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			Wednesday, May 27, 2009 News Clipping Archives *Maryland / Regional* Maryland law requires insurers to pay doctors for EHR adoption (Healthcare IT News) MedChi leader targets physician shortage (Montgomery County Gazette) Hospitals freeze wages, cut benefits (Annapolis Capital) State to review upcounty hospitals (Montgomery County Gazette) Law keeps some pools closed (Montgomery County Gazette) Man pleads to smuggling 16 million cigarettes (Annapolis Capital) 2 dead from apparent carbon monoxide poisoning (Salisbury Daily Times) *National / International* Two More New Yorkers With Swine Flu Die (New York Times) Test may predict early Alzheimer's disease (Baltimore Sun) Soy milk for a 1-year-old? (Baltimore Sun) The Dangers of Treadmills (New York Times) Antitrust Laws a Hurdle to Health Care Overhaul (New York Times) UN health agency wins prestigious Spanish prize (Washington Post) *Opinion* Maryland bill forces payors to offer EMR incentives (Health Imaging.com Editorial) Fighting off a scourge (Baltimore Sun Commentary) A prescription for healthy babies (Baltimore Sun Commentary) *Maryland / Regional* Maryland law requires insurers to pay doctors for EHR adoption By Diana Manos Healthcare IT News Wednesday, May 27, 2009 ANNAPOLIS, MD – A new law signed by Maryland Gov. Martin O'Malley will coax physicians into making the switch from paper to electronic medical records by requiring private insurance companies to provide financial incentives. Maryland officials have said this is the first state law of its kind to advance EHR adoption in this way. The law also requires Maryland to designate a health information exchange for the state on or before October 1. "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, according to the Baltimore Sun. "Health IT is the future of healthcare in our country, and we want Maryland to lead the way." Health Secretary John Colmers said 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 Sun reported. "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." CareFirst, a large insurer in the mid-Atlantic region, already offers increased reimbursements to doctors who use electronic medical records. Last summer, Maryland began piloting two electronic health exchanges, the Chesapeake Regional Information System for our Patients and the Montgomery County Health Information Exchange Collaborative. Copyright 2009 Healthcare IT News. MedChi leader targets physician shortage Hong Kong émigré John Young ‘will do a great job in improving health care' By Crystal Cranmore Montgomery County Gazette Wednesday, May 27, 2009 Physician John Young has been speaking out about the shortage of physicians in Maryland and now he has an even more visible platform. Young, the newly elected president of the Montgomery County Medical Society, said the recent swine flu outbreak has made people more aware of the weaknesses of Maryland's health care system. "People are seeing how important health care is," said Young, 57, of Potomac, who is also a member of the Governor's Commission on Asian and Pacific American Affairs. "President Obama has made health care one of his top priorities, but what bothers me is that everyone wants to increase access to health care, but no one is addressing how we are going to pay the doctors so that doctors remain viable in this economy." Just last week, Gov. Martin O'Malley (D) announced that he had signed three bills aimed at increasing physician income and helping pay off education loans for doctors who practice in regions where there are shortages. The legislation "puts Maryland's families first by ensuring that doctors are open for business when and where they're needed most," O'Malley said in a statement. "This is another important step in making sure every family in every corner of the state has access to affordable, quality health care." Young, an Ob-Gyn who practices prenatal genetics at Genetics Consultants in Rockville, was an officer of Montgomery MedChi for three years before he was elected president this year and installed in late April. The Montgomery County Medical Society represents more than 1,700 physicians and medical practice members who live and-or practice in the county. It was founded in 1903, and is the largest component of the Maryland State Medical Society, MedChi. According to a study by Montgomery MedChi, Maryland has 259 physicians per 100,000 residents. That is less than the U.S. average of 269 physicians per 100,000, which means Maryland has 16 percent fewer physicians per 100,000 people than the national average. Additionally, the study also estimated that for every 100 students who receive a medical degree from a university in Maryland, only 52 percent practice in the state. Young said initiatives are needed to increase physician reimbursement to help solve the physician shortage. Information from the Maryland Health Care Commission indicates that Maryland physician reimbursements fall below the 25th percentile nationally and that the scarcity of physicians is expected to increase over the next five to 10 years. "People don't believe it because we are surrounded by so many medical centers," said Young. Under normal circumstances, out-of-state doctors replace those who retire in Maryland, "but when Maryland's reimbursement rates are so poor, doctors are less likely to practice in the state," he said. Young will have an impact, said Gene M. Ransom III, executive director of Maryland MedChi. "His leadership skills are well-known in the community," Ransom said. "What is going on in the news right now is highlighting the fact that we need more physicians and we are happy to see Young ascend to president. I think he is going to work well toward improving reimbursement and he'll do a great job in improving health care in Maryland." Young has joined with other concerned physicians to tell state legislators about their low insurance reimbursements. "We are all getting older and health care will become more of an important issue," Young said. "Anything that affects the medical profession will have an impact on the delivery of health care. Our health care system used to be the envy of the world, but it is broken." An immigrant from Hong Kong, Young has lived most of his life in Maryland, graduating with a bachelor's degree from the University of Maryland, College Park, in 1971. He received his medical degree from the University of Maryland School of Medicine in 1975 and did his residency at Johns Hopkins Hospital from 1975 to 1979. Young said he was fortunate to come to the U.S. with his parents to pursue the American dream, thanks to President Kennedy lifting the immigration quota for Asians. Young comes from a long line of physicians, including his mother; also, three nephews are physicians and his son is a pre-med major. Young said that in high school he wanted to become an aerospace engineer because of his strong interest in mathematics, but his mother persuaded him to study medicine. Young, who lives with his wife and three children in Potomac, enjoys traveling and watching sports with his two sons. "I take a family vacation at least once a year and found it to be a tremendous bonding experience," he said. "For instance, last year, my family and I went to Thailand and Hong Kong. This year, we will be going to Southern California." Among his many community activities, Young co-founded the Asian American Chamber of Commerce with three others, including George Dang, president of Acacia Financial Advisors in Rockville. Their goal was to create a more unified voice for businesses within their community. Copyright © 2009 Post-Newsweek Media, Inc./Gazette.Net. Hospitals freeze wages, cut benefits AAMC, BWMC feel impact of recession By Sean Patrick Norris and Shantee Woodards Annapolis Capital Wednesday, May 27, 2009 The recession and new payment standards are forcing Anne Arundel County's two hospitals to impose a variety of cost-cutting measures, including salary reductions and wage freezes. Advertisement Baltimore Washington Medical Center last week announced employee wage freezes and benefit cuts to deal with the deepening impact of the recession. And Anne Arundel Medical Center has been holding employee forums to discuss the upcoming year, which also will include wage freezes and salary reductions for management. At this point, neither hospital is considering job cuts. Both hospitals are in the midst of million-dollar construction projects and predicted little impact to those efforts. AAMC is undergoing a $424 million expansion, which is expected to be complete next year. Meanwhile, BWMC's $117 million construction project will wrap up this fall with the opening of an obstetrics unit. "This is a growing community and we are growing to meet the needs of the community," BWMC President Karen Olscamp said. "We are a bedrock both as a health care provider and an employer." Earlier this year, the Maryland Hospital Association released a study showing that hospitals across the state were seeing widening margins of red ink. BWMC's profit margin dropped 11 percent in the final three months of 2008 and AAMC's dropped 77 percent in that same period, according to the study. In addition, the Health Services Cost Review Commission voted earlier this month to allow hospitals in the state an increase of only 1.77 percent on the amount they can charge patients. That's far less than the 4.5 percent increase approved last year. The new rates will go into effect July 1. At AAMC, wages have been frozen for the next year and management is taking a salary reduction. Hospital officials are also evaluating vacant positions and working with suppliers and vendors on pricing issues. They will continue to fill clinical positions, such as those for nurses, and others dealing with patient care. Starting in September, employer matches for contributions to retirement accounts will be temporarily stopped. The changes impact 3,155 workers employed either at the hospital or with Anne Arundel Health System, AAMC's parent company. "Our next fiscal budget preserves safe patient care - we're not cutting any programs - and unlike many hospitals in the state, we have preserved jobs," AAMC Media Coordinator Justin Paquette wrote in an e-mail. "We're also focused on fulfilling our building commitment to the community and going forward with implementing the electronic medical records we believe will only enhance the level of care AAMC provides. These are all budgetary accomplishments we are proud of." At BWMC, the hospital is suffering from increases in uncompensated care, co-pay fees and investment losses. Olscamp sent employees a letter that outlined the hospital's cost-cutting plans. Starting on July 1, there will be no raises, available overtime will be cut by 10 percent and matching contributions to retirement plans will be reduced by 50 percent. In addition, new employees will have to wait six months instead of three months to enroll in disability plans. Hospital officials said they are exploring every possible avenue for reducing costs, such as negotiating for better prices or terms with suppliers of everything from testing to knee implants. Earlier this year, the hospital implemented an Employee Suggestion Program and held focus groups. "We asked employees if we had to save money, give us some ideas," said Allison Eatough, BWMC spokeswoman. "The one thing that was clear was that they wanted to protect jobs and employee salaries." Copyright 2009 Annapolis Capital. State to review upcounty hospitals Conflict leads to procedure change at health commission By Meghan Tierney Montgomery County Gazette Wednesday, May 27, 2009 The state will conduct a comparative review of two hospitals that have been proposed in the upcounty. Adventist HealthCare, which has been planning a hospital in Clarksburg for several years, has been petitioning state lawmakers and the Maryland Health Care Commission for a comparative review since Holy Cross Hospital's announcement in August that it had begun the formal review process to build a hospital on Montgomery College's Germantown campus. Holy Cross officials opposed a state bill that would have required the commission to conduct a comparative review of the hospitals. The reversal comes because Holy Cross was concerned that Adventist would benefit by seeing Holy Cross' proposal before filing its application, according to Holy Cross officials. The bill, also opposed by the commission, stalled in committee. Holy Cross said last month that it would be willing to participate in a comparative review under certain conditions, and the commission agreed to the proposed solution in a May 18 letter from Commissioner Reviewer Marilyn Moon. Moon will review both projects at the same time and determine which hospital, if any, should be built. She will consider cost-effectiveness, the financial viability of the proposed hospital and impact on existing health care providers. "We're happy we have a good consensus and can move forward with the comparative review," said Pamela Barclay, director of the commission's Center for Hospital Services. "[Building a new hospital] is an important issue, and we'll have a lot of discussion throughout the review." Adventist and Holy Cross officials said they were satisfied. "Any time you're making a major decision about building a hospital, you should look at multiple options," according to Robert Jepson, vice president of government relations and public policy for Adventist. Commission officials have changed the agency's procedures for soliciting letters of intent from health care providers interested in building hospitals. The commission previously only accepted letters of intent twice a year, and Adventist officials argued that the system discouraged competing projects. Adventist filed its letter of intent in February, putting it six months behind Holy Cross, which also plans to expand its Silver Spring hospital. Adventist also submitted a letter of intent in February to build a new Washington Adventist Hospital in the White Oak area of Silver Spring and Montgomery General Hospital in Olney filed to expand an addition that is under construction. The commission now accepts letters of intent, the first step in the review process, for new hospitals all year as long as the commission determines there is a need for additional hospital capacity, according to Barclay. Once the letter is published by the commission, health care providers have 30 days to file their own letters if they want to participate in a comparative review. Replacement hospitals, new construction or renovation and increases in acute care bed capacity at existing hospitals are still subject to the commission's review schedule, Barclay said. Copyright © 2009 Post-Newsweek Media, Inc./Gazette.Net. Law keeps some pools closed Facilities need upgraded drains to comply with safety regulations By Bradford Pearson Montgomery County Gazette Wednesday, May 27, 2009 Three public county-operated pools and other private and community pools across the county were not allowed to open Memorial Day weekend — traditionally the beginning of the swimming season — because they failed to complete necessary safety upgrades and inspections in time or the holiday. Pools in Bethesda, Germantown and Wheaton remained closed last weekend as the county waited for custom-made drains to be installed so the pools would comply with new federal regulations requiring safe drains and anti-entrapment systems. "It's been a challenge for the industry, and it's been a challenge for us to review and respond to each pool," said John Munley, a program manager with the licensure and regulatory services branch of the county Health and Human Services Department. "But I don't think the compliance has been a major challenge; this is something they've known about." The new regulations are outlined in the Virginia Graeme Baker Pool and Spa Safety Act, which went into effect this year, Munley said. The law is named for the granddaughter of former Secretary of State James Baker who died at the age of 7 in 2002 after she was entrapped by the suction of a spa drain. The new drain covers required by the law are designed to prevent swimmers from drowning when their hair becomes entangled in drains. The main pool was closed at Bethesda Pool on Little Falls Parkway, while a smaller lap pool, junior pool and tot pools were all open, according to the county recreation department. At the Germantown Outdoor Pool, the shallow pool was closed, while the main pool and tot pool were open and at Wheaton/Glenmont Pool the leisure pool was closed, but all other pools were open. As of Thursday afternoon, 19 pools and spas in the county, plus the three county-operated pools, had not yet submitted their VGB Pool and Spa Safety Act inspection form, Munley said. The number was down from 90 earlier in the week, he said. More current numbers were not available Tuesday by The Gazette's deadline, though Munley said last week that the number would drop as more inspections were done. Pools and spas that did not submit their inspection forms were not allowed to open, he said. The county inspects 71 indoor pools, 488 outdoor pools, 262 wading pools and 76 spas multiple times each year, Munley said, so the 19 locations not in compliance represent a small fraction of the total number of locations countywide. In addition to the 19 pools and spas that had not complied with the new law as of Thursday, seven pools elected to open later in the season, and another 20 pools were given a variance that allowed them to open this season despite not making the necessary safety upgrades. The drains in these pools were generally in deep areas where a swimmer was not in danger, Munley said, but the pools will need to be in compliance for 2010. The county employs 17 field inspectors who inspect swimming pools in addition to restaurants, camps, public schools and other locations, Munley said. The Bethesda, Germantown and Wheaton pools were made by different contractors and therefore had different sized pumps, so drain covers had to be produced by different companies, complicating the upgrade process, said Robin Riley, a division chief for the department of recreation. Sean Ruttkay, pool manager at the Garrett Park Community Pool, said as soon as he heard about the regulations this spring he immediately contacted a pool maintenance company to complete the upgrades. "I talked to my guy a month ago, and he hooked it up pretty good," he said. "Luckily I was proactive so I didn't have a problem." After $3,000 of improvements, the community's two pools on Cambria Avenue opened right on time. According to the United States Consumer Product Safety Commission, failure to comply with the new regulations will result in a closure of the pool or spa. "[The] CPSC would like to quell rumors that we intend to bring million dollar fines or prison sentences against individual pool and spa operators," the commission said in a written statement. "The Act does allow for the closure of a non-compliant pool until the owner/operator can successfully bring the facility into compliance." Despite the more stringent guidelines, the Association of Pool & Spa Professionals, a group dedicated to representing swimming pool, spa, and hot tub builders, supported the act. "We thought it was an effective to save people from entrapment," said Dick Wolfe, a spokesman for the group. "When it became clear that there was a way to improve pools, we were all for it." Staff Writer Meghan Tierney contributed to this report. Copyright © 2009 Post-Newsweek Media, Inc./Gazette.Net. Man pleads to smuggling 16 million cigarettes Associated Press By Matthew Barakat Annapolis Capital Wednesday, May 27, 2009 ALEXANDRIA, Va. (AP) — A New Jersey man pleaded guilty Tuesday to smuggling nearly 16 million cigarettes he bought from undercover federal agents in Virginia to sell in New York and New Jersey. Advertisement Mark A. Frondelli, 48, of Parlin, N.J., admitted as part of a plea agreement in U.S. District Court in Alexandria that he paid more than $2.3 million in cash in 47 separate transactions with undercover agents between November 2007 and August 2008. Nearly all of the purchases were made in northern Virginia, though some were made in New Jersey and Maryland. Frondelli bought untaxed cigarettes from the undercover agents and took them for black-market sale to areas like New York City, where required tax stamps add $4.25 to the price of a pack of cigarettes. Authorities estimate state and local governments were cheated out of about $2.1 million in tax revenue from the illegal purchases. Mike Campbell, a spokesman for the Washington field office of the Bureau of Alcohol, Tobacco, Firearms and Explosives, said Fairfax County has become a hot spot for cigarette smugglers. As cigarette taxes have increased in some states, so has the profit opportunity for smugglers. Campbell said one recent case involved an offer to pay for contraband cigarettes with a kilogram of cocaine; another case revealed links to Korean organized crime. Investigations like that of Frondelli can sometimes take several months and multiple purchases, Campbell said, because investigators are looking to track down others who might be involved in criminal conduct. "Most every case we investigate doesn't end with one person," Campbell said. Frondelli is scheduled for sentencing on Aug. 7 and faces up to five years in prison. His lawyer, Christopher Amolsch, said his client accepts full responsibility for his actions. Last year in Kentucky, a federal judge sentenced a Chicago man to 30 months in prison for smuggling 9 million cigarettes from Kentucky to Chicago and New York. Copyright 2009 Annapolis Capital. 2 dead from apparent carbon monoxide poisoning Associated Press Salisbury Daily Times Wednesday, May 27, 2009 PORTSMOUTH, Va. (AP) — Portsmouth fire officials say two men are dead from apparent carbon monoxide poisoning, and a third victim was hospitalized after inhaling the lethal gas. Fire department spokesman Capt. Paul Hoyle says authorities went to a home shortly after 9 a.m. Wednesday after getting a call from a contractor who was scheduled to work at the house. Hoyle said the contractor heard what he thought was a generator running inside. The rescuers found two men dead, and crews took a woman to a local hospital. Hospital spokeswoman Lynne Zultanky said she was in critical condition. Hoyle said that investigators were withholding the names of the people who died until their relatives could be notified. Copyright 2009 The Associated Press. All rights reserved. *National / International* Two More New Yorkers With Swine Flu Die By Anemona Hartocollis New York Times Wednesday, May 27, 2009 Two more New Yorkers have died with confirmed cases of swine flu, the city’s health commissioner said on Tuesday, bringing the city’s total number of deaths related to the virus to four. Emergency room visits and hospitalizations also continued to rise. The commissioner, Dr. Thomas R. Frieden, said the two latest casualties, a 41-year-old woman in Queens and a 34-year-old man in Brooklyn, were linked to the H1N1 virus by lab tests completed on Monday and Tuesday. Both patients had underlying health conditions that put them more at risk, he said. He added that he could not say officially whether the flu had caused their deaths until autopsies were finished. Both died on Friday. Officials have cited underlying conditions as a factor in all four deaths in the city, but they have not revealed those conditions, citing medical confidentiality. Five more public schools were closed on Tuesday because of suspected swine flu cases, while more than a dozen that had been closed were reopened. “It’s good that they’re back because they were missing a lot of school days, but in a way it’s frightening,” said Elizabeth Rosa, 33, a home attendant, after seeing off her daughter, Jasilyn, 11, and son, Kristian, 8, at the entrance of Public School 19 in Corona, Queens. “When I kissed them goodbye I thought, ‘Is it going to be O.K.? Is the school safe?’ ” Dr. Frieden, speaking at a news conference at the health department, noted that both patients who died were relatively young. Health officials have said that there is some evidence that people born before 1957 may have been exposed to a similar virus and may have some immunity to the novel strain of flu that is circulating. Hospitals that normally get about 200 visits to the emergency room each day are getting 2,000 per day, he said, and more than 25,000 people have gone to emergency rooms over the past month. The numbers are highest in Queens, but are increasing in Brooklyn and, to a lesser extent, in the Bronx and Manhattan. Over the last five days, he said, 20 to 25 people a day have been hospitalized with the flu. Before the weekend, the city had recorded only 57 hospitalizations for flu during the entire preceding 30 days. Dr. Frieden said the numbers of emergency room visits have been rising over the past week, perhaps driven by the publicity surrounding the deaths, but also by the pervasiveness of the virus through the general population. To put the current situation in perspective, Dr. Frieden said that in a regular flu season, 400,000 to 1 million New Yorkers get the flu, and about a third of them never even realize it. Of those who have gone to the emergency room, fewer than 1 in 50 needed to be admitted to the hospital, Dr. Frieden said. “The vast majority of people going to the hospital emergency department probably shouldn’t be going,” Dr. Frieden said. Similarly, he said, a spot check of schools with high absenteeism showed that two-thirds of the children who were kept home were not sick. The pressure on emergency rooms could be seen on Tuesday at Maimonides Medical Center in Brooklyn, where many sick parents came in with sick children. The hospital created a flu clinic in an area that usually accommodates patients who have been admitted and are waiting for a bed. It was filled on Tuesday with people in masks being evaluated for flu. Last year in May, the Maimonides emergency room saw an average of 263 patients a day. On Monday, emergency room doctors saw 480 patients. “The consensus among these physicians,” said Dr. Steven J. Davidson, the chairman of the hospital’s emergency medicine department, “is that the influenza is mild but the patients are unusually scared.” While the ailments that may have made the four New Yorkers who died more vulnerable to the flu have not been identified, federal and city health officials have released a list of conditions that increase the risk from flu. They include being older than 65 or younger than 2; respiratory ailments like asthma or emphysema; a weakened immune system because of pregnancy, diabetes or immune-suppressing drugs like steroids; tuberculosis; heart disease; kidney disease; and morbid obesity. With reports of new flu cases tapering off around the country — except in New York, New Jersey and New England — federal health officials said on Tuesday that they would concentrate on tracking the swine flu’s progress in the Southern Hemisphere and preparing for a surge of cases in the fall. Outside of the Northeast, reports of people with flu symptoms who visited doctors and hospitals dropped to normal levels for late May, said Dr. Anne Schuchat, director of immunization and respiratory disease for the Centers for Disease Control and Prevention. Although Dr. Schuchat would not say that the flu had peaked for the season, she said the country was “at a transition point” and officials would look ahead to the next season, which usually begins in November. Since the flu was identified in New York in late April, the city has closed 42 schools in 31 buildings, Dr. Frieden said. Schools have generally been closed for five days. Since then, 25 have reopened, including about 20 on Tuesday. Most of the newly reopened schools had more than 85 percent attendance on Tuesday, although more than a quarter of the students at Public School 35 in Hollis, Queens, were absent. The handful of schools that reopened on Friday also appeared to have resumed normal routines, with more than 90 percent in attendance, according to the Department of Education’s Web site. A spokeswoman for the department, Marge Feinberg, said that the overall attendance rate in the city was 82 percent on Tuesday, compared with 87 percent on May 4, before the flu had struck many students. The attendance rate in Queens was 82.6 percent on Tuesday, compared with 88.5 percent at the beginning of May. Five additional schools are to be closed on Wednesday until Monday: Q811, a special education program at P.S. 822 in St. Albans, Queens; P.S. 231, a special education school inside P.S. 180 in Bensonhurst, Brooklyn (the rest of the building is open); P.S. 369 in Boerum Hill, Brooklyn (only the special education part of the building); P.S. 68 in Wakefield, the Bronx; and the Audubon School (P.S. 128) in Washington Heights. Reporting was contributed by Ann Farmer, Donald G. McNeil Jr., Jennifer Medina and Mathew R. Warren. Copyright 2009 The New York Times Company. Test may predict early Alzheimer's disease Associated Press By Linda A. Johnson Baltimore Sun Wednesday, May 27, 2009 TRENTON, N.J. - A research institute devoted to Alzheimer's and related diseases has teamed up with a major maker of diagnostic tests to speed development of what could be the first test to detect Alzheimer's in its early stages. If all goes well, the first commercial version of the test could be available in 12 to 18 months, possibly enabling patients to try to slow progression of the increasingly common disease, said Dr. Daniel Alkon, scientific director of the Blanchette Rockefeller Neurosciences Institute. "This may be a way of monitoring how effective a treatment is for Alzheimer's disease" as well, through periodic retesting once scientists can develop a medicine to stop the mind-robbing disease, Alkon told the Associated Press in an exclusive interview Tuesday. Alkon's institute, based at West Virginia University and affiliated with Johns Hopkins University, on Wednesday was to announce a multimillion-dollar contract with Inverness Medical Innovations Inc. of Waltham, Mass. Inverness will fund development of the Alzheimer's test and future improvements, including an eventual home version, for at least three years. The test works by detecting abnormal function of a protein that has been shown to be involved in memory storage, Alkon said. First, a small sample of cells is removed from a patient's skin at a doctor's office or testing center and shipped to the institute. There, scientists grow the skin cells in a glass dish and add a substance to stimulate an enzyme called PKC to make the protein combine with the element phosphorous inside the skin cells. If too much phosphorous ends up in the combination, then the patient has Alzheimer's, Alkon said. So far, the test has been tried on more than 300 patients at 15 hospitals, including 42 for whom the Alzheimer's diagnosis was later confirmed by an autopsy showing the disease's signature pattern of brain damage -- the only definitive way to diagnose it. The test was 98 percent accurate on the autopsied patients. But of those, only 11 had early Alzheimer's, as very few people die within three or four years of the disease starting. Alkon hopes to test thousands more patients before his diagnostic test is marketed. Dr. Ralph Nixon, vice chairman of the Alzheimer's Association's medical and scientific advisory council, said the institute's test needs more evaluation, particularly among patients with early symptoms, to determine its accuracy. Researchers elsewhere also need to be able to duplicate the results. "I think it's a potentially promising direction ... that has some basis in the science of Alzheimer's disease," said Nixon, a professor of psychiatry and cell biology at New York University School of Medicine. Currently, diagnosis of early Alzheimer's often is wrong, because it's based on evaluating a patient's behavior and trying to rule out other causes for symptoms such as forgetfulness. Nixon said early diagnosis would help patients plan their future and even take steps to slow the disease, such as improving their diet and getting more "mental exercise" or getting into a clinical study of one of the many promising experimental drugs. Alkon said his group's test might be particularly helpful for people with a family history of Alzheimer's worried about their risk. "It's not invasive," he said, an advantage over tests in development that require painful removal of cerebrospinal fluid. He said the test would only cost a few hundred dollars, making it much cheaper than advanced brain imaging, which can show a pattern of plaque buildup in the brain that indicates a person might eventually develop Alzheimer's. Meanwhile, the institute just got U.S. approval to start its first small test in Alzheimer's patients of what might turn out to be a treatment, what Alkon describes as an "incredibly potent" natural substance that activates the PKC enzyme. "It's not unreasonable," Nixon said, but it's too early to tell whether that approach would work. Inverness makes the Home Check consumer test for abuse of illegal and prescription drugs, plus tests for doctors and hospitals to determine pregnancy, fertility, cholesterol levels and early stage bladder cancer. The institute was founded by West Virginia Sen. Jay Rockefeller in memory of his mother, Blanchette Hooker Rockefeller, who died of Alzheimer's disease. More than 5 million Americans have Alzheimer's disease, a number growing steadily as the population ages. Early symptoms such as trouble recalling recent events or where keys are worsen to being unable to recognize loved ones, losing all sense of time and place, wandering and physical aggression. Alzheimer's is one of the hottest areas of research in the pharmaceutical and biotechnology industries, with companies trying to develop treatments that would actually stop or reverse the course of the disease. Copyright 2009 Baltimore Sun. Soy milk for a 1-year-old? By Kate Shatzkin Baltimore Sun Wednesday, May 27, 2009 Michelle, our contest winner, asked about feeding her 1-year-old daughter soy milk instead of cow's milk as she makes the transition from drinking formula. Julie Yeh, a pediatrician at Greater Baltimore Medical Center, says it's OK. Here's her answer: "It is traditionally recommended that infants are breastfed as long as possible, ideally until 1 year of age. When the time comes for the baby to be weaned off the breast, an iron-fortified formula is recommended until age 1. In an otherwise healthy infant, there is no advantage in using a soy-based formula vs. a cow's milk based formula. "After 1 year of age, the recommendation is to introduce whole cow's milk. If there is a large concern for obesity or cardiovascular disease in either the infant or the family, then a low-fat milk can be substituted under the instruction of your pediatrician. If preferred, soy milk is a healthy alternative to cow's milk after 1 year of age and provides nearly equal amounts of calcium and is more iron rich. "Soy milk is lower in fat content, which may be beneficial in those at risk for obesity. However, in infants in whom poor weight gain or nutrition is a concern, the use of soy milk under age 2 should be discussed with your doctor. "Children who continue to demonstrate a cow's milk protein allergy after one year of age often do well with soy milk. Both whole milk and soy milk are not recommended under a year of age. After age 2, children can continue on either low fat cow's milk or soy milk. So, in this case, it is perfectly fine to use soy milk as an alternative to cow's milk, especially if there is adequate dairy intake through cheese and yogurt." Copyright 2009 Baltimore Sun. The Dangers of Treadmills By Tara Parker-Pope New York Times Wednesday, May 27, 2009 The death of Mike Tyson’s 4-year-old daughter after a treadmill accident has highlighted the dangers that home exercise equipment poses to children. The child, Exodus Tyson, was discovered with a treadmill cord around her neck. The girl was found by her brother while her mother was cleaning in another room. Doctors estimate about 25,000 children end up in the emergency room each year as a result of injuries related to home exercise equipment. According to Consumer Reports, children can be harmed in a variety of ways. Emergency rooms around the country are reporting a growing number of severe burns on the hands and fingers of young children who reach down or under and touch the treadmill belt when it’s running. Though some incidents occur when unsupervised children are playing with unlocked equipment, many occur when children approach from behind as a parent is using the equipment. Curious hands that reach out and touch the moving belt or reach under the machine can suffer excruciating burns that can require multiple skin grafts and cause permanent disability. Last summer, an Australian study found that treadmill friction injuries accounted for about 1 percent of pediatric burns, but concluded that the incidence of these injuries is on the rise. The Australian government has launched a campaign called “Treadmills and Kids Don’t Mix!” In June, a new safety standard will take effect in the country, requiring all new treadmills to carry a prominent warning sticker to alert treadmill users to keep children away from machines when they are in use. Parents should keep home exercise equipment locked and unplugged so children can’t start the machines on their own. Equipment should also be positioned so parents have a clear view of their surroundings and can see children approach the equipment when they are using it. Copyright 2009 The New York Times Company. Antitrust Laws a Hurdle to Health Care Overhaul By Robert Pear New York Times Wednesday, May 27, 2009 WASHINGTON — President Obama’s campaign to cut health costs by $2 trillion over the next decade, announced with fanfare two weeks ago, may have hit another snag: the nation’s antitrust laws. Antitrust lawyers say doctors, hospitals, insurance companies and drug makers will be running huge legal risks if they get together and agree on a strategy to hold down prices and reduce the growth of health spending. Robert F. Leibenluft, a former official at the Federal Trade Commission, said, “Any agreement among competitors with regard to prices or price increases — even if they set a maximum — would raise legal concerns.” Already, some leaders of the health care industry who appeared at the White House on May 11 say the president may have overstated their cost-control commitment. Three days after the gathering, hospital executives said that they had agreed to help save $2 trillion by gradually slowing the growth of health spending, but that they did not commit to cutting the growth rate by 1.5 percentage points each year for 10 years. White House officials say even the more limited commitment is significant. Under current law, federal officials predict that health spending will grow an average of 6.2 percent a year, to $4.4 trillion in 2018. Mr. Obama is asking the industry for detailed proposals to control costs. But so far the administration has not offered the industry any relief from antitrust laws and has, in fact, vowed to step up enforcement. As a presidential candidate, Mr. Obama said consumers had suffered because of “lax enforcement” of antitrust laws in many health insurance markets. In 1993, when President Bill Clinton made the last major effort to overhaul the health care system, the lobby for the drug industry, then known as the Pharmaceutical Manufacturers Association, devised a voluntary cost-control plan. Under it, each drug company offered to limit the annual increase in the average price of its prescription drug products to the increase in the Consumer Price Index. The Justice Department rejected the proposal, saying it would violate antitrust laws. In blocking the proposal, the department said the Supreme Court had made clear that agreements setting maximum prices were just as illegal as agreements that set minimum ones. “Such maximum price-fixing agreements create the risk that the maximum prices will become minimum or uniform prices,” the department said in a business review letter signed Oct. 1, 1993, by Anne K. Bingaman, then the assistant attorney general in charge of the antitrust division. In 1978, hospitals also asked the Justice Department for an assurance they would not be charged with antitrust violations when they undertook a “voluntary effort” to curb costs as an alternative to legislation proposed by President Jimmy Carter. The department would not provide such an assurance. Many savings now envisioned by the health care industry would require much closer cooperation by independent doctors and hospitals, taking them into a gray area of the law where federal agencies have not provided clear guidance. In a recent letter to the Senate Finance Committee, the American Hospital Association said uncertainty about enforcement of the antitrust laws “makes it difficult for a hospital and doctors to collaborate to improve care” and lower costs. Doctors often want to collaborate and share information about prices without sharing financial risk or fully merging their office practices. The American Medical Association has asked Congress to revise antitrust laws so doctors can collectively negotiate with insurers over fees and other issues. The Federal Trade Commission has repeatedly challenged such collective action as illegal price-fixing, even though doctors say they are at a severe disadvantage in trying to negotiate with giant insurance companies. A new study by an economist at Northwestern University, Leemore S. Dafny, finds that a growing number of geographic markets are dominated by a handful of insurance companies, and that the decline in competition may contribute to higher prices. Among the groups that say they have joined together to rein in health costs, besides the hospital and medical associations, are America’s Health Insurance Plans and the Pharmaceutical Research and Manufacturers of America. Jamie Court, the president of Consumer Watchdog, an advocacy group, said he was wary of such joint efforts. “When companies that control the health care system get together to change it, there is a serious risk that they are doing it to stifle competition at the expense of consumers,” Mr. Court said. The Federal Trade Commission says that while cooperation among health care providers can benefit consumers, it can also increase the bargaining power of hospitals and doctors, making it easier for them to set prices and eliminate competition. Copyright 2009 The New York Times Company. UN health agency wins prestigious Spanish prize Associated Press By Paul Haven Washington Post Wednesday, May 27, 2009 MADRID, Spain -- The World Health Organization, which has helped spearhead efforts to contain swine flu, won Spain's prestigious Prince of Asturias prize on Wednesday for its work fighting global killers such as AIDS, polio and tuberculosis. The jury also singled out the Geneva-based U.N. health organization for its efforts to lower infant mortality rates and reduce tobacco consumption around the world. "WHO is one of the most respected international institutions for its remarkable work fostering coordination and cooperation between countries in health matters," the foundation said in announcing the award. WHO has nearly 150 country offices and some 8,000 employees. Along with the Atlanta-based U.S. Centers for Disease Control and Prevention, it has been at the forefront of the fight against swine flu and efforts to produce a swine flu vaccine. Some health activists, however, have criticized WHO for focusing so much on the swine flu epidemic, saying it has neglected other serious diseases. The Asturias Prize announced Wednesday, for international cooperation, is one of eight the Prince of Asturias Foundation gives out yearly. Last week, British architect Norman Foster won the arts prize. Four other prizes _ in social sciences, humanities, scientific research and literature _ will be announced each week in June. Two others, for sports and "concord," a category that honors those who work for peace or fight poverty, will be announced in September. Each carries a euro50,000 ($70,000) cash stipend and a sculpture by Joan Miro. The prizes are named after Spain's Crown Prince Felipe, whose formal title is Prince of Asturias, a region of northern Spain. Last year, the international cooperation prize went to four African malaria research centers and in 2007 it was awarded to Al Gore, the former U.S. vice president and Nobel Peace prize winner, for his work fighting global warming. © 2009 The Associated Press. *Opinion* Maryland bill forces payors to offer EMR incentives Health Imaging.com Editorial Tuesday, May 27, 2009 Maryland Governor Martin O'Malley signed a bill on May 19 intended to coax doctors into using EMRs by requiring private insurance companies to offer financial incentives for adopting the technology. Doctors who do not bring an EMR system online by 2015 could face penalties, according to the new state legislation. "This is where government and private healthcare 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 healthcare in our country, and we want Maryland to lead the way." The bill requires the state to develop a health information exchange for all of Maryland's physicians, hospitals, medical laboratories and pharmacies. The Baltimore Sun reported that 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 called it "creating one common gauge of railroad track." The legistlation also allows insurers to choose among several forms of inducement-increased reimbursements, lump-sum payments or in-kind services--as long as it has monetary value. "The goal here in Maryland was to assure that all of the payors pull their oars in the same direction," Maryland Health Secretary John Colmers said. "There is a great promise in EHRs, but the greatest promise comes when it's done in a coordinated fashion, across all of the payors." Copyright 2009 HealthImaging.com. Fighting off a scourge HIV/AIDS devastates black America, but a new campaign offers hope By Kevin Fenton Baltimore Sun Commentary Wednesday, May 27, 2009 Nearly 30 years after the discovery of HIV and AIDS, the epidemic is still ravaging black neighborhoods in Baltimore and across the nation. Unfortunately, complacency about HIV and the continued stigma associated with the disease are hindering progress by preventing too many African-Americans from seeking either HIV testing and treatment or support from their friends and family. But this is a challenge that can be overcome. At a White House event last month, the Obama administration took an important step in confronting the United States' HIV epidemic, which threatens the health of African-Americans more than any other racial or ethnic group. Joined by some of the nation's most influential African-American leaders, the Centers for Disease Control and Prevention (CDC) and administration officials announced Act Against AIDS, a five-year communication campaign designed to refocus the nation's attention on the HIV crisis here at home. The campaign highlights the fact that every 9 1/2 minutes, someone in the United States becomes infected with HIV. That statistic is based on CDC estimates released last year, which found that approximately 56,000 Americans become newly infected with HIV annually - and that nearly half of them are black. The harsh reality is that one in 16 black men and one in 30 black women will be diagnosed with HIV during their lifetime. The epidemic has a severe impact on all regions of the country, but Baltimore is one of the hardest-hit places. The Baltimore metropolitan area has the fifth-highest rate of reported AIDS cases in the country - more than double the national average. The vast majority of cases in Baltimore are among blacks. In 2009, HIV and AIDS should not be taking such a toll. As part of the new campaign, 14 of the nation's leading African-American civic organizations - from the Baltimore-based NAACP and the Urban League to the Southern Christian Leadership Conference and the National Council of Negro Women - are joining the CDC to increase knowledge, awareness and action within black communities across the country. This new initiative will harness the strength and reach of these organizations by enhancing their ability to make HIV prevention a core component of their daily activities. The CDC is providing $10 million over the next five years to enable these organizations to support HIV coordinators, who will deliver critical information about HIV through each organization's chapters and help African-Americans throughout the nation access HIV prevention and testing services. By raising the visibility of HIV and AIDS, the new campaign also aims to confront and overcome the fear and stigma that help keep HIV alive in black communities. We need to talk openly about tough, uncomfortable issues like homophobia. I have been encouraged in recent years to see black leaders, including black faith leaders, speak out more openly across the nation about the need to confront HIV and the stigma that persists surrounding this disease. And I was moved that Dorothy Height - a civil rights pioneer and, at age 97, chair of the National Council of Negro Women - addressed stigma head-on when she spoke at the White House event. "We need to be able to talk about HIV as we talk about jobs, as we talk about housing, as we talk about civil rights," she said. "We all have a responsibility to break the silence about this disease." Ending this epidemic will require not only frank and difficult discussions about HIV but also a shared sense of responsibility and commitment. All of us can and must be part of the solution. Dr. Kevin Fenton is director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention at the Centers for Disease Control and Prevention. For more information about the campaign and HIV, visit www.NineAndaHalfMinutes.org. Copyright 2009 Baltimore Sun. A prescription for healthy babies By Jay Wolvovsky Baltimore Sun Commentary Saturday, March 23, 2009 Lack of health insurance drives many people to under- and over-utilize health services in ways that are costly to taxpayers and damaging to their long-term health. The ranks of the uninsured are swelling each day, and we can expect the human and financial costs of inadequate preventive and primary care to rise in proportion. Recent local reports have highlighted a classic example: our health financing system's shortsighted investment in acute care over preventive care. This newspaper's recent call for expanding coverage for women who have had a poor pregnancy outcome does not go far enough. It focuses on intervening after the problem has manifested - too much in line with the flawed policy approach that has gotten us to where we are today. The Baltimore Health Department reports that in 2007, Baltimore's overall rate for low-birthweight babies was 12.8 percent, and in Maryland the rate was 9.1 percent. At Baltimore Medical System, we delivered 1,497 babies last year; only 8.15 percent had low birthweights. Yet our patients represent all the highest-risk categories: the working poor, the newly immigrated, people living in long-term poverty and the unemployed. A well-thought-out prescription for healthy babies would be comprehensive and truly preventive in its approach. It would include preventive care for all low-income families, including women before they become pregnant (and not forgetting fathers, who are marginalized by benefits that focus only on women). That system should be designed with incentives at the primary care level - the least costly and most holistic link in our fragmented health system. Such a system needs to embrace new immigrants as well, many of whom are not eligible for coverage within the current system until their date of delivery under an "emergency Medicaid" provision. There is no better way to make a birth an emergency, with all the ensuing negative consequences for the family and for society, than to not provide coverage until the date of delivery. And the cost of one day in a neonatal intensive care unit is more than the cost of providing care for the whole prenatal period. How is a community health provider to keep meeting this growing need with grants that remain fixed at a static level and with limited space? The health care financing system puts us at risk at every step, with inadequate reimbursement of our basic health services and inadequate capital investment in our facilities. It doesn't take a pilot study to show that if you give women access to comprehensive, accessible, affordable and culturally competent care, you can cut down on low birthweights and reduce all the attendant economic and human costs. What we need is health care reform, putting the money where the problem and the solution both lie - in community-based primary and preventive care. Anything less than a comprehensive approach toward prenatal services risks throwing good money after bad. Copyright 2009 Baltimore Sun. BACK TO TOP


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