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U.S. Department of Health and Human Services.  HHS.gov  Secretary Mike Leavitt's Blog

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From Montana: 8/16/07

Thanks to all of you who commented and wished me luck. I quickly reviewed all the comments. It’s clear the pandemic influenza blog is still generating conversation.

Several of you expressed interest in Tamiflu being an over the counter drug. I don’t possess the technical background to detail the challenges presented by that idea, however, I feel certain its status as a serious antiviral is a significant barrier.

I can’t remember if I mentioned on the pandemic blog that we are testing various distribution alternatives, including making available medical home kits with personal supplies of various emergency medications. CDC actually designed the kit and we have placed 5,000 of them in homes. We need to assure that families don’t break them open and use the medications etc. in advance of a true emergency. I’m told the first phases of the test have gone well.

We’ve also tested postal service delivery of medications in emergency situations in two cities with a third test scheduled soon. Those have been extremely instructive.

Tonight I’m sitting in a hotel room in Montana. I’ve got the television on in the background. Ironically, Charlie Rose’s program is about pandemic influenza. He has David Nabarro, Jeff Koplin, Larry Brilliant and a couple of others on. It’s a very thoughtful discussion.

My primary reason for being in Montana was to work with Senator Max Baucus. We visited a Boys and Girls Club in Bozeman.

One of the blog comments I read tonight was from Goju who referred to herself as “an ordinary mom,” and said she was glad to have her health care concerns heard. The event I did with Senator Baucus was an opportunity he provided to hear from several “ordinary moms” about SCHIP (State Children’s Health Insurance Program). Their situations were all a little different but all expressed how important it was to them.

They are right; SCHIP needs to be reauthorized before September 30th so no child’s coverage is endangered. There is significant disagreement right now between the Senate, House and Administration on what constitutes a low income child. We need to get reauthorization done and then get on with the question of how we solve the problem for adults and children who aren’t eligible for SCHIP or other programs for those in hardship.

I am a passionate believer that our nation, in a relatively short period of time, could organize a system so that every American could have access to affordable health insurance coverage; a topic for another night.

Friday, I’m headed to Africa. I hope to use this blog to record some of my feelings and experiences.

-Mike Leavitt

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Mr Secretary,

I appreciate the need to reauthorize SCHIP, but what we do not need is a federal program to guarantee that everyone has health insurance. You (the government) should be spending time educating people on how to fix the system. Look at the difference between health insurance and car insurance. Car insurance does not pay for oil changes and gasoline, nor does it pay for repairs caused by not getting your oil changed.

Health insurance does just that. Instead of covering accidents and large expenses it covers everything. The result is that individuals pay large amounts for such comprehensive coverage. The secondary result is that, having paid so much already, people want to get their money's worth so they are more likely to pay the copays for procedures which are not necessary.

High Deductible plans with HSA's are more like what health insurance should be. Individuals are covered in emergencies, but they are responsible for their own care. The premiums are much more affordable as well.

Posted by: David | August 16, 2007 at 11:48 AM

Secretary Leavitt, I can't imagine how you juggle all of the pressing issues that you have to contend with.

I am not familiar with the State Childrens Health Fund. I do know that health care and health insurance are significant issues, ones that have impacted my family personally. I no longer can afford to pay for health insurance AND the copayments that I need to pay at the time of service. Because of this we pay for health insurance just in case of catastrophe. We face significant health issues in our family and now cannot see our physicians. I rationalize this by thinking we all rely on them too much anyway. Sad though, isn't it. We are a middle-class family. My husband and I both have two jobs. He has worked honorably for the same company for 34 years.

I must admit to becoming discouraged when I see people who cannot afford healthcare, and are on state programs, pay $10.00 to go to the doctor when I cannot go myself. I do not begrudge them this priviledge but I am frustrated. We work so hard. Two years ago my husband had a physical. Since our deductible had not been met, our bill was almost $500.00, we are still paying for this bill. I had an illness recently, all of the tests, the visit etc came to almost $800.00. Thankfully an individual deductible is $450.00. This money has to come out of our food budget, and I am trying to prepare for this pandemic.

When you say "I am a passionate believer that our nation, in a relatively short period of time, could organize a system so that every American could have access to affordable health insurance coverage..." you have me waiting on pins and needles for this discussion.

I look forward to what you have to post on from Africa. You have an amazing life. God Bless.

Regards,
standingfirm

Posted by: standingfirm | August 16, 2007 at 11:57 AM

David, I beg to differ. We cannot afford our deductibles because our money is going to pay for our insurance. We pay $350.00 per month for insurance and we have a $1500 family deductible. The HSA that we had was cumbersome and if we did not spend the money on healthcare we would forfeit our money that we put in the account....we hated it.

Posted by: standingfirm | August 16, 2007 at 02:34 PM

"I am a passionate believer that our nation, in a relatively short period of time, could organize a system so that every American could have access to affordable health insurance coverage; a topic for another night."

By "our nation" do you mean "our government"?

Such an enterprise should be left to the private industry, where such measures would not be backed by a gun, as they would if implemented by Uncle Sam.

What we absolutely do not need is more bureaucrats who through central planning think they know how to best solve the nation's issues.

I recently returned from a three week trip to Africa myself and am convinced that what they do not need is politicians in another country solving their problems. They are able and willing to do so themselves (autonomy!) if given the opportunity.

Posted by: Connor | August 16, 2007 at 03:00 PM

Secretary Leavitt:

Please let us see your real personality. Blogging on health care issues, watching Charlie Rose on TV . . . I was hoping to see some pictures and read about the flyfishing in Montana! Well, at least you could talk about Whirling Disease instead of pandemic influenza . . .

Posted by: Steve from Utah | August 16, 2007 at 04:00 PM

Secretary Leavitt,

It heartens me that you have decided to continue conversations with the public by means of another blog. That's what I had hoped would happen.

First, just a blog tip. The name of the person posting a comment appears under the comment, not above. Goju is a male; it was Northstar who is the mom :-). I'm sure you can make a quick correction, editing your post. Perhaps you can also edit my comment, too, deleting this paragraph.

I think the kits are a very useful idea, though I'm thinking they ought to be pre-positioned in communities and distributed at the outset of a pandemic anywhere in the world (perhaps by the National Guard??), along with a guide to home medical care, such as the one by Grattan Woodson. The guide could instruct people as to when and how to use the items in the kit. I'd be afraid of using the mail as a distribution system. It wouldn't be terribly secure, and the system would likely be overwhelmed. I suspect you've already thought of that and far more.

I'm still interested in how we can turn the volume up on the public preparedness message. I'm worried that government preparedness and business preparedness will not equal national preparedness until a significant percentage of the population is incrementally stockpiling at home. I'd so much rather see a resilient lifestyle promoted on a national scale than a bunch of people panicking when a pandemic is announced or when the store shelves are bare.

Posted by: InKy | August 16, 2007 at 08:46 PM

I am not the poster who you think I am. You quoted Northstar, whose post was just beneath mine.

I am however also a parent of 3 kids ages 12-20...
and I am scared to death about them becoming infected with H5N1 should it become the next pandemic pathogen.

I have been struggling with the importance of keeping the county's infrastructure intact and economy humming along with the knowledge that Sheltering In Place as being the only way to avoid my children dying horrible deaths before mine and my wife's eyes.

I have been working with my local government who are intent on manning an emergency operations room to distribute vaccines which don't exist and anti-virals which they don't have.

They do not seem to understand the meaning of Shelter In Place and don't believe that a flu can cause the damage that H5N1 does.

I beg of you to step up to the plate and hit a homerun for our children's sake.....

Tell the American public in clear and no uncertain terms that they must prepare to feed themselves for the duration of the first wave.

The Charlie Rose show missed the mark by such a small margin. Clearly the risk that H5N1 poses today is enough of a reason to sound the personal preparedness alarm loudly.

While the Pandemic will be global in nature, It will be extremely personal to me and everyone else on the planet.


Posted by: Mr. Secretary | August 16, 2007 at 11:01 PM

Great work Secretary Leavitt. I've now retired from the State of Utah's rural economic development effort and live in Kanab. As you may be aware, Utah is exploring a state-based effort similar to that proposed by Senator Bennett at the federal level. I hope you will work to give the state the flexibility to adapt federal health insurance initiatives to state needs. If you happen to be in the Kanab area, give me a call. I'd welcome the opportunity to renew our acquaintance.

Posted by: Ed Meyer | August 16, 2007 at 11:22 PM

Mr. Leavitt,

Thank you so much for having the courage to wade into the world of blogging. The conversation that ensues is educational even if at times frusterating. Kudos to you and if more of your peers did would engage the public with such an open mind and heart our country would be far better off.

Our Nations current health care system is failing a large number of families. Of this there is no doubt. I applaud you for trying to support the stop gaps while realizing that there is a better overall solution. The sooner the better. Not being an expert in this field I don't know what the best solution is, I doubt that any one person does. Sometimes it takes the equivalent of what we like to call the "hive mind" to really find the best overall solution. The hard part of that is that it involves people working for the greater good and putting egos and political ambition aside. Unfortunately that does not happen very often today.

Anyway, thanks again for taking such a bold leap, it has not gone unnoticed or unappreciate by some of us. I look forward to hearing about your experiences in Africa.

Posted by: Tomo | August 17, 2007 at 12:10 AM

Hello Mr. Secretary, and welcome back to the blogosphere! I'm glad that your experience with the Pandemic Flu blog was a positive one, and that you are continuing the conversation here. I am going to be speaking at the CDC's upcoming conference on health communication, marketing and media about the lessons that can be learned from the Pandemic Flu blog, and your new blog will be a wonderful way to show that you came away with an appreciation for the value of blogging. I wish you the best with your blog, and hope that it will be more than a one month experiment. Have a safe and productive trip to Africa.

Posted by: Nedra Weinreich | August 17, 2007 at 01:49 AM

Thanks for letting us know about efforts by the CDC and others to test distribution of homecare kits and medications. It's the kind of 'news' that will not get on MSM that we do look for as indicators of the current state of readiness, which btw and IMHO is a much better goal to aim at than preparedness.

May I suggest with respect that the US government seriously consider changing the message sooner rather than later?

(NB MSM is short for mainstream media. In case you or anyone needs it, we have a list of blogging 'shorthand' posted on our FW forum here http://www.newfluwiki2.com/showDiary.do?diaryId=916)

As an aside, can I raise a logistical suggestion? Even though it is customary for blogs to be listed with the most recent on the top, comments are more frequently posted the other way round, with the most recent ones at the bottom. It's a much more intuitive way of following the conversation. Thanks!

Finally, I'm sure Goju won't mind you mistaking him for an 'ordinary mom', but the post that you referred to was from Northstar, the name at the end and not the top of the post. Just another one of those netiquette thingies that you will get used to in no time! ;-)

Posted by: SusanC | August 17, 2007 at 07:36 AM

Mr Secretary, you mentioned "It’s clear the pandemic influenza blog is still generating conversation."

May I suggest with respect that it isn't so much the HHS blog but the possibility of a pandemic in the near future that is "still generating conversation"?

Speaking only for myself, were it not for the sheer scale of devastation that even a Cat 2 pandemic will cause, as shown here http://www.newfluwiki2.com/upload/disaster%20scenarios%20big.jpg I for one would probably not be blogging at all!

Posted by: SusanC | August 17, 2007 at 08:02 AM

Mr. Secretary:

Thank you so much for keeping us informed - I know how busy you are and I want you to know that your efforts are very much appreciated.

Posted by: seazar | August 17, 2007 at 09:47 AM

Dear Dr. Leavitt,

Hi. Good luck in Africa. In this global world not only can one country help another, but what affects one country affects another.

People mentioned the Charlie Rose show you where watching. Before blogs there where discussions at the table. Charlie Rose brought people Google, universities and governments sit together. It is available online for free from Google video. (Hat tip to the folks at fluwiki for posting the initial link)

Charlie Ross Science Series show from August 15th, 2007 about H5N1 and pandemics. It is 59 min long - you can start, stop, fast forward or reverse the show. It can be downloaded. The show has seven experts around the table from Laurie Garrett - U.S. foreign affairs to Larry Brilliant, Jeff Koplan, other university doctors.

It seems to be a good resource to help educate others about current state of affaires.

http://video.google.com/videoplay?docid=2157440237847954853&q=charlie+rose&total=333&start=0&num=10&so=1&type=search&plindex=6

More information here: http://www.charlierose.com/home

Hopefully it is of interest. If so please pass it along to others.

Dr. Leavitt my city did a mass dispersal test by the book. I went ok but they learned so much from one test. My kids and I went down there. Even though I knew some of the folks I pretended to be deaf in order to test that part of the system. They had little to no provisions for the deaf. There where no deaf interpreters. Also my kids went one way - I another. This was ok for a test with other adults that I know but it wound *not* have happened in a crowed. I am firm on that. The place was too large and there where way to many people flowing in and out.

I also just got back from a cruise ship in Alaska. While I feel they would be bad during a pandemic there was also an undercurrent not to monitor the sick. One family was quarantined because of a sick child. Upon hearing this the other adults around got quiet. I really doubt people would be willing to cancel a trip at the start of a pandemic. Why? Money. Plans - some people can only take off when the kids are out of school or their job is covered at work. Right sizing now has "One job - one person." If that person is not there the job may not get done. Closing a school may be far easier than canceling trips.

At first I hoped cruise lines could operate at reduced capacity for social distancing but after seeing the ports of call, the concentrated common areas, the closed air systems, how closely the crew lives and how vital each crew member is I now retract that belief. It is not the cruise lines fault. I fear Las Vegas will also suffer.

Please keep posting.

Regards,
Allen

Posted by: Allen | August 17, 2007 at 01:21 PM

Building on InKy's post (comment-79730201) Right now, pre-pandemic, what is the downside risk to distributing pandemic flu kits to all takers through the Red Cross or Scouts or local first responders? Requiring some instruction on use and on being a "flu watcher" as suggested by Allen in comment #79658233 (like being a weather spotter) to your first post.

So much could be done each day but for some federal budget dust, with very little (or no) downside risk.

Posted by: Bill Peckham | August 17, 2007 at 03:51 PM

Dear Secretary Leavitt:

It's great to see you've entered the blogosphere. I would very much appreciate reading your comments about the role of healthcare information technology (electronic medical records, e-prescribe, etc.) in our health care system. Do you think we'll ever see the day when most physicians embrace this technology? Do you think it will materially improve quality of care? And finally, what role do you think the government should play in fostering adoption of these technologies?

I'm looking forward to learning more about your healthcare IT views in a future posting!

Sincerely,

Electronic Medical Records Guy and Blogmaster,

http://www.electronic-medical-record.blogspot.com

Posted by: Electronic Medical Records Guy | August 17, 2007 at 04:00 PM

CMS is about to publish a regulation (CMS-2287-P), which will eliminate reimbursement for one of the more important of these programs.

The amount of money involved is miniscule in the overall federal Medicaid budget but would force major cuts in school programs.
For many children, school health programs are their primary access to health care. For some, it is their ONLY access.

Healthy children do better in school, and preventative health care is substantially less expensive, in both human and financial terms, than later acute intervention.

Cutting funding for school health programs is bad public policy.
CMS-2287-P has not yet been published, but it is being circulated in draft form. This blog is an excellent platform for discussion on school health programs that it would affect and on the overall debate over schools as health care providers.

Posted by: Greg Morris | August 17, 2007 at 04:23 PM

Great to see you haven't forgotten us.
My concern at this time is the lack of communication from my local government. I haven't heard anything going on in my town, nor in the papers. Can you tell me when orders from our government will start comming down to get the word out to local residents?

Good luck in Africa.

Posted by: jlopez7116 | August 17, 2007 at 04:46 PM

Welcome to blogville. I have had a blog for several years and I also moderate a section on trusted.md called RHIO Monitor.

Gary Levin MD

Posted by: Gary Levin | August 17, 2007 at 06:28 PM

Dear Secretary Leavitt and others,

As Greg Morris said Electronic records as are important. They are a force multiplier. Hospital staffing assumptions is based on electronic records. To have to record, hand deliver and print patient information would slow down health care. It would slow down reporting, increase typo’s and lesson our surveillance capability.

Electronic time card systems like Kronos and others are also beneficial. Tracking efforts, people and skill sets automatically is better than manually. This also elevates the need for IT staff. May this be the best documented pandemic for lessons learned on what does and what does not work.

For Y2K many backup solutions where created. Sending files via modem over telephone lines or cell phones. Even HAM radio operators can send data. If we are going to use electronic systems - then make them as robust as their human counterparts. People often have multiple wasys of doing things.

People know this I just want to see it stated. For blogs are great ways to get all the ideas, problems and background out in the open.

I like Bill Peckham suggestion. There are so many volunteer groups from Scouts to Ruritans, to the Red Cross that just letting them know help is needed may be all. There is a group called “Good Turn for America” that helps track ones volunteer hours. UR:: http://www.goodturnforamerica.org/

The reward is a patch and recognition. To be heard, seen and not passed over is what a lot of people like. We already have full time jobs. These groups do food drives where bags are put out and groups like the scouts deliver them. Once a pandemic gets dangerous the use of people in the 1 to 19 year old range would be reckless - IMHO.

Police and fire protection agencies produce comic books that are sent home in kids backpacks. I really hope, really hope that someone is creating that. The comic books have activities that can be done at home.

I had originally come here to post on African Coffee. Why? Because my food comes from so many different countries. That when they are hit with a Pandemic it is going to affect either the price or availability of food. The price of oil, coffee, etc fly up or down based on the rumor of trouble, a bad crop or a bad harvest. Unlike 1918 – food in the U.S. comes from many more places. Even if there is a bumper crop the lack of people to harvest it will affect its price. Yes the price of oil, bananas and fruits are more important than that of coffee.

I agree with the others here. I hope that during September “Get Ready” each person (man woman and child) will have a flash light, batteries, spare batteries and bulb. It is just one step – but a good step. Then in November they can take the next step – prepping local food banks and their cupboards with at least two weeks of food – not just two weeks of thanksgiving left over’s.

Regards,
Allen
“Nothing motivates like a contractual deadline – not delays like a vague moveable date.”

Posted by: | August 18, 2007 at 04:58 PM

Secretary Leavitt I have a deep concern. May I ask why the President and the candidates have not spoken out about the pandemic? I know that we are very close to this event. The WHO still has us at phase 3 but we know that this is not realistic and are in phase 4 or most likely 5.

I understand the ramifications of going public in a sure fire way, at least some of the ramifications, and they aren't easy to manage but don't people deserve to know the truth? It is the moral thing to do to tell people. It will be awful dealing with the panic that will ensue but we are all going to have to deal with that sooner or later. Isn't it better to deal with that while we are all well. I know that some people will stop paying their bills in order to prepare their families but who can blame them? We simply must allow them to prepare to shelter in place or when this pandemic begins people will be spreading illness even more.

Secretary Leavitt, I have done my very best to tell people to prepare and have, for the most part, failed in my endeavor. I can not longer mention the pandemic to people, they think I am nuts. What can more can we do?

Posted by: standingfirm | August 19, 2007 at 08:59 AM

Dear Secretary Leavitt and others,

As Greg Morris said Electronic records as are important. They are a force multiplier. Hospital staffing assumptions is based on electronic records. To have to record, hand deliver and print patient information would slow down health care. It would slow down reporting, increase typo’s and lesson our surveillance capability.

Electronic time card systems like Kronos and others are also beneficial. Tracking efforts, people and skill sets automatically is better than manually. This also elevates the need for IT staff. May this be the best documented pandemic for lessons learned on what does and what does not w

People know this I just want to see it stated. For blogs are great ways to get all the ideas, problems and background out in the open.

I like Bill Peckham suggestion. There are so many volunteer groups from Scouts to Ruritans, to the Red Cross that just letting them know help is needed may be all. There is a group called “Good Turn for America” that helps track ones volunteer hours. UR:: http://www.goodturnforamerica.org/

The reward is a patch and recognition. To be heard, seen and not passed over is what a lot of people like. We already have full time jobs. These groups do food drives where bags are put out and groups like the scouts deliver them. Once a pandemic gets dangerous the use of people in the 1 to 19 year old range would be reckless - IMHO. Not that the suggestion is reckless but each group has its part to
play.

Police and fire protection agencies produce comic books that are sent home in kids backpacks. I really hope, really hope that someone is creating that. The comic books have activities that can be done at home.

I had originally come here to post on African Coffee. Why? Because my food comes from so many different countries. That when they are hit with a Pandemic it is going to affect either the price or availability of food. The price of oil, coffee, etc fly up or down based on the rumor of trouble, a bad crop or a bad harvest. Unlike 1918 – food in the U.S. comes from many more places. Even if there is a bumper crop the lack of people to harvest it will affect its price. Yes the price of oil, bananas and fruits are more important than that of coffee.

I agree with the others here. I hope that during September “Get Ready” each person (man woman and child) will have a flash light, batteries, spare batteries and bulb. It is just one step – but a good step. Then in November they can take the next step – prepping local food banks and their cupboards with at least two weeks of food – not just two weeks of thanksgiving left over’s.

Regards,
Allen
“Nothing motivates like a contractual deadline – not delays like a vague moveable date.”

Posted by: allen | August 19, 2007 at 01:49 PM

Dear Secretary Leavitt and others,

Yesterday’s post did not make it. Today there are two. I hope these posts are not a re-hash. I know a lot of bright people are working on the problem. My opinion is that those high up should work on the over problems while those at the city or personal level should work on city and personal levels. Unfortunately local solutions are not given the same credit as national problems.

Last night I got into a discussion with a neighbor on self reliance vs. communication. If a person can take care of them self then they can take care of others or do a job. Yet what are a group of people who are ready to go without communication. If they do not know from when the problem comes or what others are doing then it is a tower of Babel. To have all the supplies and no communication is pointless.

A pandemic is not a problem one can run from. Securing one’s own safety and well being is good, but then what? How to secure the safety of the city?

From hospitals and transportation to food banks, homeless shelters, homes for battered wives & husbands. What would the military do if the contractors did not show up for work? What if their supply chain broke down?

Let’s say a solution is found – how to communicate it? Comic book, work book, video, internet, town meeting or small group. Train the trainer that trains the trainer to train the trainers that train the people.

Regards
Allen

Posted by: Allen | August 19, 2007 at 02:22 PM

It is ill-advised for the U.S. to be using U.S. tax dollars to promote medically unnecessary circumcisions in Africa. Recent studies claim that circumcision helps prevent HIV. A Dutch study in March 2007 cast serious doubt on the wisdom of promoting male circumcision to prevent HIV infection, not only because of the risk of increasing HIV in women, but also because circumcision removes a natural HIV-1 barrier from men.


"Langerin is a natural barrier to HIV-1 transmission by Langerhans cells"
(Nature Medicine- 4 March 2007). This study states, "Langerhans cells (LCs) specifically express Langerin . . . LCs reside in the epidermis of the skin and in most mucosal epithelia, such as the ectocervix, vagina and foreskin . . . " Removal of the foreskin (male circumcision) removes
the langerhans cells that express langerin, the natural barrier to HIV-1 transmission.


To learn more about this study, see:


http://www.cirp.org/news/healthday2007-03-05/


In addition, a recent study in the March, 2007 issue of the "Annals of Epidemiology" found that circumcision is "likely to spread" HIV. See:


http://www.afrol.com/articles/24469


A study published on June 20, 2007 found that male circumcision is
overstated as a prevention tool against AIDS. This study found that the key to understanding the global spread of AIDS is the size of the infected prostitute community around the world.
See:http://www.eurekalert.org/pub_releases/2007-06/plos-mco062007.php


A new penile touch test sensitivity study published in the April 2007 "BJU International" found that circumcised men are significantly less sensitive to fine touch than are non-circumcised men. For those who advocate condom usage, this study raises the possibility that circumcised men might be less likely to use condoms because of reduced penile sensitivity. See:


http://www.doctorsopposingcircumcision.org/pdf/sorrells_2007.pdf


Another preliminary study in Malawi suggests that the incidence of HIV is highest where male circumcision is highest.


A promising development in the battle against HIV/AIDS is the news recently from Emory University, where an AIDS vaccine to prevent HIV is nearing reality. See:

http://www.11alive.com/news/article_news.aspx?storyid=93439


Below are several articles that shed light on the circumcision/HIV issue. If circumcision truly helped prevent HIV, then
circumcised men would not need to worry about other methods of HIV
prevention. The false sense of security that circumcision provides could increase the incidence of HIV.


It is foolish for circumcision to be championed for males when 98.15% of the men in the African studies' control group who were not circumcised did NOT contract HIV after 24 months. Circumcision did nothing to protect the 22 men who acquired HIV in the Rakai, Uganda study. One has to question if incidences of condom failures were factored into the African study findings- condoms that
broke, slipped off, or leaked over the rim and which could have been the cause of HIV acquisition. In 1993 the University of Texas analyzed 11 different studies that tracked the effectiveness of condoms to prevent transmission of the AIDs virus. The average condom failure rate in the
11 studies for preventing transmission of the AIDS virus was 31%.
("Social Science and Medicine", Vol. 36, 1993.)


An intact (not circumcised) male who does not engage in risky sexual behavior is far less likely to acquire HIV/AIDS than a circumcised male who engages in risky sexual behavior. Behavior is the key component in preventing HIV, not circumcision.


The United States has a long history and experience with circumcising millions of men in the past century under hygienic medical conditions. This has NOT prevented circumcised males from acquiring HIV. Instead, the United States has one of the highest rates of HIV in the
developed world, despite the fact that male circumcision in the U.S. has been widespread here. This is in contrast to Europe and other locations around the world where male circumcision is rare and HIV rates are relatively low.


Since the late 1800s, medical luminaries have promoted circumcision to prevent a variety of problems/diseases. Luminaries today are telling people to add HIV to the historical list of diseases circumcision will
purportedly prevent- masturbation, epilepsy, spinal paralysis, curvature of the spine, clubfoot, rectal prolapse, UTIs, malnutrition, cancer, eye
problems, nervous disorders, tuberculosis, and now HIV.


Men in Africa and elsewhere should not be misled by researchers, WHO, or UNAIDS. If the African studies had not been stopped early and long-term results had been obtained, the HIV infection rate might might very well have become
statistically insignificant between the circumcised
and non-circumcised groups. Look at the progression in the number of cases of HIV in the Kisumu study:


Period since Circumcised Not circumcised
Start of study (n=1391) (n=1393)
-------------- ----------- ---------------
0- 1 month 4 1
1- 3 months 2 3
3- 6 months 5 9
6-12 months 3 18
12-18 months 0 7
18-24 months 8 9


The number of cases in each period for each group is small, so their
relative sizes are affected greatly by random variation. It appears from the data that the rate of infection is lower among the circumcised men in the first 18 months following circumcision, but that there's little difference beyond 18 months. If the study had not been terminated early
at 24 months, it is quite likely that the number of HIV cases between the groups would have become insignificant. The decision to terminate the
studies early prevented any future comparison of the progression of HIV in the circumcised and control groups and the very real possible
invalidation of the alleged "proof".


Sincerely,
Petrina Fadel, Director
Catholics Against Circumcision
http://www.catholicsagainstcircumcision.org/


"HIV infection and circumcision: cutting through the hyperbole"
THE JOURNAL OF THE ROYAL SOCIETY FOR THE PROMOTION OF
HEALTH, Volume 125, Number 6: Pages 259-265, November 2005
http://www.cirp.org/library/disease/HIV/vanhowe2005a/


The Use of Male Circumcision to Prevent HIV Infection
http://www.doctorsopposingcircumcision.org/info/HIVStatement.html


Circumcision and HIV Infection
http://www.cirp.org/library/disease/HIV/


Why Most Published Research Findings are False - John Ioannidis
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1182327
Published online 2005 August 30


Why Is HIV So Prevalent In Africa? - Michael Fumento
http://www.fumento.com/disease/aids2005.html


Position Statement on the Use of Male Circumcision to Limit
HIV Infection
http://www.nocirc.org/statements/hiv2003.php


HIV-AIDS and Circumcision
http://www.circinfo.org/hiv.html

Posted by: Petrina Fadel | August 19, 2007 at 06:14 PM

They first need to get things straight. Blogs are common in many industries, but in the area of Panflu, it's the flu "forums" that have taken the lead, and there are really very few blogs involved.

"Blogs ... We ain't no stinkin' blog". lol

www.Avianflutalk.com

Posted by: Albert | August 19, 2007 at 09:30 PM

I hope that you can find a moment in your busy schedule to look at CMS-2287-P and consider the implications on student healthcare in our nation if published.

This would eliminate millions of dollars in my small state, subsequently stopping programs and student healthcare that could not otherwise be funded.

I urge you to stop 2287 from being published.

Thanks

Posted by: TB | August 20, 2007 at 08:47 AM

Dear Secretay Michael Leavitt, I read this today and I am alarmed. ---------------------------------- Medicare won't pay for preventable malady Saturday, 18-Aug-2007 11:20PM EDT Story from United Press International Copyright 2007 by United Press International (via ClariNet) WASHINGTON, Aug. 18 (UPI) -- Medicare will no longer pay for treating bedsores, staph infections and other preventable injuries under new rules approved by the Bush administration. The policy would also cover infections caused by leaving catheters in place too long and injuries from falls, The New York Times reported. Officials said making hospitals pay for their own mistakes will reduce the number of patients who suffer injuries or illness as a result of treatment. "If a patient goes into the hospital with pneumonia, we don't want them to leave with a broken arm," said Herb Kuhn, acting deputy administrator of the Centers for Medicare and Medicaid Services. Private insurers are considering following Medicare's lead. The administration expects to save $20 million a year, but some experts say the savings could be substantially greater, the newspaper said. The rule changes bar hospitals from passing along the cost of treatment to patients. The Centers for Disease Control estimates that 99,000 people die every year in the United States as a result of infections acquired in hospitals and other health-care facilities. ---------------------------------- Did the consideration of not having enough nurses and nursing help may contribute to this problem aarise? I have always believed that these are the problem of poor nursing care but a lot now has to do with the profession. Isn't there a way that incentives can be given or more advertising the need of nurses like we do for more young people to go into the military,and to say no to drugs. Nursing homes do not get the amount of monies that the hospitals do. I know they have a hard time getting good help with the little monies they have to pay out to their workers. What happens if the a patient is taken care of in their home and falls or has decubiti? Will Medicare take care of the medical bills? I have worked in x-ray, radiation therapy and dietetics. I went to school for these and paid for them on my own. I worked as a nurse aide first while I was in high school but that was many years ago. I now have to stay home with my husband who is a 100% totally and permanently disabled veteran. If I was not around the Federal Government would be taking care of him daily instead of me. I am thankful that I get CHAMPA benefits but I look at the TRICARE program and they receive a dental plan. Many medical problems come from having bad teeth. These people can go to work. I HAVE to stay home. When I take my husband to the VA hospital and clinics I notice how many spouses that are in my shoes. They can't take care of themselves because their spouses come first. As caregivers we are always in stress. Where is the fairness. So, regarding just these two items it seems our Government doesn't really care about the long term of our health.

Posted by: Stephanie Humanic | August 20, 2007 at 09:10 AM

Secretary Leavitt I read all the info.you have on your Blog and about Tamiflu and especially a State Children's Health Insurance Program for children who haven't any insurance. I and my conservative friends are so proud of you, but still disappointed as for the past few years, we were hoping you would run for president in 2008. You are atrust worthy person for your present job, but we still had your name as #1 for president and M Mitt Romney for #2, but we wish you good health and success in your endeavors. Sylvia Pidgeon Conigliaro.

Posted by: sylvia conigliaro | August 20, 2007 at 09:11 AM

Mr. Secretary,
Thanks for the response to my Tamiflu query; I see several people have mentioned you transposed author's names. (s) I note in today's news Australia Queensland State government has released their stockpile of Tamiflu to pharmacies despite previous statements they would not do so... it seems the clamor of public outcry can go a long way in clearing obstacles to this kind of action. ;-) I hope the US can take a cue from Australia and have the plans for action in hand BEFORE weeping mothers are driving from pharmacy to pharmacy trying to find life-saving medicine for their children here.

I admit I am a little shocked at the CDC efforts in making emergency kits. I hate to harsh on anyone's efforts, but it seems to me wrongheaded; the emphasis seems to be on keeping people from getting into the kits. And 5000 kits for our population of 300 million? C'mon. The only way of getting antivirals into the hands of significant numbers of people pre a possible pandemic is through good old market economics: let us buy them. I wish the government would put this choice in our hands. At the very least, let's have a plan for releasing supplies to the pharmacies.

On another subject: I hope at some point you do pursue a blog on your passion for affordable health care for all people. I stand in awe of the Canadian system;a dear friend and young mother suffered a aneuryism and the expensive brain surgeries that she required would no doubt have caused an American family to lose their home,farm and business. Instead, she was restored to health while maintaining her home and livelihood. If this is the socialized medicine so many people fear, I say: "Bring it!"

Good luck in Africa. The health concerns of that country must seem absolutely insurmountable.

~Northstar

Posted by: Northstar | August 20, 2007 at 10:03 AM

Secretary Leavitt,

Thank you for your thoughts on the State Children's Health Insurance Program (SCHIP). While I appreciate concerns about displacing private coverage, I am nevertheless concerned, as I believe that members of both major political parties are, about federal requirements that could limit the number of children covered under SCHIP. I would urge you to work with the rest of President Bush's Administration to ameliorate requirements for SCHIP coverage so that as many children as possible can be covered. I know you're aware that Republican and Democratic governors, as well as Republican and Democratic members of Congress, support the SCHIP program and support its expansion. One of the Republican incumbent senators in my home state (Maine) is facing reelection, and limiting SCHIP is not likely to increase the chances of reelection.

Posted by: Alan Cobo-Lewis | August 21, 2007 at 02:44 PM

Mr. Secretary,
Glad to have stumbled across your blog. I encourage you to seek opinions from the very people who will be most affected by the health policies issued by the Administration and Congress. Personally, I wish to hear no more words about protecting the private insurance industry. I believe it is criminal that companies are allowed to sell individual policies which do not meet the same minimum standards as group policies which are regulated by federal law. For one citizen's opinion on health care and policy, please visit my blog at www.brassandivory.blogspot.com.

Thank you for working with states and communities to prepare for pandemics.

Posted by: Lisa Emrich | August 21, 2007 at 11:44 PM

Dear Mr Secretary,
First I'd like to thank you for this wonderful forum. This is truly democracy at its best.

My question and comments deal with SCHIP and access to healthcare. I came across this website as I was searching for information on the SCHIP debate. I am a resident physician at a large Children's Hospital in an urban setting and everyday I see countless children who benefit from programs like Medicaid and SCHIP. I wonder how many of these children would miss out on care if not for these programs. When I hear estimates that anywhere from 5 - 9 million children remain uninsured (many who would qualify as working poor) expansion of SCHIP seems intuitive. Could you please elaborate on alternatives to expansion of SCHIP that would help cover uninsured children. Also I would love to hear your thoughts on how America could develop a system where Americans will have access to affordable coverage in a relatively short amount of time. Thanks for your time and this wonderful forum

Posted by: Manny | August 26, 2007 at 09:01 PM

Mr. Secretary;

I am sure you hear this numerous times a day... health care is becoming more and more expensive, and health insurance costs (premiums) are going through the roof.

I have a family of 5. My wife and I, and 3 daughters 6, 9 and 21. We pay $1500 monthly for insurance coverage from United Health Care. That coverage just went up from about $1350 a month last year to the present $1500. And, this is "routine, and normal" coverage if you will. Normal $5000 family deductible, etc... PPO coverage.

This is getting outrageous, especially when we read in the newspapers, the Wall Strret Journal, and other media about the HUGE profits these insurance companies are making, and the outrageous salaries that these CEO's are getting. If I'm not mistaken I recall reading a while ago that the CEO of, I believe it was United Health Care was compensated over $1.5 BILLION last year in cash, stock and options. There supposedly was a congressional investigation planned... I havent read anything further about that.

All I know is, I'm struggling to pay over $18,000 annually for health insurance, and these insurance companies are booking tens of billions in profits. Millions of Americans cant even afford insurance... there is something fundamentally wrong with this system.

For years, I was a Republican Eagle and did some major fundraising for the party. While I am not blaming this administration, or past administrations for this current morass, I am seriously looking at switching political affiliations for the first time in my life.

Something needs to be done, and quickly. I've been a successful businessman, and believe fully in the principals of free enterprise BUT I am getting more and more outraged daily at the corporate excesses that are draining the pockets of too many people these days, or making it impossible for millions to afford even basic coverage.

I perssonally think its time that this administration consider a tax on these insurance companies, or some legislation to force them to rebate to the consumer a substantial portion of their annual profits to first, reduce premiums, and second to provide some basic, low cost health insurance to those who can't currently afford it. Further legislation should address affirmatively the issue of "cherry picking".. of only seeking to insure those who are healthy and deny coverage or severely limit it for those with pre-existing conditions.

I cannot see how anyone can justify the enormous profits being made by these companies, and unconcionable salaries and bonuses being paid while so many people in our country are struggling to provide what should be a basic right... Health Insurance.

What, if anything, do you and this administration propose to do about this issue?

Posted by: Paul Sussman | October 22, 2007 at 10:32 AM

Dear Mr. Secretary,

I am a graduate student in nursing, soon to be a nurse practioner. I'm sure there is a plan, but I don't understand what plan is in place to protect the front line health care providers in the event of a pandemic. We will be caring for all the afflicted, the elderly and chronically ill. If we are not protected, who will care for the others? Thank you.

Posted by: Kaia Christiansen | October 22, 2007 at 08:16 PM

We provide HBO, (Hyperbaric oxygen therapy) in a medical setting on a hospital campus in Atlanta. We have had a 2/3 cut on reimbursement with no explanation. After 10 months working with the Atlanta Region and your office (they don't return messages in your office)we are no further along today than we were months ago.

The Medicare program is a huge network of employees that don't even know how we can appeal this isssue. I have talked to over 50 people already. We have been sent "round and round" in circles for 10 months. We then found ourselves back to the original "decision makers" in Goergia who don't want us to go above their heads. They have found "excuses" for answers.
But we are losing money daily with a "bad code" that ha cut us below our costs. The code they (HHS) want us to use on our patients no longer covers the costs for the treatment.It is for a doctor visit. And the people working with Medicare in Atlanta have a terrible rapport with physicians because are difficult to deal with and don't properly adress the issues. They answer us with quotes from manuals. (We never chose the codes we used--they did.) Therfore, we find their criticisms of our codes "sad"---but almost comical. These codes worked fine until "they abruptly" changed what they would pay on it.

Many doctors here are forced to leave the program beause of unreasonable cuts. I have contacted both our senators.They are trying to help. But these cuts not only come without prior notice, they come with demands to return money from previous payments on patients. Is this right? Is this ethical? Why should doctors have to subsidize the care with their own money while we wait for answers?


Our independant clinic charges Medicare 1/2-1/3 what they pay a hospital. So, why try to harm us financially when we are not the enemy? It makes no sense. We can provide the same care in a discounted rates at a medical setting. And our patients love us. We were the first HBO provider for chronic wounds in a hospital setting. We have done this for over 15 years. What is going on?

Today, I learned from our office manager that some Medicare patients have chosen to keep their HMO coverage, as well, WITH their Medicare when they turn 65-- (in fear of what may happen to Medicare) Because of this, payments are being delayed by Medicare. Now, they have created 2 tyopes of Medicare patients--but no way for the doctors to know which plan is primary. So it all goes in one "lump" to Medicare first.

This is how: There is no identification of who has Medicare AND an HMO--- and who has just Medicare. Therefore, it all goes to Medicare first for billing. After 30 days, if the patient has BOTH, Medicare will deny it. It then has to wait another 30 days and be refiled, for the HMO to process it--since they are now identified as the primary insurance. Then, it goes back to Medicare for the balance. So, it can take 60 days for doctors to wait for a Medicare payment. Furthermore, the office has to "double bill" in these instances. This costs doctors more time and money. It causes lots of paperwork. Does this make sense?

Why can't a "sticker" or special Medicare card be issued to these patients? Why should doctors be put in this position to "re -bill" and "re- wait"?

This is all a nightmare for providers. Many doctors are giving up. Is this hard to understand? Is this what our government wants? (Our patients don't want this.) Without your providers, you have no program. And ithout proper reimbursement and timely payments, how can doctors afford to give treatments?

Please help. We need Medicare headquarters to monitor and control each region. We need sensible and timely answers to these questions. Providers can't continue with these issues. Thank-you.

Posted by: Donna B Goodhart | October 31, 2007 at 10:03 PM

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