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			Tuesday, May 19, 2009 News Clipping Archives *Maryland / Regional* Bill pushes doctors to computerize records (Baltimore Sun) O'Malley to sign domestic violence legislation, veto 2 bills (Annapolis Capital) Citing health, director resigns (Salisbury Daily Times) 2 more Maryland swine flu cases reported (Salisbury Daily Times) Va. Case Highlights Discord Over Releasing Abuse Data (Washington Post) *National / International* Hoping That the FDA Gets the Message (Washington Post) You Can Trim Some Effects of Stroke (Baltimore Sun) Developments on swine flu worldwide (Washington Post) Swine flu vaccine to take months to produce (Annapolis Capital) New Tool in the MD's Bag: A Smartphone (Washington Post) Health Outcomes Driving New Hospital Design (New York Times) Hidden Risk: Millions of People Don't Know They Are Diabetic (Wall Street Journal) GAO: Schools restrain, confine disabled children (USA Today) WHO: Swine flu vaccine to take months to produce (Baltimore Sun) *Opinion* Making Howard healthy (Baltimore Sun Editorial) Our Say: Health reform needs to fix access, coverage problems (Annapolis Capital Editorial) Paying for Health Reform (Washington Post Editorial) Great News - Fewer Blacks Being Imprisoned for Drug Cases (Baltimore Afro-American Commentary) Ensuring Patients’ Safety (New York Times Letter to the Editor *Maryland / Regional* Bill pushes doctors to computerize records Gov. O'Malley expected to sign bill that would aid in creating national health information network By Matthew Hay Brown and Kelly Brewington Baltimore Sun Tuesday, May 19, 2009 Maryland is poised to jump ahead of the rest of the nation in health information technology on Tuesday when Gov. Martin O'Malley signs a bill intended to coax doctors into using electronic medical records. The computerized files are seen as the foundation of a national health information network that proponents say will improve care, advance medical knowledge and save the country tens of billions of dollars annually. But with the startup costs to individual doctors in the tens of thousands of dollars, many smaller practices have been slow to move from clipboard to computer screen. With today's bill signing, Maryland will become the first state requiring private insurance companies to offer doctors financial incentives to adopt the technology, state officials say. Doctors who do not bring an electronic medical records system on line by 2015 could face penalties. "This is where government and private health care providers can come together to really improve not only the quality of care but also, hopefully, create some costs savings as well," O'Malley said. "Health IT is the future of health care in our country, and we want Maryland to lead the way." The bill also requires the state to develop a health information exchange, a computer network that would link all of Maryland's physicians, hospitals, medical laboratories and pharmacies. It could be linked in turn with those of other states to create the national network envisioned by President George W. Bush and affirmed by President Barack Obama. O'Malley calls it "creating one common gauge of railroad track." Obama, who has promised to spend $50 billion on the effort over the next five years, set aside $17.2 billion in the economic stimulus package to encourage the adoption of electronic medical records - sophisticated computer programs that record a patient's history, incorporate the latest medical research and propose appropriate treatments. Privacy advocates warn that the features that make the computerized patient files attractive to health care providers - the wealth of personal information, and the ease with which it may be accessed and shared - also make them ripe for potential exploitation by employers, insurers and others. State and federal officials acknowledge such concerns and say safeguards will be incorporated into the new systems. The stimulus money went to Medicare and Medicaid, which are to give it to doctors who adopt electronic medical records. But because Medicare and Medicaid account for less than half of payments to many providers, state Health Secretary John Colmers said, private insurers are now being enlisted to add incentive, beginning in 2011. The bill allows insurers to choose among several forms of inducement - increased reimbursements, lump-sum payments or in-kind services - so long as it has a monetary value. "The goal here in Maryland was to assure that all of the payers pull their oars in the same direction," Colmers said. "There is a great promise in electronic health records, but the greatest promise comes when it's done in a coordinated fashion, across all of the payers." Bush's goal was to get all of the nation's physicians using electronic medical records by 2014. The next year, insurers in Maryland may begin to reimburse holdouts at lower rates, according to the state measure. Jeff Valente, a spokesman for CareFirst Blue Cross Blue Shield, congratulated O'Malley and the state legislature on what he called "an important first step to maximize federal stimulus funding." The largest health insurer in the mid-Atlantic, CareFirst, already offers increased reimbursements to doctors who use electronic medical records, which Valente said would lead to "improved patient outcomes and safety, lower costs associated with care delivery and an overall improved patient experience." The state began work on a health information exchange last summer, when the Maryland Health Care Commission asked two very different physicians groups to develop pilot programs and advise the state on how a statewide exchange should function. The Chesapeake Regional Information System for our Patients, or CRISP, included several large Baltimore medical institutions, Johns Hopkins Medicine, MedStar Health and Erickson Retirement Communities among them. The Montgomery County Health Information Exchange Collaborative brought together community hospitals, the county health department and clinics that serve the poor and the uninsured. "It's a population that is, in many ways, invisible and not so well-connected to health care," said Montgomery County group member Dr. Tom Lewis, who helped launch an electronic medical record initiative in a group of county clinics in 2003. "They may get care in emergency rooms and a web of free clinics, but we want to bring individual patients' data together in one place." Because low-income patients tend to receive fragmented care, Lewis said, they have the most to gain from the sharing of electronic medical records among healthcare providers. For example, without such sharing between community clinics and hospitals, he said, emergency room doctors who provide much of the primary care for these patients may be unaware of their health histories, leaving the patients at risk of receiving unnecessary or unsafe procedures. The group's pilot project created a health information exchange that links 10 community clinics with Montgomery County General Hospital's emergency room. So when a patient arrives at the ER, doctors can access an electronic synopsis of his or her medications, allergies, lab results and medical visits. The emergency room can send discharge information directly to a patient's clinic, which might not otherwise know about the visit. The group hopes the effort will cut down on unnecessary emergency room visits, by better connecting patients with clinics. The pilot program is set to roll out in a few months, Lewis said. He said his group doesn't plan to bid on a statewide information exchange, but has been eager to share its findings with the Maryland Health Care Commission. Applications from groups hoping to design a statewide health information exchange are due to the commission by June 12. The commission is to award a contract in August. Startup costs are to be funded in part by stimulus money and in part by the rates that hospitals may charge. The statewide network is likely to be phased in over time, said Colmers, the state health secretary, with the first elements coming on line as early as this fall. "I expect fairly rapid adoption," he said. "And with the incentives in the stimulus package and in this bill beginning to go into effect in '11, it will be important for it to be certainly ramped up and ready to operate by then." Copyright 2009 Baltimore Sun. O'Malley to sign domestic violence legislation, veto 2 bills Associate Press Annapolis Capital Tuesday, May 19, 2009 ANNAPOLIS (AP) — Gov. Martin O'Malley is scheduled to sign legislation to keep guns away from domestic abusers. Advertisement One of the measures requires a judge to order firearms to be confiscated from people who have final protective orders filed against them for as long as the order is in effect. The other measure gives judges discretion to order the subject of a temporary protective order to give up firearms. Lt. Gov. Anthony Brown led the effort to approve the measures after his cousin was shot to death last summer by an estranged boyfriend. Gov. O'Malley has announced plans to veto two bills approved by the General Assembly. One of them is designed to protect college students by prohibiting institutions of higher education that are exempt from accreditation by the Maryland Higher Education Commission from making a reference to that exemption in diplomas or other documents. While O'Malley supported the bill's intentions, he has indicated he will veto it, because the attorney general's office has said the measure violates the First Amendment. The governor also will veto a Senate bill relating to the prohibition of private sewer systems, because of a technicality in the language. O'Malley plans to sign a similar bill approved by the House of Delegates. Copyright 2009 Annapolis Capital. Citing health, director resigns By Laura D'Alessandro Salisbury Daily Times Tuesday, May 19, 2009 SALISBURY -- The first departure of a senior city staff member since Mayor Jim Ireton took office was announced Monday, as Public Works Director Jim Caldwell said he was stepping down for health reasons. Caldwell, who had served in the post since November 2007, announced his resignation following nine days on sick leave battling a shingles infection. Contacted at his home, Caldwell said he plans to focus his energy on getting well. Friday will be his last official day with the city. "The whole (illness) event caused me to re-evaluate where I'm at," Caldwell said. "I am 65 years old. It's time to retire." Ireton, City Administrator John Pick and several other city officials declined to comment Monday on Caldwell's decision. A news conference centering on the Public Works Department is scheduled for today . Caldwell came to Salisbury from Adrian, Mich., where he worked as a municipal utilities director. He replaced John Jacobs, who left for an engineering leadership post with the Virginia Department of Transportation. Salisbury's Public Works director is responsible for overseeing water and sewer operations, engineering, sanitation, street maintenance, parks, the Salisbury Zoo, vehicle maintenance and the city marina. Caldwell spent 31 years working with various local governments. He was born and raised in West Virginia and has a bachelor's and master's degree in civil engineering. He has worked 25 years on the management level in Maryland, Florida, Kentucky and Michigan. Former Mayor Barrie Parsons Tilghman sang Caldwell's praises and said she's sorry to see him leave the position. "Jim is an extraordinarily talented professional," Tilghman said. "He brought to the city a wonderful body of experience in water and wastewater treatment, and it was just a very good fit as we were working to completely retrofit the wastewater treatment plant as well as preparing to move forward with the water treatment system." Caldwell said details of retirement plans are uncertain. Right now, Caldwell said, he just wants to make sure he gets well. "I'm not all the way out of these woods," he said. "The main thing in the next couple of weeks is getting fully out of this thing and taking it easy." Copyright 2009 Salisbury Daily Times. 2 more Maryland swine flu cases reported Associated Press Salisbury Daily Times Tuesday, May 19, 2009 BALTIMORE (AP) — Maryland health officials say two more swine flu cases have been confirmed, bringing the state's total to 35. Health department spokeswoman Karen Black says all 35 have either recovered or are recovering. The outbreak has killed 80 worldwide, including 72 in Mexico and six in the United States. There have not been any deaths in Maryland. The World Health Organization says 40 countries have reported nearly 10,000 cases, mostly in the United States and Mexico. Copyright 2009 The Associated Press. All rights reserved. Va. Case Highlights Discord Over Releasing Abuse Data By Jonathan Mummolo Washington Post Tuesday, May 19, 2009 When a letter from Prince William County's Department of Social Services arrived in the mail recently, Wes Byers was hoping for answers. He wanted to know why -- despite a report he made in December that a 13-year-old girl in his neighborhood appeared to have been abused -- officials failed to rescue her before she was slain the next month. But the letter, five sentences long, didn't shed any light on Alexis "Lexie" Agyepong-Glover's case. It said Byers's report had been investigated and that "appropriate actions" were taken, but it did not elaborate. "I can't tell you how upsetting it is to me," Byers said. "These folks are like, 'Well, it's just another day at work.' . . . We've got a life that has passed." The slow trickle of information to emerge about Lexie's death, and how local agencies handled her case while she was alive, highlights the secrecy that often surrounds child abuse cases, child welfare advocates said. Because of confidentiality rules that vary across the states, records related to cases involving juveniles are sometimes withheld even after a criminal investigation is complete. If information is eventually released, it is often heavily redacted, preventing proper scrutiny of public agencies charged with protecting children, child advocates said. Some say a federal law requires the release of records in abuse-related child deaths or near-deaths and that it should be made even stronger before it is reauthorized during this session of the U.S. Congress. State and local officials in Virginia, however, say disclosure is optional in such cases. They argue that privacy rules are necessary even after a child is dead to protect victims and reporters of abuse. "Fifty-one different jurisdictions interpret [federal law] 51 different ways," said Elisa Weichel, administrative director and staff attorney with the Children's Advocacy Institute at the University of San Diego School of Law. "When it reaches the point that a child incurs this kind of serious injury or death . . . the public's right to know about what's going on in these cases trumps the privacy rights of those involved." It is unclear how much information officials will release to the public in Lexie's case. A criminal investigation into the actions of her adoptive mother, Alfreedia Gregg-Glover -- charged in her abuse and death -- is ongoing, and her trial is set for July. "We don't want to scare away people from adopting children," said Prince William Social Services Director John P. Ledden Jr. "We also don't want to give the public the perception that we're hiding and covering up something." Since Lexie was found dead in a Woodbridge area creek Jan. 9, several investigations have been launched. County social services officials have completed probes into past abuse allegations, but the county attorney's office declined to release to The Washington Post nearly 400 pages of records pertaining to Lexie's case, citing the pending criminal trial. Assistant County Attorney Bobbi Jo Alexis said that it was too early to say whether any of the records would be made public after Gregg-Glover's trial. Prince William police have been retracing their steps, re-interviewing Lexie's former bus drivers and acquaintances who made reports of abuse to see if any red flags were missed. Police Chief Charlie T. Deane said that he will be "as thorough as I can" in releasing the findings, but that he might have to withhold certain information so others aren't discouraged from reporting abuse. The Virginia Department of Social Services is conducting a Quality Management Review of the county's social services practices, which could be completed this month but will not mention Lexie specifically. Findings of a separate probe by VDSS into Lexie's death, which began recently, would be made public upon request but with likely redactions, a VDSS spokeswoman said. How much the public gets to know about cases such as Lexie's depends heavily on how states interpret a federal law known as the Child Abuse Prevention and Treatment Act, child law experts said. CAPTA says states must "allow for" the release of "findings or information" in child fatalities or near-fatalities caused by abuse or neglect. Although the language is vague, advocates point to a federal policy manual published by the Administration for Children and Families -- a division of the U.S. Department of Health and Human Services, which implements CAPTA -- as the definitive interpretation. The manual says states do not have discretion in releasing information, unless disclosure would jeopardize a criminal investigation. But several states, including Virginia, have added restrictions. According to its administrative code, Virginia social services officials "may" release information upon request, including summaries of past abuse reports, and how a social services agency responded. The state can withhold information for several reasons, including if the information is likely to endanger the "physical or emotional well-being" of anyone, or if a civil court case might be compromised, the code states. Because of such restrictions, Virginia received a C- for transparency in a report last year co-published by the Children's Advocacy Institute in San Diego and First Star, a nonprofit child welfare advocacy group. Gregg-Glover's case is being closely followed by several people who said they told authorities that they saw Gregg-Glover drive off with Lexie in the trunk of a car, saw bruises on Lexie and found her almost naked outside her house more than once. Byers made a report after finding Lexie outside his house Dec. 2, barely dressed in the freezing cold, famished and with a head wound. "I want to know what they did," said Nancy Frederick, Lexie's former bus driver, referring to county officials who looked into the reports she made. Simply waiting for the facts to come out in court is not a reliable strategy, said William L. Grimm, senior counsel with the National Center for Youth Law, who has successfully lobbied for more open policies in California. "A lot of these cases never go to trial," Grimm said. "The abusers plead them out, or the trials are delayed for so long that everybody sort of loses interest in it. . . . That's why it's so important to get the information out in the public domain." Copyright 2009 Washington Post. *National / International* Hoping That the FDA Gets the Message By Rachel Saslow Washington Post Tuesday, May 19, 2009 Mirror, mirror on the wall, which lipstick is the most toxic of all? That's the question Tampa-based Tara Lee has for the Food and Drug Administration. Lee, 37, runs Best in Beauty (http://www.bestinbeauty.com), a Web site that sells natural makeup, fragrances, and skin- and hair-care products. The site is built around the belief that some cosmetics contain dangerous concentrations of chemicals. Its "Message on a Mirror" campaign -- waged via Facebook and e-mail -- urges consumers to write a message to the FDA in lipstick, snap a picture of it and send it to Lee. She will gather the photos and forward them to the agency. Lee has received more than 100 such notes, including ones that say "I'm not a chemist I have 2 trust u!" and "ingredients 4 pretty people should not be ugly." The lipstick issue heated up in 2007 when the Campaign for Safe Cosmetics tested 33 lipsticks and found that 61 percent contained lead, a neurotoxin that accumulates in the body over time. An FDA spokeswoman said via e-mail that "FDA scientists have not found levels of lead in lipstick that would be considered harmful to humans." Lee suggests that women read the ingredient lists on their cosmetics -- as one would with food -- and choose products with short lists and pronounceable words. Copyright 2009 Washington Post. You Can Trim Some Effects of Stroke By Liz Atwood, Baltimore Sun Baltimore Sun Tuesday, May 19, 2009 More than 140,000 people in the United States die each year from stroke, making it the second-leading cause of death for women and the third-leading cause for men. With at least a quarter of a typical year's 795,000 or so strokes occurring in people younger than 65, it is a health subject important to several age groups. Marian LaMonte, neurology chief at St. Agnes Hospital in Baltimore, offers the following advice about strokes: -- Know the warning signs of stroke. These include sudden weakness or numbness of the face, arm or leg, especially on one side of the body; sudden loss of vision in one or both eyes; sudden trouble speaking, or confusion; sudden trouble walking, or loss of balance or coordination; sudden severe headache. -- Call 911 as soon as you notice any of the stroke warning signs, and get to the nearest hospital by ambulance. It is important to seek immediate medical attention. Stroke is an emergency. -- Advocate for treatment with TPA, a clot-busting drug, in the emergency department. This treatment reduces the disability from stroke and increases the chance that you could be free of any symptoms three months after your stroke. -- Know and treat your personal risk factors for heart disease and stroke. Common risk factors include high blood pressure and cholesterol; diabetes; smoking; excess alcohol or illicit drug use; and known heart disease. Work with your doctor to keep these under control. -- It is important to eat fresh food -- not packaged or fast food -- and to exercise daily. Being inactive, obese or both can increase your risk of high blood pressure, high cholesterol and stroke. You should get at least 30 minutes of activity a day. Copyright 2009 Baltimore Sun. Developments on swine flu worldwide By The Associated Press Washington Post Tuesday, May 19, 2009 -- Key developments on swine flu outbreaks, according to U.S. Centers for Disease Control and Prevention, World Health Organization and government officials: _Deaths: Global total of 80 _ 72 in Mexico, six in U.S., one in Canada and one in Costa Rica. Officials said victims from Canada, U.S. and Costa Rica also had other medical conditions. _Confirmed cases: WHO says 40 countries have reported more than 9,830 cases, mostly in U.S. and Mexico. _CDC says 47 U.S. states plus District of Columbia have combined 5,123 confirmed and probable cases. Most probable cases are eventually confirmed. _WHO says drug manufacturers won't be able to start making a vaccine until mid-July at the earliest. The virus isn't growing very fast in laboratories, making it difficult for scientists to get a key vaccine ingredient. _New York City health department says it's investigating death of a 16-month-old boy as possible case of swine flu. _Acting CDC director says outbreak is "not winding down" in the United States and "widespread transmission" continues. He says the epidemic is not over in Mexico. _Japanese government says it will phase out airport quarantine checks after 41 more swine cases were confirmed in the port city of Kobe and nearby Osaka. A total of 176 cases have been confirmed in Japan, making it the world's fourth-most infected country. On the Net: CDC:http://www.cdc.gov/h1n1flu WHO:http://sn.im/who-flu © 2009 The Associated Press. Swine flu vaccine to take months to produce Associated Press By Frank Jordans Annapolis Capital Tuesday, May 19, 2009 GENEVA (AP) - Drug manufacturers won't be able to start making a swine flu vaccine until mid-July at the earliest, months later than previous predictions, the World Health Organization said Tuesday. The disclosure that making a swine flu vaccine is proving more difficult than experts first thought came as U.N. Secretary-General Ban Ki-moon and WHO chief Dr. Margaret Chan met Tuesday with representatives from up to 30 pharmaceutical companies to discuss the subject. Health officials from around the world are attending WHO's annual meeting in Geneva this week to discuss the outbreak that has infected 9,830 people in over 40 countries, killing 79 of them. According to vaccine experts convened by WHO last week, swine flu virus is not growing very fast in laboratories, making it difficult for scientists to get the key ingredient they need for a vaccine, the "seed stock" from the virus. The flu experts said vaccine manufacturers will not be ready to produce a swine flu vaccine until mid-July at the earliest, the agency reported Tuesday on its Web site. Previously, WHO officials had estimated that production could start in late May. Experts also found no evidence that regular flu vaccines offer any protection against swine flu. Vaccine experts estimated under the best conditions, they could produce nearly 5 billion doses of swine flu vaccine over a year after beginning full-scale production. In that situation, the U.N. might have access to up to 400 million doses for poor countries. The rest of the vaccines would presumably go to wealthy contras who have already signed deals to get the pandemic vaccine as soon as it is available. Mass producing a pandemic vaccine would be a gamble, as it would take away manufacturing capacity for the seasonal flu vaccine that kills up to 500,000 people each year. Some experts have wondered whether the world really needs a vaccine for an illness that so far appears mild. Chan said Monday it would be impossible to produce enough vaccine for all 6.8 billion people on the planet. That suggests a possible global scramble where rich countries outbid poorer nations for the vaccine, leaving them unprotected against the virus. "It is absolutely essential that countries do not squander these precious resources through poorly targeted measures," said Chan. Unlike other countries such as Britain, the United States has so far refrained from reserving its share of any new vaccine. "At this point we have not placed orders for vaccine," U.S. Health and Human Services Secretary Kathleen Sebelius told reporters in Geneva. "There is still so much uncertainty about this virus that it is really premature for us to even make a determination of how many people would appropriately be vaccinated, in what order, how many doses would be required, and at what point." These are the issues Ban and Chan will discuss with vaccine makers, believed to include top producers Sanofi-Aventis, GlaxoSmithKline and Baxter International as well as drugmakers from developing countries. On Monday, dozens of governments lobbied WHO to tread carefully before next raising its swine flu alert to the highest pandemic level of phase 6. The level currently stands at phase 5 - saying a global outbreak is "imminent." Britain, Japan, China and others said Monday that declaring a global outbreak could cause unnecessary panic and confusion, especially since the virus has turned out to be less deadly than feared. The expert group emphasized that WHO's declaration of a pandemic should not automatically force vaccine makers to switch from making regular flu vaccine to pandemic vaccine. In addition, they said even if swine flu vaccine production began, that did not mean that countries should start immunizing large groups of people. The experts told WHO that it should come up with targeted advice on which groups of people need the vaccine the most and should get it first. They also planned to meet again in several weeks to decide whether large-scale production of swine flu vaccine should begin. Since the outbreak began last month, 79 people have died from the disease - 72 in Mexico, five in the U.S., one in Canada and one in Costa Rica, WHO says. Another U.S. death - that of a 16-month-old - is being investigated for swine flu. ___ Associated Press writer Frank Jordans reported from Geneva and AP Medical Writer Maria Cheng reported from London. On the Net: WHO: http://www.who.int Copyright 2009 Annapolis Capital. New Tool in the MD's Bag: A Smartphone By Sindya N. Bhanoo Washington Post Tuesday, May 19, 2009 To his frustration, Steven Schwartz often encounters patients who have no idea what each of the pills they've been popping is called. "But usually they can tell you what it looks like," the Georgetown University Medical Center family practitioner said. "They might say it's a blue, triangular pill for hypertension." Armed with an iPhone, Schwartz is able to play detective. He uses an application called Epocrates to input pill characteristics, such as color, shape and clarity. The software replies with a list of medications and images that match those criteria, allowing him to deduce what the patient is taking. Schwartz says his iPhone has become indispensable: He uses it to pull up instructional diagrams and videos for patients, write electronic prescriptions and check basic information, with the patient beside him. " 'This is how often you need a colonoscopy,' I'll say to a patient," Schwartz said. "I'm just double-checking on my phone to make sure I don't make a mistake." Doctors are also using smartphones to look up drug-to-drug interactions, to view X-rays and MRI scans, and even to stream music from the Internet during surgery. The power and versatility of smartphones, Schwartz said, is leading more doctors to abandon their pagers and PDAs. Of the various smartphones on the market, such as the ones made by BlackBerry and T-Mobile, the iPhone's graphic, audio, video and memory capabilities are helping it take the lead in the medical field. Schwartz's use of his iPhone speaks to a larger trend: Nationally, about 64 percent of doctors are now using smartphones, according to a recent report by the market research company Manhattan Research. At George Washington University Hospital and the Johns Hopkins Health System, BlackBerrys are more popular than iPhones among physicians, according to officials at both institutions. Of the 700-plus smartphones in use by doctors, nurses and other hospital staff members at Johns Hopkins, only about 5 percent are iPhones, said Mike McCarty, the chief network officer at Hopkins; the rest are BlackBerrys. Although there are many applications being developed for the iPhone (the iTunes app store lists 674 applications related to medicine available), a lot of medical software used at Hopkins runs on the Windows operating system, which is what the BlackBerry uses, McCarty said. McCarty believes that smartphones will soon assume a permanent place in medicine. "I think over time we will be replacing pagers with these devices," he said. "Every clinician I meet says they want to be carrying one device, rather than two or three." Georgetown's medical school recently required students, after their first year, to use an iPhone or iPod Touch, which is essentially an iPhone without phone capabilities. The school receives a bulk discount on the devices and builds the cost into students' tuition. Students had pushed for such a requirement, according to Schwartz, and they use the devices to look up information during clinical rotations, to study medical vocabulary and to take quizzes. "We saw that a lot of the physicians were using them in the clinic," said Joseph Murray, one of the Georgetown students who pushed for the iPhone's adoption. "And it seemed like a useful tool." Ohio State University's medical school pledged last December to give every medical student an iPod Touch. Some have already been handed out, and by this fall all of the students and residents (more than 1,400 in total) will have the device, according to Catherine Lucey, the vice dean for education at the school. "It allows the residents and the students to ask questions at the bedside, and not rely on memory and not guess," Lucey said. "They can actually sit with the patient if they wish and use a number of online sources." Students are also encouraged to download instructional videos, Lucey said, such as the free videos put out by the New England Journal of Medicine. The videos demonstrate simple procedures such as taking blood pressure, as well as more complex surgical procedures. "I predict that in a couple years, all medical schools will be using them," Lucey said of the devices. For those already practicing medicine, smart devices can be lifesaving. One Saturday afternoon not long ago, George Washington University cardiologist Jonathan Reiner was having lunch at a deli when his BlackBerry began beeping. It was a patient's EKG, sent to him by an emergency room physician. Reiner pulled up the graphic on his handheld device and saw that the patient was on the brink of a severe heart attack. He rushed to the hospital to perform surgery. "In the past, if I were at home, the ER doc could send me a fax, but if I were anywhere else, probably not," Reiner said. "In the digital age, it's sort of archaic to rely on conventional fax technology." Some patient advocacy groups have expressed privacy concerns about the use of smartphones in medical practices. "The technology can be used for good purposes, to improve health, we're hoping," said Lilley Coney, associate director of the Electronic Privacy Information Center, a Washington-based watchdog group. "But with these small devices, physicians and staff are taking them and using them all the time. . . . We're going to have to make sure that every individual can only access the information they need to access." The key is to make sure the systems are secure and encrypted, she said. There is something else that gives pause about the shift to smartphones, doctors and medical students say. If physicians are using their devices during a consultation, looking down at a screen for formulas or research, a certain sense of intimacy may be lost between doctor and patient. "We as medical educators have to teach students to use technology and still stay patient-focused," said Ohio State's Lucey, adding that as smartphones grow in popularity, protocols will evolve in how to use them with patients. For now, common sense will have to do. "If you go into a room and instead of talking to the patient you tap into the device, there's a problem," Lucey said. "On the other hand, you can choose to pull up images and diagrams that can really engage the patient." Copyright 2009 Washington Post. Health Outcomes Driving New Hospital Design By Carol Ann Campbell New York Times Tuesday, May 19, 2009 The curtain between two hospital beds does not stop noise from the television set, offer privacy during sensitive conversations with doctors or stop germs from spreading. Yet in most of America’s aging hospitals it is the only thing that separates strangers thrust together as roommates simply because both are ill. But in many new hospitals and pavilions, these semiprivate rooms have vanished. Single-patient rooms are now viewed as an important element of high-quality health care. The benefits of the single room emerged through evidence-based hospital design, a new field that guides health care construction. More than 1,500 studies have examined ways that design can reduce medical errors, infections and falls — and relieve patient stress. American hospitals started 53 million square feet of new construction and major additions in 2008, according to a report by McGraw-Hill Construction, a company that tracks industry trends. Promoters of evidence-based design say that a building exerts a powerful force on the delivery of health care, and that the best new health centers are light-filled, quiet and easy to navigate. “Some hospitals are taking evidence-based design seriously,” said Roger Ulrich, director of the Center for Health Systems and Design at Texas A&M. “Other institutions use pretty traditional design that pays lip service to the evidence. There may be high style, but the hospital is still noisy. Or the windows are too small to let much light in. There are missed opportunities.” Besides privacy, research shows that single rooms reduce infections and patient stress, and improve sleep. In 2006, the American Institute of Architects called for single rooms in all new hospital construction. In Plainsboro, N.J., University Medical Center at Princeton is building a 237-bed hospital at a cost of $447 million. A model room is taking shape in the current building. “We want to test it out in the real world,” said Barry S. Rabner, president of Princeton HealthCare System, which runs the hospital. Because studies suggest that natural light can reduce depression and that scenes of nature can reduce reported levels of pain, rooms in the new hospital will have large windows looking out toward woods and the Millstone River. A handrail next to the headboard of the bed will prevent falls. To prevent medication mix-ups and reduce the time nurses spend fetching drugs and supplies, a small locked cabinet called the nurse server will contain only the medicine for the patient in that room. A sink near the door will allow nurses, doctors and visitors to wash their hands before entering. The rooms will be angled to create sight lines from the hallway to the bed so nurses can easily see patients, and vice versa. Acoustical materials will dampen noise, and to encourage families to visit and spend time, the rooms will be spacious and equipped with extra storage. Mr. Rabner recently showed a reporter a semiprivate room in the current building, an aging facility updated with a maze of additions. “This does not create privacy,” he said as he pulled a curtain between the two empty beds. “There is no space for family. No storage. The patient by the window has a long walk to the bathroom. There’s no handrail by the bed.” Down the hall a patient, Jay Paszamant of Princeton, said he would be more comfortable in a single room. “I have to walk past his family on the way to the bathroom,” he said, referring to the young man in the next bed. “And I feel uncomfortable overhearing my neighbor’s issues. I don’t want to invade his privacy.” Insurers who pay the bills want to know that the single rooms and the nature scenes will be more than just attractive. “When a hospital makes a change — buys a new machine, builds a new building — they need to be prepared to discuss those changes with the people purchasing their services,” said Susan Pisano, a spokeswoman for the trade association America’s Health Insurance Plans. “They have to make the case that these changes will improve quality and safety and efficiency.” The Center for Health Design, a nonprofit based in California, is promoting research through its Pebble Project. A Pebble Project study at St. Alphonsus Regional Medical Center in Boise, Idaho, for instance, found that reducing noise levels improved patients’ self-reported sleep quality by almost half — to 7.3 on a scale of 10, up from 4.9. Another study, at Bronson Methodist Hospital in Kalamazoo, Mich., found that after new private rooms were added, with well-located sinks and improved air-flow design, hospital-acquired infections declined 11 percent. The design research examines elements large and small. After Sacred Heart Medical Center at RiverBend in Springfield, Ore., installed ceiling lifts in part of its original building, staff injuries related to moving patients declined to one a year, from 10. “We think they paid for themselves within two years because of reduced worker’s compensation,” said Jill Hoggard Green, the hospital’s administrator. Architects and administrators are listening to patients. In Michigan, Henry Ford West Bloomfield Hospital largely eliminated plans for the new hospital’s emergency department after patients tested a simulation laboratory. “We started over,” said Christine Zambricki, chief operating officer and chief nursing officer of the new hospital, which opened in March. Emergency room patients, the hospital learned, wanted rooms large enough so visitors did not have to stay in the waiting room. They wanted greater privacy — walls, not curtains, between patient beds — and a private bathroom. “They didn’t want to walk to the bathroom and see other people bleeding and crying,” Ms. Zambricki said. In many new hospitals, central nurses’ stations are being replaced with smaller ones closer to patients, said Anjali Joseph, director of research at the Center for Health Design. “Design is not just focusing on making new hospitals pretty and nice,” she said. “It’s focusing on the patient outcomes we want from building design. “It’s possible that old hospitals where the nurses and the staff are great can succeed in the worst environment. But they have great obstacles to overcome.” Copyright 2009 New York Times. Hidden Risk: Millions of People Don't Know They Are Diabetic By Melinda Beck Wall Street Journal Tuesday, May 19, 2009 One of the most troubling statistics in health care is this: Twenty-three million Americans have diabetes, and one-quarter of them don't realize it. Experts know these people exist -- even if they don't know themselves -- by extrapolating from big government health surveys that include blood tests. A surprising number of adults have elevated blood-sugar levels that meet the criteria for diabetes but have never had symptoms or ignored them. The numbers would no doubt be higher if they included children, since Type 2 diabetes is being found at ages as young as 4. The danger of undiagnosed diabetes is that, left untreated, it raises the risk of heart disease and stroke and can escalate into blindness, kidney failure, loss of limbs and death. Yet fear of such complications is a key reason it often goes undiagnosed. "Many people know of elderly relatives who died or had these complications, and they don't get it checked out because they're terrified," says Robin Goland, co-director of the Naomi Berrie Diabetes Center at Columbia University Medical Center in New York. "But it doesn't have to be that way. We know how to manage it." Some people fail to get tested because Type 2 diabetes is often associated with being overweight and sedentary. "People think it's their fault, but that's not true," Dr. Goland says. Roughly 20% of the people with Type 2 diabetes are thin, and 75% of obese people never get it. The biggest risk factor is a family history. The more relatives you have with the disease, the higher your own risk is. Being overweight seems to activate the genetic predisposition in many cases, but not always. "People with a lot of genetic loading can get it at a younger age and a lower body weight," Dr. Goland says. Diabetes is technically an imbalance between sugar, or glucose, and insulin. When the body ingests glucose, the pancreas secretes insulin to convert it into energy. With diabetes, the body doesn't get enough insulin, either because the pancreas can't make it (Type 1) or because the body becomes resistant to the insulin (Type 2). With Type 2, the pancreas churns out ever more insulin, but it has little effect, leaving too much glucose in the blood stream. Eventually, the insulin-making beta cells in the pancreas may give out. The first symptoms -- including fatigue, excessive thirst and frequent urination -- often don't appear until the excess sugar has been damaging blood vessels for 10 years or more. "I felt absolutely fine," says Charles Gallagher, an attorney in Jersey City, N.J., and his doctor agreed. But his father and 10 of his 11 aunts and uncles had "sugar," as it was often called in years past, and his daughter, an endocrinologist, persuaded him to check further. He was diagnosed with diabetes at the Naomi Berrie center in November at age 63. He has since lost 15 pounds and lowered his blood sugar considerably. Standard physical exams often include a blood-glucose test, but experts say doctors at times don't take the results seriously enough. "They'll tell patients, 'Oh, your blood sugar is a little high. We'll check it again next year,' " says R. Paul Robertson, president for medicine and science of the American Diabetes Association. "That's the wrong thing to say. You want to make the diagnosis as soon as possible." A fasting-glucose level below 100 milligrams per deciliter is normal. From 100 to 125 mg/dl is considered "prediabetes," and above 125 is diabetes. Some experts think "prediabetes" should be dubbed full diabetes so that patients pay attention sooner. Some also recommend that a different test, the hemoglobin A1C, be used for screening, since the results are more clear-cut. Treating elevated blood sugar isn't as draconian as some people fear. In one study, 58% of subjects with prediabetes were able to prevent Type 2 diabetes by cutting down on carbohydrates, which reduces the glucose the body has to handle, and adding exercise, which helps insulin work more efficiently. For those who need more help, many medications are available. "Losing just a little weight, and exercising just a little more can make a huge difference," Dr. Goland says. "People can still eat in restaurants and eat foods they love, in moderation, with diabetes. They just can't ignore it." Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved. GAO: Schools restrain, confine disabled children By Greg Toppo USA Today Tuesday, May 19, 2009 Children with disabilities are being secluded from classmates and restrained against their will to control their behavior, a new investigative report finds — interventions that have led to harm and, in rare cases, deaths. In many cases, the restraints happen even when students aren't physically aggressive or dangerous, says a report from the Government Accountability Office being released Tuesday. In one case, a New York school confined a 9-year-old with learning disabilities to a "small, dirty room" 75 times in six months for whistling, slouching and hand-waving. In another, a Florida teacher's aide gagged and duct-taped five misbehaving children to their desks; and police say a 14-year-old boy died when a special-education teacher in Texas lay on top of the student when he would not stay seated. Police ruled it a homicide, but a grand jury rejected criminal charges. The findings from the GAO, Congress' investigative arm, stop short of attaching a hard number to how many children are subjected to the practices, but investigators say they found "hundreds of allegations" of abuse involving restraint or seclusion at schools from 1990 to 2009; in Texas and California, they say, public schools recorded a combined 33,095 instances in the past school year alone. The report details 10 children's cases, four of which ended in death. Unlike in hospitals or residential treatment centers, there's no federal system to regulate such practices in schools — and teachers are often inadequately trained, GAO says. Only seven states even require that educators get training before they're allowed to restrict children, and only five states have banned "prone restraint," which ended in the death of the Texas student. "A child's fate should not depend on what state they live in," says U.S. Rep. George Miller, a California Democrat who requested the report. Miller, who chairs the House Committee on Education and Labor, holds hearings on the practices today. Bill East, executive director of the National Association of State Directors of Special Education, says the techniques, if used properly, "can and should be used" in a few instances, such as when a student is a threat to himself or others. Copyright 2009 USA TODAY, a division of Gannett Co. Inc. WHO: Swine flu vaccine to take months to produce Associated Press By Frank Jordans Baltimore Sun Tuesday, May 19, 2009 GENEVA - Drug manufacturers won't be able to start making a swine flu vaccine until mid-July at the earliest, months later than previous predictions, the World Health Organization said Tuesday. The disclosure that making a swine flu vaccine is proving more difficult than experts first thought came as U.N. Secretary-General Ban Ki-moon and WHO chief Dr. Margaret Chan met Tuesday with representatives from up to 30 pharmaceutical companies to discuss the subject. Health officials from around the world are attending WHO's annual meeting in Geneva this week to discuss the outbreak that has infected 9,830 people in over 40 countries, killing 79 of them. According to vaccine experts convened by WHO last week, swine flu virus is not growing very fast in laboratories, making it difficult for scientists to get the key ingredient they need for a vaccine, the "seed stock" from the virus. The flu experts said vaccine manufacturers will not be ready to produce a swine flu vaccine until mid-July at the earliest, the agency reported Tuesday on its Web site. Previously, WHO officials had estimated that production could start in late May. Experts also found no evidence that regular flu vaccines offer any protection against swine flu. Vaccine experts estimated under the best conditions, they could produce nearly 5 billion doses of swine flu vaccine over a year after beginning full-scale production. In that situation, the U.N. might have access to up to 400 million doses for poor countries. The rest of the vaccines would presumably go to wealthy contras who have already signed deals to get the pandemic vaccine as soon as it is available. Mass producing a pandemic vaccine would be a gamble, as it would take away manufacturing capacity for the seasonal flu vaccine that kills up to 500,000 people each year. Some experts have wondered whether the world really needs a vaccine for an illness that so far appears mild. Chan said Monday it would be impossible to produce enough vaccine for all 6.8 billion people on the planet. That suggests a possible global scramble where rich countries outbid poorer nations for the vaccine, leaving them unprotected against the virus. "It is absolutely essential that countries do not squander these precious resources through poorly targeted measures," said Chan. Unlike other countries such as Britain, the United States has so far refrained from reserving its share of any new vaccine. "At this point we have not placed orders for vaccine," U.S. Health and Human Services Secretary Kathleen Sebelius told reporters in Geneva. "There is still so much uncertainty about this virus that it is really premature for us to even make a determination of how many people would appropriately be vaccinated, in what order, how many doses would be required, and at what point." These are the issues Ban and Chan will discuss with vaccine makers, believed to include top producers Sanofi-Aventis, GlaxoSmithKline and Baxter International as well as drugmakers from developing countries. On Monday, dozens of governments lobbied WHO to tread carefully before next raising its swine flu alert to the highest pandemic level of phase 6. The level currently stands at phase 5 -- saying a global outbreak is "imminent." Britain, Japan, China and others said Monday that declaring a global outbreak could cause unnecessary panic and confusion, especially since the virus has turned out to be less deadly than feared. The expert group emphasized that WHO's declaration of a pandemic should not automatically force vaccine makers to switch from making regular flu vaccine to pandemic vaccine. In addition, they said even if swine flu vaccine production began, that did not mean that countries should start immunizing large groups of people. The experts told WHO that it should come up with targeted advice on which groups of people need the vaccine the most and should get it first. They also planned to meet again in several weeks to decide whether large-scale production of swine flu vaccine should begin. Since the outbreak began last month, 79 people have died from the disease -- 72 in Mexico, five in the U.S., one in Canada and one in Costa Rica, WHO says. Another U.S. death -- that of a 16-month-old -- is being investigated for swine flu. Associated Press writer Frank Jordans reported from Geneva and AP Medical Writer Maria Cheng reported from London. Copyright 2009 Baltimore Sun. *Opinion* Making Howard healthy Our view: Howard County's experience shows low-cost health plans can be effective but that an individual mandate is a must in any national reform Baltimore Sun Editorial Tuesday, May 19, 2009 Despite a slower-than-expected start, Howard County's attempt to provide universal medical care to its residents offers some important lessons for those who would remake the nation's health care system on a much broader scale. At least one member of the County Council is questioning whether to allocate a planned $500,000 to the Healthy Howard initiative in light of its so-far lackluster enrollment - just 200 of the county's 20,000 uninsured have signed up so far. But the enrollment doesn't tell the whole story. For one thing, the county has committed to signing up those who request the service for other programs if they're eligible, and about 2,500 have been served in that way. For another, it's showing how much good a relatively low-cost health program can do by focusing on screenings, preventive care, healthy living coaching and simply steering patients to the services they need. Dr. Peter Beilenson, Howard County's health officer and County Executive Ken Ulman's point person on the effort, tells the story of an uninsured breast cancer survivor who signed up for the program and got checked out for chest pain. Doctors discovered the cancer was gone but that she had severe cardiac disease. She got bypass surgery and was back on her feet in no time. Another woman came in with neurological problems caused by a pituitary tumor. She was unable to afford medication on her own, but Healthy Howard was able to get it for free. The program can't offer all the services of a traditional insurance plan - no rheumatologists, for example - but it can still save lives. Johns Hopkins University researchers are following the program to evaluate the health outcomes of enrollees, the costs incurred, possible costs avoided, and other key measures. Preliminary results will be out late this summer - conveniently in time for possible congressional hearings on President Barack Obama's health care plan - but even what Howard has learned so far offers insight. Analysts have had a hard time estimating the true costs of a universal health care system. Would it be overloaded by a pent-up demand for health care from the truly sick? Howard's experience suggests not. A third have one chronic disease and take one or two medications, and a third have more serious problems. But a third of enrollees have no health problems at all. The Howard County program also shows that simply making universal care available isn't enough. Dr. Beilenson says he thinks much of the slow start for enrollment is due to a lack of awareness - until recently, the program has had no marketing budget. But part of it is surely that the program, while inexpensive, is not free. The monthly bill of $50-$115 is low for health care, but in economically strapped times, it may still be more than some individuals and families can spend, or more than they want to spend. Howard's experience suggests that an individual mandate - with assistance for those who truly can't afford coverage - needs to be part of any national health care plan. It may not seem fair to force people to pay for something they don't want, but otherwise some will do without, and the rest of us will ultimately be forced to pay when they land in the emergency room. Copyright 2009 Baltimore Sun. Our Say: Health reform needs to fix access, coverage problems Annapolis Capital Editorial Tuesday, May 19, 2009 As spring gives way to summer, debate on national health care reform will intensify. Chances for passing such a plan are better than at any time since the early years of the Clinton administration. This is high on President Barack Obama's priority list; he has a commanding majority in Congress and wants something done this year. Major players in the health care industry - including America's Health Insurance Plans and the Pharmaceutical Research and Manufacturers of America - have written Obama to endorse cost-control ideas that are not far from the administration's own. As the debate heats up, all of us should keep our eyes on the twin problems sketched out last week by Rep. John Sarbanes and others who spoke at a health care summit hosted by the Fort Meade Alliance at Baltimore Washington Medical Center. As Sarbanes put it, "we have a coverage problem and an access problem." Actually, we've had both problems for years, and they are not getting better. Figures from a couple years back show Maryland with an estimated 760,000 uninsured people aged 65 and younger. Given what has been happening to the economy recently, we doubt that number has shrunk. Meanwhile, the Maryland Hospital Association found in 2007 that the state has 16 percent fewer physicians per thousand of population than the national average. And that comes at a time when there's national concern about a shortage of doctors - particularly primary-care physicians. There is no mystery about why the state has either problem. Health insurance is ruinously expensive, and increasingly out of reach for hard-pressed small-business owners. Some young people gamble they can do without it - and, when they lose the gamble, wind up in hospital emergency rooms. "You can't have 50 million people without insurance and expect the hospital community to be the provider," said one of the forum's speakers, Martin Doordan, the president and chief executive officer of Arundel Health Systems. As for the shortage of physicians: Maryland has a low physician reimbursement rate - particularly relative to this area's high cost of living. When it comes time to practice, young physicians, even if they are from Maryland, are almost forced to go somewhere else where they can put away more money to pay off their student loans. New doctors, The New York Times reported last month, typically come out of medical schools owing more than $140,000. We need a national health plan that will help with these twin problems, while controlling costs and not depriving Americans of the right to choose between health care options. Can all this be done? We don't know - little came out of the efforts in the 1990s. But right now there is intense pressure to fix a health care system that, for all its virtues, has problems that are a drag on the economy - an economy that doesn't need additional burdens right now. All Marylanders - and all Americans - have a stake in what comes next. Copyright 2009 Annapolis Capital. Paying for Health Reform President Obama is avoiding one of the best options. Washington Post Editorial Tuesday, May 19, 2009 WHAT IF there were a way to pay for expanding health coverage that would also help hold down health-care costs and be fairer to low-income Americans than the current system? You'd think that President Obama would leap at this opportunity. Well, there is such a way. Unfortunately, Mr. Obama campaigned against it -- and for that and other political reasons, he is reluctant to embrace it or at least to be seen as taking the first step toward such an embrace. An important paper released yesterday by the Senate Finance Committee underscores why Mr. Obama should reconsider. The funding source is the tax-free treatment of employer-provided health insurance: Unlike wages, health coverage is not subject to income or payroll taxes. This exclusion is the single largest subsidy in the tax code; it is projected to reduce federal tax revenue (both income and payroll taxes) by more than $200 billion next year. This arrangement is not only costly, it is also unfair. Because higher-paid workers are taxed at higher rates, they enjoy a larger benefit from not having to pay taxes on the health insurance they receive. Furthermore, the exclusion is counterproductive: tax-free health benefits encourage employers to provide more compensation in the form of health insurance and encourage insured individuals to use more health care than they would if they had to pay with after-tax dollars. The result is higher health-care costs. It's not necessary to eliminate this tax preference entirely -- as Arizona Sen. John McCain urged during the presidential campaign -- to obtain significant revenue to pay for health reform. Rather, as the Senate committee outlined in its paper, capping the exclusion -- subjecting benefits to taxation but only over a certain dollar amount, or, less productively, in our view, over a certain income threshold -- could produce significant sums while avoiding the destabilizing effect of eliminating the exclusion. For example, taxing benefits above the current average cost of about $13,000 for family coverage would generate $1.1 trillion over the next decade, according to calculations by the Tax Policy Center. However, especially because premiums rise so sharply, setting that cap at a fixed amount would quickly erode the value of the tax exclusion. Instead, the cap could be set to rise at the rate of health-care costs (saving $165 billion over 10 years) or at the generally slower rate of inflation (saving $848 billion.) Dealing with the tax exclusion is not the only possible funding source for health-care reform, but it is one of the biggest. The president's proposal to reduce the value of charitable deductions for the highest-income taxpayers remains sensible if not politically popular. Len Burman of the Tax Policy Center urged the panel to consider a value-added tax to pay for universal coverage. On a smaller scale, the excise tax on alcohol has not been raised since 1991; merely adjusting it for inflation would raise $5 billion annually. Taxing high-sugar soft drinks could simultaneously raise revenue (more than $10 billion annually at a tax of a penny per ounce) and improve public health by reducing obesity. Expanding coverage is important; so is paying for it. The more revenue sources left on the table at this point, the better the likely outcome. Copyright 2009 Washington Post. Great News - Fewer Blacks Being Imprisoned for Drug Cases By Deborah Mathis Baltimore Afro-American Commentary Tuesday, May 19, 2009 Why this news has not gotten much attention raises questions about prejudices at play, but whatever the reason, it is worthy of reporting and, perhaps even, celebrating. This is the headline, courtesy of The Sentencing Project—that dogged research and advocacy organization that fights for prison, prosecutorial, police and legal reforms—“The number of African-Americans in state prisons for a drug offense declined by 21.6 percent from 1999-2005, a reduction of more than 31,000 persons.” It is, by any standard, news when a population of any sorts changes so dramatically in only a handful of years. But it is particularly noteworthy when that same population – Black Americans – has, for so many years, been moving in the other direction. Throughout the 1990s, the skewed “war on drugs” sent increasing numbers of Black persons to the state pen for offenses for which their White counterparts got no time, much less time or a bit of time in much more hospitable places. Chalk that up to the disparities in the way the laws were fashioned. Selling or using “Black” drugs, like crack cocaine, were heavily weighted offenses compared to selling or using “White” drugs, like powder cocaine. In essence, Black druggies were treated as more heinous than were White druggies. And there you had it: A system rigged to put Black people away tightly and for long spells, creating a yawning chasm in the male to female ratio in Black communities and fueling a cottage industry of prison construction. And, it spawned this curious dichotomy: People who decried “throwing money” at public education had no such qualms about spending tax millions on shiny new jails. And, finally, the woeful trend brought us all of those studies and news reports about the one-in-three or one-in-four Black males who were somehow tied up in the criminal justice system. Those were the headlines we were used to. Now, there is this one. And, chances are, this is the first you’ve heard of it. The Sentencing Project’s new report, “The Changing Racial Dynamics of the War on Drugs,” was released last month, but it has been greeted, largely, by radio silence. True, the report does not herald the kind of breakthrough that would be worthy of nationwide rejoicing – that is, the end of the illegal drug trade and, with it, the obsolescence of drug courts, mandatory sentencing and prison expansion. But, a decline – especially a significant one such as this – is something to talk about. It is news because it is new. “The decline in the number of African-Americans incarcerated for drug offenses is a significant development, coming as it does after several decades of unprecedented expansion in incarceration of people of color,” the report concludes. Hopefully, the researchers suggest that lawmakers and policymakers might be seeing a gleam of light, recognizing the lock-‘em-up tact as a long-term failure. But it also offers this depressing fact: “(T)here are still 900,000 African-Americans incarcerated in the nation’s prisons and jails. To place this in context, at the time of the Brown v. Board of Education decision in 1954, that figure was 100,000. So despite a half century of advances in social and economic opportunity, the role of incarceration in the lives of African-Americans persists to a degree that was unimaginable just a few decades ago.” How we long for the day when the good news comes without a disclaimer. Deborah Mathis is a columnist for BlackAmericaWeb.com. This commentary has been reprinted with permission from BlackAmericaWeb.com. Copyright 2009 Baltimore Afro-American. Ensuring Patients’ Safety New York Times Letter to the Editor Tuesday, May 19, 2009 To the Editor: Your May 11 editorial “Substantial Complications” calls into question the rigor of the Food and Drug Administration’s premarket oversight of medical devices and may inadvertently cause patients to question the safety and reliability of medical devices reviewed by the agency. The American public and patients in particular need to know that the F.D.A.’s premarket review process is a risk-based, science-driven method for determining the safety and effectiveness of medical devices. This process involves extensive F.D.A. review of specifications and performance testing information, and if the F.D.A. deems necessary, clinical data, before the agency determines whether a device can be made available for patients. Americans should continue to have confidence that the F.D.A. has in place effective processes to ensure the safety and effectiveness of medical devices and to protect and promote the public health. Stephen J. Ubl President and Chief Executive Advanced Medical Technology Association Washington, May 14, 2009 Copyright 2009 New York Times. BACK TO TOP


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