New Orleans hospital issue still unsettled in busy
day at Capitol
by Jan Moller
and Bill Barrow, The Times-Picayune
BATON ROUGE -- An impasse
over the proposed New Orleans
teaching hospital, a pitched battle over school-based dentistry, a
high-profile economic development announcement and a proposal to tax Internet
users highlight a busy day in state politics as the Legislature chugs toward
the finish line.
First, the impasse: This
morning marks the last time the Senate Health and Welfare Committee is
scheduled to meet this session, yet as of late Tuesday the committee's agenda
did not include House Speaker Jim Tucker's controversial bill to transfer
control of the proposed New Orleans teaching hospital from LSU to a
non-profit corporation run by an independent board.
House Bill 830, which flew
through the House with little trouble, has spent the last month stuck in a holding
pattern while Health and Hospitals Secretary Alan Levine tries to negotiate a
truce that LSU and Tulane -- whose leaders are barely on speaking terms --
can both live with.
Both sides have plenty of
incentive to deal. For Tulane, the incentive is this: Getting the bill
through a committee whose chairwoman, Sen. Willie Mount, D-Lake Charles, is
married to an LSU board member is no guarantee as long as LSU remains
adamantly opposed. And if the bill (which Tulane strongly supports in its
current form) were to fail, all the negotiating leverage would shift to LSU.
LSU also has incentive to
deal, since university officials will still have to spend the next two years
dealing with Tucker no matter what becomes of the bill. It's tough to run a
charity hospital system -- let alone build a $1.2 billion teaching hospital
-- with the House speaker as your enemy.
Levine and Tucker both said
Tuesday that they are hopeful that a deal can be reached this session, but
that it won't be done today. "We still have a little more work to
do," Levine said, adding that Thursday is the earliest an agreement
could be struck.
If that happens, the health
committee could schedule a special meeting to consider the bill. But even if
the legislation never gets a hearing, the matter still could be settled
through a memorandum of understanding between the state and the universities
that spells out how the hospital would be governed. Such an approach would
not necessarily take the Legislature out of the picture, since the Joint Budget
Committee would probably have to approve any contract that grows from the
MOU.
• Then, the dentists: One
bill that's certain to come up in the Senate health committee is the
much-lobbied House Bill 687, which has become something of a full-employment
act for lobbyists this session. The bill, which started out as an effort to
ban school-based mobile dental clinics, ran into trouble in the House and had
to be rewritten so that it now directs the Louisiana Board of Dentistry to
draw up new regulations.
While the bill has strong
backing from the Louisiana Dental Association, it still faces determined
opposition from the operators of school-based mobile clinics, who fear it
would put them out of business and reduce poor children's access to care.
There is also the matter of
Tucker, a co-sponsor of the bill who is not the most popular guy in the
Senate these days after the House essentially rejected the Senate's overtures
to make a deal on the $28 billion state budget. There has been plenty of
loose talk in the hallways about the Senate retaliating against their
colleagues across the hall and this would be an opportunity for that to
happen.
• Gov. Bobby Jindal, meanwhile, plans to leave the squabbling in Baton Rouge and fly to Monroe for an 11:30 a.m. announcement of a
new automobile plant that, in the words of economic development secretary
Stephen Moret, "will be of significant
importance to the national economy."
While details won't be
announced for a few hours, it's virtually guaranteed that the project will
require a substantial contribution from the state's Mega-Project Development
Fund, the $186 million kitty that was set up to attract just this type of
investment to Louisiana.
It was only a couple of
months ago that the Jindal administration had to
fend off legislators who wanted to raid the so-called mega-fund to plug holes
in the state's operating budget. Today's announcement pretty much guarantees
that such talk won't be part of the late-stage budget negotiations between
the House and Senate.
• In a session that's been
tough on anyone advocating higher taxes, today brings the final committee
hearing for a bill that's enjoyed surprising success to this point: Rep. Mack
"Bodi" White's House Bill 569, which
would slap a 15-cent monthly charge on Internet services to raise money for
an Internet crimes unit in the attorney general's office.
The bill has gained
surprising momentum because it would help crack down on one of the few things
Louisiana
legislators hate more than taxes: sexual predators who
use the Internet. But it also has picked up a long list of industry
opponents, who say it won't pass legal muster since federal law prohibits
taxing the internet.
http://www.nola.com/politics/index.ssf/2009/06/new_orleans_hospital_issue_sti.html
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Baton Rouge Business Report | 06.15.09
By John Maginnis
Providing tickets for
legislators to purchase for the NCAA Super Regional baseball series at LSU
was the least that school officials could do, given how much tumult,
hostility and fear the university’s issues have caused at the Capitol this
spring.
The flagship’s budget woes,
leading those of all higher education, have been a source of rancor and
tension between lawmakers and the administration. On top of that, an intense
power struggle over the size, site and control of LSU’s proposed teaching
hospital and medical center in New
Orleans has landed in the middle of the legislative
session.
With it comes the renewed
bitter rivalry between LSU and Tulane, marked by some condescending
statements about the city from the LSU president, veiled threats the medical
school might pull up stakes and an old-fashioned hallway shouting match
between the state treasurer and a school official.
The controversy might be
worth the unpleasantness if it had something to do with shaping the future of
public health care and hospitals in Louisiana.
But the state seems headed in the opposite direction from what it’s trying to
do in New Orleans.
Yet, at $1.2 billion, the fate of the project commands the interest of
legislators statewide.
LSU’s proposal to build
alongside a planned Veterans Administration hospital on a 70-block tract in
the middle of the city is opposed by preservationists, some doctors and
community groups that want it to rebuild Charity Hospital,
which they argue is the faster, cheaper alternative for restoring a vital
health asset. Supportive of its cause is Tulane, whose medical center would
be left isolated downtown if LSU and the VA relocated across elevated
Interstate 10.
LSU officials are adamant
it will not re-occupy the old building as long as it is responsible for
public health care in New Orleans.
That could change with passage of legislation by Speaker of the House Jim
Tucker, an Algiers Republican, which would remove LSU from control of the
medical complex and turn that over to an independent board of community
stakeholders, including all local universities involved in medical education.
Tucker says he is not
opposed to the new hospital complex, but he wants LSU to stick to running its
medical-education program. He gets quiet support on that score from within
the LSU community, where there are people who believe its health-care
responsibilities detract from its higher-education mission.
Gov. Bobby Jindal supports the medical complex, but says he would
sign Tucker’s bill if it passes. What Jindal really
wants, he says, is for LSU to agree to have Tulane and other schools
represented on the board of the nonprofit governing corporation still to be
formed. LSU, at first strongly opposed to power-sharing with Tulane, is
becoming more amenable under pressure. If the two schools reach some accord,
even at the point of Jindal’s shotgun, the larger
challenge would be reaching a settlement on the old building with FEMA and
selling Wall Street on its financial plan—some very big ifs.
That might leave the
preservationists feeling jilted, but state and school officials agree the
iconic 1939 structure will be saved and put to new use.
The plan for the new
medical complex, given its broad economic development potential, might sound
like the future of public health care in Louisiana, but it more likely will be the
last hospital the state builds. LSU has given up on erecting a new hospital
in Baton Rouge and instead is forging a
partnership with Our Lady of the Lake
Regional Medical
Center to train doctors
and provide indigent care. The Jindal
administration envisions gradually doing the same in other parts of the state
with the exception of Shreveport, where the
high-quality University Medical Center
is the model that LSU hopes to emulate in New Orleans.
The state’s most forward-looking
public hospital—which is ironic, given its original name, Confederate
Memorial—trains LSU doctors, treats both private-pay patients and the
uninsured, and turns a profit. It also is to its city what LSU had better
learn to be in New Orleans,
a responsive and respected member of the community.
http://www.businessreport.com/news/2009/jun/15/lsus-power-play-struggles/?columnists
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By John Pope
Staff writer
A gene that controls growth in an array of cancers,
including those of the stomach, throat and nose, can be inactivated with
compounds already available, LSU
Health Sciences
Center researchers have
found.
These cancers, as well as
several types of lymphoma, are associated with the Epstein-Barr virus, a
herpes virus that also causes infectious mononucleosis. Proteins the virus
makes are necessary for tumor growth, but they can be thwarted with existing
therapeutics, including Vitamin K, the scientists found.
The work may lead to new
ways of controlling diseases linked to the Epstein-Barr virus, said LSU
microbiologist Ashok Aiyar, the team leader.
Also in the group were
microbiologists Kenneth Johnston and Timothy Foster. Their work is in the
latest online edition of PLoS Pathogens, a
peer-reviewed journal.
. . . . . . .
MEDICAL NEWS: The LSU Health Sciences Center
Geriatric Medicine Fellowship Program has returned to New Orleans,
three-and-a-half years after Hurricane Katrina forced it to resettle in Lafayette.
Accreditation of the relocated one-year program will start July 1.
-- Tulane University
researchers have received a $7.07 million federal grant to work with Corgenix Medical Corp. to develop kits to detect Lassa
viral hemorrhagic fever, which is spread by infected rodents. It is
especially prevalent in West Africa, where
it infects as many as 500,000 people per year and causes about 5,000 deaths.
-- Cardiovascular
researchers from Tulane will work with their counterparts at the University of Buenos Aires
in Argentina
to establish the South American Center of Excellence in Cardiovascular
Health. It is underwritten with a five-year, $2.3 million grant from an arm
of the National Institutes of Health.
http://www.nola.com/news/t-p/metro/index.ssf?/base/news-34/1245216212129360.xml&coll=1
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Advocate staff report
Woman’s, BR Clinic team
for heart health
Woman’s Hospital and the
Baton Rouge Clinic have formed a partnership to provide a cardiovascular
wellness program designed for women called HerHeart.
The death rate from
cardiovascular disease has declined in men but remained unchanged in women.
“This trend regarding
woman’s heart disease has not improved mainly because the screening tools
being used are not sensitive enough to women’s health issues,” said Dr. David
Carmouche, director of the Center for Cardiovascular
Disease Prevention at the Baton Rouge Clinic.
Among the screening tools
geared for women is the carotid intima media
thickness test, which uses an ultrasound machine to measure the thickness of
artery walls in the neck. Determining the health of the carotid arteries
gives doctors an idea of the health of the arteries that directly feed into
the heart.
The HerHeart
Program will be housed at the Woman’s Center for Wellness at the intersection
of Bluebonnet Boulevard
and Jefferson Highway.
It offers nutrition counseling, fitness training and screenings to prevent
heart disease.
According to Woman’s and
the Baton Rouge Clinic, women who should consider a heart screening are ages
40 to 75 with a family history of heart disease, who smoke or did smoke,
elevated cholesterol, high blood pressure, diabetes or pre-diabetes, ongoing
hormone replacement therapy, poor diet, physical inactivity or upper body
obesity.
LSU student wins award
for knee joint
Jeremy Theriot, an LSU
bioengineering graduate now working on his doctorate at UCLA, won a
second-place award for designing a knee stabilization joint in the AbilityOne Network Design Competition.
Theriot, who represented
LSU in the competition, received $5,000 for his joint that helps people with
post-polio syndrome have more joint flexibility than the average knee brace,
a statement from the AbilityOne Program says.
The AbilityOne
Program is a national network of nonprofits that provides jobs for people
with severe disabilities. It holds the competition looking for devices to
help people with disabilities work.
Early diabetes signs in
kids recorded
A researcher at the LSU
Health Sciences
Center in the New Orleans School
of Public Health has found some probable signs of impending Type 2 diabetes
in children ages 7 to 9.
Melinda Sothern, director
of health promotion at the center, presented her data on June 8 at the
American Diabetes Association 2009 Annual Scientific Session in New Orleans.
The researchers found the
weight of fat for a child and his cholesterol levels are strong indicators of
developing insulin resistance and Type 2 diabetes.
Fat in liver and leg muscle
cells are also strong predictors of pending diabetes because it indicates an
impaired fat burning ability in the muscles. However, the leg muscle fat is
less a risk factor if the child’s mother maintained a healthy pregnancy
weight and breastfed and if the child is physically active.
The data came from
examining 118 healthy children ages 7 to 9 enrolled in an ongoing study of
insulin sensitivity in low-birth weight youth.
http://www.2theadvocate.com/features/48210612.html?index=14&c=y
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Independence, Louisiana, December 11, 2008
BATON ROUGE – Six months
ago, on December
11, 2008, snow blanketed much of south Louisiana.
For the rest of this week, highs throughout the region will be in the
mid to upper 90’s.
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By
Jan Moller
Capital
bureau
BATON
ROUGE -- As legislators try to cobble together the remaining pieces of next
year's state budget picture, they also are grappling with how to make up
shortfalls in current-year spending.
With
less than two weeks left in the 2009 fiscal year, more money is needed to
meet the state's obligations to public schools, the LSU Health
Sciences Center,
supplemental pay for law enforcement personnel and for housing state inmates
in local jails, among other things.
The
money is contained in a supplemental appropriations bill, House Bill 881 by
Rep. Jim Fannin, D-Jonesboro, which is pending in
the Senate Finance Committee. But some of the money to cover the shortfalls
is coming through a separate bill, Fannin's House
Bill 802, which would plug $48 million by raiding unspent balances from
nearly three dozen state funds.
Advertisement
The
funds bill was sent to the Senate floor Tuesday after a protracted debate in
the Finance Committee where some senators complained that the House had
failed to include enough money to finance all of the state's current-year
obligations.
Sen.
Lydia Jackson, D-Shreveport, cited $36 million to pay legal judgments against
the state that was included in the supplemental budget bill without a
financing mechanism. "I just need the House calculator. It's not working
for me," Jackson
said.
With
the $28.7 billion operating budget already sent to Gov. Bobby Jindal's desk, the debate has shifted to a number of
smaller budget bills that are generating more than the usual acrimony between
the House and Senate.
Jindal has said he plans to veto about $278
million in the budget bill, money that is tied to the passage of separate
legislation. That is expected to free up at least $120 million that
legislators could spend in other bills. Higher education, health care
providers, arts, agriculture and other state programs are all competing for a
share of the money, while legislators also want to earmark money for projects
in their districts.
Senators
want to plug even more money into the bills by tapping the state's rainy-day
fund, a move that House leaders are resisting.
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By The Associated Press
BATON ROUGE, La. (AP) —
Hospital leaders are telling lawmakers that proposed cuts to Louisiana's Medicaid
program could cost 3,700 people their jobs at hospitals around the state.
The state Department of
Health and Hospitals' $8 billion proposed budget next year would slice nearly
$400 million from the Medicaid program for the poor, elderly and disabled.
The cuts would be levied largely on the hospitals and nursing homes that care
for Medicaid patients.
The Louisiana Hospital
Association says that would mean reductions in services and layoffs of
hospital staff.
State Health and Hospitals
Secretary Alan Levine has said even with the cuts, the hospitals still would
be receiving more money from the state than they did two years ago.
The budget cuts are still
under negotiation in the Legislature.
http://www.pddnet.com/news-ap-hospitals-say-proposed-cuts-would-force-layoffs-061709/
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By MICHELLE MILLHOLLON
Advocate Capitol News
Bureau
The Senate took several
shots at both the House and the Jindal
administration Tuesday in an ongoing struggle over the state’s financial
problems.
The most-pointed remarks
came in a late night meeting of the Senate tax committee.
Many in the Senate were
vocally perturbed when the House sent the $28 billion budget bill to the
governor rather than work out differences in a conference committee.
The Senate is pushing
several revenue-generating measures the House opposes. The Senate argues the
state needs to raise money to lessen cuts to health care and higher
education. The House contends that state government needs to tighten its
belt.
In the Senate Revenue and
Fiscal Affairs Committee on Tuesday night, members acquiesced to the House’s
argument by voting to defer House bills that would decrease state revenue.
State Sen. Robert Adley, R-Benton, asked state Rep. Jonathan Perry how he
voted on House Bill 1, the main budget legislation.
Perry, who was pushing a
tax break for school support workers, retorted that Adley
probably already knew the answer to that question.
Adley confirmed he had a printout of the vote on HB1
showing Perry voted against sending the budget to a conference committee.
“That day I was …
cloudy-headed,” Perry said.
Adley started laughing and congratulated Perry on his
answer.
State Sen. Dan Morrish, R-Jennings, said Perry is one of his
representatives.
“With answers like that, he
might soon replace you,” state Sen. Rob Marionneaux,
D-Grosse Tete and the committee’s chairman, told Morrish.
The Senate Committee on
Revenue and Fiscal Affairs then voted not to forward House Bill 860, Perry’s
legislation, for further consideration.
Other House bills met
similar fates or were skipped. The session ends in a little over a week — on
Thursday, June 25 — and a number of House bills are sitting on the
committee’s calendar.
State Rep. Hunter Greene,
R-Baton Rouge and chairman of the House tax committee, asked to speak to the
panel at the end of the meeting.
He told the Senate
committee he is not ignoring Senate bills that are still with his House
committee.
Marionneaux responded that he is not paid enough to stay at the
State Capitol past 8:30 p.m. to hear bills. It was 8:30 p.m. at that point.
Earlier in the day, a
routine bill to shift money from special funds to cover state budget
shortfalls sparked testy debate in a meeting of the Senate Finance Committee.
The Jindal
administration wants to use House Bill 802 to plug $48 million into shortfalls
in the current year’s budget. Funding is falling short for education, college
scholarships and other obligations.
The Senate Finance
Committee agreed to the legislation but only after raising questions.
Several lawmakers expressed
concern about dipping into funds set up for health-care redesign, mineral
resources and other purposes.
The debate on the bill was
unusually protracted — an indication of the divide over budget issues.
HB802 was just one of a
number of budget-related bills pending before the committee with time running
short to act on them.
The committee’s chairman,
state Sen. Mike Michot, R-Lafayette, said the panel
will continue to meet.
The bills are the Senate’s
biggest negotiation tools in a dispute with the House over funding for higher
education and other services.
State Sen. Nick Gautreaux, D-Meaux, likened HB802 — the funds bill — to robbing funds. He
questioned whether the Jindal administration
thoroughly scoured state agencies for extra dollars.
Ray Stockstill,
state director of management and budget, said the administration did what it
could and still ended up with shortfalls.
He said $26 million is
needed in basic state aid to schools, partly because more teachers were hired
than anticipated. He said about $3 million is needed for TOPS, the
merit-based Taylor Opportunity Program for Students that pays students
college tuition.
“The funds that we’re
sweeping to zero, what is the continuing need?” asked state Sen. Lydia
Jackson, D-Shreveport and vice chairwoman of the committee.
She suggested that
lawmakers might be impairing the needs that the funds serve.
http://www.2theadvocate.com/news/48215522.html
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Shreveport Times | 06.17.09
By
Melinda Deslatte
The
Associated Press
BATON
ROUGE -- Ideas about how to restructure, divvy up and use the state's
"rainy day" fund are plentiful at the Louisiana Capitol, as the
fund has become one of the central arguments in the state budgeting battle
between the House and Senate.
Whether
lawmakers tap into the rainy day fund will help determine the depth of cuts
that colleges, health care and other programs take in the more than $28
billion budget for the new fiscal year that begins July 1.
An
impasse between the two chambers continued Tuesday. Lawmakers are grappling
over whether to make steep cuts in services to cope with a $1.3 billion drop
in state general fund revenue or to use one-time funds, like the rainy day
fund, or other revenue sources to plug gaps and lessen cuts.
The
Senate has overwhelmingly backed a plan to take the one-third of the rainy
day fund allowed under law -- or $258 million -- and divide that money into
three allocations of $86 million. The money would be doled out over three
budget years to help stave off cuts.
"We're
at a time where we can certainly make a case for tapping into one-third of
the rainy day fund," said Sen. Mike Michot,
R-Lafayette, chairman of the Senate Finance Committee.
The
idea hasn't come up for debate in the House because leaders there oppose
using the fund this year and instead want to use it for the 2011-12 budget
year, when federal stimulus aid disappears and Louisiana's budget woes are
expected to worsen.
"We
need to save some of our resources," said House Speaker Jim Tucker, R-Terrytown.
Either
plan would call for adjustments in the laws tied to the rainy day fund.
Formally
called the Budget Stabilization Fund, the rainy day fund was created in the
state Constitution in 1998 to help with state budget shortfalls. Certain pots
of money immediately flow into it, including budget surpluses and state
income tied to oil and gas.
The
fund can be tapped when the official state income forecast for an upcoming
budget year is less than the current year. Only one-third can be withdrawn in
a two-year period, and a two-thirds vote is needed in the Legislature.
Lawmakers have tapped the fund only once, in November 2002 for $86 million.
For
the Senate plan to work, senators said they would have to delay a glitch with
the fund that requires it to be refilled nearly immediately if lawmakers use
it. However, Gov. Bobby Jindal has said he was
concerned about that plan, saying a delay of only a year would worsen the
state's budget problems in upcoming years.
Under
the House leadership proposal, Tucker said lawmakers would have to rewrite
the complex provision that helps calculate the trigger for when the fund can
be used.
Those
aren't the only ideas for how to use the rainy day fund.
Some
lawmakers proposed using all $258 million now. Higher education leaders
floated an idea to use rainy day fund money in next year's budget and then
replace that money in the rainy day fund with state surplus cash -- to meet
the requirements for refilling the fund.
Jindal said he supports a budget maneuver
that would use $50 million from the rainy day fund to offset some higher
education cuts and then replenish the fund with dollars from a planned tax
amnesty program. The use of the rainy day fund money could help alleviate the
timing concerns of the tax amnesty money that House members agreed to use for
colleges.
But
Tucker and Appropriations Committee Chairman Jim Fannin
said this week that they don't support using the rainy day fund even as a
swap mechanism with tax amnesty money. Their opposition could ensure any
plans to use the fund for next year's budget remain stalled.
http://www.shreveporttimes.com/article/20090617/NEWS01/906170340/1060
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By
MICHELLE MILLHOLLON
Advocate
Capitol News Bureau
A
government policy research group urged the Legislature on Tuesday to avoid
making “hasty and ill-planned budget cuts” to higher education.
The
Public Affairs Research Council said the House’s opposition to
revenue-generating proposals should be reversed.
The
state is facing a $1.3 billion drop in revenue in the budget year that starts
July 1. Gov. Bobby Jindal proposed deep cuts to
health care and higher education to address the shortfall, which is expected
to last for several years.
The
state Senate suggested taking money from the state’s “rainy day” fund and
delaying a tax break to generate money for higher education and other state
government services.
Lawmakers
in the House — and the governor — are opposed to the ideas. Instead, the
House wants to take $50 million from a proposed tax amnesty program and use
that money for higher education.
The
governor said he plans to veto the Senate’s proposals from House Bill 1, the
$28 billion budget for the upcoming fiscal year.
The
proposals also are in separate pieces of legislation that appear destined to
die in the House.
The
session ends June 25.
PAR
said there still is time to agree on a plan to buy higher education time to
make changes.
The
group said the state’s public colleges and universities need to decide:
* Which degree programs are essential.
* Which programs are duplicated.
* Which services can be privatized.
* How students and faculty can be eased
through the changes.
Resizing
the state’s higher education system requires a studied approach, PAR said.
“Lacking
a clear strategy, drastic budget cuts could deter potential students and
faculty,” PAR said.
http://www.2theadvocate.com/news/48214747.html
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By DEBRA LEMOINE
Advocate staff writer
Arthur D. Lauck/The Advocate
Whitney Neves, a licensed
practical nurse, gives Tyler Williams, 10, a hepatitis A vaccination at the Ochsner Health Center
in Baton Rouge.
Incoming sixth-graders need
more than new clothes and school supplies to prepare for this coming school
year.
Their immunization records
also need to be up to date.
Starting with the 2009-10
school year, children entering the sixth grade must receive one dose of the
meningococcal vaccine, which protects against a main cause of bacterial
meningitis.
The newly minted middle schoolers and children entering kindergarten or
pre-kindergarten also will need two doses of the varicella,
or chicken pox, vaccine.
If these shots don’t seem
all that “new,” that is because the meningococcal vaccination and the chicken
pox vaccinations have been recommended for years, said Dr. Frank Welch,
medical director for the state Department of Health and Hospitals Office of
Public Health Immunization Program.
Typically, new vaccines are
recommended for a few years before health officials determine whether to make
the shots a requirement, Welch said. Not every new vaccine becomes a
requirement, he said.
“This is the next step in
that process,” he said.
What is new about this
update to childhood immunizations is that school officials must now examine
student health records for sixth-graders, said Sue Catchings,
executive director of Health Care Centers in Schools, a nonprofit
organization that provides health care for East Baton Rouge Parish public
schools.
“The only place we really look right now are kindergarten and pre-K
kids,” Catchings said.
Catchings said school staff will know which children need to
update their immunizations by the end of October. Letters to parents will go
home before the Thanksgiving holidays to give parents a chance to take their
children to a parish Health Unit or private doctor for the shots.
Additional pre-holiday
reminders will be sent out before children are put out of school, she said.
Parish Health Units and
some federally funded medical clinics provide free vaccinations to uninsured
children and children whose insurance does not cover vaccinations, according
to DHH. East Baton Rouge Parish’s Health Unit offers vaccinations from 8 a.m.
to 4 p.m. Monday through Friday.
The staff at Health Care
Centers in Schools conducted a preliminary review of student immunization
records in the East Baton Rouge Parish School System and found about 30
percent of them are not up to date, Catchings said.
The immunizations most
likely to be missing are the new meningococcal vaccine and the long-required
vaccinations against tetanus, diphtheria and acellular
pertussis (whooping cough), Catchings
said.
The second dose of the
chicken pox vaccine also is among the more commonly missed immunizations, she
said.
Immunizations are an
important component of protecting public health, Welch said. The shots act to
stimulate a child’s immune system, so that it is better prepared to fight off
the illness.
There are some communities
across the country, particularly in the western areas, where up to 20 percent
of parents decided not to vaccinate their children, Welch said. These
communities are seeing outbreaks of vaccine-preventable diseases, such as
measles and whooping cough.
Louisiana offers parents a religious exemption to the
vaccination requirements for school attendance, Welch said. But less than 1
percent of children in the state’s vaccine-tracking database have not
received vaccinations because of religious objections, he said.
The advent of childhood
immunizations has dramatically cut the rates of child death and disability,
said Dr. Robert Hart, medical director for Ochsner Medical
Center in Baton Rouge.
“The generation that’s now
having children never saw all the babies getting polio when they were
younger,” Hart said. “They don’t understand the danger that these vaccines
can protect against.”
When faced with a parent
who doesn’t want to vaccinate, Hart said he explains to them the safety of
the vaccines and their rationale.
Bacterial meningitis,
however, is an illness that parents understand and fear because they know it
can kill, Catchings said.
“We are constantly looking
for the kid who has a positive spinal tap,” she said. “We see cases every
year, but it’s typically viral. But the fear is there and rightly so.”
Meningitis is the swelling
of the membranes that protect the brain or spinal cord, Hart said.
Viruses and bacteria can
cause this swelling, but doctors are most concerned by meningitis caused by
bacteria, Hart said. If untreated or caught too late, bacterial meningitis
can cause brain damage and even kill.
“It is a very serious disease,”
he said. “It can cause a lot of debilitation.”
Early symptoms of bacterial
meningitis resemble a bad cold or the flu, with fever, headache, nausea and
vomiting, he said. Indicators that the illness is meningitis rather than the
flu include a worsening fever and headache, stiff neck and a rash.
The good news about
bacterial meningitis is that it is easily treated with antibiotics, Hart
said.
The problem is that it is
difficult to diagnose early, he said. The only way to make a definitive
diagnosis is by checking the fluid around the spine for the bacteria, an
invasive procedure known as a spinal tap, Hart said.
The haemophilus
influenzae (Hib)
vaccination, long required for incoming kindergarteners, protects against one
of the main causes of bacterial meningitis, Hart said. The newly required
meningococcal vaccine protects against another common cause.
Chicken pox, on the other
hand, is typically considered a mild disease and a childhood rite of passage,
Welch said. It causes an itchy rash that turns to blisters and scabs. It can
be accompanied by a fever.
But the chicken pox can
kill, particularly people who contract it as infants or during adolescence or
adulthood, Welch said. Among younger children, there is no way to know who
will get a mild or serious case.
People who have had chicken
pox also are at risk for developing shingles, a painful patch of blisters,
later in life, Welch said. The chicken pox vaccine appears to protect people
from shingles as well, he said.
Before the vaccine, mothers
would host chicken pox parties so their children could have the disease while
they were young rather than risk catching it later, Welch said.
To obtain vaccination
records, go to your physician or any parish health unit. The state maintains
a database of vaccinations taken at health units and many doctor’s offices
statewide.
http://www.2theadvocate.com/features/48118277.html#
[BACK TO TOP]
by The Times-Picayune
Dr. Anna Pou, an employee of the state who was accused of killing
patients with lethal drug cocktail at Memorial Medical
Center in the days
after Hurricane Katrina, will have the state pay her legal fees if Gov. Bobby
Jindal signs a bill sent to him on a 39-0 Senate
vote today.
House Bill 341 by Rep.
Patrick Connick, R-Harvey, appropriates to the
physician more than $450,000: $144,851.59 to the Dr. Anna Pou
Defense Fund and another $312,127.82 to the Louisiana State University Health
Care Network, Pou's employer at the time of
Katrina.
Senate President Joel Chaisson II, D-Destrehan, who handled the bill for Connick on the Senate floor, called Pou
"a courageous doctor who was rewarded for her efforts by being"
accused by former Attorney General Charles Foti of
serious crimes.
Pou was arrested, but an Orleans Parish grand jury
refused to indict her on any charges. The bill now goes to Jindal who can sign it into law, veto it or left it
become law without his signature.
http://www.nola.com/politics/index.ssf/2009/06/senate_approves_payment_for_dr.html
[BACK TO TOP]
Editorial: Shriners once again needs community support
Shreveport Times | 06.16.09
A
communitywide effort brought the first-ever Shriners Hospital
for Children to Shreveport
in 1922.
Quiet
support of numerous organizations has allowed it to stay open since then,
treating more than 55,000 children from around the world.
Now
the organization looks to the community with a new plea for help. In a few
weeks, Shriners from around the country will meet
and vote on whether to close the Shreveport
hospital.
This
past year's decline in the stock market has hit the organization's endowment
hard, leaving the 22-hospital network with a huge shortfall in its $850
million budget. Six hospitals are on the list for possible closure.
Losing Shriners Hospital would be a loss to the region it
serves, the Shriners' history and, most of all, to
the children who are treated there. The focus on children is obvious from the
moment you step in the door.
A
receptionist sits in front of shelves full of toys. The carpet and walls are
decorated in cheery primary colors. Waiting rooms are filled with rocking
horses and games. Exam rooms in the two-year-old outpatient clinic are
outfitted with bubble walls and painted ceiling tiles just above the
examination tables.
Beneath
the child-friendly exterior is some serious medicine. Shreveport focuses on orthopaedic
conditions, so children arrive from six states and multiple foreign countries
with missing limbs, spinal diseases or painful conditions. The hospital
performs about 600 surgeries annually and fits children with
about 5,200 orthotics (supports for limbs and joints).
In
a special motion analysis room, children are outfitted with a special suit
and sensors (like the kind used in movie special effects), so doctors can
analyze their gait and develop therapy. Around the corner, a technician fits
leopard-print plastic around the mold of a child's leg to add support. And
out on the specially designed playground children lift, pull and maneuver,
adding to their therapy without even knowing it.
They
leave smiling and with more chance at a "normal" life than many
thought possible.
And
all of this is done for free. The Shriners runs
their hospitals without government funding or competitive grants. It does not
accept insurance or Medicaid. That blessing for patients, however, has
contributed to the current pain of the endowment. Administrators are now
deciding whether the cost involved in accepting insurance and other payments
is worth it.
In
the meantime, they are looking to the cities they serve for help. At least
one fundraiser has been held since news broke of the possible closure and
another event is planned for later in the month.
Community
support made a difference for children 87 years ago, and we need to rally the
same enthusiasm today.
http://shreveporttimes.com/article/20090616/OPINION03/906160314/1002/NEWS/Editorial--Shriners-once-again-needs-community-support
[BACK TO TOP]
Dems
look to cut cost of health care bill
DAVID ESPO
The Associated Press
(AP) — WASHINGTON - Jolted
by cost estimates as high as $1.6 trillion, Senate Democrats agreed to scale
back planned subsidies for the uninsured and sought concessions totaling
hundreds of billions of dollars from private industry Tuesday to defray the
cost of sweeping health care legislation.
At the same time, key
Democrats disagreed openly among themselves over a proposed tax on health
insurance benefits to pay for expanding coverage to the uninsured.
And a compromise with
Republicans over a role for government in the insurance marketplace remained
elusive.
Despite numerous
uncertainties, Sen. Christopher Dodd, D-Conn., announced that the Senate
Health, Education, Labor and Pensions Committee would begin formal work
Wednesday on legislation he said would provide "successful, affordable,
quality health care."
The meeting would mark the
first public drafting session in either chamber on legislation to control the
costs of health care while expanding coverage to the nearly 50 million who
lack it-a goal that President Barack Obama has placed atop his domestic agenda.
Separately, the Senate
Finance Committee is expected to begin work next week on a companion measure.
Several officials said the Congressional Budget Office had issued a cost
estimate of $1.6 trillion, with only about $560 billion paid for. They spoke
on condition of anonymity, saying the matter was confidential.
Sen. Max Baucus, D-Mont.,
chairman of the panel, dismissed the estimates as outdated, and said the
final bill would come in at about $1 trillion.
Sen. Kent Conrad, D-N.D.,
said that with cost estimates so high, "It is clear there have got to be
changes made to make the whole package affordable."
At the Senate Health panel,
officials said that after penciling in subsidies for families with incomes as
high as $110,000, or 500 percent of the federal poverty level, they would
limit the help to families up to $88,000 in income, or 400 percent of the
poverty level. A preliminary CBO estimate on that measure, released Monday,
calculated a cost of $1 trillion.
The emerging Finance
Committee bill also cuts off subsidies at 400 percent of the poverty level,
but officials said that might be lowered due to cost concerns. Baucus told
reporters a reduction was "a live option," and there were
indications the final cutoff would be closer to 300 percent of poverty-$66,000
for a four-person family? than 400 percent.
Additionally, Conrad said
leading Democrats were searching for a way to prevent millions of people who
currently are insured from taking the federal subsidies and then buying
insurance on their own, opting out of their employer-provided plan.
In a brief interview with
The Associated Press, Baucus also disclosed he was "very close" to
agreement with a handful of industry groups for them to accept hundreds of
billions of dollars less in Medicare and Medicaid fees than they currently
are projected to receive. He said the talks have involved insurance
companies, hospitals, doctors, pharmaceutical firms and the makers of medical
devices, among others, but did not provide a specific figure for the savings
overall.
The efforts are separate
from pledges that Obama won earlier in the year from industry groups to
restrain future increases in health care spending by roughly $2 trillion over
a decade. In a letter to Republicans, the CBO said "most of the
proposals are steps that do not require the involvement of the federal
government or are not specified at a level of detail that would enable CBO to
estimate budgetary savings."
To pay for the legislation,
Baucus has signaled he intends to propose a tax on health insurance benefits
for individuals with the costliest health insurance coverage, possibly plans
with premiums totaling more than $15,000 between employer and employee combined.
Obama campaigned aggressively against the idea when Republican rival Sen.
John McCain proposed it during last year's presidential campaign.
While the president has
recently signaled flexibility on the issue, Dodd criticized it for
potentially penalizing individuals and families at a time they are under
financial pressure. "I'm not attracted to that idea," he said.
Other senators, allied with
organized labor, have also expressed opposition, although Baucus has told
reporters he could exempt health benefits included in union contracts from
the tax.
Baucus has been negotiating
privately with Sen. Chuck Grassley, R-Iowa, the senior Republican on the
committee, over the role of government in insurance.
Democrats generally favor
allowing government to offer insurance in competition with private companies,
and Republicans oppose it.
Conrad last week offered a
compromise that would allow nonprofit cooperatives to sell policies, and he
joined Baucus and Grassley in a closed-door evening session to review their
efforts.
Grassley said before the
meeting that nothing was finalized yet, and indicated the sticking point was
Baucus' insistence that the federal government play a behind-the-scenes role.
Baucus told reporters,
"The goal of public option is to keep the health insurance (industry's)
feet to the fire. Make sure they do all the things we tell them to do in the
legislation." He said another goal is to keep costs down.
But, he added he remains
open to "another way to accomplish the same result."
In an interview with The
Associated Press, Health and Human Services Secretary Kathleen Sebelius stressed that Obama is open to compromise on the
issue of a public plan. She spoke positively of the compromise proposal of
cooperatives, which she said could receive seed money from the Treasury but
then be free of control.
She predicted that in the
end, the insurance industry will blink first in a showdown over the issue.
"I think they
understand there's a lot of momentum both in the House and in the Senate for
something to pass, and they'd much rather be inside the room, having those
discussions, and helping to shape it as much to their liking as they possibly
can," she said.
http://www.nola.com/newsflash/index.ssf?/base/national-4/1245202542281660.xml&storylist=health
[BACK TO TOP]
By VANESSA FUHRMANS
As the recession forces
more hospitals and doctors to pare costs and services, the cutbacks are
hitting one group of patients especially hard: children.
The Grabo
family of Las Vegas learned this firsthand in
December, weeks after a state budget crisis prompted Nevada lawmakers to cut Medicaid payments
to health-care providers, some by as much as 40%. Two of the Grabos' four children receive Medicaid benefits to treat
their disabilities. But the day before their son Tyler, 10 years old, was
scheduled to see his pediatric endocrinologist, the
doctor's staff called and said he no longer accepted patients with Medicaid.
Elizabeth Grabo says she was able to find just one other local
endocrinologist who still saw children covered by the government program for
the poor or disabled, but she couldn't get an appointment before March.
Without a doctor's supervision, Tyler, who has suffered from muscle and joint
problems since birth, had to stop a growth-hormone regimen he had started
just a few months before.
"It's not the fault of
the physicians. They're actually losing money to see these patients,"
Mrs. Grabo says. "But to know we have no
options is the scariest thing."
[Kid Care]
The economic slump is
hitting many medical centers and practices in a variety of ways. Credit
remains tough to come by, revenue is down as some patients forgo care, and
the number of uninsured is ticking higher as more people lose their jobs. On
top of that, some two dozen states around the country have enacted or
proposed steep cuts to Medicaid payments because of severe fiscal crunches.
Children's hospitals and
pediatricians are among the hardest hit by state cuts. That's because, while
children have always made up about half of Medicaid's rolls, their numbers
have swelled in recent years to the point that at least 22 million, or one in
four, U.S.
kids now get their health coverage through Medicaid or a state Children's
Health Insurance Program. States often administer CHIP, which is aimed at
families with more income than Medicaid participants, as part of their
Medicaid programs. Both Medicaid and CHIP are jointly funded by state and
federal governments.
It's becoming increasingly
difficult to find a doctor, particularly a specialist, who takes Medicaid. In
a recent survey by the Medical Group Management Association, a trade group,
18% of 1,850 practices polled said they no longer took new Medicaid patients,
while an additional 11% said they were likely to stop in response to the
recession.
More children may have
Medicaid cards, but "a lot of them are being turned away at the
doctor's," says Edwin Suarez, a Las
Vegas physical therapist whose pediatric caseload
had been 70% Medicaid patients. But after state cutbacks, Mr. Suarez is having to turn away some children. "Otherwise I
just can't meet my overhead," he says.
Medicaid cutbacks also
affect services for privately insured kids, as children's hospitals cut staff
and programs to make up the revenue shortfalls.
In Minneapolis, for
instance, Children's Hospitals and Clinics of Minnesota depends on Medicaid
for 40% of its revenue, compared with 10% on average at most traditional
hospitals. Following state budget cuts in recent years, the hospital closed
an exercise-therapy program for children with chronic illnesses and
school-based health programs, and is weighing other cuts.
States also are cutting
other programs that affect children. Funding cuts have prompted the operator
of Helen DeVos Children's Hospital in Grand Rapids, Mich.,
to close one of the state's two regional poison-control call centers, a
majority of whose cases involve young children. Funding also has been
eliminated for California's
four state poison call centers.
In a recent survey by the
National Association of Children's Hospitals, about 20% of the 42 hospitals
responding reported they had cut or were considering reducing clinical
services because of the downturn. Others, like Seattle Children's Hospital,
say they haven't cut programs or jobs outright, but patient wait times have
climbed as they have pared employees' hours and not replaced departing staff.
State cutbacks come even
though Congress in February approved $87 billion in additional Medicaid funds
to states as part of the economic stimulus package. Medicaid, with a total
budget last year of about $330 billion, swallows about 7% of the federal
budget and constitutes one of the biggest chunks of state budgets. Congress
also appropriated $33 billion to expand CHIP coverage.
Cindy Mann, director of the
federal Center for Medicaid and State Operations, said reduced reimbursements
"are an area of concern to the extent that they are translating into
reduced access to care." She added that part of the recent federal
legislation provides for establishing a commission to monitor problems
enrollees might have in getting care.
States say the new money
isn't enough to make up for dwindling tax revenues and the growing ranks of
Medicaid participants. Nevada,
for instance, whose Medicaid program was already thinly funded, cut hospital
reimbursements by 5% and some pediatric specialists' reimbursements by more
than 40% last fall. Almost overnight, many specialists in the state closed
their doors to new Medicaid patients.
Mr. Suarez, the Las Vegas physical
therapist, says his Medicaid reimbursement rates were cut by a third. He
still takes as new Medicaid patients children with emergencies and newborns
with congenital disorders or injuries that occurred during delivery,
"since these are the kids with just a small window of opportunity to get
better," he says. "But I have to put older kids on a waiting
list."
Ben Spitalnick,
a general pediatrician in Savannah,
Ga., where some 60% of the
city's children are on Medicaid, says he recently had a young Medicaid
patient with a broken arm but couldn't get any local orthopedic specialist to
take him. Ultimately, Dr. Spitalnick had to send
him to the emergency room, where the boy was referred to a specialist on
call. "But that's a couple hours while a patient is in great discomfort
and at a much greater cost to the system," Dr. Spitalnick
says. "Who does that help?"
Some pediatric hospitals
that don't rely on Medicaid are hurting, too. The board of Shriners Hospitals for Children, which provides free
care, particularly in burn treatment, orthopedics and other pediatric
specialties in short supply, will vote in July on whether to close six of its
22 hospitals nationwide. The hospitals operate on returns from their
endowment and philanthropy, but plunging financial markets have shrunk the
endowment to $5 billion from $8.3 billion just a year ago and stagnating
donations haven't made up the shortfall.
One hospital in danger is
the Shriners in Springfield, Mass.,
where doctors have treated 8-year-old Gabrielle Zeller's rheumatoid arthritis
ever since her joints swelled and she began to have trouble walking as a
toddler. Though the Zellers, who live in nearby Suffield, Conn.,
are privately insured, the pediatric rheumatologist at Shriners
was the only one in practice for miles around. Without the hospital, the
family will have to travel a couple of hours to Boston for care.
"But at least we have
insurance," says Gabrielle's mother, Andrea. "What about all of the
families that don't?"
http://online.wsj.com/article/SB124519908310621365.html
[BACK TO TOP]
The New York Times | 06.17.09
By
DAVID LEONHARDT
Rationing.
More
to the point: Rationing!
As
in: Wait, are you talking about rationing medical care? Access to medical
care is a fundamental right. And rationing sounds like something out of the Soviet Union. Or at least Canada.
The
r-word has become a rejoinder to anyone who says that this country must reduce
its runaway health spending, especially anyone who favors cutting back on
treatments that don’t have scientific evidence behind them. You can expect to
hear a lot more about rationing as health care becomes the dominant issue in Washington this summer.
Today,
I want to try to explain why the case against rationing isn’t really a
substantive argument. It’s a clever set of buzzwords that tries to hide the
fact that societies must make choices.
In
truth, rationing is an inescapable part of economic life. It is the process
of allocating scarce resources. Even in the United States, the richest
society in human history, we are constantly rationing. We ration spots in
good public high schools. We ration lakefront homes. We ration the best cuts
of steak and wild-caught salmon.
Health
care, I realize, seems as if it should be different. But it isn’t. Already,
we cannot afford every form of medical care that we might like. So we ration.
We
spend billions of dollars on operations, tests and drugs that haven’t been
proved to make people healthier. Yet we have not spent the money to install
computerized medical records — and we suffer more medical errors than many
other countries.
We
underpay primary care doctors, relative to specialists, and they keep us
stewing in waiting rooms while they try to see as many patients as possible.
We don’t reimburse different specialists for time spent collaborating with
one another, and many hard-to-diagnose conditions go untreated. We don’t pay
nurses to counsel people on how to improve their diets or remember to take
their pills, and manageable cases of diabetes and heart disease become fatal.
“Just
because there isn’t some government agency specifically telling you which
treatments you can have based on cost-effectiveness,” as Dr. Mark McClellan,
head of Medicare in the Bush administration, says, “that doesn’t mean you
aren’t getting some treatments.”
Milton
Friedman’s beloved line is a good way to frame the issue: There is no such
thing as a free lunch. The choice isn’t between rationing and not rationing.
It’s between rationing well and rationing badly. Given that the United States
devotes far more of its economy to health care than other rich countries, and
gets worse results by many measures, it’s hard to argue that we are now
rationing very rationally.
On
Wednesday, a bipartisan panel led by four former Senate majority leaders —
Howard Baker, Tom Daschle, Bob Dole and George Mitchell — will release a
solid proposal for health care reform. Among other things, it would call on
the federal government to do more research on which treatments actually work.
An “independent health care council” would also be established, charged with
helping the government avoid unnecessary health costs. The Obama
administration supports a similar approach.
And
connecting the dots is easy enough. Armed with better information, Medicare
could pay more for effective treatments — and no longer pay quite so much for
health care that doesn’t make people healthier.
Mr.
Baker, Mr. Daschle, Mr. Dole and Mr. Mitchell: I accuse you of rationing.
There
are three main ways that the health care system already imposes rationing on
us. The first is the most counterintuitive, because it doesn’t involve
denying medical care. It involves denying just about everything else.
The
rapid rise in medical costs has put many employers in a tough spot. They have
had to pay much higher insurance premiums, which have increased their labor
costs. To make up for these increases, many have given meager pay raises.
This
tradeoff is often explicit during contract negotiations between a company and
a labor union. For nonunionized workers, the tradeoff tends to be invisible.
It happens behind closed doors in the human resources department. But it
still happens.
Research
by Katherine Baicker and Amitabh
Chandra of Harvard has found that, on average, a 10 percent increase in
health premiums leads to a 2.3 percent decline in inflation-adjusted pay.
Victor Fuchs, a Stanford economist, and Ezekiel Emanuel, an oncologist now in
the Obama administration, published an article in The Journal of the American
Medical Association last year that nicely captured the tradeoff. When health
costs have grown fastest over the last two decades, they wrote, wages have
grown slowest, and vice versa.
So
when middle-class families complain about being stretched thin, they’re
really complaining about rationing. Our expensive, inefficient health care
system is eating up money that could otherwise pay for a mortgage, a car, a vacation or college tuition.
The
second kind of rationing involves the uninsured. The high cost of care means
that some employers can’t afford to offer health insurance and still pay a
competitive wage. Those high costs mean that individuals can’t buy insurance
on their own.
The
uninsured still receive some health care, obviously. But they get less care,
and worse care, than they need. The Institute of Medicine
has estimated that 18,000 people died in 2000 because they lacked insurance.
By 2006, the number had risen to 22,000, according to the Urban Institute.
The
final form of rationing is the one I described near the beginning of this
column: the failure to provide certain types of care, even to people with
health insurance. Doctors are generally not paid to do the blocking and tackling
of medicine: collaboration, probing conversations with patients, small steps
that avoid medical errors. Many doctors still do such things, out of
professional pride. But the full medical system doesn’t do nearly enough.
That’s
rationing — and it has real consequences.
In
Australia,
81 percent of primary care doctors have set up a way for their patients to
get after-hours care, according to the Commonwealth Fund. In the United States,
only 40 percent have. Over all, the survival rates for many diseases in this
country are no better than they are in countries that spend far less on
health care. People here are less likely to have long-term survival after
colorectal cancer, childhood leukemia or a kidney transplant than they are in
Canada
— that bastion of rationing.
None
of this means that reducing health costs will be easy. The
comparative-effectiveness research favored by the former Senate majority
leaders and the White House has inspired opposition from some doctors,
members of Congress and patient groups. Certainly, the critics are right to
demand that the research be done carefully. It should examine different forms
of a disease and, ideally, various subpopulations who
have the disease. Just as important, scientists — not political appointees or
Congress — should be in charge of the research.
But
flat-out opposition to comparative effectiveness is, in the end, opposition
to making good choices. And all the noise about rationing is not really a
courageous stand against less medical care. It’s a utopian stand against
better medical care.
http://www.nytimes.com/2009/06/17/business/economy/17leonhardt.html?hp
[BACK TO TOP]
The New York Times | 06.16.09
By BENEDICT CAREY
One of the most celebrated
findings in modern psychiatry — that a single gene helps determine one’s risk
of depression in response to a divorce, a lost job or another serious
reversal — has not held up to scientific scrutiny, researchers reported
Tuesday.
The original finding,
published in 2003, created a sensation among scientists and the public
because it offered the first specific, plausible explanation of why some
people bounce back after a stressful life event while others plunge into
lasting despair.
The new report, by several
of the most prominent researchers in the field, does not imply that
interactions between genes and life experience are trivial; they are almost
certainly fundamental, experts agree.
But it does suggest that
nailing down those factors in a precise way is far more difficult than
scientists believed even a few years ago, and that the original finding could
have been due to chance. The new report is likely to inflame a debate over
the direction of the field itself, which has found that the genetics of
illnesses like schizophrenia and bipolar disorder remain elusive.
“This gene/life experience
paradigm has been very influential in psychiatry, both in the studies people
have done and the way data has been interpreted,” said Dr. Kenneth S. Kendler, a professor of psychiatry and human genetics at Virginia Commonwealth University,
“and I think this paper really takes the wind out of its sails.”
Others said the new
analysis was unjustifiably dismissive. “What is needed is not less research
into gene-environment interaction,” Avshalom Caspi, a neuroscientist at Duke University and lead
author of the original paper, wrote in an e-mail message, “but more research
of better quality.”
The original study was so
compelling because it explained how nature and nurture could collude to
produce a complex mood problem. It followed 847 people from birth to age 26
and found that those most likely to sink into depression after a stressful
event — job loss, sexual abuse, bankruptcy — had a particular variant of a
gene involved in the regulation of serotonin, a brain messenger that affects
mood. Those in the study with another variant of the gene were significantly
more resilient.
“I think what happened is
that people who’d been working in this field for so long were desperate to
have any solid finding,” Kathleen R. Merikangas,
chief of the genetic epidemiology research branch of the National Institute
of Mental Health and senior author of the new analysis, said in a phone
interview. “It was exciting, and some people thought it was the finding in
psychiatry, a major advance.”
The excitement spread
quickly. Newspapers and magazines reported the finding. Columnists,
commentators and op-ed writers emphasized its importance. The study provided
some despairing patients with comfort, and an excuse — “Well, it is in my
genes.” It reassured some doctors that they were medicating an organic
disorder, and stirred interest in genetic testing for depression risk.
Since then, researchers
have tried to replicate the gene finding in more than a dozen studies. Some
found similar results; others did not. In the new study, being published
Wednesday in The Journal of the American Medical Association, Neil Risch of the University
of California, San Francisco, and Dr. Merikangas
led a coalition of researchers who identified 14 studies that gathered the
same kinds of data as the original study. The authors reanalyzed the data and
found “no evidence of an association between the serotonin gene and the risk
of depression,” no matter what people’s life experience was, Dr. Merikangas said.
By contrast, she said, a
major stressful event, like divorce, in itself raised the risk of depression
by 40 percent.
The authors conclude that
the widespread acceptance of the original findings was premature, writing
that “it is critical that health practitioners and scientists in other
disciplines recognize the importance of replication of such findings before
they can serve as valid indicators of disease risk” or otherwise change
practice.
Dr. Caspi
and other psychiatric researchers said it would be equally premature to
abandon research into gene-environment interaction, when brain imaging and
other kinds of evidence have linked the serotonin gene to stress sensitivity.
“This is an excellent
review paper, no one is questioning that,” said Myrna Weissman,
a professor of epidemiology and psychiatry at Columbia. “But it ignored extensive
evidence from humans and animals linking excessive sensitivity to stress” to
the serotonin gene.
Dr. Merikangas
said she and her co-authors deliberately confined themselves to studies that
could be directly compared to the original. “We were looking for
replication,” she said.
http://www.nytimes.com/2009/06/17/science/17depress.html?_r=1&ref=health
[BACK TO TOP]
The New York Times | 06.16.09
By
GARDINER HARRIS
Federal
drug regulators warned consumers to stop using Zicam,
a popular homeopathic cold remedy, because it could damage or destroy their
sense of smell.
The
action is an early indication that the Obama administration is likely to take
far more aggressive enforcement actions against drug companies than the Bush
administration did.
The
Food and Drug Administration received 130 reports from consumers and doctors
of people losing their sense of smell after using one of the Zicam nasal products, which include Zicam
Cold Remedy and Zicam Cold Remedy Swabs. The
reports date to 1999, when Matrixx Initiatives of
Scottsdale, Ariz., first introduced the products.
In
2006, Matrixx paid $12 million to settle 340
lawsuits from Zicam users who claimed that the
product destroyed their sense of smell, a condition known as anosmia. Hundreds more such suits have since been filed.
Although
the F.D.A. took no action during the Bush administration, Dr. Margaret A.
Hamburg, who was named the agency commissioner by President Obama, said the
incidence of anosmia associated with Zicam “strikes us as a fairly large problem.”
The
agency issued its consumer alert even though Matrixx
refused to recall its products, a highly unusual event. In a news release, Matrixx said it had suspended shipments of Zicam and would reimburse customers who wanted a refund.
“Matrixx Initiatives stands behind the science of its
products and its belief that there is no causal link between its intranasal
gel products and anosmia,” the release said. “For this
reason, Matrixx Initiatives believes that the
F.D.A. action is unwarranted and will seek a meeting with the F.D.A. to
review the company’s product safety data.”
Matrixx had $101 million in sales last year,
of which $40 million came from Zicam products.
Because Matrixx has called Zicam
a homeopathic product, the company was not required to seek agency approval
before selling it.
The
F.D.A. does not have the power to order product recalls but must rely on
manufacturers to do so voluntarily. Bills now moving through Congress would
give the agency that power. Bush administration appointees said the F.D.A.
did not need mandatory recall authority because companies always withdrew
unsafe products when asked.
But
the government sometimes negotiated for days or weeks before companies agreed
to recalls, leading many more consumers to be put at risk. And the Zicam case demonstrates that aggressive enforcement
action can lead to disagreements.
An
F.D.A. warning letter sent to Matrixx on Tuesday
states that Zicam Cold Remedy intranasal products
“may pose a serious risk to consumers who use them” and are “misbranded.”
Such language would normally describe a recall alert. The products have no
proven benefits.
Matrixx has received more than 800 reports of
Zicam users losing their sense of smell but did not
provide those reports to the F.D.A., said Deborah M. Autor,
director of compliance in the agency’s drug center. The law requires
producers of approved drugs to forward to the F.D.A. all reports of
product-related injuries, but Ms. Autor declined to
say whether this reporting requirement applied to Matrixx.
“This
disabling loss of one of the five senses may be long lasting or even
permanent in some people,” Ms. Autor said. “People
without the sense of smell may not be able to detect dangers such as gas
leaks or smoke. They could lose much of the pleasure of eating, adversely
impacting the quality of life.”
Dr.
Charles E. Lee, a compliance officer in the agency’s drug center, said zinc
could be toxic to nerve receptors in the nose. In the 1930s, intranasal zinc
was tested as a polio preventative, and some patients suffered anosmia, Dr. Lee said.
http://www.nytimes.com/2009/06/17/health/policy/17nasal.html?_r=1&em
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