By KATHERINE MANGAN
A New Orleans teaching hospital that is still struggling
to recover from the effects of Hurricane Katrina faces budget cuts and new
questions about its ability to continue training 300 medical residents and
fellows from Louisiana State University and Tulane University. The
uncertainty has been fed by a feud between the two universities over the
facility and one that is planned to replace it.
From the teaching point of view, the problem is that the
hospital, which Louisiana State officials refer to as the Interim LSU
has either too many residents or too few beds. With 300 doctors-in-training
and just 283 inpatient beds, it is well over the national average of about
0.8 residents for each hospital bed, says Frederick P. Cerise, vice president
for health affairs and medical education for the Louisiana State
system, which operates the hospital.
“We were over that number before Katrina and were
addressing it by moving residents outside the city to other parts of the
state," he says. "With the loss of beds in New Orleans, the pressure is greater to
have training slots for all the residents.”
New Orleans lost two of its
primary public teaching hospitals when Hurricane Katrina caused extensive
flooding to University and Charity
remains closed, while University
Hospital was revamped
and reopened in 2006 with $90-million from the federal government.
The facility is serving as an interim teaching hospital
State proceeds with
plans to open a 424-bed academic medical complex by 2013.
But the $1.2-billion plan has been plagued by governance
and financing problems. Louisiana State says the Federal Emergency Management Agency
ordered it to call the hospital the Interim
Hospital—a name that Tulane
officials reject in an increasingly bitter battle over how the hospitals that
train both Louisiana
State and Tulane
residents should be named and run. Tulane insists that the proper name is the
Medical Center of Louisiana at New
Orleans and it wants a seat at the governing table
of the new hospital.
In the meantime, the interim hospital faces a budget
crunch. After a consultant's report found the hospital to be inefficient and
costly, the Louisiana
State system announced
this week that it will eliminate 300 jobs and make other cuts to shave costs
by $24-million a year. There are no plans to cut the number of beds.
The report, commissioned by Louisiana State,
also suggested that administrators take another look at a graduate
medical-education program that is now providing too few beds for too many
Both Tulane and Louisiana
State have already cut
back their programs since Katrina. Tulane now trains 358 residents, down from
519 in August 2005. For Louisiana
State, the numbers have
dropped from 650 to about 300.
In 2006, after Katrina flooded the two teaching hospitals,
Tulane and Louisiana
State moved most of
their training programs to small, community-based clinics and outlying
State, Tulane has been
continuing to push in recent years to get residents into community settings
where patients now receive more of their care for routine and chronic
conditions, says Tulane's medical dean, Benjamin P. Sachs.
Even as the Louisiana
State system struggles to rebuild University Hospital's pre-Katrina patient base,
Dr. Sachs says, he doesn’t believe that limiting training to teaching
hospitals makes sense.
“Nationally, we’re going through a whole re-examination of
how residents are being trained and whether it should all be done in a
hospital. Hospitals only show an episode of care. They don’t show the whole
continuum of how a disease affects the person," he says.
“Building large teaching hospitals with 500 to 1,000 beds
may be a thing of the past.”
As medical centers around the country grapple with similar
questions, many are closely watching how New Orleans's two medical schools
cope with their pioneering role in the push to decentralize medical training
and bring it closer to people's homes.
Finding enough training slots, and the critical mass of
residents to support a program in any given location, remains difficult.
While studies have projected a shortage of physicians as baby boomers age,
medical educators in New Orleans
are training far fewer doctors now than they were before Katrina. “All of the
work-force projections show that we need to be training more physicians, and
we’re going in the other direction,” says Dr. Cerise.
[BACK TO TOP]
Ann Marie Coviello
The answer to the blight problem can only be solved if we
know what kind of city we want to have. Do we want to emulate Houston and Birmingham,
or will we preserve and protect our unique aesthetic?
We must hold our leaders, so sorely lacking in this kind
of vision, accountable for creating programs that remediate blight.
We need an efficiently run program to give first-time home
owners and small business owners the means to buy and renovate blighted
For every permit issued for new construction, developers
should have to agree to renovate buildings of comparable size.
If LSU and the VA want new buildings, they must take
responsibility for the renovations of the old Charity and old VA, as well as
for moving and restoring historic buildings in the new footprint.
No medical complex, no new building can contribute to our
most valuable asset: our history.
The poet Brenda Marie Osbey once
said that people come to New Orleans
to feast on the past. If we continue to disregard our historic architecture
while building new, we will have sold our birthright for a bowl of tasteless
Ann Marie Coviello
[BACK TO TOP]
by Paul Rioux, The
The Jefferson Parish Council is urging state health
officials to reverse emergency Medicaid cuts projected to cost the parish's
three largest hospitals $20 million this year, adding to a combined $300 million
in losses since Hurricane Katrina.
Council Chairman Tom Capella
said it is "blatantly unfair" that rural hospitals are exempt from
the cuts estimated at $345 million statewide.
"If we have to tighten our belts, then everyone
should have to tighten their belts, " he said
at Wednesday's council meeting.
Department of Health and Hospitals Undersecretary Charles Castille told the council that the exemption is rooted in
a 1997 state law requiring health officials to maximize funding for rural
The law said the "very existence of Louisiana's small rural hospitals is
imperiled" by a host of factors, including the difficulty attracting
doctors and a patient base that tends to be poorer, both financially and in
terms of health.
But council members said Jefferson's two publicly owned
hospitals -- West Jefferson Medical
Center in Marrero and East Jefferson
in Metairie -- are embroiled in their own
The two public
hospitals, along with the private nonprofit Ochsner Medical
Center in Jefferson, have lost more
than $300 million since 2005 because of skyrocketing labor costs, lagging
Medicare reimbursements and a spike in uninsured patients linked to the
closure of Charity Hospital in New
"Our hospitals have provided a tremendous amount of
uncompensated medical care since Katrina, "
Councilman Chris Roberts said. "These cuts are just another blow to
Asked after the meeting whether the Medicaid cuts might be
reversed, Castille said, "There will not be a
significant reversal, if any, because of the sheer size of the state's
Although the Legislature has yet to approve the
reductions, the health department has issued emergency rules cutting Medicaid
reimbursement rates for nonrural hospitals by more
than 10 percent. Parish officials have said Jefferson's
three biggest hospitals stand to lose a combined $20 million.
Castille said the cuts were
implemented early to maximize the savings if a bill containing the lower
reimbursement rates becomes law. If the Legislature doesn't pass the bill, he
said, reimbursement rates will be increased to offset the cuts.
While acknowledging the cuts are "undeniably
significant, " Castille
said he wanted to share "a little bit of good news."
He said the three Jefferson hospitals along with Touro Infirmary and Tulane
in New Orleans
will receive a total of about $85 million in federal disaster-assistance
grants, a figure that will be doubled to $170 million through a matching
However, he said the outlook for state health-care funding
remains bleak, at least for the next couple of years.
"I wish I could say the budget picture is getting
better, " he said, "but I think it is only
going to get worse."
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Sciences Center | 05.21.09
LA ? Research led by David Worthylake,
PhD, Assistant Professor of Biochemistry and Molecular Biology at LSU Health
Sciences Center New Orleans, may help lay the groundwork for the development
of a compound to prevent the spread of cancer. The research will be published
in the May 29,
2009 issue of the Journal of Biological Chemistry.
During the transition from a localized tumor to metastatic
disease, cancer cells acquire the ability to detach from their neighboring
cells and move to and invade tissue at distant points in the body.
"Because tumor metastasis leads to a poor prognosis
and tremendously complicates treatment, it is of utmost importance that we
understand, at a molecular level, the processes that regulate cell adhesion,
migration and invasion," notes Dr. Worthylake.
He and his colleagues studied a protein in cells that is
involved in regulating cell structure, cell-to-cell contact, and cell
movement. When too much of this protein, called IQGAP1, is produced, it can
weaken cell-to-cell contacts and promote cell migration and invasion ? processes that occur
during tumor metastasis.
The research team focused on the area of IQGAP1 that
interacts with two smaller proteins Cdc42 and Rac
which, when activated, contribute to cell destabilization, cell movement, and
invasion. This region on IQGAP1 is related to proteins that accelerate
deactivation of another small protein similar to Cdc42 and Rac. However, IQGAP1 does not deactivate Cdc42 and Rac ? in fact, IQGAP1 prolongs their activated states. The
researchers determined the atomic structure of this region of IQGAP1 and
furthermore, built a model of their IQGAP1 structure bound to the previously
determined structure of Cdc42 in order to understand why IQGAP1 does not
deactivate Cdc42. The model provides detailed information about the (likely)
specific contacts made between IQGAP1 and Cdc42. The model also shows that
IQGAP1 is missing a key component required to rapidly deactivate Cdc42, and
that binding to IQGAP1 likely disturbs the positions of components of Cdc42
that are required for even normal rates of deactivation, explaining how
IQGAP1 prolongs the activated state of Cdc42.
"This knowledge could serve as a guide for further
studies to define IQGAP1 function and perhaps the design of a small molecule
to regulate Cdc42/IQGAP1 interaction to prevent cancer cells from moving to
and invading other parts of the body," concludes Dr. Worthylake.
According to the American Cancer Society, metastatic
cancer is a cancer that has spread from its primary site (the part of the
body in which it developed) to other parts of the body. If cells break away
from a cancerous tumor, they can travel to other areas of the body. There,
they may settle and form "colony" tumors. In their new location,
the cancer cells continue growing. The spread of a tumor to a new part of the
body is called metastasis. Most people who die of cancer have metastases at
the time of their death, and metastatic disease is directly responsible for
the majority of cancer deaths. This year, about 562,340 Americans are
expected to die ofcancer, more than 1,500 people a
day. Cancer is the second most common cause of death in the US, exceeded only by heart
disease. In the US,
cancer accounts for nearly 1 of every 4 deaths.
Dr. Worthylake's paper has also
been selected for Faculty of 1000 Biology. Faculty of 1000 Biology is an
award-winning online service that highlights and evaluates the most
interesting papers published in the biological sciences, based on the
recommendations of over 2000 of the world's top researchers. Papers are
highlighted on the basis of their scientific merit rather than the journal in
which they appear.
This research was funded by a Research Competitiveness
grant from the Louisiana Board of Regents.
LSU Health Sciences Center New Orleans educates Louisiana's health
care professionals. The state's academic health leader, LSUHSC comprises a School of Medicine,
the state's only School of Dentistry, Louisiana's only public School of Public
Health, and Schools of Allied Health
Professions, Nursing, and Graduate Studies. LSUHSC faculty
take care of patients in public and private hospitals and clinics
In the vanguard of biosciences research in a number of areas worldwide,
LSUHSC faculty have made lifesaving discoveries and
continue to work to prevent, better treat, or cure disease.
[BACK TO TOP]
By Jan Moller
BATON ROUGE -- Health and Hospitals Secretary Alan Levine
defended his plans to close the New
Hospital and told a
Senate committee Thursday that the budget problems his agency faces are
likely to get far worse in the coming years.
Testifying in the Senate Finance Committee, Levine said
the decision by a House committee to restore money for inpatient services at
the Uptown psychiatric hospital could take up money that would otherwise go
to community mental health programs.
The Jindal administration has
proposed closing the facility and moving its inpatient beds to Southeast Louisiana Hospital
in Mandeville, arguing that it would save money without reducing the total
number of available beds.
"NOAH as an impatient facility is not at the heart of
the mental health system in New
Orleans," Levine said.
But New Orleans
legislators are fighting the move, and the House Appropriations Committee
earlier this month added $14 million to keep the hospital open through the
2009-10 fiscal year.
"The mental health professionals in New Orleans have a different take than you
do," Sen. Edwin Murray, D-New Orleans, said.
The Finance Committee is reviewing the $27.9 billion
budget bill, and is expected to make changes to the measure later this month.
Although the House restored $130 million to the
health-care budget, the spending bill still includes about $375 million in
reductions. Most of the cuts are falling on private providers of Medicaid
services, such as hospitals and nursing homes.
"That's where the money is," Levine said.
said the cuts could reduce the budget at Children's Hospital by as much as
$40 million next year. "I can't imagine how Children's can absorb that
kind of loss and continue to do the kind of work it does," Murray said.
But Levine said Children's will benefit from a share of
$170 million in state and federal dollars being made available to New Orleans hospitals as
part of another spending bill that's working its way through the Legislature.
Levine said the health-care cuts would be worse if next
year's budget were not being propped up by one-time revenue sources,
including federal economic stimulus money and hurricane-recovery spending.
When the federal money is gone, and the percentage that Louisiana must contribute to the Medicaid
program increases, the state will have to come up with $1.2 billion to
maintain current service levels, Levine said.
[BACK TO TOP]
By MARSHA SHULER
Advocate Capitol News Bureau
Senate Finance Committee Vice Chairman Lydia Jackson,
D-Shreveport, left, and Senate Finance Chairman Mike Michot,
R-Lafayette, confer over a proposed law they pushed Thursday to generate
funds for higher education.
A state Senate panel rewrote legislation Thursday to delay
a state income tax break, a move that would generate $118 million.
Supporters said they would use the money to offset
proposed deep budget cuts in higher education.
But the plan — pushed by top Senate leaders — is going to
have tough sledding. Gov. Bobby Jindal said in a
Thursday afternoon interview he opposes the idea. And House Speaker Jim
Tucker predicted “an uphill climb” in the House.
Senate President Joel Chaisson
II, D-Destrehan, and others advocated the change to Senate Bill 335, which
would freeze the amount of federal excess itemized deductions state income
tax filers can deduct at current levels through 2011.
The tax increase would allow the state to collect $118
million in taxes annually that otherwise would be returned to state
taxpayers. The money would go toward reducing a $219 million budget hole in
Jindal said he wants to work
with the Louisiana Legislature to mitigate higher education and health cuts.
But he opposes “anything that delays tax relief for our people,” the governor
“I don’t think the right answer is to take money out of
the pockets of Louisianans,” added Jindal, a
Speaker Tucker, a Terrytown
Republican said, “Most people will view it as a tax increase.”
Lt. Gov. Mitch Landrieu, a Democrat from New Orleans, testified for the legislation.
The Senate Revenue and Fiscal Affairs Committee approved
SB335 without opposition. It now heads to the Senate floor for action.
Currently on a state income tax return, a filer can claim
65 percent of their federal excess itemized deductions. It lowers the amount
of taxes a person owes. The amount is scheduled to go up to 100 percent
beginning with the 2009 tax year, which will be filed in May 2010.
When the Legislature approved the increase from 65 percent
to 100 percent in 2007, it was estimated to affect about 20 percent of
state’s income filers.
Federal excess itemized deductions are the total amount of
certain expenses — such as mortgage interest, charitable contributions and
medical costs — that exceed the standard tax deduction.
State Sen. Lydia Jackson, D-Shreveport, proposed in SB335
to freeze the 65 percent rate until 2012, instead going to 100 percent this
year. She said the dire straits facing higher education are partially caused
by the exemption increase.
“We are facing some drastic cuts in this year’s budget
that will leave generational scars on higher education,” which Jackson said lawmakers
Senate President Chaisson said
higher education officials already have said the sizeable cut will trigger
layoffs of tenured faculty, reductions in student services and begin “a
downward spiral in the quality of our higher education institutions.”
Chaisson said the freezing of
the excess itemized deduction provides an avenue to help higher education as
it works on reorganization to reduce costs and improve quality.
“It does not provide any new taxes,” Chaisson
said. “It does not alter or reduce tax relief granted.”
State Sen. Dan Morrish,
R-Jennings, said the excess itemized deduction at 65 percent would still be
more than the 50 percent that existed prior to the adoption of a sales and
income tax swap called the Stelly plan, which
eliminated the deduction entirely.
State Sen. Robert Adley,
R-Benton, who helped get the itemized deduction restored in 2007, favored the
plan to temporarily freeze the deduction at 65 percent.
“We are not talking about going back where we were,” Adley said. “I feel very strongly about the itemized
deduction but in the circumstances we find ourselves, I certainly cannot
object to what we have to do to protect these technical schools and
Senate Finance Committee Chairman Mike Michot,
R-Lafayette, said the Louisiana House tried to help higher education —
identifying some $70 million in relief, but the dollars are iffy and some are
one-time money used for year-after-year expenses.
“We feel like this legislation is a much more viable
solution,” Michot said.
Tucker said the House “restored a great deal of the cuts”
to higher education. He said the funding is not as iffy as senators and
higher education officials suggest.
Tucker said he personally does not favor the freeze “but
until we get through the budget process I am loathe to take
any option off the table.”
Before the vote, panel members sought assurances the money
would go to higher education and not be diverted to other government
Lawmakers pushing the move said they would drop the plan
if that happened.
“How do we preserve the integrity of the money for higher
education?” asked Senate Revenue and Fiscal Affairs Committee Chairman Rob Marionneaux, D-Grosse Tete.
said she planned to insert language in the state budget bill to guarantee the
and Sen. Bob Kostelka, R-Monroe, said they also
want guarantees from the state’s higher education commissioner that the money
would go to help all universities and community and technical colleges.
[BACK TO TOP]
By MICHELLE MILLHOLLON
Advocate Capitol News Bureau
State officials expect revenue to dip even lower than
expected for the upcoming spending year.
The Revenue Estimating Conference, a four-member panel
that decides how much the state has to spend, agreed Thursday that state
revenue is likely to drop by an additional $30 million in the fiscal year
that starts July 1.
Revenue already was expected to fall by $1.3 billion.
The $30 million is in addition to that decrease.
Economists said corporate tax collections were worse than
“We are obviously not like all the other states. It’s
taken us a long time to get to a recession,” said Greg Albrecht, chief
economist for the Legislative Fiscal Office.
Gov. Bobby Jindal has proposed
substantial cuts to higher education and health care in his operating budget
for the upcoming fiscal year.
The new revenue drop means lawmakers will have to find
more spending to cut in order to balance the $27 billion budget.
The state is weathering an economic downturn even though
economist David Hoppenstedt, of the Division of
Administration, said Louisiana
still is experiencing positive employment growth.
However, a number of employers recently announced layoffs,
including Capital One’s cut of 180 Baton
Albrecht said he studied two of the biggest sources of
state revenue: corporate and personal income tax collections.
He said he expects a drop in corporate collections this
fiscal year to bleed into next year’s budget.
Hoppenstedt said April corporate
collections were close to half of what they were the prior April.
In the upcoming fiscal year, Albrecht predicted a sales
tax revenue decline will accelerate.
He said a sharper downturn in spending likely is still to
He said sales tax collections will probably experience one
of the biggest drops in revenue.
The Revenue Estimating Conference had to choose between
Albrecht predicted revenue will drop by an additional $30
million next fiscal year.
Hoppenstedt was more drastic,
predicting a decline of an additional $153 million.
The conference chose Albrecht’s prediction.
Earlier this month, there seemed to be a tug of war over
whether the conference would meet at all this week.
The panel usually meets several times a year to adjust
House Speaker Jim Tucker, R-Terrytown,
said he did not know if officials would have a reason to meet.
He said firmed up numbers came through, giving the conference
a reason to set a meeting.
Another conference member, LSU economics Professor Jim
Richardson, has suggested lawmakers might need to rethink tax breaks that are
reducing state revenue collections.
Tucker said changes to the Stelly
plan will be an uphill battle.
Stelly — named for the Lake Charles lawmaker
who authored it — repealed the state sales tax on groceries and utilities.
To offset the loss in revenue, state income tax brackets
were compressed to generate more tax revenue. Voters approved the tax swap in
Two years ago, legislators began a phased-in restoration
of tax breaks that Stelly eliminated.
The “excess itemized deductions” phase-in benefits those
who itemize on their federal returns. The change is expected to reduce state
revenue by $308 million in the upcoming fiscal year.
Last year, with the governor’s eventual backing, the
Legislature decided to return state tax rates to pre-Stelly
That change is expected to reduce state revenue by $359
million in the upcoming fiscal year.
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I am writing in the hope that state employees will realize
how they will be adversely impacted by current proposals from the state
Legislature and Louisiana Civil Service Commission and will strongly voice
their opinions to both entities without delay!
Civil Service currently proposes to suspend state
officials’ authority to grant 4 percent merit increases to classified
(least paid) state employees for the next year and to abolish “bumping
rights” for classified employees who have been laid off. The Legislature
currently proposes that no member (state employee) shall be eligible to
participate in the DROP Program from July 2009 to June 2012.
State employees are obviously being made the scapegoats
financial woes. Everyone, not just nonstate
employees, is feeling this crunch. For years, the increase in cost of
employees’ medical insurance was far greater than the 4 percent that those of
us who perform satisfactorily and above are granted.
Inflation has beaten everyone to death. Just because we
are employees of the state does not mean we should suffer even more than
others simply because we are easy targets. Remember, we are taxpayers, too.
It’s true that many state employees make $100,000-plus
annually, but there are a lot more of us who make less than half that much. A
4 percent yearly merit raise (which must be merited, it is not automatic),
while not amounting to a lot for those earning less than $50,000 annually, is
a financial lifeline to us.
Most state employees who aren’t in the over $50,000 per
year bracket depend on DROP money to be able to live upon retirement because
wages have never been significant enough for our retirement eligibility
amount to provide for us despite careful financial planning/management.
If the Legislature is successful with the proposal to
eliminate DROP, many who have devoted their lives to state service and who
had no reason to believe that DROP would not be there for them now face the
possibility of either having to stay in state employment, which the
Legislature and Civil Service do not want, or retire and be forced to get
other jobs to be able to afford food and medicine.
Not everyone at retirement age still has good health or
the capability of obtaining gainful employment. If bumping rights of laid-off
classified employees are eliminated, it would be unconscionable to put a
dedicated employee who has worked conscientiously for 20-plus years on the
street because his/her supervisor, in that supervisor’s subjective opinion,
thinks the employee is not as good an employee as one of the supervisor’s
buddies, or even better, someone whom a politician wants in that job. Essentially,
that’s what will happen.
Act before it’s too late.
[BACK TO TOP]
Re: "Dental work doesn't belong in school," Your
Opinions, May 19.
Pediatric dentist Claudia Cavallino
is probably correct in saying that, ideally, all dental work should be done
"in a safe environment with a parent or guardian present," but we
do not live in an ideal world.
I grew up in a rural area of Louisiana as part of a large family in
which there was no money to pay for dental work. I received my first dental
care when I was 18 and in the military.
By that time it was just a matter of time till I lost my
teeth, as I was told by my military dentist. I suffered pain and poorer
health than I would have if I had received proper early dental care, and I
spent a lot of money trying to delay the inevitable day that I was fitted for
Although we have Medicaid now and most dentists will take
Medicaid patients (they didn't for years), there are still many children in
rural areas for whom dental care will not be
available without school-based clinics or the mobile clinics Dr. Cavallino complains about.
If the doctor is truly only concerned about issues like
parental permission, accommodations can be found.
But if the dentists opposing clinics are concerned about
competition, shame on them.
No child in Louisiana
should have to endure what I did just because some dentists are concerned
that mobile clinics might cost them a few dollars.
[BACK TO TOP]
By JORDAN BLUM
Advocate Capitol News Bureau
Photo by Joe Hischer
Pennington Biomedical search consultant Nick Brill
discusses the search for a new executive director on Thursday.
A new Pennington
director should be hired by year’s end with public advertising beginning in
June, a search consultant said Thursday.
LSU’s Pennington search committee met with Boston-based
consultant Nick Brill for the first time Thursday to discuss the plans and
timelines to replace outgoing Pennington Executive Director Claude Bouchard.
The French Canadian Bouchard is stepping down after 10
years of leading Pennington. He will stay on the faculty to focus on
Pennington specializes in research and trials concerning
health and chronic diseases such as obesity and diabetes.
Brill said Pennington needs a “pre-eminent scientist” with
both administrative and fundraising experience. That could include a top
academic department chair or a section director at a premier research
institute, he said.
“It (Pennington) is no longer a little entity,” Brill
said. “Someone with administrative experience will have a much faster startup
Both Brill and search committee chairwoman Donna Ryan,
Pennington associate executive director for clinical research, said the hope
is to bring in three finalists for the job around October for public
interviews at the Pennington campus on Perkins Road.
Pennington has grown a lot in 20 years and is in good
position to keep improving, Brill said. “This is going to be a growth
opportunity for the institution and the person coming in,” Brill said. “This
is not a turnaround.”
“We are at a critical mass of people, and I think things
are very well organized here,” said Eric Ravussin,
Pennington chief of health and performance enhancement.
Construction on a new clinical research building is under
way at Pennington and the state has allocated additional dollars for future
construction. But Bouchard has bemoaned that the state is planning to cut
Pennington’s operating budget at the same time the campus is growing
While budget cuts hurt, Ryan said, the whole country is
suffering financially. So the cuts should not dramatically hamper the search
process, she said.
The Brill Neumann search consulting firm specializes in
higher education, medical center and research institute searches. The search
firm contract is
funded by Pennington’s private, not-for-profit foundation.
Brill said there is a strong pool of talent available to
attract top candidates. While someone top notch will be picked, he said, some
candidates will drop out because they want to stay focused on research, do
not want to move to the South or do not want to dedicate themselves to a
place for five to 10 years.
Unofficial nominations and recruiting could create an
early pool of about 100 candidates, he said, before narrowing the process
down through “informal” — secretive — conversations and meetings.
Ryan said she wants secrecy during the early stages of the
search so candidates will not be scared away by having their colleagues and
bosses find out about their interest in another job.
[BACK TO TOP]
By Ed Anderson
BATON ROUGE -- Sinus medications and some decongestants
containing ingredients that can be used to make crystal meth would only be
sold at pharmacies under a bill approved Thursday by the House.
Lawmakers voted 95-0 for House Bill 890 by Rep. Fred Mills
Jr., D-St. Martinville, to ban the sale of
non-prescription products containing ephedrine, pseudophedrine
or phenylpropanolamine at convenience stores and
grocery stores. A grocery store or retailer with a pharmacy would be allowed
to sell the products but only at the pharmacy, Mills said.
The bill would keep in place the existing limit of no more
than 9 grams of the drugs being sold in a 30-day period to one buyer. It now
heads to the Senate.
Mills told the House that 13 other states have limited the
sale of the drugs -- key ingredients in making crystal meth and other illegal
substances -- to pharmacies. The latest state to do so, he said, was Arkansas, and meth
users and meth lab operators always "find the path of least
resistance" and go where laws are more lax.
"This is a drug of concern," he said. "This
is a major problem; we have an epidemic, and it is getting worse."
Mills said that besides being addictive, crystal meth can
be made with several household ingredients that can, when cooked, explode and
kill the lab operators.
The measure also would authorize the State Police and
sheriffs to install an electronic-tracking system to flag someone who buys
more than the legal limit in a month or who makes frequent purchases under
Mills said, although state money has not been approved for
the tracking system, federal grants "are usually available" to
The measure also would require buyers to sign electronic
logs at pharmacies giving names, addresses, where they bought the drugs, when
they bought them and how much at each location. He said the log would track
the purchases "in real time" and alert police if there is a
suspicious pattern or someone goes over the limit.
[BACK TO TOP]
The New York Times | 05.21.09
By ANEMONA HARTOCOLLIS
Robert Stolarik for The New York Times
Raquel Cillacis, 18, and
her sister Jasmine, 6, at Schneider Children’s Hospital.
The staff wore green masks, the patients wore blue. As the
sun set over Queens on Wednesday, the
witching hour began in the pediatric emergency room at Schneider Children’s
Fathers came home from work, mothers thought twice about
putting their children to bed with a fever, and as if under mass hypnosis,
they headed for the hospital.
They were a New
York polyglot of unease, Orthodox Jews in sheitels and skullcaps, Muslim women in headscarves,
Asian people, black people and white people. They all wanted one thing: to
have their children checked for swine flu.
“What brings you here?” said the swine flu “greeter,” a
young medical resident, her voice muffled by her duck-billed N95 mask.
If the answer was flu, whole families got masks and were
sent to the left. For anything else, they went right.
As officials announce the latest school closings each day
— eight new ones on Thursday — and public officials tread a delicate line,
trying to seem on top of the disease while not spreading panic, parents have
turned to emergency rooms as the arbiters of the maddening ambiguity of the
disease. To worried families, the H1N1 virus is like a bogeyman in the night, and the trip to the hospital the equivalent of
checking under the bed.
Is it a deadly scourge, a Stephen King novel come to life,
or only a mild inconvenience? The emergency room is the place where public
relations and public fears confront science, where families go to find peace
The doctors try to suppress their cynicism and understand
the fear, knowing that in most cases, they will not even bother to test for
flu. The ritual of putting on masks, checking patients, then sending them home
with kind words and an admonition to stay in bed and drink plenty of fluids
is almost like a game of charades.
“The doctor said to me, ‘I could look in your eyes and
tell who’s really sick,’ ” said Esperanza Straughter,
as she led her strapping 13-year-old son, Tyrell, out of the emergency room
after his visit.
Ms. Straughter, who carried a
thermometer in her handbag, said she had retorted, “I’m glad you can, because
The last reading on the thermometer had said 102, and her
son had awakened coughing and nauseated. Still, she said, she had to accept
the doctor’s verdict. Tyrell, a precocious ninth grader in gray sweatpants,
looked bored by the whole experience, and eager to go home.
Across New York,
emergency room visits began to surge on Saturday, as schools closed like
falling dominoes and word spread of an assistant principal who was in
critical condition with swine flu; he died on Sunday night.
At Maimonides Medical Center
in Brooklyn, the pediatric emergency room
usually averages 80 to 85 patients a day at this time of year. On Saturday,
it treated 135 patients and on Sunday 145, a two-day record. On Tuesday, the
number spiked to 169, according to Dr. Estevan
Garcia, director of pediatric emergency medicine.
At Schneider, in the Glen Oaks section of eastern Queens, there were 227 visits on Sunday, 262 on Monday
and 273 on Tuesday, almost quadruple the norm. On Wednesday, 212 people
From 6 p.m. on Wednesday until the wee hours on Thursday,
Dr. Jill Leibowitz, a 27-year-old second-year
pediatric resident, was designated the pediatric emergency room greeter. In
deference to her long hours breathing in potentially contaminated air, Dr. Leibowitz wore the N95 mask, with its superior filtering
power, rather than the standard surgical mask worn by patients and many other
members of the staff.
As “American Idol” played on the television overhead, Dr. Leibowitz repeated her introductory riddle — “What brings
you here?” — over and over again. She managed to
convey both authority and empathy, no small feat, given her tousled hair and
glasses askew over the mask.
As patients entered, they were “cohorted,”
in medical lingo, meaning that they were separated from the general
population and quarantined in a 40-foot hallway (normally a psychiatric
emergency area), lined with molded plastic chairs, sealed by glass doors at
either end, a giant fish tank of people in face masks.
A sign was taped to one door with a message emphasized in
yellow highlighter: “Not all patients seen will be tested or given
prescriptions for medication.”
In accordance with city guidelines, “We’re no longer
routinely testing children who don’t have underlying conditions,” said Dr.
Joy Nagelberg, chief of pediatric emergency
medicine at Schneider.
“The overwhelming majority, you would look at them and say
that they’re fine,” she said. “You would be surprised that they’re here at
A resident, Dr. Adam Persky,
rapped on a glass door to the quarantine area and asked for swabs. He had a
woman who was six weeks pregnant with a fever in the adult emergency room and
he was going to test her for flu.
Nurses strode by carrying paper plates of ziti, pizza,
broccoli and chicken cutlets ordered in for them by the administration.
Raquel Cillacis, 18, arrived
with her 6-year-old sister, Jasmine, around 8 p.m., having fled the crowd of
people in masks at Queens
Raquel was disappointed when doctors told her they were not testing for flu;
they said she had an “upper respiratory virus” and her sister was pronounced
Some patients asked for face masks even though they had
come to the emergency room for other reasons, like Tami Pitre, who brought
her 14-year-old son, Michael, after he was hit in the head by a lacrosse
stick during a scrimmage.
For others, the visit was an adventure. Rakin Ahmed, a boisterous 6-year-old in a blue face mask,
happily rubbed Purell on his hands from one of the
many dispensers around the hospital while his exasperated father tried to
make him stop.
His father, Mumazzad Ahmed, an
electrical supervisor, said he had been unnerved by all the news reports
about swine flu and wanted to have Rakin checked
out. His wife was against it. But since they lived just a mile from the
hospital, he brought the child in. Rakin was fine.
“I wish I hadn’t come,” Mr. Ahmed said. “I think this
whole thing is a hoax. I hope it all goes away.”
A 16-year-old girl named Rachel came into the hospital
already on Tamiflu. Her pediatrician had tested her
for flu and prescribed the drug to everyone in her household, said her
father, who asked that the family not be identified further for fear of
alarming their neighbors.
The family drove to Schneider from Brooklyn,
saying they preferred it to their neighborhood hospitals. They were given a
police escort after her father was stopped for running red lights and he told
the officers that his daughter was sick.
“The doctor listened to her breathing and told us to leave
her alone, let her get back in bed,” Rachel’s mother said, as they left the
hospital at about 11 p.m.
The trip was worth it, just for peace of mind, Rachel and
her parents agreed through their masks.
Before midnight, admissions slowed to a trickle, and the
swine flu greeter, Dr. Leibowitz, had slumped on a
Her last flu case, a 12-year-old boy, arrived at 3:30 a.m.
Half an hour later, she took off her greeter’s mask
and signed out. But the patients kept coming.
[BACK TO TOP]
The New York Times | 05.21.09
By DONALD G. McNEIL Jr.
Federal health officials will probably recommend that most
Americans get three flu shots this fall: one regular flu shot and two doses
of any vaccine made against the new swine flu strain.
Having had annual flu shots for the last several years
gives “little or no immune benefit” against the new virus, the officials said
on Thursday as they released more details of blood tests briefly described on
The “working hypothesis” of the Centers for Disease
Control and Prevention is that most Americans will need two swine flu shots
to get full protection, although the elderly may be able to get away with
just one, said Dr. Anne Schuchat, the agency’s
director of immunization and respiratory disease.
Many people born before the 1957 Asian flu, and
particularly those 65 or older, seem to have antibodies in their blood
protecting them against the new virus, Dr. Schuchat
said. But she described existing antibody protection as looking “pretty
wimpy” compared with a properly matched flu shot.
Nonetheless, the outbreak is bearing out what the blood
samples predicted: only 1 percent of the 5,764 confirmed and probable swine
flu cases thus far have been in people over 65, Dr. Schuchat
Across the country, what the C.D.C. calls “flu activity”
seems to be going down, Dr. Schuchat said, adding
that there had been no unusual increase in deaths from influenza, in general,
Flu activity measures the percentage of visitors to 4,500
doctors, clinics and hospitals complaining of flulike symptoms, like fever,
cough and aches. Most are treated, based on how bad the symptoms are, without
The measure implies that “on average, the worst may be
over” for this flu season, Dr. Schuchat said. But
it could also mean that people are becoming less scared and not seeking
treatment. The decrease in flu activity is also not surprising, since
seasonal flu disappears as the weather warms while swine flu has still barely
begun to spread. Historically, pandemics infect a third of any population
over about two years, so unless a vaccine intervenes, 100 million cases of
swine flu could be expected.
Also, flu activity is still surging in New York, New Jersey
and the rest of the Northeast. Flu, “like weather, is a local occurrence,”
Also like the weather, it is unpredictable and has to be
“In New York City,
things looked like they were getting a little better, and then it looked like
they were getting worse,” Dr. Schuchat said.
In New York City on Thursday, eight more schools were
closed, bringing the total to 38 citywide: in Queens, Public School and
Intermediate School 499 in Flushing, P.S. 143 in Corona, P.S. 203 in Oakland
Gardens and I.S. 73 in Maspeth; also P.S. 111 in Eastchester, the Bronx, and
Middle School 113 in Fort Greene, Brooklyn, which also houses a special
But four schools were scheduled to reopen on Friday, and
many of the rest on Tuesday, after the three-day weekend.
The World Health Organization in Geneva said that confirmed cases of swine
flu have been found in 41 countries. Eighty-five people have died of it, 75
of them in Mexico.
removed its swine flu alert on Thursday afternoon, wire services reported.
Officials there said no swine flu cases had been confirmed since May 14.
[BACK TO TOP]
The New York Times | 05.21.09
By HIROKO TABUCHI
KOBE, Japan — It all began at a high
school volleyball tournament here on May 2 — or so residents of this Japanese
port city suspect.
Soon, volleyball players who took part in the event were
coming down with swine flu, early cases in a wider outbreak that has made Japan the worst-hit country outside North America in the global epidemic.
On Thursday, confirmed cases of the H1N1 flu virus in Japan reached 279, centering on Kobe and the neighboring city of Osaka,
in western Japan.
Like many other countries, Japan
has reported mild flu cases and no deaths. Still, it is in crisis mode: more
than 4,800 schools have been closed in the region, medical services are
swamped, and testing laboratories are working around the clock.
fears hit a new high when the area around Tokyo
confirmed its first swine flu cases late Wednesday, in two high school
students who returned Tuesday from a trip to New York.
The outbreak has come as a particular shock for
where hand-washing is religiously taught in schools, children play in
sanitized sandboxes, and everything from underwear to ballpoint pens comes
with supposed antibacterial properties.
Even before swine flu emerged, sick Japanese donned
surgical masks to avoid infecting others. The country is one of the world’s
largest stockpilers of the antiviral drug Tamiflu.
is also known for its paranoia of foreign diseases. When a Taiwanese doctor
with severe acute respiratory syndrome, or SARS, traveled to Japan
in 2003, the government retraced his every move, testing thousands of people
with whom he might have had contact. No other SARS cases were found.
Until last week, it seemed Japan would escape swine flu
similarly unscathed. Over the past several weeks, health inspectors have used
devices that sense body temperatures on all flights arriving from North America.
But in a sequence of events that experts are now piecing
together, the flu virus appears to have slipped through those stringent
checks. Then on May 2, a flu carrier is thought to have attended a high
school volleyball tournament in Kobe.
Soon afterward, swine flu was diagnosed in a Kobe High
School athlete. Thirteen other volleyball
players from high schools in the city also tested positive.
“We had a situation where lots of kids were gathered in an
enclosed auditorium,” said Chika Shirai, who leads
the infection control and prevention unit in the city of Kobe. “We suspect conditions were perfect
for the virus to spread.” The long commutes on crowded trains so common here
could have played a role in widening the outbreak, she added.
By Monday, the flu had spread to a wider group of
teenagers, and was also infecting older Japanese. All schools in the city
were ordered closed, and students were told not to leave their homes. People
formed lines at supermarkets to stock up on provisions, and masks sold out at
pharmacies across Kobe.
Yoko Yo, a mother of two in Kobe, said she was staying
inside with her family. “I’m very afraid,” she said by telephone. “Neither me
nor my kids have stepped out of the house since Saturday. We’ve bought enough
food to survive for a week.”
Some have criticized Kobe’s
response. The city was unprepared for the surge in people who suspected that
they had contracted the flu, said Hiromasa Tashiro, who leads the Kobe Medical Association.
On Saturday, more than 1,000 people rushed to Kobe’s main public
hospital, overwhelming the staff. The city on Wednesday asked private doctors
to help provide diagnoses for potential flu victims at their clinics.
Still, Mr. Tashiro warned that
it was inevitable that the flu would spread throughout the country. That has
probably happened already, though the light symptoms shown by most patients
make cases hard to track, he said.
On Thursday, Prime Minister Taro Aso
walked the fine line between keeping up the country’s guard and calling for
calm. “The virus could still suddenly mutate,” he told reporters. “We need to
be prepared for different possibilities. But if our measures are too extreme,
that could also cause problems.”
Some experts wondered whether the reason Japan appeared to have a
relatively large number of swine flu cases was that it was checking for the
disease more aggressively than other countries.
“I suspect other countries have just as many, if not more,
cases,” said Hiroshi Suzuki, an expert on infectious disease control at Niigata University and a former World Health
Organization adviser. “It’s just they haven’t been as vigorous as Japan
in testing for the virus.”
Doctors have not been the only ones critical of the
government response. “The situation is completely overblown,” said Naomitsu
Yamamoto, a spokesman for the Kobe Chamber of Commerce and Industry. The
government should heed recent findings that the new flu is not any more
severe than seasonal flu, he said. Tourism in Kobe has plunged since the flu scare began,
Mr. Yamamoto said.
18, a high school senior, said he had just finished a two-hour karaoke
session with friends. “I’m not afraid of the flu at all,” he said at a video
game arcade in Kobe.
“Personally, I think everybody is too paranoid.”
Makiko Inoue and Yasuko Kamiizumi
contributed reporting from Tokyo.
[BACK TO TOP]
The New York Times | 05.21.09
By PAULINE W. CHEN, M.D.
Early on in my internship, a senior doctor pulled me aside
after hearing a couple of other interns grouse with me about our workload.
“Caring for patients is a privilege, a calling,” he said. “Remember, no one
forced you to sign your contract.”
For years those words came to mind whenever I cared for
patients who had lethal, and potentially contagious, infections, patients
like Jean (not her real name), who was in her 50s when I met her. She had
contracted hepatitis C from receiving a vaccination with a contaminated
needle years before, and the symptoms of her end-stage liver failure had
become increasingly difficult to tolerate over the last year. She itched
constantly from jaundice; her memory had deteriorated; and she had had
episodes of life-threatening bleeding that had landed her in the intensive
care unit on two separate occasions. According to the nurses, Jean had walked
into the hospital on the night she was to receive a liver transplant,
bubbling over about the new start on life she would have with the new organ.
Despite Jean’s optimism, she ended up suffering from a
series of devastating postoperative complications and infections. By the time
I came onto her surgical team as one of the interns, she had spent three
months in the hospital.
One morning soon after I began taking care of her, one of
the nurses noticed that Jean had become short of breath. A chest X-ray showed
fluid in her lungs, fluid that I could drain to help her breathe. The
drainage procedure wouldn’t take long once the needle was in her chest; but
because everything would be done using sterile technique, once the procedure
started, I could not leave Jean’s side or touch anything other than the
instruments I was using.
My beeper went off the moment I slipped on the sterile
gloves. I tried to ignore it, forging ahead with the procedure. I disinfected
Jean’s skin, laid down sterile drapes and began numbing her skin with a
syringe filled with anesthetic solution.
Over and over again, my beeper went off. And I continued
ignoring it until the fifth page, when I began to worry that there might be
an emergency elsewhere in the hospital. I wriggled my hips against Jean’s
nightstand, trying to dislodge the beeper from my waist without touching it
or contaminating the sterile field. I shouted for help, but no one answered
Finally, when my pager went off for the sixth time, I
pulled off my left glove and reached down, groping for the beeper hanging on
my right hip while walking toward the door to find a phone.
I felt a sharp sting. Looking down, I saw a small scarlet
drop emerging from the tip of my left index finger. I had stabbed my finger
against the needle I had just used to anesthetize Jean’s skin, a needle I
still held in my right hand.
I stared at the tiny red bloom on my fingertip. And for a
moment, I felt the floor beneath my feet give way, pulling everything — Jean,
my heart, my work, my life — down with it. I stood there paralyzed, staring
at the puncture wound on my fingertip and unable to stop the movie playing in
my mind’s eye, a movie of a future like Jean’s. Jean would never leave the
hospital and, a few months later, would die in the I.C.U., succumbing to a
final, massive infection.
Over the years, I have been stuck, cut, coughed on,
scratched and splashed several more times. Each time, I feel the floor and my
life fall away. I have never contracted a life-threatening infectious
disease; but sometimes I catch myself wondering if it’s only a matter of
time. During the SARS epidemic a few years back, for example, health care
workers were disproportionately affected; certain hospitals in affected areas
reported that over half their workers contracted the disease.
And then every day there is news that swine flu may still
reach pandemic proportions.
When I think about the possibility of becoming infected
with a potentially deadly disease during the course of my work — when I allow
myself to think about it — I struggle to reconcile my beliefs about a
doctor’s responsibilities and my fears about my own safety.
But, always, I arrive at the same conclusion. Like that
senior doctor, I believe it’s a privilege, a calling, to take care of
patients. And I believe that in deciding to practice medicine, I have
consented to an unspoken contract with the public, one that requires that I
take care of those who are sick.
Lately, however, I have also begun to think that there is
another side to that contract. Maybe there are obligations that the general
public has to its health care workers.
Four years ago, Dr. Kent A. Sepkowitz
from Memorial Sloan-Kettering
in New York and Dr. Leon Eisenberg from Harvard Medical School
published a study on occupational deaths among health care workers. They
estimated that anywhere from 17 to 57 deaths per million workers occur
annually in the United
States as a result of occupational
exposures. When placed in the context of other occupations, this calculated
death rate was more than the national average, less than that of policemen
and firefighters, and much less than that of the most dangerous occupations
like fishing, construction, flying and being a part of the military. (Lawyers
and waiters, interestingly enough, came at the bottom of the entire list with
some of the safest jobs.)
But with some nine million people working in the health
care industry, health care workers end up with one of the highest numbers of
total deaths, upwards of more than 300 per year.
There is a flaw, however, in all of these comparisons. And
it is that the estimated annual death rate for health care workers is, well,
just that — a calculated guess that is an
underestimate at best. Despite the very real risk that exists for all health
care workers, the actual number of deaths from occupational injuries or
infections is unknown. Unlike policemen and firefighters and other high-risk
occupations, health care workers have no national registry to track deaths
caused by infections or injuries acquired on the job. As Drs. Sepkowitz and Eisenberg are quick to point out, the
figure they use is based on their best educated guess regarding occupational
deaths from only four infectious diseases: hepatitis B, hepatitis C, H.I.V.
In a recent e-mail, Dr. Sepkowitz
confirmed that four years after the publication of their paper, we still do
not know what the actual occupational death rate is for health care workers.
No federal or national organizations have stepped up to the plate and taken
on the task of tracking these deaths. Without those numbers, without a clear
idea of just how many people are affected, there is no way any of us can come
up with better ways to protect those workers who put themselves at risk to
care for others.
I recently spoke to Gerald M. Oppenheimer, a historian who
has written extensively about the doctors who chose to care for AIDS patients
just as the disease was emerging in the 1980s. It was a frightening period;
no one understood how the illness was transmitted or infected.
“We are so used to seeing heroes as different, as people
who are larger than life and who prepare all their lives for this event. But
it’s not that at all,” Dr. Oppenheimer said. “[These doctors] were ordinary
people who were responding to something that appeared to be very dangerous.
And they were willing to take that risk because of their beliefs.”
Supporting a national registry of occupational deaths in
health care workers would go a long way toward recognizing and supporting
some of the extraordinary decisions of ordinary individuals. And that
registry, I believe, should be part of the agreement between health care
workers and those they serve.
Join the discussion on the Well blog.
[BACK TO TOP]
The New York Times | 05.21.09
By BENEDICT CAREY
Sandy Huffaker for The New York Times
Georgia Scott, 99, center, during a game of bridge at
her retirement community. “It’s what keeps us going,” she says.
LAGUNA WOODS, Calif.
— The ladies in the card room are playing bridge, and at their age the game
is no hobby. It is a way of life, a daily comfort and challenge, the last
communal campfire before all goes dark.
“We play for blood,” says Ruth Cummins, 92, before taking
a sip of Red Bull at a recent game.
“It’s what keeps us going,” adds Georgia Scott, 99. “It’s
where our closest friends are.”
In recent years scientists have become intensely
interested in what could be called a super memory club — the fewer than one
in 200 of us who, like Ms. Scott and Ms. Cummins, have lived past 90 without
a trace of dementia. It is a group that, for the first time, is large enough
to provide a glimpse into the lucid brain at the furthest reach of human
life, and to help researchers tease apart what, exactly, is essential in
preserving mental sharpness to the end.
“These are the most successful agers on earth, and they’re
only just beginning to teach us what’s important, in their genes, in their
routines, in their lives,” said Dr. Claudia Kawas,
a neurologist at the University of California, Irvine.
“We think, for example, that it’s very important to use your brain, to keep
challenging your mind, but all mental activities may not be equal. We’re
seeing some evidence that a social component may be crucial.”
Laguna Woods, a sprawling retirement community of 20,000
south of Los Angeles,
is at the center of the world’s largest decades-long study of health and
mental acuity in the elderly. Begun by University of Southern
California researchers in 1981 and called the
90+ Study, it has included more than 14,000 people aged 65 and older, and
more than 1,000 aged 90 or older.
Such studies can take years to bear fruit, and the results
of this study are starting to alter the way scientists understand the aging
brain. The evidence suggests that people who spend long stretches of their
days, three hours and more, engrossed in some mental activities like cards
may be at reduced risk of developing dementia. Researchers are trying to
tease apart cause from effect: Are they active because they are sharp, or sharp because they are active?
The researchers have also demonstrated that the percentage
of people with dementia after 90 does not plateau or taper off, as some
experts had suspected. It continues to increase, so that for the one in 600
people who make it to 95, nearly 40 percent of the men and 60 percent of the
women qualify for a diagnosis of dementia.
At the same time, findings from this and other continuing
studies of the very old have provided hints that some genes may help people
remain lucid even with brains that show all the biological ravages of
Alzheimer’s disease. In the 90+ Study here, now a joint project run by U.S.C.
and the University of California, Irvine, researchers regularly run genetic
tests, test residents’ memory, track their activities, take blood samples,
and in some cases do postmortem analyses of their brains. Researchers at Irvine maintain a brain
bank of more than 100 specimens.
To move into the gated village
of Laguna Woods, a tidy array of bungalows
and condominiums that blends easily into southern Orange County,
people must meet several requirements, one of which is that they do not need
full-time care. Their minds are sharp when they arrive, whether they are 65
They begin a new life here. Make new friends. Perhaps
connect with new romantic partners. Try new activities, at one of the
community’s fitness centers; or new hobbies, in the more than 400 residents’
clubs. They are as busy as arriving freshmen at a new campus, with one large
difference: they are less interested in the future, or in the past.
“We live for the day,” said Dr. Leon Manheimer,
a longtime resident who is in his 90s.
Yet it is precisely that ability to form new memories of
the day, the present, that usually goes first in
dementia cases, studies in Laguna Woods and elsewhere have found.
The very old who live among their peers know this
intimately, and have developed their own expertise, their own laboratory.
They diagnose each other, based on careful observation. And they have learned
to distinguish among different kinds of memory loss, which are manageable and
A Seat at the Table
Here at Laguna Woods, many residents make such delicate
calculations in one place: the bridge table.
Contract bridge requires a strong memory. It involves four
players, paired off, and each player must read his or her partner’s strategy
by closely following what is played. Good players remember every card played
and its significance for the team. Forget a card, or fall behind, and it can
cost the team — and the social connection — dearly.
“When a partner starts to slip, you can’t trust them,”
said Julie Davis, 89, a regular player living in Laguna Woods. “That’s what
it comes down to. It’s terrible to say it that way, and worse to watch it
happen. But other players get very annoyed. You can’t help yourself.”
At the Friday afternoon bridge game, Ms. Cummins and Ms.
Scott sit with two other players, both women in their 90s. Gossip flows
freely between hands, about residents whose talk is bigger than their game,
about a 100-year-old man who collapsed and died that week in an exercise
But the women are all business during play.
“What was that you played, a spade was it?” a partner asks
“Yes, a spade,” says Ms. Cummins, with some irritation.
“It was a spade.”
Later, the partner stares uncertainly at the cards on the
table. “Is that ——”
“We played that trick already,” Ms. Cummins says. “You’re
a trick behind.”
Most regular players at Laguna Woods know of at least one
player who, embarrassed by lapses, bowed out of the regular game. “A friend
of mine, a very good player, when she thought she couldn’t keep up, she
automatically dropped out,” Ms. Cummins said. “That’s usually what happens.”
Yet it is part of the tragedy of dementia that, in many
cases, the condition quickly robs people of self-awareness. They will not
voluntarily abandon the one thing that, perhaps more than any other, defines
their daily existence.
“And then it’s really tough,” Ms. Davis said. “I mean,
what do you do? These are your friends.”
Staying in the Game
So far, scientists here have found little evidence that
diet or exercise affects the risk of dementia in people over 90. But some
researchers argue that mental engagement — doing crossword puzzles, reading
books — may delay the arrival of symptoms. And social connections, including
interaction with friends, may be very important, some suspect. In isolation,
a healthy human mind can go blank and quickly become disoriented,
psychologists have found.
“There is quite a bit of evidence now suggesting that the
more people you have contact with, in your own home or outside, the better
you do” mentally and physically, Dr. Kawas said.
“Interacting with people regularly, even strangers, uses easily as much brain
power as doing puzzles, and it wouldn’t surprise me if this is what it’s all
And bridge, she added, provides both kinds of stimulation.
The unstated rule at Laguna Woods is to support a friend
who is slipping, to act as a kind of memory supplement. “We’re all afraid to
lose memory; we’re all at risk of that,” said one regular player in her 90s,
who asked not to be named.
Woody Bowersock, 96, a former
school principal, helped a teammate on a swim team at Laguna Woods to race
even as dementia stole the man’s ability to form almost any new memory.
“You’d have to put him up on the platform just before the
race, just walk him over there,” Mr. Bowersock
said. “But if the whistle didn’t blow right away, he’d wander off. I tell
you, I’d sometimes have to stand there with him until he was in the water.
Then he was fine. A very good swimmer. Freestyle.”
Bridge is a different kind of challenge, but some
residents here swear that the very good players can play by instinct even
when their memory is dissolving.
“I know a man who’s 95, he is starting with dementia and
plays bridge, and he forgets hands,” said Marilyn Ruekberg,
who lives in Laguna Woods. “I bring him in as a partner anyway, and by the
end we do exceedingly well. I don’t know how he does it, but he has lots of
experience in the game.”
Scientists suspect that some people with deep experience
in a game like bridge may be able to draw on reserves to buffer against
memory lapses. But there is not enough evidence one way or the other to know.
Ms. Ruekberg said she cared less
about that than about her friend: “I just want to give him something more during
the day than his four walls.”
Drawing the Line
In studies of the very old, researchers in California, New York, Boston and elsewhere
have found clues to that good fortune. For instance, Dr. Kawas’s
group has found that some people who are lucid until the end of a very long
life have brains that appear riddled with Alzheimer’s disease. In a study
released last month, the researchers report that many of them carry a gene
variant called APOE2, which may help them maintain mental sharpness.
Dr. Nir Barzilai
of the Albert Einstein College of Medicine has found that lucid Ashkenazi
Jewish centenarians are three times more likely to carry a gene called CETP,
which appears to increase the size and amount of so-called good cholesterol
particles, than peers who succumbed to dementia.
“We don’t know how this could be protective, but it’s very
strongly correlated with good cognitive function at this late age,” Dr. Barzilai said. “And at least it gives us a target for
For those in the super-memory club, that future is too far
off to be meaningful. What matters most is continued independence. And that
means that, at some point, they have to let go of close friends.
“The first thing you always want to do is run and help
them,” Ms. Davis said. “But after a while you end up asking yourself: ‘What
is my role here? Am I now the caregiver?’ You have to decide how far you’ll
go, when you have your own life to live.”
In this world, as in high school, it is all but impossible
to take back an invitation to the party. Some players decide to break up
their game, at least for a time, only to reform it with another player. Or,
they might suggest that a player drop down a level, from a serious game to a
more casual one. No player can stand to hear that. Every day in card rooms
around the world, some of them will.
“You don’t play with them, period,” Ms. Cummins said.
“You’re not cruel. You’re just busy.”
The rhythm of bidding and taking tricks, the easy
conversation between hands, the daily game — after almost a century, even for
the luckiest in the genetic lottery, it finally ends.
“People stop playing,” said Norma Koskoff,
another regular player here, “and very often when they stop playing, they
don’t live much longer.”
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The New York Times | 05.21.09
By PAUL KRUGMAN
That didn’t take long. Less than two weeks have passed
since much of the medical-industrial complex made a big show of working with
President Obama on health care reform — and the double-crossing is already
well under way. Indeed, it’s now clear that even as they met with the
president, pretending to be cooperative, insurers were gearing up to play the
same destructive role they did the last time health reform was on the agenda.
So here’s the question: Will Mr. Obama gloss over the
reality of what’s happening, and try to preserve the appearance of
cooperation? Or will he honor his own pledge, made back during the campaign,
to go on the offensive against special interests if they stand in the way of
The story so far: on May 11 the White House called a news
conference to announce that major players in health care, including the
American Hospital Association and the lobbying group America’s Health
Insurance Plans, had come together to support a national effort to control
health care costs.
The fact sheet on the meeting, one has to say, was classic
Obama in its message of post-partisanship and, um, hope. “For too long,
politics and point-scoring have prevented our country from tackling this
growing crisis,” it said, adding, “The American people are eager to put the
ways behind them.”
But just three days later the hospital association
insisted that it had not, in fact, promised what the president said it had
promised — that it had made no commitment to the administration’s goal of
reducing the rate at which health care costs are rising by 1.5 percentage
points a year. And the head of the insurance lobby said that the idea was
merely to “ramp up” savings, whatever that means.
Meanwhile, the insurance industry is busily lobbying
Congress to block one crucial element of health care reform, the public
option — that is, offering Americans the right to buy insurance directly from
the government as well as from private insurance companies. And at least some
insurers are gearing up for a major smear campaign.
On Monday, just a week after the White House photo-op, The
Washington Post reported that Blue Cross Blue Shield of North Carolina was
preparing to run a series of ads attacking the public option. The planning
for this ad campaign must have begun quite some time ago.
The Post has the storyboards for the ads, and they read
just like the infamous Harry and Louise ads that helped kill health care
reform in 1993. Troubled Americans are shown being denied their choice of
doctor, or forced to wait months for appointments, by faceless government
bureaucrats. It’s a scary image that might make some sense if private health
insurance — which these days comes primarily via HMOs — offered all of us
free choice of doctors, with no wait for medical procedures. But my health
plan isn’t like that. Is yours?
“We can do a lot better than a government-run health care
system,” says a voice-over in one of the ads. To which the obvious response
is, if that’s true, why don’t you? Why deny Americans the chance to reject
government insurance if it’s really that bad?
For none of the reform proposals currently on the table
would force people into a government-run insurance plan. At most they would
offer Americans the choice of buying into such a plan.
And the goal of the insurers is to deny Americans that
choice. They fear that many people would prefer a government plan to dealing
with private insurance companies that, in the real world as opposed to the
world of their ads, are more bureaucratic than any government agency,
routinely deny clients their choice of doctor, and often refuse to pay for
Which brings us back to Mr. Obama.
Back during the Democratic primary campaign, Mr. Obama
argued that the Clintons
had failed in their 1993 attempt to reform health care because they had been
insufficiently inclusive. He promised instead to gather all the stakeholders,
including the insurance companies, around a “big table.” And that May 11
event was, of course, intended precisely to show this big-table strategy in
But what if interest groups showed up at the big table,
then blocked reform? Back then, Mr. Obama assured voters that he would get
tough: “If those insurance companies and drug companies start trying to run
ads with Harry and Louise, I’ll run my own ads as president. I’ll get on
television and say ‘Harry and Louise are lying.’ ”
The question now is whether he really meant it.
The medical-industrial complex has called the president’s
bluff. It polished its image by showing up at the big table and promising
cooperation, then promptly went back to doing all it can to block real
change. The insurers and the drug companies are, in effect, betting that Mr.
Obama will be afraid to call them out on their duplicity.
It’s up to Mr. Obama to prove them wrong.
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