Last week's White House declaration of a national emergency over swine flu prompted many people to get vaccinated who had previously taken a blase attitude toward the threat. But it also pointed up a worrisome reality: There currently isn't enough vaccine available for everyone who needs or wants it.

Back in late July, the administration was confidently predicting there would be enough doses of the H1N1 vaccine available to immunize 160 million Americans by the beginning of this year's flu season. But since then that number has been repeatedly cut -- first to 40 million doses and then, earlier this month, to just 28 million doses, less than a quarter of the original estimate. Meanwhile, people have been flooding clinics and doctor's offices around the country with requests for the vaccine.  

Clearly, the government overpromised on its ability to organize and implement the massive H1N1 vaccination program it envisioned. Now it faces the prospect of a collapse in public confidence similar to what the administration of President George W. Bush suffered over its botched handling of relief efforts in New Orleans after Hurricane Katrina in 2005. If the H1N1 epidemic, which has already killed about 1,000 Americans, turns into a deadly pandemic on the order of the 1918 Spanish Flu, which killed an estimated 50 million to 100 million people worldwide, there's little doubt President Barack Obama will pay an enormous political price for the nation's lack of preparedness.

Continue reading "H1N1 vaccine shortage could be political pitfall for Obama" »

Posted by Glenn McNatt at 2:46 PM | Permalink | Comments (14)
Categories: Health and mental health
        

Debates over gun laws too often are based on the assumption that having a gun in one's possession deters crime. A recent public health study reveals the fallacy of that assumption: Epidemiologists at the University of Pennsylvania School of Medicine found that people with a gun are 4.5 times more likely to be shot in an assault.

Researchers interviewed more than 600 shooting victims in Philadelphia from 2003 and 2006 and compared their experience with a control group, mostly people drawn randomly from the neighborhoods where the shootings took place. Pro-gun groups may not be happy with its conclusions, but they can't claim bias: The study was funded by the National Institutes of Health during the Bush administration, not by organizations favoring gun control.

As the study's authors note, the results should cause urban residents everywhere to rethink their assumptions about gun possession. Certainly, there are people who successfully defend themselves with a gun, but the chances of doing so are slim. On the other hand, how many civilian shooting victims were walking around with a false sense of security because they had a gun in their pocket, holster, waistband or car?

Continue reading "Armed and still in danger" »

Posted by Peter Jensen at 12:33 PM | Permalink | Comments (34)
Categories: Health and mental health
        

The Sun's Laura Smitherman reports this morning on an overlooked tidbit in the Congressional Budget Office's analysis of the health reform bill moving through the Senate Finance Committee. Most of the attention to that bill has been focused on its effects on the federal deficit -- it's projected to actually reduce the deficit over the next 10 years, a key factor given President Barack Obama's pledge not to sign a bill that adds at all to federal borrowing. But does it accomplish its goals, in part, by shifting costs onto the states? The CBO estimates that the bill would increase state spending on Medicaid, the federal health program for the poor, by $33 billion over the next 10 years. That would seem like unwelcome news to states like Maryland that are already in the hole from increased health spending and other rising costs at a time when tax revenues are dropping.

The CBO doesn't do a state-by-state breakdown of the numbers, so it's hard to estimate the impact on Maryland, specifically. But based on figures from the Kaiser Family Foundation, Maryland's spending on Medicaid accounts for about 2.3 percent of the national total for states. Assuming that $33 billion is distributed evenly, that would make our share about $766 million over 10 years. To put that in context, Maryland's Medicaid spending has increased by about $1.4 billion over the last five years.

Gov. Martin O'Malley and the 20 other Democratic governors who sent a letter to Congress urging action on health reform certainly had political reasons for doing so. But they have practical ones as well; Medicaid spending is out of control as it is, and without an attempt to seriously rein in costs, Maryland and other states will go broke. An extra $76 million a year would certainly be a difficult pill for Maryland to swallow at the moment, but it's peanuts compared to what could happen if health costs are allowed to grow unchecked.

Posted by Andy Green at 11:14 AM | Permalink | Comments (2)
Categories: Health and mental health
        

I'm no medical expert, but even I can see that the cocktail of powerful sedatives Michael Jackson's physician administered to his patient over the 24 hours before the star stopped breathing last month ought to have been considered a potentially lethal brew. On Monday, the Lost Angeles Country coroner ruled Mr. Jackson's death a homicide and the doctor, Las Vegas cardiologist Conrad Murray, is now the target of a manslaughter investigation by the Los Angeles Police Department.

What was the good doctor thinking when he acceded to Mr. Jackson's "repeated demands/requests" for a shot of the drug propofol, an intravenously administered hypnotic agent whose use as a general anaesthetic normally is restricted to hospital settings, on top of tabs of Valium and injections of Lorazepam and Midazolam given only hours before? As a self-indulgent world celebrity, Mr. Jackson may have believed he had a right to take any drug he pleased if it would help overcome his chronic insomnia, but his doctor should have known better. Clearly, in this case just saying no would have been the best medicine.

Did the physician play along against his better judgment for fear of losing such a rich and famous client? Or was he merely incompetent -- or worse, criminally negligent? These are the sorts of questions Los Angeles authorities will have to sort out before deciding whether to bring charges against Mr. Murray. But from all that is known about the case so far, at least one thing seems clear: Whatever the outcome of the investigation, it's likely neither Mr. Jackson's family, friends and fans nor Dr. Murray and his defenders will end up completely satisfied that justice has been served.

Posted by Glenn McNatt at 7:59 AM | Permalink | Comments (139)
Categories: Health and mental health
        

Color me shocked, too, when I heard about Whole Foods CEO John Mackey's opposition to President Obama's health care plan. Not because of his quirky views on alternatives to the public option but because his exercise in free speech could cost his company a whole lot of money.

When the nation's chief granola-eater and avatar of environmentally friendly farming comes out against a plan that's likely supported by a majority of the arugula-and-endive-eating liberal Democrats who flock to his stores, in part because they pride themselves on holding progressive views, Mr. Mackey's mind has got to be a long way from his bottom line.

His own company tried to distance itself from the remarks he made in a recent Wall Street Journal commentary critical of "Obamacare," which infuriated long-time customers and sparked a boycott movement on Facebook that 18,000 people reportedly have joined. You know it's serious when people are willing to give up their imported Italian balsamic vinegar, creamy French cheeses, vegetarian soybean sausages and curried lamb kebab to protest their greengrocer's  musings on health care policy.

 Marketing experts say Mr. Mackey risks running his business into the ground on a shockwave of "brand dissonance" -- the disconnect between what people think a product stands for and how its makers actually behave. Most Whole Foods customers are the sort of people who probably would never be caught dead plopping nonorganic bananas into a plastic bag at Wal-Mart. But now that Mr. Mackey has ticked them off royally, there's no telling what the company may have to do to assuage their ire, let alone what might turn up on their dinner tables tonight.  

Posted by Glenn McNatt at 6:00 AM | Permalink | Comments (29)
Categories: Health and mental health
        

Here's another excellent article about health care reform, written by physician Atul Gawande for the New Yorker a few weeks ago. This article has gotten lots of buzz and, reportedly, was must-reading in the White House. Sadly, the ideas don't seem to have permeated the debate in Congress much. It's long (did I mention it was in the New Yorker?) but definitely worth a read:

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

Posted by Andy Green at 2:40 PM | Permalink | Comments (5)
Categories: Health and mental health
        

One thing about the current health reform debate that's certain is that things are pretty confusing. There are three different bills in the House of Representatives and two in the Senate, one of which hasn't seen the light of day, plus plenty of speculation and innuendo floating around. For those trying to make sense of things, here's a link to an article in this morning's New York Times that seeks to shed light on some of the questions about the various reform plans. I'll try to post more of these links as I come across them:

http://www.nytimes.com/2009/08/10/health/policy/10facts.html?ref=us

We've also gotten a tremendous number of letters to the editor on the topic over the last few days. See what fellow readers are saying here.

Posted by Andy Green at 1:44 PM | Permalink | Comments (1)
Categories: Health and mental health
        

Since California's Proposition 8 was passed last year, the narrative has largely been that religious and black communities shun homosexuals and actively challenge their rights. That's why today's story detailing Project SHALEM, a partnership with the Maryland AIDS Administration, the JACQUES Initiative* and various religious and community institutions is so heartening. As the story explained:

"'The ultimate goal is to make churches, mosques and synagogues a safe place where people can receive HIV support,' said Derek Spencer, the executive director of the JACQUES Initiative.

'We are no longer going to wait for people to come into our academic centers for help,' he said."

Baltimore churches have long been the rallying points for communities to band together against poverty, violence and other urban ills. It is only right that they now focus on educating their parishioners and community members about the often-fatal virus and how to remain HIV-negative.

Continue reading "Faith program to save lives, ease stigma of HIV/AIDS" »

Posted by Nancy Knight at 7:59 AM | Permalink | Comments (0)
Categories: Health and mental health
        

The Rosewood Center in Owings Mills is finally closed after years of reports of abuse and neglect of the mentally and physically disabled residents there. It was clear that the facility had massive maintenance and management issues and badly failed many of its extremely vulnerable residents. But it's also clear that the alternative -- housing the former residents in group homes -- is not an ideal answer for some.

The state has had problems overseeing them, too, and many of the residents have not known another home for almost their entire lives. The adjustment in many cases will be extremely difficult.

How should the state structure its care for this population? Can everyone be served in group homes, or is there still a need for an institution like this one?

(Sun photo: Algerina Perna)

Posted by Andy Green at 10:30 AM | Permalink | Comments (36)
Categories: Health and mental health
        

Today's Sun carries opposing views on the controversy surrounding vaccination and autism, one from Dr. Virginia Keane, the head of the Maryland chapter of the American Academy of Pediatrics and the other from Alison Hamilton, the co-coordinator of the Maryland/DC chapter of Talk about Curing Autism. Both came in response to a Sun editorial on the topic. To put it in a nutshell, the Keane says the purported link between vaccines and autism has been debunked and parents are putting their kids at risk by withholding immunization, and Hamilton says there isn't any good science on the issue.

In her letter, Keane also addressed the issue of the economics of vaccination, which had to be cut for space in the print edition. (Hamilton's letter was also cut for space, but less so.) I'll paste the full letters below the jump.

Continue reading "The vaccine-autism controversy" »

Posted by Andy Green at 12:59 PM | Permalink | Comments (6)
Categories: Health and mental health
        

People believe all kinds of strange things, and most of the time it doesn't matter. Trouble arises, however, when their odd beliefs affect other people's health.

Such is the case with parents who choose not to immunize their children against diseases that killed and crippled millions in decades past -- before such vaccines were developed and made widely available. The anti-vaccine movement is driven largely by parents who believe that vaccines can cause autism, a suspicion that has been investigated and disproven in numerous studies.

A new study in the journal Pediatrics has found that children not vaccinated against pertussis are 23 times more likely to contract the disease, also known as whooping cough. This is hardly a surprise. What may be more alarming is that those who refuse to vaccinate are likely endangering the rest of us.

That's why, as Stephanie Desmon reported Tuesday, at least one local doctor is refusing to treat children whose parents have not had them immunized. Although fewer than 1 percent of children are not immunized, their numbers have doubled in recent years, a trend that worries Dr. Daniel Levy of Owings Mills: "We're going to start seeing the return of diseases we had almost gotten rid of."

Continue reading "The vaccine denialists" »

Posted by Michael Cross-Barnet at 9:16 AM | Permalink | Comments (1)
Categories: Health and mental health
        

Stephanie Desmon's story Thursday outlining the potential benefits and costs to a new round of work-hour reforms for doctors in training hit close to home for me -- my wife is now finishing up her internship in internal medicine. I haven't been able to ask her what she thinks of the story -- she, of course, left for the hospital some hours before the paper arrived -- so the following represents my semi-insider's views alone.

I'd say that as crazy as it may seem to have doctors working 30 hours straight, there are plenty of things the health care system can to do improve patient outcomes besides enacting new mandatory work-hour limits.

In medical circles, the debate over residents' hours generally runs between those who say exhausted doctors are likely to make more mistakes and those who say that artificial limits to work hours reduces continuity of patient care. (There's also a major undercurrent of "I walked to school through the snow uphill both ways" attitude among the generations of doctors who learned under the old system.)

I would say this: Yes, residents get exhausted at the end of long shifts, especially in the beginning. But there are already safeguards in place to help mitigate that. For example, residents aren't allowed to perform procedures (central lines, spinal taps, etc.) at the end of an overnight call shift. And the way the rhythm of the day works, tired doctors are the ones handing off cases to fresh replacements, not the ones admitting new patients. The proposal that doctors would have to take a mandatory five-hour nap if they've been on for 16 hours would force them to hand off cases arbitrarily, which could be a real problem for patients in critical condition.

Could the medical system come up with new schedules that mitigate these problems? Maybe. But if the nation wants to spend the $2.5 billion a year it would take to further reduce residents' work loads, there are plenty of other interventions that would probably be at least as effective and have other ancillary benefits.

Electronic medical records, for example, would certainly improve patient outcomes. The system now is incredibly fragmented, especially for chronically sick or complicated patients who get transferred from community hospitals to big research centers such as Hopkins and Maryland. Electronic medical records would help residents and more experienced doctors alike make better decisions -- and would eliminate tremendous redundancy and waste caused by unnecessary and repeated tests. It would also save residents a ton of time they new spend trying to track down information about patients.

Universal health coverage would, obviously, help tremendously, but a variety of smaller-scale interventions would make a dfference, too. Just reminding doctors, nurses and others to wash their hands frequently has been proven to boost patient outcomes. Further residency work-hour reforms haven't.

Posted by Andy Green at 9:34 AM | Permalink | Comments (0)
Categories: Health and mental health
        

Gil Kerlikowske's proposal to banish the term, "war on drugs," is likely going to earn him criticism in some circles as soft on crime, but it's a sign that drug policy in this country is about to become more reality-based - and potentially effective.

As President Obama's drug czar, Mr. Kerlikowske is expected to set the agenda for drug policy in this country. And if his interview with the Wall Street Journal is any indication of his thinking, the former Seattle police chief is interested in a more public health-oriented and less law enforcement-dominated approach.

That's overdue. Over the past decade, drug use in this country is little changed. And as long as demand for drugs is high, police seizures and other enforcement actions are unlikely to have much effect.

(Photo: Bloomberg News)

Continue reading "An end to a misguided war" »

Posted by Peter Jensen at 2:39 PM | Permalink | Comments (0)
Categories: Health and mental health
        

Even as federal authorities see encouraging signs that the H1N1 flu outbreak is not nearly as bad as many had feared, Maryland's health secretary is having to justify how much antiviral medication the state is buying.

For the record, the Centers for Disease Control and Prevention recommend states have enough on hand to treat one-fourth the population. In the case of Maryland, that's 1.4 million courses, of which the state currently either possesses or has access to 1.2 million -- with much of the rest on order or soon to be delivered.

Feel safe enough yet? Keep in mind that antiviral drugs like Tamiflu are no cure-alls. And the private sector has access to the same drugs, too.

As of 3 p.m. Monday, Maryland had four confirmed cases of H1N1. Four. That's not the 1918 flu outbreak. It's good to be prepared, but it's unlikely there's something magical about having 25 percent of the population potentially covered with government-bought antivirals at this moment in time, instead of 22 percent.

Continue reading "Tamiflu and Relenza, anyone?" »

Posted by Peter Jensen at 3:56 PM | Permalink | Comments (0)
Categories: Health and mental health
        

With cases of swine flu reported around the world - from Spain to New Zealand - public health officials are racing to take steps to avert a potential pandemic and avoid public panic. The swift action is important because nations that fail to take early action to meet the potential challenge could find it difficult to contain. That's why the United States declared a public health emergency on Sunday and  President Barack Obama is set to address the health crisis Monday in remarks to a meeting of the nation's top scientists.

The flu outbreak, which is suspected in as many as 103 deaths, most in Mexico- none in the U.S.- is a reminder of the importance of funding reporting systems that give medical authorities early and accurate information about the spread of disease. In the United States, concerns have been recently expressed about the adequacy of the reporting system leading to confusion about whether new numbers really mean ongoing infections — or just that health officials had missed something simmering for weeks or months. The emergency declaration allows the government to ship roughly 12 million doses of flu-fighting medications from a federal stockpile to states in case they eventually need them.

A spokesman for the World Health Organization, Peter Cordingley, said the virus was spreading quickly in Mexico and the southern U.S. and has the potential to become a pandemic and a global threat. The Obama administration is seeking to  strike a balance, informing Americans without panicking them. "We do think this will continue to spread but we are taking aggressive actions to minimize the impact on people's health," said Dr. Richard Besser, acting chief of the Centers for Disease Control and Prevention.  

  Patients wait for care at Mexico City health center   Mario Guzman / EPA

Posted by Larry Williams at 6:15 AM | Permalink | Comments (5)
Categories: Health and mental health
        

We may never know exactly what drove William Parente, the father of Loyala College sophomore Stephanie Parente, to murder his wife, his daughter and her younger sister in a Towson hotel room this week, then take his own life. The father, a tax and estate lawyer, reportedly was distaught over the recent death of his mother. But he may also have been involved in what Baltimore County police called "questionable financial dealings" in New York. The FBI reportedly is looking into allegations that Parente bilked a client there of nearly $450,000: it's possible he feared he might soon be prosecuted and publically disgraced.

Howard County health commissioner Peter Bielensen says that's the kind of financial stressor that, when combined with mental a health disorder such as depression, can push some men over the edge. Most murder-suicides involving families are committed by men who can't face the humiliation of financial failure or the prospect of being separated from their families as a result of a criminal prosecution. They kill out of a deluded belief that the only way they and their loved ones can remain united is in death.

 Answers to such questions might throw light on William Parente's state of mind in the days leading up to the killings. Did he arrive in Baltimore with the intention of murdering his family? Or was the trip possibly an attempt to avoid scrutiny of his financial dealings in New York, and he only thought of killing himself and his family after deciding that he couldn't go back? We need to know a lot more about the circumstances that led up to this tragedy before we can even begin to think about how it might have been prevented.

Newsday photo

Continue reading "More unanswered questions in the Towson tragedy" »

Posted by Glenn McNatt at 6:01 AM | Permalink | Comments (5)
Categories: Health and mental health
        

Dear Son, On my way to the office yesterday morning I couldn't help but notice that the family room was barricaded with a large pile of your sporting gear (even more than I sometimes run across in the middle of the floor). A "Keep Out" sign was posted on the door. It looked a lot like your handwriting.

This is TV Turnoff Week, isn't it?

Well, I don't blame you for making some provisions. Between your favorite shows on Nickelodeon and your favorite Nintendo video games, you obviously don't trust yourself to stay away from the television for an entire six days.

But let me tell you, it's a good idea anyway. Did you know that studies show that Americans are watching screens of some kind for an average eight hours each day? Television accounts for more than half of that, but video and computer games, cell phones, iPods, PDA's and similar electronics constitute the rest. That's a lot of sedentary - and solitary - hours.

Continue reading "Why is the family room barricaded?" »

Posted by Peter Jensen at 6:00 AM | Permalink | Comments (0)
Categories: Health and mental health
        

Every year, 30 million blood products are transfused in the United States, a procedure that has been widely perceived as medically safe with only 46 patients dying of medical complications last year. But missing from that calculation is any effective measurement of the negative medical consequences from transfusions, ranging from infections to allergic reactions.

Now Johns Hopkins Hospital and a handful of other major medical centers are setting out to gather more comprehensive data on the effects of transfusions to with the hope of suggesting standardizing procedures to minimize negative transfusion side effects, The Sun's Robert Little reported Sunday. 

Transfusions have saved many lives, it's not surprising that not much time has been spent searching for non-fatal medical side effects. But careful study to discover and guard against dangerous side effects is a smart move. 

Posted by Larry Williams at 9:42 AM | Permalink | Comments (0)
Categories: Health and mental health
        

The federal agency charged with keeping food and drugs from harming people may soon be asked to take a consumer product that kills more than 400,000 people a year and make it safer. Its a legislative move that deserves strong public support.

Since 2000, when the Supreme Court ruled that the Food and Drug Administration did not have the authority to regulate tobacco, legislation has been introduced in Congress every year that would give it that right. Last year, the legislation passed the House but died in the Senate after President Bush threatened to veto it. Last week, the House passed similar legislation but Sen. Richard Burr, a Republican from South Carolina is threatening a filibuster.

Moderate Republicans in the Senate should help pass the bill this year.

Cigarettes are generally acknowledged as being anything but safe. Smoking accounts for nearly one in five deaths in the United States. The bill would let the FDA regulate the levels of tar, nicotine and other harmful components of tobacco products. Cigarette smoke alone contains some 4,000 chemicals, more than 40 of which are known to cause cancer.

Posted by Larry Williams at 6:01 AM | Permalink | Comments (0)
Categories: Health and mental health
        

Former Montgomery County Executive Douglas M. Duncan's talk this week at Sheppard Pratt about his own experience with depression opened a window on an illness that affects millions of Americans yet remains widely misunderstood. In 2006, Duncan took himself out of the Maryland gubernatorial race after suffering a major depressive episode.

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders describes major depression as a prolonged and all-encompassing period of low mood that can seriously affect a person's family and work life. Most psychiatrists believe major depression is caused by imbalances in the brain's chemistry, that it may run in families and that counseling and antidepressants can be effective in treating the disorder. It is not usually something that people can just "snap out of" on their own. For an article about a British family's struggle with depression, click here: http://www.telegraph.co.uk/health/healthadvice/lesleygarnerlifeclass/5076067/How-can-I-help-my-depressed-husband.html

Continue reading "Depression and recovery" »

Posted by Glenn McNatt at 5:59 AM | Permalink | Comments (0)
Categories: Health and mental health