Reports of a cover-up may be premature

November 23, 1997|By Sara Engram

IMAGINE MEDICAL researchers pinpointing a dozen drugs that might show promise in fighting cancer. They devise a test in which Mne drug produces tantalizing results. Would the headlines read: ''Anti-cancer tests fail''?

Not likely. But that is what has happened in a bizarre turn of events involving the leak of a preliminary evaluation of a federal effort to reduce infant mortality and low birth-weight babies.

''Top federal officials have barred researchers from releasing a report indicating that the government's most ambitious and expensive effort to reduce infant mortality may not be achieving its goal,'' said the Philadelphia Inquirer in a Nov. 12 story.

Falling short

''Public health researchers said today that the Clinton administration had canceled a presentation of preliminary data suggesting that an ambitious federal program to reduce infant mortality had fallen short of its goals,'' the New York Times reported the same day.

It sounds like another case of government covering up its own ineptitude. But in Baltimore, some veterans of such efforts disagree. One is Dr. Bernard Guyer, chairman the Department of Maternal and Child Health at the Johns Hopkins School of Hygiene and Public Health and head of the Maryland Commission on Infant Mortality Prevention.

Data presented to the state commission last year showed that in Healthy Start's target areas -- neighborhoods like those in the Sandtown-Winchester area of the city -- pregnant women enrolled in Healthy Start programs had significantly better outcomes than women who enrolled after their babies were born.

Although the majority of women in each group considered their prenatal care adequate, the early enrollees had almost half the rate of premature births and far fewer low birth-weight babies.

They also had one-third the rate of very-low-birth-weight babies, the infants most likely to die or to require long periods of intensive treatment.

Dr. Guyer considers those findings ''pretty robust,'' and says they are holding up this year, even as the program documents that it is reaching 97 percent of pregnant women in some areas.

That's big news for a social problem that has shown a stubborn resistance to improvement. Infant mortality -- the death of a child before its first birthday -- is also shorthand for the larger issue of babies born at such low birth weights that they require massive medical intervention and may survive with life-long disabilities.

Baltimore's encouraging findings may not be duplicated in other Healthy Start sites. When the federal government funded the initiative during the Bush administration, it granted local programs wide latitude in their ways of attacking the problem.

It also required a national evaluation of Healthy Start, despite the fact that such an assessment would be comparing completely different approaches. An early report in that process is what's stirred up such a fuss.

Critics say the study, performed by Mathematica Policy Research Institute in Princeton, N.J., surveys the programs as if they all operated by the same guidebook -- comparing apples to oranges to peaches without examining reasons for the differences in outcomes.

Incomplete study

Worse, the critics say, is that the report covers data from '92 to '94, though many of the Healthy Start programs were not fully up and running before late '93.

The firm is by contract not allowed to comment on the details of the report until it is officially released. But spokeswoman Joanne Pfleiderer says Mathematica stands by the content and quality of the report and that it passed internal review.

Dr. Guyer and other researchers familiar with Baltimore's Healthy Start program do not agree. ''It's lousy data, [and the study was] done at the wrong time,'' says Dr. Guyer, since the authors did not look at the first three years of full operation of Healthy Start.

Some Healthy Start projects will run the course of the federal grant with no significant positive results to show for the millions of dollars invested. But that's not the story here.

In Baltimore, a far more detailed evaluation than the national version is painstakingly examining every Healthy Start initiative, collecting reams of data, tracking every client and trying to determine exactly what works.

That's not easy. And it may end up documenting failure to reach the program's ambitious goal of a 50-percent reduction in infant mortality over five years. But for now, the findings are startling enough for the state to base infant mortality projects in Prince George's County on the Baltimore design.

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