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Tuesday, May 26, 2009

News Clipping Archives

Maryland / Regional
Pertussis risk higher for unvaccinated children, study says (Baltimore Sun)
Health officials monitor Va beaches' water quality (USA Today)
Severna Park coalition takes on teen suicide (Annapolis Capital)

National / International
The Depression Test (Washington Post)
Doctor Uses Some Foods As Medicines (Washington Post)
New FDA chiefs stress science, better food safety (Washington Post)
Flu scare reveals strapped local health agencies (Washington Post)
Barnyard Pestilence (New York Times)
Patterns: A Long, Bright Summer and Many Suicides (New York Times)
Mexico, US, Canada announce swine flu deaths (Washington Post)
Vaxart moves possible swine flu vaccine into animal testing (San Francisco Business Times)

Opinion
Alternatives to New Drugs (New York Times Letter to the Editor)


Maryland / Regional

Pertussis risk higher for unvaccinated children, study says
Those whose parents refuse injections 23 percent more likely to get whooping cough

By Stephanie Desmon
Baltimore Sun
Tuesday, May 26, 2009

When an unvaccinated child in Dr. Daniel Levy's practice came down with whooping cough this year, the Owings Mills pediatrician made a decision: He would no longer see patients whose parents refused to have them immunized against that disease or others, such as measles and meningitis.

The risks posed to his other patients were too great, Levy reasoned. And he felt he couldn't give adequate care to children whose parents rejected some of his most basic advice: That routine childhood vaccines are safe and are the key to preventing diseases that used to kill many before they could reach adulthood.

A new study out today in the journal Pediatrics shows that children who are not vaccinated are 23 times more likely to contract whooping cough - also known as pertussis - than those who have received all of their shots. Lead author Jason M. Glanz, an investigator at the Kaiser Permanente Colorado Institute for Health Research, said he and his colleagues found that, while 1 in 500 vaccinated children came down with pertussis, about 1 in 20 children who were not vaccinated got the disease.

That confirms Levy's fears. "We don't have a large refusal rate in Maryland, but it's something we're really concerned about," he said. "We're going to start seeing the return of diseases we had almost gotten rid of."

Pertussis, which is caused by bacteria, makes children cough uncontrollably. With the cough so hard and so persistent, children often can't catch their breath and they make a "whooping" sound when they attempt to breathe in. Pneumonia or seizures can also develop. There were 64 confirmed cases of pertussis in Maryland last year, including an outbreak of multiple cases in a school and another in a hospital, according to the state health department. That was up from 43 the year before.

A measles outbreak was reported last month in Rockville, with four cases linked to unvaccinated people. Last year, the number of cases of measles in the United States rose to its highest level in a decade.

"The ones who are refusing vaccines are often the epicenters of the outbreaks," said Dr. Daniel Salmon, a vaccine safety specialist with the National Vaccine Program Office at the U.S. Department of Health and Human Services.

State law requires children to get two dozen vaccines against a dozen different diseases from birth to age 5, though parents may object for medical or religious reasons or choose to delay some of the shots. The number who have refused any vaccines for their children has doubled in recent years, though the figure is still under 1 percent, said Dr. Paul A. Offit, chief of infectious diseases at Children's Hospital of Philadelphia and an expert on vaccines.

"We ask a lot and the public generally has responded well," he said.

But there remains a vocal minority who say vaccines are unsafe for children. Some say the large number of shots given to children in a short period of time causes autism - a belief promoted on national television by actresses Jenny McCarthy and Holly Robinson Peete, who blame vaccinations for their sons' autism.

The belief has been rejected by mainstream science, yet it has been widespread enough to make many parents think twice about giving their children so many shots at once. Dr. Robert Sears, son of parenting guru Dr. William Sears, advocates spreading them out.

Meanwhile, there is a generation of parents who didn't see firsthand the devastating impact of the many vaccine-preventable diseases. That allows fear of the vaccine to displace fear of infections, doctors said. Whooping cough is highly contagious and deadly. Prior to the vaccine, pertussis killed about 8,000 people in the United States every year. Now the number is down to about 10.

The vaccine "has kept young children out of the hospital and out of the morgue," said Offit, the author of Autism's False Prophets: Bad Science, Risky Medicine and the Search for a Cure.

Still, pertussis has not been eradicated; it is constantly circulating. Immunity typically wanes in adulthood, so pertussis is more common than most of the other vaccine-preventable diseases. Often, adults pass the disease to their children, who in recent outbreaks have borne the brunt of serious infection, Offit said, just as they did in the pre-vaccination era.

In recent years, health officials have recommended adolescents and adults get a booster shot that includes protection from pertussis.

When there is a decrease in immunizations, Offit said, pertussis is the first disease to come back, making it sort of a proverbial canary in the coal mine.

Most states require children to be vaccinated to enter school, but most allow for exemptions. In Maryland, all a parent has to do to opt out is sign a statement on a school health form that says it is contrary to the family's religious beliefs to be vaccinated.

What can drive an outbreak, doctors say, is when a cluster of parents have refused vaccination for their children.

Offit said he wonders when people will start to realize that the failure to vaccinate puts children at risk - both those whose parents made the decision and those who are unwittingly exposed to disease by the unvaccinated.

"I used to say the tipping point will come when children start to die. But I was wrong," he said. "Now I think it will be when enough children die.

"That vaccines work and are safe is not a question. But people are easily scared. It just seems easier to scare people than to reassure people."

Whooping cough in Md.

Year	Total cases	Status
Definite	Probable
2004	159	43	116
2005	219	48	171
2006	153	42	111
2007	118	43	75
2008*	164	64	100

*Data for 2008 are provisional as of May 21, 2009

Sources: Maryland Electronic Reporting and Surveillance System, National Electronic Disease Surveillance System

Copyright 2009 Baltimore Sun.

Health officials monitor Va beaches' water quality

Associated Press
USA Today
Tuesday, May 26, 2009

RICHMOND, Va. (AP) — The Virginia Department of Health has kicked off its annual water-quality testing program at 44 state beaches.

Local health department employees are going out weekly to check whether it's safe to swim in waters off the beaches along 70 miles of the Chesapeake Bay and coastal shoreline. Water samples are tested for enterococcus group bacteria, the type found in the intestines of humans and animals, which can indicate whether fecal matter is present.

Results above a certain level -- 104 colony-forming units per 100 milliliters of water -- will be posted on the state health department's Web site. Officials also plan to post swimming advisories that inform people that getting in the water could pose a health risk.

Copyright 2009 The Associated Press. All rights reserved.

Severna Park coalition takes on teen suicide

By Elisabeth Hulette
Annapolis Capital
Tuesday, May 26, 2009

Under the bright lights of Severna Park High School's stadium, a camera panned across a staged football game, coming to rest on a set of cheerleader's pompoms lying on the ground. Their owner was missing.

The clip is one of several that will appear in a two-minute public-service announcement created by a group of Severna Park residents to draw awareness to the county's - and the nation's - increasing problem with teen suicide. Each scene, from an art classroom to a birthday party, shows an empty seat where a student should have been.

At the end, after a narrator urges teens to speak up if someone they know is depressed or suicidal, a student sits in one of the empty seats.

"The message is one of action," said Dan Gvozden, a 2004 Severna Park graduate who is directing the PSA. "If you or someone you know is expressing signs of suicidal tendencies, there is somewhere to go."

Although the local rise in teen suicide is a countywide problem, Severna Park's community has been hit particularly hard. To raise awareness, locals have banded together to produce the announcement and a curriculum they hope teachers will use to build classroom discussions around teen-suicide prevention.

More than 400 people, including students recruited from Severna Park and other area high schools, have been involved in filming over the past few weeks. Already, leaders of the project said the filming has opened dialogue on a taboo topic and allowed people affected by the deaths to do something constructive to help.

"It's been good to shift so the kids have been part of the solution," Gwen Douma, president of the high school Parent-Teacher-Student Organization, said at the stadium filming on May 16. "Hopefully, some healing is happening here."

Plenty of support
The group heading up the project is calling itself the Guiding Coalition for the Prevention of Teen Suicide. Already it has support from the high school's PTSO and counseling center, local churches and individual residents. Leaders also have recruited help from experts, psychologists and county agencies.

And because members have joined forces with Winds of Hope, Winds of Healing, a nonprofit organization that uses music in its work with mental-health issues, all donations to the coalition will be tax-deductible.

That could help tremendously, as the project is expected to cost about $50,000, said Steve Anstett, a parent in the coalition. That includes the PSA, the curriculum and a planned documentary featuring interviews with people who have been directly affected by the deaths of some local teens, said Nancy Lincoln-Reynolds, an associate pastor at Woods Memorial Presbyterian Church.

At least six people in Anne Arundel County between ages 15 and 22 have committed suicide since July, and in March police found four middle-schoolers skipping school to plot suicide together. But that's just the tip of an iceberg of increased attempts and thoughts of self-harm among the area's teens, county mental-health officials said.

Severna Park residents have tried to raise awareness before, notably with a forum at Woods last year and the new Students Taking Action Responsibly, or STAR program, at the high school. But with this latest effort, they said they hope to reach beyond their community and deliver an education package that can be used in schools throughout and beyond Anne Arundel County.

Gvozden, who earned his film degree from New York University in 2008, has been working on the PSA for about two months. In high school he and Peter Black, another 2004 Severna Park graduate, were friends with a student who later killed himself. The two said they hope the project helps people recognize the signs of depression that they didn't see.

But already the project has met with some disapproval. When the filmmakers ran the script for the PSA past the American Psychological Association, they were told some scenes - particularly one in which students walk up to a gravestone - "glorified" suicide, meaning the image could make death seem appealing to someone considering self-harm.

Right message
Despite the association's criticism, those working on the project said they still believe it sends the right message.

"I wanted to create something emotional, something that gets you to think about it and talk about it," said Gvozden, who thought up the empty seat idea. "The empty seat can be filled if you speak up and say something."

"Some schools are afraid to talk about it, but I'm afraid not to talk about it," Anstett said.

Other recent graduates who turned out for the filming said the project is a good thing not only for Severna Park, but for surrounding communities.

Maggie Leahy, who graduated from Severna Park High School in 2007, said teens often don't speak up when friends are in trouble because they don't want to betray them. The PSA, she said, shows it's OK to ask for help.

"It's great that it's happening now," added Evan Roe, who graduated from Broadneck High School last year. "I just wish it had happened before."

The coalition plans to release the PSA at a community event in September, and tie both to an Out of the Darkness Community Walk with the American Foundation for Suicide Prevention.

Senior Ian Candelaria, captain of Severna Park's football team and an extra in the PSA, said being part of the project has made him and the other students who are involved feel like they're helping.

"I hope everyone sees it and it changes a lot of kids' minds, and they know you don't have to kill yourself to get rid of your problems," he said. "Someone can help you."

For more information or to donate to the Guiding Coalition, e-mail gwen_douma@yahoo.com or steve_anstett@yahoo.com.

---
WARNING SIGNS AND RESOURCES

SUICIDE WARNING SIGNS
• Increased alcohol and/or other drug use.
• Recent impulsiveness and taking unnecessary risks.
• Threatening suicide or expressing a strong wish to die.
• Making a plan - giving away prized possessions; sudden or impulsive purchase of a firearm; obtaining other means of killing oneself, such as poisons or medications.
• Unexpected rage or anger.
• Observable signs of depression: unrelenting low mood, pessimism, hopelessness, desperation, anxiety, withdrawal, sleep problems.

WHERE TO GET HELP

Hotlines:
• Call 911 for immediate assistance in any emergency.
• County Crisis Warmline: 410-768-5522, 24 hours a day, seven days a week.
• Maryland Youth Crisis Hotline: 800-422-0009, 24 hours a day, seven days a week.
• County Public Schools Student Safety Hotline: 877-676-9854, 24 hours a day, seven days a week.

On the Web:
• County Mental Health Agency: www.aamentalhealth.org.
• County Health Department: www.aahealth.org.
• Network of Care: www.annearundel.md.networkofcare.org/mh/home.

Source: The American Foundation for Suicide Prevention and county Public Schools

Copyright 2009 Annapolis Capital.

National / International

The Depression Test
By screening all teens, doctors hope to identify those with mental disorders

By Shankar Vedantam
Washington Post
Tuesday, May 26, 2009

Soon after her sister committed suicide, Caroline Downing started doing poorly at school. During math tests she would freeze up, and she found her mind wandering constantly. Officials at St. Andrew's Episcopal School in Potomac gently suggested that the high school sophomore get a mental health screening.

The idea of a psychiatric evaluation sent chills down the spine of Caroline's mother, Mathy Milling Downing, who believed that her younger daughter, Candace, had committed suicide because of an adverse reaction linked to a psychiatric drug -- the antidepressant Zoloft. Shortly after Candace's death, the Food and Drug Administration placed black-box warnings on several antidepressants to say they elevated suicidal thinking among some children. If Caroline were going to get the same kind of mental health care as Candace, Downing wanted no part of it.

Downing's family offers a powerful case study into the pros and cons of new guidelines recommending widespread screening of adolescents for mental disorders: Last month, the U.S. Preventive Services Task Force, a federal group that makes public health recommendations, said that all adolescents between ages 12 and 18 should be screened for major depression. In March, the Institute of Medicine, which advises Congress on scientific matters, told policymakers that early screening was key to reducing the financial and medical burden of mental disorders in the United States.

Downing said she agreed to have her older daughter screened because the child was obviously in distress, but she told school officials that if an evaluation led to a prescription for medications, she would refuse to go along.

The screening, unsurprisingly, found that Caroline's emotional problems were linked to her sister's death. After several intensive evaluations that delved into the girl's mental and emotional history, and that obtained a family history and detailed information about Candace's death, Caroline was placed in "art therapy," painting or making sculptures with a therapist who simultaneously used the sessions to draw out the teenager's emotional problems.

The therapy had an immediate and beneficial impact and turned Mathy Milling Downing, a skeptic about some kinds of mental health treatment, into a fan of mental health treatment done right.

"My grades went from almost failing algebra to honor roll," Caroline Downing, now 20, said in an interview. The treatment worked, she said, because "getting all the stuff out of your head that you don't need there gives you more room for all the stuff you need to have in your head."

The very different experiences of the two sisters illustrate the paradox at the heart of screening recommendations: What matters is not whether screening is done but how it is done and how screening information gets used.

In the case of her younger daughter, Downing said, a child psychiatrist put Candace on Zoloft after a very brief evaluation because the child was experiencing anxieties during tests. When Candace turned 12, the psychiatrist upped the dose on the grounds that it would help her academically. When Downing expressed concerns about the drug, she said the doctor blew her off: "He said, 'What are you worried about? It is safe and effective.' "

One day in January 2004, Candace had just finished watching a show on Animal Planet with her father and sister. She had been laughing during the show. A short while later, Downing said, Candace hanged herself in her bedroom, using a belt from a bathrobe and a rod on her four-poster bed.

Candace's treatment, Downing said, involved a one-size-fits-all approach to mental health that sees medications as a magic pill. By contrast, she said, the multiple screenings that Caroline received carefully evaluated the child as an individual and homed in on the kind of therapy that was best for her.

"Screening a child to find out what the root of the problem is can be useful," Downing said. "In the case of my daughter [Caroline], it helped [that] they found a connection between her focusing problems and the death of her sister."

The recommendation by the Preventive Services Task Force, which advises primary care physicians on contentious medical issues, says that children between 12 and 18 should be routinely screened in doctor's offices. But the task force offered an important caveat: Screening made sense only if the children then had access to the kind of specialized and individualized care that Caroline Downing received. The new guidelines reversed an earlier recommendation by the same group in 2002 that said there was insufficient evidence to recommend screening children for depression.

The panel of experts evaluated numerous studies, including several looking at the potential adverse effects of medications.

Ned Calonge, the chief medical officer for the Colorado Department of Public Health and Environment and a senior member of the task force, said that the panel had concluded that there were effective screening tools for depression, as well as effective drug and psychotherapy treatments for children ages 12 to 18. But there were potential risks to the use of drugs among children, he said.

As a result, Calonge said, the panel believed psychotherapy ought to be the first line of treatment for all adolescents with depression, rather than antidepressant drugs such as Prozac, Paxil and Zoloft, which are known as selective serotonin reuptake inhibitors, or SSRIs.

"We wanted to recommend against the idea doctors would do a screen and pull out their prescription pad," he said. "The recommendation says you have to do really close clinical monitoring. So don't pull out the prescription pad and write an SSRI prescription; the best treatment is psychotherapy."

Calonge said the response to the recommendations has generally been positive, but the biggest concern by far has been the worry that such screening would cause many children to be placed on drug therapy. Vera Sharav, a prominent critic of psychiatric drug therapy and president of the Alliance for Human Research Protection, for example, said widespread screening would result in doctors' writing many new drug prescriptions, perhaps at the behest of drug companies.

But Calonge said his task force imposed rigorous conflict-of-interest guidelines on its members to keep away advocates motivated by financial considerations or pet theories. A similar recommendation for screening was delivered to policymakers in March by the Institute of Medicine. Unlike the Preventive Services Task Force, the IOM panel did not limit itself to recommending screening only for depression or only to teenagers but said that screening in general could be useful, given that so many mental illnesses first begin to manifest themselves among children.

About one in four visits to pediatricians' offices are for behavioral problems, said Thomas Boat, executive associate dean for health affairs at the University of Cincinnati and a vice-chair of the IOM panel.

"Pediatrics has not really owned up to the fact this is a major health problem in kids that they need to be responsible for," said Boat, who is himself a pediatrician. While screening could also be offered in schools, Boat said that physicians' offices were best set up for screening children.

Both Boat and Laurie Flynn, national executive director of TeenScreen, a mental health screening program affiliated with Columbia University, emphasized that screening tests had to be cleared by parents before they were administered. TeenScreen focuses on screening children between ages 11 and 19 -- and gets signed parental consent before administering the tests. Flynn said the program is active in 530 schools and community settings but is increasingly focused on screening youngsters in the offices of primary care doctors, as new guidelines have suggested.

The typical screen requires a paper-and-pencil or computer test that takes about 10 to 12 minutes for a child to complete. The test raises red flags in about 25 to 30 percent of the children, Flynn said, and those children are then given a more comprehensive, 20-minute evaluation to make sure they understood the questions correctly. About 16 to 17 percent of kids out of the 40,000 that TeenScreen evaluated last year were referred for a formal psychological evaluation. Between half and three-quarters of the families typically follow up on the recommendation: TeenScreen is not involved in making formal diagnoses of mental health disorders or recommending particular kinds of treatment.

Steven Hyman, Harvard University's provost, who is also a psychiatrist and former director of the National Institute of Mental Health, said he sided with the recommendations of the Preventive Services Task Force in that he thought that mental health screening for children should be limited to depression, and limited to adolescents.

Like all public health measures, he said, screening made sense only for conditions that were widespread, where tests were accurate, where treatments available, where the costs of administration were not prohibitive and where the screening techniques did not lead to large numbers of normal children getting misdiagnosed and large numbers of children with real disorders getting missed.

"A good reason to screen for depression is it can be a brief, discreet and relatively private interaction," Hyman said. "Depression meets the public health challenge that makes screening worthwhile."

Copyright 2009 Washington Post.

Doctor Uses Some Foods As Medicines

By Daphne Miller
Washington Post
Tuesday, May 26, 2009

"Just a cold? I thought I was dying." Martha sounded irritated.

She had hustled the kids off to day care and skipped work, clearly expecting to hear that something more dramatic was brewing than a late springtime cold. But what motivated her visit to my office, I realized, was not the infection itself as much as the dizzying array of symptoms caused by her self-administered treatments: The fatigue and stomach pain appeared to intensify with each dose of opioid-derived cough suppressant she chugged; as for her headache, dry mouth and racing heart, they coincided suspiciously with a decongestant that contained pseudoephedrine (a close cousin to methamphetamine).

Bolstered by a growing body of data and my own clinical experience, I opened my electronic medical record and entered a prescription that would give Martha relief without more side effects: mushroom ginger soup. The recipe sits right there on my screen, one click below morphine and one above mycostatin.

There was a time when I might have scoffed at a physician whose pharmacopeia included gastronomical offerings. Like many of my colleagues, I left medical school with a sturdy respect for biomedical research and a belief that there was a drug to match every ill, or almost. When medication wasn't the answer, surely there was a surgery.

Such illusions were swiftly dispelled within months of entering a family medical practice where my patients range in age from 2 minutes to 102 years and, on any given day, I am challenged with everything from upper-respiratory infections to asthma and lung cancer. Rare are the moments when a specific pill promises a quick fix. To the contrary, medications often produce a buckshot-like effect, hitting organs far beyond their intended target. So prescriptions to control cough end up causing incontinence, arrhythmias and sleepiness, and those for joint and low-back pain frequently kick off a series of digestive woes.

Over the years, these frustrating experiences have prompted me to take a closer look at nutrition and herbal research. Take that soup: Unlike standard pharmaceutical cold preparations, which study after study has shown do little to block symptoms or speed up recovery, ginger and mushrooms have the potential to help, and with virtually no ill effects. Indeed, a phalanx of lab-coated scientists have finally convinced me of something that generations of traditional Chinese and Japanese healers, and my great-grandmother, already knew to be true: Ginger is an excellent decongestant, and mushrooms boost your immune system.

Some of the most compelling mushroom research has been done by Keith Martin, a nutritionist at Arizona State University and author of more than 30 papers in peer-reviewed journals. Martin and his colleagues have tested a variety of common mushrooms, such as white buttons and shiitakes, and found that in the presence of viruses such as those that cause cold and flu symptoms, all of them can raise the levels of the immune system's proteins to three to five times normal.

Although mushroom extracts and supplements have gained popularity on store shelves, with promises that they can stop the spread of cancer and help manage infections, Martin cautions that no one has been able to definitively pinpoint the substances that give fungi the immune-boosting qualities he has identified. "Nutrition researchers have gotten themselves in trouble before when they tried to find the magic bullet in foods," he says, referring to studies where high-dose nutrient extracts given to reduce a cancer paradoxically caused a cancer spike in the study participants.

Martin, who does get some funding from the mushroom industry, went on to advise that eating whole fungi rather than taking supplements is likely to be the healthier choice. Lucky for us, it happens to be the tastier option as well.

Another favorite recipe in my EMR is turmeric stir fry. In 1999, while Merck and Pfizer were ceremoniously launching their painkillers Celebrex and Vioxx, researchers in the United Kingdom reported the results of laboratory research suggesting that curcumin extracts of turmeric (first referenced in ancient Sanskrit medical theses for its ability to soothe joints, wounds and intestinal tracts) could have the very same impact in treating arthritis pain.

We all know how this story ends: Vioxx and Celebrex have since been linked to heart problems and stomach ulcers, while turmeric marches on, posing few risks other than its tendency to permanently stain your collar (and semi-permanently, your teeth).

Not wanting to miss out on the action, nutraceutical companies have produced an array of anti-inflammatory, curcumin-containing supplements. Being mindful of wallets and taste buds (and aware that unregulated supplements sometimes don't contain what they purport to), I steer patients instead toward my turmeric stir fry and other turmeric-laced dishes. (They are also in my EMR below "Triphasal Birth Control Pills" and above "Tylenol"!) According to physician Tieraona Low Dog, chair of U.S. Pharmacopeia's Dietary Supplements and Botanicals Expert Committee: "You need to take two to three teaspoons per day of turmeric to see a benefit. Remember, though: Eat the turmeric with some fat and add black pepper, as this dramatically increases the absorption of the curcumin."

Certainly recipes are not a panacea for our health woes; nor will EMRs clear up the quagmire that is our current medical system. But when it comes to treating the chronic or subacute medical problems that are the bread and butter of most primary care practices, non-pharmacological prescriptions for edibles (and, for that matter, exercise and mindful breathing) may have the potential to save billions of dollars annually, in both direct drug costs and the treatment of side effects.

Most important, recipes offer an attractive alternative for those who are wary of popping too many pills.

A recent study reported that 1.6 million Medicare beneficiaries per year fail to fill or refill one or more prescriptions. While some of the abandoned prescriptions may have been lifesaving or life-prolonging, somewhere between 35 and 65 percent were given to addresshealth issues such as osteoarthritis pain or the cough and congestion experienced by my patient Martha, all problems where pharmaceuticals have no clear advantage over other forms of treatment.

In this study, the reasons Medicare beneficiaries gave for their "non-adherence" not doing what the doctor tells you to do) were varied: Some were worried about cost, some felt the medication would not work and others feared side effects.

A tasty dish made with inexpensive ingredients from the local market could sidestep many of their concerns. After all, food is the one medicine that we seem quite willing to swallow -- at least three times a day.

Daphne Miller is the author of "The Jungle Effect: A Doctor Discovers the Healthiest Diets From Around the World -- Why They Work and How to Bring Them Home." Comments: health@washpost.com.

Copyright 2009 Washington Post.

New FDA chiefs stress science, better food safety

Associated Press
By Lauran Neergaard
Washington Post
Tuesday, May 26, 2009

WASHINGTON -- The huge salmonella outbreak from peanut butter represented a failure of the Food and Drug Administration, that agency's new chiefs declared Tuesday _ one they hope to fix.

Expect a "modern food-safety system focused on prevention of contamination," FDA Commissioner Margaret Hamburg and her deputy, Joshua Sharfstein, wrote in The New England Journal of Medicine.

Even its defenders acknowledge the FDA _ the nation's chief consumer protection agency _ is struggling, given increasing responsibilities overseeing ever-more-complex health industries, but not a budget sufficient to do the job. An independent review in 2007 concluded lives were at risk, and morale plummeted as the agency's own scientists charged their safety concerns were dismissed by leaders too cozy with industry.

Hamburg, who just won Senate confirmation for the job last week, and Sharfstein have pledged to restore the FDA's credibility. The two physicians introduced themselves to the country's doctors Tuesday in an article published online by the respected medical journal _ and they didn't underestimate the work ahead.

One priority: Working with the Agriculture Department to improve food safety, following some high-profile crises including the peanut butter outbreak earlier this year that sickened nearly 700 people and is blamed for at least nine deaths. Peanut Corp. of America is under criminal investigation for allegedly shipping peanut butter and another ingredient used in thousands of other products that it knew to be tainted.

That outbreak "represented far more than a sanitation problem at one troubled facility. It reflected a failure of the FDA and its regulatory partners to identify risk and to establish and enforce basic preventive controls," the duo wrote. "And it exposed the failures of scores of food manufacturers to adequately monitor the safety of ingredients purchased from this facility."

The FDA's success shouldn't be judged by how many factories it inspects or drugs it approves, but in its overall work to improve public health, the pair wrote. For example, FDA scientists are working behind the scenes to grow the new swine-flu virus and make the ingredients necessary to test if vaccines against it are potent enough, and eventually will oversee vaccine production quality.

"The agency's success will be determined by the nation's access to a safe and effective vaccine," the pair wrote.

And while "the FDA must make difficult decisions in the absence of ideal information," they acknowledged that recent controversies were "opening the door to legitimate questions from the media, the public and Congress about whether the public interest is being served."

To help get back on track, the new bosses promised "a culture that encourages scientific exchange" and to better explain the science behind their decisions to the public.

© 2009 The Associated Press.

Flu scare reveals strapped local health agencies

Associated Press
By Rita Beamish and Frank Bass
Washington Post
Tuesday, May 26, 2009

OAKLAND, Calif. -- The swine flu outbreak fell short of a full-blown international crisis, but revealed the precarious state of local health departments, the community bulwarks against disease and health emergencies in the United States.

A sustained, widespread pandemic would overwhelm many departments that are struggling with cutbacks as well as increased demand from people who have lost jobs and medical insurance.

Stung by the lean economy, 13 states and U.S. territories had smaller health budgets in 2008 than in 2007, and eight more made midyear cuts, according to a survey by an advocacy group, the Association of State and Territorial Health Officials. With local budgets also in trouble, many health officials fear a serious outbreak.

"We would be in a lot of trouble," said Alameda County's director of public health, Anthony Iton in Oakland. "We weren't tested to push the system to see how it responds when you have to make hard decisions. I worry about that because the resources have been cut."

A review by the U.S. Health and Human Services Department in January noted great strides in preparedness but said many shortfalls remain. They include the ability to maintain public health functions such as food safety and daily needs during a pandemic, and the capacity to meet surges in health care demand and to strategically close schools.

State capabilities vary. But some local departments, strapped by layoffs and working overtime on swine flu, say they could not maintain the pace in a major outbreak. An Associated Press review found troubling signs:

*Twenty-nine public health workers in Sacramento County, Calif., learned just before being called to work on swine flu that they probably will lose their jobs this summer. Senior nurse Carol Tucker, contacting potential flu victims, thought about future epidemics.

"Who will be around to do these things?" she said.

*Nationwide, officials have reported more than more than 6,700 swine flu cases, and 12 deaths.

"We have good plans and we're exercising them," said Matthew A. Stefanak, health commissioner of Mahoning County, Ohio, whose work force dropped 20 percent in two years. "But for the nuts and bolts of an outbreak * contact investigations, probable cases of H1N1 flu _ we don't have the manpower, the trained disease investigators the public health nurses who would do it. That's where we're weakest right now."

*Federal investment in local emergency planning since attacks of Sept. 11, 2001, has paid off in a smooth response to the limited swine flu outbreak. But the money has dwindled.

Last year at least 10,000 local and state health department jobs were lost to attrition and layoffs, including at laboratories that identify disease strains, according to surveys by the state and territorial group and the National Association of County and City Health Officials.

An annual flu-shot clinic no longer comes to town hall in Berlin Center, Ohio. "The real danger is how many just won't get shots," said Ivan Hoyle, 78.

Public health nurses such as Erica Horner won't deliver in-home newborn help in Mahoning County. With the program closed, Horner's duties will change.

*People calling for routine immunizations now reach a recording saying the Worcester, Mass., clinic is closed. With just two of its six public health nurses surviving layoffs, the city is re-evaluating its responsibilities and says it can meet emergencies by working with the University of Massachusetts and local hospitals.

Ann Cappabianca, one of the remaining nurses, scrambles to track communicable disease and tuberculosis cases. "We just can't get it all done. You try to focus on the most important thing at the moment," she said.

Worst is having to make cuts without "enough ability to assess the needs of my community," said Bob England, the health director of Arizona's sprawling Maricopa County, which closed its family planning clinic.

Public health departments will get some help from this year's stimulus spending of $1 billion for prevention and wellness efforts.

But it will take years to bring local health agencies to the point where they can fight a sustained, widespread pandemic, said Richard Hamburg, a lobbyist at the nonprofit Trust for America's Health, an advocacy group supported by private and government grants.

A report from the group in December found emergency planning gaps in areas such as rapid disease detection, food safety and "surge capacity" to quickly scale up equipment, staff and supplies to meet a major outbreak.

Dan Sosin, head of emergency response at the Centers for Disease Control and Preparedness, praised the federal swine flu response, but acknowledged that public health officials face "capacity issues in terms of ongoing resources and funding."

"We could spend more money," he said. "We could use more than we have."

The CDC's acting director, Richard Besser, told Congress last month the government is concerned about states being too short-staffed to conduct required emergency exercises.

The main fund for local health emergency planning after the Sept. 11 attacks, the federal Public Health Emergency Preparedness program, has dropped nearly one-third since a 2006 peak of almost $1 billion, according to CDC figures. The money had included a special three-year congressional allocation for pandemic flu preparation that ran out last year.

President Barack Obama now is asking Congress for $1.5 billion to fight swine flu.

A second fund to help local agencies plan for public health emergencies, the Hospital Preparedness Program, has fallen nearly a quarter from $457 million in the 2006 budget year.

Decreases in the Public Health Emergency Preparedness program were most significant in Iowa, Mississippi, Colorado, Missouri, Michigan, Ohio, Pennsylvania and Louisiana. After a pair of killer hurricanes hit Louisiana in 2005, Washington sent nearly $15 million in 2006 health emergency help. This year, it's down to $9.8 million.

Louisiana's dollars from the hospital program slid from $7.1 million in 2006 to $5.2 million this year.

Even New York City, site of one of the Sept. 11 attacks, saw its Public Health Emergency Preparedness program funds fall to $20.6 million this year from $28.7 million during the 2006 budget year.

In Orange County, Fla., people were diverted from other duties for swine flu needs in a health department increasingly burdened with a range of demands as people lose jobs, said health director Kevin Sherin.

Sherin, president of the advocacy group American Association of Public Health Physicians, questioned longer-term capabilities for lab and field work in his state and elsewhere.

"In the event of a real emergency, these systems have capacity problems," he said.

Georges Benjamin, executive director of the American Public Health Association, a nonprofit lobbying group, said that after the federal emergency buildup, "We didn't complete the job and we didn't make the system sustainable. Our ability to manage more than one thing, or scale up fast is really worrisome."
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On the Net:

Association of State and Territorial Health Officials:http://www.astho.org/

Health and Human Services Department:http://www.hhs.gov/

National Association of County and City Health Officials:http://www.naccho.org/

Trust for America's Health:http://healthyamericans.org/

Centers for Disease Control and Preparedness:http://cdc.gov/

Public Health Preparedness Program:http://emergency.cdc.gov/cotper/cphp/

Hospital Preparedness Program:http://www.hhs.gov/aspr/opeo/hpp/

American Association of Public Health Physicians:http://www.aaphp.org/

American Public Health Association:http://www.apha.org/

© 2009 The Associated Press.

Barnyard Pestilence

By C. Claiborne Ray
New York Times
Tuesday, May 26, 2009

Q & A

Q. Did all human infectious diseases originate in domesticated animals?

A. Of 25 infectious diseases that have historically caused high mortality in human beings, many probably or possibly reached humans from domesticated animals, according to a major review article published in Nature in 2007.

The main ones among so-called temperate diseases are diphtheria, influenza A, measles, mumps, pertussis, rotavirus, smallpox and tuberculosis. Three others probably came from apes (hepatitis B) or rodents (plague and typhus), the review says, and four other temperate diseases (rubella, syphilis, tetanus and typhoid) came from sources that are still unknown.

Among the important tropical diseases, the review says, domestic animal origins can be ruled out for 6 of the 10: AIDS, dengue fever, vivax malaria and yellow fever, all derived from wild primates; cholera, from aquatic algae and invertebrates; and falciparum malaria, from birds. The case is not clear for Chagas’ disease, West and East African sleeping sickness and visceral leishmaniasis, because the ancestors of the agents that cause them infect both domestic and wild mammals.

The strong links to domestic animals for the temperate diseases is tied to the rise of agriculture, 11,000 years ago, which allowed human populations to survive and pass on the diseases and brought these populations into frequent contact with source animals. The main reason few tropical diseases arose from domestic animals is that such animals have historically been concentrated mainly in the temperate zones. The sole abundant domestic animal to have originated in the tropics is the chicken, from Southeast Asia.

Copyright 2009 The New York Times Company.

Patterns: A Long, Bright Summer and Many Suicides

Vital Signs

By Nicholas Bakalar
New York Times
Tuesday, May 26, 2009

Greenland has one of the highest suicide rates in the world, and according to a new study suicides peak in the long, bright days of summer.

The study, published online in BMC Psychiatry, looked at 1,351 suicides from 1968 to 2002 and found that the concentration of suicides in the summer was greater north of the Arctic Circle than south. The highest concentration of summer suicides was in the northernmost inhabited region, where the sun remains above the horizon for four months.

The reasons for the summer increase are unclear. Alcohol consumption is associated with suicide, but there was no significant variation in alcohol sales over the course of the year. Major depression, another known factor in suicide, was uncommon, and most of the suicides appeared to be impulsive rather than the result of a diagnosed mental illness.

The authors speculate that sleeplessness caused by constant exposure to sunlight might lead to delirium and suicide. The lead author, Dr. Karin S. Bjorksten of the Karolinska Institute, said that the mechanism may involve disruptions in the sleep cycle and an imbalance in the neurotransmitter serotonin, which is released in greater amounts in bright light. “A lack of sleep may be the key,” she said. “It’s very dangerous when people don’t sleep enough.”

An earlier version of this article misstated the significance of the fact that the highest concentration of summer suicides in Greenland was in the northernmost inhabited region. The population there was small, but the suicide rate was statistically significant.

Copyright 2009 The New York Times Company.

Mexico, US, Canada announce swine flu deaths

The Associated Press
Washington Post
Tuesday, May 26, 2009

CHICAGO -- Authorities in Mexico announced three more swine flu deaths and the United States and Canada one more death each as the world's largest vaccine maker signed a deal with the United States to produce a swine flu vaccine.

The World Health Organization says at least 46 countries have confirmed more than 12,950 swine flu cases. The Mexican death toll now stands at 83, and Canada's is two. The U.S. death is the 12th in the country.

The tiny nation of Bahrain reported Tuesday that a 20-year-old student had come down with mild swine flu _ the first case in a citizen of a Gulf Arab country. Kuwait, another Gulf nation, reported Sunday that 18 U.S. soldiers who passed through were infected with swine flu but had recovered and left the country.

Puerto Rico and the Czech Republic both reported their cases on Monday.

Sanofi Pasteur said Monday it has won a $190 million order from the United States government to make a swine flu vaccine. Sanofi Pasteur, which operates flu vaccine production plants at Swiftwater, Pa., and in Val de Reuil, in France, said it could begin commercial production in June.

Mexico unveiled a $90 million campaign aimed at luring back tourists to the country where the illness has hit hardest. Tourism is Mexico's third-largest source of legal foreign income, but worries over swine flu have sent hotel occupancy rates to a record low.

In the U.S., federal health authorities have confirmed 6,700 swine flu cases, most of them mild. But New York health officials reported another death during the weekend. And Dr. Damon Arnold, director of the Illinois Department of Public Health, said a resident of the Chicago area had died.

Canadian officials said Monday that a Toronto man who had swine flu but also suffered a chronic medical condition died Saturday.
___

On the Net:
Centers for Disease Control and Prevention:http://www.cdc.gov/h1n1flu

World Health Organization:http://www.who.int/

© 2009 The Associated Press.

Vaxart moves possible swine flu vaccine into animal testing

San Francisco Business Times
Tuesday, May 26, 2009

Vaxart Inc. has started animal testing for a possible swine flu vaccine.

The South San Francisco company is one of several biotech companies speeding to develop a vaccine for the H1N1 influenza. Since that strain was first reported in Mexico in early April, there have been 6,764 confirmed or probable cases in the United States, including 10 deaths.

Vaxart could produce its first batch of human H1N1 vaccine by August, the company said, but human testing may not begin until the fall or later.

Experts have warned that rushing to create a vaccine may cause more safety problems than tried-and-true - but slower - means of developing a vaccine.

The Centers for Disease Control has isolated a strain of the H1N1 virus to ship it to vaccine makers - taking about six months before the first large amounts of vaccine are available. Others, like Vaxart, have used the genetic sequence of the virus’ key gene to construct a synthetic version that could lead to speedier production of a vaccine in the form of a capsule.

Vaxart’s candidate vaccine for swine flu was developed 25 days after the company initiated the project.

“Our oral vaccine could provide an important tool for swine flu pandemic preparation, because of the speed with which it could be delivered to groups such as first-line medical personnel,” Sean Tucker, Vaxart’s vice president of research, said in a prepared release.

The federal government has earmarked $1 billion to the search for a swine flu vaccine, the Associated Press reported.

The company, formerly called West Coast Biologicals, also is trying to develop an avian flu vaccine. Its backers have included Life Science Angels, Quantum Technology Partners, Bay Partners and Sand Hill Angels.

All contents of this site © American City Business Journals Inc. All rights reserved.

Opinion

Alternatives to New Drugs

New York Times Letter to the Editor
Tuesday, May 26, 2009

To the Editor:

Re “New Drugs Have Allure, Not Track Record” (Mind, May 19): Richard Friedman is appropriately troubled by the loss of a “larger context” by physicians who prescribe newer, aggressively marketed drugs instead of older, less expensive but more reliable ones. His own therapeutic context is, however, far too narrow.

My own work over the last 40 years, and my reading of the “evidence-based” scientific literature, strongly suggest that an integrative, nonpharmacological approach based on self-awareness and self-care is in many cases superior to drug treatment.

This approach has been shown to enhance biological as well as psychological functioning without the negative side effects of drugs. Moreover, such an approach enhances the self-esteem of patients who, using it, experience the satisfaction of helping themselves.

James S. Gordon, M.D.
Washington

The writer is founder of the Center for Mind-Body Medicine.

Copyright 2009 The New York Times Company.

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