Yesterday afternoon, the Obama administration declared a public health emergency in response to a swine flu outbreak that has affected 20 US citizens. It is the same strain that has killed 81 people in Mexico.

Homeland Security Secretary Janet Napolitano described the move as “precautionary” and said the Feds planned to release 25% of the 50 million treatment courses of Tamiflu and Relenza it has stockpiled, just in case.

The CDC has confirmed 8 cases in New York City, 7 in California, 2 in Texas and Kansas, and 1 in Ohio. All have been mild and only one person has required hospitalization so far. 

Richard Besser, the CDC’s Acting Director said however, that he expected to see “more serious illness” this week.

Anne Schuchat, the CDC’s interim deputy director of science and health echoed that sentiment and upped it one. “I fear we will have deaths here,” she was reported to have said by MedPageToday.

The agency is trying to figure out why the virus seems to be targeting young adults, Schuchat added.  One theory is that older folks have previously been exposed to H1N1 viruses–which have contributed some to the current virus’ genetic make-up–so they’re partially immune to the new bug.

The CDC has already obtained specimens of the new pathogen from which it can develop a vaccine “if that is necessary,” said Besser. In addition, it has put vaccine manufacturers on speed dial.

Tamiflu, a pill, is made by Roche and Gilead. Relenza is inhaled. It’s produced by GlaxoSmithKline and Biota. Both drugs appear to be effective against this virus, so long as they are given quickly after symptom onset.

The Big O recently visited Mexico, but he’s shown no symptoms so he’s not been tested.

West Virginia Republican delegate Craig Blair thinks that people who file for welfare, unemployment or food stamps ought to be drug-free. So he introduced a bill requiring applicants for such programs to undergo random drug testing.

He makes the case at notwithmytaxdollars.com.

“The message that we’re trying to send is, first of all, we need to respect taxpayers and how their monies are spent,” Blair told CNN. “Drug addiction is in epidemic proportions, and not only in West Virginia but throughout the United States.”

The bill proposes that people who fail the test would get benefits and 60 days to sober up. A second failed test would result in the loss of benefits for 2 years.

“It seems ironic that welfare and unemployment are both designed to get you back to work and everything, but how is that possible if you’re on drugs?” Blair wondered.

Nine other states are considering similar legislation, although proposals in Arizona and Michigan have either been nixed by the courts or deemed too expensive.

Graham Boyd, director of the ACLU’s Drug Law Reform Project, ridiculed the idea as “typical political theater. [You'd think] people would be more compassionate now that people have lost jobs,” Boyd added.

And the Brookings Institute’s Ron Haskins clarifies that “unemployment is really not a welfare program. It’s an insurance program. (People have) paid into the program each month they’ve had earnings,” he explained to CNN.

But Blair claims he’s been flooded with support for his proposal. The nation’s epidemic drug abuse problem and the tanking economy call for “tough love,” he said.

The Labor Department reports that 5.6 million people collect jobless checks right now, and nearly 32 million get food stamps.

That’s a lot of drug tests, Craig.

Naltrexone, a drug usually reserved for the treatment of alcohol and drug addiction, has been found to reduce the urge to steal in kleptomaniacs, according to Jon Grant and colleagues at the University of Minnesota.

Kleptomania is a rare disorder characterized by recurrent stealing. Until now, there had been no empirically validated treatments for the condition.

The scientists lured 25 kleptomaniacs to participate in an 8-week, randomized, double-blind, placebo-controlled trial of the opioid antagonist.

Subjects had spent at least an hour per week stealing things prior to enrollment.

Many had tried to control their impulses by wearing tight-fitting clothes, carrying a small purse or shopping with friends with little success.

Every 2 weeks, participants were assessed using the Yale Brown Obsessive Compulsive Scale Modified for Kleptomania and associated tools for the assessment of depression, anxiety and psychosocial functioning.

Subjects receiving naltrexone were found to have greater reductions in K-YBOCS scores, stealing urges and stealing behavior than placebo-treated subjects. 

Remarkably, nearly 2/3 of the treatment group stopped stealing altogether.

The drug “gets rid of that rush and desire (to steal)” Grant told Reuters. “These people were really troubled by their behavior.”

“Based on the fact that (kleptomania) clinically presents like an addiction, our thought was, why shouldn’t we use a medication that was approved by the FDA for addiction, to see if it can help with shoplifting?’” he told NPR.

The write-up appears in the Journal of Biological Psychiatry.

The shoplifting pill is marketed as Revia by Duramed and as Depade by Mallinckrodt.

Massachusetts General Hospital can’t seem to get out of its own way lately.

Already in the doghouse with Bay state public health officials for high mortality rates in its cardiac cath program, the prestigious Harvard Medical School affiliate has suspended its pediatric cardiac surgery program after errors during 2 open-heart surgery procedures caused serious complications.

The public health officials, who have to be considering monthly parking permits in the lot on Fruit Street as a way to control costs, began looking into the incidents shortly after the General notified them last week.

Both babies survived the mishaps, although one sustained neurological damage and required transfer to Children’s Hospital across town.

Just 2 years ago, the General beefed up what had been a tiny pediatric cardiac surgery program by recruiting Jeff Myers, a specialist in the field.

The unfortunate development has reignited debate concerning the extent to which patient outcomes are compromised by policies, or the absence of same, that foster proliferation of multiple low-volume providers for complex, risky procedures like this one.

Children’s Hospital is located just 4 miles west of the General. It does 1,100 pediatric open-heart cases per year, making it the highest-volume program in the country.

The General has managed to log 90 cases in the last 20 months. Meanwhile, about 3 miles south of the General, Tufts Medical Center has a program that did 24 last year.

The General’s “numbers are pretty small” Peter Manning told the Boston Globe. The director of CT surgery at Cincinnati Children’s Hospital added, “when you get below 100 cases you really worry… whether the [surgeon] is doing enough to keep their skills up.”

New results from an ongoing study have raised doubt about the long-term effectiveness of drug therapy for ADHD and provoked bellicose rhetoric between co-authors who disagree about how to interpret their own data.

Results of the first phase of the Multimodal Treatment Study of Children with ADHD were published a decade ago.

They showed that kids receiving Adderall and Concerta did better after 14 months than those receiving talk therapy or routine care.

In 2007 however, MTA scientists published follow-up data showing the positive effects had extinguished.

Treated and untreated kids had no behavioral differences and strikingly, kids taking the drugs were an inch shorter and 6 pounds lighter than the drug-free kids.

Somehow, the corresponding NIMH presser managed to convey that benefits of the drugs had been sustained. Study contributor Peter Jensen was quoted in the release as saying for example, “we were struck by the remarkable improvement in symptoms and functioning across all treatment groups.”

Now, newly released data confirm the drugs have no long-term benefits. The write-up is in the Journal of the American Academy of Child and Adolescent Psychiatry.

Study co-author William Pelham concluded the drugs work in the short term but are ineffective long term, and that “the stance the group took in the first paper was so strong that people are embarrassed to say they were wrong and we led the whole field astray.”

To which Jensen scoffed that his colleague stood alone with that “silly message,” while adding that kids from troubled backgrounds and those with mild forms of ADHD did do better with drugs in the long term.

Co-authors Brooke Molina and James Swanson concurred with Pelham. “If you want something for tomorrow, medication is the best, but if you want something 3 years from now, it does not matter,” Swanson told the Washington Post.

RealAge has become an Internet sensation by using the results of its 150 question test to assign participants a “biological age” and provide tips about how to improve health and well being.

Typical advice includes flossing your teeth, wearing seatbelts, eating breakfast and taking multivitamins.

The company claims that 27 million people have taken the test, a third of whom have signed on to become RealAge members.

Not all members are aware, however, that Big Pharma pays RealAge to analyze their test results and email promotional messages on its behalf.

Would these people fill out a similarly detailed questionnaire for a drug company?

RealAge has gained popularity in no small part because physician-celebrity Mehmet Oz talks up the program during his gig on Oprah, where he’s known as “America’s Doctor.”

It’s not clear how much the good Dr. Oz is paid for his plugs. 

While taking the RealAge test, people are asked to become RealAge members. It costs nothing and requires only that people provide an email address. Enrollees’ test results go straight into a marketing database.

RealAge customers include GlaxoSmithKline, Novartis and Pfizer. They pay RealAge to identify subpopulations of the membership that are good candidates for one drug or another in their quiver based on certain answer combinations from the 150 question test.

RealAge then distributes promotional emails to the target group.

“If you want to reach males over 60 that (have) high blood pressure in northwest Buffalo that also have a high risk of diabetes, you could,” RealAge VP Andy Mikulak boasted to the New York Times.

“Millions of people have unknowingly signed up,” said Peter Lurie, the deputy director of the Health Research Group at Public Citizen.

RealAge was acquired for $60 million by Hearst Magazines in 2007 when it was doing $20 million in revenue.

Hillarycare was already on the ropes in ’93 when Big Insurance landed a haymaker in the form of Harry and Louise, a TV commercial series featuring 2 everyday Americans scared sleepless that health reform meant government meddling and bloated bureaucracy. 

Now, the Big O claims we can’t tame deficits without a health care do-over and HHS nominee Kathleen Sebelius adds that 40% of recent home foreclosures are related to financial stress caused by uninsured health expenses, so it would be vexing indeed if Big insurance scuppered reform yet again.

At first it seemed to be on board, floating constructive proposals and even manning up for the Big O’s morning teas.

But recently, things have turned frosty.

Big Insurance has warned it will oppose any plan involving a government-sponsored insurer that competes against the privates, a cornerstone of several reform proposals, including those of Speaker Nancy Pelosi and Sebelius herself.

And don’t look now but Big Insurance may secure providers as allies on the matter.

Mayo Clinic boss Denis Cortese is on record for example, with concerns that a public insurer would underpay providers, as Medicare has done to Mayo, according to Cortese, to the tune of $840 million in the last year alone.

Meanwhile, Harvard health economist Regina Herzlinger has pointed out that the apparent cost advantages of a government run program are in part an artifact of accounting trickery.

The Feds don’t have to set aside funds to meet future obligations like Big Insurance does, she told the Economist. “The government does not have the $36 trillion needed to finance the services it has promised to those who pay for Medicare.”

Nearly 25% of Americans live at least an hour from an Emergency Department that’s equipped to save lives in the event of a heart attack, stroke, bacterial bloodstream infection or major trauma.

To reach this conclusion, Brendan Carr and colleagues from the University of Pennsylvania School of Medicine queried the National Emergency Department Inventories–USA to identify the location and visit volume for all EDs in the country.

They estimated driving distances, driving speeds and population density, and measured ED access as the total population that could reach any particular ED within specified time intervals.

The scientists determined that 71% of Americans can access an ED within 30 minutes, and 98% can do so within an hour. But many of these facilities can’t handle the life-threatening stuff. Only high volume EDs are staffed, trained and equipped to do that.

In Montana for example, just 8% of the population resides within an hour of an ED that sees at least 3 patients per hour.
 
The write-up appears in the Annals of Emergency Medicine.

“Whether you are bleeding to death from an injury, having a heart attack or a stroke, the common denominator is time,” lead author Brendan Carr told BurrillReport.

The assistant professor of Emergency Medicine and Epidemiology added “in life-threatening emergencies, we must rely upon the system to deliver us to the care that we need.”

“If we knew what services were provided where, we could design a system that would do that everywhere in the country.”
 
The scientists suggest EMTs should be empowered to bypass the closest hospital in lieu of facilities better equipped to handle appropriately sick patients, ED facilities at rural hospitals should be beefed up, and incentives should be offered for physicians to practice in remote locations.

Scientists at the University of Pennsylvania have developed a screening test for Alzheimer’s disease.

They claim the test can detect the condition before symptom onset and predict whether patients with mild cognitive impairment will progress to the full-blown syndrome.
 
The test involves measuring cerebrospinal fluid concentrations of the disease’s 2 principal biochemical hallmarks—amyloid beta42 peptide and tau protein.

Compared with unaffected people, Alzheimer’s patients have decreased levels of the former and increased levels of the latter.
 
“With this test, we can detect and track progression of Alzheimer’s disease,” Leslie Shaw asserted to BurrillReport.

The co-director of Penn’s Alzheimer’s Disease Neuroimaging Initiative and lead author of the study added, “validated biomarkers will improve the focus of Alzheimer’s clinical trials, enrolling patients at earlier stages of the disease to find treatments that can delay, and perhaps stop neurodegeneration.”
 
Shaw and her colleagues wrote it up in Annals of Neurology.

The scientists examined CSF samples from 410 volunteers at 56 sites in the US and Canada, as well as 52 presumed normal volunteers and post-mortem specimens from 56 patients with autopsy-proven Alzheimer’s disease.
 
The test was 87 percent accurate overall.

It correctly ruled out Alzheimer’s in 95% of normal volunteers, correctly detected the disease in 96% of those with autopsy-proven disease, and predicted conversion from mild cognitive impairment to Alzheimer’s in 82% of participants.

Further validation studies are underway. 
 
“We have validated a test where a safe, simple lumbar puncture can provide information to confirm suspected Alzheimer’s disease and predict the onset of the disease,” John Trojanowski told Burrill.

The director of the Penn Alzheimer’s Disease Core Center added that “using this technique, we will further our understanding of how the disease progresses and what we can do to stop Alzheimer’s disease before it starts.”

Norm Eisen, the Big O’s Ethics Czar is a busy guy.

Eisen, who guards his boss’ integrity like Curtis Sliwa, is the go-to guy every time someone in the new administration needs a curbside consult on how ethical government is supposed to work.
 
Can we hire that former lobbyist? Better call Norm. Is it OK to accept presents from former clients? Blow it by Norm. Need to brief a new appointee on the Big O’s ethics policies? Norm’s the guy.

The man gets yanked from his desk to handle emergencies like this 20 times per day, according to the Washington Post.

A former Obama classmate at Harvard Law, Eisen apparently didn’t have trouble crafting an executive order that resulted in the most comprehensive government ethics reform in a generation.

That order prohibited people who had lobbied government in the last 2 years from working in the Obama administration, and permanently banned anyone who left the administration from returning as a lobbyist.

It’s enforcing the rules that makes him sweat.

And the pressure’s been turned up since Daschle’s and Tiny Tim’s tax problems dropped shoe polish on the otherwise pristine start. Now Eisen helps vet pretty much all administrative positions.

And when he’s not doing that he’s hounding interns to sign their ethics pledge, crafting rules on economic regulatory reform and shaping all manner of public policy.
 
“He’s the original propeller-head ethics geek, like something right out of ‘The West Wing’ TV show,” White House chief council Gregory Craig told the Post.

“Everybody loves Norm. I don’t go anywhere without him. I don’t leave home without Norm on these issues.”