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                                                           IN THE NEWS
                                                       [MONDAY, JULY 28, 2008 ]

Medicaid revamp among hot topics in health care
The Times-Picayune | 07.26.08 .................................................................................................................... 3

LSU, West Jeff team on epilepsy treatment
New Orleans CityBusiness | 07.28.08 .......................................................................................................... 6

St. Bernard on the mend after Katrina
The Advocate | 07.27.08 ............................................................................................................................... 8

The Times-Picayune | 07.24.08 .................................................................................................................. 12

State to probe health, children
The Times-Picayune | 07.28.08 .................................................................................................................. 14

Cancer patient, 12, revels in surprise party
Bastrop Daily | 07.25.08.............................................................................................................................. 15

Students discuss summer research
Shreveport Times | 07.25.08....................................................................................................................... 17

Money Awarded to States for Health Care
Health News | 07.28.08...............................................................................................................................18

Health department puts contracts online
Town Talk | 07.25.08................................................................................................................................... 19

Letter: Cancer screening project applauded
The Advocate | 07.26.08 ............................................................................................................................. 20

The Implications of Health-Care Reform
Business Week | 07.25.08 .......................................................................................................................... 21

A Lifesaving Tool Against Cervical Cancer Remains Underused
The New York Times | 07.25.08.................................................................................................................. 23

Weight Drives the Young to Adult Pills, Data Says
The New York Times | 07.26.08.................................................................................................................. 25

House Approves Delay of Medicare 'Trigger' Measure
Kaiser Network | 07.25.08........................................................................................................................... 28

House Committee Report Finds Medicare Pays Up to 30% More for Medications Under Part D
Kaiser Network | 07.25.08........................................................................................................................... 29

                            LSU HEALTH CARE SERVICES DIVISION • P. O. BOX 91308 • BATON ROUGE, LOUISIANA 70821-1308
                                                         PHONE: 225.922.0488 • FAX: 225.922.2259
                                       LSU HEALTH CARE SERVICES DIVISION                   -   PAGE 2 OF 32

HHS, DHS issue guidance on allocating pandemic flu vaccine
AHA News | 07.25.08.................................................................................................................................. 30

Web Alerts for Asthma
The Wall Street Journal | 07.27.08............................................................................................................. 31

Effective in Rheumatoid Arthritis
The Wall Street Journal | 07.27.08.............................................................................................................. 32

                            LSU HEALTH CARE SERVICES DIVISION • P. O. BOX 91308 • BATON ROUGE, LOUISIANA 70821-1308
                                                        PHONE: 225.922.0488 • FAX: 225.922.2259
                              LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 3 OF 32

Medicaid revamp among hot topics in health care
The Times-Picayune | 07.26.08
By Jan Moller

BATON ROUGE -- With time running out on the Bush administration, Gov. Bobby Jindal and state
officials are working with Washington policymakers on a range of issues that could affect how health care
is delivered in Louisiana.

The state's recent discussions with the U.S. Department of Health and Human Services have centered on
three issues:

-- A partial transformation of the state Medicaid program into an HMO-style system in which patients
would have a choice of managed-care plans and access to local clinics.

-- The federal government's reimbursement to the state for the damage to Charity Hospital from Hurricane

-- A final settlement on $600 million that the federal government claims Louisiana owes for past
overspending in its Medicaid program.

The negotiations began shortly after Jindal took office in January and have taken on a new urgency since
the close of the legislative session in June, with U.S. Health and Human Services Secretary Michael
Leavitt visiting Baton Rouge this week for a private meeting with Jindal, state Health and Hospitals
Secretary Alan Levine and the presidents of Louisiana State and Tulane universities.

The talks come about 18 months after the state rejected a plan, backed by Leavitt, to restructure the
state's charity-care safety net by using some of the money that now flows to the LSU-run hospital system
to buy private health insurance for some low-income uninsured residents.

Levine said the overhaul plan that's now being negotiated would not disrupt the flow of "disproportionate
share" money that pays for uninsured care in the LSU-run Charity Hospital System, but would instead
seek to rely on state and federal dollars that already go into Medicaid.

"Our goal is to make sure every Medicaid recipient has the ability to choose from among a network of
providers that are adequate to their needs, " Levine said. "We have a $7 billion program (now), and all we
do is pay claims."

Aiming for 2010

If an agreement can be reached, the plan would be to roll out the changes in three major markets -- most
likely New Orleans, Baton Rouge and Shreveport -- by 2010, Levine said. He said it's unclear whether the
proposal would seek to cover some uninsured people or would serve only people who already are
enrolled in Medicaid.
"There have been very productive conversations, but there's no guarantee that we'll come up with a
consensus, " Jindal said Friday, adding, "We're certainly grateful that we got the attention of the senior

While health-care policy first brought Jindal into the public eye as the 24-year-old state health secretary
under former Gov. Mike Foster, the subject has taken a back seat as Jindal has spent his first six months
as governor focusing on ethics and work-force development.

With the governor's relations with the Legislature at a low ebb after his veto of a controversial pay raise
and more than 250 legislative earmarks, health care provides him a chance to make policy without going
to the full House and Senate for approval, thanks to a bill approved in the waning months of Gov.
Kathleen Blanco's administration.

                    LSU HEALTH CARE SERVICES DIVISION • P. O. BOX 91308 • BATON ROUGE, LOUISIANA 70821-1308
                                             PHONE: 225.922.0488 • FAX: 225.922.2259
                              LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 4 OF 32

Senate Bill 1 by Sen. Joe McPherson, D-Woodworth, which lawmakers approved in 2007, gives the state
health department wide latitude to redesign the Medicaid system into a "medical home" system of care, in
which primary-care providers such as neighborhood clinics are linked into managed-care networks with
hospitals and specialists.

Federal approval, in the form of a waiver, is required before the state makes any major changes to the
Medicaid program, which serves about 1.2 million poor, elderly and disabled Louisianians and is financed
with a mix of state and federal dollars.

Levine said his department has been working with its counterparts in Washington to develop a waiver
application that can pass federal muster once it's submitted. The state's application would need approval
from the health-care and budget committees in the House and Senate, but it would not need to go before
the full Legislature for debate.

"The Legislature decided that, " Levine said. "They passed the law. We're just carrying out their direction.
. . . There's not going to be any surprises about what we propose."

A spokeswoman for Leavitt declined to comment on the meeting or the substance of the deliberations.

Fight over hospital funding

The most contentious of the three issues is likely to be the federal reimbursement for Charity Hospital,
where the two sides remain sharply at odds as the three-year anniversary of Hurricane Katrina
approaches. The state calculates the storm damage in the hundreds of millions of dollars and insists that
the federal government should pay the "replacement cost" for a new hospital, which LSU pegs at $492

But FEMA puts the damage estimates in the tens of millions of dollars.

A hefty settlement is critical to the state's efforts to finance a new teaching hospital in downtown New
Orleans, which is projected to cost at least $1.2 billion. A large federal down payment would reduce the
amount that the state must borrow in order to build the proposed 424-bed facility. But if substantial federal
help isn't forthcoming, it could imperil the project by increasing the subsidies required from the state.

"Our position is clearly that the federal government should be paying us the replacement value of the
hospital. That's been our position all along, " Levine said.

The state has been negotiating for years with FEMA, and three separate consultants retained by the state
have concluded that the art deco building on Tulane Avenue was at least 50 percent damaged by the
storm and subsequent flooding -- the legal standard for the federal government to foot the replacement

"We're counting on FEMA and the federal government to follow the rules that are out there, " said Dr.
Fred Cerise, the head of LSU's health-care division.

Cerise said the state appeared close to a deal with FEMA until last month, when the Office of
Management and Budget stepped into the negotiations and cast doubt on the state's estimates. In recent
weeks, Leavitt has taken over as the federal government's point person on the matter.

"It's troubling that with three independent assessments, and we're three years out from Katrina, that we
still don't have a resolution, " Cerise said.

Complicating matters even more are three separate Medicaid "disallowances" -- health-care money that
the federal government paid the state in recent years that it now wants back, claiming the payments
violated federal rules.

                    LSU HEALTH CARE SERVICES DIVISION • P. O. BOX 91308 • BATON ROUGE, LOUISIANA 70821-1308
                                             PHONE: 225.922.0488 • FAX: 225.922.2259
                              LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 5 OF 32

Levine said the state does not agree with the federal government's $600 million figure and is hoping to
reach a settlement in which it pays a fraction of that amount.

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                    LSU HEALTH CARE SERVICES DIVISION • P. O. BOX 91308 • BATON ROUGE, LOUISIANA 70821-1308
                                             PHONE: 225.922.0488 • FAX: 225.922.2259
                              LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 6 OF 32

LSU, West Jeff team on epilepsy treatment
New Orleans CityBusiness | 07.28.08

Louisiana State University Health Sciences Center New Orleans and West Jefferson Medical Center have
teamed to provide epilepsy care for patients in the metropolitan New Orleans area.

WJMC has added an Epilepsy Monitoring Unit at its main campus, 1101 Medical Center Blvd., in Marrero.

“With the addition of a ‘clinical home’ for epilepsy monitoring, surgery and outpatient care for LSUHSC
physicians and their adult patients at West Jefferson Medical Center, LSU Health Sciences Center is now
able to fully re-establish its Epilepsy Center of Excellence and Level 4 Epilepsy Center,” said Peter
Olejniczak, LSUHSC Epilepsy Center of Excellence director.

Metairie teen wins gold at Transplant Games

A group of athletes who have received heart, kidney or liver transplants are now basking in the glow of

Three Louisiana residents competed in their own Olympic–style event at the National Kidney Foundation
2008 U.S. Transplant Games.

Hailing from throughout the state, the athletes won two gold medals, five silvers and three bronze medals.
The games were held July 11-16 in Pittsburgh and open to recipients of any transplant.

“Before I had my transplant, I couldn’t imagine being well enough to compete, much less carry home a
medal,” said Metairie’s Britney Dugas, a 2001 heart transplant recipient. The 18-year-old was the high
scoring athlete for Louisiana with two gold medals and two silver medals in swimming and field events.

More than 1,300 transplant athletes nationwide participated in the games, making it the largest-ever
gathering of transplant recipients in the world.

Transplant athletes — including kidney, liver, heart, lung, pancreas and bone marrow recipients —
competed for medals in 12 sports, including bicycling, bowling, golf, racquetball, swimming, tennis, and
track and field events.

$16.6M to support 25 local care providers

The Primary Care Access and Stabilization Grant program announced its third round of grant funding
totaling $16.6 million to 25 public and private nonprofit health care provider organizations that operate 70
clinics in the New Orleans area.

To date, including grant awards made in September and December, the program has released more than
$43 million to bridge gaps in local services.

“Between September of last year and March of this year, the 70 PCASG-funded clinics provided medical
and/or behavioral healthcare to over 80,000 people. Furthermore, many of the grant recipients have
opened new clinic locations and expanded hours to accommodate the great needs in the region that
persist since Hurricane Katrina,” said Clayton Williams, director of Health Systems Development for the
Louisiana Public Health Institute.

Georgia firm to work on cancer center in Slidell

Slidell Memorial Hospital has selected AE Design as the architectural firm for design and construction of a
new regional cancer center.

Marietta, Ga.-based AE Design, which specializes in oncology and diagnostic imaging facilities, has
completed more than 100 oncology facility projects worldwide. Groundbreaking is anticipated in

                    LSU HEALTH CARE SERVICES DIVISION • P. O. BOX 91308 • BATON ROUGE, LOUISIANA 70821-1308
                                             PHONE: 225.922.0488 • FAX: 225.922.2259
                             LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 7 OF 32

Money to build the $17.5 million center will come from a 2003 tax that was rededicated with voter
approval in 2007.

Hospital CEO Bob Hawley said the center will allow SMH to provide comprehensive cancer care in one
central location. Patients will be able to have diagnostic workup, outpatient treatment and support
services under one roof.

The company has assembled a team of engineers for the project including Duplantis Design Group of
Thibodaux, Wardlaw and Lasseigne of Baton Rouge, CRS Engineering and Design Consultants of
Birmingham, Ala., and Louisiana Landscape Specialty Inc. of Baton Rouge.
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                   LSU HEALTH CARE SERVICES DIVISION • P. O. BOX 91308 • BATON ROUGE, LOUISIANA 70821-1308
                                            PHONE: 225.922.0488 • FAX: 225.922.2259
                                 LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 8 OF 32

St. Bernard on the mend after Katrina
The Advocate | 07.27.08

                                                                                ADVOCATE PHOTOS BY PAT SEMANSKY

A memorial to the people of St. Bernard Parish who died in Hurricane Katrina stands in the Mississippi River Gulf Outlet
near Shell Beach. Douglas Couture, 73, watches activity on a dock at Shell Beach in St. Bernard Parish. Couture lived in St.
Bernard before Hurricane Katrina but now drives from Picayune, Miss., with his wife, Sharon, to visit family and friends.

‘They didn’t expect me to live,” 73-year-old Douglas “Duddy” Couture says of the doctors who put five
stints in his heart in July 2005 — the month before Hurricane Katrina.

Aided by “angels” in north Louisiana, the ailing fisherman and his wife, Sharon, survived three
subsequent years of storm-related evacuation, recovery and reconstruction of their bayou home in St.
Bernard Parish.

But now, after all that, they recently moved to Picayune, Miss.

“We’re out because Duddy’s health is the main thing,” Sharon Couture said.

Dr. Cathi Fontenot, interim CEO of the LSU-run Medical Center of Louisiana at New Orleans, sums
up post-Katrina health care in the metro area with a medical metaphor: “We’re off life support but
we’re still in ICU.”

Almost three years after Katrina, amid signs the depopulated parish is rebounding, there is still no
hospital to replace the flood-ruined Chalmette Medical Center.

Hospitals in neighboring New Orleans and St. Tammany Parish are either too far away or overwhelmed
with patients, residents and officials say.

“If you had a heart attack, it would take you 30 minutes to get to a hospital from here — if you had an
ambulance already outside,” Chalmette High School Principal Wayne Warner said.

                       LSU HEALTH CARE SERVICES DIVISION • P. O. BOX 91308 • BATON ROUGE, LOUISIANA 70821-1308
                                                PHONE: 225.922.0488 • FAX: 225.922.2259
                              LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 9 OF 32

That may soon change.

The parish has committed $25 million toward a new hospital, according to newly elected Parish President
Craig Taffaro. Members of a hospital service district created after the storm will meet this week in an old
FEMA trailer to announce bid specifications for the community hospital, parish officials say.

But the shortage of physicians and medical care remains dire, by most accounts. The hospital issue
proved critical for the Coutures.
They say their new home in Picayune is a 35-minute drive from a hospital in Gulfport. It took almost twice
that long from their old home in Yscloskey to hospitals in the New Orleans area.

During Katrina, all but five of the 27,000 structures in the parish were destroyed by the storm surge and
by flood waters unleashed by broken levees. The storm killed more than 100 people, who are
memorialized at Shell Beach.
About 64,700 people lived in St. Bernard Parish before Katrina hit, according the U.S. Census. Taffaro
estimates 35,000 to 37,000 have returned.

Whole neighborhoods remain boarded up around Chalmette, but businesses are returning on the major
arteries of Judge Perez Drive, St. Bernard Highway and Paris Road.

Rocky & Carlo’s, a well-known restaurant in Chalmette, seems to be thriving. Groundbreaking for a $5
million fire station took place in Arabi on Friday, and a post office is slated to open there later this

Reconstruction of the Parish Governmental Complex is scheduled for completion in November. A newly
elected parish government now meets in a recently renovated Parish Council chambers, amid obviously
better relations with FEMA, officials say.

Communication can be problematic. For example, locals advise Internet users to seek out the wireless
service at a library-trailer — or after hours, in the parking lot.

Many churches have not reopened, officials admit, though the need remains.

At rededication ceremonies for the reopened council chambers, black and white clergy members
advocated racial and political unity. The appeal followed a well-publicized “blood-relative-only” rental
ordinance in the majority-white parish, a measure that has been rescinded.

A family’s experience
On a hot July morning, three generations of Coutures mingle with busy workers under the shade of a crab
shack along Bayou La Loutre near the Yscloskey bridge.

Across the narrow road leading to the fishing mecca at nearby Shell Beach, a small store — Duddy’s
Quick Stop — still bears the name of the family patriarch.

Duddy and Sharon Couture recall how, as Katrina approached, they fled north with their 50 animals — a
dog, six cats and a flock of breeding birds (parrots, cockatoos, macaws and love birds). They gave them
all up for adoption in the long aftermath of the storm.

During the evacuation, in a rural parking lot far from home, Duddy Couture’s health seemed to worsen.
Passersby noticed and gave the displaced couple lodgings for a month.

“That was the turning point,” said his wife, now 48. “We found two ‘angels’ in Minden.”

In October 2005 they returned to flood-ruined Yscloskey. Most of the 600 or so families in the close-knit
fishing village lost their homes or boats, or both. The bridge over the bayou was out of commission.

The Coutures proudly recalled that their little store was the first business in Yscloskey to reopen,
providing the decimated fishing industry with essential ice and bait.
But the crippled parish government was slow to help, residents say. And the characteristic grit and self-
reliance of the outdoorsy residents did not always suffice.

                    LSU HEALTH CARE SERVICES DIVISION • P. O. BOX 91308 • BATON ROUGE, LOUISIANA 70821-1308
                                             PHONE: 225.922.0488 • FAX: 225.922.2259
                              LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 10 OF 32

Money ran out. Anxious neighbors demanded credit terms that did not exist before the storm, Duddy
Couture recalls.

Today, all but two dozen or so commercial fishing families in Yscloskey have left, residents said. Only
visiting sports fishermen have returned in large numbers.

The state-maintained lift bridge reopened a month ago but is in service only 18 hours daily, Duddy
Couture said. He said the government needs to clean out a mile of ditches along residential Citrus
Avenue. Construction of a large ice house would help the fishing economy, he said.

His wife’s daughter, Pheebe Squires, sees progress.

“It’s starting to come back — it really is,” said Squires, the wife of a crabber, mother of three and a breast
cancer survivor.

The future of the village lies in sports fishing, Squires said as crabbers dumped snapping blue crabs on a
table in the shack.

Meanwhile, the toughness of residents is evident in recollections of Katrina.

Squires, for example, recalls how she resumed chemotherapy treatments the month before Katrina,
losing up to 170 pounds as he and her family fled the storm and then Hurricane Rita the next month. They
relocated to Florida — where Hurricane Wilma destroyed their trailer that October.

As she watches the bridge rise for a fishing boat, she confidently predicts the town‘s revival. “It’ll come
back,” she said.

Life still hard
Inside Duddy’s Quick Stop, workers line up for sandwiches at lunch hour.

“It’s hard on the elderly people here,” said Raymond Krennerich, 45, whose 85-year-old ailing uncle lives
in Kenilworth, further west in St. Bernard.

Krennerich said the two stayed in Baton Rouge after Katrina, then moved to Marksville for eight months.

“We came back 20 months after the storm,” he said. “We came home to empty lots. Half of the people lost
their homes and boats — all in one day.”

His uncle’s health is his biggest concern. The hospitals in neighboring New Orleans are often
overwhelmed, he said.
“It don’t pay to go up there because they are so packed and they’ll send you to Slidell Memorial, anyway,”
he said.

Cashier Brittany Naquin, 19, suggested several ways the parish could hold on to its young people.

“We need a clothing store,” said Naquin, a 2007 graduate of Chalmette High, the only one of four high
schools to reopen since Katrina. “The nearest good clothing store is in Slidell.”

The Super Wal-Mart and the K-Mart in Chalmette remain closed.

“Me and my parents are still living in a camper-trailer,” Naquin said.

A $10,000 down payment for a house is out of reach for a lot of people since the storm, she said, adding:
“We didn’t get any help from FEMA.”

Naquin has mixed feelings about the future of the parish.

“I’d say that it’s bright, if they bring back businesses,” she said.

                     LSU HEALTH CARE SERVICES DIVISION • P. O. BOX 91308 • BATON ROUGE, LOUISIANA 70821-1308
                                              PHONE: 225.922.0488 • FAX: 225.922.2259
                             LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 11 OF 32

Naquin said she is considering enrolling in Nunez Community College in Chalmette to study to be an X-
ray technician.

Among the goals of the two-year college is meeting the high demand for nurses and other medical
professionals in the state. But Nunez is still rebuilding from the storm, and higher education officials
throughout the area say they are having a hard time attracting and retaining faculty.

Some teens bemoan the lack of recreation in St. Bernard Parish.

“There ain’t nothing here but a little store and a crab dock,” 14-year-old Brandon Chustz, a native of Port
Allen, said sourly.

He said he moved to Yscloskey last summer because of his father’s work. Aside from swimming in the
bayou, there’s little to do, Chustz said.

“We need a grocery store down here,” said Justin Jones, a freckled 17-year-old who has lived in
Yscloskey most of his life.

“Dude — we need a MALL,” Chustz retorted.

At the same time, the national economic downturn has brought some people to St. Bernard despite the
post-Katrina lack of amenities.

Chris Coletta, dock supervisor for Deno’s Fishing in Yscloskey, looks over the crab-trap buoys his
workers have painted pink. The distinctive buoys are used to mark Deno’s traps.

“Nobody else around here uses pink,” he said.

A native of Naples, Fla., Coletta said he refused to evacuate his hometown for hurricanes Andrew,
Katrina or Wilma. But the lack of jobs in Florida propelled him to tiny Yscloskey several weeks ago.

“Deno’s my brother-in-law,” Coletta said. “I came here to help, best I can. Nothing’s going on in Florida —
things are bad there.”

But time is an implacable foe for Duddy and Sharon Couture. They say they will leave the future of St.
Bernard Parish to younger family members in Yscloskey.

“We got a lot of people in Picayune from home,” Duddy Couture said. “They want to come back, but age
is against them.”

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                    LSU HEALTH CARE SERVICES DIVISION • P. O. BOX 91308 • BATON ROUGE, LOUISIANA 70821-1308
                                             PHONE: 225.922.0488 • FAX: 225.922.2259
                             LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 12 OF 32

The Times-Picayune | 07.24.08
By Jennifer Evans
Staff writer

Solid darkness inside an LSU School of Dentistry lecture room shattered as magnified images of
protruding teeth, shackled together with metal, were projected onto a screen. The illuminated faces of 15
students did not flinch as the lecturer flashed image after image of teeth being pulled into place.

"You should've been here earlier," said Allen Mayon Jr., a recent graduate of LSU in Baton Rouge.
"Gunshot wound to the face . . . requiring total reconstruction."

The recent lecture was part of LSU's inaugural Summer Multicultural Enrichment Program, a six-week
program introducing minority undergraduates to skills typically reserved for first-year dental students.

The 174-hour program was part of the dental school's ongoing effort to diversify its student body and train
a dental work force reflective of Louisiana, where minorities make up more than 35 percent of the state's

Minority dentists comprise less than 7 percent of licensed dentists in the state, according to Erin Conner,
a spokeswoman for the Louisiana Board of Dentistry.

With a budget of $100,000 from the School of Dentistry, John Ritchie, director of Diversity and Minority
Affairs at the school, created a summer program offering students a balance between basic science and
clinical dentistry courses with hands-on work and rotations.

Led by LSU faculty, minority undergraduates from the University of New Orleans, LSU-Baton Rouge,
University of Arkansas-Pine Bluff, Xavier, Dillard and Southern universities who want to pursue careers in
dentistry participated in the program.

Mayon, who grew up in Opelousas and recently became the first male in his family to graduate from
college, said it didn't take him long to get hooked on dentistry. When he was only 5, dental visits turned
into learning opportunities as he peered into the mouths of patients. Mayon credits his mother, who
encouraged him to explore a professional career as a way to steer clear of the path that led five of his
eight male cousins to prison.

"My mom always said to me, 'Education is everything. What you learn, no one can take away from you,' "
he said.

This year, Mayon will begin shopping around for dental schools. In previous years, he may not have
considered LSU.

As the only dental school in Louisiana, LSU boasts the training of more than 70 percent of all practicing
dentists in the state. But throughout its history, the school has had difficulty attracting Latino, African-
American and American Indian students -- minority groups nationally underrepresented in the dental work
force. Since 1999, enrollment records from the School of Dentistry show underrepresented minority
students combined have made up only 2 percent of the average incoming LSU class of dentists.

The shortage of minority dentists in Louisiana is not unique to the state but reflective of a national
dilemma. While the population of racial and ethnic minorities in the United States continues to grow, a
2004 Journal of Dental Education report found underrepresented minorities made up only 14 percent of
the nation's practicing dentists and 11 percent of students entering dental schools.

According to a spokesperson from the American Dental Education Association the 2004 report is the
most recent of such reports. In 2000, the underrepresentation of minority dentists captured the attention
of dental educators with the release of the Surgeon General's first-ever report on the oral health of
Americans. In it, the Surgeon General pointed out that while the oral health of the country improved
throughout the 21st Century, oral disease continued to be a silent epidemic disproportionately affecting
the poor, children, elderly and minority racial and ethnic populations.

                    LSU HEALTH CARE SERVICES DIVISION • P. O. BOX 91308 • BATON ROUGE, LOUISIANA 70821-1308
                                             PHONE: 225.922.0488 • FAX: 225.922.2259
                              LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 13 OF 32

The Surgeon General's report "just underscored what people already knew," Ritchie said. "The major
issue underlying oral health disparities is access to care."

While the Surgeon General's report estimated more than 108 million Americans lacked dental insurance,
numerous studies suggest insurance may only be part of the problem. A 2002 Institute of Medicine review
of 100 studies examining the quality of health care across racial and ethnic minority groups found health
care disparities regardless of patient income and insurance status.

Educational, cultural and language barriers also play a role in whether or not populations go to the
dentists, said Sarita Arteaga, president of the Hispanic Dental Association.

Studies of health-care services also show minority dentists are more likely to serve minority and medically
underserved populations, and minority patients prefer health providers of similar racial and ethnic

"Patients want to go to a professional who they feel they can relate to," Arteaga said.

The Surgeon General's report marked a turning point for dental educators who recognized the need to
diversify dental schools across the country and educate dentists on how to deliver the best care to
culturally diverse groups, Ritchie said.

"If we can diversify the dental schools, graduates can help (reduce barriers) to care, and go back to
community," said Eric Hovland, dean of LSU School of Dentistry.

Mayon said he feels the call to one day perform dental work in his hometown, where he has witnessed
just how difficult it can be for people living in rural Louisiana to access dental care.

"I want to be a general dentist, the jack-of-all-trades, to help in lots of different ways," Mayon said. "In the
short term, I get to give back to the community . . . it benefits not only me but helps others. My work will
become bigger than myself."

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                     LSU HEALTH CARE SERVICES DIVISION • P. O. BOX 91308 • BATON ROUGE, LOUISIANA 70821-1308
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                             LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 14 OF 32

State to probe health, children
The Times-Picayune | 07.28.08
The Associated Press

BATON ROUGE, La. (AP) — Officials say new findings on how education and health traits are largely
determined by the age of 5 are so striking that the state plans to host a symposium on the issue this year.

State Representative Hollis Downs and eight other state and local policy-makers attended a two-day
conference on the issue at Harvard University in June.

State officials are now in early talks on how the new findings can help Louisiana combat daunting
education, health and other problems.

The meeting was hosted by the Center on the Developing Child, which does research on how an infant
and toddler's early years shape their quality of life.

Downs said the study could pave the way for new laws and other changes designed to detect learning
problems much earlier.

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                               LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 15 OF 32

Cancer patient, 12, revels in surprise party
Bastrop Daily | 07.25.08
By Bonnie Bolden

By Bonnie Bolden

Registered Nurse Michelle McKinnie helps cancer patient Angel Rodriguez, 12, open gifts at his surprise birthday party
Friday in Bastrop.

Bastrop, La. -

A young man recovering from cancer treatments was surprised when family, friends, and his home health
nurses hosted a birthday party for him Friday.

Angel Rodriguez of Bernice turned 12 on July 20, but celebrated again at TruCare Home Health at his
surprise party.

To lure Angel to Bastrop, he was told he had to go to an office for blood work. Angel arrived wearing a
mask to protect him from airborne germs but was allowed to remove it for the festivities.

At the party, he received a PlayStation Portable, Yugioh cards, several games, and a gift card.

More than a year ago, Angel said he went to the doctor because he “felt bad a lot.” Doctors found a
cancerous tumor behind Angel’s sternum on the right side; he underwent two surgeries with incisions
through his back to remove the cancer and was on chemotherapy for several months.

Angel has finished his last round of chemotherapy at the LSU Health Sciences Center in

Throughout his illness and subsequent treatments, Angel has been a Spanish to English translator for his
mother, Camilla Rodriguez. Some medical terms do not translate well to Spanish, if at all.
Neither Angel nor his mother know the name of the cancer he’s battled — only what treatments he
needed to undergo.

A registered nurse who worked with Angel said the entire staff became attached to him because of his
inquisitive nature and optimistic personality.

“He never had any complaints,” nurse Michelle McKinnie said. “He’s very wise for his age and likes to be
interested in his care.”

State privacy laws prevented health-care officials from releasing other details about Angel’s condition.

                      LSU HEALTH CARE SERVICES DIVISION • P. O. BOX 91308 • BATON ROUGE, LOUISIANA 70821-1308
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Students discuss summer research
Shreveport Times | 07.25.08
From Staff Reports

High school and college students discussed their summer research at LSU Health Sciences Center in
Shreveport during a poster session Thursday.

The students worked beside LSUHSC faculty members on real research projects for eight weeks through
the Jump Start and Undergraduate Apprentice programs. Jump Start offers high school students
interested in math and science careers an opportunity to learn over the summer. The Undergraduate
Apprentice program provides similar experiences for college students.

Research topics include skin cancer, Alzheimer's disease and treatment of bipolar disorder in children
and teens.

The two programs are part of the Partnerships in Science Pipeline developed by LSUHSC Multicultural
Affairs Director Shirley Roberson.

The pipeline provides students from kindergarten through the first year of medical school an opportunity
to work with health care professionals.

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                              LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 18 OF 32

Money Awarded to States for Health Care
Health News | 07.28.08
By: Madeline Ellis

As part of the current administration's strategy for expanding access to health care, the U.S. Department
of Health and Human Services (HHS) recently announced grants of over $49 million issued to 30 states
that provide health insurance to those who cannot get conventional coverage due to their health status.
This year's grants are in addition to approximately $286 million that states have received since 2003 to
support this program. "Getting health insurance to the uninsured has been a high priority of the Bush
Administration," said Kerry Weems, HHS' Center for Medicare & Medicaid Services (CMS) Acting
Administrator. "These new grants for high-risk pools will help get coverage to people who otherwise would
not have access to health care."

The purpose of the grants is to offset losses that the states incur during the operation of "high-risk pools,"
which are typically non-profit associations created by the state that offer health coverage to people with
serious medical conditions. These funds also help provide support for disease management for chronic
conditions and premium subsidies for those with lower incomes. HHS says enrollment in these types of
pools is growing, with currently more than 200,000 enrolled in state pools. "These grants will make it more
affordable for states to expand access to health care through high risk pools for the uninsured," said HHS
Secretary Michael Leavitt. "Individuals who benefit from these pools usually have a history of health
problems that make it extremely difficult to find affordable health coverage in the individual market."

In order to be eligible for the grants, states must have a "qualified" high-risk pools, meaning they must
meet the criteria specified in section 2745 of the Public Health Service Act, and must follow certain rules,
such as capping premiums at no higher than 200 percent of the standard charge in the state. The funds
were allocated based on the number of uninsured in each state and number of people enrolled in each

The 30 states that received grants are (in alphabetical order): Alabama, Alaska, Arkansas, Colorado,
Connecticut, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Minnesota,
Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Oklahoma,
Oregon, South Carolina, South Dakota, Texas, Utah, Washington, Wisconsin, and Wyoming.
HHS estimates than more than 40 million Americans are currently without health insurance.

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                            LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 19 OF 32

Health department puts contracts online
Town Talk | 07.25.08

BATON ROUGE, La. (AP) — Have any interest in finding out who the state health department contracts
with for services? It’s online now.

The">Department of Health and Hospitals has set up an online, searchable
database for the public to comb through its contracts.

The site includes amounts and the start and stop dates of each contract. DHH says the database will be
updated monthly in July, August and September and quarterly thereafter.

The database can be found by clicking on the "DHH Contracts Online" icon on the department's home
page at

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                             LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 20 OF 32

Letter: Cancer screening project applauded
The Advocate | 07.26.08
Rick Kyle

I want to thank the Louisiana Legislature and Gov. Bobby Jindal for their approval of the Colorectal
Cancer Screening Demonstration Project, which was supported by the American Cancer Society, LSU
and a number of health organizations in our state.

This project will save lives and save the state on costs related to colorectal cancer treatment. Everyone
eligible for colorectal cancer screening in Louisiana deserves access to these lifesaving tests. The
Louisiana Colorectal Cancer Screening Demonstration Project will help low-income, uninsured and
underserved residents ages 50-64 across the state gain access to lifesaving screening programs for early
detection of colorectal cancer.

The demonstration project has been allocated $1.5 million in the state budget. This is a sound investment
for a healthier Louisiana. Early estimates are that the demonstration project will save more than $7.4
million over three years in initial colorectal cancer treatment costs and more than $2.7 million in ongoing
treatment costs.

Additionally, by building capacity for screening and treatment statement, Louisiana will be in the position
to access federal Centers for Disease Control and Prevention dollars once approved by Congress. These
dollars will most likely go first to states with a proven track record for successful, population-based
colorectal cancer screening.

This project is a huge victory for our state, and I applaud our elected leaders for sharing in the vision.

Rick Kyle, colon cancer survivor
senior electrical designer
Baton Rouge

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                             LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 21 OF 32

The Implications of Health-Care Reform
Business Week | 07.25.08
by Wendy Diller

From Standard & Poor's Equity ResearchWith the U.S. presidential election coming this November,
health care reform is becoming a political priority in a way it hasn't since the Clinton Administration in the
early 1990s. What are the implications for health care companies — payers, providers, and
manufacturers? While it's too early to say for sure, most of the solutions presented so far share
underlying principles that we think enable realistic discussion.

We believe an ongoing flow of statistics underscores the current health care system's flaws: In 2006,
about 47 million Americans lacked health insurance, up 8.6 million from 2000, according to The
Commonwealth Fund, a health care policy think tank. A Commonwealth study released in June 2008
noted that the number of underinsured American adults rose nearly 60% to 25 million in 2007, from 16
million in 2003. The underinsured have health coverage, but still face access and financial constraints
similar to uninsured people.

At the same time, total costs are rising: In 2007, the nation’s health care spending was $2.7 trillion, up
from $2.1 trillion in 2006, according to the Centers for Medicare and Medicaid Services (CMS). Employer-
sponsored health insurance premiums rose 10 times faster than family income between 2001 and 2005,
according to the Robert Wood Johnson Foundation. Medicare trustees project that Medicare’s chief
financing vehicle, the Health Insurance Trust Fund, will be exhausted by 2019.

Details vary, but in broad terms, most groups — Democrats and Republicans, the private and public
sectors, big corporations, and individuals — agree that solutions must include broader access to health
insurance through more affordable, simpler insurance plans, greater efficiencies, and cost containment
measures. Proposals to achieve these aims typically center around a greater emphasis on value-based
medicine, that is, closer correlation of reimbursement to effectiveness, more cost sharing between payers
and consumers, greater pricing transparency for medical services and products, and development of
reliable, independent measures of quality and cost-effectiveness of health care services and products.

In general, we think companies that are involved in initiatives of the kind mentioned above stand to
benefit. Most large managed care organizations (MCOs), for example, are rapidly diversifying their
customer base and product portfolios, moving into the small group and individual markets, which until
recently they considered niches with modest potential. Coventry Health (CVH), Cigna (CI), WellPoint
(WLP), and others are offering a bevy of new kinds of health plans at different price points that appeal to
people who are struggling to afford health insurance premiums. While their main motivation is to offset
slowing growth in their core large group businesses, they’re also addressing the uninsured population

These niche markets remain, however, only a small part of their business, and their potential is uncertain.
As of the end of the first quarter of 2008, companies offering lower-cost plans struggled to increase
enrollment; a Kaiser Family Foundation (KFF) study released in April found that most uninsured
households can't afford high-deductible health plans. One reason is the faltering economy, which is
forcing consumers to make hard choices; another reason is, for a certain subset of people, the premiums
are still too high. "The question is how low can the companies bring the price point and still provide
meaningful coverage in the face of rising medical costs?" asks Phillip Seligman, a Standard & Poor's
equity analyst.

Companies with larger exposure to Medicare and government-financed programs also may be more
vulnerable to health care reform proposals, as government programs often lead the way in changing the
health care payments and reforms. Pharmaceutical companies have benefited greatly from Medicare’s
new prescription drug plan (PDP), but they could be at risk if the government takes steps to better control
costs of this expensive program, in our view.

Among pharmaceutical companies, those with a large proportion of drugs that are widely used by seniors
— and thus recipients of significant PDP funds — include Merck (MRK), Pfizer (PFE), and Eli Lilly (LLY).
Others, like Wyeth (WYE) have less exposure to Medicare PDP, in our view. Among device companies,
those that make products widely used by seniors are also at risk of changes to Medicare funding. These

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                             LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 22 OF 32

include implantable device makers St. Jude Medical (STJ), Zimmer (ZMH), Boston Scientific (BSX), and
Medtronic (MDT).

That being said, health care reforms are likely to play out in unintended ways because Democrats and
Republicans hold widely disparate views on how to achieve greater access to health care insurance and
how to fund a system that is beset by spiraling costs. Democrats would guarantee access to affordable
health insurance by replacing individual insurance policies with new group options, offered by both private
and public payers, and, in some cases, by expanding government programs, including Medicaid.

Republicans, in contrast, favor tax credits for individuals to encourage them to buy insurance on the
private market, while removing existing tax incentives for employers that offer health insurance.
Employer-sponsored health insurance is the backbone of the current system, but many Republicans
believe it discourages competition and disconnects costs from utilization and effectiveness.

No matter which party’s candidate wins the presidential election in November, most experts agree that
incremental reforms are much more likely to occur in the near term and substantial nation-wide reform
remains a long-term proposition. In the absence of national consensus, states are undertaking some
high-profile but small reforms on their own. Massachusetts, Maine, and Vermont have come closest to
instituting near-universal health insurance coverage for their residents. Another 14 states are in the
process of developing comprehensive reform plans, according to the KFF.

The two-year-old Massachusetts plan, in particular, is in the spotlight as a potential harbinger for more
sweeping, nationwide change. As of July 2007, the state has mandated that all residents purchase health
insurance or, beginning in 2008, face financial penalties. To help low-income people, it offers subsidies
and premium fees based on a sliding scale. At the same time, all employers with 11 or more employees
have to offer health insurance or pay into a fund set up to subsidize individual policy purchases. A public-
private organization, the Commonwealth Health Insurance Connector Authority, administers the program.
As of March 2008, some 350,000 of an estimated 600,000 previously uninsured people had obtained
health insurance, KFF reports; Maine's and Vermont's programs are a fraction of the size and scope.

While state governments are driving these initiatives, some involve the private sector. Companies,
however, can't yet estimate how much they will benefit, if at all.

In Massachusetts, the enrollment numbers seem impressive. However, none of the large MCOs that
dominate national markets were willing to offer their services; the participating private carriers are small,
regional players. Also, the Massachusetts program's costs are greater than expected, while efforts to
contain medical spending are stalled in the legislature. Thus, other states may be reluctant to duplicate
the effort.

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                             LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 23 OF 32

A Lifesaving Tool Against Cervical Cancer Remains Underused
The New York Times | 07.25.08

By getting vaccinated for human papillomavirus, or HPV, before she becomes sexually active, a girl
reduces her lifetime risk of developing cervical cancer by 70 percent, studies suggest.

Fewer than one in four eligible girls and women, ages 9 to 26, has been vaccinated against HPV.

The HPV vaccine remains controversial, despite some studies showing its safety and effectiveness.

One in four American girls and women ages 14 to 19 has a sexually transmitted disease, and one in four
ages 14 to 59 is infected with HPV.

Preventing cervical cancer may be the last thing on the mind of the average 11-year-old girl. But by
getting vaccinated for human papillomavirus, or HPV, the virus that causes nearly all cases of cervical
cancer, a girl reduces her lifetime risk of developing the disease by 70 percent, studies suggest.

The vaccine, called Gardasil and made by Merck, protects against the two types of HPV — 16 and 18 —
responsible for most cervical cancers, the second leading cancer killer among women worldwide. It also
immunizes against HPV 6 and 11, the types of the virus that cause 90 percent of genital warts, which are
not life-threatening but can be distressing and difficult to treat.

The federal Advisory Committee on Immunization Practices recommends vaccinating girls between the
ages of 11 and 12, and as young as 9 at the discretion of doctors. It also advises that girls and women
ages 13 to 26 receive the vaccine if they have not yet been immunized. But the vaccine is controversial,
and only 24 percent of eligible girls and women have gotten at least one of the three recommended

One reason for the controversy is that the vaccine is relatively new. The Food and Drug Administration
approved it in 2006, and this leaves some parents, and doctors, questioning its long-term safety and

“Studies have been done on fewer than 2,000 girls ages 10 to 15, and to know if a vaccine is safe,
millions of people have to get it and have a chance to report any adverse events,” said Dr. Diane Harper,
director of the Gynecologic Cancer Prevention Research Group at Dartmouth Medical School. “It’s a
public health experiment, but that’s the nature of vaccines.”

Proponents counter by pointing to Gardasil’s track record. An estimated eight million girls and women in
the United States have received one or more doses of the vaccine, with fewer than 7 percent reporting
serious side effects — about half the rate for vaccines over all.

“There’s six years of safety data that shows no long-term risks, and that’s the same timeframe for other
recently recommended vaccines,” said Dr. Mark H. Einstein, director of clinical research in the
gynecologic oncology division of Albert Einstein College of Medicine in New York.

Safety issues aside, some people oppose the vaccine because they fear that its use will encourage
promiscuity. Or they have religious objections to vaccines, or argue that the government has no right to
mandate its use, as some states have tried to do.

With or without the vaccine, many teenagers are already sexually active. A recent government study
found that one in four girls ages 14 to 19 has a sexually transmitted disease. And one in four American
girls and women ages 14 to 59 is infected with HPV, according to the Centers for Disease Control and
Prevention. “This vaccine is a preventive health measure, not a sex education measure,” Dr. Einstein
said. “From a science standpoint, it completely makes sense to vaccinate girls against HPV.”

The vaccine is being studied for use in boys and men, too.

“We don’t have widespread vaccination of women, so immunizing men may help protect those women
who aren’t vaccinated,” said Dr. Kevin Ault, associate professor of gynecology and obstetrics at Emory

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University Medical School in Atlanta. It would also protect men against genital warts, which they get at a
higher rate than women, and may immunize against relatively rare HPV-related cancers of the penis,
anus, neck and head.

Most HPV infections clear up on their own, but those that persist, usually for five years or longer, increase
a woman’s risk for developing precancerous cervical lesions. Pap tests, a routine part of a gynecological
exam, usually detect these precancers, which can be treated so they do not develop into cancer. Still,
11,000 new cases of cervical cancer are diagnosed in the United States every year, most in women who
haven’t gotten regular Pap tests, but some in women whose Pap tests didn’t detect precancerous cells.

Fortunately, cervical cancer is slow-growing.

“Usually the time to progression from a premalignant lesion to an invasive cancer is about 10 years,” said
Dr. Teresa Diaz-Montes, gynecologic oncologist at Johns Hopkins Medical Center. When caught early,
which is usually the case in the United States, cervical cancer can often be treated and cured by a simple
or radical hysterectomy. Survival rates are high. “If the tumor is confined to the cervix, the five-year
survival rate will be 80 to over 95 percent,” Dr. Diaz-Montes said.

And women can improve their chance of survival by getting treated by gynecologic oncologists rather
than general gynecologists, studies show.

“Cervical cancer is not as common now as it was in the past because of Pap tests, so it’s important to be
seen by a gynecologic oncologist because these are the specialists trained to treat this disease,” Dr.
Diaz-Montes said. She advises women to look for a physician who sees a high volume of patients that
need the same type of treatment they require.

Still, 3,700 women die from cervical cancer in the United States every year. Experts say that doesn’t need
to happen.

“By getting vaccinated early and having regular Pap tests, and HPV tests when her health care provider
recommends them,” Dr. Einstein said, “a woman has the best chance of preventing what is by far one of
the most preventable cancers we have.”

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Weight Drives the Young to Adult Pills, Data Says
The New York Times | 07.26.08

A growing number of American children are taking drugs for a wide range of chronic conditions related to
childhood obesity, according to prescription data from three large organizations.

The numbers, from pharmacy plans Medco Health Solutions, Express Scripts and the marketing data
collection company Verispan, indicate that hundreds of thousands of children are taking medication to
treat Type 2 diabetes, high blood pressure, high cholesterol and acid reflux — all problems linked to
obesity that were practically unheard-of in children two decades ago.

The data, disclosed publicly in recent months or provided at the request of The New York Times, shows
that concerns that children will be taking adult medications — heightened recently by a controversial
recommendation by a national pediatricians group — are already a reality.

This month, the American Academy of Pediatrics said that more children, as young as 8, should be given
cholesterol-lowering drugs. The recommendation was quickly attacked by some experts as a license to
put children on grown-up drugs.

While the drugs do help treat the conditions, some doctors fear they are simply a shortcut fix for a
problem better addressed by exercise and diet. Even so, some pharmaceutical companies are developing
new versions, including flavored ones, of adult medications for children.

While some of the percentage increases in the three analyses are significant, doctors empha-size that
prescriptions of these drugs to children still represent less than 1 percent of their sales.

Express Scripts and Medco developed estimates of how many children might be taking such drugs by
extrapolating their data — involving a total of more than four million children — across the broader

The companies use different assumptions to reach their estimates, but the data suggests that at least
several hundred thousand children are on various obesity-related medications.

The greatest increase occurred in drugs for Type 2 diabetes, with Medco’s data showing a 151 percent
jump from 2001 to 2007.

Medco’s data, released in May, showed that use of drugs to treat acid reflux problems in children, often
aggravated by obesity, increased 137 percent over seven years. Its analysis also showed an 18 percent
increase in drugs to treat high blood pressure and a 12 percent increase in cholesterol-lowering
medications during the seven-year period.
Express Scripts found a 15 percent increase over three years in drugs to treat cholesterol and other fats
in the blood, a category that is primarily statins.

“We were amazed at how quickly the rates of drugs used have climbed,” said Dr. Donna R. Halloran, an
assistant professor at St. Louis University who worked on the Express Scripts analysis, presented at a
meeting of the American Public Health Association in November.

Verispan data recorded a 13 percent increase in high blood pressure prescriptions in the under 19 age
group from 2005 to 2007. Its numbers show, however, a less than 1 percent increase during the period in
cholesterol-lowering drugs in children.

Doctors and some financial analysts have said that less pronounced increases in cholesterol drugs
compared with some other medications — seen in all three analyses — reflect a wariness by some
doctors about using those drugs in children.

Some experts have expressed concern that the increases in many of these obesity-related drugs reflect a
systemic failure, with doctors and parents turning to them because they find lifestyle changes too difficult
to implement or enforce.

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“I think a lot of people in pediatrics, myself included, are struggling with what is the right management to
do for these kids,” said Dr. Russell L. Rothman, an assistant professor at Vanderbilt University, who
recently surveyed doctors and found wide variations in how children were being treated.

“You see elevated blood pressure, or elevated sugars, or elevated cholesterol and you try exercise and
diet and you don’t see any improvement,” Dr. Rothman said. “I worry that some providers and some
families are looking for the quick fix, and are going to want to start medication immediately.” Some
pediatricians say they have been treating children with statins for several years.

Dr. David Collier, director of a pediatric weight management center at East Carolina University in
Greenville, N.C., an area where 45 percent of the children are overweight, is among doctors who support
the recent recommendations that statins may be warranted in some children as young as 8. “We have
been using statins for two or three years now,” he said.

One of his statin patients, he said, was a 6-year-old girl.

Dr. Collier, who describes his location as “right smack dab in the middle of the stroke belt,” believes that
aggressive therapy is needed to prevent a health crisis. “It’s hard to overstate the size of the problem,” he

Dr. Francine R. Kaufman remembers a patient, a 13-year-old girl, whose weight had ballooned to 267
pounds. The teenager appeared destined for the same fate as her grandmother, who lost a leg to Type 2
“To control her high blood sugar level, her high blood pressure, and her high cholesterol, this young girl
left my office with five medications,” Dr. Kaufman, a pediatric endocrinologist in Los Angeles, told a
Senate subcommittee last week during hearings on obesity in children.

The girl stood out as unusual more than 10 years ago, but children with the same array of problems are
increasingly seen in the diabetes center where she practices at Children’s Hospital Los Angeles, Dr.
Kaufman said.

Diet and exercise are tried first, but “lifestyle is really tough,” Dr. Kaufman said. Some of her patients live
in neighborhoods without grocery stores and attend schools that do not offer physical education

“They deserve to be treated,” Dr. Kaufman said. “I think the slant from most of the media is that
pediatricians are jumping to put kids on medications. That’s not true at all. Since lifestyle is so difficult, we
have no other choice but to go to pharmacotherapy.”

At Camp Pocono Trails, a weight loss camp in Reeders, Pa., that enrolls about 700 children each
summer, owner Tony Sparber said that campers are arriving with medications, a pharmacopeia that
include statins and diabetes medications.

“You just look at these kids’ medical forms,” Mr. Sparber said. “You see kids with some very high-risk
numbers. Cholesterol in the high 200s.”

Experts say that the trend could balloon health care costs. As many as 30 percent of children nationwide
are overweight. And children who start such medication often rely on the drugs for a lifetime and are
prone to health problems as adults.

Despite a push by the Food and Drug Administration to foster drug studies in children, many experts
believe that many clinical studies in children have not been extensive enough. And adult doses are often
not correct for children.

The agency publishes a list of drugs for which pediatric versions are needed. So far, the size of the
pediatric market is not big enough to make it profitable for companies to make special children’s formulas
of drugs for disorders that commonly go along with obesity and high-fat diets. That appears to be

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Madeira Therapeutics, based in Leawood, Kan., is formulating a liquid statin for children that will be sold
in either grape, cherry or bubblegum flavor, according to the company’s chief executive, Peter R. Joiner.

Madeira became interested in the drug to treat children with a genetic cholesterol condition, familial
hypercholesterolemia, which strikes 1 in 500 children regardless of their diet. The recent American
Academy of Pediatrics statement adds to the potential market, according to Mr. Joiner.

The company, whose liquid statin may be available by late 2010, is also interested in a liquid oral
diabetes medication.

“Because of the obesity epidemic in the United States, we see diabetes as another important area for
contribution,” Mr. Joiner said.

A nonprofit group in Cambridge, Mass., the Institute for Pediatric Innovation, is working to encourage the
reformulation of medications for children.

Dr. Stephen P. Spielberg, the former dean of Dartmouth Medical School, is leading the effort.

“What we’ve learned over the years is that the way in which the body handles medicines, the half life of a
medicine, how it’s metabolized, how it’s excreted by the body, does vary, from babies all the way up to
adolescents,” Dr. Spielberg said.

Hypertension medications present a particular challenge in dosing for children. “Even in clinical trials
where adult pills were crushed and such, you often can’t even demonstrate that the medication works,” he

Medco cautioned that hypertension data can be misleading because some children with attention deficit
disorder are treated with hypertension drugs.

The most significant increase in the use of drugs for children has been in oral medication for Type 2
diabetes. And some doctors believe much of those prescriptions were “off-label” use of the drug,
metformin, to treat prediabetes, which may affect two million children nationwide.

But some doctors object to the use of metformin for that purpose in children, even though studies have
shown it may prevent diabetes in young adults.

“There are no studies like this in children,” said Dr. Tamara S. Hannon, a pediatric endocrinologist at the
Children’s Hospital of Pittsburgh.

“The argument may be that we know what happens in adults, so the same should happen in children. It’s
been proven untrue in several cases in the history of medicine.”

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                    LSU HEALTH CARE SERVICES DIVISION • P. O. BOX 91308 • BATON ROUGE, LOUISIANA 70821-1308
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                             LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 28 OF 32

House Approves Delay of Medicare 'Trigger' Measure
Kaiser Network | 07.25.08

The House on Thursday by a 231-184 vote approved a rule (HRes 1368) that delays consideration of
President Bush's Medicare "trigger" bill for the remainder of the 110th Congress, the AP/Arizona Daily
Star reports. The resolution does not require Senate action (AP/Arizona Daily Star, 7/25).

A provision of the 2003 Medicare law requires the president to propose a savings measure if the
Medicare trustees for two consecutive years project the program to pull more than 45% of its funding from
general government revenue. In April 2007, the trustees issued a second warning. The House Rules
Committee on Wednesday approved the rule to circumvent another provision of the Medicare law that
requires action to be taken on the president's savings measure by July 30 (Kaiser Daily Health Policy
Report, 7/24). Without the House rule, any representative could have forced debate and a floor vote on a
bill (HR 5480) intended to reduce Medicare spending (Armstrong, CQ Today, 7/24).

According to the AP/Daily Star, Democrats said the rule change was necessary because the 45%
threshold is arbitrary and would force reductions in Medicare spending or shift costs to beneficiaries
(AP/Arizona Daily Star, 7/25). In addition, Democrats said that the new Medicare law enacted last week
brings spending below the threshold, according to a Congressional Budget Office scoring (CQ Today,
7/24). House Majority Leader Steny Hoyer (D-Md.) said that Medicare "was designed to be substantially
financed by general revenues, not payroll taxes" and that the program being "financed by general
revenues is not problematic" (Bendery, Roll Call, 7/24). Democrats likely will try to eliminate the trigger
provision next year, according CongressDaily (Edney, CongressDaily, 7/25).

Republicans said that Medicare spending is growing beyond solvency and that something should be done
to control spending, according to the AP/Daily Star (AP/Arizona Daily Star, 7/25).

HHS Secretary Mike Leavitt in a statement on Thursday said, "The Congressional Budget Office may
have determined that budget gimmicks contained in Medicare legislation passed last week meet the
technical requirements of the trigger law. But parliamentary sleight of hand will do nothing to resolve the
enormous financial challenges presented by Medicare in the future" (CongressDaily, 7/25).
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                                             PHONE: 225.922.0488 • FAX: 225.922.2259
                             LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 29 OF 32

House Committee Report Finds Medicare Pays Up to 30% More for Medications Under
Part D Plans
Kaiser Network | 07.25.08

The House Committee on Oversight and Government Reform during a hearing on Thursday released a
report that found the Medicare drug benefit in its first two years has paid about 30% more for prescription
drugs than Medicaid would have paid for the same medications, costing the program about $3.7 billion,
the Los Angeles Times reports (Gaouette, Los Angeles Times, 7/25). The report examined drug benefit
spending for about six million so-called "dual eligibles," beneficiaries who qualify for both Medicare and

In 2006, the first year of the drug benefit, Medicare paid $1.7 billion more for the 100 most commonly
used drugs by dual eligibles than Medicaid would have paid. In 2007, Medicare paid about $2 billion more
than Medicaid would have paid. Medicaid, on average, gets discounts of about 30% on drugs for
beneficiaries. Medicare receives a discount of about 8% on average through its drug benefit.

The report stated that Johnson & Johnson received $615 million more from Medicare part D than it would
have from Medicaid, the largest portion of the $3.7 billion. Of that money, $500 million came from sales of
Risperidal, an anti-psychotic. Bristol-Myers Squibb received an additional $400 million, including $200
million from sales of Plavix, a heart attack and stroke medication.

Committee Chair Henry Waxman (D-Calif.) said he would soon introduce legislation that will require the
drug benefit not pay more than Medicaid would for dual eligible drug coverage, which he said would
reduce drug spending by as much as $86 billion over 10 years (Reichard, CQ HealthBeat, 7/24). "This is
an enormous giveaway and it has absolutely no justification," Waxman said (Edney, CongressDaily,

Acting CMS Administrator Kerry Weems said that the drug benefit has reduced spending by about 40%
from original projections when Congress was creating the program. Republicans on the committee also
said that the drug benefit gives beneficiaries more choices than Medicaid coverage. They also warned
that cutting drug costs could hinder innovation in the pharmaceutical industry.

Waxman responded that spending for the drug benefit is not as high as projections because enrollment
has not reached projected levels. He also said that innovation in the drug industry was not hampered
when the dual eligibles were receiving drug benefits through Medicaid, so it would not change if the drug
benefit paid the same rates (CQ HealthBeat, 7/24).

Richard Smith, vice president of the Pharmaceutical Research and Manufacturers of America, said that
private market competition has brought down costs of the drug benefit for beneficiaries and taxpayers. He
added that the government should not interfere by setting price controls (Los Angeles Times, 7/25).

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                    LSU HEALTH CARE SERVICES DIVISION • P. O. BOX 91308 • BATON ROUGE, LOUISIANA 70821-1308
                                             PHONE: 225.922.0488 • FAX: 225.922.2259
                             LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 30 OF 32

HHS, DHS issue guidance on allocating pandemic flu vaccine
AHA News | 07.25.08

The U.S. departments of Health and Human Services and Homeland Security this week issued guidance
on allocating flu vaccine in a pandemic.

Developed by a federal interagency work group with input from the public and stakeholders, the guidance
provides a planning framework for state and community leaders to prioritize vaccine allocation to groups
based on their occupation and health risk.

The document defines broad target groups, such as people who maintain national security or critical
infrastructure, provide health care and community support services, or are at high risk due to their age or
health status.

“Further work is being undertaken to more specifically define critical occupations whose members should
receive early vaccination and to provide guidelines to employers on the proportion of their workforce that
may be prioritized for vaccination,” the authors note.

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                    LSU HEALTH CARE SERVICES DIVISION • P. O. BOX 91308 • BATON ROUGE, LOUISIANA 70821-1308
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                             LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 31 OF 32

Web Alerts for Asthma
The Wall Street Journal | 07.27.08

Summer can be the worst season for asthma and allergy sufferers, especially when trying to enjoy a
beach vacation or mountain hike.

But a few Web sites aim to monitor and forecast air quality and alert you on particular days to avoid
spending too much time outside. The results are based on a standardized indicator called the Air Quality
Index (AQI) that measures major air pollutants such as ground-level ozone, carbon monoxide, sulfur
dioxide and nitrogen dioxide.

The index ranges from 0 to 500 -- the higher the AQI value, the greater the health concern. According to
the U.S. Environmental Protection Agency, an AQI value over 300 represents hazardous air quality.

The EPA's Airnow.gov1 allows users to see a national and international forecast on how clean or polluted
the air is, associated health effects and special advisories.

At Azma.com2, operated by medical-data company Surveillance Data, asthma sufferers can enter their
Zip Code to see a forecast for the allergy and air-quality levels for up to four days. You can also sign up
for asthma alerts by email on the days that your asthma index level is above low.

For pollen and mold counts view's sister Web site Pollen.com3, which provides similar Zip
Code based data, or the American Academy of Allergy Asthma & Immunology's National Allergy Bureau's
daily count at

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                    LSU HEALTH CARE SERVICES DIVISION • P. O. BOX 91308 • BATON ROUGE, LOUISIANA 70821-1308
                                             PHONE: 225.922.0488 • FAX: 225.922.2259
                             LSU HEALTH CARE SERVICES DIVISION                 -   PAGE 32 OF 32

Effective in Rheumatoid Arthritis
The Wall Street Journal | 07.27.08

Roche Holding AG's Actemra appears effective at treating rheumatoid arthritis, a disease that can destroy
joints and causes chronic pain for patients, the U.S. Food and Drug Administration said Friday.

The drug appears effective for treating patients with moderate to severely active rheumatoid arthritis, but
has been linked to serious infections, malignancies and other problems, according to documents posted
on the FDA's Web site Friday.

A panel of outside medical experts will meet Tuesday to discuss whether the benefits of Actemra
outweigh the risks, and whether the drug should be approved. The FDA doesn't have to follow its panels'
advice, but generally does.

Actemra is one of the Roche's most promising new products.

Deutsche Bank analysts said in a recent note that they are expecting a positive recommendation by the

"This should add to Roche's premium growth potential, and add another asset to the immunology
franchise," Deutsche Bank said. The bank expects the drug to generate sales of just 809 million Swiss
francs ($778 million) in 2012 due to potential regulatory concerns and because many alternative
treatments are available for rheumatoid arthritis and it will take some time until the drug has established

Other estimates run much higher. JP Morgan analysts, for example, forecasts sales of CHF4.6 billion in
2012, equivalent to around 8% of Roche's prescription drug revenue.

Actemra, also known as tocilizumab, was developed by Japan's Chugai, which is controlled by Roche.
Roche owns the rights to sell Actemra outside Japan. In Japan, the drug won approval in April.

Rheumatoid arthritis affects more than 2 million Americans. Sufferers of rheumatoid arthritis, or RA, begin
to experience progressive joint damage early in the disease. The disease differs from what is popularly
known as arthritis, typically associated with age-related joint pain, as RA is a far more serious
inflammatory disease that leads to destruction of cartilage and bone, and can lead to disability.

There is already a large number of treatments available for rheumatoid arthritis, but many merely relieve
pain, in some cases at the cost of severe long-term side effects, including osteoporosis and high blood

Actemra works by a different mechanism. It is a humanized monoclonal antibody -- an antibody produced
by a single cell -- and the first to inhibit the interleukin-6, or IL-6, receptor.

IL-6 is considered an important mediator of the acute inflammatory response that underpins the
rheumatoid arthritis disease process. Thus, Actemra targets a new mechanism of action compared to
existing biologic agents, which are dominated by a type of drug known as anti-TNFs. TNF is a protein
made by the body's immune system, which plays a key role in the development of inflammation.

Such therapies include Johnson & Johnson's blockbuster drug Remicade, Abbott Laboratories' Humira,
and Enbrel, which is marketed by Wyeth Pharmaceuticals outside North America. In the U.S., Wyeth sells
the drug jointly with Amgen.
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