Posted by John Maginnis,
Columnist
Providing tickets for legislators to purchase for the
national collegiate baseball tournament series at LSU last weekend was the
least that school officials could do, given how much tumult, hostility and
fear the university's issues have caused at the Capitol this spring.
The flagship's budget woes, leading those of all higher
education, have been a source of rancor and tension between lawmakers and the
administration. On top of that, an intense power struggle over the size, site
and control of LSU's proposed teaching hospital and medical center in New Orleans has landed
in the middle of the legislative session. With it comes the renewed bitter
rivalry between LSU and Tulane, marked by some condescending statements about
the city from the LSU president, veiled threats that the medical school might
pull up stakes and an old-fashioned hallway shouting match between the state
treasurer and a school official.
The controversy might be worth the unpleasantness if it
had something to do with shaping the future of public health care and
hospitals in Louisiana, but the state
overall seems headed in the opposite direction from what it's trying to do in
New Orleans.
Yet, at $1.2 billion, the fate of the project commands the interest of
legislators statewide.
LSU's proposal to build alongside a planned Veterans
Affairs hospital on a 70-block tract in the middle of the city is opposed by
preservationists, some doctors and community groups that want it to rebuild
the old hospital, which they argue is the faster, cheaper alternative for
restoring a vital health asset.
LSU officials are adamant it will not re-occupy the old
building as long as it is responsible for public health care in New Orleans. That could
change with passage of legislation by Speaker of the House Jim Tucker,
R-Algiers, which would remove LSU from control of the medical complex and
turn that over to an independent board of community stakeholders, including
Tulane and other local universities involved in medical education.
Tucker says he is not opposed to the new hospital complex,
but wants LSU to stick to running its medical education program. He gets
quiet support on that score from within the LSU community, where there are
those who believe its health-care responsibilities detract from its higher
education mission.
Gov. Bobby Jindal supports the
medical complex, but says he would sign Tucker's bill if it passes. What the
governor really wants, he says, is for LSU to agree to have Tulane and other
schools represented on the board of the non-profit governing corporation
still to be formed. LSU, at first strongly opposed to power-sharing with
Tulane, is becoming more amenable under pressure. If the two schools reach
some accord, even at the point of the governor's shotgun, the larger
challenge would be reaching a hurricane damage settlement on the old building
with FEMA and selling Wall Street on its financial plan -- some very big ifs.
That might leave the preservationists feeling jilted, but
state and school officials agree that the iconic 1939 structure will be saved
and put to new use.
The plan for the new medical complex, given its broad
economic development potential, might sound like the future of public health
care in Louisiana,
but it more likely will be the last hospital the state ever builds. LSU has
given up on erecting a new hospital in Baton Rouge
and instead is forging a partnership with Our Lady of the Lake
to train doctors and provide indigent care. The Jindal
administration envisions gradually doing the same in other parts of the
state. Except in Shreveport, where the
high-quality University Medical Center
is the model that LSU hopes to emulate in New Orleans.
The state's most forward-looking public hospital -- which
is ironic, given its original name, Confederate Memorial -- trains LSU
doctors, treats both private-pay patients and the uninsured, and turns a
profit. It also is to its city what LSU had better learn to be in New Orleans, a
responsive and respected member of the community.
http://blog.nola.com/johnmaginnis/2009/06/lsu_struggles_with_hospital_po.html
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LSUHSC New Orleans | 06.10.09
By Leslie Capo
New Orleans, LA – After three and a half years in Lafayette,
LA where it moved as a result of the
flooding of New Orleans
after Hurricane Katrina, the LSUHSC Geriatric Medicine Fellowship Program is back home. The Accreditation Council for Graduate Medical
Education has notified program director Dr. Charles Cefalu,
Professor of Medicine and Chief of Geriatric Medicine at LSU Health Sciences
Center New Orleans School of Medicine, that the move to New
Orleans has been approved and that the Geriatric Medicine
Fellowship Program in New Orleans
has earned accreditation effective July 1, 2009.
The program is a one-year clinical fellowship in Geriatric
Medicine, available to Family Medicine and Internal Medicine residents who
have satisfactorily completed their residency and are board eligible in their
specialty of Family Medicine or Internal Medicine. Two positions are
available and time of entrance is flexible, depending on the applicant.
Rotational experiences include geriatric psychiatry, physical medicine and
rehabilitation, geriatric consultation/concentrated LTC experience, special
clinics (Pain, Orthopaedics, Urology, Neurology,)
home care, hospice and an elective. Longitudinal experiences include home
care, nursing home, and primary care clinic.
Dr. Cefalu commuted to Lafayette once or twice
a week to supervise fellows and take care of administrative duties while the
fellowship program was housed at LSU’s University Medical Center (UMC). In
the early days, there was no office, telephone or administrative support. He
was successful in obtaining an emergency grant from the Hartford Foundation
for temporary housing without which the fellowship program would not have
survived.
“Dr. Cefalu is to be commended
for his dedication, commitment, and sacrifice to maintain this vitally needed
asset for Louisiana’s
elderly through an enormously trying time,” notes Dr. Steve Nelson, Dean of
the LSU Health Sciences Center New Orleans School of Medicine.
While in Lafayette, Dr. Cefalu helped LSU faculty at UMC in Lafayette to establish a Geriatric Medicine
Fellowship Program of their own which was approved in 2006. Both of the
fellows in the program at the time of the disaster, one who started in July
of 2005 and the other on September 1, 2005, graduated, at which point Dr. Cefalu directed his attention to rebuilding the program
in New Orleans. The Hartford Foundation provided a $500,000 grant to support
that effort.
“The State of Louisiana
owes Dr. Cefalu a huge debt of gratitude for his
tireless efforts on behalf of our elders,” says Dr. Larry Hollier,
Chancellor of LSU Health Sciences Center New Orleans. “He not only saved the
state’s one Geriatric Medicine Fellowship Program, but he established a
second and is now working to expand capacity.”
Data from 2005 indicated that at that time, there was a
shortfall of 209 geriatricians in the state. The Governor’s Office of the
Elderly estimates that there are now about 725,000 Louisiana residents 65 years and older.
The two LSU Geriatric Medicine Fellowship programs are the only two in Louisiana and a new
requirement for certification in Geriatrics is completion of an accredited
fellowship in Geriatric Medicine.
“While we celebrate every step forward, we need to do more
to catch up with the rest of the nation,” notes Dr. Cefalu.
“There is a huge need to expand training in this increasingly needed
subspecialty across the State of Louisiana, including other members of the
team in Geriatrics and Gerontology where there is also a huge need – nurses,
nurse practitioners, pharmacists, social workers, nutritionists, and health
care administrators.”
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Shreveport Times | 06.10.09
Dr. Anil Nanda, chairman of the LSU Health Sciences
Center-Shreveport Department of Neurosurgery, recently performed live surgery
during the 11th Annual Microneurosurgery Workshop
in New Delhi, India.
Nanda was recognized as the distinguished visiting
neurosurgeon during the event.
He delivered the Sarveshwari
Memorial Oration titled Skull Base Surgery: The good, the bad and the ugly,
to more than 300 international neurosurgeon participants.
http://www.shreveporttimes.com/article/20090610/NEWS01/906100368/1060
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Louisiana legislators should give higher education
and health care room to breathe
by The Times-Picayune
Gov. Bobby Jindal is critical of
the Senate's attempts to ease severe budget cuts on higher education and
health care, saying they would only delay the inevitable.
The Senate's budget proposal, which includes delaying an
income tax break and dipping into the state's rainy day fund, doesn't
"so much relieve the budget pressure as much as it moves it forward,
maybe a year," the governor said.
That may be true, but cushioning the blow isn't
necessarily a bad thing.
The depth of cuts proposed by the administration could be
damaging, particularly in higher education. What the state ought to do is
weed out duplicate and under-performing or unnecessary programs, including a
hard look at whether Louisiana
has too many four-year colleges.
That isn't what will happen if 15 percent -- $219
million-- in cuts have to be made to colleges and universities for the next
budget year. Higher education already absorbed a $55 million cut in the
middle of this budget year.
If some cuts were delayed for a year, there would be more
time to make trims strategically and plan for the long-term. A strong higher
education system is crucial to Louisiana's
ability to compete for jobs and attract investment.
The Senate's revisions would make that possible. Its $28.7
billion version of the budget restores $284 million to higher education and
health care but still cuts spending in most state programs. The infusion of
money is contingent upon the approval of other measures, including a partial
delay of an income tax reduction approved last year.
The House declared that proposal unconstitutional Monday
because it didn't originate in that chamber, which is where revenue and tax
measures are supposed to begin.
The idea is sound, though, and would give the state $118
million more to spend on colleges and universities in the upcoming budget.
Gov. Jindal is right to be
concerned about future budgets, especially as federal stimulus money
evaporates.
But the Senate budget doesn't ignore financial realities.
Its budget still includes $166 million in cuts to the Department of Health
and Hospitals and $105 million to colleges and universities.
But it would allow the state to slow down a bit and be
smart about where it makes cuts.
http://www.nola.com/politics/index.ssf/2009/06/louisiana_legislators_should_g.html
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OPINION: Improving Louisiana's health statistics not legislative
priority
Kallie Barras
Louisiana
long has lagged behind the rest of the nation in measurements of population
health and health-care provision. I had hoped that term limits and recent
elections would bring us a new crop of state leaders with innovative ideas to
help us improve in these critical areas.
Sadly, it has become clear that this is not what has
happened. At a time when our state is facing a budget crisis, health care is
one of the areas targeted for heavy cuts. While some, like state Rep. Karen
Carter Peterson of New Orleans,
have proposed fiscally responsible ways to protect health care programs,
other legislators and our governor have offered only resistance.
During a session in which innovative thinking has been
sorely lacking, Peterson has presented not one, but two bills that would
improve public health and create new funding for health programs by raising
the price of tobacco products. Unfortunately, one was defeated last month and
the other has been stalled. Countless studies have shown that raising tobacco
prices has a significant impact on tobacco use. In addition, a recent poll of
Louisiana
residents shows that a vast majority support such a price increase.
Why are these legislators against smart policies to
improve public health in our state and save taxpayers' money?
Kallie Barras
New Iberia
http://www.theadvertiser.com/article/20090610/OPINION03/906100318
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By SARAH CHACKO
Advocate Capitol News Bureau
Legislation that would require health insurance companies
to post lists of their provider network online passed a House committee
Tuesday.
The House Insurance Committee also advanced a measure that
would change how the state-run property insurance company of last resort sets
its rates.
Senate Bill 282, sponsored by Sen. Troy Hebert,
D-Jeanerette, would require health insurance companies to report the
facilities and health-care workers they contract with on their Web sites.
Hebert said he hopes the disclosure will inform patients
who receive care and are billed by health-care workers, such as
anesthesiologists or radiologists, who are not covered by their insurance
provider.
The information may not completely solve the problem,
Hebert said. But hopefully residents will see that one hospital has more of
their network doctors than another, and choose accordingly, he said.
SB282, which was replaced in its entirety through
amendment, now also applies to the Office of Group Benefits.
Committee Chairman Chuck Kleckley,
R-Lake Charles, said he and Hebert, who is chairman of the Senate Insurance
Committee, are looking at other insurance coverage issues for potential
legislation in the future.
Hebert noted that Senate Bill 170, sponsored by Senate
President Pro Tem Sharon Weston Broome, D-Baton Rouge, would have addressed
another problem of coverage.
SB170 would have given patients the option to receive care
only from health-care providers covered by their insurance, or in-network. If
the option were not offered and accepted by the patient, out-of-network
providers would be reimbursed by the insurance company at the in-network
rate, according to the bill.
Broome withdrew her bill on the Senate floor Monday.
The committee also advanced Hebert’s Senate Bill 130,
which would change how the Louisiana Citizens Property Insurance Corp. sets
it rates.
Citizens rates are set 10 percent
higher than the highest property insurance company in an area.
Currently, Citizens’ rate is determined by surveying the
10 companies with the highest premiums in a parish.
Hebert said some companies purposely keep their rates high
because they do not want any new business in certain areas.
“It skews Citizens’ rates and makes them a whole lot
higher than they should be,” he said.
SB130 would use the rates of companies that hold at least
2 percent of the policies in a parish or have written 25 new policies in the
past year to set Citizens’ rates.
Had the bill been in place this year, Citizens’ recent 7
percent rate increase would have been a 3.5 percent increase, Hebert said.
Citizens CEO John Wortman said
SB130 will still keep Citizens as the highest priced but will take out the
“peaks and valleys” in the rate-making process.
Hebert said after the meeting he has asked Kleckley to amend the bill on the House floor to allow
for rates to be set by ZIP code instead of parish.
Rates reflect the assessed risk of an area, Hebert said.
Within the same parish, there could be areas with different risk assessments
but they are all covered with the same rate, he said.
The proposed amendment would allow for rates to differ by
ZIP code, Hebert said.
http://www.2theadvocate.com/news/47486082.html.
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by Jan Moller and Bill Barrow,
The Times-Picayune
BATON ROUGE -- There are five legislative committees
scheduled to meet this morning at the Capitol. But in terms of news value,
all eyes will be on the John J. Hainkel Jr. Room,
where the Senate Health and Welfare Committee has three much-discussed bills
on its agenda:
• There is the heavily lobbied dentist bill -- House Bill
687 by Rep. Kevin Pearson, R-Slidell -- which was heavily amended last week
but still appears to curb the activities of Dr. Greg Folse,
the Lafayette
dentist whose school-based mobile dental clinic sparked this whole brouhaha
to begin with.
• There also is House Bill 517 by Rep. Bernard LeBas, D-Ville Platte, which would allow some health-care
workers to refuse to do their jobs if it conflicts with their religious
convictions. The bill, a top priority for religious conservatives, got bogged
down in the committee last week and is back for a second hearing.
• And then there is the bill to repeal Louisiana's mandatory helmet law for
motorcyclists. House Bill 639 by Rep. James Morris, R-Oil City,
has the support of Gov. Bobby Jindal, who included
it in his legislative package. It already has received support from the same
House committee that thinks backseat passengers should be required to wear
seat belts. But this morning it faces a showdown in the same Senate committee
that killed an almost identical bill last year.
The one clear difference between last year and this is
that now the governor is putting his political capital behind the effort,
which makes this a tidy test case of the governor's sway in the upper
chamber.
Also of note is what's not on the Health
& Welfare agenda: House Speaker Jim Tucker's House Bill 830, to
establish the governance of the proposed state teaching hospital for New Orleans. Tucker said
he awaits the outcome of ongoing mediation sessions that state Health and
Hospitals Secretary Alan Levine is conducting with the presidents of the
Louisiana State University System and Tulane University.
The latest gathering of Levine, LSU's John Lombardi and Tulane's Scott Cowen
was Tuesday.
Tucker said he trusts Levine to craft a workable plan that
meets the speaker's and the Jindal administration's
goal of an independent board that includes representatives of all the schools
involved, without any one school controlling the new entity. Whatever the
outcome, timing is important: the Senate Health & Welfare Committee's
last regularly scheduled meeting of the session is slated for next Wednesday.
Elsewhere in the Capitol, the House Committee on
Municipal, Parochial & Cultural Affairs will
take up Sen. Edwin Murray's bill to require voter approval of the New Orleans master plan
-- an idea that has drawn opposition from the Bureau of Governmental Research
and newspaper editorialists.
In the Senate and Governmental Affairs Committee, members
will give a hearing to Rep. Hunter Greene's House Bill 695 to require gubernatorial
transition teams to report their contributors and cap the amount that
individuals can give. The same committee also is scheduled to hear Rep. Mert Smiley's bill to abolish a bunch of useless boards
and commissions.
Lingering on the Senate calendar are two bills dear to
social conservatives. One is Rep. Cameron Henry's proposed retooling of the
Louisiana Constitution's religious freedom clause; the other is Rep. Jonathan
Perry's bill reaffirming the state's refusal to issue birth certificates listing
two unmarried (read: gay) parents who adopt a Louisiana-born child in another
state. It's not clear when senators will call the bills, but Louisiana Family
Forum leader Gene Mills spent much of Tuesday afternoon huddling with members
of the upper chamber and the Jindal administration.
The House, meanwhile, plans to take up a whole bunch of
Senate measures, including Sen. Danny Martiny's
"Centaur" bill to outlaw man-animal hybrids.
http://www.nola.com/politics/index.ssf/2009/06/medical_conscience_bill_motorc.html
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Advocate Opinion page staff
The best argument for raising tobacco taxes is the public
health benefit. Louisiana is once again
behind most states — including Mississippi,
this year — in using higher taxes on cigarettes and other tobacco products as
a way to deter their use by young people.
Despite opposition from Gov. Bobby Jindal
and others, the idea of raising tobacco taxes is a good one. A 50-cent per
pack increase on cigarettes, and comparable boosts on other products, has
been put into play by the Ways and Means Committee in the House.
The $100 million or so that the bill by Rep. Karen
Peterson, D-New Orleans, would raise is hardly the
answer to the state’s long-term financial problems.
And by long term, we mean as early as two years from now,
when the state will no longer get the federal stimulus funds used by Jindal to prop up his budgets.
The money is nevertheless needed. It is irresponsible to
oppose any and all taxes, especially a tax that has as its primary goal a
significant lessening of youth addiction.
Jindal’s own health secretary
agrees that the increase probably would mean a measurable reduction in youth
smoking. But we agree with Alan Levine, secretary of the Department of Health
and Hospitals, that
taxing every potentially harmful substance — “Twinkie taxes” on sweets or
other common products — is not a good idea.
Cigarettes are unique in this arena in their addictive
qualities and their killing consequences.
The public-health costs of tobacco products are being
offset by this bill.
We urge the Legislature to back this proposal.
It’s a responsible decision not just in a budget crisis,
but in any year when the health of young people is a concern of lawmakers.
http://www.2theadvocate.com/opinion/47485242.html?showAll=y&c=y
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By MARSHA SHULER
Advocate Capitol News Bureau
An effort to raise taxes on cigarettes and other tobacco
products survived a full-fledged legislative attack Tuesday in the Louisiana
House of Representatives.
Opponents tried and failed in three separate parliamentary
moves to scuttle the tax legislation without directly voting on the issue.
House Bill 889 would increase the tax on a pack of cigarettes by 50 cents.
The measure still faces debate and a vote by the full
House.
The last attempt came as opponents moved to “table” HB889,
which would have effectively killed the measure for the current legislative
session.
“Let’s just settle it right now,” said state Rep. Joe Lopinto, R-Metairie.
Sixty-one state representatives voted against tabling the
measure while 37 voted in favor of the motion. The measure would need 70
votes to pass the House.
HB889 sponsored by Rep. Karen Peterson, D-New Orleans,
would increase the
tax on a pack of cigarettes from 36 cents to 86 cents. The tax
is estimated to generate about $100 million, which would go to help pay for
health-care programs.
Peterson asked her colleagues not to fear voting to allow
debate on the tax proposed in “The Louisiana Healthier Families Act.”
At the end of nearly two hours of wrangling, the House
agreed to advance Peterson’s legislation for a full House debate and vote,
perhaps by next week.
Lopinto said he had no more
parliamentary maneuvers to try.
“I think we have done them all,” replied House Speaker Jim
Tucker, R-Terrytown.
HB889 is the only major tax bill that remains alive —
although on life support — to generate revenues to close big health care and
higher education budget funding gaps.
A two-thirds majority — 70 votes — is needed for the House
to advance the measure to the state Senate for consideration.
Lopinto said that before the
full House debates the measure, it should receive another hearing and another
vote, this one before the Health and Welfare Committee because public health
issues are involved.
“It’s an opportunity to kill the bill,” Peterson
protested. “Mr. Lopinto is working the process to
try to do that.”
The House voted against sending the measure for further
review by the health panel with 33 representatives voting in favor while 62
opposed.
Opponents then found a House rule that required sending
the tobacco tax bill for another hearing and vote before the House
Appropriations Committee.
State Rep. Jim Fannin,
D-Jonesboro, who the chairs appropriations committee, said the procedural
step was required because HB889 established a special fund.
Peterson’s bill sets up a health care fund with the tax
proceeds and dedicates the revenues to specific purposes, including
reimbursing physicians, hospitals and other health care providers for the
medical care they deliver.
Peterson appealed that decision, losing when 44
representatives sided with her and 52 supported sending the bill to
appropriations.
Then, Peterson asked the House to discharge the
Appropriations Committee from hearing the measure, which required another
vote. Discharging the panel would avoid another hearing and put the measure
in line for House floor debate and vote.
Peterson said time is of the essence and sending the
measure to another committee would not give the tax an opportunity to get
through the legislative process, which includes a vote by the full House
followed by a committee hearing, then vote by the full Senate, and
reconciling any differences between the versions passed by each chamber. The
legislative session adjourns at 6 p.m. on June 25.
State Rep. Harold Ritchie, D-Bogalusa, supported Peterson.
“As a smoker for 45 years, I think this is a health care
issue. As an owner of a funeral home for 40 years it’s helped me realize
that. It’s important to everybody in our state that we have this debate on
our floor,” Ritchie said.
The House voted 58-41 to discharge the appropriations
committee and allow the legislation to proceed to House floor debate next
week.
But the fight wasn’t over, Lopinto
tried once again to derail the House debate with the motion to table — or
kill — the bill. The House rejected the move, ending the parliamentary
battle.
Here’s how the Louisiana House voted Tuesday when it
refused to table -
or kill – a proposed tobacco tax increase contained in HB889.
Voting FOR tabling the tobacco tax (37): Reps. Billiot, Burford, H. Burns,
Carter, Chandler, Chaney, Cortez, Dove, Fannin,
Foil, Geymann, Hazel, Howard, S. Jones, Katz, Kleckley, LaBruzzo, Landry, Ligi, Lopinto, McVea, Mills, Monica, Morris, Pearson, Pope, Pugh,
Richardson, Robideaux, Schroder, Simon, Smiley,
Talbot, Templet, Thibaut
and Willmott.
Voting AGAINST tabling the tobacco tax (61): Speaker
Tucker and Reps. Abramson, Anders, Armes, Arnold,
A. Badon, B. Badon, Baldone, Barras, Barrow, Brossett,
T. Burns, Burrell, Carmody, Champagne, Connick, Danahay, Dixon, Doerge, Downs, Edwards, Ellington, Ernst, Franklin, Gisclair, Greene, Guillory, Guinn, Hardy, Harrison,
Henderson, Henry, Hill, Hines, Hoffmann, Honey, Hutter,
M. Jackson, Johnson, R. Jones, LaFonta, Lambert, LeBas, Montoucet, Norton, Nowlin, Perry, Peterson, Ponti,
Richard, Richmond, Ritchie, Roy, G. Smith, P. Smith, St. Germain,
Stiaes, Waddell, White, Williams and Wooton.
NOT VOTING (6):
Reps. Aubert, Cromer, Gallot,
G. Jackson, Leger and J. Smith.
http://www.2theadvocate.com/news/47486387.html?index=1&c=y
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The Associated Press
(AP) — BATON ROUGE, La. -
A battle over who tends to the teeth of Louisiana's poor children moves to the
state Senate.
The Senate Health and Welfare Committee is set to debate
Wednesday a bill that would direct the Louisiana State Board of Dentistry to
come up with new, tighter regulations on mobile dental clinics at public
schools. That was the compromise proposal worked out in the House after
lawmakers there rejected an outright ban on the clinics.
The bill has become one of the more heavily lobbied issues
of the legislative session.
Critics of the clinics say it is unsafe to drill on
children's teeth in school libraries and cafeterias. Others say they bring
care to poor children who otherwise would never see a dentist.
http://www.nola.com/newsflash/index.ssf?/base/national-24/1244631334209430.xml&storylist=louisiana
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By SANDY DAVIS
Advocate staff writer
The 134 confirmed cases of swine flu in Louisiana — 16 of which are in East Baton
Rouge Parish — would have caused a major reaction, maybe even panic, just a
few weeks ago.
But now, all is calm — at least publicly, said Dr. Frank
Welch, the state Department of Health and Hospital’s medical director for
pandemic preparedness.
While DHH still has about five divisions actively
following the outbreak of the flu — officially called H1N1 flu — there are no
more news conferences by the governor detailing the number of cases in the
state as there were during the first days of May.
“When the outbreak first began in Mexico, it appeared to be
serious,” Welch said. “The deaths reported were high and they appeared to be
people who we would not typically expect to die from the flu.”
The state and federal governments ramped up an emergency
response when the disease spread to the U.S.
and Louisiana
in late April and early May.
Schools were closed, cruise ships began to avoid the coast
of Mexico,
and a team of epidemiologists and investigators descended on those diagnosed
with the disease.
But on May 7, the Centers for Disease Control and
Prevention in Atlanta
determined the disease was mild and issued new guidelines instructing states
to stand down: All schools should reopen and only those people who contracted
a serious case of swine flu were to be tested by doctors.
Welch said that is the reason the number of H1N1 flu cases
in Louisiana
is probably off; the real number of cases in the state is probably much
higher, he said.
“But I can’t even ballpark what the underestimation is for
the disease,” he said.
And the numbers should continue to increase, he said.
“If it’s like the seasonal flu, about 10 to 15 percent of
the population will get the disease,” Welch said.
Experts, including Welch, are now focused on how swine flu
will emerge in the fall and winter.
“A lot of that speculation comes from the 1918 flu,” Welch
said. “It emerged as a relatively mild H1N1 virus in the spring.”
But it mutated over the summer and came back in the fall,
killing an estimated 20 million to 30 million people globally between 1918
and 1919, with more than 600,000 dead in the U.S.
Today’s version of the H1N1 virus has moved into the
Southern Hemisphere, where flu seasons are beginning with the onset of fall
and winter there, said Dr. Fred Lopez, professor of medicine in infectious
diseases at LSU’s Health Sciences Center, New Orleans.
“This strain has caused some deaths, but it hasn’t been
more virulent than the seasonal flu we have year to year,” Lopez said.
“But that’s just so far,” he added. “We don’t know what
the story will be when it re-emerges in the winter.”
“By then, hopefully, we’ll have a better method to protect
ourselves once a vaccine is developed,” Lopez said.
Government officials have said that by fall or early
winter, there should be a vaccine available.
If the H1N1 flu remains a mild virus in the fall, at the
very least this has been a trial run for preparing for a pandemic, Lopez
said.
“It’s easy to think it’s not going to happen in my
lifetime,” he said of a deadly pandemic. “This one has opened people’s eyes
that the stories of 1918 can re-emerge.”
The World Health Organization announced last week it is
considering raising its alert level for the H1N1 flu to Phase 6 — a
full-blown pandemic.
Confirmed community spread of the disease in a second
region of the world — beyond North America —
would trigger moving to Phase 6 from the current Phase 5 on the WHO’s six-level pandemic alert scale.
The declaration does not indicate the seriousness of the
disease, only the geographic spread of the disease, WHO officials have said.
The WHO reported Monday that 73 countries have reported
25,288, cases, including 139 deaths. Within that number, 13,217 cases were
from the U.S.,
with 27 deaths.
Lopez said he hopes people don’t get complacent about the
disease as summer approaches.
“We aren’t going to know the whole story until fall and
winter get here,” he said. “Interest has waned, but this is still very much
an issue.”
http://www.2theadvocate.com/news/47486237.html
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By MARILYNN MARCHIONE, AP Medical Writer
Lead in ginkgo pills. Arsenic in herbals. Bugs in a baby's
colic and teething syrup. Toxic metals and parasites are part of nature, and
all of these have been found in "natural" products and dietary
supplements in recent years.
Set aside the issue of whether vitamin and herbal
supplements do any good.
Are they safe? Is what's on the label really what's in the
bottle? Tests by researchers and private labs suggest the answer sometimes is
no.
One quarter of supplements tested by an independent
company over the last decade have had some sort of problem. Some contained
contaminants. Others had contents that did not match label claims. Some had
ingredients that exceeded safe limits. Some contained real drugs masquerading
as natural supplements.
"We buy it just as the consumer buys it" from
stores, said Dr. Tod Cooperman, president of
ConsumerLab.com. The company tests pills for makers that want its seal of approval,
and publishes ratings for subscribers, much as Consumer Reports does with
household goods.
Other tests, reported in scientific journals, found
prenatal vitamins lacking claimed amounts of iodine, and supplements short on
ginseng and hoodia — an African plant sparking the
latest diet craze.
"There's at least 10 times more hoodia
sold in this country than made in the world, so people are not getting hoodia," said Dr. Mehmet
Oz, a heart surgeon and frequent Oprah Winfrey guest who occasionally has
touted the stuff.
Industry groups say that quality problems are the
exception rather than the rule.
"I believe that the problem is narrow, that the
well-established and reputable brands deserve their reputations," said
Michael McGuffin, president of the American Herbal
Products Association.
Of course, prescription drugs have had problems, too.
Dozens of deaths were linked last year to tainted heparin, a blood thinner
produced in China,
for example. However, pharmaceutical drugs must show evidence to the
government of safety and effectiveness before they go on sale. Not so for
dietary supplements.
Fifteen years ago, Congress passed a law that treats
supplements like food and allows them to go straight to market without
federal Food and Drug Administration approval. The FDA can act only after
consumers get sick or a safety issue comes to light.
"We called it 'the body rule,'" said William Obermeyer, a chemist who left the FDA to found
ConsumerLab.com with Cooperman. If a supplement was harmful, "we had to
have so many adverse events before we could make a move on it. It was really
like closing the barn door after all the animals left."
The law said the FDA could write quality control rules for
products sold in the U.S.
It took the FDA 13 years to adopt these, and they are just now taking effect.
But the rules do not say what tests companies must do to prove what is in
their products, and some tests can be fooled by subbing other ingredients.
The rules also set no limits on toxins such as lead; nor do they change the
fundamental way these products are sold to the public.
"It leaves the level of quality up to the
manufacturer," Cooperman said.
In a written statement, FDA spokeswoman Susan Cruzan said
the new rules contain what is "needed to ensure quality," and that
products that contain contaminants or whose labels do not honestly describe
their contents, are considered adulterated and subject to further action by
the agency. But she conceded that the agency is spread thin.
"In that FDA has limited resources to analyze the
composition of food products, including dietary supplements, it focuses these
resources first on public health emergencies and products that may have
caused injury or illness," she wrote.
Millions of Americans take vitamin, herbal or other
dietary supplements. Annual sales exceed $23 billion, and more than 40,000
products are on the market. Tens of thousands of supplement-related health
problems are handled by U.S.
poison control centers each year, according to a report in the New England
Journal of Medicine in 2002.
Until last year, supplement makers were not required to
report problems to the FDA, and even now they must report only serious ones.
The agency estimates that more than 50,000 safety problems a year are related
to supplement use.
The Institute
of Medicine, an
independent science panel that advises the government, studied the situation
in 2005.
"The committee is concerned about the quality of
dietary supplements in the United
States. Product reliability is low,"
says its report, which urged amending the 1994 law to tighten consumer
protections.
Trade associations say the FDA's new rules do that.
"We are FDA-regulated products," though not in
the same way as prescription or over-the-counter drugs, said Steven Mister,
president of the Council for Responsible Nutrition.
The FDA can ask law enforcement to act against any company
selling an adulterated product, said McGuffin of
the herbal products association. "You can go to jail, you can have your
company seized," he said.
"We represent companies that we consider the
responsible center of the industry," who are working to comply with the
new rules, he said.
But his group only represents 250 of the 1,500 companies
selling such products. And even though millions of people take supplements
with no apparent ill effects, there have been many quality problems that a
consumer might never realize because they don't always produce symptoms:
_CONTAMINANTS
ConsumerLab.com found lead in at least one brand each of
zinc, black cohosh and ginkgo products tested in
recent years. Lead can accumulate and cause many health problems, and the
testing company wants a national limit of 0.5 micrograms per day — a level
that in California
requires a warning on the label.
A fungal toxin was found in four red yeast rice products
in March 2008. And in 2007, federal officials warned about a liquid herbal
supplement sold for colic and teething pain after finding cryptosporidium, a
waterborne parasite that causes severe diarrhea.
Ayurvedics — popular herbals
used in traditional medicines from India — often contain hazardous
metals, studies in medical journals report. In 2004, researchers tested 70 ayurvedic remedies in the Boston area and found that one in five had
potentially harmful levels of lead, mercury or arsenic. Tests in Houston, Chicago, San Francisco and New
York City turned up similar results.
Metals naturally accumulate in certain herbs and come from
the soil they are grown in. Many supplement ingredients come from Europe, India and China.
"We don't know how much of the ingredients are
imported — whether they're coming from across town or across the world,"
Mister of the trade association conceded.
But even manufacturers get duped, said Jana Hildreth of the Analytical Research Collective, a group
of scientists advocating better supplement testing.
"Companies started going to China and demanding lower
prices," and unscrupulous suppliers sometimes spiked products with cheap
ingredients that can trick lab tests, she said. An example: a buckwheat
derivative, rutin, in place of pricier ginkgo.
_POTENCY PROBLEMS
In ConsumerLab.com testing last November, four out of
seven supplements contained less ginkgo than claimed
on their labels, and one failed to break apart properly to release its
ingredients. Seven out of nine failed in tests in 2003, as did six out of 13
in 2005.
"It is now believed that ginkgo is among the most
adulterated herbs," the company reports.
Tests by California
scientists of two dozen ginseng supplements, reported in a nutrition journal
in 2001, found that many differed from their labels. The concentrations of
some ginseng compounds varied by up to 200-fold from product to product.
In ConsumerLab.com tests, six out of nine chondroitin supplements failed testing in April 2007. One
had only 8 percent of what it claimed to contain, and one "maximum
strength" product had none.
Vitamins and minerals had problems, too. A "high
potency" iron supplement contained less than half the amount claimed. Of
23 top-selling vitamin C pills, one provided less than half the amount
promised; the suggested dosages of some others were beyond recommended safe
levels. Of 10 vitamin A supplements, one provided twice its stated amount,
raising concern about toxic side effects.
Last year, nearly 200 people were sickened by supplements
containing up to 200 times the amount of selenium stated on the label.
Symptoms included hair loss, discolored and painful fingernails, muscle
cramps, joint pain, diarrhea and fatigue.
_HIDDEN PRESCRIPTION DRUGS
The FDA has repeatedly warned about herbal pills found to
contain versions of Viagra and similar drugs to help men get an erection.
These can pose a heart hazard, especially when taken with certain
medications.
In December, the FDA expanded warnings about dozens of
brands of weight loss pills. Though the labels did not say so, some contained
sibutramine, a controlled substance that poses
heart risks; rimonabant, a drug not approved in the
United States;
a seizure medicine, and a diuretic.
Red yeast rice, a traditional Chinese medicine, has
compounds that may block cholesterol in a way similar to statin
drugs. Some red yeast rice products have been found to contain lovastatin, the active ingredient in the drug Mevacor. Problems can occur at high doses or with other
medicines.
_OTHER RISKS
Even "safe" supplements can be harmful. Beta-carotene
takers still had increased rates of lung cancer six years after one study was
stopped. These supplements "appear to increase rates of the disease,
particularly among smokers," the National Cancer Institute warns.
In another study, men taking vitamin E were slightly more
likely to get prostate cancer, and those taking selenium were a little more
likely to develop diabetes. The results could have been due to chance, but
federal officials were taking no chances and stopped the study last October.
Other studies suggest that high doses of vitamin C may
help shield cancer cells from treatments designed to kill the cancer.
"Antioxidants are not the magic bullets that the
supplement industry would like consumers to believe," said David Schardt, a nutrition expert with the consumer advocacy
group, the Center for Science in the Public Interest. "They're not even
necessarily benign."
Herbal sex pills containing the African tree bark extract yohimbe have landed men in hospitals with heart rhythm
problems. This herb can cause high blood pressure, increased heart rate and
other symptoms, the government warns.
The most serious side effects occurred with diet pills
containing ephedra — heart problems, seizures and
even deaths. The FDA banned it in 2004. The battle started in 1997, when the
agency wanted strong warnings on labels, and it became a test case of FDA
authority that went all the way to the U.S. Supreme Court, where the FDA
ultimately prevailed.
_DRUG INTERACTIONS
Ginkgo, vitamin K, garlic, ginseng and other herbals can
cause bleeding or clotting problems if taken with certain medications or
before surgery. St. John's
wort, promoted for depression, affects metabolism
of more than half of all prescription drugs and can undermine birth control
pills. Other supplements that can interfere with medicines include
glucosamine, saw palmetto, soy and valerian.
_OVERSTATED HEALTH CLAIMS
Makers can say a supplement addresses a nutrient
deficiency, supports health, or reduces the risk of developing a problem, but
then must say the product "is not intended to diagnose, treat, cure, or
prevent any disease."
So consumers will see vague claims, such as "promotes
healthy immune system function." The immune system has dozens of parts,
and modifying one can be helpful or harmful, so "it's a quack
concept," said Dr. Stephen Barrett, a retired physician who runs Quackwatch, a Web site on medical scams.
The Federal Trade Commission has stepped up actions
against deceptive ads, said commission lawyer Rich Cleland.
"It is a little like playing Whack-A-Mole,"
because each time one problem is resolved, more seem to pop up, he said.
Last year, his agency reached a settlement against the
makers of Airborne, a supplement aimed at people in crowded places such as
airplanes, offices and schools. Company founders "made false claims that
Airborne products are clinically proven to treat colds," and there is
also no evidence the products can prevent colds, the FTC complaint says.
Airborne's makers agreed to add $6.5 million to the $23.5
million they had already agreed to pay to settle a related private
class-action lawsuit, bringing the total settlement fund to $30 million.
Industry also has stepped up self-policing. The Council
for Responsible Nutrition gave money to the Council of Better Business
Bureaus so it could hire a lawyer to investigate some supplement sellers'
sketchy claims.
"There were cancer cures and 'blast off 29 pounds in
39 days' — really the Wild West of advertising. It was totally out of
control," said the BBB's advertising division director, Andrea Levine.
The BBB council targets the worst claims in popular
categories, such as diet, cold and flu, menopause, joint problems and sleep
aids.
"We can't do them all," but want to send a broad
signal about what kinds of claims are over the line for each type of product,
she said.
http://news.yahoo.com/s/ap/20090609/ap_on_bi_ge/us_med_unproven_remedies_safety
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The New York Times | 06.09.09
By RONI CARYN RABIN
Low-carbohydrate diets like the popular Atkins plan can
lead to rapid weight loss but tend to rely heavily on animal protein, and
studies suggest they may do little to lower LDL, or low-density lipoprotein,
the “bad” type of cholesterol linked to heart disease. Enter what researchers
are calling the “eco-Atkins” diet, a high-protein, low-carbohydrate and
entirely vegan diet.
A small, four-week randomized controlled clinical trial
that tested the new regimen found that overweight adults who consumed a
high-protein, entirely vegan diet were able to lose about the same amount of
weight as a comparison group of dieters on a high-carbohydrate, low-fat
vegetarian dairy diet. But while those on the high-carbohydrate dairy diet
experienced drops of 12 percent in their LDL cholesterol, those on the high
protein vegan diet saw cholesterol reductions of 20 percent.
“We felt this was quite remarkable,” said the study’s lead
author, Dr. David J. A. Jenkins, a professor of medicine and nutritional
sciences at the University
of Toronto and St.
Michael’s Hospital. “The early statins reduced
cholesterol by 30 percent,” he added, referring to the first generation of
cholesterol-lowering statin drugs.
Results of the study were published in this week’s issue
of The Archives of Internal Medicine.
“The idea preyed on me for a long time: Heavens, if the
Atkins Diet looks good, and it’s got so much saturated fat and cholesterol in
it, suppose we took that out and put vegetarian protein sources in, which
themselves may lower cholesterol,” Dr. Jenkins said. “We know that nuts lower
cholesterol and prevent heart disease, and soy is eaten in the Far East, where they don’t get much heart disease. So
we put these foods together as protein and fat sources.”
The 50 participants in the study, all of whom were overweight
men and women with high cholesterol, were randomly assigned to either the
low-carbohydrate high-vegetable protein diet or a high-carbohydrate
vegetarian diet including eggs and dairy for four weeks. All of the food was
provided by the study.
Those in the “eco-Atkins” arm got their protein from vegan
sources like soy, gluten or seitan, nuts and
cereals as well as fruits, vegetables and vegetable oil. The comparison group
ate a more traditional high-carbohydrate but vegetarian diet that included dairy
and eggs and was closely modeled on the DASH diet, an eating plan designed to
lower hypertension.
The low-carbohydrate diet eliminated bread, baked goods,
potatoes and rice but did not reduce carbohydrates as much as the Atkins diet
does. Some 26 percent of the calories in the eco-Atkins plan were from
carbohydrates, compared with 10 percent to 25 percent on the Atkins Diet,
while 31 percent of calories on the eco-Atkins plan came from protein and 43
percent from fat. The high-carbohydrate diet included roughly 58 percent of
calories as carbohydrates, 16 percent as protein and 25 percent as fat, using
low-fat and skim milk dairy products and egg whites or other egg substitutes.
Another popular diet, the South Beach Diet, which some
have dubbed a “modified low-carb” plan, has people
getting up to 28 percent of their calories from carbohydrates.
Twenty-two participants in each group completed the
four-week study, with an average weight loss of 4 kilograms, or just under 9 pounds in each group.
In both groups, participants lost weight because they were
on a reduced-calorie diet, providing 60 percent of daily caloric needs, Dr.
Jenkins said, not because of the composition of the diet.
An editorial accompanying the article said larger
long-term studies of the diet are needed to determine the safety and
sustainability of the regimen.
“This is another option for people who are trying to lose
weight and do it in a prudent manner,” said editorial writer Dr. Katherine R.
Tuttle, who is the medical and scientific director of the Providence Medical
Research Center at Sacred Heart Medical Center in Spokane, Wash. “It suggests
that a high-protein diet, especially one that is more vegetarian-based than
meat-based, appears to have some favorable effects.”
Earlier this year, a large study that compared different
kinds of diets — including low-fat and low-carbohydrate plans — found that
the method didn’t matter as long as people cut calories. That study also
found that after two years, most people had regained at least some of the
weight they had lost.
Dr. Tuttle said that while different weight loss plans
offer people different “tricks” and strategies, ultimately, “It really comes
down to calories in and calories out.”
http://www.nytimes.com/2009/06/09/health/09diet.html?_r=1&ref=health
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