The LSU Board of Supervisors rejected a compromise agreement Monday for a new academic medical center in New Orleans and instead approved an amended version that gives LSU expanded authority.

The state’s health chief last week released a proposed “draft” agreement that would create a private, nonprofit organization to finance and operate the planned $1.2 billion academic medical center to replace the shuttered Charity hospital.

The agreement attempted to resolve tensions between LSU and Tulane University. It formed a 12-person, independent operating board with four LSU representatives.

But the LSU Board on Monday instead approved a plan for an 11-member board with five LSU representatives. Tulane would have one representative on the board in both versions.

LSU System President John Lombardi said he expects Tulane to next consider the amended agreement. Tulane’s board signed off on the original agreement draft Friday.

“There’s always a lot of tensions when you try to have two institutions operating one hospital,” Lombardi said after the 12-2 vote by the LSU Board.

LSU Board members argued that the LSU System should have more authority because it is putting up the money and holding all the liability.

“It’s our credit card, and somebody else is going to lunch on it,” Lombardi said after the meeting.

LSU Board member Rod West, of New Orleans, said he is tired of hearing about supposed “power grabs” by LSU.

“LSU is on the hook and it is absolutely critical this (medical center) board has to support LSU’s academic mission,” West said. “We’re the ones taking all the financial risk.”

LSU Board member Dr. Jack Andonie, of New Orleans, said that Tulane took advantage of a good relationship with LSU by developing the habit of taking patients with insurance to Tulane Medical Center and sticking LSU with the indigent.

Last week’s compromise board had four members appointed by LSU, one by Tulane, one by Xavier University and another on a rotating basis by Delgado Community College, Dillard University and Southern University. Another five board members would have no university affiliation.

The LSU Board’s counter offer gives LSU five members and lessens the independent board members from five to three.

Tulane spokesman Mike Strecker released a statement that said, the vote shows that LSU leaders have “fundamental and philosophical differences” concerning the board composition and medical center oversight.

“Given the importance of the unresolved issues to the community and the state, Tulane believes the matter should now return to the Legislature and the administration for further action,” the statement said.

House Bill 830 by Speaker Jim Tucker is pending before a Senate committee that would create the board and give LSU just one of nine seats on the board.

State Department of Health and Hospitals Secretary Alan Levine, who released the draft agreement last week, did not respond to an interview request.

But Levine released an e-mail stating: “While I am disappointed LSU’s Board of Supervisors did not sign on to the agreement, I am pleased with the progress that had been made.

“I am also grateful Tulane’s Board unanimously signed off on the entire agreement,” Levine added.

Under the draft agreement, LSU would own the medical center and lease it to the nonprofit corporation. The new center would replace the LSU public hospitals in New Orleans, known as the University and Charity Hospital, which was badly damaged by Hurricane Katrina.

The official name of the proposed center would be “University Medical Center” with the main building called the “Rev. Avery C. Alexander Hospital.”

The state has set aside $300 million for the facility, with nearly $500 million potentially coming from the Federal Emergency Management Agency and the rest to be funded through revenue bonds issued through the nonprofit corporation.

Lombardi said negotiations have been “intense.” But LSU Chairman Jim Roy called Monday’s vote the “beginning of a dialogue.”

Playing off Roy’s words, Lombardi said it was a “new beginning.”

Lombardi called the structure of the 11- or 12-member board a detail that will be worked out.

Lombardi said the key actually is that LSU and Tulane agree on maintaining the same division of medical residency slots as before Katrina. LSU would have 373 slots, Tulane 200.

http://www.2theadvocate.com/news/48820042.html

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LSU board returns Charity Hospital pact to Tulane

The Advertiser | 06.23.09

The Associated Press

BATON ROUGE - A struggle continued Monday over developing a new teaching hospital in New Orleans, as the LSU System Board of Supervisors sent Tulane University a plan that would boost LSU's clout on the hospital's governing board.

The LSU board approved a version of the preliminary agreement that would give LSU five appointees on an 11-member hospital board. Tulane University's Board of Trustees last week approved a plan that gives LSU four seats on a 12-member board.

Several LSU board members said they were frustrated that LSU would not have significant control over a project in which the school would be responsible for financing $400 million in bond debt for the 424-bed hospital, estimated to cost $1.2 billion.

"We're the ones taking all of the financial risk," board member Rod West of New Orleans said. "LSU ... is the only one on the hook."

John Lombardi, LSU system president, downplayed the dispute. He said his board's action was a positive sign: Only one significant point of disagreement remains over how to manage the proposed hospital in downtown New Orleans.

"This is an agreement to continue the conversation on one issue, and that's the governance of the board," Lombardi said.

A Tulane spokesman said the school did not have an immediate response to the LSU board's action.

Before Monday's board meeting, Gov. Bobby Jindal said he was pleased with progress the two schools have made on the hospital, whatever happens with the preliminary plan now at issue. He predicted continued back-and-forth between LSU and Tulane.

"I'm not naive (enough) to think that, simply once we get the document signed, everything is done. I suspect you'll see proposed amendments, changes, and there will continue to be issues," Jindal told reporters.

The LSU-run Charity Hospital was flooded and shuttered by Hurricane Katrina in 2005. The university opened a temporary replacement, called the Interim LSU Public Hospital, while pushing plans to build a new research and teaching facility.

In the background of the dispute is legislation by Speaker Jim Tucker, R-Terrytown, that would make the disagreement irrelevant.

Tucker's bill would give ownership of the hospital to a quasi-public board created in the state health department and managed by a separate private, nonprofit board of appointees. Tucker said the change in governance of the hospital would let LSU spend its time on other matters.

Tucker's bill passed the House but has not had a committee hearing in the Senate.

Jindal on Monday gave Tucker's bill credit for speeding up negotiations between the schools.

"I do think the legislation helped to focus people's minds," he said. "It's amazing how that happens sometimes."

http://www.theadvertiser.com/article/20090623/NEWS01/906230313/1002/LSU-board-returns-Charity-Hospital-pact-to-Tulane

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LSU-Tulane fight intensifies over N.O. hospital

The Advertiser | 06.23.09

BATON ROUGE (AP) — A battle intensified on Monday between LSU and Tulane University over a new teaching hospital in New Orleans, after the LSU System Board of Supervisors proposed a plan that would boost LSU's clout on the hospital's governing board.

Tulane officials quickly rejected the LSU board's version of a preliminary plan that would give LSU five appointees on an 11-member hospital board. Tulane's Board of Trustees last week approved a plan giving LSU four seats on a 12-member board.

LSU board members amended the plan after voicing frustration that LSU would not have significant control over a project in which the school would be responsible for backing $400 million in bond debt for the 424-bed hospital, estimated to cost $1.2 billion.

"We're the ones taking all of the financial risk," board member Rod West of New Orleans said. "LSU ... is the only one on the hook."

LSU's move essentially sent the plan back to Tulane, though Tulane spokesman Mike Strecker said the board of the private New Orleans university is finished negotiating it.

Tulane issued a statement saying the LSU board's move "indicates that Tulane and LSU have fundamental and philosophical differences with respect to the board composition and the appropriate safeguards and independent oversight of the proposed academic medical center."

"Given the importance of the unresolved issues to the community and the state, Tulane believes the matter should now return to the Legislature and the administration for further action."

John Lombardi, LSU system president, tried to downplay the dispute. He said his board's action was a positive sign: Only one significant point of disagreement remains, over how to manage the proposed hospital in downtown New Orleans.

But given the impasse, it was unclear how the project will proceed.

In the background is legislation, opposed by LSU, that would give ownership of the hospital to a quasi-public board created in the state health department and managed by a separate private, nonprofit board of appointees. The sponsor, House Speaker Jim Tucker, R-Terrytown, said the change in governance of the hospital would let LSU spend its time on other matters.

Tucker's bill passed the House but has not had a committee hearing in the Senate, with just three days remaining in the legislative session.

Alan Levine, Gov. Bobby Jindal's health secretary, issued a statement saying the Jindal administration would continue seeking a way to get LSU and Tulane to agree on the hospital's governance.

"I have said that in order to have a successful academic medical center, we need the combined support of LSU and Tulane ... Both have a critical stake in any academic medical center," Levine is quoted in the statement.

Before Monday's board meeting, Jindal said he was pleased with progress the two schools have made on the hospital, whatever happens with the preliminary plan now at issue. He predicted continued back-and-forth between LSU and Tulane.

Jindal on Monday gave Tucker's bill credit for speeding up negotiations between the schools.

"I do think the legislation helped to focus people's minds," he said. "It's amazing how that happens sometimes."

http://www.theadvertiser.com/article/20090623/NEWS01/90623006

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LSU approves medical center plan with strings attached

WWLTV | 06.22.09

Maya Rodriguez / Eyewitness News

Watch the story: http://www.wwltv.com/video/featured-index.html?nvid=373621

NEW ORLEANS – It sparked a contentious debate between two of Louisiana's most well-known universities: LSU and Tulane.

Video: Watch the Story

The issue revolves around control of a new university medical center, set to be built in New Orleans. On Monday, LSU's board voted on a potential compromise agreement in Baton Rouge.

However, board members expressed their frustration over negotiations with Tulane University, which already voted in favor of the deal.

"If you can't put any money up, Tulane, you don't play as far as the governance of the hospital," said Hank Gowen, an LSU board member.

The issues between the two schools come down mainly to two things – money and control of the new hospital. Tulane wants a spot on the board that would oversee the hospital. Yet, LSU board members worried about Tulane not being financially invested in the project.

"We can position this argument however we want in terms of Tulane vs. LSU-- you follow the money," said LSU board member Rod West. "In terms of who's ultimately on the financial hook for the financial obligations associated with this, it's us. It's the LSU board."

However, Dr. Fred Cerise of the LSU health care system said a hospital agreement like this one is nothing new and may be the best option, at the moment.

"We think that makes sense. We think we can implement a model like that and it is something where there is an established track record," Dr. Cerise said. "At least 13 other public medical schools across the country have moved to this model."

LSU board members, though, wanted their university to have a stronger say in the running of the hospital. Under a proposed agreement, the 12-member board overseeing the hospital would have four members appointed by LSU.

LSU system president John Lombardi said the proposed agreement isn't perfect, but rather, it's a compromise.

"This is a political plan, which is before us as a political entity and requires the cooperation of political groups, which are in the legislature and the administration and elsewhere," Lombardi said. "So this is the kind of compromise one gets in a politically driven process, in which we are trying to moderate competing interests – all of whom have the ability to torpedo the process."

In the end, the LSU board voted 12-2 in favor of the hospital agreement. However, they added several amendments aimed at increasing LSU's influence on the board. That includes reducing the hospital board from 12 people to 11 – and increasing LSU's number of board members from four to five.

Tulane would still retain its one spot on the board, but the number of community members on it would be reduced from five to three.

DHH Secretary Alan Levine issued a response late Monday afternoon.

“While I am disappointed LSU's Board of Supervisors did not sign on to the agreement, I am pleased with the progress that had been made. I am also grateful Tulane's Board unanimously signed off on the entire agreement [last Friday],” Levine said. “I remain hopeful we can reach a conclusion. I have said that in order to have a successful academic medical center, we need the combined support of LSU and Tulane.

"Tulane has been training physicians in Louisiana since the 1800s, and LSU, as our public medical school, is a principal partner in medical training. Both have a critical stake in any academic medical center. We will continue to work with the leadership of LSU and Tulane to move forward in this process.”

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LSU board approves hospital deal at odds with Tulane version

The Times-Picayune | 06.22.09

by Bill Barrow, The Times-Picayune

John McCusker / The Times-Picayune

Back of town in New Orleans where the proposed medical complex may be constructed replacing Charity Hospital and the LSU teaching hospital.

BATON ROUGE -- The Louisiana State University System Board of Supervisors today rejected the draft governing agreement for a proposed teaching hospital in New Orleans, instead endorsing a revised model that board members said would give LSU more influence over the enterprise.

The next step in the governance wrangling is not clear, given that Tulane University's governing board approved the original draft agreement in its own special meeting Friday, one day after state Health Secretary Alan Levine pitched the deal as the product of intense private negotiations between the two schools.

LSU System President John Lombardi said, "I assume it will go back to Tulane to see if they can live with the action we took here today."

The principal complaint from LSU board members is that the Baton Rouge-based university system would have ownership of the hospital and responsibility for its bond debt, while having just four out of 12 spots on the governing board.

"It's our credit card, and somebody else is going to lunch on it," Lombardi said.

LSU called for an 11-member board, with five coming from LSU. Both versions would give Tulane and Xavier University one seat each, with other New Orleans schools sharing an additional seat.

The difference comes in "non-permanent" members that would not be affiliated with any of the schools. The Levine plan that Tulane approved calls for five of those seats. LSU's plan includes three.

Lombardi said he pitched the same model in the negotiations with Tulane President Scott Cowen. Both men, Lombardi said, made it clear to Levine that they could not guarantee final approval from their respective boards. The deal was merely to present the draft, he added: "The secretary knew that some of our board members had concerns."

Supervisor Hank Gowen said before the vote, "We need to be in control; we are the ones who are going to borrow $400 million," referring to the minimum bond issue that would be necessary for the $1.2 billion hospital if the state gets $492 million from the federal government for damage to Charity Hospital.

If the Charity settlement is less than the full reimbursement, the proposed hospital corporation would either have to borrow more money or scale back its plans for 424 beds in the lower Mid-City facility.

LSU officials have bemoaned before and repeated today that the business plan for the hospital depends on LSU physicians directing privately insured patients to the new facility.

Lombardi told board members he asked Tulane repeatedly to make the same commitment. "That element of equity ... was not supported and did not end up in" the proposed memorandum of understanding, Lombardi said, because of a "conflict of interest" with Tulane Medical Center.

Tulane University owns a 17.5 percent share of that for-profit hospital, with the rest controlled by controlled by Tennessee-based HCA, a publicly traded hospital corporation.

"If it is a conflict of interest, they should not be in this agreement," Gowen said.

Board member Alvin Kimble said, "If Tulane has 200 out of 500 residents (in the new hospital), I'd like them to come up with 40 percent of the money. If we're going to be on the hook for the money, we've got to have the ability to control the direction."

System attorney Ray Lamonica told board members that the LSU System may not be legally on the hook for future bond debt, which would be issued in the name of the proposed hospital corporation. But, he said, "It's certainly a moral and practical obligation if LSU ever intends to issue bonds again."

Lombardi said he does not have a specific time frame in mind for the next step in the hospital planning process. LSU Board Chairman Jim Roy called the vote "the beginning of a dialogue." Lombardi modified that to "a new beginning."

Lombardi declined to speculate whether today's vote will send lawmakers into a mad scramble to settle the issue through legislation before Thursday's final adjournment of the regular session.

House Speaker Jim Tucker, R-Algiers, earlier this year introduced House Bill 830 that would have stripped LSU's control of the hospital altogether. Tucker abandoned the bill last week when Levine announced the draft governance deal.

http://www.nola.com/politics/index.ssf/2009/06/lsu_board_criticizes_hospital.html

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Tulane and Louisiana State U. Differ Over Governance of New Teaching Hospital

Chronicle for Higher Education | 06.22.09

Katherine Mangan

Louisiana State University and Tulane University appear to be at an impasse over governance of a new teaching hospital in New Orleans, according to news reports. At issue is how much control the Louisiana State system should have on the board of a 424-bed hospital, which is expected to open in 2013 and cost around $1.2-billion.

Last week Tulane officials approved a plan that would give LSU four seats on a 12-member board. The LSU system’s Board of Supervisors amended the plan today to give LSU five seats on an 11-member board, The Times-Picayune reported. LSU deserves the additional clout, officials told the New Orleans newspaper, because the university would be responsible for backing $400-million in bond debt.

“We need to be in control,” Hank Gowen, a member of the LSU board, said before the vote. “We are the ones who are going to borrow $400-million.”

According to the Associated Press, Tulane officials rejected the plan and issued a statement saying that LSU’s move “indicates that Tulane and LSU have fundamental and philosophical differences with respect to the board composition and the appropriate safeguards and independent oversight of the proposed academic medical center.”

Both medical schools’ teaching hospitals were flooded and badly damaged during Hurricane Katrina. The interim downtown hospital they plan to use until the new hospital is built faces financial pressures, in addition to tensions caused by the governance feud between the two universities. —Katherine Mangan

http://chronicle.com/news/article/6685/tulane-and-louisiana-state-u-differ-over-governance-of-new-teaching-hospital

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Make LSU show us the money

The Times-Picayune | 06.22.09

Charlotte Hamrick

Re: "Feeling discarded, " Other Opinions, June 21. Having recently learned about Rick Nowlin's HB 780 to protect property owners in New Orleans from irresponsible use of eminent domain, I am outraged that the Senate Education Committee has moved to table it.

What could possibly be so objectionable about requiring LSU to prove they have the money to build a new hospital before they start seizing private property out from under people who own homes and businesses?

What kind of precedent are we setting? What kind of message are we sending?

Expropriation is perhaps the most powerful tool of the state. To see it employed so recklessly represents a shameful low and an attack on each and every property owner and community in the city.

I have written my state senator to demand he work to pass HB 780 before the end of the session, and I hope you do the same.

Charlotte Hamrick

New Orleans

http://blog.nola.com/letterstotheeditor/2009/06/make_lsu_show_us_the_money.html

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Emergency Rooms Get Ready for Hurricane Season

Louisiana Medical News | 06.22.09

By: LISA HANCHEY

In the aftermath of Hurricanes Ike and Gustav one year ago, Louisiana's emergency rooms are gearing up for the 2009 storm season. Lessons learned from these storms, as well as 2005's Hurricanes Katrina and Rita, are leading to upgrades at hospital ERs from New Orleans' levees to Cameron's coast.

Interim LSU Public Hospital in New Orleans

On August 29, 2005, Hurricane Katrina hit the Gulf Coast, leaving a path of destruction in its wake. Subsequently, New Orleans' levees failed, inundating the city with flooding waters. Severe flood damage shut down Charity Hospital and University Hospital, operated by LSU Health System's Health Care Services Division, rendering the indigent and underinsured in the area without medical care.

In September, the U.S.N.S. Comfort, one of the Navy's hospital ships, sailed into New Orleans to provide medical services and disaster relief. Days later, University Hospital reopened its parking lot with a series of military medical tents to treat patients. Simultaneously, faculty and residents worked alongside the military at the Ernest N. Morial Convention Center. About a month later, the parking lot's makeshift medical center closed, and the portable tents relocated to the convention center.

In April, 2006, LSU's hospitals set up shop in the former Lord & Taylor building and Ochsner's Elmwood Hospital to deliver trauma care for the metropolitan area. That November, University Hospital reopened as the Interim LSU Public Hospital, with an eight-bed emergency department and a six-bed fast track. Trauma services returned to the facility in February, 2007. Three months later, the beds increased to 28 – less than a third of the 90 ER beds pre-hurricane.

Last year, the hospital installed a helipad for transporting trauma patients. In July, LSU's interim hospital will launch a new fast-track area, consisting of 17 beds and its own laboratory.

As the interim hospital continues to add services, its census is gradually increasing. Prior to Katrina, the charity system tallied about 180,000 patient visits per year. Over the past year, 60,000 patients were treated at the facility – an increase of 10,000 over the previous year. "We really don't know where this is going, and how fast," reported Dr. Peter DeBlieux, director of emergency medicine services at the Interim LSU Public Hospital.

But, DeBlieux said that what the New Orleans area really needs is a new hospital to service the returning population. Before the storm, about 60 to 65 percent of medical students who trained at LSU's medical school in New Orleans stayed to practice. Now, only 40 to 50 percent of graduates remain in the area. "There is no firm commitment from the state and federal governments for a new facility," he said. "Our currently facility that we are working in was surrounded by 11 feet of water. The likelihood that we will get flooded again is pretty great. It's even tougher to get our medical students to stay without a firm commitment to a healthcare system for the city. There is no permanency in the healthcare industry here. That's unfortunate."

Memorial Hospital in Lake Charles

Immediately after Katrina, evacuees from the New Orleans metro area inundated hospitals in Lake Charles. "What came out of New Orleans after Katrina was a horror show," recalled emergency room physician Steven Hedlesky. "We were treating patients with tremendous leg wounds – diabetics who had walked through the water, people with terrible sunburns who had been infected from being on roofs of buildings." The most poignant event – a tour bus transporting nursing home residents from New Orleans to Houston dumped off a dead and a dying patient at the hospital's doors.

Less than a month later, Rita smashed the southwest border. At that time, Katrina victims were still trickling in. Memorial's seriously ill patients were shuttled to facilities in north Louisiana, while staff hunkered down in Lake Charles. The storm crashed through the hospital, knocking out windows and heavily damaging the main tower. While the self-generating facility did not lose electricity, the hospital was unable to run its air conditioning through the inoperable public water system. After shutting down for about a week, the hospital reopened to provide emergency services.

Memorial fared much better through Hurricane Ike, which engulfed the city with a massive storm surge. "Our emergency room continued to work fine," Hedlesky reported. "We had the staff and equipment that we needed, and we were able to take care of what came through our doors."

This year, Memorial's ER personnel are fired up and ready for hurricane season. On May 21-22, the facility conducted a disaster preparedness session for staff. The first lesson: getting families out of harm's way so that employees can concentrate on doing their jobs. Vendors also taught employees about generator, electricity and candle safety during power outages. Nutritionists advised participants what foods to buy, including canned goods and quick energy non-perishables – candy bars, crackers, energy drinks and liquid high-calorie supplements. Experts recommended allotting one gallon of water per day per person, and using baby wipes and pre-moistened towelettes for bathing and personal hygiene.

Learning from past storms, Memorial is also improving its evacuation procedures. During Hurricane Gustav, the hospital evacuated 84 patients out of the storm's projected path. This June, Mutual Aid, a 150-member organization comprised of industrial, commercial, municipal and hospital volunteers from the five-parish Imperial Calcasieu area, conducted an air evacuation drill at Chennault International Airport Authority. Additionally, the association recently tested all 800 MHz radio systems in the area. Both Bill Wilkie, Memorial's director of plant operations, and Tim Coffey, the hospital's senior vice president of operations, are Mutual Aid members.

Now that hurricane season is here, Memorial has already taken steps to get ready, not only as a hospital, but also as a base of operations for first responders. "We have an agreement with the city to house first-responders – law enforcement, fire fighters and municipality workers," Wilkie explained. "They use us as a base of operation because of our having emergency generators. So, we have power and supplies, not only with food and water, but also with medications."

Emergency generator fuel tanks are tuned up and topped off for hurricane season. Pre-planning for resources, supplies and personnel is done. "No matter what the situation is, we will be open," Wilkie emphasized. "We do our best to reduce the risk to our staff, our patients or others who come in our building. We are a full-service hospital that is serving the community."

West Calcasieu Cameron Hospital in Sulphur

After Hurricane Rita, West Calcasieu Cameron Hospital treated a

slew of evacuees from Louisiana's southeast coast. Luckily, the facility sustained only minor damage and a temporary power outage, with backup generators bringing operations quickly back up to speed. Cal-Cam treated displaced patients primarily for post-hurricane injuries relating to encounters with flailing chainsaws, broken boards, hidden nails and shattered windows.

Following Hurricane Ike in September, 2008, Cal-Cam experienced a temporary decrease in patient numbers. Since that time, the ER has steadily increased its patient population to 1,800 visits a month, or about 20,000 per year.

To keep up with the rising patient census, the hospital is staffed with a full-time physician and nurse practitioner contracted through Lafayette-based Schumacher Group.

Having back-to-back hurricanes spurred the Schumacher Group to form a program called the Disaster Assistance Response Team (DART). DART consists of about 100 physicians in Louisiana, and multiples nationwide, dedicated to disaster response. "It is a group that is going to be dedicated for any disaster, may it be hurricane- or fire-related – any disaster which requires immediate response," explained Cal-Cam's ER medical director, Dr. Syed Amir Shah. "We are going to have some core physicians who can be posted in that area, so you don't have to worry about shifts and finding physicians and crew."

Another new Schumacher Group initiative – Sort, Order and Treat (SORT) – is aimed at getting the patient from the ER door to the doctor as quickly as possible. At Baton Rouge General Medical Center, SORT reduced the number of people walking out without treatment (LWTs) by 75 percent since implementation. Over the last few months, Cal-Cam has experimented with SORT, and will implement it at full speed this summer. "When you walk into the crowded emergency room, you will get first care which will be prompt and proper," Shah said. "It's working great."

University Medical Center in Lafayette

Since Hurricane Lili in 2002, LSUHCSD's University Medical Center has managed to stay out of harm's way. During Hurricane Gustav, UMC evacuated patients and staff to Alexandria, La., and reopened after a few days. But, dodging those bullets has not stopped UMC from preparing for the current storm season.

Last year, LSUHSCD entered into a contract regarding evacuation procedures for its hospitals. Recently, UMC held meetings with the corporation's leaders to discuss lessons learned from prior storms. Now, once a hurricane is in the area, the hospital notifies the contractor, who secures ambulances, aircraft and helicopters for deployment.

In 2008, UMC improved its communications network by adding ham radios, installing satellites and giving BlackBerrys to key personnel. LSU is also acquiring a service to send blast e-mails or text messages to staff when a hurricane is approaching. "Communication with the employees has always been of high concern," said Larry Dorsey, UMC's hospital administrator. "So, we will be using this system this year if we have to evacuate or have to close the hospital."

During the year, the facility held a series of employee drills and management training for hurricane preparation. Additionally, UMC is hiring an architect to evaluate the building for any weaknesses. The hospital is also organizing an emergency management team. "We have already notified all of our employees that it's hurricane season, and sent out information to them to get ready," Dorsey said. "If something should come up, then we'll start enacting our emergency plan. We are taking all precautions possible to get ready for the hurricane season."

http://www.louisianamedicalnews.com/news.php?viewStory=1330

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Jindal aims to compromise by restoring $200 million to health care, higher education

The Daily Reveille | 06.23.09

Kyle Bove, Senior Writer

Gov. Bobby Jindal addresses a news conference at the state Capitol, June 11.

Rivaling the smoldering Baton Rouge heat, debate over what to do with the state budget is reaching its boiling point in the last few days of the 2009 legislative session.

Gov. Bobby Jindal said at a news conference Monday he is willing to restore $200 million to next year’s budget for health care and higher education — a move that may spark a compromise between the bickering House and Senate.

Since the session started two months ago, disagreements on how (or if) to restore money to higher education have run rampant at the Capitol.

Jindal’s original $28.7 billion state spending budget had higher education taking a $219 million cut in order to make up for an expected $1.3 billion drop in revenue next year.

The state Senate sought ways to restore the cuts to public colleges and universities, proposing the use of the rainy day fund and dollars generated from an income tax break delay to fill the gaps. The Louisiana House, meanwhile, proposed the use of a tax amnesty program to restore only part of the cuts, forcing the state to tighten its belt and review its expenses.

Jindal vowed last week to strip $278 million from the state’s budget because the money is tied to the passage of legislation he doesn’t agree with.

Among that legislation is SB 335, which would delay a planned income tax break to generate $118 million to restore a large chunk of higher education’s expected cuts.

Senate President Joel Chaisson, D-Destrehan, recently proposed a resolution that would take $256 million out of the state’s rainy day fund — formally known as the Budget Stabilization Fund — and spread the funds across three years for budget relief.

But Jindal’s plan only uses $86 million from the rainy day fund and draws the rest from other places — including $75 million from the expired Louisiana Incentive Program fund, $20 million from the Medicaid Trust Fund for the Elderly, $18.5 million from incentive money the Shaw Group vowed to return to the state and $5 million in unused money from a college scholarship fund.

Jindal said he wants to use the one-time funds to restore $70 million to higher education, making their cuts $149 million if the plan is supported by the House and Senate.

The session ends Thursday at 6 p.m.

The University’s budget plan is expected to be released this week, but a bill that increases graduate school tuition gained two-thirds Senate approval Monday, sending the legislation to the House for final approval. The University supports HB 872.

The bill, by Rep. Hollis Downs, R-Ruston, allows colleges to raise tuition by up to $30 dollars per credit hour. That means a student taking 15 hours per semester may see a $900 hike in tuition starting July 1.

Under the bill, veterinary school tuition at the University would increase by up to $1,500 a year and the state’s master’s of business administration programs by up to $2,000 a year. Dentistry and law school programs are not included in the bill, but the LSU Health Science Center is included.

http://www.lsureveille.com/news/jindal-aims-to-compromise-by-restoring-200-million-to-health-care-higher-education-1.1765188

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Jindal agrees to $80 million more in spending

The Times-Picayune | 06.23.09

By Jan Moller

Capital bureau

BATON ROUGE -- A budget deal appeared closer Monday, as Gov. Bobby Jindal said he would be willing to accept up to $200 million in restorations for health care, higher education and other programs.

The amount is $80 million more for the 2009-10 fiscal year than the governor had previously said he would support, and comes as the House and Senate continue negotiations to end the brinkmanship that has divided the chambers in recent weeks.

"Both sides are closer today than they were a few days ago," Jindal said.

While the $28 billion budget for next year has already been sent to the governor, that bill includes deep cuts for many state programs that legislators, with Jindal's support, are trying to patch through other spending bills.

But with three legislative days remaining before adjournment Thursday, there is still no final agreement on how much money should be put back, where it would come from and how it should be distributed among the various groups vying for a share.

While Jindal wants to hold the line at $200 million, the Senate approved a supplemental budget bill Monday -- House Bill 881 by Rep. Jim Fannin, D-Jonesboro -- that calls for $274 million in restorations.

That bill would provide $118 million for public colleges and universities that is tied to the passage of a separate bill to postpone a scheduled income-tax cut by three years. If the tax-cut delay is not approved, the higher education money would come from a surplus in the Medicaid program.

House members, by contrast, are hewing close to the governor's position and have resisted any attempts to delay the phased-in income tax cut that was approved in 2007.

Although spending decisions rest with the Legislature, the governor plays a key role, since he wields a line-item veto authority. Jindal is proposing that the restorations come from four sources:

-- $75 million from the Insure Louisiana Incentive Program fund, which was set up in 2007 to entice out-of-state insurance companies to write policies in Louisiana, but which has since expired;

-- $86 million from the Budget Stabilization Fund, or rainy-day fund. The House late Monday voted 101-1 for a House Concurrent Resolution 236, also by Fannin, that would authorize that withdrawal;

-- $20 million from the Medicaid Trust Fund for the Elderly, which could be matched by federal dollars but can be used only to mitigate the cuts proposed for nursing homes;

-- $18.5 million that's earmarked for specific uses in higher education, but which would be freed up so colleges and universities could use it to offset cuts.

"There is enough money to restore funding to higher ed and health care and address other high-priority areas," Jindal said at a meeting with reporters to discuss his priorities for the week.

He said he would not try to "micromanage" the Legislature as it seeks to divide the money, but said he wants at least $70 million to be used to offset the $219 million in cuts for public colleges and universities.

Health care officials, meanwhile, have said their top priorities are to provide more money for private group homes for the developmentally disabled and hospitals that treat a disproportionate amount of high-cost, high-complexity cases.

That would still leave significant cuts for mental health, home-care services for the elderly and disabled and other Medicaid programs.

Legislators also are hoping to earmark at least $30 million for "member amendments" that finance pet projects in their districts, $30 million in judgments against the state, as well as money for tourism promotion, arts programs and the New Orleans Adolescent Hospital.

There is no guarantee that the "member amendments" will survive, however, as they are not included in the Senate's version of the supplemental budget bill. Language added to the rainy-day resolution says no money taken from that account can be used for such amendments.

The differences over the supplemental budget bill, as well as the rainy-day resolution and other pieces of the spending puzzle, are expected to be worked out in House-Senate conference committees in the next three days.

http://www.nola.com/news/t-p/capital/index.ssf?/base/news-7/1245735099193680.xml&coll=1

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Health care funding still undecided

Shreveport Times| 06.23.09

By Mike Hasten

BATON ROUGE — Hundreds of mentally and physically handicapped people came to the Capitol on Monday seeking answers to what their future holds, only to find that health care funding is among several issues still waiting to be settled.

At stake is funding for community-based health centers, hospitals and other services that have been targeted for cuts.

The crowd gathered under trees seeking shade in 95-degree heat waved signs and chanted "Don't cut us" before filing into the Capitol to talk to lawmakers.

The Legislature is moving to restore cuts by shuffling funds but Laura Brackin, executive director of ARC of Louisiana, says "there's a problem with what they're restoring."

The move in recent years has been to shift to lower-cost, home-based care but that's what is targeted for cuts, she said. People currently receiving care there would be forced to go to larger state-run residential facilities.

"In the long run, this will be more costly," Brackin said.

Earlier in the day, Gov. Bobby Jindal said House and Senate leaders are nearing an agreement on funding for health care and higher education. "They have identified close to $200 million for higher education and health care and other critical priorities."

He said Department of Health and Hospitals Secretary Alan Levine has said group homes for the developmentally disabled and "outliers" — primarily premature babies in neonatal intensive care units — would be the best use of state dollars to secure Medicaid funds.

"We have resolvable gaps between the House and Senate," Jindal said.

"It is very frustrating," Brackin said, because health care and higher education are always the targets of cuts and in this case, the wrong thing is being cut.

"Community-based care is less costly," she said. "Why put the most cost-effective measure of providing services out of business?" She said if Jindal used a business model, "he would never make this decision.

Brackin said the state is working on a cost-saving plan to be implemented within the next year, so the state could provide one-time funding to help community-based care centers survive until the new plan comes into effect.

During debate on HCR236, a plan to supply funds, Rep. Sam Jones, D-Franklin, said "I don't think people care how we do it. They want us to fix health care, fix higher education and not throw people out of nursing homes."

Jindal proposed that the restorations come from four sources:

$75 million from the Insure Louisiana Incentive Program fund, which was set up in 2007 to lure out-of-state insurance companies to write policies in Louisiana but has since expired;

$86 million from the Budget Stabilization Fund, or rainy day fund;

$20 million from the Medicaid Trust Fund for the Elderly, which would be used to raise the reimbursement rates for nursing homes;

$18.5 million for higher education, taken from incentive money that the Shaw Group has agreed to return to the state and $5 million in unused money from a college scholarship fund.

"There is enough money to restore funding to higher ed and health care and address other high priority areas," Jindal said at the morning news conference.

http://www.shreveporttimes.com/article/20090623/NEWS01/906230312

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OPINION: Does it have to end in brinksmanship?

Shreveport Times | 06.23.09

Are Louisianans naive to wonder why brinksmanship has to be part of state government?

Rather than openly and deliberately working their way through a state budget facing a billion dollar shortfall, Monday dawned with lawmakers staring down the barrels of a Thursday adjournment and potential vetoes from the governor. Among the aspects that irk us:

# Special needs citizens and their advocates converged on sun-baked state Capitol steps Monday while legislative leaders and the governor in their air conditioned warrens looked for money to reduce health care budget cuts.

On the specific issue of funding for the developmentally disabled, we were reminded of state Rep. Wayne Waddell's pre-session thoughts on ways to trim the budget. He called for serious review of the money spent on state-run developmental centers: "Rough estimates suggest that the state spends around $170,000 per person per year in the state-run facilities and only $75,000 per person per year in home and community-based providers." And yet that was where the state's health care budget was headed before Monday, cutting back on funds that allow disabled people to live at home or in the community. Institutions will continue to have a place, but if the governor is pushing for reforms in the way government does business, whether in higher ed or health care, the cuts in community- and home-based alternatives are counterproductive.

# Ten days ago the House eschewed a conference committee to hammer out differences in the Senate-amended budget. The professed reason: Behind closed doors in conference is where too many deals are struck. The result of that decision? House and Senate leaders, along with members of the administration, have been working behind closed doors — out of the public eye — to find money to lessen budget cuts.

# What's up with all these pots of money? We've got a fiscal crisis, and late in the game folks start showing cards known only to knowledgeable government observers. Consider that health care budgets may be plugged with some of the $76 million being taken from the Insure Louisiana Fund (set up to induce insurance companies to locate in the state) and another $20 million from the Nursing Home Trust Fund. Can we get an amen for greater budget transparency?

As the session collapses toward a Thursday adjournment, we suggest voters begin jotting down questions to ask their lawmakers and governor when they head north.

http://www.shreveporttimes.com/article/20090623/OPINION03/906230311/1058

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Healthcare advocates protest Jindal's cuts

Shreveport Times | 06.22.09

By Fred Childers

SHREVEPORT, LA (KSLA) - After a brief pep talk, Ark-La-Tex healthcare providers, advocates, and the disabled headed for the state capitol in Baton Rouge.

They boarded several charter busses to deliver a message to Governor Bobby Jindal.

The message: We do not appreciate him vetoing House Bill 1 and cutting services.

Because of a 1.3 billion state revenue shortfall, advocates say Jindal is cutting their funding, which allows the disabled to function in their own homes.

"It might have to cut down on the number of hours per week that i receive someone to come in and help me with my activities of daily living," said Duane Eberb, a disabled person who is making the trip along with hundreds of others.

"They want to be working, they want to be living in their own homes, they want to be doing what everybody else does, they want to be productive citizens," said a representative for ARC.

Jindal vows to veto house bill 1, which would reportedly restore the deep cuts, and has said Louisiana must learn to do more with less.

But for them, less is not an option, and that's why advocates from all over the state are making the same trip to Baton Rouge.

Healthcare providers say the cuts which would result in about a million dollars would also result in lay offs.

Governor Jindal's office has responded to the criticism, saying that his opposition parts of House Bill 1 will help the healthcare industry. In an email to News 12 Melissa Sellers, the Communications Director for the Office of the Governor wrote, "The Governor announced last Monday that he was freeing up around $120 million in funding for higher education, health care, and other state priorities by vetoing sections of HB 1 that were tied to legislation that would have failed in the House of Representatives. This funding would have been lost without the Governor's action to free it from a bill bound for defeat. The Governor stressed his support for aiding higher education and health care priorities again this morning and said there is now a total of $200 million available to aid these critical areas. He also said DHH Secretary Alan Levine is working with legislators to recommend how they can add funding to health care programs, for example Medicaid outlier funding for hospitals and funding for group homes for the disabled, if they choose to do that."

This year's session will end on Thursday.

http://www.ksla.com/Global/story.asp?S=10575183&nav=menu50_2

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Louisiana Senate OKs $213M for hospitals hurt by hurricanes

New Orleans CityBusiness | 06.22.09

by The Associated Press

BATON ROUGE - Private and community hospitals will divvy up $213 million from the state and federal government to help them cope with revenue losses caused by hurricanes Katrina and Rita, if Gov. Bobby Jindal agrees to a bill that won final passage today with a vote of the Senate.

The measure, House Bill 879, by House Speaker Jim Tucker would use $45 million in one-time federal hurricane recovery dollars to draw down an additional $168 million in federal matching cash through the Medicaid program for the poor and a program to help cover the costs of uninsured care.

The bulk of the money, $170 million, would go to New Orleans-area hospitals through the Medicaid program. Another $18 million would go to other hospitals impacted by the hurricanes, while $17 million would be divided on a formula basis among hospitals that provide uninsured care and $8 million would go to rural hospitals.

The state's public hospitals, run by LSU, wouldn't receive any of the dollars.

http://www.neworleanscitybusiness.com/uptotheminute.cfm?recid=25398

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Expanded conscience measure for health providers approved

The Times-Picayune | 06.23.09

By Bill Barrow

Capital bureau

BATON ROUGE -- Social conservatives went one-for-two Monday in the Louisiana Senate, winning approval of new rights for health care workers to refuse certain duties based on their religious or moral beliefs but failing to get a vote on reaffirming that Louisiana will not issue birth certificates to some gay adoptive parents.

But neither matter is settled.

The health-provider conscience measure, House Bill 517 is headed for a compromise committee representing both chambers, according to the sponsor, Rep. Bernard LeBas, D-Ville Platte. The birth certificate measure -- House Bill 60 by Jonathan Perry, R-Kaplan -- could still come up on the Senate floor but only with a two-thirds approval of the body under rules in place for the session's final three days.

LeBas' bill, pushed by the Louisiana Family Forum, a conservative Christian organization, is intended to provide civil immunity and job protection to health care employees who decline a certain list of procedures out of "sincerely held religious belief or moral conviction."

The House amended the measure to affect only public employees, allowing them to decline to provide abortions, distribute "abortifacient drugs," work on human embryonic stem cell research or cloning, or participate in euthanasia or physician-assisted suicide.

The Senate, with LeBas' backing, left intact the House's list of procedures but returned private health care workers to the bill.

That could prove problematic in the House, however, where Rep. John Bel Edwards, D-Amite, won overwhelming approval of narrowing the affected procedures and excluding private businesses. Edwards said the bill would represent a fundamental shift in Louisiana employment law, which gives private enterprises wide latitude in firing employees.

The Louisiana Association of Business and Industry, the Louisiana Hospital Association and other health care lobbying groups have not taken a public position on the bill during numerous hearings. Instead, they have left the debate to the Family Forum, the state's Catholic Bishops, Planned Parenthood and the American Civil Liberties Union. The latter two groups oppose the bill outright, regardless of the nuances, arguing that patients could be denied access to services and information.

The birth certificate bill stems from a federal court case filed by two men in California who are challenging the refusal of the Louisiana Office of Vital Records to issue a birth certificate recognizing both of them as parents of a Shreveport-born toddler they adopted through a New York court in 2006.

Adoption decrees routinely call for a revised birth certificates.

A U.S. District Court judge said Louisiana is compelled to honor the New York court's order. Louisiana is appealing to the 5th U.S. Circuit Court of Appeals with hopes that Perry's bill would clarify state vital records law.

Gay rights advocates blast the measure as mean-spirited.

The bill appeared to have enough votes to pass Monday night, but Sen. A.G. Crowe, R-Slidell, reluctantly shelved the measure when it became apparent that a handful of senators were going to delay a vote until after 6 p.m. That is the deadline after which all bills require a supermajority to pass.

http://www.nola.com/news/t-p/capital/index.ssf?/base/news-7/1245735139193680.xml&coll=1

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'Future of medicine' demonstrated at Bunkie General Hospital

Town Talk | 06.23.09

By Jeff Matthews

BUNKIE -- For years, Dr. Don Hines had a dream to bring the best of big-city health care to the smallest of rural hospitals.

It's not a dream anymore.

On Friday, Hines led a telemedicine demonstration at Bunkie General Hospital, showing off the equipment and techniques that he hopes will spread and move rural hospitals throughout the state toward the cutting edge of treatment.

"I think it's real good," said Hines, the former longtime state senator. "It gives patients in this area access to specialist care without having to leave the community."

"We are in the top 20 percent of hospitals in the country as far as Internet technology," said Bunkie General CEO Linda Deville. "We're ahead of 80 percent. So this is huge for us. The state of Louisiana, can you believe, is ahead of the nation."

Hines is executive director of the Louisiana Rural Health Information Exchange, an organization dedicated to improving patient care at the state's rural hospitals.

As part of its plan, LARHIX is helping Louisiana's hospitals hook up to an electronic records network to assist doctors in accessing patient records and keep them from duplicating expensive tests and other services, and starting an internal medicine residency program with a focus on rural medicine to help attract doctors to rural areas.

The third part of the plan, the one that was demonstrated Friday, is telemedicine, or treatment via videoconferencing.

In Friday's demonstration, Deville played the part of a patient at Bunkie General being treated by Hines. Hines, needing a consult from a specialist, videoconferenced with a doctor at the LSU Health Sciences Center in Shreveport.

Hines was able to share test results, give an overview of the patient's symptons and perform an on-camera exam in a matter of minutes. The fictional patient was then scheduled for a test in Shreveport.

Without the video consult, that patient would have had to travel to Shreveport and perhaps be subjected to some of the same tests she had in Bunkie before she was scheduled for the follow-up test. She would then have to go back for that test and follow-up exams, which thanks to the videoconferencing, can now be done in Bunkie.

"That just saved her two or three trips to Shreveport," Hines said. "Many that we see are disabled. They lack transport or they have to borrow money for gas. This solves the problem. It gives our patients access to specialists in Shreveport."

"It means our patients will have access to specialists," Deville said. "It means less travel time, and some of our patients can't travel."

LARHIX was born in the aftermath of Hurricane Katrina, when LSUHSC-New Orleans was devastated along with much of the city. That resulted in many more patients being referred to the hospital in Shreveport, which had a hard time dealing with the overflow.

The telemedicine and electronic records programs, it is hoped, will save money and time that can be spent on improving other medical programs. Hines said 15 hospitals currently have the telemedicine capabilities, and he hopes to expand to 23 hospitals in the north and central parts of the state.

"This is very impressive," said Dr. Robert Barish, chancellor at LSUHSC-Shreveport. "This is the future of medicine. This is how we need to deliver medicine going forward."

http://www.thetowntalk.com/article/20090623/BUSINESS/306230002

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Prostate Cancer Progression Averted by Green Tea

Softpedia | 06.22.09

By Tudor Vieru, Science Editor

Active compounds inside green tea have the ability to delay the development of prostate cancer, a new study finds.

Prostate cancer is a form of the disease affecting the prostate gland in men, and its effects can be very severe, leading even to death. Because the condition is very widespread, like the breast and cervical varieties are in women, researchers have been trying to identify a way of stopping it, or at least slowing down its development, for quite some time now. A recent study shows that prostate cancer patients who consume the active ingredients in green tea show fewer serum markers predicting the progression of the terrible disease.

“The investigations agent used in the trial, Polyphenon E [provided by Polyphenon Pharma] may have the potential to lower the incidence and slow the progression of prostate cancer,” Professor James A. Cardelli, PhD, the director of basic and translational research in the Feist-Weiller Cancer Center, at the LSU Health Sciences Center-Shreveport, explains.

The paper, which appears in the American Association for Cancer Research's publication Cancer Prevention Research, is one of the few to date to look at the effect that green tea has on biomarkers, which modern medicine uses to assess a person's risk of contracting and developing a certain disease.

“These studies are just the beginning and a lot of work remains to be done, however, we think that the use of tea polyphenols alone or in combination with other compounds currently used for cancer therapy should be explored as an approach to prevent cancer progression and recurrence,” the expert adds, quoted by ScienceDaily.

“There is reasonably good evidence that many cancers are preventable, and our studies using plant-derived substances support the idea that plant compounds found in a healthy diet can play a role in preventing cancer development and progression,” he says.

As part of the experiments, the expert's group looked at more than 26 men, aged between 41 and 72, which were scheduled for radical prostatectomy. The patients were studied for about 12 days to 73 days, and, during this time, they were asked to take four capsules of Polyphenon E, the rough equivalent of 12 normally brewed cups of green tea. The team followed the levels of several biomarkers at the same time, including the hepatocyte growth factor (HGF), the vascular endothelial growth factor (VEGF) and the prostate specific antigen (PSA).

After the treatment, they noticed a sharp decrease in the levels of serum markers, which, in some cases, was equivalent to more than 30 percent. The conclusion that Cardelli derived from the results was that using green tea extracts in high amounts, potentially alongside other drugs already employed for cancer treatment, could be an avenue of research worth exploring, if not for its seemingly immediate benefits, at least for its potential of stopping the progression of the disease for a while.

http://news.softpedia.com/news/Prostate-Cancer-Progression-Averted-by-Green-Tea-114844.shtml

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Expanded conscience measure for health providers approved

The Times-Picayune | 06.23.09

By Bill Barrow

Capital bureau

But neither matter is settled.

The Senate, with LeBas' backing, left intact the House's list of procedures but returned private health care workers to the bill.

Adoption decrees routinely call for a revised birth certificates.

Gay rights advocates blast the measure as mean-spirited.

http://www.nola.com/news/t-p/capital/index.ssf?/base/news-7/1245735139193680.xml&coll=1

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Scientist: Unattractive stairs may be to blame for obesity

The Daily Reveille | 06.23.09

Xerxes A. Wilson

GRANT GUTIERREZ / The Daily Reveille

Biological sciences freshman Carolina De la Pena and her family we stairs in the Student Union on Monday afternoon.

In a state where nearly 30 percent of the population is considered obese by the Center for Disease Control and Prevention, University researcher Ishak Mansi partially blames the unattractive design of stairs for America’s growing problem.

A report authored by Mansi focuses on how making stairs more attractive could result in a long-term solution for obesity.

Encouraging people to use stairs instead of escalators or elevators is a practical way to increase physical output, but the unappealing design of stairs keeps people from using them on a regular basis, Mansi said.

“In my area of work, I don’t mind using the steps, but I usually can’t find them,” Mansi said.

“They are usually hidden under a fire exit. If you do find them, they are very steep and uncomfortable, they have no air-conditioning and you can’t get your cell phone to work on them.”

Ishak Mansi’s wife, Nardine Mansi, is an architect and co-authored the report.

Complying with government regulations on multi-story building design usually results in stairs being located in obscure parts of the building with elevators being a central feature of the design, Nardine Mansi said.

“There needs to be a cultural change in the mind of architects and owners,” said Nardine Mansi. “We need to increase the area of steps to make them more comfortable and make them the focal point of the building instead of having elevators fancy in the middle of the entrances of the building. We can make stairs the nice part of the building with music and lights and really make them cheerful so people will want to use them.”

Ishak Mansi explained that leisure time activities — like exercising — only make up 5 percent of people’s daily physical output, while the other 95 percent of a person’s physical output is related to jobs and conducting mundane tasks. So making changes that moderately increase a person’s daily energy output — like taking the stairs at work — will yield much greater results in the long term.

“It’s ironic that people have the actual stairs in front of them at work, and they don’t chose them,” Ishak Mansi said. “But then they go home or to a gym and pay for something that simulates the stairs.”

Nardine Mansi argues that local and state authorities should reward building owners that design their buildings to be friendly to physical health, similarly to how state authorities give tax incentives to energy efficient building.

http://www.lsureveille.com/news/scientist-unattractive-stairs-may-be-to-blame-for-obesity-1.1765163

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Map shows HIV rate highest in South

The Advocate | 06.23.09

By STEVEN WARD AND MIKE STOBBE

Advocate and AP writers

A new online atlas launched Monday that highlights the areas of the country with the highest rates of HIV and AIDS shows East Baton Rouge, West Feliciana, East Feliciana and Iberville parishes are hot spots for the disease in Louisiana.

The HIV/AIDS Atlas, created by the nonprofit organization The National Minority Quality Forum, also shows Orleans and Allen parishes as other areas in the state hard-hit by HIV and AIDS, said Becky Fleischauer, a spokeswoman for the forum.

The new Internet data map finds the infection rates tend to be highest in the South.

Beth Scalco, the Louisiana AIDS director of the HIV/AIDS Program for the Office of Public Health, said the six Louisiana parishes highlighted in the map are six of 72 counties in the country with the highest rate of people living with HIV or AIDS.

Scalco said East Baton Rouge and Orleans rate high because of population and large urban areas.

Even though the other four parishes are rural areas, they rate high because of the number of correctional facilities in each parish. Numbers of HIV and AIDS cases are usually high in prisons, Scalco said.

The highest numbers of HIV cases are in population centers like New York and California. However, many of the areas with the highest rates of HIV — that is, the highest proportion of people with the AIDS-causing virus — are in the South, according to the data map, which has information for more than 90 percent of the nation’s counties and Washington, D.C.

HIV infection rates are higher in African-American communities, and high minority populations in the South help explain the finding. While that’s not surprising, the high rates seen throughout states like Georgia and South Carolina were, said Gary Puckrein, president of the National Minority Quality Forum, the nonprofit research organization that put the map together.

Of 48 counties with the highest prevalence rates for HIV that had not yet progressed to AIDS, 25 were in Georgia, according to the map. Those were counties in which more than 0.7 percent of the population was infected with HIV.

Georgia, Florida, South Carolina and Virginia were heavily represented on another map of counties, which showed the highest prevalence rates for cases that had progressed to AIDS.

The map depicts reported numbers of people living with HIV and AIDS in 2006. Puckrein said the data came from state health departments and was checked against information from the U.S. Centers for Disease Control and Prevention.

Different states report data in different ways, and there may be case duplication that could impact some of the findings, Puckrein said.

The CDC’s HIV and AIDS prevalence data is reported on a state level, not by county. CDC officials were cautious about the data map, saying they hadn’t seen all the organization’s information.

“But we have long been part of the effort to identify geographic differences in the HIV epidemic, and we do see the need for efforts like these to facilitate better understanding of these differences,” CDC spokeswoman Elizabeth-Ann Chandler said.

http://www.2theadvocate.com/news/48819387.html

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Bringing Down the House

Slate.com | 06.23.09

By Darshak Sanghavi

The debate over achieving universal health care can seem hopelessly confusing. But the issues are actually pretty simple when you consider the lessons of Massachusetts.

In 2006, state lawmakers seeking to broaden health coverage made it illegal to be uninsured. It works like this: Employers have to offer you a health plan. If you are jobless or don't like your employer's plan, you must buy your own. If you don't get one, you pay a stiff fine. This strategy—known as an employer and individual "mandate"—forms the backbone of the national health reform bills now making their way through Congress.

On paper, the experiment was a resounding success. According to an Urban Institute estimate, the number of uninsured residents quickly fell from 13 percent to 7 percent following the law's passage.

And yet, something strange happened. Despite having health insurance, roughly one in 10 state residents still failed to fill prescriptions, ended up with unpaid medical bills, or skipped needed medical care for financial reasons. Hundreds of millions of dollars were spent to insure more Massachusetts citizens, but many people still weren't getting necessary care. What happened?

Assume you're looking to buy insurance. The state has a handy Web site where you can find the cheapest plan. For a young family of four, that plan costs roughly $9,500 per year, which doesn't include a minimum annual deductible of $3,500 before many benefits kick in. (The state helps cover some of the premiums for those who make very little money, but many still have to pay the other fees.) And if anyone is hospitalized or needs a lot of specialized care, you also pay 20 percent of that bill. In this relatively cheap plan, the family can be liable for an extra $10,000 per year of medical costs. This sort of "high deductible" health plan is clearly structured to discourage medical care.

Imagine, for example, that your homeowner's insurance had a $1,000 deductible. If the faucet leaks, you'll try to fix it yourself instead of calling the plumber. The same thing applies to health care. If your newborn has a fever, you might give her Tylenol and just hope there's no serious infection rather than head to the emergency room and face a hefty co-pay.

Why does a progressive state like Massachusetts strong-arm many individuals and businesses into buying expensive insurance plans that don't encourage actual visits to the doctor and hospital? According to the Kaiser Family Foundation, the average person consumes more than $5,000 per year in health care resources. No matter how you slice it, some entity—government, business, or the individual—owes a boatload of cash for medical expenses. The annual costs for the 500,000 or so uninsured Massachusetts residents would run more than $2.5 billion, far in excess of the original state subsidy of $559 million.

That left billions to be paid by businesses and individuals. So for them, a high-deductible plan was a rational gamble. You (or your employer) front just enough money to get some coverage in case of catastrophe and then hope no one actually gets sick. But someone invariably does. As a result, out-of-pocket medical bills are the leading cause of bankruptcies—even though of most affected families actually have health insurance.

The expensive Massachusetts plan is not well-designed to systematically improve anyone's health. Instead, it's a superficial effort to clear the uninsured from the books and then clumsily limit further costs by discouraging care.

This brings us to the real task facing health reformers in our nation. Atul Gawande recently observed that for too long we've been "arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks." What's more important are the doctors who write the bills. The more procedures they do, the more money they make. To fix medicine, he argues, we have to create better incentives for doctors to do right by patients instead of their own bank accounts.

But that's not the whole story. Health care costs are rising everywhere, even in places like Minnesota, which Gawande cites as a prime example of low-cost, high-quality care that should be replicated nationwide. (Per capita health spending is actually 25 percent higher in Minnesota than in Texas, which has a hospital system that Gawande criticizes for profiteering.) In Massachusetts, some employers offering high-quality plans have annual rate increases of 10 percent to 15 percent. These jumps are certainly due to some overuse of services but also indicate increasingly high-technology care.

The lesson of Massachusetts is that really good health care is also really expensive. The concern isn't who writes the checks or who writes the bills. The real question is who makes the tough decisions about the limits of the checks and bills—in other words, who ultimately rations the money. Not everybody can have everything, and the sooner we admit that, the sooner our health care debate will get realistic.

In the haphazard Massachusetts plan, rationing fell to individuals, who then skimped on important prescriptions and routine visits. Gawande would leave rationing to properly incentivized doctors, but we have no data about whether this can be done widely. Others advocate for bodies like the Medicare Payment Advisory Commission (an impartial medical Federal Reserve Board), which can make the hard calls to promote and limit certain kinds of medical care. Britain, for example, has a national institute that makes precisely these decisions, like limiting drug-eluting stents for coronary artery disease and certain pricey drugs for kidney cancer. And health insurance executives here are again talking about "capitation," or fixed global budgets in which a group of health providers gets fixed monthly fees to handle all of a person's health needs.

In the meantime, one thing is sure: Without a smart plan to ration our resources well—that is, stick to a budget—and improve health, simply mandating that employers and individuals buy health insurance will only worsen the mess.

Darshak Sanghavi is a pediatric cardiologist and assistant professor of pediatrics at the University of Massachusetts Medical School. He is the author of A Map of the Child: A Pediatrician's Tour of the Body.

http://www.slate.com/id/2221031/

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President Obama says government-run insurance essential to health care reform

The Times-Picayune | 06.22.09

by Jonathan Tilove, The Times-Picayune

WASHINGTON -- President Barack Obama insists that offering Americans the choice of a government-run alternative to private insurance is indispensable to health care reform.

That public option, Obama wrote Sens. Edward Kennedy, D-Mass., and Max Baucus, D-Mont., earlier this month, would give Americans "a better range of choices, make the health care market more competitive, and keep the insurance companies honest."

Liberal activist groups last week began bombarding Sen. Mary Landrieu, D-La., with negative ads -- online to start, with radio and TV ads to follow -- for opposing the public option.

In fact, no one in the Louisiana congressional delegation supports the public option as envisioned by Obama, and only freshman Rep. Anh "Joseph" Cao, R-New Orleans, remains undeclared on the question.

"At this point, I'm not sure where I stand on it, " Cao said.

The other Republicans in the delegation, including three medical doctors -- Charles Boustany, R-Lafayette, Bill Cassidy, R-Baton Rouge, and John Fleming, R-Minden -- all say they think a public option would ultimately destroy the private insurance market.

They agree with Mike Reitz, president of Blue Cross and Blue Shield of Louisiana, who made the rounds on Capitol Hill last week, visiting every member of the delegation except Cao and Boustany.

Reitz said that inserting a public plan in the market would rig the process. The tax-supported system, he said, would be able to artificially lower premiums and shift costs to private insurers, cutting away at any competitive advantage they might have.

"The government makes the rules, so they are always going to win the game, " he said.

Reitz predicted that employers would drop private coverage en masse, forcing employees in huge numbers into the public system.

"What employer is going to want to cover their employees if the government will do it?" Rep. Rodney Alexander, R-Quitman, asked.

Rep. Steve Scalise, R-Jefferson, said consumers who move to the public plan won't realize until it's too late how limited their health care choices will be.

Landrieu and Rep. Charlie Melancon, D-Napoleonville, the delegation's only two Democrats, said they think a government-sponsored health care option should be introduced only under certain circumstances.

Melancon said a public alternative should be "an option of last resort" if market forces fail to lower health care costs.

Landrieu spokesman Aaron Saunders said the senator supports a "predominantly private system that features a federal backup plan that serves as a safety net." While she is "open to compromise, " Saunders said, Landrieu "does not believe that health care reform starts with a public option."

Landrieu's Republican Senate colleague, David Vitter, recently congratulated her for agreeing with him.

But activists supporting Obama's effort are incensed, especially because Landrieu signed a letter on the eve of her re-election last fall pledging her support for overhaul that included the choice of a "public health insurance plan." Saunders said his boss hadn't read the letter carefully.

An advocacy group called Change Congress has launched $10,000 in online ads, focused in New Orleans, asking: "Will Mary Landrieu sell out Louisiana for $1.6 million?" The dollar figure refers to the sum Landrieu has received in political contributions from health and insurance interests over the course of her senatorial career.

By week's end, MoveOn.Org announced it would air similar 60-second radio ads this week in New Orleans, while Democracy for America, a sister organization of Change Congress founded by Howard Dean, was creating a Landrieu-focused TV spot.

Besides the political donations to Landrieu, the Change Congress campaign features a testimonial from Carrollton resident Karen Gadbois, founder of the Web site "Squandered Heritage" and a breast cancer survivor who has no health insurance coverage for herself or her teenage daughter.

Later in the week, Change Congress promoted the story of Zach Hudson, a senior at the University of New Orleans who volunteered in Landrieu's re-election campaign but is now "disillusioned."

Hudson was most recently in the public eye as the young man who launched the campaign to persuade adult film star Stormy Daniels to run for the Senate against Vitter. Hudson said he is no longer involved in that effort

To Fleming, what supporters of a public option really want is a single-payer system. "It's just the first step to what their ultimate objective is: the elimination of competition, " he said.

But Alex Lawson, a health care researcher with the Institute for America's Future, said "health insurance is a classic example of a market failure" that can only be jolted into real competition by a robust public alternative.

Lawson is an author of a recent report that found that in Louisiana, Blue Cross and Blue Shield controls 61 percent of the market.

"There is absolutely no competitive pressure to either compete by delivering better services to the customer or by driving down premiums, " he said. "They can set rates at whatever they want to -- and do."

But Reitz dismissed that notion, saying Blue Cross and Blue Shield competes hard for every dollar in Louisiana.

The fate of Obama's public option is very much up in the air. At the end of last week, House Democrats issued a plan that included a public option, but the draft of a Senate Finance Committee plan, more mindful of centrists such as Landrieu, did not.

http://www.nola.com/news/index.ssf/2009/06/president_obama_says_governmen.html

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Americans struggle to pay for healthcare: study

Yahoo News | 06.22.09

By Maggie Fox, Health and Science Editor Maggie Fox, Health And Science

WASHINGTON (Reuters) – Americans are struggling to pay for healthcare in the ongoing economic recession, with a quarter saying they have had trouble in the past 12 months, according to a survey released on Monday.

Baby boomers -- the generation born between 1946 and 1964 -- had the most trouble and were the most likely to put off medical treatments or services, said researchers at Center for Healthcare Improvement, part of the Healthcare business of Thomson Reuters.

The study, available at http://provider.thomsonhealthcare.com/, found that 17.4 percent of households reported postponing or delaying healthcare over the past year.

The U.S. Congress is working on a way to cover more of the 46 million people who lack health insurance, lower costs and coordinate care better. President Barack Obama has made it one of his administration's top priorities.

Americans pay more per capita for healthcare than people in any other country, yet have high rates of infant mortality, diabetes, untreated heart disease and other conditions. Americans are often dissatisfied with their access to care.

Thomson Reuters -- the parent company of Reuters news agency -- used its annual Pulse survey that queries 100,000 households to get information about health behavior.

Gary Pickens, George Popa and colleagues at the Michigan-based center interviewed more than 6,000 people in March and April about job losses, what healthcare they had used and their plans for future treatment.

UNEMPLOYMENT FACTOR

"April numbers showed a significant increase in the percentage of households in which a member had lost a job in the last three months (13.5 percent)," the researchers wrote. In March, 11 percent said they had lost jobs.

"The percentage of households that had difficulty in paying for care in the last year was statistically unchanged between March and April (about 25 percent)."

They found 40 percent of all households planned to postpone care in the coming three months, with about 15 percent planning to put off routine doctor visits.

People born before 1946 were the least likely to delay care, probably because most can take part in Medicare, the federal health insurance plan for the elderly, the researchers found.

Baby Boomers were four times more likely than seniors to have trouble paying for healthcare, according to the report.

People born after 1984 were also unlikely to put off care, probably because they are too young to need much medical attention, the researchers said.

Income was also a big factor -- homes where people made less than $50,000 a year were three times as likely to say they had trouble paying for medical bills as homes with combined incomes of $100,000 or more.

"It is important for healthcare providers, employers and policymakers to consider how the economy and healthcare policies affect demographic segments differently," Pickens said in a statement.

http://tinyurl.com/l8as6h

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Where Can the Doctor Who’s Guided All the Others Go for Help?

The New York Times | 06.22.09
By Elissa Ely, M.D.

Gracia Lam

Psychiatry is a relatively safe profession, but it has a hazard that is not apparent at first glance: if you are in it long enough, there may be no one to talk to about your own problems.

It is not that way when you start out. Most psychiatric residents spend a good deal of time in therapy with a senior psychiatrist, for a number of reasons — not least, that it is the most intimate way to learn technical magic. Books teach the same thing to everyone who reads them. But no one forgets the crystalline remark their therapist made just to them, and how they viewed themselves differently ever after.

At a certain point, though, you stop being the student and become the teacher. You settle into the details of a career — hospital, research, private practice. Roots go down, time passes. Eventually, younger psychiatrists begin to approach you. Now you are the generation above, saving early-morning slots for residents before they head off to clinic and class. You lower fees and accommodate their hurtling, insane schedules. You remember how it was.

But no amount of wisdom prevents personal frailty. You are never too old for your own problems. Yet when you are the professional others go to, where do you bring your sorrows and secret pain?

Sometimes the situation is clear. During my training there was a formidable psychiatrist who disappeared periodically. Everyone knew she was being hospitalized for a recurrent manic psychosis, and that she would be back to intimidate the trainees as soon as medications had stabilized her.

There was an oddness about it, but no dishonor. Actually, her illness made her more impressive. We are taught to explain that mental illness has a biological component responsive to medical treatment, just like diabetes or heart disease. Her example brought conviction to our tone.

In my residency, I moonlighted in a medication clinic where an elderly psychiatrist was being treated for a dementia he did not recognize. He could not remember simple requests, raised his cane to strangers, screamed at family members; his wife met with me separately and told me she was ready to leave him.

Carefully writing “Dr.” on the top line of each of his prescriptions, I felt undersized and overregarded. Yet he took the pills without question and showed a fatherly interest in my career. Years later, I thought maybe his wife had chosen a student deliberately. My junior status allowed him to maintain his senior status.

Often, though, the situation is not straightforward, and medication is not the problem. Life is. Maybe we are overcome, maybe ashamed, maybe despairing. Self-revelation — the nakedness necessary in therapy — is hard when you have been a model to others.

“In my situation, it would be difficult to find someone,” Dr. Dan Buie, a beloved senior analyst in Boston, told me. It is not that psychiatrists aren’t waiting in wing chairs all over the city. It is that so many of them are former students and former patients. One generation of psychiatrists grows the next through teaching and treatment.

Surrendering that professional identity to become a patient reverses a kind of natural order. “You can’t be a simple patient,” Dr. Buie said. “Anyone I’d go to, I’ve known.” To avoid it, some travel to other cities for therapy (probably passing colleagues in trains heading in the other direction).

There is also the factor of experience. It is one thing if my internist is younger than I; she is closer to the bones of medicine, and with any luck we can get to know each other for years before serious illness requires more intimate contact. It is another thing if my therapist is younger than I.

“It would be a big mistake not to turn to someone,” Dr. Buie went on, “but I might have some trouble going to younger colleagues. It’s hard to understand the issues that come up in the course of a life cycle unless you’ve lived it yourself.”

Dr. Rachel Seidel, a psychoanalyst and psychiatrist in Cambridge, said that when people feel vulnerable, “we want someone with more insight than we have.”

“It’s a paradox,” she added. “Do I have to have gone through what you’ve gone through in order to be empathic to you? And yet, I’d have a preference for someone who’s been around longer.”

Some look laterally for help. Peer supervision is a well-known form of risk management; presenting troubling professional cases to colleagues prevents folly and mistakes at any age.

“I use a couple of peers,” said Dr. Thomas Gutheil, professor of psychiatry at Harvard Medical School. “Then they use me. It’s the reciprocity that’s key — you feel the comfort of telling everything about yourself when you know the reverse is also true.”

Other solutions are even closer. The playwright Edward Albee once wrote that it can be necessary to travel a long distance out of the way in order to come back a short distance correctly. The best source of help can be the nearest source of all. An elderly luminary at the Boston Psychoanalytic Society and Institute listened without comment when asked: Whom does he — the doctor others seek out for help — seek out for help himself? He wasted no words.

“My wife,” he said crisply.

Elissa Ely is a psychiatrist in Boston.

http://www.nytimes.com/2009/06/23/health/23mind.html?_r=1&ref=health

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Abnormal Test Results May Not Get to Patients

The New York Times | 06.22.09

By NICHOLAS BAKALAR

If you think your doctor will automatically tell you if you have an abnormal test result, think again. Researchers studying office procedures among primary care physicians found evidence that more than 7 percent of clinically significant findings were never reported to the patient.

The scientists, led by Dr. Lawrence P. Casalino, an associate professor at Weill Cornell Medical College, reviewed the records of 5,434 patients at 19 independent primary care practices and four based in academic medical centers. They extracted records that contained abnormal results for blood tests or X-rays and other imaging studies, and then searched for documentation that the patient had been properly informed of the problem in a timely way.

Then they surveyed the doctors with uninformed patients. Some told them that the patient had been informed, even though there was no documentation, while others believed the results were not significant and therefore required no notification. In a few cases, the doctor said that the patient had not yet been informed but soon would be. After accounting for these and other ambiguous cases, the researchers found that of 1,889 abnormal results, there were 135 failures to inform.

Results varied widely among the primary care practices, and all but the smallest — those with fewer than eight doctors — had at least one failure. In two of the largest academic medical centers, with a combined 80 primary care specialists, 23 percent of abnormal results were never mentioned to the patients.

Dr. Eric G. Poon, director of clinical informatics at Brigham and Women’s Hospital in Boston, who was not involved in the work, said it was a high-quality study with good methodology. “You go to the doctor and you get tests and assume that there is a right way for the doctor to look at the results and to act on them quickly,” he said. “But the truth of the matter is that a lot of things can fall through the cracks. Information is handed down from one person to another to another before the doctor actually sees it.”

Unsurprisingly, practices that used electronic medical records had lower failure rates than those that used only paper documents. But offices that used a combination of paper and computer records had the worst results of all.

Using information from a study of the literature and an earlier pilot study, the authors concluded that following five relatively simple procedures could eliminate most errors: results are routed to the responsible doctor, the doctor signs off on them, the office informs patients of all results, the practice documents that patients have been informed, and finally patients are told to call after a certain time interval if they have not learned the results of their tests. Most practices examined in the current study, published Monday in The Archives of Internal Medicine, failed to follow those steps.

The authors acknowledge that their sample was self-selected — offices volunteered to participate — and included only 23 practices. A random sample of offices, or a larger number of them, they write, could have produced different results.

Although some doctors may have informed their patients without documenting it, Dr. Casalino said that failure to document is almost as bad as failing to inform. “If what happens doesn’t get documented,” he said, “it can be very confusing when the patient next needs to be taken care of.”

For patients, Dr. Casalino said, the message is simple. “Don’t assume that ‘no news is good news’ when you have tests done. That’s a very dangerous assumption. If you’ve had a test done and you don’t hear about it after a week or two goes by, call the doctor’s office.”

http://www.nytimes.com/2009/06/23/health/23patient.html?ref=health

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How the Food Makers Captured Our Brains

The New York Times | 06.22.09

By TARA PARKER-POPE

As head of the Food and Drug Administration, Dr. David A. Kessler served two presidents and battled Congress and Big Tobacco. But the Harvard-educated pediatrician discovered he was helpless against the forces of a chocolate chip cookie.

In an experiment of one, Dr. Kessler tested his willpower by buying two gooey chocolate chip cookies that he didn’t plan to eat. At home, he found himself staring at the cookies, and even distracted by memories of the chocolate chunks and doughy peaks as he left the room. He left the house, and the cookies remained uneaten. Feeling triumphant, he stopped for coffee, saw cookies on the counter and gobbled one down.

“Why does that chocolate chip cookie have such power over me?” Dr. Kessler asked in an interview. “Is it the cookie, the representation of the cookie in my brain? I spent seven years trying to figure out the answer.”

The result of Dr. Kessler’s quest is a fascinating new book, “The End of Overeating: Taking Control of the Insatiable American Appetite” (Rodale).

During his time at the Food and Drug Administration, Dr. Kessler maintained a high profile, streamlining the agency, pushing for faster approval of drugs and overseeing the creation of the standardized nutrition label on food packaging. But Dr. Kessler is perhaps best known for his efforts to investigate and regulate the tobacco industry, and his accusation that cigarette makers intentionally manipulated nicotine content to make their products more addictive.

In “The End of Overeating,” Dr. Kessler finds some similarities in the food industry, which has combined and created foods in a way that taps into our brain circuitry and stimulates our desire for more.

When it comes to stimulating our brains, Dr. Kessler noted, individual ingredients aren’t particularly potent. But by combining fats, sugar and salt in innumerable ways, food makers have essentially tapped into the brain’s reward system, creating a feedback loop that stimulates our desire to eat and leaves us wanting more and more even when we’re full.

Dr. Kessler isn’t convinced that food makers fully understand the neuroscience of the forces they have unleashed, but food companies certainly understand human behavior, taste preferences and desire. In fact, he offers descriptions of how restaurants and food makers manipulate ingredients to reach the aptly named “bliss point.” Foods that contain too little or too much sugar, fat or salt are either bland or overwhelming. But food scientists work hard to reach the precise point at which we derive the greatest pleasure from fat, sugar and salt.

The result is that chain restaurants like Chili’s cook up “hyper-palatable food that requires little chewing and goes down easily,” he notes. And Dr. Kessler reports that the Snickers bar, for instance, is “extraordinarily well engineered.” As we chew it, the sugar dissolves, the fat melts and the caramel traps the peanuts so the entire combination of flavors is blissfully experienced in the mouth at the same time.

Foods rich in sugar and fat are relatively recent arrivals on the food landscape, Dr. Kessler noted. But today, foods are more than just a combination of ingredients. They are highly complex creations, loaded up with layer upon layer of stimulating tastes that result in a multisensory experience for the brain. Food companies “design food for irresistibility,” Dr. Kessler noted. “It’s been part of their business plans.”

But this book is less an exposé about the food industry and more an exploration of us. “My real goal is, How do you explain to people what’s going on with them?” Dr. Kessler said. “Nobody has ever explained to people how their brains have been captured.”

The book, a New York Times best seller, includes Dr. Kessler’s own candid admission that he struggles with overeating.

“I wouldn’t have been as interested in the question of why we can’t resist food if I didn’t have it myself,” he said. “I gained and lost my body weight several times over. I have suits in every size.”

This is not a diet book, but Dr. Kessler devotes a sizable section to “food rehab,” offering practical advice for using the science of overeating to our advantage, so that we begin to think differently about food and take back control of our eating habits.

One of his main messages is that overeating is not due to an absence of willpower, but a biological challenge made more difficult by the overstimulating food environment that surrounds us. “Conditioned hypereating” is a chronic problem that is made worse by dieting and needs to be managed rather than cured, he said. And while lapses are inevitable, Dr. Kessler outlines several strategies that address the behavioral, cognitive and nutritional factors that fuel overeating.

Planned and structured eating and understanding your personal food triggers are essential. In addition, educating yourself about food can help alter your perceptions about what types of food are desirable. Just as many of us now find cigarettes repulsive, Dr. Kessler argues that we can also undergo similar “perceptual shifts” about large portion sizes and processed foods. For instance, he notes that when people who once loved to eat steak become vegetarians, they typically begin to view animal protein as disgusting.

The advice is certainly not a quick fix or a guarantee, but Dr. Kessler said that educating himself in the course of writing the book had helped him gain control over his eating.

“For the first time in my life, I can keep my weight relatively stable,” he said. “Now, if you stress me and fatigue me and put me in an airport and the plane is seven hours late — I’m still going to grab those chocolate-covered pretzels. The old circuitry will still show its head.”

http://www.nytimes.com/2009/06/23/health/23well.html?_r=1&ref=health

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A Chance for Clues to Brain Injury in Combat Blasts

The New York Times | 06.22.09

By ALAN SCHWARZ

PROGRESSION From left, a normal cerebral cortex and a magnification of it; cortexes of two now-deceased N.F.L. players with neurofibrillary tangles; and the cortex from an Alzheimer’s patient with both the tangles and beta amyloid plaques.

No direct impact caused Paul McQuigg’s brain injury in Iraq three years ago. And no wound from the incident visibly explains why Mr. McQuigg, now an office manager at a California Marine base, can get lost in his own neighborhood or arrive at the grocery store having forgotten why he left home.

But his blast injury — concussive brain trauma caused by an explosion’s invisible force waves — is no less real to him than a missing limb is to other veterans. Just how real could become clearer after he dies, when doctors slice up his brain to examine any damage.

Mr. McQuigg, 32, is one of 20 active and retired members of the military who recently agreed to donate their brain tissue upon death so that the effects of blast injuries — which, unlike most concussions, do not involve any direct contact with the head — can be better understood and treated.

The research will be conducted by the Sports Legacy Institute, a nonprofit organization based in Waltham, Mass., and by the Boston University Center for the Study of Traumatic Encephalopathy, whose recent examination of the brains of deceased football players has found damage linked to cognitive decline and depression.

Whether single, non-impact blasts in battle can cause the same damage as the years of repetitive head bashing seen in football is of particular interest to researchers. The damage, primarily toxic protein deposits and tangled brain fibers, cannot be detected through noninvasive procedures like M.R.I.’s and CT scans.

“We don’t know much about the medium- or long-term effects of head trauma experienced by our military,” said Robert Stern, co-director of the Boston University center as well as its Alzheimer’s Disease Clinical and Research Program. “We know that there are some immediate effects in terms of blast injury on cognition and behavior. But we do not yet know whether there are any long-term effects.”

“Does that single blow result in something that doesn’t go away,” he added, “or perhaps sets off a cascade of events that leads to a progressive degenerative brain disease?”

Mr. McQuigg may be finding out the cruelest way. In February 2006, he was on combat patrol when his Humvee was hit by a roadside bomb, knocking him unconscious, shattering his jaw and damaging his right eye. His helmet could not protect him from a severe concussion that doctors told him was caused solely by the bomb’s force waves, not direct impact.

Now he is experiencing headaches, short-term memory problems and trouble with balance that have only worsened.

“With prosthetics, you can replace an arm or a leg and can still throw a football with your kid,” said Mr. McQuigg, who works at Camp Pendleton, north of San Diego. “If you have a severe brain injury, you might not be able to live on your own.”

“And people don’t know what’s wrong with you,” he added. “People know if you’re missing an arm, something happened. If it happened to your brain, they can’t tell.”

An estimated 320,000 soldiers have experienced some form of traumatic brain injury during their service in Iraq or Afghanistan, according to a 2008 RAND Corp. study. Blast injuries have risen in prominence in recent years because improvements in armor and medical treatment allow soldiers to survive explosions, then experience any delayed effects.

Blast injuries result from waves of air pressure that can travel several times as fast as hurricane winds. Those waves can not only throw a soldier dozens of feet in the air into other objects — causing a conventional concussion as the brain crashes inside the skull — but may also subject brain tissue to sudden pressure variations that can cause similar damage.

Repeated brain trauma among some football players and boxers has been linked to the subsequent appearance of toxic proteins and neurofibrillary tangles in the brain — a disease known as chronic traumatic encephalopathy, or C.T.E. Many athletes who were found after death to have had the disease experienced memory loss, depression and oncoming dementia as early as their 30s, decades before afflictions like Alzheimer’s appear in the general population.

Just as researchers at the Boston University center and elsewhere have linked some athletes’ later-life emotional problems to their on-field brain trauma, the research on military personnel will try to determine whether some soldiers with post-traumatic stress disorder — a psychological diagnosis — actually retain physical brain damage caused by battlefield blasts. Some signs of P.T.S.D., particularly depression, erratic behavior and the inability to concentrate, appear similar to those experienced by concussed athletes.

Such a link could have effects beyond medicine. Disability benefits for veterans can vary depending on whether an injury is considered psychological or physical. And veterans with P.T.S.D. alone do not receive the Purple Heart, the medal given to soldiers wounded or killed in enemy action, because it is not a physical wound.

Dr. Stern, at Boston University, said that blast injuries could be seen as this generation’s version of exposure to Agent Orange, the herbicide used in the Vietnam War.

“During exposure to Agent Orange, it wasn’t known what long-term effects there would be, but through scientific study, long-term study of veterans, those effects have been more clearly understood,” he said. “We need to know if these individuals with blast injuries are going to require long-term care and treatment.”

The Boston University center and the Sports Legacy Institute will compare findings from the brains of military personnel with those from their athlete program, which has signed up more than 120 donors in less than a year, and other brain banks around the world. The two centers, not the military, are paying for the registry, storage and examination of brain tissue.

But Col. Michael S. Jaffee, national director of the Defense and Veterans Brain Injury Center, said the Defense Department supported the spirit of the research and could assist in approaching active and retired soldiers to register for brain donation.

“Having a brain bank to allow us to study what these brains look like will help us correlate this with other emerging research findings,” said Colonel Jaffee, who is a physician.

But he cautioned: “Whenever we’re talking about organ donation for the sake of science, we’re dealing with a lot of sensitive and cultural issues. We ask people to consider and realize that asking family and individuals to remove the brain from the body, many cultures and traditions may not find that acceptable. So it’s always a challenge to balance the benefits, which are real and will come, with a way to maintain the dignity and respect of people who have made the ultimate sacrifice.”

Benefits of the research on military personnel could extend to the general population, said Dr. Daniel P. Perl, director of neuropathology at the Mount Sinai School of Medicine in New York. Even though civilians are rarely subjected to anything close to the devastating waves that burst from battle explosions, the characteristics of blast injuries could lend insight into brain damage caused by single impacts in automobile accidents, for example.

If protein deposits and tangles appear in the hippocampus area of the brain, for instance, then they would affect short-term memory; appearance in the frontal lobes could impair executive function, and in the cerebellum coordination and balance. The researchers will also be looking at possible genetic factors.

“I wouldn’t be surprised if there was a great deal of overlap between examples of this from the sports arena and the military, but we don’t know,” Dr. Perl said. “The forces are different and presumably the mechanisms are somewhat different. If this research and the examinations are done right, they have the potential to contribute significantly. It could tell us what happens, which we’re not going to get otherwise.”

http://www.nytimes.com/2009/06/23/health/23brai.html?ref=health

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Please email questions and comments to lsuhospitals@lsuhsc.edu.