Public Health

On Thursday, the day the Supreme Court upheld Obamacare, a 47-year-old Baltimore woman went to the drugstore, and pulled out her debit card to pay for a prescription refill. But she didn't have enough money in the account to cover the $425 charge. So she asked the pharmacist and staff for a favor. "I asked them to break up the prescription to give me one-third," says the woman, who would not allow her name to be published because she didn't want to disclose her medical conditions.

Dr. Frederick L. Brancati, an internationally known expert on the epidemiology and prevention of type 2 diabetes who was director of the Division of General Internal Medicine at the Johns Hopkins University School of Medicine, died Tuesday of amyotrophic lateral sclerosis, also known as Lou Gehrig's disease, at his Lutherville home. He was 53. "He was a delightful human being — smart, witty and fun to be around," said Dr. Michael J. Klag, dean of the Johns Hopkins Bloomberg School of Public Health, whom Dr. Brancati succeeded as division chief.

Public policy views the health-care crisis as basically acute and transitory. Like other contemporary problems, such as pollution and global warming, the crisis in health care is believed to be a technical problem confined to the last decades of the 20th century. For this reason, the health-care debate is rarely intellectualized. Economics, not philosophy, is expected to provide the relevant and practical solutions.I believe, however, that the crisis in health care is in part a product of longstanding intellectual assumptions about health care.

Summer is almost here, and with it likely some blistering hot days. A recent study suggests the elderly should beware when the temperature spikes, because they face an increased risk of winding up in the emergency room short of breath on those days. And that's just a taste of what health problems to expect as global climate change cranks the heat up in many places. Researchers for Johns Hopkins, Harvard and Yale universities reviewed a nationwide health database of 12.5 million older Americans on Medicare and found that increases in outdoor temperatures raise the risk for the elderly of being rushed to the hospital with respiratory disorders.

Many Americans would be surprised to learn that chimpanzees are still being used in biomedical research and that millions of other animals are utilized in consumer product and toxicity testing. Others may find a sense of security in knowing that this practice continues to provide information on which chemicals and products are deemed safe. The fact is that it doesn't have to be this way, and there are a number of public health, economic and animal welfare reasons to change our ways. The evolving process by which the U.S. regulates chemicals is important to every American household.

Up to half of sexually active young people will get a sexually transmitted disease by the time they are 25, yet many don't seek testing because it may be difficult, costly or embarrassing. Public health officials nationally and in particularly affected cities like Baltimore, however, say they've found a method that seems to address the major hurdles — a website that supplies free in-home testing kits for three of the most commonly reported STDs. "The highest prevalence is in young adults, and we knew we had to reach these kids," said Charlotte A. Gaydos, a professor of infectious diseases at Johns Hopkins University in Baltimore.

The Maryland Stadium Authority's decision to prohibit smoking at both Camden Yards and at M&T Bank Stadium is great news for sports fans ("State Authority bans smoking at M&T Stadium, Oriole Park," Feb. 26). Secondhand smoke causes serious disease and premature death among nonsmokers, and there is no safe level of exposure. A study conducted at the University of Maryland Baltimore County found that even outdoors, nonsmokers up to a distance of 23 feet away or more are still exposed to carcinogens.

Regarding Doug McNeil's letter criticizing stricter regulation of firearms sales, is everyone as tired of reading about gun legislation and crime reduction as I am ("Gun licensing won't reduce crime," March 3)? Of course criminals will ignore the law. But it might well be better if fewer hotheads, fools and depressed personalities owned handguns and assault weapons. We all know what a hothead is. An acquaintance of mine once got angry at his car and shot out the windshield. Should he have had a pistol?

As a resident of Howard County and a member of the board of directors of the Horizon Foundation, I give three cheers for Nikki Highsmith Vernick's article on a health issue that will prove to be one of the most challenging of the 21st century ("A healthier way to snack," May 15). Her insightful and provocative article was an excellent complement to recent HBO special "The Weight of the Nation. " Her article is the product of months of research and study by the Horizon Foundation and the board's decision to tackle head on the "largest single source of added sugar in our children's diets and a major source of excess calories.

Regarding your article about the city's plan to strip some liquor stores of their licenses, many studies have shown that communities with greater densities of alcohol outlets have higher levels of drinking, unintentional injuries and violence ("Baltimore to strip some liquor stores of licenses in rezoning effort," June 18). Specifically, published data about Baltimore show not only an inequitable distribution of liquor stores in predominantly African-American and low-income communities but also significant associations between the presence of liquor stores and the risk of health-related problems.

The dean of the Johns Hopkins Bloomberg School of Public Health is among a group of leading scientists that has joined an initiative to eradicate polio. Dr. Michael J. Klag signed a declaration last week endorsing a Polio Eradication Endgame Strategic Plan. It calls for creating a polio-free world by 2018. The initiative is led by Emory University and Aga Khan University. Officials say there is an opportunity to end polio because there are so few cases being reported. More than 400 other scientists from 80 countries signed the declaration, which calls for sustaining containment of the disease once it is eradicated.

The publication of Alfred Sommer's new memoir, "10 Lessons in Public Health," comes precisely 30 years after the publication of the most important thing he's ever written: "Increased mortality in children with mild vitamin A deficiency," a report of a medical discovery that has saved an estimated 10 million children from blindness and death. This is one of the classic stories from the realm of epidemiology, the stuff of medical detectives, and for it we slip back to the winter holidays of 1982 in Baltimore: Sommer, an ophthalmologist and professor at the (pre-Bloomberg)

On Thursday, the U.S. Senate will hold a confirmation hearing on Gina McCarthy, President Barack Obama's nominee to lead the U.S. Environmental Protection Agency. Over her decades of public service, Ms. McCarthy has demonstrated a strong commitment to protecting public health with pragmatic solutions to our pollution challenges. In short, she has proved that she is a true public health champion. While Ms. McCarthy's most high-profile accomplishments came from her work strengthening and modernizing historic clean air standards to ensure that Americans will be able to breathe easier over the long term, she has dedicated her entire career to keeping kids safe from chemicals, ensuring we have clean and safe drinking water, and tackling the environmental health issues that really matter.

Melissa Healey's article, "NYC's failed cap on sugary drinks prompts soul searching" on April 4 draws an interesting parallel between New York City Mayor Michael Bloomberg's improbable public health battle against obesity and our nation's long history of public health activism and success stories. Taking on the "larger forces" through policy - whether the tobacco and alcohol industries or "Big Food" - is a winning model in public health. The impact of taking on corporate interests is best appreciated in individual behavioral change.

Many Americans would be surprised to learn that chimpanzees are still being used in biomedical research and that millions of other animals are utilized in consumer product and toxicity testing. Others may find a sense of security in knowing that this practice continues to provide information on which chemicals and products are deemed safe. The fact is that it doesn't have to be this way, and there are a number of public health, economic and animal welfare reasons to change our ways. The evolving process by which the U.S. regulates chemicals is important to every American household.

In 2009, Congress passed legislation reversing the decades-old ban on the use of federal funding for syringe exchange but, for unclear reasons, in late 2011, it reversed this decision, again withholding federal funding from programs that provide drug users with sterile needles and syringes. This month, Congress approved the health spending budget for the rest of this fiscal year without lifting the ban. This lack of action worsens public health problems, makes our communities less safe, and increases future financial burdens on taxpayers.

Even as aid trickled in Thursday to earthquake-ravaged Haiti - and estimates emerged of as many as 50,000 dead and countless more gravely injured - experts feared the country was on the brink of a public health disaster that could persist for months. While relief workers hoped to provide food and water and to confront the most pressing of immediate medical needs, from antibiotics to bandages, disaster response experts say what remains ahead could be equally daunting: rebuilding from scratch a public health system that was fragile at best before disaster struck.

Regarding Doug McNeil's letter criticizing stricter regulation of firearms sales, is everyone as tired of reading about gun legislation and crime reduction as I am ("Gun licensing won't reduce crime," March 3)? Of course criminals will ignore the law. But it might well be better if fewer hotheads, fools and depressed personalities owned handguns and assault weapons. We all know what a hothead is. An acquaintance of mine once got angry at his car and shot out the windshield. Should he have had a pistol?

The Maryland Stadium Authority's decision to prohibit smoking at both Camden Yards and at M&T Bank Stadium is great news for sports fans ("State Authority bans smoking at M&T Stadium, Oriole Park," Feb. 26). Secondhand smoke causes serious disease and premature death among nonsmokers, and there is no safe level of exposure. A study conducted at the University of Maryland Baltimore County found that even outdoors, nonsmokers up to a distance of 23 feet away or more are still exposed to carcinogens.