By GERARD SHIELDS
Advocate Washington
bureau
WASHINGTON — In the wake
of the government’s decision not to fully fund the rebuilding of Charity Hospital, U.S. Rep. Anh
“Joseph” Cao told the nation’s Homeland Security secretary Wednesday that he
has concerns over the appeals process being created by the department.
Homeland Security Secretary Janet Napolitano told the New
Orleans Republican that her office is trying to create the arbitration
process that was mandated through the recent federal stimulus bill.
An appeals panel of the Federal Emergency Management
Agency earlier this week denied the state’s request for the agency to pay $492
million to rebuild the hospital. FEMA had offered $150 million.
Cao told Napolitano that he wanted to ensure that the new
arbitration panel is independent from FEMA, which made the initial decision
not to fund the hospital. Cao told Napolitano that the appeals process has
held up any movement on the Charity matter.
“You must understand the frustration of our constituents
down there,” Cao said. “We’ve been waiting four years.”
Cao called the FEMA denial critical to the region.
“That denial has dramatically changed the health-care
system,” Cao said.
Without naming Charity, Napolitano said the department has
a duty to be a steward of federal dollars. “We have a responsibility as well
to the taxpayers’ pocket,” Napolitano said. “There are legitimate differences
of opinion.”
After the hearing, Cao said he was not satisfied with
Napolitano’s answers.
“There are questions and problems in the appeals process
that the secretary has to address,” Cao said.
Cao, who recently delivered a letter to President Obama
seeking the Charity money, said after the hearing that he hopes the agency
will reconsider its decision. Charity, which is a teaching hospital for LSU,
provides care to the city’s poor.
“I believe it will put the residents in dire straits,” Cao
said of the FEMA decision. “The people are still waiting for a hospital and
we are still waiting for the secretary and FEMA to fund that hospital.”
http://www.2theadvocate.com/news/44950022.html
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Maya Rodriguez / Eyewitness News
Watch the video:
http://www.wwltv.com/medical/stories/wwl051309tpcao.2188927c.html
NEW ORLEANS - Hundreds of millions
of dollars are at stake in the rebuilding of Charity Hospital
and in the latest battle over federal money, the state has seen setback.
Video: Watch the Story
FEMA denied the state's latest appeal to pay more than
$490 million to build a new hospital. On Wednesday, in a Homeland Security
committee hearing on Capitol Hill, Congressman Cao expressed frustration
about the lack of answers about Charity's funding future.
"I think it will put the residents of New Orleans in dire
straits," said Rep. Joseph Cao, R-Louisiana. "Often times, some of
those people who were involved in the first denial are deciding the appeal
applications. I believe that system they have right now, lacks the
objectivity that we desperately need in any appeal process."
It is a point that Cao made to Homeland Security Secretary
Janet Napolitano. During the hearing, Napolitano said she sympathized with New Orleans, but had
concerns.
"We have a responsibility as well," Napolitano
said. "These are taxpayer dollars. We're not just giving an unending
pocket here, to make sure they go to qualified projects that need to be
compensated. And there are some legitimate differences of opinion."
One of differences, outlined in the letter, is that the
state did little to protect Charity
Hospital, in the days
surrounding Hurricane Katrina. It is a charge, state officials said, that is
not true.
"No one's shown me proof of negligence as of yet, so
I'm going with the studies and the engineers and the technical reports that
have been done," said Louisiana Recovery Authority director Paul
Rainwater.
The state can file a second appeal beyond the regional
office, all the way to Washington
D.C., or officials could go
before a newly-created arbitration panel.
"That system, I believe, will provide a more
objective determination," Cao said.
"I think Katrina is so unusual in scope and the like,
that the arbitration add-on and augmentation is going to be very helpful, not
only to resolve things quickly but also give people a sense that they really
had their shot," Napolitano said.
Speaking during the hearing, Secretary Napolitano would
not give a timeline for when an arbitration panel would be set up to hear the
Charity appeal.
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NEW ORLEANS -- FEMA's
refusal to pay nearly $500 million to replace Charity Hospital
is fanning the flames of an ongoing to dispute about whether to repair or
rebuild the Katrina-damaged facility.
A group of citizens and medical professionals want the
hospital repaired, but the state of Louisiana
wants to build a new building in Mid-City.
"There's pictures and eyewitness testimony that this
building should have been open in 2005, that it clearly was not damaged
beyond repair," said Dr. James Moises.
Moises was one of those
witnesses inside Charity following Hurricane Katrina. He said he thinks the
hospital needs to be repaired and reopened.
"Our position is let's save hundreds of millions of
dollars, re-invest it back into Charity -- which the architects say can be
done -- and make it a world class hospital again," Moises
said.
But the state disagrees. It wants the federal government
to pay $492 million in damages so it can start over and built a brand new
medical center.
This week, FEMA said no. Instead, it is offering about a
third of what the state is asking.
"Studies have shown, in my opinion convincingly, the
possibility of reopening Charity is not a reality," said LSU Health
Sciences Center Vice Chancellor Joseph Moerschbaecher.
He said it's not just about the money -- it's about
providing the highest quality medical care in New Orleans. He said even before the storm,
Charity was not competitive in a modern health care system.
"Charity's certification was in jeopardy prior to the
storm because of its physical plans and structural status," Moerschbaecher said. "It hadn't been maintained by
the state over the years."
FEMA is giving LSU 60 days to appeal its decision or go
before the appropriations board for a second review.
The new medical center has a price tag of $1.2 billion,
and LSU thinks it would take five to seven years to break ground.
http://www.wdsu.com/news/19453953/detail.html
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Charity Hospital advocates send message with billboard
by Bill Barrow, The Times-Picayune
BATON ROUGE -- The Foundation for Historical Louisiana, one
of the groups calling for the state to gut and rebuild within the shell of Charity Hospital, has taken its message to
lawmakers in the form of billboard near the Capitol.
As lawmakers contemplate hundreds of millions of dollars
in state budget cuts, the billboard states: "Want to save $283 million?
Reopen, Restore
Charity Hospital."
That dollar figure represents the estimated difference between what an
architectural firm, hired by the foundation, estimated a Charity gutting
would cost versus the state's proposed plans for a new 424-bed hospital in
lower Mid-City.
Each side disputes the numbers touted by the other. State
facilities director Jerry Jones said it is impossible to estimate the costs
of construction involving 70-year-old buildings such as Charity. Foundation
spokeswoman Sharon Stokes points to new construction -- particularly on major
complexes, including hospitals -- that come in over budget, as well.
As it stands, the state is in the middle of its design
phase for the hospital, though it's financing plans still await resolution of
the state's dispute with the Federal Emergency Management Agency over how
much Louisiana
is due for Hurricane Katrina damage to Charity. The state says it can open a
hospital by 2013.
http://www.nola.com/politics/index.ssf/2009/05/charity_hospital_advocates_sen.html
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From staff reports
The City Planning Commission will hold a public meeting
May 28 on plans for new Veterans Affairs and Louisiana
State University
hospitals in New Orleans.
The session will begin at 4 p.m. in the City Council chamber at City Hall and
is expected to run several hours.
The meeting is being termed a "special forum"
rather than a public hearing because the commission has nothing on its agenda
requiring action related to plans for the two hospitals. Commission leaders
said the panel has no jurisdiction over the projects.
However, critics of plans to locate the hospitals in
Mid-City have called upon the commission for months to get involved in the
debate over where they should be built, and some City Council members
eventually said they also thought the commission should hold a meeting on the
issue.
Critics have called for renovating Charity Hospital,
closed since Hurricane Katrina, instead of demolishing several blocks of
Mid-City buildings to create a campus for a new state teaching hospital.
Planning Director Yolanda Rodriguez said she expects VA
and LSU officials to make presentations on their plans at the meeting. She
said information gathered at the meeting will be reviewed by those writing
the city's new master plan and zoning ordinance.
http://www.nola.com/news/t-p/neworleans/index.ssf?/base/news-10/1242192108131070.xml&coll=1
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Jerry Alexander
Re: "Preservation group files suit to block new N.O.
hospitals: Environmental law not followed, it says," Page A2, May 2.
As a veteran, I applaud the VA for trying to help New Orleans' recovery by
selecting our city as the location of its planned VA Hospital.
But the primary mission of the VA is not to help New Orleans recover --
it is to provide top-quality health care for our veterans.
Advertisement
The recent lawsuit clearly impedes the VA's ability to
proceed with its plans in a timely manner. Meanwhile, while the city and
state are mired in delays, our veterans are forced to travel elsewhere to
receive the treatment they need.
Once again misguided preservationists, as represented by
the National Trust for Historic Preservation, are interfering with New Orleans' progress.
Selfishly, they are asking our veterans to make an
additional and unnecessary sacrifice.
This lawsuit asks the VA to rebuild its incredibly
important project elsewhere. Isn't that a shame for our area and our local
veterans?
Jerry Alexander
River Ridge
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-13/124227852659370.xml&coll=1
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Johnnie Hunt
As a practicing dentist, I support HB687 because it
eliminates potentially dangerous activities on school campuses.
Implying that this is a financial issue for dentists
ignores the larger concerns for proper treatment and safety for children.
It is safe to say that the children, who aren’t being seen
by a dentist today, need significant dental care. This treatment includes
extracting teeth, performing root canals and placing crowns on decaying
teeth.
These procedures can’t simply be done in the school
library. Dentists are the experts on this issue. We have the best treatment
for our patients in mind.
Why is The Advocate so quick to rely on medical “opinions”
from the Federal Trade Commission, which has never treated one child or adult
for a dental problem?
The best solution is getting children AND their parents or
guardians into a proper office.
Medicaid has recently added new options for families to
receive dental care in a dentist’s office, including paying for two dental
visits per year and offering transportation to and from the dentist’s office.
Louisiana’s
dentists, the state Department of Health and Hospitals and various school
systems have to work together to get kids — and their parents — to the
dentist’s office. It’s better.
It’s safer.
Johnnie Hunt
pediatric dentist
Baton Rouge
http://www.2theadvocate.com/opinion/44945732.html
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By CHERAMIE SONNIER
Advocate Food writer
Many people who need to cut calories or keep their blood
sugar under control turn to sugar substitutes to add sweetness to their
favorite drinks, breakfast cereals or baked goods. The good news is health
experts say that, with rare exceptions, artificial sweeteners seem to have
little or no risk.
Depending on the type, artificial sweeteners are from 160
to 13,000 times sweeter than sugar.
Obviously, when using sugar alternatives for baking, some
adjustments must be made because of the difference in the properties in sugar
and the sugar substitute. The differences can affect the texture, volume, the
browning and the rising qualities of the item being baked.
“I’m on record as saying artificial sweeteners are a good
thing for people who need to cut calories,” said Catherine Champagne, a
registered dietitian, professor of dietary assessment and food analysis, and
professor of nutritional epidemiology at Pennington Biomedical
Research Center.
“Sugar doesn’t give you anything but calories in terms of
nutrition. If you are looking to cut something, sugar is a good thing to
start with,” she said. “If you don’t have a weight limit or diabetes, you can
eat sugar.”
However, she was quick to point out that people should
rely instead on the natural sweetness of fresh fruits. “As we get older, our
calorie needs decrease, but we aren’t adapting as we get older. We have to make
adjustments. You should evaluate your dietary intake. People don’t eat enough
fruits and vegetables and are too dependent on soft drinks.”
The safety of artificial sweeteners is always a concern, Champagne said, but “I
really don’t think that concern is grounded.”
Saccharin, used in Sweet ’N Low, was discovered in 1887,
she said. It was used during World War I and World War II to make up for
sugar shortages, and governmental regulation began in 1958. Saccharin was
almost banned in 1977 because of studies in rats linking it to bladder
cancer, but Champagne
said those studies were flawed.
The U.S. Food and Drug Administration and the American
Medical Association have termed aspartame (Equal, Nutra-Sweet)
safe at recommended levels. “There is only one safety precaution,” Champagne said.
“People with the disorder phenylketonuria (PKU)
can’t metabolize an amino acid” found in aspartame.
Sucralose (Splenda,
NatraTaste Gold) is made by converting sugar to noncaloric sucralose by
changing its chemical makeup.
The FDA has approved stevia, a
botanical, as a dietary supplement, but not as a sweetener, she said.
However, it has long been consumed in other countries, Champagne said, and has the approval of
the World Health Organization. The FDA has approved Truvia
and PureVia, natural zero-calorie sweeteners
derived from stevia, for use in beverages, she
said.
The sweetener you choose is a personal preference, Champagne said. “I
feel comfortable consuming any of them. It comes down to how well it performs
for you, and some products cannot be used for baking.”
It does take a bit of trial and error to adapt recipes for
cooking and baking with sweeteners, The Advocate’s food staff discovered when
making pound cakes for a blind taste-test.
One of the pure sugar cakes was made with all-purpose
flour. The other five cakes were made with cake flour.
First discovery: Pound cake is probably not the most
economical baked good to make with some sugar substitutes. Take, for example,
Swerve, the new product developed in Louisiana
that, according to the company, has properties close to sugar and is to be
used cup for cup like sugar. It’s available either in single-serve packets or
in 1-pound bags that cost $13.95 each. A bag contains 2 cups; however, the
recipe requires 3 cups of sugar. Regular sugar was used to make up the
difference.
Second discovery: Sugar does more than sweeten; it also
adds volume and browning, moistness and activates yeast. Products made in
granular form, such as NatraTaste Gold or Splenda Granular, work best in such items as cheesecakes,
quick breads and cookies.
For cakes that need volume, McNeil Nutritionals, which
makes Splenda products, suggests adding about 1/2
cup of nonfat dry milk and ‰ teaspoon of baking soda for every 1 cup of Splenda Granular. This step is not necessary for Splenda Brand Sugar Blend for baking, which is a mix of
pure sugar and Splenda Brand Sweetener.
The sugar substitute cakes were made using a recipe for
Sour Cream Pound Cake from the Splenda Brand “Sweet
Possibilities Recipe Collection.” It calls for 1-1/2 cups of Splenda Brand Sugar Blend.
For the cake made with Sweet ’N Low Brand Zero Calorie
Sweetener for Cooking and Baking, 12 teaspoons of the sweetener and 1-1/2
cups of sugar were used.
Another cake was made using 3 cups of NatraTaste
Gold Brand Zero Calorie Granulated Sweetener, 1-1/2 cups of powdered milk and
1-1/2 teaspoons of baking soda. This resulted in a cake that had lots of
volume, not enough color, wasn’t sweet enough and was too dry. The last
problem probably occurred because the cake was left in the oven too long.
The baking time was another important discovery. To keep
cakes made with sugar substitutes from over-baking and being too dry, they
should be checked 7 to 10 minutes before the end of the baking time.
Finally, the staff found that the taste of all the cakes
improved with age.
http://www.2theadvocate.com/features/food/44905442.html
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By Mike Hasten
BATON ROUGE — The count of cases of H1N1 virus in Louisiana rose to 33 Wednesday with the Centers for
Disease Control and Prevention confirming 13 more samples gathered in Lafayette.
Rene Milligan, communications director for the Louisiana
Department of Health and Hospitals, said state officials expected the rise
because the CDC was confirming about 99 percent of the suspected cases
forwarded to the national labs in Atlanta.
But officials were a bit surprised to get eight negative reports, too.
"A lot of these people whose cases were confirmed
have been treated and are fine, back out in their communities," Milligan
said.
"No one has been hospitalized" for treatment of
flu symptoms, he said. All were treated at home.
Milligan said that because the flu symptoms are so mild,
DHH will no longer publicize a daily report. It still is keeping track of
suspected cases, though.
"It's useful for our epidemiology research," he
said.
Researchers are examining the more than 2,500 samples sent
to the state lab from around the state to see how the disease spread and
where it spread. So far only 33 have been confirmed
The results could prove helpful, he said, when the next
major flu outbreak occurs.
The CDC eased its guidelines for who should get tested and
treated and basically is recommending antiviral treatment only for cases that
require hospitalization. Other cases can be treated with regular flu
medication.
People with weakened immune systems and other factors that
could lead to serious problems from flu should see a physician.
Milligan said DHH is recommending that most people who get
flu-like symptoms stay home and treat it as they would regular flu.
http://www.thenewsstar.com/apps/pbcs.dll/article?AID=2009905130327
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The New York Times | 05.14.09
By DONALD G. McNEIL Jr.
Swine flu has reached 33 countries, the World Health
Organization said Wednesday, and there have been deaths in four nations: Mexico, the United
States, Canada
and Costa Rica.
The agency, based in Geneva,
is under pressure to change how it issues pandemic alerts, which go up as a
new virus spreads even if it is relatively mild. But Dr. Sylvie Briand of the
W.H.O.’s global flu program said it would be “not
very helpful” to switch to alerts like those for hurricanes, which are based
on wind speeds. A virus’s severity, she said, varies from country to country,
depending on the population’s previous immunity, average age, the level of
readiness of the health care system and the prevalence of diseases that could
make people more vulnerable.
http://www.nytimes.com/2009/05/14/health/14briefs-flureport.html?ref=health
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The New York Times | 05.13.09
By NICHOLAS WADE
An English chemist has found the hidden gateway to the RNA
world, the chemical milieu from which the first forms of life are thought to
have emerged on earth some 3.8 billion years ago.
He has solved a problem that for 20 years has thwarted
researchers trying to understand the origin of life — how the building blocks
of RNA, called nucleotides, could have spontaneously assembled themselves in
the conditions of the primitive earth. The discovery, if correct, should set
researchers on the right track to solving many other mysteries about the
origin of life. It will also mean that for the first time a plausible
explanation exists for how an information-carrying biological molecule could
have emerged through natural processes from chemicals on the primitive earth.
The author, John D. Sutherland, a chemist at the University of Manchester, likened his work to a
crossword puzzle in which doing the first clues makes the others easier.
“Whether we’ve done one across is an open question,” he said. “Our worry is
that it may not be right.”
Other researchers say they believe he has made a major
advance in prebiotic chemistry, the study of the
natural chemical reactions that preceded the first living cells. “It is
precisely because this work opens up so many new directions for research that
it will stand for years as one of the great advances in prebiotic
chemistry,” Jack Szostak of the Massachusetts General Hospital
wrote in a commentary in Nature, where the work is being published on
Thursday.
Scientists have long suspected that the first forms of
life carried their biological information not in DNA but in RNA, its close
chemical cousin. Though DNA is better known because of its storage of genetic
information, RNA performs many of the trickiest operations in living cells.
RNA seems to have delegated the chore of data storage to the chemically more
stable DNA eons ago. If the first forms of life were based on RNA, then the
issue is to explain how the first RNA molecules were formed.
For more than 20 years researchers have been working on
this problem. The building blocks of RNA, known as nucleotides, each consist
of a chemical base, a sugar molecule called ribose and a phosphate group.
Chemists quickly found plausible natural ways for each of these constituents
to form from natural chemicals. But there was no natural way for them all to
join together.
The spontaneous appearance of such nucleotides on the
primitive earth “would have been a near miracle,” two leading researchers,
Gerald Joyce and Leslie Orgel, wrote in 1999.
Others were so despairing that they believed some other molecule must have
preceded RNA and started looking for a pre-RNA world.
The miracle seems now to have been explained. In the article
in Nature, Dr. Sutherland and his colleagues Matthew W. Powner
and Béatrice Gerland
report that they have taken the same starting chemicals used by others but
have caused them to react in a different order and in different combinations
than in previous experiments. they discovered their
recipe, which is far from intuitive, after 10 years of working through every
possible combination of starting chemicals.
Instead of making the starting chemicals form a sugar and
a base, they mixed them in a different order, in which the chemicals
naturally formed a compound that is half-sugar and half-base. When another
half-sugar and half-base are added, the RNA nucleotide called ribocytidine phosphate emerges.
A second nucleotide is created if ultraviolet light is shined
on the mixture. Dr. Sutherland said he had not yet found natural ways to
generate the other two types of nucleotides found in RNA molecules, but
synthesis of the first two was thought to be harder to achieve.
If all four nucleotides formed naturally, they would zip
together easily to form an RNA molecule with a backbone of alternating sugar
and phosphate groups. The bases attached to the sugar constitute a
four-letter alphabet in which biological information can be represented.
“My assumption is that we are here on this planet as a
fundamental consequence of organic chemistry,” Dr. Sutherland said. “So it
must be chemistry that wants to work.”
The reactions he has described look convincing to most
other chemists. “The chemistry is very robust — all the yields are good and
the chemistry is simple,” said Dr. Joyce, an expert on the chemical origin of
life at the Scripps Research Institute in La Jolla, Calif.
In Dr. Sutherland’s reconstruction, phosphate plays a
critical role not only as an ingredient but also as a catalyst and in
regulating acidity. Dr. Joyce said he was so impressed by the role of
phosphate that “this makes me think of myself not as a carbon-based life form
but as a phosphate-based life form.”
Dr. Sutherland’s proposal has not convinced everyone. Dr.
Robert Shapiro, a chemist at New
York University,
said the recipe “definitely does not meet my criteria for a plausible pathway
to the RNA world.” He said that cyano-acetylene,
one of Dr. Sutherland’s assumed starting materials, is quickly destroyed by
other chemicals and its appearance in pure form on the early earth “could be
considered a fantasy.”
Dr. Sutherland replied that the chemical is consumed
fastest in the reaction he proposes, and that since it has been detected on
Titan there is no reason it should not have been present on the early earth.
If Dr. Sutherland’s proposal is correct it will set
conditions that should help solve the many other problems in reconstructing
the origin of life. Darwin, in a famous letter of 1871 to the
botanist Joseph Hooker, surmised that life began “in some warm little pond,
with all sorts of ammonia and phosphoric salts.” But the warm little pond has
given way in recent years to the belief that life began in some exotic
environment like the fissures of a volcano or in the deep sea vents that line
the ocean floor.
Dr. Sutherland’s report supports Darwin. His proposed chemical reaction take
place at moderate temperatures, though one goes best at 60 degrees Celsius.
“It’s consistent with a warm pond evaporating as the sun comes out,” he said.
His scenario would rule out deep sea vents as the place where life originated
because it requires ultraviolet light.
A serious puzzle about the nature of life is that most of
its molecules are right-handed or left-handed, whereas in nature mixtures of
both forms exist. Dr. Joyce said he had hoped an explanation for the
one-handedness of biological molecules would emerge from prebiotic
chemistry, but Dr. Sutherland’s reactions do not supply any such explanation.
One is certainly required because of what is known to chemists as “original syn,” referring to a chemical operation that can affect a
molecule’s handedness.
Dr. Sutherland said he was working on this problem and on
others, including how to enclose the primitive RNA molecules in some kind of
membrane as the precursor to the first living cell.
http://www.nytimes.com/2009/05/14/science/14rna.html
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The New York Times | 05.13.09
By RONI CARYN RABIN
Scorpion stings rarely leave a trace, so when 10-year-old
Michael Moerdler-Green woke up at 3 a.m. during a
recent family trip to Phoenix,
all he knew was that his leg hurt. But as the scorpion’s poison began to
spread, his body started to tingle, his eyes rolled around in his head and his
legs and arms began to flail.
At the emergency room of Phoenix Children’s Hospital,
doctors offered Michael’s parents a choice of treatments: heavy sedation to
quell the boy’s symptoms, or an experimental
scorpion antivenom made in Mexico but not approved by the Food and Drug
Administration for use in the United
States.
The boy’s father, Dr. David Moerdler-Green,
chose the antivenom. A new study suggests he made
the right decision.
No other antivenom specifically
for scorpion stings is available in the United States, and a small
clinical trial of young children stung by bark scorpions has found that most
of those given the investigational drug recovered within two hours, while
children given a placebo had symptoms that lasted four hours or more and
required heavy sedation and hospitalization.
The study is to be published on Thursday in The New
England Journal of Medicine.
“It was like a miracle,” said Dr. Moerdler-Green,
who is head of radiology at St. Barnabas Hospital in the Bronx.
His son was able to leave the hospital just an hour after receiving the
medication. “How many people go into the emergency room around the world and
are able to get medication and be cured in the course of one hour?”
Dr. Leslie V. Boyer, principal investigator of the new
study, said the trial, though small, demonstrated that the effects of bark
scorpion venom could be quickly reversed.
“Using this antivenom in the
emergency room will make intensive care treatment unnecessary for most
patients,” said Dr. Boyer, who is director of a venom research institute at
the University of Arizona College of Medicine in Tucson.
Although 8,000 Arizona
residents are stung by poisonous scorpions each year, most adults recover
without needing medical treatment. Each year about 200 young children,
however, suffer severe neurotoxic symptoms,
including trouble breathing, after being stung.
Wider use of the scorpion antivenom,
called Anascorp, could make treatment much easier
in rural areas and small towns in the state that do not have pediatric
intensive care units and usually have to helicopter children to hospitals for
care, Dr. Boyer said.
A professor at Arizona
State University
used to make her own scorpion antivenom. She
retired in 1999, leaving behind her recipe and enough of the drug to last
about five years. Ever since, the state has been using up its inventory.
In the new study, children from ages 6 months to 18 years
who were admitted to a pediatric intensive care unit in Tucson after being stung by scorpions were
randomly assigned to receive either Anascorp or a
placebo. Eight received the antivenom, and seven
received a placebo.
Within two hours, children who had received Anascorp recovered from most of their symptoms; within
four hours, the children recovered completely, the researchers found. None of
the children who received the drug had detectable levels of scorpion venom in
their blood an hour after infusion.
By contrast, children who received the placebo treatment
required sedation at levels 65 times higher than did the children who
received antivenom. Symptoms persisted for more
than four hours in all but one of the children receiving the placebo, the
researchers found, and some were hospitalized for up to 48 hours.
http://www.nytimes.com/2009/05/14/health/14scorpion.html?ref=us
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The New York Times | 05.13.09
By NATASHA SINGER
Australians have been riveted over the last month by a
class-action lawsuit that is pulling back the curtain on strategies that the
American drug giant Merck used in its international marketing of the
painkiller Vioxx.
The revelations in court testimony and defense evidence
include accusations that Merck’s Australian affiliate circulated a marketing
publication in the guise of an independent medical journal for doctors and
countered safety concerns by giving its sales representatives a training
manual called the “Vioxx Objection Handling
Module.”
Australian newspapers have been covering the court
proceedings in daily installments like a soap opera — with headlines like
“Drug Representatives for Merck & Co. Given ‘Cheatsheets’
” and cliffhangers like “the trial continues.”
Merck removed the drug from the global market over safety
concerns in 2004. Compared with the $4.85 billion Merck agreed to pay in the United States two years ago to settle with
nearly 50,000 people who claimed cardiovascular injuries from Vioxx, legal experts say, the company’s potential
liability in Australia
is a pittance.
Even the Australian plaintiff’s lawyer in charge of the
case against Merck in Melbourne
says the best outcome for his side — a favorable decision for several
thousand plaintiffs who could potentially join the case — might cost Merck only
several hundred million dollars.
That is why, on this side of the Pacific, industry
observers are asking themselves why Merck would want to go through another
embarrassing airing of dirty linen.
“How much money can Merck be
saving on the payouts that would be worth this kind of bad publicity years
later?” said Michael A. Santoro, an associate professor at Rutgers Business
School who teaches a
course on pharmaceutical industry ethics.
But Merck says the issue is not potential liability or
negative publicity. The point of trying the case is to stand behind the
company’s conviction that it acted responsibly in developing, marketing, and
ultimately withdrawing Vioxx, Bruce N. Kuhlik, Merck’s general counsel, said in an interview
this week.
With plaintiffs’ lawyers in countries including Canada closely watching the Melbourne
trial, Mr. Kuhlik said, Merck was using the same
legal strategy it used in the United
States: to fight every personal injury
case in court and convince judges that patients with
idiosyncratic medical histories should not be allowed to sue as a group.
Often, he said, individual plaintiffs cannot prove that
they used Vioxx or that the drug caused their
health problems.
Merck took Vioxx off the market
in more than 80 countries in 2004, after a clinical trial indicated that the
drug could raise the risk of strokes and heart attacks. But Merck, in winning
most of the cases to reach juries in this country before agreeing to its big
settlement, has consistently argued that there is no proof of a causal link
between Vioxx and any one patient’s heart problems.
The company said at the time of the settlement that judges had encouraged
both sides to come to terms.
In the Melbourne
trial, which began March 30 and is expected to continue through June, an
Australian named Graeme Peterson says that taking Vioxx
caused him to have a heart attack in 2003. The plaintiff also accuses Merck
of using deceptive and misleading marketing strategies to promote Vioxx.
The judge in the case will determine whether Mr.
Peterson’s claims can be applied generally to other members of the
class-action group. The defense, which began presenting its case on May 4,
plans to introduce evidence showing that Merck extensively studied the safety
of Vioxx, that Merck Australia’s marketing was
consistent with that study data, and that Mr. Peterson’s heart attack
resulted from pre-existing conditions, according to a news release from Merck
Australia
But whether or not Merck prevails, the trial has already
attracted relentless news and blog coverage of the plaintiffs’ evidence —
nearly 600 documents of which were obtained by The New York Times — which
detail Merck’s efforts to woo doctors to the side of Vioxx.
Even before introducing Vioxx in
Australia
in 1999, Merck’s Australian affiliate began to create an arthritis advisory
board of influential physicians whose ostensible purpose was to educate the
medical community about painkillers.
An internal e-mail message that is included in the
plaintiff’s evidence, however, describes the board’s unofficial purpose as
priming those chosen doctors to “accept the data and positioning of Vioxx” and “publicly state that Vioxx
is superior.”
Other documents indicate the company sought to teach
employees to quell doctors’ concerns, as various studies emerged, that Vioxx could increase the risk of strokes and heart
attacks. For example, the company started in 2001 to issue a series of
training manuals for sales representatives called “Vioxx
Objection Handling Module” with talking points to deflect doctors’ questions.
From 2002 to 2005, Merck also sponsored a marketing
compilation entitled Australasian Journal of Bone and Joint Medicine,
published by Elsevier, a respected academic publishing house. A professor of
marketing who testified for the plaintiff said in a written statement that
Merck distributed the pro-Vioxx publication to
doctors as if it were as an independent medical journal.
Merck said the articles and abstracts had been reprinted
from peer-reviewed medical journals.
After Vioxx was taken off the
market, some doctors who had supported the drug said they felt disillusioned.
The plaintiff’s evidence includes an e-mail message dated Oct. 2, 2004, that Dr.
James V. Bertouch, an Australian physician who had
been a member of Merck’s arthritis advisory board, sent to fellow board
members saying he felt “like the proverbial mushroom” and asked colleagues
how they felt being kept in the dark about Vioxx.
Mr. Kuhlik of Merck said that
the Australian news media had covered only the plaintiffs’ side of the case
and that the totality of the evidence would support Merck’s conduct.
“It is not uncommon that in high-visibility litigation,
you find publicity based on facts, documents and testimony that is often taken out of context,” Mr. Kuhlik
said. He added that “a short-term negative story” would not deter Merck from
what the company considers the correct course of action.
But plaintiffs’ lawyers elsewhere, awaiting their days in
court, said they could not explain why Merck would risk such negative
publicity in Melbourne after putting Vioxx to rest in the United States
“This fantastic stuff is being revealed to us,” said
Michael A. Peerless, a lawyer in Ontario who
is representing 1,700 Canadian Vioxx plaintiffs and
had just returned from a week observing the proceedings in Melbourne. “Where is it going to get them?”
The trial continues.
http://www.nytimes.com/2009/05/14/business/14vioxx.html?ref=business
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The New York Times | 05.13.09
By ARIANNE COHEN
Q. What’s the best way to clean the air in my home?
A. Air researchers talk about the Rule of 1,000: anything
released indoors is about 1,000 times more likely to be breathed in than
something released outdoors.
“It doesn’t take a lot of something released indoors to
cause exposure,” said Dr. Kirk Smith, a professor of global environmental
health at the University of California, Berkeley.
“Even in California,
which has among the strictest controls on smoking and among the lowest
smoking rates in an industrial country, a significant fraction of total
pollution exposure is from smoking.”
Indoor pollution is, in a word, potent. And our attempts
to combat it often make it worse.
“People think incense or candles are beneficial, but of
course they’re not,” Dr. Smith said. “It’s just combustion, and the smoke has
the same health effects as cigarette smoke.”
As for air fresheners, “it’s just adding chemicals on top
of chemicals,” he said. “We might not know the exact health effects, but why
expose yourself?”
Plants are overrated as air cleaners, said Dr. Richard Shaughnessy, director of the indoor air program at the University of Tulsa. “Many leafy plants can be
allergen collectors,” he said. “And the soil is wet, which can be a source of
mild spores.”
Before you begin an air-cleaning effort, ask yourself what
you are combating. Dust? Pollen? Traffic exhaust? Dr. Shaughnessy
said: “Consumers are usually responding to an odor in their house. It could
be related to cooking, flooring, painting or even mold. These are all gases,
and the portable air cleaners you see at the store are not very effective at
removing gases.”
But filter-based cleaners can be effective at removing
pollen, dust or smoke, which have larger particles. Dr. Shelly Miller, an
air-quality researcher at the University of Colorado, Boulder, said she
bought a HEPA (or high-efficiency particulate air) filter-and-fan-based
cleaner that helped combat forest-fire smoke at her parents’ home in San
Bernardino Valley, Calif.
Before buying the unit, which cost about $80, she said,
she made sure it had a clean-air delivery rating (or CADR) certification from
the Association of Home Appliance Manufacturers, which measures the amounts
of pollen, dust or smoke the model can remove. Some
units are better at eliminating one pollutant than another, so the
information allows consumers to pick the unit that best suits their needs.
For a quick fix in less extreme situations, like
high-pollen days, Dr. Miller suggests turning an air-conditioner into an
air-cleaner by replacing the regular filter with a HEPA filter, and running
the unit a few times. Look for a filter with a minimum efficiency reporting
value, or MERV, of over 10, she said.
In general, Dr. Miller said, she doesn’t advocate the use
of air cleaners, which she considers the equivalent of using a broom to clean
up M & M’s spilled on the floor. Or, as Dr. Smith put it: “The best way
to not have polluted air is to not have sources of pollution in the house.”
Dr. Miller, who lives in Boulder, Colo.,
with her husband, two small children and a malamute, said she had very little
carpet, since “carpets can be a reservoir for all sorts of particles. We call
it resuspension — where you walk on a carpet and
particles become airborne again. And I have a HEPA filter vacuum so that all
the particles I’m vacuuming don’t get blown right back out into the air.”
But the most important thing, she said, is venting the
stove to the outside when cooking. “Gas stoves’ combustion emissions have
been shown to cause respiratory health effects in children,” she said.
Dr. Shaughnessy agreed that
removing the source of the pollutant is the key. Often, parents will keep
pets in a separate room from a child sensitive to their allergens, he said,
and assume that running an air cleaner cancels that out, when, in fact, the
“allergen is overwhelming in comparison to the air cleaning.”
Just getting rid of those M & M’s could provide the
freshest breath of air.
http://www.nytimes.com/2009/05/14/garden/14fix.html?ref=health
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