WASHINGTON – Barack Obama praised the health care industry's promise to cut $2 trillion in costs over 10 years Monday, taking a sharply different course than President Bill Clinton did 16 years ago in an opening bid to overhaul the U.S. health system.
Drawing skepticism from lawmakers, Obama summoned representatives of the insurance industry, doctors, hospitals, pharmaceutical companies and labor groups to the White House for what he called "a watershed event in the long and elusive quest for health care reform."
It was a gathering of strange bedfellows. More than a decade ago, then-President Bill Clinton and his wife, now-Secretary of State Hillary Rodham Clinton, designed a health care plan in secret, fought industry leaders over it and lost — setting back the Democratic Party's cause for years.
If Obama succeeds in lowering costs and increasing access to health care, the meeting will be remembered as pivotal. If not, it will be just another Washington photo-op.
Indeed, the industry's proposal was short on specifics. And it appeared to do little to change minds in Congress as lawmakers attempt to write legislation to implement Obama's goal of extending health care to some 50 million uninsured Americans.
Within moments of Obama's appearance with the industry leaders, lawmakers praised the effort but suggested it didn't go to the heart of the health care debate.
Several lawmakers made clear that the industry proposal would do nothing to stave off the outcome that health insurers and others are trying to avoid — a new government insurance plan that would be available to middle-income Americans. Health insurers say such a plan would drive them out of business.
Sen. Ron Wyden, D-Ore., cautiously welcomed the industry's offer while saying, "I am not about to take the fox's word that the hen house is safe." He said the industry's promises need to be given the weight of law.
The industry groups said they would slow the growth of health care costs by 1.5 percent a year by coordinating care, reducing administrative costs and focusing on quality, efficiency and standardization. Health care costs would still grow faster than the economy as a whole, but not as fast as they otherwise would.
The specifics, industry officials said, would come later.
Obama has spoken often of the exorbitant costs in the nation's health care system, but slowing the rate price increases doesn't translate directly to paying the estimated $1.5 trillion cost of covering the uninsured. Money saved by the private sector doesn't flow directly to the federal treasury.
The top Republican on the Senate Finance Committee, Chuck Grassley of Iowa, called the announcement a "move in the right direction," but said it would be more significant if the Congressional Budget Office, Washington's arbiter of what costs or saves money for the government, determined it saved money.
"When the White House and the industry put concrete proposals on paper and get a score from the Congressional Budget Office, then we'll know if the suggestions really achieve that kind of savings, and it'll be big news," Grassley said. "For health care budgeting purposes, CBO's word is the only one that counts."
Karen Ignagni, president of America's Health Insurance Plans, contended that the voluntary cost-containment effort would help lawmakers who are aiming to craft health overhaul legislation by August.
"They need help from the stakeholder community on cost containment and what you're hearing from all of us is we intend to help and that I think is the story today," Ignagni said.
The groups who signed onto Monday's effort were the American Medical Association, America's Health Insurance Plans, the Pharmaceutical Research and Manufacturers of America, the Service Employees International Union, the American Hospital Association and the Advanced Medical Technology Association.
Officials said they could bring costs down even while continuing to stay profitable — noting that if health care legislation passes they'd be able to tap into a huge pool of currently uninsured people.
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Associated Press writers Henry C. Jackson and Ricardo Alonso-Zaldivar contributed to this report.
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Senin, 11 Mei 2009
Obama praises health industry's vow to cut costs
Worry over weight: Poll finds health disconnect
WASHINGTON – Scan the breathless headlines at any magazine rack — Fight Flab in Minutes! Get Beach Ready! Add the skinny yet buxom model, and it should be no surprise that the average woman feels insecure if not downright unhappy with her real-world figure. Hang on: Are we worried just about appearance, or about whether our size signals a health problem?
There's a big disconnect between body image and true physical condition, an Associated Press-iVillage poll suggests. A lot of women say they're dieting despite somehow avoiding healthy fruits and veggies. Many others think they're fat when they're not.
"The priorities are flipped," says Dr. Molly Poag, chief of psychiatry at New York's Lennox Hill Hospital.
She points to women athletes as much better role models than supermodels: "There's an undervaluing of physical fitness and an overvaluing of absolute weight and appearance for women in our culture."
About 60 percent of Americans are overweight or obese. The AP-iVillage poll of 1,000 adult women mirrors the government's count on that. More surprising, perhaps, are women's attitudes and actions.
Half don't like their weight, even 26 percent of those whose body mass index or BMI — a measure of weight for height — is in the normal range. But just a third don't like their physical condition, even though being overweight and sedentary are big risk factors for Type 2 diabetes, heart disease and other ailments.
The poll found women putting in a median of 80 minutes of exercise a week, meaning half do even less. The average adult is supposed to get 2 1/2 hours of exercise a week for good health.
And just 8 percent of women ate the minimum recommended servings of fruits and vegetables — five a day. A staggering 28 percent admit they get that recommended serving once a week or less.
Time is a big barrier.
"I was a fanatic about exercise when I was younger, and I quit focusing on that when I had kids," says Laura Comer, 45, of Sugar Land, Texas, a mother of two.
But she just her lost her job as a hospital system vice president and is using the new free time to ease in more activity. First up: walking 10,000 steps a day.
Vesna Stemwell, 51, of Delano, Minn., has a sedentary job — she's a computer programmer — with lots of overtime and a 45-minute commute.
Temporarily giving up meat and dairy products for a religious observance helped her drop five pounds, so she's considering becoming vegetarian to drop more. But her husband isn't keen about a menu change.
"Changing the diet," Stemwell said, "affects everybody in the house and it's hard to have something different."
About a quarter of the women surveyed said they'd consider plastic surgery to feel more beautiful. Their overwhelming choice: a tummy tuck.
"There isn't any quick fix," says Dr. Nieca Goldberg, who directs the women's heart program at the New York University Langone Medical Center.
A tummy tuck is cosmetic, removing just some surface fat, and a far cry from more radical surgeries like stomach stapling that are reserved to help the health of the very obese.
"People can't see the damage that's being done inside their body," says Goldberg. "If you increase your fitness but don't lose as much weight, you still have a lower heart disease risk than someone who is obese and sedentary."
At the other end of the spectrum, the poll found 16 percent of normal-weight women who nonetheless are dieting to drop pounds. Most extreme are eating disorders like the anorexia that has tormented Daleen Johnson of Oceanside, Calif., for years.
Her two children spurred the 5-foot-9 Johnson to put on 20 pounds in the past year, getting up to 125.
"My 8-year-old came up to me and was like, 'Mom, why don't my hip bones stick out like yours?'" said Johnson, 28. "I could put my selfishness aside so that she didn't think being skinny is what matters."
Still, Johnson says, "Summer's coming and I'm panicking because I don't think that I'm good enough. I don't look like the supermodel on TV."
Eating disorders aside, normal-skinny doesn't automatically mean healthy, stresses University of Houston sociologist Samantha Kwan, who studies gender and body image.
"Someone who is fat or even overweight can be healthy if they have a balanced diet and are physically active," Kwan says. "Our culture really does put a lot of pressure on women to look a certain way," taking precedence over health measures.
Olive James, 60, of Cincinnati gets that message. She calls herself about 10 pounds over her target weight, but exercises 30 minutes a day and takes her cholesterol and blood pressure medicine.
"I do get a lot of compliments for the way I carry myself," she says. "I feel great."
The AP-iVillage poll was conducted April 20-30 by Knowledge Networks, which contacted survey participants using traditional telephone and mail polling methods but then intensively questioned them online, providing Internet access for those who needed it. The poll has a margin of error of plus or minus 3.7 percentage points.
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EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
AP Polling Director Trevor Tompson and Associated Press Writer Christine Simmons contributed to this report.
On the Net:
iVillage sites: http://healthvideo.com/ap_poll and http://yourtotalhealth.ivillage.com/healthier-habits-tummy-tuck.html
AP survey results: http://surveys.ap.org/
Swine flu spreads in world; Mexico opens schools
MEXICO CITY – Mexico welcomed millions of children back to school Monday with masks, thermometers and globs of hand sanitizer, as scientists estimated the new strain of swine flu could have sickened 23,000 people before anyone realized it was an epidemic.
At least 61 people have been killed by swine flu around the world, and the World Health Organization has confirmed 4,800 cases, including the first in mainland China. China scrambled Monday to find and quarantine more than 200 people on the infected man's flight from the U.S., though the University of Missouri campus where he had been studying planned no special precautions.
A study published Monday in the journal Science estimated Mexico alone may have had 23,000 cases by April 23, the day it announced the epidemic. The study estimates swine flu kills between 0.4 percent and 1.4 percent of its victims, but lead author Neil Ferguson of Imperial College, London, said the data remain incomplete.
"It's very difficult to quantify the human health impact at this stage," he said.
The reopening of kindergartens and primary and middle schools shut since April 24 was the latest step in Mexico's efforts to restore a sense of normality. Businesses, government services, high schools and universities reopened last week.
But six of Mexico's 31 states put off reopening schools for a week because of local rises in the number of cases, and a seventh ordered a one-day delay.
In Mexico City, children lined up outside the Ignacio L. Vallarta public elementary school so teachers could check students for flu symptoms. Some parents worried schools were opening too soon, but many were also relieved after spending two weeks trying to entertain bored children. Officials said any students with symptoms would be sent home.
"It's good that schools are reopening. Our children were getting lazy," said Eugenia Martinez as her 8-year-old son, Edgar, ran around in a white mask and Power Rangers T-shirt. "I think everything is under control."
The federal Education Department said Monday that all 250,000 schools — except some 30,000 in states that did not reopen Monday — had been cleaned and disinfected as 25 million children prepared to return to class.
"It's very important for families to know that the disease is curable; we have enough medicine to treat any cases that arise," Education Secretary Alonso Lujambio Irazabal said. "As soon as we suspect we have a case we are going to offer antivirals to that person, that teacher, that student."
Mexico also is trying to revive its economy after the epidemic pummeled tourism, the country's third-largest source of legal foreign income. Mexico provided details Monday of a 14 billion peso ($1.1 billion) package to help restaurants, hotels and other businesses.
At least 10 commercial banks are involved in the plan, promising three-month reprieves for small businesses with outstanding loans in Mexico City and two hard-hit states. Small businesses in beach resorts and other tourist destinations were promised a six-month grace period.
"We are not looking for magical or spectacular solutions — which would be illusory — only that businesses have the liquidity need to recover from this emergency," Finance Secretary Agustin Carstens said. "Mexico is facing a very complicated year that combines a flu outbreak with one of the most severe global recessions in the last 60 years."
Later in the day, Tourism Secretary Rodolfo Elizondo said the government would launch a 1.2 billion peso ($90 million) publicity campaign this week urging Mexicans to take vacations in their own country.
Noting several nations have issued travel warnings or restricted airline flights to Mexico, Elizondo said that for now trying to promote trips to Mexico by foreigners "would be like throwing money away." He said occupancy rates at Mexico's top beach resorts are averaging between 15 percent and 23 percent.
The number of countries reporting confirmed swine flu cases grew to 31, with Cuba saying a Mexican who came to the island to study was sick with the virus. Cuba said the student was among a group from several Mexican states that began arriving April 25 — four days before Cuban authorities halted airline flights from Mexico in hopes of keeping out the illness.
The United States now has the most confirmed cases — 2,618 — according to the U.S. Centers for Disease Control and Prevention. Mexico has confirmed 2,059 cases. Swine flu has killed 56 people in Mexico, three in the U.S., one in Canada and one in Costa Rica.
The analysis in Science suggests there are many more cases than those confirmed by laboratories — anywhere from 6,000 to 32,000 cases in Mexico as of April 23. The flu has since spread around the world, and the study said it appears to be substantially more contagious than normal, seasonal flu.
Researchers also compared the DNA of the viruses in 23 confirmed cases, and came up with an estimate of Jan. 12 for their earliest common ancestor — presumably when person-to-person transmission began. But with everything that isn't known, they said it could have been anywhere from Nov. 3 to March 2.
The researchers said the 2009 H1N1 flu appears to be about equal in severity to the flu of 1957 and less severe than the deadly 1918 version.
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Associated Press writers Maria Cheng in London, Randolph E. Schmid in Washington and Gillian Wong in Beijing contributed to this report.
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Critics: WHO slow on generics for swine flu
LONDON – As poor countries face a possible swine flu pandemic with only enough Tamiflu to treat a tiny fraction of their populations, some experts are calling for a simple but contentious solution: massive production of generics.
Antivirals such as Tamiflu are believed to be effective against swine flu if administered early.
Tamiflu, made by the Swiss drugmaker Roche, sells for as much as $100 per treatment in countries such as the U.S., but since 2005 the company has offered a discounted price of $16 per treatment to poor nations. Cheap generics also can easily be manufactured by other companies, if the drug producers allow it.
Many rich nations sit on stockpiles of expensive Tamiflu, which was created in 1996 and is patent protected in most countries. However, Roche granted two companies in China and one in India permission to produce generic versions of Tamiflu in 2006. It also announced a transfer of the technology needed to make the drug to a company in South Africa.
Roche could not say how many developing countries have ordered Tamiflu at the cheaper price.
"We remain ready to discuss options with any manufacturers who can make Tamiflu," David Reddy, who works on Roche's global pandemic task force in Basel, Switzerland, said Monday.
Despite this availability, the World Health Organization — which maintains its own stockpiles of Tamiflu for poor nations — has not ordered up new batches of generic Tamiflu, even though WHO raised its pandemic alert level to phase 5, signaling it believes a global flu outbreak to be "imminent."
Critics say Roche should allow even more companies to produce generic Tamiflu, and that money from donor countries would go further in the Third World, if WHO was buying generic flu medicines itself or advising poorer countries to do so.
Meanwhile, in India, which does not recognize Roche's patent, the pharmaceutical giant Cipla has said it will charge about $12 per course of a generic Tamiflu.
Some critics suspect WHO is reluctant to anger drug companies, which supply it with free stockpiles of drugs, by encouraging the use of generics. Given all they spend on research and development to produce new drugs, Western pharmaceuticals have long fought to keep generics out of the market in all circumstances.
"There needs to be a better system in place so that WHO does not have to rely on the goodwill and charity of drug makers to get medicines for poor countries," said Sangeeta Shashikant of Third World Network, a nonprofit development organization.
WHO insists it's doing its best to secure antivirals for poor countries.
"WHO will work on behalf of its member states to secure further antivirals as needed, either through donations or purchase at the lowest possible price, to support developing countries in need," said Elil Renganathan, a WHO official working on antivirals.
Tamiflu and a similar medicine, Relenza, are mainly used to treat flu, but they only work if started within 48 hours of first symptoms. Studies show they cut the duration of illness by about one day, compared with no treatment. Little is known about whether these medicines cut the chances of serious flu complications, like pneumonia, and few studies have tested them in children.
Experts say vaccines would offer the best protection against a swine flu pandemic, but they won't be available for months.
And even when they are, rich countries are first in line: Britain, Canada, Denmark, France, the United States and others have all signed deals with vaccine makers to ensure they get the first batches of pandemic vaccine off the production line.
WHO is appealing to vaccine makers to save some of their vaccines for poor countries, but it's doubtful they will get enough to treat a significant portion of the population.
Last week, Cipla said it could produce 1.5 million treatments of a generic version of Tamiflu in the next few weeks. But Yusuf Hamied, the company's chairman, said it is ready to make millions more courses as soon as poor countries and agencies like WHO place orders.
"We could make a lot more, but there needs to be firm commitment from countries and international agencies like WHO," he said. "The ball is in their court."
So far, WHO has not recommended that countries with production capacity start making their own generic supplies of antivirals.
WHO has a stockpile of about 5 million Tamiflu treatment courses donated by Roche, and last week the agency began sending 2.4 million treatments to 72 poor countries. But such numbers pale in comparison to hundreds of millions of people in the developing world who would be vulnerable in a flu pandemic.
WHO says it is exploring generic production, but no decisions have been made. WHO says it is unsure how much massive generic production could increase the global supply and would not estimate a cost.
Renganathan said WHO wants to ensure any generic medicines meet drug safety standards. He said they are investigating the possibility of generic production with companies wherever they are located.
Still, critics say WHO has been slowfooted on generics.
"I don't know why WHO hasn't pursued generics," said Tido von Schoen-Angerer, director of Medecins Sans Frontieres' Access to Essential Medicines Campaign.
"A big role for WHO is to increase the world's generics supply of antivirals and make sure all countries have access," von Schoen-Angerer said. "It's not clear why WHO hasn't prioritized this."
With a large supply of generics, developing countries that could afford them, like Thailand and Brazil, could reinforce their own supplies. For poorer nations, agencies like UNICEF might buy the antivirals and distribute them to countries in need.
High rates of HIV, malaria, tuberculosis, malnutrition and other health problems greatly deepen the vulnerability of the world's poorest countries to a flu pandemic.
So far, critics say there's no indication from WHO that generic options will be prioritized for poor countries that can't afford Roche's Tamiflu.
"Countries are going to scramble to get as many medicines as they can in this situation," said Martin Khor, executive director of the South Centre, a think tank focused on developing countries.
"WHO should be helping countries to get stockpiles of antivirals as cheaply as possible."
news source www.news.yahoo.com
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Minggu, 10 Mei 2009
With swine flu, we're all in this together
MEXICO CITY – On the western edge of Mexico's capital, 10 new luxury apartment towers promise an antiseptically modern lifestyle with spas, private playgrounds and an exclusive shopping center. Blocks away, a world-class private hospital has opened.
But there's no escaping the view from these $1.5 million apartments: Just across a ravine is a slum where maids and construction workers make do in crowded, humid homes of raw concrete and spotty drinking water. For them, getting sick means medicating themselves at a discount pharmacy, or waiting for hours in an overcrowded public hospital.
Wealthy Mexicans aren't alone in trying — and failing — to distance themselves from deprivation and disease. People all over the world want to protect their families from the problems of the less fortunate.
But if there's anything we've learned from the swine flu epidemic, it is this: the virus doesn't discriminate.
"We're all in this together," President Barack Obama said as he urged public health agencies to reach all corners of America. "When one person gets sick, it has the potential of making us all sick."
The outbreak might not have become an epidemic if Mexico's first swine flu victims had been identified and treated quickly. We now know that for most, the virus causes only mild symptoms, and that nearly all of those who become quite sick can recover if they get proper treatment within 48 hours.
We also know that most of Mexico's dead didn't get that treatment in time.
But it feels awfully late to be pointing fingers over initial delays. And by ordering a nationwide shutdown last week of public gathering places where flu can spread, Mexico saved many more lives, experts say.
Now the world must face what Mexicans learned as they stayed home from schools and restaurants, venturing outside fearfully in face masks only to replenish their refrigerators: Rich and poor breathe the same air. The 53 people killed around the world so far range from poor day laborers to the grandson of one of the richest men in Mexico.
It's a moral challenge, as clear now as the view from those luxury living room windows: When vast numbers of poor people lack decent health care, no one is immune from disease.
A rural bricklayer with a bad cough, a kindergartner in a remote mountain village, a maintenance worker in a vast urban slum — these swine flu cases might have seemed a world away from the United States and Europe.
But it takes just four hours by bus for workers to reach the capital from the pig-farming community of La Gloria, where hundreds of villagers were suffering from acute respiratory infections for weeks before one of their kindergartners became Mexico's earliest confirmed swine flu case.
It takes even less time to fly from Mexico City to the U.S., where this strange new strain of swine flu was first identified in a 10-year-old San Diego boy.
No one knows yet where this outbreak began. Despite calls to close the U.S. border, scientists say the deadly chimera — a blend of bird, human and pig flu genes for which humans have limited natural immunity — may have jumped from pigs to humans in North Carolina, about 10 years and 10,000 generations of virus ago.
Millions of dollars have been spent on pandemic preparedness since scientists realized flu could jump between species. Top flu experts even developed a detailed containment plan — with an extremely limited window of opportunity.
World Health Organization experts determined that a virus with pandemic potential would have to be identified, the epicenter quarantined and 80 percent of the initially affected population blanketed with antiviral drugs within three weeks of the first symptoms.
Oh, and the outbreak would have to be limited to a small geographic area — like a remote village of about 1,000 people.
This H1N1 virus was likely spreading all over Mexico and parts of the United States long before anyone got sick enough to be tested. By the time the wheezing, sneezing villagers of La Gloria complained enough for their samples to be taken, dozens had been commuting to Mexico City for weeks.
Before anyone knew this flu's name, cases were popping up all over the megalopolis of 20 million.
A Canadian lab quickly confirmed that swine flu had reached Mexico, and a global alarm was raised. But only hours later, the WHO said it was useless to close borders and ban flights. Travelers had already carried the virus from Mexico to New York and New Zealand. It has since spread to at least 29 countries around the world.
So now Mexico's challenge has become a truly global problem. Experts say even normal seasonal flu infects millions and kills about 500,000 people worldwide every year. With the WHO warning that a possible swine flu pandemic could infect 2 billion people, how on earth can we protect the whole world?
The drug makers say they can "most likely" produce 917 million doses in 10 months, a number considered overly ambitious by some experts.
Even the first vaccines won't be ready for months — too late for the Southern Hemisphere, where flu season is about to start. And if the virus evolves into something more contagious or deadly — possibly by mixing with regular flu or even H5N1 bird flu, which is endemic in parts of Asia and Africa — these vaccines may not provide much protection in the end.
Antiviral drugs will be critical if it comes to that, but they are expensive, and there aren't enough to go around. The largest stockpiles are kept by the wealthiest nations, for their own citizens' protection.
But hoarding antivirals could backfire. A 2007 study modeled what would happen in a flu pandemic if wealthy nations hoard or share these drugs.
They concluded that the hardest-hit populations should be blanketed with antivirals, even if they are too poor to pay for them, and even if it means people with reliable health care in wealthier nations would go untreated.
Doing so would save many millions of lives, they found — including in the wealthy countries that share.
Nobody knows where this current outbreak is headed as the swine flu virus evolves. It may lose its potency.
Or it may become a real killer. And if that happens, there will be some hard decisions to make.
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US, Costa Rica swine flu deaths reported
SEATTLE – The number of swine flu-related deaths outside Mexico has inched up to five with the U.S. reporting its third fatality and Costa Rica its first, both involving men who also had underlying illnesses.
The number of confirmed cases of the infection in the U.S. has risen to 2,532 in 44 states, the Centers for Disease Control and Prevention reported Sunday.
Washington state health officials said the victim there was a man in his 30s who had underlying heart conditions and viral pneumonia when he died Thursday from what appeared to be complications from swine flu. The state Department of Health said in a statement Saturday that swine flu was considered a factor in his death.
"We're working with local and federal partners to track this outbreak," said Washington State Secretary of Health Mary Selecky.
The man was not further identified. He began showing symptoms on April 30, and was treated with anti-viral medication. Dr. Gary Goldbaum, Snohomish Health District medical director, said medical officials hadn't been able to isolate any "risk factors" for the man to identify where he might have been exposed.
The death of a 53-year-old man in Costa Rica on Saturday was the first involving swine flu outside North America. He also suffered from diabetes and chronic lung disease, the Health Ministry said.
Most of the victims in Mexico, the center of the outbreak where 48 people with swine flu have died, have been adults aged 20 to 49, and many had no reported complicating factors.
Previously, U.S. authorities reported swine flu deaths of a toddler with a heart defect and a woman with rheumatoid arthritis, and Canadian officials said the woman who died there also had other health problems but gave no details.
Mexico, which raised its count of confirmed cases to 1,626 based on tests of earlier patients, has been gradually lifting a nationwide shutdown of schools, businesses, churches and soccer stadiums.
But an upswing in suspected — though not confirmed — cases in parts of Mexico prompted authorities in at least six of the country's 31 states to delay plans to let primary school students return to class Monday after a two-week break.
"It has been very stable ... except for those states," Health Department spokesman Carlos Olmos said, referring to states in central and southern Mexico.
Mexican health authorities released a breakdown of the first 45 of the country's 48 flu deaths that showed that 84 percent of the victims were between the ages of 20 and 54. Only 2.2 percent were immune-depressed, and none had a history of respiratory disease.
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Marshall reported from Seattle; Jimenez reported from San Jose, Costa Rica.
news source www.news.yahoo.com
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Health overhaul draws groups' competing demands
WASHINGTON – Patients and doctors. Small businesses and multinationals. Retirees, workers and insurance companies.
Some have more money and clout. All have something in common when it comes to overhauling health care: a huge stake in the outcome.
Their competing demands will help determine what happens as Congress writes legislation to reshape the nation's $2.5 trillion health care system to bring down costs and cover 50 million uninsured people. If the whole undertaking starts to fall apart, look to opposition from one or more of these groups as the reason why.
All say their goal is for everyone to have access to quality and affordable care. Beyond that, consensus breaks down.
A look at 10 groups with the most influence, or most at stake, in the health debate, and what they want and are trying to avoid:
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Workers:
Some 60 percent of people under age 65 get health care through an employer. But employers don't have to offer health insurance, and as the economy frays, some are dropping it. Labor unions want to require employers to help pay for coverage for their employees.
Unions also believe the path to affordable care runs through a new public insurance plan that would compete with private plans. Middle-class workers, for the first time, would have the option of government insurance. Proponents of this approach, already embraced by President Barack Obama and many Democrats, believe it would drive down costs for all.
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People with health conditions:
A common complaint about insurers is that they won't cover people with existing health conditions or that they charge them too much. Patients' advocacy groups want to require insurers to cover all comers, not just the healthy, and limit what they can charge the sick. They contend that would spread risk and costs throughout the population.
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Older people:
Among the top goals for AARP is ensuring health coverage for people age 50-64 (at 65 they can get Medicare). That could be done by allowing middle-aged people to buy into Medicare. AARP also is eager for Congress to fix the coverage gap in the Medicare drug benefit that patients fall into once their prescription expenses exceed about $2,700.
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Uninsured people:
The estimated 50 million uninsured people in the U.S. don't have lobbyists, but various advocacy groups aim to speak on their behalf. The liberal group Health Care for America Now says any health overhaul should mean coverage for everyone by including a public plan, basing out-of-pocket costs on ability to pay and providing a standard benefit with preventive care and treatment for serious and chronic diseases.
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Insurance companies:
For private insurers, the bogeyman is competition from the government. They contend a public plan would drive them out of business. To stave that off, the industry is offering to curb its practice of charging higher premiums to people with a history of medical problems, as long as Congress requires all Americans to get insurance.
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Small businesses:
Opposition from small business helped kill a health care overhaul during the Clinton years. Their top goal remains the same: to avoid any kind of requirement for employers to provide health care. The National Federation of Independent Business says that is unacceptable and favors subsidies to help people buy insurance. Small businesses want to make the same tax breaks for health insurance available to all, not just those who get coverage through an employer.
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Big businesses:
Even though most big businesses offer health care to their employees, they strongly oppose an employer mandate, fearing the government would start dictating what kind of policies they could offer. Businesses want to avoid taxes on the health insurance benefits.
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Hospitals:
Hospitals worry that a new government insurance plan would reduce the fees they can collect. They support requirements for individuals and employers to purchase insurance so "everyone plays a role in making sure that there's coverage," says Tom Nickels, a senior vice president at the American Hospital Association.
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Doctors: Doctors have similar concerns as hospitals about a public plan. They also want to prevent insurers from raising rates on patients with health problems. They would cap or eliminate tax breaks for employer-provided benefits, using the revenue to subsidize care for low-income people. Doctors want curbs on medical malpractice awards so they don't face the threat of huge jury awards. They contend that leads to "defensive medicine" — performing unnecessary procedures to avoid getting sued.
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Drug companies:
The drug lobby opposes a government insurance plan and has joined the advocacy group Families USA in proposing to cover more of the uninsured by expanding Medicaid, the federal-state insurance program for the poor. Pharmaceutical companies support federal subsidies to help middle-class people unable to afford insurance. Drug companies oppose efforts to squeeze bigger discounts from them under Medicaid.
"We don't want bureaucrats making the decisions about what medicines can be used by the patients of our country and that's the end result of a pure public plan," says Billy Tauzin, head of the Pharmaceutical Research and Manufacturers of America.
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On the Net:
Pharmaceutical Research and Manufacturers of America: http://www.phrma.org/
American Hospital Association: http://www.aha.org/
National Federation of Independent Business: http://www.nfib.com/
AFL-CIO: http://www.aflcio.org/
AARP: http://www.aarp.org/
America's Health Insurance Plans: http://www.ahip.org
American Medical Association: http://www.ama-assn.org/
Families USA: http://www.familiesusa.org/
Health Care for America Now: http://www.healthcareforamericanow.org/
news source www.news.yahoo.com
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Flu exposes flaws in Mexico's health care system
MEXICO CITY – Mexicans will do almost anything to avoid a public hospital emergency room, where ailing patients may languish for hours slumped on cracked linoleum floors that smell of sweat, sickness and pine-scented disinfectant.
Many don't see doctors at all, heading instead to the clerk at the corner pharmacy for advice on coping with a cold or a flu.
So it's no surprise that when a dangerous new swine flu virus began to sweep across Mexico, many waited too long to seek medical help — more than a week on average, according to federal Health Secretary Jose Angel Cordova.
These initial delays complicated treatment, possibly explaining why 48 of the world's 52 confirmed swine flu-linked deaths occurred in Mexico.
It also made it more difficult for Mexico to recognize the outbreak for what it was. By the time Cordova announced a swine flu epidemic on April 23, the virus had already spread across the country and beyond.
Mexico's big cities have fancy private hospitals stocked with modern equipment and staffed with U.S. board-certified specialists. Americans increasingly come to Mexico for good care at low prices. The best of the public system is world-class too, with top doctors at elite centers for specialized diseases.
But Mexico's everyday public hospital system is in crisis.
Some patients suspected of having swine flu told The Associated Press that public hospitals turned them away or forced them to wait for hours for treatment even after the government declared a national emergency.
Those who sought help before the alert — often arriving with headaches, high fevers and difficulty breathing — encountered baffled doctors who had not been warned to watch for a new virus.
Mexicans navigate a patchwork of public and private hospital systems. There are hospitals for government employees and hospitals for workers enrolled in government health plans through private employers. Most patients have to go to a hospital tied to a specific agency.
"If someone is sick, he can't simply say, 'I'm going to the doctor' or 'I'm going to the hospital,' because it depends on whether he has Social Security or if he has to go to another institution," said Dr. Malaquias Lopez Cervantes, a leading epidemiologist at Mexico's National Autonomous University.
"And if he comes (to the wrong hospital), somebody is going to tell him that he doesn't have the right to be treated."
While access to health care is a right enshrined in the Mexican constitution, millions of Mexicans have no health insurance at all.
Mexico spends only 6.6 percent of its gross domestic product on health care — less than half the U.S. figure. No country in the 30-nation Organization for Economic Cooperation and Development puts a smaller share of public money into its health care system.
That means the hospitals serving most of Mexico's 44 million poor are often crowded, ill-equipped and staffed with harried, underpaid staff working for a dizzying array of bureaucracies.
It's so crowded, confusing and bureaucratic that the poor are more likely to head for a pharmacy, hoping to find a cheap remedy for "gripe" (pronounced GREE-pay) — a word that can cover anything from a mild cold to a deadly flu.
Most pharmacies dole out antibiotics and a host of other powerful drugs without a prescription. That encourages Mexicans to self-medicate, relying on a counter clerk's suggestion, dosing themselves with whatever worked the last time they had a fever and waiting a day or two to see what happens.
Some pharmacies even drum up business by tacking a doctor's office onto the side — offering basic checkups for as little as 25 pesos ($2) — still roughly half a day's pay for a minimum-wage worker.
In Mexico City's working-class Padierna neighborhood, Dr. Oscar Aguilera sees patients in a small office at the back of a discount pharmacy, with an open-air waiting room behind a row of graffiti-tagged taco stands.
Even in normal times, most of his patients come in with a cold or a flu. Most now show no signs of swine flu, he said, but "20 percent show some symptoms and we send them to the hospital."
Following the public alert on April 23, fear has driven patients to his office even at the slightest symptom.
Mexicans with flu symptoms might have sought better care far earlier if the public health care system had done the same kind of flu surveillance common in the U.S. and other developed nations.
Mexico keeps close watch on dangerous tropical diseases such as dengue, but epidemiologists pay less attention to flu, just one class of viruses contributing to Mexico's 23 million annual cases of respiratory illness.
Mexican doctors "really were not trained thinking of the existence of influenza" as a specific threat, Lopez Cervantes said.
In all of 2008, Mexico's official epidemiological bulletin reported only 151 confirmed cases of flu. By comparison, U.S. officials ran tests that confirmed nearly 40,000 flu cases last season. Mexico has about a third the population of the United States.
Research suggests children can recover from autism
CHICAGO – Leo Lytel was diagnosed with autism as a toddler. But by age 9 he had overcome the disorder.
His progress is part of a growing body of research that suggests at least 10 percent of children with autism can "recover" from it — most of them after undergoing years of intensive behavioral therapy.
Skeptics question the phenomenon, but University of Connecticut psychology professor Deborah Fein is among those convinced it's real.
She presented research this week at an autism conference in Chicago that included 20 children who, according to rigorous analysis, got a correct diagnosis but years later were no longer considered autistic.
Among them was Leo, a boy in Washington, D.C., who once made no eye contact, who echoed words said to him and often spun around in circles — all classic autism symptoms. Now he is an articulate, social third-grader. His mother, Jayne Lytel, says his teachers call Leo a leader.
The study, funded by the National Institute of Mental Health, involves children ages 9 to 18.
Autism researcher Geraldine Dawson, chief science officer of the advocacy group Autism Speaks, called Fein's research a breakthrough.
"Even though a number of us out in the clinical field have seen kids who appear to recover," it has never been documented as thoroughly as Fein's work, Dawson said.
"We're at a very early stage in terms of understanding" the phenomenon, Dawson said.
Previous studies have suggested between 3 percent and 25 percent of autistic kids recover. Fein says her studies have shown the range is 10 percent to 20 percent.
But even after lots of therapy — often carefully designed educational and social activities with rewards — most autistic children remain autistic.
Recovery is "not a realistic expectation for the majority of kids," but parents should know it can happen, Fein said.
Doubters say "either they really weren't autistic to begin with ... or they're still socially odd and obsessive, but they don't exactly meet criteria" for autism, she said.
Fein said the children in her study "really were" autistic and now they're "really not."
University of Michigan autism expert Catherine Lord said she also has seen autistic patients who recover. Most had parents who spent long hours working with them on behavior improvement.
But, Lord added, "I don't think we can predict who this will happen for." And she does not think it's possible to make it happen.
The children in Fein's study, which is still ongoing, were diagnosed by an autism specialist before age 5 but no longer meet diagnostic criteria for autism. The initial diagnoses were verified through early medical records.
Because the phenomenon is so rare, Fein is still seeking children to help bolster evidence on what traits formerly autistic kids may have in common. Her team is also comparing these children with autistic and non-autistic kids.
So far, the "recovered" kids "are turning out very normal" on neuropsychological exams and verbal and nonverbal tests, she said.
The researchers are also doing imaging tests to see if the recovered kids' brains look more like those of autistic or nonautistic children. Autistic children's brains tend to be slightly larger than normal.
Imaging scans also are being done to examine brain function in formerly autistic kids. Researchers want to know if their "normal" behavior is a result of "normal" brain activity, or if their brains process information in a non-typical way to compensate for any deficits.
Results from those tests are still being analyzed.
Most of the formerly autistic kids got long-term behavior treatment soon after diagnosis, in some cases for 30 or 40 hours weekly.
Many also have above-average IQs and had been diagnosed with relatively mild cases of autism. At age 2, many were within the normal range for motor development, able to walk, climb and hold a pencil.
Significant improvement suggesting recovery was evident by around age 7 in most cases, Fein said.
None of the children has shown any sign of relapse. But nearly three-fourths of the formerly autistic kids have had other disorders, including attention-deficit problems, tics and phobias; eight still are affected.
Jayne Lytel says Leo sometimes still gets upset easily but is much more flexible than before.
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On the Net
National Institute of Mental Health: http://www.nimh.nih.gov
Autism Speaks: http://www.autismspeaks.org/
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Kamis, 07 Mei 2009
Flu overhyped? Some say officials 'cried swine'
CHICAGO – Did government health officials "cry swine" when they sounded the alarm on what looked like a threatening new flu?
The so-far mild swine flu outbreak has many people saying all the talk about a devastating global epidemic was just fear-mongering hype. But that's not how public health officials see it, calling complacency the thing that keeps them up at night.
The World Health Organization added a scary-sounding warning Thursday, predicting up to 2 billion people could catch the new flu if the outbreak turns into a global epidemic.
Many blame such alarms and the breathless media coverage for creating an overreaction that disrupted many people's lives.
Schools shut down, idling even healthy kids and forcing parents to stay home from work; colleges scaled back or even canceled graduation ceremonies; a big Cinco de Mayo celebration in Chicago was canned; face masks and hand sanitizers sold out — all because of an outbreak that seems no worse than a mild flu season.
"I don't know anyone who has it. I haven't met anyone who knows anyone who contracted it," said Carl Shepherd, a suburban Chicago video producer and father of two. "It's really frightening more people than it should have. It's like crying wolf."
Two weeks after news broke about the new flu strain, there have been 46 deaths — 44 in Mexico and two in the United States. More than 2,300 are sick in 26 countries, including about 900 U.S. cases. Those are much lower numbers than were feared at the start based on early reports of an aggressive and deadly flu in Mexico.
Miranda Smith, whose graduation ceremony at Cisco Junior College in central Texas was canceled to avoid spreading the flu, blames the media.
"It's been totally overblown," she said Thursday.
"Everyone seems to know it's not going to kill you and it's not as deadly as they think," she said. "Everybody needs to just calm down and chill out."
Craig Heyl of Decatur, Ga., said the government overreacted.
"Swine flu is just another strain of flu. People get the flu. I guess you have to call it a pandemic when it's a widespread virus, but I don't think the severity of it is all that concerning," said Heyl, 43.
Public health authorities acknowledge their worst fears about the new virus have not materialized. But no one's officially saying it's time to relax. And experts worry that people will become too complacent and tune out the warnings if the virus returns in a more dangerous form in the fall.
"People are taking a sigh of relief too soon," said Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention.
In an interview Wednesday with The Associated Press, Besser said the outbreak in the United States appears to be less severe than was first feared. But the virus is still spreading and its future potential as a killer is not clearly understood.
"The measures we've been talking about — the importance of handwashing, the importance of covering coughs, the real responsibility for staying home when you're sick and keeping your children home when you're sick — I'm afraid that people are going to say, 'Ah, we've dodged a bullet. We don't need to do that,'" Besser said.
"The thing that's keeping me up right now is that feeling of dodging the bullet," he added.
Peter Sandman, a risk communication specialist, says on his Web site that reminding people the risk is still real and warning them in the future if a pandemic looks imminent "will be extremely difficult."
"Swine flu looks to be an extremely mild pandemic if it goes pandemic at all, despite WHO warnings that it may 'come back with a vengeance' in the fall. People are going to be very, very skeptical," Sandman wrote.
That concern is shared by infectious disease specialists. But elsewhere, especially online, talk of hype is rampant.
"If I hear 1+ person freaking out because of the "Swine Flu" they won't have 2 worry about dying from it. I will kill them w/ my handbag!" read a comment Wednesday on Twitter.
"Adults are acting like a bunch of crybabies in a B-rated science fiction germ-outbreak movie, wringing their hands, whining about what to do next," Dallas Morning News reader Mark Thompson wrote in a letter to the editor posted online Wednesday.
Kari Carsey Valente of Lake Oswego, Ore., had similar thoughts in a letter on the Oregonian newspaper's Web site.
"Is the daily front page body count really necessary? In reading the entire content of the collected articles one learns that the H1N1 strain is not likely to be more lethal than its predecessors. Give it a rest — and lots of liquid!," Valente wrote.
Colt Ables, 22, an economics major at the University of Texas in Arlington, said he thinks the Obama administration overreacted and unfairly tried to make it seem as if Republicans have been soft on preparedness.
"This shouldn't be about politics or about hyping up a virus to send the American people into a panic. Do yourself a favor, wash your hands and turn off the TV," he wrote in a campus newspaper column.
Whether the media overhyped or accurately reported the dangers is a toss-up, according to a USA Today/Gallup poll published Thursday on Americans' views of the media's flu coverage.
The May 5 poll also found that concern about the flu peaked a week ago. But even then, only 25 percent of Americans said they worried about getting the virus.
Dr. Robert Daum, a University of Chicago infectious disease expert, says authorities acted properly when news first broke about the new flu strain.
"It's like overcalling a snowstorm in Chicago. You want the plows out even if it's only going to snow a flake," Daum said. If not, and a blizzard hits, "there will be an outcry like you've never seen before."
Still, Daum says authorities have been a bit awkward in "downshifting" now that it appears the U.S. situation isn't dire.
"I think it was right to place everyone on high alert, and now right" to say it's time to calm down, Daum said.
___
Medical Writer Lindsey Tanner reported from Chicago and Medical Writer Mike Stobbe reported from Atlanta.
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WHO: Up to 2 billion people might get swine flu
GENEVA – Up to 2 billion people could be infected by swine flu if the current outbreak turns into a pandemic lasting two years, the World Health Organization said Thursday. WHO flu chief Keiji Fukuda said the historical record of flu pandemics indicates one-third of the world's population gets infected in such outbreaks. Independent experts agreed that the estimate was possible but pointed out that many would not show any symptoms.
In Mexico, the hardest hit country so far, high schools and universities opened for the first time in two weeks as the government's top health official insisted the epidemic is on the decline. All students were checked for swine flu symptoms and some were sent home.
"If we do move into a pandemic, then our expectation is that we will see a large number of people infected worldwide," Fukuda said. "If you look at past pandemics, it would be a reasonable estimate to say perhaps a third of the world's population would get infected with this virus."
With the current total population of more than 6 billion, that would mean an infection total of 2 billion, he said, but added that the world has changed since pandemics of earlier generations, and experts are unable to predict if the impact will be greater or smaller.
"We don't really know." said Fukuda. "This is a benchmark from the past. Please do not interpret this as a prediction for the future."
Chris Smith, at flu virologist at Cambridge University in England, said the 2 billion estimate was possible.
"That doesn't sound too outlandish to me for the simple reason that this is a very infectious virus," Smith told The Associated Press. "You're talking about a virus that no one in the population has seen before and therefore everyone is immunologically vulnerable. Therefore it's highly likely that once it starts to spread, people will catch it. And since the majority of the world's population are in contact with one another, you're going to get quite a lot of spread."
John Oxford, professor of virology at St. Bart's and Royal London Hospital, agreed.
"I don't think the 2 billion figure should scare people because it's not as though 2 billion people are going to die. The prediction from WHO is that 2 billion people might catch it. Half of those people won't show any symptoms. Or if they show any symptoms, they will be so mild they will hardly know they've had it."
Fukuda said it also is impossible to say if the current strain of swine flu will become severe or mild, but that even with a mild flu, "from the global perspective there are still very large numbers of people who could develop pneumonia, require respirators, who could die."
A mild outbreak in wealthier countries can be "quite severe in its impact in the developing world," Fukuda said.
People react differently to the flu depending on their general state of health and other factors, he said. Some younger people in the Southern Hemisphere may be more vulnerable because of poor diet, war, HIV infections and other factors.
"We expect this kind of event to unfold over weeks and months," Fukuda said. "Really if you look over a two-year period that is really the period in which you see an increase in the number of illnesses and deaths during a pandemic influenza."
So far the swine flu virus has spread to 26 countries. Brazil and Argentina on Thursday became the second and third countries in South America to announce confirmed cases.
Mexican dance halls, movie theaters and bars were allowed to fully reopen Thursday after a five-day shutdown designed to curb the virus' spread. Businesses must screen for any sick customers, and restaurant employees must wear surgical masks.
Fans can attend professional soccer matches this weekend after all were played in empty stadiums last weekend.
Mexico confirmed two more deaths, for a total of 44, while 1,160 people have been sickened, up 90 from Wednesday. Despite death tolls and confirmed caseloads that rise daily, Health Secretary Jose Angel Cordova insisted the epidemic is waning in Mexico.
WHO raised its global total of laboratory-confirmed cases to 2,099, from 1,893 late Wednesday, and said swine flu also has caused two deaths in the United States.
This swine flu seems to have a long incubation period — five to seven days before people notice symptoms, according to Dr. Marc-Alain Widdowson, a medical epidemiologist from the U.S. Centers for Disease Control and Prevention now tracking the flu in Mexico City. That means the virus can keep being spread by people who won't know to stay home.
Laughing and joking, high school students gathered at the entrance of the National School of Graphic Arts in Mexico City, waiting to fill out forms that asked about their health.
Of 280 students entering the school in the first 20 minutes, two showed symptoms of swine flu, including coughing and nasal congestion, said assistant principal Ana Maria Calvo Vega. Their parents were notified and they won't be readmitted without a statement from a doctor saying they don't have the virus, she said.
Students at a Mexico City vocational high school were welcomed with a hand sanitizer and a surgical mask. Joyful to see each other again, students embraced and kissed — some through masks.
But some worried that the virus could surge back once young people gather in groups again.
"My 17-year-old daughter is afraid. She knows she must go back but doesn't want to," said Silvia Mendez as she walked with her 4-year-old son, Enrique, in San Miguel Topilejo, a town perched in forested mountains near the capital.
Working parents have struggled to provide child care during the shutdown. It forced many to stay home from work, bring their youngsters to their jobs, or leave them at home.
Each school, Mexican officials said, had to be cleaned and inspected this week. Complicating the task: Many schools are primitive buildings with dirt floors and lack proper bathrooms. It was unclear how students attending those schools could adhere to the government's strict sanitary conditions.
The government promised detergent, chlorine, trash bags, anti-bacterial soap or antiseptic gel and face masks to state governments for delivery to public schools. But some local districts apparently didn't get the word.
U.S. health officials are no longer recommending that schools close because of suspected swine flu cases since the virus has turned out to be milder than initially feared. But many U.S. schools have done so anyway, including the school of a Texas teacher who died.
In Asia, top health officials said the region must remain vigilant over the threat of swine flu, stepping up cooperation to produce vaccines and bolstering meager anti-viral stockpiles.
The virus has so far largely spared Asia. Only South Korea and Hong Kong have confirmed cases. On Thursday, China and Hong Kong released dozens of people quarantined over suspected contact with one of the region's few swine flu carriers.
Experience has been the spur to WHO to make sure the world is as prepared as possible for a pandemic, which would be indicated by a rise to phase 6 from the current phase 5 in the agency's alert scale. That would mean general spread of the disease in another region beyond North America, where the outbreak so far has been heaviest.
"I'm not quite sure we know if we're going to phase six or not or when we would do so," Fukuda said. "It's really impossible for anybody to predict right now."
Officials said the agency was likely to shorten its annual meeting of its 193 member states later this month from 10 days to five because of the outbreak, which it was scheduled to discuss.
"That is under consideration," Fukuda said. "Sure it is possible."
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Contributions from AP Medical Writer Maria Cheng in London and Associated Press writers Andrew O. Selsky in Mexico City and Michael Casey in Bangkok.
news source www.news.yahoo.com
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US swine flu victims had chronic health problems
ATLANTA – America's two swine flu deaths — a toddler and a pregnant woman — each suffered from several other illnesses when they were infected with the virus, according to a study released Thursday.
The report by the Centers for Disease Control and Prevention presented a clearer picture of the complicated medical situations faced by those who have gotten swine flu and had the most serious cases so far.
The Mexican toddler had a chronic muscle weakness called myasthenia gravis, a heart defect, a swallowing problem and lack of oxygen. Little Miguel Tejada Vazquez fell ill and died during a family visit to Texas.
The pregnant woman, Judy Trunnell, 33, was hospitalized for two weeks until she died Tuesday. The teacher was in a coma, and her baby girl was delivered by cesarean section. According to the report, she had asthma, rheumatoid arthritis, a skin condition called psoriasis and was 35 weeks pregnant.
People with chronic illnesses are at greatest risk for severe illness from the flu, along with the elderly and young children. So far, most of those with the swine flu in the U.S. and Mexico have been young adults.
"We're still learning about what patients are most at risk" from the new virus, said Dr. Fatima Dawood, a CDC epidemiologist.
The CDC report released by the New England Journal of Medicine also provided more detailed information on 22 people hospitalized with swine flu. Nine had chronic medical conditions, including the two who died and a 25-year-old man with Down syndrome and a congenital heart disease. Five of the patients had asthma alone.
Separately, the CDC also described the symptoms experienced by Americans with swine flu. About 90 percent reported fever, 84 percent reported cough and 61 percent reported a sore throat — all similar to what's seen with seasonal flu.
But about one in four cases have also involved either vomiting or diarrhea, which is not typical for the normal flu bug.
It's possible the virus is spreading not only through coughed and sneezed droplets — as with seasonal flu — but also through feces-contaminated hands, said Dawood.
"This is a new virus and we're still learning how transmission occurs," she said.
There are now nearly 900 confirmed cases in the United States, said the CDC's acting chief, Dr. Richard Besser. That count included 42 hospitalizations as of Thursday.
About 10 percent of the Americans who got swine flu had traveled to Mexico and likely picked up the infection there. That's a change from over the weekend when the CDC said about a third of the U.S. cases at that point were people who had been to Mexico, where the outbreak began.
The ongoing spread within the U.S. borders explains why a shrinking proportion of cases are people who traveled to Mexico, Besser said.
The ages of those in the U.S. who got swine flu now range from 1 month to 87. More than half are under 18.
In the new report, CDC scientists discussed what's known about the swine flu virus. It has a unique combination of genes from flu viruses seen in birds, humans and pigs from not only North America but also Europe and Asia.
"There are no really close relatives, nothing we can say was an immediate precursor," said Michael Shaw, a CDC microbiologist.
It's still not clear how the combination occurred. Pigs from the Americas are imported into Europe and Asia for breeding purposes, but not the other way around, CDC officials said. Yet the virus first surfaced in California and Mexico.
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On the Net:
CDC swine flu web site: http://www.cdc.gov/h1n1flu/
news source www.news.yahoo.com
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FDA: Kids at risk from testosterone gel
WASHINGTON – A little testosterone might be good for adults, but it can cause serious harm to children, federal health officials warned Thursday. The Food and Drug Administration said adults using prescription testosterone gel must be extra careful not to get any of it on children to avoid causing serious side effects.
These include enlargement of the genital organs, aggressive behavior, early aging of the bones, premature growth of pubic hair, and increased sexual drive.
Boys and girls are both at risk.
The agency ordered its strongest warning on the products — a so-called black box.
The problems arise if adults don't wash their hands well.
Also, since testosterone gel is usually applied to the upper arms or shoulders, adults must cover up to keep kids from accidentally touching a spot that has the medicine on it.
Testosterone gel is used by men whose bodies no longer make the sex hormone, or who have very low levels of it. Doctors sometimes prescribe it to women to increase sexual drive, although the FDA has not approved that use.
U.S. pharmacies dispensed about 1.8 million prescriptions in 2007 for testosterone gel, with the leading brand, AndroGel, accounting for about three-fourths of the sales.
"These drugs are approved for an important medical need, but can have serious unintended side effects if not used properly," Dr. Janet Woodcock, director of the FDA's drug division, said in a statement. "We must ensure that the adults using them are well-informed about the precautions needed to protect children."
Although current drug warnings recommend that people using the gels wash and cover up, some patients are apparently not heeding the advice.
The FDA said it received reports of eight cases since the beginning of December in which children were accidentally exposed to testosterone gels. The kids ranged in age from nine months to five years. Only a small fraction of cases in which there is a problem with a drug are reported to the FDA, so there could be many more.
Health officials said in most cases the signs and symptoms went away once testosterone gel was identified as the cause of the problem and adults took the proper precautions.
But in some children, enlarged sex organs did not return to their appropriate size, and bone age remained somewhat higher than the child's chronological age. One child underwent surgery because the link to testosterone gel was not recognized right away.
Health officials are recommending that adults who use testosterone gel wash their hands with warm soap and water after each use and cover their skin after the gel has dried. Pregnant women, and those who may become pregnant, should avoid any exposure, since it could lead to birth defects.
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On the Net:
FDA press release: http://tinyurl.com/dnkyeo
news source www.news.yahoo.com
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WHO: up to 2 billion people might get swine flu
GENEVA – The World Health Organization says up to 2 billion people could be infected by swine flu, if the current outbreak turns into a pandemic.
WHO flu chief Keiji Fukuda says the number wasn't a prediction, but that past experience with flu pandemics indicated one-third of the world's population gets infected.
Fukuda says that with a world population of 6 billion people, it's "reasonable" to expect that kind of infection tally.
He said WHO is unable to know what the future holds, and it is impossible now to say whether the pandemic would be mild or severe.
WHO has said it believes a global swine flu outbreak is imminent, and last week it raised its alert to five, one step short of a pandemic.
news source www.news.yahoo.com
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Rabu, 06 Mei 2009
Plenty of flu caution as Mexico returns to work
MEXICO CITY – In gleaming office towers and gritty markets, Mexicans returned to work Wednesday after a five-day swine flu shutdown, and dozens returned to a heroes' welcome from "humiliating" quarantines in China. But Mexico's death toll rose, feeding fears of more infections now that crowds are gathering again.
The World Health Organization urged countries not to quarantine visitors or impose trade restrictions without scientific reasons. But China defiantly justified its quarantines as protection for its densely populated cities. And even impoverished Haiti turned away a Mexican ship carrying desperately needed food aid because of flu fears.
In Mexico City, friends and co-workers greeted each other with back slaps, firm handshakes — and dollops of hand sanitizer. Some high-rises stationed doctors in their lobbies who questioned returning employees and required visitors to fill out forms stating they had no flu symptoms. Maitre d's in surgical masks stood at attention amid rows of sidewalk tables that were pulled out and washed down for the first time in days.
"We're returning to normal," said Eugenio Velis, 57, a graphic artist sipping coffee with friends in the trendy Condesa neighborhood.
But Ernesto Viloria, 40, worried about his children using public transit and returning to school.
"Nothing can be the same," insisted Viloria, who works in finance. "The virus continues, even though it's declining, and we have to pay attention."
Mexico's government said the shutdown reduced the spread of the virus at its epicenter. Deaths have slowed as the country mobilized an aggressive public health response to the epidemic that has sickened thousands in 24 countries.
Sweden and Poland were the latest countries to confirm swine flu cases, both in women who had recently visited the U.S.
In Mexico, the confirmed death toll reached 42 Wednesday — mostly as backlogged cases got tested, but also two new deaths on Tuesday. It also confirmed more than 1,100 nonfatal cases. Eighty percent of Mexico's swine flu infections have been in and around the capital, and a majority of the dead were between 20 and 39 years old.
There was some concern that Mexico was relaxing too quickly, especially with high schools and universities reopening Thursday, and primary schools reopening next week. While "filter teams" prepared to screen out sick students and teachers, epidemiologists warn that the virus has spread throughout Mexico, and could bounce back.
"We have seen a tendency (of the outbreak) to diminish but not disappear," Health Secretary Jose Angel Cordova acknowledged.
Indeed, this swine flu seems to have a long incubation period — 5-7 days before people notice symptoms, according to Dr. Marc-Alain Widdowson, a medical epidemiologist from the U.S. Centers for Disease Control and Prevention now tracking the flu in Mexico City. And that means the virus can keep being spread by people who won't know to stay home.
While restaurants opened, Mexico City's government indefinitely closed bars, discos, gymnasiums, movie theaters and dance halls. Sports halls and arenas were allowed to reopen only at half capacity. Archaeological sites began reopening Wednesday, with museums to follow.
From gritty taco stands to the Cartier store on Mexico City's version of Rodeo Drive, people were glad to be back at work.
Jesus Cortez, 43, manned El Taquito Veloz, "The Speedy Little Taco," in the rough Tepito neighborhood, offering roasted pork on a spit as its specialty — tacos al pastor. Nearby, workers sliced chunks of meat from a boiled steer's skull, flanked by cilantro branches.
"People are just starting to come back out, but they're still afraid," Cortez said. "We're going to have to open on Sundays now, and we're going to have to work really hard. If not, we're not going to make enough money."
Cartier manager Paula Guerra, 34, waited out the furlough in Valle de Bravo, a lakeside retreat for Mexico City's well-to-do, and returned Wednesday blowing air kisses to her employees through her surgical mask. But she, too, was hoping to make up for lost sales — in Mother's Day merchandise.
Rafael Ramirez, 65, rushed to the just-reopened Metropolitan Cathedral to pray to a Christ statue known as the Lord of Health, which the church brought out from storage for the first time in 300 years.
"I gave thanks that the city is returning to normal, and prayed so countries stop looking down their noses at us," Ramirez said.
Mexico has protested Chinese quarantines and China's cancellation of direct flights between the countries as discriminatory.
First lady Margarita Zavala was up before dawn to greet 136 Mexicans who were flown home from China on a government charter. None had flu symptoms, Mexican diplomats said.
While Zavala pointedly removed her face mask and smiled broadly as she welcomed the Mexicans home, the scene in Shanghai was far different: 119 returning Chinese gamely waved their country's flags as health workers in full body suits escorted them into a weeklong quarantine.
Several Mexican passengers said they were treated well in China. Others begged to differ.
"It was discrimination and humiliation in my case," said Myrna Berlanga, who said she was taken off a flight from the United States and put in a mobile laboratory for five hours without food, water or a bathroom. "They took me out because of my passport."
Haitian officials said they would not accept a Mexican navy ship carrying 77 tons of rice, fertilizer and emergency food kits, said Mexico's ambassador, Zadalinda Gonzalez y Reynero. She said Haiti asked for the ship to come "on another occasion."
Haitian officials had no immediate comment.
In San Diego, Calif., the U.S. Navy canceled the deployment of the USS Dubuque, an amphibious transport ship, after a crew member was confirmed to have swine flu. About 50 others were suspected cases, and all crew members were being treated with anti-viral drugs.
The ship was to leave June 1 on a humanitarian mission to the South Pacific, Navy spokesman Lt. Sean Robertson said.
And the Philippines urged boxing idol Manny Pacquiao to postpone a triumphant return home after beating Ricky Hatton in Las Vegas, saying a motorcade in Manila could risk spreading the virus through adoring crowds. There are no confirmed cases in the Philippines.
In Washington, officials with the U.S. Centers for Disease Control and Prevention said they identified genetic characteristics of the virus and were in position to produce a vaccine if one is needed.
Dr. Dennis Carroll, a special adviser on pandemics with the U.S. Agency for International Development, said investments to stave off an avian flu epidemic aided the quick swine flu response.
Canada, meanwhile, said researchers at the National Microbiology Laboratory in Winnipeg, Manitoba, genetically sequenced three samples of the virus from Mexico and Canada, a breakthrough they hope will answer questions about how it spreads and mutates.
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Associated Press writers Margie Mason, Mark Stevenson, Lisa J. Adams and Juan Carlos Llorca in Mexico City and Jonathan M. Katz in Port-au-Prince contributed to this report.
