Mr. Graedon alerted the FDA. He also
asked ConsumerLab.com, which normally runs tests for dietary supplement
manufacturers, to compare Budeprion and Wellbutrin. Using a test-tube test that
some industry experts question, ConsumerLab found that Budeprion dissolves
faster, releasing 34% of the drug within the first two hours, compared with 8%
for Wellbutrin.
"If you get four times the drug
in the first two hours, that's too much drug in the beginning and not enough
for the rest of the day," says Mr. Graedon, who worries that what he calls
"dose dumping" could cause seizures, a concern with the brand-name
drug as well.
Complaints about Budeprion also were
coming into the FDA -- at least 130 from December 2006 to January 2008,
according to Andy Georgiades of Dow Jones News Service, who filed a Freedom of
Information Act request. http://louis1j1sheehan.blogspot.com/
Only four complaints were filed about
two rival generic versions of Wellbutrin XL 300 that went on the market in June
2007.
The FDA conducted an investigation and
reported last week that although there were "small differences"
between the two formulations, "they are not outside the established
boundaries for equivalence." The generic did reach its maximum blood
concentration in two to three hours, compared to five to six hours for
Wellbutrin, but the FDA said those differences "were not considered
clinically significant."
What accounted for the consumer
complaints? The FDA cited "the natural history of depression," in
which some patients have a recurrence of symptoms even while on medication.
HOW TO REPORT DRUG PROBLEMS
• If you have a bad reaction to a drug
or concerns about quality, your first stop should be your doctor, who can file
a medical report with the FDA.
• You can also submit a consumer
report to the FDA's MedWatch program at www.fda.gov/MedWatch3. You will be
asked to describe the medication, the adverse event and some brief medical
history. Your identity isn't requested. If you supply an email address, you will
receive confirmation that your report was received. You can also speak to an
FDA representative at 1-888-INFO-FDA .
• Contact the manufacturer or
distributor. The FDA requires prescription and over-the-counter drugs to list
contact information on the packaging.
• Return the medication to the
pharmacist; use one you know and trust.
• www.PeoplesPharmacy.com4 also logs
complaints about generic drugs, but these aren't counted as official FDA
adverse-event reports.
Some critics say the FDA, in effect,
was saying, "it's all in their heads." But they were more alarmed to
read in the report that the FDA relied on tests comparing a lower dose of
Wellbutrin and Budeprion -- 150 mg -- when it first approved the 300 mg version
in 2006, and didn't have specific bioequivalence data on the 300 mg dose that
had generated the complaints.
"Everybody involved in this whole
chain -- pharmacists, physicians, insurance companies, drug-store buyers --
assumes the FDA approves every single generic formulation to prove that it isn't
harmful," says Mr. Graedon. http://members.greenpeace.org/blog/purposeforporpoise
"We learned last week that that's
not the case."
The FDA explained that it didn't want
to expose test subjects to the risk of seizures with the 300 mg dose.
Bioequivalence tests are conducted on healthy people, not those who need the
medication, and each gets just a single dose, so there is no chance to work up
to 300 mg slowly, as actual patients are advised to do. Sandy Walsh, an FDA
spokeswoman, says this is common procedure for testing antidepressants and
antipsychotics.
"If we see scientific evidence
that a product is not performing as expected, we will take action," Ms.
Walsh says. "The FDA cannot offer examples where generics have not
performed as expected because there have been none for the agency to
report."
Deborah Jaskot, vice president for
regulatory affairs at Teva Pharmaceuticals USA, which distributes Budeprion,
says the ConsumerLab dissolution test was an invalid comparison, and that on
all the accepted tests, Budeprion performed within the range of bioequivalence
with Wellbutrin. Teva itself has received 101 reports of problems with
Budeprion -- out of 4.5 million prescriptions written -- and hasn't heard
reports of unusual smells, a spokeswoman says.
Ms. Jaskot also says Web sites that
collect complaints about drugs "are doing the public a disservice."
If consumers have problems with their medications they should "tell their
physician, tell the manufacturer, tell the pharmacists, tell the FDA -- that's
the only way these can get acted on and evaluated for veracity," she says.
But what if you complain to the FDA
and are told, in effect, that your concerns are insignificant? As with so many
other areas in health care, consumers have to be their own regulator and their
own chief advocate.
"Consumers need to know that
there are variations between generic drugs and brand-name drugs, and from one
generic drug to another," says Wayne Pines, a former FDA spokesman who now
consults for drug companies. "This is an area in which the patient has to
be really self-protective, to be sure that they are getting the therapeutic
effect that is best for them."
If you are taking a medication for a
long-term condition, Mr. Pines advises staying with the version you are
stabilized on. Some pharmacies sell generic versions interchangeably; tell your
pharmacist you want to stay with the same one.
If you need to switch to a generic
from a brand name for cost reasons, monitor your symptoms and review them with
your doctor. Assess whether it's worth it to you to pay more. (There are some
medications, particularly for thyroid and blood conditions, in which
substitutions are never advised.)
The Graedons also recommend asking for
copies of your lab reports, so you can help your doctor monitor any changes in
your condition.
Be alert to changes in smell or
appearance of your medications. Tell your doctor, pharmacist and the
manufacturer if you notice anything odd.
Dr. Zealberg, however, is still
waiting to hear back from the pharmacy that sold his patient blank pills.
The robot will see you now. At least
in the operating room, where more and more often robots stand between doctor
and patient, the New York Times reports. http://Louis2J2Sheehan2Esquire.US
At many hospitals robots, under the
control of doctors, are performing some of the precision work of prostate and
gynecological surgery. In their favor, robots’ “hands” don’t shake, don’t tire
and can make precise cuts in tiny places. Robots don’t care about X-ray exposure
or need days off either.
But how well are medical robots
complying with the Three Laws of Robotics as codified by the late sci-fi author
and Health Blog hero Isaac Asimov? Let’s take a look at Intuitive Surgical’s da
Vinci robot, featured prominently in the NYT’s piece.
1. A robot may not injure a human
being or, through inaction, allow a human being to come to harm.
Robots aren’t perfect, but, let’s face
it, neither are humans. A quick check of the FDA’s database of problems
reported for medical devices turns up a few, but not a ton, of complaints about
the da Vinci. Among the recent ones, the robotic scissors in a prostate surgery
case malfunctioned, filling the O.R. with the smell of garlic, but the patient
wasn’t harmed.
Some fatalities were reported to the
FDA recently, but it wasn’t clear they were related to the robot, such as the
death of a hysterectomy patient from sepsis four days after surgery.
2. A robot must obey orders given to
it by human beings, except where such orders would conflict with the First Law.
Again, the FDA database shows a few
cases of an obstinate or malfunctioning robot, but not a revolution of machines
against their masters. One user reported to the FDA that a flurry of error
codes led a surgeon to abort a robot-assisted prostate procedure and continue
the old-fashioned way last year–no harm to the patient. Intuitive Surgical,
maker of the robot, later fixed the device, the report said.
Another report says one of the robot’s
arms stopped working during a cardiac procedure. The surgeon made another
incision to insert another instrument to complete the operation, but a re-boot
of the machine by a company rep revived the robotic arm. The surgeon completed
the operation without the robot balking again.
3. A robot must protect its own
existence as long as such protection does not conflict with the First or Second
Law.
Robots are thriving, and their
survival instincts appear strong. Despite the da Vinci price tag of about $1.3
million, on average, “it is rapidly becoming unusual for a urologist to operate
without using one,” the Times reports.
Rather than conflicting with the first
two laws, the robots may be bumping into the iron law of hospital
profitability. Health technology consultant Winifred Hayes tells the Times that
most hospitals and clinics are losing money or not making much on their
investments in robots. http://louis-j-sheehan.net/
“The real story is that this is a
technology that has been disseminated fairly widely prematurely,” she adds.
It was like a college mixer, a
classroom full of young men and women seeking a recipe for romance.
They had assembled for the first class
of “Love Relations for Life: A Journey of Romance, Love and Sexuality.”
There was giggling and banter among
the students, but that was all part of the course as their teacher, Suki Tong,
led them into the basics of dating, falling in love and staying together.
The course, in its second year at two
polytechnic institutes, is the latest of many, mostly futile, campaigns by
Singapore’s government to get its citizens to mate and multiply. Its popularity
last year has led to talk of its expansion through the higher education system.
“We want to tell students, ‘Don’t wait
until you have built up your career,’ ” said Yu-Foo Yee Shoon, the minister of
state for community development, youth and sports, at a news conference in
March. “Sometimes, it is too late, especially for girls.”
The courses are an extension of
government matchmaking programs that try to address the twin challenges
embodied in a falling birthrate: too few people are having babies, and too few
of those who are belong to what Singapore considers the genetically desirable
educated elite.
Over the past 25 years, the mating
rituals organized by the government — tea dances, wine tastings, cooking
classes, cruises, screenings of romantic movies — have been among the country’s
least successful social engineering programs.
Last year Singapore’s fertility rate
fell to a record low of 1.24 children per woman of childbearing age, one of the
lowest in the world. It was the 28th year in a row Singapore had stayed below
the rate of 2.5 children needed to maintain the population.
But even a replacement-level rate
would not be enough for today’s planners. http://louis-j-sheehan.net/page1.aspx
The government recently announced that
it was aiming to increase the population by more than 40 percent over the next
half-century, to 6.5 million from the current 4.5 million.
“Teaching our youth in school how to
fall in love” is a good solution, wrote Andy Ho, a senior writer at The Straits
Times, a government-friendly newspaper that does its best to help out in
Singapore’s many campaigns.
In 1991, for example, when the
government began offering cash bonuses to couples with more than two children,
the newspaper printed tips for having sex in the back seat of a car, including
directions to some of the “darkest, most secluded and most romantic spots” for
parking.
It suggested covering the windows with
newspapers for privacy.
Singapore is known for its campaigns
of self-improvement, including efforts to get residents to be polite, to smile,
to be tidy, to speak proper English and to not chew gum.
In 1984, the country’s master planner,
Prime Minister Lee Kuan Yew, declared that too few of the country’s most
eligible women, those with college degrees, were marrying and having children.
He set up the Social Development Unit to address the problem, and since then
the government has been the country’s principal matchmaker.
In addition to its tea dances and
moonlight cruises, the agency acts as a lonely hearts adviser, with an online
counselor named Dr. Love and a menu of boy-meets-girl suggestions on its Web
site, www.lovebyte.org.sg.
“Guys, girls notice everything!” the
Web site offers in one of its dating tips. “Comb your hair differently and they
notice. Change your watch and they notice! Skipped your morning shower and
sprayed on deodorant to cover the smell — they notice! What does this mean?
Well, bathe regularly, change something about yourself, be observant, and
compliment the lady.”
Mr. Lee himself acknowledged how silly
some of this may seem.
“Never mind the hullabaloo in the
press, all the foreign correspondents writing that a crackpot government is
trying to interfere in people’s lives,” he said when he inaugurated the Social
Development Unit. “If we continue to reproduce ourselves in this lopsided way,
we will be unable to maintain our present standards.”
In other words, said Annie Chan,
director of a matchmaking agency, “Our government wants smart ladies to meet
smart guys to get smart children.”
But in Singapore it is impossible to
get very far from thoughts of money and the workplace. http://louis-j-sheehan.info/page1.aspx
These guys may have other things on
their minds besides romance and babies.
“Some people say if you’re a smart guy
you should marry a smart woman who can help you with your finances and career,”
said Ms. Chan, whose agency is called Club2040 and who has worked under
contract for the Social Development Unit.
Singaporeans quite seriously describe
their society as being driven by a local concept called kiasu, a desire not so
much to get ahead as to not lose out. That concept might be applied, for
example, to a person who pushes ahead of everybody else to get into an
elevator.
This single-mindedness, in life as in
elevators, seems to leave little room for social graces or for romance or
procreation.
“The E.Q. here,” said Ms. Chan,
referring to an emotional quotient of social skills, “can be appalling.”
But even while working on the
solution, Ms. Chan seems to be part of the problem. She is 39 and has been
married for four years, but said she did not have the time or energy to have
children.
It is a lot to ask of a college course
to break attitudes like this. Three 20-year-old graduates of last year’s
inaugural course at Singapore Polytechnic still seemed imbued more with kiasu
than romance.
Despite everything their teachers had
told them about multitasking work and love, none was in a relationship. And
nothing they had heard in class seemed to have dented their stereotypes about
the opposite sex.
“I’m not open to relationships in
school,” said Wei Shan Koh, a former student who works as a teacher’s aide.
“Boys in school are not my cup of tea. They are male chauvinist pigs. They’re
annoying and childish. And they won’t give in to you. They’re just not mature.”
Another former student, Tian Xi Tang,
was quick to respond.
“I think girls’ ideas are a bit
childish, or you might say girlie,” said Mr. Tian, who hopes to become an
engineer. “It’s a matter of pride. Guys are more outspoken. We don’t like a
girl to be more outspoken.”
Kamal Prakash, who hopes to be a
lecturer in mathematics, gave voice to what appears to be the common theme
here, among both young people and their elders.
“I am not interested now in love
relations because I want to continue my studies,” he said. “If I concentrate on
love relations, I won’t be able to concentrate on my studies.”
With his Mercedes-Benz and his fine
clothes, Josef Fritzl looked every inch a property owner, neighbors in this
tidy Austrian town said Monday. Even when running errands, they said, he wore a
natty jacket, crisp shirt and tie.
Mr. Fritzl’s apartment house, its back
garden obscured by a tall hedge, was his kingdom, one neighbor said, and
interlopers were not welcome. On Monday, investigators in white jumpsuits combed
the house and garden for clues. http://louis-j-sheehan.info/
The authorities said Sunday that Mr.
Fritzl, 73, had kept one of his daughters imprisoned for 24 years in a basement
dungeon, where she bore him seven children.
The daughter, Elisabeth, now 42, is in
psychiatric care, along with two of her children. Her eldest daughter, Kerstin,
19, who was also kept in the basement and whose illness pulled apart Mr.
Fritzl’s secret after he had her taken to a local hospital, was in a medically
induced coma and was in critical condition, the authorities said.
The authorities said Mr. Fritzl
confessed Monday to imprisonment, sexual abuse and incest. The case has left
this town of 22,000 people, 80 miles west of Vienna, in stunned disbelief.
Neighbors milled around the three-story apartment building on Monday, watching
the investigation unfold and asking how such an atrocity could have occurred in
their midst.
“One cannot comprehend the dimension
of this,” said Doris Bichler, 34, a neighbor who was walking with her daughter.
“Natascha Kampusch was bad, but this is of a totally different scale.” Ms.
Bichler was referring to the notorious kidnapping of an Austrian schoolgirl,
who was hidden in a windowless cellar for eight years until she escaped in
August 2006. Until now, the Kampusch case was considered by many as the epitome
of depravity in the post-World War II history of this country.
But as details of this latest case
filter out, it seems even harder to fathom than Ms. Kampusch’s abduction,
involving nearly a quarter-century of confinement and sexual abuse, and the
birth of seven children, three of whom never emerged from the cellar into
daylight until last week.
It also raises a troubling question:
Why did two such horrifying crimes occur in the same period in Austria, known
as a tranquil, picture-book land?
There seems no easy answer — and
Austrian officials, while insisting that similar crimes had occurred in other
countries, said they were struggling to make sense of Mr. Fritzl’s singular
misdeeds.
“He was man of stature,” Franz Polzer,
the chief of the criminal investigations unit for the Province of Lower
Austria, said at a news conference here, holding up a photograph of Mr. Fritzl,
a heavyset, gray-haired man dressed in black.
“He led a double life,” Mr. Polzer
continued, “with one family of seven children, with his wife, and a second
family of seven children, with his daughter.”
The police described Mr. Fritzl as an
authoritarian figure who had brooked no dissent.
Trained as an electrician and an
engineer, Mr. Fritzl owns the small apartment building, renting out a few
apartments and living on the top floor. Over many years, he built an
underground world for his captives in a warren of cramped, windowless rooms. He
provided them with food and clothing, bought outside town to avoid suspicion.
Photographs show a miniature bathroom,
finished with tile and wood trim on the ceiling. A claustrophobic passageway
leads to a bedroom. http://louis-j-sheehan-esquire.us/page1.aspx
The chamber was accessible through a
four-foot-high door that opened with a remote-control device, for which only
Mr. Fritzl held the code.
The police said his wife, Rosemarie,
68, had no inkling of his secret life, believing that their daughter had fled
the family for a cult and was unable to take care of her children. Mr. Fritzl
forced Elisabeth to give up three of the children as babies, and he and his
wife raised them. A seventh child, a twin boy, died soon after being born; Mr.
Fritzl told the police he threw the body in an incinerator, the authorities
said.
“You have to imagine that this woman’s
world fell apart,” a local official, Hans-Heinz Lenze, said of Rosemarie.
At the news conference, officials came
under sharp questioning about how the situation could have remained unknown to
the authorities. After Mr. Fritzl and his wife began taking care of Elisabeth’s
children, social workers visited their home several times.
Officials defended themselves hotly,
saying that if Mr. Fritzl was able to keep his wife ignorant of his crimes when
she lived upstairs from the cellar, how could outsiders have guessed?
Neighbors expressed similar
bafflement.
“You’re amazed that something like
this could happen in your neighborhood,” said Günther Pramreiter, who runs a
bakery next door to the Fritzls’ building. He said the couple, or their adopted
children, came in every other day to buy rolls.
By most accounts, the three children
who grew up in the Fritzls’ care were well-adjusted, each learning to play a
musical instrument.
Karl Dattinger, 20, a volunteer
firefighter, recalls that one of the daughters, Monika, had received a perfect
score on a test of fire safety he gave at their school.
Matthias Sonnleitner, who manages a
hardware store, said his children had taken martial arts classes with the
Fritzl children. Rosemarie Fritzl occasionally came to his store to buy
curtains, he said.
Even two of the three children
imprisoned in the cellar were surprisingly healthy, if pale, according to the
authorities. Elisabeth taught them to speak German, and they had access to a
television.
The television played a key role in
untangling the case, the police said. After the 19-year-old, Kerstin, was taken
to the hospital, authorities appealed for her mother to come forward. Elisabeth
saw the broadcast and persuaded her father to release her and the other two
children living with her. Officials declined to give a prognosis for Kerstin.
Among people in the Fritzls’
neighborhood, there was a disquieting sense that more could have been done.
“I think the authorities are
overworked and weren’t able to follow up every lead,” said Franz Jandl, 50, who
owns a shop across the street from the apartment. “For a little country, to
have this kind of thing happen a second time is a catastrophe. It’s just very
sad.”
Spain's National Court has decided
against extraditing the former Argentine president MarÃa Estela MartÃnez de
Perón, 77, to Argentina, where she is wanted on charges of human rights abuses
during her presidency in the 1970s. In two rulings, the court said that the
charges did not constitute crimes against humanity and that the statute of
limitations for the offenses of which Ms. Perón, known as Isabelita, is accused
expired after 20 years. The rulings may be appealed. Ms. Perón was the third
wife of Gen. Juan Domingo Perón and vice president when he died in 1974. She
then led the country for two tumultuous years before being deposed in a
military coup. She has lived in Spain since 1981.
The number of people traveling the
globe for medical treatment likely is far lower than commonly assumed, but
there remains potential for huge growth in the industry, according to a study
by consulting firm McKinsey & Co.
Just 60,000 to 85,000 patients a year
travel to another country expressly for inpatient hospital care each year,
according to the study, which is scheduled for release Tuesday. http://louis-j-sheehan-esquire.us/
http://louis-j-sheehan.com/Moreover, most aren't seeking low-cost care in the developing
world, the phenomenon that has garnered considerable attention lately. Instead,
many of the medical tourists seek the latest treatments available in the U.S.
and other industrialized countries.
The consulting firm analyzed the
behavior of nearly 50,000 patients using data from unidentified hospitals
around the world, as well as government travel records and other information.
The researchers also interviewed patients and hospital officials. They estimate
the sample amounted to 60% to 80% of the world-wide market.
The figure contrasts sharply with
those often used by medical-tourism marketers -- one said Asia attracts 1.3
million medical tourists a year -- and anecdotal accounts. "There's been
an enormous amount of hype," said Paul Mango, who heads McKinsey's
health-care practice. However, he noted that the report estimates that the
eventual market for Americans seeking cheaper care abroad at perhaps 710,000
procedures a year.
The Medical Tourism Association, a
trade group in West Palm Beach, Fla., that represents hospitals, travel agents
and brokers, among others, avoids trying to quantify the industry's size
precisely because there is no consistent definition of medical tourism, said
Chief Operating Officer Renee-Marie Stephano. And, citing the complexity of
collecting comprehensive data, she cautioned that McKinsey's numbers are likely
to be similarly flawed because they involve only a sample of facilities and
look at hospital admissions. "A large portion of the medical-tourism
industry is based in cosmetic procedures and dental care, which are not
performed in hospitals," Ms. Stephano said.
To arrive at its estimate, Mr. Mango's
team focused on patients traveling expressly for inpatient hospital care and
excluded several categories that the consultants said were commonly included in
higher estimates. Those include expatriates seeking treatment in the countries
where they live, tourists seeking unexpected medical attention, and some
patients traveling short distances across borders for care not available nearby
in their own country.
About 40% of "medical
travelers" identified in the report are patients, largely in developing
countries, seeking top-notch medical care, primarily in the U.S. Another 32%
sought better care than was available at home. About 15% sought to circumvent
waiting times at home, particularly in Canada and the United Kingdom, Mr. Mango
said.
Americans and others seeking
lower-cost care for medically necessary procedures accounted for about 9% of
the total, the consultants estimate. http://louis-j-sheehan.org/
Elective procedures such as cosmetic
surgery accounted for about 4%.
Still, much of the growth potential
lies in patients seeking cheaper care in the developing world, the report
concludes. It estimates that about 710,000 procedures a year -- procedures that
currently bring $35 billion of revenue -- could be done overseas at a savings
of about $15,000 a procedure.
But about
80% are likely to continue to be more cost-effective to perform in the U.S.
Most Americans seeking cheaper care overseas now are uninsured, and Mr. Mango
said the "No. 1 factor" is whether insurers, employers and the
government will begin encouraging foreign treatment.
Some people want a little more out of
their vacation than a fruity drink served poolside. Diving with sharks in South
Africa, for example. Or living among penguins for five days in Antarctica. Or
paddling in a canoe down a crocodile- and hippopotamus-infested river in
Zambia.
For those people, the travel company
Abercrombie & Kent has created a series called Extreme Adventures. Starting
next fall, 15 adventure packages will be available in countries that range from
Norway to Kenya to Nepal, featuring activities that include hiking, dog
sledding, bungee jumping and cross-country skiing.
The first trip is scheduled for Sept.
28 through Oct. 6 and will take participants on foot through the Selous Game
Reserve, a nature sanctuary and Unesco World Heritage site in Tanzania with
elephants, black rhinoceroses, cheetahs and giraffes (from $9,830 a person,
including airfare).
Egyptians mostly ignored the April 8
local elections to fill 52,000 places on municipal and village councils.
Seventy percent of the seats were earmarked for [Hosni Mubarak]'s National
Democratic Party because they were "uncontested." Mubarak's son,
Gamal, happens to head the NDP.
Recalling the failed policies of the
Shah of Iran, Mubarak has defeated the non-Islamist opposition, leaving the
Muslim Brotherhood as the only credible voice of reform. This is the same toxic
movement, founded in 1928, whose world-view spawned al-Qaida and Hamas. http://louis1j1sheehan1esquire.us/page1.aspx
It wants Shari'a law imposed in Egypt
and relations with Israel broken off. Prudently, the Brotherhood eschews
violent revolution, patiently waiting for power to fall into its hands. Despite
Mubarak's machinations, Brotherhood- supported "independent"
candidates captured 20% of the 454- seat parliament.
How well the regime feeds, clothes and
employs its population, how swiftly it creates a civil society and system of
representative government should be of foremost concern to Israel. Mubarak is
mistaken in emasculating the moderate opposition, misguided in trying to
"out-Islam" the Brotherhood by persecuting homosexuals. He is wide
off the mark in allowing Egypt's media to demonize Jews and Israel. It took him
too long to realize that letting Hamas bleed Israel was ultimately not in
Cairo's interest.
American International Group joined
the ranks of the credit crisis's biggest losers Thursday, reporting a $7.81
billion first-quarter loss and announcing plans to raise $12.5 billion in fresh
capital as losses on complex securities soared.
The insurer said profits were hurt by
a $9.11 billion hit on its portfolio of derivatives sold to hedge securities
that have plunged in value and $6.82 billion in losses on investments. AIG
reported another $6.82 billion in impairments that for accounting reasons only
showed up on its balance sheet.
The blows brought AIG's total
write-downs and losses from the credit crisis to more than $30 billion, with
another $9 billion-plus in damage just to the balance sheet, putting the
insurer in the same league as UBS AG, Citigroup Inc. and Merrill Lynch &
Co.
The massive losses spooked investors
and could deal a blow to optimists who have bet the worst of the crisis has
passed.
The cost of protecting AIG's bonds
against default soared after the announcement, and the insurer's shares plunged
8.7% to $40.30 in after hours trading. Standard & Poor's cut its credit
rating on AIG one notch to AA- and put it on watch for a further downgrade.
"Although we expected that AIG
would have some losses in the first quarter, the level of the additional losses
exceeds these expectations," S&P analyst Rodney Clark said in a
release.
The insurance company reported a net
loss of $7.81 billion, or $3.09 a share, compared with year-earlier net income
of $4.13 billion, or $1.58 a share. http://louis1j1sheehan1esquire.us/
Analysts polled by Thomson Reuters were expecting a much
smaller loss of 76 cents a share.
To repair the hole opened by the losses,
AIG on Thursday launched a $7.5 billion offering of common stock and other
equity securities. Another offering of hybrid securities will follow later. AIG
had a market capitalization of $110.19 billion at the close of trading
Thursday.
Even as it sought more capital to
repair its balance sheet, AIG raised its quarterly dividend 10%, to 22 cents a
share.
"While we anticipated a difficult
trading environment, the severity of the unrealized valuation losses and
decline in value of our investments were beyond our expectations," CEO
Martin Sullivan said in a release.
AIG has multiple exposures to the
housing crisis, and results were weak across the board. Its financial-products
unit manages its derivatives portfolio of credit default swaps written on collateralized
debt obligations backed by residential mortgages. The financial services unit
swung to an operating loss of $8.77 billion in the first quarter from a profit
of $292 million a year earlier.
The company's asset management unit
posted an operating loss of $1.25 billion versus profits of $758 million a year
ago amid losses on hedges, lower investment returns and depreciation expenses
related to real estate investments acquired late last year.
The life insurance unit swung to an
operating loss of $1.83 billion from a profit of $2.28 billion on hedging
losses and damage to investment income from "volatile capital
markets." Operating income in AIG's big general insurance operations fell
57% to $1.34 billion.
Representative Vito J. Fossella, a
Staten Island Republican who was arrested on May 1 in Alexandria, Va., and
charged with drunken driving, issued a statement on Thursday acknowledging that
he had had an extramarital affair with Laura Fay, a former Air Force lieutenant
colonel, and that the two of them have a 3-year-old daughter together.
The prospect that Mr. Fossella could
face a mandatory jail sentence if convicted had already threatened to bring to
an end his decade-long career in the House, where Mr. Fossella is the only
Republican representing New York City. The Daily News has reported that Mr.
Fossella called Ms. Fay for help after his arrest and told officers that he was
on his way to Grimm Street, where Ms. Fay lives, to visit a sick daughter. http://louis-j-sheehan.info/
As speculation swirled over Mr.
Fossella’s relationship with Ms. Fay in recent days, his aides said only that
they were good friends.
In Mr. Fossella’s four-sentence
statement on Thursday, he declined to address his political future or specify
whether he would seek re-election this fall to a sixth full term:
I have had a relationship with Laura Fay, with
whom I have a three-year-old daughter. My personal failings and imperfections
have caused enormous pain to the people I love and I am truly sorry. While I
understand that there will be many questions, including those about my
political future, making any political decisions right now are furthest from my
mind. Over the coming weeks and months, I will to continue to do my job and I
will work hard to heal the deep wounds I have caused.
Mr. Fossella, 43, was driving with a
blood-alcohol level more than twice the legal limit when he was pulled over. He
faces a mandatory five days in jail if convicted. The House ethics committee
also could open an investigation into the matter.
Mr. Fossella, the only Republican
member of Congress from New York City, has apologized to his constituents on
Staten Island and in Brooklyn, but already, there is speculation that his
decadelong career in the House could come to an end. http://louis-j-sheehan-esquire.us/page1.aspx
After serving three years in the City
Council, he was elected to the House in a November 1997 special election to
replace Susan Molinari.
In 2006, Mr. Fossella’s Democratic
opponent, Stephen Harrison, a Brooklyn lawyer, fared better than any previous
opponent, winning 43 percent of the vote.
This year, Mr. Harrison and another
Democrat, City Councilman Domenic M. Recchia Jr. of Brooklyn, are in a primary
race to challenge Mr. Fossella. Democrats in Washington said the fact that
there were two candidates they called credible seeking to challenge Mr.
Fossella underscored his vulnerability this year. The Democrats currently hold
a 235-to-199 edge in the House, with one vacancy.
If Mr. Fossella resigns or declines to
seek re-election, several other Republicans might run to replace him and keep
the seat in the party’s hands. They include the Staten Island district
attorney, Daniel M. Donovan Jr.; City Councilmen James S. Oddo and Vincent M.
Ignizio; and State Senator Andrew J. Lanza.
The Staten Island Advance quoted Guy
V. Molinari, a Republican power broker on Staten Island and a former
congressman and borough president and mentor of Mr. Fossella’s, as saying,
“Vito is going through a very difficult time. I will be by his side regardless
of what decisions he makes.” (Mr. Molinari is the father of Susan Molinari and
held the House seat himself, from 1981 to 1989.)
Born on Staten Island on March 9,
1965, Mr. Fossella is the son of a construction engineer and a florist and the
fourth of seven children. He attended Monsignor Farrell High School and
graduated from the Wharton School of the University of Pennsylvania in 1987. He
received a law degree from Fordham University in 1994, the same year he was
elected to the City Council. Mr. Fossella’s great-grandfather James A. O’Leary,
a Democrat, represented Staten Island in the House from 1935 until his death in
1944.
Mr. Fossella and his wife, the former
Mary Patricia Rowan, married in 1990. They have two sons and a daughter. http://louis-j-sheehan-esquire.us/
On Wednesday, Mr. Fossella attended a
confirmation ceremony for his oldest child, Dylan, at St. Clare’s Roman
Catholic Church in the Great Kills neighborhood of Staten Island, before
returning to Washington.
After the 2004 tsunami smashed into
South Asia, thousands of the dead awaited identification for weeks and even
months. http://louis-j-sheehan.org/
The more time passed, the harder it
became to identify the victims, let alone determine their age.
In the wake of a similar catastrophe,
however, a new technique may help us learn victims' ages by analyzing the
crystalline proteins in their eyes. The proteins form in the lens of the eye
during the first two years of life, remaining unchanged thereafter. For anyone
born in the last six decades, moreover, the lens proteins carry a radioactive
marker—a special signature reflecting the pattern of nuclear bomb tests
starting in 1955 and declining at an exponential rate since 1963.
"We're always on the lookout for
methods of improving our ways to identify corpses," says Niels Lynnerup, a
forensic anthropologist at the University of Copenhagen, who developed the
technique based on levels of carbon-14. A rare radioactive isotope whose levels
were boosted by radiation emitted by the bomb tests, carbon-14 leaves an
imprint on plant cells and, by extension, the animals that eat them. While
carbon-14 accumulates in tissue like skin or muscle, these cells undergo
constant turnover. http://louis-j-sheehan.us/Blog/blog.aspx
The eye lens proteins, on the other
hand, are unchanging, making them an ideal indicator for date of birth.
To validate the new technology, eye
pathologist Steffen Heegaard sliced out the lenses of 13 deceased people born
between 1922 and 1991; then the team extracted the carbon, placed samples in a
mass spectrometer, and counted the number of carbon-14 atoms in each.
From these results, Lynnerup
constructed a mathematical model that would enable him to calculate the age of
any unidentified corpse. The research has other practical applications as well:
The method could be used to chart the course of Alzheimer's disease or some
types of slow-growing cancers, which lay down protein plaques that subsist for
decades unaltered.
Sleeping on the floor of the Congolese
jungle with only a tarp beneath her, herpetologist Kate Jackson dreams of “a
luxurious palace, with soft couches and thick carpets, and filled with snakes
of many different species.” Catching reptiles and amphibians for the
Smithsonian Institution is no tropical holiday—her hired guide sulks and
occasionally fails to show up, her cook endlessly prepares macaroni and canned
pork, and worst of all, her nets often turn up empty. But each day she
optimistically wades hip-deep through the flooded forest in hopes of capturing
a magnificent water cobra or a new venomous snake. “The sense of living things
interacting, humming all around me, is palpable,” Jackson writes. And she
immerses herself in that ecosystem.
When a Grayia strikes at her from the
net, she lets it bite—proving once and for all to her horrified guide that it
isn’t, actually, poisonous.
As a neuro-ophthalmologist, Larry
Frohman diagnoses unusual visual problems and many complex nervous disorders
that often baffle other doctors. He's also part of an endangered species.
Over the next decade, roughly 140 of
the country's remaining 400 neuro-ophthalmologists -- specialists trained to
detect and treat visual problems connected to the brain -- will have reached
retirement age, according to an analysis of the North American
Neuro-Ophthalmology Society's membership roster. http://louis-j-sheehan.us/
Yet only 20 medical residents have
opted to enter the field in the past four years, according to the society.
Why? "The compensation just isn't
there," says Roman Shinder, a senior ophthalmology resident at New Jersey
Medical School, who says money was one factor that led him to pursue a surgery
specialty instead.
A discipline built on spending time with
patients to gather clues for a diagnosis, neuro-ophthalmology could become
another casualty of a medical payment system that favors high-tech procedures
over low-tech exams. The median income of a neuro-ophthalmologist at a teaching
hospital is $200,000, according to the North American Neuro-Ophthalmology
Society. That's a third less than most general ophthalmologists, who undergo
less training but can see more patients, and do more pricey procedures, in a
given day.
Many in health-policy circles have
focused on how the current health-care payment system is helping create
shortages among primary-care doctors, internists and others on the front lines
of medicine. But often lost is how the system is endangering some of the
country's most highly trained specialties as well.
Endocrinologists, rheumatologists and
pulmonologists -- specialties that also don't involve performing many
procedures -- face acute shortages. Many of the severest deficits affect
children. Though nearly 300,000 children in the U.S. are diagnosed annually
with juvenile arthritis, lupus or other complex rheumatic diseases, there are
fewer than 200 pediatric rheumatologists to take care of them, according to the
U.S. government's Health Resources and Services Administration.
Not everyone believes the future of
such specialists is in jeopardy. Some doctors point out that shortages in
medical specialties often correct themselves on their own. "We don't have
[a neuro-ophthalmologist] on every street corner, but maybe we shouldn't,"
says Marco Zarbin, chairman of the ophthalmology department at the University
of Medicine and Dentistry of New Jersey, where Dr. Frohman practices and
teaches. "It's a sub, sub-specialty."
Critics, though, say the decrease in
specialists can hurt patients in need of proper diagnosis and treatment. Five
years ago, when her 5-year-old daughter Kaitlyn was diagnosed with a connective
tissue disease called juvenile scleroderma,Tammie Fishel says she was told to
see a pediatric rheumatologist right away. But her daughter first would have to
see a dermatologist in St. Louis -- a four-hour drive away -- and the first
available appointment was in two months.
In its severe forms, juvenile
scleroderma can weaken limbs and damage internal organs. Terrified her daughter
could suffer brain damage, Ms. Fishel says she broke down crying on a voice
message system. The dermatologist relented, but Kaitlyn had to wait another
month before she could be seen by the pediatric rheumatologist. "It was a
very long month," Ms. Fishel says. Now stable, Kaitlyn is regularly making
the drive to St. Louis for treatment.
The shortages also contribute
significantly to the relentless rise in health-care costs, say health-policy
analysts, as both patients and physicians are driven into more expensive,
procedure-driven care.
For two years, 68-year-old Al Purdon
says he searched for a diagnosis for his persistently drooping eyelid. A visit
to an optometrist led to a referral to an ophthalmologist and six more doctors,
including an endocrinologist and a plastic surgeon. (Optometrists complete a
four-year postgraduate program; ophthalmologists have a medical degree.)
Several scans, a surgery and a biopsy later, Mr. Purdon says his eye still
drooped, his Medicare had spent $10,850 on bills and there was no diagnosis.
Frustrated, Mr. Purdon and his wife
went in early 2007 to Dr. Frohman. Dr. Frohman "took one look and said, 'I
think I know what it is,'" Mr. Purdon's wife, Johannah, says. http://louis-j-sheehan.us/
A series of seemingly basic tests, some questions and a blood
sample later, Dr. Frohman diagnosed Mr. Purdon with myasthenia gravis, an
auto-immune condition that impedes signal transmission from nerves to muscles
throughout the body, but often first in the eyes. Medicare paid $220 for the
visit, and Dr. Frohman said he'd continue to monitor the condition.
Mr. Purdon's prior treatments may pose
another risk. Because myasthenia can go into remission, doctors say the eye-lid
surgery Mr. Purdon had can sometimes overcorrect the lids and make them appear
to bulge.
Dr. Frohman says that unless something
changes, more neuro-ophthalmologists will eventually abandon academia and
devote more time in private practice to more profitable areas like general
ophthalmology. "There won't be anybody left to teach" the next
generation, he says.
The son of a Bronx pharmacist, Dr.
Frohman says he decided at age 6 that he would be a doctor. Attending the University
of Pennsylvania's medical school, he was intrigued by ophthalmology but worried
that a career of eye exams and routine procedures would feel too rote.
Dr. Frohman was dazzled, though, by
the detective work involved in solving visual problems linked to other parts of
the body. At one lecture, he recalls how the professor, a
neuro-ophthalmologist, examined the patient then accurately deduced the
patients' history.
"It completely grabbed me,"
says Dr. Frohman. After an internship and a three-year residency training in
ophthalmology, he undertook a one-year fellowship needed to enter the
specialty.
When Dr. Frohman joined the faculty of
UMDNJ's New Jersey Medical School in 1985, neuro-ophthalmology was still a
popular field, and had broken important ground in the connection between the
eye and the nervous system. Advanced brain scans hadn't been around long, and
neuro-ophthalmologists were coveted for their ability to diagnose otherwise
mysterious disorders like multiple sclerosis. "Neuro-ophthalmologists were
like Wii games; every [teaching hospital] had to have one," says Steven
Feldon, neuro-ophthalmologist and director of the University of Rochester Eye
Institute in New York.
Neuro-ophthalmology was never a field
to go into for the money. But in the 1980s, its practitioners still made a
handsome living. Many charged close to $200 for a new patient consultation and
$90 for a followup. It was even better times for their ophthalmology
departments, thanks to the $2,500 many surgeons could command for cataract
surgeries.
For the first 10 years, Dr. Frohman
says his department was flush enough that contributing 7% of his revenues was
enough to cover his overhead expenses. Doctors got $5,000 a year to travel to
medical meetings. Dr. Frohman and his wife bought a three-bedroom house in an
upper middle-class community and had two sons.
But in the early 1990s, Medicare
implemented a new system to set standard fees for physicians' services and
procedures. The system's aims were to clamp down on prices and, ironically,
narrow the disparity between the bread-and-butter office visit and
more-expensive specialty procedures. Over time, private insurers have taken
their cue from Medicare to set their reimbursements, too.
But many health-policy experts argue
Medicare's fee-setting mechanisms are making those disparities worse. Its
formula still rewards the capital expenses of new technologies, and is slow to
reduce those fees as costs depreciate and physicians learn to perform
procedures faster. But at the same time, it hasn't significantly increased fees
for lengthy and complex patient visits, which are much harder for doctors to
make more efficient without harming patient care.
Primary-care doctors and specialists
"who are dealing with a patient with a lot of different problems -- they
get killed," says Thomas Bodenheimer, professor in the department of
family and community medicine at the University of California, San Francisco.
Medicare's fees for a follow-up neuro-ophthalmology visit are typically 20% less
now than what Dr. Frohman could collect early in his career, he estimates. http://louis-j-sheehan.us/
Some private health plans pay even
less.
Medicare officials say the government
program tries to address cost disparities by continually reviewing its fee
schedule but says it relies a lot on medical-specialty societies to raise such
issues. "We want to make sure that payment is appropriate and that includes
not underpaying," says Terrence Kay, senior adviser to the director of the
Center for Medicare Management.
As the years passed, reductions in
payments for cataract removals -- historically Medicare's priciest procedure --
slashed revenues of the ophthalmology department Dr. Frohman worked in. By
1994, the stipends Dr. Frohman and others used to receive for travel or
academic expenses had disappeared. About the same time, the department began
requiring him to shoulder much of his own overhead expenses, totaling between
$40,000 and $60,000 a year. Dr. Frohman estimates that two-thirds of the $160
to $220 he receives per new-patient visit now go to overhead costs.
Dr. Frohman won't disclose how much he
earns but says his income from practicing medicine, not adjusted for inflation,
hasn't budged in nearly 14 years. Dr. Frohman, who sports a shock of black hair
and a jovial bedside manner, says he and his wife live in the same house they
purchased when he started his job in 1985.
In the past couple of years, Dr.
Frohman says he dropped out of a few of the lowest-paying private health plans
because he was losing money on their reimbursements. He's tried to squeeze in
another patient or two a day by asking patients to answer a lengthy
questionnaire before an appointment.
Despite such efforts, Dr. Frohman says
he often has to spend more than an hour with new patients, asking questions
about their sight and other medical history and performing dozens of low-tech
tests, such as checking how well patients can track the movement of his finger
with the eye and whether they can identify shapes within a mosaic of
differently colored dots.
Other neuro-ophthalmologists are
giving up on the field or shifting focus to more lucrative pursuits. During his
eight years as a neuro-ophthalmologist, Robert Egan says he was increasingly
under pressure to see more patients. "I'd see everyone else drive their
BMWs into work, and there I was with my '92 Cadillac," he says. In
December, Dr. Egan, previously trained as a neurologist, switched to private
neurology practice where he'll practice neuro-ophthalmology a small fraction of
the time. The move has doubled his income and has enabled him to start paying
back the $160,000 in medical student loans he was barely able to dent before.
Dr. Frohman vows to keep on practicing
"until they put me in a pine box." But he says he understands why
many younger doctors and medical students are shying away from the field.
"Had I started 10 years later in this profession, I don't think I would have
given up doing surgery," he says.
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