State Sen. Elbert Guillory, D-Opelousas, spoke to the Opelousas Noon Rotary Club on Tuesday about his assessment of the just completed legislative session and what it will mean for this area.

The bad news is that the state had to deal with a $1 billion deficit this year and things aren't looking any better for at least the next two years. The loss of $1 billion in federal stimulus funds alone means next year's budget will start off in the red.

"The revenue estimates are showing a significant shortfall. The next two years will be worse than this," Guillory said.

Because of the many protected funds in the state budget, health care and higher education are among the few areas where significant cuts can be made and, according to Guillory, Gov. Bobby Jindal is too willing to make them do most of the heavy budget lifting for the state.

"Many of us were disappointed with the budget the governor presented us with. It cut too deeply into higher education and health care. A lot of time was spent trying to make those cuts less draconian and we were largely successful," Guillory said.

Despite the Legislature's efforts, Guillory said savings may be possible by streamlined the system.

"There is no question that higher education is bloated. We have too many universities that offer the same degrees, that offer the same courses. There is too much duplication," Guillory said.

He said significant savings can be made by consolidating programs and closing under-performing colleges. "You will see a lot of consolidation in the next four years," Guillory predicted.

While that may be bad news for some areas, especially New Orleans, he said it shouldn't hurt this area too badly. Both UL and LSUE in Eunice are the only schools in their respective areas.

As for health care, Guillory said the big debate is on the fate of "Big Charity."

Charity Hospital in New Orleans is controlled by the LSU system.

The hospital was all but destroyed by hurricanes Katrina and Rita. LSU and the hospital are proposing it be reborn, bigger, better - and more expensively than ever.

"They are talking about a 29 city block area. You are looking at more than $5 billion to relocate families alone," Guillory said.

He said the project, as currently envisioned, would suck up every available dime of health care spending in the state for the next 10 years, which Guillory called excessive.

Instead, he proposed decentralizing health care for the state, putting the money into multiple, smaller, regional facilities.

"That way the people of Acadiana would have a hospital nearby, the same for central and northern Louisiana," Guillory said.

Guillory also outlined some of the host of bills passed - or rejected - by Legislature.

On the subject of local member amendments, often called "pet projects" that are designed to fund a community center here, a police department there - Guillory called them "neither pet nor petty."

The governor vetoed almost every one of them last year and is threatening to do the same this year.

Referring to his own projects to fund local libraries, local men's and women's shelters and law enforcement, Guillory said: "These are all valuable and valid government expenditures."

He said the Legislature gave the governor the line-item veto to remove any inappropriate use of such funds but called Jindal's blank veto "a lazy way to govern. He needs to understand that local government needs assistance from Baton Rouge," Guillory said.

For Guillory this session was a special challenge. He started the session in the House and then won a special election to replace retiring state Sen. Donald Cravins Jr., meaning he finished out the term on the Senate side.

That meant a lot of starts and stops and scrabbling but Guillory said: "I love what I do even though I have never worked harder for less money in my career."

http://www.dailyworld.com/article/20090701/NEWS01/907010301/1002

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LSUHSC, Shriners talk partnership

Shreveport Times | 07.01.09

By Melody Brumble

Henrietta Wildsmith/The Times

Physical therapist Shannon Davis helps Peyton Roth walk with the body weight support system on a treadmill Tuesday afternoon at Shriners Hospital in Shreveport.

Shriners Hospital in Shreveport may get a reprieve.

Members of the board that oversees the hospital are discussing a partnership with LSU Health Sciences Center-Shreveport. Representatives of each group met Tuesday in anticipation of the Shriners annual meeting, at which some 1,500 delegates will decide the fate of the Shreveport hospital and five others.

"I was at a meeting today with most of the powers that be at LSU, and they were upbeat about it," Shriner Bryant Yopp said Tuesday.

Yopp is an emeritus member of the local Shriners Hospital board and one of the delegates who will attend the annual meeting. He heads to San Antonio today for discussions with national hospital trustees about the Shreveport hospital.

A $10 million chunk of the state's budget surplus provided to LSU Health Sciences Foundation in Shreveport will help fund a children's hospital in Shreveport.

"I think everybody's exploring the possibilities" of how LSUHSC-S would be involved in a partnership with Shriners, said Sen. Sherri Cheek, R-Keithville.

"The funding will open many doors. Overall, I think everyone is very pleased. Everybody's goal is to have better health care for children."

News that the hospital might close spurred groups and individuals to donate and raise money. Biker Gene Stewart raised $1,500 with a motorcycle show and related events last weekend. He's planning another fundraiser in the fall.

"Years ago, I played in a band. And we would go out there on Sunday afternoons and play for the kids," Stewart said. "The Shriners do a lot of good work. To make it even better, Shriners is free."

Yopp believes the Shreveport Shriners Hospital will continue providing orthopedic care for children from throughout the region with the help of hospital partners and supporters like Stewart. The 87-year-old Shreveport hospital was the first in the Shriners system.

"The way I have it pictured, (the Shriners delegates) are not going to close a hospital. They're not going to close Shreveport nor any other hospital in the Shriners system," Yopp said. "But I do think the delegates are going to be intelligent enough to know they need to do something."

He believes the delegates may approve measures requiring long-range planning for Shreveport and other Shriners hospitals with an eye toward cutting budgets.

"Shriners Hospital will still have a budget. Even though it won't be as big as it was, we're still going to have a significant amount of money coming into Shreveport and Louisiana," Yopp said.

He thinks delegates also will approve accepting insurance, Medicare and Medicaid payments. Since its inception, the Shriners hospital system has provided free care to children.

However, as the hospital system's endowment shrank during the stock market crash, national trustees started exploring other ways to underwrite the hospitals' budgets.

"Third-party pay is something a potential partner would handle," Yopp said. "We could start doing that right away."

He cautioned that nothing is set in stone but said everything discussed to date would allow Shriners to keep its name and unique, child-friendly atmosphere.

"When you drove up in front of Shriners Hospital, you wouldn't be able to tell any difference at all."

Felicia McGee, of Bossier City, wants the Shreveport hospital to stay open. She and her family moved here from Kansas, in part, so son Peyton Roth could be treated there.

The 4-year-old has cerebral palsy. He underwent leg and hip surgery and is working on physical therapy so he'll be able to stand and walk on his own.

"I would be heartbroken if the hospital closed," McGee said.

"We have an amazing doctor, and the therapists have been outstanding. If it closed, we would have to follow his doctor."

http://www.shreveporttimes.com/article/20090701/NEWS01/907010344/1060

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LSU Health Sciences Center MD/PhD Student Awarded NIH Grant for Research on Protective Effects of Fish Oil in Stroke

LSU Health Sciences Center | 06.30.09

NEW ORLEANS, June 30 (AScribe Newswire) -- Tiffany Niemoller, a 5th year MD/PhD student at LSU Health Sciences Center New Orleans Schools of Medicine and Graduate Studies, has been awarded a grant in the amount of $148,480 over four years by the National Institute on Aging of the National Institutes of Health. A training grant for individual predoctoral students, the Ruth L. Kirschstein National Research Service Award is an individual fellowship (F30) is given to "promising applicants with the potential to become productive, independent, highly trained physician-scientists." It is a very competitive grant. The project is being supported with funds from the American Recovery and Reinvestment Act.

Niemoller is working with Dr. Nicolas Bazan, Boyd Professor and Director, at the LSUHSC Neuroscience Center of Excellence. She is investigating potential therapeutic uses of novel omega-3 fatty acid derivatives in experimental stroke. Injuries like stroke affect the brain's ability to communicate which it does through signaling by chemicals messengers. Niemoller has identified new mechanisms by which omega-3 fatty acids influence cascades of pro-survival protein signaling. Her goal is to define these interactions and characterize their therapeutic potential specifically for the aging brain after stroke.

According to the National Institutes of Health, each year in the United States, there are more than 780,000 strokes. Stroke is the third leading cause of death in the country and causes more serious long-term disabilities than any other disease. Nearly three-quarters of all strokes occur in people over the age of 65 and the risk of having a stroke more than doubles each decade after the age of 55. Stroke places a major health burden on our society in terms of mortality, morbidity and economic costs. The National Stroke Association estimates stroke costs the U.S. about $43 billion a year. Direct costs for medical care and therapy average $28 billion a year. The average cost per patient for the first 90 days after a stroke is $15,000 although 10 percent of those cases exceed $35,000.

"Tiffany is a very bright and talented medical student also working on a doctorate who came to LSU Health Sciences Center after she distinguished herself at the University of California Berkeley," said Dr. Nicolas Bazan, Boyd Professor and Director of the Neuroscience Center of Excellence at LSU Health Sciences Center New Orleans. "It's remarkable how she has grasped an extremely complex research project and has already advanced knowledge about these signals that are decisive in whether brains cells live or die after stroke. Even at this young stage of her career, she is making a difference."

http://newswire.ascribe.org/cgi-bin/behold.pl?ascribeid=20090630.151820&time=16%2003%20PDT&year=2009&public=0

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State budget year begins with cuts

The Advocate | 07.01.09

By MICHELLE MILLHOLLON

Advocate Capitol News Bureau

The new state fiscal year starts today with far less drastic budget cuts than Gov. Bobby Jindal originally proposed.

Widespread layoffs are no longer as likely on public college campuses. Rosedown Plantation in St. Francisville should remain open seven days a week. Food bank shelves should not be completely bare.

But late Tuesday Jindal used his line-item veto to cross $3 million out of $34 million for projects in legislators’ districts.

Locally, Jindal refused $150,000 for the Louisiana Art and Science Museum in downtown Baton Rouge.

He also vetoed funding for several festivals, a library summer movie program in Beauregard Parish, a boat launch, a few Girl Scouts organizations and some senior citizen programs. Jindal stated in his veto message that the projects did not meet his criteria for spending taxpayer dollars on “member amendments.” But he did leave alone $31 million of the legislators’ projects.

Even with last-minute additions by the Legislature and more than $1 billion in federal stimulus money, the $28 billion operating budget for 2009-2010 fiscal year still contains significantly less spending than last year’s $30.1 billion budget. Higher education institutions, health care programs and other state services received less money. About 1,200 state government jobs were eliminated, though most were vacant and few people went unemployed.

In the final hours of the legislative session that ended last week, lawmakers decreased the reductions to many areas of the budget by tapping into the state’s “rainy day fund” and drawing on other revenue sources.

LSU Chancellor Michael Martin said he is grateful the Legislature allowed colleges to avoid the “worst-case scenario,” despite the large cuts that remain.

State Agriculture Commissioner Mike Strain said lawmakers reduced the cuts to his agency by about $4 million.

“We did as good as we could have under the circumstances,” Strain said. “We are all going to have to tighten our belts up.”

Pam Breaux, secretary of the state Department of Culture, Recreation and Tourism, said her agency still is facing substantial cuts.

“Within two weeks, we’ll have all of the plans in place to move forward with organizational strategies that limit the public impact of these cuts,” Breaux said Tuesday.

Natalie Jayroe with Second Harvest Food Bank of Greater New Orleans and Acadiana said, “We’re trying to scramble and figure out how we’re going to meet the needs.”

The recent legislative session began with grim talk about budget cuts to public colleges, health care programs, the arts, state historic sites and agriculture.

The state is facing a $1.3 billion shortfall in revenue. Like the rest of the nation, Louisiana is suffering from the effects of the recession.

Jindal proposed a $26.7 billion budget that contained heavy cuts to many state services.

Public colleges and universities stood to lose $219 million in state funding — a 15 percent reduction — under Jindal’s plan. The Legislature chopped those proposed cuts nearly in half.

The Medicaid program that treats the poor and uninsured faced hundreds of millions of dollars in reductions. Roughly one in every four Louisiana residents is covered by Medicaid. The extent to which lawmakers reduced those cuts still is being determined.

Under Jindal’s original spending plan, the Department of Culture, Recreation and Tourism’s budget was supposed to shrink from $127 million to $89 million.

The arts community protested the proposal in a march outside the State Capitol.

CRT officials asked lawmakers to add $13 million for historic sites, tourism, the Main Street program, state aid to libraries and two art grants.

They warned that the cuts would:

* Eliminate 47 positions at state historic sites.

* Reduce the sites’ opening hours to two days a week instead of seven days.

* Slash $455,000 from the Main Street Program, which helps small communities with downtown development.

* Trim state aid to public libraries from $3 million to $800,000.

* Reduce arts program funding from $7.3 million to $3.2 million.

* Postpone the grand openings of three parks — Bogue Chitto in Washington Parish, Palmetto Island in Vermilion Parish and Fort Randolph/Buhlow near Alexandria.

The Legislature revamped the governor’s proposal to add an additional $2.3 million for state historic sites and $210,490 for the Main Street Program.

With the added funding, Breaux said there will be $1.7 million less in state aid to public libraries and $1.2 million less for arts grants.

She said lawmakers chopped cuts to the Main Street Program in half.

The Legislature inserted $2.1 million for Bogue Chitto State Park but added no funding for Palmetto Island or Fort Randolph/Buhlow.

Strain said the forestry and boll weevil programs within his department are short despite lawmakers’ additions.

“We were grateful for what we have received,” he said.

Jayroe said the $500,000 that food banks received — compared to the $5 million received in the past –—was a blow.

She said the needy will get a lot less food.

“I’m very, very, very concerned,” Jayroe said.

http://www.2theadvocate.com/news/49565042.html

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Jindal: Organizations didn't meet criteria

The Advertiser | 07.01.09

Mike Hasten

BATON ROUGE - Gov. Bobby Jindal use his veto pen Tuesday to scratch through 53 items and provisions, slicing millions of dollars that were to go to local projects across the state.

Prior to the recently concluded legislative session, the governor reminded lawmakers that he had established criteria for funding non-government organizations and that he would veto any that didn't meet those specifications.

Many of the 53 line-item vetoes were local projects but some were within state government. Three just struck language that was deemed unnecessary.

"Just as families and businesses do in response to challenging financial times, we took steps to make sure that government lives within its means, passing a state budget for the upcoming fiscal year that tightens the belt of state government while also protecting critical services," Jindal said in a news release.

Many of the projects injected into House Bill 881, a supplemental appropriations bill, had been vetoed from HB1, the primary appropriations bill that funds state government.

For most of the 55 items vetoed from HB881, this was their axing in a month.

The primary purpose of HB881was to restore funding that was being cut from higher education and health care. Lawmakers chose to also add 434 million in local projects.

Much of the funding was in HB1 but because the bill passed by the Legislature relied on funding sources contingent on legislation that the governor vowed to veto, he sliced it.

Jindal said that "working closely with the Legislature, we took steps through House Bill 881 to mitigate reductions to higher education and healthcare and to give us an opportunity to prepare for continuing budget challenges in the years ahead."

HB881 restored $118.1 million to higher education, which was facing a $219 million cut. That's a reduction of 6.78 percent from current funding, after a $50 million mid-year cut.

The Department of Health and Hospitals, including restorations made in HB881 and $212.8 million authorized by House Bill No. 879 to hospitals for uncompensated care and hurricane related losses, has a 2.94 percent decrease from the previous fiscal year, Jindal said.

The Medicaid private provider program for FY 10 totals $4.2 billion, which the governor says is a $179 million or 4 percent decrease from the previous year. That does not include the special one-time payment of $212.8 million to hospitals. When these one-time hospital payments are included, the net Medicaid private provider program expenditures will increase by 0.75 percent.

Some of the oddities vetoed were the Mayhaw Festival in Calcasieu Parish and Friends of the Fire Departments Engines.

Additional Facts

Some of the vetoed projects

- $5,000 additional Family Violence Program assistance in Iberia Parish

- $5,000 for additional Family Violence Program assistance in St. Martin Parish

- $25,000 for the Voluntary Council on Aging of Iberia Parish

- $25,000 to the St. Martin Parish Government for the St. Martin Council on Aging

- $300,000 to the Louisiana Immersive Technologies Enterprise (LITE) at UL for year two of the 3D Squared digital media technologies and creative processes initiative, and related leadership development program.

http://www.theadvertiser.com/article/20090701/NEWS01/907010327/1002

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New Orleans community health center among 24 in state to receive federal grant

The Times-Picayune | 07.01.09

by The Associated Press

The federal Department of Health and Hospitals is giving Louisiana $411.7 million in Recovery Act grants to 24 community health centers around Louisiana.

The grants were announced Tuesday, as a center in Winnfield opened. It already has $100,000 under the act; U.S. Sen. Mary Landrieu says Tuesday's grants bring another $250,000.

Others, up to $805,485, go to centers in Baton Rouge, Sicily Island, Shreveport, New Orleans, New Iberia, Innis, Avondale, Bastrop, Natchitoches, Clinton, Monroe, Alexandria, Opelousas, St. Gabriel, Luling, Greensburg, Lake Charles, Franklin, St. Joseph and Independence.

The Iberia Comprehensive Community Health Center is getting the largest grant. The St. Thomas Community Health Center in New Orleans, like the Winn Community Health Center, is getting $250,000.

http://www.nola.com/news/index.ssf/2009/07/new_orleans_community_health_c.html

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Jindal vetoes money for hospital

The Times-Picayune | 07.01.09

By Jan Moller

Capital bureau

BATON ROUGE -- Gov. Bobby Jindal used his line-item veto authority Tuesday to eliminate $14.2 million the Legislature had earmarked for the New Orleans Adolescent Hospital, a move that means the Uptown mental facility is likely to close by Sept. 1.

The governor also reduced at least $3 million legislators set aside for their own pet projects as he signed the last major spending bill from the 2009 legislative session that wrapped up last week.

A Department of Health and Hospitals spokesman said the hospital money will be redirected elsewhere in the mental health budget, and that the 35 inpatient beds at NOAH will be shifted to Southeast Louisiana Hospital near Mandeville.

J.T. Lane, deputy chief of staff to Health and Hospitals Secretary Alan Levine, said there will be no net reduction of services in the New Orleans area as a result of the veto and that the department plans to open two new outpatient clinics by the end of the summer: one on Canal Street and another on the West Bank.

Jindal's original budget blueprint proposed closing NOAH and moving its operations to the Mandeville hospital, a move that administration officials said would save $9.1 million without any loss of services. But legislators disagreed, and added language designed to keep the Uptown hospital open, albeit with a smaller operating budget than in the current year.

In his veto message, Jindal said the restorations for NOAH "do not appropriate new funds, but only shift funds from Southeast Louisiana Hospital in Mandeville and from other outpatient mental health services . . . therefore requiring additional cuts to these inpatient and outpatient programs."

Legislators who fought to keep the hospital open said they were disappointed with the governor's veto.

Rep. Neil Abramson, D-New Orleans, whose Uptown district includes NOAH, disputed the administration's claims that restoring money for the hospital would lead to cuts elsewhere. He said the $14 million restoration plus $3 million for outpatient services would have meant an overall budget cut of about 15 percent for NOAH, an amount Abramson said is "in line with" what many other agencies will take.

Cecile Tebo, director of the New Orleans Police Department's mental health crisis unit, said the administration's priority should have been finding more inpatient beds in the city -- the center of the metropolitan area -- rather than Mandeville.

The NOAH veto was among 53 separate cuts by Jindal to House Bill 881 by Rep. Jim Fannin, D-Jonesboro, a supplemental spending bill that lawmakers approved in the final minutes of the 2009 session and which restores millions of dollars to health care, higher education and lawmakers' pet projects.

The bill resulted from a series of last-minute negotiations between the House and Senate over the size and shape of budget cuts to health care and education programs. It used money from the state's rainy-day fund, an expired insurance-incentive program and other one-time sources to plug back some -- but not all -- of the spending that Jindal had tried to cut.

Besides the NOAH language, Jindal also eliminated financing for dozens of legislators' earmarks, including $500,000 for the Algiers Development District.

The reductions for the development district appear to be directed at House Speaker Jim Tucker, R-Algiers, who championed the money but broke with the administration on a bill that sought to open more records in the governor's office to public inspection.

Jindal offered no explanation for vetoing the Algiers money.

Other vetoes include $60,000 for the New Orleans Afrikan Film and Arts Festival; $150,000 for the Louisiana Arts & Science Museum; $300,000 for a boat ramp in St. Charles Parish; $50,000 for the Satchmo SummerFest; and $7,755 for the Starks Mayhaw Festival in Calcasieu Parish.

http://www.nola.com/news/?/base/news-2/1246426209237080.xml&coll=1

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New Orleans Mayor Nagin Responds To Louisiana Governor Veto Of Hospital Funding

BayouBuzz | 06.30.09

Written by: BayouBuzz Staff

New Orleans Mayor Nagin has responded to Louisiana Governor Bobby Jindal after the Governor vetoed funding for the New Orleans Adolescent Hospital. Previously, the Mayor had written the Governor expressing in advance his concerns about the possible closure of the hospital and has made NOAH the leading legislative item for the spring 2009 regular session.

Here is the statement from Mayor C. Ray Nagin after discovering that the Governor vetoed funding for NOAH.

"I want to thank the New Orleans legislative delegation for their hard word during this legislative session to ensure that the needs of our citizens are met. I am disappointed that Governor Jindal has vetoed funding for NOAH, as we continue to face a mental health crisis, with increased suicides, higher rates of depression and more mental health related arrests.

"I am calling on Governor Jindal to ensure that appropriate mental health services are available to all New Orleanians. I will be asking to meet with the Governor to discuss how the state can use recovery resources to restore our health and mental health network, which was decimated by Hurricane Katrina."

C. Ray Nagin

Mayor

http://www.bayoubuzz.com/News/Louisiana/Government/New_Orleans_Mayor_Nagin_Responds_To_Louisiana_Governor_Veto_Of_Hospital_Funding__9117.asp

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Jindal Vetoes New Orleans Mental, Health Services: Louisiana DHH Comments

BayouBuzz | 06.30.09

BayouBuzz Staff

The following is a statement from DHH Secretary Alan Levine on Mental Health Services in New Orleans and Veto of New Orleans Adolescent Hospital:

It is clear Gov. Jindal has listened to the stakeholders and decided to follow the evidence by opening two new clinics in New Orleans, maintaining the inpatient bed count in the region and adding new community- and home-based services. Without a veto of the New Orleans Adolescent Hospital, which was underfunded by HB 881, DHH would have been forced to make cuts that would harm New Orleans-area children, adults and families.

In the executive budget, we offered a proposal that would expand evidence-based, community placed services in New Orleans without decreasing the number of inpatient beds available to serve adults and youth. The Department’s proposal expanded these important community-based services while also saving the state $9.1 million annually.

The cost of operating the New Orleans Adolescent Hospital (NOAH) annually is $24 million. We proposed retaining $4 million to dedicate to community-based services, including the opening of at least two additional community mental health sites in Algiers and Mid-City. Of the remaining $20 million cost to operate the inpatient services at NOAH, the HB 881 NOAH amendment only funded $14.2 million – leaving a shortfall of $5.8 million. Problematic is the fact that $10.2 million of the $14.2 million restoration would have been required to be moved from Southeast Louisiana Hospital (SELH) in Mandeville, leaving a shortfall at SELH as well. And, the amendment required $4 million of SSBG funding be moved from the Area A mental health programs, further reducing the dollars available for proven community-based services.

To deal with these shortfalls, significant cuts would have had to be made to existing services. These cuts could have been implemented in a number of ways, including, among others, the following options or combination of options:

-Closure of 20 adult beds at NOAH, reducing the total number of beds in the region and thereby reducing access for at least 400 adults.

-Closure of evidence-based community services such as Forensic Assertive Community Teams, Assertive Community Teams or Child and Adolescent Response Teams, for example, resulting in the loss of capacity for these services for nearly 1,000 children, adults and families. Currently, the FACT team is serving 83 individuals, the ACT team is serving 74 individuals, the CART team is serving 335 children and 128 families and individuals are receiving supported housing.

-Closure of 12 adult beds and 10 youth beds at SELH, reducing the total number of beds in the region and thereby reducing access for 288 adults and 60 youth.

-A combination of other bed closures or service reductions.

The net result of these, and other, options was the potential for the reduction of as many as 49 adult and child beds in the region or a step backwards in the recent investments made in community-based services, such as FACT, ACT and CART. This would have had a devastating impact on literally hundreds of people currently seeking, or potentially requiring, services.

This is clearly unacceptable, as these options missed the goal of reducing cost while optimizing services. In fact, continuing to fund the inpatient beds at NOAH, at twice the daily cost as other inpatient facilities, makes no financial sense, and would have led to the unnecessary reduction of critical services to the region. Last year, NOAH served only 70 children as inpatients, while the recent investments in community-based services are helping literally hundreds of children and adults. NOAH is not a crisis unit for adults, and therefore consolidation of the beds at SELH will have no impact on the crisis system. The data shows that most referrals for institutional care from the Mental Health Emergency Room Extension at the Interim Hospital are made to DePaul and not to NOAH – demonstrating that other institutions play a far more significant role in the provision of inpatient mental health services. Quite simply, this amendment subsidized higher cost inpatient services by reducing beds at another institution, or worse, retreating on the major investments made in evidence-based community services.

Building a Robust Continuum of Care in New Orleans

Last year, a tragedy unfolded in New Orleans that captured the collective concern of all who are frustrated with Louisiana’s lagging mental health system. A heroic young police officer, Nicola Cotton, was murdered with her own weapon at the hands of Bernel Johnson. As reported in the press, Mr. Johnson was released from a state mental health institution prior to this horrific act. In reviewing this case, it was clear the lack of available community-based services—and the lack of a means to compel participation by Mr. Johnson in these services once released from institutional care—had a great deal to do with this terrible outcome. This event led to swift and aggressive action by Gov. Jindal and the Department, in partnership with the local community. The Governor issued an emergency Executive Order directing DHH to intervene in the Metropolitan Human Services District, leading to new leadership and massive reforms. The state sought from the Legislature an emergency appropriation, and invested in millions of dollars in proven community-based services, such as Forensic Assertive Community Teams, Assertive Community Teams and Child and Adolescent Response Teams. A variety of other therapies were expanded, such as Multi-Systemic Therapy, Functional Family Therapy and other programs. And, the Governor proposed several pieces of legislation intended to begin a transformation of the mental health system in New Orleans and statewide. Among the legislation was a bill referred to as “Nicola’s Law.” This law permits DHH to seek Involuntary Outpatient Treatment for people who need these preventive services, but whom refuse to—or cannot—participate or comply, as was the case with Mr. Johnson. If an individual is proven to need the services in order to protect themselves or the public, they would be compelled to comply or face the potential for being involuntarily placed in inpatient care by a judge.

These actions were taken because it was clear that once released from the state inpatient institution, there were few community-based services available to Mr. Johnson, and no means by which the patient could be directed to participate, even if they were available. There was no Forensic Assertive Community Team or, for that matter, no other coordinated way of ensuring the patient received the services that may have helped avoid this tragedy. Today, because of our actions, with the support of the Legislature, these venues are now available, and hundreds of people are benefiting. We cannot afford to go backwards.

According to the Surgeon General’s Mental Health report, which was co-authored by the National Institutes of Health and the U.S. Substance Abuse and Mental Health Services Administration, the national trend in mental health is to reduce dependence on inpatient services and move toward effective evidence-based community services. One such service is Assertive Community Treatment (ACT), which has proven to reduce inpatient hospital days by at least 58 percent, jail days by 83 percent and homelessness by 37 percent, according to studies by Dartmouth Medical School, Indiana University and Purdue University. Additionally, National Mental Health Association studies show that at least 40 percent of the hospital placements of children are not appropriate and the children would be better-served by community-based services.

Virtually all states are moving toward a community-based model of care, and are reducing and reorganizing state psychiatric inpatient units. This is evidenced by simply evaluating the changes in state expenditures. Data shows that in 1981, states spent roughly 63 percent of their mental health budgets on hospital beds and 33 percent on community-based mental health services. By 1993, those same expenditures were equal. By 2004, about 69 percent of state mental health budgets were spent on community-based services and 29 percent were spent on inpatient hospital beds—a complete reversal of more than 20 years ago. Today, Louisiana spends 57 percent on inpatient hospital beds and 43 percent on outpatient, community-based mental health services – clearly demonstrating we are lagging the nation in needed improvements. This is both wasteful of resources and demonstrates an improper balance of service provisions. Plainly, as demonstrated by our proposal, the state could save $9.1 million without reducing bed capacity while increasing access to community-based services. This happens when we make better use of limited resources, and spend the money where it will work the hardest—in the community closest to our families and neighborhoods.

In 2005, DHH, in partnership with other state agencies, began developing a plan for specific changes to Louisiana’s System of mental health care delivery. Last year, through HCR 184, the Legislature created the Mental Health Care Improvement Task Force to study the ongoing mental health crisis in Louisiana and the progress made on the 2005 plan. The Task Force—including representatives from DHH, LSU, Louisiana Mental Health Planning Council, Mental Health America of Louisiana, Louisiana State Medical Society, Louisiana Psychiatric Medical Association and the AFL-CIO—recognized the significant advances made in last year’s implementation of the new community-based programs and called for continued coordination in the system. Indeed, if the mental health funding available is misdirected and used to support inefficient hospital services, the very advances we have made in improving the system will be lost. Specifically, the task force recommended:

“…the following evidence-based practices as the initial focus for statewide training and implementation: Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Assertive Community Treatment, Forensic Assertive Community Treatment, Multi-Systemic Therapy, Functional Family Therapy, Illness Management and Recovery, Family Psychoeducation, Medication Management Approaches in Psychiatry, Supported Employment, and Co-Occurring Disorders.”

After Hurricane Katrina, several community access points were closed, and families were required to commute to NOAH in order to receive these otherwise community-based services. We proposed reopening outpatient access points on New Orleans’ east and west banks—thereby bringing these services closer to the communities that lost them after Katrina. Set to open in August, these clinics will offer the ACT, FACT, CART and Supportive Housing programs, as well as other new programs, in easily accessible locations near public transportation. These clinics will offer screening and assessment, psychiatry and medication management, collateral counseling with parents, life skills treatment for youth and substance abuse prevention and treatment services. DHH will continue to offer services from the Mobile Mental Health van (NOAH’s Ark) that travels throughout the three parish area and especially serves families in low lying areas of St. Bernard and Plaquemines parishes. DHH will staff all sites with psychiatrists and psychologists from the LSU and Tulane Departments of Child Psychiatry, which will train the mental health workforce of the future.

Of note, we will fully staff three new community- and home-based Medicaid-billable teams:

-Two Multi-Systemic Treatment (MST) teams, which will treat 120 children, adolescents and their families; and

-One (FFT) Functional Family Therapy team.

MST therapy, one of the services targeted for expansion, is an intensive service that treats severe behavioral problems and decreases out-of-home care by 64 percent, according to juvenile justice and mental health experts. FFT, an evidence-based family systems approach, also lessens out-of-home placement and reduces recidivism by up to 60 percent.

In addition to the commitment to continue the services referenced above, as well as the expanded services, the following ongoing services will be continued through this transformation initiative:

-Access Unit to triage all the calls and coordinate with the Child and Adolescent Crisis Response Team (CART), which responds to prevent or quickly de-escalate crisis situations and serves 300 people each year.

-Six Community-based Crisis Respite beds for diversion from hospital and out-of-home placements and serves nearly 300 clients per year.

-Two Louisiana Spirit Specialty Access Teams with 20 staff members will be available to schools and communities for children and families still struggling from storm-related trauma.

-Five Louisiana Spirit General Outreach Teams comprising 50 staff members will be providing ongoing storm recovery counseling 24/7 to adults and children in the communities of Orleans, Plaquemines, St. Bernard and Jefferson parishes.

-DHH’s LA-YES’s System of Care Initiative, which provides intensive case management to 150 youth involved in the juvenile justice or child welfare systems each year.

-Early Childhood Supports and Services program, which treats children ages 0-5 and is a future Mental Health Rehabilitation (MHR) provider. This program is the state-wide training site for all infant mental health providers through an MOU with the Tulane Department of Psychiatry’s Infant Mental Health Division.

-Coordination with MHSD’s Child and Adolescent Division for utilization of wrap-around funds to pay for unmet needs such as transportation, uniforms, cash subsidies, recreational programming.

DHH is moving forward to carry out this plan on behalf of the children, adults and families of the Greater New Orleans area. I remain committed to transforming our health care delivery system to one that is responsive to the needs of people rather than the needs of government.

Alan Levine

DHH Secretary

http://www.bayoubuzz.com/News/Louisiana/Government/Jindal_Vetoes_New_Orleans_Mental_Health_Services_Louisiana_DHH_Comments___9115.asp

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Medicaid: True Or False?

Kaiser Health News | 07.01.09

By Phil Galewitz

Because of its size and cost, Medicaid has been called the "workhorse" of the U.S. health system. Now it’s front and center in the debate on overhauling the U.S health system and expanding coverage to the uninsured. With 60 million enrollees, Medicaid dwarfs other insurance programs, including its cousin, Medicare, which covers 44 million elderly and disabled people.

Test your knowledge of Medicaid:

1. Medicaid is a national program of the federal government.

Partly true. Medicaid is a joint federal-state program, with the federal government picking up about 57 percent of the overall Medicaid tab. But the federal contribution varies by state, ranging from 50 percent to 73 percent, with poorer states getting a bigger matching rate.

Medicaid isn’t a one-size-fits-all program; after meeting certain federal requirements, each state has the flexibility to shape coverage and benefits. As a result, the Medicaid program in Pennsylvania bears little resemblance to the one in Louisiana. For example, non-working parents in Pennsylvania qualify for Medicaid if their incomes are below twice the federal poverty level ($44,100 for a family of four). But in Louisiana, non-working parents qualify only if their incomes are below 11 percent of the poverty level ($2,426 for a family of four). States frequently experiment with new concepts in benefit design, eligibility and delivery systems.

2. If you're poor enough, Medicaid will cover your health care needs.

False. Medicaid covers about 45 percent of poor Americans, defined as those with incomes below the federal poverty level (about $22,000 for a family of four). To be eligible for coverage, individuals must fall below certain income thresholds, which vary by state, and belong to certain categories, such as having dependent children, or being pregnant or disabled. In 20 states, a parent in a family of four who gets paid the federal minimum wage makes too much to qualify. Only 18 states cover adults without dependent children.

3. Medicaid provides bare-bones coverage compared to what’s available in the private sector.

False. "At least on paper, Medicaid has a longer list of benefits than many private plans," said John Holahan, director of the health policy center at the Urban Institute, a Washington think tank. Medicaid benefits include mental health services, transportation-to-health services, and comprehensive screenings and treatment for children. In addition, Medicaid enrollees have much lower out-of-pocket costs than people with private coverage. There are typically no monthly premiums and no, or very low, copayments.

4. Medicaid patients get better treatment than patients covered by private insurance.

Not necessarily. In many states, specialists and dentists don’t see Medicaid patients. "It is far from a given to get referrals to specialists," said Dan Hawkins, policy director for the National Association of Community Health Centers. Providers typically blame low reimbursement rates as the main reason for not accepting Medicaid patients. In Kentucky, Medicaid pays doctors $210 for a colonoscopy; Medicare pays $333. Private insurers usually pay more. In Pennsylvania, Medicaid pays doctors $300 for an appendectomy, while Medicare pays $575. "It's a sad fact that Medicaid payments don't come close to covering the cost of caring for the vulnerable patient population that relies on it for coverage," said Dr. Joseph Heyman, chairman of the American Medical Association Board of Trustees.

5. Most Medicaid enrollees are children and their parents.

True. About 76 percent of all enrollees are children and their parents. And 65 percent of people on Medicaid come from working families.

6. Most Medicaid spending pays for services for children and their parents.

False. About three quarters of Medicaid spending is for the elderly and disabled, even though the two groups make up only about one quarter of the program’s enrollees. Medicare provides little coverage for long-term care, so many elderly, after depleting their savings, rely on Medicaid to pay their costly nursing home bills.

7. Medicaid is more efficient than private insurance.

True. Administrative costs of Medicaid are less than 7 percent, or half the rate that’s typically seen in the private sector. Medicaid holds down costs in part by paying providers lower fees and doing little marketing.

http://www.kaiserhealthnews.org/Stories/2009/July/01/Medicaid-True-or-False.aspx

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Vicodin, Percocet should be pulled off market, FDA panel recommends

The Times-Picayune | 06.30.09

by Matthew Perrone, The Associated Press

ADELPHI, Md. (AP) -- Government experts say prescription drugs like Vicodin and Percocet that combine a popular painkiller with stronger narcotics should be eliminated because of their role in deadly overdoses.

A Food and Drug Administration panel voted 20-17 that prescription drugs that combine acetaminophen with other painkilling ingredients should be pulled off the market.

The FDA has assembled a group of experts to vote on ways to reduce liver damage associated with acetaminophen, one of the most widely used drugs in the U.S.

Panelists cited FDA data indicating 60 percent of acetaminophen-related deaths are related to prescription products. Acetaminophen is more commonly found in over-the-counter medications like Tylenol and Excedrin.

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

New therapy found to prevent heart failure

UPI.com | 06.30.09

U.S. scientists say implantable cardiac resynchronization devices can produce a 29 percent reduction in heart failure or death in heart disease patients.

University of Rochester Medical Center researchers said the results came from a 4 1/2-year clinical trial that involved more than 1,800 patients in the United States, Canada and Europe. Some of the patients used an implanted cardiac resynchronization therapy device with defibrillator and some were given only an implanted cardiac defibrillator.

The study, led by Dr. Arthur Moss, ended last week.

A prior study by Moss and associates in 2002 showed implantable cardiac defibrillators were effective in reducing mortality. The new study sought to determine if cardiac resynchronization devices with defibrillators could reduce the risk of mortality as well as heart failure.

Moss said the results are very positive.

"Now we can prevent sudden cardiac death and inhibit the development of heart failure, thus improving survival and outcome in patients with heart disease," Moss said. "There is a very large population of patients with heart disease who will benefit from this combined therapy."

http://www.upi.com/Science_News/2009/06/30/New-therapy-found-to-prevent-heart-failure/UPI-38011246387616/

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Insured, but Bankrupted by Health Crises

The New York Times | 06.30.09

By REED ABELSON

Erich Schlegel for The New York Times

Claire and Larry Yurdin filed for bankruptcy when his insurance didn’t cover his medical bills.

Health insurance is supposed to offer protection — both medically and financially. But as it turns out, an estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured.

And so, even as Washington tries to cover the tens of millions of Americans without medical insurance, many health policy experts say simply giving everyone an insurance card will not be enough to fix what is wrong with the system.

Too many other people already have coverage so meager that a medical crisis means financial calamity.

One of them is Lawrence Yurdin, a 64-year-old computer security specialist. Although the brochure on his Aetna policy seemed to indicate it covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the treatment he received at an Austin, Tex., hospital.

He and his wife, Claire, filed for bankruptcy last December, as his unpaid medical bills approached $200,000.

In the House and Senate, lawmakers are grappling with the details of legislation that would set minimum standards for insurance coverage and place caps on out-of-pocket expenses. And fear of the high price tag could prompt lawmakers to settle for less than comprehensive coverage for some Americans.

But patient advocates argue it is crucial for the final legislation to guarantee a base level of coverage, if people like Mr. Yurdin are to be protected from financial ruin. They also call for a new layer of federal rules to correct the current state-by-state regulatory patchwork that allows some insurance companies to sell relatively worthless policies.

“Underinsurance is the great hidden risk of the American health care system,” said Elizabeth Warren, a Harvard law professor who has analyzed medical bankruptcies. “People do not realize they are one diagnosis away from financial collapse.”

Last week, a former Cigna executive warned at a Senate hearing on health insurance that lawmakers should be careful about the role they gave private insurers in any new system, saying the companies were too prone to “confuse their customers and dump the sick.”

“The number of uninsured people has increased as more have fallen victim to deceptive marketing practices and bought what essentially is fake insurance,” Wendell Potter, the former Cigna executive, testified.

Mr. Yurdin learned the hard way.

At St. David’s Medical Center in Austin, where he went for two separate heart procedures last year, the hospital’s admitting office looked at Mr. Yurdin’s coverage and talked to Aetna. St. David’s estimated that his share of the payments would be only a few thousand dollars per procedure.

He and the hospital say they were surprised to eventually learn that the $150,000 hospital coverage in the Aetna policy was mainly for room and board. Coverage was capped at $10,000 for “other hospital services,” which turned out to include nearly all routine hospital care — the expenses incurred in the operating room, for example, and the cost of any medication he received.

In other words, Aetna would have paid for Mr. Yurdin to stay in the hospital for more than five months — as long as he did not need an operation or any lab tests or drugs while he was there.

Aetna contends that it repeatedly informed Mr. Yurdin and the hospital of the restrictions in policy, which is known in the industry as a limited-benefit plan.

The company says such policies offer value by covering some hospital expenses, like surgeons’ fees or a stay in the intensive care unit. Aetna also says all of its policyholders receive significant discounts on the overall cost of hospital care. But Aetna also acknowledges that a limited-benefit plan was inappropriate in Mr. Yurdin’s case because his age and condition — an irregular heartbeat — made him likely to require more comprehensive coverage.

“Limited benefits aren’t right for everyone, and it clearly wasn’t right for Mr. Yurdin,” said Cynthia B. Michener, an Aetna spokeswoman.

Charles E. Grassley, the ranking Republican on the Senate Finance Committee, which is taking a lead on health legislation, says Congress needs to make “meaningful” insurance coverage more affordable and accessible. But “until that happens,” he said, “any presentation of limited-benefit plans ought to be completely straightforward, and not misleading in any way.”

Insurers like Aetna generally defend limited-benefit policies as a byproduct of the nation’s flawed health care system, which they say makes it too expensive to adequately insure someone like Mr. Yurdin.

If everyone in the country were required to have insurance, the industry says — a mandate that Congress is contemplating — the costs and risks of insurance would be spread over a large enough pool of people to let insurers provide full, affordable coverage even to people with pre-existing medical conditions.

Mr. Yurdin worked at TEKsystems, which employs people for short periods as contractors for other companies. TEKsystems says it does not pay for the contract workers’ health benefits, but it does enable them to purchase individual policies with limited benefits so they have at least some coverage.

“There’s no way we make this sound like regular coverage,” said Neil Mann, an executive vice president at Allegis Group, which owns TEKsystems.

Although Mr. Mann acknowledged that the plan Mr. Yurdin purchased excluded routine hospital care, he said he thought it still provided value to employees who wanted “peace of mind.”

True peace of mind, however, comes with a much higher price tag. When Mr. Yurdin no longer qualified for the Aetna coverage after he left TEKsystems and his eligibility eventually ended, his only option was a special state plan in Texas for people who are at high risk for expensive medical care. He has been paying more than $1,000 a month for comprehensive coverage, compared with the roughly $250 a month he was paying for the Aetna plan.

But as of Wednesday, his future insurance problems are largely solved: he qualifies for Medicare because he turns 65.

Many insurers, as part of the Congressional overhaul of their business, say they expect the demand for limited-benefit policies to fall. “Until the nation achieves the universal coverage that we strongly support, some individuals will want to be able to choose limited indemnity products, but with comprehensive health reform we think that need should diminish,” said Simon Stevens, an executive at UnitedHealth.

UnitedHealth drew criticism last year for selling policies with sharply limited coverage through AARP, the advocacy group for older people. One of the plans capped reimbursement for an operation at $5,000, for example, although many procedures cost at least several times that amount. After Senator Grassley began investigating its sales practices, UnitedHealth agreed to stop offering the limited AARP plans.

Mr. Yurdin and his wife say it was not clear that he was liable for tens of thousands of dollars in hospital bills until after he had the first two of what would eventually be four operations. St. David’s says it tried to persuade them to apply for charity care, under which the hospital would absorb much, or all, of the unpaid bills.

But the couple says a lawyer advised them to turn to bankruptcy as the way to be certain they would not be left with too much debt. “I knew we were getting way, way over our heads,” Mrs. Yurdin said.

While Aetna disputes the Yurdins’ and the hospital’s version of events, it also says it has tried to clarify the language it uses to describe the coverage. In its most recent brochure, the fine print describing the limits to “other” hospital services now defines what they are in a footnote on the same page and warns that the excluded expenses could be “significant.”

Senator John D. Rockefeller IV, Democrat of West Virginia, who is also on the Finance Committee, has introduced legislation that would require insurers to be more clear about what they do — and do not — cover. He says he advocates such a change, even if Congress cannot agree to a more sweeping overhaul of the health insurance industry.

But advocates for broad changes to the health care system say Congress can succeed only by making sure health reform goes beyond giving every American a buyer-beware insurance card. One such person is Len Nichols, a health economist for the New America Foundation.

“Conceptually,” he said, “insurance means normal people should not go bankrupt from serious medical conditions.”

http://www.nytimes.com/2009/07/01/business/01meddebt.html?_r=1&ref=health

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Panel Suggests U.S. Medical Priorities

The New York Times | 06.30.09

By BARRY MEIER

Ozier Muhammad/The New York Times

It isn’t clear whether drugs or ablation, a surgical procedure, is more effective to treat a heart problem called atrial fibrillation.

An influential scientific advisory panel has recommended that federal officials give top priority to comparing the effectiveness of competing medical strategies in areas that include treating prostate cancer, reducing hospital infections and lowering the rate of unwanted pregnancies.

In a highly anticipated report, released Tuesday morning, a panel assembled by the Institute of Medicine released a list of 100 health topics that it said should get high priority as the Obama administration proceeded with a plan to spend $1.1 billion in comparing the effectiveness of competing drugs, medical devices, operations and other treatments for specific health conditions.

The report is one of the first concrete steps in a broad effort by administration officials and health experts to shift the focus of medical practice toward scientific evidence — rather than a physician’s personal views or treatments promoted by medical product companies.

Currently, though, in many areas of medicine there is scant data that compare competing strategies. And systems for gathering such data by mining hospital or insurance industry records are also very limited.

“Health care decisions too often are a matter of guesswork, because we lack good evidence to inform them,” said Dr. Harold C. Sox, the editor of The Annals of Internal Medicine, a medical journal, who was co-chairman of the panel.

Supporters of comparative effectiveness reviews include many medical researchers, consumer groups, unions and insurers. They say such studies are essential to curbing the widespread use of ineffective treatments and to helping control health care costs, which totaled $2.2 trillion in 2007, or 16 percent of the nation’s gross domestic product.

But the effort has come under attack by critics, including some conservative commentators and medical products companies, who warn that the process could lead to inadequate treatment for some patients and even the rationing of health care. There also may be sharp Congressional debate in the weeks ahead on issues like whether a new federal entity should be created to oversee government-financed comparative research and what role private industry might play in the effort.

Dr. Sox said that medical products makers had a “muted” response to the panel’s efforts, including its call for public comments and recommendations on what should receive financing for comparativeness reviews. Of the approximately 2,000 recommendations the panel received, only 28 came from makers of medical devices, drugs or biologic products, he said.

While medical products manufacturers pay for clinical trials of their own products, such studies often compare a drug or device’s effectiveness in treating an illness against a placebo or no treatment, rather than against a competing product or treatment. In addition, people selected for clinical trials often do not represent the many different types of patients who will receive a drug or device after it is approved by federal regulators for sale.

In many areas of medicine, there is frequently more than one treatment with no clear winner. To treat prostate cancer, for example, a patient is faced with strategies ranging from watchful waiting to surgery to the use of radioactive implants.

A similar conundrum faces patients diagnosed with abnormal heart rhythm known as atrial fibrillation. In such cases, a doctor may recommend drugs or a surgical procedure known as ablation, with little evidence as to which strategy works better or has fewer side effects.

The Institute of Medicine panel said studying both those conditions should be among the top priorities.

The panel, composed of doctors, health care experts and consumers, was convened at the request of Congress. Its recommendations are expected to have an impact on how some of $1.1 billion initially allotted by lawmakers for comparative effectiveness research is spent.

Along with recommending 100 health areas for comparative effectiveness reviews, the panel’s report focused heavily on setting up systems for collecting the data to undertake such studies and ensuring that such information is clearly communicated to patients. The panel also urged that the government subsidize the training of a new generation of researchers skilled in doing comparative effectiveness reviews.

While most of health areas cited by the panel involved medical treatments, others included topics like the best way to reduce hospital-based infections or to compare the effectiveness of differing medical imaging technologies.

Some of the panel’s recommendations also involved social or preventative issues that could generate controversy among industry or interest groups. For example, the panel urged that researchers look at the effectiveness of school programs to reduce childhood obesity through means like bans on vending machines. It also recommended research to determine the programs most effective in reducing unwanted pregnancies, including the free distribution of contraceptives.

Speaking to reporters Tuesday, Dr. Sox, the medical journal editor, said that based on public comments, the panel had decided it was important to look at such public health issues.

http://www.nytimes.com/2009/07/01/health/policy/01compare.html?ref=health

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Study Dismisses Protein’s Role in Heart Disease

The New York Times | 06.30.09

By GINA KOLATA

A blood protein that only a short time ago was thought by some to be more important than cholesterol in heart disease now appears to be little more than a bystander.

The substance, C-reactive protein, or CRP, a marker of inflammation in the body, is unquestionably associated with heart disease: the more CRP in a person’s blood, the greater the likelihood of heart disease.

But in a paper to be published Wednesday in The Journal of the American Medical Association, researchers analyzing genetic data from more than 100,000 people conclude that their study “argues against” the notion that the protein causes heart disease.

Dr. David Altshuler, a professor of genetics and medicine at Harvard Medical School, said the distinction was important. If CRP caused heart disease, lowering it would protect people. But if it was merely associated with the disease, lowering CRP would have no more effect on health than quelling a shrieking fire alarm would have on putting out a fire.

Many believed CRP caused heart disease, especially after a widely publicized study released last year suggested that people with low cholesterol but high CRP levels had fewer heart attacks if they took a statin, a cholesterol-lowering drug that also lowers CRP.

That could mean that lowering CRP could prevent heart disease. Of course, it also could have been the cholesterol lowering that was protective, but many researchers argued that it was the reduction in CRP.

“There certainly has been a very vocal constituency in the idea that CRP causes or contributes to the development of heart disease,” said Dr. Daniel Rader, a lipid expert at the University of Pennsylvania. He noted that some companies were trying to develop drugs to lower CRP.

But Dr. Michael S. Lauer, director of the division of prevention and epidemiology at the National Heart, Lung and Blood Institute, said it might now be smart to abandon that search.

“It is likely that drugs or agents that specifically target CRP are not going to work,” Dr,. Lauer said.

The findings will not change current treatment. And one leading CRP researcher, Dr. Paul M. Ridker of Brigham and Women’s Hospital in Boston, director of last year’s study, called Jupiter, and the researcher most closely associated with the excitement over CRP, said the new study did not change anything for him.

Dr. Ridker, an inventor of a laboratory test for CRP who profits from its use, said that while the new results did not support causality, he did not think they definitely excluded it either.

Anyway, he said, it does not matter because the real issue is inflammation. CRP goes along with inflammation, and it is inflammation that is likely to be causing heart disease, Dr. Ridker said.

The thought is that white blood cells invade artery walls and release damaging chemicals, leading to plaque formation.

The new study, by Dr. Paul Elliott of Imperial College in London and 35 co-authors, used a recently developed technique that can get answers quickly about causality. Without it, the only method was what is seen as the gold standard in medicine: large clinical trials in which people are randomly assigned to take a drug, or not, and followed for years.

The new method, Mendelian randomization, “is changing the way we think about causality,” Dr. Lauer said. It only recently became feasible as researchers found genetic variants associated with proteins like CRP and developed tools to analyze data from what was, in this case, more than 100,000 people.

Different people produce different amounts of CRP, and the amount a person produces is determined by tiny inherited changes in the CRP gene. So in a population, there are people who just happen to produce more CRP throughout their lives and others who just happen to produce less. If CRP causes heart disease, those who make more would have more heart disease. That, however, is not what the study found.

“There was no association” between CRP genes and heart disease rates, Dr. Elliott said.

The association between CRP and heart disease must be reflecting something else. For example, if CRP levels go up when heart disease begins, because of inflammation in arteries, CRP levels would be higher in people with incipient heart disease. But CRP itself would be playing no role in heart disease risk; it was just marker of inflammation.

A smaller study of CRP, using the same method and published last October in The New England Journal of Medicine, came to the same conclusion.

But this second, larger, study was needed to convince heart experts, said Dr. Sekar Kathiresan, director of preventive cardiology at Massachusetts General Hospital.

“It’s a very important question particularly in the context of the Jupiter trial,” Dr. Kathiresan said.

Dr. Rader, at Penn, said he still did CRP tests on selected patients and expected to continue. An elevated CRP level indicates increased risk, even if the protein does not cause the risk. Dr. Rader tests CRP to help decide whether to give a statin to patients with normal cholesterol but with a family history of heart disease. A high CRP, he said, could tip the balance, leading him to prescribe a statin.

Dr. Altshuler noted that part of the power of a Mendelian randomization study was that it could stop a hypothesis from prematurely becoming viewed as fact.

Ordinarily, science starts with an observation, like the one associating CRP with heart disease. That generates a hypothesis — that CRP causes heart disease. Then comes a trial, if there is a treatment, like a drug to specifically attack CRP, that people can be randomly chosen to take or not.

But it can be years or decades before the clinical trials are completed. In the meantime, Dr. Altshuler said, the hypothesis comes to be regarded as true.

And if the clinical trial contradicts the hypothesis, “some people are unwilling to question their beliefs, even if there was no evidence of causality to begin with,” Dr. Altshuler said.

http://www.nytimes.com/2009/07/01/health/01heart.html?ref=health

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