By Jan Moller
Capital bureau
BATON ROUGE -- The House agreed unanimously Monday to
strip Louisiana State University
of most of its oversight responsibility for hospital operations in New Orleans and hand
that power to a new, independent board.
The 102-0 vote on House Bill 830 came after it was heavily
amended by its sponsor, House Speaker Jim Tucker, R-Algiers, who described
the bill as an effort to take LSU out of the hospital business so it can
focus on its core missions.
"I want LSU to really focus on medical education, to
focus on research, and not have to worry about changing lightbulbs
and waxing floors," Tucker said.
But LSU officials are fighting the bill, and said that
divorcing the school's hospital and education missions is not in line with
models that have been successful in other states. The LSU System has proposed
a plan in which the new hospital would be governed by an independent,
nonprofit board with LSU controlling the largest share of appointments.
"It's not a matter of not liking the Tucker bill.
It's about what model is going to allow us to develop a high-performance
academic medical center," said Dr. Fred Cerise, LSU's vice president for
health care and medical education.
Governance issues have become a flashpoint in the state's
ongoing effort to build a $1.2 billion academic medical center in lower
Mid-City that would be a permanent replacement for the shuttered Charity Hospital
and the Interim
LSU Public
Hospital, which
together make up the Medical Center of Louisiana-New Orleans.
The amended version of Tucker's bill would transfer
ownership of the New Orleans
hospitals from LSU to a new quasi-public board within the state Department of
Health and Hospitals. A separate, nonprofit corporation would be created to
run the hospital's daily operations.
Unlike the original version of Tucker's bill, which had a
completely independent board, the amended version would create a nine-member
governing authority, called the University Hospital Corp., to run the
day-to-day affairs.
Five of the members would be permanent, with one seat each
for LSU, Tulane, Xavier, Dillard and Delgado Community College.
The four non-permanent members, two of whom would be appointed by the governor
and one each by the House and Senate, would be required to have expertise
relevant to running a major medical center.
Still unclear is where Gov. Bobby Jindal
stands on the bill. Last year his administration proposed a governance
structure virtually identical to the one that LSU now is backing. But Jindal has not come out against the Tucker bill, saying
his main priority is making sure all the New Orleans institutions that would train
their students at the new hospital be given a voice.
The bill now heads to the Senate, where it is expected to
face a tougher test.
http://www.nola.com/news/t-p/capital/index.ssf?/base/news-7/1242710495267630.xml&coll=1
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By MARSHA SHULER
Advocate Capitol News Bureau
The Louisiana House on Monday night overwhelmingly
supported taking control of the Medical Center of Louisiana in New Orleans away from
LSU.
The House voted 102-0 for legislation pushed by House
Speaker Jim Tucker, R-Terrytown, which creates a
new nonprofit organization that would manage the hospital which is home to
LSU physician and other allied health training programs.
LSU would have one of nine seats on the new board just
like other universities such as Tulane, Xavier, Dillard and Delgado Community College
that have physician, pharmacy and other health professional training programs
at the LSU hospital today.
“This is the most important economic engine the city of
New Orleans has going for it over the next 100 years,” Tucker told the House
shortly before the vote on his House Bill 830.
“What we have now clearly is not working. It was not
working before the storm,” Tucker said. “We have rampant waste in the
existing (post-Katrina) facility. We cannot have that when we need every
single health-care dollar to go as far as it can go.”
Tucker said the proposal will put the operations of the
hospital under professionals where it belongs. “I want LSU to focus on
medical education and research,” he said.
LSU has put on the table a counter proposal in the form of
a “memorandum of understanding” in which it would create a not-for-profit
entity to run the hospital with an 11-member board.
LSU already can form affiliated not-for-profits and has
for such things as the Tiger Athletic Foundation and takeover of a public
hospital in Bogalusa.
Tucker amended his bill on the House floor to establish a
similar arrangement without it going through LSU.
Under the set up, the seven-member board of trustees for
the Medical Center of Louisiana at New Orleans
would own and the nine-member University Hospital Corporation board would
possess, control, use and operate the Medical Center of Louisiana at New Orleans.
The Medical
Center board would
operate under the state Department of Health and Hospitals.
State Rep. Neil Abramson, D-New Orleans, suggested a
revamp of the University Hospital Corp. board to give LSU three seats instead
of the one Tucker suggested because of the heavier health-care role LSU plays
at the facility.
http://www.2theadvocate.com/news/45373477.html
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Shreveport Times| 05.19.09
The Associated Press
BATON ROUGE -- The Interim LSU
Public Hospital
is costly, inefficient, administration-heavy and
still reacting to the effects of Hurricane Katrina rather than looking for
ways to improve efficiency, a consultant says.
Louisiana
State University
said Monday that it will cut 300 jobs and make other improvements at the
hospital to save $24 million during the next year.
Dr. Fred Cerise, who oversees health care operations for
the LSU system, had described those cuts a month ago in legislative testimony,
saying the hospital was overstaffed.
The university also published the 161-page report from the
firm of Alvarez and Marsal, which it sent The
Times-Picayune on Sunday under a public records request, on its Web page.
"The study clearly demonstrates the ineffectiveness
and inefficiencies of committee governance in operating an academic teaching
hospital," LSU System President John Lombardi said Monday. "LSU is
taking action and putting into effect the recommendations of this professional
study."
Alvarez and Marsal said all its
recommendations could cut costs by $66 million and add $6.7 million in
revenue, for a $72 million improvement.
It said the hospital spends $5,031 per patient per day,
compared with $2,794 at other teaching hospitals about the same size, and
about one-quarter of its nurses hold management
jobs. This 1-to-3 ratio compares with a normal ratio of 1-to-8, the report
said.
The consulting firm, hired in January, turned in its
report and a 27-page summary of its findings on March 23.
"The hospital's staff struggle with the effects of
Hurricane Katrina and tend to think in 'recovery terms' instead of placing
greater emphasis on operational efficiency and cost-effectiveness," it
wrote.
The university hopes to replace the interim hospital with
a $1.2 billion, 424-bed hospital and is trying to fend off an attempt by
House Speaker Jim Tucker, R-Algiers, to transfer management of the New Orleans hospital to
an independent board.
Formerly known as University
Hospital, the hospital was rebuilt
with federal money after it was flooded during Hurricane Katrina; it reopened
in November 2006 as the Interim
LSU Public
Hospital. With 2,500
staff members, 300 medical residents and fellows, and 400 nursing and allied
health students, it is the main training ground for the LSU
Health Sciences
Center in New Orleans.
Among the report's findings:
# Its system for buying and tracking equipment and
supplies is "poorly organized, operates out of multiple locations, has
cumbersome work flow processes and is minimally automated."
Accountability often is lacking, and many managers don't know week to week
how much their departments spend on supplies, it said.
The firm recommends closing the 63,480-square-foot,
offsite supply warehouse, eliminating 20 jobs -- and $40,000 a month to rent
a diesel generator because the state has not fully repaired an electrical
system that failed during Katrina.
Similarly sized hospitals dedicate between 5,000 and 7,000
square feet for supply storage, according to the report, and have more than
twice the inventory turnover rate. Slow turnover means some materials expire
or become obsolete before they can be used, according to the report.
# Top administrators should monitor contracts more closely
and think about whether the work could be done more efficiently by hospital
employees.
# Although the report praises the dedication of operating
room staff, it said the hospital does a poor job of making efficient use of
its 12 operating rooms. The average use of the operating rooms during the
prime-time hours of 7 a.m. to 3 p.m. was 55 percent, compared to an industry
standard of 70 percent to 80 percent.
http://www.shreveporttimes.com/article/20090519/NEWS01/905190329/1060
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by The Associated Press
BATON ROUGE -- The Louisiana House unanimously voted today
to strip governing authority over the public teaching hospital in New Orleans from LSU and
hand management and ownership to boards not tied to the university.
The House's approval was not a surprise since House Bill
830 was proposed by House Speaker Jim Tucker, R-Algiers. But the likelihood
of passage in the Senate, where the bill heads next, is less clear because
LSU is opposed to the measure.
Tucker's bill calls for the hospital to be owned by a
quasi-public board created in the state health department and managed by a
separate private, nonprofit board of appointees. Tucker said the change in
governance of the hospital would let LSU spend its time on other matters.
"I want LSU to really focus on medical education,
focus on research and not have to worry about dealing with changing light
bulbs and waxing floors," Tucker said.
LSU System President John Lombardi has opposed the move,
saying it could harm plans to build a new $1.2 billion replacement teaching
hospital in the city.
No one spoke against the bill on the House floor.
The proposal heads to the Senate for debate.
The measure is the latest volley in an ongoing argument
about who has authority over the public hospital and who should control the
new hospital the state is proposing to replace it.
The LSU-run
Charity Hospital
was flooded and shuttered by Hurricane Katrina in 2005. The university opened
a temporary replacement, called the Interim LSU
Public Hospital,
while pushing plans to build a new research and teaching facility.
Tulane
University and other
colleges that use the hospital to train medical students want more say in the
hospital's governance.
The hospital would be transferred from LSU's control on Jan. 1, 2010.
http://www.nola.com/politics/index.ssf/2009/05/house_oks_bill_to_strip_lsu_of.html
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by Staff reports, The Times-Picayune
BATON ROUGE -- The Louisiana State University System
announced today it will implement $24 million in spending cuts over the next
year including the elimination of more than 300 jobs at the Interim LSU
Public Hospital
in New Orleans.
The announcement follows the release of a management
study, first reported today in The Times-Picayune, that
revealed more than $66 million in potential savings.
"The study clearly demonstrates the ineffectiveness
and inefficiencies of committee governance in operating an academic teaching
hospital," LSU System President John Lombardi said. "LSU is taking
action and putting into effect the recommendations of this professional study."
Commissioned by the LSU Board of Supervisors, the analysis
was conducted by the Alvarez & Marsal
consulting firm of Atlanta.
The consultants said it is time for LSU, which has managed the facility since
1997, to "adopt a business-oriented, fiscally responsible strategy for
providing quality care and training future health care professionals."
Savings of more than $66 million were outlined by the
report, including a potential savings of $46 million in payroll costs by
eliminating 659 fulltime positions. These positions include more than 126
nurse managers with "administrative titles and without routine patient
care responsibilities."
The hospital operates a Level One
Trauma Center.
The consultants called for better use of operating rooms and management of
purchasing services.
"We're taking the responsible approach of getting
better organized at the interim hospital so that we can be in position for
the successful operation of the new academic medical center," said said Dr. Fred Cerise, LSU System Vice President for
Health Affairs and Medical Education.
Cerise said the spending cuts would not affect patient
services.
http://www.nola.com/politics/index.ssf/2009/05/lsu_system_to_cut_300_jobs_at.html
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Scott Satchfield / Eyewitness
News
NEW ORLEANS – Huge cuts in
spending for LSU will mean big changes at the University's Interim Public
Hospital in New Orleans.
More than 300 jobs are on the chopping block, officials
said as they work to save cash in the midst of Louisiana's budget crisis.
Since Hurricane Katrina, the former University
Hospital has become the center of
public healthcare in New Orleans.
But soon, there will be a big shakeup at the facility as LSU tries to tighten
its own belt.
"How should we be doing things to move into the 21st
Century, to be ready to move into a new academic medical center," said
LSU Interim CEO Dr. Roxane Townsend.
Townsend said cuts will be sweeping, including jobs.
"We're looking at our contracts, we're looking at our
staffing, we're looking at just how we run our processes." said
Townsend. "We don't think we're gonna have to
cut patient care, and we don't think we're gonna
have to cut training, but there may be some people that we don't necessarily
need in the job they're in now."
And from management on down LSU officials said they'll cut
more than 300 jobs at the hospital.
The changes come at the recommendation of a consulting
firm out of Atlanta.
LSU hired the firm to study the day-to-day operations at the hospital in an
effort to improve efficiency, and cut wasteful spending.
Sandra Crayton, one of the lead
consultants for the study, said there is plenty of fat to trim.
"One of the areas that we noticed right away was the
whole materials management arena, how you get supplies in from the various
vendors and manufacturers into the warehouse and then ultimately down to University Hospital," Crayton
said.
Crayton said the priority is to
identify unnecessary spending in non-labor areas first.
“After we've looked at that very carefully, we then begin
to look at the people side of the house," said Crayton.
And LSU officials praise the hospital staff pointing to
the challenges they've endured since the storm.
But with less patients these days
they say the move is necessary.
"For 275 beds, what is the right amount of staff, so,
today, we don't know who exactly will be in what positions," said Townsend.
Officials said some of the cuts could take place before
July 1. In all, they say the study found more than $66 million in savings
through cuts.
http://www.wwltv.com/topstories/stories/wwl051809cblsu.18a5c195.html
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Katie Kennedy
The LSU System announced Monday it will cut $24 million in
spending through out the next year, largely by eliminating more than 300 jobs
from the Interim LSU Public
Hospital in New Orleans.
The announcement comes on the heels of a management study
reported on by The Times-Picayune, which showed management inefficiencies
adding up to more than $66 million a year.
"The study clearly demonstrates the ineffectiveness
and inefficiencies of committee governance in operating an academic teaching
hospital," said LSU System President John Lombardi. "LSU is taking
action and putting into effect the recommendations of this professional
study."
The report stated $46 million could be saved by
eliminating 659 full-time positions, including more than 126 nurse managers
with "administrative titles and without routine patient care
responsibilities."
http://www.lsureveille.com/lsu-system-to-cut-24-million-in-spending-throughout-next-year-5-18-1-51-p-m-1.1751735
Panel backs help for hospitals’ losses
The Advocate | 05.19.09
Private and community hospitals would divvy up $213
million from the state and federal government to help them cope with revenue
losses caused by hurricanes over the past four years, under a bill by House
Speaker Jim Tucker that received approval Monday from a House committee.
House Bill 879 would use $45 million in one-time federal
hurricane recovery dollars to draw down an additional $168 million in federal
matching cash through the Medicaid program for the poor and a program to help
cover the costs of uninsured care.
The bulk of the money, $170 million, would go to New
Orleans-area hospitals through the Medicaid program. Another $18 million
would go to other hospitals affected by the hurricanes, while $17 million
would be divided on a formula basis among hospitals that provide uninsured
care, and $8 million would go to rural hospitals.
The state’s public hospitals, run by LSU, wouldn’t receive
any of the dollars.
The House Appropriations Committee approved Tucker’s bill
without objection, sending it to the full House for debate.
http://www.2theadvocate.com/news/45373457.html
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Lieutenant Governor
I appreciate columnist Stephanie Grace's insight, but the
message I delivered to the Press Club was not calculated or focused on my
future.
The issues facing Louisiana
are bigger than tax plans or my career. This is about being practical, not
personal or political.
This year, Louisiana
is looking at a $1.3 billion deficit. Higher education, health care and other
critical services are facing devastating cuts.
It's tempting to chalk our current fiscal woes up to low
oil and gas prices or a depressed global economy. Noted economists disagree.
Upon taking office, the governor and the Legislature
inherited a $2 billion surplus from the previous administration.
So, they decided to increase state spending by over a
billion dollars.
They decided to eliminate more than $360 million in
revenue through tax cuts.
Those decisions last year forced them into a position this
year of passing a budget that cuts 87 academic programs at our colleges and
universities. This budget forces cuts to health care funding across our
state.
In order to compete in a 21st century, knowledge-based
economy, our people have to be both well-educated and healthy.
How do we move Louisiana
forward? How can we pay for our schools and hospitals while keeping
expenditures under control?
First, we reduce government spending -- by making smart,
targeted cuts while maintaining the quality of services.
Next, we reorganize and reform government.
And finally, we invest our money in education, health
care, critical infrastructure and other programs that offer substantial
return on taxpayers' dollars.
We can't just cut our way to the 21st century.
If we don't consider all of our options, we will end up
further behind. That is not an outcome Louisiana
can accept.
Mitch Landrieu
Lieutenant Governor
Baton Rouge
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-13/1242710486267630.xml&coll=1
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Dr. Claudia Cavallino
Re: "Keep children smiling," Our Opinions, May
6.
House Bill 687 presented by Rep. Kevin Pearson prevents
invasive oral surgeries from occurring in the school cafeteria and gym on
children whose parents have little to no knowledge of what is taking place.
As a practicing pediatric dentist in south Louisiana, I am in
favor of providing the highest-quality dental care for children, regardless
of their financial means.
Louisiana's
dentists have grave concerns about the "drive-by" nature of mobile
dental clinics. Mobile dentists see dozens of children a day, moving from
school to school. They extract teeth, administer anesthetics and conduct
irreversible surgical procedures in the school gym or cafeteria without a
parent present. This is not an eye exam, hearing exam or basic physical. This
is invasive surgery.
The Louisiana Dental Association has worked for years to
create a "dental home" program for Medicaid-eligible children. In a
dental home, kids are treated in a safe environment with their parent or
guardian present.
There are children that urgently need dental care. Louisiana's dentists
have the expertise and technology to provide the best treatment in a proper
space. We have safe environments to prevent the spread of infection and work
with children and their parents to offer the appropriate treatment. Dentists
are the experts on this issue.
Categorizing Medicaid-eligible children into a lower class
of treatment is not the solution.
Dr. Claudia Cavallino
Metairie
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-13/1242710507267630.xml&coll=1
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By MARK BALLARD
Advocate Capitol News Bureau
State legislators Monday apologized to a doctor accused of
killing patients stranded in a New
Orleans hospital during the aftermath of Hurricane
Katrina, then endorsed legislation to reimburse her
for the legal fees.
The House Committee of Appropriations approved, without
objection, House Bill 341, which would use state funds to pay $456,979.41 to
cover the legal expenses of physician Anna Pou.
Of that amount, $144,851.59 would go to the Dr. Anna Pou Defense Fund and $312,127.82 to the LSU Healthcare
Network, which as the physician’s employer paid many of Pou’s
legal expenses.
“Miss Pou was used in a
political campaign,” said state Rep. Patrick Connick,
R-Harvey, who sponsored HB341. “A state official decided to use her to get
reelected.”
Connick recalled for panelists that
Pou was arrested on a Thursday night and accused by
then Louisiana Attorney General Charles Foti in a
widely publicized Friday news conference. Documents were released that
suggested her guilt but evidence that would exonerate her was withheld from
the public, he said.
Foti accused Pou
and nurses Lori Budo and Cheri Landry of killing
critically ill patients with overdoses of a sedative-painkiller mix in the
days after the storm, when Memorial Medical Center and other hospitals had no
electricity and no way to evacuate.
All three denied the accusations. Both nurses were given
immunity for grand jury testimony. An Orleans Parish grand jury found there
was not enough evidence to indict Pou, and the
charges have since been expunged.
State Rep. Kevin Pearson, R-Slidell, apologized to Pou.
“We don’t envy you the position you’ve been in,” added
state Rep. Karen Peterson, D-New Orleans.
Pou is employed by LSU, which
contracted with a private company to provide doctors for Memorial.
Pou is still a defendant in
three lawsuits filed by the families of the victims based on accusations
leveled by Foti. The lawsuits are pending and no
settlement talks have begun, said Pou attorney
Richard Simmons of Metairie. The state’s
Office of Risk Management is handling the civil lawsuits, as the agency
usually does when a state employee is sued.
After the hearing, Pou said the
panel’s vote sends the message that state government stands behind their
employees, particularly when the workers are called upon in an emergency.
“It’s an important message to say,” Pou
said, adding that she has no plans to leave Louisiana.
http://www.2theadvocate.com/news/45373402.html
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Dr. Anna Pou moves step closer to reimbursement of legal fees
by Ed Anderson, The Times-Picayune
BATON ROUGE -- Dr. Anna Pou
cleared the first legislative hurdle Monday in her efforts to recover more
than $450,000 in legal fees she incurred after being accused, but never
charged, with killing patients at Memorial
Medical Center
in the days after Hurricane Katrina.
The House Committee on Appropriations unanimously approved
House Bill 341 by Rep. Patrick Connick, R-Harvey,
to appropriate the state funds for her legal fees and other expenses incurred
after an Orleans Parish grand jury failed to indict her on charges brought by
then-Attorney General Charles Foti.
Connick's bill now heads to the
full House for debate.
A total of $144,851.59 will go to the Dr. Anna Pou Defense Fund and another $312,127.82 will go to the
Louisiana State University Health Care Network, who employed Pou as an ear, nose and throat specialist at Memorial
when the hurricane hit.
Any state agency or employee is allowed to recover money
spent for legal defense if the individual is acquitted or charges dropped.
A special attorney review panel examined the fees and
recommended them as appropriate.
"This is the same as saying, 'We are sorry,'¤" Connick told
the committee. "The law allows her to get her reputation back, to get
her life back. .¤.¤. We have to send a message out
to doctors that we need them to stay (in times of natural disasters) .¤.¤. and we stand behind you."
Pou, accompanied to the hearing
by her attorney Rick Simmons, said that she is now involved in three civil
lawsuits but the criminal case is over. Simmons said there were some other
legal expenses but neither he nor Pou is seeking
them.
"These are the fees from the time of arrest to expungement; no other fees are being requested,"
Simmons said. "At this point, we see closure on this matter. .¤.¤. We will not sue the state for damages for false
arrest."
http://www.nola.com/politics/index.ssf/2009/05/dr_anna_pou_moves_step_closer.html
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By DEBRA LEMOINE
Advocate staff writer
BILL FEIG/THE ADVOCATE
Dietitian Renee Puyau,
left, chats with Stephen Knox about his eating habits. Knox is undergoing
tests at Pennington
Biomedical Research
Center as part of his
participation in a study to see if calorie restriction delays signs of aging.
Stephen Knox needed a lifestyle change.
The wireless phone salesman, 28, watched his weight creep
up as he got older, exercised less and ate out more.
“I found myself in a vicious cycle,” he said.
Knox enrolled in a study at Pennington Biomedical
Research Center
that aims to determine if eating fewer calories can slow down human aging.
Although not designed as a weight loss study, Knox and other participants are
dropping pounds as a result of the prescribed calorie restrictions.
With the aid of intensive nutritional counseling from
Pennington, Knox eats no more than 2,100 calories a day, 25 percent fewer
calories than his former habits. As a result, he has lost 25 pounds over the
past 18 months.
“I have more energy, and I feel a lot better now,” Knox
said.
Following the diet is about choices, he said. If he makes
healthy food choices, then he is satisfied and not hungry. If he eats a
high-calorie dessert, then he tries to maintain his calorie limitations by
cutting back later in the day, leading to hunger.
“It hasn’t been 100 percent easy the whole time,” Knox
said.
The discipline of Knox and 50 other Baton Rouge area residents is contributing
to scientists’ understanding of biological aging in this second phase of the
landmark study on aging known as Comprehensive Assessment of the Long Term
Effects of Reducing Intake of Energy (CALERIE) trial. Pennington is seeking
additional volunteers for the study.
Funded by a $50 million grant by the National Institute on
Aging, scientists at three research centers seek to verify in humans that
reduced caloric intake affects the healthy lifespan, said Eric Ravussin, a diabetes and obesity researcher who leads the
multisite study at Pennington.
Researchers are unsure why humans age and die, but one
theory suggests that the byproducts of cells’ use of oxygen to burn food for
energy damage cells. This damage can be repaired by the body, but the damage
builds up over the years until eventually more and more cells die.
Lifestyle choices, such as getting little or no exercise
and gaining weight, also are known to affect the onset of such diseases as
cancer, dementia, heart disease and diabetes.
“We call these the diseases of aging because they seem to
be inevitable,” said Leanne Redman, another Pennington researcher working on
the CALERIE study. “One of the big advantages of caloric restriction could be
the delay of these diseases or prolonging the health span.”
The lifespan of every animal tested with calorie
restriction has increased, Ravussin said. For
example, when mice are fed a lower-calorie diet, their lifespan increases by
25 to 30 percent, Ravussin said. If the equivalent
is true in humans, that means an additional 14 to 18 years of life.
Preliminary results of a 30-year study of Rhesus monkeys
show that the monkeys allowed to eat freely have died of old age, but a few
of the calorie-restricted monkeys are still living beyond the primate’s
average lifespan, she said.
Other interesting outcomes: None of the calorie-restricted
monkeys has developed diabetes, and few calorie-restricted mice and monkeys
have developed cancer, Ravussin said.
Because of the length of the human lifespan, keeping
humans on a calorie-restricted diet for their entire lives to see if it
prolongs life is impractical at best, Ravussin
said.
Instead, researchers are restricting calories to see
whether it affects the biomarkers of aging. Among these biomarkers are
insulin, cholesterol and triglyceride levels, which predict the risk of
developing diabetes and heart disease.
Studies on human populations who eat highly nutritious,
yet low-calorie meals show that these biomarkers of aging are lower, Redman
said. For example, Okinawa, Japan, has the world’s highest population of
centurions, and the residents of this island typically eat and have a more
physical lifestyle than residents on mainland Japan.
The first phase of the CALERIE trial, completed in 2004,
also showed that people who restricted their calories for six months improved
several biomarkers of aging, Redman said.
Besides proving that calorie restriction works in humans,
the study also showed that people can do it and do it safely, Redman said.
And, it outlined the parameters for the current second phase of 25 percent
calorie restriction, she said.
“This was a landmark study,” she said. “The study was
finished in 2004, and we’re still being invited to speak about it five years
later.”
Ravussin and Redman also have
published more than a dozen articles in peer-reviewed journals on the
results.
So far, no one has experienced bone loss or loss of
reproductive functions or have lost unhealthy amounts of weight, Ravussin said. No one developed eating disorders either,
but volunteers are screened for mental health.
Rather than recommend calorie restriction as a lifestyle,
researchers want first to learn what calorie restriction does to the body and
then look for something to mimic it, Ravussin said.
For example, researchers are looking for something that
will enhance the production of a protective enzyme enhanced by calorie
restriction, Ravussin said. The well-known resveratol, found in the skin of grapes and in red wine,
is being tested as one such agent.
“We have shown people can do it, but can they sustain it?
The answer is no,” Ravussin said.
Scott Westbrook, 47, a health insurance executive, has
aimed to continue the lifestyle of eating no more than 1,900 calories a day
that he learned as a volunteer in the first phase of the CALERIE study.
But, he admittedly has fallen off the wagon from time to
time and regained seven of the 30 pounds he lost as a participant six years
ago.
“I go through my periods where I’m more active in the
summer months,” he said. “In the winter months, I’m a grazer.”
For the most part, he has used the lessons he learned from
Pennington during the study to maintain most of his weight loss. One of the
best things he learned is exactly how many calories his body burns through
normal activities, rather than guessing it based on his weight and age,
Westbrook said.
Charisma Edwards, 27, an LSU engineering doctorate
student, lost 15 to 20 pounds in her 18 months in the study and is now having to maintain her weight at 1,400 calories a
day.
“It’s a task to stay at the weight I’m supposed to stay
at,” she said.
Like the others, Edwards said she has learned lessons
about nutritious eating that she is teaching to her friends and family.
As a former research assistant, she said she knows how
hard it is to recruit volunteers for human trials, particularly among the
African-American community.
“I like being a guinea pig, so I said, ‘OK. This is
something I can do,’” Edwards said.
Volunteers for CALERIE must be healthy, nonsmokers and
lean to slightly overweight. They also are looking for women ages 21 to 47
and men ages 21 to 50.
Volunteers are asked to commit to the study for two years
and will be compensated up to $5,000 for their time.
http://www.2theadvocate.com/features/45375122.html
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by Bill Barrow, The Times-Picayune
BATON ROUGE -- The Senate voted 36-1 today to protect
health-care providers and their employees from certain civil lawsuits related
to their work in hurricane or other emergency evacuations.
Senate Bill 106 by Sen. Sherry Cheek, R-Shreveport, would
leave open civil lawsuits against the responders, volunteers and emergency
personnel only in the cases of "gross negligence" or "willful
misconduct." Those are higher standards for a plaintiff to prove than
simple negligence.
The protection would extend to "any health care
provider or ... personnel who renders or fails to render health care
services, first aid, ambulatory or mobile medical unit assistance,
transportation or care delivery anywhere in the state" for anything
related to "an evacuation, sheltering, care delivery, transportation or
repopulation of a health care provider facility" during an officially
declared emergency.
Also covered would be actions committed during a
"failed evacuation."
The immunity -- which also would apply to shareholders and
owners of affected private enterprises -- would span from the start of the
declared emergency until 30 days after the emergency period ends.
Sen. Rob Marionneaux, D-Livonia,
a plaintiffs attorney, cast the lone "no" vote.
http://www.nola.com/politics/index.ssf/2009/05/senate_more_emergency_responde.html
[BACK TO TOP]
by The Associated Press
NEW YORK -- Mayor Michael
Bloomberg couldn't have picked a busier time to introduce New York's new health commissioner.
Dr. Thomas Farley is set to succeed Dr. Thomas Frieden, who will head the Centers for Disease Control.
Farley comes to New York
from the Tulane School of Public Health and Tropical Medicine in New Orleans.
He inherits a health department that is contending with
swine flu outbreaks throughout the city. A number of schools are closed, and New York City just saw
its first swine flu death on Sunday.
Bloomberg is making the appointment official Monday.
Farley takes over some time next month.
http://www.nola.com/news/index.ssf/2009/05/tulane_doctor_chosen_as_new_yo.html
[BACK TO TOP]
by Bill Barrow, The Times-Picayune
BATON ROUGE -- The Senate voted without debate or dissent
today to outlaw research designed to create animal-human hybrids, a practice
that is apparently not occurring in the state but is cast by legislative
critics as a potential violation of Louisiana's ethics and morals.
Senate Bill 115 by Sen. Danny Martiny,
R-Kenner, lays out specific scientific acts that would result in jail time
and fines for researchers and others who profit from such activities.
Senators raised no questions before sending the bill to
the House with a 38-0 vote. In a Senate committee last week, senators heard
from impassioned supporters and, separately, from one scientist who warned
such restrictions could send intellectual capital and research money
elsewhere.
Under Martiny's bill, violators
would be subject to a prison term of as long as 10 years and a fine of up to
$10,000. Profiting from the forbidden activity would command additional civil
fines of $1 million or double the gain from the research, whichever is
greater.
Martiny said the civil fine is
targeted at researchers and other primary employers or executives of research
operations rather than unwitting shareholders of an offending entity.
Dorinda Bordlee,
a frequent Capitol presence representing the Bioethics Defense Fund, said
during the committee hearing that she does not know of any such research
occurring in Louisiana.
But lawmakers, she said, should be proactive in preventing the activities.
A stem cell researcher from Pennington
Biomedical Research
Center in Baton Rouge told lawmakers they generally
should resist limitations on research opportunities. "There are no mad
scientists at our state institutions," Dr. Jeffrey Gimble
said, in response to a comment made by Martiny.
"Anything that's going to criminalize scientific activity could
potentially restrict our ability to recruit young scientists to our
state."
Bordlee said: "Businesses
don't like regulation. Scientists don't like regulation." But she said
the state has a compelling interest to prevent research that she said
violates society's collective moral and ethical standard.
The bill would outlaw attempts to create a human-animal
hybrid; transferring a human embryo into a nonhuman womb; or transferring a
nonhuman embryo into a human womb. The bill includes a lengthy passage of
specific definitions of "human-animal hybrid" and other terms used
in the section detailing the acts that would be illegal.
Bordlee said the clarifications
ensure that ongoing research and medical activities are not affected.
Examples include the use of animal parts in surgery, research or medical
treatments.
http://www.nola.com/politics/index.ssf/2009/05/senate_passes_animalhuman_hybr.html
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by Bill Barrow, The Times-Picayune
BATON ROUGE -- The nursing home industry has attempted for
several years to expand the definition of medical malpractice to more of the
services that occur in the residential facilities for the aged and infirm.
Today, they got a breakthrough, much to the chagrin of
patient advocates and plaintiffs attorneys who said
House Bill 72 by Rep. Greg Cromer, R-Slidell, will restrict nursing home
residents' ability to recover financial damages in court.
The bill passed 6-5 on a committee that was once dominated
by plaintiffs' attorneys and their supporters.
The measure would expand the existing medical malpractice
definition to include other "patient-related service." And it would
put an entire family of torts -- those stemming from actions by non-medical
staff -- to the $500,000 cap on damages in medical malpractice lawsuits.
Nursing home industry representatives pitched the bill as
a way to close gaps in their insurance coverage. General liability insurers,
they said, do not always cover damages stemming from things like falls or
other problems attributed to negligence by non-medical staff. Because of the
current medical malpractice definitions, those issues aren't covered under
medical malpractice policies either.
Cromer called the bill a "consumer protection
measure" because he said it would ensure that nursing homes have a
source with which to pay valid claims.
But the AARP, other advocacy groups and practicing
plaintiffs attorneys said the bill is too broad and gives considerable cover
to acts that should not be included in any definition of medical malpractice.
Opponents also decried the idea of sending potential
claims to the panel of medical experts that now must review medical
malpractice claims before they proceed to civil court. Non-medical claims now
can go straight to court.
Rep. John Bel Edwards,
D-Crowley, asked nursing home representatives why they had never pursued a
statute in the insurance section of state code to require general liability
insurers to cover all non-medical patient services. Instead, he said,
"you're here trying to fit a square peg into a round hole or round peg
into a square hole."
http://www.nola.com/politics/index.ssf/2009/05/medical_malpractice_bill_clear.html
GQ report blames Rumsfeld for military delay after Katrina
The Times-Picayune | 05.18.09
A report on the GQ magazine Web site is quoting unnamed
former Bush administration official as blaming former Defense Secretary Donald
Rumsfeld for many failures, including a delay in military assistance in New Orleans after
Hurricane Katrina.
The report says "in speaking with the former Bush
officials, it becomes evident that Rumsfeld impaired administration
performance on a host of matters extending well beyond Iraq to impact America's relations with other
nations, the safety of our troops, and the response to Hurricane Katrina.
The Washington Monthly highlights more of Robert Draper's
article in GQ:
"[T]hree years later, when I
asked a top White House official how he would characterize Rumsfeld's
assistance in the response to Hurricane Katrina, I found out why. "It was commonly known in the West Wing that there
was a battle with Rumsfeld regarding this," said the official. "I can't
imagine another defense secretary throwing up the kinds of obstacles he
did."
Though various military bases had been mobilized into a
state of alert well before the advance team's tour, Rumsfeld's aversion to
using active-duty troops was evident: "There's no doubt in my
mind," says one of Bush's close advisers today, "that Rumsfeld
didn't like the concept."
The next day, three days after landfall, word of disorder
in New Orleans
had reached a fever pitch. According to sources familiar with the
conversation, DHS secretary Michael Chertoff called
Rumsfeld that morning and said, "You're going to need several thousand
troops."
"Well, I disagree," said the SecDef.
"And I'm going to tell the president we don't need any more than the
National Guard."
After the president had returned to the White House, he
eventually convened a meeting in the Situation Room to discuss the
government's response. Bush barked, "Rumsfeld, what the hell is going on
there? Are you watching what's on television? Is that the United States of America or some Third World nation I'm watching? What the hell are you
doing?"
When Rumsfeld mentioned his concerns about "unity of
command" issues, Bush stopped talking to his Defense Secretary and
directed all inquiries to Lieutenant General Honore,
via video screen, who was on the ground in Louisiana.
But still the troops hadn't arrived. And by Saturday
morning, says Honore, "we had dispersed all of
these people across Louisiana.
So we needed more troops to go to distribution centers, feed people, and
maintain traffic." That morning Bush convened yet another meeting in the
Situation Room. Chertoff was emphatic. "Mr.
President," he said, "if we're not going to begin to get these
troops, we're not going to be able to get the job done."
Rumsfeld could see the writing on the wall and had come
prepared with a deployment plan in hand. Still, he did not volunteer it. Only
when Bush ordered, "Don, do it," did he acquiesce and send in the
troops -- a full five days after landfall.
http://www.nola.com/news/index.ssf/2009/05/gq_report_blames_rumsfeld_for.html
[BACK TO TOP]
By KATHERINE MANGAN
When Lawrence G. Smith was tapped to help create a new
medical school on Long Island, the last
thing he wanted was a traditional model in which students had to wait until
their third year of training to have any meaningful interaction with
patients. Dr. Smith, the chief medical officer of a 15-hospital health
system, instead favored approaches like sending first-year students out with
ambulance crews and encouraging future doctors to develop long-term
relationships with patients.
Otherwise, he says, "you're two years into medical
school and $100,000 in debt, and you're about as useful as a Boy Scout at a
family picnic."
Dr. Smith is the founding dean of Hofstra
University School of Medicine, one of nine new allopathic medical schools,
which are in various stages of seeking full accreditation. (Four of the
schools, which graduate doctors with M.D. degrees, have already received
preliminary accreditation.)
Unlike the schools of old, where students spent two years
focused on science and theory before they set foot in a hospital, these new
schools are integrating clinical care into the first two years.
Existing schools have taken steps in this direction. But,
says John E. Prescott, chief academic officer of the Association of American
Medical Colleges, "the new schools are moving the bar farther and faster
in coming up with innovative ways to provide important clinical experiences
early in medical education."
At least two new osteopathic medical schools, which
graduate Doctors of Osteopathy and emphasize holistic approaches and hands-on
manipulation, are also seeking accreditation for programs that include early
clinical experience.
One reason that established medical schools have moved
slowly is that course work in the first two years tends to be so demanding
that faculty members are often reluctant to introduce clinical requirements
that would take away from classroom time.
That mind-set is loosening as new schools open in response
to warnings from both the medical colleges' association and the American
Medical Association about a looming shortage of physicians.
Following is a look at new or proposed schools at Hofstra, Florida
International, and Rocky
Vista Universities
and how they are reconsidering the way physicians should be trained:
Hofstra
U. School of Medicine
The Long Island medical
school is pursuing preliminary accreditation and hopes to open in the fall of
2011 with an inaugural class of around 40 students.
The school's dean, Dr. Smith, will also continue his job
as chief medical officer of the North Shore-Long Island Jewish Health System,
which will be a partner with the medical school.
Being part of a sprawling medical system with services
like a 60-vehicle ambulance fleet will give first-year students early
exposure to patients in various settings. The school plans to assign
first-year and possibly second-year students to ambulance crews, where they
will work with emergency medical technicians and learn some basic EMT skills.
"Working on our ambulance crews will give students an
opportunity to literally pick up patients in their own homes, which is a
powerful way to start a relationship," says Dr. Smith.
Students will also be assigned to individual patients, to
track their progress over a period of months or even years. A student who
went with an ambulance crew to the home of an elderly woman who fell and
broke her hip might follow that patient's progress over the next few years as
she was treated in a hospital, rehabilitated in an outpatient clinic, and
moved by her family into a nursing home.
Dr. Smith concedes that having 40 students tracking 40
patients as they make their way through the maze of health-care providers
could be a "logistical nightmare," so the school will rely heavily
on students' initiative to make it work. It is a bit of a risk, but he
believes that students will welcome the challenge.
Students will probably spend one day a week in the
system's hospitals from the beginning of the first year, with close
monitoring by mentors gradually giving way to more independent interactions
with patients.
"The show-and-tell method of education doesn't work
with people old enough to be in medical school," says Dr. Smith.
When students are studying geriatrics, they could spend
time in one of the system's nursing homes, and when the topic is the
gastrointestinal tract, they might observe patients with conditions like Crohn's disease.
The curriculum is being developed by David L. Battinelli, associate dean for education. He moved to Hofstra from Boston
University, where he
had been a professor and vice chair of the department of medicine.
"Many schools have rotations of six to eight weeks.
We're looking at rotations that could be years in length," he says.
Those rotations, in which students will follow a physician, will occur in the
first two years, before the shorter, specialized rotations that upper-level
medical students usually experience.
In planning the curriculum, administrators solicited
advice from older physicians who had begun their practices at a time when a
physician followed a patient through her pregnancy and delivery and then
treated the mother and baby for years afterward. "People who did that
remember the names of their patients," Dr. Battinelli
says. "It's one of the most vivid experiences a doctor can have, and
it's dropped away."
Dr. Battinelli says the school
has received support from its accreditor, the
Liaison Committee on Medical Education, in its efforts to shake up the
typical medical-school curriculum. "They want you to reassure them that
you won't be out of business in a year, but they're encouraging us to be daring."
Rocky Vista
U. College of Osteopathic
of Medicine
Approved by the state in 2006 and granted preliminary
accreditation two years later, the Miami
medical school will accept its first students this fall. A major feature of
the new curriculum will be its NeighborhoodHELP
program, which will send interdisciplinary student teams from the
university's medical, nursing, social work, and public-health programs into
some of South Florida's poorest
neighborhoods to learn from and help struggling families.
The medical school's founding dean, John A. Rock, predicts
that by improving access to education, preventive care, and research, the
program could save the state millions of dollars in health-care costs by
2020. If, for example, students can explain to women that taking folic-acid
supplements while pregnant can reduce the chances of their babies being born
with spina bifida, a crippling disorder of the
spinal cord, the number of cases could drop, he says. And if students can
identify people with diabetes and get treatment to them, fewer patients might
show up in local emergency rooms with complications such as heart disease or
nerve damage.
The 43 students in the inaugural medical class will be
divided into four teams. Each team will focus on a predominantly Hispanic,
African-American, Caribbean, or Jewish neighborhood and will work with
students from other professional programs, all supervised by a faculty
member.
During the first half of their first year, students will
pursue topics including biostatistics, epidemiology, and culture in the
context of their assigned neighborhoods.
Then, in the spring, each medical student will be assigned
to a family whom he or she will visit in their home a couple of times a
month. That relationship will extend through the remaining three years of
medical school. Students will work with the families' physicians and refer
family members to health and social services in the community.
"The households become faculty members, part of our
teaching," says Dr. Rock. "It will be an important experience for
our students to understand the difficulties families have navigating the
health-care system in our country."
Following a family over more than three years, students
will be able to witness the progression of diseases and other medical
conditions in a way that a teaching hospital, with its rapid patient
turnover, does not allow.
Students whose training is limited to teaching hospitals
also tend to see patients at their sickest, but not as they struggle with the
day-to-day challenges of living with chronic problems such as diabetes or
kidney disease. By meeting these patients when they are relatively healthy,
students can learn how to teach preventive care. Four times a year, the teams
will get together to discuss and document the unique characteristics of their
neighborhoods' cultures and health-care needs.
Among the school's high-profile faculty recruits is Joe
Leigh Simpson, executive associate dean of academic affairs. Dr. Simpson came
from Baylor College of Medicine, where he served as chair of obstetrics and
gynecology. His duties at Florida International include hiring faculty
members and overseeing the accreditation process and curriculum development.
He says he was attracted by the chance to "start with a clean slate."
Deans of other medical schools had tried to recruit him
from Baylor before, he says. But established institutions have too many
obstacles to change. "It's always an issue not of what you can do, but
of what you can't do," he says. "There are so many sacred cows you
have to maneuver your way around in order to get anything done."
Starting from scratch, he and his team collapsed the usual
six basic-science departments to four. "Where there were artificial
distinctions, we saw opportunities to mix and blend in a way that makes
sense."
Other medical schools have been consolidating basic-science
departments into fewer distinct units, and some have gone so far as to create
a single department of basic sciences. But new schools can do so without
encountering resistance from professors whose careers, and professional
reputations, have been tied to their departments.
The new faculty members "like the pioneering spirit
and being able to help write the rules," says Dr. Rock.
The provisionally accredited school in Parker, Colo., opened this academic
year with an inaugural class of 152 students.
Every student is required to perform community service in
a domestic-violence shelter, drug-and-alcohol-treatment center,
migrant-worker clinic, or other public-health facility. That experience is
meant to enrich their yearlong firstand second-year
courses in clinical and community medicine.
The school's dean, Ronnie B. Martin, says this approach
bolsters the sense of altruism students have when they enter medical school.
"Medical school, with its 18-hour days and constant
studying for tests, will beat that right out of you, and putting students in
those service centers is critical," he says.
Camille Z. Bentley, the school's chair of community and
rural medicine, agrees. "This is what motivates them and keeps them
going in the rough times of medical school," she says. This is the
carrot we dangle in front of them that they get to nibble at from time to
time."
Students who help out at a migrant health center might
give physical examinations, under a faculty member's supervision, to day
laborers who suffer from back pain after long days of farming or building
houses. The exam might include muscle-energy technique, a treatment that
relies on moving or massaging muscles and bones to relax muscle spasms.
Courses are aligned, whenever possible, so that anatomy
students are studying the same body parts that they are handling in a course
on manipulation techniques.
"Change is so much easier at a new school," says
Walter R. Buck, chair of structural medicine at Rocky Vista. "You don't
have to convince this committee or that and fight 50 years of
tradition."
The newer schools seem, in fact, to be establishing some
traditions of their own based on these new ideas. Dr. Prescott, of the
medical-colleges' association, says their leaders have been meeting and
sharing ideas on how to structure firstand
second-year curricula in ways that allow students to practice what they are
learning.
"More and more are realizing the value of having
students exposed to clinical situations early and often."
http://chronicle.com/weekly/v55/i37/37a00103.htm
[BACK TO TOP]
The New York Times | 05.18.09
By ANDREW POLLACK
Jeff J. Mitchell/Getty Images
Quest Scientists are working on a universal flu
vaccine, but one will not be ready in time to fight the new swine flu strain.
Above, a lab at Vitrology, a Scottish company
pursuing a swine flu vaccine.
Two shots of measles vaccine given during childhood
protect a person for life. Four shots of polio vaccine do the same. But flu
shots must be taken every year. And even so, they provide less than complete
protection.
The reason is that the influenza virus mutates much more
rapidly than most other viruses. A person who develops immunity to one strain
of the virus is not well protected from a different strain.
That is shaping up to be a major problem as the world
prepares for a possible pandemic this fall from the new strain of swine flu.
It is impossible to know how many people might die before a vaccine matched
to that strain can be manufactured.
But scientists and vaccine manufacturers are hard at work
on a so-called universal flu vaccine that would work against all types of
flu. The goal is to provide protection for years, if not a whole lifetime,
against all seasonal flu strains and pandemic strains, making flu inoculation
much more like that for measles and polio.
“The universal would completely change the way flu
vaccination would be done,” said Sarah C. Gilbert, a vaccine expert at the University of Oxford. “The sooner we have a
universal vaccine the better because we can stop worrying about what the next
pandemic will be.”
Such a one-shot-fits-all vaccine would also end the
guessing game that now occurs at the beginning of each year as scientists
decide which strains should be included in the seasonal vaccine for the
following winter. If they guess wrong, the vaccine is less effective.
And it would make flu immunization practical for countries
that now cannot afford a yearly effort. Seasonal flu is estimated to
contribute to an average of 36,000 deaths in the United States and as many as half
a million worldwide each year.
Unfortunately, a universal vaccine will not be ready soon
enough to combat a possible pandemic from the new strain of swine flu that
has already sickened thousands of people. The most advanced of the vaccines
have been tested only in small clinical trials. It is likely to take several
more years to show if the vaccines really work.
Indeed, the universal vaccines developed so far do not
totally prevent infection, as the strain-specific vaccines can do. Rather,
they limit severity and spread of the disease. Some experts
say that would be sufficient, but others have their doubts.
“It wouldn’t replace the seasonal flu vaccine,” said Dr.
Robert Belshe, director of the center for vaccine
development at Saint Louis
University. “I think it
would be considered a supplement to it.”
Some experts say booster shots might still be needed every
10 years or so. It is also not clear if the vaccines would be able to provide
protection against all strains, including animal-derived viruses like the new
swine flu. Most of the universal vaccines under development do not even try
to provide protection against influenza type B. They focus on type A, which
tends to cause more severe disease and pandemics.
When someone is vaccinated or infected, the immune system
makes antibodies that mostly attack a protein on the surface of the virus
called hemagglutinin. But that protein is the
fastest-changing part of the virus, so antibodies to one strain might not
recognize another.
A universal vaccine would have to spur an immune system
attack on part of the influenza virus that does not vary from strain to
strain.
If that were easy to do, skeptics say, the immune system
would have figured it out and people would have lasting protection. Vaccine
researchers counter that some people might have immunity lasting at least a
few years. And a vaccine can teach the immune system to do things it might
not be able to do on its own.
“I don’t see any reason it should be impossible,” said
Suzanne Epstein, a researcher at the Food and Drug Administration. “It works
quite well in animals.”
The big problem is that most of the flu virus proteins
that do not vary much are on the inside of the virus, out of reach of
antibodies. But there is one internal protein, called M2,
that protrudes a bit from the virus. This external piece is not much
of a target for antibodies, but it is the main focus of universal vaccine
research.
“The trick is you’ve got to have a system that will raise
a robust immune response against this puny little protein that’s not present
in any abundance,” said Alan Shaw, president of VaxInnate,
a small company trying to develop a universal vaccine that combines the
external part of M2 with a bacterial protein that stimulates the immune
system.
VaxInnate, Merck and Acambis, which is owned by Sanofi-Aventis,
have each run a small test of their M2 vaccines on healthy volunteers.
Vaccinated people do make antibodies to M2. But those antibodies do not
totally prevent infection. It will take much larger tests to see if vaccines
actually work to ameliorate disease during a real flu season.
Another issue is that the M2 protein in animal influenza
viruses can be somewhat different from that in human viruses. That raises
questions about how well an M2 vaccine might work, say, against the new swine
flu, which is known formally as H1N1.
“The new H1N1 virus could throw a little bit of a wrench
into things,” said Andrew Pekosz, an associate
professor of molecular microbiology and immunology at Johns Hopkins
University.
Earlier this year, two teams of researchers reported independently
that there might be another nonvarying region on
the outside of the virus. It is in the stick of the lollipop-shaped hemagglutinin protein rather than the constantly changing
head.
One of the groups showed that antibodies isolated from
human blood that bound to this part of the stick protected mice against many
strains of flu, including the 1918 pandemic Spanish flu and the H5N1 bird
flu.
But experts say it will be very difficult to isolate this
part of the protein from the virus to use in a vaccine, or to manufacture it
using genetic engineering.
“My first thought was, ‘Oh, you have to make the vaccine,’
” said Dr. Hildegund C. J. Ertl,
a universal vaccine researcher at the Wistar
Institute in Philadelphia
who was not involved in the discovery. “But then when I looked at the
sequence, it wasn’t straightforward at all.”
An alternative would be to use the antibodies themselves
as a medicine, though antibodies are expensive to manufacture and
time-consuming to infuse into patients.
With constant regions outside the virus hard to find, some
efforts aim at nonchanging proteins inside the
virus, like one called nucleoprotein. Antibodies cannot get at these proteins
to prevent an infection. So the idea is to spur other soldiers of the immune
system called T cells to quickly kill the infected cells before they could
make new viruses. That would limit disease severity.
Dr. Epstein of the F.D.A. said a vaccine based on a
nucleoprotein from a human H1N1 virus was able to protect animals from a
lethal dose of the H5N1 bird flu, the virus which stoked pandemic fears a few
years ago. Oxford
University has tested a
T cell vaccine in 28 healthy adults and found it did increase T cell
responses.
Ultimately, the best results might come from combining the
techniques. Dynavax, a California biotechnology company, hopes to
begin trials next year of a vaccine designed to spur antibodies against M2
and T cells against nucleoprotein.
Dr. Epstein said expectations for a universal vaccine must
be realistic. “It’s not intended to totally block infection,” she said. “But
what it can do is greatly reduce disease and spread and symptoms.”
http://www.nytimes.com/2009/05/19/science/19vacc.html?_r=1&ref=health
[BACK TO TOP]
By LAURAN NEERGAARD, AP Medical Writer
WASHINGTON – It may be
riskier on the lungs to smoke cigarettes today than it was a few decades ago
— at least in the U.S.,
says new research that blames changes in cigarette design for fueling a certain
type of lung cancer.
Up to half of the nation's lung cancer cases may be due to
those changes, Dr. David Burns of the University
of California, San Diego, told a recent meeting of tobacco
researchers.
It's not the first time that scientists have concluded the
1960s movement for lower-tar cigarettes brought some unexpected consequences.
But this study, while preliminary, is among the most in-depth looks. And
intriguingly it found the increase in a kind of lung tumor called adenocarcinoma was higher in the U.S. than in Australia even though both
countries switched to so-called milder cigarettes at the same time.
"The most likely explanation for it is a change in
the cigarette," Burns said in an interview — and he cited a difference:
Cigarettes sold in Australia
contain lower levels of nitrosamines, a known carcinogen, than those sold in
the U.S.
That's circumstantial evidence that requires more
research, he acknowledged.
But anti-smoking advocates are citing the study as
Congress considers whether the Food and Drug Administration should regulate
tobacco, legislation that would give the agency power to decide such things
as whether to set caps on certain chemicals in tobacco smoke.
Smokers once tended to get lung cancer in larger air
tubes, particularly a type named "squamous
cell carcinoma." Then doctors noticed a jump in adenocarcinoma,
which grows in small air sacs far deeper in the lung. Initial studies blamed
introduction of filtered, lower-tar cigarettes. When smokers switched, they
began inhaling more deeply to get their nicotine jolt, pushing cancer-causing
smoke deeper than before.
Burns' study, presented at a meeting of the Society for
Research on Nicotine and Tobacco, took a closer look. He compared smoking
behaviors of different age groups over four decades — how much they smoked,
when they started, when they quit — and how cancer-risk changed.
The risk of squamous cell
carcinoma stayed about the same over those years, Burns found. But adenocarcinoma rose. It makes up 65 percent to 70 percent
of newly occurring U.S.
lung cancer cases, but no more than 40 percent of Australia's lung cancer, he said.
While the nation's total lung cancer cases have inched
down as the number of smokers has dropped in recent years, the study suggests
an individual smoker's risk of getting cancer is higher.
It's well known that cigarettes differ from country to
country, because of different tobacco crops grown locally and smokers'
varying tastes. Nitrosamines are a byproduct of tobacco processing and levels
vary for several reasons, including differences in curing practices.
Australian cigarettes contain about 20 percent of the
nitrosamine content of U.S.
cigarettes, making the chemical a prime suspect, concluded Burns, who has
been scientific editor of several surgeon general reports on tobacco.
That doesn't rule out a role for deeper inhaling,
cautioned Dr. Michael Thun of the American Cancer
Society: "There's several strong suspects in
the lineup. They may have acted in combination."
Philip Morris USA spokesman David Sutton called the study
speculative and hard to evaluate until it's published in a medical journal,
something Burns plans to do.
Still, Philip Morris, which supports FDA tobacco
regulation, began taking steps with its growers in 2000 that have yielded
"significantly lower" nitrosamine levels in recent years' supplies,
Sutton said.
Be careful in assuming lower-nitrosamine cigarettes are
less lethal, said Dr. Neal Benowitz of the University of California,
San Francisco,
a well-known tobacco expert. Lung cancer is only one
of tobacco's many risks — it causes heart disease and other killer diseases,
too.
"If you reduce someone's (lung cancer) risk by 10
percent, that's not really meaningful for an individual," he said.
"The goal still is to get them to stop."
http://news.yahoo.com/s/ap/20090518/ap_on_he_me/us_med_smoking_risk;_ylt=Am3JduTcFy3L7p6L9DIDpcTVJRIF
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The New York Times | 05.18.09
A new tool will help researchers identify the minute
changes in DNA patterns that lead to cancer, Huntington's disease and a host
of other genetic disorders. The tool was developed at North Carolina State
University and
translates DNA sequences into graphic images, which allows researchers to
distinguish genetic patterns more quickly and efficiently than was
historically possible using computers.
David Cox, a Ph.D. student in computer science at NC
State, devised the "symbolic scatter plot" tool to provide a visual
representation of a DNA sequence. Cox explains, "The human visual system
is more adept at identifying patterns, and differentiating between patterns,
than existing computer programs such as those that try to identify
repetitions of DNA sequences." In other words, the naked eye sees
patterns better than computers can.
Identifying patterns in a sequence of DNA is important
because it can help researchers identify the minute genetic variations
between subjects that suffer from a disease, such as cancer, and subjects
that do not. "Improved identification of relevant DNA sequences will
hopefully expedite the development of successful treatment for a range of diseases,"
Cox says, "by allowing researchers to focus on the components of DNA
that are related to the disease and improving our understanding of the
genetic mechanisms of these diseases. For example, what turns specific genes
on and off?"
So, how does the symbolic scatter plot create a visual
representation of DNA? DNA is composed of a series of nucleotides. There are
only four types of nucleotides, represented by the letters A, T, G and C.
Each three-letter string of these nucleotides, such as AAA or ATG, is called
a 3-mer. Cox explains, "There are only 64 possible 3-mers, thus each
3-mer maps to a number from zero to 63. The symbolic scatter plots take a
very long string of letters representing a DNA sequence and split it into a
bunch of 3-mers. It then plots a point for each 3-mer, zero through 63, with
that number serving as the y-coordinate." The x-axis is the order that
the 3-mer appears in the genetic sequence.
"If this seems really simple," Cox says,
"that's because it really is simple. Even so, the resulting scatter
plots reveal interesting patterns in the original DNA. I can also string
these scatter plots together to produce animations for the purpose of
comparing DNA sequences."
Cox chose to focus on 3-mers because they correlate to codons, which are the genetic codes the body uses to
specify the insertion of a specific amino acid during the creation of
proteins. In other words, they oversee the creation of proteins
? which are themselves the basic building
blocks of the human body. "There are 64 3-mers, but only 20 amino
acids," Cox says, "so each amino acid corresponds to multiple
3-mers." Cox designed the symbolic scatter plot so that those 3-mers
that correspond to the same amino acid are adjacent to one another.
"This way," Cox says, "it is easier to
determine when a difference in 3-mers is significant ?
from one amino acid to another ? rather
than a difference in 3-mers that still results in the production of the same
amino acid. A change in a single amino acid can be the difference between a
relatively harmless disease and a fatal one," Cox says.
Cox will present the research this July at BIOCOMP '09 ? The 2009 International Conference on Bioinformatics
and Computational Biology in Las
Vegas. The research was co-authored by Dr. Lina Dagnino of the University of Western Ontario.
http://www.nytimes.com/pages/health/index.html
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The New York Times | 05.18.09
By DONALD G. McNEIL Jr.
In Africa, AIDS patients
rarely get viral load testing to see whether they are developing dangerous
resistance to their first-line drugs. The testing, routine in wealthy
countries, is just too expensive and complex.
Scientists from Makerere University’s
hospital in Kampala, Uganda, along with American and
Belgian scientists, have developed a formula, based on close questioning of
patients, for predicting which ones are most likely to have treatment
failure.
Their methods, described in The Journal of the
International AIDS Society, appear to work better than current World Health
Organization guidelines, which are based on clinical signs of advancing
disease and a CD4 count, a technique easier and less expensive than viral
load tests.
The doctors questioned 496 patients about how often they
had taken their pills in the last three days, the last four weeks and since
they began taking them; they also asked whether the patients had ever missed
two days’ worth. They asked whether patients had ever paid for treatment and
whether women had ever had single-dose nevirapine
to protect new babies. They also asked about weight loss and rashes. Blood
samples were taken for CD4 counts.
Having ever missed treatment for two days, and having ever
had a 30 percent drop in CD4 count (a white blood cell measure that indicates
AIDS progression) predicted treatment failure, the researchers found. They suggested that viral load testing, if
available, be done on those patients first.
http://www.nytimes.com/2009/05/19/health/19glob.html?ref=health
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The New York Times | 05.18.09
By DENISE GRADY
Alex Nabaum
My sister had barely taken her last breath when a nurse
appeared in the doorway of her room in the intensive care unit and asked if
our family wanted an autopsy.
We looked at each other, my surviving sister and I, and
said no. It wouldn’t bring her back. We had had enough. We wanted to get on
with funeral plans. Another reason, I realized later, was a vague, underlying
sense of distrust. We weren’t confident that the hospital could provide a
thorough and competent autopsy, and even if it could, we didn’t trust the
doctors to tell us the whole truth.
It was an unfair judgment. But we were distraught. For
months, my sister, 67, had been seeing two doctors for ailments that they did
not seem to regard as serious. One afternoon, feeling ill, she saw one of the
doctors, who examined her and sent her home. The next day, she was rushed to
the hospital, the same one where those doctors practiced. A week later, she
was dead. Sepsis and organ failure, the death certificate said.
Had the doctors not realized how sick she was? How could
we, her family, have failed to see it? Could her death have been prevented?
Almost a year later questions remain, and I find myself
wondering what an autopsy might have found. If I’d thought it through
beforehand, I might have given that nurse a different answer. But I never
expected my sister’s life to end the way it did.
Unsettled feelings are not uncommon when there is
uncertainty about a death, and autopsies apparently help some people resolve
them, according to an article by doctors in the Netherlands who interviewed
relatives of patients who had died. Many had the same concerns I did. Was
something overlooked? Could they have done anything to prevent the death?
Writing in the journal Family Practice, the doctors said
that some of the relatives were reassured by autopsy results, because they
feared that they had failed to notice important symptoms and so had been
partly responsible for the death.
“The absolution of guilt and the resulting reassurance
were common to most of the interviews,” the doctors wrote.
They also said relatives wanted to know if the patient had
died of something hereditary that might affect others in the family. For some
people, questions about cancers that run in the family are crucial.
If I could have arranged for an independent autopsy by a
pathologist outside the hospital where my sister died, I might have done it.
But at the time, I had no idea how to go about it and felt too dispirited to
try.
Recently, I typed “autopsy expert” into a search engine
and found Dr. William Manion, a pathologist and
lawyer in New Jersey.
Besides working for hospitals and the Burlington County Medical Examiner
Office, Dr. Manion performs autopsies privately,
for about $3,000, for people who want an outside expert to tell them what
killed a loved one. He also reviews medical records and autopsy reports, for
a smaller fee, without performing the autopsy himself.
Some clients hire him because they want to sue doctors, he
said in an interview, but others are just looking for peace of mind. Some are
upset because they feel doctors didn’t take the time to explain what
happened.
“A lot of times people just feel guilty themselves that
their loved one died,” Dr. Manion said. “They blame
themselves that they didn’t get them help sooner for
an alcohol or drug problem, and I say, you can’t help an alcoholic or an
addict. I try to explain to people, this isn’t your fault.”
Similarly, he said that people whose relatives died of
undiagnosed, advanced cancer sometimes recalled symptoms from a few months
back that they might have overlooked or dismissed. He tells them that the
cancer must have been there for a long time, and that they couldn’t have done
anything.
“I think a lot of times I can just talk to people and get
them calmed down,” he said. “A lot of times they send me records and I’ll
look through it for a little bit and explain it, and hopefully they’ll move
on.”
As for my concern that a hospital might try to cover its
mistakes in an autopsy report, Dr. Manion didn’t
buy it. Pathologists based in hospitals are reliable, he said, in part
because they have to pass muster with various accrediting groups.
“For a pathologist, it is what it is,” he said. “We’re there
to try to figure out why the patient died. We can’t hide or fabricate
anything. Pathologists are not going to risk their license to cover up
malpractice.”
The Web site for the College of American
Pathologists keeps a list of board-certified
pathologists who perform private autopsies. Most charge $3,000 to $5,000,
said Dr. Gregory J. Davis, a professor of pathology at the University of Kentucky
and a spokesman for the pathologists’ group. He said families seeking a
private autopsy could also try calling local medical examiners or medical
schools. But it’s important to decide quickly; Dr. Manion
says an autopsy is best performed within 24 hours of the death, before organs
deteriorate too much.
Dr. Davis also reviews medical records of patients who
died, but he insists that families first try to talk with the doctors who
treated their relative.
“You’d be amazed at how often they hadn’t even thought to
do that,” he said. “Most physicians would do that pro bono, gratis, for the
family, and a lot of concerns the family had would be allayed and obviated.”
Sometimes, Dr. Davis said, the conversations don’t take
place because the family feels guilt or anger, or the doctor doesn’t
communicate well or takes the death as a personal failure.
“One would hope the physician would have reached out to
the family to explain things, but for a lot of reasons that doesn’t happen,”
he said.
Ultimately, what the pathologist finds may fill in some
blanks, solve a few puzzles, provide a missing
detail here or there. But the real mysteries aren’t written in anatomy, and
they don’t yield to the scalpel. In my mind’s eye I see my sister in
sunlight, laughing, her eyes vivid blue. Those of us
who are left behind come to realize that we are asking questions about life
and death, love and loss, for which there are no answers.
Two experts are answering questions about autopsies on the
Consults blog, nytimes.com/consults.
http://www.nytimes.com/2009/05/19/health/19seco.html?ref=health
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The New York Times | 05.18.09
By CAROL ANN CAMPBELL
The curtain between two hospital beds does not stop noise
from the television set, offer privacy during sensitive conversations with
doctors or stop germs from spreading. Yet in most of America’s aging hospitals it is
the only thing that separates strangers thrust together as roommates simply
because both are ill.
But in many new hospitals and pavilions, these semiprivate
rooms have vanished. Single-patient rooms are now viewed as an important
element of high-quality health care.
The benefits of the single room emerged through
evidence-based hospital design, a new field that guides health care
construction. More than 1,500 studies have examined ways that design can
reduce medical errors, infections and falls — and relieve patient stress.
American hospitals started 53 million square feet of new
construction and major additions in 2008, according to a report by
McGraw-Hill Construction, a company that tracks industry trends. Promoters of
evidence-based design say that a building exerts a powerful force on the
delivery of health care, and that the best new health centers are light-filled,
quiet and easy to navigate.
“Some hospitals are taking evidence-based design
seriously,” said Roger Ulrich, director of the Center for Health Systems and
Design at Texas A&M. “Other institutions use pretty traditional design
that pays lip service to the evidence. There may be high style, but the
hospital is still noisy. Or the windows are too small to let much light in.
There are missed opportunities.”
Besides privacy, research shows that single rooms reduce
infections and patient stress, and improve sleep. In 2006, the American
Institute of Architects called for single rooms in all new hospital
construction.
In Plainsboro, N.J., University
Medical Center
at Princeton is building a 237-bed hospital
at a cost of $447 million. A model room is taking shape in the current
building. “We want to test it out in the real world,” said Barry S. Rabner, president of Princeton HealthCare System, which
runs the hospital.
Because studies suggest that natural light can reduce
depression and that scenes of nature can reduce reported levels of pain,
rooms in the new hospital will have large windows looking out toward woods
and the Millstone
River. A handrail next
to the headboard of the bed will prevent falls. To prevent medication mix-ups
and reduce the time nurses spend fetching drugs and supplies, a small locked
cabinet called the nurse server will contain only the medicine for the
patient in that room.
A sink near the door will allow nurses, doctors and
visitors to wash their hands before entering. The rooms will be angled to
create sight lines from the hallway to the bed so nurses can easily see
patients, and vice versa. Acoustical materials will dampen noise, and to
encourage families to visit and spend time, the rooms will be spacious and
equipped with extra storage.
Mr. Rabner recently showed a
reporter a semiprivate room in the current building, an aging facility
updated with a maze of additions.
“This does not create privacy,” he said as he pulled a
curtain between the two empty beds. “There is no space for family. No
storage. The patient by the window has a long walk to the bathroom. There’s
no handrail by the bed.”
Down the hall a patient, Jay Paszamant
of Princeton, said he would be more
comfortable in a single room. “I have to walk past his family on the way to
the bathroom,” he said, referring to the young man in the next bed. “And I
feel uncomfortable overhearing my neighbor’s issues. I don’t want to invade
his privacy.”
Insurers who pay the bills want to know that the single
rooms and the nature scenes will be more than just attractive. “When a
hospital makes a change — buys a new machine, builds a new building — they
need to be prepared to discuss those changes with the people purchasing their
services,” said Susan Pisano, a spokeswoman for the trade association America’s
Health Insurance Plans. “They have to make the case that these changes will
improve quality and safety and efficiency.”
The Center for Health Design, a nonprofit based in California, is
promoting research through its Pebble Project. A Pebble Project study at St. Alphonsus Regional Medical Center in Boise, Idaho,
for instance, found that reducing noise levels improved patients’
self-reported sleep quality by almost half — to 7.3 on a scale of 10, up from
4.9.
Another study, at Bronson
Methodist Hospital
in Kalamazoo, Mich., found that after new private rooms
were added, with well-located sinks and improved air-flow design,
hospital-acquired infections declined 11 percent.
The design research examines elements large and small.
After Sacred Heart
Medical Center
at RiverBend in Springfield, Ore.,
installed ceiling lifts in part of its original building, staff injuries
related to moving patients declined to one a year, from 10. “We think they
paid for themselves within two years because of reduced worker’s
compensation,” said Jill Hoggard Green, the
hospital’s administrator.
Architects and administrators are listening to patients.
In Michigan, Henry Ford
West Bloomfield
Hospital largely
eliminated plans for the new hospital’s emergency department after patients
tested a simulation laboratory.
“We started over,” said Christine Zambricki,
chief operating officer and chief nursing officer of the new hospital, which
opened in March. Emergency room patients, the hospital learned, wanted rooms
large enough so visitors did not have to stay in the waiting room. They
wanted greater privacy — walls, not curtains, between patient beds — and a
private bathroom.
“They didn’t want to walk to the bathroom and see other
people bleeding and crying,” Ms. Zambricki said.
In many new hospitals, central nurses’ stations are being
replaced with smaller ones closer to patients, said Anjali
Joseph, director of research at the Center for Health Design. “Design is not
just focusing on making new hospitals pretty and nice,” she said. “It’s
focusing on the patient outcomes we want from building design.
“It’s possible that old hospitals where the nurses and the
staff are great can succeed in the worst environment. But they have great
obstacles to overcome.”
http://www.nytimes.com/2009/05/19/health/19hosp.html
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Kept From a Dying Partner’s Bedside
The New York Times | 05.18.09
By TARA PARKER-POPE
When a loved one is in the hospital, you naturally want to
be at the bedside. But what if the staff won’t allow it?
That’s what Janice Langbehn, a
social worker in Lacey, Wash., says she experienced when her partner of 18
years, Lisa Pond, collapsed with an aneurysm during a Florida vacation and
was taken to a Miami trauma center. She died there, at age 39, as Ms. Langbehn tried in vain to persuade hospital officials to
let her visit, along with the couple’s adopted children.
“I have this deep sense of failure for not being at Lisa’s
bedside when she died,” Ms. Langbehn said. “How I
get over that I don’t know, or if I ever do.”
The case, now the subject of a federal lawsuit in Florida, is being
watched by gay rights groups, which say same-sex partners often
report being excluded from a patient’s room because they aren’t “real” family
members.
And lawyers say the case could affect the way hospitals
treat all patients with nonmarital relationships,
including older people who choose not to marry, unmarried heterosexual
couples and single people who rely on the support of close friends rather
than relatives.
One point of contention in the lawsuit is whether a
hospital has a legal duty to its patients to always give visiting rights to
their designated family members and surrogates.
Robert Alonso, a spokesman for the public trust that runs
the Miami
hospital, Jackson Memorial, said it typically did not comment on pending
litigation, but added that the hospital grants visitation if it doesn’t
interfere with other emergency care. “The primary legal point is that the
amount of visitation allowed in a trauma emergency room should be decided by
the surgeons and nurses treating the patients,” he said.
A similar lawsuit is under way in Washington State,
where Sharon Reed says she was denied access to her partner of 17 years, Jo
Ann Ritchie, who was dying of liver failure. Although the hospital had
liberal visitation policies, a night nurse from an employment agency insisted
that Ms. Reed leave her partner’s room, the lawsuit says.
“One of the things her partner said to her was, ‘I’m
afraid of dying. Don’t leave me alone,’ ” said Judith A. Lonnquist,
a lawyer for Ms. Reed. “That’s why the suffering was so enormous — she felt
as if her partner was thinking she had betrayed her trust.”
In both cases, the couples had prepared for a medical
emergency, creating living wills, advanced directives and power-of-attorney
documents.
As recounted by Ms. Langbehn,
the details of the Miami
episode are harrowing. It began in February 2007, when the family — including
three children, then ages 9, 11 and 13 — traveled there for a cruise. After
boarding the ship, Ms. Pond collapsed while taking pictures of the children
playing basketball.
The children managed to help her back to the family’s
room. Fortunately, the ship was still docked, and an ambulance took Ms. Pond
to the Ryder Trauma Center
at Jackson Memorial. Ms. Langbehn and the children
followed in a taxi, arriving around 3:30 p.m.
Ms. Langbehn says that a
hospital social worker informed her that she was in an “antigay city and
state” and that she would need a health care proxy to get information. (The
worker denies having made the statement, Mr. Alonso said.) As the social
worker turned to leave, Ms. Langbehn stopped him.
“I said: ‘Wait a minute. I have those health care proxies,’ ” she said. She
called a friend to fax the papers.
The medical chart shows that the documents arrived around
4:15 p.m., but nobody immediately spoke to Ms. Langbehn
about Ms. Pond’s condition. During her eight-hour stay in the trauma unit
waiting room, Ms. Langbehn says, she had two brief
encounters with doctors. Around 5:20 a doctor sought her consent for a “brain
monitor” but offered no update about the patient’s condition. Around 6:20,
two doctors told her there was no hope for a recovery.
Despite repeated requests to see her partner, Ms. Langbehn says she was given just one five-minute visit,
when a priest administered last rites. She says she continued to plead with a
hospital worker that the children be allowed to see their mother, even
showing the children’s birth certificates.
“I said to the receptionist, ‘Look, they’re her kids,’ ”
Ms. Langbehn said. (Mr. Alonso, the hospital
spokesman, says that except in special circumstances, children under 14 are
not allowed to visit in the trauma unit.)
Ms. Langbehn says she was
repeatedly told to keep waiting. Then, at 11:30 p.m., Ms. Pond’s sister
arrived at the unit. According to the lawsuit, the hospital workers
immediately told her that Ms. Pond had been moved an hour earlier to the
intensive care unit and provided her room number.
At midnight, Ms. Langbehn says,
her exhausted children were finally able to visit their unconscious mother.
Ms. Pond was declared brain-dead at 10:45 that morning, and her heart,
kidneys and liver were donated to four patients.
In her lawsuit, Ms. Langbehn is
being represented by Lambda Legal, a gay rights group. “We want to send a
message to hospitals,” said Beth Littrell, a lawyer
for the group. “If they don’t treat families as such, if they don’t let
patients define their own circle of intimacy and give them the dignity and
care to be with their loved ones in this sort of crisis, then they will be
held accountable.”
Join the discussion at nytimes.com/well.
http://www.nytimes.com/2009/05/19/health/19well.html?ref=health
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