Tuesday, September 30, 2008

NYC HEALTH: Health Department Targets Deadly Cosmetics

By Heather J. Chin
September 25, 2008
(originally published at the CUNY Graduate School of Journalism blogs)

New York – City health officials stepped up their efforts to alert residents that some imported cosmetics threaten them with lead and mercury poisoning.

While federal and state standards already prohibit lethal cosmetics from entering the country, consumer demand keeps the supply steady, according to officials at the Board of Health during their quarterly meeting on Wednesday.

“The problem with global … products [is] that they are falling through the cracks,” said Dr. Nancy Clark, Assistant Commissioner of the department’s Bureau of Environmental Disease Prevention.

Specific deodorants, skin creams, aphrodisiacs and herbal remedies used by residents of Dominican, Indian and Chinese communities are on the list of products with poisonous ingredients. These cosmetics are imported from Asia, Latin America, Africa and the Middle East.

Tests done by NYC’s health department and by others around the country have shown these products to have lead and mercury levels as much as 6,000 times higher than limits recommended by the U.S. Food and Drug Administration (FDA). The FDA limit for lead levels is 10 parts per million; for mercury, it is 1 part per million.

At last month’s meeting, the board authorized the health department to find and remove dangerous cosmetics from store shelves, just as tainted food or drugs are.

These tools will come in the form of signs and fact sheets in the languages spoken by consumers, explained Ms. Paromita Hore, a risk assessment coordinator. “They’re often not aware” of the danger, she said, adding that use of the unhealthy products “is longstanding in their culture.”

At least in the Chinese community, such awareness efforts are welcome, says Gary Lee, the owner of a pharmacy in Chinatown that offers both U.S. name brands and popular Chinese medicines and herbs.

“[Officials] usually want to put pressure on the importer, not putting pressure on the shop,” he said. He notes that if a store has non-FDA approved drugs in stock, it is because they sell. “What [the consumer] wants, they make a request.”

For Indian Americans, kohl and surma – two skin products listed by the Health Department as being laced with high levels of lead – pose a great threat because they are so embedded in the culture.

“Loving kohl is one of the commandments for being desi,” writes Anu, an Indian American freelance writer on her blog, The Indian Make-Up Diva.

When ingested or absorbed through the skin, high levels of lead and mercury can pose a danger to brain function, as well as to blood and renal system function. These effects are particularly dangerous in children and pregnant women.

LOCAL NYC: Unionized Drivers Protest Union And DOE Bus Cuts

By Heather J. Chin
September 10, 2008

Long Island City – Hundreds of school bus drivers, transportation aides and parents rallied together on September 10th to protest new cuts to the number of routes and service quality to the city’s special needs students.

“We are highly trained professionals [and] highly motivated individuals,” stated Caravan Transportation bus driver Miqueal Vestres, who has driven special needs students to and from school for 28 years. “We do these jobs not for the money; we love what we do [and] care about the kids.”

Read the rest of this story and listen to audio of the rally here.

Sunday, September 28, 2008

A Journalist's Direction: Divining Rod or Diversion?

(previously published here on September 25, 2008)

Like musicians and strains of melody, reporters generally have an “ear” for newsworthy events and reporting opportunities. Whether it’s being at the scene of a car accident and interviewing witnesses (after pulling people out of the wrecking, per Journalistic Ethics discussions) or chasing a tornado, or pursuing a hesitant, but important, source for a story, journalists tend toward a knack of blending curiosity and intuition. We’re reporters and we’re hungry for stories!

But sometimes reporting needs to take a backburner to our humanity, as well as to practicality.

This week, an elderly woman had a heart attack on the city bus I was taking home. Two teenaged girls sitting across from her immediately told the driver to stop and proceeded to call 911. Since the woman kept saying she lives just a few blocks away, I went over and, loathing standing by helplessly and wanting to do something for her but having 911 already taken, asked her if anyone was home to call. She said yes and I called her husband, Alex. Within 10 minutes, one set of EMTs, two fire trucks, the ambulance and Alex arrived. I watched them take her off the bus in a wheelchair, then got off the bus, made sure the EMTs didn’t need me to fill out a statement, and went home.

Pretty simple and straightforward.

But what kept bothering me for hours after was that my internal monologue/reaction to the woman having a heart attack was - at least in my mind - seflish: I wanted not just to help her, but to be a part of the action. The human side of me wanted to do all I could to help and the inquisitive side didn’t want to be left behind, not knowing and engaging in the details. So while this was not newsworthy material, but there was still a part of me that wanted to question passengers and EMTs to get into their heads, too. And now I felt somewhat ashamed.

But why be ashamed?

So my questions are: is this story an example of simply normal inquisitiveness and desire to help or could a journalist be so entrenched in a desire for answers and context that they get drawn to stories that aren’t stories?

Thursday, September 25, 2008

LOCAL HEALTH NEWS: Jefferson Offers Free Screenings For Prostate Cancer

(previously published here at www.thebulletin.us)

Philadelphia - Philadelphia area residents can get free prostate cancer screenings today at the Bodine Center for Cancer Treatment at 111 South 11th Street at Thomas Jefferson University Hospital. The service will be provided between 9 a.m. and 3 p.m. to all men who come and request it.

The free screenings are part of a research program and include a rectal exam as well as a blood test for levels of prostate specific antigen (PSA), testosterone and cholesterol.

"The blood test right now should be done once a year over the age of 50," recommended Dr. Leonard Gomella, chairman of the department of urology at Thomas Jefferson University's Kimmel Cancer Center.

Prostate cancer is the most common non-skin cancer in the United States, affecting one in six American men. It is the second-leading cancer killer, after lung tumors, among men.

Screening is generally recommended for men aged 40 to 75, and beginning at age 35 if there is family history of prostate cancer or you are of African American or Hispanic background.

The benefits of screening for older men above age 75 has been questioned in recent studies, but discussing your options and risks with your doctor is still best, said Dr. Gomella. "More men die with prostate cancer than of prostate cancer."

Although the government does not endorse PSA screenings and there is currently no cure for the disease, discovering the cancer earlier allows for possible treatment of symptoms and monitoring for continued progression.

The American Cancer Society notes that the year 2007 saw 218,890 men diagnosed in the U.S. and about 27,050 deaths. Worldwide, approximately 780,000 men are diagnosed with it each year, 250,000 of whom die.

The event is in its 19th year and is sponsored by Jefferson's Kimmel Cancer Center and the Foundation for Breast and Prostate Health. The month of September is the country's newly designated Prostate Cancer Awareness Month.

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

COMMENT: "Children's Locks..."

Added: Saturday September 13, 2008 at 02:57 AM EST
Locks of Love Sells the Hair for Profit, too

The reporter did not research adequately, By the Locks of Love own report on their federal tax filing, they make a profit as much as $500,000 a year from the sale of hair. They do not give the wigs for free either...the families pay something on a sliding scale. By their own admission that provided 2000 wigs over ten year span...that's a paltry 200 wigs per year on average. Compare that with the tons of ponytails sent to them every year. If your child knew that her donated hair was being sold to the hair extensions vendors, how would she feel about this organization then?

Paula, Providence, Rhode Island

LOCAL: Children's Locks And Love A Winning Combination

(previously published here at www.thebulletin.us)

When Elizabeth Strenge was 10 years old, she had her long, brown hair tied back in a ponytail and cut by her mother, who put the resulting 13-inch long tail into a plastic bag and envelope for mailing.

Elizabeth's hair traveled all the way from the Strenges' home in Yardley to Fort Myers, Fla., where a public nonprofit called Locks of Love used each strand to create custom hairpieces for children diagnosed with any condition that results in total hair loss.

The vacuum-fitted hairpieces help restore these youngsters' self-esteem and confidence during their treatment and recovery.

While it may seem that having the latest hairstyle is big for children and teenagers today, knowing what their cut hair will be used for seems to far outweigh anxiety felt at losing long tresses. Now the nervousness felt is that of excitement.

"I recently had a little girl about age 7 come in once a month for me to measure her hair to donate," said Debbie Michel, who has been a stylist at the Warwick Hair Salon for 34 years. "She was about four inches away from the required 10 but was willing to have me cut her hair within an inch of her scalp if it would meet the requirements."

For 12-year-old Jackie Gibson, the choice to donate her long blonde hair was an easy one. "I thought there are kids who don't have any hair and it's a great program to make hair for children who don't have any," said the seventh-grader from Country Day School of The Sacred Heart in Bryn Mawr.

Founded in 1998, Locks of Love works individually with children and families from across the country who have either applied or been recommended by a doctor, collaborating to design the custom prosthetic.

Using only human hair, hairpieces are hand-sewn to the child's head size and shape. They look natural and, according to Locks of Love's communications director, Lauren Kukkamaa, "allows them to play sports, run, swim and stay active without fear of it falling off or someone pulling it off their head."

The group says that thousands of hair bundles arrive each year. Each hairpiece requires 6-10 ponytails and 4-6 months to manufacture and children between the ages of 6 and 18 can receive a new prosthesis every 18 months, for a total of up to 8 hairpieces.

The child recipients have had conditions ranging from alopecia areata, injuries from radiation treatment to the brain stem, severe burns and dermatological conditions.

Monetary donations are also accepted and used toward production costs. They are tax deductible and ideal for donors, such as boys, whose hair is too short to donate.

"I learned about Locks of Love about 25 years ago," said Ms. Michel, the stylist. "The donations have increased to the point that I now wait until I have about six ponytails to send. People now bring them in from friends and family."

Ms. Kukkamaa said that the organization is growing and is committed to finding and helping children directly, but is also working toward expanding its mission to provide treatment services.

"Since 2006, we've been able to provide funds to medical organizations for research into alopecia," she said. "[The University of Miami's presence] in our backyard [also] allows us to be educated regularly by them."

Donor ages range from young children to those in their 70s, but over 80 percent of the donors are children themselves, this charity has become a place where children are able to help one another. More than just hair, these hairpieces provide mutual gifts of caring, confidence and community.

Both Elizabeth and Jackie plan to continue growing out their hair and will encourage others to donate. Now 15 years old, Elizabeth has donated two more ponytails, with the latest measuring 10 inches. Her younger sister has also joined the effort.

Remembering the first time she had her blonde hair cut for donation, Jackie enthused, "I was happy and excited that it would be used. ... Yes, I have told other people. People have asked 'is it a good idea' and I think it's a great idea."

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

LOCAL ARTS: Incubator Of Rhythm

(previously published here at www.thebulletin.us)

There's nothing like a good African dance class to soak your shirt in sweat, blister your feet and make you wish you could shake your booty like a professional.

Inhaling the rhythmic drum beats helps, though, as does the sight of dreads flying, wrap skirts flapping and dancers circling their arms and pumping their chests. This is exactly what you'll find Wednesday nights at the Community Education Center in University City, where each 90-minute class requires $12 and all of your energy.

Djian Tie, an Ivory Coast native, teaches the Wednesday class, where live drummers tempt dancers to try faster, funkier moves. Mixed-level African dance classes are also offered by Cachet Ivey on Monday night and Maurice Edwards on Saturday afternoon.

Only a handful of venues offer African dance classes in the city and CEC is definitely the hub.

"We've been here longer than anyone in the city," Theresa Shockley, director of CEC, a nonprofit that has been around since 1984, said. "And we're more artist-friendly. CEC is kind of an incubator, supporting artists throughout their career and giving them a place to work."

Founded 24 years ago, CEC grew out of a public-school education facility. Today, the brick building in West Philly is a refuge for emerging artists, as a forum not only for dance - African, Latin and line dance - but also theater, music, martial arts and other forms of artistic expression.

Another part of what makes CEC unique is that it partners with teachers instead of paying them as would a studio. And while the center has resident dance companies, like Group Motion and Kumquat Dance Center, the companies do not overpower the overall structure.

"Artists are always trying to get space to teach and present their work," Ms. Shockley said. "We provide space for them to develop their work and present it."

CEC's New Edge resident artist program, for example, specifically caters to new choreographers and theater artists. Each year, three choreographers and two theater artists are granted a stipend, 100 rehearsal hours and a venue to showcase their final product.

Shavon Norris and Meredith Rainey, who were chosen this year from over 30 choreographer applicants, will start their residencies this spring.

Influenced by her Baptist upbringing, Ms. Norris's teaching style is based on "the African-American tradition of testifying" and storytelling. The dancers teach each other the movements they create, which allows for an "exchange of histories" and "insight into what the others' experience is," Ms. Norris said.

After interviewing potential dancers, Ms. Norris decides whom to cast in her pieces by observing their reactions to the taped interviews. For this project, she asked three men to perform improvisational dance based on what they remembered hearing in their youth.

"I'm not interested in putting work in people, but rather, pulling work out of them," Ms. Norris said.

Mr. Rainey, who is trained in classical ballet, takes "classical vocabulary" and adds "background" to make his pieces more than merely technical. He likes to train "dancers who don't have a voice yet and make them have a voice."

The theme of his project is voyeurism, stemming partly out of his TV addiction and partly out of his own "fear of getting older and not being good enough."

"Why am I so addicted to looking at someone else's life?" he asked rhetorically. The conceived focus of his project has ranged from "power" to "coveting someone else's life" and is now "about going out there and getting a life."

Of the resident artist program at CEC, Ms. Norris said, "CEC supports artists in any stage of your career."

Mr. Rainey agreed, noting that few dance residencies are offered in the city and only CEC allows choreographers to produce shows upon its completion.

Having such an outlet and bond between the city and the creative juices of its residents is key to the CEC's mission.

"Our goal is to connect artists and [the] community," explained Ms. Shockley.

The dance floor on Wednesday night was pulsing as rows of dancers of various backgrounds, shapes and experience practiced the newly learned routine, competed in a freestyle contest to outdo the drumbeats, and then bowed in thanks to the drummers.

As dancers streamed out, some rubbing their feet, the woman collecting the money at the door advised a first-timer, "If you get a pedicure make sure they don't scrape off the calluses. Then, your feet will be too soft."

Visit www.cecarts.org for a list of classes.

Erin Maguire can be reached at emaguire@thebulletin.us. Heather Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008

HEALTH NEWS: Baby-Targeted TV Banned In France

(previously published here at www.thebulletin.us)

From the colorful costumes of "Barney and Friends" to Saturday morning cartoons like "Dora the Explorer," television programming has long targeted the pre-preschool set in America. If we take a cue from France, however, that could change.

Last week, the High Audiovisual Council, France's broadcast authority, banned French channels from airing any TV shows with a target audience of children under three years old. The goal, as stated in the published ruling, is to "protect children under three from the [negative] effects of television."

"Television viewing hurts the development of children under three years old and poses a certain number of risks, encouraging passivity, slow language acquisition, over-excitedness, troubles with sleep and concentration as well as dependence on screens," wrote the council.

The ruling affects both French channels and cable operators that air foreign channels, specifically BabyFirstTV and BabyTV. BabyTV is owned by Rupert Murdoch's News Corp. and BabyFirstTV is owned by a Fox Entertainment affiliate, as well as Netherlands-based and LA-based investment groups.

Program development will be affected and French cable operators that air foreign channels with baby-targeted programs will now be required to air warning messages to parents, such as: "Watching television can slow the development of children under three, even when it involves channels aimed specifically at them."

While such baby-marketed products are touted as specially designed for parent-baby interactive viewing, critics argue that such specific channels are more often used as a babysitting tool.

In a June newspaper interview, France's minister for culture and communication, Christine Albanel, also urged parents not to use 24-hour channels as a sleep aid, deeming it actually counterproductive to a good night's sleep. Research shows that background noise and artificial light such as those from TVs impede the body's ability to wind down and rest.

Area medical professionals agree. Dr. Gary Emmett, director of hospital pediatrics at Thomas Jefferson University Hospital, said, "While watching TV is not always harmful, it is not always helpful." It also often has long-term effects on learning and physical health, since the time spent in front of the TV takes away from other activities.

"Reading is directly correlated to success in school, while watching TV, and other things that [doctors] regard as passive, is not ... and is counter-related," he said.

Research published this July in the journal Childhood Development has also highlighted the negative effects of background noise on a toddler's ability to concentrate and learn, instead fostering restlessness and distraction.

BabyFirstTV first aired in the United States in 2006 to much debate over the value of such programming towards the youngest and most undeveloped, impressionable segments of society. The American Academy of Pediatrics recommends that children below age three should have zero hours of TV watching. However, a 2003 Kaiser Family Foundation study found that two-thirds of children under age six live in a home where the TV is on half the time, while one-third of children live in a home where it is on "most of the time" or "always."

According to Dr. Emmett, parents can help by fostering active playtime with other children and by reading storybooks with them. There is also a Philadelphia-area branch of the national charity NEMOURS that calls for a "two-one-five-zero" program: two hours or less of screen time a day, one hour of running or swift walking, five portions of fruit and vegetables a day and no sweets or sugary drinks.

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

Saturday, September 20, 2008

LOCAL HEALTH: Looking Out For Kids' Safety

(previously published here at www.thebulletin.us)

Philadelphia - While your family starts gearing up for a new school year, remember that some things stay in season all year - like keeping everyone safe and sound, whether out in the sun or racing from class to lacrosse practice. But where to go? What to look for?

This year, Kohl's Safety Center provides just that. Located within the Children's Hospital of Philadelphia gift shop, its mission is to reduce childhood injury by providing safety and health education along with safety products.

"The idea of a safety center is for families to get low cost products [as well as] safety education," said Marla Vanore, R.N., M.H.A., trauma program manager at Children's Hospital. "There is always a highly qualified safety educator in the store to offer guidance on product use, such as how to fit a helmet or install a child safety seat."

Parents, children and intrigued passersby are encouraged to come visit the Safety Center, a safe place where they are surrounded by everything from colorful - and sturdy - helmets, baby gates, power strip covers, cabinet locks, elbow and knee pads and child safety seats, as well as free literature on important safety topics and answers to any question about injury prevention.

The benefits of this are that the health educator can see the child[ren] and suggest supplies appropriate for the child's age and developmental level to families. Twenty-minute safety videos are also available to be watched in the center, and a car seat program available for qualifying low-income families.

There's even a life-size model car and different sized toy babies for parents to learn the proper way of strapping in car seats, booster seats, and their child.

"Kids love the car, "said Angela Sim-Laramee, Safety Center Coordinator. "They also get excited to be fitted and measured for a new helmet. Parents are happy with the prices and to have their kids ... able to actually try [a helmet] on."

In addition to being a place for often-elusive answers and safety education from knowledgeable professionals, every product in the store is sold at-cost to anyone from the community who comes in. This means huge savings and high affordability, with $8 bicycle helmets, $3 outlet covers, $1.30 window blind cord wind-ups, and car seats in varying sizes for $13 to $49.

While a Children's Hospital initiative, the Safety Center receives funding from the national retailer Kohl's, whose Kohl's Cares for Kids program helps support health education and services programs throughout the country. Under this program, the proceeds from selling stuffed animals at Kohl's department stores helps projects like this one.

The Safety Center is doing well, even with only a three-month run thus far.

"We've had a lot more people come in [than we expected], with around 30 people a day coming in asking questions about their own safety seats and bicycle helmets," said Ms. Sim-Laramee. "We've even had doctors coming in asking questions," added Ms. Vanore.

As a Trauma I center, Children's Hospital has a strong injury prevention program, from which an advisory board of doctors and nurses were chosen to assist the Center in what to do and how to run the store for the most efficient care.

The Safety Center is the first and only one of its kind in Pennsylvania and was based on existing safety centers throughout the country that have been successful.

As for the future of the store, both women said it's to continue to get the word out and reach as many families as possible. "The goal is not to make a profit, it's just to sell safety products and continue to replenish the stock," said Ms. Sim-Laramee.

And with the first week in September being Child Passenger Safety Week, it's the perfect time to remember that safety comes in both knowledge action.

The Kohl's Safety Center is located on the first floor near the main entrance of Children's Hospital at 34th and Civic Center Drive, within the gift/convenience shop and adjacent to McDonald's. It is open every weekday from 11 a.m. to 5 p.m.

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

MEDICAL NEWS: New Pathways Between Memory Loss, Alzheimer's

(previously published here at www.thebulletin.us)

Mild cognitive impairment (MCI) is a stage between normal aging and Alzheimer's earliest stages. Understanding how it goes from mild thought problems to dementia could be key to figuring out how to prevent Alzheimer's. The following details of some of the latest research can give you an idea of the importance of aiming early.

Understanding Risk Factors

According to a Mayo Clinic report, the MCI rate increases with age and is higher in men, who are almost twice as likely to develop the condition than women. Although previous studies show women at higher risk of dementia and Alzheimer's, women generally outlive men, perhaps surviving long enough for their conditions to progress.

According to Dr. B. Brent Simmons, assistant professor and head of Temple University Hospital's Senior Care Specialists section of geriatrics, the higher rates of heart disease in men might also affect their chances of getting vascular dementia.

This study collected data from 1,786 people aged 70 to 89 and found that after a year, about 3.5 percent of 70- to 79-year-olds and 7.2 percent of 80- to 89-year-olds become afflicted with it. Overall, the growth rate of new MCI cases in the elderly population is at 5 percent per year - higher than anticipated.

Drug Development

In research by New York's Mt. Sinai School of Medicine, the brains of 124 diabetics taking medication (insulin and other glucose-lowering drugs) had up to 80 percent less beta-amyloid plaque compared to other diabetics and 124 non-diabetics. Beta-amyloid protein clumps in and around the brain, forming plaque that inhibits and destroys neurons necessary for daily functions and memory.

However, even if a combination of insulin and oral anti-diabetes medications may prevent Alzheimer's-related factors, they cannot be prescribed for non-diabetics. Hopefully, though, brain pathways such as insulin signaling could be used in developing new treatment methods.

Besides plaque, Alzheimer's indicators include unusual changes to a protein called tau. A yearlong trial at Duke University Medical Center tested a promising new drug - a nasal spray called AL-108 - on 144 patients with MCI, between ages 55 and 85, and saw a 62.4 percent improvement in memory ability.

Patients took several tests that measured memory ability before and after medication. The tests measured short-term visual, verbal and auditory working memory, functions that deteriorate throughout the progression of Alzheimer's.

Although this drug doesn't cure Alzheimer's, it showed that attacking the protein tangles does work, stabilizing some of the progress of dementia.

Getting It Before It Starts

Instead of just treating symptoms, researchers at the University of Pennsylvania School of Medicine are trying to stop it before it starts, by finding chemical and biological markers of these conditions.

Since Alzheimer's is a disease measured by analyzing symptoms, the goal of the first investigation was, according to its lead researcher, Dr. Leslie Shaw, "to determine if we could detect Alzheimer's disease pathology before a patient went on to have full blown dementia and memory disorders."

The research focused on measuring levels of cerebral spinal fluid (CSF) and establishing benchmark concentration levels of biological indicators for normal, mildly cognitively impaired, and Alzheimer's individuals.

The differences between the baseline levels of three Alzheimer's-associated proteins were significant enough to speed up drug development efforts of biological compounds that can fix these differences.

The second Penn study uses MRI scans to detect abnormal structural changes linked to MCI in the brains of healthy elderly. Radiology professor Christos Davatzikos, Ph.D. and his colleagues monitored these slight physical changes to the brain successfully might provide a way to alert patients and doctors to brain deterioration and memory decline early enough to prepare or begin treatment.

With around 18 percent of 400 patients converting to Alzheimer's a year, this study is ongoing, and doctors are able to "study the progression as it's happening ... at a rate large enough to make our tests reliable or not with sufficiently large number of study subjects," said Dr. Shaw, who is also the director of Penn's ADNI Biomarker Core Lab.

Collaboration is key for all involved, and as Dr. Shaw noted, "the earlier we can detect the disease reliably with confidence, the earlier we can institute and monitor treatment such as diet, exercise, adjusted sleep patterns and having a social life, along with doctor visits, to delay and stop the disease."

The MRI-based study used images from the Baltimore Longitudinal Study of Aging (BLSA) and the Alzheimer's Disease Neuroimaging Initiative (ADNI) and was funded by the National Institute on Aging and the Institute for the Study of Aging.

Dr. Shaw's research was funded by the Alzheimer's Disease Neuroimaging Initiative via the National Institutes of Health.

Heather J. Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008

HEALTH NEWS: NJ Launches Campaign Against Medicine Abuse

(previously published here at www.thebulletin.us)

The Partnership for a Drug-Free New Jersey (PDFNJ) announced Monday a statewide public service campaign titled "Grandma's Stash," to raise awareness that misuse of prescription drugs is second only to marijuana as America's most prevalent drug problem.

The award-winning multi-media effort will utilize newspapers, radio stations, billboards, buses and trains to spread the message that "more teens now say it's easier to get powerful prescription drugs than it is to buy beer," as Department of Human Services Commissioner Jennifer Velez said at the press conference in Lawrenceville.

Her assertion is based on findings from the National Center on Addiction and Substance Abuse (CASA) at Columbia University's 13th annual back-to-school survey of 1,002 teens and parents. The survey asked: "Which is easiest for someone your age to buy: cigarettes, beer, marijuana, or prescription drugs such as Oxycontin, Percocet, Vicodin or Ritalin, without a prescription?"

While the overall response had teens saying cigarettes and marijuana were easiest to purchase, they also said prescription drugs were easier to get than beer. Nineteen percent of teens, compared to 13 percent a year ago, found prescription drugs are easier to get than all three of the other substances.

Over 720 New Jersey pharmacies will also distribute around 750,000 prevention messages on pharmacy bags. "[This initiative is a] great example of a public-private-nonprofit collaboration that can positively impact the lives of hundreds of thousands of New Jersey families," said Joseph Roney, R. Ph. FACP/CEO, of the New Jersey Pharmacist Association in a PDFNJ press release.

Columbia's 2008 CASA survey report also noted that many of the parents surveyed are "problem parents" whose actions - or lack thereof - increased the abuse of illegal and prescription drugs among 12- to 17-year-olds. Thirty-four percent of teens surveyed who abused prescription drugs obtained them at home, and half of those allowed out after 10 p.m. said they spent time with smokers and drug users.

There are lots of factors at play here," Elizabeth Planet, CASA's director of special projects, said to the Washington Post of the behavior differences revealed in the study. "Parents are not paying attention. There are parents who are out in the evening themselves. There are parents out at work."

"In the 2007 New Jersey Middle School Principals Study, half of the principals surveyed indicated that they believed prescription drugs were abused more than twice that of ecstasy and cocaine by their students," Joseph A. Miele, PDFNJ chairman, said at the press conference. "[Yet] the 2007 PDFNJ Parent Tracking Survey found that 44 percent of New Jersey parents of middle school students said they knew little or just about nothing about prescription drug abuse."

It is also necessary for kids to understand the risks involved with misusing prescription drugs.

"Kids [may] think that because these are medicines that are prescribed, they are safe," said Nora Volkow, director of the National Institute on Drug Abuse. "The problem is that there is very little difference between the amount they take for a high and the amount that causes an overdose."

So keeping the lines of communication open and the medicine cabinet closed is incredibly important, she said.

Joseph Califano, CASA chairman and president, told the Post he recommends more than three family dinners a week, while Steve Pasierb, president of Partnership for a Drug-Free America suggested to WebMD that parents engage in "a lot of smaller conversations that aren't so scary" compared to a big, intimidating talk.

The "Grandma's Stash" campaign also commemorates August as National Medicine Abuse Awareness Month, a designation passed this July by the U.S. Senate in light of a recent Substance Abuse and Mental Health Services Administration report about the increasing rates of prescription drug abuse.

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

LOCAL: UPHS Notifies Public Of Lost Payment Data

(previously published here at www.thebulletin.us)

The University of Pennsylvania Health System notified an undisclosed number of patients this week that an encrypted backup tape containing personal and credit information was lost in transit by an outside carrier.

Affected persons are those who made payments to UPHS between Feb. 25 and April 25.

Letters were sent to the affected people on Aug. 8 by UPHS and Bank of New York Mellon explaining the loss and detailing the information compromised, which includes names, addresses and checking account numbers. The letters also emphasized that "there is no evidence that the tape was stolen or that unauthorized persons have accessed any information on the tape."

As a precautionary measure, Mellon is offering two years of free credit monitoring and $25,000 in complementary identity theft insurance to each person affected. They assure people that these letters and offers are legitimate.

Heather J. Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008

LOCAL: DEP To Spray More In Area For West Nile

(previously published here at www.thebulletin.us)

Residents of Bucks, Delaware, Montgomery and Philadelphia counties can expect more frequent mosquito sprayings in the evening hours by state and county West Nile Virus program staff.

The Pennsylvania Department of Environmental Protection's (DEP) southeastern office is increasing treatment efforts due to an "exceptionally high number of West Nile-infected mosquitoes" in the area. Only those areas with the type of mosquitoes capable of carrying the virus will be sprayed. Spraying locations are made public online and through press release one day in advance.

"With nearly 70 percent of the state's infected mosquitoes are here in the southeast region; we're taking coordinated action to reduce this threat," said the DEP's regional director Joseph A. Feola in a press release. DEP has temporarily reassigned certified pesticide applicators from other parts of the state to support the increased treatment effort.

While most counties in the commonwealth have fewer than two positive mosquito samples, our four counties topped the list: Bucks is listed with 41 positives, Delaware with 42, Montgomery with 29 (28 mosquito, 1 human) and Philadelphia with 22.

One human case of the West Nile virus was confirmed last month in a 27-year-old Montgomery County woman, who was treated and released. The goal of spraying is to prevent the virus from spreading from insects and animals to humans.

DEP uses Biomist 3+15 spray, a permethrin insecticide produced by Illinois-based Clarke Mosquito Control. Sprays are dispersed via truck-mounted equipment by certified DEP staff. The fact that the spray is a chemical can be of concern to many parents and families, but the DEP maintains the product's safety as the spraying is done at a fraction of the volume limited by federal health regulations (0.75 ounces per acre, with a federal threshold of 3 ounces per acre).

"We are able to target our spraying closely enough n time and space, as well as with low enough concentrations that it poses no harmful risk to humans, including children," DEP spokesman Dennis Harney said. "The product was chosen based on its efficiency and ability to be applied safely."

Still, people are generally advised to stay inside while spraying is performed.

As for farmland areas, the spray's sample product label claims it is safe for many crops, but it recommends covering animal feed and not using it over open pasture lands. As the mosquito season lasts until the first frost in October, DEP spraying will continue until that period of time, Mr. Harney said.

For more precautions and information on West Nile in your area, visit the Pennsylvania Department of Health's Web site. For spraying locations, see www.westnile.state.pa.us. Current test results for mosquitoes, humans and animals are also available on the site and via telephone.

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

Thursday, September 18, 2008

MEDICAL NEWS: First Treatment For Huntington's Approved By FDA

(previously published here at www.thebulletin.us)

A drug called Xenazine (tetrabenazine) has been approved by the U.S. Food and Drug Administration as the first treatment for chorea, the involuntary jerking movements that are a symptom of Huntington's Disease.

The drug addresses only specific symptoms, however, and does not target the complete condition. It is also not without major side effects, notes the FDA, such as suicidal thoughts and depression, especially in patients already predisposed to those conditions. Other side effects include drowsiness, insomnia, nausea and restlessness.

Xenazine works by suppressing the ability of dopamine - a neurotransmitter responsible for improving nerve conduction - to communicate with certain nerve cells in the brain, resulting in an over-active system.

Huntington's Disease, or chorea major, is a rare inherited neurological disorder that affects physical, cognitive and behavioral ability - a person's coordination, speech, thought processes and muscle control. Patients with chorea are at higher risk of fall-related injuries.

About 30,000 Americans are currently affected and another 200,000 are at risk of developing the genetic disorder. Symptoms usually manifest between the ages of 30 and 50.

Xenazine should be available by prescription by the end of the year and given the FDA-approval, it is likely (although uncertain) that Medicare and other government or private insurance plans would cover the drug's cost.

The medication is already available in Australia, Canada and Europe and is manufactured by the Washington, D.C.-based Prestwick Pharmaceuticals.

Heather J. Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008

LOCAL: University Of Pennsylvania Welcomes New Medical Students

(previously published here at www.thebulletin.us)

Philadelphia - At a ceremony full of family, friends, tradition and responsibility on Friday, each member of the University of Pennsylvania School of Medicine's entering class of 2008 had the opportunity to give personal speeches and thanks, to faculty, their family and friends.

Faculty members also welcomed the 154-strong class, imparting words of wisdom. Their counsel was rooted in the UPenn School of Medicine's austere and prestigious history to imbue the responsibility of becoming a medical professional.

In his keynote speech, Henry W. Foster, Jr., M.D., professor emeritus and former dean of the school, told students that the white coat symbolizes professionalism to remember that "healthcare is the most fundamental [life challenge]."

He said, "Factors invoking change in the medical system seem to be deprofessionalizing medicine ... [and] the American healthcare system is in the midst of reformation ... [But] change is not the enemy - it's a fact. ... I'm depending on you to [impart] change."

In their personal remarks, students revealed the diversity and breadth of their collective education and backgrounds, peppering the solemn occasion with thanks - and apologies - to parents, family and friends, and jokes about what they have accomplished and what lies ahead.

The new class hails from 30 states and 61 colleges, and bring experience in everything from biology and anthropology to East Asian languages and computer science. One student, Kathryn Cunningham Hall, even started a nonprofit called Power Up Gambia! to fundraise and install solar panels to provide clean water and electricity to a Gambian hospital in West Africa.

The ceremony in which students don white coats varies from school to school, but all emphasize the responsibility and respectful care that the credibility granted by the coat requires.

After donning their white coats, students were welcomed by UPenn alum, Louis Matis, M.D., president and CEO of the Immune Tolerance Institute, who gave 154 stethoscopes to the incoming class. Then the students, as well as any family who were also doctors, recite the Hippocratic Oath, which provides standards and a core set of professional values to be followed by all physicians.

On the White Coat Ceremony, first-year student Kannie Chim, of Upper Darby, noted that she didn't know what the ceremony would entail, and "liked how it was personal, with everyone speaking for themselves ... It'll be intense, but I hear Penn students have fun, too."

Shanna Sprinkle, 22, from Oklahoma by way of Baltimore was also inspired by the ceremony.

"Going in wearing different things and coming out [looking] the same, it was symbolic and equalizing," she said.

Parents and family members were equally excited and impressed, especially after the school provided a special orientation day for families, where faculty introduced them to the curriculum and other anticipations that the students will go through over the next four years.

For John McLaughlin, whose eldest son Eamon is starting at Penn this year, the entire ceremony made him "extremely proud [since he] knows how hard he worked to get here."

When asked what appealed to them about UPenn and PennMed, first-year students were of the same mind in emphasizing the power of the people. As Eamon McLaughlin, 22, a first-year from Wilmington, Del., declared, "everyone is laid-back, not cutthroat... that was really the selling point for me."

"I've never been in a group of people so outgoing, bubbly and full of life in my life," said David Guttmann, a first-year from Abingdon who is considering pursuing oncology. "[This] bodes well for the future of medicine that people can communicate [and bond] with patients. Penn did a good job [of picking us]."

As Jon B. Morris, M.D., a professor of surgery, said, "[the ceremony is us] welcoming the students into the family. ... All the family came - involving them is an integral part of this process."

At the UPenn School of Medicine, students learn within the themes of Science of Medicine, the Art and Practice of Medicine, and Professionalism and Humanism, while also engaging in a four-year patient-centered "Doctoring" course where pairs of students follow a chronically ill patient to understand the effect of care on patients and family. First year classes begin today.

The University of Pennsylvania School of Medicine is the nation's first teaching medical school and one of the top research-based medical schools. Along with the UPenn Health System, the school is part of Penn Medicine, an enterprise dedicated to the inter-related missions of patient care, education and research. Its "White Coat Ceremony" was established in 1996 to build on a tradition symbolizing the clinical beginning of every student's medical education.

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

NATIONAL:MEDICAL ETHICS: Hundreds Protest Psychologists' Role In Torture

(previously published here at www.thebulletin.us)

Outside the American Psychological Association's 116th annual convention this weekend in Boston, between 100 and 200 psychologists rallied together to protest the ongoing role of psychologists in military interrogations, particularly amid concerns of torture.

The demonstrators are among those mental health professionals who have criticized the long-standing relationship as a violation of their code of ethics. They are urging the implementation of an APA ban on its members participating in such military and intelligence operations.

A resolution petition has been submitted and the 148,000 members of the APA are submitting their ballot votes over the next month, with a decision due by late September. If passed, it would expand on the APA's existing policy, passed last year, which some say is adequate.

Some psychologists and health professionals maintain that without psychologists' participation, the interrogations would be more harmful and go unchecked and unaccounted for.

The current policy prohibits psychologists from taking part either directly or indirectly in 19 coercive procedures often considered forms of torture, including waterboarding, the use of hoods, forced nudity, stress positions, rape, mock execution, use of drugs, and exposure to extreme temperatures. The policy says this list is not exhaustive and also urges the U.S. government to discontinue such practices.

"Torture and abuse are always unethical and prohibited ... the question is how to best fight an administration policy that permits such practices," APA's ethics office director Stephen Behnke said to the Boston Globe.

In a statement released earlier this year, the APA describes its position that "No psychologist - APA member or not - should be directly or indirectly involved in any form of detention interrogation that could lead to psychological or physical harm to a detainee ... [and] doing so would be a clear violation of the profession's ethical standards."

At Saturday's rally, where people held signs that declared "Do No Harm" and "Abolish Torture," Nathaniel Raymond of Physicians for Human Rights, a Washington-based health professional organization, maintained at Saturday's rally that "it's about restoration of the values that define us. ... It's about who we are in the world."

The group's director, Leonard Rubenstein, also suggested that the APA should note the American Medical Association's policy of prohibiting physicians from participating in interrogations and divulging whether a prisoner's health would sustain torture.

Other groups that participated in the rally included professional coalitions such as Psychologists for an Ethical APA, Psychologists for Social Responsibility, and human rights organizations such as Amnesty International and the American Civil Liberties Union.

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

Friday, September 12, 2008

HEALTH NEWS: Returning Veterans At Higher Risk For Alcoholism And Stress Disorder

(previously published here at www.thebulletin.us)

New research supports ongoing observations that military deployment into combat zones puts young men and women at greater risk of developing mental health issues, including post-traumatic-stress-disorder (PTSD) and heavy drinking.

The two studies were presented in a themed issue on violence and human rights by the Journal of the American Medical Association, as was a study that found suicide rates for returning combat veterans were no higher than rates for the general U.S. population.

In the study on alcohol abuse, returning service members who had seen combat were 63 percent more likely to experience new-onset heavy and binge drinking than those who were in non-combat areas.

The rates for new-onset heavy weekly drinking was 8.8 percent, with it being 25.6 percent for binge drinking, and 7.1 percent for other alcohol-related problems.

Binge drinking rates were 31 percent higher for combat veterans than for those not exposed to the same level of violence.

The results also showed a higher risk for younger service members compared to older personnel, and a higher incidence rate for Reserve or National Guard members compared to members in other military branches.

Surveys were taken of 48,400 military personnel before and after assumed deployment (between 2001-2003 and again in 2004-2006), setting a pre-deployment precedent for drinking levels and alcohol-related issues. Only 5,500 were actually deployed into combat zones, with 5,661 deployed into non-combat areas. The rest remained on active duty in the Reserve or National Guard.

The researchers suggested in their report that alcohol use likely serves as a coping mechanism for returning soldiers, as it does for individuals in the general populace. To combat this unhealthy response, the building and provision of familiar and stable support networks of trusted family, friends or fellow veterans is best - anywhere that doesn't involve meeting at a bar.

A separate study on excess alcohol intake lists additional dangers as including a greater chance of developing metabolic syndrome, which includes obesity, high blood pressure and diabetes.

This study by the CDC's National Center for Chronic Disease Prevention and Health Promotion defines excess drinking as more than two drinks daily for men and one drink a day for women, as well as binge drinking.

In the U.S., 58 percent of drinkers fall into this "excess" category and a majority had engaged in at least one instance of binge drinking, according to a recent survey cited by the researchers in their report.

Researchers suggest that public health messages emphasize the cardiometabolic risk of excess drinking. This study will be published in the Journal of Clinical Endocrinology & Metabolism.

Heather J. Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008

HEALTH NEWS: Study: Breast Cancer Survivors Still At Risk

(previously published here at www.thebulletin.us)

New research from a 16-year study indicates that early-stage breast cancer patients who have completed five to 10 years of drug and/or chemotherapy treatment have a one in five - around 20 percent - chance of relapse.

Between 1985 and 2001, oncologists/researchers at the University of Texas' M.D. Anderson Cancer Center examined 2,838 patients with stage I to III breast cancers who had been treated at the center. All were cancer-free five years after initial treatment with surgery or surgery and radiation.

All of the women underwent up to five years of additional treatments with chemotherapy, the anti-estrogen drug tamoxifen or both. After a 28-month follow-up, 215 women developed recurrent cancer.

This incidence rate put the risk at 7 percent for women with stage I breast cancer, 11 percent for stage II, and 13 percent for women with stage III cancer. This relapse rate increased to 20 percent 15 years after first being diagnosed.

"The risk of relapse was still small, but certainly not insignificant," Abenaa M. Brewster, M.D., an oncologist and researcher with M.D. Anderson Cancer Center told WebMD. "I think these numbers are somewhat reassuring, but they also highlight the need for new [therapeutic] options for women who have completed five years of treatment."

Factors associated with the risk of recurrence were tumor grade, hormone receptor status and endocrine therapy.

Forms of treatment available to newly diagnosed patients usually include surgery and radiation therapy (chemotherapy) or surgery and drug therapy.

Up until the year 2000, drug treatment consisted of tamoxifen for both premenopausal and postmenopausal women with estrogen-receptor positive tumors (they respond to hormone treatments). Today, a newer class of drugs called aromatase inhibitors are used.

In the study, 34 ER-negative women had a relapse and 149 ER-positive women did. The study and results were published Tuesday in the online edition of the Journal of the National Cancer Institute.

Estrogen-receptor (ER) negative tumors are considered more deadly than ER-positive ones. However, "women who had ER-positive cancer were more likely to have late recurrences than those with ER-negative," according to Len Lichtenfeld, M.D., the American Cancer Society deputy chief medical officer in healthday.com.

However, what to do about this continued risk is up in the air, Dr. Lichtenfeld said.

A possible treatment alternative is in the works by British and Finnish researchers, who are testing a combination of two inexpensive, commonly used and easily available drugs on killing cancer-cells in tumors.

The first drug is doxorubicin, a common chemotherapy-regimen drug, followed 24 hours later by the osteoporosis medication zoledronic acid. When tested on mice, the drug combo was 99.99 percent effective in killing such cells. Human trials are currently underway with results expected later this year.

This announcement was also made in the Journal of the National Cancer Institute.

Each year in the U.S., around 180,000 women are diagnosed with breast cancer. In the U.K., almost 46,000 new cases are diagnosed every year.

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

HEALTH NEWS: Diabetes Before Pregnancy Linked To Birth Risk

(previously published here at www.thebulletin.us)

A study from the U.S. Centers for Disease Control and Prevention (CDC) reported that women with diabetes prior to becoming pregnant are eight times more likely to have children with multiple birth defects compared to women without diabetes.

The study found also that women with diabetes are three to four times more likely to give birth to a baby with at least one birth defect.

Women with pregnancy-induced diabetes, or gestational diabetes, were also found more likely to have a child with a birth defect, although usually only if they were overweight or obese at conception. This range would mean a body mass index (BMI) - weight measured in proportion to height - of 25 or higher.

The study expanded on previous research by examining women with type 1 and type 2 diabetes as well as gestational diabetes, and considering both cardiac and non-cardiac defects, nearly 40 in all.

Only 2 percent of babies with single birth defects and 5 percent with multiple defects were born to mothers with pre-pregnancy diabetes, while 93 percent of the birth defects examined were not associated with maternal diabetes.

Overall, diabetes diagnosed before pregnancy was linked with about half of the birth defect categories examined.

Birth defects may include heart problems, brain and spinal defects, oral clefts, limb deficiencies, and kidney and gastrointestinal tract defects. These affect 1-in-33 infants and are a leading cause of infant death, according to the CDC. Most causes are unknown.

The findings were based on data analyzed from over 13,000 infants with birth defects and nearly 5,000 without defects, all born between 1997 and 2003. Of those without defects, 24 mothers had diabetes before diabetes. Of those newborns with defects, 283 mothers had pre-pregnancy diabetes.

All children were part of the National Birth Defects Prevention Study, which drew data from 10 birth-defect surveillance systems in 10 states.

However, according to Janis Biermann, a spokeswoman for the March of Dimes which reviewed the study for WebMD, women shouldnotbe unduly concerned.

"Just because there is an increased risk of a baby having a birth defect if a woman has preconception diabetes doesn't mean it is going to happen," she said, "It just means there is a greater chance than if a woman doesn't have it."

The study is the largest yet done to identify the range of birth defects linked to pre-pregnancy diagnoses of diabetes, but the link itself has been known for almost two decades. Researchers hope that increased awareness will encourage people to seek the best available everyday preconception care.

"Early and effective management of diabetes for pregnant women is critical in helping to not only prevent birth defects, but also to reduce the risk for other health complications for them and their children," said lead author Dr. Adolfo Correa, an epidemiologist at the CDC's National Center on Birth Defects and Developmental Disabilities, in a news release.

According to the March of Dimes, about 1.85 million U.S. women of childbearing age have diabetes.

"The most important thing is that the patient ... get [her diabetes] in control," said Dr. Louis Weinstein, M.D., professor and chairman of OBGYN at Thomas Jefferson University.

In an urban area such as Philadelphia, "we tend to see more diabetes than in other parts of the country because we have lower socioeconomic populations with higher BMI [levels] than elsewhere," Dr. Weinstein added.

"It's important to take care of yourself, exercise, be at an optimal weight, plan your pregnancy, and make sure the diabetes is well controlled before you get pregnant," Ms. Biermann, from the March of Dimes, said to WebMD.

Once pregnant, Ms. Biermann notes the importance of following the same healthy habits and having regular prenatal care, along with regular appointments with a diabetes specialist for those diagnosed.

The report was published this month in the American Journal of Obstetrics & Gynecology.

Heather J. Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008

MEDICAL POLICY: State, Medicaid Enact Cost-Cutting Measures

(previously published here at www.thebulletin.us)

The Pa. Department of Public Welfare (DPW) last week added early refills of prescription drugs to the state's list of Medicaid services and items that require prior authorization.
An "early refill" is a request for a refill when over 25 percent of the previously filled prescription would normally remain if followed properly. Requiring approval is aimed at preventing people from "stockpiling" medications.

Refilling prescriptions early resulted in Medicaid payments being paid for more than 12 months worth of prescriptions over a 12-month period, according to Stacey Witalec, a DPW spokeswoman.

The DPW's change was made on Aug. 4 and is expected to save the state more than $2.5 million on the purchase of medicines in the 2009 fiscal year. It comes after a failed bid by DPW to take over management of the state Medicaid program's prescription drug program. Matching federal Medicaid dollars would provide a total savings of $5.4 million in 2009 and $6.5 million for fiscal year 2010.

In a similar effort to both cut costs and promote more responsible health care, Philadelphia's three Medicaid HMO plans are following the DPW's lead in not paying hospitals for added costs that result from preventable medical errors.

The DPW estimates that "hundreds of millions of dollars" will be saved under this program, Ms. Witalec said.

Keystone Mercy Health Plan will implement the policy beginning on Oct. 1. The company serves over 293,000 residents, making it the region's largest Medicaid managed-care company.

After Oct. 1, all hospital claims will be required to indicate that the medical condition for which the patient received care was "present at admission" - that it existed before the patient was admitted to the hospital, said Dr. Jay Feldstein, Keystone Mercy's chief medical officer.

Dr. Feldstein said Keystone Mercy have met with its provider hospitals throughout the year to outline the new policy. Provider hospitals covered by the company will retain the right and ability to appeal what DPW has defined as a "preventable serious adverse event."

A hospital trade group, Delaware Valley Healthcare Council (DVHC), has created a team of clinicians and hospital administrators to discuss and review the policies of the Medicaid managed-care companies.

"We're looking for [the HMO's] policies to be clinically sound and financially fair," said Kenneth J. Braithwaite II, a regional executive for the DVHC.

Health Partners, the Philadelphia area's largest not-for-profit health plan serving Medicaid patients, is in the early stages of developing its policy, according to spokeswoman Felicia Phillips.

Health Partners serves over 135,000 members in southeastern Pa. and is owned by a group of seven Philadelphia hospitals, including St. Christopher's Hospital for Children and the Hospital of the University of Pa.

Similarly, AmeriChoice of Pa. has just begun work on how to implement such a policy, Steve Matthews, a spokesman for the company told a local publication. The Philadelphia-based subsidiary of United Health Group has 75,000 members in the five-county area.

DPW's original program, which began in January, was developed to identify and stop Medicaid payments to hospitals for preventable mistakes that result in a serious negative outcome. The program was created in coordination with the Hospital & Health System Association of Pa., a state trade group.

This applies to 27 types of medical errors, or "never events," such as medication mistakes, bad blood transfusions and operating on a wrong body part.

Also in October, the federal Medicare program will stop paying hospitals for procedures and treatment of hospital-acquired conditions in eight categories that cover medical errors, injuries and infections that are judged to "reasonably have been prevented."

New Jersey health officials are waiting for the national program to begin before adopting a state policy of their own.

Heather J. Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008

HEALTH: Study: Americans Drinking Less Alcohol, More Wine

(previously published here at www.thebulletin.us)

Americans may drink more in one sitting than some Europeans (who drink steadily in small amounts), but their average overall alcohol intake has decreased across age and gender differences, according to a study published last week in the American Journal of Medicine.

The results from a 55-year study (1948-2003) on 8,600 white adults in Framingham, Mass., found Americans drink less as they get older, and they tend to gravitate away from beer and toward wine in the process. Each successive generation also showed a trend from heavier drinking toward moderate drinking.

All participants were initially at least 28 years old and were born between 1900 and 1959.
The average amount of alcohol intake was highest between ages 30 and 50 for most cohorts, regardless of gender.

Up to their mid-30s, young men relied on beer for at least half of their alcohol consumption. After that, beer consumption dropped to around one-quarter of the average male in his mid-70s.

While both men and women in each generation drank less with age and each generation drank less than the generation before it, the overall incidence rate of an alcohol use disorder among those aged 40 to 79 years was about three times higher among men (12.8 percent) than women (3.8 percent).

Female participants also showed a move from beer to wine over time, although the report's authors noted that they were less partial to beer to begin with. No significant alcohol-related problems were linked with women here, but a report by University of Washington researchers in the May issue of Alcoholism: Clinical and Experimental Research found that women born after 1953 had rising rates of alcoholism.

Lead author Yuqing Zhang, D.Sc., of the Boston University School of Medicine, told WebMD he doesn't know why the rates of alcohol use dropped over generations and this study "did not try to answer these questions."

The long-term health study collected data by asking participants to answer questions about their lifestyle and health, including alcohol consumption over time. Researchers hoped that the data would help determine patterns of alcohol use and disorders according to sex, age and birth cohorts.

The study, supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (part of the National Institutes of Health), is not clearly representative of all U.S. adults, but researchers said the data supports the efficacy of efforts to reduce alcohol use disorders.

Researchers also hope the data may be useful for policy-making groups responsible for drinking and alcohol recommendations, continuing "to support potentially beneficial effects of moderate drinking on cardiovascular disease and other diseases of aging, as well as adverse health and social effects of heavy alcohol use."

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

MEDICINE: Aetna-Wharton To Test Paying Patients To Take Their Heart Meds

(previously published here at www.thebulletin.us)

Researchers at the University of Pennsylvania's Wharton School are studying whether daily lottery cash incentives of $10 and $100 will help improve the likelihood of patients' taking their prescribed medication.

The research will begin this fall and take place over a six-month period, with results being available in March of next year.

The Aetna Foundation, the non-profit arm of the national health insurer, is sponsoring the study with a $400,000 grant. Philadelphia is a designated community under the foundation's Healthy Community Grants Program and Healthy Community Outreach Program.

Dr. Kevin G. Volpp, director of the Center on Health Incentives at Wharton's Leonard Davis Institute for Health Economics, explained that since people often stop taking medication within a few days, potential health benefits cannot be realized.

"People find it difficult to do things long term [like taking medication] in the short term [on a daily basis]," Dr. Volpp said. "A lot of behavioral economic research shows that people tend to weigh the present more heavily as opposed to [a] future decision."

So he and colleagues designed a two-arm randomized trial based on a system of feedback and incentives and proposed it to Aetna. The trial would enroll 100 participants to test a daily lottery as incentive for taking Warfarin, a blood thinner prescribed to prevent swelling and blood clots.

An electronic monitor would connect to pill boxes, tracking whether each participant takes his or her medicine. Participants would receive daily text messages saying whether he or she has won the lottery, or, if the dose was missed, whether they would have won.

An incentive group of 50 people would have a 1-in-10 chance of winning $10 for every day they take their medication and a 1-in-100 chance of winning $100. A control group of 50 people would use the same electronic monitor but not be entered into the lottery.

According to Dr. Troyen A. Brennan, Aetna's Chief Medical Officer, they chose to sponsor the trial because adherence is key to quality of care and statistics show that a year after beginning medication, only about 50 percent of patients are taking medications as directed. "If it looks like it works, we'll try to incorporate it in things we do," he said.

For Dr. Volpp, the trial's co-founder, this is just one of many possibilities in using behavioral economic tools towards strengthening health applications.

"There is a synergy between health professionals who want people to adopt healthy behaviors and commercial interests who want to find ways to effectively make sure that people ... behave in healthy ways in higher rates," Dr. Volpp said. "I think there are big opportunities to try to think creatively about how to use incentive systems to try to help people adopt healthy behaviors at higher rates."

Heather J. Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008

LOCAL: Beginning The Journey

(previously published here at www.thebulletin.us)

Philadelphia - Moments before reciting the Hippocratic Oath together, each member of Jefferson Medical College's incoming Class of 2012, aided by family and friends, donned their physician's white coat. The resulting "sea" of 255 white coats marked the beginning of their journey toward becoming physicians.

At JMC's annual White Coat Ceremony on Friday morning, family and friends gathered to take part in the event in the Wanamaker Building's Crystal Tea Room. Medical faculty, dressed either in alma mater robes or their own white coats, welcomed everyone and spoke about professionalism, the Jefferson Legacy, and the White Coat Legacy.

Mitchell J.M. Cohen M.D., associate professor of psychiatry and human behavior at JMC, who initiated the ceremony years ago, emphasized to students that the coming years would bring two transformations in their lives. The first would be medicine transforming from a job to work to a profession, and the second would be their personal transformation into physicians.

Keynote speaker Richard C. Wender M.D., alumni professor and chairman of the Department of Family and Community Medicine, delivered a rousing and highly entertaining address that highlighted the credibility that the white coat lends young men and women, "empowering [them] with the opportunity and perhaps even obligation to approach their newfound access to people with respect and care."

"High quality caring leads to high quality learning," he said.

Dr. Wender also stressed the importance of humor in medicine, both for the well being of the physician and the patient.

The coat - a familiar sight on hospital doctors - is a symbol of a physician's knowledge and responsibility toward the patient. As described by Dr. Cohen, its ancestry is tied spiritually to healing work, similar to the clergy. Like a judge's robe, the white coat, even in modern times, hopefully inspires the giving of justice, fair access and delivery of care to everyone.

After donning the white coat, students were read Maimonides' Prayer for the Physician and, along with family who were also doctors, recited the Hippocratic Oath, which provides standards and a core set of professional values to be followed by all physicians, including the critical value of confidentiality.

First-year student Tamar Berger, 23, of Stanford, Calif., said that the faculty speeches left her feeling "inspired, moved [and] ready to live up to everything this coat represents."

Parent reactions were similarly humbled and hopeful, with Ms. Berger's father, Jonathan, and grandfather Irving being left feeling "very proud." For Wynmore parents Bob Rhoades and Kate Winkler, whose son Ruben Winkler-Rhoades is also starting at Jefferson, the entire ceremony was an "incredible moment."

When asked what appealed to them about JMC, first-year students from around the country all noted a great sense of a community and camaraderie between students and faculty. For good friends Aaron Yung and Ben Pham, both first-years from San Diego, this especially stood out.

"It's like a big family," said Mr. Yung, 22. "I don't think I've ever seen any unhappy Jefferson faculty," added Mr. Pham, 25.

At Jefferson, the first year of study for medical students is broken up into three-month blocks during which students focus on one course at a time while also learning how to be a doctor through study of Clinical Medicine. First year classes begin today.

"It's been great," said fourth-year student and ceremony speaker on shared professional values Matthew Eldridge, JMC '09. "There's a certain aspect of community [with] classmates and teachers really looking out for each other... everyone is down-to-earth and [focused on] patient care."

Mr. Eldridge, who may go into either family medicine or internal medicine, also noted that for the new students, this is "a very exciting time" and to know that soon, their white coats will "get heavy," filled with tools, stethoscopes, books and snacks.

As Charles A. Pohl M.D., the associate dean for student affairs and career counseling said, "every day, we get to learn something, teach something and take care of people."

Jefferson Medical College, of Thomas Jefferson University, was the first medical school in Philadelphia to establish the "White Coat Ceremony," a tradition symbolizing the clinical beginning of every student's medical education. It has been part of the first year program at JMC since 1994. The college offers both traditional medical education and joint degree programs, and enrolls over 900 students each year.

Heather J. Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008

Tuesday, September 09, 2008

INT'L:HUMAN INTEREST: One Country, Many Friendships, Many Memories

Source: worldblog.msnbc.msn....
How fantastic an experience and opportunity for these girls. I dread goodbyes myself, even when reuniting is almost guaranteed.
So much of our opportunities are the result of our own social mobility and arena in which to make choices, get on a plane or bus with our own money, and steer our own future.

These opportunities are so few and far between for these young women.. thank goodness it was given.
They need more opportunities like this one - more long-term possibilities and cause for hope for something beyond occasional moments of happiness. We all need that.

Sunday, September 07, 2008

POLITICS:OPINION: Zoot Suit Riot - The Distracted and Silent Press

CULTURE: Food, Culture At Festival At Reading

(previously published here at www.thebulletin.us)

Food, family, farmers and animals all come together this weekend for the 19th annual Pennsylvania Dutch Festival at Philadelphia's historic Reading Terminal Market, bringing a little taste of the Lancaster countryside to the big city.

In between buggy rides and digging into chicken pot pie, though, it's worth remembering that fun and games aside, it takes a lot of work to prepare and cook the food, make the crafts and put on the show that we've come to know and love ... plus a few new surprises.

They stand there every day, doling out heaps of apple dumplings, bags of fresh produce and slabs of ribs. One of the few constants in city of hectic unease, the Market's Pennsylvania Dutch merchants are a welcome reminder to celebrate deep-rooted traditions and simple yet beautiful creativity.

At the Dutch Eating Place, workers - wearing everything from plain dresses, aprons and bonnets to T-shirts, overalls, jeans and baseball caps - work side-by-side to prepare their award-winning blueberry pancakes, as well as hot soups, fresh-roasted open-faced turkey sandwiches with mashed potatoes, and fresh-squeezed lemonade.

"It's a lot of fun, but a lot of work," said Phares Glick, the owner of the neighboring Rib Pit, which has operated here for 21 years. "It's always [about] the new customers and new interest."

Merchants are Amish families who have operated here since the market began in 1980. All hailing from Lancaster County, these farmers and entrepreneurs bring a rare charm and dedication to both their products and their customers, whether it is Fisher's ice cream (which comes in flavors for diabetics, too), Kauffman's colorful tomatoes, Beiler's delicious donuts, L. Halterman's sausages or Dienner's barbeque chicken.

The families all know one another and according to Kevin Beiler, who runs Beiler’s Bakery and A J Pickle Patch & Salads, they all “try helping each other out.”

The days of feasting culminates in a barn-raising and auction on Saturday, when a small barn - in this case, a garden shed - will be sold to the highest bidder. Both events are new to the festival.
All proceeds will go to the Lancaster Farmland Trust, a private nonprofit that seeks to preserve and protect Lancaster's agriculture, land and the way of life tied to it.

The three-day festival will take place in the market's center court seating area from 8 a.m. to 5 p.m., as well as outside between 11th and 12th streets and Arch and Filbert streets.

Heather L. Chin can be reached at hchin@thebulletin.us
©The Evening Bulletin 2008

HEALTH: Psychiatrists Are Prescribing More Pills, Less Therapy

(previously published here at www.thebulletin.us)

With Sigmund Freud and HBO's popular series "In Treatment" featuring a psychiatrist and his patients, it seems a safe bet that paying someone to analyze your life is still a strong option.

However, a new report published in the Archives of General Psychiatry this Monday reveals that fewer psychiatrists are providing psychotherapy to patients during office visits, instead prescribing drug therapy - medication - at increasing rates.

According to the researchers, the trend appears to be linked to there being fewer trained psychiatrists, the marketing of improved psychiatric drugs and pressure from managed care companies that offer incentives for prescribing drugs over giving the more expensive psychotherapy.

"Psychiatrists get [paid] more for three 15-minute medication management visits than for one 45-minute psychotherapy visit," said Dr. Ramin Mojtabal, who co-led the research at Beth Israel Medical Center in New York, and who now works at Johns Hopkins Bloomberg School of Public Health in Baltimore.

"I was trained almost 30 years ago and received a lot of training in psychotherapy," said Dr. Christopher C. Colenda, a psychiatrist and Dean of Medicine at Texas A&M Health Science Center College of Medicine. "Thanks to the advances of managed care, psychotherapy was basically devalued from the perspective of psychiatry. ... A lot of the incentives for wanting to be in psychiatry were essentially removed by managed care."

The study examined data from the National Ambulatory Care Survey on visits to psychiatrists' offices for a 10-year period between 1996 and 2005, finding that the proportion of visits over 30 minutes long dropped from 44 percent in 1996-1997 to 28.9 percent in 2004-2005. Overall, out of 14,108 visits, only 34 percent provided psychotherapy to patients.

The number of psychiatrists who provided psychotherapy to all patients also fell, from 19.1 percent to 10.8 percent during the same 10-year period. Those who chose to continue psychotherapy had more patients who paid out-of-pocket for treatment than other doctors who gave less talk therapy.

For patients who require a combination of talk therapy and drug therapy, the trend towards medication-only can result in spotty treatment, in which the patient receives psychotherapy from a psychologist and drugs from a psychiatrist or general practitioner.

Physicians differ in their opinions over whether this is a problem.

"Whether it has any impact on the outcome of the disorder, we don't really know," said Dr. Mojtabal to Reuters. "I don't think necessarily that it is harmful. It might not be as efficient."

However, Dr. Eric Plakun, who leads an American Psychiatric Association committee working to restore interest in psychotherapy by psychiatrists, told Reuters that a shift away from psychotherapy began about 10 years ago when medical schools began to focus more on the biology of mental illness than on its psychology and behavior. "Either way, I'm worried about our patients [who] need the best help we can give them."

So is this the end of psychotherapy? Perhaps not, as it is effective and less expensive, and if you look deeper, there are signs that the use of talk therapy will continue and is, in fact, on the rise.

Since its benefits are well documented via behavior changes, emotional and mental habits, as well as through brain imaging studies, whether alone or combined with drug therapy, "the couch is far from dead," Dr. Plakun said. "The couch turns out to be an effective 21st century treatment."

Accreditation requirements for psychiatric residency programs are also putting more emphasis on talk therapy, so future medical professionals have the appropriate background to keep it alive.

Various forms are the recommended form of treatment for depression, post-traumatic stress disorder, bipolar disorder and other psychiatric illnesses.

In addition, visits to psychologists, social workers and other mental health counselors, who also provide talk therapy but are not medical doctors - and thus cannot prescribe drugs - were not included in this research.

Heather J. Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008