy Children are thought to transfer their illnesses to older children and adults. By Shari Roan Baltimore Sun Monday, May 18, 2009 Some people are going to fairly great lengths to avoid infection with H1N1 influenza. But a review of scientific evidence published Tuesday shows the best way to curb respiratory illnesses is to keep little hands clean. Very little hands. And very clean. Scientists at the Cochrane Library, which reviews research results, looked at 51 studies of ways to contain respiratory virus epidemics. Frequent hand washing; using gloves, gowns and masks with filtration; and isolating sick people were all found to be effective. But children's hygiene had the biggest effect. One large study involved 4,332 children in Pakistan. Those who washed their hands several times a day with soap had 50% fewer episodes of respiratory illness than children with standard hygiene practices. Another study found those who used alcohol hand gels plus hand washing had a 43% lower absenteeism rate. Flu is thought to be transmitted from young children to older ones and adults. Thus, cleaning up little hands might go a long way toward keeping everyone healthy. Parents should teach proper hand washing, and parents and teachers should work to implement hand-washing routines at school, the authors wrote. Copyright © 2009, The Los Angeles Times. New Drugs Have Allure, Not Track Record By Richard A. Friedman, M.D. New York Times Tuesday, May 19, 2009 Recently, one of my residents told me about a patient with bipolar disorder whose psychiatrist had prescribed an exotic cocktail of drugs — a sedative, a new mood stabilizer and the latest antipsychotic medication. I was puzzled — not by her case, which the resident described as textbook manic depression, but by what was left out. This patient, it seems, was never offered lithium, the single most effective treatment for bipolar disorder. When I met with my residents in their weekly seminar, I decided to make a big deal of this case. “What do you think about her treatment?” I asked them. There was a long silence. “What’s wrong with it?” one resident replied. Finally, a resident offered that he knew the right answer was lithium, but that newer treatments were more popular. Now I got it. Never mind that lithium has proved its safety and efficacy over decades of use; it’s passé — eclipsed by all the new and sexy blockbuster drugs. Lithium salts have been used to counter bipolar disorder since the 1950s, when it was discovered that they greatly reduced the intensity and frequency of mood swings in about 70 percent of patients with the disorder. While lithium must be taken with care — it is therapeutic in a narrow range of blood levels, and overdoses can be toxic — it is also the only psychotropic drug that has ever been shown to have specific antisuicidal effects. That makes it especially valuable, given the high risk of suicide associated with mood disorders. But lithium is cheap and unpatented, so drug companies have little interest in it. Instead, they have made a new generation of mood stabilizers, some more tolerable than lithium, but none more effective. And lithium is hardly the only unsexy but effective drug to fall by the wayside. New medical treatments are a bit like the proverbial new kid on the block: they have an allure that is hard to resist. Doctors and patients alike are inundated by drug company marketing. The companies like to say they are interested in educating the public and physicians about various illnesses, though I have yet to meet a single patient who learned anything informative about any disease from an advertisement. Instead, I have seen scores of patients in my office, eager to get the latest antidepressant or mood stabilizer that promised them tranquility on their TV screens. No wonder: drug company spending on consumer advertising skyrocketed 330 percent from 1996 to 2005, according to a 2007 study in The New England Journal of Medicine. Unlike the public, physicians continue to believe that they are immune to the influence of drug companies, despite strong evidence to the contrary. Studies have shown that doctors with ties to industry are more likely to prescribe a brand-name drug over a cheaper generic version than doctors without such ties. This is not to say that all influence is bad. If a new drug actually proves to be safer or more effective than its predecessors, then of course it should be prescribed for those whom it will benefit. All too often, though, the new panacea is nothing more than a “me too” drug — a minor modification of an available drug, offering little or no advantage in safety or efficacy. Not long ago I saw a patient who told me she had treatment-resistant depression. She had failed to respond to multiple trials of five new antidepressants, including two from the same class of drugs. I called her psychiatrist, a smart young doctor whom I know, to ask if she had ever been given one of the older antidepressants, like a tricylic or a MAOI (for monoamine oxidase inhibitor). He had little experience with these highly effective older drugs, so he hadn’t thought to use them. I suggested that she try an MAOI. After six weeks, she improved remarkably. Now it’s true that the newer antidepressants are generally safer and more tolerable than older ones, which is an important advantage, but they are no more effective than older antidepressants. My younger colleague had been trained recently and had tremendous knowledge about the latest research and drugs. But his training failed to provide him with the larger context in which to place all these exciting developments. Specifically, how do all these new drugs stack up against older ones? That is not something that we know enough about. And it is not something drug companies have any interest in discovering. To earn approval from the Food and Drug Administration, a new drug just has to beat a placebo, not a standard drug, in two clinical trials. But patients and doctors need to know not just whether a new drug outperforms a placebo, but whether it’s a real advance on what is already on the market. For that, we need head-to-head trials comparing new and standard treatments. That is precisely the goal of comparative-effectiveness research, President Obama’s ambitious initiative to help determine which treatments really work. As you might expect, it has provoked strong resistance from the makers of drugs and devices who fear that their fancy new products may not be any better than current ones. I don’t know about you, but I’d opt for an old drug with a known track record of efficacy and safety over an expensive newcomer with no added benefit — any day of the week. Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical College. Copyright 2009 New York Times. New swine flu outbreak hits Japan WHO convenes as officials eye further spread in Spain, Britain Associated Press Baltimore Sun Monday, May 18, 2009 GENEVA — Health experts are looking very closely at the spread of swine flu among people in Spain, Britain and Japan, a WHO official said Sunday as Japan reported a one-day explosion of over 70 new cases, mostly among teenagers. The swine flu epidemic is already expected to dominate the World Health Organization's annual meeting, a five-day event that begins Monday in Geneva and involves health officials from the agency's 193 member states. WHO Director-General Margaret Chan will reveal experts' recommendations on the production of a swine flu vaccine sometime at the meeting. Pharmaceutical companies are ready to begin production, but many decisions have to be made first - such as how much vaccine to make, how it should be distributed and who should get it. Some experts say there's no question that a swine flu vaccine must be produced but WHO needs to discuss the issue with its members. As of Sunday, the swine flu virus - which WHO calls the A (H1N1) virus - has sickened at least 8,480 people in 40 countries, killing 75 of them, mostly in Mexico. Japan's health ministry confirmed dozens of new cases of swine flu in waves of announcements Sunday, prompting the government to shut down schools and cancel public events. By late Sunday, Japan's tally rose from five confirmed cases to 78 - many of them high school students who had not traveled overseas. Most new cases involved students in the western prefectures of Hyogo and Osaka, and health officials said they were recovering in local hospitals or at home. Customer service workers at stores, restaurants and train stations in those two regions immediately began wearing masks as a precaution. "We have not determined how the virus spread in the region, and we are doing our best to track down the route of the infections and contain them," Chief Cabinet Secretary Takeo Kawamura said. Japan had established strict quarantines at airports, but decided Saturday to focus on containing the domestic outbreak. WHO spokesman Gregory Hartl said in-country transmission rates were a key factor in whether the global body decides to increase its pandemic alert level. Right now, the world is at phase 5 - out of a possible 6 - meaning that a global outbreak is "imminent." Spain and Britain have had the highest numbers of cases in Europe, reporting 103 and 101 cases respectively. Britain announced 14 new cases on Sunday - with 11 of those being transmitted in-country - people who had not traveled to Mexico or the United States but became infected from others who had the virus. New York City has 1st virus-linked fatality A school assistant principal who was sick for several days with swine flu on Sunday became the city's first death linked to the virus and the nation's sixth. Mitchell Wiener, who worked at an intermediate school in Queens, died Sunday evening, Flushing Hospital Medical Center spokesman Andrew Rubin said. As of Sunday afternoon, health officials had reported five other deaths in the U.S.: three in Texas, one in Washington state and one in Arizona. The Associated Press Copyright 2009 Baltimore Sun. *Opinion* Healthcare reform won’t be easy Carroll County Times Editorial Monday, May 18, 2009 Health care for the uninsured sounds like a great idea, but figuring out how to pay for it will require bipartisan work in Congress. About 50 million Americans are without health care insurance. On Wednesday, House Speaker Nancy Pelosi touted her chamber having sweeping legislation on U.S. health care ready for debate by the end of July. Pelosi and President Barack Obama, who has made health care reform one of his major legislative priorities, were on hand for the announcement, but neither had details on how they plan for this legislation to be shaped. And missing when the big announcement was made were any Republicans, who need to have a seat at the table when any plan is being formulated. According to the Associated Press, experts have tabulated that an overhaul of the country’s health-care system could cost as much as $1.5 trillion over 10 years. What this all means is that there’s a long battle ahead to decide how health care reform would be paid for and who is going to pay for it. That makes having legislation on the table in a little over two months that much more ambitious. Where would the money come from? It could come from tax increases on alcoholic beverages, tobacco products and sugary soft drinks, according to AP, plus restrictions on health care-related tax breaks like flexible spending accounts for medical expenses. During a roundtable discussion in the Senate earlier this week, one of the ideas floated was limiting the tax-free status of employer-provided health benefits. Using this tactic as a revenue source to expand health care to more people could backfire, though. By repealing some of these tax breaks, some employers would consider dropping coverage and some employees might no longer be able to afford the benefits, which could create a larger pool of people without health insurance. The cost of health care is already quite expensive for those who can afford it, making that cost higher to provide health care to more people isn’t fixing the problem, just compounding it. Copyright 2009 Carroll County Times. BACK TO TOP


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