LSU and Our Lady of the Lake Discussions for Graduate Medical Education Move
Baton Rouge, LA – Louisiana
and Our Lady of the Lake Regional Medical
Center today agreed to a non-binding
Memorandum of Understanding (MOU) that creates a public-private
collaboration between the two organizations and outlines relocation of
certain Baton Rouge based Graduate Medical
Education programs to Our Lady of the Lake’s
“This accord is a step in the right direction. It moves graduate medical education to a higher level and
enhances health care delivery for LSU and residents of the Baton Rouge
Region,” said LSU System President Dr. John V. Lombardi. “The Jindal
administration, including the Department of Health and Hospitals, has
strongly encouraged this private-public relationship as a model for health
This agreement provides for LSU to relocate a number of
inpatient Graduate Medical Education programs from the Earl K. Long Medical
Center to the OLOL
hospital campus on Essen Lane.
With the move of certain of its physician training programs, certain
inpatients currently seen at Earl K. Long will be admitted to LSU’s teaching
service at the OLOL campus. OLOL will expand its inpatient capacity by a minimum
of 60 beds and will work to expand the current Trauma Center
at the Essen Lane
LSU will expand its outpatient clinics currently in
operation. The LSU Health System North
Baton Rouge Clinic, the new state-of-the-art facility recently opened on Airline Highway,
will add a 24-hour urgent care clinic for patients who currently seek
non-emergency or primary care in the ER.
OB services and care for
prisoners will not be provided at OLOL.
Both LSU and OLOL will continue to work with the Department of Health
and Hospitals and the Capitol Area Human Services District to maintain
current levels of psychiatric care in the Baton Rouge area.
“Both LSU and OLOL recognize that this successful
collaboration is dependent on certain commitments from the state of Louisiana. This now
actually becomes a three-way discussion. Everyone is aware of the current
state budget constraints as well as the challenges and opportunities within
an uncertain national landscape of healthcare financing, so the funding model
must be sustainable in the long term,” said Scott Wester,
CEO, Our Lady of the Lake. “Our goal is to make sure we have doctors trained
in and for Louisiana
for the foreseeable future.”
The MOU spells out that LSU would purchase or build a Medical Education
Building on or near the Our Lady of
the Lake campus to be used by faculty,
residents, fellows and medical students.
“We are excited about this proposed public-private
collaboration,” said DHH Secretary Alan Levine. “It’s an innovative model that makes sense
for LSU, for Baton Rouge and, potentially, for other parts of the state,
where we are looking for ways to sustain access to inpatient care, expand the
availability of much-needed primary and preventive services, and enhance
graduate medical education to train a first-class physician workforce for the
future. I commend the forward-thinking
vision of LSU and the leadership of Our Lady of the Lake. This type of collaboration requires a
willingness to think not about the past, but about the future.”
The proposal requires the commitment of the Department of
Health and Hospitals for necessary sustainable funding through a combination
of federal and state funding sources in order to provide care for these
inpatients by the LSU teaching service relocated to the OLOL campus.
“The MOU demonstrates LSU’s dedication to pursue every
avenue available in providing the best possible graduate medical education,”
said Dr. Fred Cerise, LSU System vice president for health affairs and
medical education. “This collaboration
with Our Lady of the Lake also will maintain
the high quality health care LSU patients receive in all our hospitals.”
The next steps in the discussions will include further
evaluation of the financial and patient volume impact of the collaboration as
well as facility planning and governance. This MOU sets the stage for a more
formal agreement called a Cooperative Endeavor Agreement or CEA, which will
be a three-party agreement between the state, LSU and OLOL. After a CEA is
agreed upon, it is anticipated that LSU’s physician training programs will be
relocated to OLOL in the next two years.
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may become teaching hospital
By MARSHA SHULER
Advocate Capitol News Bureau
A proposed deal in which Our Lady of the Lake Regional
would become LSU’s Baton Rouge
teaching hospital could be completed by Sept. 30, officials involved in the
negotiations announced Thursday.
LSU and Our Lady of the Lake
officials signed a memorandum of understanding late Wednesday. The memo
outlines the responsibilities of each party in a potential public-private
The next step is the signing of a cooperative endeavor
agreement, which would seal the deal.
Gov. Bobby Jindal and health
chief Alan Levine support the partnership, which would ultimately lead to the
closure of LSU’s antiquated Earl
LSU operates medical education programs that train future
physicians at Earl K. Long in north Baton
Rouge. The hospital serves the area’s poor and
Under the agreement, training programs and inpatient care
would move to the Lake, which is on Essen Lane near
The memorandum of understanding sets Sept. 30 as the goal
for reaching a “binding” agreement that includes a state pledge of financial
support for the arrangement.
The Legislature next week would be asked to endorse a
resolution that outlines LSU’s intentions to continue negotiations, said LSU
System vice president Fred Cerise. The Legislature’s budget panel must
approve a final deal when it is inked.
“It’s not time for people to start showing up at the Lake,” Cerise said. “We are moving forward … but we are
still a ways away from a move.”
Cerise and the Lake’s CEO
Scott Wester said progress is being made on working
out complicated federal and state health-care financing issues related to
medical education and hospital care reimbursement. Both are key to the collaboration’s success, they said.
In addition, the agreement requires financing of an
estimated $125 million in capital construction. Included are
construction or purchase of a medical education building on the Lake campus off Essen Lane, a 60-bed hospital addition
and expansion of the facility’s trauma center.
“The state needs to work with both parties to make a
commitment to make sure this can happen,” said the Lake’s
CEO Scott Wester. “The funding model must be
sustainable in the long-term.”
If a final agreement is struck, Wester
said it would probably take two-plus years before the Lake
could construct additional bed capacity to allow transition of LSU patients
LSU and the Lake
announced they had entered into serious discussions last December. At the
time, LSU shelved plans to build a new $300 million public hospital.
Under the recently signed memo, LSU would continue to
operate its out-patient clinics in the Baton
Rouge area and expand them to meet community needs.
Included would be the addition of a 24-hour urgent care center at LSU’s new
state-of-the-art north Baton Rouge
clinic — located near Earl K. Long.
State Sen. Sharon Broome, D-Baton Rouge, in whose district
EKL sits, made a pitch last week to Jindal for the
urgent care center funding.
Left open is the possibility of an approximately
15,000-square-foot clinic for LSU to be located on or near the Lake’s campus. It would be owned by the Lake and leased to LSU.
Prisoner care and obstetrical services would not be
located at the Lake. LSU would have to enter
into other contractual arrangements for alternative locations.
The initial term of any cooperative endeavor agreement
reached would be at least five years, or a period of time equal to the
longest residency program.
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by The Associated Press
BATON ROUGE, La. (AP) -- A Catholic-operated hospital
would become LSU's Baton Rouge teaching
hospital and get $125 million in improvements under a proposal that would
ultimately close the public hospital in Baton
Officials say a memorandum of understanding with Our Lady
of the Lake Regional Medical
Center was signed late
Wednesday, and the proposed public-private partnership could be completed by
Gov. Bobby Jindal and health
chief Alan Levine support the partnership.
LSU now uses Earl
Hospital, which serves
the area's poor and uninsured.
Training programs and inpatient care would move to the Lake under the agreement. It would require financing an
estimated $125 million in capital construction, including a medical education
building, 60 new beds and expanding the trauma center.
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By Bill Barrow
BATON ROUGE -- The Senate Education Committee buried a
bill that would have put the brakes on the state acquiring land for the
proposed teaching hospital slated to be built in lower Mid-City, requiring a
new legislative review of a financing plan.
After sailing through the House earlier this session,
House Bill 780 by Rep. Rick Nowlin, R-Natchitoches,
ran into a 7-1 buzzsaw, led by Sen. Ann Duplessis, D-New Orleans, who disputed the notion that
the bill was designed to protect private property rights.
"This bill is more about the new hospital being
focused at Charity
said, referring to some of the bill's backers who oppose the lower Mid-City
site and want the state to gut Charity and rebuild within its shell.
Duplessis also pointedly asked Nowlin, "Are you from New Orleans?"
Nowlin said private property
rights, the importance of medical education across Louisiana
and the hospital's advertised $1.2 billion price tag -- with $300 million in
state money already committed -- made it acceptable for a northern Louisiana lawmaker to
State Treasurer John Kennedy, a critic of the hospital
planning, said, "I don't see this as a New Orleans bill or a health care bill.
This is an expropriation bill. . . . We shouldn't take land until we know we
can build a hospital."
Jerry Jones, the state facilities chief who is planning
the project along with Louisiana State University System executives, found
senators sympathetic that Nowlin's bill would cause
a delay in the project.
Fred Cerise, vice president of the LSU System, showed
lawmakers copies of two previous business plans that the Legislature's Joint
Budget Committee has already approved, including the latest version released
in mid-2008 with Jindal's backing.
Sen. Eric LaFleur, D-Ville
Platte, cast the lone vote in support of Nowlin's
measure. LaFleur questioned why the state couldn't
delay land closings and takings -- given that it awaits
a resolution of its dispute with the federal government over how much the
Federal Emergency Management Agency will pay for Charity Hospital
damage caused by Hurricane Katrina. The outcome of that decision also will
influence how much of the construction budget will come from bonds backed by
future hospital revenues.
Jones confirmed for LaFleur that
the bonds -- whatever the amount -- would not be sold until after the state
knows how much FEMA is chipping in.
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Sciences Center Research Finds Single Gene Controls
Growth of Some Cancers
NEW ORLEANS, June 11 (AScribe
Newswire) -- Research led by Ashok Aiyar, PhD,
Associate Professor of Microbiology at LSU Health Sciences Center New
Orleans, showing that a single gene can control growth in cancers related to
the Epstein-Barr virus and that existing therapeutics can inactivate it, will
be published in the June 12, 2009 online issue of PLoS
The Epstein-Barr virus (EBV) is closely associated with
many human cancers such as Burkitt's lymphoma,
Hodgkin's lymphoma, AIDS-related lymphomas, post-transplant lymphoproliferative disease, cancers of the nose and
throat, and stomach cancer. In many of these malignancies, proteins made by
EBV are necessary for tumor cells to grow indiscriminately. This is
especially true of AIDS-related lymphomas and post-transplant lymphoproliferative disease, which are serious
complications of AIDS and transplant surgery. These cancers are responsible
for thousands of deaths each year in the United States.
The LSUHSC research team, which also includes Kenneth
Johnston, PhD, Professor of Microbiology, and Timothy Foster, PhD, Assistant
Professor of Microbiology and faculty of the LSUHSC Gene Therapy Program,
investigated a small region of a certain Epstein-Barr virus protein called
EBNA1, to determine the role it plays in the activation of the EBV genes
responsible for the indiscriminate growth of tumor cells in these cancers.
Their research shows that EBNA1 is controlled by oxidative stress (pathologic
changes in response to excessive levels of free radicals) within the
EBV-infected cells. Varying levels of oxidative stress change EBNA1's ability
to activate EBV genes responsible for indiscriminate tumor cell growth.
"We have shown that in vitro, existing therapeutics
such as Vitamin K that can change oxidative stress within cells, inactivate
EBNA1," notes Dr. Aiyar, who is also a member
of the faculty of the LSUHSC Stanley S. Scott Cancer Center. "As a
consequence, EBV genes required for proliferation are no longer expressed,
and malignantly transformed cells stop proliferating."
The research was funded by grants from the National Cancer
Institute, the Louisiana Cancer Research Consortium, and the Department of
Microbiology, Immunology, and Parasitology at LSU
Health Sciences Center New Orleans School of Medicine.
"It is our hope that this research will lead to new
ways of controlling EBV-associated diseases in humans," concludes Dr. Aiyar.
ABOUT LUSHSC: LSU
Orleans educates Louisiana's
health care professionals. The state's academic health leader, LSUHSC
comprises a School of Medicine, the state's only School
of Dentistry, Louisiana's only public School of Public Health, and Schools of Allied
Health Professions, Nursing, and Graduate Studies. LSUHSC faculty
take care of patients in public and private hospitals and clinics
In the vanguard of biosciences research in a number of areas worldwide,
LSUHSC faculty have made lifesaving discoveries and
continue to work to prevent, better treat, or cure disease.
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From staff reports
Two sides are doing a lot of talking about the problems that
have put Louisiana
in a deep budget hole.
Whether they will start listening to each other, and what
they'll be able to accomplish if they do, are questions yet to be answered.
fouled-up budgeting system, there may be nothing to talk about anyway.
A group of Acadiana people with
high-ranking positions in education and heath care invited reporters to hear
what Gov. Bobby Jindal's proposed budget cuts mean
to their companies and institutions. We'd already heard from one of them, UL
President Joseph Savoie, who had warned that Lafayette's university
is being asked to absorb the equivalent of oil-crunch budget-scrubbing in one
Alongside Savoie were representatives of the local
health-care industry, who sounded warnings of their own. The proposed $450
million cut in fiscal year 2010 health-care spending would reduce funding at Acadiana hospitals by more than $21 million a year.
They said those hospitals would be forced to idle 450
employees. Throw in another 50 employees who would lose their jobs at Acadian
Ambulance, said CEO Richard Zuschlag. In Lafayette
Parish alone, they said, the economy would stand to lose $200 million and 525
Jindal has a compelling story of
Just in case you don't get cable, there's a recession on,
unemployment has been creeping upward even though we've been far luckier than
other parts of the country. Even so, lower employment will inevitably lower
income and sales tax collections even as social welfare spending rises, or
It wasn't long ago that the Revenue Estimating Conference
pegged the price of oil, for revenue-estimating purposes, at a little more
than $80 a barrel. At its peak, oil topped $140, so the conference figure
seemed absurdly conservative. Nowadays, oil is bumping its head on a $70
And, just to rub it in, the federal government is counting
every bit of hurricane aid in the per-capita income calculation on which our
share of state-federal Medicaid funding is based. So, because we got ravaged
by hurricanes Katrina and Rita, the feds will pay less.
This isn't just about bad times. It's about a broken state
budget system - health care and higher education are being asked to absorb
more than $700 million cuts in a single year because other sectors are protected
- and a federal Medicaid system with some bizarre ideas about need.
Jindal has proposed fixes for
both problems, including reduced Medicaid expenditures via partial
privatization and more budgeting flexibility for his office and the
Legislature. This year's predicament adds urgency to both.
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Weekly | 06.12.09
By John Maginnis
With a deft maneuver, the House and the governor got the
budget they wanted by accepting the Senate’s version of the $28.8 billion
spending bill. Senators, fully
expecting a drawn-out conference committee to work out a compromise bill,
realized too late they had made a strategic error in crafting their version
of the budget that would add more money for higher education and healthcare.
The House now has the upper hand because the extra money
the Senate added was “below the line,” that is, contingent on passage of two
separate revenue-raising bills, which the House opposes. One is Senate Bill 335 to raise $118
million by freezing the phase-in of personal income tax deductions. Another would pull $86 million from the
so-called rainy day fund, which is more than the governor and the House will
commit to. Without the passage of
those revenue measures, the added higher education and healthcare spending is
nullified, and the bill becomes much closer to the version the governor
proposed and the house first passed.
Budget process not over, but narrowed down
The budget bill is on its way to the governor’s desk, but
the appropriations process is not over.
The governor and House leaders say they can add back up to $70 million
for higher education by using one of several smaller special appropriations
bills still moving through the process.
The Senate will press to restore more money, but it won’t have the
leverage of holding the entire budget hostage in conference committee. Instead, the differences between the two
bodies now amount to less than 1 percent of the spending plan already passed.
The trailing funds bill can also include the dozens of
member amendments for about $20 million in local grants and projects dear to
legislators. Senators had put those
member amendments in the contingency part of the budget bill, thinking that
would force the House into negotiations.
They apparently did not anticipate the House using another bill to
include those local projects and some new money, though less than the Senate
wanted, for higher education.
In a released statement, Senate President Joel Chaisson said it will be “a sad day in Louisiana” if the House does not act on
the revenue measures. He further
stated that “concurring with House Bill 1 with very limited debate and
discussion and no agreement from Senate leadership, is an extremely
disappointing development that runs counter to a healthy and honest debate
regarding the differences in the House and Senate version of our state
Yet, say representatives, the Senate should not have sent
over the bill if it didn’t want the House to accept it, knowing full well the
House opposed the contingent revenue bills.
Also, some House members were not happy with Chaisson’s
chastising the 55 representatives who signed a letter of opposition to SB 335
before it was debated in the upper chamber.
The House has its own revenue measure on the calendar, the
50-cent-per-pack cigarette tax bill.
But procedural motions on it this week gained more than the one-third
plus one votes needed to kill it if and when it comes up.
While the House move on the budget was a highly unusual
one, late-session tensions and resentment between the two bodies are nothing
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By Mike Hasten
Gannett Capitol Bureau
BATON ROUGE -- The House of Representatives Thursday
unexpectedly concurred with Senate amendments to the budget, even though
House leaders said they didn't like the way senators tied many projects to
bills that likely won't pass.
Rep. Jim Fannin, author of HB1,
told House members that many things the Senate version of the bill won't
survive because the funding sources, as planned by the Senate, won't be
approved. He said the House won't approve freezing a planned increase in
income tax deductions and dipping into the "Rainy Day Fund" is
Speaker of the House Jim Tucker refused to send to a
committee Senate-passed legislation by Sen. Lydia Jackson, D-Shreveport, that
delays the deduction and would save the state $118 million. Tucker says
revenue-raising measures must start in the House but Jackson insists it is saving existing
money, not raising more.
Asked what would happen if the House agreed with the
Senate version but didn't approve the way to fund the projects, Fannin replied "they go away."
He said other House-passed bills that appropriate money
are in the Senate and can be amended to fund things like higher education and
Rep. Joel Robideaux,
I-Lafayette, a supporter of concurring, said some people in his district hope
some of the items do go away. The Senate placed all the non-governmental
organization and legislator's preferred projects in the contingency category.
"I don't think the public likes member amendments
anyway," he said, although he's a bit disappointed to lose the
infrastructure projects for the city of Lafayette
that he amended into the bill.
"Overall, the health of the state's better off"
without those $35 million in amendments, Robideaux
said. "If that money can be used for higher education, that's
The original House-passed version included $50 million to
restore cuts to higher education by utilizing revenues from a tax amnesty
program next year. Senators concerned that the money wouldn't arrive in time
to help colleges and universities, chose to utilize "Rainy Day Fund"
money instead. The Senate version also allotted higher education and health
care, the two section of government hit hardest by budget cuts, money from
the tax break delay and a cigarette tax.
Those amendments also "go away" without the
Robideaux said the funding
process is "far from finished. In the total process of funding things, a
lot's got to happen in the final two weeks."
Jindal, after meeting with four
previous governors about making higher education a priority, said that he
wants to reduce college and university cuts from the proposed $219 million
(15 percent) by about $100 million, which he said would be less than a 10
Former Gov. Buddy Roemer said he set up the meeting with Jindal after talking with former governors Kathleen
Blanco, Mike Foster and Dave Treen because they all
were concerned about the proposed cuts.
They originally were going to call a press conference
without Jindal to express their concerns.
Blanco said she wanted to remind Jindal
of the importance of higher education.
Countering a statement often made by Jindal,
Blanco said, "We cannot do more with less. That's an impossible task.
You do less with less. That drives us to mediocrity."
Blanco, the only Democrat in the group, said she hoped
members of the House would "cast some votes that might be
But Jindal said he opposes the
revenue-raising proposals and would veto them if approved by the Legislature.
Roemer said the former governors "had the feeling
something needed to be done" and "what we need is leadership ...
Lead, governor. We are prepared to follow."
Sen. Robert Adley, R-Benton,
said he agrees with the former governors and "if you don't lead, someone
else will do it for you. The thing I found ironic is that these were the same
governors who Jindal said never provided leadership
telling Jindal he needs to lead."
Adley said he disagrees with the
way the House handled HB1. If the House leadership didn't like it, the bill
should have been sent to conference committee to iron out differences
"like it always has, like it should have been. It's more than politics.
We're dealing with people's lives."
Besides House and Senate local projects in the
"contingency" section to be funded only if additional revenue was
raised, the Senate version includes health care and higher education funds.
That section called for $278 million in funding.
Rep. Karen Peterson, D-New Orleans, the only opponent who
got to speak on the House floor before debate was cut off, said she couldn't
cast a vote that would say "just trust me that if you send HB1 to the
governor's office, $278 million will be found. Some people have not earned
With juggling funds in other legislation, some things that
are normally in the budget will not be in it.
Fannin said that although he
disagreed with the Senate version, the House should concur because "it's
time we sent a message to the other side we work with that this is not the
way we do business."
Sen. Joe McPherson, D-Woodworth, responded, "I think
higher education should send him a message."
"I feel like we kind of got railroaded," said
Rep. Roy Burrell, D-Shreveport, who during debate questioned the wisdom of
approving a budget with no intention of funding parts of it. He also
questioned why the administration was veering from its policy of not using
one-time revenues to fund recurring expenses.
"Just trusting that everything's going to be all
right is naïve," he said. "We just handed the budget over and now
the governor has full authority to do what he wants. This was a travesty of
justice and an extreme disservice to the people we serve."
Adley disagrees. He said the
House action "took Bobby Jindal out of the
process. All he has authority to do is cut. He cannot appropriate funds. He
cannot honor his promise to the former governors to reduce higher education
cuts below 10 percent without us. It now rests with the Senate and the House
how we go."
Burrell said he was also disappointed in Speaker of the
House Jim Tucker, "who says he wants separation of the legislative and
executive branches but he's merging the two" by working so closely with Jindal.
Adley said the House acted in
"a rush to judgment" and House members didn't have a chance to see
what the Senate version really did.
Senate President Joel Chaisson, D-Destrehan,
said the House action could be read two ways. Either the House agrees to pass
the bills required to fully fund the budget, which he applauds, of if it
won't act on the proposals, "this is indeed a sad day in Louisiana"
because it sets up higher education and health care for "devastating
"Whatever their intentions may have been, concurring
in House Bill 1 with very limited debate and discussion and no agreement from
Senate leadership is an extremely disappointing development that runs counter
to a healthy and honest debate regarding the differences in the House and
Senate versions of our state budget," he said.
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By Jonathan Tilove
WASHINGTON -- On the eve of her re-election last fall,
Sen. Mary Landrieu, D-La., was approached at a campaign event and asked to
sign a letter supporting Health Care for America Now's "statement of
common purpose." She obliged.
The single-spaced, page-and-a-half letter stated:
"Under this approach, everyone gets a choice of health insurance,
including the right to keep your current insurance, choose another private
plan, or to join a public health insurance plan."
This week, however, Landrieu was quoted as saying that she
doesn't support the public health insurance plan option.
Democratic supporters of the public option howled in
outrage even as The Huffington Post Web site, which had reported Landrieu's
words of opposition to it, linked to the Health Care for America Now letter
signed by Landrieu.
Landrieu's office said that the senator has been
consistent in her support and co-sponsorship of the bipartisan Wyden-Bennett
health plan, which does not include a provision for a public plan. But
Landrieu and Wyden both say it will provide universal access to health care
coverage on a par that is enjoyed by members of Congress. Landrieu's office
suggests that the senator is a victim of, in effect, not reading the fine
print of a document thrust at her at a campaign stop.
But the folks behind the letter say that, considering how
assiduously they had lobbied Landrieu's office on the issue, she should have
known what she was signing.
Landrieu's office at first questioned the authenticity of
the letter linked to by The Huffington Post.
But Saunders said they subsequently learned from
representatives of the Service Employees International Union -- along with
ACORN, the lead Health Care for America Now organizers in New Orleans -- that they had approached the
senator with the letter at the campaign event last fall.
Saunders said Landrieu had perused the document, endorsed
its spirit, and signed.
"If you go line by line she agrees with the vast
majority" of what is in the letter, Saunders said. "There's just
one little line or two that's now being set up as her position on the
But, according to Health Care for America Now, that line
or two -- repeated twice in the letter -- makes all the difference. The
concern of Health Care for America Now and its allies is that a handful of
Democratic senators, seeking a bipartisan plan, may spoil the Democrats'
chances of getting what they consider truly meaningful reform, including a
public option, through Congress. Health Care for America Now has run ads in Oregon trying to
persuade Sen. Ron Wyden, D-Ore., to support a public alternative.
"What she's doing now is she's dancing around,"
said Jacki Schechner, the
national communications director for Health Care for America Now -- a broad
coalition of labor, community, religious and other activist groups -- noting
that the organization has been "very, very, very clear" about the
crucial role of having a meaningful public alternative.
Saunders said that while the Wyden plan does not include a
"Medicare-like public option," it does have a federal backup plan
to ensure that there are at least two high-quality comprehensive health plans
in every state.
That's not good enough, Schechner
Health Care for America Now lists 150 supporters among
members of Congress, including Landrieu.
Will she now be stricken from the list?
"We'll figure it out," Schechner
said. "This is not done yet.
"We believe that when she looks at health reform more
closely," she said, "she will do what's best for the residents of Louisiana and reaffirm
her support for the public health insurance option."
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By David Spunt
BATON ROUGE, LA (WAFB) - After weeks of debate, Governor
Bobby Jindal has the state's operating budget on
his desk, but the 69-25 approval vote Thursday afternoon by the House is not
necessarily a done deal.
Usually at this stage in the session, lawmakers are much
further behind in the budget process.
That all changed after a surprising move in the House to pass the
budget, but two of the biggest sticking points this session, health care and
higher education, are both still hanging in the balance.
A total of $278 million hinges on the passage of other
bills that still haven't been finalized. "The bill that came back to the
House was about 98% of what the House sent over to the Senate," said
House Speaker Jim Tucker, R-Terrytown.
Tucker and 68 of his colleagues passed what they call a
bill that will help lower cuts. The 25 who voted against the measure feel
they were rushed. "We come in, within five or ten minutes and say, 'This
is what we're going to do with the bill. This is how we're going to spend
billions of taxpayer dollars, and this is how we're going to cut health care
and education,'" said Rep. Juan LaFonta, D-New
Orleans. "I just don't think it's a fair process."
"I'm committed to making sure higher education has
the money needed," Rep Jim Fannin, D-Jonesboro
Governor Jindal, by law, has ten
days to sign the budget. He's expected to use what's called "line item
veto" power, where he'll basically go through line by line and cut out
what he doesn't want.
[BACK TO TOP]
By MARK BALLARD
Advocate Capitol News Bureau
Michael Baer, a lawyer who was the secretary of the
Louisiana Senate for 26 years, died Thursday, according to Senate president
Joel Chaisson II.
Chaisson, D-Destrehan, halted
Senate proceedings to note Baer’s passing and called for a moment of silence.
The House also observed a moment of silence.
The Senate would have a resolution Monday to recognize
Baer’s Senate service and government career, Chaisson
A Senate secretary is the upper chamber’s chief
administrator, overseeing the staff that drafts legislation. The secretary
also advises the presiding officer on the Senate’s rules.
Baer’s career in the Senate ended in 2005. The Senate
voted to fire him after he sent a mass e-mail to the Legislature and staff
containing vulgar jokes and a sexually suggestive video.
Baer said he meant to delete the suggestive e-mail but hit
the wrong button.
Since leaving the Senate, Baer had handled legal cases for
free, said Glenn Koepp, who succeeded Baer as
secretary of the Senate.
Koepp was Baer’s assistant for
about 25 years. The two attended high school in Bogalusa and LSU law school together.
Koepp said Baer had a
photographic memory and deep knowledge about the history of the Louisiana
“Somebody would have thought they came up with some new
unique idea and he would remember something from years and years ago when
somebody tried the same thing,” Koepp said.
Baer collected exotic birds and loved fishing, he said.
He was married twice, Koepp
said. With his first wife, Alice, his high school sweetheart, Baer had three
children, he said. Baer had two children with his second wife, Debbie, he
Baer long had health problems. During the legislative
session in 1995, Baer suffered chest pains and was treated by then Sen. Don
Hines, D-Bunkie, who is a physician, and sent to the hospital on a stretcher.
He was back at work the next day.
Baer got his start with the Legislature in 1971 when, as a
first-year law student, he called his local state senator, B.B. “Sixty”
Rayburn, D-Bogalusa, about getting a job.
“Without even seeing me, he got me hired for $1.60 a hour as a proofreader with the legislative counsel’s
office,” Baer recalled in a 1990 interview. He later worked as a law clerk
for former state Rep. Peppi Bruneau,
Baer served as a legal adviser to former Gov. Edwin
Edwards in one capacity or another over the years. He was a law partner of
Camille Gravel, one of Edwards’ closest associates. During Edwards’ second
term in office, Baer served as counsel to the governor.
Baer also served as attorney for the Joint Legislative
Committee on the Budget and the Senate Finance Committee before being named
[BACK TO TOP]
The New York Times | 06.11.09
By DONALD G. McNEIL Jr. and
Mike Clarke/Agence France-Presse — Getty Images
The government of Hong Kong
on Thursday ordered all primary schools in the city to be closed for two
weeks after the first cluster of local swine flu cases was found. Above,
kindergarten students at a local school on Thursday.
It came as no surprise on Thursday when the World Health
Organization declared that the swine flu outbreak had become a pandemic.
The disease has reached 74 countries, and probably met the
technical definition of a pandemic — or global spread — weeks ago. Nearly
30,000 cases have been reported, but disease experts think hundreds of
thousands or millions of people have actually been infected.
So the agency made official what had become obvious: that
the H1N1 virus is spreading quickly in different parts of the world, and its
chief, Dr. Margaret Chan, said, “Further spread is considered inevitable.”
The announcement does not mean that the illness, which has
been mild in most people, has become any worse. The term pandemic reflects
only the geographic spread of a new disease, not its severity. Pandemics
typically infect about a third of the world in a year or two, and sometimes
strike in successive waves.
“Globally, we have good reason to believe that this
pandemic, at least in its early days, will be of moderate severity,” said Dr.
Chan, director general of the health agency. So far, 144 people have died
The decision to raise the pandemic alert from Phase 5 to
Phase 6, its highest level, is meant to signal to countries to step up their
efforts to deal with the disease.
It also means that the health organization is asking drug
makers to start making vaccine as quickly as possible, with the hope of
having some batches ready by September. Efforts to make a vaccine are under
way, and stockpiles of antiviral drugs have been opened. But the agency does
not recommend closing borders or restricting travel.
“This is not a surprise,” said Dr. Thomas R. Frieden, the new director of the Centers for Disease
Control and Prevention. “For all intents and purposes, the United States government has been
in Phase 6 of the pandemic for some time now.”
Even though the disease has been relatively mild in most
people so far, governments must not relax, Dr. Chan said. For one thing, she
explained, the virus could change at any time and become more severe.
In addition, the illness may take a greater toll when it
reaches poor countries with higher rates of malnutrition, AIDS and other
diseases that can lower people’s resistance to infection. Dr. Chan said rich
countries should help poor ones less able to protect themselves.
Even in developed countries, the virus can cause severe and
sometimes fatal illness in pregnant women, babies and people with underlying
problems like asthma, heart disease, diabetes, obesity and autoimmune
diseases. Dr. Frieden said people in those risk
groups should seek treatment if they have a fever of at least 100.4, and a
cough or a sore throat.
A third to half of the severe and fatal cases have occurred in young and middle-aged people who were
previously healthy. In contrast, seasonal flu tends to kill the frail
The severity of the new virus does not even approach that
of the 1918 one, which killed 40 million to 50 million people worldwide. But
even the milder flu pandemics took serious death tolls. The one in 1957
killed two million people, and the 1968 pandemic killed about one million.
Seasonal flu, by comparison, kills 250,000 to 500,000 people a year.
Countries that have not yet had cases must anticipate them
and prepare their health systems to treat patients, Dr. Chan said. Countries
in the early stages of outbreaks should try to contain the disease, she said.
Those further along, like Mexico,
should not let their guard down even if the disease seems to be waning, she
“The virus can come back in a second wave,” Dr. Chan said.
“When you’re over the first wave, start preparing for the future.”
The W.H.O. has been questioned sharply for weeks as to why
it would not go to Phase 6 even though the spread of cases, first in Britain and Spain,
then in Japan, Australia and Chile, seemed to meet its
pandemic definition: the sustained community spread of a novel virus in two
different W.H.O. regions.
Dr. Chan has indicated recently that she thought a
pandemic was under way, especially as cases in Australia quadrupled in a
week, but she wanted to consult with countries that had large outbreaks and
then with a panel of experts on Thursday.
From early reports in Mexico
and the United States,
scientists have said that H1N1 appears to have roughly the same 0.6 percent
death level as the 1957 Asian flu. The 1918 flu killed about 2.5 percent of
But in 1918, antibiotics did not exist, and many people
died of secondary bacterial infections. In 1957, antiviral drugs did not
exist, and mechanical ventilators were less common.
Dr. Michael T. Osterholm,
director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said this year’s flu is not
acting like the 1957 one, which quickly faded into a seasonal pattern. There
would normally be no flu cases in the United
States in June, but flu hospitalizations are increasing
Flu levels continue to be high in New
York and New England, and especially in Massachusetts, the C.D.C. said.
[BACK TO TOP]
The New York Times | 06.11.09
By PAULINE W. CHEN, M.D.
I blog, I tweet and I use Facebook.
And as I recently told a medical colleague, social media has been an
enormously useful tool in my work.
“I can barely keep up with e-mail,” he snorted back. “I’m
not about to open up that black box.”
About 15 years ago, during my residency and just as the
first blogs were starting up, I took care of a patient in his mid-40s whom
I’ll call Eddie. In a waiting room filled with elderly patients crippled by
vascular disease, Eddie looked out of place. Until you looked closer at his
fingers and toes. Parts of them had been amputated.
Eddie suffered from Buerger’s
disease, or thromboangiitis obliterans,
an illness that causes clotting and inflammation of the blood vessels of the
hands and feet. Considered an “orphan” disease because of its relative
rarity, Buerger’s disease compromises the blood
supply to a patient’s fingers and toes. Eventually these patients, who are
usually men in their 20s to 40s who smoke, develop excruciating pain, severe
ulcerations and gangrene. And more often than not, they must undergo
progressively higher amputations.
There is no cure for Buerger’s
disease; the only way to slow the process is to quit smoking. Therein lies the tragedy. For unknown reasons, patients who suffer
from Buerger’s disease are profoundly addicted to
tobacco, far more so than most smokers. It is nearly impossible for them to
Eddie wanted desperately to quit. Over the two years that
I cared for him, he tried at least a dozen times. But his already challenging
task was made even more difficult by his isolation. Eddie lived alone,
estranged from his family, with friends and co-workers who grew increasingly
unsympathetic to his plight. “They don’t understand why I keep smoking if I
keep losing fingers,” he said to me one afternoon. “They just don’t
understand how hard it is for me.” Moreover, because his disease was so rare,
he had no community of fellow patients to turn to in his town or at our
But his visits to the clinic always seemed to cheer him
up. He responded, it seemed, to my encouragement, and each time he left, he
renewed his vow to quit smoking. But weeks would pass and his enthusiasm
would wane. If I contacted him by phone, his momentum might continue another
few days, but finding a mutually convenient, quiet moment to talk on a
regular basis was exceedingly difficult. I tried scheduling frequent
follow-up appointments, but Eddie lived over an hour away from our hospital
and could not afford to keep missing work.
Eventually, Eddie lost another two fingers, the front half
of his left foot and his entire right foot. The youngest man in my waiting
room soon became confined to a wheelchair. At the end of our last visit, I
stood in the clinic hall watching him inch away from me in that chair,
pushing off the ground with the remaining stump of his left foot and grasping
at the wheels with hands that had become mitts.
I thought about Eddie and other patients I have cared for
who might have benefited from more frequent contact when I spoke with my
colleague about social media and the patient-doctor relationship. I wondered
if Eddie would have felt a little less isolated and perhaps been able to quit
smoking if I had, for example, texted a word of encouragement to him every
few days, interacted through blog comments, or directed him to an online
community of people who were dealing with the exact same disease.
A survey released today by the Pew Internet and American
Life Project reports that 61 percent of Americans go online for health
information, and the majority of them have turned to user-generated health
information. But a quick scan through peer-reviewed journals reveals only a
handful of articles, and no evidence-based guidelines, to guide doctors on
the use of social media. It is unclear whether such engagement adds to or
detracts from a therapeutic patient-doctor relationship, and clinicians are
unsure about what constitutes good standards of care and professional
responsibility on these platforms. For example, should doctors give out
diagnoses or prescribe treatment on Facebook or a
blog? If doctors and patients communicate on Twitter, is a doctor liable if
she or he misses a patient’s tweets about the acute onset of shortness of
Dr. Sean Khozin, who blogs and
can be found on Twitter @SeanKhozin, is an
internist and founding member of Hello Health, a paperless “concierge”
practice based in Brooklyn that utilizes e-mail, instant messaging and video
chat for coordinating care. “There are so many layers of bureaucracy between
health care providers and patients,” Dr. Khozin
said. “We can use social media to coordinate care with patients and with
different specialists, all using the same platform. I can monitor my
patients, and they can also use these tools to become empowered through a
better understanding of their own disease state and active engagement.”
In Dr. Khozin’s practice, that
engagement occurs on a secure site, as patient privacy remains a major
concern with all forms of social media. But on platforms such as Twitter and Facebook, where privacy is more difficult to insure,
those concerns also extend to physicians. “On the one hand it is really good
to see the human side of your doctor on a site like Facebook,”
observed Dr. Daniel Sands (@DrDannySands), a
physician at Beth Israel Deaconess Medical Center in Boston, Mass., and a
consultant with the Cisco Internet Business Solutions Group, as well as
co-author of the first set of guidelines ever published on using e-mail in
patient care. “On the other hand,” Dr. Sands continued, “maybe letting your
patient get too close isn’t always good for the therapeutic relationship.”
Taking on the responsibilities of yet another form of
communication can also be onerous for physicians, many of whom already feel
overburdened by multiple demands on their time. “Physicians are really busy,”
Dr. Sands said. “In our current health care environment, the only commodity
they have is time. Doctors don’t want to introduce new technologies of
unknown value, which is why many were hesitant about e-mail. Something like
Twitter is going to take longer to accept because the value proposition is
Still, there continues to be anecdotal evidence regarding
social media’s potential to strengthen the patient-doctor bond. “One way I
see that power is through education,” said Dr. Christian Sinclair, a
physician for Kansas City Hospice who has created a palliative care network
through his blog and Twitter (@ctsinclair). “I can
help to inform the public, I can put the knowledge I
have out there. And if there are patients or families who need this
knowledge, I can help them because of this network.” Dr. Sinclair has, for
example, helped individuals he has met through Twitter connect with local
hospices, a process he believes was expedited by
Twitter’s particular platform.
And social media can also help patients and physicians
widen illness support networks, which in turn can augment the patient-doctor
relationship. Health care providers have long known that patients with
chronic or life-threatening diseases benefit from support groups made up of
people who can sympathize and empathize with them. But such support is
difficult for physicians or hospitals and clinics to cobble together when
patients and families are physically isolated or homebound, or when they have
an orphan disease like Eddie’s.
“With social media,” Dr. Sands observed, “we can aggregate
across space and across the world and create a safe environment for support.
Although there may be only 10 people in greater New York with a certain disease, there may
be 250 people across the world.” Dr. Sands recalled guiding a patient to the
Association of Cancer Online Resources, a social network of online
communities for patients and families. “That was the most important advice I
ever gave him. It was an information prescription.”
Social media platforms can turn 10- or 20-minute doctor’s
visits into an ongoing dialogue, where sources of information and,
potentially, support are continually available to the patient and the doctor.
“Platforms like Twitter can be powerful if doctors are a lot more active in
disseminating their expertise,” Dr. Khozin said.
“Patients are being bombarded with information online, but I don’t think all
that information necessarily empowers them. You also need expertise.”
Social media has kept me connected with colleagues and a
few former patients, allowed me to stay up-to-date with certain health care
and medical education issues, and helped me to keep abreast of Web-based
resources that might be useful to those I care for. It has also taught me a
tremendous amount about the experiences of patients and caregivers,
information I’m not sure I would have had access to had I not been engaged
online. Although I am far from a savvy user, I have come to think of social
media like I do any other test, instrument or procedure; it’s extremely
helpful in some situations, and for some patients, and less so in others.
A few days ago, staring at a blank screen and thinking
about this column, I tweeted: Working on column on social media (spec.
Twitter, Facebook, blogs) and patient-doctor
relationship. Any opinions?
Minutes later I began to receive replies, including this
one from @achronicdose:
Knowledge from patient-peers thru social media *can* mean
more helpful talks w/ dr; dr. p.o.v.
helpful for patients to read.
Doctor or patient, you are never alone in the twitterverse or blogosphere; there is always someone who
is willing to offer some help or lend some support. It’s a world that I think
might have made all the difference for a patient like Eddie.
[BACK TO TOP]
The New York Times | 06.11.09
By DUFF WILSON
— More than four decades after the surgeon general declared smoking a health
hazard, the Senate on Thursday cleared the final hurdle to empowering federal
officials to regulate cigarettes and other forms of tobacco for the first
The legislation, which the White House said President
Obama would sign as soon as it reached his desk, will enable the Food and
Drug Administration to impose potentially strict new controls on the making
and marketing of products that eventually kill half their regular users. The
House, which passed a similar bill in April, may vote on the Senate version
as soon as Friday.
“This is a historic step changing the nature of tobacco in
society forever,” said Clifford E. Douglas, the director of the University of Michigan Tobacco Research Network,
which has extensively studied the health effects of smoking and was one of
many groups that have long pushed for tobacco regulation.
The Congressional Budget Office has estimated the new law
would reduce youth smoking by 11 percent and adult smoking by 2 percent over
the next decade, in addition to reductions already achieved through other
actions, like higher taxes and smoke-free indoor space laws.
The Family Smoking Prevention and Tobacco Control Act, as
it is called, stops short of empowering the F.D.A. to outlaw smoking or ban
nicotine — strictures that even most antismoking advocates acknowledged were
not politically feasible and might drive people addicted to nicotine into a
criminal black market.
But the law would give the F.D.A. power to set standards
that could reduce nicotine content and regulate chemicals in cigarette smoke.
The law also bans most tobacco flavorings, which are considered a lure to
first-time smokers. Menthol was deferred to later studies. Health advocates
predict that F.D.A. standards could eventually reduce some of the 60
carcinogens and 4,000 toxins in cigarette smoke, or make it taste so bad it
The law would also tighten restrictions on the marketing
and advertising of tobacco products. Colorful ads and store displays will be
replaced by black-and-white-only text. Beginning next year, all outdoor
advertising of tobacco within 1,000 feet of schools and playgrounds would be
And cigarette makers will be required to stop using terms
like “light” and “low tar” by next year and to place large, graphic health
warnings on their packages by 2012.
“This is a bill not for a one-year or two-year splash, but
for a long-term impact,” said Matthew L. Myers, president of the Campaign for
Tobacco-Free Kids, a Washington
advocacy group that took a lead in coordinating support for the legislation.
Industry analysts say that the imposition of fees on
cigarette companies to pay for the creation and administration of a new
F.D.A. tobacco oversight department, which could eventually reach 6 cents a
pack, could further raise the cost of smoking.
Industry analysts, though, predict that federal
regulation, like higher taxes, will be manageable for the tobacco companies.
As long as they have a market of addicted customers, even if that clientele
is dwindling, they can raise prices to remain profitable.
The law would be the first big federal step against
smoking since the 1971 ban against tobacco advertising on television and
radio and the 1988 rules against smoking on airline flights — but potentially
much more sweeping than either of those moves.
The law might also address the perceived shortcomings of
the $206 billion “master settlement” agreement that seven tobacco companies
reached with 46 states in 1998 to resolve lawsuits and change their marketing
practices. Afterward, cigarette companies nearly doubled their marketing
spending and increased their advertising in stores.
Although the nation’s smoking rate has gradually declined
in recent years, an estimated one in five people in this country still smoke.
And more than 400,000 of them die each year from smoking-related disease.
For decades, though, despite influential studies in the
early 1950s linking smoking to cancer and even after the surgeon general’s
report in 1964, Congressional efforts to regulate tobacco met stiff
opposition from lawmakers from tobacco-growing states and their political
And when the F.D.A. tried on its own to start regulating
nicotine as a drug, the Supreme Court struck down that effort in 2000, saying
the agency could not take such a step without Congressional authority.
Cigarettes remained less regulated than cosmetics or pet food.
But this time the antitobacco
forces came into alignment, with broad bipartisan support in Congress, where
Mr. Obama — himself a smoker who has acknowledged his trouble in quitting the
habit — had been a sponsor of the legislation when he was still in the
Senate. The Senate passed the bill Thursday by a vote of 79 to 17. The only
Democrat voting against it was Kay Hagan of the North Carolina, the leading
Another political factor was the willingness of the
nation’s biggest tobacco company, Altria Group — owner of Philip Morris and
its industry-leading Marlboro brands — to accede to federal regulation. No
other tobacco company supported the legislation.
Publicly, Altria pushed the legislation for “the greater
predictability and stability we think it will bring to the tobacco industry,”
as a spokesman, Brendan J. McCormick, said this week.
But the impulse dates to the 1990s, when according to
Philip Morris documents released during lawsuits, the company decided to
remake its image as a responsible corporate citizen. Part of that strategy
was to advocate legislation to reduce the risks in cigarettes, and avoid
smoking’s being outlawed outright.
Moreover, as the industry’s richest company, with profits
last year of more than $3 billion, Altria, based in Richmond, Va.,
has built an extensive scientific research operation. It may thus be the
company best equipped to deal with the F.D.A.’s new
review process for new, ostensibly safer tobacco products.
Under the law, new smokeless tobacco and other products
pitched as having lower health risks could be approved only if makers could
demonstrate health benefits to society as a whole — meaning the products
would not induce too many nonsmokers or would-be quitters to try them, rather
As Altria’s competitors have repeatedly argued in opposing
the legislation, Altria stands to retain more market share if the advertising
crackdown makes it harder for other companies to improve their sales
Yet, even Altria said Thursday the legislation, while “an
important step forward,” was “not perfect.” The Association of National
Advertisers says the act’s “unprecedentedly broad advertising restrictions”
violate First Amendment protections for commercial speech. Legal experts say
a court challenge on that ground is virtually certain.
[BACK TO TOP]
The New York Times | 06.11.09
By RONI CARYN RABIN
Morning sickness is an unavoidable part of pregnancy for
most women, but many are reluctant to take medications to quell nausea and
vomiting. Now one of the largest studies ever done
on a commonly used anti-nausea drug, metoclopramide,
has concluded it is safe and does not affect fetal development, even when
taken during the first trimester, a critical period of development.
The study, released Thursday in The New England Journal of
Medicine, analyzed the outcomes of more than 80,000 births in southern Israel
over the course of a decade. It found that the 3,458 babies whose mothers
were prescribed the drug during the first trimester of pregnancy fared just
as well as other babies.
They were no more likely to be born with congenital
abnormalities or to have other problems, such as being born prematurely,
having a low birth weight or dying, the study found.
“Our study is about 10 times larger than all of the other
studies of this drug put together,” said Dr. Rafael Gorodischer,
one of the study’s authors and a professor emeritus of pediatrics at Ben-Gurion University
“We studied exposure in the first trimester because that is the most critical
period for the development of the fetus, when most malformations would be
caused by an external cause.”
“We can now say with a high degree of confidence that it’s
a safe medication,” he said.
Metoclopramide is already used
to treat severe morning sickness in the United States, where it is
commonly sold under the brand name Reglan. But
while physicians who care for pregnant women said the results of the new
study are reassuring, they said they weren’t likely to prescribe it for
run-of-the-mill morning sickness of the kind most women experience at the
beginning of pregnancy.
For women with mild nausea and vomiting once or twice a
day, “There are conservative measures they can try, like eating little bits
of food all the time so they always have something in their stomach, using
antacids to deal with indigestion, or staying away from caffeine or anything
that smells bad to them,” said Dr. Peter Bernstein, a maternal-fetal medicine
specialist at Montefiore Medical Center in New
Still, Dr. Bernstein said the study was strong not just
because of its size but because it weighed factors other than malformations,
such as birth weight, that also affect the health of the baby.
To do the study, researchers analyzed a computerized
database of all medications dispensed to women in a health plan in southern Israel
from the start of 1998 to the end of March, 2007. They linked that with
maternal and infant hospital records during the same period of time, looking
at associations between the use of metoclopramide
and adverse outcomes in the babies.
Some 4.2 percent of the 81,703 babies born during the
10-year period were born to mothers who had been prescribed the drug, but
researchers found they were not at increased risk for congenital
abnormalities, prematurity, low birth weight or mortality soon after birth.
While some 5.3 percent of babies exposed to metoclopramide
were born with birth defects, compared with 4.9 percent of those who had not
been exposed to the drug, the difference was so small that it could easily
have occurred by chance.
There were also no significant differences in the risk for
low Apgar scores, a series of measures done
immediately after birth to assess newborn health, the researchers found.
Most of the women were prescribed the equivalent of about
a week’s worth of the medication, but researchers were unable to know for
sure whether they actually took the drug or not. Additional calculations
determined that even babies whose mothers took the drug for more than a week
did not face increased risks.
Metoclopramide, which has been
approved by the Food and Drug Administration, is used to treat gastric
problems, nausea and heartburn in adults. Long-term chronic use, however, is
associated with tardive dyskinesia,
a movement disorder. It is considered a Category B drug, which means it is
presumed to be safe to a fetus based on animal studies, though controlled studies
of pregnant women have not been done. It is one of several drugs already used
in the United States
to treat severe nausea and vomiting during pregnancy.
[BACK TO TOP]
The New York Times | 06.11.09
By DONALD G. McNEIL Jr.
PREVENTION In Mexico
City in May, a student wore a mask against swine
The swine flu virus is rapidly making its way around the
world, but it has been relatively mild so far, causing only 139 confirmed
deaths. Could it mutate into something more lethal?
Scientists looking at its genetic structure say there is
no obvious pressure for it to do so — no reason for this virus to “want,” in
the Darwinian sense, to kill more of its hosts.
It is already doing a near-perfect job of keeping itself
alive by invading human noses and inducing humans to cough it from one to
another, said Dr. W. Ian Lipkin, director of the
Center for Infection and Immunity at Columbia University’s Mailman School of
“A really aggressive flu that quickly kills its host” —
like SARS and H5N1 avian flu — “gives itself a problem,” Dr. Lipkin said.
But flu viruses are highly mutable, and anything could
happen in the next two years, the time a new strain normally takes to circle
the globe. After all, Spanish influenza began as a mild strain, then turned horrifically virulent, killing 20 million to 100
million people in 1918-19.
But Dr. Peter Palese, head of
microbiology at Mount Sinai Medical School and part of the team that rebuilt
that virus in 2005 from fragments found in old lung tissue, said that strain
was a “once-a-millennium or once-every-10-millennia event — things like it
don’t happen very often.”
Nor is it clear, he added, that viruses really “want” a
“For me, that’s too much anthropomorphic thinking,” Dr. Palese said. “Look, I believe in Darwin. Yes, the fittest virus survives.
But it’s not clear what the ultimate selection parameter is.”
A mutation that confers lethality, he explained, may
confer another advantage scientists have not pinned down.
The new virus has been described as “a real mutt” by
Walter R. Dowdle, the former chief of virology for
the Centers for Disease Control and Prevention, because of its unique mix of
Eurasian and American swine, human and bird genes.
Flu chromosomes are quite simple — eight short strands of
RNA that issue the genetic code for a grand total of 11 proteins. They break
apart in a jumble inside cells they infect, and then they reassemble, picking
up random bits of other flus, which makes the results unpredictable.
The current swine flu strain lacks several genes believed
to increase lethality, including those that code for two proteins known as
PB1-F2 and NS-1, and one that codes for a tongue-twister called the polybasic
hemagglutinin cleavage site.
PB1-F2 appears to weaken the protective membrane of the
energy-producing mitochondria in an infected cell, ultimately killing the
cell. Specifically, it attacks dendritic cells, the
sentinels of the immune system. Its lethality could be accidental — a protein
good at killing sentries might just go on killing other cells once inside the
All pandemic flus, including
those of the Spanish, Hong Kong and Asian flus,
make PB1-F2. So does the H5N1 bird flu. The current swine strain does not.
The NS-1 protein also maims the immune response by
blocking interferon, an antiviral protein made by cells.
Very lethal bird flus also have
the unusual cleavage site, which allows the hemagglutinin
spike on the virus’s shell to split and inject its genetic instructions into
different kinds of cells, like those in the lungs and the gut.
Such an addition to the novel H1N1 would be very
dangerous. But because it has been found only in avian flus,
it is unlikely to become a component of a human flu, Dr. Palese
said. Even the 1918 virus, which was avian in origin, lacked it.
A much more likely change, scientists have said, is that
the H1N1 swine flu will become resistant to the antiviral drug Tamiflu. A gene for Tamiflu
resistance is now almost universal in seasonal H1N1 flus.
If that happens, the world’s Tamiflu
stockpiles will be all but worthless, and doctors may have to switch to Relenza, which is a powder used with an inhaler, which
makes it more expensive and harder to take.
Depending on the mutation, older antiviral drugs like rimantidine may be useful, but so much resistance to them
developed in seasonal flu that they were largely abandoned a few years ago.
Dr. Palese was asked about
another notion concerning likely mutations. There has been outrage at Egypt’s
decision to kill all the pigs belonging to its Coptic Christian minority. It
has been depicted as misguided and motivated by religious bigotry, because
the “swine flu” is really now a human flu.
is also in an especially dangerous situation. The new swine flu reached it
just last week. The H5N1 avian flu has circulated in its backyard chickens
since 2006, defying all eradication efforts. In the last year, dozens of H5N1
cases have been confirmed in toddlers, almost all of whom have survived —
which led some experts to speculate that those are cases of a less lethal
version of H5N1 that is better adapted to humans.
In that case, might it be wise to get rid of the country’s
relatively small pig population, since pigs are “mixing vessels” that can
catch both human and bird flus?
“I agree with the premise, if you really could eliminate
an animal reservoir,” Dr. Palese said. “But the
virus is out of pigs now — and it’s more important that those poor people
have something to eat.”
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The New York Times | 06.11.09
By Anne Underwood
Brandon Thibodeaux for The New York Times
Bob Branham, 78, at home with some of his quilting
projects. He participates in a study designed to see whether acquiring new
skills can stave off dementia.
At the age of 78, Bob Branham, a retired computer software
developer in Dallas, Tex., took up quilting. It wasn’t his idea,
actually. He’d never dreamed of piecing together his own Amish diamond
coverlet or rummaging around Jo-Ann Fabrics in search of calico prints. But
then he enrolled in a trial sponsored by the National Institute on Aging to
assess whether learning a new skill can help preserve cognitive function in
old age. By random assignment, he landed in the quilting group.
When it comes to mental agility, we’re more likely to
think of crosswords than cross-stitch. But neuroscientists suspect that
learning a challenging new skill — a new language, a new musical instrument —
may be even more effective than mental games at keeping the brain sharp. And
quilting is more complicated than it may seem.
“It’s a very abstract task,” said Dr. Denise Park, a
cognitive neuroscientist at the University
of Texas at Dallas, who is leading the trial. “You have
to picture what the pattern will look like, match fabrics, manipulate
geometric forms, mentally rotate objects.”
In Mr. Branham’s case, he also had to learn to use a
sewing machine. And while it’s too early to tell if quilting is sharpening
his mind, he quickly found that he loved his new pastime. He spends as much
as 40 hours a week piecing and stitching, both at home and at the social
center that Dr. Park set up for the trial.
“I get ideas and pointers from the instructor and the
other participants,” he said. “We have a real good time.”
Memory is among the least understood areas of
neuroscience, and the sad truth is that there is no magic pill or potion at
present that will prevent our parents’ minds from failing. But a panel of 30
experts from the United States
and Europe recently issued a consensus
statement on what we do know about maintaining brain fitness (which includes
not only memory, but also reasoning, attention and speed of processing). The
verdict was that three things are crucial: physical exercise, mental
challenges and good health habits in general.
But wait! What about the supplements and software programs
we’ve been stocking up on? “There’s a lot of snake oil out there,” warned Dr.
Laura Carstensen, director of the Center on
Longevity at Stanford
co-chaired the panel. In short, don’t count on supplements. (The rationale
behind ginkgo biloba is plausible, but there is no
scientific evidence it works.) Steer clear of anything that promises to
prevent Alzheimer’s disease. (Such a claim would require approval from the
Food and Drug Administration, and no product has it.) And look skeptically on
software programs. (Most improve performance only on the games themselves,
not mental function in general.)
Quilter Bob Branham reaches for a needle.Brandon
Thibodeaux for The New York Times
Instead, Dr. Carstensen said,
get moving. Exercise may sound like an impractical way to boost Mom’s
cognition when her energy levels are dwindling. But multiple studies show it
helps. In a study published in the Archives of Internal Medicine in 2001,
women ages 65 and older who walked the most showed the least cognitive
decline over an eight-year period — up to 30 percent less than their
Another trial in the journal Nature by Dr. Arthur Kramer,
a neuroscientist at the University of Illinois at Urbana-Champaign, found not
just slower declines but actual improvements in working memory, attention and
executive skills in older adults (average age 72) after six months of an
aerobic exercise program — specifically, 45 minutes to an hour of walking,
three times a week.
How could aerobic exercise possibly accomplish this? Among
other things, it increases blood flow, encourages the formation of new
synapses and reverses some of the age-related decline in brain volume. “If
exercise were a pill, it would be the most expensive drug on the market,”
said Dr. Carstensen.
Other good habits are important, too. As neuroscientists
like to say, what’s good for the heart is good for the brain. That would
include maintaining healthy blood sugar and blood pressure levels. A study
last December in the Annals of Neurology showed that controlling blood sugar,
even in non-diabetic adults, can help prevent deterioration in a part of the
brain that’s necessary for memory formation. Another paper published in the
Archives of Neurology in February by scientists at Columbia University found
that eating a heart-healthy Mediterranean diet — rich in fish, vegetables,
whole grains, fruits, legumes and unsaturated fats — lowered the risk of mild
cognitive impairment over four and a half years by as much as 28 percent.
But even if Mom follows all the advice she herself used to
propound — eat your vegetables, go outside and exercise — there is no
substitute for mental challenges. The brain is a use-it-or-lose-it type of
organ. Synaptic connections that aren’t firing will weaken.
The problem with most of our favorite approaches to
staying sharp is that they are narrowly focused when what’s needed is global
improvement. Crosswords are great for word retrieval. That’s clearly
important. But not even The Times’s Sunday puzzle
by Will Shortz will help you remember where you
left your car keys. “If you want lots of improvement, you have to do mental
cross-training,” said Dr. K. Warner Schaie, a
professor of psychology at Pennsylvania
In short, engage in many types of mental activity. Do
crosswords, Sudoku, acrostics, play bridge, read books, join clubs, get into debates, volunteer — anything to keep the mind
alive and engaged in new and interesting tasks. If the activity includes
social interaction, so much the better. Or take up a new hobby, a new
language or a new instrument that will challenge the brain in entirely
different ways, preferably for years. “One problem with aging is that you develop
expertise in a few things and do them over and over,” said Dr. Carstensen. “Proficiency is good, but it’s probably not
growing new synapses.”
Mr. Branham, on the other hand, seems to be sprouting
plenty of neural connections. He’s now completed two full-sized quilts — one
a sampler with various patterns, the other a split rail design with stars in
the four corners. He’d even like to launch a small business selling his
patchwork place mats and table runners. When friends at church ask him why he
signed up for such a study, and why on earth he agreed to start quilting, he
has a ready answer. “Studies need participants,” he says. “And you should
sign up, too.”
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