HFHS IN THE NEWS:
Metro Detroit medical centers struggle to attract, retain pharmacy
workers
Detroit News
February 2, 2009
http://www.detnews.com/apps/pbcs.dll/article?
AID=/20090202/BIZ/902020351/1040/LIFESTYLE03
Pharmacy student George El-Turk had always envisioned himself working
behind a drugstore counter after graduation. Now, in his final year
at Wayne State University, he's getting an inside look at a side of
the profession he hadn't considered before: hospital pharmacist. "I
didn't know anything about hospitals until I started rotations," said
El-Turk, 25, after finishing rounds in the cardiology unit at St.
John Hospital in Detroit as part of his degree training. "Up until
recently, it wasn't a marketed option." Filling vacancies among
hospital pharmacy staff has become more difficult the past several
years, with the profession splintering into specialized areas and
more pharmacists taking jobs in nontraditional roles at
pharmaceutical companies and health insurers. Metro Detroit hospitals
also have to contend with more Michigan-educated pharmacists leaving
the state, as drugstore chains draw them to fill jobs elsewhere. Even
with three pharmacy schools in Michigan, graduating some 295
pharmacists a year, supply is falling short of demand as prescription
drug use is expected to swell as the nation's baby boomers age,
driving a greater need for pharmacists on hospital floors and at
patient bedsides. Many hospitals also are seeking to fill pharmacy
technician jobs, which pay in the mid- to-upper $20,000s, and in many
cases only require a year-long certification course. The shortfall
has stifled the growth of some hospital-based programs that allow
pharmacists to get more involved with helping patients manage
prescriptions, monitor doses and prevent errors, especially for
elderly patients who may take multiple drugs. Hospital-based
pharmacists typically work in two areas: in-house pharmacies where
prescriptions are filled for patients; or alongside doctors and
nurses in clinical rotations, helping to treat patients at their
bedsides. "Pharmacists are spending much more of their time working
with patients to prevent medicine-related problems," said Ed
Szandzik, director of pharmacy at Henry Ford Hospital in Detroit.
That demand is driven by changes in insurance policies, such as the
creation of Medicare Part D in 2006, that have made prescription
drugs more affordable, Szandzik said. A nationwide survey conducted
by the American Hospital Association in 2007 found that the vacancy
rate for hospital pharmacists was the same as for registered nurses --
  8.1 percent. Similarly, of the 5,000 hospitals surveyed that year,
nearly half said they perceive recruitment becoming more of a
challenge. While Michigan numbers weren't available, job listings at
area hospitals show numerous postings for staff pharmacists and
pharmacy technicians. About one-third of the state's licensed
pharmacists work in hospitals, while more than half are employed by
retail drugstores.



INDUSTRY NEWS:
Blue Cross seeks rate increase
Nonprofit insurer wants to raise price of individuals' policies by as
much as 56% to offset a projected $1B loss in next three years.
Detroit News
January 31, 2009
http://www.detnews.com/apps/pbcs.dll/article?
AID=/20090131/BIZ/901310367
Blue Cross Blue Shield of Michigan is making good on its promise to
seek rate increases on its individual lines of insurance -- as much
as 56 percent in some cases -- for policies bought by people who
aren't covered by their employers or are seeking supplemental
Medicare coverage. The nonprofit insurer filed a rate increase
request Friday with the Michigan Office of Insurance and Regulation
to raise monthly premiums on plans that cover about 400,000 Michigan
residents. It's asking for average rate increases on three types of
policies: a 56 percent increase on individual plans; 42 percent on
group conversion coverage (which extends benefits from a former
employer); and 31 percent for Medicare supplemental plans. The
request targets nine coverage options for the individual plans and
another three for supplemental Medicare plans. Depending on the
option, the increase will vary with some rising more than others. For
instance, a consumer with a Blue Cross's individual PPO, called Blue
Value, could see monthly rates for one person rise from $171 to $213
if the increase was granted. That's about a 24 percent change. If the
rate increase goes unchallenged, the changes could go into effect as
early as June 1, Blue Cross said. Typically, the process takes much
longer, with some previous rate requests pending for more than a year
before they were approved. Blue Cross officials said the increase was
necessary to offset a projected $1 billion loss during the next three
years from its individual insurance lines.

See additional coverage in The Detroit Free Press at:
http://www.freep.com/article/20090131/BUSINESS06/901310319/1019/BUSINE
SS/
Blue+Cross+asks+Michigan+to+hike+rates++400+000+to+be+affected (
http://www.freep.com/article/20090131/BUSINESS06/901310319/1019/BUSINE
SS/Blue+Cross+asks+Michigan+to+hike+rates++400+000+to+be+affected )


Adult psychiatric center to open at Samaritan Center
Crain's Detroit Business
February 2, 2009
A 55-bed inpatient adult behavioral health facility is expected to
open in March at Detroit-based Samaritan Center. The Samaritan
Behavioral Center, 5555 Conner Ave., eventually will employ 100
nurses, psychiatrists and other support staff, said Esther Waldman,
director of marketing and public relations. Samaritan Behavioral
first will open 20 beds and then undergo accreditation inspection by
the Chicago-based Joint Commission. Waldman said all 55 beds are
expected to become available by early April. The center projects it
will treat 2,000 patients this year, Waldman said. Samaritan
Behavioral is owned by Troy-based Madison Community Hospital, a
nonprofit organization headed by principals Dr. Ram Gunabalan and
Robert Clemente, Waldman said. To manage Samaritan Behavioral,
Madison Community has contracted with 42-bed The Behavioral Center of
Michigan in Warren. The Samaritan Center also features an urgent care
center, medical diagnostic services, a pharmacy and a 120-bed nursing
home, said Executive Director Loren Brown. Other services include a
convenience store, job training and placement, and spiritual
ministries.



Cynthia Williams: MESSA helps school districts conserve dollars
Lansing State Journal
January 30, 2009
http://www.lansingstatejournal.com/article/20090130/OPINION02/
901300311/1087/OPINION02 (
http://www.lansingstatejournal.com/article/20090130/OPINION02/90130031
1/1087/OPINION02 )
As policy-makers work to rebuild Michigan's economy around new
technologies, clean energy and life sciences, our schools, colleges
and universities are undoubtedly a key part of the foundation. And a
cornerstone for success is quality health care for all citizens.
Quality health benefits have long been a powerful career incentive
and top priority for Michigan educators. MESSA is proud to serve the
education market. We're a not-for-profit association and a Lansing
business success story. We employ 300 Michigan citizens statewide.
MESSA provides award-winning member service from its East Lansing-
based call center. Our members consistently express 98 percent
satisfaction with our benefits and service. MESSA is able to provide
a great value in the market because of our member-focus and efficient
business model. We place a strong emphasis on preventive care and
wellness. Our pro-active focus on wellness clearly holds great
promise for reducing health care costs while also supporting
healthier, more satisfied and more productive employees. MESSA not
only provides a great value, our plans often cost less than
comparable plans. Many school groups are moving back to MESSA to save
money. Like all citizens, school employees have shared in the state's
economic pain. School employees are making significant sacrifices to
help their districts balance budgets and preserve quality education.
They've bargained less-costly health plans and shouldered more costs,
saving school districts more than $500 million in the past four
years. MESSA has done its part as well. MESSA's average rate increase
over the past three years has been under 4 percent. Many MESSA
districts are paying less this year for health insurance than they
were three years ago. We've fully complied with Public Act 106 of
2007 and we've expended thousands of hours to revise our business
strategies. We've reformed our benefit structure. Eighty percent of
our members have bargained less-costly PPO plans with their employers
and 73 percent have accepted higher prescription drug co-payments. We
launched six new cost-saving riders for bargainers Jan. 1. Pinckney
teachers left MESSA three years ago because they were promised annual
savings of $600,000. The district's costs soon ballooned and it was
hit with a 35 percent increase this year. The district's teachers
came back to MESSA on Jan. 1. MESSA's health plan will save the
district more than $334,000 in the next six months alone. MESSA has
its critics. But just as the Big Three auto companies discovered with
U.S. Sen. Richard Shelby, such criticism is often more about special
interest politics and partisan agendas than about good public policy
or school quality. The State Journal reports often on the importance
of MESSA coverage to area school employees. MESSA is the No. 1 health
plan for Michigan education employees for many reasons. We are cost
effective and have provided bargainers with cost-saving reforms. We
are the best value in the market. But most important, having a MESSA
plan helps schools, community colleges and universities build strong,
talented professional staffs.



Disruptive Innovation, Applied to Health Care
NY Times
February 2, 2009
http://www.nytimes.com/2009/02/01/business/01unbox.html?
_r=3&ref=health
The health care system in America is on life support. It costs too
much and saps economic vitality, achieves far too little return on
investment and isn't distributed equitably. As the Obama
administration tries to diagnose and treat what ails the system,
however, reformers shouldn't be worried only about how to pay for it.
Instead, the country needs to innovate its way toward a new health
care business model - one that reduces costs yet improves both
quality and accessibility. Two main causes of the system's ills are
century-old business models, for the general hospital and the
physician's practice, both of which are based on treating illness,
not promoting wellness. Hospitals and doctors are paid by insurers
and the government for the health care equivalent of piecework:
hospitals profit from full beds and doctors profit from repeat
visits. There is no financial incentive to keep patients healthy.
Advances in technology and medical research are making it possible to
envision an entirely new health care system that provides more
individualized care without necessarily increasing costs, some health
care experts say. As researchers develop ways to define diagnoses
more precisely, more effective treatments can be prescribed, says
Matthew Holt, founder of the Health Care Blog and co-founder of the
biannual conference Health 2.0. Ultimately, those therapies can be
administered by nurse practitioners or others trained to handle
routine ailments. The expensive "intuitive medicine" practiced by
doctors trained to wade through a thicket of mysterious symptoms in
search of an accurate diagnosis can then focus on those cases that
truly require their services. Using innovation management models
previously applied to other industries, Clayton M. Christensen, a
Harvard Business School professor, argues in "The Innovator's
Prescription" that the concepts behind "disruptive innovation" can
reinvent health care. The term "disruptive innovation," which he
introduced in 2003, refers to an unexpected new offering that through
price or quality improvements turns a market on its head. Disruptive
innovators in health care aim to shape a new system that provides a
continuum of care focused on each individual patient's needs, instead
of focusing on crises. Mr. Christensen and his co-authors argue that
by putting the financial interests of hospitals and doctors at the
center, the current system gives routine illnesses with proven
therapies the same intensive and costly specialized care that more
complicated cases require. "Health care hasn't become affordable," he
said in an interview, "because it hasn't yet gone through disruptive
decentralization." It's coming, though. Some health care suppliers
have set up fixed-fee integrated systems, and accept monthly payments
from members in exchange for a promise of cradle-to-grave health
care. Each usually also charges a small co-payment for treatment.
Routine cases are handled through lower-cost facilities, leaving more
complicated cases to higher-cost hospitals and specialists. Such
systems include Kaiser Permanente, Intermountain Healthcare in Utah,
the Mayo Clinic, the Geisinger Health System in Pennsylvania and the
Veterans Health Administration. By creating a continuum of care that
follows patients wherever they go within an integrated system, says
the Princeton University economist Uwe Reinhardt, care providers can
stay on top of what preventive measures and therapies are most
effective. Tests aren't needlessly duplicated, competing medications
aren't prescribed by different doctors, and everyone knows what
therapies a patient has received. As a result, integrated systems
like Kaiser's provide 22 percent greater cost efficiency than
competing systems, according to a 2007 study by Hewitt Associates.



CUSTOMER NEWS:
Auto suppliers turn to medicine
Manufacturers seek contracts in health care for products ranging from
heart stents to hospital bed parts.
Detroit News
February 2, 2009
http://www.detnews.com/apps/pbcs.dll/article?AID=2009902020328
Auto parts makers, which have watched their business prospects nearly
flat-line in recent years, are setting their sights on an industry
with a stronger pulse -- health care. Many Michigan-based suppliers
are turning to the booming medical device market to buffer against
declining orders from Detroit's Big Three automakers, retooling their
production equipment to make everything from heart stents to hospital
bed components. Despite the withering economy, the medical device
market has remained strong, growing at a fast clip and promising more
stability for companies that join its supply chain. The migration to
milling medical supplies could represent a new beginning for the
state's embattled manufacturing sector. "It's a very desirable place
to be as far as manufacturing," said Chris Buch, sales director at
Omega Plastics, Inc., a Clinton Township plastic components supplier
that at one time derived more than half of its business from top-tier
auto suppliers. Several years ago, Omega Plastics decided to break
into the medical market, which now makes up about a quarter of its
business. Michigan is home to more than 130 medical device makers,
including one of the world's largest, Stryker Corp. in Kalamazoo,
which has reported double-digit sales growth the last several years.
Nationwide, the industry generates annual revenues of $88.8 billion
and is expected to grow nearly 9 percent a year over the next five
years, according to Frost & Sullivan, an industry research firm in
San Jose, Calif. Creative Technology Services, a medical device
manufacturer in Canton, reports being "flooded" with calls in the
last six months from auto suppliers seeking advice on how to make the
switch. Troy-based Delphi Corp. spun off its medical device unit six
years ago, hoping to grab a larger share of this multi-billion dollar
industry. But with the persistent troubles in the auto industry, the
company, which filed for bankruptcy in 2005, is pushing to make its
medical division a bigger part of its business. It is working on a
slew of new gadgets, from medicine pumps to portable oxygen tanks,
said Al Hoffman, director of sales and marketing at Delphi Medical
Systems. "It's still a very small percentage of our business today,"
he said, "but we expected it to grow rapidly in the next three to
five years."



MEDICAL/PUBLIC HEALTH:
'Wake Up' to the Health Risks of Heavy Snoring
The nighttime nuisance could signal breathing problems associated
with strokes, heart attacks and other cardiovascular problems
PR Newswire (press release)
February 2, 2009
http://news.prnewswire.com/DisplayReleaseContent.aspx?
ACCT=104&STORY=/www/story/02-02-2009/0004964295&EDATE=

Heavy snoring can be far from a nuisance. It can be a sign of
obstructive sleep apnea, a condition where an individual briefly
stops breathing during the night which raises the risk of heart
failure and strokes. "Sleep apnea or sleep disordered breathing is
one that we're getting more and more interested in because we see a
very strong association with strokes, heart attacks and other
cardiovascular problems," says Dr. Melvyn Rubenfire, M.D., director
of Preventative Cardiology at the University of Michigan Health
System's Cardiovascular Center. Snoring is caused by a blockage in
the back of the throat. What you hear is the tongue forced to the
back of the throat when a person is lying on their back. When people
snore they don't always stop breathing, but there are chemicals in
the brain that should trigger breathing that are not stimulated when
a person snores. Without the stimulation the person will often stop
breathing. When a person obstructs at night and stops breathing,
oxygen levels drop dramatically and hormones and adrenaline surge.
Those hormones contribute to high blood pressure, irregularities of
the heart and can trigger heart attacks. People who snore do not
necessarily have obstructive sleep apnea but the relationship is
pretty strong. And the relationship between snoring and
cardiovascular problems goes both ways. Those with heart problems are
more likely to have sleeping disorders. The most important step in
treating snoring is recognition and appropriate diagnosis. A very
effective treatment -- one that helps 90 percent of those who are
compliant with the method -- is using a Continuous Positive Airway
Pressure device.



Air Force to Train Combat Docs to Use Acupuncture
Associated Press Online
January 30, 2009
http://www.ahiphiwire.org/News/Default.aspx?doc_id=235194
Chief Warrant Officer James Brad Smith broke five ribs, punctured a
lung and shattered bones in his hand and thigh after falling more
than 20 feet from a Black Hawk helicopter in Baghdad last month.
While he was recovering at Walter Reed Army Medical Center in
Washington, his doctor suggested he add acupuncture to his treatment
to help with the pain. On a recent morning, Col. Richard Niemtzow, an
Air Force physician, carefully pushed a short needle into part of
Smith's outer ear. The soldier flinched, saying it felt like he "got
clipped by something." By the time three more of the tiny, gold alloy
needles were arranged around the ear, though, the pain from his
injuries began to ease. "My ribs feel numb now and I feel it a little
less in my hand," Smith said, raising his injured arm. "The pain
isn't as sharp. It's maybe 50 percent better." Acupuncture involves
placing very thin needles at specific points on the body to try to
control pain and reduce stress. There are only theories about how,
why and even whether it might work. Regardless, the ancient Chinese
practice has been gradually catching on as a pain treatment for
troops who come home wounded. Now the Air Force, which runs the
military's only acupuncture clinic, is training doctors to take
acupuncture to the war zones of Iraq and Afghanistan. A pilot program
starting in March will prepare 44 Air Force, Navy and Army doctors to
use acupuncture as part of emergency care in combat and in frontline
hospitals, not just on bases back home. They will learn "battlefield
acupuncture," a method Niemtzow developed in 2001 that's derived from
traditional ear acupuncture but uses the short needles to better fit
under combat helmets so soldiers can continue their missions with the
needles inserted to relieve pain. The needles are applied to five
points on the outer ear. Niemtzow says most of his patients say their
pain decreases within minutes. The Navy has begun a similar pilot
program to train its doctors at Camp Pendleton in California. For
now, the Air Force program is limited to training physicians.
Niemtzow says it's "remarkable" for the military, a "conservative
institution," to incorporate acupuncture. "The history of military
medicine is rich in development," he said, "and a lot of people say
that if the military is using it, then it must be good for the
civilian world."

GIs' New Armor Too Heavy, Army Says
  February 05, 2009
Associated Press

WASHINGTON - Concerned that U.S. troops are already saddled with too
much heavy gear, military officials will not require them to wear
improved body armor until manufacturers cut the weight of the new
protective plates.

The Army plans to buy 120,000 sets of the advanced bullet-blocking
plates this year. This initial purchase of the plates, known
as "XSAPI," will be stocked in Kuwait and be available if commanders
need them, service officials said at a congressional hearing
Wednesday.

The quality of small numbers of the current plates, called "ESAPI,"
was questioned last week in an audit by the Defense Department
inspector general's office. The audit said the ESAPI plates from one
body armor manufacturer - Armor Works of Chandler, Ariz. - were
tested improperly and may not provide troops adequate protection.

The Army disputed the conclusion. ESAPI is the best body armor
available and a lifesaver in Iraq and Afghanistan, service officials
insisted. Nonetheless, as a precautionary step the Army decided to
withdraw nearly 33,000 Armor Works plates in question from an ESAPI
inventory of about 2 million produced by nearly a dozen different
companies.

The body armor used by most American forces consists of a vest with a
series of inserts that protect most of the upper body from armor-
piercing rounds. The specially hardened ceramic plates are the
largest of the inserts; one is placed in the front of the vest and
another in the back.

But making the roughly 6-pound XSAPI any lighter is harder than it
sounds. The plate has to be thick enough to defeat new and more
potent bullets finding their way onto the battlefield, says Joel
Moskowitz of Ceradyne in Costa Mesa, Calif., one of the companies
making XSAPI.

"A certain amount of thickness is required," Moskowitz said Wednesday
in an interview. "You just need that to stop that first hit."

The Army's testing methods were backed by the Pentagon's director of
operational testing, an independent office that assesses how gear
performs.

But in an action separate from the ESAPI armor recall, the Army in
December voluntarily withdrew just over 8,000 plates because of
testing gaps. Those plates were made by Armor Works and other
manufacturers, including Ceradyne.

Contracts potentially worth $6 billion for XSAPI and ESAPI plates
were awarded in October 2008 to Ceradyne, BAE Systems of Phoenix, and
The Protective Group of Miami Lakes, Fla. The work was put on hold
after BAE filed a protest over the manufacturing schedule.

Overall, the military could acquire up to 1 million sets of XSAPI
plates.

ESAPI plates range in size from extra small to extra large and weigh
on average 5 1/2 pounds each. XSAPI plates come in the same sizes and
weigh about half a pound more.

An extra pound may not seem overly burdensome. But when added to the
combat loads the troops already carry - backpack, combat rifle,
ammunition, helmet - it creates more strain, particularly in harsh
environments like Afghanistan, the Army says. The elevation and
rugged terrain there means troops must often track insurgents on foot
and every pound counts.

"Over time, the body armor, it does wear on your body," said Army
Staff Sgt. Fred Rowe, who has done two combat tours in Iraq. "I
couldn't imagine doing what I did, carrying what I carried, in
Afghanistan."

Rowe appeared at the hearing along with several senior Army officers,
including Maj. Gen. Robert Lennox, who oversees operations and
training.

Brig. Gen. Michael Brogan, head of the Marine Corps Systems Command
in Quantico, Va., agreed with Army leaders who said that the vast
majority of requests from commanders in the field, especially those
in Afghanistan, ask that the troops' load be lightened.

"We must balance levels of protection in order to maintain the
agility, mobility and lethality of our Marines," according to
Brogan's written testimony.

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INDUSTRY NEWS:
Costs for individual health plans soar
USA Today
February 20, 2009
http://www.freep.com/article/20090220/NEWS07/90220015
At a time when more people are forced to buy their own health
insurance because of job losses, costs for many individual policies
are soaring. Advocates say the 17 million Americans who buy their own
coverage can't negotiate lower rates the way employers or other large
group plans can. The Golden Rule Insurance Company, a part of
UnitedHealth Group, says sales of individual policies are up 24% in
the past two months. A website that links people with insurers,
eHealthInsurance, says applications are up 18% in the fourth quarter,
compared with a year ago. Among this year's large rate increases on
the individual market: Blue Cross of Michigan is seeking state
approval for a 56% increase in individual premiums. Spokesman Andy
Hetzel says the company needs to offset losses stemming from state
rules making it the sole insurer required to take all applicants. By
comparison, group health insurance premiums paid by employers rose
about 5% in 2008, says a survey by the Kaiser Family Foundation. Some
insurers say increases this year for individual policies aren't out
of the ordinary.Aetna, for example, says individual policy increases
nationwide range from 8% to 22%. Still, such hikes can cause "sticker
shock" for people used to smaller increases under employer plans,
says Robert Laszewski, who heads Health Policy and Strategy
Associates, a consulting firm. Premium rates for individual policies
vary widely, depending on state rules, the type of coverage and the
applicant's age and health. Unlike group coverage, in which all
applicants are accepted, insurers can reject applicants for
individual coverage in most states if they have medical problems.  A
sample of 227,000 individual policies sold by eHealthInsurance found
average monthly premiums for single people ranged from $107 to $301
in 2007, the latest data available. The average deductible, the
amount paid before coverage begins, was nearly $2,000. Family
coverage ranged from $219 to $494 a month with an average $2,600
deductible.




EDITORIAL: Don't delay cure for Blues
Legislature must balance public's interest and Blues' long-term health
Detroit Free Press
February 22, 2009
http://www.freep.com/article/20090222/OPINION01/902220352/1069/OPINION
/
Don+t+delay+cure+for+Blues (
http://www.freep.com/article/20090222/OPINION01/902220352/1069/OPINION
/Don+t+delay+cure+for+Blues )
When Blue Cross Blue Shield of Michigan tried to ram through
insurance reform during the Michigan Legislature's lame-duck session
last year, lawmakers were right to send the Blues packing. But it's a
new year, with a new Legislature and a just-begun legislative
session. And the Blues still have legitimate issues that need
addressing, ones that must be handled in a more sophisticated and
open way than the company approached them in the last legislative
term. So it's a little surprising, and somewhat disappointing, that
Lansing has been quiet on this issue so far. What gives? Does it make
any sense to push insurance reform into the late months of another
session, and again force a hurried, and perhaps dark-of-night,
solution? To date, there's no bill introduced in either chamber of
the Legislature to address the Blues' troubles. For their part, the
Blues are still pressing forward. The company has requested a rate
increase for individual insurance plans -- the troubled, growing
sector of the business -- of 56%. That's to account for all of the
individual health plans the Blues are picking up these days, as
people continue to lose jobs and their employer-paid insurance. Other
insurance carriers are also seeing growth in the individual market,
but the Blues in Michigan have special not-for-profit status as the
insurer of last resort. They've got to take whoever comes along,
regardless of their health. So the Blues wind up with nearly every
high-risk or already ill customer in the state, raising its costs to
an untenable level. How untenable those costs are is a matter of some
debate in Lansing, where Attorney General Mike Cox and some
legislators say the Blues exaggerate badly and are not in a position
that justifies radical changes to the current system. Certainly, what
the Blues tried to accomplish last year was unreasonable. The
company's proposed changes -- which passed the state House after only
one quick hearing -- would have increased its power in the market but
would have done little to enhance consumer protections or control
customer costs. Among the more controversial proposals, the Blues
wanted to continue buying up for-profit subsidiaries to accompany
their workers compensation business, the Accident Fund, and proposed
a high-risk "pool" that would share the burden for the sickest
customers with for-profit insurers. The for-profit end of the Blues'
business certainly is helping their bottom line, but there are
questions about whether the money they're spending on other companies
might better be used to lower premiums, and whether more for-profit
ventures are even appropriate for a nonprofit insurer. The risk pool
is a great idea on paper, but it hasn't worked to expectations in
other states, and it's unclear whether private insurers in Michigan
would even agree to participate in a pool with a not-for-profit
company. But beyond the controversial first proposals, it's also
clear that the Blues deserve some relief from the current system, and
that if they don't get relief, they risk equity shortages that could
endanger their license with national Blue Cross/Blue Shield, which in
turn threatens their important role as insurer of last resort here in
Michigan. So the Legislature needs to take up the subject again in
earnest, and soon. This is far too important an issue to leave to
last-minute politicking and emergency legislating. And the Blues are
too valuable a part of the state insurance system to let them
languish under a system that won't ensure their long-term survival.




Health Costs: Insurers Reach Fee Deal
Wall Street Journal
February 21, 2009
A majority of Americans who have employer-sponsored managed-care
health insurance choose plans that allow them to go to doctors and
hospitals outside their provider networks. They usually pay a higher
premium for this flexibility. But some plan members who have gone
outside their networks have complained that insurers paid less than
the members and providers were expecting, leaving them responsible
for unpaid balances, sometimes thousands of dollars. At issue has
been insurers' practice of paying a percentage of the "usual,
customary and reasonable" fee, which is supposed to represent the
going rate within a geographical area, and is based on data collected
from providers and insurers. Insurers say health-care providers' fees
vary widely for identical procedures and they need some objective way
of determining a fair rate. Plan members usually pay 70% to 80% of
the "usual and customary" fee for services delivered by out-of-
network providers. Plan members and physicians who believe they were
unfairly compensated have filed a string of class-action lawsuits in
recent years, charging that the claims database many insurers used to
set the fees was flawed. It's important for health-plan members to
fully understand the financial implications of going out-of-network.
Check first with your doctors, hospitals and insurers to make sure
you understand what your plans will cover, and by how much. Some
insurers provide online tools so members can find out what the
estimated "usual and customary" fee is. Otherwise, ask. If there is a
problem, try to resolve it early. Most doctors and hospitals have
personnel who specialize in helping patients navigate insurance
benefits. You may also be able to get help from your employer's
benefits department. If you believe the "usual and customary" rate or
your claim payment is too low, you can appeal. The procedure is
generally printed on your explanation-of-benefits statement, in the
plan description booklet, or on the insurer's Web site. There are
time limits to file appeals, often 180 days, so again, check. Your
state insurance department or managed-care department is another
resource for resolving disputes.




WellCare Suspends Medicare Enrollments Article
Wall Street Journal
February 20, 2009
WellCare Health Plans Inc., already burdened by a Medicaid-fraud
probe, said Friday it would suspend new enrollment in its Medicare
health plans after the U.S. imposed sanctions on it. WellCare's
Medicare business represents about half its premium revenue, and the
news sent the managed-care company's stock down more than 21%. But
the suspension's ultimate impact is unclear because the 2009 open-
enrollment season has passed, and WellCare has time to address its
problems before the next such period starts in November. According to
the U.S. Centers for Medicare & Medicaid Services, which ordered
WellCare to suspend marketing to and enrolling Medicare participants
by March 7, WellCare's problems include noncompliance, deficiencies
in Medicare prescription-drug contracts and misleading beneficiaries.
WellCare has the highest number of beneficiary marketing complaints
among large Medicare Advantage plans, with many beneficiaries
alleging marketing misrepresentations, CMS said. The agency said
CMS's secret shoppers found evidence that WellCare misled and
confused beneficiaries at December sales events. It also accused
WellCare of failing to discover forged applications. WellCare said in
a statement it is working with CMS to address the issues, and Chief
Executive Heath Schiesser said the company takes CMS's concerns "very
seriously."




McLaren health site on pace in N. Oakland
Detroit News
February 23, 2009
http://www.detnews.com/apps/pbcs.dll/article?
AID=/20090223/BIZ/902230367/1001
McLaren Health Care, a newcomer to Metro Detroit's health care scene,
has surpassed chief rival Beaumont Hospitals in a race to open a new
medical center in the comfortably middle-class suburbs of northern
Oakland County. The Flint-based health system is finishing the first
phase of a sprawling new health care campus set to open this May in
Clarkston. That leaves Beaumont trailing in its efforts to secure a
foothold in this well-heeled market as it tries to raise enough cash
to start construction on its own medical center in the area. The
development is McLaren's third major investment in Oakland County in
the past three years, and one of its largest yet, costing $600
million to develop a 79-acre site on I-75 and Sashabaw Road in three
phases. The second phase calls for a 200- to 300-bed hospital, an
endeavor that will first need approval of the state's health
department. Several miles down I-75, Beaumont is fine-tuning the
blueprints of its development: a $37 million medical center with an
emergency center, doctors' offices and a skilled nursing center on
the corner of Ortonville Road. Beaumont's plans also call for a 100-
bed community hospital in the third and final phase. The Royal Oak-
based hospital system has yet to break ground on the project, which
has been stalled by redesigns, opposition from development-wary
locals and, more recently, a nearly frozen credit market that's made
financing construction difficult. For consumers, the establishment of
two massive medical complexes could mean more options closer to home.
But some industry experts worry that the area could become overbuilt
with medical centers, especially at a time when many patients are
holding off on expensive medical care or more people are losing their
employer-backed health benefits. Some health experts also worry that
with many people fleeing the state because of the economy, there
won't be enough patients to fill one newly built medical office, let
alone two massive developments. For the two rival health systems, the
northern edge of the county has fallen into the crosshairs of their
growth plans. With about 34,300 residents, Independence Township
straddles the unofficial line where Metro Detroit ends and the Flint
area begins. "It's an area that's ripe for the picking," said Dr.
Betty Chu, an obstetrician and gynecologist based in nearby
Clarkston. Chu said hospitals have been eyeing the area for some
years now, mostly because many of its patients are privately insured
and willing to spend more on profitable elective treatments. The
payoff for patients could be huge, as well, with two high-tech
medical centers opening within minutes of their homes. "That's a huge
growth corridor in that the population is going to continue to push
north," said Phil Incarnati, McLaren's CEO. "We're just filling in
the blanks." Beaumont, with hospitals in Royal Oak, Troy and Grosse
Pointe, is expanding its regional footprint, adding satellite
outpatient centers in northern and western Oakland County, where
population continues to grow. Meanwhile, McLaren, a seven-hospital
system with locations in Lansing, Bay City and Lapeer, is pushing
south into Metro Detroit's northern reaches. In 2007, McLaren bought
the struggling 338-bed Pontiac Osteopathic Hospital, hoping to
restore it to profitability. Then last year, it purchased an
institutional stake in the soon-to-open Doctor's Hospital of Michigan
in Pontiac, giving it part ownership of the medical center, which is
opening in the place of the now-bankrupt North Oakland Medical
Center. For now, these hospitals plan to move forward, even while
contending with a darkening economic outlook that has stalled other
health care projects.




St. John, Trinity, WSU seek $524M
Crain's Detroit Business
February 23, 2009
Three Southeast Michigan health care institutions have submitted
$524.5 million in wish list requests to the state to fund 14 projects
that are ready to begin within the next six months. The projects
would be funded out of the state's share of the $787 billion federal
stimulus package. Officials for St. John Health, Trinity Health and
Wayne State University School of Medicine, however, are not sure when
the state will make decisions on the projects. St. John's information
technology projects are for physician-order entry systems, electronic
health records, cardiology data systems and information technology to
develop a patient-centered medical home, said Terence Thomas Sr., St.
John's senior vice president of advocacy. The St. Joseph projects
would be building a $230 million patient tower filled with 250
private rooms and funding a $6 million expansion for retail, pharmacy
and holistic health services as part of a $60 million surgical
pavilion and neonatal ICU project already underway, said CEO Jack
Weiner. Wayne State University in Detroit is proposing to build a
$180 million, 300,000-square-foot multi-disciplinary biomedial
research building at I-75 and Warren Avenue in a partnership with the
John D. Dingell VA Medical Center in Detroit. The research facility
would attract $200 million annually in research funding for rapid
transfer of health care and disease prevention activities, said
Harvey Hollins, Wayne State's vice president of government and
community relations.



CUSTOMER NEWS:
GM health fund at heart of concession talks
Automaker trying to conserve cash, meet obligations with stock
Indianapolis Star
February 22, 2009
http://www.indystar.com/article/20090222/BUSINESS/902220343/1003/BUSIN
ESS
Lenders and union leaders talking over concessions to keep General
Motors afloat are wrangling over a side issue -- a retiree health-
care fund. General Motors has urged the United Auto Workers union to
accept a smaller cash contribution from GM for a future health-care
fund for 900,000 retirees and their spouses. While the UAW worries
GM's plan could weaken the retirees' so-called VEBA trust fund,
bondholders fear they might end up making a larger sacrifice than the
union. General Motors has been set for months to hand the VEBA trust
fund to the union on Jan. 1, 2010. The trust fund was set up to
relieve the cash drain on GM caused by paying for retirees' medical
benefits. GM already has put $16 billion in cash in the health fund.
Rather than pour another $20 billion in cash into the health fund as
original plans called for, GM now wants to put in $10 billion worth
of its own stock and $10 billion in cash. GM also asked bondholders
who loaned GM $27.5 billion to take a big chunk of their repayment in
GM stock, analysts say. Both union leaders and bondholder advisers
are concerned about the new plan. Standard & Poor's said Wednesday
there was high probability GM and Chrysler could file for bankruptcy
this year or next. Another rating agency, Moody's, put the
probability at 70 percent. Now, GM employees and retirees are worried
the VEBA might wind up underfunded and are calling union officials to
express their concerns. Part of the reason the VEBA is at issue rests
with the White House. In December, then- President George W. Bush
advanced $13.4 billion to GM and insisted the company renegotiate the
VEBA and the debt to bondholders. That has drawn protest from
autoworkers, including Michigan union activist Gregg Shotwell, whose
Bait & Ammo newsletter Thursday noted the trust fund already is
underfunded and would be weakened by the concessions: "Now the
government demands that 50 percent of the 50 percent underfunded
trust be replaced with stock worth less than six rolls of toilet
paper. . . . A real union solution would advocate for all workers not
just an isolated gaggle in the gated community of the UAW elite. A
real union would reject the VEBA demolition derby and pit all its
energy into John Conyers' bill (HR 676) which would insure everyone
equally, not just the privileged.'' Conyers, a Michigan congressman,
sponsored a bill that would expand Medicare into a national health
insurance program available for everyone. With the Obama
administration getting ready to join GM in negotiations with the
bondholders and the UAW, it's not clear if the terms spelled out by
Bush might be modified. Bondholder advisers say the discussions could
go on through March as the sides sort out the issues.



PUBLIC HEALTH/MEDICAL:
Granholm wants tax to snuff tobacco habit, help budget
Detroit Free Press
February 23, 2009
http://www.freep.com/article/20090223/NEWS06/902230361/
Granholm+wants+tax+to+snuff+tobacco+habit++help+budget (
http://www.freep.com/article/20090223/NEWS06/902230361/Granholm+wants+
tax+to+snuff+tobacco+habit++help+budget )
Cost-cutting smokers soon will pay a whole lot more to roll their own
cigarettes. And Gov. Jennifer Granholm wants to make them pay even
more. She has called for doubling the state tax on loose tobacco,
cigars and snuff to help balance next year's state budget. That's on
top of whopping increases in federal tobacco taxes -- including those
for manufactured cigarettes -- that take effect April 1 to pay for
expanding health insurance for low-income children, known as SCHIP.
The biggest federal tax increase hits roll-your-own tobacco, rising
from $1.10 per pound to $24.78 per pound. Store-bought cigarette
taxes are headed from 39 cents per pack to $1.01 per pack. Granholm's
budget wouldn't touch Michigan's $2-per-pack cigarette tax. But it
would slam other tobacco smokers, chewers and puffers who've been a
favorite tax target for states to balance budgets and, in the name of
good health, discourage tobacco use. If approved by the Legislature,
state taxes on non-cigarette tobacco items would jump from 32% of
wholesale price to 64% next year. Combined with the new federal tax,
the average price of a one-pound bag of popular Gambler tobacco would
skyrocket from $19 to $70 in Michigan. A pound of tobacco can yield 2
1/2 cartons of homemade cigarettes, using inexpensive machines that
stuff tobacco into premade paper tubes with filters. At $70, plus the
cost of tubes, homemade would still be cheaper than $50-per-carton
pre-rolled cigarettes, but would not be the bargain it is now.
Tobacco taxes are expected to generate about $1 billion for the state
this fiscal year. Taxes on other tobacco products (OTP) -- other than
cigarettes -- account for 4% of the total. State officials predict
that doubling the OTP tax will double revenues to $90 million.
However, they admit they did not account for the higher federal tax,
which could spur more smokers to quit. Judy Stewart, lobbyist for the
American Cancer Society, said raising taxes on cigarettes has proved
to cut smoking, and that the tax on non-cigarette items should be
raised equally to discourage their use. For tobacco retailers, OTP
have become a large percentage of business, as smokers seek savings
by rolling their own.

WEEKLY WELLNESS TIP:

As parents age, it becomes more important for their children to look
after them.

Make it a practice to check your parents' home every six months to
make sure there are no hazards. In particular, test the smoke
detectors, door locks, handrails, and lighting. Also, make sure that
your parents know who to call or what to do if an emergency should
arise.


HFHS IN THE NEWS:
High-Tech Rx for Wellness: Henry Ford West Bloomfield Hospital Opens
Great Lakes IT Report
February 25, 2009
http://www.wwj.com/High-Tech-Rx-for-Wellness--Henry-Ford-West-
Bloomfi/3918581

When the doors to the new Henry Ford West Bloomfield Hospital open
March 15, patients, their families and the community will find a
health care experience offering the latest in medicine, technology
and patient safety, integrated with wellness and prevention programs
all under one roof. The new $360 million hospital with all-private
rooms -- attached to the existing Henry Ford Medical Center-West
Bloomfield -- will provide convenient care close to home for
thousands of Oakland County residents. It is the first new hospital
Henry Ford Health System has built since its flagship hospital in
Detroit opened in 1915 and the seventh hospital in Henry Ford's
regional hospital network. The 730,000-square-foot hospital will be
staffed by 2,300 medical professionals, including 500 primary care
physicians and specialists, once complete. In all, the opening of
Henry Ford West Bloomfield Hospital will create 1,200 new jobs in
Michigan. Modeled after a northern Michigan lodge, the hospital
features Michigan-quarried fieldstone, river rock, and skylights in
its three-story grand atrium, as well as a place for multi-
denominational reflection. Beyond its aesthetically pleasing and
relaxing design, the entire hospital was first and foremost built
with safety in mind. Studies have found that private rooms reduce the
spread of infection, as does the hospital's air filtration system.
And with nurses' work alcoves outside patients' rooms, and mobile
bedside work stations, health care teams can remain close to the
patient, reducing risk of injury and medical errors. Of the 300 beds
at Henry Ford West Bloomfield Hospital, 191 will open March 15. The
remaining beds will open in 2011. Each room includes a view of the
pond and wooded area surrounding the facility. Patient bedrooms have
wireless Internet access, a flat screen TV with on-demand
programming, remote-controlled window treatments, patient-controlled
thermostat and multiple lighting options. In addition, van Grinsven
explains that the new hospital will be the first to introduce
patients to food menus that will contribute to the healing process,
as well as integrated wellness programs designed to promote
restoring, maintaining and improving health status. "Studies have
shown that more and more patients also are seeking out integrative
medicine, but many don't tell their doctor they're doing it. That's
why we've built a bridge between integrative and traditional
medicine, to offer our patients and the community the full spectrum
of therapeutic options," says Bruce Muma, M.D., chief medical officer
for the new hospital. "Each therapy offered at Vita -- both
traditional and integrative -- has been carefully evaluated by a
scientific advisory panel to ensure its safety and effectiveness."
Like all of Henry Ford's hospitals, innovative medical care is at the
heart of Henry Ford West Bloomfield Hospital. It offers full-service
medical and surgical services in orthopedics, obstetrics and
gynecology, urology, neurosurgery and back surgery, pediatric
urology, cardiovascular, women's health, gastroenterology, ear, nose
and throat, cancer and emergency care. Patients will have access to
the latest in technology, including robotic surgery for prostate
cancer, the most accurate non-invasive treatment for cancer called
Novalis Tx -- the only one in the country -- and imaging technology
that includes MRI, PET and CT scanning for real-time visualization of
the patient's condition. Henry Ford designed the hospital to keep the
environment healthy too, and is seeking Leadership in Energy and
Environmental Design certification from the U.S. Green Building
Council. It features a rooftop garden, energy-efficient heating and
cooling systems, as well as high-efficiency equipment and window
systems. Plus, a variety of woodlands and wetlands were preserved to
reduce chemical and irrigation needs, and 3,000 trees have been
planted on the property. There also are plans to create walking and
biking trails in the wooded area surrounding the hospital.



Hospital builds unit for women
New Henry Ford facility in W. Bloomfield to see if female-only area
improves patient care.
The Detroit News
February 26, 2009
http://www.detnews.com/apps/pbcs.dll/article?AID=2009902260401
What do women want? Henry Ford Health System thinks it knows. When
the new $360-million Henry Ford West Bloomfield Hospital opens next
month, it will debut a 16-bed unit for female patients only, hoping
to study whether gender-specific floors improve patient care, or at
least, make women more comfortable during their hospital
stays. "That's really one of the things we want to test," said
Christine Zambricki, the hospital's chief operating and nursing
officer. "Is this an unspoken wish and need of our patients right
now?"  The female-only unit -- a ground-breaker in Metro Detroit,
according to Henry Ford officials -- is on the hospital's third floor
beside pediatrics and maternity. It will differ from a typical
women's health center, where hospitals tend to group women's
services, such as maternity and OB/GYN, because it will accommodate
women with more generalized medical needs, such as recovering from
surgery, Zambricki said. "We may find women are more comfortable
getting out of bed, walking, sitting in a day room" with just other
women around, Zambricki said. Studies show post-surgical patients
heal better when they're able to stretch their legs and walk around,
she added. "We may find it's a healthier environment," she said.
While not necessarily a new concept, female-only areas aren't common
because most hospitals group their admitted patients according to
their illness or medical needs, such as cardiac care or oncology
units. Gender-specific wings used to be the norm, though, and it
wasn't until the 1960s that hospitals integrated their inpatient
floors -- placing women alongside men, said Dr. Dee Fenner, director
of gynecology at the U-M Health System in Ann Arbor.  Before, men and
women were kept separate because hospital beds were arranged in open
halls with little privacy. But with the advent of private and semi-
private rooms, hospitals began grouping patients according to their
illness or complexity of the care to ensure medical expertise is
concentrated in one area, Fenner said. Stays in Henry Ford's female-
only unit are optional and won't cost more, hospital officials said.
And while the majority of the unit's staff also will be women, men
aren't banished from the unit's corridors, where the walls are deep
blue with nothing distinguishing the unit as something for women
only. Male doctors and visitors will be permitted to see patients
there. Hospital officials say they are well-aware of the challenges
in grouping different medical needs on one floor but the practice is
becoming more common. And not all female patients who request the
women-only unit will be admitted, because doctors may determine they
would be better served in another department, Zambricki said. Rather,
she said, the hospital is looking to experiment with the concept and
tweak it as needed. "It's not the 1990s," she said. "We know a lot
more about integrated medicine. We know that women respond
differently to disease than men." And does Henry Ford know what men
want? "We are going to start with women," Zambricki said, and
depending on how that goes, "we may expand it to men."

CEO: Every hospital should be as equipped as new Henry Ford
Luxury facility claims rebuffed
Detroit Free Press
February 26, 2009

Is it a luxury hospital? Nancy Schlichting, president and CEO of the
Henry Ford Health System, Detroit, takes issue with the comment,
which she's heard a few times. "I don't think this is a luxury
hospital. The concepts we have built in are concepts that should be
in every hospital in this country," she said Wednesday in an
interview. Private rooms, accommodations on the same floor for
families of hospitalized patients and good food "aren't wild
concepts," she said. "If we built a hospital today that was like the
other ones we would have failed." She expects the innovations in West
Bloomfield will infiltrate Ford's other hospitals. And like them,
West Bloomfield will provide care to anyone who comes there,
regardless of income and insurance status, she said. "I've spent my
life trying to change the way patients and families experience health
care. Frankly we treat people in health care a lot like the way
prisoners are treated. You put them in semi-private rooms, take away
their clothes; you give them a number and put a band around their
wrist. It's not real appealing."


See additional coverage of the new Henry Ford West Bloomfield
Hospital at:
http://henry.hfhs.org/body.cfm?id=25&action=list

INDUSTRY NEWS:
Health plan proposed
Obama wants $634B to help cover the uninsured by raising taxes on
households earning $250,000-plus.
Associated Press
February 26, 2009
http://www.detnews.com/apps/pbcs.dll/article?AID=2009902260390
President Barack Obama is asking Congress to raise taxes on the
wealthy and cut Medicare costs to provide health care for the
uninsured while making the just-enacted $400 tax cut for most workers
permanent. In his first budget blueprint, Obama proposes setting
aside $634 billion over the next decade to expand government
subsidized health coverage -- a little more than half the money
needed to ensure that every American gets medical care. Obama's
budget proposal would effectively raise income taxes and curb tax
deductions on couples making more than $250,000 a year, beginning in
2011. About half of what officials characterized as a $634
billion "down payment" toward health care coverage for every American
would come from cuts in Medicare. That is sure to incite battles with
doctors, hospitals, health insurance companies and drug
manufacturers. Some of the Medicare savings would come from scaling
back payments to private insurance plans that serve older Americans,
which many analysts believe to be inflated. Other proposals include
charging upper-income beneficiaries a higher premium for Medicare's
prescription drug coverage. To raise the other half, Obama wants to
reduce the rate by which wealthier people can cut their taxes through
deductions for mortgage interest, charitable contributions, local
taxes and other expenses to 28 cents on the dollar, rather than the
35 cents they can claim now.



HEALTH BLOG: Efforts to Cut Health Costs Could Take a Decade to Show
Results
Wall Street Journal
February 25, 2009
For some sobering thoughts on efforts to cut health costs, check out
the Senate testimony given by the head of the Congressional Budget
Office today. Not only are health-care costs growing, but a lot of
the ideas out there to cut them may not result in savings for the
federal government or the nation within a decade, CBO Director
Douglas Elmendorf told the Senate Finance Committee today. That's a
long time, particularly given that federal spending on Medicare and
Medicaid are projected to hit $1.4 trillion in a decade, up from $720
billion this year. A few examples Elmendorf provided: Disease
management programs, in which nurses or other coordinators work with
patients to better manage and treat their chronic illnesses, "can
improve health and may well be cost-effective," Elmendorf said. But
the programs still might not result in overall spending reductions
within 10 years because number of the patients who participate is far
larger than those who avoid expensive care as a result. Requiring
hospitals to adopt electronic medical records would reduce their own
costs for treating Medicare patients. But for the government to
capture the savings, it would in turn have to reduce what it pays the
hospitals. Cutting payments to hospitals who readmit patients because
of avoidable complications could mean savings for Medicare. But
programs like that can be slow to show tangible savings: Readmission
information would have to be gathered and hospitals would have to be
notified before cuts took place.



Study: Big regional differences in Medicare costs
Associated Press
February 25, 2009
http://www.google.com/hostednews/ap/article/ALeqM5ijgp5dnO4
_Vg1XyeyW0MkT7QWwbAD96IRV2G0 (
http://www.google.com/hostednews/ap/article/ALeqM5ijgp5dnO4_Vg1XyeyW0M
kT7QWwbAD96IRV2G0 )
Medicare costs vary wildly across the country, according to a study
that found the government paying twice as much for treating a patient
in Miami as in San Francisco. The dramatic cost differences don't
appear connected to climate or to who lives where, and people in the
more expensive areas don't get better care. More expensive medical
technology is only part of the picture, according to the report
released Wednesday by the Dartmouth Atlas Project, which studies
medical resources. The findings were being published in the New
England Journal of Medicine. The study said the differences in
spending from one area to another can be blamed on decisions made by
individual doctors who are influenced by what medical services are
available nearby. "Technology doesn't drive the growth in health care
spending, people do," said Dr. Elliott Fisher, the lead study author
and a medicine professor at the Dartmouth Institute for Health Policy
and Clinical Practice. Fisher said physicians are not the only issue,
but also questions like whether there's a local medical health race
among local hospitals or whether a community has a single hospital
that is more focused on primary care. Medicare is expected to cost
more than $500 billion this year. The program covers about 44 million
people. The Dartmouth Atlas findings, drawn from an analysis of
government Medicare data from 1992-2006, suggest great inefficiencies
in care in some parts of the country. It also says there is plenty of
room for reform if practices in the regions of the country that are
less expensive could become the national norm. That won't come easy
since the country's medical system frequently rewards expensive
practices, the study notes. For example, hospitals lose money if they
improve care in a way that reduces admissions. Doctors don't have a
financial incentive to spend time carefully listening to a patient
rather than quickly referring them to a specialist. "There are no
financial rewards for collaboration, coordination or conservative
practice," the study said. The study found that among the 25 largest
hospital-referral regions, Manhattan was the costliest, at $12,114
per patient in 2006. Minneapolis was the least expensive, at $6,705
per patient. The authors called on doctors to take the lead in
bringing costs down by opting for conservative care â€" for example,
putting a patient with heartburn on heartburn medication and
monitoring their progress, rather than referring them to a
specialist. But, the study noted, doctors will need help from
policymakers who should change payment systems to reward quality
rather than quantity of care. See the Regional comparisons at:
http://www.rwjf.org/qualityequality/interactive.jsp?id=38




Survey: Health care cost keeps the doctor away
Associated Press
February 26, 2009
http://www.wwj.com/topic/ap_news.php?story=AP/APTV/National/f/f/APFN-
HealthCare-Poll
One in four Americans said in a survey that someone in the family put
off needed health care in the past year because of cost, including 16
percent who postponed surgery or a doctor's visit for chronic
illness. In all, 53 percent of Americans in the Kaiser Family
Foundation poll released Wednesday said they or a family member
living with them cut back on health care in one or more ways to save
money in the past 12 months. Most commonly, they relied on home
remedies or over-the-counter drugs instead of seeing a doctor, or
they skipped a visit to the dentist about a third of respondents
reported doing each. Nearly one in four postponed a recommended
medical test or treatment. Nearly as many didn't fill a prescription,
while 15 percent cut pills in half or skipped doses of medicine.
Seven percent reported problems getting mental health care. Overall,
27 percent said their household postponed needed medical care. That
included 16 percent who put off dealing with at least one serious
problem: 10 percent delayed seeing a doctor for a chronic illness
like diabetes or asthma, 6 percent postponed minor surgery in the
doctor's office and 5 percent delayed major surgery requiring an
overnight hospital stay. And 19 percent each skipped a doctor's visit
for temporary illness or preventive care. As President Barack Obama
vows to reform the health care system, the Kaiser Family Foundation
found consistently high support for that action despite the country's
economic woes: 62 percent said ''it's more important than ever to
take on health care reform now'' while 34 percent said we can't
afford it now. The survey interviewed 1,204 adults by landline and
cell phone from Feb. 3-12.



Lacusta is new president of DMC Surgery Hospital
Crain's Detrot Business
February 25, 2009
Michael P. Lacusta has been appointed president of DMC Surgery
Hospital, replacing Frank P. Iacobell, who has retired after 40 years
with Detroit Medical Center. Lacusta has been DMC's executive vice
president of strategic and business partnerships. As executive vice
president, Duggan said Lacusta renegotiated long-term information
technology agreements, assisted in developing clinical service line
planning, physician partnerships and managed a variety of other DMC
business programs. Lacusta graduated from the University of
Michigan's College of Engineering with a bachelor's degree in
industrial and operations engineering and Marquette University's
School of Business with a master's degree in business and
administration. He is also a fellow with the Chicago-based American
College of Healthcare Executives. DMC operates nine hospitals.



CUSTOMER NEWS:
GM lost $30.9 billion in 2008
Detroit News
February 26, 2009
http://www.detnews.com/apps/pbcs.dll/article?
AID=/20090226/AUTO01/902260438
General Motors Corp. today reported a $30.9 billion loss last year,
the troubled automaker's fourth straight annual loss, as
deteriorating economic and market conditions and questions about the
company's viability continued. Its fourth-quarter net loss last year
was $9.6 billion. For the quarter, GM said it lost $15.71 per share,
compared to a net loss of $1.5 billion, or $2.70 a share for the same
period a year earlier. The results underscore GM's need for up to
$16.6 billion in additional federal loans, a case chairman and CEO
Rick Wagoner will make later today during a meeting with President
Obama's autos team, which is overseeing the automaker's restructuring
and federal loan repayment. GM already has received $13.4 billion,
which helped the troubled automaker avoid running out of money in
December and survive the weakest sales market since the early 1980s.
The automaker and its auditors must determine if there is substantial
doubt about the company's ability to continue as a going concern, GM
said in a statement today. GM, which had lost almost $73 billion in
the last four years, is coping with financial pressures that have
forced the automaker to eliminate 47,000 jobs this year, shutter 14
plants in the next three years and sell, shrink or kill its Saturn,
Saab, Hummer and Pontiac brands. GM also is forcing most of its U.S.
salaried workers to accept temporary pay cuts. If GM fails to show
sufficient progress, the Treasury Department could recall the loans,
forcing bankruptcy.



Ford cuts a painful deal
UAW members will be asked to give up benefits in order to preserve
wages and health care.
Detroit News
February 26, 2009
http://www.detnews.com/apps/pbcs.dll/article?AID=2009902260385
Factory workers at Ford Motor Co. seem ready to ratify a tentative
agreement between the struggling automaker and the United Auto
Workers, if only because they see the alternative as too frightening
to contemplate. Union members began getting details of the proposed
amendment to their 2007 labor contract Wednesday, after UAW leaders
voted unanimously to recommend ratification Tuesday. The new deal
preserves wages and health benefits, but eliminates hundreds of
dollars in bonuses and cost-of-living adjustments, ends the jobs bank
program, changes work rules and allows Ford to pay up to half its
contributions to a union-run retiree health care trust with company
stock. Workers will begin voting on the agreement as early as this
weekend. Retirees also are watching developments closely. "My biggest
concern is the VEBA," said Gerald Borsenik, referring to the
Voluntary Employees' Beneficiary Association, the union-run retiree
health care trust. "Of course, we don't get to vote." He said that is
a sore point with many retired workers, since it is their benefits
that are at stake. The UAW has said it wants all voting on the
proposed agreement to be completed by March 9.


PUBLIC HEALTH/MEDICAL:
Calorie Counters Have It Right, Diet Study Says
Wall Street Journal
February 25, 2009
You aren't what you eat. You're how much. That's the message from a
two-year National Institutes of Health-funded study that assigned 811
overweight people to one of four reduced-calorie diets and found that
all trimmed pounds just the same. It didn't matter what foods
participants ate, but rather how many calories they consumed. An
intense debate has long raged over which dieting regimen is best. Low
carb? High protein? Low fat? But the federal study, one of the
longest of its kind, "really goes against the idea that certain foods
are the key to weight loss," says Frank Sacks, principal investigator
and a professor of cardiovascular-disease prevention at Harvard
School of Public Health. "This is a pretty positive message. It gives
people a lot of choices to find a diet they can stick with." In the
study, published Thursday in the New England Journal of Medicine,
doctors calculated each participant's energy needs, and structured a
diet that had 750 fewer calories than would be necessary to fuel his
or her activity. Typical diets in the study had between 1,400 and
2,000 calories a day. Rudy Termini, a retiree in Cambridge, Mass.,
says that before joining the study, he downed about 2,400 calories a
day. If he dined on T-bone steak, he'd make it a one-pounder. "I just
didn't need all that food," says the 69-year-old and former owner of
a telecommunications company. Mr. Termini, who is 5 feet 11 inches
tall, says he dropped to 175 pounds from 195 pounds and lost
his "little pot belly" by limiting himself to 1,800 calories a day.
Mr. Termini says he stuck with the diet because he could eat what he
enjoys, but just smaller portions -- his steak choice now is a small
fillet. He says he's kept the weight off since the study ended. The
message is that dieting may be "much simpler" than everyone thought,
says Catherine Loria, a nutritional epidemiologist at the NIH and co-
author of the study. Along with choosing healthful foods, "all you
have to do is count your calories." The findings could influence
public policy through efforts to require more disclosure of calorie
counts in prepared food, she says.

SURA 2:3-10

Who believe in the Unseen, and establish worship, and spend of that
We have bestowed upon them; (3) And who believe in that which is
revealed unto thee (Muhammad) and that which was revealed before
thee, and are certain of the Hereafter. (4) These depend on guidance
from their Lord. These are the successful. (5) As for the
Disbelievers, Whether thou warn them or thou warn them not it is all
one for them; they believe not. (6) Allah hath sealed their hearing
and their hearts, and on their eyes there is a covering. Theirs will
be an awful doom. (7) And of mankind are some who say: We believe in
Allah and the Last Day, when they believe not. (8) They think to
beguile Allah and those who believe, and they beguile none save
themselves; but they perceive not. (9) In their hearts is a disease,
and Allah increaseth their disease. A painful doom is theirs because
they lie.(10)

SURA 2:30-39
And when thy Lord said unto the angels: Lo! I am about to place a
viceroy in the earth, they said: Wilt thou place therein one who will
do harm therein and will shed blood, while we, we hymn Thy praise and
sanctify Thee? He said: Surely I know that which ye know not. (30)
And He taught Adam all the names, then showed them to the angels,
saying: Inform Me of the names of these, if ye are truthful. (31)
They said: Be glorified! We have no knowledge saving that which Thou
hast taught us. Lo! Thou, only Thou, art the Knower, the Wise. (32)
He said: O Adam! Inform them of their names, and when he had informed
them of their names, He said: Did I not tell you that I know the
secret of the heavens and the earth? And I know that which ye
disclose and which ye hide. (33) And when We said unto the angels:
Prostrate yourselves before Adam, they fell prostrate, all save
Iblis. He demurred through pride, and so became a disbeliever. (34)
And We said: O Adam! Dwell thou and thy wife in the Garden, and eat
ye freely (of the fruits) thereof where ye will; but come not nigh
this tree lest ye become wrong-doers. (35) But Satan caused them to
deflect therefrom and expelled them from the (happy) state in which
they were; and We said: Fall down, one of you a foe unto the other!
There shall be for you on earth a habitation and provision for a
time. (36) Then Adam received from his Lord words (of revelation),
and He relented toward him. Lo! He is the relenting, the Merciful.
(37) We said: Go down, all of you, from hence; but verily there
cometh unto you from Me a guidance; and whoso followeth My guidance,
there shall no fear come upon them neither shall they grieve. (38)
But they who disbelieve, and deny Our revelations, such are rightful
owners of the Fire. They will abide therein. (39)

Lo! nothing in the earth or in the heavens is hidden from Allah. (5)
He it is Who fashioneth you in the wombs as pleaseth Him. There is no
God save Him, the Almighty, the Wise. (6) He it is Who hath revealed
unto thee (Muhammad) the Scripture wherein are clear revelations - they
are the substance of the Book - and others (which are) allegorical. But
those in whose hearts is doubt pursue, forsooth, that which is
allegorical seeking (to cause) dissension by seeking to explain it.
None knoweth its explanation save Allah. And those who are of sound
instruction say: We believe therein; the whole is from our Lord; but
only men of understanding really heed. (7) Our Lord! Cause not our
hearts to stray after Thou hast guided us, and bestow upon us mercy
from Thy Presence. Lo! Thou, only Thou, art the Bestower. (8) Our Lord!
Lo! it is Thou Who gatherest mankind together to a Day of which there
is no doubt. Lo! Allah faileth not to keep the tryst. (9) (On that Day)
neither the riches nor the progeny of those who disbelieve will aught
avail them with Allah. They will be fuel for Fire. (10) Like Pharaoh's
folk and those who were before them, they disbelieved Our revelations
and so Allah seized them for their sins. And Allah is severe in
punishment. (11) Say (O Muhammad) unto those who disbelieve: Ye shall
be overcome and gathered unto Hell, an evil resting-place. (12)

HFHS IN THE NEWS:
Posh birthing center offers midwife service, too
Observer & Eccentric
March 2, 2009
http://www.hometownlife.com/article/20090301/NEWS23/903010398
New moms will be treated like royalty at the new Henry Ford West
Bloomfield Hospital. "There's no greater joy than bringing a new life
into the world," said Dr. Brent Davidson, service chief for women's
health at the new hospital. "We want to give them the best experience
possible." And that includes state-of-the-art rooms, with flat-screen
TVs, made-to-order meals and a choice of a room (all are private)
with hydrotherapy tubs to ease labor pains. There will be four
certified nurse midwives on staff. "The goal is to give women the
kind of birth they want, and as long as it's safe, we'll do it,"
certified nurse midwife Janice McIntosh said. Using a midwife is an
up-and-coming practice. About 30 percent of the babies born at Henry
Ford Hospital in Detroit last year were delivered with the help of a
midwife, McIntosh said. "I think there is a little stereotype of the
midwife who visits the log cabin in the olden days," said McIntosh,
who works at an office in Canton. "But we're registered nurses with
master's degrees. It's required that we work with a physician."
Midwives admit and assess their patients at the hospital and help
manage labor, by administering medication or just providing extra
moral support. However, midwives don't perform Caesarean sections and
usually don't work with high-risk or oncology patients. New moms stay
in the same room until they go home. Dads can also stay nearby on a
fold-out couch. The rooms also have special sinks for baby's first
bath and for new parents to learn how to bathe their baby. "The
overall focus of the birthing center is family-friendly," McIntosh
said. "Families can begin bonding at the hospital."



Henry Ford Hospice seeks volunteers
Detroit News
March 3, 2009

Henry Ford Hospice seeks volunteers to offer companionship to people
who are terminally ill and living at home or in nursing facilities or
the hospital. Volunteers also help provide support for their loved
ones and relatives. Opportunities are available through southeast
Michigan for the adult and pediatric hospice program, and for
SandCastles, a grief support program for children and their families.
Flexible schedules are offered. For information, call (800) 492-9909
or visit www.henryford.com/hospice.



For more HFHS news, read the Monday, March 2 Monitor at:
http://henry.hfhs.org/body.cfmxyzpdqabc=0&id=221&action=detail&ref=193
5&ArticleRefs=
1933,1935,1936,1937,1934&issueref=269 (
http://henry.hfhs.org/body.cfmxyzpdqabc=0&id=221&action=detail
&ref=1935&ArticleRefs=1933,1935,1936,1937,1934&issueref=26
9 )


INDUSTRY NEWS:
Freep.com to host Web chat on buying health plans
Detroit Free Press
March 3, 2009
http://www.freep.com/article/20090303/BUSINESS06/903030347/1002/BUSINE
SS/
Freep.com+to+host+Web+chat+on+buying+health+plans (
http://www.freep.com/article/20090303/BUSINESS06/903030347/1002/BUSINE
SS/Freep.com+to+host+Web+chat+on+buying+health+plans )
Many people are losing their jobs and health benefits and are buying
health insurance for the first time. To help, the Free Press will
host a Web chat at 11 a.m. Wednesday on how to buy health insurance.
Participants will be Richard Murdock, executive director, Michigan
Association of Health Plans, representing 21 Michigan HMOs; Joel
Clark, president of J.S. Clark, a Southfield employment-benefits
consulting firm, and Jason Moon, public information officer for
Michigan's Office of Financial and Insurance Regulation. Detroit Free
Press medical writer Patricia Anstett is to moderate the chat.



Two insurers move into Blues' turf
Increased competition may mean more choices, cheaper rates for Metro
consumers.
Detroit News
March 3, 2009
http://detnews.com/apps/pbcs.dll/article?AID=/20090303/BIZ/903030379
Blue Cross Blue Shield of Michigan, the state's largest insurer, is
facing stiffening competition on its own turf in the group and
individual health insurance market. Michigan-based insurers Priority
Health in Grand Rapids and Flint-based McLaren Health Plan are
quickly expanding in Metro Detroit, where Blue Cross has its
headquarters. The two newcomers are rolling out new health plans that
give consumers more options and, in some cases, cheaper rates for
medical insurance. They are eyeing the group insurance market,
selling benefits to employers in the state's most populous region,
but Priority also plans to launch a product line this year for the
self-insured -- people who aren't covered by their employers. The new
individual plans are designed to go head-to-head with self-insured
plans offered by Blue Cross and Detroit-based Health Alliance Plan,
the state's No. 2 insurer with more than 545,000 members. "If you
look at the concentration of business, there is room for healthy
competition among high-quality health plans," said Michael Koziara,
Priority's vice president for network strategy in the eastern region.
For consumers, the arrival of new insurance plans could bring healthy
competition that drives down rates and results in better service and
more options in selecting plans, industry observers say. For the new
insurers, the faltering economy could help business as cost-conscious
employers are more inclined to shop for cheaper rates or plans with
more variety, said Patrick Pennefather, president of the Michigan
Association of Health Underwriters, which represents health insurance
agents and buyers for employer groups. Since entering the Metro
Detroit market, Priority has undercut Blue Cross pricing for group
health by 5 percent to 15 percent, causing Blue Cross to react with
markdowns, Pennefather said. Blue Cross officials said the company
has responded with innovations, offering new plans that better suit
client needs. With a half-million members in western Michigan,
Priority is no small player. The insurer entered the Metro Detroit
market two years ago with the purchase of Care Choices Health Plan
from Trinity Health Priority, and now counts 94,000 members in
eastern Michigan. It also has expanded its network to include 1,000
doctors and Beaumont Hospitals. Priority has also ramped up its
marketing in Metro Detroit, lining major thoroughfares with
billboards touting itself as "the new alternative." Priority has yet
to release details on its individual plans -- they are in development
and must receive state approval -- but the offerings could hit the
market later this year. Their arrival comes as Blue Cross seeks to
hike rates on its individual insurance plans, including an average 56
percent increase in non-group coverage. Whether Priority's new
individual plans will give Blue Cross formidable competition depends
on whether Priority plans to medically underwrite its policies,
meaning it will base rates and coverage on an applicant's health
information, Pennefather said. "If Priority Health comes in offering
products on a non-medically underwritten basis, that will create a
lot of competition and some good competition for Blue Cross,"
Pennefather added. Priority officials said the insurer has not yet
determined whether it will base rates and coverage on a patient's
medical background. Meanwhile, McLaren Health Plans, the health
insurance arm of McLaren Health Care in Flint, has pushed south into
Metro Detroit, selling coverage to employer groups. Its entry comes
as McLaren also expands its footprint locally as a medical provider.
It has already bought two hospitals in the region and plans to open a
new medical center in Clarkston in May. "Ultimately, that's our goal:
to be one of the main health insurers in Michigan," said Ed Harden,
vice president of sales for McLaren Health Plans, which has about
200,000 members in 21 counties. For now, McLaren plans to stick with
selling group plans, but Harden said the individual market "is
certainly on our radar." The individual market has also become a
major growth segment for Health Alliance Plan, owned by Henry Ford
Health Systems. In 2006, the insurer launched SOLO, a product geared
toward the self-insured. But even with growing competition, the
insurer doesn't plan to lower prices. "We won't get into a price
war," said Michael Flasch, vice president for corporate product
development at HAP, noting that individual products don't typically
bring large profit margins. "We'll have to show our members that we
can provide value." The new competition could help alter the
landscape for health insurance in Metro Detroit, making it more
attractive to other insurers that have been reluctant to enter the
market. "If the market were to splinter, it could become more of a
multiplayer market," Pennefather said. "As long as Blue Cross has 50
percent or more market share, companies either have to dip their foot
in slowly or be cautious."



Blue Cross posts loss of $144.9M for 2008
The net deficit, which is attributed to prices of its individual
health policies, is firm's first since 1988.
Detroit News
March 3, 2009
http://www.detnews.com/apps/pbcs.dll/article?AID=2009903030354
Blue Cross Blue Shield of Michigan posted a $144.9 million loss in
2008 on consolidated revenue of $21.2 billion, mostly due to red ink
flowing from its individual health insurance policies, which racked
up a $133.2 million loss in that same one-year period, Blue Cross
officials said Monday. In 2007, Blue Cross lost about $134 million on
individual insurance policies, making last year's results a slight
improvement. Still, Blue Cross said its losses in the individual
market are significant and accumulating year-by-year, despite having
raised rates on individual plans in 2008. Overall, the nonprofit
insurer lost $128.1 million on health underwriting for all of its
plans under Blue Cross and subsidiary HMO, Blue Care Network. But
because some were profitable, they helped mitigate deeper losses from
individual policies. Blue Cross also grew its consolidated revenue in
2008 to $21.1 billion from $19.4 billion the year before, in part
because of increased enrollment in its Medicare Advantage and
Medicare Part D plans. To bolster weakening finances, Blue Cross
filed a rate increase in January for its individual insurance plans
asking for average increases on three types of policies: 56 percent
on individual plans; 42 percent on group conversion coverage; and 31
percent for Medicare supplemental plans. Blue Cross attributed last
year's loses to a "broken regulatory system," which allows for-profit
insurers to cherry-pick healthy customers and leave the sickest --
and most costly -- to Blue Cross. "It was the individual market that
dragged down our financial performance," CEO Daniel Loepp said. Blue
Cross state-regulated cash reserves stand at $2.25 billion in 2008, a
drop from $2.41 billion the year before, but are in line with
requirements by state regulators.



FROM OUR READERS: Progress on health insurance
Detroit Free Press
March 3, 2009
http://www.freep.com/apps/pbcs.dll/article?AID=2009903030332
By Tom George, State senator, District 20, Kalamazoo

In the Feb. 22 editorial "Don't delay cure for Blues" the Free Press
concluded that work on health insurance reform in Michigan has come
to a halt. Let me set the record straight. The Senate is working
hard, looking for ways to make insurance more accessible and
affordable. Last year, the state House passed measures promoted by
Blue Cross Blue Shield of Michigan to change laws governing the
individual health insurance market. After due consideration, the
Senate adopted an alternative proposal. It was not possible to
reconcile the competing proposals that expired when the Legislature
adjourned in December. Building on the knowledge base that was
acquired during that process, the Michigan Senate is working
diligently to move the debate forward. Rather than act as a referee
in a contest between competing insurance interests, we are looking at
what is best for the people of Michigan. To that end, we are now
engaged in a effort to craft legislation with the aim of making
insurance more affordable and available to our citizens. Michigan
spends billions of dollars each year on health care, yet we have more
than 1 million uninsured, and as a state we remain unhealthy. Instead
of waiting for a national solution to our health care problems,
Michigan should move forward now. Other states have taken the
initiative, and there is no reason that Michigan should wait. Earlier
this year, Senate Majority Leader Mike Bishop, R-Rochester, asked me
to lead a bipartisan work group on health insurance accessibility and
affordability. This work group has already met five times and taken
testimony from dozens of people. In order to study local initiatives
aimed at providing care to the uninsured, the work group recently
held hearings in Muskegon, Grand Rapids and Saginaw. We are also
studying what other states have done. Any proposal to make health
insurance more accessible and affordable to the uninsured necessarily
involves reforming the individual market, and to the degree it is
successful, will decrease the burden on BCBSM. The goal, however, is
not to bail out the Blues at the expense of others; the goal is
helping the thousands of families that are struggling to obtain
health insurance at an affordable price.



Health Blog: Insurers Control Quantity Over Quality in Medical Imaging
Wall Street Journal
March 2, 2009
http://blogs.wsj.com/health/2009/03/02/insurers-control-quantity-over-
quality-in-medical-imaging/
When it comes to medical imaging like CT scans and MRIs, the
insurance industry has been spending resources trying to curb
unnecessary tests. But the issue with scans isn't just quantity: It's
also quality. Insurers pay the same for scans done in decade-old
machines and newer models, even though the differences of the images
can be significant, the New York Times reports. They also don't
distinguish between scans done well or poorly or interpreted by more-
or less-qualified physicians, NYT says. Differences in scan quality
have a real impact on patients and the cost of their care. Linking
pay to quality may be especially tough in medical imaging. Insurers
don't receive the images and reports, making it impossible for them
to know whether the scans are high quality, a spokeswoman for the
trade group America's Health Insurance Plans told NYT. So even as
radiology benefit management becomes more widely used and has made
its way into President Obama's budget blueprint, it's easier to focus
on quantity.



Obama picks 2 to help him revamp health care system
Sebelius, DeParle are steady hands
Associated Press
March 3, 2009
http://www.freep.com/apps/pbcs.dll/article?AID=2009903030378
President Barack Obama turned to Kansas Gov. Kathleen Sebelius on
Monday to help him overhaul a health care system whose cost has risen
four times as fast as people's wages in recent years. "Health care
reform that reduces costs while expanding coverage is no longer just
a dream we hope to achieve; it's a necessity we have to achieve,"
Obama said as he introduced Sebelius as his choice to be secretary of
health and human services and Nancy-Ann DeParle, a health policy
figure during the Clinton administration, to head the White House
Office for Health Reform. The president also said he would release
$155 million in the $787-billion, economic-stimulus measure to
support 126 new health centers to give people more access to primary
and preventive care. He said he was mindful of the difficulty ahead
as he seeks to expand health care coverage, expecting tough choices
and likely tradeoffs. If confirmed, Sebelius will assume her new role
as the recession is taking its toll on Medicare, which provides
health care for older and disabled people. Plunging tax revenues have
weakened the program's hospital fund, accelerating its projected
insolvency to as early as 2016. That is only about five years after
the first baby boomers will start signing up for services.



U-M names pediatric doctor new health chief
Detroit News
March 3, 2009
http://www.detnews.com/apps/pbcs.dll/article?
AID=/20090303/BIZ/903030341/1001
University of Michigan has named Dr. Ora Hirsch Pescovitz to lead U-M
Health System as its new CEO. A nationally-recognized pediatric
endocrinologist, Pescovitz also will serve as the university's
executive vice president for medical affairs. She comes to Ann Arbor
from Indiana University, where she was the medical school's executive
associate dean for research affairs.  U-M President Mary Sue Coleman
said Pescovitz joins the university at a "critical juncture",
following U-M's purchase of the former Pfizer Inc. campus, a facility
ripe for growth and scientific research. In her new role, Pescovitz
will oversee the entire health system, including its hospitals.



WELLNESS:
Step up your workout the old-fashioned way
New York Times/Detroit News
March 3, 2009
http://www.detnews.com/apps/pbcs.dll/article?AID=2009903030387
Eighteen years ago, Ronnie Guie considered buying a treadmill or a
stair-climbing machine to stay in shape. Then one day on his lunch
hour at Con Edison in New York, two co-workers invited Guie to take a
walk to the top of the 10-floor building. He was breathing heavily by
the time he got there, but was hooked: He had found his workout for
free. At 59, Guie says he still has the same waist size (30 inches)
and weight range (150 to 155 pounds) that he did when he was 17,
thanks to his five-day-a-week regimen. He climbs the concrete stairs
usually 10 times or so in an hour, depending how much time he has. "I
get the results out of it -- and it's not easy," he says. "But I
always feel great."  Stairs are everywhere, of course, but they are
rarely embraced as an option for getting into shape. They await in
the stale air wells of tall office buildings, or on stationary
machines in the corners of health clubs now inundated by the more
popular, but less strenuous, elliptical machines. Stairs provide a
workout that returns maximum value in minimum time, with low impact.
And going up is much better for your knees than going down. "Stair
climbing will give you a little more bang for your buck because of
the vertical component," says Cedric Bryant, chief science officer
for the American Council on Exercise. Compared to jogging or cycling
at a moderate pace without much of an incline, stair climbing, Bryant
says, "will be a bit more challenging and, therefore, allow you to
burn more calories for that same amount of time."

I want to meet you. Give me a chance! Click here to chat with me online:
http://kydeluxe.zoomshare.com/files/chat.htm

SURA 4:49 – 57    In the name of Allah, the Beneficent, the Merciful


Hast thou not seen those who praise themselves for purity? Nay, Allah purifieth
whom He will, and they will not be wronged even the hair upon a date-stone. (49)
See, how they invent lies about Allah! That of itself is flagrant sin. (50) Hast
thou not seen those unto whom a portion of the Scripture hath been given, how
they believe in idols and false deities, and how they say of those (idolaters)
who disbelieve: "These are more rightly guided than those who believe"? (51)
Those are they whom Allah hath cursed, and he whom Allah hath cursed, thou (O
Muhammad) wilt find for him no helper. (52) Or have they even a share in the
Sovereignty? Then in that case, they would not give mankind even the speck on a
date-stone. (53) Or are they jealous of mankind because of that which Allah of
His bounty hath bestowed upon them? For We bestowed upon the house of Abraham
(of old) the Scripture and wisdom, and We bestowed on them a mighty kingdom.
(54) And of them were (some) who believed therein and of them were (some) who
disbelived therein. Hell is sufficient for (their) burning. (55) Lo! Those who
disbelieve Our revelations, We shall expose them to the Fire. As often as their
skins are consumed We shall exchange them for fresh skins that they may taste
the torment. Lo! Allah is ever Mighty, Wise. (56) And as for those who believe
and do good works, We shall make them enter Gardens underneath which rivers flow
- to dwell therein for ever; there for them are pure companions - and We shall
make them enter plenteous shade. (57)

SURA 4:62 – 70    In the name of Allah, the Beneficent, the Merciful

How would it be if a misfortune smote them because of that which their own hands
have sent before (them)? Then would they come unto thee, swearing by Allah that
they were seeking naught but harmony and kindness. (62) Those are they, the
secrets of whose hearts Allah knoweth. So oppose them and admonish them, and
address them in plain terms about their souls. (63) We sent no messenger save
that he should be obeyed by Allah's leave. And if, when they had wronged
themselves, they had but come unto thee and asked forgiveness of Allah, and
asked forgiveness of the messenger, they would have found Allah Forgiving,
Merciful. (64) But nay, by thy Lord, they will not believe (in truth) until they
make thee judge of what is in dispute between them and find within themselves no
dislike of that which thou decidest, and submit with full submission. (65) And
if We had decreed for them: Lay down your lives or go forth from your dwellings,
but few of them would have done it; though if they did what they are exhorted to
do it would be better for them, and more strengthening; (66) And then We should
bestow upon them from Our presence an immense reward, (67) And should guide them
unto a straight path. (68) Whoso obeyeth Allah and the messenger, they are with
those unto whom Allah hath shown favour, of the prophets and the saints and the
martyrs and the righteous. The best of company are they! (69) That is bounty
from Allah, and Allah sufficeth as Knower. (70

I will start deleting members who do not respond to any messages or submit new
ones…. Once this happens you will need to request to be added to my Yahoo page
to correspond with any of our members…. I will leave this message up for 30 days
starting from today (09 March 2009) after that you will be deleted. No other
messages will be kept or accepted  if it does not meet the requirement of basic
outline in my introduction. No sexually implicit messages or solicitation will
be permitted on this site.

THE BOOK OF THE SECRETS OF ENOCH.

part of the "Forgotten" books of Eden

THIS new fragment of early literature came to light through certain manuscripts
which were recently found in Russia and Servia and so far as is yet known has
been preserved only in Slavonic. Little is known of its origin except that in
its present form it was written somewhere about the beginning of the Christian
era. Its final editor was a Greek and the place of its composition Egypt. Its
value lies in the unquestioned influence which it has exerted on the writers of
the New Testament. Some of the dark passages of the latter being all but
inexplicable without its aid.
Although the very knowledge that such a book ever existed was lost for probably
1200 years, it nevertheless was much used by both Christian and heretic in the
early centuries and forms a most valuable document in any study of the forms of
early Christianity.
The writing appeals to the reader who thrills to lend wings to his thoughts and
fly to mystical realms. Here is a strange dramatization of eternity--with views
on Creation, Anthropology, and Ethics. As the world was made in six days, so its
history would be accomplished in 6,000 years (or 6,000,000 years), and this
would be followed by 1,000 years of rest (possibly when the balance of
conflicting moral forces has been struck and human life has reached the ideal
state). At its close would begin the 8th Eternal Day, when time should be no
more.

Sura 3:19      In the name of Allah, the Beneficent, the Merciful

O ye who believe! It is not lawful for you forcibly to inherit the women (of
your deceased kinsmen), nor (that) ye should put constraint upon them that ye
may take away a part of that which ye have given them, unless they be guilty of
flagrant lewdness. But consort with them in kindness, for if ye hate them it may
happen that ye hate a thing wherein Allah hath placed much good. (19)

Sura 4:4 - 5        In the name of Allah, the Beneficent, the Merciful


And give unto the women (whom ye marry) free gift of their marriage portions;
but if they of their own accord remit unto you a part thereof, then ye are
welcome to absorb it (in your wealth). (4) Give not unto the foolish (what is
in) your (keeping of their) wealth, which Allah hath given you to maintain; but
feed and clothe them from it, and speak kindly unto them. (5)

SURA 4:11 - 14     In the name of Allah, the Beneficent, the Merciful


Allah chargeth you concerning (the provision for) your children: to the male the
equivalent of the portion of two females, and if there be women more than two,
then theirs is two-thirds of the inheritance, and if there be one (only) then
the half. And to of his parents a sixth of the inheritance, if he have a son;
and if he have no son and his parents are his heirs, then to his mother
appertaineth the third; and if he have brethren, then to his mother appertaineth
the sixth, after any legacy he may have bequeathed, or debt (hath been paid).
Your parents or your children: Ye know not which of them is nearer unto you in
usefulness. It is an injunction from Allah. Lo! Allah is Knower, Wise. (11) And
unto you belongeth a half of that which your wives leave, if they have no child;
but if they have a child then unto you the fourth of that which they leave,
after any legacy they may have bequeathed, or debt (they may have contracted,
hath been paid). And unto them belongeth the fourth of that which ye leave if ye
have no child, but if ye have a child then the eighth of that which ye leave,
after any legacy ye may have bequeathed, or debt (ye may have contracted, hath
been paid). And if a man or a woman have a distant heir (having left neither
parent nor child), and he (or she) have a brother or a sister (only on the
mother's side) then to each of them twain (the brother and the sister) the
sixth, and if they be more than two, then they shall be sharers in the third,
after any legacy that may have been bequeathed or debt (contracted) not injuring
(the heirs by willing away more than a third of the heritage) hath been paid. A
commandment from Allah. Allah is Knower, Indulgent. (12) These are the limits
(imposed by) Allah. Whoso obeyeth Allah and His messenger, He will make him
enter Gardens underneath which rivers flow, where such will dwell for ever. That
will be the great success. (13) And whoso disobeyeth Allah and His messenger and
transgresseth His limits, He will make him enter Fire, where he will dwell for
ever; his will be a shameful doom. (14)

SURA 4:24 - 27   In the name of Allah, the Beneficent, the Merciful


And all married women (are forbidden? unto you) save those (captives) whom your
right hands possess. It is a decree of Allah for you. Lawful unto you are all
beyond those mentioned, so that ye seek them with your wealth in honest wedlock,
not debauchery. And those of whom ye seek content (by marrying them), give unto
them their portions as a duty. And there is no sin for you in what ye do by
mutual agreement after the duty (hath been done). Lo! Allah is ever Knower,
Wise. (24) And whoso is not able to afford to marry free, believing women, let
them marry from the believing maids whom your right hands possess. Allah knoweth
best (concerning) your faith. Ye (proceed) one from another; so wed them by
permission of their folk, and give unto them their portions in kindness, they
being honest, not debauched nor of loose conduct. And if when they are
honourably married they commit lewdness they shall incur the half of the
punishment (prescribed) for free women (in that case). This is for him among you
who feareth to commit sin. But to have patience would be better for you. Allah
is Forgiving, Merciful. (25) Allah would explain to you and guide you by the
examples of those who were before you, and would turn to you in mercy. Allah is
Knower, Wise. (26) And Allah would turn to you in mercy; but those who follow
vain desires would have you go tremendously astray. (27)

Brief on Race and Genetic Determinism
Race Bibliography
The (recent) completion of the Human Genome Project has led many in the
scientific community to speculate that we are quickly approaching a time when
medicines will be "tailored" to the unique genetic characteristics of each
individual. Yet, the time needed to develop the technologies for such
treatments, and the associated costs, may keep them from being used in the near
future. In the meantime, a push to address health disparities, treat disease,
and evaluate disease-risk, has led to a re-invigoration of categories that had,
until recently, been considered outside the realm of human biology. Yet, the use
of race in biomedical research has been defended by some biologists as
appropriate for assessing individuals' disease risk and other factors associated
with health.
The re-invigoration of the use of race as a category has also led to the
development of the first race-based drug, BiDil, which became available on the
US market in 2005 [1]. Prescribed as a treatment for heart failure in
African-Americans, BiDil has won the support of many scientists and physicians
and even professional groups such as the Association of Black Cardiologists [2].
It has been called the first tailored treatment—one that may address differences
in disease-risk for a particular group. Yet whether the drug is effective in
treating heart failure only in African-Americans remains unclear.
The U.S. Food and Drug Administration's approval of BiDil has resulted in a
range of reactions from science and advocacy groups nationwide. A 2005 op-ed
piece for the New York Times [3], written by British biologist Armand Marie
Leroi, indicates how some scientists regard the issue of race and biology. In
his essay, Leroi argues that collections of outward features such as hair color,
skin color, and nose shape are characteristics that reflect important natural
divisions between groups. Other scientists maintain that humans cannot be
classified into discrete categories such as those described in Leroi's
essay—that a long history of migration and mating between groups, among other
factors, has prevented this. These debates highlight the problems inherent in
discussing a term that has many definitions yet no parameters. In the early
1970's, Richard Lewontin, a Harvard geneticist, revealed that the vast majority
of human genetic variation occurs within, rather than between, groups [4]. His
work and that of others have led to a general consensus among biologists that
race is not a scientific concept but a social one and that efforts to include it
as a meaningful category in science can be misleading.
Yet, there is a growing investment in genetic research in pharmaceutical and
other biomedical treatments for medical conditions. Efforts to locate the
genetic basis of disease are aimed, ostensibly, at improving health outcomes;
advocates state that investigations which use race as a variable will result in
improved treatments for disadvantaged groups. But race is an ill-defined
variable. The use of race does not provide a rigorous scientific basis from
which to gain information about a person's biology. Findings from numerous
studies suggest that, while in some cases a person's race may provide
information about the probability that they may be at risk for developing some
diseases, it can also mask the probability of their risk for developing others
[5]. The human species is 99.9 percent the same genetically. The remaining 0.1%
of variation accounts both for differences that are visible, such as eye and
hair color, and those that are not seen, such as disease-risk. Yet these unseen
differences are not consistently represented by an individual's racial
designation. Additionally, though a handful of diseases have been shown to occur
more often in some groups than in others, these conditions are not isolated to
those groups. This makes it very difficult to make accurate calculations based
on an individual's inclusion in a specific group.
Meanwhile, a range of new genetic technologies has added a somewhat complicated
feature to concepts of biology, race, and human rights.  Recently, an industry
has emerged whose products may confuse notions of race with biology. The number
of companies offering "personal genetic history" analysis has grown over the
past decade, reflecting an ongoing public interest in both family and ethnic
origins. Many of these companies previously specialized in genealogical research
but have expanded the range of their services to encompass the analysis of DNA
to trace human lineages back to a geographical region of origin. Much as the
1980's TV series chronicle "Roots [6]," on ABC, offered an historical identity
to the African-American community, personal genetic history analysis has been
framed as a way for individuals to find their own specific biological "roots."
Press attention has been devoted to the robust response this new technology has
elicited from the public. Many human-interest stories have focused on
individuals who have purchased ancestry information as a way of drawing a
connection to the possible ethnic identities of their ancestors. High-profile
public figures, such as talk show host Oprah Winfrey, have used the technology.
Winfrey's recent announcement, on her show, that she is descended from a
well-known tribe in Africa [7] touched on how these tests are often perceived by
consumers as providing a connection to ethnic identity.
Some of these companies have made efforts to underscore that they are not
conducting "race" tests. Yet the marketing strategies they employ send an
implicit message. An example is illustrated by the DNA Print Genomics web page
[8], dedicated to ancestry testing products. On this page, the photos of four
individuals appear prominently. Though the photos are not labeled, the physical
appearance of each individual fits some of the classically defined descriptions
of race made by anthropologists. The text on the web page suggests that the
groupings reflect descent from particular geographical regions such as East
Asia, Europe, Africa, and the Americas, and the presence of the photos suggests
that physical appearance can reflect this descent.  But appearance is often how
individuals are racially classified as well. This could lead consumers to
confuse notions of race with ancestry —and to assume that personal genetic
history analysis tests for race. Consumers may take away from such
advertisements the idea that race is "coded" into human genes.
Speculations about race and biology have a long history. And though more
sophisticated terminology regarding genetics and human ancestry dominates in
contemporary academic papers, popular press articles continue to reflect
perspectives about race and biology that were popular at the turn of the
century. A review of the history of race and science reveals how outdated ideas
about race continue to influence contemporary lay understanding.
A Short History of Race and Science
Throughout the world, and depending upon the time, notions of race have varied
widely. Race has been used as a way of defining human differences at least as
far back as ancient Egypt. In the Book of Gates, a detailed text of the
afterlife, Egyptians, Nubians, Asiatics, and Libyans were described as distinct
peoples [9]. Whether an individual was designated black, white, yellow, red, or
of any other racial/ethnic group, depended upon the cultural context. For
instance, the "one drop of blood" rule, employed in the southern part of the
United States during the eighteenth and nineteenth centuries, stated that an
individual with any non-white ancestry was "black." The rule was based on the
belief that the races had different kinds of blood as well as corresponding
social and intellectual capacities [10]. At different points in history,
individuals with ancestry from regions of Africa, the Middle East, or India,
among others, have been considered "black," and "white" by different societies.
In scientific discourse, race first appeared as a category during the eighteenth
century [11] when folk notions of blood were transformed into scientific ideas.
At that time, anthropologists developed these notions into categories for
dividing up the species. Different theorists identified anywhere from three to
thirty groupings but the most commonly accepted number of categories was five:
Negroid, Caucasoid, Mongoloid, Capoid, and Australoid [12]. Criteria were based
primarily on living in certain regions of the world and on physical features,
such as hair texture, skin color, and face shape. Today, these categories still
tend to capture concepts of race, but definitions have been broadened to include
religious, cultural, historical, and socio-economic status as well. Thus, the
parameters constructed to define race remain fluid and inconsistent despite
their translation into biological classifications a few hundred years ago.
During the eighteenth, nineteenth and part of the twentieth centuries, race was
thought to represent deeper biological realities that were believed to affect
characteristics like morality or intelligence. Johann Blumenbach, a German
biologist and social philosopher, was one of the first to connect the subjects
of race and biology. His literary piece that detailed an analysis of human
skulls, On theNatural Varieties of Mankind, was published in 1795 [13]. Claiming
that a skull found in the Caucasus Mountains was a beautiful and ultimately
superior form compared to skulls of the "diverging" races, he laid the
groundwork for future claims of white biological superiority. His racial
designations were widely adopted and reflected, to some extent, peoples'
geographic region of origin, but were largely based on the skin colors "white,
yellow, black, red, and brown." The facial characteristics of these human
hierarchies were often interpreted in highly subjective terms. For instance, the
sallow color and folds of skin around the eyes of the then-termed "yellow"
Mongolians were interpreted as a sign of craftiness. In contrast, the high
forehead of a Caucasian was seen as setting "whites" at the farthest remove from
lower animals, particularly apes.
Some historians have argued that science was being used as a vehicle to
substantiate socially constructed racial hierarchies. Tying race to biology
served to further strengthen the idea that some groups were superior to others.
A notable declaration of this type was made by [prominent political figure and
founding father] Thomas Jefferson. In what can be assumed as an effort to
justify the practice of slavery in the new democracy, Jefferson wrote
extensively of the "suspicions" that Blacks were inferior to Whites. Jefferson
owned many slaves who worked on his plantation in Virginia. Without the
availability of the free labor, he, like many wealthy white landowners, would
have struggled to retain his economic and socially powerful position as a leader
of the new nation. Jefferson addresses the question of the emancipation of
African slaves in his piece, On Slavery [14]: " ... It will probably be asked,
Why not retain and incorporate the blacks into the state, and thus save the
expense of supplying, by importation of white settlers, the vacancies they will
leave…[they are] in reason much inferior, as I think one could scarcely be found
capable of tracing and comprehending the investigations of Euclid; and that in
imagination they are dull, tasteless, and anomalous…" Jefferson's sentiments in
this passage reflect the political climate of that time as it related to the
emancipation of slaves (this reflects how the use of concepts about biology and
race affected large-scale social policies as late as the eighteenth century).
Perspectives such as this carried through the Darwinian revolution of the
mid-nineteenth century when social philosophers such as Herbert Spencer re-cast
the theory of evolution to explain the social hierarchy of races as an outgrowth
of natural selection. A contemporary of Darwin's, Spencer introduced the concept
"survival of the fittest" which advocated against social reform movements that
aimed to improve the circumstances of individuals at the bottom of the social
hierarchy, often non-Whites and the poor [15]. The social hierarchies of the day
were rationalized as a result of inborn "natural" divisions between the races
that had evolved over time. These racial hierarchies became reified into
concepts which early researchers utilized as a foundation in their study of the
human species. Termed "eugenics" by Francis Galton, this new strain of thought
placed emphasis on heredity as a path to the further improvement of the human
species [16]. These ideas were celebrated at the time and came to pervade both
the scientific and political landscape during the early part of the twentieth
century. Social policies, based on this new  "science" of heredity, were enacted
in an effort to perfect human populations through controlled breeding practices.
Some of these involved tighter immigration policies and segregated schooling.
Others were more extreme—involuntary sterilization of members of particular
racial groups, the mentally ill, criminals, etc. Eugenics policies were carried
out during the pre-World War II-era in parts of Scandinavia and the United
States, but perhaps the best known of these practices was the genocide of the
Jewish population by the German Nazis during the war. Despite efforts by groups
of scientists and progressive social philosophers, large-scale efforts to
discredit eugenics and the "science" of racial hierarchies were not taken
seriously until after the discovery of the Jewish holocaust [17].
In opposition to eugenics, a counter-movement was forming and slowly gaining
popularity among groups of scientists, anthropologists, philosophers, and social
theorists throughout the world. The gathering of representatives from over fifty
countries to discuss the effects of eugenics at the Universal Races Congress in
1911 [ 18], held in London, represented one of the earliest collective efforts
to discredit the "race as biology" perspective. W.E.B. Du Bois, on behalf of the
then nascent National Association for the Advancement of Colored People (NAACP)
was elected co-secretary of the American delegation. It was here that a large
body of research on race from the social sciences was presented in an effort to
promote an alternative way to think about race and the results of worldwide
colonialism. One of the many results of this first congress was a declaration
proclaiming the equality of all peoples of the world regarding human endowments.
This statement represented a direct opposition to the tenets of race science,
and, though this viewpoint did not gain acceptance quickly, it began to have an
effect around mid- century.

Perspectives on Human Genetic Diversity Emerge
Beginning in the 1960's and 1970's, research on disease-risk and work in the
field of population genetics fundamentally changed the way scientists viewed the
variation of human traits both within and between groups. Since that time,
numerous studies have supported the finding by Lewontin that the vast proportion
of variations occurs within any given local group [19]. Additionally, concepts
about race-specific diseases began to shift. Research on sickle-cell anemia, a
disease thought to affect only African populations, was found to occur in
significant proportions of Mediterranean, Middle Eastern, and Indian populations
as well. This was linked to the discovery that the geographic specificity with
which the corresponding gene variation occurs is related to malaria resistance,
not to race [20]—individuals who inherit only one allele for the trait benefit
from a greater resistance to malaria, whereas those who inherit both alleles
come to be afflicted with the illness. Prior to these discoveries it was thought
that sickle cell anemia was linked to skin color—and therefore suggested obvious
parallels with racial designations. This example illustrates how complex human
traits vary not from racial group to racial group. Rather, they vary across
populations because different selective pressures arise in particular regions of
the world.
Findings such as these have resulted in scientists moving away from the idea
that race has a biological basis. Still, some researchers believe that racial
designations can be of use and have crafted explanations of how human genetic
variation can be represented in "racial" terms [21]. By demonstrating that small
markers on portions of DNA cluster in ways that can be shown to vary between the
classically defined racial groups, these scientists maintain that race can be
found in an individual's genetic structure. Using short sections of
non-functional DNA, known as microsatellites, scientists can cluster populations
along continental lines of descent. The variations that occur on these sections
represent a tiny portion of an individual's genome and are chosen because they
contain the most information regarding group differences. These do not inform
our knowledge about large trait differences, but sometimes can be used to
represent a handful of characteristics such as skin color or hair texture [22].
The focus on these variations has been defended based on their purported
usefulness in calculating disease-risk. But this focus provides an unstable
foundation from which to calculate such risks. Using the sickle-cell trait as an
example, knowledge of African, Mediterranean, and/or Indian ancestry may prompt
an individual to get tested for the disease despite the fact that there is no
causal connection between the genes linked to this disorder and the small
variations that delineate continental ancestry. Focusing on these small
variations can mislead both patients and doctors.
Increased immigration and the effects of globalization have greatly encouraged
mating between groups. It is possible that as populations throughout the world
become even more mixed, concepts of "race" will change accordingly. In terms of
health care and disease-risk, modern ancestry testing has sought to provide
avenues for assessing mixed populations through admixture analysis, the breaking
down of an individual's genetic lineage based on multiple geographic regions of
origin. Though these are not "race" tests, their use has been interpreted as a
search for racial mixture. These tests are not exact, but provide estimates that
are based on probabilities. It is not clear how admixture analysis can
accurately inform research on health risks.
Available evidence suggests that a combination of socioeconomic, environmental,
and biological factors that include differences in access to health care, the
effects of discrimination, and inherited risk factors contribute heavily to
health disparities between racial groups. A balanced perspective regarding how
these interact with one another is important in understanding the basis of these
disparities. Additionally, distinguishing the difference between race and
ancestry is imperative for designing an appropriate approach to preventing and
treating disease for all groups.

Race, Ancestry, and Health Disparities
Different racial/ethnic groups demonstrate different risks for developing, and
recovering from, certain diseases. For example, White women have an overall
higher rate of breast cancer than women of other groups. However, as discussed
in the following paragraphs, studies show that the reasons for this do not lie
in specific genetic mutations, common to White women. Though, in this case, data
suggests a connection between disease-risk, mortality rates, and "race," the
underlying causes for the difference between groups is not related to genetics.
Rather, social and environmental factors that are related to a person's "race"
play a major role in these differences.
However, the ancestry of an individual (as represented by the biogeographical
region(s) of origin of his or her ancestors) may affect her or his risk for
developing a small number of diseases due to geographically specific selective
pressures that have caused mutations over time. It is important to distinguish
how a person's "race" versus their ancestry affects the probability that they
will develop certain diseases. The discrepancy between reported or observed race
and a person's ancestry can result in a loss of information important in
assessing disease risk. For instance, a person who appears to be of European
descent may be classified as "White" based on appearance. However, if this same
person has West African ancestry that he or she is not aware of, an increased
risk for a disease associated with descent from that region, such as sickle-cell
anemia, may not be taken into account by their doctor, resulting in their not
being screened for the disease. The assumption that a person's race, which is
often identified by appearance, can inform his or her disease-risk can result in
errors such as this. While accurate information about a person's ancestry may
aid physicians in assessing those at risk for a small number of conditions,
information about race will not. Often, health disparities between groups do not
result from differences related to ancestry, but from differences in treatment,
access to healthcare, socioeconomic status, and other environmental factors.
A recent study published in the New England Journal of Medicine [23] showed that
despite major legislative efforts, disparities in medical treatment based on
race continue in the United States. In the last decade, greater attention has
been focused on narrowing the gap between groups in terms of healthcare
treatment and outcomes. During this time, thirty- four states have established
offices of minority health and in 1993, The National Institutes of Health began
to require that minority patients be adequately represented in clinical studies.
The 2005 study, "Racial Trends in the Use of Major Procedures Among the
Elderly," focused on the use of high-cost surgical proceduresthat could not be
attributed to patients' clinical characteristics. A.K. Jha led a team that
reviewed the Medicare enrollee census for every year from 1992 through 2001.
Their sample included 29 million enrollees for each of the years. The use of
nine major procedures was reviewed. Despite efforts to improve healthcare for
all groups, the data indicated that racial/ethnic differences in the use of
procedures did not narrow significantly between 1992 and 2001. The outcomes of
legislative efforts suggest that they have not been successful in narrowing
disparities between racial/ethnic groups in terms of use of these procedures. In
an interview for National Public Radio [24], Jha stated that even when access to
health care is controlled for, Black patients consistently receive different
treatment than White patients: "We're not talking about small differences; we're
talking about substantial differences that have a very profound impact on
whether people live or die, what quality of life they have. And in the year 2005
[these inequities] really should not be something we should be willing to live
with." Appearance serves as a proxy for different treatment by physicians, the
study showed.
Research on breast cancer has revealed differences in age of onset of the
disease between African American and White groups of women [25]. Although
overall rates of breast cancer are higher in White women, new incidences are
rising in African Americans, particularly for those under the age of 50; for
women under 35, African Americans are 1.5 times as likely to develop the
disease. Additionally, while mortality rates for White women diagnosed with
breast cancer have been declining for the past twenty years, this has not been
the case for African American women.  A study conducted by Lisa Newman et al.,
published in a 2002 issue of Cancer [26], found that race was an independent
predictor of breast cancer mortality—African American women have a 20% higher
likelihood of dying than white women following diagnosis. Why do these
disparities exist? A broad review of recent research points to several factors.
First, differences in treatment may affect overall chances of recovery. A recent
visit by a health professional to a "major hospital in middle America"
documented in the Breast Cancer Action Newsletter [27] found that the treatment
of breast cancer in African American women differed from what a typically
health-insured woman in the United States could expect when getting screened for
the disease. Among other problems, there was a noted lag time in the processing
of mammogram results (up to four months, rather than a few days) and biopsies.
This may have resulted in higher mortality rates [28]. Second, there appear to
be differences in risk factors for the disease between the two groups. On
average, African American women tend to suffer higher rates of other illnesses
in addition to breast cancer. Combined with the tendency to get diagnosed during
more advanced stages of the disease—and with more aggressive tumors—results in
an increased mortality risk when compared to Whites. There may be a genetic
contribution to these differences in pathology but little is known regarding how
specific genes or markers contribute to the illness. Due to the distribution of
income by race, African American women are more likely to live in areas
contaminated by pollutants that may affect the onset and course of the disease.
A recent paper published in the American Psychologist by Shields, et al. [29] on
the use of race variables in genetic studies of complex traits, focused on
smoking research as a case study. The authors conducted a broad,
trans-disciplinary review of the history of racial categories in medicine,
current research practices, and arguments for and against using race variables
in genetic analysis. They found that in the context of genetic research,
differences in patterns of variation were often being framed in racial or ethnic
terms. This was occurring without adequate attention to measures known to affect
health such as socioeconomic and other environmental factors, despite the known
fact that "identified polymorphisms account for only a small portion of
individual variation in disease known to have a genetic component." All of this
has led to a debate within the healthcare field regarding the importance of
race/ethnicity as a variable in research on health disparities.
Highlighting the fact that the smoking prevalence among African-Americans and
Whites in the United States is similar, the authors underscore important
differences regarding age of onset, number of daily cigarettes, and relative
success in quitting the habit between the groups. For example, studies show that
37% of African Americans report success with quitting smoking, while 51% of
Whites do. The figure for African Americans may be lower due to how
socioeconomic status may have confounded many studies' reported quit rates.
Nevertheless, this group has higher mortality rates for diseases associated with
the long-term effects of smoking such as lung cancer.
In their review of several studies, the authors found that those who conducted
the research tended to rely on participants self-reporting their race/ethnicity
rather than asking them about ancestry. Their review found that of thirty-four
studies conducted on smoking or nicotine through June 2003 that utilized
race/ethnicity as a variable, only six were explicit in describing how race was
defined within the specific study. Within those six studies, the authors found
that terms like "White" were defined differently.
When race/ethnicity is used as a variable, the accuracy of an individual's
genetic diversity is not always accounted for. This can be seen in the results
of a 2003 study by Shriver, et al. [30] who looked at self-reported
race/ethnicity in a Washington, D.C. sample of participants who identified as
African American. Utilizing 31 genetic markers, the data showed that
approximately 22% had predominant European or Native American genetic
contributions and a lower African one.
The above research on health disparities between racial groups highlights
several public health issues. Jha's study demonstrates that, regardless of the
clinical characteristics of a disease, discrimination exists within the medical
community towards members of minority groups. When decisions about important
surgical procedures, and other medical decisions, are at stake, discrimination
can profoundly affect mortality rates and skew data regarding the origins of
such disparities.  Second, when researchers and other medical professionals
treat race/ethnicity as a category of biology, the accuracy of data remains
questionable. The study by Shields, et al. demonstrates that caution is
warranted when attributing a genetic perspective to race variables. Third,
despite recent policy efforts to decrease between-group disparities, inequities
in access to healthcare, screening for illness, and treatment continue. Yet,
there has been a general increase in genetic research aimed at finding solutions
to these problems. One outcome of this has been an increased investment in
research into the development of race-based drugs to target the symptoms of
illnesses. The development and F.D.A. approval of the first race-based drug,
BiDil, has accelerated these efforts.




Race and Pharmaceuticals: The Case of BiDil
A recent article in an October 11, 2005 web-exclusive of the journal Health
Affairs [31] described the origins of race-based pharmaceuticals. In their
review of the approval process for the heart-failure medication, BiDil, authors
Pamela Sankar and Jonathan Kahn underscored how the approval process for the
drug shaped its later being cast as a medication for a specific race. The review
begins with several drug trials, conducted by the Veteran's Administration in
the 1980's. The Vasodilator Heart Failure (V-HeFT) Trial I and Trial II were
conducted in an effort to find appropriate drug treatments for heart failure.
Findings from the first trial indicated that a combination of two generic
vasodilators, hydralazine and isosorbide dinitrate (H/I) showed promise in
treating the condition. The Second Trial focused on ACE Inhibitors and also
showed promise—ACE Inhibitors went on to become the first line treatment for
heart failure through the next two decades. Unfortunately, this line of
medications did not work effectively for all patients. Therefore an effort was
made to bring the H/I combination to the market.
Jay Cohn, the lead research scientist for both studies, attempted to patent the
H/I combination treatment in one pill, despite evidence from the trial that
suggested the combination of the two generics worked no better than using each
one separately. Cohn began several studies to prepare a patent application to
present to the U.S. Food and Drug Administration for approval.
In 1997, the Food and Drug Administration rejected Cohn's application, based on
the availability of the generic forms of H/I. Two years later, an analysis of
the V-HeFT trials by scientists at the University of Minnesota found that
African American individuals in the study responded more positively to the H/I
combination. It was following this analysis that speculation about the
race-specific use of H/I began. Cohn and another scientist, Peter Carson, worked
to determine if a new application might be approved if the H/I combination was
shown to be an effective treatment for heart failure patients who were African
American.
The two published a paper in 1999 that re-analyzed the data from V-HeFT I based
on the small sample of forty-nine African American subjects who were placed on
H/I, and data from this re-analysis helped Cohn to re-license the intellectual
property rights of H/I to the Massachusetts pharmaceutical company NitroMed. The
following year the two scientists re-applied for a patent based on the
race-specific application of H/I with the market name BiDil.
The FDA indicated that the data looked promising, and encouraged the two to
conduct a new trial on African-American subjects. Cohn, Carson, and NitroMed
moved forward with A-HeFT, the African American Heart Failure Trial, utilizing
1,000 African-American subjects suffering from advanced heart failure. The
method used to identify the race of the study sample was a self-identification
survey. Notably, those not claiming African American as their race were not
included in the study.
The trial began in 2003 and was slated to continue through 2005. The study was
halted, however, in 2004, when the study's Data Safety Monitoring Board declared
that the positive results of using BiDil were substantial enough that continuing
the placebo group would be unethical. Preliminary data showed that the use of
the drug resulted in a 43% reduction in the rate of death from any cause and a
33% percent reduction in first hospitalization from heart failure. Shortly
thereafter, NitroMed submitted a revised application to the FDA which approved
BiDil as a race-specific treatment for heart failure, the first of its kind in
history. The marketing rights from this patent continue through the year 2020.
Though BiDil is a treatment that will clearly benefit patients, especially those
who do not respond to ACE inhibitors, the costs associated with the use of
BiDil, and other concerns associated with the testing process and its approval
should not be ignored. Consumers can expect to spend a lot more for the drug.
Even after adjusting for dosage amounts, there is a vast difference in price
between the generic isosorbide and hydralazine pills (at around $0.25 cents per
pill), and the cost of one BiDil (about $1.80 per pill). The average recommended
dosage for BiDil is six pills per day, bringing the daily cost to $10.80. In
contrast, ACE inhibitors cost relatively little, even the non-generic forms of
the drugs commonly prescribed to heart failure patients. A survey of three of
these, Vasotec, its generic Enalapril, and Captopen revealed an average daily
cost of $1.60, $0.57, and $3.62 respectively [32]. What prevents doctors from
prescribing to patients the much cheaper, generic forms of H/I instead of BiDil?
By testing doses that were unavailable commercially, Nitromed effectively
eliminated sales competition with manufacturers of the generic versions of H/I.
Additionally, it is not clear whether BiDil is a treatment that works only, or
even better, for African Americans. Sankar and Kahn report, "The study of
racially differential response to hydralazine/isosorbide dinitrate by Carson and
colleagues was based on…[an] analysis of 15-year old data derived primarily from
V-HeFT I which enrolled [a small sample size] of 180 African-American subjects."
Other studies have found no such disparities in response to heart failure
medications. Derek Exner and colleagues published a study on differential
response to ACE inhibitors that showed no difference in mortality rates between
blacks and whites [33].
Participants from other racial groups were not included in the A-HeFT study. How
do we know that BiDil would not be a suitable treatment for Hispanics, Whites,
or members of other "racial" groups? Biologist David Goldstein of the University
College, London, and his colleague Sarah Tate state in the November 2004 issue
of Nature Genetics: "Many differences in drug response associated with race or
ethnicity are due to environmental factors [such as diet] rather than population
genetic differences…In the case of BiDil, it is not currently known whether it
works differently in African Americans and European Americans because of
genetics, environment, or both [34]."
Within the African American population, there exists tremendous variability for
characteristics such as disease-risk and mortality rates. New York University
professor Troy Duster, explains in his essay, "Race and Reification in Science
[35]," that in heart failure patients, Americans of African descent show much
higher rates of hypertension than Americans of European descent, but darker
skinned blacks show higher rates of hypertension than lighter skinned blacks. It
is not currently known what the reasons for these differences are or if drug
treatments such as BiDil are more or less effective because of this.
What are the implications of the approval and use of BiDil for the future of
pharmaceutical research? Duster argues that institutions, such as the FDA,
should exercise caution in approving drugs like BiDil. He suggests that
regulations be instituted that require companies to conduct research aimed at
locating markers that have an "actual functional association" to drugs. This
way, patients may be tested for the markers regardless of their race or
ancestry, thereby avoiding pitfalls associated with the use of either. Without
this type of regulatory action, Duster warns, the use of race threatens to cloud
associations between illness and biology.

Personal Genetic Histories
The public use of "personal genetic history" (PGH) testing has exploded over the
past few years. A quick search on the internet produces a list of companies with
names like Ancestry By DNA [36], AfricanAncestry.com [37], and Family Tree DNA
[38], which offer services to assist individuals in tracing their "bloodlines"
back to a geographic region of origin through the analysis of genetic material.
For all its simplicity, a cheek swab is purported to provide many with answers
to questions about family history that seemed previously unknowable.
Many individuals have reported that PGH results offer a connection to racial and
ethnic identity that is deeply meaningful for them [39]. The popularity of these
tests underscores the degree to which people associate their identity with their
biology. The New York Times ran an article recently entitled, "Blacks Pin Hope
on DNA to fill Slavery's Gaps in Family Trees," published in the Science section
which demonstrated just this. A woman who was interviewed reported that her test
showed that her African roots were quite old. Being of light skin color, she had
been viewed by members of her community as having lower status, but the test,
she said, "showed underneath I'm deepest Africa [40]." Though no test can reveal
a person's racial/ethnic background, consumers may attribute such meanings as
inherent within their results.
Consumers may be easily confused both by the different testing options available
and the relative accuracy of the results. Though each of the available methods
attempts to determine a person's ancestry by region, they often achieve
different results. The first type, lineage-based tests, have been used by
evolutionary biologists to trace human origins back to Africa. Going back far
enough, DNA from all types of human genomes traces our origins back to that
continent. After a sample is extracted and sequenced, it is compared to samples
from a database of haplotypes (sets of markers that have been associated with
one another because they tend to cluster). The presence of these haplotypes has
been attributed to specific geographic regions. Estimates of descent are based
on the presence (or absence) of particular haplotypes within a sample [41].
The accuracy of matches depends on the database with which the samples are
compared. An average database carries haplotypes that range in number from a few
thousand to tens of thousands. The majority of these databases are private, and
companies tend not to share information with one another. The larger and more
varied the samples from each population, the more accurate the matches will be.
But these matches are still based on probabilities, not absolutes. Regardless of
the size of the database, the more common haplotypes include regions that are
quite large and overlap. The results of these overlaps lead to inconsistent and
vague estimates of geographical region that consumers are often unaware of. A
second issue of concern is that these tests produce estimates that are focused
on a single lineage, and therefore ignore other genetic contributors to a
person's DNA (and the vast majority of their ancestors). It should be made
explicit that maternal and paternal lineages together do not represent the total
genetic diversity represented in an individual's genome. A customer may be
misled into thinking that these test results represent his or her entire genetic
history.
The second type of PGH tests for biogeographical ancestry by the use of Ancestry
Informative Markers" (AIMs). This small number of markers differs in frequency
across population groups, ranging from local to larger continental clusters. A
person's genetic history is estimated by searching his or her DNA for these
markers and calculating percentages of ancestry based on their presence and
frequency against the known percentages in ancestral populations.  The use of
AIMs has also become increasingly widespread in the field of criminology in
recent years. AIMs have been seen as useful to criminal investigations, based on
their contribution to the understanding of admixture mapping (or how an
individual's genome is made up of differing proportions of markers representing
various regions). These calculations are statistically based. However, relative
to lineage-based tests, knowledge of how the markers are distributed
geographically is less specific. Many potential ancestral patterns could be
consistent with one result. For example, M. Shriver and R. Kittles state in
their paper "Genetic Ancestry and the Search for Personalized Genetic
Histories," that "a person might show 75% West African and 25% Western European
ancestry in a BGA estimate because three grandparents are from West Africa and
one is from Western Europe or because all four grandparents are of East African
Ancestry."
What do Personal Genetic Histories tell us about race? Some would say nothing at
all. Only 0.1% of the human genome provides information that can give us answers
to the story of human migration. And though this information has been helpful in
tracing our common origins back to Africa, it has also revealed the seemingly
countless movements our species has made everywhere else on the planet. This
does not translate into the biology of a "racial/ethnic" identity, however.
Unfortunately, it seems unlikely that companies will convey this source of
uncertainty to their customers. Yet, a standardized code of conduct should be
established for the industry for ethical reasons, especially as the use of these
technologies increase, as they have in the criminal justice system.
Race and the DNA technology of the Criminal Justice System
There has been a major push in the United States to expand the size and use of
DNA databases for the purposes of "catching criminals" based on biological
evidence left at crime scenes [42]. This push led the U.S. Attorney General, in
2002, to order the Federal Bureau of Investigation to expand federal databases
from 1.5 million to 50 million profiles. Reasons for this updating strategy are
numerous but can be distilled into three different categories. First, the DNA
from these databases can be used in post-conviction cases (often ones where
convictions occurred prior to the development of this technology) to determine
whether there has been a wrongful conviction. Second, prior to trial, DNA
collected from accused or suspected individuals can be used to match that from
crime scenes. Lastly, having DNA samples from previously incarcerated
individuals allows law enforcement agents to link future crimes to those guilty
of recidivism [43].
Why would it be a problem to use DNA evidence to "catch criminals?" There are
several problems with the current way that DNA from the accused and forensic DNA
from a crime scene are matched that should give us pause when considering the
relative accuracy of readings. First, the science is based on samples from a
population that is composed mostly of incarcerated individuals. The sets of DNA
markers frequently used for matching are derived from these samples. Certain
ethnic or racial groups are over-represented in these databases, as they are in
the criminal justice system in general. Already, there exists a systematic bias,
by race, of a full range of criminal behaviors associated with these groups that
has led to the widespread use of the term "racial profiling."
Have certain racial or ethnic groups always been over-represented within the
criminal justice system? In 1933, the prison population was 77% White, which was
close to representative of the U.S. population at the time. Beginning then, and
increasing dramatically during the 1980's, the majority of the prison population
slowly represented ethnic minorities so that, by 1989, there were seven times as
many Black individuals than Whites in the prison system.  This turn-over in
demographics occurred for many reasons, but the dramatic over-representation of
Blacks in the 1980's can be attributed to one sweeping social policy of the
Reagan Administration known as the "War on Drugs." During this time, law
enforcement officials were trained and encouraged to stop likely drug offenders
based on a system that targeted young, minority, males as the most likely to
offend. Though, at the time, Blacks accounted for only 15-20% of the country's
drug users, they were suddenly making up half to two-thirds of arrests for drug
offenses in urban areas. Thus, the "War on Drugs" had a profound effect on the
racial/ethnic makeup of most U.S. prisons [44].
Fast-forwarding to today, the term "racial profiling" has come under much
scrutiny from both the public and public officials. Several studies by state
governments have revealed the extent to which racial biases have
disproportionately singled out members of minority groups by law enforcement
officials. Despite this awareness, a new type of racial profiling could well
occur with the use of forensic DNA. A new terminology known as "ethnic
estimation based upon allele frequency variation," describes a technique used by
forensic scientists who find that the utility of population markers helps to
narrow lists of suspects. These "ethnic estimations" are based on variable
markers at several locations on the DNA (termed "loci"). This is based on the
theory that, in a given population, such as the Chinese, a certain marker will
occur with greater frequency than it does within another population, such as the
Danish. These are proportional estimates only, as these markers are not
restricted to individuals of particular races/ethnicities. By choosing markers
that have a very high frequency for certain populations, scientists attempt to
narrow the likely racial profile of a given suspect. They might do this by
choosing several sets of markers in order to get a reading with higher accuracy.
However, no matter how many sets of markers are used, there is no way to ensure
100% accuracy. Still, many argue that proportional differences can be of
practical significance to criminologists in narrowing down a group of suspects.
Yet this method could also result in overlooking a suspect who should be
considered, or charging and convicting one who shouldn't be, simply because they
have a less typical DNA profile when compared to other members of their
racial/ethnic group.
Another problem, associated with the use of ethnically affiliated DNA markers,
lies in the danger of their being associated with undesirable behavioral
characteristics. Not much is known about the genetic basis of behavioral
characteristics, yet theories abound regarding the origins of the "criminal
personality." Personality features such as aggressiveness or low inhibition,
that are thought of as inherent to criminal types, may come to be associated
with particular markers—and particular populations. And since the majority of
samples that make up U.S. databases are from minority populations, the risk of
associating these traits with particular racial or ethnic groups seems high.


Conclusion
The human species consists of many "fluid bio-cultural units." In the time we
have spent criss-crossing the planet, we have created thousands of diverse
cultures, each of which has adapted to, and changed with, different
environmental conditions over periods of time. The effects of countless
migrations due to famines, wars, weather patterns, the search for economic
stability, and other motivators, has engendered a long history of mating between
groups. The more recent effects of world travel, web communication and a global
economy have only added to this.  As a result, within the "human race," there
are no sub-species that can be ranked into taxonomies according to differences
in traits and abilities. As a whole, we are far more alike than different.
Yet, as can be seen in debates around Affirmative Action, and more recently,
immigration, race has been perceived as a category that keeps some people "out"
while ensuring that others stay "in." The U.S. Immigration Act of 1924 provided
86% of quotas to the entry of "White," Northern and Western European immigrants,
leaving a much smaller percentage to immigrants from other parts of the world.
Today, the situation has not changed much; the view of America as a `country of
immigrants' has caused a contentious debate in response to a large influx of
immigrants of color. In the spring of 2006, debates around the "problem of
immigration" as members of Congress and the media have referred to it, highlight
a topic that has brought race back into the forefront of socio-political debate.
The search for human identity has led many to seek answers to social issues such
as this one within the realm of biology. The reverse is also true—as the focus
on "racial" genes in biomedical research makes clear: we seek answers to the
biological in the social. But it is a major mistake to confuse the two. Race is
a social category that continues to be misapplied in scientific endeavors. What
few clues ancestry categories may be able to give us regarding the origins and
incidence of disease often succeed only in masking other important sources of
these disorders. Research on health disparities demonstrates that an excessive
focus on genetic research into the origins of illness in specific populations
often bypasses opportunities to develop appropriate preventive measures for
those very populations as well as for others. It also threatens to justify the
misplaced concept that race is biological.

SURA  5:89 – 91     In the name of Allah, the Beneficent, the Merciful


Allah will not take you to task for that which is unintentional in your oaths,
but He will take you to task for the oaths which ye swear in earnest. The
expiation thereof is the feeding of ten of the needy with the average of that
wherewith ye feed your own folk, or the clothing of them, or the liberation of a
slave, and for him who findeth not (the wherewithal to do so) then a three days'
fast. This is the expiation of your oaths when ye have sworn; and keep your
oaths. Thus Allah expoundeth unto you His revelations in order that ye may give
thanks. (89) O ye who believe! Strong drink and games of chance and idols and
divining arrows are only an infamy of Satan's handiwork. Leave it aside in order
that ye may succeed. (90) Satan seeketh only to cast among you enmity and hatred
by means of strong drink and games of chance, and to turn you from remembrance
of Allah and from (His) worship. Will ye then have done? (91)

SURA  5:58 – 63     In the name of Allah, the Beneficent, the Merciful

And when ye call to prayer they take it for a jest and sport. That is because
they are a folk who understand not. (58) Say: O People of the Scripture! Do ye
blame us for aught else than that we believe in Allah and that which is revealed
unto us and that which was revealed aforetime, and because most of you are
evil-livers? (59) Shall I tell thee of a worse (case) than theirs for
retribution with Allah? Worse (is the case of him) whom Allah hath cursed, him
on whom His wrath hath fallen ! Worese is he of whose sort Allah hath turned
some to apes and swine, and who serveth idols. Such are in worse plight and
further astray from the plain road. (60) When they come unto you (Muslims), they
say: We believe; but they came in unbelief and they went out in the same; and
Allah knoweth best what they were hiding. (61) And thou seest many of them vying
one with another in sin and transgression and their devouring of illicit gain.
Verily evil is what they do. (62) Why do not the rabbis and the priests forbid
their evil-speaking and their devouring of illicit gain? Verily evil is their
handiwork. (63)

SURA  5:97 – 101     In the name of Allah, the Beneficent, the Merciful


Allah hath appointed the Ka'bah, the Sacred House, a standard for mankind, and
the Sacred Month and the offerings and the garlands. That is so that ye may know
that Allah knoweth whatsoever is in the heavens and whatsoever is in the earth,
and that Allah is Knower of all things. (97) Know that Allah is severe in
punishment, but that Allah (also) is Forgiving, Merciful. (98) The duty of the
messenger is only to convey (the message). Allah knoweth what ye proclaim and
what ye hide. (99) Say: The evil and the good are not alike even though the
plenty of the evil attract thee. So be mindful of your duty to Allah, O men of
understanding, that ye may succeed. (100) O ye who believe! Ask not of things
which, if they were made known unto you, would trouble you; but if ye ask of
them when the Qur'an is being revealed, they will be made known unto you. Allah
pardoneth this, for Allah is Forgiving, Clement. (101)

SURA 5:46 - 50      In the name of Allah, the Beneficent, the Merciful


And We caused Jesus, son of Mary, to follow in their footsteps, confirming that
which was (revealed) before him in the Torah, and We bestowed on him the Gospel
wherein is guidance and a light, confirming that which was (revealed) before it
in the Torah - a guidance and an admonition unto those who ward off (evil). (46)
Let the People of the Gospel judge by that which Allah hath revealed therein.
Whoso judgeth not by that which Allah hath revealed: such are evil-livers. (47)
And unto thee have We revealed the Scripture with the truth, confirming whatever
Scripture was before it, and a watcher over it. So judge between them by that
which Allah hath revealed, and follow not their desires away from the truth
which hath come unto thee. For each We have appointed a divine law and a
traced-out way. Had Allah willed He could have made you one community. But that
He may try you by that which He hath given you (He hath made you as ye are). So
vie one with another in good works. Unto Allah ye will all return, and He will
then inform you of that wherein ye differ. (48) So judge between them by that
which Allah hath revealed, and follow not their desires, but beware of them lest
they seduce thee from some part of that which Allah hath revealed unto thee. And
if they turn away, then know that Allah's Will is to smite them for some sin of
theirs. Lo! many of mankind are evil-livers. (49) Is it a judgment of the time
of (pagan) ignorance that they are seeking? Who is better than Allah for
judgment to a people who have certainty (in their belief)? (50)

SURA 5:6 - 11      In the name of Allah, the Beneficent, the Merciful


O ye who believe! When ye rise up for prayer, wash you faces, and your hands up
to the elbows, and lightly rub your heads and (wash) your feet up to the ankles.
And if ye are unclean, purify yourselves. And if ye are sick or on a journey, or
one of you cometh from the closet, or ye have had contact with women, and ye
find not water, then go to clean, high ground and rub your faces and your hands
with some of it. Allah would not place a burden on you, but He would purify you
and would perfect His grace upon you, that ye may give thanks. (6) Remember
Allah's grace upon you and His covenant by which He bound you when ye said: We
hear and we obey; and keep your duty to Allah. Lo! Allah knoweth what is in the
breasts (of men). (7) O ye who believe! Be steadfast witnesses for Allah in
equity, and let not hatred of any people seduce you that ye deal not justly.
Deal justly, that is nearer to your duty. Observe your duty to Allah. Lo! Allah
is Informed of what ye do. (8) Allah hath promised those who believe and do good
works: Theirs will be forgiveness and immense reward. (9) And they who
disbelieve and deny Our revelations, such are rightful owners of hell. (10) O ye
who believe! Remember Allah's favour unto you, how a people were minded to
stretch out their hands against you but He withheld their hands from you; and
keep your duty to Allah. In Allah let believers put their trust. (11)

The Silkel Tree, also commonly called the Ilárol'pherán in Styrásh
(Ilaról'pherán, "Silver Tree", sometimes also refered to as "Cáo fá Eú'reóll",
Cáo fá Eú'reóll, or "Child of the Tree of Life"), is regarded as one of the most
beautiful trees in all of Caelereth, and many believe it to be touched by a kind
of immortal magic. Either its enchanting appearance, or perhaps its amazing
healing powers, or maybe its inclination to grow in places touched by myth and
wonder, lead to the belief that it's a tree closer to ethereality than to
corporeality. This sheen tree has a number of uses, many of them of medical
nature. The tree is mostly known for its thread-like bark that can be made into
silk, which is sometimes used to make cloth.

Appearance. Silkel Trees are known for their striking appearance. They are
sheen, silvery, and, like the elves in whose forests they often grow in, seem to
always be covered in a soft light. In spring and summer, their trunks and
branches are a silvery-bronze color. The texture is stringy, as though the
branches and trunk were made out of thousands upon thousands of tiny threads.
Sometimes the thread-like texture is hard to see until the autumn, when the
bronze color lightens to a striking silver and the outer threads of the tree are
shed in thousands of small strings. These strings are harvested by tailors and
seamstresses and treated into silk, which is used to make cloth. Under these
silver strings lies another hue that has been called "white gold", The tree is
silver-white, and appears ethereal amidst the snow.

The trunk is very straight and can reach a height of 6 to 7 peds in height. The
branches reach out with a strong majesty, fairly straight before splitting into
slender twigs. The form of the tree tends to be slightly rounded, forming a
thick, light-clung canopy.

Leaves of the Silkel Tree are curved, slightly egg-shaped, with smooth sides
coming up to an elegant point. The leaves are very soft but not paper, though
they do have a delicate look to them. At the largest, they are a palmspan in
length and about 6 nailsbreadth in width. The colored vary based on the season.
In spring and mid-summer, thin leaves are a rich, golden green, which has a
tendency to catch the light, be it sun, moon, star, or even candle. They always
seem to be alight. Silkel Trees loose their leaves in late summer and autumn,
but before falling, the leaves' green fades and they turn a brilliant gold.
Sometimes they are burnt into a golden red, but the color is always bright and
magnificent.

The tree does not often form flowers, producing buds no more than one every 10
to 20 years, if that. Their rarity, however, is not all that makes the flower
such a special sight to see. In the spring, if the tree is to bloom that year,
buds will form on the tree, usually disguised by sepals of the same golden-green
hue as the leaves. By mid-spring, though, the flowers will open in an elegant
silver-white, powdered with gold from the pollen on its stamens. The flowers
have carefully pointed petals each of which is about 4 to 6 nailsbreadths long.
Petals come in sets of five. When the petals are fallen and the base is matured,
seeds are formed. They come in bronze-covered shells that are typically 2 to 3
nailsbreadths in diameter. The nut inside usually has a silvery sheen, and tends
to be very juicy and soft. These seeds fall with the falling leaves.

The Silkel Tree is believed to be one of the most mystic and beautiful tree in
all of Caelereth.

Territory. The tree's territory is hard to define because, under a scientific
eye, the tree seems to grow without any care of climate or soil properties. They
grow commonly in elven forests all over Caelereth, but grow with especially high
concentration within the forest of Thaelon. Many theorize that this tree grows
around places touched by magic, not of Ximaxian definition nor clerical, but of
something even more spiritual and profound. It is believed, thus that the tree
grows in a place where the ethereal touches the realm of reality in some way,
including the existence of mythological light elf spirits or the existence of
those believed to carry their blood.

As previously stated, the Silkel grows with an amazing concentration within the
forest of Thaelon. More Silkel Trees grow within that forest than any other in
Caelereth. They grow well on Bolder and Quallian, as well as certain places in
Zeiphyrian. They can sometimes be found in good amounts also in the Sharadon
Forest and at times in the Auturian Woods and the Shaded Forest. They grow
scarcely in the Paelelon, Hovel Frond, and other forests where dark elves make
their home. Additionally they grow in varying amounts on other continents, as
well. These trees tend to sprout up around the palaces where the Ránn and Rónn
live, and especially near their graves.

Silkel Trees have also been known to grow on the graves of those believed to
have some attachment to the ethereal world, whose spirit mimics the qualities of
a high Ránn or Rónn. This, however, is extremely rare, having only happened on a
few exceptional occasions. They can, at times, be found around the same grounds
crystal grass occupies, but again, these occasions do not occur very often.

Usages. The Silkel Tree has a number of usages, both medical and otherwise. Each
part of the tree yields a different use.

The leaves can be taken in autumn when they've fallen from their branches and
dried. If crushed and mixed into a tea, they will help with colds and pains,
though the tea is known for making the drinker extremely sleepy. It is thus
advised not to drink such tea until the evening when there can be plenty of time
to sleep after the concoction is taken. It should also be noted that the leaf
should not be harvested until after it has fallen from its maternal twig. There
have been scores of cases that a leaf was plucked prematurely from its branch,
resulting in throwing the drinker into a coma. More advanced healers are able to
predict by the color and size of the leaf how long it will knock a person out,
and are able to utilize this knowledge when they need to put someone out in
order to help heal them in some fashion. Overall, the sleep is a gentle one,
often full of pleasing dreams, and those that wake from it find themselves
refreshed, renewed, and healthy.

Flowers have a variety of uses. Petals are known to achieve great healing,
destroying deadly diseases and mending fatal wounds. They have, in rare cases,
been known to cause miracles. The differences come in how the petals are treated
and applied. For diseases causing rashes or outer sores, the petals are
typically mashed into a fine paste and then applied to the irritated area. This
has also been used to heal fatal gashes, and though the idea of applying a
silvery-white cream may not be the most appealing idea, many who have received
such healing reported feeling a warmth and numbness as the petals did their
magic. For diseases of the mind and spirit, petals need to be dried and mashes
into a fine powder. It is best to be ingested atop or mixed within some food
easy for the stomach to digest. Soup is the most common choice, but other dishes
have been used.

The flowers have been known to make miracles happen, though the recipes of these
are yet unknown, or work too inconsistently to be printed. It has been recorded
that these petals have healed the crippled and made blind men see. They aren't
guaranteed to work, though, and despite there being multiple cases where the
magic petals have helped a man regain his lost sight or gave to a girl the gift
of motion, there are more cases where they have done nothing at all.

Seeds are known for healing many problems related to fertility and reproduction.
Midwives will, if they can get the seeds, take the juicy nut and work it into a
cream, then warm it and apply it to the skin during contractions to lessen the
pain. It is best if the cream is massaged gently into the skin around the
mother's abdomen to warm and relax the muscles. In some cases, this has also
worked for menstrual pains.

Removing the nut from the shell, chopping it up, and adding it to food before
eating it has been known to make infertile women able to bare children. While it
doesn't always work, as there is quite a large number of cases where it hasn't,
there is an even higher number of cases where it has, and thus blessed many
women with being able to have children who normally wouldn't be able to. The
shell and nut can also help infertile fields as well. Both the shell and nut are
ground up into a fine powder that is then spread over the field, usually in late
summer. By spring, the soil is fertile enough to yield growth.

The most well known use of the Silkel Tree comes from its bark. In autumn, when
the branches and trunks become a shiny silver, the thread-like pieces peel away
and are collected by harvesters. The bark is treated in various kinds of
concoctions and mixtures, including one that makes the strings very sticky and
malleable so that the many individual pieces can be put together. When treated
and dried, the strings look shiny white, though the strings, now silk, are often
dyed in scarlets, cobalts, and purples. The thread is often woven into various
pieces of clothing. The Maeverhim use the silk to make many of their clothing,
and the Caltharians depend on the silks produced in the Thaelon Forest to
support their production. They do some of the most impressive dying of these
soft strands. Fabric made from this thread is highly sought after, especially by
nobility.

Reproduction. Silkel Trees do not reproduce often. Not only is the production of
the seeds rare (occurring no more than every 10 to 20 years) but more than often
the seeds never sprout. Also, trees tend to sprout in places where no seed fell
or had ever fallen. The slow reproduction of the tree, however, doesn't seen to
dampen their numbers. Unless cut down or severely harmed in some way or another,
the tree will never wither away or die. Because of this, Silkel trees,
especially those living in the borders of Thaelon, are considered to be as old
as Caelereth itself.

Seeds are the only known and explainable way in which these trees reproduce. In
the spring of the year they are to bare seeds, they produce elegant blossoms.
Their beautiful, silver-white flowers grace their strong branches all through
the season, delicate breezes carrying their golden pollen to other Silkel
flowers, thus pollinating them. When summer reaches its zenith, the petals drift
down like snowy feathers through the warm air, and by mid autumn, when the
leaves have turned a brilliant gold, what is left of the flowers turns to
bronze-colored seeds. They fall with the falling leaves. Sometimes the seeds
grow, but often they do not. Rarely do they go to waste, though, as elves and
humans alike pick them up for their many uses.

These trees spring up in sometimes very unexpected places, strals and strals
from any others. Some thing this is because birds and other migratory animals
carry the seeds, or that the Silkel Tree is unique in that its very pollen can
produce a tree, but most think it is magic that bids this tree to rise from the
earth.

Myth/Lore. Some people believe magic and myth are manifested through the Silkel,
and thus, in paintings and stories touched by some myth or mystique, Silkel
Trees dwell. Some believe that Silkel Trees show where the ethereal has touched
reality, or that some light elven spirits take up residence in these trees. Some
have even made up wondrous stories to explain their existence.

One of these stories involves unicorns and is told to Caltharian children of the
east-Jernais region. It is told that long ago, unicorns were everywhere, grazing
upon the grassy plains and galloping through the verderous forests. It is said
that when the men came to cut down their precious forests, they were filled with
sorrow, for while, it is said, they loved the humans, they grieved for the
forest. They asked the light elves of the forest Thaelon to help them, to turn
them into trees to replace those that were lost, and make them able to produce
great gifts and blessings to the men so that they would never cut them down. The
Astyrhim granted their wish, and they became great Silkel Trees, forever able to
give gifts to men and brighten the sacred forests. Because of this myth, many
Caltharians call silk "unicorn hair".

Still others remain true to the popular myth of the trees being created by light
elves and their close kin. This story was told by an elven elder, Elear Tindome,
of the Aellenrhim elves:

"A long time ago, as Avá was just beginning to dream and the earth and rivers
were new, when Baveras' gentle hand sculpted the oceans and lakes, and Urtengor
had forged the moon, and life was sprouting for the first time, the Astyrhim
were young. They lingered like careful candles in the forest, fingers
shimmering, blessing the world with magic.

They watched the humans and elves grow, watched them live their lives and die.
Invisible, untouchable, they smiled at the new lives. As the world aged, though,
and Queprur bid plague and pain to trouble the world with tears, they saw
mortals suffering. Disease covered their skin with sores and rashes. Colds made
their eyes and noses red. Women screamed as children moved out from their womb.
They turned cripple and blind, dressed themselves in itchy wool, and each night
they lay themselves in the prickly hay to sleep.

It is said that the light elves cried to see such a sight, to see the humans and
elves in such plight as this. They met together within the seclusion of the
Thaelon Forest and decided to give a bit of their spirit to create trees that
would brighten the world of Caelereth. These trees would lend aid to them, would
produce medicines to cure their wounds, diseases, their cripple and blindness.
They would help to soften the pangs of childbirth. It would fertilize both the
fields and the womb.

And so the trees were created, blessing the world of mortals in a strong yet
gentle light, and all close kin of light elves ever after, it is said, when
their spirits return to the sky and the lakes, to the fire and the earth, may
create a tree to bring light into an ever-dying world. That, little elflings, is
how the Ilaról'pherán came to be."


It is commonly believed that children born within the blooming year of a Silkel
Tree will be blessed.

The Silkel Tree, however, does not grow in just one place, and neither have the
stories. In Aeruillin, it is believed that when all things had been created,
Nakashi was so touched with joy of the fresh new world, so moved by the beauty
and promise and hope, she cried, and from her tears sprung the Silkel Tree. In
Nybelmar, it is believed during an ancient plague, a Kaýrrhem woman went down
upon her knees and prayed for someway to cure those suffering. When she stood
and threw her arms to heaven, the gods turned her into a beautiful Silkel Tree.
The stories go on and on, but the air of mysticism and magic is there.

A number of poets and musicians have been inspired by the Silkel Tree and have
written of the tree in stanza and verse.

"Beneath the first white star of morning gleams
A figure tall to touch the cobalt skies
With leaves of gold and branches draped in dreams
Takes cue from lowly earth in hope to rise.
In slender grace and gentle strength, in light
To shine away the winged shadows dark,
She makes the waning rays of moon turn bright
And guides its steps upon its ancient arc.
Through waxing sorrow, plague, through pain and tears
She glistens, cutting through despair and hurt.
In gifts of health she melts all ills and fears
And bids heart's demons crumble into dirt.
And when the world seems caught in evil and gloom
She laughs then as her silver flowers bloom."

- Composed by Celenth Dyrmin, a wondering Helcrani Scholar, 1607


"When the morn coms and cok crows
Meet me whaer the Sylkel tree grows
And we wyll bow awer heds and pray
To sprowt whytte wings and fly away.

When the last won fals, when war ys done
And blud hath kolored the rysing sun,
When Innisents that no won culd sayve
Ly likke flauwers stroon on a grayve,
When doo coms yn a skarlyt hew
And no rein cann wash the world a-new,
When Aelyrels ar flone and starbacks fled
And there ys no room but for the ded,

When dysees drynks upon lyffe lykke wyn
And up-on all joys dos hard'ly dyn,
When mones thru empty streets reezownd
And all up-turned ys the grownd,
When yn plaeces whaer deth releevs
The rottyn aer's too thyk to breeth,
When a mother has to bery her chyld
And there seems no way to be rekonsyld,

When the nytte coms and wynds blows
Meet me whaer the Sylkel Tree grows
And we wyll bow our heds to pray
Then close our ays and dreem away."

Composed by Fina Kenes, a peasant woman of Nyermersys, 546 b.S

SURA 5:51 – 55    In the name of Allah, the Beneficent, the Merciful

O ye who believe! Take not the Jews and the Christians for friends. They are
friends one to another. He among you who taketh them for friends is (one) of
them. Lo! Allah guideth not wrongdoing folk. (51) And thou seest those in whose
heart is a disease race toward them, saying: We fear lest a change of fortune
befall us. And it may happen that Allah will vouchsafe (unto thee) the victory,
or a commandment from His presence. Then will they repent them of their secret
thoughts. (52) Then will the believers say (unto the people of the Scripture):
Are these they who swore by Allah their most binding oaths that they were surely
with you? Their works have failed, and they have become the losers. (53) O ye
who believe! Whoso of you becometh a renegade from his religion, (know that in
his stead) Allah will bring a people whom He loveth and who love Him, humble
toward believers, stern toward disbelievers, striving in the way of Allah, and
fearing not the blame of any blamer. Such is the grace of Allah which He giveth
unto whom He will. Allah is All-Embracing, All-Knowing. (54) Your freind can be
only Allah; and His messenger and those who believe, who establish worship and
pay the poordue, and bow down (in prayer). (55)

Never Step  on Shit Where You Walk …..



I know that some of you just would love to just step on some people that pisses
you off to the point of every time you see them it makes you sick to your
stomach. Even their causal smell just want you to stomp the shit out of them….
But, being the type of person you are you just smile and keep walking as though
they are fertilizing every spring flower that they come across…..  Shit,
although it smells helps the generate beauty… Let's look at it's meaning:

Fertilizer
Fertilizers (People the pisses you off) are chemical compounds given to plants
(People who are being stepped on) to promote growth (Enhances your career); they
are usually applied either through the soil (Within your work environment), for
uptake by plant roots, or by foliar feeding (Learning your trade), for uptake
through leaves (Passing on what you have learned).
Fertilizers (People the pisses you off) can be divided into organic (composed of
plant or animal matter) (Taking shit off of other ass kissing peers) , or
inorganic (made of simple, non-carbonaceous chemicals or minerals) (Peers that
may piss you off by not saying what is on their mind).
'Organic' fertilizers are composed of 'naturally' occurring compounds (Peers who
kiss ass as a Art) such as peat manufactured through natural processes (such as
composting) or naturally occuring mineral deposits (Peers who are put near you
to tell on you); or in the case of 'inorganic' fertilizers (Casual ass-kissers),
manufactured through chemical processes (such as the Haber process) or from
naturally occuring deposits that have been chemically altered (concentrated
Triple superphosphate[1]. (Peers who would do anything to get to the top).
Properly applied, these fertilizers can improve the health, productivity, and
appearance of plants (other employee's) as they provide different essential
nutrients (awareness of who will piss you off) intended to encourage plant
growth.
Fertilizers typically provide, in varying proportions, the three major plant
nutrients: nitrogen (Keeping Your Cool) , phosphorus (Keep Smiling While Pissed
Off), potassium (Saying a Kind Word To Prevent From Choking The Shit Out of
Them) known shorthand as N-P-K) (Fuck This Shit); the secondary plant nutrients
(calcium (Doing What Is Necessary), sulfur (To Keep Your Job), magnesium (Or,
Your Ass Will Be Unemployed) and sometimes trace elements (or
micronutrients)(Peers who go back and tell on your ass) with a role in plant or
animal nutrition: boron (Stay Away From Haters), chlorine (Always Smile),
manganese (Never Let Them Know What You Are Thinking), iron (Stay Strong), zinc
(Keep Prayerful), copper (Read Your Bible/Quran), molybdenum (Meditation Usually
Helps) and (in some countries[which?]) selenium (Kill Their Asses).
Both organic and inorganic fertilizers were called "manure" (Shit Talkers With
No Back Bone) derived from the French expression for manual (of or belonging to
the the hand[2]) tillage (In Short: Kiss Ass), however, this term is currently
restricted to organic manure (Bull Shitters).

Now that you understand how everything works go to you desk and have a fucked up
day with a Smile!!!!!!!!!

SURA 7:1 – 11      In the name of Allah, the Beneficent, the Merciful

Alif. Lam. Mim. Sad. (1) (It is) a Scripture that is revealed unto thee
(Muhammad) - so let there be no heaviness in thy heart therefrom - that thou
mayst warn thereby, and (it is) a Reminder unto believers. (2) (Saying): Follow
that which is sent down unto you from your Lord, and follow no protecting
friends beside Him. Little do ye recollect! (3) How many a township have We
destroyed! As a raid by night, or while they slept at noon, Our terror came unto
them. (4) No plea had they, when Our terror came unto them, save that they said:
Lo! We were wrong-doers. (5) Then verily We shall question those unto whom (Our
message) hath been sent, and verily We shall question the messengers. (6) Then
verily We shall narrate unto them (the event) with knowledge, for verily We were
not absent (when it came to pass). (7) The weighing on that day is the true
(weighing). As for those whose scale is heavy, they are the successful. (8) And
as for those whose scale is light: those are they who lose their souls because
they disbelived Our revelations. (9) And We have given you (mankind) power in
the earth, and appointed for you therein livelihood. Little give ye thanks! (10)
And We created you, then fashioned you, then told the angels: Fall ye prostrate
before Adam! And they fell prostrate, all save Iblis, who was not of those who
make prostration.(11)

Sent on the Now Network™ from my Sprint® BlackBerry

O Allah, bestow Your favor on Muhammad and on the family of Muhammad as You have
bestowed Your favor on Ibrahim and on the family of Ibrahim, You are
Praiseworthy, Most Glorious. O Allah, bless Muhammad and the family of Muhammad
as You have blessed Ibrahim and the family of Ibrahim, You are Praiseworthy,
Most Glorious.
Reference: Al-Bukhari, cf. Al-Asqalani, Fathul-Bari 6/408.

SURA 7:158 – 162   In the name of Allah, the Beneficent, the Merciful

Say (O Muhammad): O mankind! Lo! I am the messenger of Allah to you all - (the
messenger of) Him unto Whom belongeth the Sovereignty of the heavens and the
earth. There is no God save Him. He quickeneth and He giveth death. So believe
in Allah and His messenger, the Prophet who can neither read nor write, who
believeth in Allah and in His Words, and follow him that haply ye may be led
aright. (158) And of Moses' folk there is a community who lead with truth and
establish justice therewith. (159) We divided them into twelve tribes, nations;
and We inspired Moses, when his people asked him for water, saying: Smite with
thy staff the rock! And there gushed forth therefrom twelve springs, so that
each tribe knew their drinking-place. And we caused the white cloud to
overshadow them and sent down for them the manna and the quails (saying): Eat of
the good things wherewith we have provided you. They wronged Us not, but they
were wont to wrong themselves. (160) And when it was said unto them: Dwell in
this township and eat therefrom whence ye will, and say "Repentance," and enter
the gate prostrate; We shall forgive you your sins; We shall increase (reward)
for the right-doers. (161) But those of them who did wrong changed the word
which had been told them for another saying, and We sent down upon them wrath
from heaven for their wrongdoing. (162)