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DHMH Daily News Clippings
Saturday, February 23, 2008
Maryland / Regional
Strategies to control bupe abuse outlined (Baltimore Sun)
New Bailout Proposed for Pr. George's Hospital System (Washington Post)
Funding cuts hurt health department (Frederick News-Post)
Accused doctor acquitted (Salisbury Daily Times)
Maryland Doesn't Play Around With Toy Safety (Capital News Service)
Abuse-reporting bill OK'd (Baltimore Sun)
Battle-weary lawmakers eye low-key measures (Washington Times)
National / International
Family leave survives review (Baltimore Sun)
F.D.A. Extends Avastin’s Use to Breast Cancer (New York Times)
Popular heart test questioned (Baltimore Sun)
Dentist of the Back Roads (Washington Post)
China: Rise in AIDS and Syphilis (New York Times)
Purr-fect Health (Annapolis Capital Editorial)
Politics and Needle Exchanges (New York Times Editorial)
Safety of phthalates still open to debate (Baltimore Sun Letter to the Editor)

Strategies to control bupe abuse outlined
By Doug Donovan and Fred Schulte
Baltimore Sun
Saturday, February 23, 2008
WASHINGTON – Amid growing illegal sales and abuse of buprenorphine, top federal officials outlined yesterday action they might take to curb problems with the addiction-treatment drug, including more precise detection methods, improved training of doctors and stronger warning labels for patients.
"The issue of diversion has been out there since 2004," said Dr. H. Westley Clark, director of the Center for Substance Abuse Treatment, which oversees the federal government's buprenorphine initiative. "We've been concerned about that, and we will continue to be concerned about that."
Clark spoke to reporters after a two-day, closed-door summit of experts on buprenorphine, which the government sees as the best medical treatment for hundreds of thousands of people addicted to heroin or painkillers.
Introduced in 2003, the drug known as "bupe" has been subject to increasing misuse and illegal sales as more of it is prescribed by physicians, The Sun reported in a series of articles beginning in December. Some patients sell it on the street; buyers use it to get high or hold off withdrawal symptoms until they can get their next heroin or painkiller hit.
With tens of thousands of opiate addicts in Maryland, Baltimore and state officials are investing millions of dollars in bupe treatment. Experts say it's safer than methadone - the traditional heroin treatment, normally given out under close supervision - and more likely to appeal to addicts because they can get bupe from their doctors.
Though Clark and other officials said they are encouraged that bupe has expanded access to drug treatment, they acknowledged publicly for the first time a need to tighten safeguards over use of the drug, sold mainly under the name Suboxone.
Suboxone was developed as a joint project by the National Institute on Drug Abuse and Reckitt Benckiser Pharmaceuticals Inc. of Richmond, Va. An estimated 170,000 addicts are taking it.
Many patients and doctors say that bupe pills are extremely effective in curbing withdrawal sickness and help ease cravings for heroin or prescription opiates.
The Sun's articles identified a variety of problems the government hadn't acknowledged when it approved buprenorphine. Some users crush and inject the drug, a dangerous practice because it can spread diseases. Many experts told the newspaper that an eight-hour training course required for doctors who prescribe bupe is not adequate and that some physicians are contributing to illegal sales of the narcotic substitute by prescribing it too generously.
Dr. David Fiellin, a Yale University professor who directs the Physician Clinical Support System, said that "there are physicians who are practicing outside" the standards of care.
Fiellin said the support system, funded by the government, will work with private medical societies to teach doctors how to properly store the medication and to identify patients who might be misusing or selling the drug.
"There is not an active surveillance system in place to identify physicians who are practicing outside the guidelines," Fiellin said. When they are found, he said, his group will work to report them.
Dr. Charles R. Schuster, a former director of the National Institute on Drug Abuse who tracks abuse of the drug for the manufacturer, agreed.
"We have reports from physicians that they know of other physicians not practicing within the standards of care," Schuster said.
The biggest problem, according to Schuster, is that some doctors are prescribing 30-day supplies of the pills to addicts after only a single visit. While that's legal, Schuster said, doctors should become comfortable that a patient is not abusing the drug before prescribing large amounts.
"A small minority of doctors are not practicing good medicine," he said. "That's a problem we need to be concerned with."
Experts and officials identified other problems, including doctors who provide little counseling. An official with the NIDA said studies are showing that buprenorphine works better with pain-pill addicts, not heroin abusers.
Schuster also said he learned at the two-day conference that federal government drug-abuse warning systems were considering ways to add new medications to their watch lists.
"Currently they are designed for detecting the use and abuse of drugs that have been around for quite a while," he said.
Dr. Celia Winchell, a medical officer for the U.S. Food and Drug Administration, which approved Suboxone in late 2002, acknowledged that some abusers are able to crush the pills and inject the drug despite the presence of a chemical intended to deter that.
"Certainly, we're concerned about diversion and abuse," she said.
Winchell said the FDA is evaluating whether to strengthen warnings on the drug labels to "prevent diversion" and alert doctors and patients to adverse effects that accompany misusing it.
"We're exploring if there's anything left unsaid in packaging," Winchell said.
But the government can do little to alter doctors' practices. The Drug Addiction Treatment Act of 2000, which authorized buprenorphine treatment, forbids the government from interfering in private medicine.
Federal regulations allow doctors to prescribe a 30-day supply of buprenorphine and up to five refills, a practice that is far more lenient than in most countries.
Canada, for instance, requires that a patient be in treatment for two months before receiving Suboxone to take unsupervised.
Copyright © 2008, The Baltimore Sun

New Bailout Proposed for Pr. George's Hospital System
By Philip Rucker and Ovetta Wiggins
Washington Post
Saturday, February 23, 2008; B01
Prince George's County Executive Jack B. Johnson met secretly with the county's delegates yesterday to present a long-awaited plan to bail out the county's financially troubled hospital system by transferring ownership to the nation's largest Catholic health-care system, a proposal that could run into trouble with state officials because of its cost.
Under the proposal, Ascension Health would take over the struggling hospital system beginning July 1. It would be subsidized by $495 million in public money, with $297 million coming from the state and $198 million coming from the county, according to several sources familiar with Johnson's proposal. The transfer would take five years and be overseen by an authority with seven members, five appointed by the county and two by the state, the sources said.
Johnson (D) declined to speak publicly about the negotiations, telling the county's delegation that he would brief them only if the meeting were closed to reporters. Several lawmakers confirmed details of his plan, but only on the condition of anonymity because they said Johnson swore them to secrecy.
Johnson said he has been negotiating with Gov. Martin O'Malley (D) and St. Louis-based Ascension and hopes to formalize a deal next week. But some Prince George's legislators said the state is unlikely to support the deal because it would require too big a state contribution amid an economic downturn and because the authority would be controlled by the county.
One delegate from the county went so far as to say, "It's the kind of deal the state will laugh at."
Further complicating the negotiations are concerns from some lawmakers that Ascension could prohibit doctors from performing abortions or distributing birth control at the facilities.
"It certainly could throw a monkey wrench into it," Del. Victor R. Ramirez (D-Prince George's) said, noting that most of the county's delegates and senators support abortion rights.
Ascension did not respond yesterday to several phone calls.
Johnson's plan is designed to help stabilize the hospital system, which is composed of Prince George's Hospital Center in Cheverly, Laurel Regional Hospital, the Bowie Health Campus and two nursing homes. The system, which is owned by the county and managed by the nonprofit Dimensions Healthcare Systems, serves about 180,000 patients each year.
The county's delegation is pressing forward with legislation to transfer ownership of the county-owned hospital system to a state authority, said Del. Barbara A. Frush (D), chairman of the county delegation.
"We can't take the chance of ending up empty at the end of the session," Frush said.
O'Malley told Johnson that he "would be happy to review the county's proposal," but is waiting to get input from fiscal and health-care experts before making a decision, spokesman Rick Abbruzzese said.
"Governor O'Malley remains committed to finding a long-term and viable solution for the Prince George's community hospital center that provides the county with the highest level of care," Abbruzzese said.
Johnson was scheduled to brief lawmakers during the Prince George's delegation meeting yesterday in Annapolis. But at Johnson's request, Frush made reporters and lobbyists leave the room, saying the meeting had changed to a "Prince George's County Democratic Caucus" meeting. She said caucus meetings are not subject to open meeting laws.
"The fiction, if you will, is that we went into Democratic caucus, but we only have Democrats in Prince George's County, and we adjourned one meeting and started another meeting with the same cast of characters," Del. Doyle L. Niemann said.
Then, Johnson entered through a back door to brief the delegation. When the meeting reopened, Johnson told a Washington Post reporter that he would speak about the hospital plan but immediately left through a back door without answering questions.
Johnson's spokesman, John Erzen, issued a statement a few hours later, saying the county executive came to Annapolis to brief only the delegation. "Due to the complexity of the negotiations and the presence of a confidentiality agreement, he did not want to speak publicly about the status of the negotiations with the state," Erzen said.
Several lawmakers said the state's finances this year make it difficult for the General Assembly to appropriate such a large amount to the project. Niemann called Johnson's plan "expensive, very expensive."
"The question the governor is going to look at is: Who's paying what?" Niemann said.
The union for nurses and other hospital workers said it wants any deal reached in an "open and transparent process."
"We need to get the County Council and politics out of the hospital business," said Ebs Burnough, political director of local 1199 of the Service Employees International Union.
Unlike previous attempts to find a solution, Johnson and the County Council appear to support of the same proposal. Johnson is "taking the lead," but the council backs his plan, County Council Chairman Samuel H. Dean (D-Mitchellville) said.
A deal collapsed in the final days of the 2007 legislative session after the council was unwilling to sign on to it. That proposal would have cost $329 million over eight years, with $170.3 million from the county and $158.7 million from the state.
During the special session in November, the state reserved $50 million for the hospital system. But that money will be available only if local and state leaders formally agree to a long-term solution.
© 2008 The Washington Post Company

Funding cuts hurt health department
By Ashley Andyshak
Frederick News-Post
Saturday, February 23, 2008
More than 800 expecting and new mothers received home visits from Frederick County Health Department nurses last year. That's nearly one-third of all women in the county who gave birth during that time.
But Healthy Start, the program that's provided prenatal care and prevented preterm births for thousands of county women over the past decade, won't be funded in 2009.
And that's just the tip of the iceberg for the health department, which stands to lose employees and major programs as federal funding is cut and the state shifts a million-dollar bill for retiree health insurance to the county.
The federal Centers for Medicare and Medicaid Services has notified states they won't be providing reimbursement next year for a number of case management programs, including Healthy Start, the Administrative Care Coordination Unit, and the county's Infants and Toddlers and HIV/AIDS programs, health officer Barbara Brookmyer told county commissioners this week. Since the state won't be reimbursed, it can't fund the programs. The health department's federal grant for pandemic flu planning will also be discontinued in 2009, she said.
The funding cuts, which Brookmyer called "a step backward in public health," will eliminate services for women who use Healthy Start and about 25 percent of the department's HIV/AIDS caseload, she said. Six nurses and one clerical employee will be terminated.
The services facing cuts have proven beneficial to thousands of clients, Brookmyer said. For instance, a study of Prince George's County's Healthy Start program showed that 8 percent of women who received prenatal care through the program delivered their babies prematurely, compared to 46 percent of women who had no prenatal care.
And the health department is the only place many of the affected HIV and AIDS clients can get treatment. One private practitioner in Frederick County provides HIV specialty care, but absorbing all of the county's clients whose services are no longer funded would be difficult, said Darlene Armacost, the department's communicable disease program manager.
The department's financial woes only get worse from there, Brookmyer said, as it's faced with a $1 million bill for state employee retirement benefits. The department must come up with an average of $7,000 for each of its 163 state employees to fund promised pensions for retirees.
Statewide, this move will cost 11 health departments more than $1 million each and may force elimination of 400 to 625 jobs, Brookmyer said.
The Frederick County department has whittled their state bill from $1.2 million to about $917,000 by eliminating vacancies it had planned to fill and reducing operating expenses as much as possible, she said. Department employees have come up with other ways to save money, but Brookmyer said they're drops in the bucket.
In a last-minute effort to save at least one employee, Brookmyer asked commissioners this week to fund a half-time teaching position at the Infants and Toddlers developmental center for $50,000 in fiscal year 2009. The deadline for termination notification for the employee is March 10.
The teacher works with infants and toddlers with developmental disorders like autism both at home and at daycare centers, and center director Monica Grant said the department may not be able to meet state mandates for care without the employee.
Commissioners voted 3-2, with Charles Jenkins and John Thompson opposed, to fund the position.
Nearly half of the needed $50,000 will come from the county's 2009 airport fund, and the rest may come out of a contingency fund. County budget officer Michael Gastley said the county has a $1.4 million staffing resource pool to tap into, but commissioners said it's unclear whether that money will be available after they finalize the 2009 budget.
Commissioners president Jan Gardner said she will continue to fight against the shifting of state obligations to the counties.
"We should not be forced to absorb that cost or to decrease services to cover that cost," Gardner said of the county's $1 million liability. "We have no obligation to fund that at all."
Brookmyer said she doesn't know if the department will approach the county for more funding to save other programs, but said she previously submitted several other budget appeals.
Copyright 1997-08 Randall Family, LLC

Accused doctor acquitted
Wicomico jury finds Dr. Mahmaud Shirazi not guilty of alleged patient sex offense
By Ben Penserga
Salisbury Daily Times
Saturday, February 23, 2008
SALISBURY -- A doctor accused of sexually assaulting a patient at his Salisbury office was acquitted by a Wicomico County Circuit Court jury Friday.
Dr. Mahmaud Shirazi was found not guilty of second-degree assault and fourth-degree sex offense charges following a three-day trial in which he was accused of sexually molesting a patient during a Nov. 15, 2006, appointment. Police said the doctor allegedly "grinded on" the woman from behind and violated her with a hand.
After the verdict, Shirazi issued a statement through his lawyers.
"Dr. Shirazi is gratified by today's verdict, which confirms what he has consistently maintained -- that he was innocent of any wrongdoing," said Cynthia MacDonald, one of his attorneys. "He continues to be very appreciative of the substantial support he has received from countless numbers of former patients, colleagues and friends."
Throughout the trial, prosecutors from the Wicomico County State's Attorney's Office and Shirazi's defense team both made character the bulk of their case.
Assistant state's attorneys Ella Disharoon and Elizabeth Ireland said the alleged victim in the case -- a 49-year-old woman from Pittsville -- was a normal person put in the worst of situations. During the defense's closing arguments Friday, the alleged victim cried openly in the gallery before leaving with her family.
"She's just a good person that had a very tragic thing happen to her," Disharoon told the jury.
Disharoon said the woman was so shocked about what had happened to her that she originally vowed not to tell anyone about it. It was only when she continued to receive bills from Shirazi's office that she was driven to tell her family and the police five months after it allegedly happened.
The prosecutor also asked the jury to see past Shirazi's good reputation as a physician and consider testimony that he reportedly asked co-workers to lie for him about what happened.
"This is not a medical malpractice case," Disharoon said. "This is a criminal case."
Still, defense attorney Helen Guyton asked that the inconsistencies in the accuser's testimony be looked at, especially the fact that the woman saw Shirazi at the office once more after the alleged incident and continued asking for medical samples months later.
"Actions speak louder than words and her actions spoke loudest when she went back (for another appointment) Dec. 12," she said.
Once the announcement was made, family and friends of the victim cried and muttered in disbelief over the decision.
Ireland and Disharoon expressed disappointment about the trial's ending, saying they were hamstrung by state laws that did not allow them to present all the witnesses they wanted to.
"We do not fault the jury for their decision," read a statement issued by the prosecutors after the verdict. "They were not permitted to hear from the 10 patients of Dr. Shirazi who waited for 2 1/2 days for a chance to tell the jury about their experiences with Dr. Shirazi. They did not get that chance because of current Maryland law. Until that law is changed, predators will continue to avoid accountability for their conduct in the courts of Maryland."
Outside the courtroom, Shirazi thanked the people who had supported him throughout the trial with hugs and handshakes.
"I got my doctor back," said one woman.
Copyright © 2008 The Daily Times

Maryland Doesn't Play Around With Toy Safety
By Veena Trehan
Capital News Service
Saturday, February 23, 2008
WASHINGTON - Maryland state and national lawmakers are leading efforts to get the lead and other toxins out of children's playthings.
"Maryland is in the front of a group of states that wants to protect its citizenry," said Delegate James Hubbard, D-Prince George's. He's the sponsor of two of three bills making their way through the Maryland General Assembly to ban toxic chemicals from toys.
The bills would lower the permissible amount of three chemicals in children's products: lead, recently found in paint on toys; phthalates, a chemical used to make vinyl more flexible; and bisphenol A, an organic compound used in beverage containers, including baby bottles.
A Maryland bill to immediately limit lead in toys to 600 parts per million passed its House committee on Friday. The same legislation is in a Maryland Senate subcommittee, and both are expected to pass.
The moves are partly in response to a series of massive toy recalls last year, largely focused on the use of lead in U.S. toys by Chinese manufacturers.
The solution to making toys safer, the lawmakers and others said, will likely require cooperation from toy manufacturers and retailers as well as greater federal funding and legislation.
"We are talking about a major chasm in our system that absolutely must be addressed by every party involved," said Maryland Rep. Elijah Cummings, D-Baltimore, at a December news conference addressing high levels of lead in children's toys.
The news conference followed his letter to Mattel's CEO calling on the company to stop producing toys with lead and to recall two toy blood pressure cuffs with several times the lead level for a recall. On Jan. 30, Cummings, joined by 56 representatives, including Rep. Al Wynn, D-Mitchellville, sent a similar letter to the company.
Also at the federal level, the House of Representatives passed legislation, cosponsored by Cummings, Wynn, and Rep. Chris Van Hollen, D-Kensington, to reduce lead content to 600 parts per million immediately, lowering it to 300 parts per million two years after bill enactment and 100 parts per million in another two years.
Similar Senate legislation is expected to pass early next month, but it also boosts funding for the Consumer Product Safety Commission, which has been weakened by cuts and has just 15 inspectors to screen a growing number of toy imports.
"It is neither reasonable nor responsible to task an agency with a job as important as protecting the public health without providing the resources necessary to accomplish that task," said Van Hollen in a statement.
The federal and Maryland legislation targets children's products because the young are believed to be uniquely vulnerable to these toxic substances that can have a lasting effect, according to experts.
Lead, contained in paint and gas, for decades has been known to cause learning disabilities. Phthalates, included in soft vinyl toys like teething rings, have been tied to kidney and liver problems. Bisphenol A, that can leak out of baby bottles when they are heated, may disrupt hormones, critics charge.
"We can take some progressive steps to remove toys or pay consequences later on down the road in mental health, special education services, or in some cases, institutional costs," said Hubbard.
Maryland is well ahead of the pack in regulating the other potentially harmful compounds in toys -- plastic softeners.
The General Assembly's Health & Government Operations Committee on Wednesday heard a bill to ban the manufacture or sale of children's products with phthalates and bisphenol.
"I think Maryland will be a leader on the East Coast of this country with relationship to phthalates this year," said Hubbard, who first introduced the bill three years ago.
Phthalates have been banned by the European Union, Japan and California.
David Kosmos, a program associate at Maryland Public Interest Research Group, said research into the effects of phthalates on the body have lagged behind studies of other toxins.
"Phthalate research is a point now that lead was in the late 1970s and 1980s," he said. "The science is emerging and we should do something now."
Legislation to limit lead poisoning 10 years earlier would have saved a lot of lives and trouble, said Kosmos.
Kosmos also said the switch to other chemicals is feasible.
"Factories in China make phthalate-free toys for half of the world and toys with phthalates for the other half of the world to save a few pennies," he said.
The hottest debate of Wednesday's hearing came on bisphenol A. No states or nations have banned the chemical, although several U.S. states have introduced legislation to phase it out.
Julie Goodman, a scientist at Gradient Corporation, said her review of the research shows current uses of bisphenol A are safe. Goodman also said, when questioned, that her firm's clients include several in the chemical industry.
State action is necessary, backers of the legislation told the committee, because federal legislation is often delayed and it's important for Maryland to lead government in protecting citizens.
Hubbard said the government often steps in only after several states pass competing standards and industry asks the federal government for "protection" from higher standards.
Toy manufacturers and retailers also weighed in on toy safety after a year of record toy recalls. Toys 'R Us and Wal-Mart, two retailers that comprise just under half the U.S. toy market, last week announced steps to rid their products of problem chemicals. The two companies operate more than 25 stores in Maryland.
Starting March 1, the retailers are setting a higher standard than one expected to pass Congress for lead on the surface paint for toys. The companies are also phasing out chemicals found in vinyl.
Toys 'R Us said this and other recent safety initiatives demonstrate their commitment to children. "The bar can never be too high for safety," said company spokeswoman Kathleen Waugh.
Hubbard framed these initiatives as a reaction to perceptions among consumers. Polls show a dramatic rise last year in those concerned about the safety of Chinese-made toys that make up 80 percent of the total.
"Their actions are driven by economics," said Hubbard. "They are responding to a marketplace that's scared to buy their toys by virtue of what they've heard and read."
The toy recalls of last year may spread to other products made in China, said Eric Johnson, a professor at the Tuck School of Business at Dartmouth.
"Many of these things we've been talking about with toys we're going to be talking about with other products because they see a lot more scrutiny than other products coming out of China."
Copyright © 2008 University of Maryland Philip Merrill College of Journalism

Abuse-reporting bill OK'd
Failure to notify authorities in suspected cases would be crime
By Laura Smitherman
Baltimore Sun
Saturday, February 23, 2008
The Maryland Senate approved yesterday a bill making it a crime for health care workers, police officers, educators and others to fail to report suspected child abuse to authorities, a measure that some fear would make those professionals scapegoats.
The chamber voted 35 to 10 to approve the proposal, which would make failure to report abuse a misdemeanor subject to a fine of up to $1,000. Similar legislation has failed in previous years, but proponents said recent high-profile cases such as the death last year of 2-year-old Bryanna Harris in Baltimore might spur more lawmakers to support the bill this year.
"Why not err on the side of children because injury and death are the results if we fail to report," said Sen. Delores G. Kelley, a Baltimore County Democrat who sponsored the bill.
But several lawmakers said they have heard from teachers and doctors who are concerned that the bill could unfairly put them in legal jeopardy or cause them to report every child injury as possible abuse, inundating strapped caseworkers at local departments of social services.
"Teachers are required to do so much nowadays in terms of their responsibilities," said Sen. Nathaniel J. McFadden, a Baltimore Democrat who opposed the bill. "I do understand the intent of the legislation because we do have so many problems. But I have a feeling that the cure in this particular instance goes a bit too far."
Forty-six states and the District of Columbia impose penalties on people who are required to report suspected abuse or neglect but knowingly or willfully fail to do so, according to a legislative analysis.
Thirty-eight of those states make it a misdemeanor, and some, including Delaware and the District of Columbia, allow for jail time upon conviction.
Under current Maryland law, some professionals, such as nurses, doctors and social workers must report abuse or face possible sanctions from licensing boards.
The bill not only expands the list of those who are required to report to include parole and probation officers, but also adds the criminal penalty.
Attorneys and clergy are generally exempt from reporting requirements if they become aware of abuse through privileged, or confidential, communications that they can't be legally compelled to divulge.
MedChi, a professional society for doctors, and the Maryland chapter of the American Academy of Pediatrics urged lawmakers to reject the proposal. They argued that physicians already face the loss of their licenses for failing to report suspected abuse. Further penalties would be "superfluous and unnecessary," MedChi lobbyists wrote to a Senate committee.
"They are not criminals when they miss something," said Sen. Bobby A. Zirkin, a Baltimore County Democrat.
The state's public defender's office also weighed in against the bill, saying it would increase the number of false reports and expose children and their families to "needless embarrassment and potential separation," according to written testimony.
A similar bill passed the Senate in 2003 but died in the House of Delegates. It was introduced the next two years but floundered in committee.
This year, House Speaker Michael E. Busch said the bill is likely to get a favorable reception in his chamber, depending on how the legislation is written. Busch said there should be a process whereby professionals are made aware of their obligations and the consequences for not fulfilling them.
"It's important for people to be held responsible and accountable," said Busch, an Anne Arundel Democrat.
The state's system for protecting vulnerable children has come under scrutiny since Bryanna Harris' death in June from methadone poisoning. Child-protective workers allowed her to stay with her drug-addicted mother, who has been charged with murder.
A recent report from the Baltimore City Health Department found that a nurse who worked closely with the Harris family did not observe physical abuse, nor did the nurse identify any imminent life-threatening risk.
Lawmakers also invoked the case of Shamir Hudson, 8, who was beaten to death by his adoptive mother in their mobile home outside Berlin in 1998. Social workers in that case had repeated reports of abuse but never removed him the home.
During debate over whether new legislation is needed, Sen. Thomas "Mac" Middleton, a Charles County Democrat, noted that the chamber voted Thursday to approve a bill to increase penalties for people who attend illegal dogfights and cockfights to as much as one year in prison and a $2,500 fine.
"We're talking about abuse of children versus abuse of animals," he said.
Copyright © 2008, The Baltimore Sun

Battle-weary lawmakers eye low-key measures
By Kristen Wyatt, Associated Press
Washington Times
Saturday, February 23, 2008
ANNAPOLIS — For Maryland lawmakers, sweeping, controversial proposals are out in this year's General Assembly session. Manageable, unlikely-to-offend measures are in.
After a divisive special Assembly session in which taxes were increased, health care reform was debated and a new environmental program was added, the lawmakers say they are worn out and looking for smaller, less flashy measures this session. Halfway through, few controversial proposals appear headed toward approval.
"We're hung over, to tell you the truth, and we haven't caught up yet," said Delegate Adrienne A. Jones, a top-ranking Baltimore Democrat.
Though proposals to ban the death penalty and address same-sex "marriage" have been introduced, lawmakers are expected to concentrate efforts this term on less glamorous topics such as energy efficiency and mortgage-lending reform.
There's plenty of time for lawmakers to take up meatier topics, and the closing days of any session get busy. But so far, it appears unlikely this term will have the intense, round-the-clock politicking that marked the special session in which lawmakers raised $1.3 billion in new taxes.
"I think there is some legislative fatigue from the special session," said House Speaker Michael E. Busch, Anne Arundel Democrat. "It was intense."
This year's legislative agenda is light from the top. Gov. Martin O'Malley, a Democrat, has proposed a modest slate for lawmakers to consider, compared to his plans last fall to overhaul the state budget, allow the legalization of slot machine gambling and pour millions into a health-insurance expansion and a new fund devoted to restoring the Chesapeake Bay.
This year, the governor's slate includes measures to reform mortgage-lending practices and to boost energy efficiency. They may be important, complex initiatives, but they don't carry the kind of flash-point interest with the public that a proposal to legally recognize same-sex couples or renew efforts to defeat the death penalty would have.
Mr. O'Malley's agenda asks lawmakers in the Democrat-controlled Assembly to agree to less divisive plans. After asking them to pass new taxes in the special session — during a time of year when they usually are at home — Mr. O'Malley has applied less pressure to take up tough subjects.
"He is realizing he has precious little political capital left, and he is hiding in the bunker and only pops his head out when he has something popular to say to the public," said Delegate Christopher B. Shank, the House's second-ranking Republican.
Democrats insist the governor's package is ambitious and that lawmakers aren't as tired as they seem.
"The legislature's a little bit fatigued," said Delegate Kevin Kelly, Allegany Democrat. "But that being said, I don't see any lack of gusto to take up controversial topics."
Several lawmakers said some sleeper issue remain in the session — including a plan to cap carbon emissions to address global warming or a measure to overhaul state zoning laws for development near water. But they cautioned that it's far too early to conclude the session has no hot-button issues.
"It's still kind of early," said Delegate Talmadge Branch, Baltimore Democrat who pointed out that hundreds of bills haven't even had public hearings yet. "It'll get real busy very soon, and you'll find all sorts of things that take an interesting turn."
All site contents copyright © 2007 The Washington Times, LLC

Family leave survives review
But regulators propose minor changes in law
By Molly Selvin
Baltimore Sun
Saturday, February 23, 2008
Federal regulators have proposed relatively minor changes to the popular Family and Medical Leave Act, a relief for advocates who had feared a sweeping rewrite that would have made it difficult for people to take advantage of it.
The proposals, released this month by the Department of Labor, would give employers more leeway in verifying that people taking medical leave are sick. The proposals would impose other restrictions that business groups said might curb what they see as a major problem: employees who leave their bosses short-handed on short notice.
Regulators did not propose any change in the definition of the medical conditions for which people are allowed to take unpaid leave under the act, disappointing employers who have contended that too many workers invoke the act to stay home with a head cold or sore back.
Complaints from employers sparked the months-long review of the act, which guarantees a worker 12 weeks of unpaid leave for a major illness or the birth or adoption of a child or to nurse an ailing relative. The time can be used in one block, to bond with a newborn, for example, or taken as needed for cancer treatment or to deal with other chronic or emergency medical problems.
"Generally, the law is working well," said Victoria Lipnic, assistant secretary of labor for employment standards. "It is certainly highly valued by workers and by employers who believe it's good workplace policy."
But Lipnic said "updates and targeted improvements" were necessary.
The proposed rules would allow employers to ask workers -- or their doctors -- to more fully document the nature of an injury or illness and estimated length of treatment and recovery. People with chronic medical conditions could be required to renew their applications for leave every six months if the full 12 weeks have not been taken.
So-called intermittent leave has been a "real problem" for bus companies, airlines, emergency-response centers and other employers that depend on a full staff of workers for every shift, said Marc Freedman, labor-law policy director for the U.S. Chamber of Commerce. The chamber was among the business groups that pressed for changes.
Family advocates were not altogether pleased with the proposals.
"Once you open the door to an employer being able to talk with someone's health care provider, the potential for abuse is huge," said Debra Ness, president of the National Partnership for Women & Families. In addition, she said, requiring workers to renew their leave requests will mean paying for additional doctor visits and more time away from work.
At the same time, Ness said, the Labor Department "left some very important protections in place."
For instance, employers wanted a list of serious health conditions that made workers eligible for the unpaid leave. The proposed rules do not change the definition of a serious condition as one requiring at least three consecutive days of treatment and recovery. The condition also must meet other standards, such as requiring a physician's care or hospitalization.
The family leave law has been popular with workers, particularly to cover childbirth and adoption. The Labor Department estimates that 2.4 million Americans took advantage of the law in 2005. The federal law applies to companies with 50 or more employees.
Last month, President Bush signed a bill expanding the leave law by up to six months for families of wounded military personnel.
The Labor Department will take comments on the latest proposed changes before issuing final regulations this year. The comment period will end April 11. To submit comments, go to www.regulations.gov and enter "Family and Medical Leave Act" in the "Comment or submission" field.
Molly Selvin writes for the Los Angeles Times.
Copyright © 2008, The Baltimore Sun

F.D.A. Extends Avastin’s Use to Breast Cancer
By Andrew Pollack
New York Times
Saturday, February 23, 2008
The Food and Drug Administration approved Genentech’s best-selling drug, Avastin, as a treatment for breast cancer, in a decision that appeared to lower the threshold somewhat for approval of certain cancer drugs.
The decision late Friday surprised many analysts and investors, because an F.D.A. advisory committee had voted against approval in December, although by a 5-4 margin.
The approval could add hundreds of millions of dollars in annual sales to Avastin, which had previously been approved for colorectal cancer and lung cancer and had sales last year of $2.3 billion in the United States. Roche, which owns a majority stake in Genentech, sells it overseas.
Genentech’s stock, which has been generally declining over the last two years as the company’s growth has slowed, rose more than 8 percent in after-hours trading to $77.45. The decision been closely watched as a harbinger of the F.D.A.’s requirements for cancer drugs.
The big question was whether it was enough for a drug temporarily to stop cancer from worsening — as Avastin had done in a clinical trial — or was it necessary for a drug to enable patients to live longer, which Avastin had failed to do. Oncologists and patient advocates were divided, in part because of the drug’s sometimes severe side effects.
In the end, the agency found a compromise of sorts. It gave Avastin “accelerated” approval, which allows drugs for life-threatening diseases to reach the market on the basis of less than ideal data, subject to further study.
“We wanted to have the regulatory flexibility to approve effective drugs where there isn’t overall survival,” said Dr. Richard Pazdur, who oversees cancer drugs at the F.D.A. He said the agency had sympathy for the view that delaying the progression of life-threatening disease “may be a direct clinical benefit in itself.”
Dr. Pazdur insisted the decision did not represent a change in the F.D.A.’s policies. He said the agency had approved other cancer drugs based on their ability to delay the worsening of cancer, a measure called progression-free survival, but that the F.D.A. still favored overall survival as the standard.
Yet at the advisory committee meeting in December, agency officials said that they had not used delayed disease progression as an approval standard for drugs meant as an initial treatment for breast cancer that has metastasized. But with Avastin, the agency has.
“We believe that they have lowered the bar,” said Fran Visco, president of the National Breast Cancer Coalition Fund, a patient advocacy group, which had opposed approval.
“Our goal is to get the best treatments out to patients that really will be effective and safe,” Ms. Visco. “This particular circumstance will not advance that goal.”
Others hailed the decision, saying there was ample proof the drug works.
“I think it’s just a matter of time before a survival benefit is documented,” said Dr. Amy D. Tiersten, an associate professor at New York University, who said she routinely used Avastin off-label to treat breast cancer in her patients. Doctors are allowed to use a federally approved drug for any uses they see fit.
Avastin, also known as bevacizumab, was already being used fairly widely off label to treat breast cancer. But the approval, which now allows the company to market it specifically for metastatic breast cancer, will very likely increase use and make more insurance companies willing to cover it. Had the F.D.A. ruled against the drug, it might have curtailed insurance coverage and off-label use of Avastin for breast cancer.
The approval also means that breast cancer patients with incomes below about $100,000 a year will be eligible for a program in which Genentech caps payments at $55,000 a year for patients and their insurers.
The company’s payment program, which applies only to approved used of Avastin, was announced in 2006 as Genentech was facing criticism about the drug’s price. As a breast cancer treatment, Avastin costs about $7,700 a month, or $92,000 a year.
In the clinical trial on which the approval was based, women who received Avastin in combination with the chemotherapy drug paclitaxel went a median of 11.3 months before their cancer worsened or they died, in contrast to the 5.8 months for women getting paclitaxel, also known as Taxol, alone.
But the women in the Avastin group lived a median of 26.5 months, compared with 24.8 months for those getting paclitaxel alone — life extension that was not statistically significant.
Moreover, the women receiving Avastin suffered more side effects. And 5 or 6 of them out of 363 died from the drug itself.
Genentech and Roche have begun other trials that could be used to turn the accelerated approval into a full approval. The companies said last week that one such trial had confirmed that the drug delayed the worsening of cancer but it was too soon to show if it lengthened lives.
Dr. Pazdur of the F.D.A. and Dr. David Schenkein, a senior vice president of Genentech, both said it was undecided whether a survival benefit would be needed to obtain full approval.
If Avastin does not show a benefit in the newer trials, the F.D.A. could remove the approval for breast cancer. The agency in 2005 curtailed use of AstraZeneca’s lung cancer drug, Iressa, when trials showed it did not prolong survival. Iressa had been given accelerated approval based on its ability to shrink tumors.
Copyright 2008 The New York Times Company

Popular heart test questioned
Critics see CT risks, with profits trumping science
By David Kohn
Baltimore Sun
Saturday, February 23, 2008
Computed tomography angiography is booming. In 10 painless minutes, this noninvasive test provides a detailed, colorful three-dimensional view of a patient's heart. Many specialists say the CT procedure is more accurate and precise than other heart tests.
Exact figures aren't available, but some experts think Americans undergo several hundred thousand CT angiographies a year, perhaps more than a million.
"It's a very easy test to do," says Dr. Michael Lauer, a heart researcher at the National Heart, Lung and Blood Institute. The test is "proliferating," he says.
That, critics say, is a problem. They call the procedure untested, overused, risky and a prime example of health care ruled by profit and fad rather than hard science.
The debate has intensified since January, when the federal agency that oversees Medicare proposed tight restrictions on insurance reimbursement for CT angiography, a technique that relies on multiple X-rays to create a three-dimensional image of internal organs.
The test typically costs $1,000 to $1,200, more than many patients can pay on their own. So the agency's move would significantly reduce its use. Because many insurance companies follow Medicare's lead, the agency's final decision, due next month, could affect the entireindustry.
"It would have a major effect" on the number of patients who get the test, says Dr. Sean Tunis, director of the Center for Medical Technology Policy.
His San Francisco-based group is an independent nonprofit that studies the ways new medical procedures are tested. Until 2005, Tunis, who lives in Baltimore, was chief medical officer of the Centers for Medicare and Medicaid Services, the agency that oversees Medicare.
Since the CMS proposed the change, cardiologists, radiologists and other doctors who use CT angiography have flooded the agency with appeals.
"This test has huge promise," says Dr. Armin Zadeh, a cardiologist at Johns Hopkins University School of Medicine. "For the first time, we are able to non-invasively see coronary artery disease."
CT angiography arrived a decade ago, and its use has grown steadily. It is one of a growing number of tests that use computed tomography. The Food and Drug Administration oversees CT scanners but does not regulate their day-to-day use.
"CT angiography has revolutionized the way doctors treat heart disease," says Andrew Whitman,vice president of the Medical Imaging & Technology Alliance, a medical-imaging trade group. "The evidence is well established."
Despite the test's appeal and popularity, many researchers say CT angiography has not been adequately studied.
"We have a technology that takes really nice pictures," says Dr. Rita Redberg, a cardiologist at the University of California, San Francisco. "But we have absolutely no data on whether it actually helps patients."
As a result, some argue, many patients get the test unnecessarily. Stephen R. Baker, a professor of radiology at New Jersey Medical School, estimates that at least half of CT angiographies are unnecessary.
Critics also note that CT angiography typically delivers a radiation dose equivalent to hundreds of standard X-rays. They say the dose could significantly increase a patient's risk of some cancers, particularly thyroid cancer.
All CT scans, not just angiography, expose patients to significant radiation. Recent studies have argued that these scans - more than 60 million a year - might cause millions of cases of cancer in coming decades.
Baker worries that many patients and doctors don't understand the radiation risks involved in CT angiography.
"Radiation is a toxin," he says. "It seems obvious that if you give a patient a toxin, then some harm will be done."
He attributes much of the test's popularity to the fee-for-service system, which pays doctors for performing and interpreting tests. "These tests enrich the people who read them," Baker says. "When you get paid for every study, you want to do more."
Zadeh, who orders about 15 CT angiographies a week, says CMS' proposed limits could cost lives. He sees the test as less risky than cardiac catheterization, a longtime standard for diagnosing many heart problems.
In such catheterizations, a doctor inserts a tube into an artery in the groin and threads it up to the heart. Typically, the tube is filled with dye that makes the heart and blood vessels visible to an X-ray. One of every 435 patients who undergoes the procedure has a heart attack, a stroke or dies.
This week, Zadeh performed a CT angiography on Lori Nauman, 50, an office manager and lifetime smoker from Chase. A recent checkup revealed a weak heart. Zadeh wanted to check the arteries around her heart but also wanted to avoid a catheterization because he suspected that the vessels were fine.
Lying on the CT table, Nauman said she was not worried about radiation. That didn't surprise Zadeh, who said, "I haven't met any patients who wouldn't prefer the CT angiography over the cath."
As Zadeh watched, three radiology technicians adjusted the CT machine - a new model that takes 960 pictures a second (most take fewer than 200) and delivers the equivalent of two to three times a person's average yearly radiation dose. Older machines typically deliver at least five times the yearly dose.
Within minutes, the machine produced a sharp color image of Nauman's heart. The verdict: no damage and no need for catheterization.
Concerned about radiation risk and unnecessary costs, CMS wants to limit reimbursement for patients who are at intermediate risk for coronary artery disease, a common heart problem in which blood vessels around the heart are narrowed or blocked. Such patients would be reimbursed only if part of a study to evaluate CT angiography.
Risk categories are determined by a formula based on age, blood pressure, lifestyle and ailments such as diabetes.
The proposal would "significantly restrict coverage if it goes through," says Dr. Marcel Salive, CMS' director of medical and surgical services.
There is no conclusive evidence that intermediate-risk patients get any benefit from CT angiography, he says, hence the need for the studies. Those in high-risk groups don't need a CT angiography because they are clearly sick, Salive says. And low-risk patients don't need the CT angiography because the dangers from radiation outweigh the potential benefits of the test.
Zadeh said he understands CMS' concern and agrees that some patients might be receiving unnecessary CT angiographies. But he says the agency is throwing the baby out with the bathwater.
"You have to put this in context. Every test is a weighing of risks and benefits," he says. " The CMS thing has the potential to really damage the field. In years to come, this test will be the cornerstone of heart imaging."
Copyright © 2008, The Baltimore Sun

Dentist of the Back Roads
House Calls to Neediest Patients Bridge Health-Care Gap
By Mary Otto
Washington Post
Saturday, February 23, 2008; A01
LAFAYETTE, La. – The cane fields and the bayous of Louisiana's Cajun heartland whir past the pickup's cracked windshield. Gregory Folse is at the wheel. He wears green scrubs. His dental instruments and a grinding tool he uses to repair dentures are stowed behind the seat.
Most of his 1,800 patients are too fragile to go out for dental appointments or denture fittings, so he goes to them, riding a circuit of eight parishes.
They represent a cross section of the region's elderly, poor and disabled: Cajun fishermen, retired farmers and oil field workers, younger people crippled by illness or trauma, frail Hurricane Katrina nursing home evacuees, including one who floated on a mattress for seven hours and lost her dentures. There was a madam, too, but she has gone to her reward.
Many, until he sees them in nursing facilities and isolated homes, have not had an oral exam for years. When Folse looks into a new patient's mouth, he often finds decay, rampant infection, the broken stumps of ruined teeth, even oral cancers.
The pain and disease speak to a lack of dental benefits and dental care.
Evidence links oral disease to heart and respiratory problems, and studies show that the old, frail and poor have the worst dental conditions of anyone in the country.
Most of those who had dental insurance during their working lives lost it when they retired. Medicare, the national health insurance program for senior citizens, does not cover routine oral health or dental services. Private dental insurance is limited and too costly for many. And the price of dental care can overwhelm people on fixed incomes: A pair of dentures can cost hundreds, sometimes thousands, of dollars.
Most of Folse's patients are on Medicaid, the public health-care program for the poor, which offers a scant patchwork of dental benefits.
Even in states that subsidize some care, there is a shortage of dentists who will treat seniors and the homebound and who are willing to accept Medicaid, with its complexities and historically low reimbursement rates.
In Louisiana, for instance, fewer than 50 of about 2,000 dentists provide dentures, said Ward Blackwell, executive director of the Louisiana Dental Association. Fewer than five attempt to meet the broader oral health-care needs of the frail and old in nursing homes.
Folse estimates that he donates more services than he bills to Medicaid. But he draws deep satisfaction from his work -- and sometimes a sack of crawfish along the way.
In Abbeville, Folse pulls up to a little house with crawfish traps stacked out front. He's here to adjust Elaine Sherman's dentures. He washes his hands at her kitchen sink.
"So you were hurtin', Sweetheart?"
* * *
When a nursing home has a small beauty shop that offers water, good light and a little quiet space, Folse, 47, tries to set up there. In the beauty shop at the River Oaks Retirement Manor in Lafayette, southwest of Baton Rouge, there are also bingo supplies and a priest's vestments.
He checks the chart of his next patient. The 74-year-old man suffers from dementia and is delusional. Sometimes such appointments "can get pretty wild," the dentist says.
But he thinks that everything, not just dental school, but also his years as a cowboy and his experience riding along with his country doctor grandfather, Phillip Robichaux, prepared him for this work.
A nurse gently but firmly brings the patient. His gum disease is advanced, and some of his teeth are so loose he could swallow them or inhale them. A timely $100 extraction can save $50,000 worth of surgery, hospitalization and complications.
"Those are bad. I'm going to take those out for you," Folse says. At first, the man balks.
"How bad?"
"They are real loose."
"Not to me."
"I want to take 'em out. I don't want them to make you sick. They are infected."
Folse does not take no for an answer. He leans in, projecting calm authority. He doesn't wear a mask or safety glasses. He leads by example and nonverbal cues. When Folse opens his mouth, the patient opens his.
He gives the patient shots of local anesthetic.
"Great job," the dentist says. "You are doing a great job."
And slowly, carefully, he draws out the worst of the man's yellow teeth.
"The others are in horrible shape," Folse says. "But these three were life-threateningly loose."
The nursing homes on Folse's circuit pay him a monthly stipend of $6 a patient. He serves as their medical director. With an office manager who keeps track of the caseload and a young part-time dentist and hygienist, Folse provides exams, responds to emergencies and tries to meet the overwhelming need he sees.
"It's way worth the money we pay," River Oaks' director, Guy Sarver, says.
Sarver sees an irony in the lack of Medicaid dental coverage for the old and poor in Louisiana and many other states. "They'll pay for eyeglasses or penile implants. But they won't pay for teeth."
Dental benefits vary by state and often by year, based on budgetary decisions. Louisiana covers only dentures.
Maryland's dental services for senior citizens under Medicaid are confined to emergency and trauma care. In Virginia, adults are limited to medically necessary oral surgery and extractions when infections compromise their health. The District recently introduced a comprehensive dental package for adults. A few states offer nothing.
* * *
In 1965, when President Lyndon B. Johnson signed the Medicare and Medicaid bill into law, neither program included routine dental care.
In Medicare's case, "the justification was this is a routine service you don't need insurance for," said Marilyn Moon of the Silver Spring-based American Institutes for Research. Adult dental coverage was later made optional under Medicaid. But lawmakers have remained reluctant to expand benefits, given the program's spiraling costs.
Private dental insurance is expensive as well. A plan for AARP members in Lafayette, for example, offers annual premiums starting at $424.20. The bulk of Folse's patients, before entering nursing homes, lived on fixed Social Security incomes of less than $1,000 a month.
Folse estimates that adding a dental guarantee under Medicaid for the aged and disabled would cost $700 million a year. He advocated for such a provision, and a bill was introduced in Congress in 2005. It never moved past the committee level.
Last year, galvanized by the death of a 12-year old Prince George's County boy, Congress tried to include a dental guarantee for the children of the working poor in an expansion of the State Children's Health Insurance Program. The expansion was vetoed twice by the president and shelved.
Benefits for seniors and the disabled never entered the discussion.
* * *
The twice-divorced Folse lives on a farm north of Lafayette. His hay crop this year will help pay the bills. He also sells a baling machine called the Bale Band-It. When he drives his circuit, he sometimes gets "hay calls" from people who want to buy hay or from Bale Band-It customers.
"Sometimes a bale will bust, and it's not the Band-It's fault," he says. "You gotta know what to do."
Folse drives 40,000 to 50,000 miles a year. He never uses a map.
He was born farther south, down in Raceland. His grandfather, the country doctor, was a big influence. So was his father, a livestock auctioneer. Folse worked cattle to pay his college bills. He thought about going to veterinary school, but then he found dentistry. The idea just hit him one day.
"Senior year, we did a rotation in nursing homes. The residents really inspired me," Folse said. "They had so much need."
After graduation, he worked in a nice office with regular healthy patients. But he started visiting nursing homes on Fridays, his day off. He was overwhelmed again by what he saw and how he felt treating the frail, the deranged, the forgotten, the truly grateful.
He thought, "This is really what I want to do."
"Nine hundred patients with severe gum disease or abscess. Half of my patients. I take everybody that has swelling. Everybody in pain. Everybody that's got loose teeth. And I help them as best I can. With funding. Without funding. The family pays some, the nursing homes. Sometimes no one pays. It doesn't matter. I do it."
The rewards are often intangible.
"I had a patient in a wheelchair. She had a stroke. She was so happy to get her dentures. She reached down and grabbed her purse. She reached inside. She found a piece of bread. " 'Here doc,' she said. 'Take it.' I didn't want to take her last piece of bread. No telling how long it had been at the bottom of her purse.
"We have to give out of being wealthy. She gave to me out of her poverty."
* * *
Sixty miles northwest of Lafayette, at a nursing home in Pine Prairie, Folse gets help from a young dentist, Wendy McCurdy, who heard him lecture at the Louisiana State University School of Dentistry and was intrigued by the challenges of his work. "My mother has worked with special-ed kids all my life," McCurdy says.
They set up in the beauty shop. A little sign outside the door reads: "Haircut $6, Shampoo and set $7. . . . Wash and blow dry $3."
"Come on in, Sugar Plum," Folse calls to the first patient.
A line quickly forms at the door.
He finds troubles no one else would, says Sandra Book, nursing facility administrator: "Some of these people are in pain, but they can't tell you. Without an exam, you can't tell if they have a big old ulcer in their mouth."
At a nursing facility in the town of Eunice, they are also waiting.
"Hey, Mr. Teethman!" shouts one fellow.
A woman stops Folse in the hallway. Her root tips are exposed. She wants them pulled. Another is impatiently awaiting her dentures. "My teeth. Where are they?"
On his way to his next place, Folse stops at a cemetery to visit the grave of a fragile old woman who died recently from complications of a facial abscess. She had many medical issues, but an infection in her mouth finally overran her body's defenses.
"This is an example of oral health being a matter of life and death," he says. "Over the past seven or eight years, I've seen oral health contribute to the death of at least one or two a year."
In many cases, an oral cancer proves fatal. Other times, it's pneumonia, which can be linked to bacteria in the mouth. "I see pneumonia patients all the time. I know oral health, and oral hygiene is a significant factor in that disease," Folse says.
* * *
He's driving past fields of sugar cane and scrub woods to deliver a pair of dentures to a retired retail clerk in St. Martinville.
Smoke from a cane field curls in the blue sky. Driving over a coulee, a drainage canal. The sun is setting. A hawk is on the wire. Driving over a black bayou with a shrimp boat.
"I can't forget to stop at the lab to get that repair," he says.
Over the Vermillion River, the sky is changing from blue to black. There is a line of dark clouds on the horizon over the rice fields.
In Abbeville, Elaine Sherman is feeling better now that her dentures have been adjusted. She and her husband fished today.
"I have gumbo and crawfish ¿touff¿e and fried garfish balls," she says. "Homemade bread and pecan pie."
He stays for dinner.
© 2008 The Washington Post Company

China: Rise in AIDS and Syphilis
By Reuters
New York Times
Saturday, February 23, 2008
China disclosed a large percentage rise for 2007 in diseases transmitted sexually or via blood, including AIDS and syphilis, without reporting exact figures. The number of new AIDS cases rose 45 percent in 2007 from the year before and new syphilis cases rose 24 percent, the Health Ministry said on its Web site. It did not elaborate. China has been battling an acknowledged rise in cases of AIDS and H.I.V., the virus that causes AIDS, now mainly sexually transmitted, though it had said before that the overall rate was slowing. In the past, most cases were caused by intravenous drug use. The government said last year that it estimated that about 700,000 people had H.I.V. or AIDS.
Copyright 2008 The New York Times Company

Purr-fect Health
Annapolis Capital Editorial
Saturday, February 23, 2008
Score one for the cat owners this week. A study of more than 4,400 people by researchers at the University of Minnesota's Stroke Research Center concluded that, over a 20-year period, those who had never owned a cat had a 40 percent greater risk of death from a heart attack and a 30 percent higher risk of death from any sort of cardiovascular disease.
And, no, the study (unlike others) didn't find any health benefit from owning dogs.
Perhaps what's really being measured is a personality difference that protects against heart disease - and predisposes those people to indulging fuzzballs-with-attitude whose idea of doing something nice for their owner is presenting him with a half-chewed mouse.
Or perhaps the difference is that dogs, in return for all that tail-wagging, require much more hands-on attention. They need to be walked. They need to be fed routinely. They want to play on their schedule, not yours. They bark (and sometimes howl and yap). They are a bit like having a perpetual 2-year-old - who sheds.
Perhaps all this isn't particularly good for an owner's heart. Or perhaps this latest study just got it wrong.
Most will probably take all this with a couple pounds of kitty litter. But what we really want to know is this:
There are an estimated 90 million cats owned in the United States, and nearly 75 million dogs. How come these facts are never brought up when people on late-night radio spin conspiracy theories about who is really running the country?
Copyright © 2008 Capital Gazette Communications, Inc.

Politics and Needle Exchanges
New York Times Editorial
Saturday, February 23, 2008
Needle exchange programs save lives. They slow the spread of H.I.V., the virus that causes AIDS, and they help get addicts into treatment. Yet when it comes to supporting these programs, it seems that the political cowardice never ends.
For the last 20 years, Congress has blocked the use of federal money to pay for needle exchange programs in the United States or abroad. For 10 years, Congress banned Washington from using tax dollars raised in the District of Columbia to pay for needle exchange efforts.
Congress finally lifted Washington’s ban in December, stripping that provision in the federal budget that President Bush had signed. The District of Columbia has now allocated $650,000 that will, among other things, pay to open a clinic that combines needle exchanges with H.I.V. testing. In what would be an unconscionable reversal, President Bush’s new budget request would reimpose that ban.
Needle exchange programs have proved highly successful around the world, and the country’s most important medical and public health organizations have endorsed the efforts for more than a decade. Opponents’ claims that needle exchanges would encourage addiction have turned out to be nonsense.
The nation’s capital has the country’s highest rate of H.I.V. infection, and a recent report by the District of Columbia’s health department found that more than 20 percent of the city’s AIDS cases could be traced to intravenous drug users. Now that Washington has a chance to fight back, the White House must not be allowed to hobble that effort.
Congress must insist that Washington be allowed to spend its own money on needle exchange programs. And it must begin passing budgets that allow states — and health organizations overseas — to use federal dollars for these life-saving programs.
Copyright 2008 The New York Times Company

Safety of phthalates still open to debate
Baltimore Sun Letter to the Editor
Saturday, February 23, 2008
We were dismayed to read the letter "No reason to fear products for babies" (Feb. 11).
The current understanding of the potential adverse effects of phthalates comes from laboratory animal and human epidemiological studies.
More than 100 studies have raised concerns that exposure to phthalates is associated with health outcomes such as genital birth defects in males, decreased testosterone production in boys and decreases in male fertility.
The Centers for Disease Control and Prevention have discovered the presence of phthalates in body fluids of almost 100 percent of Americans.
Studies have even shown that babies have phthalates circulating in their bodies at birth, giving us a "pre-polluted baby."
While we do not have all of the answers that we would like to have about the effects of these chemicals, until we get those answers, we need public policy that will reduce their potential harm to children.
We must not use uncertainty as an excuse to falsely reassure parents and consumers.
Brenda M. Afzal, Robyn Gilden
The writers are, respectively, the director of health programs and a program manager for the Environmental Health Education Center at University of Maryland School of Nursing.
Copyright © 2008, The Baltimore Sun