In July 2001, Capt. Monica Hill was just another Air Force physician on reserve duty. Then she was summoned from a civilian hospital in Ohio to work at Andrews Air Force Base in Maryland.

No big deal, she thought.

Sure, she was a lesbian in a 14-year committed relationship, but Hill had long lived as an out lesbian only at home and kept her military coworkers in the dark. She joined the Air Force soon after the military’s “don’t ask, don’t tell” policy went into effect, knowing the system was flawed but also thinking it would protect her. She now admits that was naive thinking.

Two weeks after Hill was ordered to Andrews, her partner, Terri Cason, was diagnosed with terminal lung cancer that had metastasized to her brain. “There wasn’t a way to take care of Terri and serve in the Air Force,” says Hill. When she asked the Air Force for a deferment from her assignment to be with her sick partner, her request violated “don’t ask, don’t tell.” Hill was dismissed.

From 1993 to 2003 nearly 10,000 gay men and lesbians were discharged from the U.S. military due to their sexual orientation. Now 12 ejected service members, including Hill, are putting human faces on that daunting statistic by suing the U.S. Department of Defense to be reinstated. The lawsuit, Cook v. Rumsfeld, may not be heard until 2006.

Notes Steve Rails, a spokesman for Servicemembers Legal Defense Network, which is backing the suit: “They are not asking for promotions, pay increases, or other advancements”–just to get their jobs back.

Cason died in September 2001. Three months later Hill was called to her discharge hearing. She was forced to produce a death certificate for Cason to prove that her request for a deferral was not a ploy to escape active duty. She was asked invasive questions: Had she been faithful? Did she intend to sleep with women again?

“It was just cruel,” Hill says quietly. “It was like I was dirty and a criminal. I had no value in the world. I was just astonished and shocked and dismayed.” As if that weren’t demoralizing enough, the Ah” Force demanded that Hill immediately repay her medical school tuition–about $65,000.

SLDN officials believe that Lawrence v. Texas, the U.S. Supreme Court ruling that overturned sodomy laws in 2003, has made it possible to fight “don’t ask, don’t tell.” Lawrence was successfully argued by putting consensual sodomy in the context of privacy rights for gay men and lesbians. Also helpful is a November military court ruling that cited Lawrence in overturning a male Army specialist’s guilty plea for engaging in private, consensual oral sex with a female civilian. In the past the military has argued that military law is not antigay, simply anti-”sodomy”–a rule that must apply equally to gays and straights.

Yet the current administration’s unabashedly conservative tilt has many legal experts concerned that while the case of the SLDN 12 will keep the military’s unfair gay bashing and expulsions before the media, the accused will not be putting on uniforms again anytime soon.

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In the film “The Graduate,” a neighbor gave one hushed word of business advice to Dustin Hoffman’s character: “plastics.” That screenplay was written more than 30 years ago. If it were written 15 years later, that word might have been “medical.” The exploding growth in the market for medical components, such as metal joints, bone screws and laparoscopic tools, has helped many job shops survive when orders from other industries lessened or disappeared in the late 1990s. The medical market is expected to continue to be strong as life expectancy lengthens, the Baby Boom generation crosses into senior citizenship, and orthopedic and microinvasive surgical advancements continue to evolve.

Before a shop seeks out medical customers, there are factors to consider to help ensure the shop’s success in the medical market. These have to do with the nature of orthopedic parts, the optimum way to produce them efficiently, quality requirements by both medical companies and the government, along with labeling and packaging.

JKB Tool in Milford, Connecticut, is a company that made a leap to medical machining about 6 years ago. The shop made its reputation in the 1980s as a designer and builder of sophisticated automatic assembly and test systems. An adjunct to that business was a small contract production shop and, later, a stamping business. Jason Blake, son of the founder, has worked with his dad since the business started, deburring parts in the family’s basement.

“When I graduated from college, I came to work at JKB full time,” Mr. Blake says. “That was 1994, and by 1997, the automation projects were getting bigger and more complex, but were less profitable. We were making money in the stamping business, but more jobs were going to China and Mexico, so the future in that was questionable.” As Mr. Blake tells it, the company was on the verge of despair by 1998.

“We had one hopeful spark going for us,” he says. “We had a small machining contract for a laparoscopic tube running on our CNC milling machine. We saw a future in medical parts and made a commitment to do whatever was necessary to go after more of that business; we had to become more efficient if we wanted to be successful at it.”

Mr. Blake was particularly interested in the orthopedic segment and understood that the shop would have to invest in new multifunction equipment to be competitive. In a typical bone screw, for example, the operations are thread whirling, broaching, gundrilling and micromilling. If conventional equipment is used for each operation, then three or four machines would be required.

“I went to the EASTEC trade show in ‘98 and looked at CNC screw machines for the bone screw parts that we wanted to attract, plus additional laparoscopic parts,” Mr. Blake says. “I knew that these were multi function machines, but that’s all I knew. I had never worked on one, nor had any of our employees.”

JKB purchased a “Deco” Swiss-type sliding headstock turning center from Tornos Technologies (Brookfield, Connecticut) in 1999. The machine was 60 percent faster (41 seconds) in a competitive test involving the laparoscopic tube part. Today, 6 years later, Mr. Blake and his crew produce that part even faster (36 seconds) as a result of gaining expertise in the technology.

First Machine

Once the machine was on the floor, the shop employees began working to master bone screw manufacturing. Titanium bone screws are used for spinal corrective surgery, trauma, and other types of bone repair and correction. Other bone screws are made of 316 stainless steel. They are produced by the millions in the United States to strict demands for tolerance, surface properties, cleanliness and packaging. The titanium screws range in length from 6 mm to 80 mm and have ODs from 2 mm to 8.5 mm. They typically require a 0.4-micron to 0.8-micron surface finish and dimensional tolerance of [+ or -] 0.025 mm. Customer specifications also often include the addition of an anodized coating for color coding different sizes and types of screws. Surface finishes and tolerances must take into account the coated layer, allowing for additions or reductions in material.

“It was a difficult time,” Mr. Blake says. “Remember, this was a new discipline for us, using a new technology in a new market. This was our very first screw machine.”

It was a challenge for JKB to adapt to the large volume of parts coming off the machine.

“If we made a mistake in programming or setup or tooling, it set us back in production time,” Mr. Blake says. “The bone screw machining process is not very forgiving.’”

Mr. Blake and his staff also had never worked with titanium, which is a tough, flammable material. If a tool breaks, the material’s temperature is so high that it can ignite the cutting fluid. It’s necessary to have fire extinguishers at every machine. According to Mr. Blake, he and his employees worked 14-hour days, 7 days a week for about 4 months to learn how to make the parts.

“But we were driven. We were hungry. We persevered,” he says. “The only thing we didn’t worry about during that learning phase was threading, which is usually the big problem for people requiring expensive, dedicated equipment. The Deco has a thread whirling attachment that puts the thread on so easily. They come out burr-free; we can put any shape we want into it; and we get tremendous life out of the tooling inserts.”

First Contract

JKB won a bone screw contract in 2000. The company sold off its press equipment and bought another Deco.

“We got the business because we could produce it for less than our competitors and with better quality and faster delivery,” says Mr. Blake.

Armed with confidence and experience in the technology, and driven by the spirit of survival and perhaps also by youth (Mr. Blake is 34; most of his employees are younger), the orthopedic part business grew.

“There were bumps and challenges along the way, of course,” he says. “One part comes to mind–a fixed-angle bone screw. We worked on that part for 2 years to make it successfully. We use all 20 tool positions on the Deco to make this part complete in one setup. The elliptical shape of the head posed unique challenges, such as part holding and the many operations that have to be performed in the machine’s counter spindle. The Deco gives you eight tool positions for counter operations, all of which can be live tools.”

JKB’s goal is to always make a part in what it calls “done-done” in the machine. The shop always tries to avoid secondary operations.

Art Deco

The ten-axis Deco machine can use two turning tools at the same time, completing rough and finish cuts in the same operation. One of the machine’s cross slides accepts up to four live tools for operations such as cross milling and off-center drilling. A gundrilling and high-pressure coolant attachment can be mounted on the end-working unit. This feature is a plus when producing cannulated bone screws, which are screws with a 1.5-mm to 2.5-mm hole through the entire length. JKB prefers to gundrill the hole rather than to buy cannulated stock, which is often unavailable. Polygon milling of flats or contours can be accomplished using the machine’s optional C axis on the main spindle.

While the bar in the main spindle is machined, operations are performed on the previously parted piece mounted on the counter spindle. For example, the counter spindle can present the part’s cut-off end to as many as four live tools or turning tools. In effect, the user gets these operations at zero time because they occur while the part in the main spindle is machined. Users such as JKB can minimize part cycle times by balancing operations between the main and counter spindles. As many as ten axes can be controlled simultaneously on the Deco, and up to four tools can be operating simultaneously.

“The programming is a different approach,” Mr. Blake says. “Tornos calls it PNC, parallel numerical control, because so much is happening simultaneously, but it’s the control and dedicated software that give you the productivity. The machine goes from operation to operation before you finish an eye blink. The payoff is worth learning it.”

The machine’s software automatically calculates real machining times, taking into account tool paths, operation sequences and other cutting data entered by the user. It also incorporates canned cycles that speed programming, such as barstock advance, cut-off and pick-up by the counter spindle. It also displays the part’s production rate.

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It’s now a core tenet of employer-sponsored health care: The more employees know about their health options and their own health status, the better off everyone is.

With good health education resources, experts say, employees can make more-informed decisions about medical matters, be more judicious in their health spending habits, and get problems diagnosed and under treatment before they mushroom into costly major illnesses. In turn, as employees become smarter health consumers, employers will be able to tighten their rein on premium increases and productivity losses.

Although employee-centered health education could be a plus for employers no matter what types of health plans they offer, it may be especially important, experts say, for employers offering consumer-directed plans. Those are the high-deductible plans that require employees to decide how to spend health care dollars that are, in effect, theirs. As employees take on more responsibility for health decisions, they should have access to resources to make the best possible decisions, experts explain.

In fact, many employers with consumer-directed plans already provide such resources, typically through health plan providers or other third parties. But even some companies without such plans are offering health education–not only to make employees more careful in their health spending habits now but also to prepare them for possible consumer-directed options in the future.
Another, perhaps more speculative, reason for employers to provide such education, however, is to shield themselves from potential complaints–and even litigation–centered on whether employees’ health problems stemmed from a lack of proper health decision tools.

Although no such suits are believed to have materialized, they are “theoretically possible,” says Helen Darling, president of the National Business Group on Health in Washington, D.C.

Timothy J. Stanton, a benefits attorney with Gardner, Carton & Douglas LLP in Chicago, says that although he has not seen any such lawsuits, “I could imagine cases where a participant who made ill-advised … decisions in a [consumer-directed] plan could sue a plan sponsor, alleging a breach of an ERISA fiduciary duty for failing to educate participants.” (ERISA is the Employee Retirement Income Security Act of 1974, which governs private health and welfare plans.)

“As fiduciaries,” Stanton continues, “employers should never put employees into plans the employees don’t understand and won’t be able to navigate successfully.” And because employees stand a greater chance of making mistakes in deciding about their health care under consumer-directed plans than under conventional plans, he adds, “I think education will be very important with the new consumer-directed programs.”

Schooling Needed

Although health care consumerism is still in its early stages, HR has been engaged from the start. HR professionals at many companies have been implementing health education and communication strategies–many of them online–for some time, and such efforts are spreading. (For more information, see “Health Education Turns Proactive” in the April 2005 issue of HR Magazine.)

But newer, better efforts may be needed because there is evidence that many employees lack the skills necessary to use the health information already available to them–which can be costly for employers.

According to a report issued last year by the Institute of Medicine, a private science advisory organization in Washington. D.C., nearly half of U.S. adults suffer from “health illiteracy” and cannot adequately use the mass of data already available to them.

About 90 million people have trouble obtaining, understanding and using information to make decisions about their health, which results in billions of dollars in avoidable medical costs, according to the institute’s report, Health Literacy: A Prescription to End Confusion. The report explains that those individuals who know little about health matters get less preventive care and use more emergency services than those who are health literate.

Health illiteracy crops up in many ways, from misreading drug dosage information to misunderstanding patient consent forms. Moreover, it spans the educational spectrum–from Ph.D.s to those with poor reading and writing skills to those for whom English is not their native language–according to William Smith, who served on the committee that wrote the report.

Smith, executive vice president of the Academy for Educational Development, a Washington, D.C.-based organization focused on the least-advantaged people in the United States and in developing countries, adds: “If you employ a significant number of employees, some of those with health illiteracy are working for you and costing you money. They’re using more health care than they should.”

Employers can do their part to make employees better informed about health matters, Smith says, by testing the read-ability of their benefits materials, making sure employees understand the health information they receive and guiding them to objective sources of information.

“Employers are very credible sources of information to their employees,” Smith says. And HR leaders can be especially effective, he adds, because they possess good interpersonal and communication skills.

Education For Now–And Later

While the driving force in health education for employees is the growth of consumer-directed plans, even companies with conventional health plans find they have to educate their employees on the facts about health costs–while also preparing them for a possible consumer-directed future. It happened recently at VML Inc., a marketing company in Kansas City, Mo.

VML, which last year was named one of the 25 Best Small Companies to Work for in America–a list created by the San Francisco-based Great Place to Work Institute and featured in the July 2004 issue of HR Magazine–had been picking up the full tab for health insurance for its 285 employees and their families. But the company had to make changes after two high-cost cancer cases in 2003 led to a proposed 40 percent premium hike last year, says Kristi Veitch, HR director.

VML negotiated a 25 percent increase with its provider after eliminating coverage for “lifestyle” drugs such as Rogaine and Viagra and for prescription drugs with over-the-counter equivalents–a change that affects mainly those who take allergy and acid-reflux drugs.

The company still pays the full premium for employees’ health coverage, but it has also helped them better understand the costs of various types of prescription drugs. “Now people are paying attention,” Veitch says. “People say, ‘Ah, this is going to cost me more money.’”

While VML was able to benefit from the situation by reducing drug coverage, workers also benefited by gaining a better understanding of certain health care costs, Veitch adds. “The awareness we’re teaching will help them if they go to other jobs or a consumer-directed health plan.”

Laying the Groundwork

Another company educating its employees on health coverage, even though it currently does not have a consumer-directed plan, is Washington Mutual Inc., a Seattle-based bank and financial services company. However, it has rolled out a number of health education tools in advance of the possible offering of a consumer-driven health plan next year, says Marilyn A. Guthrie, assistant vice president and manager of health promotion.

Faced with substantial health expense increases, Washington Mutual three years ago laid out a cost-containment strategy that included employee involvement, Guthrie explains. “The biggest issue for us was to engage employees in the cost and quality of health care.”

Washington Mutual’s 55,000 employees include many young individuals who generally are not sophisticated health care consumers, Guthrie says. “We wanted to hit them with the message of what’s in it for them” by emphasizing the ability to choose care and avoid wasteful spending.

The bank last year introduced an employee health portal as part of its corporate web site. The portal offers one-stop shopping for benefits enrollment and health information, including a personal health-risk assessment that, if completed, will earn employees points redeemable for gift cards. (For more information on health-risk assessments and other pre-emptive methods of curtailing employees’ health costs, see “Getting Personal” on page 98.)

Guthrie says employees haven’t used the health education tools to their fullest extent, but she adds that it’s too early to judge success or failure. What is clear is her ultimate goal: “We expect to see a reduction in the [health care cost] trend increase and an improvement in the overall health profile of our population.”

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Dozens of GE Healthcare software engineers will soon begin work alongside Intermountain Health Care staff in Utah. The two health IT noteworthies announced plans Wednesday to jointly develop systems that do not just verify that patients receive medications as prescribed by doctors, but also make sure that the medication makes sense.

Moreover, constant interaction between engineers and clinicians will make sure that the computer connects caregivers and patients rather than coming between them, said Brandon Savage, medical director of health care IT at GE Healthcare.

“What makes this [project] distinct is that we’re really focusing on how you build a monitor directly into the workflow.”

Clinicians and engineers will work side by side on the project, planned as part of a 10-year, $100 million collaboration between Intermountain Health Care Inc. and GE.

GE is providing its Centricity IT technologies across institutions within IHC’s network, which serve more than 2 million patients.

These installations will enable the widespread use of new software throughout the IHC network, including both hospitals and outpatient facilities.

IHC is known for inventing technologies to help clinicians make better decisions.

“We don’t have databases, we have knowledge-bases,” said Laura Heerman, a registered nurse and medical informaticist with IHC.

IHC and GE staff will work in a joint research center located within an hour’s drive of six IHC facilities, said Heerman, so engineers can readily observe clinicians at work. In addition, clinicians will visit the research center daily.

The program is just one of several collaborations between nonprofit health institutions and software companies.

In April, IBM and the University of Pittsburgh Medical Center inked an eight-year, $402 million deal to overhaul the medical center’s IT infrastructure. Duke University Health System has been working with McKesson to implement computerized physician order entry. However, the coordination between GE and IHC seems unusually deep.

IHC has used and designed decision-support software since the 1970s, often working with outside experts, but this is the first time it has joined forces with a global presence, said Heerman.

Headquartered in the United Kingdom, GE Healthcare is a $14 billion unit of General Electric Company with more than 42,500 employees. Some GE software engineers will move to Utah, said Savage, but others will be hired locally.

IHC and GE estimate the research center could create up to 100 new jobs.

“The rich clinical data IHC has collected over the years combined with GE’s clinical information technology programs will enable clinicians to capture and learn from embedded protocols, leading to a significant reduction in medical errors,” said Vishal Wanchoo, president and CEO of GE Healthcare Information Technologies.

The system will integrate physician ordering, pharmacy support, and bedside administration using bar codes and handheld devices linked into patient medical records.

The latest vital signs and other information will alert nurses to consider overriding medication orders. The software should be in use at some IHC hospitals over the next 12 to 18 months.

Heerman said that the software would improve both efficiency and patient safety. “The information is presented in a more useful manner so that less time is spent looking for data, and the decisions can be made more quickly and more accurately.”

To make information accessible, said Savage, GE would be leveraging open-source standards and contributing to them. Barriers to exchanging data cut down on innovation, said Savage, and innovation is what provides value in terms of clinical capabilities.

Read the full story on CIOInsight.com: Intermountain Health, GE Healthcare Join Forces on Electronic Medical Records

Check out eWEEK.com’s Health Care Center for the latest news, views and analysis of technology’s impact on health care.

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Q: I work in a 200-bed acute care facility. Our medical director is very aloof and is disinterested in providing direction for our laboratory. This is affecting the morale of the employees. As a supervisor, what can I do to change the atmosphere?

A: Larry Crolla recommends, “Try talking to the medical director and explaining what is happening. Offer solutions that the director can use to correct the problem–like suggesting that he hold a quarterly continuing education session or that he bring in a good case on occasion to show the staff how they have contributed to the patient diagnoses. Ask the medical director about reviewing surveys together when they are returned from your proficiency agency. You can also ask that the director attend your monthly lab meetings, even if it’s only for five minutes, to answer staff questions.”

Alton Sturtevant suggests, “A subtle, yet effective, method may be to define the team leaders for the various areas of the laboratory (i.e., hematology, chemistry, preanalytic, etc.), and identify them in an organizational document. Sit down with the medical director and go over this structure. Let him know that these leaders are responsible to you, him and the administration for making the laboratory a functional and responsible department. Tell him that you expect him to meet with you and these team leaders on a routine basis to deal with the issues affecting the lab. This group should also develop routine operating policies for the laboratory to respond to the needs of the medical staff.”

Dr. Sturtevant adds, “Organize the periodic consultation meetings with a predefined agenda to meet the needs of the laboratory as defined by the JCAHO and/or CAP. Send a copy of the agenda to the medical director, copied to administration, so that all parties will be informed as to the functions of the meetings. Inform hospital administrators about what you have done, and let them know that this structure will provide periodic input to you and the administration on the laboratory for review. Let the director know that regular visits and reports are needed for continued input to administration. Ensure that this interaction and reporting happens.

“Organize routine meetings and continuing education sessions with the medical director and the laboratory staff during his visits to increase staff and director interaction. Involve the director in personnel evaluations and routine competency reviews. Keep the medical director informed of all procedures to be reviewed, changed or deleted to proactively drive the process. Ensure that periodic reviews of JCAHO and/or CAP checklists are reviewed and approved by the medical director and the specific team leader. The approach discussed here is one designed to encourage appropriate director participation in the lab. Should this approach fail to yield the anticipated results, talk directly with your boss and ask him for advice about how to approach the situation with the medical director.

According to Marti Bailey, “There is variation in direct involvement by medical directors with their laboratory staffs. Just like other physicians, medical directors come in a broad range of technical, human resource and management skills. They probably function in large part according to their particular skill sets that, in turn, define their comfort level with certain activities. Just as varied as the medical directors themselves are the job situations they are hired into. In some cases, they’re expected to be actively involved with setting direction for the laboratory, while in others they’re expected to serve mainly in a technical capacity. In the latter, a laboratory manager or chief technologist usually heads laboratory operations.

“There probably is no one perfect model to follow. Trying to pressure a lab director who has no interest in leading the department or being involved with management functions could easily have a negative outcome. If there is a lab manager or other person at a level between the supervisors and the lab director, then he should have, by default, stepped into the leadership role for the department. It is a lab manager’s responsibility to manage the department along with assistance from the supervisors. In this situation, the lab director could certainly serve in a capacity only as consultant for technical or patient-care related issues without the department suffering.”

Ms. Bailey adds, “If there is no one between the supervisors and the lab director, it seems to me that this is a golden opportunity for one or more of your supervisors to step up to the bat. Since the supervisors are the people who work most closely with the staff, it is their interest in the staff and in providing good laboratory service that should have the most impact on morale, regardless of the attitude of the lab director. You should get beyond believing that the morale problem is the fault of your medical director. Supervisors are the ones who need to forge excellent relationships with their staff and let them know every day that they’re there to help the staff succeed. They’re also the ones who can provide an uplifting atmosphere in the day-to-day workplace.”

Bottom line. A job description with expectations is needed for all jobs in the hospital, including the medical director of the laboratory. Encourage appropriate medical director participation in the lab. Should this approach fail to yield the app ropriate results, talk directly with your manager and ask him for advice based on specific deficiencies of the director. If all of this fails, then a new director of the laboratory is probably needed.

Core lab supervisor working too many hours

Q: When our laboratory decided to create a core laboratory, management combined the hematology and chemistry supervisory positions to create a new core lab supervisor position. Nothing else changed, including the salary. I now find myself working 60 hours a week to keep up with all the paperwork and problems. What are my options?

A: Marti Bailey points out, “You always have the option of looking for greener pastures if you feel that’s a possibility. I’m sure you understand that the situation you find yourself in is not unique. All of the downsizing, rightsizing, mergers, and other reorganizations happening in today’s business world seem to have a common theme, and that is fewer people doing more work. In some cases, this is certainly justifiable, but increasingly I see employees beaten to death with insatiable demands on their productivity. A lot of employees take it as long as they can and then just leave.”

Ms. Bailey adds, “There is at least one other option available to you–redistribute your workload. There are two ways to go with this, but delegation is at the heart of either. This may be an opportunity for you to provide development for some of your staff members, and in this respect, assigning some of your work to others could be considered a growth challenge. On the other hand, some of your additional workload could justifiably be shared among all of the staff. I’m sure that a fair share of the work you do as supervisor is repetitive, would lend itself to a written procedure and could be handled by someone else other than yourself.

“I don’t think that you should simply assume that because two positions were merged into one, you are expected to handle all the tasks and responsibilities of those two jobs. I think it’s more likely that merging of the two supervisory positions was not intended to be an isolated change, but that others are depending on you to make additional operational changes needed to accommodate the core lab model. I think you need to develop and then propose a plan to distribute a portion of your workload so that you face a reasonable share of the work of the department.”

Alton Sturtevant recommends, “Review the defined structure and your current functions to determine whether you are functioning as you should be, based on the reorganization. If you are not functioning appropriately, then change your functions to meet the definition of the department. If you continue to work the excess hours, talk to your manager and explain your quandary. If you cannot direct changes to help you to meet the need to work less hours, then you must convince your manager to change the functions of the job, or you might do best to seek another position.

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Thanks for the warm welcome. It’s good to be back in the Windy City. I’ll try not to be too windy. [Laughter]

The last time I was here, which was in January, I talked about big objectives of my administration and big responsibilities we share, and I talked about the need to continue to fight the war on terror. I reminded our citizens that this country would uphold the just demands of the world and confront the real threat posed to the free world by Saddam Hussein. Since I was here, thanks to the bravery of our military and to friends and allies, the regime of Saddam Hussein is no more; the world is peaceful and free. Thanks to their bravery and their sacrifice, the world is more peaceful, America is more secure, and the Iraqi people are now free.

We have a lot more work to do in Iraq, and we’ll stay the course. And we’ve got a lot more work to do to make sure our country is secure, because the war on terror goes on. There are still terrorist networks which hate America because of what we love. They hate us because we love our freedoms. And since we’re not going to change, we’re going to have, to deal with them. We will be strong; we’ll be diligent; and we will win.

I also talked about economic security when I was here last. I laid out a plan, what I called a growth-and-jobs plan, that recognized that so long as any of our fellow citizens are looking for work, that we’ve got to be concerned about the fact they can’t find a job. We need a–I reminded the country that we needed to grow our economy so people could find work.

The crux of the plan I laid out said that if a person has more money in their pocket, they’re likely to demand an additional good or a service. In our type of economy, when you demand a good or a service, somebody is going to produce the good or a service. And when somebody produces that good or a service, it’s more likely a fellow citizen will find work. And the Congress acted, and they passed substantial tax relief, which will give more Americans their own money.

Today I’ve returned to Chicago to discuss another issue relating to our security, and that’s the need for us to improve the health security of the American citizens. We have an unprecedented opportunity to give America’s seniors an up-to-date Medicare system that includes more choices and better benefits like prescription drug coverage. And for the sake of health care for all Americans, we must reform the medical liability system. For years, leaders of both political parties have talked about these reforms. Now is the time to get the job done.

I am very grateful for the Illinois State Medical Society for hosting me today. This distinguished organization was founded in 1840 in Springfield, the same time that Abraham Lincoln was practicing law in that city on North 5th Street. Lincoln was a lawyer who believed in discouraging unnecessary litigation. I want to thank Dr. Ron Ruecker for his hospitality, his introduction.

I want to thank Tommy Thompson. Tommy used to be in this neighborhood. [Laughter] But he’s doing a fantastic job as our Secretary of Health and Human Services. When we talk about tort reform in this administration, Tommy is the point man up on Capitol Hill, working hard with Senators and Members of the United States Congress, some of whom traveled with us today. Senator Peter Fitzgerald is with us today, and I want to thank the Senator for joining us. Congressmen Bobby Rush and Luis Gutierrez, Rahm Emanuel, Danny Davis, Phil Crane, Mark Kirk, and Congresswoman Judy Biggert also traveled, and I want to thank the Members of Congress for your interest and for joining us.

We have just had a roundtable discussion with fellow citizens, some docs, some people on Medicare. I want to thank them for joining me today and sharing their stories and their concerns about the future of health care in our country.

One thing is for certain about health care in our country, is that we’ve got the best health care system in the world, and we need to keep it that way. We’ve got great docs in America. We’re really good at research. We’re developing technologies and medicines which are extending lives not only in our country but all across the world.

To make sure we’ve got a good health care system today and tomorrow, we’ve got to make sure that no policy of the Federal Government will undermine the system of private care in America. As folks who deliver that care, you know that we’ve got challenges in our system. We must address the challenges while not undermining the strengths of American medicine.

There are some hard-working folks in our country who do not qualify for Medicaid and cannot afford to buy health insurance. So I sent a proposal to Congress for refundable tax credits to help low-income people purchase their own insurance. There are too many needy Americans who use emergency rooms as their main source of health care. So I worked with Congress, and I want to thank Congress for increased funding, for more community and migrant health care centers all across America.

And we’ve got another challenge that we’re now dealing with in America, and that’s Medicare. It’s an essential commitment of this Government, yet the system is not keeping pace. The system is not adjusting to the advances of modem medicine. This year we have an opportunity to seize and strengthen and–to strengthen and improve Medicare for the sake of all our seniors. I’m here to urge Congress not to miss the opportunity. I’m here to ask for your help in making sure that Congress does not miss the opportunity.

Four decades–over four decades, the Government has made some improvements in Medicare. Notice I said “the Government” has made improvements in Medicare. Therein lies part of the problem. [Laughter] We’ve expanded the program to cover persons with disabilities, to cover kidney dialysis, to cover more home-based services to the bedridden, to cover some cancer screenings and vaccines. Yet, health care moves faster than bureaucracy. Health care is being transformed by drug therapies and active prevention. These are an increasingly important part of how docs treat their patients, yet seniors with Medicare must pay for those treatments out of their own pocket or go without them.

Medicine is changing; Medicare is not. As many as one-third of seniors on Medicare have no drug coverage at all. It’s about 900,000–90,000 seniors in Chicago without any drug coverage. Because seniors don’t have drug coverage for prescription drugs and preventative care, we are creating a health care system that is more expensive and less effective.

Let me give you two examples. Prolonged hospital stays for ulcers can cost up to $28,000, which Medicare pays. But Medicare does not pay the annual bill of $500 for drugs that can eliminate the cause of most ulcers. Medicare would pay many of the costs to treat a serious stroke, including bills from the hospital and the rehab center, doctors, home health aides, and outpatient care. And those costs can total upwards of $100,000. Medicare will not pay for a year’s worth of treatment with blood-thinning drugs that can prevent stroke, drugs which cost less than $1,000.

Time and time again, Medicare’s failure to pay for drugs means our seniors risk serious illnesses, disease, and injuries, all of which Medicare would pay to treat after the fact. America’s seniors deserve a modern system of health care, instead of a bureaucracy that covers the latest medical treatments slowly and sporadically. Our seniors should have choices under Medicare, so that affordable health care plans compete for their business and, at the same time, give them the coverage they need.

This principle of choice, of trusting people to make their own health care decisions, is behind the health plan enjoyed by every person on the Federal payroll, including every Member of Congress. All Federal employees get to choose their health care plan. Health plans compete for their business by offering good services and better choices at lower costs. It seems logical to me that if Members of Congress and staffs get good choices and good service, so should the seniors of America.

Here are the principles of the plan that I have submitted to Congress. Seniors who want to stay in the current Medicare system should have that option plus a prescription drug benefit. Seniors who want enhanced benefits, such as more coverage for preventative care and other services, should have that choice as well. Seniors who like managed care plans should have that option as well. And all low-income seniors should receive extra help, so that all seniors will have the ability to choose a Medicare option that includes a prescription drug benefit.

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Mallory Gray is figuring it all out. She doesn’t quite know exactly what her future career will be, but she’s on the right track. The 17-year-old from Springfield, Mo., has already had two fairly unusual part-time jobs. “I really just wanted to get a feel for different things,” she says. Last year, she groomed, exercised, and showed horses at a thoroughbred auction. Today, she works part-time as a food-service technician at a hospital, where she delivers food trays to patients. She’s also picturing herself building a career in health care.

Mallory thought about being a doctor when she was little and still thinks it could be an option. Her part-time job is helping her decide. “Even though I specialize in food and nutrition, I’m still around doctors and nurses,” Mallory points out. She watches how medical professionals do their jobs; she interacts with patients and has learned her way around a hospital–things that may help her decide on that medical career. “I know it isn’t as glamorous as ER on television, but I could still have fun with it and help people,” she says. Pediatrics and surgery are two areas she’s now considering.

WHY WORK NOW?

More than half of high school seniors, 56 percent, said they worked in the spring of their final year of school, with most earning minimum wage, according to a study by the University of Washington. Nationwide, about two out of five teens ages 16 to 19 hold a part-time job. Retail gigs and burger joints are the jobs teens have traditionally gravitated toward, since they’re close to home, convenient to school, or often the only options available. But if, like Mallory, you’re exploring your future career options or simply want to work with something you have a passion for–cars, for instance–there are opportunities to bust out of the box.

“Whether you’re bagging groceries, working at an amusement park, or painting houses, it’s never too early to start honing marketable skills and building a strong resume,” says Sharon Rosengart, director of career services at DeVry University in North Brunswick, N.J. Rosengart suggests taking on as much responsibility as possible and finding creative ways to get the most out of your part-time, after-school, or summer job. If you are enthusiastic about your work, aren’t afraid to put your originality on display, and step up to the difficult tasks no one else wants, you’ll earn the respect of your employers–and they can help you with networking and provide references later on.

HOW PART-TIME PAYS OFF

There are serious benefits in any part-time job: First, you’ll make your own money (cool for sure), but you’ll also be responsible for deciding how to spend and save those greenbacks. You’ll need to make decisions–for example, do you really need another lip gloss or a pair of expensive tennis shoes? Or should you save up to buy a car or to pay that cell phone bill due at the end of the month?

“Another thing that’s valuable is gaining soft skills,” says Rosengart. These aren’t technical skills required for your job but all the other things your day-to-day work may involve–like written and verbal communication, dealing with customers, handling money, putting people at ease, managing your time, relating to someone who may not speak English well, or dealing with kids.

John Gaeta, 17, of St. Petersburg, Fla., is gaining a lot of important skills he can use in the future. He’s put his love of water and swimming to good use by taking a lifeguard certification course and snagging a job at an area pool. Lifeguarding has taught John about dealing with the public, communicating well, and handling daily responsibilities. “At any second, someone’s life may be in danger and I have to act quickly to ensure their safety,” he says.

John has learned how to react in tough situations–rowdy kids, unhappy patrons, people who need to be put at ease quickly. He notes that his lifeguarding job “has given me good experience working with others and taught me how I need to respond calmly but differently in every situation.” John is interested in a career in sales–and he knows the skills and experience he’s gained as a lifeguard will be useful in almost any career.

HOW TO FIND THAT JOB

If you’re prowling for a cool part-time job, start by writing down your skills, talents, strengths, weaknesses, hobbies, likes, and dislikes, says Jeanne Webster, author of If You Could Be Anything, What Would You Be? A Teen’s Guide to Mapping Out the Future (Dupuis North Publishing, 2004). That list can help you determine the kind of job you’d be most happy doing.

Then it’s time to spring into action and find that job. Think about the businesses you and your family use most often: veterinarians, accountants, repair shops. What skills do you have that they could use? Once you have a specific job idea in mind, contact the businesses and offer your services.

Network with people you know. Let everyone–parents, friends, neighbors, your brother’s friend’s dad–know that you are looking for work. Make sure you tell them the kind of job you’re seeking.

Kim Oates, 18, of Jacksonville, Fla., found her job when a friend mentioned that her mom’s salon needed a receptionist. “Working in a salon fits me well, since I love sampling the products, seeing people’s transformations, and keeping up on the latest styles and trends,” says Oates. She checks clients in and out, handles a computerized appointment schedule and cash register, makes reminder calls, does shampoos, and assists the stylists with mixing color and perm solutions.

“I’ve learned a lot about giving customers what they want,” she says. Oates has honed marketable skills in keeping clients happy, staying organized, and working with a team of people. She’s even thought about getting a cosmetology license as a way to earn money for college.

PLAY YOUR CREATIVE CARD

Teens who are looking for more than a 3 to 7 p.m. commitment might want to start their own small business in babysitting, landscaping, Web design, or graphic arts. “Get creative,” says Webster. If you have a talent and find yourself using it frequently for friends and neighbors anyway, maybe it could help you earn some cash.

Greg Katz, 19, a freshman at Johns Hopkins University, went into business with his best friend when they were high school sophomores. “We wanted some extra income, but we weren’t really interested in having a boss and doing it the traditional way. So we sat down and brainstormed what we could do to make money,” says Katz. The duo decided to use their computer skills and launched K&R Computer Repair in North Caldwell, N.J.

They experimented with different advertising methods, from flyers to direct mailings, and built up a client list. “Any problem a person has, we can take care of it; we do upgrades, software installation, cleaning a computer virus, fixing an Internet connection,” says Katz.

By identifying problems they were able to solve, Katz and his friend built a successful small business. During high school they charged $35 an hour but recently raised their rate to $50. This year they incorporated (became legally recognized as a business) and hired employees to keep the business going while they are away at college.

Katz, who is leaning toward a political science degree, hopes to keep his company going after college and well into the future. “We always felt the best Option was to go into business,” he says. Though starting a business was much more challenging than getting a part-time job–business owners must handle taxes and payroll, for example–he feels the payoff has been worth it. Katz and his partner have earned more money than they would have made working for an employer–and they’ve set the wheels in motion for their future careers.

YOUR BOTTOM LINE

“The more experiences you have, the better,” says Rosengart. If you don’t find something you love or have a passion for right out of the gate, keep trying. Sampling a variety of jobs is a great way to jump into the work world. Don’t be afraid to change your mind either. Your likes, dislikes, passions, and interests evolve as you mature, head through college, or enter adulthood, says Webster. Remember what you wanted to be at 6, 8, or 12? Chances are, you have probably changed your mind many times!

“And don’t just look for jobs that pay the most money,” says Webster. Everyone wants to live well and drive a cool car, but we all have talents, the potential to serve others in a positive way, and passions that we can develop even in a part-time job.

ON-THE-JOB TIPS

* ASK QUESTIONS. You’ll be surrounded by professionals with experience in their field. Talk to them about their career path during free time, advises Sharon Rosengart, director of career services at DeVry University.

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The University of North Carolina School of Journalism and Mass Communication has received a $100,000 gift to create a new graduate scholarship designed to improve media coverage of minority health issues.

The gift, from the Pfizer Medical Humanities Initiative, will establish the Pfizer Minority Medical Journalism Scholarship in the school’s medical journalism program. The award will provide a $4,000 stipend and full tuition for each of the first three semesters of the two-year program, plus two years of health insurance.

“The Pfizer Minority Medical Journalism Scholarship helps to ensure that the health and medical issues that disproportionately impact underserved minorities in our societies will continue to have a prominent place in the future of medical reporting,” says Dr. Michael Magee, director of the Pfizer Medical Humanities Initiative, a part of the Pfizer pharmaceutical and health-care products company.

“This scholarship is a tremendous opportunity for a graduate student to receive training in medical journalism,” says Dr. Tom Linden, program director. “Our hope is that the student, upon graduation, will report about minority health issues, which receive little coverage in our popular media.”

Recent program graduates have secured jobs at Long Island’s Newsday, Voice of America, the National Institutes of Health and other organizations.

To seek the scholarship, candidates must apply to the medical journalism program and complete admissions requirements. They also must submit a 500-word autobiographical sketch demonstrating commitment to the intent of the award, as well as three writing samples, preferably in journalistic form. Candidates also must have an undergraduate grade-point average better than 3.0 and demonstrate financial need. The application deadline is Jan. 1 for admission the following fall.

For more information about the Pfizer Minority Medical Journalism Scholarship and the Medical Journalism Program,

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The American public is concerned about the fact that many physicians and scientists have financial ties to the drug and device industries, and most people want the news media to do a better job disclosing these ties whenever experts are quoted. These results from a survey conducted by the Center for Science in the Public Interest (CSPI) led this advocacy group to convene a recent conference in Washington, DC, entitled, “Conflicted Science: Corporate Influence on Scientific Research and Science-Based Policy.” The speakers were primarily researchers and investigative journalists who have written articles about this topic which has become the focus of mounting concern for editors of medical journals.

Michael Jacobson, CSPI’s executive director, set the tone for the conference: “The corporate world seeks to influence science and science policy at many different levels, from the sponsorship and design of university research to the creation of scientific journals; from placing sympathetic scientists on federal and international advisory committees to generating publicity in the mass media; from influencing major health charities to creating their own friendly nonprofit organizations.” Jacobson said, as he turned the program over to the speakers, that he had asked them not just to express their concerns, but also to suggest remedies.

Passive smoking is one major area followed by Lisa A. Bero, PhD, Center for Tobacco Control Research and Education, University of California, San Francisco. “Researchers funded by the tobacco industry were nine times more likely to find no relationship between ill health and passive smoking,” she found. When a 1981 study showed a link between lung disease and nonsmoking women living with smokers, Dr. Bero said that the tobacco industry created its own study to refute it. For example, the industry funded studies that found ill effects of other sources of indoor air pollution to distract from the importance of secondhand smoke, reported Dr. Bero. Another tactic is to simply create doubt in the media about the studies that showed adverse health effects associated with smoking and to characterize such findings as “controversial.”

Drummond Rennie, MD, deputy editor of the Journal of the American Medical Association, pointed out that drug companies often set up comparison trials designed in such a way that their products are bound to come out on top. He gave as example the trial Pfizer designed for its oral drug fluconazole (Diflucan), which treats yeast infections and toenail fungus. To prove that fluconazole is best at treating the potentially fatal funguses that afflict people with AIDS, Pfizer pitted its drug against oral versions of competitors’ antifungal drugs, one of which should have only been given intravenously and the other already known to be ineffective in people with AIDS.

Secretiveness is also a major problem. To the drug industry, “everything is a trade secret, even the very existence of a clinical trial,” Dr. Rennie said, referring to the fact that industry-sponsored trials that produce negative results often go unpublished. The remedy for this problem, he said, would be the required registration of all trials at inception. That way a drug company cannot hide the number of trials that come up with results unfavorable to their products. As for the common problem of university researchers with financial ties to industry, Dr. Rennie noted, wryly, “What is called conflict of interest is called synergy by Wall Street.”

Dr. Rennie alluded to two high-profile cases in which researchers found that the cheaper, older drug was not only more effective, but also safer than newer products. In both cases, the drug companies whose products were in danger of losing market share attacked the researchers and initiated lawsuits to stop them from going public with the results.

Two weight loss drugs sold in the combination called “fen-phen” made news in the 1990s because they caused heart valve damage. Investigative reporter Alicia Mundy, who wrote a book on the topic, told the conference how much she learned about the use of medical studies as public relations while searching the files of Wyeth-Ayerst Laboratories. Her book Dispensing With the Truth “documents how this drug company and its partners knew about the diet drugs’ links to an increasing number of deaths from a lung disease and to major heart valve damage, and did not reveal this to doctors, to the press, or to the FDA.” About 7 million people took the drugs from 1994 to 1997.

After the diet drugs Redux and Pondimin (the “fen” of the “fen-phen” combination) were withdrawn in 1997 at the urging of the FDA, the manufacturers put their considerable resources toward damage control. A 1998 front-page story in USA Today proclaimed, “Study: No heart damage from diet drug.” The source of the headline was a study presented by Dr. Neil Weissman at an American College of Cardiology conference, and the upbeat news was also reported in The New York Times. Mundy said that her investigative work led her to this scoop: After the conference, Dr. Weissman sent his study to The New England Journal of Medicine, which provisionally rejected it. Mundy found that the Journal editor had sent a letter to Dr. Weissman, telling him to recalculate his results using a methodology suggested by the Journal’s reviewers.

Once Dr. Weissman complied, Mundy said, his results were quite different. A significant link was shown between heart-valve damage and the drug Redux. Two other studies eventually found the same link, but when the recalculated study was eventually published by The New England Journal, the revised findings never got the same media attention. “No one noticed,” observed Mundy, that the lead researcher was the same Weissman who, only six months earlier, had dismissed the heart-valve problems.

“We don’t hear much about the fen-phen story anymore,” noted Mundy, explaining the reason. The people who brought lawsuits against Wyeth-Ayerst because they had been harmed by these diet drugs had to sign confidentiality agreements that prevent them from warning others.

One common way drug companies can easily get free air time for their sales pitches is the video news release (VNR), which is an ad disguised as objective reporting. TV stations love these VNRs because they save them money and feeds the desire for news with a positive spin, according to Trudy Lieberman, a journalist and director of the Center for Consumer Health Choices at Consumers Union. She tracked the Cytyc Corporation’s VNRs for its new Pap test technology called ThinPrep. “It followed the standard VNR formula,” explained Lieberman, “It is patient-based, always positive and always provides a take-away message: have this test, buy this product, ask your doctor.”

Lieberman encountered the same “patient” in dozens of stories in print and TV. Her name is Peggy Smith, and she tells women that ThinPrep had saved her life. What harm do these disguised ads cause? asked Lieberman, rhetorically. “There is no evidence that this technology saves lives, though ThinPrep does generate a lot of false-positive results and unnecessary investigations,” she said, “And the people viewing these VNRs probably do not have a clue that they are ads.”

Of the remedies suggested by the speakers, full disclosure was on everyone’s list. One can’t help but notice, however, that the media are currently doing an uneven job in this regard. For example, last November, The New England Journal of Medicine published a major study that found testing people for C-reactive protein might be more useful in determining heart disease risk than cholesterol screening. The media were filled with upbeat quotes about the importance of C-reactive protein testing from the lead author, Paul M. Ridker, MD. However, virtually all the news stories left out the information that Dr. Ridker holds a patent on the new test, a fact disclosed at the end of his study in The New England Journal of Medicine..

On the other hand, some journalists are doing their jobs. When the National Cholesterol Education Program revised their guidelines in 2001 by lowering the level at which people were considered to have dangerously high cholesterol, Thomas Burton and Chris Adams of The Wall Street Journal noted that 36 million people now had high cholesterol which automatically triples the number of Americans who are candidates for cholesterol-lowering drugs. Burton and Adams also noted that five of the 14 members of the committee that made this decision were either consultants to, or had received honorariums from, companies that made cholesterol-lowering drugs.

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A U.N. agency said Friday in its annual report on China that the government should increase basic education, employment and healthcare for its vast underclass to close the yawning income gap.

The U.N. Development Program’s China Human Development Report 2005 recommends a social security system for every worker in the country and household registration reforms that will give more rights to the 150 million rural inhabitants who work in cities.

It also suggests loans for small entrepreneurs and creation of home-care jobs to serve the elderly.

Chinese authorities, meanwhile, must keep improving access to primary education and the quality of schooling to give farmers knowledge they need to raise their income later, the UNDP recommends.

The report further suggests creating adequate preventive healthcare, scheduled immunizations and disease control in rural areas.

The UNDP said in a statement its third China report is ”the first comprehensive study to offer a set of bold and practical policy recommendations” for the underclass. It is also the first China report to include input from the Chinese government.

As China’s population approaches 1.6 billion by 2030, differential access to work, school and medical services has pushed urban income up three to 11 times more than what rural people earn, the report says.

Gender inequalities, such as the impact of state-owned company layoffs on their largely female former employees, also need correcting, the report says.

Foreign governments, development banks and nongovernmental organizations have noted similar disparities in China. Some say the gap could create conditions for massive social instability.

The UNDP report will be forwarded to the Chinese government for policymaking consideration.

”This report is particularly timely as the government is shaping its new economic blueprint to ease the strains of inequality,” said Khalid Malik, UNDP resident representative in China, in a statement.

”There is no question that more can be done to mind the gap that so often triggers social unrest when economic growth on a national scale leaves the poor and the disadvantaged behind,” it says.

The report also cites manifestations of the widening gaps.

A farmer in the western provinces of Guizhou or Yunnan lives to an average age of 65, while someone in the coastal provinces of Hainan or Jiangsu can live to 74, the UNDP says as an example of healthcare disparities.

Fifteen percent of rural residents had health insurance last year, the U.N. agency added, while half of Chinese city dwellers had it.

Less than 1.5 percent of Tibetan children go to junior high, down from more than 60 percent of children from the cities of Beijing, Shanghai or Tianjin, the UNDP says. It says the government also spends 10 times more on social security for urbanites than for people in the countryside.

The upside of China’s income gap is driving statistics such as its annual economic growth rates of more than 9 percent and a reduction in abject poverty from 250 million to 26.1 million since 1979, the report indicates.

”Nevertheless, China remains plagued by imbalances in development — most notably between urban and rural areas, between regions, between sexes and between different population groups,” the report says.

China is moving in the right direction now, the UNDP said. The report lauded the government for canceling agricultural taxes by the end of 2005 and for offering free school textbooks to 24 million low-income elementary school children.

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