Office of Public Relations

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Office of Public Relations

Monday, January 22, 2007

News Clipping Archives

Medicaid called harder for poor (Baltimore Sun)
Frederick County farmer sues state over new restrictions on raw milk (Daily Record)
Life after death (Baltimore Examiner)
U.Md. program helps deaf overcome substance abuse (Baltimore Examiner)
Radio show host speaks for Baltimore's foster children (Baltimore Sun)
'We're Like a Family' (Cumberland Times-News)
Use of fluoride in water supply raises questions (Carroll County Times)
In Good Health — A smart vaccine, just in case (Frederick News-Post)
For decongestants, is the hassle worth the relief? (Cecil Whig)
Universal Health Coverage Attracts New Support (Washington Post)
In Live Bacteria, Food Makers See a Bonanza (New York Times)
Faith in Quick Test Leads to Epidemic That Wasn’t (New York Times)
Study: Doctors out of sync with cancer patients' wishes (USA Today)
Drug seen as aid for muscular dystrophy (Baltimore Sun)
New WHO Chief Calls Meeting on Polio (Washington Post)
Minding the jail (Baltimore Sun Editorial)
The Clinic Is Open (New York Times Editorial)
No reason to tamper with drug program (Baltimore Sun Letters to the Editor)



Medicaid called harder for poor
Health advocates fear document rules cause many to lose coverage

By Kelly Brewington
Baltimore Sun
Monday, January 22, 2007

Public health advocates fear that a new federal regulation requiring Medicaid applicants to supply proof of identity and citizenship has resulted in thousands of poor Marylanders losing their health insurance.

The requirement, part of the federal Deficit Reduction Act that went into effect in Maryland in September, was designed to prevent illegal immigrants from fraudulently receiving Medicaid, the nation's premier health insurance program for the poor.

But advocates and health officers in some Maryland counties insist the rule has burdened citizens who need health care the most and is likely responsible for thousands of Marylanders being kicked off the Medicaid rolls.

"It's a completely unnecessary law and Congress made a big mistake in passing it," said Laurie Norris, an attorney with the Public Justice Center. "The people who are on Medicaid in Maryland are supposed to be on Medicaid."

The announcement of the regulations last June sparked an uproar among advocates and state health officials, who were given a July 1 deadline to enforce the mandate or risk losing federal funding. The officials complained they were not given enough time to train staff and inform Maryland's approximately 650,000 affected Medicaid recipients that they must furnish such identification as birth certificates, driver's licenses and passports.

Nationwide, advocates feared huge enrollment declines, saying many of Medicaid's neediest recipients don't possess the necessary documents and would have to struggle to come up with the money to obtain them. Maryland, for instance, does not automatically issue birth certificates, which may be ordered for $12.

Last summer, the federal government exempted from the requirement elderly and disabled Medicaid recipients who receive Supplemental Security Income from Social Security, and last month it extended the exemption to foster children. Still, states such as Virginia, Iowa, Wisconsin and New Hampshire noted plunging Medicaid enrollment figures and backlogs related to the regulation, according to a report released earlier this month by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured. In Virginia, 12,000 children have been dropped from Medicaid rolls in the requirement's first four months of implementation, the report stated.

In Maryland, Medicaid enrollment numbers are down overall, but state health officials say they are unsure whether the drop is due to the new rule, a point that has frustrated county health officers eager for evidence of the regulation's impact that they could use to push for change.

From August through December 2006, the state Department of Health and Mental Hygiene recorded about 6,000 fewer Medicaid enrollees statewide compared with the same period in 2005. Maryland officials say the enrollment computer system is not configured to determine the exact cause of the decline.

"It is imperative that the state disclose data to demonstrate the impact of this law," said Dr. Joshua Sharfstein, Baltimore health commissioner. "There are warning signs that a major erosion in health coverage could be happening as a result of this new law. This is really concerning. ..."

Charles Lehman, who oversees eligibility issues in the state's Medicaid office, said the agency has concentrated its limited resources on "keeping people on Medicaid rather than tracking the people going off."

"It may not sound like we are doing everything we can, but really, we are, with the resources we have," he said. "It's not just the clients, not just the caseworkers, everyone has been impacted by this."

Officials said while applicants are typically allowed a 30-day grace period, caseworkers will not discontinue the insurance if applicants are "making a good-faith effort" to obtain the documents.

"I think we have done a good job applying the law appropriately but not in a way that arbitrarily cuts people off," said Lehman. "We have made our best effort to keep people on."

The department has spent $1 million for a toll-free number to help applicants, 866-676-5880.

The state health department has also partnered with other state databases to verify the citizenship and identity of beneficiaries, without requiring recipients to hand over documents. In July, the agency searched birth certificate records for about 600,000 Medicaid enrollees at the cost of $12 per search, said Lehman.

But the effort has not gone as smoothly as hoped, said Norris, with the Public Justice Center. For instance, the databases are not automatically synched - staff must print out the information and check it by hand.

"The state has been severely hampered in information technology," she said.

Norris alerted state lawmakers to the problem at a briefing in Annapolis last week. The problems come during a push by advocates and some lawmakers and business groups to expand Medicaid and help about 780,000 uninsured Marylanders.

Officials with local agencies have increased outreach and said they have allowed people extra time to provide the documents they need.

Nevertheless, in Anne Arundel County, for example, denial rates for the state's Medicaid program for pregnant women and children have jumped from an average of 18 percent from June through December 2005 to 42 percent for the same period in 2006.

"It's really shocking," said Frances Phillips, the county's health officer. "This is so serious because the people we are talking about are either children with no insurance and no way to access health care, or pregnant women."

Many applicants eventually produce the documents and get back on Medicaid, Phillips noted. But for vulnerable populations, any discontinuation in coverage can be harmful, she said.

A health department program in which nurses make home visits to women with at-risk pregnancies has focused on educating women on the documentation. "We just feel that this is so critical," said Phillips. " ... We touch base with the women, find out what is going on with them and make sure they get insurance."

In Baltimore, outreach workers with Baltimore HealthCare Access Inc., which assists some of the city's estimated 200,000 Medicaid enrollees, are making home visits and contacting state agencies on applicants' behalf.

The agency received $5,000 from the Abell Foundation to help applicants cover the cost of documents.

"We are plowing away that money pretty quickly," said Kathleen Westcoat, the organization's president.

The funding helped Brenda Kent, 36, pay for her birth certificate last month. She lost her wallet two months before she was due to apply for Medicaid benefits for herself, her twin sons and a daughter.

"I didn't know how I was supposed to get it," said Kent, who does not work. "If they didn't help me with the cost, it would have taken me longer to do it."

Copyright © 2007, The Baltimore Sun.

Frederick County farmer sues state over new restrictions on raw milk

Associated Press
Daily Record
Monday, January 22, 2007

A Frederick County farmer is suing the state Department of Health and Mental Hygiene over new regulations aimed at stemming consumption of raw milk, his lawyer said Friday.

Farmer Kevin Oyarzo, of Buckeystown, challenges a rule the agency adopted last fall prohibiting cow-share agreements, in which consumers buy shares in dairy cattle herds and receive unpasteurized milk in return.

The new regulation closed a loophole in the state’s nearly 100-year-old ban on retail sales of raw milk, which has been associated with illness caused by pathogens that are killed by pasteurization.

The lawsuit is supported by the Washington-based Weston A. Price Foundation, a natural-foods advocacy group that contends pasteurization destroys healthful components in milk.

Oyarzo’s lawyer, Paul Walter, of Baltimore, said the rule illegally outlaws consumption of raw milk from one’s own livestock.

“Such a restriction — which has never been contemplated or proposed in any state — would require legislation and cannot be implemented by bureaucrats seeking to define a cow-share agreement as a ‘sale,”‘ Walter said.

The lawsuit, filed Jan. 5 in Frederick County Circuit Court, says Maryland adopted the rule after Oyarzo sought an agency ruling that his cow-share business plan wouldn’t violate the general ban on raw milk sales.

Ted Elkin, chief of the Division of Milk Control at DHMH, acknowledged that the agency adopted the rule on an emergency basis without public hearings after receiving a cow-share proposal.

“It just seemed that what they were proposing was basically a means of getting around the sale of raw milk. It just seems like a sham to us,” Elkin said.

The Maryland Dairy Industry Association supports the new rule, President James Stup said.

“Our position is, we’re opposed to the sale of raw milk; it’s not a healthy practice,” Stup said. “There’s a reason why raw milk is pasteurized.”

Raw milk advocates have been gaining ground despite episodes last year of E. coli contamination that sickened at least eight children in Washington and three children in Southern California.
In late December, a state judge in Ohio reversed the license revocation of a farmer in a cow-sharing dispute.

The Philadelphia Inquirer reported in October that raw-milk sales are rising in Pennsylvania, one of 28 states the Weston Foundation lists as allowing sales for human consumption — although six allow only goat’s or sheep’s milk to be sold and two have regulatory hurdles that have effectively prevented sales. Six other states either allow or have ignored cow-share programs, the organization says.

Copyright 2007 Daily Record.

Life after death

By Jaime Malarkey
Baltimore Examiner
Monday, January 22, 2007

BALTIMORE - So much for resting in peace.

If you die in Baltimore and your body goes unclaimed, there will be no flower-filled funeral home. No heartfelt remembrances from family and friends. No sad goodbyes. No tears.

Instead, your body — a cadaver to state authorities — may find a new short-lived career as a crash dummy to test safety features. Or it may show its patriotic side by participating in gory armor experiments for the military. Or parts of your body may end up in medical research labs. The best-case scenario? Cremation. And that happens after a 14-day waiting period. If old Uncle Joe wants his body to go elsewhere, he has two weeks for someone to claim him.

For most, the two-week cutoff makes no difference. More than half never get claimed. But for some, the two-week cutoff can be disastrous.

Take the case of Roger Frazier, a 61-year-old repairman from Fells Point, who died of heart disease last July in his Broadway Street apartment. While his landlord tried frantically to track down relatives in Philadelphia, the state’s medical examiner performed an autopsy and then sent his body to Ronald Wade, director of the Maryland State Anatomy Board, whose headquarters are in the basement of the University of Maryland Medical School’s Bressler Research Building on West Baltimore Street.

Just 22 days after he came into Wade’s custody — and five days before his son traced his father’s body to that basement — he was ashes.

“It took his landlady a while to find us,” Roger Frazier Jr. said. “I went to the apartment where my dad lived, but they said they took him and had him cremated. I was kind of upset.”

Still, what happened to the Fraziers is not the norm. From June to August 2006, for instance, only 13 of the 97 bodies claimed went past the 14-day limit.

“It’s a transient society,” Wade said. “You have people who are found dead on the street, and maybe they’re not from around here. Maybe there is no family, maybe no one knows if there’s family.

“Police try to locate next of kin, and we’ll contact hospital agencies and try to talk to friends, but it’s hard. There is no magic answer, and there are no investigative units.”

Frazier’s father was one of about 1,400 bodies that came into the anatomy board’s custody last year, about 40 percent of which were voluntary donors to medical research. The rest were unclaimed.

Many were Baltimore’s own with only distant relatives too hard to find or relatives who simply couldn’t afford a funeral. The others were the homeless or people passing through town. In the end, though, they are the forgotten, many of whom will end up as involuntary anatomical donations.

Some of the 800 bodies that go unclaimed each year can lie in the board’s freezers, cooled to 10 below zero, waiting for as long as 12 months to be used for research. After they’re used, Wade authorizes cremation and holds the ashes for at least another year, just in case a relative comes calling.

But, like the Frazier case, how often does somebody come to retrieve a body that’s already been cremated? Wade says it doesn’t happen more than a few times a year, but he doesn’t keep statistics. The assumption is that if somebody wants to claim a body, it’ll be done sooner than later.

“There is no reason to statistically quantify this,” Wade said. “If it happened once a week, then maybe we would adjust the policy.”

The cost of afterlife
Despite federal laws that prohibit profits from cadaver sales to universities, pharmaceutical companies and medical-device firms, the monetary allowances for preparing and transporting bodies for research are sometimes abused, according to anatomical donation experts.

The potential for exploitation made headlines two years ago, when the director of the UCLA willed-body program was arrested for illegally selling about 500 cadavers to a mortuary worker, netting some $700,000. The result was a somewhat false public perception of a lucrative black-market industry, said Brent Bardley, director of the Hanover-based Anatomy Gift Registry, a nonprofit corporation that operates a whole-body donation bank.

“There isn’t a lot of oversight,” Bardley said. “These willed-body programs that operate out of universities and some states don’t have an accounting system like those of a tissue bank, which makes sure how reputable the end users are, and whether or not they are adhering to safe-handling standards and abuse prevention.”

At Maryland’s Anatomy Board, Wade said he would have to sift through thousands of files to identify where each donor or unclaimed body went, but he insists that no one profits from the sales.

“If we’re going to provide our resources, they are going to subsidize our programs here,” Wade said.

The average body costs taxpayers about $750 to embalm, transport and then cremate after the research is complete, Wade said. Because medical schools within the state pay just $125 per cadaver, to subsidize costs the board charges out-of-state schools and government-funded institutions $1,960 per cadaver.

Private medical-research firms that need bodies pay $2,500 per cadaver.

For some, like Prince Frederick (Calvert County) resident Dina Devers, the anatomy board provides desperately needed relief.

Financial hardship forced Devers to hand the moral decision-making over to the government last August when Holy Cross Hospital in Silver Spring called to say her father, Garry Goheen, 69, had died of pneumonia. When she told Wade she couldn’t afford to pick up her father’s body, he told her he’d call when the ashes were available.

“I know they are using his body for experiments,” Devers said. “But I let them go ahead and take it. He didn’t have any money for a funeral.”

Still, Wade says that for some people, scientific research can give their lives meaning in death, especially those who struggled to find meaning in life.

“Maybe a person was mistreated or had a tough life,” Wade said. “At least through this, good is going to come of it.”

Protecting the state’s unwanted
Outside the basement of the Bressler Research Building, an orange fluorescent bulb casts an eerie glow over a loading dock where mortuary workers park their hearses.

Inside, Wade keeps his windowless office entirely dark, save for a dim desk light. Behind the desk, a giant Styrofoam mummy stands next to a row of human organs Wade likes to use for impromptu anatomy lessons. In a storage room down the hall, glass jars of brains fill shelves, and boxes labeled in black marker as femurs, tibias and sacrums sit stacked on a cart.

The embalming solution formaldehyde strongly permeates a hallway lined with freezer doors that are plastered with signs warning workers to place bodies on their backs only.

It’s here Wade exercises custody over the state’s unwanted dead. Raised in the funeral business, Wade softly touches arms and gently pats backs while he talks to people, reflecting a lifetime spent near grieving people.

He calls himself protective of the bodies and establishes ground rules for himself, such as requiring private companies to use institutionally based labs for experiments.

“I’m not going to have a situation where something is found in the trash can when it shouldn’t be,” Wade said. “I’ll release custody, but I won’t release control.”

But things aren’t always as textbook as Wade likes.
Mary Dent lived at the Augsburg Lutheran Home, a continuing-care facility in Lochearn, where family and church friends visited regularly, according to a 2001 lawsuit against the anatomy board filed by her daughter, Jean Jett. When Dent’s granddaughter went to visit one day, she was told that her grandmother had died at Sinai Hospital 38 days prior and had been sent to the anatomy board, where she was cremated.

The news shocked the family, who had prepaid for funeral arrangements.

“I loved my mother dearly,” Jett told defense attorneys. “I was flying here and there, trying to find out where my mother was, where her body was.”

Jett’s attorneys argued the board can only legally embalm a body — not destroy it.

But a judge agreed with a board attorney, who argued the state is not obligated to identify relatives and said the law implies cremation is permissible.

The lawsuit was one of only three filed against the board in the past 20 years. Each time, the board prevailed, thanks in part to laws that shield government employees from negligence claims unless their actions were provably malicious.

But Wade says he strives to incorporate compassion into the bureaucracy that governs his operation.

When Michael Coco, 46, died of liver failure in June, no one came to claim him at Bon Secours Hospital. His sister, Michelle Ritter, lived in Arkansas, which complicated arrangements.

It was Wade, Ritter said, who contacted Veterans Affairs and confirmed he was honorably discharged and his ashes were eligible for burial in the Maryland Veterans Cemetery in Crownsville, Md.

“I’m sure they are overworked and understaffed, but he really went out of his way to help me,” Ritter said. “I’m very grateful.”

Examiner Staff Writer Kathleen Cullinan contributed to this report.

Copyright 2007 Baltimore Examiner.


U.Md. program helps deaf overcome substance abuse

By Kristin Vorce
Baltimore Examiner
Monday, January 22, 2007

BALTIMORE - Baltimore resident Calvin Taylor was addicted to cocaine, but if he had walked into a Narcotics Anonymous meeting he would have found no help — he is deaf, and interpreters are rarely at meetings.

Instead, Taylor found the Deaf Addiction Services at Maryland, part of the University of Maryland School of Medicine. He has been sober for three and a half years.

Based in the Walter P. Carter Center at Maryland’s Baltimore campus, Deaf Addiction Services launched in 2000 and has since provided substance abuse services to deaf people throughout Maryland, which boasts the largest deaf population in the nation.

Although small, all six staff members know American Sign Language, Laurie Yaffe, founder and director said. They provide substance abuse assessments, support groups, anger management, counseling, literacy education and case management

“When you’re trying to have a relationship with a therapist, it’s hard to build up trust if you have to use an interpreter,” Yaffe said. Maryland has the highest per capita deaf population in the country.

Yet many residents are not aware of the challenges facing the deaf and hard of hearing. Even bright hearing-impaired students may become frustrated, unable to understand what the teacher is saying. They may feel isolated and angry at home with parents who do not learn how to sign, Yaffe said.

For those who escape to drugs, finding a physician who offers an interpreter is a challenge, she said.

“The fight is unbelievable,” Yaffe said. “You’re talking about people who’ve been using drugs who may have STDs and don’t have access to doctors.”

With limited funding, staff has worked hard to reach clients across the state. They currently have one case manager, Lisa Blumenthal, who said she spends much of her time driving to different locations.

She helped Taylor find a job and an apartment. Now his children come to visit him.

“Before was awful,” Taylor said. “I was sick and I needed help. I was getting high all the time. Everything is peaceful now that I’m clean.”

Copyright 2007 Baltimore Examiner.


Radio show host speaks for Baltimore's foster children

By Lynn Anderson
Baltimore Sun
Monday, January 22, 2007

Back from a short commercial break, WOLB radio show host Kewanee Smith shouts out a warm "Welcome back, Baltimore!" before turning to the telephone, its lights blinking, to take calls. First up is Johnny.

"My son is 14 years old, and he keeps asking me to adopt him a little brother," says Johnny.

Next up is Sharon, who wants to know why it is difficult to adopt, and later, Linda, who had adopted a little girl and wants to say how happy she is.

Typical talk radio this is not.

And Smith, a licensed social worker with more than 30 years experience in the foster care field, is no typical host.

Her radio program - the short title of which is Putting Children First - has the talk show format, including engaging guests, chatty callers and free giveaways, but is unique in its mission to connect caring adults and needy children.

Smith's success is vital to the mission of the Baltimore Department of Social Services, which has the largest roster of abused or neglected children - about 6,500 - in the state, and an ever-dwindling number of families willing to take them in.

The number of foster families in the city has dropped from 1,784 in December 2004 to 1,456 at the end of last year.

As a result, more city children must be sheltered in foster homes in surrounding counties, a situation that can create stress for fragile children as well as relatives with visitation rights. It also means long drives for case workers - especially in times of crisis.

Samuel Chambers Jr., director of the city Department of Social Services, said it worries him that while his agency approved 117 new foster families between July and December, it lost 157 in the same period. In most of those cases, Chambers said families either adopted the foster child they were housing or decided to drop out of the system after a relative's child for whom they were caring left foster care.

"We have got to be more aggressive," Chambers said. "We have got to market the benefits of staying in the system to families who are thinking about leaving."

The city's push for foster families mirrors one by the state, which has dedicated new funds to recruitment, as well as support for existing foster families.

According to a 2005 report by the state Department of Human Resources, about 73 percent of the state's foster children are placed with foster families, but officials would like to see that number increase. They argue that group homes - facilities that house multiple children - are more costly and are often some distance from a child's home community.

Given the dip in foster families, Smith admits she is under pressure, but explains that in her nearly 20 years of foster family recruitment, that is pretty much the way it has always been.

But if she is stressed, she doesn't show it.

"Good morning, Baltimore!" the social worker/radio personality called out Friday from her studio at WOLB (1010 AM) in Woodlawn. "Today we are going to be talking about strengthening families on behalf of the children of Baltimore!"

With the enthusiasm and pep of a kindergarten teacher, Smith is a hit with her listeners, some of whom are foster parents and foster children. She has been doing the show, which airs from 10 a.m. to 11 a.m., for about seven years - a budget cut took her off the air last year - and has hosted programs on HIV and AIDS as well as on "Chessie," a new computer system that is supposed to keep better track of foster children.

"We try to humanize the bigger picture [of foster care] and show people how they can participate," said Smith, explaining how she picks topics for her shows.

The show, which costs about $400 a week to produce, is paid for by the state, and hosting it is, well, part of Smith's job. Off the radio, she is the city's foster family recruitment supervisor, who oversees two recruitment workers and a small support staff.

"I don't get paid extra to do the show," Smith said. "I will have to talk to someone about that," she added with a giggle.

On Friday, the foster care show lineup at WOLB included caseworkers Abdul Hedayatpour and Anna Claxton, who spoke about finding foster children permanent homes with adoptive parents.

"What they need is a family - a father and a mother," said Hedayatpour in response to a question from Smith, who also explained case worker jargon - including "re-placement," the process of finding a new home for a foster child - to uninitiated listeners.

Later, when Claxton started to explain that older foster children can opt not to be adopted, Smith again pushed for clarification.

"But we always revisit that in case they change their minds, right?" she asked.

"Yes," said Claxton. "A lot of people think that when children get older they don't want to be adopted, but who doesn't want a home?"

When it was time for a commercial break, Smith, like any radio pro, instructed her listeners "not to touch that dial." And when she came back on the air - "Welcome back, Baltimore!" - she encouraged listeners to call her with questions.

She said one of her best listeners before her recent hiatus was a truck driver who would distribute foster family brochures at roadside restaurants.

Smith often tells her listeners that if they want to talk to her off the air, they can leave a telephone number and she will call them back.

And she does so, religiously.

Why?

"To support our children," Smith said.

Copyright © 2007, The Baltimore Sun.

'We're Like a Family'
Glad to be alive, cancer survivors ready to help others

By Daleen Berry
Cumberland Times-News
Monday, January 22, 2007

CUMBERLAND - Cancer isn't a word anyone wants to hear, but people who end up getting the disease don't have a choice.

Before they're diagnosed, they think it won't happen to them. After a diagnosis, they aren't sure what to think.

"You're overwhelmed when you first hear you have cancer," Cumberland resident Sharon Powell said. "Totally overwhelmed."

Melody McMillen would agree with her. After being sick for about two months, with a deep ache in her right shoulder that she thought was first, a pulled muscle, due to the volunteer work she does at her local fire department; then next, a strain from scrubbing her kitchen floor and finally, a cold that turned into pneumonia, the damage was done.

By the time McMillen went to the emergency room, because her family doctor was out of town, and had X-rays taken, the technician told her to call her doctor "before the end of the week," McMillen's mother, Peggy Bell said.

That was in May 2005, and from then until November, McMillen received heavy doses of chemotherapy and radiation. Then she had surgery to remove three ribs and the top lobe of her right lung.

McMillen, a Corriganville resident who took up smoking at age 20, had lung cancer. She was just 48 when she got the news.

"At first I didn't want to think about it," McMillen said.

But she had no choice, as her mother shuttled her to daily chemo appointments that lasted all day long, making McMillen quite sick in the process. If it weren't for the $100 pills paid for by the American Cancer Society, Bell said her daughter would have been much worse.

"They were just wonderful with her. They did a lot to help Melody through this," Bell said. "It's just fantastic, what they do."

That's why McMillen, her husband John, and her mother are going to take part in this year's Relay for Life, the American Cancer Society's signature fund-raiser.

"I went last year. This year I want to stay all night," McMillen said. But she isn't doing it only for herself - she's doing it for the other cancer survivors who will be there.

"She wanted to give something back, give her time," Bell said.

Powell could be McMillen's sister, with her shared desire to give something back, after facing - and defeating - the dreaded disease.

Powell was diagnosed with breast cancer in 1998. She had a bilateral mastectomy, which means both breasts were removed, and then had immediate reconstructive surgery.

"To have part of you taken away and then to look like it never happened, it's amazing," Powell said. "You just look normal."

Having cancer is anything but normal, something both women can attest to, but at least Powell was spared the agony and expense of chemotherapy or radiation. She believes that's because the cancer was detected while still in an early stage. Because she has fibrocystic disease, which causes cysts in the breasts that are usually benign - but which can become cancerous - Powell was used to making regular visits to her doctor, where fluid was often aspirated and checked. Until September 1998, everything was fine.

But then, five new cysts were removed, only to return about 10 days later. Her doctor did a biopsy, and when the results returned, Powell was blindsided by the news.

"You take life for granted, think 'it's not going to happen to me,'" she said.

But, like McMillen, Powell had equally strong support from her husband, who is also named John. "He's my right-hand man. He went with me to every single appointment. Never missed one," Powell said.

In addition to family, friends and church members who are like family, Powell said being a part of a support group can make a huge difference to a cancer survivor.

It has for her. Powell joined 'Hand in Hand,' a group that she says is laid back enough to let survivors do as they need, whether that means talking about their disease, or staying silent.

"People either want to share their story with others or they don't ever want to hear the word cancer again," Powell said. And some survivors start out with little to say, only to find they breathe "that sigh of relief," as they realize other survivors are there to let them cry, give them a hug or offer support in some other way.

Support groups such as this one are, Powell believes, invaluable.

"I really think that knowledge is power. I really believe that when you can hear other people's experiences ... even when they die, it gives you information you can use ... power and knowledge to talk to someone else about it," Powell said.
It is inevitable that some cancer victims don't get a chance to be survivors forever. Even those who attend support groups. But Powell said group members know this, and still learn from - and appreciate - each other.

"We're like a family," she said. "Whatever it is (other members) need, we try to give it back to them."

Powell also plans to be part of this year's Relay for Life. She's been a participant since 1999. Last year she was in charge of the opening ceremony; this year she plans to be involved in the kickoff meeting.

Part of being involved in the annual event is about giving back, by giving to other participants. It's also about looking at life differently - beyond the cancer. For McMillen, that means telling her mother every day how glad she is to be alive, and really being grateful for the little things, like the fishing and camping she loves so much.

For Powell, it's speaking up about what really matters most.

"Life is too short not to say 'I'm sorry to someone you need to say it to, or 'I love you.' You don't want to (regret) that. At least I don't," she said.

Daleen Berry can be reached at dberry@times-news.com.

© 2007, The Cumberland Times-News.
Associated Press content © 2007. All rights reserved.

Use of fluoride in water supply raises questions

By Carrie Ann Knauer
Carroll County Times
Monday, January 22, 2007

UNION BRIDGE — Bret Grossnickle never thought much about the fluoride compounds he puts into the Westminster water system until a stranger called the water department asking where the city gets its fluoride.

In light of Sept. 11 and a greater concern for homeland security, Grossnickle wondered why someone would want to know where the sodium fluoride and hydrofluosilicic acid, which comes in packaging marking it as a toxic material, came from and why anyone else would want to get some.

After talking with the caller, who turned out to be a city resident concerned about the safety of putting fluoride in drinking water, Grossnickle began to question public water fluoridation himself. He visited the Web site of the Fluoride Action Network, an international coalition aimed at broadening public awareness about negative health effects of fluoride exposure, and grew more concerned.

He also read the book “The Fluoride Deception,” which explores the use of fluoride in the development of the atomic bomb, its later use in numerous industries and the concealment that fluoride made some workers ill as industry-supported scientists pushed to have the fluoride byproducts put in public water systems to divert attention from the compound’s pollution of the air.

Reading about the diseases fluoride can cause, particularly dental fluorosis and skeletal fluorosis, which causes defects and weaknesses in tooth enamel and arthritic bone disease, Grossnickle started to wonder about some white marks he had noticed on his sons’ teeth. When he asked his children’s dentist about it, the dentist confirmed Grossnickle’s suspicions that they were the signs of dental fluorosis — a result of overconsuming fluoride during early childhood years.

Grossnickle said the dentist told him not to worry about it because it was a mild form.

“It’s mild, but it’s permanent,” Grossnickle said, shaking his head. “These are their permanent teeth.”

Taking a stand
Grossnickle attended Wednesday’s meeting of the Carroll County Environmental Advisory Council to give his input on the fluoride debate, which was just beginning before the council.

The EAC is considering two issues with fluoride: its risks to infants and the general policy behind public water system fluoridation.

The first issue involves publicizing a new statement by the American Dental Association from November 2006 warning that infants up to 12 months of age should not have fluoridated water or formula made with fluoridated water. That statement also warned that children under the age of 2 should not be given fluoride toothpaste, and that children up to age 6 should be supervised while brushing their teeth and reminded to spit out the toothpaste rather than swallow it — to prevent overconsumption.

The EAC agreed that a letter containing the warning about infants and fluoridated water should be sent to all public water system operators in the county in time for printing the June water quality reports.

These annual consumer confidence reports are mailed to water users, printed in newspapers or included in town newsletters, and are required to reach water users by July 1 following the end of the calendar year that the report is based on, said Ann Baugher, county environmental compliance technician.

Only four water systems in the county are fluoridated, according to the Carroll County Health Department: Freedom District, Mount Airy, Wakefield Valley and Westminster.

At last week’s meeting, EAC member Sher Horosko brought charts from the World Health Organization that showed a decline of tooth decay and cavity cases in all Western European nations over the past 40 years, despite the fact that the majority of these countries do not fluoridate public water. If these nonfluoridated countries have had the same success as fluoridated countries, Horosko wondered what the purpose is of continuing public water system fluoridation, in light of associated health risks.

Robyn Gilden, a public health nurse on the EAC, said she believes the decrease in tooth decay and cavity cases are still linked to fluoride usage, and that residents in countries that don’t add fluoride to their water are getting the chemical from a different source.

Grossnickle agreed that people do get fluoride from other sources — which is one of the reasons he now opposes fluoridating public water. In Union Bridge, Grossnickle’s hometown where he also serves as mayor, the public water is not fluoridated, so his children did not get their fluoride from the drinking water, he said.

The fluoride supplements prescribed by doctors are supposed to give children a more accurate dose of fluoride than drinking water because some children drink more water than others, he said, and yet his children still have dental fluorosis from overconsumption of fluoride. They have since stopped taking the pills, he said.

Fluoride can be found in toothpaste, mouthwash, juice, soda, tea, alcohol, fish, seafood, mechanically deboned chicken, fluoridated salt and even some cigarettes, according to studies in the Journal of Public Health Dentistry, Journal of the American Dental Association and Journal of Agricultural Food Chemistry.

Fluoride also occurs naturally in some groundwater, Grossnickle said, but he does not believe that is the case with Union Bridge.

A widespread problem
According to a 2005 report by the Centers for Disease Control and Prevention, 32 percent of American children now have some form of dental fluorosis, with 2 percent to 4 percent of children having moderate to severe stages.

The U.S. Environmental Protection Agency previously allowed 2 milligrams of fluoride per liter of water, stating that there were no known or anticipated adverse effects on human health at that level. But in 1985, under an administration change in the EPA, the regulations were changed, stating that while 2 mg/L was likely to produce dental fluorosis, that should not be considered a health risk, Horosko said. Instead, the EPA classified the tooth mottling caused by dental fluorosis as a cosmetic defect. The maximum contaminant load was increased to 4 mg/L, Horosko said, which remains the current standard.

The National Academy of Sciences released a report in March 2006 that concluded that the current allowable level of fluoride in drinking water, 4 mg/L, does not protect public health and should be lowered, Gilden said. The committee highlighted concerns about the potential of fluoride to lower IQ and an increased risk of bone fractures for children overexposed to fluoride. The study, however, did not recommend a safe level of fluoride, Gilden said, but has left it to the EPA to set a new standard.

The U.S. Public Health Service recommends between 0.7 and 1.2 parts per million of fluoride in public water systems as an additive to strengthen teeth, and yet dental fluorosis still affects 32 percent of children in America, Grossnickle said. If the recommended standards aren’t protecting the children, then maybe they aren’t good enough standards, he maintains. This issue deserves to be researched and questioned, he said.

“I don’t think that the government should medicate drinking water,” Grossnickle said. “We’re forcing people to accept a product that they may not want.”

Reach staff writer Carrie Ann Knauer at 410-857-7874 or carriem@lcniofmd.com.

Copyright 2007 Carroll County Times.

In Good Health — A smart vaccine, just in case

By Katie E. Leslie
Frederick News-Post
Tuesday, January 16, 2007

THIS YEAR, 5,000 AMERICAN WOMEN WILL DIE FROM CERVICAL CANCER, according to the American Social Health Association. The statistic serves as a somber reminder for women to mind their cervical health this year.

January is Cervical Health Awareness Month, an initiative by the National Cervical Cancer Coalition.

The National Cancer Institute recommends women have a Pap test and pelvic exam at least once every three years, though many women choose to have an annual exam. Those tests can help detect abnormal changes in the cells that could signal cervical cancer.

Thankfully, the approval of a vaccine last June is giving many women new hope that they won't develop the condition. Gardasil, a series of three injections given over six months, focuses on preventing cancers and lesions caused by four strains of the human papilloma virus -- 6, 11, 16 and 18.

The Food and Drug Administration approved the drug for females ages 9 to 26. Some say the vaccine should be administered to a girl before she is sexually active, as the drug is most effective for females unexposed to HPV.

But sexually active female adults shouldn't dismiss the vaccine. Some might still want to be vaccinated in the event they haven't been exposed to all four of the cancer-causing strains. Some immunity is, of course, better than none.

Receiving Gardasil shouldn't be an indictment of one's sexual morals. If we have the option to protect ourselves and provide what we hope will be a happier life for our families, we should take it.

It's roughly $360 for the vaccination, but for the peace of mind ... . You can fill in the blank.

What's happening in health
# Faithful readers, you aren't mistaken -- my column has officially moved. Beginning today, you will see me every Tuesday on the Health & Fitness pages.

# Seniors who qualify for the low-income subsidy for a Medicare Part D plan need not worry about the late-fee penalty, according to Leslie Norwalk, acting administrator of the Centers for Medicare and Medicaid Services. Upon realizing some seniors weren't enrolling for fear of being slapped with a lifetime penalty of 1 percent premium increase for every month delayed, CMS decided to waive late fees for low-income seniors.
Eligible people now have until Dec. 31 to enroll penalty free. To find out if you qualify for extra assistance, first contact the Social Security Administration to determine eligibility by calling 800-772-1213, or visit www.socialsecurity.gov.

If you are eligible for the low-income subsidy, apply for drug coverage penalty-free. People who are first eligible for Medicare in 2007 also will not have to pay penalties.

The Frederick County Department of Aging is meeting with local seniors to help navigate the tricky Medicare system.

To make an appointment, call 301-694-1605.

# The Frederick County Health Department will hold a second walk-in flu clinic this month. It's not too late for a flu shot, as influenza season is expected to stay strong through March. The flu vaccine kicks in within two weeks, according to the Centers for Disease Control and Prevention. The clinic is scheduled for Jan. 16 from 4 to 7 p.m. at the health department, 350 Montevue Lane.

No appointment is required. For more information, call 301-631-3342.

Copyright 1997-07 Randall Family, LLC. All rights reserved.

For decongestants, is the hassle worth the relief?

By George Mast
Cecil Whig
Monday, January 22, 2007

As the temperature drops to actual winter standards and cold and flu season surfaces again, shoppers face the hassle of purchasing decongestants the government has moved behind the pharmacy counter.

But by choosing to grab something off the nearest shelf, people may find they are sacrificing quality and efficiency.

The federal Combat Methamphetamine Epidemic Act, which took effect in September, put a clamp on the sale of all products containing pseudoephedrine.

Government officials hoped that putting all products containing the ingredient behind pharmacy counters and keeping records of purchases would hinder those who used — or shoplifted — the popular decongestant to make methamphetamine.

The downside, though, is many experts believe the common replacement ingredient many pharmaceutical companies are switching to, phenylephrine, is simply not as effective.

Two University of Florida research pharmacists published an article in July in the Journal of Allergy and Clinical Immunology that questioned the effectiveness of the recommended dosage of phenylephrine.

In the article, the pair said they reviewed 13 previous studies on the drug and found that only four of those showed the drug to be effective at the recommended 10-milligram dose.

Harry Finke, a pharmacist at Elkton Friendly Pharmacy, said one of the major differences between the two is that pseudoephedrine products have a longer duration than ones containing phenylephrine.

“It works, it’s just that it’s not as long acting,” he said about phenylephrine, which has been on the market for around 40 years.

Because of this, Tom Connelly, a pharmacist at Sun Pharmacy in Rising Sun, said some companies, such as the makers of Claritin-D, decided to retain the stronger pseudoephedrine in their product despite the regulations in order not to lose the prolonged effectiveness of their medicine.

Although both ingredients are meant to treat the same symptoms and have both been around for years, Connelly said products containing pseudoephedrine were the primary over-the-counter choice.
For customers who need a decongestant, Connelly said he would still recommend customers take the extra time and ask for pseudoephedrine-based products, even with the extra hassles of showing identification and signing a log book for the medicine.

Connelly said he thinks the stringent regulations are an overreaction to a few incidents in which drug makers were buying the product in bulk at larger chain pharmacy stores.

“It’s unfortunate, because it was a very small percentage of the pseudoephedrine that was being diverted into methamphetamine,” he said.

While admitting it is weaker, phenylephrine is still the second-best ingredient for cold medicines on the market, Connelly said.

He added that one thing about cold symptoms is that they normally go away eventually, whether or not something was taken to relieve them.

Finke said it is important to remember that no drug is guaranteed to be 100 percent effective and different ones work better in some people than others.

“It’s not an either this or that thing,” he said. “It’s whatever works best in you.”

Copyright © 2007 Cecil Whig. All Rights Reserved.

Universal Health Coverage Attracts New Support
Onetime Foes Become Unlikely Advocates, Citing Rising Costs and Tougher Access

By Christopher Lee
Washington Post
Monday, January 22, 2007; A03

Harry and Louise have had a change of heart.

Thirteen years after television ads from the insurance industry featuring the fictional middle-class couple helped kill the Clinton health-care plan and make universal coverage politically radioactive, comprehensive proposals for expanding coverage to millions of uninsured Americans are flowering again inside the Beltway and around the country.

And this time, advocates hope, the political climate is right for the best ideas to grow, in large part because many business groups that opposed earlier efforts now agree that rising health-care costs and increasingly tougher access to insurance are unsustainable trends.

Whether Washington will do more than talk about the problem, however, remains to be seen. Money is tight, and some experts say major shifts in federal policy are unlikely until after the 2008 presidential election, in which health care is expected to be a major focus.

Many are not willing to wait. Karen Ignagni, president of America's Health Insurance Plans -- the same industry association that once funded the "Harry and Louise" ads -- was among representatives of 16 business, medical and consumer groups that last week called for Congress to spend $45 billion over five years to extend health coverage to most of the nation's uninsured children. After that, the groups said, lawmakers should direct billions more toward covering uninsured adults, mostly through a mixture of tax breaks and expanded federal programs.

"On this issue, the polls show that Democrats, Republicans and independents want progress," Ignagni said. "The most expensive course is to do nothing."

John J. Castellani, president of the Business Roundtable, an association of chief executives of 160 U.S. companies, issued a similar call at a separate news conference last week with leaders of AARP, the politically powerful seniors organization, and the Service Employees International Union (SEIU). "Our soaring health-care costs put American goods and services at a significant competitive disadvantage, and they slow economic growth," Castellani said. "Policymakers must act."

In recent weeks, proposals for dramatically expanding coverage have been floated by Ignagni's industry group, the Children's Defense Fund and Sen. Ron Wyden (D-Ore.). Sen. Edward M. Kennedy (D-Mass.) and Rep. John D. Dingell (D-Mich.), who lead important congressional committees, plan to pursue legislation to allow Americans under 65 to enroll in Medicare or in the health coverage enjoyed by Congress. And a bipartisan group of two senators and three House members introduced legislation last week to help states fund innovative ways to cover more people.

"Health care has been poked and prodded for years," said Wyden, who wants to replace employer coverage with a centrally financed system of private insurance for all Americans. "I believe it is time for diagnosis and treatment."

Much of the activity in Washington is being spurred by a wave of experiments at the state level, particularly Massachusetts's decision last year to require all residents to obtain health insurance, through state-subsidized policies if necessary. This month, California Gov. Arnold Schwarzenegger (R) proposed a similar plan for all 36 million Californians, funding its $12 billion cost partly through fees on employers, hospitals and doctors.

In Pennsylvania, Gov. Edward G. Rendell (D) last week proposed creating a program of state-subsidized private insurance to help many of the 767,000 uninsured people in his state. The plan would impose taxes on tobacco and on businesses that do not offer coverage, and it would phase in a requirement that people earning more than 300 percent of the poverty level (about $60,000 for a family of four) obtain insurance.

"It is no longer a question of whether we can afford to act," Rendell said, noting that treating Pennsylvania's uninsured costs $1.4 billion annually. "The cost of inaction is far greater in terms of individual health consequences and from the increasing burden on taxpayers."

Vermont enacted legislation last year that seeks to expand coverage so that at least 96 percent of residents will have insurance by 2010. Illinois began a major expansion of coverage for children in 2005. That same year, Maine began implementing a plan whose goal is to cover all of the state's 130,000 uninsured residents by 2009.

Other states considering expanding coverage include Connecticut, Indiana, Iowa, Louisiana, Minnesota, Missouri, New Hampshire, New Jersey, New Mexico, North Carolina and Wisconsin, according to the National Conference of State Legislatures.

All the state activity is adding pressure on politicians in Washington to act on a problem that grows worse year by year. Recent census figures show that a record 46.6 million Americans, including 8.3 million children, had no health insurance in 2005, up from 39.7 million in 1994. Employer coverage is more expensive and less available.

"As usual, Washington is behind the rest of the country," said Andy Stern, president of the SEIU. "We're ready to have a very bipartisan solution. What you are seeing now that you didn't see in 1994 is that everyone is on the same side saying, 'We want universal coverage.' The only question is, 'How?' "

Ah, yes, "how" -- and how to pay for it.

Expanding coverage is a costly proposition, and Democrats, in control of Congress for the first time since 1994, have pledged not to pass major new spending proposals unless other programs are cut to avoid increasing the federal deficit.

While there is bipartisan support for reauthorizing the decade-old state-federal Children's Health Insurance Program, which covers more than 4 million children at a cost of $5 billion a year, experts say at least $12.7 billion more is needed over the next five years just to keep covering the same number of kids.

Moreover, President Bush has given no sign of departing from his advocacy of special tax-favored savings accounts and changes in the tax code as the best ways to make health insurance more affordable. In his State of the Union speech this week, Bush plans to propose more such changes and to announce a new initiative to help states get more residents into private insurance.

"We must address these rising costs so that more Americans can afford basic health insurance," the president said Saturday in his weekly radio address. "And we need to do it without creating a new federal entitlement program or raising taxes."

Despite the new enthusiasm, in the short run, most attempts to expand coverage will probably continue to happen at the state level, some lawmakers said. Federal efforts will be largely incremental and devoted to helping the states find their way.

"The states become laboratories," said Rep. Frank Pallone Jr. (D-N.J.), chairman of the House Energy and Commerce subcommittee on health. "Politically that's necessary. If we tried to adopt a universal health-care plan on the federal level, we probably wouldn't have the votes."

Sen. George V. Voinovich (R-Ohio), a member of a bipartisan group that wants to steer new grants to states, called health care "the greatest domestic problem" but also said that "the truth of the matter is that dealing with this problem between now and the election is not realistic."

"Congress is not going to act in a major way to deal with this access problem in the next couple of years," said Sen. Jeff Bingaman (D-N.M.), another member. "That's the unfortunate reality that we're facing. And so we're saying most of the effort that is possible is at the state level and at the local level. And we want to encourage it and we want to provide assistance."

But ultimately, Washington will have to do more, said Charles N. Kahn III, president of the Federation of American Hospitals.

"At the end of the day, I think the federal government and the federal taxpayers have a responsibility," said Kahn, whose organization was among those calling for $45 billion to cover children. "Clearly, there are states that are looking into this. They can come up with some resources. But we feel that in order to get the ball rolling from where we are now, this is the role that the federal government needs to play."

© 2007 The Washington Post Company.

In Live Bacteria, Food Makers See a Bonanza

By Andrew Martin
New York Times
Monday, January 22, 2007

The fastest way to consumers’ hearts may be through their troubled stomachs.

In the year since the Dannon Company introduced Activia, a line of yogurt with special live bacteria that are marketed as aiding regularity, sales in United States stores have soared well past the $100 million mark, a milestone that only a small percentage of new foods reaches each year.

Now other food makers, eyeing Activia’s success, are scrambling to offer their own products with special live microbes that offer health benefits, known as probiotics.

Probiotic foods have been popular in Europe and Asia for decades; in fact, Activia has been sold overseas since 1987. But there are challenges in replicating that success in the United States, including an American public that eats far less yogurt than Europeans and a culture that has traditionally relied on pills, rather than food and natural remedies, to remain healthy.

Still, given Activia’s popularity and the growing public demand for natural products in the United States, some experts say that probiotics have the potential to be this decade’s oat bran, which became a food sensation in the 1980s after it was shown to lower cholesterol levels.

“I know marketers will start looking to put it on everything,” said Bob Goldin, executive vice president of Technomic, a food industry research and consulting firm. But probiotic foods will sell only if they taste good and consumers believe they are credible, he said.

There is broad agreement that probiotics may help improve health, plus a growing body of research linking them to relief of irritable bowel syndrome, yeast infections, and diarrhea that results from certain illnesses. But so far there is no definitive proof for some extravagant claims. Already, manufacturers have suggested that probiotics may help ward off everything from allergies to colon cancer.

The Food and Drug Administration takes a neutral position, policing food packages to make sure that companies do not try to equate probiotic products with disease-curing drugs (unless they have scientific evidence to back up a claim). One scholarly group that has addressed the topic recently, the American Academy of Microbiology, said in a 2006 report that “at present, the quality of probiotics available to consumers in food products around the world is unreliable.”

The oat bran craze fizzled in part because its health benefits were overstated, and some nutrition and medical experts say the situation may be the same with probiotics. Detractors say that a lot of fuzzy claims are being made, and it is sometimes unclear how much of a food a person would have to eat — or how often they would have to eat it — to obtain any benefits.

But the doubts do not seem to have toned down the marketing for probiotics.

“They are gaining a reputation as being good for you in some way, and there is an element of truth in that,” said David Schardt, a senior nutritionist at the Center for Science in the Public Interest, a nutrition advocacy group. “But it is a very narrow element of truth, in certain very specific diseases where it’s been proven to be helpful.”

Probiotics in food are part of a larger trend toward “functional foods,” which stress their ability to deliver benefits that have traditionally been the realm of medicine or dietary supplements. Whether or not their claims are to be believed, some food companies say that their orange juice with omega 3 fatty acids is good for the heart, that their green tea drinks can burn calories and that their granola bars with plant sterols can lower cholesterol.

Nutritionists scoff at some of these claims, and not all foods marketed as functional have been hits. The ones that come across to consumers as less natural, such as fortified soft drinks, have not sold as well as those that seem inherently healthy, like yogurt and orange juice. For Activia — which Dannon recommends eating daily in order to derive health benefits — it didn’t hurt that yogurt sales have been soaring and that millions of Americans complain of stomach problems.

“Activia is unique,” said Michelle Barry, senior vice president for consumer insights and trends at the Hartman Group, a market research firm. “They are kind of the poster child of great success in this category of functional foods.”

So far, most probiotic products can be found in the dairy case or as dietary supplements. TCBY sells a probiotic frozen yogurt, and Stonyfield Farm is introducing a dairy-based energy drink called Shift with probiotics. Both Dannon and Stonyfield Farm are owned by the Group Danone, a French company.

But there is also a trickle of non-dairy probiotic food, including a cereal called Kashi Vive and “wellness bars” from a company called Attune Foods.

At the Whole Foods store in Union Square in Manhattan, there are several shelves of probiotic dairy products, including DanActive, a new offering from Dannon, as well as Wildwood Soyogurt Smoothie and Probugs Organic Whole Milk Kefir, from Lifeway Foods.

Susan Kramer, a 50-year-old mother who was shopping at the store recently, said she regularly bought DanActive. “I assume it has more probiotics than regular yogurt,” she said. “It just makes me feel good to drink it, and my kids like it.”

Probiotics include bacteria that is used to ferment food, whether it is yogurt, cheese or pickles. While there are thousands of different probiotics, only a handful have been tested in clinical trials and been shown to deliver specific health benefits when eaten regularly. Critics say that some food products do not say which bacterial strains they contain nor how much of the ingredient is in each package.

The growth of probiotics in food comes as some scientists are focused on the role of beneficial bacteria in people’s intestinal tracts in aiding digestion, boosting the body’s natural defenses and fighting off harmful bacteria that could cause health problems.

Gary B. Huffnagle, a professor of internal medicine at the University of Michigan and a strong proponent of probiotics, says there is independent research that shows that probiotics help with some bowel problems, plus strong but not conclusive evidence that probiotics help alleviate yeast infections and the stomach woes often associated with taking antibiotics.

But Professor Huffnagle, who said he had no financial ties to companies that sell probiotic products, said there simply was not enough research to support claims that probiotics could ward off cancer, allergies, high blood pressure and other diseases.

“It’s early in terms of the research,” he said.

Mr. Schardt, the nutritionist with the Center for Science in the Public Interest, said the claims of many probiotic foods and supplements were not backed by scientific research.

For instance, Kashi Vive cereal promises to “care for your digestive system and enhance your joie de vivre,” but there is no published research that shows that the probiotic strain in Vive has any health benefits, he said. Kashi, which is owned by the Kellogg Company, declined to comment other than to say the strain it uses in Kashi Vive is proprietary.

Similarly, Mr. Schardt said that a study supporting DanActive’s claim for strengthening the body’s defenses showed that it did not prevent colds or infections, though it did reduce the duration of colds by a day and a half. Dannon officials said that Mr. Schardt’s analysis was full of errors and that other studies showed that DanActive strengthens the body’s defenses.

As for Activia, the company does not claim that it reduces the risk of specific medical conditions like constipation. Rather, Dannon says, it “can help regulate your digestive system by helping reduce long intestinal transit time.”

The success of Group Danone’s probiotic products has helped boost its stock by more than 50 percent over the last year. Mark Lynch, an analyst with Goldman Sachs in London, said that Danone’s growth in dairy had been due mostly to growth in new markets combined with the introduction of innovative products in existing markets.

Besides Activia and Actimel (the European equivalent of DanActive), Danone has introduced a yogurt called Danacol in Europe that contains plant sterols that the company says lower cholesterol. Another Danone yogurt is on the way that claims to improve skin quality.

As word circulates among consumers about probiotics, not all shoppers are sold. At a Giant Eagle grocery store in Cleveland, Amanda Ross, a 31-year-old grant writer, said she had tried Kashi Vive and concluded that it tasted like cardboard.

“It didn’t make my mouth feel good,” she said. “And I’m a big granola and cereal person.”

As for Activia, Ms. Ross said she had bought it on sale and liked the taste, but did not notice any digestive changes. “When it went up to its regular price, I didn’t buy any more,” she said.

Christopher Maag contributed reporting from Cleveland.

Copyright 2007 The New York Times Company.

Faith in Quick Test Leads to Epidemic That Wasn’t

By Gina Kolata
New York Times
Monday, January 22, 2007

Dr. Brooke Herndon, an internist at Dartmouth-Hitchcock Medical Center, could not stop coughing. For two weeks starting in mid-April last year, she coughed, seemingly nonstop, followed by another week when she coughed sporadically, annoying, she said, everyone who worked with her.

Before long, Dr. Kathryn Kirkland, an infectious disease specialist at Dartmouth, had a chilling thought: Could she be seeing the start of a whooping cough epidemic? By late April, other health care workers at the hospital were coughing, and severe, intractable coughing is a whooping cough hallmark. And if it was whooping cough, the epidemic had to be contained immediately because the disease could be deadly to babies in the hospital and could lead to pneumonia in the frail and vulnerable adult patients there.

It was the start of a bizarre episode at the medical center: the story of the epidemic that wasn’t.

For months, nearly everyone involved thought the medical center had had a huge whooping cough outbreak, with extensive ramifications. Nearly 1,000 health care workers at the hospital in Lebanon, N.H., were given a preliminary test and furloughed from work until their results were in; 142 people, including Dr. Herndon, were told they appeared to have the disease; and thousands were given antibiotics and a vaccine for protection. Hospital beds were taken out of commission, including some in intensive care.

Then, about eight months later, health care workers were dumbfounded to receive an e-mail message from the hospital administration informing them that the whole thing was a false alarm.

Not a single case of whooping cough was confirmed with the definitive test, growing the bacterium, Bordetella pertussis, in the laboratory. Instead, it appears the health care workers probably were afflicted with ordinary respiratory diseases like the common cold.

Now, as they look back on the episode, epidemiologists and infectious disease specialists say the problem was that they placed too much faith in a quick and highly sensitive molecular test that led them astray.

Infectious disease experts say such tests are coming into increasing use and may be the only way to get a quick answer in diagnosing diseases like whooping cough, Legionnaire’s, bird flu, tuberculosis and SARS, and deciding whether an epidemic is under way.

There are no national data on pseudo-epidemics caused by an overreliance on such molecular tests, said Dr. Trish M. Perl, an epidemiologist at Johns Hopkins and past president of the Society of Health Care Epidemiologists of America. But, she said, pseudo-epidemics happen all the time. The Dartmouth case may have been one the largest, but it was by no means an exception, she said.

There was a similar whooping cough scare at Children’s Hospital in Boston last fall that involved 36 adults and 2 children. Definitive tests, though, did not find pertussis.

“It’s a problem; we know it’s a problem,” Dr. Perl said. “My guess is that what happened at Dartmouth is going to become more common.”

Many of the new molecular tests are quick but technically demanding, and each laboratory may do them in its own way. These tests, called “home brews,” are not commercially available, and there are no good estimates of their error rates. But their very sensitivity makes false positives likely, and when hundreds or thousands of people are tested, as occurred at Dartmouth, false positives can make it seem like there is an epidemic.

“You’re in a little bit of no man’s land,” with the new molecular tests, said Dr. Mark Perkins, an infectious disease specialist and chief scientific officer at the Foundation for Innovative New Diagnostics, a nonprofit foundation supported by the Bill and Melinda Gates Foundation. “All bets are off on exact performance.”

Of course, that leads to the question of why rely on them at all. “At face value, obviously they shouldn’t be doing it,” Dr. Perl said. But, she said, often when answers are needed and an organism like the pertussis bacterium is finicky and hard to grow in a laboratory, “you don’t have great options.”

Waiting to see if the bacteria grow can take weeks, but the quick molecular test can be wrong. “It’s almost like you’re trying to pick the least of two evils,” Dr. Perl said.

At Dartmouth the decision was to use a test, P.C.R., for polymerase chain reaction. It is a molecular test that, until recently, was confined to molecular biology laboratories.

“That’s kind of what’s happening,” said Dr. Kathryn Edwards, an infectious disease specialist and professor of pediatrics at Vanderbilt University. “That’s the reality out there. We are trying to figure out how to use methods that have been the purview of bench scientists.”

The Dartmouth whooping cough story shows what can ensue.

To say the episode was disruptive was an understatement, said Dr. Elizabeth Talbot, deputy state epidemiologist for the New Hampshire Department of Health and Human Services.

“You cannot imagine,” Dr. Talbot said. “I had a feeling at the time that this gave us a shadow of a hint of what it might be like during a pandemic flu epidemic.”

Yet, epidemiologists say, one of the most troubling aspects of the pseudo-epidemic is that all the decisions seemed so sensible at the time.
Dr. Katrina Kretsinger, a medical epidemiologist at the federal Centers for Disease Control and Prevention, who worked on the case along with her colleague Dr. Manisha Patel, does not fault the Dartmouth doctors.

“The issue was not that they overreacted or did anything inappropriate at all,” Dr. Kretsinger said. Instead, it is that there is often is no way to decide early on whether an epidemic is under way.

Before the 1940s when a pertussis vaccine for children was introduced, whooping cough was a leading cause of death in young children. The vaccine led to an 80 percent drop in the disease’s incidence, but did not completely eliminate it. That is because the vaccine’s effectiveness wanes after about a decade, and although there is now a new vaccine for adolescents and adults, it is only starting to come into use. Whooping cough, Dr. Kretsinger said, is still a concern.

The disease got its name from its most salient feature: Patients may cough and cough and cough until they have to gasp for breath, making a sound like a whoop. The coughing can last so long that one of the common names for whooping cough was the 100-day cough, Dr. Talbot said.

But neither coughing long and hard nor even whooping is unique to pertussis infections, and many people with whooping cough have symptoms that like those of common cold: a runny nose or an ordinary cough.

“Almost everything about the clinical presentation of pertussis, especially early pertussis, is not very specific,” Dr. Kirkland said.

That was the first problem in deciding whether there was an epidemic at Dartmouth.

The second was with P.C.R., the quick test to diagnose the disease, Dr. Kretsinger said.

With pertussis, she said, “there are probably 100 different P.C.R. protocols and methods being used throughout the country,” and it is unclear how often any of them are accurate. “We have had a number of outbreaks where we believe that despite the presence of P.C.R.-positive results, the disease was not pertussis,” Dr. Kretsinger added.

At Dartmouth, when the first suspect pertussis cases emerged and the P.C.R. test showed pertussis, doctors believed it. The results seem completely consistent with the patients’ symptoms.

“That’s how the whole thing got started,” Dr. Kirkland said. Then the doctors decided to test people who did not have severe coughing.

“Because we had cases we thought were pertussis and because we had vulnerable patients at the hospital, we lowered our threshold,” she said. Anyone who had a cough got a P.C.R. test, and so did anyone with a runny nose who worked with high-risk patients like infants.

“That’s how we ended up with 134 suspect cases,” Dr. Kirkland said. And that, she added, was why 1,445 health care workers ended up taking antibiotics and 4,524 health care workers at the hospital, or 72 percent of all the health care workers there, were immunized against whooping cough in a matter of days.

“If we had stopped there, I think we all would have agreed that we had had an outbreak of pertussis and that we had controlled it,” Dr. Kirkland said.

But epidemiologists at the hospital and working for the States of New Hampshire and Vermont decided to take extra steps to confirm that what they were seeing really was pertussis.

The Dartmouth doctors sent samples from 27 patients they thought had pertussis to the state health departments and the Centers for Disease Control. There, scientists tried to grow the bacteria, a process that can take weeks. Finally, they had their answer: There was no pertussis in any of the samples.

“We thought, Well, that’s odd,” Dr. Kirkland said. “Maybe it’s the timing of the culturing, maybe it’s a transport problem. Why don’t we try serological testing? Certainly, after a pertussis infection, a person should develop antibodies to the bacteria.”

They could only get suitable blood samples from 39 patients — the others had gotten the vaccine which itself elicits pertussis antibodies. But when the Centers for Disease Control tested those 39 samples, its scientists reported that only one showed increases in antibody levels indicative of pertussis.

The disease center did additional tests too, including molecular tests to look for features of the pertussis bacteria. Its scientists also did additional P.C.R. tests on samples from 116 of the 134 people who were thought to have whooping cough. Only one P.C.R. was positive, but other tests did not show that that person was infected with pertussis bacteria. The disease center also interviewed patients in depth to see what their symptoms were and how they evolved.

“It was going on for months,” Dr. Kirkland said. But in the end, the conclusion was clear: There was no pertussis epidemic.

“We were all somewhat surprised,” Dr. Kirkland said, “and we were left in a very frustrating situation about what to do when the next outbreak comes.”

Dr. Cathy A. Petti, an infectious disease specialist at the University of Utah, said the story had one clear lesson.

“The big message is that every lab is vulnerable to having false positives,” Dr. Petti said. “No single test result is absolute and that is even more important with a test result based on P.C.R.”

As for Dr. Herndon, though, she now knows she is off the hook.

“I thought I might have caused the epidemic,” she said.

Copyright 2007 The New York Times Company.

Study: Doctors out of sync with cancer patients' wishes

By Liz Szabo
USA Today
Monday, January 22, 2007

ORLANDO — A new study sheds light on the hardships that cancer patients are willing to endure in the hope of a cure — as well as the communication gap between patients and their doctors.

In a study of 150 patients presented Sunday at the 2007 Gastrointestinal Cancers Symposium, researchers found that many colorectal cancer patients were willing to undergo chemotherapy, even when the potential benefit was very small.

Researchers posed a hypothetical question to patients who had already been treated with surgery and drugs: Would they again have chemo — which can cause diarrhea, nausea and crushing fatigue — if it cut the risk of relapse by 1%? About 35% said they would.

Doctors weren't very good at judging patients' responses, the survey shows. Of 150 interviewed, only 19% of doctors and 17% of researchers thought patients would agree, says Neil Love, the study's lead author and president of a Miami medical education company called Research to Practice.

It's easy to understand why doctors and patients don't always communicate well, says Neal Meropol, director of gastrointestinal cancer at Philadelphia's Fox Chase Cancer Center. Overwhelmed patients may not be able to concentrate during office visits, especially when dealing with technical medical terms.

The study revealed other communication gaps, Love says. About 60% of patients say they weren't given the chance to join a clinical trial. Yet 81% wished they had gotten such information.

Leonard Saltz, a co-author and colorectal cancer researcher at New York's Memorial Sloan-Kettering Cancer Center, noted that the study had important limitations. Patients who answered the survey may be more positive about chemo than others. "They had already had chemo and lived to tell about it, so they are probably already leaning in that direction," Saltz says.

Love now plans to interview patients before they have chemo. Sanofi-Aventis, which makes cancer drugs, paid for the survey.

Copyright 2007 USA Today.

Drug seen as aid for muscular dystrophy
Hopkins study finds that losartan reduces muscle damage in mice

Associated Press
Baltimore Sun
Monday, January 22, 2007

WASHINGTON -- A widely used blood-pressure drug reduced muscle damage in mice with the most common form of muscular dystrophy, researchers report.

A team at the Johns Hopkins University found the drug losartan seemed to improve muscle regeneration in mice with a rare condition known as Marfan syndrome and in mice with Duchenne muscular dystrophy - the most common form in children.

"The results are very intriguing and certainly worthy of further investigation," said Dr. Valerie Cwik, medical director of the Muscular Dystrophy Association.

While noting that it is only a single study, Cwik said the drug is used in treating children and has a good safety profile.

The only current treatment for Duchenne has side effects, so it is worth investigating whether this can offer an alternative, said Cwik, who was not part of the research team.

In Marfan mice treated with the drug, the aorta was strengthened, reducing the chance of an aneurysm in which this major blood vessel bursts.

"In addition to the aortic defect, children with severe Marfan syndrome often have very small, weak muscles, and adults with Marfan often can't gain muscle mass despite adequate nutrition and exercise," Dr. Harry C. Dietz of Johns Hopkins, the lead researcher, said in a statement.

In Marfan mice, treatment with losartan "completely restored muscle architecture" and vastly improved strength, according to Dietz. He is planning a test in people with Marfan syndrome.

Researchers wondered whether the muscle response was specific to Marfan or if they had discovered something basic about muscle biology. So they then tested the drug in mice with Duchenne muscular dystrophy.

After six months of treatment, the mice showed a significant reduction in muscle damage. The mice showed increased grip strength in their fore- and hind-limbs and experienced less fatigue in repetitive tests, the researchers reported in today's online issue of the journal Nature Medicine.

Losartan was approved for use as a blood-pressure medication in 1995 by the Food and Drug Administration. It is known to block a protein known as TGF-beta.

Excessive activity by TGF-beta is associated with reduced muscle generation and repair, leading Dietz's team to test it against Marfan and muscular dystrophy.

Duchenne muscular dystrophy is a muscle-wasting genetic disorder that affects only boys. It occurs in about 1 in every 3,500 male births. It is the most severe and most common childhood form of muscular dystrophy and the best-known.

Marfan is a genetic disorder that affects about 1 in 5,000 to 10,000 individuals.

Copyright © 2007, The Baltimore Sun.

New WHO Chief Calls Meeting on Polio

Associated Press
By Alexander G. Higgins
Washington Post
Monday, January 22, 2007

GENEVA -- The new head of the World Health Organization said Monday she will hold an urgent meeting of leaders in the battle against polio to determine whether to push ahead toward the elusive goal of eradicating the disease.

Some public health experts question whether it is feasible to rid the world of polio and have suggested it would be better simply to control it. Smallpox is the only disease that has been eradicated worldwide.

"It is technically feasible to interrupt polio transmission worldwide," said WHO Director-General Margaret Chan, citing a report last year from the U.N. agency's advisory committee on polio eradication.

Chan told the WHO's 34-member Executive Board that she was calling "an urgent, high-level consultation" to be held in Geneva on Feb. 27-28.

"Here is the key question: are we now in a position to overcome the operational and financial obstacles?" she said, adding that health authorities needed to assess operations in affected countries carefully to ensure that the campaign can succeed.

She said she expected the meeting to produce a set of milestones that must be met if polio transmission is to be halted in the four remaining endemic countries _ India, Afghanistan, Pakistan and Nigeria _ and to say how much it will cost.

WHO has invited the ministries of health and finance as well as the heads of state of the four countries to send delegates to the meeting. Also invited are major donor countries and the other key players in the campaign _ UNICEF, Rotary International and the U.S. Centers for Disease Control and Prevention.

The global campaign to eradicate polio has already spent US$4 billion (euro3 billion). Estimates are that it may cost another US$1 billion to succeed. Initially the goal was to succeed by 2000, but that deadline was put back to 2005. Since then no new target date has been set, and

When Chan took over WHO earlier this month, she said she was reviewing what should be done now that the global campaign is using a more effective vaccine because "having a vaccine is not good enough." The eradication campaign has also been plagued in the past by rumors that its vaccine is dangerous. Such rumors have never been justified by scientific evidence.

Chan foresaw the need to set down planning for what needed to be done over the next two years.
WHO registered 1,874 cases of polio around the world last year, an increase from 1,749 in 2005. The vast majority of cases were in the endemic countries.

Polio is spread when people _ mostly children under 5 _ who are not vaccinated come into contact with the feces of those with the virus, often through water. The virus attacks the central nervous system, causing paralysis, muscular atrophy and deformation and, in some cases, death.

AP Medical Writer Maria Cheng in London contributed to this story.
© 2007 The Associated Press.

Minding the jail

Baltimore Sun Editorial
Monday, January 22, 2007

Four more years to improve conditions at the Baltimore City Detention Center, a jail that has been on the federal government's watch list since 2000? That's not a gift to the outgoing Ehrlich administration. It's consistent with how long it will likely take for the state to rebuild infrastructure at a facility that in part dates to the 19th century. And it keeps the state under the eye of federal officials for that much longer. Until then, mandatory inspections - as well as an unrelated lawsuit filed on behalf of inmates - should keep the state moving forward.

The memorandum of understanding between the state and the U.S. Department of Justice was reached last week. It is the result of years of negotiations on a host of problems that date to a 2002 finding that many conditions at the facility violated inmates' constitutional rights. The deficiencies included poor health care, lack of mental health treatment, inadequate fire safety, the mixing of juveniles and adult prisoners and unsanitary conditions.

The Justice Department has preferred negotiating a settlement in order to avoid costly litigation and allow states to spend those dollars on the needed improvements. And that should be the overall goal. The incentive for the state to comply is the threat of a federal lawsuit, which remains an option.

Problems at the detention center predate the state's takeover in 1991. At the time, the jail didn't even have a sprinkler system; the facility had been a source of inmate complaints for decades before that and the subject of federal court intervention because of overcrowding. It was a black hole that the city had been trying to get rid of for years.

During the 1990s, the state spent about $22 million on plumbing, ventilation and fire safety systems, and since 2000, an additional $5.6 million in upgrades. But the deficiency most troubling to federal officials was the lack of consistent, quality health care for inmates. The state replaced the medical contractor, ending the inappropriate practice of having correctional staff conduct health screenings of inmates.

Now it will be up to the O'Malley administration to comply with the agreement and continue with plans to replace the juvenile and women's sections of the detention center. Its first test will be in four months, when it must submit an action plan to ensure improvements will be made. The state should maintain a steady level of progress.

Copyright © 2007, The Baltimore Sun.

The Clinic Is Open

New York Times Editorial
Monday, January 22, 2007

Companies are proving that when it comes to health care, you can re-teach old dogs an old trick. On-site health clinics in the workplace, which had been disappearing since their peak in the 1970s, are staging a comeback. Corporations are waking up to the fact that healthy employees are more productive, while sick workers are a drag on the bottom line. And they’re trying to do something about it.

The sky-high cost of health care in the United States isn’t just a challenge for the families that struggle to pay rising premiums and co-payments. It’s also a serious issue for American companies, whose competitors in other countries often benefit from national health insurance programs.

As Milt Freudenheim reported recently in The Times, some big American-based companies have rediscovered that it’s cheaper in the long run to spend a little more on in-house health clinics. Companies from the Pepsi Bottling Group to Credit Suisse have opened or expanded their clinics. More than a quarter of the nation’s 1,000 largest employers will likely offer some kind of on-site health services by the end of the year.

For employees, a clinic is a major time saver, convenient and cheap (or even free). For companies, spending a relatively small amount of money on early detection and basic preventive care can save on expensive hospital bills down the line. It’s an interesting stopgap solution, provided companies do not abuse their knowledge of employee medical conditions and remain focused on the long-term health of their workers, instead of just steering them away from expensive procedures.

Innovative as they are, office and factory infirmaries will hardly solve the nation’s entrenched health care crisis.

Total health spending reached nearly $2 trillion in 2005, accounting for 16 percent of the economy. It is a bit scary that the 6.9 percent increase in health spending that year — rather than a cause for alarm — is celebrated as the slowest pace of increase in six years. There are 47 million uninsured people in this country. State governments, like those in Massachusetts and California, are trying to chip away at the problem and business groups are lobbying in Washington for help with out-of-control costs.

While it is a welcome sign that businesses and states are trying to come up with answers, health care is a national issue that requires a comprehensive solution.

Copyright 2007 The New York Times Company.

No reason to tamper with drug program

Baltimore Sun Letters to the Editor
Monday, January 22, 2007

Rather than rashly pursuing restrictive policies that threaten to undermine the success of the Medicare prescription drug benefit, the government and private sector should slow down, work together and find practical ways to make a good program even better for older and disabled Americans ("Democrats, go forward, but don't go overboard," Jan. 10).

The Medicare prescription drug program is working well.

Just a few years ago, barely half of America's seniors had comprehensive prescription drug coverage.

Today, more than 90 percent of them do.

Seniors and disabled Americans are seeing real savings on their prescription medicines, and they are able to select from a wide range of plans rather than a one-size-fits-all program.

Seniors are saving, on average, $1,200 a year on their prescription medicines, according to the Centers for Medicare and Medicaid Services (CMS).

What's more, the program's estimated 10-year costs are now 30 percent - or $189 billion - below initial forecasts, the CMS reports.

Imposing new restrictive policies that could limit patient access to potentially lifesaving medicines is not in the best interest of American patients.

Fundamentally, Medicare Part D is working. Let's give it a chance.

Ken Johnson
Washington

Copyright © 2007, The Baltimore Sun.

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