DHMH Daily News Clippings

Sunday, November 6, 2005
News Clipping Archives
Correction (Baltimore Sun)
Political Winds Blowing Smoke-Free (Washington Post)
AIDS Rally Calls Attention to Disease's Devastation Among Blacks (Washington Post)
Blood bank accredited (Cumberland Times-News)
Seniors urged to do homework on Medicare Part D (Annapolis Capital)
Sentries in U.S. Seek Early Signs of the Avian Flu (New York Times)
Hawaii monitors airport for bird flu (Baltimore Sun)
Hitting the Flu at Its Source, Before It Hits Us (New York Times)
Changing vaccine systems no easy shot (Baltimore Sun)
Indonesia Stretched to the Limit In Battle Against Two Diseases (Washington Post)
Passport to Health Care At Lower Cost to Patient (Washington Post)
Clearing the air in Howard (Baltimore Sun Editorial)
A Hospital Plan for Pandemics (Washington Post Commentary)
The Benefits of Mammograms (New York Times Editorial)
A line drawn wrong (Baltimore Sun Editorial)
Facts about Medicare Part D prescription program (Hagerstown Herald-Mail Commentary)
Pandemic ammo (Washington Times Commentary)
To Fight the Flu, Change How Government Works (New York Times Commentary)
Warning: Some Health Ads May Be Dangerous to Your Health (Washington Post Commentary)

Baltimore Sun
Sunday, November 6, 2005
The Sun is committed to providing fair and accurate coverage. Readers who have concerns or comments are encouraged to call Paul Moore, the newspaper's public editor. He can be reached at 410-332-6364 or toll free at 1-800-829-8000, ext 6364, or by e-mail at publiceditor@baltsun.com
An article on flu shots in yesterday's edition incorrectly stated that Maryland has yet to record any cases of influenza this season. The state Department of Health and Mental Hygiene reported Thursday that a woman had come down with a confirmed case of the "B" strain.
The Sun regrets the error.
Copyright © 2005, The Baltimore Sun

Political Winds Blowing Smoke-Free
Lobbyist Struggles As Bans Multiply Through D.C. Area
By Dan Morse
Washington Post Staff Writer
Sunday, November 6, 2005; C06
Montgomery County, Melvin Thompson could understand. It's filled with government workers. "There's a tendency to believe that government can solve problems for you," he said.
Similar sentiments run in Howard County,home to Columbia, the giant planned community. It wasn't until Prince George's County moved last month to outlaw smoking in bars and restaurants, he says, that he fully understood how rapidly smoke-free forces can now move through jurisdictions.
Thompson is a lobbyist for restaurant and bar owners in Maryland. He fights proposed smoking bans. Tracking his recent efforts helps explain how an area stretching from the District to just south of Baltimore could soon become a no-fly zone for smoking in bars and restaurants.
The Montgomery County ordinance is two years old. Howard's ban was proposed Oct. 25. The next day, a D.C. Council committee approved its measure. In Prince George's, council members will hold a hearing Tuesday and are poised to pass it.
"Initially, I wouldn't have said Prince George's was vulnerable," Thompson said, citing the county's desire to lure sit-down restaurants, concerns raised by the county's chamber of commerce and a strong working-class bar crowd near the Route 1 corridor.
But statistics indicate that fewer than one in four voters smoke. At the same time, anti-smoking advocates have been presenting politicians with more research concluding that the bans don't hurt the restaurant business overall and that they protect workers from secondhand smoke. Last month, Montgomery released a study showing that its ban hasn't hurt its hospitality industry.
"In terms of what's good for votes, it's a political no-brainer," said Thompson, who asserts that many of the studies are flawed.
In Virginia, where tobacco interests have long held political sway, a statewide ban on smoking in bars and restaurants seems unlikely anytime soon. And because the state's constitution generally forbids counties from passing laws more restrictive than the state's, local jurisdictions are hindered in efforts to pass anti-smoking measures. Still, in Alexandria, more than 50 restaurants have voluntarily agreed to ban smoking on their premises, according to city officials.
"I think the entire state of Maryland and D.C. within the next two years will be smoke-free," said Kari Appler, executive director of the Smoke Free Maryland Coalition and Thompson's political arch-opponent on the issue.
Thompson said there are plenty of battlegrounds left, such as Anne Arundel and Baltimore counties. Smoke Free Maryland's polling data show that although support is strong for statewide bans in suburban Washington, it drops to 55 percent in suburban Baltimore.
Thompson and his supporters say the bans hit certain establishments hard, such as those catering to sports fans and draft beer drinkers. Thompson also takes the position that the known dangers of secondhand smoke are repeatedly overcooked. But, he said, sighing, fewer politicians want to hear his arguments.
"I don't need a ton of bricks to fall down on my head to know they don't want to sit down with us," he said of the Prince George's County Council's nine members, only two of whom have returned his recent calls.
Thompson earlier worked for U.S. Rep. Wayne T. Gilchrest, a Republican from Maryland's Eastern Shore. He then pursued a longtime dream and worked as an assistant chef in a French restaurant. He and his wife didn't like the hours, so he returned to politics, joining the Restaurant Association of Maryland five years ago.
In fighting this battle, he also faces challenges from his own side. He doesn't get much help from big chains, such as Outback Steakhouse and the Olive Garden, that survive more on dinner volume than bar receipts, independent restaurant owners say. Even some Maryland restaurant and bar owners who are members of his organization tell lawmakers they'd be willing to live with a statewide ban if the District follows through with its own legislation, eliminating that competition.
And when Thompson tries to generate momentum among smokers, such as recently faxing material to bars in Prince George's, those folks tend not to show up at public hearings, where ardent smoking foes regularly do, he said.
Local officials certainly are following trends. At least seven states, including California, New York and Delaware, and 180 localities, insist on smoke-free bars and restaurants. Even Ireland now forbids smoking in pubs.
In Maryland, smoke-free proponents say that Thompson is too quick to cite politics and criticize research and that local officials simply are trying to promote safe environments for all workers.
Debates on smoking in Maryland bars stretch back to at least the early 1990s. In 1993, Howard and Anne Arundel counties and the city of Baltimore proposed cutting back. Even the restaurant association seemed to agree about the dangers.
"We see more and more scientific reports linking exposure of tobacco smoke with illnesses," Paula Kreuzburg, the association's then-president, wrote in a memo to the group's board of directors, according to a copy of the memo posted under the "Secret Documents" section of the Smoke Free Maryland Coalition's Web site.
In 1995, Maryland enacted rules barring smoking in indoor workplaces. But state politicians carved out exemptions for restaurants and bars. The industry's argument has long been that restaurants, and particularly bars, aren't like airplanes or office buildings -- that many of them need smokers to thrive. In 1996, Howard officials enacted a law calling for establishments to seal off smoking sections.
Things remained relatively quiet for the next eight years. Then, in 2003, Montgomery's ban went into effect.
As for Talbot County, where smoking in nightspots was snuffed out last year, it is increasingly filling with wealthy retirees -- who, unlike longtime residents, weren't as apt to get a beer at a smoky bar, Thompson said.
He continues to distribute research by James E. Enstrom at the School of Public Health at the University of California at Los Angeles. Enstrom and others studied 35,561 nonsmokers with smoking spouses, concluding that the data didn't support a causal relationship between secondhand smoke and tobacco-related mortality.
Reached in Los Angeles, Enstrom said that he is not necessarily opposed to smoking bans -- in part because he thinks actually smoking is more dangerous than many people believe -- but that his research into secondhand smoke tends to be dismissed out of hand in the current environment.
"All the science gets lost in the battle to implement these bans," he said.
Other studies, of course, show secondhand smoke to be dangerous.
In Prince George's, Chairman Samuel H. Dean (D-Mitchellville) and council member Douglas J.J. Peters (D-Bowie) say they expect the council to pass the smoking ban Tuesday.
Regarding possible sit-downs with opponents of the bill, Peters said, "What we're trying to say is we appreciate your input but we've weighed the pros and cons and we think public health is going to win out."
In the District, even council member Carol Schwartz (R-At Large), an opponent of the ban, said the measure is likely to pass. She also predicts it will be a challenge to amend the ban for establishments that, among other measures, install ventilation systems. "Listen," she said, "the votes are there for smoke-free."
The debate in Howard County might turn out to be the most contentious.
Council member David A. Rakes (D-East Columbia) intends to submit legislation that grandfathers in establishments with sealed-off smoking areas.
"They've already spent so much money to comply with our old law that we shouldn't now change the rules on them," he said.
© 2005 The Washington Post Company

AIDS Rally Calls Attention to Disease's Devastation Among Blacks
HIV Patients Plan To Lobby Congress
By Lori Montgomery
Washington Post Staff Writer
Sunday, November 6, 2005; C03
Kendal Richardson, 27, tested positive for the AIDS virus in 1996, not long after graduating from high school in Sterling. He said he continued to have unprotected sex with men for five years before seeking treatment.
Geno Dunnington, 49, tested positive in 1985. "The first thing I did was went out and got married," he said. His wife and two children were not infected, he said, but he continued to have unprotected sex with men for more than a decade.
Ronald Morgan, 43, tested positive in 1984 but continued to have unprotected sex until last winter, when his skin broke out in boils. "My HIV had progressed to full-blown AIDS," he said.
Yesterday, Richardson, Dunnington and Morgan joined nearly 300 other people with HIV from across the country outside Robert F. Kennedy Memorial Stadium to call on the president, Congress and society to make a renewed commitment to ending the AIDS epidemic.
Then the crowd, organized by the Campaign to End AIDS, marched to Anacostia Park to call attention to the virus's growing devastation of the black community, particularly in the nation's capital.
Washington has a far higher incidence of AIDS -- 170.6 cases per 100,000 people, according to federal statistics -- than other major U.S. cities, including New York and San Francisco. An estimated one in 20 District residents is infected with HIV, the virus that causes AIDS. And that number climbs to an estimated one in seven among black men in the District, said Michael Pickering of RAP Inc., a drug treatment program that works with people who have AIDS.
"That number should petrify us all," Pickering said as marchers chanting to a single snare drum and carrying colorful state flags straggled into Anacostia Park to listen to music and hear speeches from AIDS activists and D.C. Council member Adrian M. Fenty (D-Ward 4). "There shouldn't be room to stand in this park," Pickering said.
Richardson, Dunnington and Morgan are among the statistics. All three are African Americans who contracted HIV while living in or around the District. They are also examples of why the virus can spread so rapidly in the city's black community: All said they initially dealt with news of their infection not by seeking treatment, but by withdrawing into a state of denial.
"I wanted to be regular. I wanted to fit in. So I did everything everyone else was doing so they wouldn't know," said Richardson, who lives in Atlanta. That included going to "the sex shops, the O Street Follies, and just doing anything and everything," he said.
Since seeking treatment and finding religion, Richardson said, he has contacted former sex partners and was relieved to find that none had contracted the virus. "But you don't know who else you could have done it to," he said.
Dunnington, who lives near RFK Stadium, and Morgan, who lives at RAP's treatment center in Northeast Washington, said they have no doubt that they passed the AIDS virus on to others before seeking treatment for drug and alcohol addictions -- behavior similar to that of Sundiata Basir, the former D.C. government worker who was sentenced last week to 21 years in prison for exposing at least seven women and girls as young as 15 to the AIDS virus.
Although Basir was unapologetic, Dunnington and Morgan said they are trying to atone for their actions by getting involved in advocacy programs and reaching out to young people who might be making the same mistakes they did.
"We need to stop, take a chill pill and get a new direction," Morgan said. "If you have HIV, you need to learn to disclose."
Although the marchers voiced concern chiefly about changing individual behavior, leaders of the Campaign to End AIDS said little will improve until Congress fully funds education and prevention programs that teach people to do more than practice abstinence. They also decried proposed cuts in the Medicaid budget and the expiration of the Ryan White CARE Act, both of which provide a crucial safety net for hundreds of thousands of people with HIV.
Over the next three days, leaders of the campaign will lobby Congress for more attention and money for research on the disease.
They also will protest outside the White House and the offices of conservative organizations.
But most important, they said, they will urge national leaders to fund research into a cure for the disease that is still killing millions worldwide.
No one "is articulating a vision of a world without AIDS," said Charles King, president of Housing Works, a nonprofit organization that serves the HIV-infected homeless in New York and Mississippi. "We really could end this epidemic if we had the will, the compassion to do that."
© 2005 The Washington Post Company

Blood bank accredited
Cumberland Times-News
Sunday, November 6, 2005
CUMBERLAND - The Western Maryland Health System was recently granted accreditation by the American Association of Blood Banks (AABB).
The accreditation follows an extensive an on-site assessment by the specially trained assessors and establishes that the level of medical, technical and administrative performance within the facility meets or exceeds the standards set by AABB.
By successfully meeting these requirements, WMHS joins approximately 1,700 similar facilities across the United States and abroad that have earned accreditation.
“The AABB's Accreditation procedures are voluntary,” said Dr. Jonathan Walburn, pathologist and medical director of transfusion services at WMHS.
“Both Memorial and Sacred Heart have sought AABB accreditation because this program assists facilities around the country in achieving excellence by promoting a level of professional and medical expertise that contribute to quality performance,” he said.
Walburn said the WMHS employees who work with blood services are extraordinary and should be commended.
“Without our blood bank staff, we could not achieve the high standard of excellence that AABB has bestowed on us,” he said.
Since 1958, AABB has been engaged in the accreditation of blood banks and transfusion services.
Today, its accreditation program assists blood banks, transfusion services, cellular therapy facilities, parentage testing laboratories, immunohematology reference laboratories and perioperative services in determining whether methods, procedures, personnel knowledge, equipment and the physical plant meet established requirements.
Copyright © 2005 Cumberland Times-News

Seniors urged to do homework on Medicare Part D
By Pamela Wood, Staff Writer
Annapolis Capital
Sunday, November 6, 2005
Starting Nov. 15, seniors can join in on the biggest change in Medicare history: a program to help pay for prescription drugs.
But with 47 available plans and an avalanche of information arriving in mailboxes, seniors have a lot to sort through before signing up for the program, known as "Part D."
Advocates are urging seniors to take the time to research the plans so they can sign up soon after Nov. 15. If they are hopelessly lost, there's help available.
"It will become easier with time," said Susan Knight, who leads the county Department of Aging's Senior Health Insurance Program. "Although this may not be a perfect plan, it's the one we have to work with."
The addition of Part D represents a huge change in how Medicare works.
Until now, Medicare - the federal government's health insurance program for seniors - didn't offer a dimefor regular prescriptions. When Medicare was started decades ago, there weren't as many drugs prescribed as there are today.
Seniors now find themselves on regimens that can include several prescription drugs, and they are often expensive.
A survey of 200 drugs released by the AARP last week found that the price rose an average of 6.1 percent from July 2004 to June 2005 - twice the rate of inflation.
Ms. Knight and her team of insurance experts have been giving presentations on Part D at senior centers since July in anticipation of the Nov. 15 opening of enrollment. They've also been fielding about 50 calls a day from Medicare members seeking help.
About 60,000 seniors live in Anne Arundel County. A good portion of them are retired from the government, military or private employers with so-called "creditable" insurance plans or are covered through the Veterans Administration, and therefore won't enroll in Medicare Part D.
But Ms. Knight estimated the county's Medicare population somewhere in the tens of thousands. That's a lot of people looking for answers.
The reason for so many questions is that Part D is complicated. The 47 plans are each offered by a private company and approved by Medicare.
Each plan has its own variables: participating pharmacies, costs to the patient and lists of covered drugs. Not every plan will offer the same coverage, drugs and co-payments.
Ms. Knight said seniors should make sure their chosen plan will work with their pharmacy and offer savings on at least the most expensive drugs. Discount cards can be used for drugs that aren't covered by a Part D plan.
One way to sort them all out is to log onto www.medicare.gov and try out the "planfinder" feature.
It's a good idea to list all necessary prescriptions to make it easier when sorting through all the literature coming from the plan sponsors. Having things organized can help when talking with counselors from the Department of Aging or the AARP.
Doughnut hole
The plans have been roundly criticized for having major gaps in coverage dubbed "the doughnut hole." It's a term being used to describe how in some cases seniors have to pay varying fractions of the overall cost of drugs.
An example plan put out by Medicare shows the senior's portion going from 25 percent to 100 percent and down to 5 percent at different levels of how many drugs are bought.
But not all plans have that same doughnut hole.
"In reality, none of these plans is set up exactly like the model plan," Ms. Knight said. "That doughnut hole could vary."
All the choices can be bewildering for seniors like 82-year-old Helen Crane.
She's trying to choose a plan to cover her $500-per-month prescription drug costs. Because of poor eyesight, she relies on her daughter to read the fine print about the plans to find the one that's best for her.
"We really need help," said the Crownsville resident as she played a game of cards last week at the Annapolis Senior Center. "It's very confusing."
All Part D plans start Jan. 1. The deadline to enroll is May 15, and Medicare beneficiaries who don't sign up will be subject to financial penalties when they do sign up. That penalty does not apply, however, to seniors with more generous retiree plans, which are termed "creditable coverage."
Another element of the program is extra help for low-income seniors to pay for their drugs.
In addition to Ms. Knight's presentation, there are other sources of help.
U.S. Rep. Wayne Gilchrest is planning eight visits to senior centers and libraries in his district, and his staff will make seven more presentations. Mr. Gilchrest represents the Eastern Shore, as well as some Western Shore communities, including the Broadneck Peninsula, Arnold, Severna Park and Millersville.
"The congressman's goal is to get out there and provide some experts to give answers," said Cathy Bassett, Mr. Gilchrest's spokesman.
The congressman's offices have been getting plenty of calls about Part D, and Mrs. Bassett expects the volume will only increase as Nov. 15 approaches.
Other congressmen have been hitting the road, too, though none of Anne Arundel's three other congressmen has local presentations planned this month.
Representatives from the AARP also have been out in force since summer helping seniors understand Part D. The group also has plenty of advertising and put out an informational brochure, "The New Medicare Prescription Drug Coverage: What You Need to Know."
"We're going to continue through November and into May," said Kelley Coates-Carter, a spokesman for AARP-Maryland.
While AARP sponsors one of the Part D-approved plans, Ms. Coates-Carter said AARP is focusing on helping seniors find the right plan, no matter who the sponsor is.
"The word 'informed decision' is what we're focusing on," she said.
Capital News Service reporter Kim Hart contributed to this story.
Published November 06, 2005, The Capital, Annapolis, Md.
Copyright © 2005 The Capital, Annapolis, Md.

Sentries in U.S. Seek Early Signs of the Avian Flu
By Donald G. McNeil Jr.
New York Times
Sunday, November 6, 2005
DAVIS, Calif. - Bang! Inside an improvised duck blind - her parked car - Grace Y. Lee presses a switch, and her gun blasts a square of light volleyball net over the dirt road she is watching.
One of the two magpies she has baited into range with cornbread, cheese-flavored rice snacks and dog food is snagged, flopping furiously around.
"We mostly catch the young ones," Ms. Lee said. "These birds are too smart to be caught again. We get them once, and they don't shop here anymore."
With the country waiting nervously for avian flu to arrive, catching wild birds is no hobby. It has become part of a national early detection effort, and Ms. Lee, a researcher at the University of California here, is a sentry on the country's epidemiological ramparts.
She is one of hundreds of ornithologists, veterinarians, amateur bird-watchers, park rangers and others being recruited by the National Wildlife Health Center to join a surveillance effort along the major American migratory flyways. They will test wild birds caught in nets; birds shot by hunters on public lands, who must check in with game wardens; and corpses from large bird die-offs in public parks or on beaches.
The plan also calls for sampling bodies of water for the influenza virus, which is shed in bird feces. And it is designating some ducks and geese - like those in backyard flocks or living year-round in park ponds - as "sentinels" to be captured, tested, released and periodically retested.
Surveillance of poultry is already in place. Long-standing federal and state laws require farmers to report deaths of birds from any flu strain. The surveillance system was worked out this summer by the Agriculture Department, which oversees poultry, and the wildlife health center in Madison, Wis., part of the Interior Department, which oversees wildlife - including migratory birds, which are thought to be the most likely entry route for the flu virus.
Dr. Christopher J. Brand, the center's research chief, estimated the cost at $10 million. [On Nov. 1, President Bush announced a $7.1 billion plan to guard against a flu pandemic; Dr. Brand said he hoped money for the surveillance system would come from that.] The sampling plan had a small test run this fall in Alaska, which Dr. Brand said was the obvious choice because of the flu's surprise appearance in Siberia in July. Birds from there mingle in the summer Arctic nesting grounds with birds that migrate down the North American coast.
Now the flu's recent crossing of Europe "has opened up more eyes," Dr. Brand said. It is unlikely that infected birds will cross the Atlantic, because most migrate north-south and the birds detected in Eastern Europe were from species that migrate to Africa. Still, Dr. Brand said, there is now talk of setting up a surveillance network for Greenland, eastern Canada and the East Coast.
The threat of avian flu has also sped a transformation that was begun by the fear of bioterrorism and fueled by the fight against West Nile virus: veterinarians and doctors, as well as the agencies overseeing them, are joining forces.
Previously, said Dr. William B. Karesh, head of the field veterinary program at the Wildlife Conservation Society, which runs the Bronx Zoo, the two fields almost never worked in tandem.
"Human medicine and veterinary medicine have advanced beautifully in the last 30 years, but they were not linked," Dr. Karesh said. That has always frustrated him, he said, because "diseases don't care which way they flow - there is a whole world of bacteria, viruses and fungi that move between wild animals, domestic animals and humans."
Dr. Karesh described once trying to get a research grant for surveillance of animal diseases that infect humans, known as zoonoses. The National Institutes of Health told him to apply to the Department of Agriculture, he said, and officials there sent him to the Fish and Wildlife Service, which told him it had no mandate to study disease.
"Then we went to Homeland Security, and they understood what we were talking about," Dr. Karesh said. "But they said: 'You're an orphan. No one does this.' And in their rankings, we're lower than people trying to blow up the subway in New York."
Now, instead of sharing information haphazardly and getting into jurisdictional disputes - problems that cropped up during the 2003 monkeypox outbreak and in surveillance for mad cow disease - health officials are writing plans that emphasize teamwork.
The United States still does far better at animal surveillance than most other countries because its medical and veterinary systems are each excellent and because outbreaks cannot be hushed up - as, for example, the SARS outbreak was in China.
But zoonoses fall into a gray area, and the 2003 monkeypox outbreak in the Midwest is a perfect example of what can go wrong, said Peter Daszak, director of the Consortium for Conservation Medicine at the Wildlife Trust, a group specializing in human-animal diseases.
The disease, related to smallpox but less deadly, arrived in a shipment of 18 Gambian giant pouched rats imported for a Chicago pet store, where they infected prairie dogs. By summer's end, there were 37 confirmed human cases - none fatal, but some scary - mostly among prairie-dog owners.
"Millions of live animals come into the country each year, and very few have really good surveillance," Dr. Daszak said. "Fish and Wildlife checks cargoes to see if they have endangered species, but it's the U.S.D.A. that does health checks, and they don't go unless it's an agricultural product, so the pet trade tends to get a pass."
"The C.D.C. does a great job with outbreak investigation, but that's after the fact," he said of the federal Centers for Disease Control and Prevention. "After monkeypox, they put a blanket ban on rodents from some West African countries. But who's looking at rodents from other places? Nobody. And that's a gap."
Surveillance for diseases in wild animals is particularly difficult, since they do not come to hospitals, are not watched by veterinarians and do not like to be caught.
In the case of the magpie in Davis, it took Ms. Lee and her boss, Dr. Walter M. Boyce, director of the university's Wildlife Health Center, more than 30 minutes to disentangle the bird, set up a lab table, zip themselves into disposable coveralls and get a beak swab, a feces swab and a blood sample before releasing the miffed-looking bird, which high-tailed it for the nearest tree.
Dr. Boyce also gets swabs from hunters' ducks, and his colleagues at the state-run agriculture laboratory on campus get them from poultry farms and from dead crows, jays and robins collected by city health departments on the watch for West Nile virus, which arrived in California earlier this year.
During the test run in Alaska, Dr. Jonathan Runstadler, a biology professor at the University of Alaska in Fairbanks, said he had collected nearly 5,000 fecal samples from ducks, geese, gulls and other shorebirds, owls and other raptors, and even songbirds.
With limited money, Dr. Runstadler could not mount his own bird-catching efforts, but university ornithologists and dedicated amateurs who study migratory patterns run what he called "ring and fling" leg-banding operations. "Our technicians and grad students go out with them, pull out a Q-Tip and say, 'Excuse me, can I take a sample here?' " he said.
Another difficulty is deciding which species to pursue. Dr. Karesh expressed frustration that no country with birds dead of flu, from China to Romania, had noted which healthy species were nearby, because survivors were the more likely carriers, he said.
Which explains why Ms. Lee was netting birds that live year-round in Davis.
It's "a bit of a maverick approach," Dr. Boyce admitted, but his theory is that scavengers like magpies, crows and cattle egrets are the most likely vectors for moving the virus from the millions of ducks flying down California's Central Valley each fall to domestic chicken farms.
American industrial farms have high levels of biosecurity, penning thousands of birds in hangar-size barns "that no self-respecting duck or goose is looking to get into," Dr. Boyce said, "but there's a lot of free food there for an opportunist."
Since scavengers also bathe in the ponds where ducks stop over and hang around humans' garbage cans, he said, "we're looking for flu in species that can make the link between wildfowl, poultry and people."
Copyright 2005 The New York Times Company

Hawaii monitors airport for bird flu
Baltimore Sun
Sunday, November 6, 2005
HONOLULU // Hawaii became the first state in the nation this week to monitor airports for signs of bird flu or other flu viruses, health officials said. Passengers and visitors at Honolulu International Airport will not be required to submit to examinations but will be tested only voluntarily using nose or throat specimens taken at the airport clinic. Passengers could also be referred to the clinic by an airline or medical personnel. Making flu testing available is expected to improve the state's ability to respond to any threat of a pandemic flu, according to Catherine Chow, a medical prevention officer for the U.S. Centers for Disease Control and Prevention.
Copyright © 2005, The Baltimore Sun

Hitting the Flu at Its Source, Before It Hits Us
By Donald G. McNeil Jr.
New York Times
Sunday, November 6, 2005
PRESIDENT BUSH was greeted with blunt skepticism a month ago, when he first mentioned the deadly H5N1 strain of avian flu at a White House news conference and suggested he might need new authority over the military to enforce quarantines.
Cynics suggested that he was reaching for greater presidential powers, or trying to distract attention from Iraq and Hurricane Katrina. (After all, in 2002, part of the groundwork he laid for the Iraq war was to call for the inoculation of 10 million health care workers in case Saddam Hussein unleashed smallpox on the world.)
But last week, when Mr. Bush issued an urgent warning about avian flu, unveiling a $7.1 billion flu-fighting plan in a speech to the National Institutes of Health, virtually all public health experts agreed that it was well past time to act.
The World Health Organization and the European Union have already sounded the warning, and in March, the Centers for Disease Control ranked the bird flu as the world's No. 1 public health threat. But why is it time to raise the alarm, to institute elaborate public health procedures at great expense to protect against an illness that has still claimed only a few dozen people in Asia (as well as 140 million birds killed or culled to stop the virus's spread).
The short answer is that those protections must be in place before a pandemic hits.
"Pandemic flus are like earthquakes and hurricanes," said Dr. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "There have been 10 in the last 300 years. They're the one area in public health you can predict.
"Now, we're like the guy going to his 25th reunion who decides the night before that he needs to lose 50 pounds. The best he can do is get a new suit and a shoeshine."
But there is, experts said, no way to predict exactly when or whether a particular virus will become an imminent threat. "It's a very difficult balancing act," said Dr. Andrew T. Pavia, chairman of the pandemic influenza task force of the Infectious Diseases Society of America. "You want to create an alertness without creating a panic."
Flu, at least, is familiar. Mysterious killers tend to create more panic. AIDS terrified gays and hemophiliacs for years before its cause was found. SARS, an unknown coronavirus, terrified Asia.
But even flu is unpredictable. No public health expert forgets the swine flu debacle of 1976, in which 40 million people were inoculated with a vaccine made in haste after a single recruit in Fort Dix, N.J., died of what appeared to be a new lethal bug. The epidemic never emerged, but a rush to vaccinate was created in part by confused news coverage of Legionnaire's disease, an unrelated new bacterial illness that broke out that same year at an American Legion convention, killing 29 people.
Vaccinations were halted after many who were vaccinated were struck by paralyzing Guillain-Barré syndrome, and the director of the Centers for Disease Control was forced out of office. "Ever since, that has made people gun shy about declaring an epidemic," said Dr. Donald R. Hopkins, a former deputy director of the C.D.C.
So are the experts right this time, with the call to arms on avian flu, which is still almost exclusively a poultry disease? (Other types of bird flu usually give poultry workers only pinkeye.)
The obvious trigger moment would be the emergence of a strain that moves easily between humans. That might never happen. But if it does, "by then, it's too late" said Dr. David Nabarro, the new United Nations coordinator for pandemic flu.
"The last thing I want is to be truly alarmist," added Dr. Nabarro, whose job is to raise the alarm. "But the world is not really ready to deal with an avian pandemic."
It won't be, he said, until governments not only have vaccination, quarantine and treatment plans written and stockpiles in place, but have run repeated simulation exercises that include doctors, police officers, utility workers and others. All these are called for in Mr. Bush's plan, but putting them in practice is still well off in the future.
Other experts expressed dismay that the hoopla over Mr. Bush's plan turned the focus to measures in America, like closing airports, forcing patients to wear masks, rationing the drug Tamiflu and ventilators, and having the army enforce quarantines or control riots. Much smarter, said Dr. William B. Karesh, chief of field veterinarians for the Wildlife Conservation Society, would be to focus on fighting the virus "upstream," while it is still in chickens and ducks.
In Vietnam and China, poor farmers have told reporters that they are reluctant to admit owning sick chickens because the government will kill their flocks without paying for them. (In China, the official price is 60 cents per chicken, but farmers say they rarely get it.) Using taxpayer dollars to buy those birds would be more effective and cheaper than buying Tamiflu, some experts said. More money is also needed to test backyard flocks and migrating birds, rather than waiting for dead birds like those found in Chinese nature reserves last summer to give notice that the virus is on the move.
Last week, the World Organization for Animal Health in Paris called on rich countries to donate $150 million to help poor countries vaccinate their poultry and train rural veterinarians to diagnose flu.
Some of the proposals are controversial. Improperly weakened vaccines are suspected of spreading the flu in Asia, Dr. Osterholm said. But many experts say the focus should still be overseas.
Both Dr. Karesh and Dr. Nabarro said they were pleased that Mr. Bush's proposal envisioned tactics like compensating Asian farmers. "I'm very encouraged," Dr. Karesh said. "These things weren't even being talked about a month ago."
Copyright 2005 The New York Times Company

Changing vaccine systems no easy shot
Cell-culture technology Bush advocates would require major investment by manufacturers
By Frank D. Roylance
Baltimore Sun Reporter
Sunday, November 6, 2005
The threat of a pandemic may persuade the makers of flu vaccine to give up the chicken eggs they've used for decades and begin moving to a newer, faster production system.
The question is whether they're willing to abandon the tried-and-true - or do it soon enough to head off the next potential public health disaster.
Last week, President Bush branded current vaccine production methods "antiquated" and asked Congress for a $2.8 billion "crash program" to help the industry develop simpler and more flexible "cell-culture" technologies that can better keep up with new flu strains.
For decades, drug companies have made flu vaccines by growing viruses in millions of live, fertilized eggs. The system works well, but all agree that it's cumbersome, time consuming and hard to ramp up quickly in a public health emergency.
Cell-based production methods grow the flu virus in steel vats filled with living cells derived from monkeys, dogs, humans or even insects. Some vaccines produced this way have won limited approval in Europe, but none has been cleared for use here.
"By bringing cell-culture technology from the research laboratory into the production line, we should be able to produce enough vaccine for every American within six months of the start of a pandemic," Bush said.
Cell-culture technology is hardly new. The industry has used it successfully since the 1950s to produce vaccines for such viral ailments as polio, measles, mumps and tetanus.
But vaccine experts and drug makers say the industry has stuck with eggs for flu vaccine production because they work pretty well. And change would cost billions.
"We've got the plants set up. We've got the whole system worked out, and we're not going to rock the boat unless we have to," said Dr. Samuel L. Katz, a professor of pediatrics at Duke University and co-developer of the measles vaccine.
"Now, maybe we have to," he said.
Moving the industry to cell-based technologies will require billions - money for continued research and development, money to win federal approval for new cell lines in human products, money for human clinical trials.
When all that's done, drug makers will need millions more to build the factories to produce hundreds of millions of doses of the new vaccines every year.
That's why the president is asking Congress to help.
Proven technique
Len Lavenda was understandably miffed by Bush's use of the word "antiquated." He's a spokesman for Sanofi Pasteur of Swiftwater, Pa. The company, based in France, is one of the world's largest flu vaccine makers, and the last one with production in this country.
Sanofi Pasteur uses eggs.
"The fact is, it's a tried and proven technology that has worked well for us," Lavenda said. Other drug makers have abandoned the flu market in recent years because of low and inconsistent demand for flu vaccine and correspondingly slim profits - not problems with the egg-based vaccine technology.
"We believe our nation will remain dependent on egg-based technology for at least the short to medium term," Lavenda said. "We're looking at quite a few years before we can obtain licensure for commercial-scale, cell-culture flu vaccine."
Meanwhile, Sanofi is using an infusion of $41 million in federal tax dollars to expand and maintain its chicken flocks and enable year-round egg production.
Flu vaccine makers got into the egg business to start with, Katz said, because the first flu vaccines were developed before World War II - before the first cell-culture techniques were invented.
At that time, eggs were already being used to make yellow fever vaccines, and the technology proved to work well for flu vaccines, too. Drug makers who later adopted cell-culture technologies for other vaccines saw no reason to tackle the established technology for flu vaccines, Katz said,
Besides, he said, flu is a real headache because the viruses change so quickly.
"It's something you have to fiddle with every year," he said. By contrast, "we're making the same measles vaccine in 2005 that we made in 1963, when we developed the vaccine."
That might be changing. Several big drug companies, from Sanofi Pasteur to GlaxoSmithKline and Chiron, are developing cell-based flu vaccines.
No Maryland companies are known to be working on cell-based flu vaccine at the moment. But government and business leaders see it as an opportunity.
Baltimore Mayor Martin O'Malley, with backing from state officials and the Economic Alliance of Greater Baltimore, is pushing for a new cell culture vaccine production center in the city or elsewhere in Maryland.
"I think we've got a great shot at it," said Nipon Das, executive vice president of the Alliance, a nonprofit group dedicated to furthering the region's business interests.
Das said the group hopes to complete a feasibility study by the end of January.
Small companies are engaged as well. In Meriden, Conn., for example, Dan Adams, president and chief executive officer of Protein Sciences Corp., insists the future of cell-based flu vaccine is not that far away.
He says his tiny company - just 35 employees - has a vaccine that has done well in clinical trials and could win federal approval as soon as 2006. "If we focused on the pandemic [H5N1 avian] flu and not the annual vaccine, we could produce around 400 million doses in a year," he said. He added that he could do it by 2007.
There are plenty of differences between the egg-based and cell-culture technologies. But they have some things in common.
Both start with a "seed virus" supplied by the federal Centers for Disease Control and Prevention, which identifies and isolates the target flu virus from its earliest victims.
First, CDC scientists alter the virus' genes. While preserving proteins the virus needs to stimulate a human immune response, the scientists snip out DNA segments that cause serious disease, or would kill off the very eggs or cells in which they grow. Scientists add other genes that will make the altered virus more likely to multiply well in the manufacturing process.
Samples of the altered virus, called the "seed" virus, are then shipped to vaccine manufacturers.
At egg-based plants such as Sanofi's, the seed virus is processed to produce enough volume to inject into millions of eggs. Each egg is punctured by a needle that leaves a tiny amount of virus in the fluid around the embryo. The virus invades the embryo's cells and commandeers their metabolic machinery to replicate itself.
After several days of incubation, the egg's fluids are teeming with the virus. At that point, it's harvested and killed so that it can't produce illness; then it's purified, filtered, concentrated and packaged. The whole process can take four to five months, from preparation of the seed virus to shipping, Lavenda said.
There are advantages to using eggs, according to Richard J. Webby, a virologist at St. Jude Children's Research Hospital, in Memphis, Tenn. "Most flu strains grow very well in those conditions, and you get lots of virus out of a single egg," he said.
The downside is that the whole system relies on the availability of millions of chicken eggs - which have to be ordered months in advance, laid and fertilized.
"When you have a flu season, as we have in the past, where one of the manufacturers goes down, or when there's a pending pandemic, you can't scale up that production process very quickly," Webby said. In fact, an outbreak of avian flu could destroy the egg flock.
Until drug makers can deliver the new vaccine supplies, doctors have to rely on antiviral drugs that can prevent infection or lessen the impact of the illness once infection occurs.
In cell-based vaccine production, the seed virus is mixed into a culture of living cells and nutrients. It invades the living cells and begins to reproduce, just as it does in eggs.
Some manufacturers are developing flu vaccines from virus grown in a cell line called MDCK, derived from dog kidneys. Others use "Vero" cells extracted from the kidneys of African green monkeys - a type used to produce polio vaccines.
Still others rely on cells grown from human retinal cells, or the ovaries of the fall army worm - a green caterpillar.
Unlike chicken eggs, these cell lines don't have to be harvested from live animals for each vaccine production run. They come from cells that were harvested from animals once and then kept growing and reproducing in laboratories. "You can have a freezer with hundreds of vials of cells," Webby said. When the new seed virus arrives, "you take out a vial of cells, put it in the medium and ... within a couple of weeks, they're ready to infect the cells and grow up your vaccine."
"The benefit is, it's much more flexible and easier to ramp up quickly," he said.
Also, unlike viruses grown in egg shells, these are accessible, Katz said. Drug makers can dip in and "observe directly what's happening, how the cells are changed by the virus growing in them. You can quantify the amount of virus that's growing."
When they're ready, the viruses can be extracted, purified, processed and made into vaccine.
Even Sanofi's Lavenda acknowledges the upside of cell-line technology, including the elimination of chicken and egg proteins that can cause allergic reactions in some recipients. "And, from a manufacturing point of view, it's a more desirable, controllable, predictable process," he said.
Sanofi, under a $97 million federal contract, has embarked on its own pursuit of a cell-line vaccine, based on a human cell line. Clinical trials could start next year, Lavenda said.
But there's also a downside. Cell lines generally aren't as productive as chicken eggs, Webby said. "The amount of doses you get per production run is less than what you get out of an egg. ... From a manufacturer's point of view, the more vaccine they can get for the least amount of volume, the better it is for them," he said.
Then there's a simple fact: No company is ready to go into production with a cell-based flu vaccine for the U.S. market. Manufacturers face a long list of challenges. First, drug makers who have developed cell-based flu vaccines in small quantities for testing still face the uncertainties of scaling the process up to commercial volume. "Making vaccine in a small flask is relatively easy," said Dr. James Campbell, lead investigator for avian influenza vaccine trials at the University of Maryland School of Medicine's Center for Vaccine Development. But "making it in large flasks or containers, you have issues of keeping the cells alive, and having the same yield you would be able to get in small quantities."
Then there's the government, Katz said. "Up until now," he said, "the cell systems in which it has been possible to grow these viruses have never been approved by the FDA ... for the production of human products."
Federal regulators must be convinced that these cells don't carry other viruses or contaminants that could cause illness in people.
Then drug makers face long and costly clinical trials to prove to the FDA that their cell-based vaccines are safe and effective.
Healthy profits?
Ultimately, if they're convinced they can make money producing flu vaccines from cell cultures, drug companies must find and spend the money to build large-scale factories.
The federal dollars that President Bush is asking Congress for would help the manufacturers address these issues.
All the big vaccine makers are expected to compete for the money. These include Sanofi Pasteur; Chiron Corp. of Emeryville, Calif. (which also has an egg-based flu vaccine in development); Netherlands-based Solvay Pharmaceuticals, which has a cell-line vaccine approved in the Netherlands; and Britain-based GlaxoSmithKline.
But even with billions in federal dollars to grease the wheels, it will be years before the cell-based flu vaccines are ready for market.
For now, said Lavenda, it's all about chicken eggs.
"There are advantages to cell-based technology, but we don't have that technology available to us today," he said. "And nobody can predict exactly when it will be available. We really can't afford to wait."
Copyright © 2005, The Baltimore Sun

Indonesia Stretched to the Limit In Battle Against Two Diseases
Campaign to End Polio Complicated by Rise of Bird Flu
By Alan Sipress
Washington Post Foreign Service
Sunday, November 6, 2005; A19
TANGGAMUS, Indonesia -- When the first human case of bird flu was discovered on Indonesia's Sumatra island this fall, provincial officials raced to investigate. But local health officers were unavailable to help them because they were busy vaccinating thousands of young children against a polio outbreak.
Within the last six months, Indonesia has moved to the front lines of two global health crises, seeking to curb the spread of both bird flu and polio before they spill across the border.
"It has stretched resources and capacity to the limit," said Thomas Moran of the World Health Organization's office in Jakarta, the Indonesian capital.
Faced with the fastest growth of new polio cases on Earth, Indonesia launched a campaign this summer to immunize about 24 million young children. Then, just as officials were preparing in July for the first of three nationwide rounds of polio vaccination, Indonesia detected its first human case of bird flu and since then has registered more cases of the disease than any other country.
Since January 2004, more than 60 people have died of bird flu in Vietnam, Thailand, Cambodia and Indonesia. The virus has also spread through parts of Russia and to Eastern Europe.
Indonesia's two-front battle is straining the country's sorely underfunded health system, which had sharply eroded since the 1997 Asian financial crisis and was already unable to provide basic care across much of the far-flung archipelago.
"We've become a red zone for bird flu because it's endemic in livestock and infected humans here," said Ida Fitriati, deputy health director in Lampung province on Sumatra's eastern tip. "We're overwhelmed by this."
Health experts said the country needs funds to monitor possible cases, improve laboratories for testing and enhance medical facilities and supplies to include a larger stockpile of antiviral drugs.
Health officials said they worry that efforts to contain bird flu and polio could drain funding from other disease control programs that have begun to make progress in recent years.
Indonesia ranks third in the world for a high burden of tuberculosis, according to the WHO. Attempts to improve the detection of new cases regained momentum two years ago after stalling in the wake of the financial crisis and political upheaval after the ouster of longtime dictator Suharto in 1998.
Malaria remains endemic on many Indonesian islands, worsening in the late 1990s before foreign funding for control programs helped reverse the trend. Dengue and diarrhea-related diseases are epidemic.
"Anyone trying to manage public health, especially with an avian influenza risk, is faced with an extremely difficult and complex decision about how to get the maximum good out of limited resources," said Steven Bjorge, the WHO official in Indonesia responsible for managing bird flu, malaria and several other diseases.
Fitriati, who oversees communicable diseases for Lampung, a province of seven million people, said her team of six investigators responds to reported avian influenza cases one morning and polio the next, often venturing to isolated hamlets in the island's mountainous interior. Local health staff, she added, lack the expertise to verify outbreaks themselves, and communication is so spotty that days can pass before provincial experts are notified.
Indonesia had been free of polio for a decade when a traveler from the Middle East carried it to the main island of Java early this year. The crippling virus quickly reached 10 provinces and infected at least 288 people. After repeated immunization drives, the disease was contained where it first surfaced in western Java, health officials reported. But just a short ferry ride away across the Sunda Straits, Lampung province is now recording the most new infections with more than two-thirds of the 24 cases centered in its district of Tanggamus.
Bird flu also first appeared in Java, infecting at least five people in and around the capital Jakarta. When the virus spread, it likewise jumped to Lampung, sickening a man and his young nephew, again in Tanggamus.
Although there have been only a few confirmed cases of bird flu, international health experts predict the virus could develop into a new form easily passed among people, potentially devastating Indonesia and the world beyond.
But at the Pagelaran public clinic in Tanggamus, health officers admitted they had no program to monitor bird flu or prepare for a wider outbreak. Their preparations consist of a lone poster on the entrance of their low white building warning of the danger.
Bird flu remains a concern for agriculture officials, explained Edy Susanto, 41, a local paramedic.
Susanto, who directs the clinic's immunization program, shuffled into his tiny, tiled office, apologizing for the rat droppings that litter the floor. He opened the rusty clasps on the 15-year-old freezer in which he keeps the vaccines, lifted the cover and motioned to the contents. It was almost empty.
"For us, it's hard to answer the parents when they ask why the vaccines have run out," he said, smiling sheepishly and raising his eyebrows. "We can't answer it. It's not in our hands."
He complained that health workers are forced to scavenge for unused syringes in other medical offices or scrape together money to buy their own. The refrigerator with which they usually make ice for transporting vaccines into the field is broken. He said there is also a shortage of doctors. The physician who serves as the clinic's director is often absent during the busy morning hours because he runs his own, better-paying practice, he said.
"There's been less money and support since the financial crisis," Susanto concluded. "Money is our unending problem."
At the provincial health department, Fitriati agreed that the Indonesian health system has slipped. "The function of local health posts has deteriorated. And since they don't function well, some people don't use them any more," she said. "It's not only Lampung. This is the picture in other provinces of Indonesia."
I Nyoman Kandun, Indonesia's national director for communicable disease control, estimated that half the village health posts in the country no longer operate. And although the central government has enough money to buy vaccines for all Indonesian children, officials in the cash-strapped districts are unable to pick them up from the provincial health office, according to Kandun.
Now devoting much of his time to soliciting money from foreign governments and agencies, Kandun said he is finalizing his "shopping list" for bird flu programs that require financial support.
The emergency polio campaign to immunize the country's children has already cost the central government more than $12.5 million for the first two rounds, with foreign donors paying nearly an equal sum, he said. For the third round, scheduled for Nov. 30, Indonesia can muster only $2.7 million, leaving a shortfall of $10 million.
Kandun said last week his fundraising efforts have whittled that deficit to $1.4 million.
Special correspondent Yayu Yuniar contributed to this report.
© 2005 The Washington Post Company

Passport to Health Care At Lower Cost to Patient
California HMOs Send Some Enrollees to Mexico
By Sonya Geis
Washington Post Staff Writer
Sunday, November 6, 2005; A03
TIJUANA, Mexico -- There are world-class hospitals in San Diego, not far from where Luis Gonzales lives. But when he or a member of his family needs a doctor, they drive 50 miles south to a clinic in Tijuana.
The Gonzaleses are members of a Blue Shield of California HMO that provides all of the family's nonemergency care in Mexico. They are among 20,000 California workers and their dependents in health plans that cost 40 to 50 percent less than comparable care in the United States because the doctor's visits are outsourced south of the border.
With health care costs in the United States continuing to rise, many employers in Southern California are turning to insurance plans that send their workers to Mexico for routine care, plans that are growing by nearly 3,000 people a year. And Gonzales, for his part, is happy about it.
"They have everything I need," Gonzales said. "They're clean. You don't see a difference between a doctor over here and over there."
Despite Gonzales's satisfaction with the quality of his family's care, the new trend has some medical professionals in the United States worried that care is being sacrificed to low prices.
"There are quality standards that we are developing and implementing in America that are not going to be implemented there for a long time," said Jack Lewin, chief executive of the California Medical Association. "In terms of specialized care, it's critically important that we look beyond just cost savings."
Five years ago, California became the only state to regulate insurance programs that require border crossing for basic health care. Since then, more than 700 non-agricultural businesses have offered plans requiring treatment in Mexico. Hundreds of farms offer similar coverage for about 120,000 migrant laborers.
In Texas, legislators explored the possibility of allowing health maintenance organizations to operate on both sides of the border. But physicians in South Texas lobbied against the changes, arguing that local doctors could not compete with the lower costs in Mexico.
Lower-priced labor, malpractice insurance and overhead in Mexico mean both basic and sophisticated medical procedures can be performed at a small fraction of the cost. A hysterectomy that averages $2,025 in the United States costs $810 in Mexico, said Mary Eadson, director of legal compliance for the Western Growers Association, an agricultural organization that provides health insurance for California workers in Mexico.
The movement of U.S. health care across the border has sparked a boom in hospital construction in Tijuana, with clinics and pharmacies opening a short walk from the border.
Francisco Carrillo owns and operates a Mexican HMO plan for California workers called SIMNSA, and he owns the Centro Medico clinic, where large windows face the border bridge many of his patients cross on their way to the waiting room.
On a recent weekday, half the cars in the parking lot bore California license plates. On two of the clinic's six floors, a new surgical center and a dentist's office are under construction. The clinic's other floors were crowded with patients.
"Things are moving very fast," Carrillo said. "We're growing."
David Castillejos Rios has performed laser eye surgery on both sides of the border. At a small hospital in Tijuana, he charges one-third as much as he does in San Diego.
"The medicine is the same, and to me, whether I do it here or there, it's the same," Castillejos Rios said. "Only the price changes."
The difference can translate into the kind of affordable monthly premiums most American businesses have not seen in a decade. At Health Net, the cost of insuring a family of four whose treatment was covered in the states is $631 a month. Using physicians in Mexico, the same family would pay $306 a month, company officials said.
At the Santaluz golf resort in San Diego, where Gonzales supervises golf course maintenance, workers can sign up for a Blue Shield of California plan called Access Baja. Their doctor visits are covered in the United States or Mexico, while their families are covered only in Mexico. Dale Standfast, the resort's controller, said several workers whose dependents were not covered switched plans to cover their families.
Offering Access Baja saves the resort about $1,000 per month in premiums, he said. This year the club used the savings to offer vision coverage to all employees for the first time, Standfast said.
Representatives of Blue Shield of California and Health Net, both of which offer cross-border HMO plans in California, said the quality of care is comparable in both countries. Their doctors are credentialed in Mexico, and the HMO operations are subject to California oversight. The insurance companies audit Mexican clinics themselves, and then report to the California Department of Managed Health Care.
Company officials emphasize the warmth of the Mexican medical culture.
"Mainly, the patients that come here are searching for more attention," said Juan Carlos Helu Vazquez, a gastroenterologist in Tijuana who sees Mexican and American patients. "They want the doctor to talk to them, be warm to them. There are a lot of patients who like the old-time medicine. They like the doctor asking about your family, your work."
Gonzales said he had better care in Mexico than in the San Diego region.
"I went to the doctor over here and he never cured the problem, he never gave me a good medicine, never sent me to a specialist. He never cared about my health," Gonzales said. "When I went over there, the first doctor I saw, he sent me to a specialist. He wasn't just going to say, 'Take this and go home.' "
Administrators at cross-border HMOs expect their plans to grow because the cost of health insurance in the United States is out of reach for an increasing number of working families.
That is what worries Lewin of the California Medical Association.
"It's understandable that lower-income workers are trying to seek health care they can afford," he said. "But these people are largely paying taxes and contributing some of their own financial resources to this country. It's high time we provided good care for these people through enlightened public policy."
© 2005 The Washington Post Company

Clearing the air in Howard
Baltimore Sun Editorial
Sunday, November 6, 2005
Smoking is banned from most workplaces in this country. Why? Because secondhand smoke contains 50 known carcinogens and raises the risk of lung cancer and heart disease in people who don't smoke. The Centers for Disease Control and Prevention estimates that at least 38,000 people in the U.S. die each year because of exposure to secondhand smoke. Unfortunately, many states, Maryland included, don't prohibit smoking in all restaurants and bars. It's a costly - and potentially deadly - loophole.
But that's changing. Tomorrow, Howard County Executive James N. Robey is expected to formally introduce legislation to ban smoking in bars and restaurants as well as at outdoor athletic and entertainment events. If successful, Howard will join Montgomery and Talbot counties, where similar smoking bans have proved to be effective. Two County Council members have already promised support for the proposal, and a third, David A. Rakes, pledged to vote for a ban when he ran for office in 2002.
It's a welcome trend. In recent years, eight states (including neighboring Delaware) have endorsed smoke-free bars and restaurants, as have at least 190 localities. Howard County has a history with the issue, too. Under legislation passed 12 years ago, restaurants that choose to permit smoking must have a smoking area with separate ventilation. That was a progressive decision for its day, but the requirement failed to address the health of the county's restaurant and bar workers.
Protecting employee health is a prime reason why Howard County - and the rest of Maryland - needs to ban smoking in all businesses. Customers can choose not to patronize bars that permit smoking. Employees can't. And they have to breathe the toxic fumes day after day. Certainly, we wouldn't allow companies to knowingly expose workers to harmful chemicals. Tobacco shouldn't be treated differently.
Research shows smoking bans are effective and the public supports them. A recent study in Ireland found a similar nationwide smoking ban has significantly improved the health of bar staff. Mr. Robey's proposal wouldn't go into effect for two years, but we see no reason for such a delay. Smoking bans don't hurt the restaurant industry, but secondhand smoke does - by harming employees and driving up health care costs. Might a ban inconvenience some customers? That could prove a secondhand benefit: The more lives spared, the better.
Copyright © 2005, The Baltimore Sun

A Hospital Plan for Pandemics
Don't Close Walter Reed and Other 'Obsolete' Facilities
By Phillip Longman
Washington Post Commentary
Sunday, November 6, 2005; B07
Got your Tamiflu yet? How about a home respirator and a live-in nurse? If expert predictions of a coming flu pandemic prove right, there's little chance you'll be able to find a hospital bed in which to recover.
Here in Washington, for example, after a long series of hospital closures, there are only 4,346 hospital beds left -- a number that will soon go lower with the closing of Walter Reed Army Medical Center's main facilities. Yet projections show that even a moderately severe strain of a pandemic flu virus would require some 5,000 people to be hospitalized in the District alone. Even if we discharged every patient in Washington's hospitals -- including all the mental patients in St. Elizabeths, all the frail elderly in Hadley Memorial's long-term acute care facility and all the veterans in Veterans Affairs Medical Center -- there still would not be enough hospital beds available to care for, or even to quarantine, highly infectious flu patients.
The same is true nationally. Since 1980 the number of hospital beds available per U.S. resident has declined by roughly 40 percent. Today the United States has only about 965,000 staffed hospital beds. Yet Trust for America's Health, a nonprofit group committed to promoting public health, estimates that the emergence of a pandemic flu virus like the one of 1918 would require hospitalization of 2.3 million people in this country.
There are many sound reasons why the number of hospital beds has been declining. New technology allows for much greater use of outpatient facilities. Galloping medical inflation demands more cost-effective care. But the result is a health care system that is perpetually running at or above 100 percent capacity, and that will be overwhelmed by a pandemic, major terrorism attack or natural disaster.
Fortunately, there is a way to help solve this problem and many others that plague our health care system.
Let's start with the example of Walter Reed. Located just 5 1/2 miles from the White House, 6 1/2 miles from the Capitol and six miles from the Washington Convention Center, its facilities, including a hospital built in 1972, are an integral component of the District's emergency preparedness plan. In the event of a mass casualty terrorist attack or other public health emergency, the plan calls for Walter Reed to discharge its noncritical patients and begin treating civilian victims within as little as three hours. Walter Reed is particularly well equipped and well situated to treat not only victims of a flu pandemic but also those wounded by a nuclear or biological attack in downtown Washington. But maintaining this capacity is expensive, and right now Congress is poised to accept the recommendation of the Base Realignment and Closure Commission that the main hospital and most other buildings on the 113-acre campus be razed.
It may well be appropriate for the military to reorganize and rationalize the way it delivers care in the Washington area and many other parts of the country, just as it is for the private sector. Across the Northeast and Midwest, for example, many VA hospitals have lost their patient base because so many aging veterans have retired elsewhere. The Department of Veterans Affairs has announced that it is closing hospitals in Pittsburgh and in Brecksville, Ohio, and it is threatening to close facilities in Brooklyn and Manhattan. But rather than abandon these and other "obsolete" hospitals -- including many shuttered public hospitals such as D.C. General -- we should turn at least some of them into facilities that will stand ready to serve the public in the event of disasters and that between disasters will serve the uninsured and those on Medicaid.
Private health care providers are under such enormous pressures to contain costs that they cannot begin to afford to keep wards open that aren't filled nearly every day. This makes it the proper role of government to ensure we have surge capacity that the private sector cannot deliver. Literally every American, including those with gold-plated health insurance plans, stands to benefit from a health care system built to handle such increasing risks as a flu pandemic, another Katrina, a major earthquake or a terrorist attack.
Such a plan would also go a long way toward both rationalizing the U.S. health care system and making it more equitable. Study after study has shown that Veterans Affairs, by making extensive use of electronic medical records, information technology and provider incentives, is providing health care of far higher quality, and at less cost, than that received by most insured Americans, let alone the uninsured. At the same time, hospitals in the District of Columbia spend nearly 7 percent of their revenue on the uninsured, and the total cost to the local health care system is much higher. Meanwhile, nearly a quarter of all patients in Washington hospitals are on Medicaid, and to hear the hospitals tell it, they lose money on every one.
Message to Congress and local decision makers: Why not turn Walter Reed and facilities like it across the country into pilot projects that can point the way toward true reform and improvement of our beleaguered health care system?
The writer is a senior fellow at the New America Foundation.
© 2005 The Washington Post Company

The Benefits of Mammograms
New York Times Editorial
Sunday, November 6, 2005
Long-simmering doubts about the benefits of mammograms to screen women for breast cancer should be dispelled by a new study conducted by seven major research groups. Mammograms have long been recommended as an effective tool for detecting tiny breast tumors so that they can be treated before they become dangerous. But four years ago, an analysis published in a British medical journal found so many flaws in studies that purported to show a benefit from mammography that the results were deemed virtually meaningless. Other experts agreed that the evidence was shaky, but mainstream cancer and medical organizations remained convinced that mammograms save lives.
Now comes a study, published in The New England Journal of Medicine, that was conducted by research teams including both skeptics about mammograms and true believers. The study sought to estimate the relative importance of screening mammograms and powerful new drugs in producing a 24 percent decline in breast cancer mortality in the United States from 1990 to 2000. Seven research teams each developed statistical models of breast-cancer incidence and mortality and plugged in additional information to tease out the answer.
The results varied widely. One team found screening responsible for 65 percent of the decline and drug therapies a mere 35 percent. Another team gave drugs fully 72 percent of the credit. The other estimates fell in between.
What seems most important is that each team found at least some benefit from mammograms. The likelihood that they are beneficial seems a lot more solid today than it did four years ago, although the size of the benefit remains in dispute.
Women still need to make their own judgments as to whether the usefulness of screening outweighs the risks, which include false positives and possibly needless treatment to remove tiny tumors that might never have caused a problem if left alone. The good news is that women can now be pretty confident that there really are benefits from mammography.
Copyright 2005 The New York Times Company

A line drawn wrong
Baltimore Sun Editorial
Sunday, November 6, 2005
Two years ago, when Congress was designing the new Medicare drug benefit that takes effect in January, lawmakers feared drug plans might not be offered in rural areas because private insurers would consider them unprofitable.
Those fears proved wildly off base. Ten separate drug plans are available to Medicare beneficiaries nationwide, and thousands more regional plans have been offered, leaving no part of the country out.
Thus, Senate budget cutters, looking to reduce the deficit without cutting direct benefits to people, figured the $5.4 billion in incentives intended to lure drug plans into rural markets was an obvious target.
Amazingly, the Bush administration has singled out this common-sense cut as a reason to veto the first deficit reduction legislation enacted since 1997 - a $35 billion to $50 billion package likely to meet some of the president's most dearly sought goals.
Our first impulse is to say of the veto threat: Go ahead, make our day.
After the House adds its contribution to this legislation, the package appears likely to be an all-out assault on the poor, sick and disabled that won't even save money because $70 billion more in tax cuts for the wealthy are scheduled to soon follow.
This phony belt-tightening exercise is also the device through which oil companies are expected to finally get the right to drill in Alaska's pristine wildlife refuge.
But genuine deficit reduction is a worthy goal. Perhaps some queasiness among House Republicans about such hard-hearted proposals as kicking 300,000 people off food stamps - as well as opposition to the Alaska drilling - can lead to the crafting of a more responsible measure.
Few items more clearly qualify for chopping from the budget than the $5.4 billion earmarked over the next five years to pay incentives, if necessary, to get private drug plans to offer the Medicare benefit.
The administration argues that the current flurry of interest by drug plans could dissipate in later years. And Mr. Bush is particularly determined to avoid any legislative tinkering with the prescription drug program before it takes effect.
When such caution comes at the expense, though, of families losing food stamps, single mothers denied help collecting child support and poor children forced to make co-payments for health care, it simply can't be defended. Judd Gregg, the Senate Budget Committee chairman whose colleagues eliminated the incentive fund money to avoid harming individuals, called Mr. Bush's veto threat "absurd."
While we wouldn't mind seeing the president finally wield his veto pen on this legislation, we'd prefer a deficit-reduction measure worthy of the name that puts the highest priority on protecting the most vulnerable Americans.
Copyright © 2005, The Baltimore Sun

Facts about Medicare Part D prescription program
By Bob Maginnis
Hagerstown Herald-Mail Commentary
Sunday, November 6, 2005
By now you should have received the booklet "Medicare & You 2006" in the mail. It contains instructions for signing up for the Part D program and a list of the 47 approved plans.
What follows are a list of questions answered by Katrina Eversole, an insurance advocate who works out of the offices of the Washington County Commission on Aging.
Which plan is right for me?
It depends on a number of things. Your pharmacy probably won't participate in every plan, so a good first step would be to talk to your pharmacist and find out which drug plans they will accept.
What do all the plans have in common?
All plans must offer brand-name and generic drugs. Each plan will have a network of pharmacies for its members. Each plan must allow its members to obtain at least some prescriptions in an out-of-network pharmacy, if, for example, you're on vacation and need medicine.
Each plan must include at least two drugs in a therapeutic or diseases class, so your doctor has some choice. If a pharmacy decides to withdraw a drug that has been on its list, it must notify the beneficiaries in writing.
How much will it cost?
Every plan is different, but if you meet income guidelines, you will be eligible for financial help, and application forms are available through the local Social Security office. Those who qualify include individuals with less than $14,355 in gross annual income who have less than $11,500 worth of assets. Your home and car don't count as assets. Couples qualify if they have a gross annual income of less than $19,245 and less than $23,000 worth of assets. Again, your car and home don't count in the asset total.
What if I don't qualify for assistance?
The Part D program is not just for low-income people. Every Medicare recipient is eligible. There are various premiums and deductibles, depending on the plan that you choose. But whether you have to sign up depends on whether the prescription drug plan you have now is "creditable."
In other words, if it is as good or better than Part D program, you can stick with what you have now.
How will I know whether my present plan is "creditable"?
You may already have been notified by mail or will be notified by Nov. 14, 2005. You may want to call your former employer to see if drug coverage will continue and whether it will be as good or better than what the federal government is offering.
How do I know whether my present plan will continue?
Again, you should have been notified by mail. Three plans we know for sure will continue are: Federal Employee Health Benefits Program (FEHBP), the Veterans Administration (VA) program and Tri-Care.
Which plans are closing for sure?
Medigap plans with H, I and J coverage are not creditable and the prescription part of this supplemental medical coverage will not continue after Dec. 31 - you will be offered a choice of Medigap plans (with comparable medical coverage) without prescription coverage.
Maryland Pharmacy Assistance Program, as well as the Maryland Pharmacy Discount Program, will end Dec. 31. CareFirst Senior Rx Plan will also end on Dec. 31, and members will receive help transitioning to new plans; namely a $25 per-month subsidy for the plan of the member's choosing. CareFirst members are receiving information in the mail now about trade shows and seminars in Washington County.
What if my employer decides to discontinue the Rx coverage to retirees at a future date?
Then you will have 63 days to enroll in a Medicare Part D plan with no penalties (if it is after the May 15, 2006 deadline.)
Will the Part D program affect my medical coverage under Medicare?
What if I'm on Medicare and medical assistance?
The pharmacy part of that coverage will end Jan. 1. You will automatically be eligible for financial assistance, but if you do not choose a plan on your own, one will be chosen for you and it may not be the best choice. You need to pick a plan that covers all the drugs that you are using.
What if I receive state assistance (QMB or SLMB programs) to help pay for my Medicare Part B coverage?
You will also receive assistance to pay for Part D, but you must actively choose a plan to get the benefit of that assistance.
What about Medicare approved discount drug cards?
They will be phased out by May 15, 2006, or if you choose an Rx plan earlier than that date, the card will cease to provide assistance.
I get my prescriptions through Medbank. Can I continue to do so?
Medbank funding will continue for those who are not eligible for Medicare.
Some pharmaceutical companies recently notified Medbank that they will not supply free drugs to anyone who is eligible for Medicare Part D (this means all Medicare beneficiaries).
Other companies want to see proof that you have applied for "extra help" through Social Security and have been denied financial assistance.
What if I don't take any prescription drugs now? Do I still need to sign up?
Yes, because you will face a penalty later if you don't. Choose the cheapest plan now and you can transfer to another later if your needs change. Do the math to see if it is worthwhile for you to do so at this time.
How often can I change plans?
You are locked into a plan for one year. Open enrollment is from Nov. 15 through Dec. 31 of each year.
What if I'm in a plan and my doctor says I need a drug that isn't in the list of approved drugs?
There's a special exception process that requires the physician to request that the drug be added to their formulary until you are able to choose another plan that covers all of your drugs.
Medicare Part D
Public Education Seminars Robinwood Medical Center
Suite 142
(blue or silver entrance)
Monday, Nov. 7 9 a.m.
Friday, Nov. 18 1 p.m.
Tuesday, Nov. 22 - 6:30 p.m.
Tuesday, Dec. 6 9 a.m.
Monday, Dec. 12 9 a.m.
Monday, Dec. 19 1 p.m.
Monday, Jan. 9 1 p.m.
Wednesday, Jan. 18 9 a.m.
Tuesday, Jan. 31 1 p.m.
Friday, Feb. 10 1 p.m.
What you will learn at Medicare Part D seminars
(Note: Please bring a pencil and pad so you can take notes. A question-and-answer period will be held at the end of each seminar.)
1) What is Medicare Part D?
2) Will the prescription drug coverage that I carry now change or expire at the end of 2005?
3) Should I enroll in a prescription Rx plan sponsored through the federal government?
4) Am I eligible for extra financial assistance to help pay for the premium of the drug plan that I choose?
5) How long do I have to make a decision before my coverage runs out or until a penalty is imposed?
6) What kinds of Rx plans are being offered in Maryland?
7) How do the new drug plans work?
8) What do I need to know to make an informed decision?
9) What resources/contacts are available to help me make a wise decision?
What Medicare Part D seminars will NOT do (or what can YOU or a family member can do to help yourself)
1) Check with your pharmacy to see what prescription drugs plans they have decided to participate in.
2) Call your doctor to ask questions about current drugs.
3) Call a Rx drug plans to see if your drugs are covered under that plan.
4) Pick a plan for you.
Copyright The Herald-Mail ONLINE

Pandemic ammo
By Daniel Gallington
Washington Times Commentary
Sunday, November 6, 2005
It's hard to think of anything more important than to get enough of the right vaccine and get it quickly enough to prevent millions of deaths in a pandemic if bird flu virus in central Asia mutates into a form contagious among humans.
Yet we're going about it in the opposite way we should. Here we are, with the virus practically upon us, talking about appropriating money and immunizing (no pun intended) from civil liability the only private company that can produce the vaccine necessary to protect us -- even then with old, small-batch technology that will not produce nearly as much vaccine as would be needed to immunize all of us.
Nor will it produce the right vaccine, quickly enough, to deal with the bird flu virus as it mutates further.
While the president's speech last week was reasonably optimistic, at its heart was the idea Draconian measures might be needed to control movement of people and to deny access to certain areas to prevent against from a viral catastrophe. In short, the vaccine approach to the bird flu might fail.
This is the wrong answer. We should be much more "ahead of the problem," and we need to address it -- comprehensively.
Let's fund and build a state-of-the-art government facility and keep it producing enough of the right vaccine to immunize us against the most serious flu-based viral diseases that develop.
The "model" for this is the Government Ammunition Plant, an we have held onto for 200 years to ensure our military always has enough of the proper ammunition in any conflict involving us at any time, anywhere.
And, as we debate the flu pandemic, there is a huge government factory in Lake City, Mo., turning out all the small-arms ammunition we need. The last of 12 government-owned and -run ammunition plants, now run by a contractor, the Lake City Ammunition Plant, has several associated Web sites. Look at them and think how we might use this idea to produce enough of the flu vaccines we will need each year.
Without getting into a political discussion, most Americans would probably agree that protecting our people -- at home -- against a catastrophic flu epidemic is a priority at least as high as ensuring U.S. troops have enough bullets.
And, there will always be the public-private debate: Even as the Army worries about "shortfalls" in small-caliber ammunition, it opposes building more government-owned plants and believes shortages can be made up through private-sector contracts.
If there were vaccine "shortfalls," we could look to the private sector too. But should we look there for all of it? I think not.
There will always be at least one government-owned ammunition plant, albeit run by a private contractor. Congress has always seen the great wisdom of this.
And the lawmakers should likewise see the same wisdom regarding production of enough of the proper flu vaccine so every American can be immunized.
Much of the last year's vaccine supply proved bad and we simply didn't have enough of the good kind. The government's sole contract with a foreign vaccine producer failed to deliver: The contractor could not provide nearly enough vaccine.
The odds of this occurring with a government-owned plant, even if operated by a contractor, are very low. And we must plan our public-heath strategies around this sort of confidence, especially when the potential disaster is so great.
This year, we simply can't afford to make a mistake. Yet we again have limited our options: We must depend on the private sector, pay what they ask, and suffer the results of their failure if they don't deliver -- and, like last year, they may not.
In short, we need much better odds against the Asian bird flu pandemic than we have given ourselves.
Daniel Gallington is a senior fellow at the Potomac Institute in Arlington, Va. He has served in a number of senior national security policy positions.
Copyright © 2005 News World Communications, Inc.

To Fight the Flu, Change How Government Works
By Newt Gingrich and Robert Egge
New York Times Commentary
Sunday, November 6, 2005
Washington – Last week, President Bush released plans to prepare the nation for the possibility of an outbreak of deadly influenza, calling for Congress to appropriate $7.1 billion for research and the stockpiling of vaccines and antiviral drugs. As a summary of goals and strategies, the president's plans are commendable. But drafting them was the easy part. Putting them into effect will be the challenge.
The problem with President Bush's plans is that they can't succeed in the current bureaucratic structure. Were the federal government ever entitled to the benefit of the doubt, it forfeited that presumption in the aftermath of Hurricane Katrina. Unless these shortcomings are fixed, we have no grounds to presume the administration's laudable avian flu strategies will be translated into action.
What we need to do to prepare for and respond to a pandemic is change the very way the government delivers services. And to do that, the following initiatives must be integrated into the government's response:
Designate a single, accountable leader. An avian flu pandemic is among the greatest threats to our country today. Given our vulnerability and the amount of work to be done, the president must appoint a leader who is singularly focused on avian flu. This leader must be fully accountable for the government's progress. And the president must make it clear that this leader speaks on his behalf.
Fragmented authority will cripple the administration's efforts. In the president's plan, responsibilities are spread out among a number of United States departmental and agency heads. This is a recipe for disaster that could result in confusion, finger-pointing and neglect. If after the failure of Hurricane Katrina the administration hasn't understood the need for a single, dedicated leader, it hasn't yet faced up to the scale of disaster that a flu pandemic presents.
Replace bureaucratic administration with entrepreneurial management. If an avian flu pandemic sweeps the United States, it will pose a tremendous challenge in terms of speed, lethality and complexity. Federal, state and local governments will need to act with the speed and agility of the information age.
Unfortunately, our government cannot operate at anything approaching this level. Despite modest civil service reforms over the years, the government remains caught up in a bureaucratic process-oriented approach to business. The government's pandemic preparations must be equipped with 21st century entrepreneurial management practices that mirror those of America's best-run corporations. The government will need to stop focusing on process and concentrate instead on results.
To do this, it will need a management system that allows for collaboration between the government and communities similar to the Compstat crime system used by the New York and Los Angeles Police Departments. Compstat links headquarters to each precinct, allowing for accurate intelligence, rapid deployment and relentless follow-up.
Prepare for the days of a phony war mentality. Until we receive word that a pandemic is loose in this country, last week's announcement could well be the high point of public attention to the threat posed by avian flu. The pressure to prepare will decline. And as this happens, government attention will be pulled in other directions.
Resisting this temptation will require strong leadership from the administration and from Congress. But it will also be aided by concentrating on efforts that have multiple uses in peacetime as well as during a pandemic. These dual-use investments will be easier to justify if they are presented as an essential step in preparing for a deadly flu outbreak.
A leading example of such an investment is an electronic health record system, which would allow the federal government to track the course and impact of a pandemic in real time. Public health experts widely agree that this kind of network would not only allow for safer and more efficient care under normal circumstances, but would also equip federal, state and local governments with the data needed to direct scarce therapies, medical teams and supplies to where they are most needed as a pandemic unfolds. There's no good reason why every American couldn't have a preliminary electronic health record by the end of 2006.
While we can be grateful that President Bush has acknowledged the seriousness of a possible deadly flu outbreak and outlined strategies to prepare the nation to respond, much more needs to be done. Focusing on these three initiatives will ensure that we are prepared. The success of the president's plans hinges on getting this right.
Newt Gingrich, a former speaker of the United States House of Representatives, is the founder of the Center for Health Transformation. Robert Egge is a project director at the center.
Copyright 2005 The New York Times Company

Warning: Some Health Ads May Be Dangerous to Your Health
By Richard Morin
Washington Post Commentary
Sunday, November 6, 2005; B05
Department store magnate John Wanamaker once famously said that he knew that half of the money he spent on advertising was wasted -- he just didn't know which half.
His wry comment helps describe the serious dilemma now faced by those who create advertising for new drugs or organize public service health campaigns, according to researchers at Indiana University. It seems that many drug ads and public service messages may have the unintended consequence of dissuading people from obtaining potentially life-saving drugs or taking preventive steps such as getting vaccinated, according to studies conducted by Anthony and Dena Cox, professors of marketing in the university's Kelley School of Business, and Gregory D. Zimet, a professor of pediatrics and clinical psychology at the Indiana University School of Medicine.
"People who design real campaigns may -- with the best intentions -- actually end up designing programs that are ineffective or even harmful," Anthony Cox said. And what's more, he added, it is exceedingly difficult to predict whether a particular ad message will help or hurt.
In a study funded by the National Institutes of Health, the researchers tested different print messages to see whether they affected the willingness of people to get vaccinated against hepatitis B, a potentially lethal liver disease transmitted by sexual contact and drug abuse. Their test subjects were 213 randomly selected clients at three public clinics offering treatment for sexually transmitted diseases -- precisely the group that should get vaccinated.
One group saw messages emphasizing that the vaccine would greatly reduce the chance of getting hepatitis B or spreadingthe disease to uninfected partners. Advertisers call this a "gain-framed" message, because it highlights the benefits that would be obtained from getting vaccinated.
The others read a "loss-framed" message that stressed the awful consequences -- death or infecting a loved one -- of not getting vaccinated. (Only a few words were changed to alter the messages. The positive message included this statement: "People who get the hepatitis B shot are gaining a chance to protect themselves and the ones they love," while the negative message read, "People who don't get the hepatitis B shot are losing a chance to protect themselves and the ones they love.")
These subtle but opposing approaches produced dramatically different results. Test subjects who read the positive pitch were inclined toward vaccination, and more likely to discount so-called "nuisance risks" ("the shot will be painful"). The subjects who read the negative appeal were more likely to say they didn't want to get vaccinated and to worry about the nuisance risks, the researchers report in a forthcoming issue of the Journal of Marketing.
The solution seems simple enough to me -- design ads that emphasize the benefits and avoid messages that attempt to scare people into action.
Not so fast, says Anthony Cox. An earlier study produced what he called "a very different" finding.
In that study by the Coxes, published four years ago, women were shown different print ads that encouraged them to get a mammogram. One ad emphasized the benefits of getting the test, including a greatly reduced risk of dying from breast cancer. (Significantly, Cox noted that similar upbeat messages are almost universally employed in campaigns encouraging women to get regular breast exams.)
The other ad emphasized what would happen if they didn't get a mammogram, including the fact that they ran a much higher risk of dying from cancer. A third group saw no ad. Then the women in the three groups were asked whether they intended to get a mammogram and their overall views of breast cancer, including whether they expected to develop the disease sometime in their lives.
Those who saw the upbeat ads said they were less likely to get a mammogram than those who saw the negatively framed ad. And if that weren't enough, they also were more likely to believe that they would not get breast cancer than either the group that saw the negative ad or the women who saw nothing.
So, Professor, what's your prescription for deciding whether to go positive or negative in a health campaign?
"Pretest these campaigns to see what the real-world effects may be," Cox advised.
And cross your fingers.
© 2005 The Washington Post Company