Got the flu? CDC says Tamiflu may not be much help

ATLANTA – The medical arsenal against the flu just got weaker. Government health officials said Friday that a leading flu medicine, Tamiflu, might not work against all cases of the flu this year. The most common flu bug right now is overwhelmingly resistant to Tamiflu, they said. The alert is "an early heads-up" for doctors. If current trends continue, they may need to change how they treat patients this flu season, said Dr. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention.

Health officials say they aren't too worried, for several reasons. First, it's early in the flu season, and it's not clear this strain will dominate through the next several months. Second, not many people take antiviral medications for the flu.

Third, the flu vaccine — the primary weapon against flu — seems well matched against the circulating bugs.

But doctors need to take it seriously, said William Schaffner, a Vanderbilt University infectious diseases expert.

"Each influenza seasons provides a bit of a surprise and we got our (surprise) a little early this year," he added.

The flu causes 200,000 hospitalizations and 36,000 deaths annually, according to official estimates. The elderly, young children and people with chronic illnesses are considered at greatest risk.

For the public, the best course of action is vaccination, health officials said. Only about 30 percent of U.S. adults had gotten a flu vaccination this flu season, according to an online survey conducted by the RAND Corporation in November. A flu shot is recommended for those 50 and older, children from 6 months to 18 years, pregnant women, nursing home patients and those with certain medical conditions or who care for people with those conditions.

For people who get the flu, the two most commonly used antivirals are Tamiflu, a pill also known as oseltamivir, and Relenza, an inhaled drug also called zanamivir. The drugs are most effective if taken within two days of getting sick but most people don't see a doctor that quickly.

Early tests indicate that 49 of 50 samples of the main flu virus circulating this year — H1N1 — were resistant to Tamiflu. The samples came mainly from Hawaii, Texas and ten other states. Widespread flu has not yet been reported in most of the country.

"It could fizzle out," or H1N1 could become the dominant strain, Gerberding said.

A spokesman for Tamiflu's manufacturer — Roche, a Swiss company — said it's too early to draw strong conclusions about the drug's usefulness this flu season. The basis of the CDC's alert "is a small sample in a limited number of states, and Tamiflu is showing good activity against other circulating viruses," said spokesman Terry Hurley.

For those sick with the flu, doctors cannot simply choose Relenza instead of Tamiflu. That treatment is not approved for children younger than 7 or people who have asthma or certain other breathing problems. GlaxoSmithKline PLC, which makes Relenza, said Friday it has enough to meet the demands of the current flu season.

An option for some patients, Gerberding said, may be a combination of Tamiflu and rimantadine, another antiviral medication that works against H1N1 but lost effectiveness against another kind of flu virus.

However, it's not clear how well that combination will work, Schaffner said.

"This is a 'best advice with our back against the wall' kind of thing," he said.

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On the Net:

The CDC flu report: http://www.cdc.gov/flu/weekly/

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New rule for health providers stirs objections

WASHINGTON – The Bush administration, in its final days, issued a federal rule Thursday reinforcing protections for doctors and other health care workers who refuse to participate in abortions and other procedures because of religious or moral objections.

Critics say the protections are so broad they limit a patient's right to get care and accurate information. For example, they fear the rule could make it possible for a pharmacy clerk to refuse to sell birth control pills without ramifications from an employer.

Under long-standing federal law, institutions may not discriminate against individuals who refuse to perform abortions or provide a referral for one. The administration's rule is intended to ensure that federal funds don't flow to providers who violate those laws, Health and Human Services officials said.

"Doctors and other health care providers should not be forced to choose between good professional standing and violating their conscience," said HHS Secretary Mike Leavitt.

The rule requires recipients of federal funding to certify their compliance with laws protecting conscience rights.

Despite multiple laws on the books protecting health providers, the administration argued that the rule was needed "to raise awareness of federal conscience protections and provide for their enforcement."

But many groups described the rule as a last-minute push designed to make it harder for women to get services such as contraception or counseling in the event they are pregnant and want to learn all of their options.

Several medical associations, more than 100 members of Congress, governors and 13 attorneys general were among the many thousands who wrote the department to protest the rule after it was proposed. Opponents didn't like the rule any better after it was finalized.

"In just a matter of months, the Bush administration has undone three decades of federal protections for both medical professionals and their patients," said Nancy Northup, president of the Center for Reproductive Rights. "It replaced them with a policy that seriously risks the health of millions of women, then tried to pass it off as benevolent."

Abortion opponents hailed the regulation because they said the lack of regulation had resulted in confusion and a lack of awareness.

"This is a huge victory for religious freedom and the First Amendment," said Tony Perkins, president of the Family Research Council.

The administration estimated the cost of complying with the rule at $43.6 million annually, which is spread throughout the hundreds of thousands of health providers subject to the rule — from hospitals and physician offices to medical schools and pharmacies.

Several lawmakers have promised to take up legislation that would overturn the rule once Congress reconvenes in January. Another option is for the Obama administration to issue new regulations that would trump it. The rule will take effect on Jan. 18, two days before Obama takes office.

Obama's transition team did not specifically address the rule Thursday, but spokesman Nick Shapiro issued a statement that said Obama "will review all eleventh-hour regulations and will address them once he is president."

While campaigning in August, Obama criticized the proposal: "This proposed regulation complicates, rather than clarifies the law. It raises troubling issues about access to basic health care for women, particularly access to contraceptives," he said.

The 127-page rule disputed concerns that the protections being proposed were too broad and would affect too many workers in the health care industry, not just doctors or nurses involved with an abortion or sterilization.

"These laws are intended to protect the conscience rights of all individuals participating in health care services, and research programs and activities receiving certain federal funds, or that are administered by the department," the rule said.

Opponents consistently described the rule as a last-minute effort that would reduce access to health care services, particularly access to birth control.

"Making birth control more — not less — accessible is the best way to prevent unintended pregnancies and reduce abortion," said Rep. Nita Lowey, D-N.Y.

Others said the rule would go so far as to protect providers who refuse to give rape victims emergency contraceptives.

The Planned Parenthood Federation of America said about 200,000 people submitted comments opposing the rule, including about 90,000 comments from its supporters.

"This midnight regulation, issued in the last days of the Bush administration, undermines this country's fragile health care system as well as patients' access to health care information and services," said the group's president, Cecile Richards.

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On the Net:

Health and Human Services Department: http://www.hhs.gov

Planned Parenthood: http://www.plannedparenthood.org

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Urban areas struggle to find grocers, fresh food

LOS ANGELES – Selma Lozoya didn't realize how tough it would be to help her obese mother lose weight until she had to forage for fresh groceries in the inner city.

For Lozoya, 17, not having a driver's license was part of the challenge. But the dearth of supermarkets in her South Los Angeles neighborhood choked with liquor stores, auto repair shops and warehouses made it even harder.

"I can't drive yet so I'm not gonna do anything extraordinary like jump on my bike and ride it for two or three miles and ride it back with tons of stuff on it, oh no," said Lozoya.

Seizing control of her kitchen, Lozoya helped her mom shed 50 pounds by banning lard from tamales and poaching chicken instead of frying it — and she is expanding her efforts to help her neighbors.

Lozoya is working to bring better food to one of the poorest communities in America, where neon lights illuminate a greasy fast-food vista and obesity and diabetes are rampant. While grocery stores and healthy restaurants are scarce, corner stores are stocked with beer, cigarettes, fried snacks and fatty sweets.

Lozoya's work with high school classmates to urge bodegas to stock healthier options is part of a larger campaign nationwide by nutritionists and community activists to eradicate so-called food deserts.

"Deserts are naturally occurring things," said Joanne Kim, chief operating officer of the Community Coalition of South Los Angeles. "We call this food apartheid because people have chosen to locate elsewhere even though there is substantial purchasing power here."

Between the three major Southern California grocery chains — Ralphs, Albertsons and Vons — there are six supermarkets in South Los Angeles, serving a population of about 688,000. By comparison, 19 supermarkets serve West Los Angeles' population of about 395,000.

Retailers blame theft in urban supermarkets, high employment turnover and lack of space for choosing to locate their stores elsewhere.

While farmers markets and trucks peddling fruits and vegetables have taken root in South Los Angeles, they are inconsistent and inadequate for the area's population, Kim said.

Some cities are trying to get more supermarkets into urban areas. The state of Pennsylvania invested $30 million five years ago and got 61 supermarkets opened in rural and urban areas.

Chicago and New Orleans are considering similar programs, but legislation to bring the same assistance to California cities died in the Legislature in 2006 due to budget constraints.

The food disparity in South Los Angeles is an echo of the area's history, marked by decades of segregation and racial strife, dating back before the deadly 1965 Watts riots.

In the state's post-riot report, residents alleged price gouging and the sale of stale bread, rancid meat and rotten produce — complaints that re-emerged decades later after race riots erupted in the wake of the Rodney King verdict in 1992, said City Councilwoman Jan Perry.

South Los Angeles has shifted from a mostly black to a mostly Hispanic community in the last decade, with Latinos making up about two-thirds of the population, according to 2006 Census figures.

Today, fast food is king in South L.A. Nearly three-quarters of restaurants offer food on the go, compared to 42 percent in pricier neighboring West Los Angeles.

The city's Community Redevelopment Agency estimates the area could support 14 new grocery stores and 74 more restaurants. But few businesses are biting on incentives that include hiring tax credits, 35 percent electricity discounts for a year and low interest loans.

"You throw public subsidies at them, and they still don't come," Kim said.

Like many residents of Lozoya's community, where 28 percent of households live below the federal poverty line, she relies on the small corner grocery a few blocks from her home for chicken, fruit and vegetables.

Until recently, Los Compadres Market and Restaurant looked like most others. But Lozoya and her classmates gave it a healthy makeover through a grant from The California Endowment, a private health foundation that aims to create healthy communities.

Chips and candy were removed from the front aisle of the store; a large cooler in the back was stocked with fresh fruits and vegetables; fruits were carefully laid out to avoid bruising; milk and cheese chilled alongside beer.

"These problems are really killing our communities," said Marion Standish, a program director for the endowment. "They're really disabling young people all over the state and limiting their potential in very serious ways, and limiting all of our potential as a result."

It's those limitations that Lozoya is trying to push past — even in her own quiet ways at home.

A few times, she's convinced her parents to drive 45 minutes to Beverly Hills, where her father, a contractor who doesn't consider a meal complete without red meat, balks at the price of the perfectly ripe berries Lozoya piles into the cart.

"When we get to the checkout he says, 'This is the last time! Never again!'" Lozoya said, wagging her finger in imitation. "Now, me and my mom try to pay when he isn't looking."

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Nursing home industry worries about new ratings

WASHINGTON – Rating systems help people decide which restaurants to go to or hotels to stay at. So why not something similar from the federal government for the nation's 16,000 nursing homes?

Such a simple rating for so complex a task as caring for the elderly is leading to much anxiety in the nursing home industry. Home operators worry about the ramifications for their business if they get one or two stars — when five is the best.

The Centers for Medicare and Medicaid Services was to let everyone know Thursday just how many stars each home is getting. Already the industry is questioning the validity of the rankings. To operators, the five-star system is a great idea whose time has not yet come.

The system "is poorly planned, prematurely implemented and hamhandedly rolled out," said Larry Minnix, president and chief executive officer of the American Association of Homes and Services for the Aging, an industry trade group.

Federal officials say the rankings will put nursing homes "on the path to improvement" because they know family members will think twice before putting someone in a one-star home.

The ratings are based on state inspections, staffing levels and quality measures, such as the percentage of residents with pressure sores. The nursing homes will receive stars for each of those categories as well as for their overall quality.

Consumer groups like the concept, but they agreed there are some potential problems with the data. For example, the staffing data is self-reported just before state surveys and is widely recognized as unreliable.

"From a consumer viewpoint, it's not stringent enough," said Alice H. Hedt, executive director of the National Citizens' Coalition for Nursing Home Reform. "It's basically taking information already available on Medicare's Nursing Home Compare Web site and pulling it into an easier system for consumers to use, and that is a good thing."

Hedt said consumers should consider the star ratings, but not solely rely on them when comparing facilities. Her organization also issued a press release warning that nursing homes may appear in the ratings to give better care than they actually do.

"Our initial reaction is that consumers should probably avoid any facility with a one- or two-star rating and even a three-star rating unless people they trust convince them that the rating is inaccurate or unfair," she said.

But, in Indiana, eight nonprofit nursing homes have reported they got one star for staffing even though they have some of the highest staffing levels in the states, said Jim Leich, president and chief executive officer of the Indiana Association of Homes for the Aging. He believes the one-star rating is the result of a records glitch particular to any nursing home that is part of a campus that includes housing for residents with less intensive care needs.

"It's really going to be an injustice for some of our best facilities," he said.

The Jennings Center for Older Adults in Garfield Heights, Ohio, got four stars for its nursing home, said Martha Kutik, the center's president and CEO. Still, she's worried that the rating system relies on surveys that measure cracks in the ceiling but don't measure patient and family satisfaction.

"Any system that's going to measure quality for consumers should keep satisfaction high on the list," Kutik said.

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On the Net:

Medicare's Nursing Home Compare Web site: http://Medicare.gov/NHcom.

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Tumor in Colorado newborn's brain contained foot

COLORADO SPRINGS, Colo. – A pediatric neurosurgeon says a tumor he removed from the brain of a Colorado Springs infant contained a tiny foot and other partially formed body parts.

Dr. Paul Grabb said he operated on Sam Esquibel at Memorial Hospital for Children after an MRI showed a microscopic tumor on the newborn's brain. Sam was 3 days old and otherwise healthy.

Grabb said that while removing the growth, he discovered it contained a nearly perfect foot and the formation of another foot, a hand and a thigh.

"It looked like the breach delivery of a baby, coming out of the brain," Grabb said. "To find a perfectly formed structure (like this) is extremely unique, unusual, borderline unheard of."

Grabb isn't sure what caused the growth but says it may have been a type of congenital brain tumor. However, such tumors usually are less complex than a foot or hand, he said.

The growth may also have been a case of "fetus in fetu" — in which a fetal twin begins to form within another — but such cases very rarely occur in the brain, Grabb said.

Sam's parents, Tiffnie and Manuel Esquibel, said their son is at home now but faces monthly blood tests to check for signs of cancer or regrowth, along with physical therapy to improve the use of his neck. But they say he has mostly recovered from the Oct. 3 surgery.

"You'd never know if he didn't have a scar there," Tiffnie Esquibel said.

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