KPCC: Health News

National Institutes of Health seeks to educate and get more volunteers for clinical trials with new website

Fri, 10 Feb 2012 17:42:16 -0800

Clinical trials are credited with such breakthroughs as curing the first solid tumor through chemotherapy to recognizing the benefits of nitroglycerin in response to heart attacks. Credit: Joe Raedle/Getty Images

The National Institutes of Health (NIH) recently launched a new website designed to educate the public about clinical trials and to (hopefully) attract more volunteers for the life-saving studies.

According to the NIH, it's the lack of public knowledge about clinical trials in medical research that poses the greatest challenge to scientists hoping to recruit volunteer subjects. It's a problem they're hoping to remedy through the new site.

Go to health.nih.gov and you’ll find all sorts of tidbits about clinical trials, which are credited with such breakthroughs as curing the first solid tumor through chemotherapy to recognizing the benefits of nitroglycerin in response to heart attacks.

The site explains the role of these human studies for identifying and understanding new ways to prevent, diagnose and treat disease, as well as providing visitors with information about the requirements of participation in clinical trials.

The NIH says clinical trials are vital to driving medical studies and improved health outcomes worldwide.

UCLA program brings Latino doctors to underserved areas

Fri, 10 Feb 2012 11:36:23 -0800

Dr. Blanca Campos (3rd from L, 1st row) standing with Executive Director Dr. Michelle Bholat (3rd from R, 1st row), former program coordinator Ana Jimenez (1st row R), Associate Director Patrick T. Dowling (3rd from L, 2nd row) and Blanca's graduating class of UCLA IMG colleagues in their program's headquarters. Credit: Courtesy of UCLA International Medical Graduates

As California’s Latino population grows, so too does the need for doctors who speak fluent Spanish and who understand the Latino culture. Yet proportionately, few Latinos graduate from medical schools in California, and that’s created a void that threatens care to Spanish-speaking populations. But UCLA’s David Geffen School of Medicine has a solution in its novel International Medical Graduate's (IMG) program.

Dr. Blanca Campos was among the first to complete the program. For the past six months, she's spent her days seeing patients at the Wilmington Family Health Center. Most of her patients are Spanish-speakers who struggle with English, if they can speak it at all.

"Most of them are illegal, some are legal," Campos says. "Most of them don’t have jobs. You’ll see a lot of patients who have lost their insurances and are looking for clinics like this to help them with their basic needs."

Campos, 38, is a native of Belize. She’s among more than three dozen native Spanish-speaking medical school graduates hand-picked by UCLA to help fill California’s shortage of bilingual and bi-cultural Latino doctors. The UCLA program, offered through the university’s Department of Family Medicine, is the only one in the nation to address the linguistic and cultural barriers that stand between most US doctors and their Latino patients.

Campos says Spanish-speaking doctors are key to bringing quality medical care to the state's underserved communities, "because we understand how they grow up; we understand certain terminology that they use in Spanish that may not be in medical books, but we’ve heard it before and we understand what it means."

Without doctors like Campos, the aches and pains that lead to clinic visits can get lost in translation. And that often results in wasted dollars and poor medical care for many native-Spanish speakers.

"It leads to misdiagnosis and misunderstanding and errors and often a tremendous amount of over-testing," says Dr. Patrick Dowling, chairman of UCLA’s Department of Family Medicine. Six years ago, he started the IMG program that operates solely on private grants and donations. The program provides stipends for resident doctors as they study for their U-S medical exams. In exchange, the doctors commit to practicing medicine for up to three years in California’s low-income communities.

"When you don’t know what the patient’s saying, the easiest thing to do is refer them on for more testing," he says, which leads to costly and ineffective medical care. Yet that's becoming more commonplace in a state that graduates slightly more than a hundred Latino med students each year. "And it’s not clear how many of those are fluent in Spanish or have ever lived in or understand that culture."

Dowling’s colleague, Dr. Michelle Bholat, is executive director of the IMG program that each year admits only about a dozen med school grads who meet narrow criteria:

"The ideal candidates are those that were born and raised in a Latin American Country; who have lived and worked in the United States and have learned to speak the language with some level of fluency," she says.

Foreign doctors who apply to the UCLA program must be US citizens or legal residents. For many potential candidates, that can mean working for years at jobs unrelated to medicine. Bholat says one of the doctors who applied for legal residency earned money as a book binder; another made and sold tamales – and yet another worked as a maid.

"She was 'Doctora Pion,' and when she got over here, she was somebody’s house cleaner."

Colombia native, Ingrid Sarmiento, is among the newest batch of UCLA international residents. She came to California under political asylum for death threats she received after providing medical care to a rebel. Now, she says, she's eager to show her thanks to the U.S.

"The United States has been a great support for me," Sarmiento says. "And I want to give them back. I’m going to be a great physician and I’m going to help people. That’s for sure."

And Sarmiento’s help is certain to become even more necessary as the year 2014 approaches. That’s when an estimated five million more Californians — many of them Latinos — are expected to become insured under the federal health care reform law. Dowling says it's his hope that all California med schools will begin recruiting bi-cultural, Spanish-speaking doctors to meet that need.

Laguna Hills medical assistant arrested after allegedly molesting 3 women in their 50s

Thu, 09 Feb 2012 15:44:33 -0800

Police caution tape Credit: Picture Perfect Pose/Flickr.com

A medical assistant at Saddleback Hospital in Laguna Hills was arrested Wednesday evening for allegedly molesting three patients, all women in their 50s.

Investigators said they suspect there may be more victims.

Narciso Romanes Blando of Orange was arrested at home on suspicion of sexual assault, according to Jim Amormino of the Orange County Sheriff's Department.

According to Amormino, Blando works at the hospital, located near the Laguna Woods senior citizen community, as a "patient care assistant."

On Monday night, a patient in her 50s complained to hospital officials that Blando touched her groin area as he was rubbing pain-medication cream on her ankles, Amormino said.

A few hours later, about 1 a.m. Tuesday, another patient in her 50s woke up to find Blando stroking her hair and kissing her face.

"She told him to stop and eventually he did comply," Amormino said.

A third patient also alleged that Blando kissed her on the face and stroked her hair, but Amormino did not know when that alleged encounter occurred.

All of the women were under the influence of prescription-strength pain medication at the time of the alleged molestations, Amormino said.

Blando was being held in lieu of $25,000 bail, according to jail records.

Consumer Watchdog sues Senior Health Insurance for allegedly cheating elderly

Wed, 08 Feb 2012 18:38:25 -0800

Elderly hands Credit: Rosie O'Beirne/Flickr

Consumer Watchdog announced a suit Wednesday against a long-term care insurance company, accusing it of cheating the elderly by making them jump over too many hurdles to get care.

The non-partisan group denounced the Senior Health Insurance Company of Pennsylvania in a statement, saying it uses tactics such as delays, denials and undue requests for documentation to avoid paying for care.

"These insurance companies prey on the elderly," said Consumer Watchdog founder Harvey Rosenfield. "They take their premiums. They pocket them and then they don’t pay when the time comes."

Rosenfield filed suit on behalf of an elderly man from Southern California — a doctor and decorated war hero who ran a hospital. He paid his premiums on time for 16 years without making a claim, Rosenfield says, and then he needed in-home care.

According to Rosenfield, the insurance company put the man off with excuses, paperwork and "conditions and requirements that are violations of state law."

"They basically made it impossible for him to comply with the requirements they were imposing," Rosenfield. added. "Here’s an 87-year-old guy — Korean War Purple Heart vet, former head of the Kaiser hospital in Fontana. Now in a wheelchair, ill. And they are making him jump through hoops."

Senior Health Insurance Company has about 10,000 long-term care policy holders in California.

The company has not yet issued a statement.

Birth control battle: Congress debates Obama rule requiring employers to offer free birth control prescriptions

Wed, 08 Feb 2012 15:42:24 -0800

File: President Barack Obama delivers remarks on the economy February 1, 2012 at the James Lee Community Center in Falls Church, Virginia. Credit: Alex Wong/Getty Images

Capitol Hill has taken up the political battle over an administration rule that requires all employers to offer free birth control prescriptions in their workers’ medical coverage. The conflict began between the White House and U.S. Catholic Bishops, but it’s turned into a partisan fight.

The new health care law requires all employer health care plans to cover contraception and sterilization. President Barack Obama exempted religious organizations — but not the hospitals, schools and social services they operate.

Don Clemmer, spokesman for the U.S. Catholic Conference of Bishops, says that’s a problem. "Forcing religious organizations to do something that violates their religious beliefs," he says. "In this case, paying for products and services that they believe are immoral."

Clemmer says the issue is about more than birth control pills. "In the United States, under the First Amendment of the Constitution, can the federal government compel a religious body to do something that is against its belief? Where does that leave religion in this country?"

In a speech on the House floor, Republican Speaker John Boehner pledged that the new rule from Health and Human Services “will not stand.” He said, if the president "does not reverse the department’s attack on religious freedom then the Congress, acting on behalf of the American people and the Constitution, that we are sworn to uphold and defend, must." Speaker Boehner said the House Energy and Commerce Committee would lead efforts to find what he called an “effective and appropriate solution.”

Five Senate Democrats, including California’s Barbara Boxer, accused Boehner’s party of denying American women a health care benefit. "Women in this country are tired of being treated like a political football by Republicans in Congress, who have tried continually and are continuing to try to take away their benefits, to take away their rights."

House Democrats also denounced GOP calls to reverse the rule. Congresswoman Lois Capps of Santa Barbara, a registered nurse, said California and 27 other states already require contraception coverage in medical insurance plans. "And the new federal standard is based on the one that has worked in my home state of California for years with no harmful detriment to employment of anyone."

But a spokesman says L.A.'s Roman Catholic Archdiocese is self-insured and has been for more than a quarter century. That means it’s exempt from the state requirement to pay for contraceptives.

Senator Boxer insists that it’s possible to make the new requirement work for Catholic organizations.

"Many hospitals do this their own way," Boxer said. "One way is they will contract with an outside entity to provide the particular benefit. So there’s many, many ways."

This is an election year, though, and compromise and calm discussion are in short supply. Now the focus is on the White House and the Department of Health and Human Services to craft a plan that lawmakers won’t debate from now until November.

2 centers related to 1-800-GET-THIN to halt Lap-Band surgeries

Tue, 07 Feb 2012 16:16:26 -0800

A Google Maps screenshot of a Lap-Band billboard on W 11th Street, Los Angeles, Calif. The billboards are under fire after the FDA criticized their misleading displays. Credit: Corey Bridwell/KPCC

Two surgery centers of the eight associated with the 1-800-GET-THIN marketing campaign are halting scheduling of new Lap-Band procedures, the company announced Tuesday.

A statement was released by the surgery centers saying: "Recent allegations question the safety of the Lap-Band procedures at two centers. While we strongly believe these allegations paint a false picture of the care provided overall and discount our capabilities and success rate, we have stopped scheduling new Lap-Band surgeries at those centers."

The statement also said the allegations are "unfounded and without merit," but that new surgeries have been halted "pending a top-to-bottom review."

The statement did not say who would conduct the investigation.

The patients had been treated at clinics in Beverly Hills and West Hills, according to autopsy reports and lawsuits.

Last week, the company that manufactures the adjustable gastric bands used in surgeries at those clinics announced it would no longer supply them with the devices. The only other company that manufactures adjustable gastric bands approved in the U.S. for weight loss surgery says it has not, and will not, sell its device to the eight surgery centers.

The company says the decision by the manufacturers does not affect its ability to continue the procedures.

Five Southern Californian patients have died since 2009 after undergoing lap band surgeries at clinics related to 1-800-GET-THIN, according to investigations by the Los Angeles Times.

The California Department of Insurance is investigating the surgery centers for possible fraud. That inquiry follows a recent federal reprimand by the FDA against the surgery centers and their marketing campaign for failure to adequately warn consumers about serious risks associated with the weight-loss surgery. They've also received criticism from members of Congress.

Secondhand smoke an unwelcome passenger in cars with kids

Mon, 06 Feb 2012 10:54:00 -0800

About 1 in 5 kids in middle school or high school is exposed to secondhand smoke in cars. Credit: Richard Clark/Stockphoto.com

Sitting in a car with a smoker is about as close to lighting up as a nonsmoker can get.

And quite a few schoolchildren get exposed to secondhand smoke this way, according to an estimate by researchers at the Centers for Disease Control and Prevention.

About 1 in 5 nonsmoking kids in middle and high school reported sharing a car with a smoker who had lit up within a week of answering a survey in 2009. The researchers say the survey, which included responses from thousands of students, gives an accurate snapshot of what's happening across the country.

"The car is the only source of exposure for some of these children, so if you can reduce that exposure, it's definitely advantageous for health," CDC researcher Brian King told the Associated Press. The findings appear in the latest issue of Pediatrics.

The American Academy of Pediatrics says that any exposure to secondhand smoke is unsafe for kids.

And the latest report does find that nonsmoking kids' exposure to secondhand smoke in cars declined to 22.9 percent in 2009 from 39 percent in 2000. The researchers figure that laws barring smoking in many public places may have been a factor.

A decline in smoking prevalence and a hardening of attitudes against secondhand smoke also could be helping.

Still, researchers say more should be done. They recommend a ban on smoking in cars when children are present. That's already the law in a few places, they note, including California and Arkansas (for children under 14).

Fewer autopsies mean crucial info goes to the grave

Sun, 05 Feb 2012 21:27:36 -0800

Colleagues of Renee Royak-Schaler at the University of Maryland School of Medicine paid for and conducted an autopsy that revealed that cancer had ravaged her body. Today, autopsies are conducted on just 5 percent of patients. Credit: Jenna Isaacson Pfueller/ProPublica

A half-century ago, autopsies — sometimes called the ultimate medical audit — were an integral part of American health care, performed on roughly half of all patients who died in hospitals. But today, autopsies are conducted on roughly 5 percent of such patients, and experts say that is a troubling trend.

For the past year, ProPublica, PBS' Frontline and NPR have probed America's deeply flawed system of death investigation. The decline in autopsies, some experts say, means that death certificates aren't as accurate as they could be — and that information drives research dollars.

For family members, information from autopsies can give a sense of closure in a painful situation.

'Not Knowing Has Always Been Worse'

Renee Royak-Schaler was a 64-year-old professor and cancer researcher. As her husband shared at her memorial, last May she unexpectedly collapsed and was rushed to a hospital, where she died.

Dressed in a black suit, Jeffrey Schaler stands under the stained-glass windows in front of an audience of about 100 people to pay tribute to his wife.

"Thank you all for coming here today," he said. "If Renee were alive right now and could see what her friends and colleagues have done and feel towards her, she would truly be in tears long before I finish this sentence."

Renee died from a pulmonary embolism. "The only reason we know this now is because her friends and colleagues here at the University of Maryland School of Medicine paid for and conducted an autopsy," Schaler says.

The autopsy showed that cancer was all over her body and had caused the pulmonary embolism.

"Not knowing, to me, has always been worse than knowing the truth, and we know the truth ... as a result of autopsy. Even though that's still painful, there's a sense of peace," Schaler says.

But federal records show that few Americans receive that sense of peace when a loved one dies at a hospital.

A Steep Decline In Autopsies

Currently, American hospitals have no obligation to provide an autopsy when a patient dies. But if there is evidence of foul play or suspicious circumstances, a government-assigned coroner or a medical examiner may review the case, but they rarely intervene in hospital deaths.

Dr. George Lundberg, a pathologist and editor of the journal MedPage Today, says autopsies used to be the standard in hospitals, but not anymore.

"They've gone down so far now that there are large numbers of hospitals that do almost no autopsies at all," Lundberg says.

Hospital autopsies used to be mandated by The Joint Commission, an agency that works on the government's behalf to accredit hospitals in the U.S.

Until 1971, hospitals had to autopsy at least 20 percent of patients who died in their care, but they are not required to meet a quota.

Lundberg puts it this way: "The people who pay the bills say, 'Well, why would I want to pay money for an autopsy on a patient who's already dead? My money is supposed to be spent on people while they're alive.' "

Health insurance companies don't cover autopsies because they say they pay for care for the living patient, not the dead. Families can opt to pay for an autopsy out of pocket, but that can be expensive.

Death Certificates A 'Benchmark'

Besides providing closure to the families, there is another reason why autopsies might be important. Studies also show that doctors make diagnostic errors in about 25 percent of cases, but the errors remain unknown without autopsies.

According to Lundberg, that has broad implications for public health in America. For one thing, incorrect information is being written on death certificates.

"Death certificates are used all the time to establish what the leading causes of death are in the United States," he says. "This is ... the benchmark for how one develops a public health agenda and a spending agenda."

Robert Anderson manages the mortality statistics for the Centers for Disease Control and Prevention. He says flawed information about the ways Americans are dying is being written on death certificates and may be leading officials to allocate medical research dollars in the wrong way.

"The quality of the statistics is only as good as the accuracy of the information that's provided," Anderson says. "You put inaccurate information into the statistics, you're going to get bad statistics. So you put garbage in, you're going to get garbage out."

Working With Limited Resources

Some experts say that to reverse this troubling trend, The Joint Commission needs to go back to mandating a minimum rate of autopsies. But that's not likely to happen anytime soon.

"No, we're not taking any action at this point to try to increase the number of autopsies," says Dr. Paul Schyve, who heads up the quality programs for The Joint Commission, which accredits hospitals.

"The CDC is certainly correct in saying that the reliability or the accuracy of what's put on death certificates would be increased if we had autopsies," he says. "If we had unlimited resources, then it would be a different picture, but we all know we don't."

But Schyve says technology may be the answer.

"Particularly in recent years ... there has been a big advancement in the type of diagnostic capabilities that people have to be able to diagnose and understand what's going on inside a patient without the autopsy," he says.

But experts like Lundberg don't agree, and say that even with the advancement in technology, sometimes errors in medicine can only be learned on the autopsy table.

Companies behind gastric bypass bands refuse to sell to SoCal surgery centers

Fri, 03 Feb 2012 18:22:14 -0800

A Google Maps screenshot of a Lap-Band billboard on W 11th Street, Los Angeles, Calif. The billboards are under fire after the FDA criticized their misleading displays. Credit: Google Maps

The second of the two companies that manufacture the only adjustable gastric bands approved in the U.S. for weight loss surgery says it will not sell its device to the eight surgery centers marketed by 1-800-GET-THIN.

A spokesman for Johnson & Johnson, which owns the company that manufactures the device marketed as the Realize Band, says it has never sold its device to the centers and has no plans to do so.

That news follows an announcement this week by Irvine-based Allergan Inc., maker of the competing Lap-Band, that it will stop selling its device to the surgery centers, effectively cutting off their supply.

The decision by both companies comes in the midst of investigations and wrongful death lawsuits against the eight surgery centers associated with the 1-800-GET-THIN marketing campaign.

The centers have found themselves targeted by the FDA, the Department of Insurance and various members of Congress.

Five southern California residents have died after undergoing surgery at the centers, which are also under investigation by the California Department of Insurance for alleged fraud.

Attorneys who represent the surgery centers did not respond to a request for comment.

Many hits, rather than a big one, pose greatest concussion risk

Fri, 03 Feb 2012 12:10:24 -0800

Members of the Jefferson High School football team took 200 to more than 1,800 hits to the head in a season. Credit: Purdue University

High school football players have changes in their brain function long before they have recognizable signs of a concussion, according to a new study.

The more hits a player got, the more brain function changed. The findings support the growing belief that a concussion comes as the result of a succession of insults, not just one bad hit.

"I think what you're seeing here is the sum total of what happens throughout the season," says Eric Nauman, an associate professor of mechanical engineering at Purdue University and lead author of the study.

This researchers followed players on the Jefferson High School football team in Lafayette, Ind., over two seasons. The athletes wore special helmets with sensors that measured the number and severity of head impacts. The researchers also put the players in an MRI scanner to measure their brain activity while the students took a test of thinking and memory.

Then they compared the brain scans with the hits. Those hits weren't rare. Each player logged from 200 to more than 1,800 hits to the head in a single season. Over two seasons, six players had concussions, but 17 others showed brain changes even though they didn't have concussions. There were 21 players in the first season, and 24 in the second, 16 of whom were repeat participants in the study.

Over time, the changes in brain function that showed up in the MRIs correlated to the number and distribution of hits. Mental performance didn't change, but brain activity did.

"The magnitude of changes in the brain were a function of how many hits you took, and where you took them," Nauman told Shots.

Those brain changes may be workarounds, with the brain using other areas to replace those affected by the hits, according to Thomas Talavage, an associate professor of electrical and computer engineering at Purdue University and a co-author of the study. The results haven't been been published yet, but the work has been accepted by the Journal of Biomechanics.

This study raises a lot of questions that it can't answer. It doesn't tell us if these brain changes will improve over time, or if they're the beginnings of permanent brain damage.

The researchers have expanded their work to include two more football teams, and a girls' soccer team. They're also looking for a boys' soccer team, to see if they can test the widely held belief that girls are more vulnerable to concussion.

And they are following the players who took the most hits to see if the brain changes seen are permanent.

Since millions of teenagers play football, soccer, hockey and other sports where hits to the head are common, a clear sense of when those hits start to cause damage would be the start of better ways to prevent and diagnose what has become a major issue in children's health.

Yesterday, Shots reported on a study that found that widely used computerized tests used to establish a baseline of cognitive function for student athletes aren't accurate enough to diagnose concussions, or to determine if a player is safe to return to the action.

Researchers say malaria deaths are twice the official count

Fri, 03 Feb 2012 12:01:34 -0800

Chhay Meth, 9, suffering through an attack of malaria at the family's home in O'treng village on the outskirts of Pailin, Cambodia, in 2009. A drug-resistant form of malaria in the region medical led officials to declare a health emergency. Credit: David Longstreath

The World Health Organization estimates that 655,000 people died of malaria in 2010. But a new report says no, the real total is twice as high — 1.24 million people.

If the new numbers are right, it means there's little chance that malaria deaths can be cut to near-zero by 2015, just three years from now. That's the official goal set last year by the World Health Organization.

"We estimate that if decreases from the peak year of 2004 continue, malaria mortality will decrease to less than 100,000 deaths only after 2020," write Christopher Murray and his colleagues in this week's edition of The Lancet.

The group does ratify what a Lancet editorial calls the "phenomenally successful" campaign that has reduced malaria deaths in Africa by 30 percent since the 2004 peak.

"It's rare in global health that we see such a clear quantitative story," Murray told Shots. "You can see the money flowing in, you can see the expansion of interventions, and you can see the outcome."

He says the success has been driven by the distribution of insecticide-treated bed nets (145 million in 2010 alone) and effective combination drug therapy (181 million courses in 2010).

Murray and his co-authors are at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. They've made made interactive graphics for making sense of the data, too..

Murray, whose specialty is triangulating disease and death incidence from maddeningly sparse and incomplete data, says there's more uncertainty about malaria deaths than from any other cause.

After all, death certificates and cause-of-death data are nonexistent in many of the 99 countries where malaria is still a problem.

One of the principal ways the researchers get around this is to use "verbal autopsies." The technique involves extensive interviewing of families and neighbors of deceased people to put together a picture of their symptoms and infer the cause of death.

"With a lot of effort, we ended up with 163 verbal autopsy studies that met our quality criteria," Murray said.

With those studies, other kinds of fill-in-the-gap indicators and a lot of fancy extrapolation, the team has come up with what it calls "the most systematic assessment to date of malaria mortality."

Their most important finding is that in 2010 there were 433,000 more malaria deaths worldwide among people over age 5 than the WHO estimates.

This challenges a widespread belief about malaria deaths – that they mainly involve young children. The WHO says 86 percent of such deaths are children under 5, and 91 percent occur in Africa.

But Murray says his group's finding runs counter to the traditional wisdom "at least as I learned it in medical school, that you acquire immunity as a child and don't die of it as an adult." In other words, children who don't die of it grow up to be resistant to the malaria parasite, more or less. They may get sick from it, but they're not very likely to die, as conventional wisdom has it.

That's the reason one tenet of anti-malaria strategy is to focus prevention efforts, such as distribution of bednets, on young children and mothers.

Murray acknowledges that young children are much more likely to die of malaria – perhaps 10 times more likely – but "there are a lot of people over age five, so even a lower risk adds up to a lot of deaths."

The new estimates are likely to prove controversial, just as previous work was questioned when it suggested a much higher malaria death rate in India, using such techniques as verbal autopsies. (The Murray group also says India contributes far more malaria deaths to the global total than the WHO estimates.)

"I would be very cautious" about the new estimates, Sarah Kline, director of the UK branch of the advocacy group Malaria No More told Shots. "It is a dramatic increase from what the WHO says, and it contributes to the overall discussion, but it's unclear if it will lead to significant policy change. The tools to combat malaria are the same."

The problem is, will the funds keep flowing to use those tools? The Global Fund to Fight AIDS, TB and Malaria, which has lately accounted for two-thirds of the world's anti-malaria spending, is in fragile condition. It suspended its next round of grants last fall, and everyone is wondering when and if the fight to end malaria will get back on track.

Advocates say flu vaccine should be mandatory for health workers

Fri, 03 Feb 2012 11:23:02 -0800

Consumer and business groups said an annual vaccination of all health workers with only limited exemptions should be required. Credit: Lance McCort/Flickr (Creative Commons)

Despite more than 20 years of recommendations that health workers get flu shots, the most recent data from the Centers for Disease Control and Prevention show more than a third don't comply.

The voluntary approach to reducing the risk that workers will transmit flu to patients has fallen short.

So consumer and business groups met in Washington Thursday to show their support for a recommendation from the National Business Group on Health that hospitals require all health care workers to be vaccinated annually against the flu.

"We believe that patients have the right to assume that health care personnel, themselves, will take all reasonable measures to reduce and avoid transmission of preventable diseases including the flu," said Helen Darling, president and CEO of the NBGH. "I think we, as people, assume that after all, they're our caretakers and we look to them for care and treatment."

The NBGH is a nonprofit representing more than 300 large employers, including 68 of the Fortune 100. Its statement urged hospitals to "require annual flu vaccination of all employees as a condition of employment unless employees can demonstrate medical contraindications (with physician documentation) or religious objections."

If that is the case, the NHBG says those employees "should not engage in direct patient care if they have flu-like symptoms."

But flu vaccinations have been a point of contention among health care workers and labor groups for years. New York health workers pushed back against mandatory vaccination during the pandemic in 2009. A judge sided with nurses who sued to block the requirement.

Even within the government, there are conflicting views. In a letter to the National Vaccine Program Office last month, Jordan Barab, deputy assistant secretary for the Department of Labor's Occupational Safety and Health Administration, said his organization supports the goal of the HHS' Healthy People 2020 initiative to get 90 percent of health care personnel vaccinated. But "we are troubled that some have tried to convert the goal into a mandate," he wrote. (The Department of Labor letter was first reported on by Inside Health Policy)

At the media briefing, Darling said a mandate is an effective means to ensure health care providers are safe from the influenza infection. "We know that mandates work."

Among other groups supporting the proposal there were Consumer Reports and the American Hospital Association. Dr. Don Wright, deputy assistant secretary for health care quality at the Department of Health and Human Services, said at the briefing that the agency will be publishing data by next year on hospitals that have vaccinated employees as part of their efforts to reduce hospital-acquired infections.

Hospitals that report their employee vaccination data will receive a bonus payment, Wright said, and already well over 95 percent of hospitals are doing that. Wright said in an interview later that HHS is not "endorsing any one method [of boosting vaccination rates] over another. Our goal is to get the rate of vaccinations up, so the jury is still out on the best way to do that."

HHS' plan for reducing the number of hospital-acquired infections suggests "that we need a 70 percent rate of immunizations for health care workers by the end of 2015. That really splits the difference from the Healthy People 2010 goal, which was 60 percent, and the Healthy People 2020 goal which is 90 percent," Wright said.

Susan G. Komen for the Cure organization cuts Planned Parenthood breast cancer funding

Wed, 01 Feb 2012 18:44:27 -0800

Pink breast cancer ribbons Credit: Kai Chan Vong/Flickr (Creative Commons-licensed)

The nation's leading breast-cancer awareness group, Susan G. Komen for the Cure, is cutting its funding to Planned Parenthood.

Nationwide, Planned Parenthood will lose about $700,000 in grants from the Susan G. Komen for the Cure organization, known worldwide for its pink ribbons in support of breast cancer research.

Planned Parenthood blames the decision on political pressure from anti-abortion advocates.

"I find it really unfortunate that we put our politics ahead of lives," said Susan Dunlap, president and CEO of Planned Parenthood, Los Angeles, "because at the end of the day, when Planned Parenthood provides cancer screenings, we’re saving lives."

The Komen organization denies that politics played a role.

Planned Parenthood of Orange & San Bernardino Counties is the only Southern California chapter that receives Komen grants. Last year, Komen awarded it $120,000 for breast cancer screenings and educational outreach to tens of thousands of women.

USC study: Depo-Provera birth control may increase diabetes risk for obese women

Wed, 01 Feb 2012 16:57:45 -0800

Registered nurse Sharon Cassady displays some of the contraceptives she dispenses to women at a Planned Parenthood of Central NewJersey clinic in Shrewsbury, N.J., Wednesday, March 17, 2004. Credit: Daniel Hulshizer/AP

Obese women who take long-term birth control injection Depo-Provera may be at greater risk for developing diabetes, according to a new USC study.

Researchers at the Keck School of Medicine found that obese women who received the Depo-Provera injection become more resistant to insulin. That means they were less able to lower their blood sugar levels, which leaves them more susceptible Type 2 Diabetes.

Researchers compared the effects of the drug on 10 obese women and five women of healthier weight. Both groups became more insulin resistant after the injections, but the obese women stayed that way. The others were better able to compensate, by producing more insulin.

Injection-delivered contraceptives, such as Depo-Provera, have been recommended for obese women over oral contraceptives. That’s because obese women are more prone to blood clots, and most birth control pills further increase that risk.

The study suggests that other forms of long-term contraceptives, such as the IUD, may be preferable for obese patients.

Riverside County public employees stage 24-hour strike

Tue, 31 Jan 2012 16:05:48 -0800

Hundreds of Riverside County public employees occupy county headquarters in Riverside during day long strike. Credit: Steven Cuevas/KPCC

Several thousand Riverside County public employees walked off the job Tuesday to protest the terms of a new labor contract.

Of these thousands, hundreds of the strikers (all from the Service Employees International Union) went on to march against the county headquarters in Riverside, nearly shutting down a meeting of the board of supervisors.

While a few hundred SEIU members in purple T-shirts hoisted picket signs and chanted slogans outside, hundreds more marched inside — all the while chanting, "We are SEIU! We are SEIU!"

The union members packed into the lobby outside the board of supervisors' chambers, temporarily bringing the meeting inside to a halt.

"Ladies and gentlemen," announced Riverside County Supervisor John Tavaglione, "we’re going to stop the meeting for a while until the deputies control the lobby which means they may have to remove the entire lobby and lock the front doors."

Protestors were allowed to stay in the lobby. The meeting eventually resumed, supervisors struggling to speak above the crowd's roars of "Let us in! Let us in!" just beyond the walls.

Missing from the crowd were dozens of county nurses. On Monday, a judge barred them from taking part in the strike.

Workers are protesting the terms of a new three-year contract imposed by county leaders. The contract includes changes requiring that all employees contribute more each year to their own retirement, on top of previous pay cuts and work furloughs.

The county says it’s trying to avoid layoffs — and close an $80 million budget gap.

"Fine," social worker Crystal Shackelford responds. "I think we all need to take it to save this county. Every single person should share in the burden, then the burden can be a little less."

But, she hastens to add, county supervisors refuse to take similar wage and benefit cuts.

"Our pensions are not going to be those lavish six-figure pensions," says Shackelford. "It’s the Board of Supervisors that get those kinds of pensions, not us! We will hold them accountable and we’re not divided anymore. We’re together and we’re going to show them we can be loud."

Supervisors did promise a 2.5 percent salary increase to most workers. It would take effect next year. Both sides are set to resume contract talks in March. The union says it could call for more work stoppages before then.

Correction: The original version of this story said that picketers walked on a lawn outside the Riverside County Administration Building, while there is no lawn outside the building.

21,000 strike against Kaiser Permanente health care across California, including 4,000 in Southern California

Tue, 31 Jan 2012 05:00:04 -0800

Kaiser Permanente Microclinic, Garfield Center 2 Credit: tedeytan/Flickr (Creative Commons-licensed)

Workers at Kaiser Permanente facilities across California will strike for 24 hours beginning Tuesday at 6 a.m. This is not their first walkout, but union leaders say it’ll be the biggest.

Kaiser employees are hitting the picket lines to protest what they say are unfair cuts to worker benefits and chronic understaffing that compromises patient care. About a fifth of those protestors will march in Southern California at Kaiser Sunset, Downey Fontana and Woodland Hills.

The walkouts mark the fourth time Kaiser workers have walked out, since they began negotiating a new contract.

Union leaders say they’re protesting cuts in their health care coverage and retirement benefits during a period of record profits for Kaiser — $5.6 billion over the last three years. The union also points out that Kaiser's CEO, George Halvorson, took home almost $9 million in compensation in 2010, with other top managers making what the union calls "lavish" salaries, bonuses and perks.

"What it all boils down to is Kaiser top executives putting profits before patient care," said Dr. Spencer Gross, a psychologist at Kaiser Pleasanton, in a press release.

Kaiser says all of their facilities will remain open during the work stoppage. They are calling the strike “counterproductive” and say they will continue to bargain in good faith with the union.

Parents cheat on booster seats, despite safety risks

Mon, 30 Jan 2012 18:04:24 -0800

Booster seats reduce children's risk of injury by more than half. Credit: iStockPhoto.com

Grade-schoolers are supposed to be riding in booster seats. But anyone who's ever chauffeured a bunch of second-graders can tell you that the day will come when you don't have enough boosters to go around. Faced with this obvious safety risk, most parents (including this one) buckle up the kids without boosters, and pray.

That's confirmed by a new survey in this week's Pediatrics, which found that parents are good at using booster seats when driving 4- to 8-year-olds in the family car, with 76 percent using boosters.

But they were not so good when carpooling. Only half make their children use booster seats when they are riding in the family car with friends who don't have boosters, and 21 percent let their own child ride booster-less when in someone else's car.

Some parents resorted to obviously unsafe choices, including buckling two children in one seat belt, or putting a child in the cargo area.

That means a lot of children are being exposed to the risk of serious injury. Children in this age range still aren't big enough to be safely restrained by car seat belts. Using a booster to position the lap and seat belt properly reduces injury risk by half.

The 681 parents surveyed said they didn't use booster seats for a number of reasons, including difficulty getting seats from other parents, and being unable to fit enough seats in the car.

Legal pressure clearly helps; parents were far more likely to use boosters if they live in one of the 47 states that require them for children up to 4 feet 9 inches in height. (Here's an earlier NPR story on state efforts to require booster seats.)

I've never known a child injured in a car crash, even though it's the most common cause of death in children ages 3 to 14. But I figured I should find out what can happen to a child if they're in an accident without a booster seat. It's not pretty. In this 2005 study, eight children ages 4 to 8 who were wearing only seat belts suffered serious abdominal injuries. Five broke their spine. And four are permanently paralyzed. That sure got my attention.

The National Highway Transportation Safety Administration spells out the details for safe use of boosters in children ages 8 to 12.

Brazilian Blowout settles with California attorney general over 'formaldehyde-free' advertising

Mon, 30 Jan 2012 15:41:59 -0800

A woman gets a Brazilian straightening treatment at a salon. Credit: circle/square/salon/Flickr.com

Brazilian Blowout, a hair-smoothing treatment that can soar to $300 a pop, has reached a settlement with the California attorney general after falsely advertising two of its most popular products as being "safe" and "formaldehyde-free."

The settlement will force Brazilian Blowout to change its advertising, as well as overhaul its website and pay $600,000 in fees and penalties.

The office originally filed suit against GIB LLC (Brazilian Blowout's parent company) in November, blasting it for lying in ads and failing to issue warning labels about the product's use of a carcinogen.

"California laws protect consumers and workers and give them fair notice about the health risks associated with the products they use," said attorney general Kamala Harris in a statement. "This settlement requires the company to disclose any hazard so that Californians can make more informed decisions."

Labels for Brazilian Blowout products have long claimed to "contain no formaldehyde," and before that they were "formaldehyde-free." What they do contain is methylene glycol — a liquid form of the chemical that emits a formaldehyde gas when heated.

In the past, GIB LLC has argued that the levels of formaldehyde emitted were within safety limits.

"OSHA has very clear guidelines on formaldehyde emissions," Mike Brady, CEO of GIB LLC, told ABC last year. "Our product has never exceeded those guidelines ever."

GIB LLC could not be reached for comment on the settlement.

The procedure is a popular (and lucrative) treatment across Los Angeles salons, and a mainstay option on websites like LivingSocial and Groupon.

Pasadena salon owner Jazmine Zakarian says that Brazilian Blowouts have gained popularity in the last two years, and that while the treatments saw a dip after the formaldehyde controversy first hit the news, "People ask a lot of questions... but in the end, they get it done."

"You know what? A chemical's a chemical," said Zakarian, a hairdresser of 15 years who herself gets regular "Brazilians." "I work with color all day. It is what it is. It's a part of the industry."

Could a club drug offer 'almost immediate' relief from depression?

Mon, 30 Jan 2012 12:16:40 -0800

Ketamine has been used as an anesthetic for decades. It's also a widely popular but illegal club drug known as "Special K." Credit: Huw Golledge

There's no quick fix for severe depression.

Although antidepressants like Prozac have been around since the 1970s, they usually take weeks to make a difference. And for up to 40 percent of patients, they simply don't work.

As a result, there are limited options when patients show up in an emergency room with suicidal depression.

The doctors and nurses at Ben Taub General Hospital in Houston say they see this problem every day.

You can get a sense of what they're up against by visiting the cavernous, bustling emergency center at Ben Taub, which is part of the massive Texas Medical Center. More than 100,000 patients a year get emergency care here, and about 5,000 of them need psychiatric evaluation.

The hospital's 24-hour Psychiatric Emergency Center gets a steady stream of people with suicidal depression, says Charlzetta McMurray-Horton, who is in charge of mental health nursing.

"If the police bring them in, they're going to come through this door," McMurray-Horton says, pointing to one entrance. "If the ambulance brings them in, they're going to come through this door," she says, pointing to a different entrance.

And one of the challenges in treating these severely depressed patients is that there simply isn't any drug that provides quick relief, says Anu Matorin, medical director of the Psychiatric Emergency Center.

Matorin talks about one recent patient. The woman had suffered bouts of depression since college, Matorin says. But after she had a baby, it became severe. She stopped eating and sleeping. She began to think about suicide.

Finally, the woman made a desperate call to her mother, Matorin says.

"She was very emotional, very tearful, not making sense," Matorin says. "She says, 'I just can't take it anymore. I don't know how to feed the child.' The mother could hear the infant crying in the background."

The family called 911, and the woman arrived at the hospital with a police escort. Matorin says she evaluated the woman and put her on antidepressants.

Then came the hard part, Matorin says. She knew the drugs might help the woman eventually. But they weren't going to do anything about her suicidal thoughts during the next few critical days.

So Matorin did the only thing she could for her patient. She admitted her to the hospital's locked inpatient unit.

I ask to see the facility, so McMurray-Horton takes me there.

'Keep Them Safe, Keep Them Alive'

The unit can handle 20 patients, and its main room is warmer, softer and more colorful than you might expect. Think Holiday Inn, without any sharp objects or hard edges.

But there's no avoiding the fact that this is a place where safety is paramount and privacy isn't, says McMurray-Horton. Shatterproof plastic windows around the nurses' station provide unobstructed sightlines to pretty much everywhere.

"Patients don't want to be here," says McMurray-Horton, explaining that about three-quarters of them are in the unit because they have been deemed a threat to themselves or someone else.

So it's not surprising that our tour of the unit is interrupted by the loud protests of one enraged patient.

Units like this are necessary in part because drugs for depression don't work fast enough to help someone in the early days of a crisis, Matorin says.

And McMurray-Horton says staff members here have a simple goal for patients in crisis: "Keep them safe, keep them alive until they're in a different space."

Counseling can help, McMurray-Horton says. So can family. And she says most people in crisis just start to feel better after a few days in a place where staff make sure that "they stay in, and the world stays out."

That was certainly true of the depressed young mother that Matorin admitted. She got better and went home several days later.

But that woman probably could have skipped the hospital stay altogether if the drugs used to treat depression were as quick and effective as, say, painkillers, Matorin says.

If drugs were more effective, "I think it would transform psychiatric care and really eliminate some of the stigma and fear and concern about treatment," she says.

'A Completely Different Mechanism'

A growing number of scientists think it won't be long before psychiatric care is transformed.

And they are particularly excited about an experimental drug that is being tried in the NeuroPsychiatric Center next to Ben Taub hospital.

It's here that drug researchers are studying a drug that's unlike anything now used to treat depression. And they're giving it to patients who haven't done well on existing drugs.

One of these patients is Heather Merrill, who speaks to me in a small conference room that is part of the large and very busy outpatient clinic.

Merill is 41, with three kids and a nice house in the suburbs.

"I've suffered from depression for most of my adult life," she says. "It got to the point where I kind of felt like there wasn't going to be anything that was going to be able to help me."

At times her depression gets so bad that she can't take care of her family or even herself, she says. And that's how she was feeling the day before, she says, when doctors placed an IV in her arm and began to administer a drug.

Because it was part of an experiment, there were two possibilities. The drug could have been just a sedative. Or it might have been something called ketamine.

Ketamine has been used for decades as an anesthetic. It also has become a wildly popular but illegal club drug known as "Special K."

Mental health researchers got interested in ketamine because of reports that it could make depression vanish almost instantly.

In contrast, drugs like Prozac take weeks or even months. And the frustrating thing is that depression medications really haven't changed much since Prozac arrived in the 1970s, says Sanjay Mathew from Baylor College of Medicine, who is in charge of the ketamine study at Ben Taub.

"Everything since then has been essentially incremental," he says. "There have been tweaks of existing molecules."

But ketamine represents much more than a tweak, Mathews says.

"It's a completely different mechanism," he says. "And the focus is on really rapidly helping someone get out of a depressive episode."

'No More Fogginess. No More Heaviness.'

Heather Merrill says she's pretty sure it was ketamine that flowed into her veins 24 hours earlier.

"It was almost immediate, the sense of calmness and relaxation," she says.

Some of the doctors think she might be right.

"Her demeanor has changed tremendously," says Dr. Asim Shah, who directs the mood disorder program at Ben Taub. "She looks like a happy person who is genuinely happy, whereas before the study, she looked very down, very withdrawn, sort of almost tearful."

But of course, nobody knows whether Merrill actually got ketamine. That information will be kept secret until the study is done, months from now.

So I decide to see how Merrill's experience compares with the experiences of people who definitely took ketamine for depression.

I talk to Carlos Zarate, who does ketamine research at the NIH and has never met Merrill. Zarate says patients typically say, " 'I feel that something's lifted or feel that I've never been depressed in my life. I feel I can work. I feel I can contribute to society.' And it was a different experience from feeling high. This was feeling that something has been removed."

I compare this to what Merrill said about her experience: "No more fogginess. No more heaviness. I feel like I'm a clean slate right now. I want to go home and see friends or, you know, go to the grocery store and cook the family dinner."

The similarities are hard to ignore.

And researchers say the consistent patient reactions have actually made it more difficult to do good studies of ketamine. The drug's effects are so powerful and distinctive, they say, it's hard to prevent doctors and patients in an experiment from figuring out who got the drug and who didn't.

A bid to replace neglect for tropical diseases with attention

Mon, 30 Jan 2012 11:34:41 -0800

An artist on Rio de Janeiro's Copacabana beach puts the final touches on a sand sculpture of the assassin bug, which spreads Chagas disease. Credit: Vanderlei Almeida/AFP/Getty Images

Tropical diseases that have long been overlooked are getting their due.

An ambitious new push to eradicate, eliminate or control 17 scourges over the next eight years was just unveiled in London. The initiative brings together the some of the world's largest drugmakers, health-oriented foundations and nongovernmental organizations. Governments from the developed world and the countries most affected by the diseases are also on board.

The drug companies will donate billions of doses of drugs and open their libraries of experimental medicines to quicken the pace of new drug development.

"We're saying look, if we focus our energies we can make some real progress," says Andrew Witty, the CEO of GlaxoSmithKline tells Shots. "We're serious about making a huge impact in the short run."

Witty says it's the first time that the world's 13 biggest pharmaceutical competitors have agreed to collaborate on a common goal and share their expertise on potential new drugs.

He says the project will lead to something like 1.5 billion free treatments per year to people in Africa. Witty declined to put a dollar figure on the total effort, but it includes almost a half-billion dollars in new funds from foundations and governments, plus the value of donated medicines.

To westerners, many of the diseases in question are unknown. While most have heard of leprosy and sleeping sickness, they'd be hard-pressed to tell the difference between yaws and lymphatic filiariasis, Chagas disease and dracunculiasis.

But taken together, these illnesses account for a heavy burden of misery, disability, poverty and death. They afflict 1.4 billion people in the world's poorest countries.

Dr. Mwele Malacela spoke with Shots about the impact of just one disease on her homeland of Tanzania — lymphatic filariasis, sometimes called elephantiasis from the ponderous swellings that disfigure the legs, arms, scrotums and breasts of infected people.

"People with these big growths can hardly do their normal chores, can hardly walk," Malacela says. "Two weeks out of a month they are in bed with fevers. It keeps them in a cycle of poverty."

The disease is caused by tiny worms injected into the blood by mosquito bites. When the worms develop into adults, they block lymph channels, causing huge swellings that can weigh over 100 pounds.

But Malacela says there's a "great possibility" that filariasis can be eliminated from Tanzania and other countries where it's been endemic forever. People who have the disease can't be cured, but if they get the right drug combination, the microscopic larval stage of the worms can be eliminated from the blood.

"We hope we will reach a point where there are no microfilaria in the blood," Malacela says. "Once that happens, when the mosquito bites, there is nothing to transmit and hence the disease is interrupted."

Malacela says authorities hope to bring mass drug treatment to 96 of Tanzania's 123 districts by the end of this year. "That's tremendous progress," she says. "Just a few years we were looking at only about 26 districts."

Lymphatic filariasis is slated for global elimination by 2020, along with blinding trachoma, leprosy and sleeping sickness. That means incidence would be reduced to zero, but continued surveillance and intervention will be required to prevent a resurgence.

Slated for eradication — permanent reduction of worldwide incidence to zero--are dracunculiasis or guinea worm disease, by 2015, and yaws, a bacterial skin infection that can be cured with a single injection of penicillin or azithromycin, by 2020.

The London Declaration, as it's called, calls for elimination in some regions by 2015 of rabies, Chagas disease, river blindness and schistosomiasis. By 2020 regional elimination is scheduled in other areas for these diseases plus the most serious form of the parasitic disease leshmaniasis.

Coupled with recent progress against HIV, polio and development of a vaccine against malaria, this new initiative signals a new optimism about the control or elimination of a wide range of public health scourges.

"I think our confidence level has never been higher," says Glaxo's Witty. "We now have treatment options... good weapons. What you're seeing is the cumulative effect of a great deal of research and great scientific ingenuity."

Malacela, who is director-general of Tanzania's National Institute for Medical Research in Dar es Salaam, says the London conference, which attracted about 300 of the world's experts on neglected tropical diseases, was "a bit emotional."

"It is a period of hope," she says. "Given the difficulties around the world at the moment, one wouldn't have expected to see such enthusiasm about diseases in the developing world."

If someone had told her years ago that it might be feasible to eradicate or eliminate many of these diseases, Malacela says, "I would probably have shaken my head and said that's not possible."