CareView Communications, Inc. Announces Success of SouthCrest Hospital Deployment

CareView Communications, Inc. (“CareView” or the “Company”) (Pink Sheets:CRVW), an information technology provider to the healthcare industry, announced today the successful deployment of the CareView System(TM) at SouthCrest Hospital, a 180-bed hospital and #1 provider of coronary interventional procedures and cardiac surgery, maternity and general healthcare services in Tulsa, Oklahoma.

The CareView System(TM) is a suite of products that brings the information technology of the 21st century directly to patients, families and healthcare providers by connecting them through one easy-to-install and simple-to-use system. SouthCrest Hospital is now able to provide:

— Doctors, nurses and other healthcare providers with the ability to efficiently and cost-effectively monitor, treat and visit their patients.

— Family members and friends with the ability to use the Internet to monitor, visit and correspond with their loved ones in SouthCrest.

— Patients and their visitors with direct access to on-demand high-speed Internet and first run movies in their rooms.

— The ability to implement audit tools to insure that quality standards are being met and safety measures are being complied with, while both are used to further educate caregivers to continually enhance quality and safety.

“The CareView System allows our nurses to visually monitor patients in their rooms every minute of every day which improves patient care and ultimately provides an even safer hospital environment. In addition to providing patients with Internet access, they can also have their family and friends for a video visit and watch first run movies in their rooms. So, if a grandparent is in the hospital, family members out-of-state can view the patient in their room and talk with them via the CareView system. Family members and even our soldiers overseas have the ability to view new infants via BabyView. With this system, patients have complete control over when the camera in their room is on and can turn it off at any time,” said Tony Young, President and CEO of SouthCrest Hospital.

“We are proud to be a part of the SouthCrest team and are extremely excited to make today’s announcement. This deployment not only expands our network, but it gives us the continuing privilege to work with the dedicated healthcare professionals at SouthCrest who are the first to promote improvements in the care, safety and environment of their patients,” stated Samuel A. Greco, CareView’s CEO.

Governor Tommy G. Thompson, the Company’s Chairman of the Board and former Secretary of Health and Human Services stated, “I have long been a staunch advocate of improving technology in our hospitals and SouthCrest is a leader in bringing the healthcare industry into the Information Age.”

About CareView Communications, Inc.

CareView has created a proprietary high-speed data network system that may be deployed throughout a healthcare facility using the existing cable television infrastructure. This network supports CareView’s Room Control Platform (RCP) and complementary suite of software applications designed to streamline workflow and improve value-added services offered to customers. Real-time bedside monitoring and point-of-care video monitoring and recording improve efficiency while limiting liability, and entertainment packages and education enhance quality of stay. This technology may also act as an interface gateway for other software systems and medical devices moving forward. CareView is dedicated to working with all types of hospitals, nursing homes, adult living centers and selected outpatient care facilities domestically and internationally.

Corporate offices are located at 5000 Legacy Drive, Suite 470, Plano, TX 75024. Questions may be directed to John R. Bailey, Chief Financial Officer at (972) 943-6044. More information about the Company is available on the Company’s website at www.care-view.com.

This press release shall not constitute an offer to sell or a solicitation of an offer to buy securities of CareView Communications, Inc. Certain statements in this release and other written or oral statements made by or on behalf of the Company are “forward looking statements” within the meaning of the federal securities laws. Statements regarding future events and developments and our future performance, as well as management’s expectations, beliefs, plans, estimates or projections relating to the future are forward-looking statements within the meaning of these laws. The forward-looking statements are subject to a number of risks and uncertainties including market acceptance of the Company’s services and projects and the Company’s continued access to capital and other risks and uncertainties. The actual results the Company achieves may differ materially from any forward-looking statements due to such risks and uncertainties. These statements are based on our current expectations and speak only as of the date of such statements. The Company undertakes no obligation to publicly update or revise any forward-looking statement, whether as a result of future events, new information or otherwise.

Kindred Healthcare Announces Planned Disposal of Two Unprofitable Hospitals

Kindred Healthcare, Inc. (“Kindred” or the “Company”) (NYSE:KND) today announced its plans to dispose of two unprofitable long-term acute care (“LTAC”) hospitals.

Last evening, the Company signed a definitive agreement to acquire for resale the real estate associated with the 79-bed Kindred Hospital Northeast – Braintree in Braintree, Massachusetts from the current lessor, Health Care REIT, Inc. (NYSE:HCN), for approximately $22.3 million. Upon completion of the transaction, the Company intends to close the hospital and sell the related real estate as soon as practicable.

The Company also is currently marketing Kindred Hospital Modesto in Modesto, California. The hospital operations have been closed but the Company continues to operate a co-located 64-bed skilled nursing unit.

These two facilities reported aggregate revenues of approximately $37 million and $18 million for the year ended December 31, 2007 and the six months ended June 30, 2008, respectively, while aggregate pretax operating losses associated with these facilities (including an asset impairment charge related to the Modesto facility of approximately $5.1 million recorded in the second quarter of 2008) approximated $8.0 million and $9.3 million for the same respective periods.

In the aggregate, the Company expects to report a pretax loss ranging from $35 million to $40 million in connection with these divestitures, including the write-off of approximately $15 million of intangible assets. Dependent upon the timing of certain events, the Company expects to report a substantial portion of the loss on sale in the third quarter of 2008 and the remainder, if any, in the fourth quarter of 2008.

For accounting purposes, the Company expects to classify the loss on sale and historical operating results of the Braintree hospital as continuing operations when it reports its third quarter operating results. In the fourth quarter of 2008, assuming that certain conditions have been met, the Company expects that the loss on sale and historical operating results of the Braintree hospital will be reclassified to discontinued operations. The asset impairment charge and historical operating results of the Modesto facility will be classified as discontinued operations in the third quarter of 2008.

“While our primary focus is continuing to improve the quality of our operations in each of our sites of service, we are also continuing our efforts to improve our financial results through the disposal of unprofitable or non-strategic assets,” said Paul J. Diaz, Kindred’s President and Chief Executive Officer. “These transactions will allow us to focus more management time and resources on our other more productive operations which should improve the quality of our services and promote better financial results as well. We are working with our patients and their families, as well as our employees, to ensure that these transactions are handled smoothly and that all patients are transferred to an appropriate healthcare setting.”

Forward-Looking Statements

This press release includes forward-looking statements within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934. All statements regarding the Company’s expected future financial position, results of operations, cash flows, financing plans, business strategy, budgets, capital expenditures, competitive positions, growth opportunities, plans and objectives of management and statements containing the words such as “anticipate,””approximate,””believe,””plan,””estimate,””expect,””project,””could,””should,””will,””intend,””may” and other similar expressions, are forward-looking statements.

Such forward-looking statements are inherently uncertain, and stockholders and other potential investors must recognize that actual results may differ materially from the Company’s expectations as a result of a variety of factors, including, without limitation, those discussed below. Such forward-looking statements are based upon management’s current expectations and include known and unknown risks, uncertainties and other factors, many of which the Company is unable to predict or control, that may cause the Company’s actual results or performance to differ materially from any future results or performance expressed or implied by such forward-looking statements. These statements involve risks, uncertainties and other factors discussed below and detailed from time to time in the Company’s filings with the Securities and Exchange Commission.

In addition to the factors set forth above, other factors that may affect the Company’s plans or results include, without limitation, (a) changes in the reimbursement rates or the methods or timing of payment from third party payors, including the Medicare and Medicaid programs, changes arising from and related to the Medicare prospective payment system for LTAC hospitals, including potential changes in the Medicare payment rules, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, and changes in Medicare and Medicaid reimbursements for the Company’s nursing centers; (b) the impact of the Medicare, Medicaid and SCHIP Extension Act of 2007, including the ability of the Company’s hospitals to adjust to potential LTAC certification and the three-year moratorium on future hospital development; (c) the Company’s ability to operate pursuant to the terms of its debt obligations and its master leases with Ventas, Inc. (NYSE:VTR); (d) the Company’s ability to meet its rental and debt service obligations; (e) the Company’s ability to attract and retain key executives and other healthcare personnel; (f) increased operating costs due to shortages in qualified nurses, therapists and other healthcare personnel; (g) the effects of healthcare reform and government regulations, interpretation of regulations and changes in the nature and enforcement of regulations governing the healthcare industry; (h) failure of the Company’s facilities to meet applicable licensure and certification requirements; (i) national and regional economic conditions, including their effect on the availability and cost of labor, materials and other services; (j) the Company’s ability to control costs, particularly labor and employee benefit costs; (k) the Company’s ability to successfully pursue its development activities and successfully integrate new operations, including the realization of anticipated revenues, economies of scale, cost savings and productivity gains associated with such operations; (l) the increase in the costs of defending and insuring against alleged professional liability claims and the Company’s ability to predict the estimated costs related to such claims; (m) the Company’s ability to successfully reduce (by divestiture of operations or otherwise) its exposure to professional liability claims; (n) the further consolidation of managed care organizations and other third party payors; (o) the Company’s ability to successfully dispose of unprofitable facilities; (p) changes in generally accepted accounting principles or practices; and (q) the Company’s ability to maintain an effective system of internal controls over financial reporting. Many of these factors are beyond the Company’s control. The Company cautions investors that any forward-looking statements made by the Company are not guarantees of future performance. The Company disclaims any obligation to update any such factors or to announce publicly the results of any revisions to any of the forward-looking statements to reflect future events or developments.

About Kindred Healthcare

Kindred Healthcare, Inc. is a healthcare services company, based in Louisville, Kentucky, with annual revenues of over $4 billion and approximately 54,000 employees in 40 states. At June 30, 2008, Kindred through its subsidiaries provided healthcare services in 656 locations, including 83 long-term acute care hospitals, 228 skilled nursing centers and a contract rehabilitation services business, Peoplefirst rehabilitation services, which served 345 non-affiliated facilities. Kindred’s mission is to promote healing, provide hope, preserve dignity and produce value for each patient, resident, family member, customer, employee and shareholder we serve. For more information, go to www.kindredhealthcare.com.

Video: U.S. Department of Health & Human Services Joins Ad Council, NBA, and Boys & Girls Clubs of America to Tip Off National Obesity Prevention Contest on YouTube(R)

NEW YORK, Sept. 12 /PRNewswire/ — The U.S. Department of Health & Human Services (HHS) joined today with The Advertising Council, the National Basketball Association (NBA), and Boys & Girls Clubs of America (BGCA) to tip off a national user-generated video contest on behalf of HHS’ and the Ad Council’s Small Steps Obesity Prevention public service advertising campaign. Hosted on YouTube, the contest aims to encourage teens and young adults ages 14-24 to submit original videos demonstrating the power of taking small steps to get healthy.

To view the Multimedia News Release, go to: http://www.prnewswire.com/mnr/adcouncil/34657/

HHS Secretary Mike Leavitt and NBA All-Star and Washington Wizards’ point guard Gilbert Arenas will announce the winner in partnership with Boys & Girls Clubs of America in Washington, D.C., at the end of October.

“Small changes to your eating and exercise routines can result in big successes. The message is simple but compelling,” Secretary Leavitt said. “This contest provides an opportunity for young adults to inspire others to make small steps toward a healthier life.”

Over the next four weeks, young Americans will be encouraged to create and submit videos illustrating the benefits of taking small steps to get healthy, including physical activity and good eating habits. Submissions will be accepted until Oct. 7, after which contestants are encouraged to share their video entries with their peers. The 10 videos that receive the most views on YouTube between Oct. 8 and Oct. 28 will be judged by a panel comprised of advertising professionals, health officials, BGCA representatives and the NBA’s Arenas. The panel will choose the grand prize winner.

One Grand Prize winner will receive $2,500 in cash and prizes to NBAStore.com. Four runners-up will receive $500 toward NBA merchandise and athletic gear.

According to HHS’ Centers for Disease Control and Prevention, nearly two-thirds of American adults are overweight or obese. The percentage of young people who are overweight has more than tripled since 1980, with more than 10 million school-age children currently considered overweight.

“This contest is a wonderful opportunity to engage teens and young adults throughout the country in the important messages communicated in our campaign,” said Peggy Conlon, president and CEO of the Ad Council. “We are grateful to the NBA for donating the prizes and using their valuable inventory to promote the contest among their fans, an ideal demographic for our messages.”

The Ad Council, HHS, NBA and BGCA will promote the contest in their newsletters, on their websites and through their marketing channels. The NBA will encourage participation in the contest through on-air announcements during NBA games on TNT and TBS, as well as in-store and online promotions as part of its NBA FIT initiative, a league-wide, comprehensive health and wellness platform that encourages proper eating habits and promotes exercise to children and young adults. As a member of the NBA FIT team, Arenas will serve as one of the contest’s featured spokespersons and encourage kids to get involved.

“As an athlete, I know how important both exercise and nutrition are to my everyday performance,” said Arenas. “This contest is a great way to get young people across the country to show that they are up to the challenge of telling us just how important regular exercise and maintaining a healthy diet are to them and how creative they can be in fitting it into their daily lives.”

Boys & Girls Clubs of America will enlist its local Clubs throughout the country to drive interest in the Small Steps Video Contest and support video submissions from children in the communities they serve. The Ad Council has also developed a promotional video, as well as a series of Web banners, which will run in donated space on websites frequented by the target audience. Additionally, Students Against Destructive Decisions (SADD) will promote the contest among its chapters in high schools throughout the country and an integrated social media program will encourage submissions on popular social networking sites and blogs.

“Obesity has become a major public health concern in the United States, and we agree that by teaching young people the importance of making small steps in developing healthy and active lifestyles, we can start to move the needle and help curb this epidemic,” said Romero Brown, vice president of Programs & Youth Development Services for BGCA. “As the largest youth serving organization, Boys & Girls Clubs of America is proud to participate in this Small Steps initiative.”

Participants will register through a mini-site featured on the campaign’s website, http://www.smallstep.gov/. Videos can be created using video phones, digital cameras with video abilities, video cameras or any other video recording device. Judging will be based on creativity, entertainment value, and appropriateness to theme. All submitted videos will be hosted on You Tube. Winning videos will be featured on http://www.smallstep.gov/ for a minimum of two months after the competition, and may have their small steps added to HHS’ list of small steps at http://www.smallstep.gov/take_small_steps_today.html.

The “Small Steps” Obesity Prevention Campaign first launched in March 2004. The Ad Council also developed the Coalition for Healthy Children to help address the obesity crisis by providing consistent, research-based messages to children and parents on the importance of practicing a healthier lifestyle. The NBA and Boys & Girls Clubs of America are members of the coalition, which harnesses the combined strengths of marketers, media companies, non-profit groups and government agencies. For more information about the coalition, visit http://www.healthychildrencoalition.org/.

NBA FIT

In February 2007, the NBA launched the NBA FIT Program (http://www.nba.com/nba_cares/smallsteps_contest.html), a league-wide, comprehensive health and wellness platform that encourages proper eating habits and promotes exercise to children and young adults. For this initiative, NBA Cares has partnered with the Alliance for a Healthier Generation, collaboration between the William J. Clinton Foundation and the American Heart Association, to engage in outreach and program activities that will reverse the trend of childhood obesity in America.

Boys & Girls Clubs of America

For more than 100 years, Boys & Girls Clubs of America (http://www.bgca.org/) has been changing and saving young lives, providing hope and opportunity for kids who need them most. Today, some 4,300 Clubs serve some 4.8 million young people through Club membership and community outreach. Known as The Positive Place for Kids, Boys & Girls Clubs can be found all across the country and on U.S. military bases throughout the world. Clubs provide young people 6-18 years old with guidance-oriented character development programs conducted by trained, professional staff. In communities large and small, Clubs positively impact lives and help young people reach their full potential as productive, caring citizens. Key Boys & Girls Club programs emphasize leadership development; education and career exploration; community service; financial literacy; health and life skills; the arts; sports, fitness and recreation; and family outreach. In a recent Harris Survey of Club alumni, 57 percent said the Club saved their life. National headquarters are located in Atlanta.

U.S. Department of Health & Human Services

The U.S. Department of Health and Human Services (http://www.hhs.gov/) is the United States government’s principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. The department includes more than 300 programs, covering a wide spectrum of activities, including health and social science research, preventing disease, including immunization services, assuring food and drug safety, and administering Medicare and Medicaid.

The Advertising Council

The Ad Council (http://www.adcouncil.org/) is a private non-profit organization that marshals talent from the advertising and communications industries, the facilities of the media, and the resources of the business and non-profit communities to produce, distribute and promote public service campaigns on behalf of non-profit organizations and government agencies in issue areas such as improving the quality of life for children, preventive health, education, community well-being, environmental preservation and strengthening families.

Video: http://www.prnewswire.com/mnr/adcouncil/34657

The Ad Council

CONTACT: Ellyn Fisher of The Ad Council, +1-212-984-1964,[email protected]; or Jon Hammond, NBA, +1-212-407-8671, [email protected];or HHS Press Office, +1-202-690-6343

Web site: http://www.adcouncil.org/http://www.smallstep.gov/http://www.hhs.gov/http://www.bgca.org/http://www.healthychildrencoalition.org/http://www.nba.com/nba_cares/smallsteps_contest.html

SkyEurope Partners With Silverpop for Customer Insights

Slovakia-based airline SkyEurope has partnered with email service provider Silverpop to incorporate customer insights from its two-million email marketing database.

The airline has established a long-term customer loyalty program enhanced by Silverpop’s ability to respond to email recipients’ preferences and actions.

SkyEurope underwent a lengthy selection process, reviewing a number of email service providers, before selecting Silverpop for its suite of marketing execution tools that can easily manage airline’s day-to-day customer email communications, enabling the airline to deliver highly relevant messages.

Silverpop said that it enhances the ability to reach customers with one-to-one messaging. Marketers can access customer information in relational tables which can contain rich amounts of actionable data to identify who and when to target, and which offers are most appropriate. The availability of rich amounts of customer insights enables the creation of highly personalized and targeted messages with greater ease.

Steven Greenway, commercial director of SkyEurope, said: “Silverpop’s expertise in email data management, deliverability and ISP relationships, along with its suite of on-demand marketing tools, will enable us to take a sophisticated approach to meeting our customers’ myriad preferences.”

Celebrity Designer Ty Pennington to Host 10th Annual ‘ADHD Experts on Call’ Program

NEW YORK, Sept. 12 /PRNewswire/ — The 10th annual ‘ADHD Experts on Call’ program will take place on Wednesday, September 17, 2008, from 8 a.m. to midnight EDT to provide families and caregivers of patients with Attention Deficit Hyperactivity Disorder (ADHD), as well as adults with ADHD, with the opportunity to ask questions and learn more about ADHD from experts in the field. Celebrity designer Ty Pennington, who was diagnosed with ADHD as a teenager, is partnering with Shire, the ADHD Support Company, to host the event and talk about his experience living with the disorder.

During the program, which takes place amidst ADHD Awareness Week, experts will answer questions via the toll-free telephone hotline, 1-888-ASK-ADHD, and through live online chats at http://www.adhdexpertsoncall.com/. The confidential one-on-one hotline and online chats will provide access to English and Spanish-speaking experts, including physicians, nurses, educators and patient advocates who can help educate the public about ADHD.

“I am psyched to host this year’s ‘ADHD Experts on Call’ event,” said Ty Pennington, host of ABC’s Extreme Makeover: Home Edition(TM). “As an adult with ADHD, I know how important it is to be able to focus and get work done each day. After I was diagnosed and started treatment for my ADHD symptoms, I was able to hold steady jobs in the construction and graphic design businesses, which ultimately led to me hosting ABC’s Extreme Makeover: Home Edition.”

Over the last nine years, the ‘ADHD Experts on Call’ program has fielded tens of thousands of inquiries, helping people affected by ADHD better understand the disorder. This program also serves as a resource for those affected by ADHD, providing access to an expert to discuss tips and strategies for managing their ADHD and staying organized during today’s increasingly busy day. It is also an opportunity for people to learn which symptoms are commonly associated with ADHD. Participants are also encouraged to speak with their physician if they believe ADHD is affecting their daily life.

While the experts participating in ‘ADHD Experts on Call’ cannot provide specific medical advice or recommend a particular course of action, they can provide helpful information about:

— How to recognize ADHD symptoms in children and adults;

— The potential for ADHD to run in families and why adults sometimes recognize their personal symptoms of ADHD only after their child is diagnosed;

— The impact of ADHD at work, at school, at home and in relationships with family and friends;

— Tips for how to achieve daily successes in school, at work and during your busy day;

— Ideas to help adults with ADHD to better focus at work or at home, remember meetings or appointments and be able to manage and finish projects;

— How parents can approach teachers about their child’s ADHD-related educational needs;

— Common myths and misconceptions about ADHD.

“‘ADHD Experts on Call’ is a terrific resource for people to learn about ADHD and how the disorder impacts people of all ages,” said David Goodman, M.D., director of the Adult Attention Deficit Disorder Center of Maryland and assistant professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine. “Many people think ADHD is something you outgrow, however, up to 65 percent of children with ADHD may still exhibit the core symptoms of inattention, hyperactivity, and impulsivity into adulthood, although they may present differently in these two age groups. For example, while children with ADHD may seem easily distracted or have difficulty sitting still, adults may have ADHD symptoms that appear as having difficulty finishing tasks or seeming impatient. ‘ADHD Experts on Call’ aims to increase awareness of this impairing disorder and provide educational support to help people with ADHD succeed both at work or school and at home.”

About ADHD

ADHD is one of the most common psychiatric disorders in children and adolescents. Approximately 7.8 percent of all school-aged children, or about 4.4 million U.S. children aged 4 to 17 years, have been diagnosed with ADHD at some point in their lives, according to the Centers for Disease Control and Prevention (CDC). The disorder is also estimated to affect 4.4 percent of U.S. adults aged 18-44 based on results from the National Comorbidity Survey Replication, a nationally representative household survey, which used a lay-administered diagnostic interview to access a wide range of DSM-IV disorders. When this percentage is extrapolated to the full U.S. population, approximately 9.8 million adults are believed to have ADHD. ADHD is a neurobiological disorder that manifests as a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development. To be properly diagnosed with ADHD, a child needs to demonstrate at least six of nine symptoms of inattention; and/or at least six of nine symptoms of hyperactivity/impulsivity; the onset of which appears before age 7 years; that some impairment from the symptoms is present in two or more settings (e.g., at school and home); that the symptoms continue for at least six months; and that there is clinically significant impairment in social, academic, or occupational functioning and the symptoms cannot be better explained by another psychiatric disorder.

Although there is no “cure” for ADHD, there are accepted treatments that specifically target its symptoms. The most common standard treatments include educational approaches, psychological, or behavioral modification, and medication.

About VYVANSE(R)

Vyvanse is indicated for the treatment of ADHD. Efficacy based on two controlled trials in children aged 6 to 12 and one controlled trial in adults.

Tell the doctor about any heart conditions, including structural abnormalities, that you, your child, or a family member, may have. Inform the doctor immediately if you or your child develops symptoms that suggest heart problems, such as chest pain or fainting.

Vyvanse should not be taken if you or your child has advanced disease of the blood vessels (arteriosclerosis); symptomatic heart disease; moderate to severe high blood pressure; overactive thyroid gland (hyperthyroidism); known allergy or unusual reactions to drugs called sympathomimetic amines (for example, pseudoephedrine); seizures; glaucoma; a history of problems with alcohol or drugs; agitated states; taken a monoamine oxidase inhibitor (MAOI) within the last 14 days.

Tell the doctor before taking Vyvanse if you or your child is being treated for or has symptoms of depression (sadness, worthlessness, or hopelessness) or bipolar disorder; has abnormal thought or visions, hears abnormal sounds, or has been diagnosed with psychosis; has had seizures or abnormal EEGs; has or has had high blood pressure; exhibits aggressive behavior or hostility. Tell the doctor immediately if you or your child develops any of these conditions or symptoms while taking Vyvanse.

Abuse of amphetamines may lead to dependence. Misuse of amphetamine may cause sudden death and serious cardiovascular adverse events. These events have also been reported rarely with amphetamine use.

Vyvanse was generally well tolerated in clinical studies. The most common side effects reported in studies of Vyvanse were: children — decreased appetite, difficulty falling asleep, stomachache, and irritability; adult — decreased appetite, difficulty falling asleep, and dry mouth.

Aggression, new abnormal thoughts/behaviors, mania, growth suppression, worsening of motion or verbal tics, and Tourette’s syndrome have been associated with use of drugs of this type. Tell the doctor if you or your child has blurred vision while taking Vyvanse.

SHIRE LIMITED

Shire’s strategic goal is to become the leading specialty biopharmaceutical company that focuses on meeting the needs of the specialist physician. Shire focuses its business on attention deficit and hyperactivity disorder (ADHD), human genetic therapies (HGT) and gastrointestinal (GI) diseases as well as opportunities in other therapeutic areas to the extent they arise through acquisitions. Shire’s in-licensing, merger and acquisition efforts are focused on products in specialist markets with strong intellectual property protection and global rights. Shire believes that a carefully selected and balanced portfolio of products with strategically aligned and relatively small-scale sales forces will deliver strong results.

For further information on Shire, please visit the Company’s website: http://www.shire.com/.

“SAFE HARBOR” STATEMENT UNDER THE PRIVATE SECURITIES LITIGATION REFORM ACT OF 1995

Statements included herein that are not historical facts are forward-looking statements. Such forward-looking statements involve a number of risks and uncertainties and are subject to change at any time. In the event such risks or uncertainties materialize, the Company’s results could be materially affected. The risks and uncertainties include, but are not limited to, risks associated with: the inherent uncertainty of pharmaceutical research, product development, manufacturing and commercialization including, but not limited to, the establishment in the market of VYVANSE(R) (lisdexamfetamine dimesylate) (Attention Deficit and Hyperactivity Disorder (“ADHD”)); the impact of competitive products, including, but not limited to, the impact of those on the Company’s ADHD franchise; patents, including but not limited to, legal challenges relating to the Company’s ADHD franchise; government regulation and approval, including but not limited to the expected product approval date of INTUNIV(TM) (guanfacine extended release) (ADHD); the Company’s ability to secure new products for commercialization and/or development; the Company’s proposed offer for Jerini AG, including but not limited to, the Company’s ability to successfully complete the offer and integrate Jerini AG, as well as realize the anticipated benefits of the acquisition; and other risks and uncertainties detailed from time to time in the Company’s filings with the Securities and Exchange Commission, including the Company’s Annual Report on Form 10-K for the year ended December 31, 2007.

Shire Limited

CONTACT: Alana Brier, +1-212-601-8432, [email protected], orLauren Plate, +1-212-601-8188, [email protected], both of PorterNovelli for Shire

Web site: http://www.shire.com/http://www.adhdexpertsoncall.com/

Naiomi Wise to Shun Nightlife

By Andy Richardson

STUDENT life is all about partying, late nights and, if you?ve time, attending the occasional lecture.

While this may be true for some youngsters, for Redcar?s NaiomiWise, a student of Liverpool John Moores University, life is centered around training, voluntary work ? and, if time permits, going to the odd Kanye West gig.

Wise was the deserved winner of last year?s Local Heroes Youth Award for Remarkable Achievement ? after fighting back from being told she had two days to live, she went on to compete in the World Dragon Boat Championships.

And she continues to be an inspirational figure ? when she graduates from university next year, she intends to become a swimming coach for disabled children. As Wise puts it.

?I wanted to go to the Olympics when I was younger but I had heart surgery. I received plenty of help when I was ill so I want to put something back, ? said the 19-yearold who hopes her own health problems are a thing of the past.

At the age of 12, Wise was diagnosed with the rare heart condition, mitral regurgitation and at 16, she was struck down with endocarditis and meningitis but she defied doctors to make a full recovery.

?Ididn?t know at the time I had two days left ? my mum kept it from me. But I came through ? they said it was because I was so fit. ?But nowmy health is fine. I just have an annual check-up tomake sure things are ok ? it?s all looking good? she said.

It was during her rehabilitation that she became involved in Dragon Boat racing and she is trying to start a team at university, where she is studying Sports Development.

?We?re waiting for funding, if I can get recognition from the University, we?ll compete at national Dragon Boat events? she confirmed, the trace of a scouse accent in her voice evidence of her year on Merseyside.

Living on a campus with excellent sports facilities on site and being a member of the university swimming team has helpedWise maintain her fitness levels.

?I?m looking to compete at theWorld Dragon Boat Championships in Poland in June next year.

?It will be a real step up for me because I?ll be competing with adults ? it?s like going from novice to Olympic level, ? confirmed Wise, who spends one day a week coaching swimming to disabled children. But she still finds time to sample the more relaxing aspects of the 2008 City of Culture.

?It?s not all training, I do get out and enjoy myself. The nightlife in Liverpool is amazing, I?m offto see Kanye West in concert soon.

?I?ve even become a bit of a Liverpool FC fan ? but Middlesbrough are really my team ? it they were playing each other I?d have to support the Boro, ? she insists.

Nigel Armstrong, Managing Director of The Bannatyne Group, said: ?Naiomi is a real inspiration.

?Her ability to overcome adversity and not let her condition get the better of her is truly admirable.

?Taking part in any sort of physical activity is beneficial to living a healthy lifestyle and can help in the recovery from injury or illness.

In Naiomi?s case exercise has also provided her with motivational goals that have helped her become a sporting success. ?

(c) 2008 Northern Echo. Provided by ProQuest LLC. All rights Reserved.

Support Groups Special Events

Datebook

CARCINOID: The Carcinoid/Neuroendocrine Support Group will meet at 2 p.m. Sunday, Sept. 14, at Church of the Apostles, 1850 Marietta Ave.

Registered nurse and carcinoid cancer survivor Susan Nolt and social worker Dorothy Meyer will discuss “Managing Your Disease.”

Others with a cancer diagnosis or chronic disease, their family and friends also are welcome.

For more information, call Susan Nolt at 898-1732.

INSTRUMENT DRIVE: Elizabethtown College assistant professor of music and director of music education Karendra Devroop, a native of South Africa, will host a musical instrument drive for the 2009 South African Music Project on Saturday, Sept. 13.

The event, which includes a free jazz concert by Elizabethtown College faculty and friends, will be held from 8 to 11 p.m. at the Black Gryphon Restaurant, 54 Mount Gretna Road, Elizabethtown.

Any musical instrument will be appreciated, but wind instruments are especially needed. Anyone making a donation will receive a Black Gryphon gift certificate, compliments of the restaurant.

For more information, call 361-1495.

FLEA MARKET: Calvary Fellowship Homes, 502 Elizabeth Drive, will hold its annual flea market from 8 a.m. to noon Saturday, Sept. 13, in the community’s fellowship hall.

Most items are priced under $5. All proceeds benefit programs for residents at the home.

For more information, call 393-0711.

(c) 2008 Intelligencer Journal. Provided by ProQuest LLC. All rights Reserved.

Applying Experimental Economics to Obesity in the Family Household

By Ehmke, Mariah D Warziniack, Travis; Schroeter, Christiane; Morgan, Kari

The objective of this study is to identify experimental economic tools that can be employed to explain the role of economic behavior in overweight and obesity in the household. We identify three economic experiments that can be used to understand how parent- child economic relationships relate to obesity. Loss aversion experiments are discussed as a tool to understand challenges some individuals face in achieving a healthy diet. Finally, testbed experiments are introduced as a means to test and understand new policies and incentives for better health at the household level. Key Words: “carrot stick,” child obesity, discount rate, generosity, loss aversion, parentchild, punishment, trust

JEL Classifications: I19, Q18, D01, D63

It is increasingly accepted that both the environment and behavior affect the propensity of overweight and obesity in the household (French, Story, and Jeffery; Friedman 2003, 2004; Hill 1998, 2003). It is less clear how such factors interact with the economic characteristics of the household. Economists have considered the effects of prices and government policies on the propensity toward obesity for certain demographic groups. For example, overweight and obesity is more prevalent in low-income households, Hispanic and African American households, and households with working mothers (Anderson, Butcher, and Levine 2003; Sigman- Grant 2003). Although general macroeconomic analyses of the problem can tell us who is obese, it does not tell us why they are obese or explain heterogeneity within the demographic groups.

The need is clear and present to understand which decisions and behaviors, including economic behavior, lead to overweight and obesity in the household. Childhood overweight and obesity (COO) is of special concern because we have yet to realize the full consequences of early overweight and obesity in life. Over the last 20 years, COO has increased from 4% to 17% among children and adolescents between 2 and 19 years of age in the United States1 (Centers for Disease Control and Prevention/National Center for Health Statistics (CDC 2004a,b, 2006a,b; Institute of Medicine; Ogden et al.). Currently, 61% of overweight children have at least one additional risk factor for heart disease and are at greater risk of Type II diabetes. They also have higher probability of sleep apnea and social and psychological problems (CDC 2006b; Mokdad et al.). In the future, we will see an increased occurrence of lifethreatening illnesses affecting children and adolescents, such as early kidney failure, coronary heart disease, and limb amputations (Ludwig). This is of import to policy development because society (not just obese individuals) incurs the costs of obesity through third-party insurance and government programs such as Medicare and Medicaid. As of 2003, obesity contributed to $75 billion in medical expenditures in the United States. The state- level annual Medicaid costs ranged from $23 million in Wyoming to $3.5 billion in New York. Annual Medicare costs ranged from $15 million in Wyoming to $1.7 billion in California (CDC 2004c). Experts predict the costs of obesity will jeopardize the solvency of Medicare in the future (Ludwig).

The objective of this study is to outline experimental economic tools that could help explain the effect of economic behavior on overweight and obesity in the household. Over the last 25 years, economists have used experiments to develop policies relating to problems such as pollution and environmental regulation (e.g., Cason; Cason, Gangadharan, and Duke 2003; Cherry, Crocker, and Shogren), airline deregulation (Smith), and accounting issues (e.g., Kachelmeier and Shehata). These experiments shed light on important behavioral considerations beyond institutional constructs, which improve market allocation efficiencies and policy outcomes. In this spirit, we discuss the behavioral dimensions that other fields find relevant to the obesity epidemic. We then identify possible economic behaviors, their relevant experiments, and which tools can be used for understanding these behaviors.

Background

Although family genetics do influence an individual’s susceptibility toward overweight and obesity, the rapid change in its prevalence is evidence of changing behavioral and environmental factors affecting individual weight outcomes (French, Story, and Jeffrey; Friedman 2003, 2004; Hill 1998, 2003). These behavioral and environmental factors are broad and far-reaching. Thus far, many researchers outside of economics have focused more on micro- rather than macro-level issues and variables. Specifically, different dimensions of parent-child and family relationships are identified as key elements to understanding child health outcomes (Agras and MascoIa; Birch and Fisher; Fiore et al.; Gable and Lutz; Patrick and Nicklas; Stang, Rehorst, and Golicic; Strauss and Knight).

Recent literature focuses on parent feeding styles with their child. Family attitudes and beliefs relating to food determine when, where, and how children eat, even beyond the preschool years (Birch and Fisher; Faith et al.; Stang). Whether or not families eat together influences the child’s food knowledge and habits, especially with regard to fruit and vegetable consumption (Cooke et al.; Davison, Francis, and Birch; Mamum et al.; Schroeter, House, and Lorence; Variyam, Shim, and Blaylock; Wardle, Carnell, and Cooke). When feeding children, it is important that parents are not excessive in restricting access to unhealthy foods, do not overly encourage the eating of certain foods, and limit the use of food as a reward (Ritchie et al.). This style of feeding has been defined as “authoritative”parents encourage healthy eating, but the children are given the ultimate choice in deciding what they eat (Davison, Francis, and Birch; Patrick et al.). Two other feeding styles are “authoritarian” and “permissive.” Authoritarian parents exercise extreme control over eating. This can be negative if parents limit children’s abilities to self-regulate their food intake (Ritchie et al.). On the other hand, permissive parents often allow the child too much freedom over food eating without structured meal settings, which also leads to increased risk of overweight and obesity.

In addition to parent feeding behavior, parent-child physical fitness relationships are also important. Children’s physical fitness is shaped by their parents’ physical fitness behavior and attitudes (e.g., Epstein et al.; Lindsay et al.). Parents model active behavior when they engage in sports and actively play with their child. Other behaviors that contribute to sedentary behavior, such as television viewing, could be influenced by family, too (Lindsay et al.).

So far, the role of economics becomes more obvious at the macro level when considering environmental variables influencing obesity and overweight. Economists find changing values of time, food costs, food technology, and physical activity all coincide with increasing overweight and obesity in the household. Over the past two decades, higher wages in the workplace led to a decrease in the household time devoted to family meal preparation (Capps, Tedford, and Havlicek; Chou and Grossman). Convenience and fast food demand has increased because of a higher number of women working. A factor contributing to the increased demand for food away from home is the doubling of the per capita number of fast food restaurants between 1972 and 1997, reducing the search and travel time for food (Chou, Grossman, and Saffer).

As time increased in value, food costs fell because of production technology improvements and agricultural policy incentives. Agricultural policies and the switch from individual to mass food preparation have reduced the price of food energy consumed (Drenowski; Pollan). At the same time, technological change lowered real food prices while shifting the work environment from manual to sedentary labor (Lakdawalla and Philipson; Philipson and Posner). Of each consumer dollar spent, food accounted for 13 cents in 2003, down from 32 cents in 1950 and 43 cents in 1901 (Atkinson).2 Unfortunately, these price reductions have nonmarket costs linked to them. The resulting lower cost energy sources have been noted for their high fat and sugar content (Drenowski). High-calorie foods have assumed a main role in the U.S. food supply because they are goodtasting, cheap, and convenient to consume (Drenowski and Levine). Although the number of calories consumed has increased, calories expended have remained relatively constant since the 1980s (Cutler, Glaeser, and Shapiro). The resulting energy imbalance manifested itself in higher weight.

Other, noneconomic environmental variables affecting overweight and obesity include changes at home and in schools. These variables include the physical structure of the neighborhood and school food policies, in particular the availability of soda and vending machine snacks (Anderson and Butcher; Economist).

Economic Experiments and Obesity

The existing economic literature does not determine who is most susceptible to changes (such as a “fat tax”) in the economic environment or how they translate to specific household behavior.3 We believe a better understanding of the economic behaviors underlying the obesity epidemic is necessary to formulate effective policy interventions. We identify several economic behaviors related to obesity, and their relevant experiments are presented in Table 1. Four economic experiments (dictator, ultimatum bargaining, trust, and “carrot stick” experiments) could be employed to understand how parent and child economic relationships relate to obesity. Food policy research suggests time preference is important in the timing and consistency of food purchases in the household (Shapiro; Sigman- Grant). A basic time preference experiment is identified as a tool to measure individuals’ discount rates and how they relate to overweight and obesity in the household. Loss aversion experiments are discussed as a tool to understand the challenges some individuals face in achieving a healthy diet. Finally, testbed experiments are introduced as a means to test and understand new policies and incentives for better health at the household level. Table 1. Dimensions of Economic Behavior and Related Economic Experiments

Bargaining/Negotiation Experiments

Children differ from adults in that they are not primarily price- takers in the market. Children typically receive the food they eat from their parents. As the literature suggests, the way in which this transfer occurs can vary dramatically from family to family (Birch and Fisher; Fiore et al.; Gable and Lutz; Patrick and Nicklas; Stang, Rehorst, and Golicic; Strauss and Knight). Economists can use economic experiments to determine how differences in parenting styles might also be reflected in differences in economic behavior between the parent and child. The dictator game, ultimatum bargaining game, and carrot stick experiments measure generosity, fairness, and punishment and reward expectations between individuals. In this two-player dictator game, a dictator is endowed with an allocation, x, and decides what portion of ? to give the other player, the recipient. The Nash equilibrium prediction is that the dictator will give the recipient nothing through self-interest. Yet, the standard experimental result rejects the notion of complete self-interest. Instead, the dictator gives the recipient at least some small portion of the allocation (Davis and Holt). This indicates that there is some level of altruism compelling individuals to share their riches.

The ultimatum bargaining game is like the dictator game, but the recipient has an opportunity to respond to the dictator’s offer. The dictator becomes a proposer, and the recipient can either accept or reject the offer made. The Nash equilibrium prediction is that the proposer will make a very small offer, epsilon, and the respondent will accept this offer because it is better than nothing. Again, the Nash equilibrium is rejected in experiments. The proposer offers a substantial portion of the endowment, from 25% to 50%, and the respondent demands a similar amount. The amount offered and accepted depends on the proposer and respondent’s social and cultural fairness norms (Henrich et al.; Roth et al.).

Although both of these experiments may be used to measure basic economic behavior in the household, they do not allow continuous interaction between household members. One experiment that does allow for continuous interaction is the carrot stick experiment developed by Andreoni, Harbaugh, and Vesterlund. Unlike the dictator game, the respondent is given the opportunity to punish or reward the dictator after receiving an allocation from the endowment. The respondent can pay the experimenter a small fee (e.g., 1 dollar or token) to give (reward) or take (punish) a notable amount (e.g., 4 dollars or tokens) from the dictator. If the respondent takes earnings away from the dictator, the earnings go to the experiment bank, not directly to the respondent. Likewise, if the respondent gives earnings to the dictator, they are bought from the experiment bank and do not come directly from the respondent. This arrangement makes either giving or taking earnings from the dictator more direct reward or punishment. The respondent also has the option not to change the dictator’s earnings in any way.

Ehmke et al. adapted the carrot stick game to measure control dynamics in the parentchild relationship that could affect COO. The parent is placed in the dictator role and the child is the respondent. The parent is endowed with $5.00 in $0.25 tokens. He or she decides how many tokens to send to the child. Once the child receives his or her tokens, the child then decides whether or not to reward or punish the parent. When the game is complete, the child has the option to spend his or her tokens in the experimental store. Following within subject design, the experimental store is stocked with toys and books in the first treatment and with junk food in the second treatment. The experiment is used to test several hypotheses, including whether parental giving is significantly different across treatments on the basis of both child and parental weight status.

The results from the experiment indicate that parental weight is the most important determinant of parental generosity and child control in the game. All parents give an average of 56% of the endowment to their children in the nonfood treatment. This drops to an average of 33% of the endowment given to children in the food treatment. However, giving between healthy (parent BMI s 25) and overweight and obese parents (parents BMI > 25) is significantly different. Parents with higher BMIs give more to their children to spend on junk food. This indicates heavier parents might be less concerned with the consequences of giving their children money to spend on junk food.

Such experiments provide an important link to understanding the connection between economic behavior and other general family health- and nutrition-related behavior. They also provide a potential tie between economics and research in other disciplines, including psychology, sociology, family studies, and health fields.

Time Preference Experiments

One of the challenges for many households is to maintain a healthy and steady nutritional intake over the course of the month. Young children are not able to make the metabolic adjustments to variations in calorie intake and are more at risk of overweight and obesity (Sigman-Grant). Thus, food insecurity could be a factor in obesity prevalence. Shapiro finds caloric intake among low-income food stamp recipients declines 10% to 15% over the course of a month. The relationship between food stamp use and overweight and obesity is positive for low-income women and young girls, but leads to underweight boys (Gibson). When food stamps are dispersed at the beginning of the month, approximately 90% are spent in the first 3 days of dispersion (Klinefelter). This evidence implies food stamp recipients display a high, if not hyperbolic time preference.

Harrison, Lau, and Williams designed one of the most referenced experiments for measuring time preference. They develop a basic methodology to measure subjects’ discount rates. In their study, Danish subjects were asked if they would prefer to have $100 in 1 month or $100 + ? in 7 months. Subjects answered 15 repeated versions of this question, with ? increasing in each question. The researchers aim was to determine the point at which a subject chooses to receive payment in 7 months instead of in the next month. If a subject chooses to receive the money in 7 months, it is implied that their discount rate is x% over the 6-month period.

This experiment can be adjusted to account for hyperbolic discounting. Individuals exhibit hyperbolic discounting when their discount rate (i.e., internal interest rate) is not consistent over time and actually declining over time (Frederick, Lowenstein, and O’Donoghue). More simply, individuals value short-term gains/losses more than long-term gains/losses. The Harrison, Lau, and Williams experiment can be adjusted to measure the degree of hyperbolic discounting a subject exhibits. Using the Harrison, Lau, and Williams experiment, the subject first decides whether she wants $100 in 1 week or $100 + x in 8 days. Then, she is asked whether she would like $100 in 7 months or $100 + x in 7 months and 1 day. If she displays hyperbolic discounting, she will be less willing to wait for x in 8 days, but more indifferent to waiting for it in 7 months versus 7 months and 1 day.

Experimental measures of individual discount rates could help explain the challenges that low-income families face as they allocate food expenditures over a month. It could be that the hyperbolic discounting behavior observed by Shapiro might be measurable in an experimental setting. If there is a relationship between high and/or hyperbolic time preference and an individual’s diet composition, economic experiments can explain these relationships. Policy mechanisms might then be better designed to help low-income households with high or irregular time preference to eat a more healthy diet throughout the month.

Loss Aversion Experiments

A healthy diet is one key to a healthy weight. For many, though, “dieting” is often viewed as sacrificing food consumption to gain health benefits, and despite prior plans to make this sacrifice, many fail to actually carry it out. One reason individuals struggle to maintain a healthy diet might be because of an economic phenomenon called loss aversion. Loss aversion is the tendency for people to base decisions on movements away from a current state rather than on the final outcome and to regard losses from that state more than gains (see Kahneman and Tversky, and Kahneman, Knetsch, and Thaler for evidence and model specifications).

If people are loss-averse, atmosphere becomes an important part of their diet struggle. Studies have shown that anticipation of food, whether physical (sight, smell) or psychological (thought of food), can trigger biological responses that prepare the body to digest food (Johnson and Wildman; Mattes; Powley; Simon et al.). If passing fast food restaurants and vending machines can trigger a physiological response, individuals must constantly choose not to consume these products, rather than decide whether and what to eat, as implied by traditional utility theory. Comparison of food intake surveys by the U.S. Department of Agriculture (USDA) shows that caloric intake during meals has declined, whereas the number of calories during snacks has increased (Cutler, Glaeser, and Shapiro).4 Even if a person originally preferred a healthy lifestyle to an unhealthy lifestyle, loss aversion allows an immediate reversal of preferences once snacks or fast food meals become available. Experiments have been designed to measure loss aversion with riskless and risky choices. One common experiment to test for loss aversion in riskless choices begins by randomly selecting half the participants in an experiment to endow with an object of value. For example, Kahneman, Knetsch, and Thaler endow half their subjects with coffee mugs and ballpoint pens. After allowing all participants to thoroughly inspect the object, willingness to pay is calculated for the group without the object and willingness to accept is calculated for individuals endowed with the object. If the objects are assigned randomly, there is no reason one group would have stronger preferences than the other. However, experiments show that those endowed with the object value the object much more than those not endowed with the object. The ratio of willingness to accept to willingness to pay measures the degree of loss aversion.

Another version of these experiments is to give half of the participants in an experiment one item and half of the participants another item of equal value. After inspection of the items, participants are given the opportunity to switch. If the allocation is random, one would expect either a strong preference for one of the goods (perhaps everyone likes the first good more) or about half the participants to switch. Instead, experiments find a strong bias against switching. Knetsch and Sinden carried out this experiment with a lottery ticket and $2. This experiment can test for the presence of loss aversion but it cannot measure it.

Perhaps the simplest way to measure an individual’s loss aversion occurs under uncertainty. Catcher and Johnson ask subjects whether they would be willing to accept a gamble of winning $X or losing $ Y based on a coin toss. Keeping A’constant, they increase Y incrementally until the participant no longer accepts the gamble. For small monetary amounts, they argue that the ratio XIY measures the degree of loss aversion.

Samuelson and Zeckhauser found evidence of loss aversion in both survey and field data.5 In their lab experiments, they provided several scenarios about investment portfolios. In one treatment, they asked subjects in which of four portfolios they would invest a large inherited sum of money. In another treatment, they ask subjects which of the same four investments they would choose, but instead of inheriting money, they inherit one of the portfolios. There is a strong tendency for people not to switch regardless of the portfolio inherited. They find similar evidence in actual decisions between health care and retirement plans.

The presence of loss aversion has direct implications for dietary policy and goals. When framing the dietary discussion, loss averse individuals will be more swayed by what they will have to give up rather than by what they gain. Levin et al. showed this to be true with regard to controlling cholesterol. Participants told the positive benefits of reducing red meat consumption were less likely to reduce their consumption than those given the same information focusing on the negative effects of continuing to eat red meat.

In light of these findings, two things become evident. First, if the goal is to move an individual away from an unhealthy lifestyle, the most effective way might be to focus on the negative effects of the current lifestyle rather than the positive effects of a new lifestyle. second, in the long run, the best policy might be to develop a “culture of health,” wherein choosing the unhealthy lifestyle means giving something up, rather than the other way around, as most people may currently view it.

Testbed Experiments

A type of economic experiment named “testbed” experiments might be helpful when considering new approaches to align the costs of obesity with the decisions that result in obesity. Testbed experiments are used to implement new processes and ensure that these processes work once they are implemented. Plott (1994) discusses the use of testbedding as it applies to market experiments. Through testbed experiments, market policies are testbedded either to ensure design consistency or to see whether the theory underlying a mechanism correctly explains what the mechanism accomplishes. With market inefficiencies, the experiments can be used to test theoretical explanations of the efficiencies and how the markets could be improved.

Testbed experiments could be useful tools as policy makers and business managers consider new ways to deal with the surmounting but disproportionally dispersed health care costs. If government or private industry want to consider schemes to more closely align costs with the individual (e.g., Medical Savings Accounts are currently being implemented to do this), they can test new approaches with the use of testbed experiments. This can be done as overall policies are developed or as incremental processes needed to achieve these policy are developed (e.g., Plott [1997] uses testbed experiments to understand different steps in the Federal Communications Commission’s auction of licenses for personal communication systems). Furthermore, they could be used to explore what other social factors influence individuals’ support of new insurance and policy schemes (Durant and Putterman). For example, one question to explore might be whether individuals’ preferences for progressive taxation override the acceptability of a flat tax in the form of a fat tax in order to reduce unhealthy food consumption.

In the case of health insurance and public health programs, testbed experiments could be used to test mechanism design alternatives to increase individual incentives for individual health and weight reduction. Some programs that have been considered include reducing health care premiums for those who maintain a healthy lifestyle. A testbed experiment could be used to determine what premium reduction would increase participation in such programs and how long a participant would need to participate for insurance companies to benefit. A laboratory experiment could be designed across multiple rounds, with individuals playing the roles of the insured and insurer.

Testbed experiments offer cost advantages to companies and government officials as they develop new experiments. In the case of health care, the costs of implementing new policies are high and the possible costs associated with poor outcomes could be even higher. By testing new policies and incentives in the lab, practitioners could save society substantial loss associated with the costs of implementation.

Conclusions and Recommendations for Future Research

The obesity epidemic has been compared with global warming. Although not all of the scientific evidence is at its full potential, especially with regard to childhood obesity, enough is present to encourage action before the full evidence of potential disaster sets in (Ludwig). As we consider the possible actions to prevent and deal with this looming health threat, economic experiments are a convenient way to test underlying causes of and possible policy solutions for the problem. They could be specifically helpful at the household level to understand underlying economic behavior issues, as well as how households interact with the market for policy design.

1 Overweight and obesity is categorized by the Body Mass Index (BMI), which is determined by the formula: weight/height2 (kg/m2). Among adults, overweight is classified by a BMI between 25.0 and 29.9, whereas a BMI greater than or equal to 30.0 defines obesity (CDC 2004a). Overweight in children is typically not referred to as “obesity,” although these terms will be used interchangeably in this paper. Overweight in children is defined as a BMI that surpasses the 95th percentile of a fixed distribution for a child’s age and gender (CDC 2004a).

2 Recent estimates by the U.S. Department of Agriculture/ Economic Research Service (USDA/ERS) suggest that the share of disposable income spent on food is about 9.9% (2006).

3 Several states plan to impose or broaden sales taxes or “fat taxes” on soft drinks or syrups and to adjust taxes on other food items (Uhlman).

4 There is a strong link between caloric intake and portion size (Rolls et al. 2002; Nielsen and Papkin 2003; Diliberti et al. 2004)

5 Samuelson and Zeckhauser call the effect “status quo bias.”

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Mariah D. Ehmke is assistant professor, Department of Agricultural and Applied Economics, University of Wyoming, Laramie, WY. Travis Warziniack is a doctoral candidate, Department of Economics and Finance, University of Wyoming, Laramie, WY. Christiane Schroeter is assistant professor, Department of Agribusiness, California Polytechnic State University, San Luis Obispo, CA. Kari Morgan is assistant professor, Department of Family and Consumer Science, University of Wyoming, Laramie, WY.

Copyright Southern Agricultural Economics Association Aug 2008

(c) 2008 Journal of Agricultural and Applied Economics. Provided by ProQuest LLC. All rights Reserved.

Determinants of Quality of Life in Primary Care Patients With Diabetes: Implications for Social Workers

By Ayalon, Liat Gross, Revital; Tabenkin, Hava; Porath, Avi; Heymann, Anthony; Porter, Boaz

Using a cross-sectional design of 400 primary care patients with diabetes, the authors evaluated demographics, health status, subjective health and mental health, health behaviors, health beliefs, knowledge of diabetes treatment, satisfaction with medical care, and quality of medical care as potential predictors of QoL and QoL in the hypothetical absence of diabetes. Those who reported difficulties meeting basic needs, diabetes-related complications, worse subjective health, and dissatisfaction with medical care were more likely to report worse QoL. Those who reported difficulties meeting basic needs, higher cholesterol level, and worse subjective health also were more likely to report better QoL in the hypothetical absence of diabetes. In addition, diabetes management played a major role in one’s QoL in the hypothetical absence of diabetes: Engaging in stricter diabetes self-care and taking pharmaceutical treatment for managing diabetes were associated with better QoL in the hypothetical absence of diabetes. Providing psychosocial support geared toward diabetes self-management may improve patients’ QoL. When doing so, social workers need to be aware of the potential trade-off between following medical recommendations that advocate for a strict lifestyle and patients’ QoL. KEY WORDS: disease management; illness representations; patient- physician relationships; quality of life; subjective well-being

Diabetes has long been acknowledged as a biopsychosocial disease (DeCoster, 2001). Diabetes management involves a dramatic change in lifestyle, including keeping a low-sugar diet, maintaining an exercise regime, monitoring daily blood sugar, and taking oral medications or insulin supplements. Social workers are in a unique position to help patients with diabetes maintain a healthy lifestyle and negotiate the medical world (Amir, Rabin, & Galatzer, 1990; DeCoster & Cummings, 2005; Gross et al., 2007). Knowledge of the specific factors that affect one’s quality of life (QoL) is of utmost importance to social workers for the development and implementation of future interventions that would help patients with diabetes manage their condition (Claiborne & Massaron, 2000). Because the QoL of diabetic patients is affected by many variables, which are not all related to diabetes, it is particularly important to ask patients about their QoL in the hypothetical absence of diabetes and not only about their subjective general QoL. The former gives information about the perceived effect diabetes has on one’s QoL.

QoL has captured an increasing role in medical literature. Research has shown that QoL is a risk factor for longer and more complicated hospital stays, poor adherence to medical treatment, and increased morbidity and mortality (Fan, Curtis,Tu, McDonell, & Fihn, 2002; Jacobson, Wu, & Feinberg, 2003; Rumsfeld et al., 1999; Westin, Nilstun, Carlsson, & Erhardt, 2005). As a result, it is no longer acceptable to evaluate only the biophysiological indicators of the disease, rather a comprehensive evaluation that takes into consideration QoL is indicated (Rubin & Peyrot, 1999).

Diabetes has been associated with low QoL that tends to decline over the years (Brown et al., 2004; Hart, Redekop, Berg, Bilo, & Meyboom-de Jong, 2005). Several studies have identified demographic and clinical characteristics, illness representations, and health behaviors associated with QoL in patients with diabetes. For example, all of the following have been associated with lower QoL in patients with diabetes: lower socioeconomic status (Wandell, 2005), medical comorbidity, diabetes-related complications and symptoms (Davis et al., 2005; De Berardis et al., 2002; Hart et al., 2005; Vileikyte, 2001; Wandell, 2005;), higher body mass index (BMI) (Maddigan, Majumdar, & Johnson, 2005), pain, depression (Lustman & Clouse, 2005; Paschalides et al., 2004), anxiety (Paschalides et al., 2004), lower perceived sense of control over diabetes (Paschalides et al., 2004), lower self-efficacy (Rose, Fliege, Hildebrandt, Schirop, & Klapp, 2002), pessimism (Rose et al., 2002), nonadherence to an exercise regime (Glasgow, Ruggiero, Eakin, Dryfoos, & Chobanian, 1997; Smith & McFaIl, 2005), and poor continuity of care (Wandell, 2005).

These studies provide important information about potential determinants of QoL in patients with diabetes. However, the majority of these studies did not evaluate a large set of predictors simultaneously to better determine the relative importance of each predictor. Furthermore, potential predictors of QoL such as knowledge of diabetes care or satisfaction with medical services have not been adequately evaluated in past research. In addition, only very few studies have asked people directly about the subjective effect of diabetes on their QoL (that is, perceived QoL in the hypothetical absence of diabetes) (Bradley & Speight, 2002; Bradley et al., 1999). This question is important because it evaluates the specific effect of diabetes on one’s QoL rather than a general perception of QoL. In contrast to past research, the present study evaluates a large array of potential predictors of QoL and perceived QoL in the hypothetical absence of diabetes in a sample of primary care patients with diabetes. This study also has the advantage of being conducted in Israel, a country that has a universal health care system. Thus, we do not expect QoL to be affected by socioeconomic or access issues. Instead, we expect daily factors associated with the management of diabetes to be associated with lower QoL. We also expect subjective health and mental health to be the strongest predictors of QoL because of the relatively symptomatic nature of diabetes.

METHOD

This is a secondary data analysis of a study funded by the Israeli National Institute for Health Policy and Health Services Research to assess adherence to diabetes and hypertension guidelines by primary care physicians. The study was approved by the Institutional Review Board of Haemek Hospital.

The Study Population

The primary sampling unit included communitybased primary care physicians who were affiliated with the two largest health plans in Israel (Clalit Health Services and Maccabi Health Services), insuring over 80 percent of the population. From each physician, we sampled a representative group of patients with diabetes, hypertension, or both. A total of 1,369 participants with diabetes, hypertension, or both completed the patient questionnaire (77 percent response rate). Each participant was assigned a weight based on the probability of being sampled, corrected to reflect the health plan’s composition of patients with hypertension, diabetes, or both conditions. The secondary data analysis presented in this article is based on 400 weighted cases of patients with diabetes type 2. We do not report in this analysis data on individuals diagnosed only with hypertension.

Data Collection

Between December 2002 and June 2003, trained interviewers conducted telephone interviews of patients with diabetes using structured questionnaires. The interviews lasted approximately 20 minutes; questionnaires were available in Hebrew, Arabic, and Russian.

Measures

All measures are based on patients’ self-report. All measures were validated before their use in the present study. Measures were extensively evaluated for face and construct validity in a pilot study with diabetes patients (see Gross et al., 2003). Face validity was established by review of the questions by four physicians and four health scientists from the Myers-JDC-Brookdale Institute. All have vast experience in conducting care surveys. To establish construct validity of the measures, a pretest with 135 patients with diabetes was conducted (Gross, 2001).

Outcome Variables

QoL was examined by the question “How would you define your overall quality of life?” Response options were very good = 5, good = 4, mediocre = 3, bad = 2, and terrible = 1. This variable followed a normal distribution. (Note that single-item measures of health, quality of life satisfaction, and so forth are routinely used in population surveys in which health is only one among many issues measured and that have to be covered in a short interview;Wilkin, Hallam, & Doggett, 1991.)

We also evaluated the perceived effect that diabetes had on patients’ QoL using a question about QoL in the hypothetical absence of diabetes. Perceived QoL in the hypothetical absence of diabetes was examined by the following question: “If you did not suffer from diabetes, how would your overall quality of life have been?” Response options were much better = 5, somewhat better = 4, exactly the same = 3, worse = 2, and much worse = 1. Because this variable was positively skewed with the majority of participants stating that their perceived QoL in the absence of diabetes would have been much better or somewhat better, it was dichotomized; those endorsing the response options much better or somewhat better were grouped under a single value representing improvement (1), and those endorsing the response options exactly the same, worse, or much worse were grouped under a single value that signifies no change or worse (0). Predictors

Sociodemographic Information. We evaluated gender (male = 1, female = 0), age, marital status (married = 1, not married = 0), place of birth (Israel = 1, outside of Israel = 0), work status (employed = 1, unemployed = 0), education (did not complete elementary school = 0, no schooling at all = 1, elementary school/ middle school = 2, high school education = 3, some college/ university = 4), and difficulties meeting basic needs (very difficult = 1, somewhat difficult = 2, no difficulty = 3).

Medical Complications. We evaluated presence of high cholesterol (yes = 1, occasionally = 2, no = 3), balanced glucose level (yes = 1, occasionally = 2, no = 3), diabetes-related complications (yes = 1, no = 0), and BMI.

Subjective Health and Mental Health. We evaluated subjective health status (excellent = 5, very good = 4, good = 3, mediocre = 2, very bad, = 1) and the presence of emotional distress (yes = 1, no = 0). Emotional distress was measured using the following question: “During the past year, have you experienced emotional distress, (for example, depression, anxiety, tension, great sadness), which you found difficult to cope with by yourself?” Possible responses were yes or no. This question was similar to the perceived need screening question used in the U.S. national comorbidity survey (Kessler et al., 1997) and the Mental Health Supplement of the Ontario Health Survey (Lin, Goering, Offord, Campbell, & Boykem, 1996). It was used in Israel in previous surveys in which construct validity was ascertained (Gross, Feldman, Rabinowitz, & Grinstein, 1998; Rabinowitz, Gross, & Feldman, 1999; Rabinowitz, Gross, & Feldman, 2003).

Health Behaviors. We evaluated whether participants were physically active (yes = 1, no = 0), followed a special food and/or drinking diet (lower score indicating a stricter regime, range = 0 to 4), regular diabetes self-care (for example, foot care, glucose checks, and regular doctor appointments; higher score indicating greater care, range = 0 to 3), and pharmaceutical treatment related to diabetes care (pills, injections, or both = 1; none = 0).

Health Beliefs and Knowledge. To evaluate diabetes-related knowledge, we used five questions concerning the potential effect of diabetes on blood vessels and feet and the effects of diet, physical activity, and weight management on diabetes management (higher score indicates better diabetes knowledge, range = 0 to 5). Perceived ability to control diabetes was evaluated by the following statements: “Diabetes medicine can help me feel better,””A diet can help me feel better,””It is important to adhere to diabetes treatment,” and “My diabetes can be under control” (higher score indicates greater beliefs in the ability to control diabetes, range = 0 to 4).

Quality of Medical Care. We used six questions about the level of medical explanation regarding diabetes complications, appropriate diet, foot care, eye check, diabetes care, and the importance of carrying a diabetes identification card (higher score represents more explanations provided by medical staff, range = 0 to 6). We evaluated whether care was provided according to guidelines by asking participants about having a physical exam, foot check, electrocardiogram, dietician services, and eye check within the past year (higher score represents greater adherence to guidelines of care, range = 0 to 5). We evaluated satisfaction with diabetes care using the following two statements: “My diabetes could have been managed in a better way” and “I am confused by instructions given by medical personnel” (higher score indicates greater satisfaction, range = 0 to 2).

Statistical Analysis

To examine potential predictors of QoL, we conducted Spearman’s correlation. To examine potential predictors of perceived QoL in the hypothetical absence of diabetes, we conducted t-test analyses in the case of continuous variables and chi-square analyses in the case of categorical variables. All variables significant at the .05 level were examined for multicollinearity and then entered into multivariate regression models; we conducted an ordinal regression with QoL as an outcome variable and a logistic regression with QoL in the hypothetical absence of diabetes as an outcome variable.

RESULTS

Overall, 74.9 percent of the sample was married. Men constituted 55.7 percent of the sample. A total of 60.9 percent had elementary or high school education. Overall, 22.8 percent reported that it is very difficult for them to meet basic needs, 32.6 percent reported that they suffer from high cholesterol, 19.6 percent reported that they suffer from diabetes-related complications, and 32.2 percent reported that they suffer from emotional distress. A total of 69.7 percent reported that their QoL was very good or good, and 71.2 percent reported that their QoL would have improved in the hypothetical absence of diabetes.

QoL

In bivariate analyses, higher QoL was associated with higher levels of education (r = .11, p

QoL in the Hypothetical Absence of Diabetes

In bivariate analyses, reporting a potential improvement in one’s QoL in the hypothetical absence of diabetes was associated with being younger [t(359) = -2.67, p

DISCUSSION

The present study evaluated QoL and QoL in the hypothetical absence of diabetes by using a large and representative sample of patients with diabetes. As expected, those who reported suffering from medical complications and having worse health status also reported worse QoL. This finding provides further support to the validity of our QoL measures. It is interesting to note that having difficulties meeting basic needs was a significant predictor of both QoL and QoL in the hypothetical absence of diabetes. Given that Israel has a national health care system, it is of particular interest that income still has such an important impact on all aspects of an individual’s QoL.

It was unexpected that engaging in stricter diabetes self-care and taking pharmaceutical treatment for managing diabetes were associated with better QoL in the hypothetical absence of diabetes but not with an individual’s QoL. These findings emphasize the trade- off between following a strict lifestyle as advocated by current medical thinking and an individual’s QoL. Our findings demonstrate the high toll diabetes management takes on an individual’s QoL. Regular checkups for potential complications of diabetes and the use of pharmacological measures are often considered necessary ingredients for the successful management of diabetes. Yet the present study highlights a noteworthy conflict related to diabetes management by showing that strictly adhering to medical guidelines for the treatment of diabetes hampers the individual’s QoL.Thus, patients may prefer to compromise their health and risk future complications to improve their QoL in the short-term. Our findings are in line with previous studies that highlight the difficulties patients with diabetes report in adopting appropriate lifestyle behaviors (Anderson et al., 2003; Hall, Joseph, & Schwartz-Barcott, 2003), as these behaviors often are disruptive and require patients to be highly motivated. Moreover, patients with diabetes may feel stigmatized by the management of their condition (for example, the need to inject and to maintain a special diet), and this may lead to further impairment in their QoL (Broom & Whittaker, 2004; DeCoster, 2003) .Our findings suggest that when working with patients with diabetes, social workers should adapt an ecological approach that takes into consideration the patient’s psychosocial and medical needs as well as the overall social environment (McLeroy, Bibeau, Sleekier, & Glanz, 1988). The finding that dissatisfaction with medical services is associated with worse QoL is understandable given that successful diabetes management requires close relationship with medical services. Thus, to improve the QoL of diabetes patients, social workers should be aware of the need to counsel patients and assist them in overcoming bureaucracy and other problems they may encounter with medical services (Grossetal., 2007).

LIMITATIONS

First, QoL and perceived QoL in the hypothetical absence of diabetes were each evaluated by a single question. However, research has shown that a single question is adequate for the evaluation of QoL (Ayalon et al., 2006; Bernhard, Sullivan, Hurny, Coates, & Rudenstam, 2001 ; de Boer et al., 2004). In addition, some may question the validity of evaluating ones QoL in the hypothetical absence of diabetes because of the hypothetical aspect of this question. However, both our pilot study and this study found that in addition to face validity, the QoL questions also have high construct validity. Furthermore, research has consistently shown that asking patients about their QoL in the hypothetical absence of the disease provides meaningful information (Ayalon et al., 2006; Bradley & Speight, 2002; Bradley et al., 1999). second, the study did not include biological markers of diabetes and did not evaluate physicians’ perceptions of patients’ conditions. A more comprehensive approach that takes into consideration biological markers and physicians’ perception may provide important insights. However, it is important to note that subjective evaluation of an individual’s own health status is considered one of the best indicators of mortality and morbidity (Idler & Kasl, 1991). Last, the cross-sectional nature of the design prohibits conclusions about cause and effect.

IMPLICATIONS FOR SOCIAL WORKERS

In recent years, researchers have called for increased cooperation between medicine and social work (Wendt, 1990) in the management of diabetes (Gross et al., 2007). The implications of this study suggest that attempts to improve the QoL of patients with diabetes should follow an ecological approach for health promotion by focusing on the individuals within the social and medical context (McLeroy et al., 1988). Social workers are in a unique position because they can assist patients with diabetes in their adjustment to lifestyle changes by providing them with supportive medical services, psychosocial counseling, and self-help groups (Wendt, 1990). When doing so, social workers need to be aware of the potential trade-off between following medical recommendations that advocate for a strict lifestyle and patients’ QoL. This may improve patients’ adherence to diabetes management recommendations and as a result improve patients’medical conditions, reduce diabetes-related complications, and reduce health care expenditures (Amos, McCarty, & Zimmet, 1997; Goldfracht & Porath, 2000). Social workers can further assist medical personnel in negotiating these changes with patients (Gross et al., 2007). Furthermore, because of their knowledge of public policy and community work, social workers can help integrate appropriate health behaviors into the public notion (McLeroy et al., 1988;Wendt, 1990). Finally, as part of a comprehensive approach toward the management of diabetes, the questions used in the present study to measure QoL and perceived QoL in the hypothetical absence of diabetes could be used to screen patients and assist those with lower QoL to better cope with the demands of diabetes management.

Social workers can assist patients with diabetes in their adjustment to lifestyle changes by providing them with supportive medical services, psychosocial counseling, and self-help groups.

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Lustman, P.J., & Clouse, R. E. (2005). Depression in diabetic patients: The relationship between mood and glycemic control. Journal of Diabetes Complications, 19, 113-122.

Maddigan, S. L., Majumdar, S. R., & Johnson, J. A. (2005). Understanding the complex associations between patient-provider relationships, self-care behaviors, and health-related quality of life in type 2 diabetes: A structural equation modeling approach. Quality of Life Research, 14, 1489-1500.

McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15, 351-377.

Paschalides, C.,Wearden, A. J., Dunkerley, R., Bundy, C., Davies, R., & Dickens, C. M. (2004).The associations of anxiety, depression and personal illness representations with glycaemic control and health-related quality of life in patients with type 2 diabetes mellitus. Journal of Psychosomatic Research, 57, 557-564.

Rabinowitz, J., Gross, R., & Feldman, D. (1999). Correlates of perceived need for mental health assistance and differences between those who do and do not seek help. Social Psychiatry and Psychiatric Epidemiology, 34, 141-146.

Rabinowitz, J., Gross, R., & Feldman, D. (2003). Perceived need and receipt of outpatient mental health services: Factors affecting access in Israeli HMOs. Journal of Ambulatory Care Management, 26, 260-269.

Rose, M., Fliege, H., Hildebrandt, M., Schirop.T, & Klapp, B. F. (2002). The network of psychological variables in patients with diabetes and their importance for quality of life and metabolic control. Diabetes Care, 25, 35-42.

Rubin, R. R., & Peyrot, M. (1999). Quality of life and diabetes. Diabetes/Metabolism Research and Reviews, 15, 205-218.

Rumsfeld, J. S., MacWhinney, S., McCarthy, M.,Jr., Shroyer, A.L.W.VillaNueva, C. B., O’Brien, M., & the PSOCS Investigators. (1999). Health-related quality of life as a predictor of mortality following coronary artery bypass graft surgery. JAMA, 281, 1298- 1303.

Smith, D.W., & McFall, S. L. (2005).The relationship of diet and exercise for weight control and the quality of life gap associated with diabetes. Journal of Psychosomatic Research, 59, 385-392.

Vileikyte, L. (2001). Diabetic foot ulcers: A quality of life issue. Diabetes Metabolism Research and Review, 17, 246-249.

Wandell, P. E. (2005). Quality of life of patients with diabetes mellitus.An overview of research in primary health care in the Nordic countries. Scandinavian Journal of Primary Health Care, 23, 68-74.

Wendt, W. R. (1990). Between social and somatic disorders: The promotion of health as part of general social work practice. Social Science & Medicine, 31, 35-42.

Westin, L., Nilstun, T, Carlsson, R., & Erhardt, L. (2005). Patients with ischemic heart disease: Quality of life predicts long- term mortality. Scandinavian Cardiovascular Journal, 39(1-2), 50- 54.

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Liat Ayalon, PhD, is lecturer, School of Social Work, Bar Ilan University, Israel. Revital Gross, PhD, is associate professor, School of Social Work, Bar Ilan University, Israel and deputy head, Health Policy and Research Program, Myers-JDC Brookdale Institute. Hava Tabenkin, MD, is professor, and Avi Porath, MD, is professor, Clalit Health Services, Tel Aviv, Israel. Anthony Heymann, MB, BS, is doctor, and Boaz Porter, MD, is professor, Maccabi Health Services, Tel Aviv, Israel. The authors warmly thank Ms. Miriam Greenstein and Ms. Remit Matzliach from Myers-JDC-Brookdale Institute for their significant contribution to the questionnaire, fieldwork, and data analysis of original research files. This study was supported by a grant from the Israeli National Institute for Health Policy and Health Services Research. Dr. Liat Ayalon had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Please address all correspondence to Dr. Liat Ayalon, School of Social Work, Bar Ilan University, Ramat Gan 52900, Israel; e-mail: [email protected].

Original manuscript received November 15, 2006

Final revision received December 11, 2007

Accepted December 17, 2007

Copyright National Association of Social Workers, Incorporated Aug 2008

(c) 2008 Health & Social Work. Provided by ProQuest LLC. All rights Reserved.

Informed Consent or Institutionalized Eugenics? How the Medical Profession Encourages Abortion of Fetuses With Down Syndrome

By Dixon, Darrin P

ABSTRACT: Many women are unprepared to make prenatal decisions about fetuses diagnosed with Down Syndrome because of societal pressures to have “normal” children, a negative view of persons with disabilities by many in society, a fear of legal liability by those in the medical community, the lack of genuine informed consent before undergoing genetic testing and abortion, and the failure of non-directive pre-abortion counseling in the medical community. Moreover, medical professionals fail to communicate correct and unbiased information before and during the genetic screening, diagnostic testing, and abortion decision-making process. This article addresses the contributing factors and causes that ultimately lead to a lack of informed consent and a very high abortion rate for fetuses diagnosed with Down Syndrome.

There are numerous contributing factors to what some may call a high termina- tion rate of fetuses that have tested positive for Down Syndrome. One major factor is the direct and indirect influences of medical professionals, which include genetic counselors, family physicians and obstetricians and gynecologists. In this article, I support the ethical principle of nondirective counseling and the genetic counselors who seek to achieve nondirectiveness. However, I suggest genetic counselors and many medical professionals have a deference to the use of medical technology and the belief that patients desire the maximum amount of information. This ingrained deference hinders most medical professionals from being neutral and often causes a subtle promotion of prenatal testing and abortion. Overall, increased prenatal testing contributes to the high abortion rate of fetuses diagnosed with Down Syndrome, a lack of genuine informed consent, greater intolerance of people and especially children with disabilities, and less money for research and development of effective treatments. To the extent that women are encouraged to terminate their pregnancies, prenatal testing and abortion of affected fetuses cannot be considered morally justified because the decision lacks genuine informed consent.

Similarly, other medical professionals, such as family physicians, obstetricians and gynecologists, contribute to the problem. Initially, almost all women seek prenatal treatment from a family physician or obstetrician and gynecologist. However, these medical professionals tend to spend significantly less time with patients compared to genetic counselors, which can result in miscommunications. Moreover, these professionals may encourage prenatal testing and the use of “up front” consent forms to reduce legal liability. In addition, these medical professionals typically receive inadequate genetic training, which can result in the misinformation, and most discouraging, undue influence, bias or prejudice against persons with disabilities, which circumvent informed consent. Time constraints, fear of liability, little genetic training and the practice of directiveness can easily result in a negative tone that manifests itself in phrase such as, “I’m sorry,” or “Unfortunately, I have some bad news to share” and conversations void of the positive reality that many individuals with Down Syndrome can become semi-independent and with good medical care can live into adulthood. Lastly, both medical professionals and patients and their families may overly rely on genetic technologies, which are far from perfect. The assumption that these technologies are 100% accurate can lead to many injudicious and erroneous choices depending upon the degree of inaccuracy. Yet, medical information is only part of what women and their families use to make their decisions. Their decisions are likely more substantially swayed by societal influences and pressures.

It is important to realize that genetic counselors and other healthcare professionals bring their own values into the prenatal testing process, with patients also adding different and competing values and background knowledge to the process. Furthermore, patients’ values reflect a combination of individual perspectives and social norms. While a great deal of variation exists among patients, some trends may be observed. Some women reject prenatal testing because they know they would not have an abortion for moral, religious or personal reasons. Others reject such testing because of the risk of miscarriage. But a vast majority of women at increased risk (those for whom it is medically indicated) of chromosomal or other detectable conditions under the old guidelines choose prenatal screening and/or testing.1 Several factors contribute to this trend. Just as medical professionals are not neutral about the value of information, neither is our society, which views the gathering of information as a sign of responsible behavior and good decisionmaking.2 In the context of prenatal testing, patients may believe that getting information about the fetus is not only the right thing to do, but a form of reassurance and a way to get a sense of control over the potentially overwhelming experience of reproduction.3 This trend contributes to the massive increase in prenatal testing and the need to know whether a child has a disability.

This article does not propose the elimination of prenatal testing. Rather, it proposes that the genetic testing and counseling should not be biased against the birth of children with disabilities. Genetic testing and counseling should not convey directly or indirectly the message that the lives of persons with disabilities are worth less than other lives, or that the only practical alternative is to prevent their existence through abortion.

Overall, prenatal testing should be a way for women and their families to reduce the stress and anxiety associated with the unexpected birth of babies with special needs and also a conduit through which women are given information to help them appreciate the value of children with special needs and expand their knowledge of available services and treatment options for such children. However, the practical result of prenatal testing tends to be an increased termination rate of fetuses diagnosed with Down Syndrome or other genetic anomalies.

Is Abortion the Solution to Down Syndrome?

On May 9, 2007, Amy Harmon of the New York Times wrote an article titled, “Prenatal Testing Puts Down Syndrome in Hard Focus.”4 In this article she stated that 90% of women who receive a positive diagnosis of Down Syndrome choose to have an abortion. The New York Times received thousands of emails and letters by readers, such as George E Will, who found the 90% percent statistic to be morally problematic, probably untrue, and a sign of medical procedural failure. This article will discuss the human, societal, and medical aspects of prenatal genetic testing of Down Syndrome fetuses that contribute to a high abortion rate.

Before examining the various contributing factors, it should be noted that the statistic that “90% of women who receive a positive fetal diagnosis of Down Syndrome choose to have an abortion”5 may be too high. That number may be overestimated and the source should be questioned for several reasons. First, although no official data exists, medical professionals report that often women abort when they discover there is mental retardation or a serious anatomical birth defect, sometimes incompatible with life.6 But some argue that the women who choose to have prenatal testing are the women most likely to be considering abortion, so the population having prenatal testing is more likely to be predisposed to have an abortion.7 Second, some doctors do not refer patients for genetic counseling or prenatal testing if they say they would not consider abortion.8 Third, all the numbers are suspect because there is no birth certificate when a baby is aborted and a lot of states do not track abortions (e.g., Pennsylvania) which results in a lack of good epidemiology9 Fourth, many cities like Pittsburgh have Down Syndrome clinics that are instrumental in helping children develop and become a part of the community. 10 Fifth, after extensive research, it appears the abortion rate varies significantly by region.11

Professor Elizabeth Gettig,12 MS, CGC, stated that during the 1980’s she practiced genetic counseling in North Carolina and after a positive Down Syndrome diagnosis, almost 100% of the women aborted because of a lack of economic resources.13 In contrast, in Pittsburgh she found that about half of the women with a positive diagnosis for Down Syndrome continue the pregnancy and about half abort.14 She gives several reasons for this disparity. First, the Pittsburgh region has a higher percentage of Catholics. Second, there are more services than most cities in Pittsburgh to assist children who have disabilities.15 Lastly, the new federal law protects all children with disabilities so that from ages 0-3 parents of children with disabilities receive free services for the disabled child and all children at age three receive an Individual Educational Plan so that they can start developmental daycare and other services before going to school.16 Furthermore, because the services are better, the child has a better chance of living independently and becoming an integral part of the community. Other genetic counselors, journalists and medical professionals find different statistics. Elizabeth A. Balkite,17 stated that in her own experience she believes the termination rate for Down Syndrome pregnancies to be roughly 60%.18 She thinks that the other 40% keep the baby or place the baby up for adoption.19 Ellen Wright Clayton, M. D., J. D., believes the number is closer to 50 percent.20 In the January 29, 2007 Newsweek article titled “Golly, What Did Jon Do?” George F. Will stated, “At least 85 percent of pregnancies in which Down Syndrome is diagnosed are ended by abortions.”21

The 90% New York Times statistic is suspect because it was based on the results of one research study rather than different regional averages.22 Furthermore, nationwide abortion numbers do not exist. In sum, although Professor Gettig experienced a 100% termination rate in the 1980’s in North Carolina and the New York Times reported 90%, these numbers may to be overestimated because of the increased financial channels and educational groups and programs available to assist parents with their Down Syndrome children.

The Medical Background

The genetic counselors I interviewed agreed that the most common reason for aborting a fetus with Down Syndrome is the financial, emotional, physical and time constraints that accompany raising a child with Down Syndrome.23 Additionally, there is immense societal pressure to produce children that are “normal” (meaning children that are disease and mental retardation free). The most direct consequence of widespread prenatal genetic testing, maternal serum fetal cell sorting24 (“MSFCS”) or maternal plasma DNA recovery25 (“MPFDR”), is a decrease in the number of babies born with genetic diseases and chromosomal abnormalities.26 Prenatal testing for many is a desired way to avoid children with genetic disease. The burdens to the child, family, and society are great enough to make a parental choice against children with this trait rational, understandable, and to some, even desirable. The above makes the Down Syndrome abortion issue a commonplace medical problem.

What is Down Syndrome?

Down Syndrome27 is the most common chromosomal problem in live born babies.28 It is a congenital condition resulting from a chromosomal defect that causes varying degrees of mental retardation and some physical abnormalities.29 The word “syndrome” means that many different characteristics are usually seen together. For example, in Down Syndrome, these features include low muscle tone, small stature, a single crease across the center of the palms, small amounts of extra skin at the corner of one’s eyes, bright “speckles” in the iris called Brushfield spots, flat nasal bridge, small mouth, small ears, excessive skin at the nape of the neck, a deep fissure between the first and second toes, flatness of the back of the head and an upward slant to the eyes.30 Although the above features are common in Down Syndrome, they are not all found in every child with Down Syndrome.31 Besides the above listed physical features, a child with Down Syndrome will resemble other family members.32

The most commonly known feature of Down Syndrome is mental retardation. Mental retardation simply means that the child will have “below normal mental functioning.”33 The degree of mental impairment is unpredictable, ranging from mild (IQ: 50-70) to moderate (IQ: 35-50), and only occasionally severe (IQ: 20-35). 34 There is an increased risk of “congenital heart defects35 (50%); leukemia36 (

In roughly 95% of children with Down Syndrome, the condition is due to a nonfamilial disorder caused by the presence of three 21st chromosomes rather than the usual pair.47 In approximately 3% to 4% of persons with the Down Syndrome phenotype, “the extra chromosomal material is the result of an unbalanced translocation between chromosome 21 and another acrocentric chromosome, usually chromosome 14.”48 Almost three-fourths of these unbalanced translocations are de novo,49 and approximately one-fourth are the result of familial translocations.50 In the remaining 1% to 2% of persons with the Down Syndrome phenotype, two cell lines are present: one normal and one trisomy 21.51 This condition is called mosaicism. People with mosaicism, on average, may be phenotypically less severely affected than persons with trisomy 21 or translocated chromosome 21, but their conditions are generally indistinguishable in all other aspects.52 Mosaic Down Syndrome usually occurs after conception, due to a mistake early in the formation of the baby’s cells.53 Because only some of the cells are involved, children with mosaic Down Syndrome may have fewer health and learning problems.54

The actual risk of Down Syndrome in a woman who is thirty-five is one in 385; the risk of her having a fetus with other anomalies is one in 434, making her total risk of chromosomal anomaly one in 204.55 The likelihood of having a child with a chromosomal anomaly is minor. However, one could argue the low risk of anomaly creates an incentive for women to abort their fetus with Down Syndrome and try again to have a child without a chromosomal anomaly because the chances of having another fetus with Down Syndrome are low. At the same time, others contend that even a small possibility of harming one’s fetus during a prenatal test is too great. Because the symptoms of Down Syndrome are treatable and the child can live without major disability, some couples refuse prenatal screening or abortion to prevent such births.56 However, because there are no guarantees in advance about the severity of a particular case, and because even the best situations will require substantial supportive efforts by parents, many couples are unwilling to bring such a child into the world.57

What is Prenatal Testing and Diagnosis?

Prenatal testing and diagnosis refers to “all the technologies currently in use or under development to determine the physi(ologi)cal condition of a fetus before birth.”58 There are two major types of prenatal diagnosis: amniocentesis and chorionic villus sampling (CVS).59 Amniocentesis is usually performed between 16 and 20 weeks of pregnancy60 This test involves inserting a needle through the abdomen into the uterus to draw off a sample of amniotic fluid.61 This fluid contains skin cells from the baby which can be used to do a chromosome test.62 The chance of miscarriage is between 0.5 percent and 1%. CVS is typically performed between 10 to 12 weeks of pregnancy63 It involves inserting a thin, plastic catheter through the vaginal canal to withdraw some placental tissue, which usually has the same chromosome makeup as the baby64 One version of this test, called transabdominal CVS, uses a needle, inserted through the abdomen, to collect the tissue sample.65 A sonogram is done before or during each test to guide the catheter or needle. Also, there are different testing methods such as “ultrasound and the maternal serum alphafetoprotein3 blood test (MSAFP3) for neural tube defects and Down Syndrome.”66 CVS has the disadvantage of being an invasive procedure, and it has a small but significant rate of morbidity for the fetus; the mortality rate is about 0.5 to 1% higher than for women undergoing amniocentesis and is 0.5%-1% over the general population risk.67

There are two dominate themes regarding prenatal diagnosis: (1) the public health model and (2) the reproductive autonomy model.68 In the “public health” model, prenatal diagnosis is viewed as a way to reduce the frequency of selected birth defects.69 Thus, under the public health model, prenatal diagnosis is a contributing factor to the high termination rate of fetus’s diagnosed with Down Syndrome. In the “reproductive autonomy” model, prenatal diagnosis is viewed as a conduit through which women are given information to expand their reproductive choices.70 Thus, under the reproductive autonomy model, prenatal diagnosis is a method to increase prenatal choice. Both approaches are active in our society and both approaches fail to recognize a major function of prenatal diagnosis. For many women, prenatal diagnosis is a way of avoiding “disaster.” Through the use of prenatal diagnosis women can avoid the family distress and suffering associated with the unpredicted birth of babies with genetic disorders.71

The Disability Rights Perspective

The premise of the disability rights movement is that persons with disabilities are disadvantaged far more by negative social attitudes than by their disabilities.72 Disability rights advocates contend that tests like amniocentesis often are performed because a value judgment has been made that there is merit in identifying a fetus who could become a person with a disability. The premise of the expressivist73 argument is that prenatal testing is morally problematic because it expresses negative or discriminatory attitudes about both impairments and those who carry them.74 Its central claim is that prenatal tests that expose disabling traits express a hurtful attitude about and send a hurtful message to people who live with those same traits.75 In the late 1980s, Adrienne Asch, a bioethicist at Wellesley College, put the concern this way: “Do not disparage the lives of existing and future disabled people by trying to screen for and prevent the birth of babies with their characteristics.”76 Persons or families with disabled children have claimed that a policy that encourages abortion of fetuses with genetic anomalies is a public statement that the lives of people with disabilities are worth less than those of the able-bodied.77 In addition, such a policy reduces the number of persons with those disabilities, thus reducing their political effectiveness. It also may manipulate couples into carrier and prenatal screening to avoid children with such characteristics.78 In short, it engenders or reinforces public perceptions that people with disabilities should not exist, making intolerance and discrimination toward them more likely.79

The message sent, from this perspective, is that a child with the condition would be unacceptable to the prospective parents. This devaluation appears more subtly in the promotion of prenatal genetic testing as helping prospective parents to guarantee that they will have “healthy” children.80 This rhetoric of good health fails to acknowledge that some traits screened for do not necessarily affect a child’s health, although they may impair the child’s abilities.81 A perfectly physically healthy child with Down Syndrome or with deafness is a prime example. Viewed in this light, the appeal to good health, while unobjectionable on its face, may promote eugenic attitudes that individuals with some disabilities are properly excludable, not only from society, but also from existence.82

This is a powerful charge, and at the very least should remind us to look more closely at the effects of genetic selection programs on persons with disabilities, and to change the programs if they are in any way harmful, denigratory or disrespectful to people with disabilities. However, the charge is not irrefutable. Surely one can find a particular living situation less preferable than others yet still respect persons in that situation. A policy to prevent accidents that cause paraplegia does not harm existing paraplegics, nor prevent us from supporting programs that make their lives easier. Similarly, a program that enables people to avoid the birth of children with disabilities does not have to denigrate existing persons with those conditions. However, this is not the current state of prenatal genetic testing in this country with regards to Down Syndrome.

While genetic counselors around the world offer prenatal testing as an opportunity to maximize a couple’s reproductive choices, disability scholars have recently condemned prenatal testing as typically done with the goal of identifying an affected fetus so that the fetus may be aborted.83 This message has important, indeed critical, significance for the profession of genetic counseling and should not be overlooked. The disability rights84 perspective has two central claims: first, prenatal testing is morally problematic; and second, prenatal genetic counseling is driven by misinformation.85 However, advocates of prenatal testing argue the widespread use of prenatal testing enables parents to prepare emotionally and financially for the special needs of a child with Downs Syndrome.86

Another concern is that prenatal genetic testing encourages reductivism.87 Here, the concern is that using prenatal testing for trait selection (or deselection) purposes will encourage the identification of a specific child with his selected trait(s) or, more generally, the identification of all persons with their selectable traits.88 The identification of individuals primarily with a single, physical trait rather than with their personhood is precisely opposed to disability rights advocates’ efforts to promote “people first” language in describing persons with disabilities.89 The possibility of reductivism appears particularly troublesome for two reasons. First, it threatens the loss of an intangible aspect of how we view our fellow humans.90 Our very respect for the dignity of the individual seems premised on our understanding that each individual is greater than the sum of his or her parts.91 If, by contrast, we were to view our children or the persons with whom we interact in society as simply a combination of traits, then persons with similar traits would begin to appear largely interchangeable, and we would lose an important sense of the humanity and individuality of persons.92

Second, reducing our understanding of individuals to the sum of their traits also threatens to create new, and exacerbate existing, bases for social division.93 Many of the seemingly intractable social divisions of our day are traceable, at least in part, to social groups focusing on one “part” of individuals (for example, their race, ethnicity, religion, or sexual orientation), rather than on their humanity94 It is easy to hate and chastise a label; it is more difficult to hate an individual when one views that individual as being a bundle of humanity – with joys, fears, dreams, concerns, vulnerabilities, and strengths.95 By encouraging us to conceptually break down persons into traits, prenatal genetic testing threatens to reinforce our existing and destructive reductivist tendencies.96

Many of the problems we have regarding the normalcy of children center around the fact that we, in the United States, live in a celebrity oriented and visually oriented culture.97 As long as the status quo remains, the abortion rate will always be high. A common exercise in genetic counseling classes involves asking students whether or not they would choose the traits of their child if they had the option. Furthermore, if they did have the option, would they choose for their child to be taller or shorter, lower or higher body fat, attractive or unattractive features, athletically gifted or intellectually talented, or neither and so on.98 Almost always students say they would choose their child’s traits and that they would choose the more socially advantageous traits.99 This shows the students value physical appearance, intellectual ability and cosmetic attributes. The root of the problem is that we as a society value some things more than others. More likely than not, children with Down Syndrome do not tend to be thought of as having the above attributes that appear to be desired by parents and the vast majority of society100 This problem will not be solved until we as a society accept people who are differently abled and demonstrate that acceptance in our choices and values.

The Negative Perceptions of Persons with Disabilities

It is estimated that 19.7 percent of people in the United States have characteristics that are considered disabilities.101 With such a large percentage of people with disabilities in the United States, one might think discrimination against persons with disabilities would be non-existent. Unfortunately, this is not the case.

In passing the Americans with Disabilities Act in 1990 (ADA), Congress recognized that millions of the nation’s population continued to be treated differently and pejoratively by the non- disabled majority: “Individuals with disabilities are a discrete and insular minority who have been subjected to a history of purposeful unequal treatment, and relegated to a position of political powerlessness in our society resulting from assumptions not truly indicative of the ability of such individuals to participate in, and contribute to, society”102

The disadvantages associated with impairments have their source in pervasive attitudes of contempt and disrespect.103 Like people of color, people with disabilities are not regarded as equals by the larger society, and the disadvantages they face reflect their devaluation.104 Professor Ron Amundson explains the devaluation as follows: “Rehabilitation literature is full of examples of how able bodied people think of disabled people not as having specific disabilities, but as being generally incompetent. This social image reinforces the illusion that global disadvantages and handicaps flow from nature itself.”105 In turn, the prejudice against people with Down Syndrome because of their social incapacitation provides an excuse to reject the demands of persons with Down Syndrome for the kinds of environmental modifications that would increase their access to resources and would further their goals.106 Like the myths that burden women and ethnic minorities, the myths about persons with Down Syndrome are self-supporting.

Attitudes toward congenital disability have not changed markedly. Both premodern as well as contemporary societies have regarded disabilities as undesirable and to be avoided. Not only have parents recognized the birth of a disabled child as a potentially divisive, destructive force in the family unit, but the larger society has seen disabilities as being unfortunate. Polls reveal that most Americans support abortion where a fetus has a severe genetic abnormality107 Our society still does not tolerate the elimination of diseased/disabled people, but it does urge the termination of diseased/disabled fetuses.108 The urging is not explicit, but implicit. The dominant culture appears to be moving in two contradictory directions: more accommodating of disabilities in adults, but less tolerant of imperfections in children.109

The disability rights critique of prenatal testing has been formulated as follows:

(1) Continuing, persistent, and pervasive discrimination constitutes the major problem of having a disability for people themselves and for their families and communities. Rather than improving the medical or social situation of today’s or tomorrow’s disabled citizens, prenatal diagnosis reinforces the medical model that disability itself, not societal discrimination against people with disabilities, is the problem to be solved. (2) In rejecting an otherwise desired child because they believe that the child’s disability will diminish their parental experience, parents suggest that they are unwilling to accept any significant departure from the parental dreams that a child’s characteristics might occasion.

(3) When prospective parents select against a fetus because of predicted disability, they are making an unfortunate, often misinformed decision that a disabled child will not fulfill what most people seek in child rearing, namely, “to give ourselves to a new being who starts out with the best we can give, and who will enrich us, gladden others, contribute to the world, and make us proud.”110

Furthermore, disability rights advocates argue that prenatal testing is being justified by mistaken assumptions about the quality of life of people with disabilities, and is demeaning to existing people with disabilities. Disability rights advocates argue that these assumptions are mistaken for several reasons:

(1) They fail to recognize the extent to which the disadvantages associated with impairments result from discriminatory attitudes and practices rather than anything intrinsic to the impairment.

(2) They place unwarranted emphasis on the size of one’s opportunity range rather than the possibility for meaningful choice and rewarding outcomes within that range.

(3) They confuse the claim that having a capacity, skill, or experience is good, with the claim that lacking a capacity, skill, or experience is inevitably bad. This confusion is due in part to the failure to distinguish the absence from the loss of a skill, capacity, or type of experience, and in part from the overly-narrow description of what is good or valuable.111

The above three points contribute to a negative view of persons with disabilities held by society. Down Syndrome is one of the most readily apparent types of disabilities because the physical characteristics are recognized by most members of society. However, one of the largest contributors to this negative view of Down Syndrome is the prevalence of prenatal genetic testing. A large number of abortions are performed for medical reasons. However, obstetricians say several factors are most likely contributing to a growth in the frequency of terminations occurring after prenatal genetic testing, including broader availability of new screening technologies and more pregnancies among women over 35, who are at greater risk of carrying a fetus with chromosomal abnormalities.112 Moreover, as genetic testing becomes more prevalent, and the public becomes more aware that testing is both available and reasonably accurate, society may reject or otherwise discriminate against children who are born with disabilities and the women who chose to have them.113

Disability rights advocates argue that the medical establishment is sending a message to patients that the goal is to guard against the birth of children with disabilities.114 Professor Adrienne Asch has said, “By putting them out there as something everyone must do, the profession communicates that these are conditions that everyone must avoid.”115 Furthermore, Asch has stated, “[T]he earlier you can get it done the more you can get away with because you never have to tell anybody”116 Terminating a pregnancy based on non-life threatening defects is causing some doctors to become troubled by what they consider to be a slippery slope from prenatal science to eugenics.117

The moral quandary we find ourselves in challenges the ideal of unconditional love of a child against the reality that most of us would prefer not to have that unconditional-love relationship with a certain subset of children. Adrienne Asch says, “I think the reason that this topic is as loaded and painful as it is, is that prospective parents want to think that they are open to loving whomever comes into their families, and they don’t want to think that they aren’t.”118 What is even more problematic is that people with Down Syndrome are described as having “warm, loving personalities and enjoy[ing] art and music.”119 Some parents claim Down Syndrome children are easier to raise than their unaffected children.120 Because children with Down Syndrome are apparently happy preventing their birth can hardly be justified as a means of preventing suffering and this makes it more difficult for prospective parents to rationalize the abortion of a child with Down Syndrome.121

Many women abort a fetus with Down Syndrome despite their views on abortion.122 This raises an interesting and yet critical point. Woman may distinguish the political question of abortion in law and public policy from abortion as a personal moral choice.123 The political question of abortion is when, if ever, it is permissible to destroy human pre-born life.124 The personal moral choice of abortion may turn on an infinite number of other questions such as: (1) Do I have the financial resources to support a child with special needs; (2) Where will this child go to school? (3) Will my family accept this child; and (4) How will this child affect my life?125 Some argue that a desire not to have a child with special needs is based on prejudice.126 Others claim that a choosy attitude toward fetuses brings a consumerist attitude to childbearing and undermines the moral stature of the family. Still others maintain that the act of aborting children with special needs drags us into a moral abyss, but raising children with special needs enhances our humanity127 The arguments result in two opposing views: (1) Prenatal testing is morally questionable because it leads people to reject fetal life because of a single trait, their disability, and (2) A “healthy” newborn is the best outcome for any parent and no reasonable person would choose disability over normalcy if they have the ability to choose based on prenatal testing. Aborting fetal life because of its below average intellectual or physical ability may be morally acceptable to some people, but aborting a fetal life for non- disabling conditions, e.g., gender, may be morally unacceptable to those same people.128 The difference is hard to discern from a moral standpoint. If someone believes that abortion is not justified for gender selection or other genetically determined traits within the “normal” range, why should it be justified for other genetically determined traits, such as Down Syndrome or dwarfism, just because such conditions are statistically less common and deemed “abnormal.”129

Disability rights advocates are right to think of genetic counseling as a search and destroy mission because testing will likely ultimately lead to greater intolerance of disabilities and less money for research or treatment. Some doctors do not want to perform abortions when fetuses have relatively minor defects.130 At the same time, genetic counselors are right to pursue what is a necessary job, counseling and helping families make the best decision for themselves.131

What adds to the problem is the fast growth of the medical genetics field. As a result of this fast growth, the evolution of enforceable legal regulations and the formulation of widely understood and accepted ethical policies have lagged behind rapid developments in technology132 The result is a medical genetics field that is loosely regulated.

While individuals may not have the necessary resources to adequately care for people with special needs, society does. Because society has greater resources to provide for children with special needs, it does not have the rationale that some pregnant women may have for genetic testing and abortion of fetuses whose subsequent care may be impossible for them to provide.133 But there are those in society that want to reduce the cost of care by eliminating or at least reducing the numbers of people with disabilities by encouraging genetic testing and the abortion of fetuses that test positive for Down Syndrome.134 That this rationale has been effective seems clear from the fact that most women who are told that their fetus has this anomaly choose to abort it more quickly than when they are given other fetal diagnoses, some of which have more devastating medical consequences.135 The desire for a “normal” or “better” child contributes to the stigma that people with Down Syndrome live with. Many factors contribute to the social attitude of society and its overall negative impact on persons with disabilities. One thing is clear, this negative view of Down Syndrome will not change until we begin to accept those who are differently abled.

Contrasting the Roles of Physicians and Genetic Counselors

The medical community also contributes to the high abortion rate for fetal life with Down Syndrome. It is important to understand the different roles of doctors and genetic counselors in the prenatal process. Typically a woman makes an appointment to see her doctor as soon as she has a positive pregnancy test result, which could be a week after conception or several months. After the first two months of pregnancy, many of the tests discussed in this article would be inaccurate and, thus, would not be offered.136

There are several types of medical providers. First, and most well known, are obstetrician-gynecologists, also known as OBGYN’s. OB is short for obstetrician, a doctor who specializes in pregnancy, delivering babies, and gynecology.137 They may have low or high risk patients. These doctors usually work in the hospital setting, although many are opening birthing centers, and a few do home deliveries. GYN is short for gynecologist, a physician who specializes in treating diseases of the female reproductive organs.138 Second, family practitioners may specialize in family care, including pregnancy and delivery139 They usually consult with an obstetrician on surgical cases. They practice in hospitals, birthing centers, and home delivery settings.140 Third, nurse midwives are nurses with training in low risk pregnancy and delivery (about 90% of births fall into this category).141 They practice in conjunction with physicians. They may practice in home, hospital or birthing center settings.142 Fourth, perinatologists are doctors who specialize in managing high risk pregnancies.143 About ten percent of pregnancies fall in this category.144 These physicians practice in hospital settings, usually in conjunction with a Level III nursery. And fifth, non-nurse midwives who have special training in midwifery only, limit their practice to women with low risk pregnancies and deliveries.145 Midwives may consult with physicians, and they usually practice in home delivery settings or birthing centers.146 Doctors typically make the offer for genetic testing in both the first and second trimester, which may be dictated by the desire to avoid legal liability that may result from the unexpected birth of a child with disabilities.147 Patients see genetic counselors because they are referred by their physician or are self referred.148 Most people who provide genetic counseling are not genetic counselors but obstetricians, because there are few genetic counselors in many places, especially rural areas. Fewer referrals occur because of this and as a result, obstetricians and primary care physicians provide genetic counseling to their patients.149 However, this is a problem because these professionals are not as well equipped to deal with substantive genetic counseling issues.150 In urban areas, there are typically more referrals because urban areas have greater medical resources and there is typically more insurance coverage because of the increased referrals.151 Furthermore, many women only see a genetic counselor if they have an abnormal test result.152 Some doctors refer all pregnant patients prior to any testing for counseling, education sessions, test coordination, and explanation of results.153 However, it is standard for a doctor to refer a woman to a genetic counselor after the test results have been reported for clarification of what the test results mean.154 Physicians typically do not have the time to explain the risks and benefits, what the detection rates are, and the procedures.155 Most obstetrician-gynecologists spend about eight minutes with their patients per session.156 Most genetic counselors spend about forty minutes with their patients per session.157

Doctors do not receive as much training in genetics as genetic counselors. The amount of genetics taught in a typical medical school is only one week or one course.158 Moreover, genetics is not taught in every medical school.159 The likely result is many doctors are ill equipped to discuss genetic issues.160 Medical schools should offer more genetic counseling instruction since many doctors will recommend genetic testing as a common part of their medical practice. It is very typical for the initial genetic screening to be performed in the doctor’s office, the results being given to the patient in the same office, as well as the patient referral to a genetic counselor, all without any detailed explanation by the doctor.161 As a result, women tend to come into a genetic counselor’s office ill equipped and uninformed.162 Moreover, some women may never see a genetic counselor because of financial constraints.163 Insurance companies often reimburse for diagnostic tests at far higher levels than for pretest counseling-if they reimburse for counseling at all.164 As a result, fiscal concerns might lead practitioners to push for testing rather than genetic counselor referrals.

An important function of genetic counseling is to assist parents who have a fetus with a genetic anomaly to deal with the implications of the diagnosis for the child, the family, and additional children that may be conceived in the future.165 Genetic counselors seek to be culturally sensitive, personally sensitive and to let people make their own decisions by being non-directive.166 They try to tell everyone similar information and let them make their own choice. Other health professionals have less training in nondirectiveness than genetic counselors, and are therefore more likely to be directive and to incorporate their own values and judgments in the counseling process.167 In general, physicians with training in genetic counseling are more directive in their counseling style than genetic counselors.168 Physicians without such training are even more so.169 As a result, many patients choose prenatal testing in part because their physician has recommended or even encouraged it. Non-genetic health professionals tend to make such recommendations partly because “the idea that one would not want information is so counter to the medical profession’s world view”170 While genetic counselors tend to accept a broad range of reasons for rejecting prenatal testing, physicians are more inclined to encourage testing, unless the patient has a history of infertility or miscarriage.171 One major reason genetic counseling should be offered in medical schools is to inform physicians about the non-directive goals of genetic counseling and educate them on the wide range of functioning that people with genetic anomalies experience.172

The choices health professionals offer are typically: (1) an initial genetic screening; (2) additional diagnostic testing; (3) and support if they chose to abort or to continue the pregnancy.173 But what is frequently missing from this process is the delivery of comprehensive information on genetic anomalies, resulting range of possible disability, and the support services available in the community.174

In prenatal genetic testing counseling, the genetic counselor typically begins by explaining that all pregnancies have a three to five percent population risk of birth defects, regardless of family history.175 The counselor then describes the patient’s particular pregnancy risk.176 Next, the counselor describes the information that tests can provide, their limitations-not all conditions can be identified-and the health risks to the patient.177 Finally, during the screening and counseling process, the genetic counselor works closely with the physicians on a health care team.178 Contact with community support services or similarly situated women or families is not required.179 Of course, some patients may independently obtain information about community services for Down Syndrome children from national or local Down Syndrome organizations, or from the Internet.180

The American Academy of Pediatrics recommends that the medical professional discuss the following topics with the family:

1. The prenatal laboratory or fetal imaging studies leading to the diagnosis.

2. The mechanism for occurrence of the disorder in the fetus and the potential recurrence rate for the family

3. The prognosis and manifestations, including the wide range of variability seen in infants and children with Down Syndrome.

4. When applicable, additional studies that may refine the estimation of the prognosis (eg, fetal echocardiogram, ultrasound examination for gastrointestinal malformations).

5. Currently available treatments and interventions. This discussion needs to include the efficacy, potential complications and adverse effects, costs, and other burdens associated with these treatments. Discuss early intervention resources, parent support programs, and any plausible future treatments.

6. The options available to the family for management and rearing of the child using a nondirective approach. In cases of early prenatal diagnosis, this may include discussion of pregnancy continuation or termination, rearing the child at home, foster care placement, and adoption.181

If the pregnancy is continued, a plan for delivery and neonatal care must be developed with the obstetrician and the family. Also, a referral to a clinical geneticist should be considered, if it has not already been considered, for a more extended discussion of clinical outcomes and variability, recurrence rates, future reproductive options, and evaluation of the risks for other family members.182

Prenatal genetic screening is being largely left to the discretion of the medical profession and is being performed for the benefit of prospective parents, not their fetuses.183 Prenatal genetic screening is about “offering prospective parents difficult choices regarding the sacrifices they are willing to make to be parents, what mental and physical characteristics their children will have, and what kind of lives they want their children to have at a time when abortion is still an option.”184 The assumption underlying voluntary genetic screening is that prospective parents will be given information and be allowed to act on that information.185 The choices created through prenatal genetic screening (whether to undergo genetic testing, which tests to run, the option to end a pregnancy based upon a broader spectrum of test results) will expand along with prenatal testing capability186 Today, the two options given to prospective parents who receive genetic screening results indicating a genetic abnormality are: delivering a child with a known impairment or propensity for being unhealthy, and aborting the child.187 The care provided by OBGYN’s, family practitioners and genetic counselors will contribute to the choice women make.

The Role of Genetic Counselors

Even though genetic counselors are not the first persons women see in the prenatal process, they play a major role because they are frequently the most knowledgeable source of medical information on genetic anomalies for pregnant women and their families.188 The genetic counselors I interviewed all agreed that the women and their families who come for genetic counseling typically understand little about what a genetic counselor does, the training they receive, their professional standards of conduct, medical guidelines for prenatal diagnosis, and ultimately their function as a whole.189 This section will provide information about genetic counselors, the people who need and use their services, their professional guidelines and standards of conduct, clinical approaches, and the process of genetic counseling. This section will discuss the new prenatal guidelines genetic counselors follow and whether those new guidelines are necessary. The National Society of Genetic Counselors (NSGC) says that genetic counseling is the process of helping people understand and adapt to the medical, psychological and familial implications of genetic contributions to disease.190 NSGC asserts that the genetic counseling process involves an attempt by one or more appropriately trained persons to help the individual or family to:

(1) comprehend the medical facts, including the diagnosis, probable course of the disorder, and the available management; (2) appreciate the way heredity contributes to the disorder, and the risk of recurrence in specified relatives; (3) understand the alternatives for dealing with the risk of occurrence; (4) choose the course of action which seems to them appropriate in view of their risk, their family goals, and their ethical and religious standards, to act in accordance with that decision; and (5) to make the best possible adjustment to the disorder in an affected family member and/ or the risk of recurrence of that disorder.191

Genetic counselors are health professionals with graduate degrees in the areas of medical genetics and counseling.192 They work as members of a health care team, providing information and support to families who have family members with birth defects or genetic disorders and to families who may be at risk for a variety of inherited conditions.193 They provide supportive counseling to families, serve as patient advocates and refer individuals and families to community or state support services.194 Furthermore, they “identify families at risk, investigate the [genetic anomaly] present in the family, interpret information about the disorder, analyze inheritance patterns and risks of recurrence and review available options with the family”195 Most enter the field from an array of disciplines that includes biology, genetics, nursing, psychology, public health and social work196 They serve as educators and resource people for other health care professionals and for the general public.197 Some counselors also work in administrative capacities. Many engage in research activities related to the field of medical genetics and genetic counseling.198

Professor Gettig believes that patients who might have a child with Down Syndrome typically see genetic counselors at two primary points: (1) prenatal testing to determine whether or not the baby has Down Syndrome or (2) after delivery, to diagnosis a child with Down Syndrome and provide information on the available educational and health programs needed for children with Down Syndrome.199

Similarly, Professor Carolyn Lee Brown argues genetic counseling actually consists of three stages: the patient-counselee must directly approach or be referred to the genetic counselor; the genetic counselor must obtain all necessary information to allow for a proper diagnosis; and, ultimately, the genetic counselor must communicate his diagnosis to the patient-counselee.200

Genetic counseling is typically advised for: (1) Pregnant women who will be 35 years old or older at delivery time (however the guidelines have changed, see infra Genetic Counseling Guidelines and Professional Standards of Conduct); (2) Individuals who are known to be at risk for carrying genetic disorders; (3) Parents of a child with a genetic disorder, birth defect or mental retardation; (4) Individuals who have had a laboratory test indicating an increased risk for a genetic disorder; (5) Individuals diagnosed with a birth defect or mental retardation, or who have a family history of a genetic disorder; (6) Individuals of ethnic groups in which particular inherited diseases are more common; (7) Individuals or couples who have had multiple miscarriages or pregnancy losses; and (8) Women exposed to certain medications or drugs, significant radiation, and/or particular infections during pregnancy.201

Genetic Counseling Guidelines and Professional Standards of Conduct

A genetic counselor must earn a masters degree from a genetic counseling/ human genetics program accredited by the American Board of Genetic Counseling.202 Most genetic counselors are board- certified.203 Most counselors enter a genetics program with an undergraduate degree in science, psychology, or genetic counseling.204 Each program has slightly different prerequisites and course requirements. However, they are all based on developing specific competencies in genetic counseling.205 Similarly, numerous nurse-counselors and social workers do genetic counseling. In the past, counselors without master’s degrees were eligible for board certification, but since the mid-1980s, a master’s degree in genetic counseling is required.206

There are two medical organizations that govern genetic counselors: the American Board of Genetic Counseling (ABGC) and the National Society of Genetic Counselors (NSGC). The ABGC certifies genetic counselors and accredits genetic counseling training programs.207 Graduates of these programs must also pass a certifying examination administered by the Board.208 Genetic counselors that have passed their certifying examination practice in a variety of settings, including hospitals, private offices, laboratories, federal and state government offices, universities, and research facilities.209

The NSGC is the professional membership association for the genetic counseling profession.210 Because they offer educational programs, it would be considered a conflict of interest for them to administer the Board exams.211 In 1991, the NSGC adopted a professional code of ethics entitled “Genetic Counselors and their Clients,” which discusses the need to respect clients’ backgrounds and cultural beliefs.212 If someone violates the NSGC code of ethics or any published practice guidelines, they may lose their certification.213 If a complaint is filed, the issue is reviewed and the review committee of ABGC renders a decision.214 According to the NSGC, the average counselor sees about 450 patients per year, with a range of 200 to 1000.215

Regarding guidelines, another major consideration needs to be the new professional standard of conduct. Before January 1, 2007, the majority of pregnant American women 35 years of age or older were offered amniocentesis.216 It has become standard practice for women older than 35 to be offered genetic counseling and diagnostic testing.217 Yet, women under the age of 35 have higher fertility rates and account for 80 percent of children born with Down Syndrome.218 Therefore, the new American College of Obstetricians and Gynecologists guidelines recommend that all pregnant women, regardless of age, be offered such counseling and testing.219 Whether it is good policy to test all women in order inform them whether they are carrying a fetus with a chromosomal anomaly must be judged in the light of the risks to their health, options for treatment, especially of possible life-threatening conditions, and the benefits of knowing in advance that a child with special needs may be born. If the benefits of such testing exceed the risks, then expanding the prenatal guidelines to include all women may be necessary220

Many older pregnant women know before they are even pregnant that they will be offered, or even urged, to undergo amniocentesis or another genetic screening if they become pregnant. While women may not know what amniocentesis entails or are confused as to what the test results mean, they know that they are in a high-risk category by virtue of their maternal age alone.221 In contrast, younger women do not consider themselves to be in a high-risk category.222 In the past, younger women were only referred for prenatal tests if they had a family history of hereditary disease, or if genetic screening suggested a need for diagnostic testing.223

Research is being conducted on the cost-effectiveness of having every pregnant woman in the United States undergo prenatal genetic testing.224 Currently, medical science has no treatment for Down Syndrome itself, but may provide treatment for certain conditions that frequently accompany it. While diagnosing Down Syndrome before birth permits or even encourages parents to choose abortion, it also permits those parents who accept a child that is differently abled to prepare for the arrival of a child with special needs. As more is learned about genetic anomalies, more genetic tests will be recommended.225 Obstetricians and gynecologists may be adopting policies that have the effect of increasing abortion for genetic anomalies.226 Is this the result of informed consent, or a reflection of our bias against people with disabilities?

Non-directiveness: The Unattainable Ideal

A major tenant of genetic counseling is non-directiveness. Genetic counselors are taught to be: educational, nondirective, unconditional, and supportive.227 The Code of Ethics states that counselors should strive to: (1) seek out and acquire all relevant information required for any given situation; (2) continue their education and training; (3) remain aware of current standards of practice; and (4) recognize the limits of their own knowledge, expertise, and therefore competence in any given situation.228 With regard to their relationship with their clients, counselors should strive to: “(1) enable their clients to make informed decisions, free of coercion, by providing or illuminating the necessary facts and clarifying the alternatives and anticipated consequences, and (2) refer clients to other competent professionals when they are unable to support the client.”229 The hallmark of genetic counseling is nondirectiveness.230 Nondirective, or client-centered, counseling is the process of skillfully listening to a client, encouraging the person to explain his or her concerns, helping the client to understand the relevant issues, and determine a course of action.231 This type of counseling is “client centered” because it focuses on the client, rather than on the counselor. The counselor primarily listens to and tries to help the client discover and follow improved courses of action.232 They especially “listen between the lines” to learn the full meaning of their client’s feelings.233 They look for assumptions underlying the counselee’s statements and for the events the counselee may, at first, have avoided talking about. Counselors often say a person’s feelings may be likened to an iceberg.234 The feelings and emotions expressed by the patient may be only the “tip” of the iceberg. Underlying these expressed feelings and emotions lay the ultimate dilemma to be faced by the patient, which the patient is almost always reluctant to reveal.

Despite their commitment to nondirectiveness, genetic counselors may subtly promote prenatal testing because of values they hold dear.235 As stated earlier, medical professionals are not neutral about the value of information, and the view that gathering of information as a sign of responsible behavior and good decisionmaking.236 Moreover, genetic counselors and patients tend to believe that getting information about the fetus is not only the right thing to do, but a form of reassurance and a way to get a sense of control over the potentially overwhelming experience of reproduction.237 Also, some popular books have linked the notion of good parents with prenatal testing.238 Professor Suter has suggested that more genetic counselors hold stronger views about the “tightness” or “wrongness” of abortion for genetic anomalies and its effect on the overall makeup of society than do most physicians.239

Most genetic counselors attempt to achieve the goal of nondirectiveness yet there are countless stories of those who do not. As a result, genetic counselors are not without fault. Although they are supposed to be nondirective, many people simply cannot make a decision. Professor Getting, among other genetic counselors, has experienced women continually asking questions such as, “What would you do in my situation?”240

How directive is it to talk patients through the decision-making process? “Talking through” means discussing the things the genetic counselor would consider important and that others have considered important, such as: How stable is the patient’s marriage? Is the patient financially capable of raising this child? Is the patient’s job flexible enough to handle a child with special needs? Should the patient stay at home instead? Will the patient psychologically and physically be able to handle the special needs of this child? What would it be like to raise this child? How would the child affect the patient’s other children? What is the patient prepared to do and not do for the special needs, both physical and psychological, of this child?241

Is the above directive or non-directive? It appears the questions asked show value judgments and concern on the part of the genetic counselor. Many genetic counselors believe they can achieve nondirectiveness through consciously being aware of their word choice, body language and maintaining an awareness of the gravity of the information being shared.242 Furthermore genetic counselors argue that being nondirective does not mean that you cannot give directions to people, and distributing information on genetic screening to people is not directive because the patient can chose whether or not to follow those guidelines.243 Although much discussion has occurred regarding nondirectiveness, there does not appear to be any exact guidelines regarding what is and what is not nondirective.244 The end result is although most genetic counselors may consciously attempt to be nondirective by remaining nonjudgmental and refraining from imposing their beliefs and values, the very words they use and questions they raise may subtly influence the patient’s decision more than they realize.

Nondirectiveness, as described in the literature,245 may oversimplify how counselors understand the counseling experience and it may ignore the very real possibility that genetic counselors do not share a uniform understanding of nondirectiveness.246 Indeed, no good empirical data exists regarding what nondirectiveness really means to genetic counselors.247 Moreover, the traditional account of nondirectiveness tends to describe a process that is potentially incoherent or inconsistent in some respects.248

While striving to achieve nondirectiveness is the correct approach, it is impossible to advance one moral viewpoint over another (i.e., deference to technology, knowledge and the like) and be neutral toward all moral viewpoints. Professor Christy A. Rentmeester, Ph.D.249 said it this way, “Despite the best efforts of a counselor to convey “value neutral” facts, risk assessment by the counselee and family is done according to normative analysis, experience with illness, and definitions of health. Each of these factors must be known by the genetic counselor in order to relate those facts which she acknowledges as relevant to the decisions that will be made by those people seeking the genetic information. In the expression of genetic risks, the authority of medical language impacts a person’s understanding of epidemiological data.”250 Moreover, the strong values genetic counselors place on knowledge, information and technology likely reinforces the public’s acceptance and expectation of prenatal testing.251 Thus, even a genetic counselor’s best effort to be nondirective has some elements of directiveness.

Contrasting the Differences Between Genetic Screening and Diagnostic Testing

It is also important to under

The Medieval Masons’ Lodge As Paradigm in Peter Behrens’s Dombauhutte in Munich, 1922

By Anderson, Ross

It is my dearest wish no longer to speak of art, rather, that we, those of us who concern ourselves with the field, had the right to call ourselves craftsmen. It is therefore understandable that we came to give our building the name Dombauhutte. Our work should once again make us proud to take part in activity previously considered the craftsman’s honor. The fervency of such productivity was at its strongest in the Middle Ages, at the time of the Bauhutten, the working communities of the builders and stonemasons, united in a common spirit. Their life and their creations were founded on regulations, whose rules they guarded as strict secrets. . . . – Peter Behrens, “Die Dombauhutte,” 1923(1)

Something of an enigma, Peter Behrens’s temporary exhibition building the Dombauhutte at the Deutsche Gewerbeschau Munchen 1922 (1922 German Exhibition of Applied Arts in Munich) has resisted convincing interpretation.2 It is eccentric both on the level of visual appearance and in respect to the architecture of modernism, which Behrens (1868-1940) is generally ascribed a central role in establishing. A small rectangular masonry pavilion with walls executed in polychromatic brick patterns of interpenetrating chevrons, it exhibits a built durability contrary to the transience of its purpose (Fig. 1). It is immediately apparent that the architectural paradigm drawn on is the Late Gothic chapel. Of a similar scale, it is longitudinally symmetrical running east to west and has a single centered entry, an abstract apse, and a regularly divided facade mirroring an internal nave-bay composition. The Dombauhutte is complete with buttresses, abstract gargoyles, and stained-glass windows. This impression of a Gothic chapel is further amplified in the interior (Fig. 2). Exposed brick walls and rustic timber rafters are dimly lit by the narrow stained-glass side windows, with the exception of the rendered apse, its smooth white plaster illuminated by skylights out of view from the nave (Fig. 3). It is endowed with carefully placed Expressionist exhibits with the character of church furnishings, including an altar, pulpit, baptismal basin, and devotional sculptures. An array of three large floor mosaics occupies the nave. Though there is much that is symbolically explicit, a great deal has remained either implicit or hidden.

Once the architectural sources that attend the motif of the medieval Bauhutte are investigated, a more complete picture of Behrens’s intentions reveals itself. The Bauhutte has an extensive history in German architecture. Originally the medieval German masons’ lodge, it enjoyed a rebirth in the context of a progressively more secular and scientific culture, acquiring a quasi- mythical status in German Romanticism.3 It became a vehicle of aspirations for cultural renewal, embodying a vision of “creative making” that stood up against industrialization. As such, it contributes to an understanding of the dilemma of “creative culture” that is the ongoing Romantic legacy: the coupling of remorse at current conditions with the confidence to do something about them.

In 1928, Joseph Cremers produced the first critical writing on Behrens’s Dombauhutte.4 He is enthusiastically supportive of the enterprise, labeling the building an ark of post-World War I religious art. He applauds Behrens’s rejection of objectivity (Sachlichkeit) in favor of returning to the emotive realm of primal Christianity ( Ur-Christentum) as a more profound reflection of the times, as well as his turning away from the contemporary tendency to exhibit exemplary individual works in favor of the collective product of a working community.

The building has received remarkably little attention from recent architectural scholarship, where it is mostly treated as an adjunct to the much larger Hochst AG Technical Administration Building, alongside which it stands chronologically and thematically.5 The grounds for neglect are manifold. As a temporary building, in existence only from May to October 1922, it offers comparatively Iitue documentary material on which to base an interpretation. False conclusions derived from insufficient evidence have been passed from one author to the next. Alan Windsor writes of the wooden beams of the roof structure protruding through the wall to the exterior and being supported by corbels and buttresses.6 Wolfgang Pehnt repeats this assertion.7 In photographs, this appears to be true, as the beams and “gargoyles” are horizontally aligned. However, Behrens’s drawings clearly reveal them to be two distinct elements (Fig. 4). Stanford Anderson provides a concise rendering of the general concerns involving the Dombauhutte in the context of Behrens’s work in the interwar period.8 As his goal is to explicate the meaning of the building within the framework of Behrens’s work as a whole, he has little interest in portraying the building comprehensively.

The Dombauhutte indeed proves difficult to convincingly situate within the rest of Behrens’s work, appearing much darker and unfamiliar. This is partly owing to the general reading of modern architecture as a ideological progression toward Sachlichkeit, marginalizing apparently uncomfortably regressive projects, among which the Dombauhutte is exemplary. In all, it has remained largely opaque to architectural investigation.

Ultimately, the Dombauhutte is neither as insignificant as recent scholarship implies nor as radically innovative as Cremers suggests. Behrens himself evaluated the building as a “modest attempt.”9 Its study serves to clarify certain aspects of the problematic and only partially understood legacy of aestheticism and historicism that arise out of the Romantic ferment, in particular, the paradoxical claim of modern aesthetics to be simultaneously autonomous and culturally allencompassing.

Behrens enlists the cultural and architectural legacy of the Middle Ages in his ambition to revive cultural continuity, viewing it as a time of sophisticated mediation in the manifestation of the highest values. To this end, he effects a decantation of religious experience into aesthetic experience, illuminating the problem of meaning in secular culture. As the receptacle for values initially attached to the Gothic cathedral, the architectural motif of the Bauhutte is particularly helpful in pinpointing how architecture stands in respect to attempts to create or reground a culture as meaningful and comprehensive as the medieval society in which the original Bauhutte was situated.

Formally, the Dombauhutte is unique in Behrens’s oeuvre, and viewed in isolation there appears little to warrant intensive study. Yet, when it is explored thematically, one realizes that actually far from being a radically willful one-off building, it raises issues more central both to Behrens’s architecture and to modernism more generally.

There are very few sources to aid interpretation, making the building even more enigmatic. The contract stipulated that the building was to be demolished prior to handing back the site to the city of Munich on January 31, 1923, and recent aerial photographs testify to the lack of physical remains. Sources therefore consist solely of photographs, drawings, and contemporary testimonies. Only two exterior photographs have ever been in circulation. One of them has been reproduced particularly often, presumably because of its dramade perspective (Fig. 1). The original was published in Deutsche Kunst und Dekoration in 1923, accompanying an extract from Behrens’s speech at the official opening of the building. Since then the image has been poorly reproduced a number of times, tightly cropped with high contrast and significant loss of detail.10 The dappled shadows cast by the foliage, which subtly textures the facade of the original, appear to consume the building in the latter generations of the image. The Dombauhutte has become progressively more rudimentary and mysterious through historiographical study, as contrast has increased at the expense of clarity.

An interpretation of the genesis and architectural content of the Dombauhutte must be situated in respect to other responses in the arts to the terrible physical destruction and cultural turmoil caused by World War I. Some artists and architects sought a fundamental reevaluation of the trajectory of modern technology, promoting a collective return to craft that was often modeled on religious working communities. In 1929, Behrens himself revealed in a letter to August Hoff that in the church he recognized “a counterweight for our modern times against the materialism, the all too pervasive neue Sachlichkeit of the new age.”11 The Dombauhutte furnished Behrens with an opportunity to unite his conviction that craft is the basis for good architecture, outlined in Uber die Beziehungen der kunstlerischen und technischen Probleme (Concerning the Relationship of Artistic and Technical Problems), 1917, and Reform der kunstlerischen Erziehung (Reform of Artistic Education), 1919, with the spiritual unity of a religious working community.

The primary source for the concrete historical background of the exhibition used here is the Amtlicher Verwaltungsbericht der Ausstellungsleitung (Official Administrative Report of the Exhibition Executive), authored by Edwin Redslob. This summary document chronicles the events leading to the exhibition, noting that from 1919 there had been repeated calls for a German exhibition of applied arts, especially through articles in the journal Munchner Bund. Munich was selected over other interested cities once its two mayors declared themselves willing to provide substantial financial assistance as well as the grounds for the exhibition, and the Deutscher Werkbund and the Verband Deutscher Kunstgewerbevereine (Federation of German Applied Arts Societies) pledged their full cooperation. The Verein zur Abhaltung einer Deutschen Gewerbeschau 1922 in Munchen (Council for the Production of a German Exhibition of Applied Arts in Munich, 1922) was founded on January 21, 1920, with the express purpose of producing the event and was to be dissolved on its closure. In February 1920 letters were sent out to artists and craftsmen all over Germany asking for expressions of interest. The site was the Theresienhohe, a large open park in Munich, and most exhibits, divided into sections including ceramics and glass, furniture, sculpture, and graphic design, were housed in large exhibition halls, though a number of smaller pavilions, including the Dombauhutte, were specially fabricated (Fig. 5). The report succinctly addresses the aspirations and submissions of the various exhibitors. The events surrounding the decision to construct a building with the name Dombauhutte at all, and Behrens’s selection as architect, remain unclear. Redslob notes that some of the buildings were commissioned directly and some were the product of invited architectural competitions. One page, specifically dedicated to the Dombauhutte, is dominated by a lament that the building and its artifacts were received with such negativity and misunderstanding, particularly given that it was among the entries most concerned to engage communal understanding in its creation and its message. Behrens claims to have contributed to the designation of the building, and Redslob refers to him as “Meister der Dombauhutte.” Taking this into account, and given his status as a founding member of the Deutscher Werkbund, a co-convener of the exhibition, we can confidently assume he enjoyed a great deal of architectural autonomy. Though Behrens’s Dombauhutte predominantly seeks to partake in the paradigm of the Gothic chapel, a brief discussion of the architectural identity and the institutional life of the original masons’ lodge outlines the attraction of the Bauhutte and indicates why it was deemed a worthy architectural motif in the context of a handicraft exhibition. The architectural identity of the masons’ lodge stood in a dialectical relation with the cathedral. Devoid of architectural self-interest, the rudimentary and compact Bauhutte channels attention toward the cathedral. As an illustration, the Bauhutte in Jan van Eyck’s oil painting Saint Barbara, 1437 (Fig. 6), is a simply roofed but otherwise unenclosed shed-the diminutive complement to the emergent building on which the masons are active. It appeals to the modern mind through the virtues of modesty, earnestness, and, most important, the powerfully creative ability to realize the cathedral’s construction. The physical building of the medieval Bauhutte belies the sophisticated representational apparatus that its masons deploy. It was the house of the institution, without representational content, whereas the cathedral was the focus of a universal iconographic program.12 In the medieval situation, decisions regarding the cathedral emerged from dialogue between sophisticated theology and concrete building practice, exercised in an elaborate chain of communication crossing classes and disciplines. It is the post-Enlightenment loss of this common orientation that Behrens laments: “architecture is still not an occasion of what is common, as it was in the Middle Ages.”13 He saw in the Dombauhutte an opportunity to reinitiate a collective creative orientation:

It [the Dombauhutte] was not intended to be a showing off of willful objects, rather, a spatial composition achieved by forces of a similar sensibility. Only those with a sensibility for the resonance of the whole were allowed to participate. I know that people have accused our work of not being made in the spirit of our age of the car and the aeroplane; rather, we have taken a “romantic direction” through the strong emphasis on craftsmanship. Okay, good. That is how it should be! There is nothing we need more than a little romanticism, to make life more attractive, to make contemporary life at all bearable.14

It is pertinent that Behrens should speak of Romanticism, though he was responding to the popular understanding of the romantic as whimsical and backward looking. In actuality, his ideals and architecture are genuinely indebted to early Romantic thinking and are best understood with reference to this cultural movement commencing with Johann Wolfgang von Goethe and August and Friedrich von Schlegel. In Von deutscher Baukunst (On the German Art of Building), Goethe wrote provocatively of Strasbourg Cathedral as a work of art created by Erwin von Steinbach, boldly pronouncing that “this characteristic art is now the single true art. . . . whether born out of raw wildness or of educated sensibility, it is utterly alive.”15 Tellingly, Behrens also mentions von Steinbach in his opening speech for the Dombauhutte. “at the time of the Bauhutten . . . there was no distinction between handicraft and art. Erwin of Steinbach, the designer of Strasbourg Cathedral, belonged to such a Bauhutte.”16 This is at the very least an indication of sentiments Behrens shared with Goethe, and conceivably an intentional reference.

Though it is less easy to speak of a literary prehistory to Expressionism than is the case with Romanticism and the Gothic Revival, there are definitely resonances between the arts. Two texts serve in tandem to illustrate this coincidence of conviction. Wilhelm Worringer’s Abstraktion und Einfuhlung (Abstraction and Empathy) from 1907 and Karl Scheffler’s Der Geist der Gotik (The Spirit of the Gothic) from 1917 revive the early Romantic polarity of classical (Greek) and medieval (Gothic).17 Scheffler’s “spirit” of the Gothic is a direct echo of Goethe’s “characteristic art”; in fact, he writes that the young Goethe was correct when he announced in his Strasbourg text, “Art creates forms long before it is beautiful, and true, great art is often truer and greater than beauty itself.”18 Though it is unclear to what extent Behrens critically engaged with Scheffler’s writings, it may be assumed he was generally familiar with them.19 Key phrases in Der Geist der Gotik read as a rallying cry to artists and may be read into Behrens’s specific intentions, such as: “that which is the most revolutionary is also always that which is the most Gothic,” and further that the Gothic “stands there in all its glory in turbulent times, when new ideas dawn, when problems are to be solved and duties are to be violently fulfilled. It belongs to the heroic age of the spirit.”20 Cremers suggests that “Romantic, as understood by Behrens, is thus the battle of the becoming with that which exists. It is the battle of the personality, in which the strengths of a people are sublimated, with the spirit of the future.”21

Bearing this debate in mind, Behrens’s commitment to the Gothic in the Dombauhutte stood as a significant personal gesture. Its contemporary resonance is not to be underestimated, particularly given his previous affiliation with classicism in projects such as his Kunsthalle (Hall of Art) pavilion at the Nordwestdeutsche Kunstausstellung (Northwest German Art Exhibition) in Oldenburg, 1905.22 He belonged to a generation with high esteem for traditions, even if reified as formal idioms. The Gothic-classical issue is marginalized in high modernism, as questions of style are suppressed in favor of the twin notions of space and function on the one side and radical personal expression on the other.

The historical allusion to the Gothic chapel in the Dombauhutte was even stronger in early design drawings, which indicate two spiral stairwells flanking the entrance, implying gates for entry into the Heavenly Jerusalem (Fig. 7). The spiral stairwells, however, also provide a compelling link to the symbolism of Solomon’s Temple when considered in conjunction with the orientation of the Dombauhutte. Whereas it had been the medieval practice to draw plans with east at the top of the page, in recognition of its ontological precedence, by Behrens’s time the architectural convention of drawing with north at the top was generally established, as cartographic accuracy had assumed precedence over symbolic import. Most readers of the Dombauhutte plans, informed by common architectural convention, would assume north to be at the top of the page, situating the choir to the east and scarcely warranting comment. Yet Behrens never actually provided a symbol for north on the plans. It is not until the site plan for the entire exhibition is carefully consulted that orientation becomes a major concern (Fig. 5). Behrens has drawn his plan with south at the top of the page, inverting general convention. The choir that until now has been implicitly equated with both liturgical and magnetic east actually faces due west. This has never been remarked on. Although such an orientation is evidently contrary to that of the Gothic chapel, it is exactly aligned according to the biblical description of another major architectural paradigm, that of Solomon’s Temple in Jerusalem. This realization prompts at least a partial rereading of the twin spiral stairwells flanking the entrance in an early design proposal, an idea that was abandoned during the design process and has subsequently never featured in discussion on the building.

The construction of Solomon’s Temple, including a detailed description of its dimensions, layout, and furnishings, is documented in 1 Kings 6-7 and 2 Chronicles 3-4. According to the biblical description, the entrance porch to the temple faced the east, where it received the rising sun. It was flanked by two columns, Joachim to the north and Boaz to the south. Representing universal dualisms, these spiral columns have together become a significant architectural symbol, frequently reinterpreted throughout history both as simple columns and as towers with spiral staircases.23 Though not detached from the main body of the building, Behrens’s proposed spiral stairwells protruded through the entry facade, forming a porch configuration. The temple symbolism does not negate the medieval reading. It is rather further evidence that Behrens drew sustenance from the paradigm of the Gothic chapel, while reading through it to establish a connection to the more ancient paradigm of Solomon’s Temple.24 Though the building was dismantled after the exposition and only a couple of enigmatic, heavily recycled photographs of it are in circulation, folios of drawings yield a remarkably complete rendering of the building. Until now, recourse has rarely been made to these drawings, which are broadly representative of the original sketch and working drawings produced in Neu Babelsberg and Vienna in 1921 and 1922. The most significant collection is archived in the Kunstbibliothek in Berlin, in four folios labeled “Gewerbeschau Munchen Dombauhutte 1922.”25 This set is augmented by a smaller collection in the Pfalzgalerie, Kaiserslautern.26 In addition to architectural drawings, designs exist for features such as the altar, pulpit, and niches. A number of drawings host small, lightly drawn sketches around the edges. Most drawings were made with graphite pencil on drafting paper, and some are ammonia blueprint copies sketched over in graphite or colored pencil. Though an associate has clearly drawn a number of sections,27 the majority of drawings evidence Behrens’s drawing and labeling technique, familiar from other projects. To assist interpretation of the building in this study, a faithful three-dimensional computer model was constructed to enable, for the first time, observation of the building in its entirety (Figs. 8, 9).

It is well documented that geometry and proportions were central to Behrens’s architecture, particularly in earlier buildings where the systems he used are very explicit. In 1913 Fritz Hoeber observed that “in his energetic striving after impressional spatial clarity, Behrens actually only concerned himself with geometric surface- proportions and fearfully avoided purely arithmetic number games.”28 Behrens himself spoke often of the geometric systems used by the “ancients,” claiming that they

composed geometric constructions that provided helping lines and helping figures, which determined the size relationships, the dimensions and the division of the building. This is in contrast to our times, where everything is determined by scale, through numbers that are arithmetically derived. . . . The derivation of proportions through this kind of measure often maintained itself through the Middle Ages as the secret of individual Bauhutten.29

In 1917 he again wrote that it was “above all in the Gothic Bauhutten where at all times the laws of architectural design based on regulatory geometrical systems were practiced.”30 Given Behrens’s professed and practiced dedication to geometric systems as generators of architectural form, as well as his repeated references to the medieval Bauhutten as the places where building secrets were maintained, it seemed reasonable to assume both that geometry would play a central role in the design of the Dombauhutte and that the system would not have been made readily apparent.

A brief review of the typical architecture of the medieval chapel illuminates why and how Behrens worked with it as a paradigm and supplies a standard for the subsequent discussion on the geometric disposition of the Dombauhutte plan (Fig. 10). Gothic chapels and drawings are valuable sources, but equally valuable are texts written by masons themselves. The setting out of the plan on the medieval building site as disclosed by Lorenz Lechler in his Unterweisungen from 1516 affords a sound vehicle for understanding the origins and meaning of the geometry and its symbolic import. The two fundamental operations are derivation of an orientation and the inscription in the ground of a boundary figure. The primary axis and direction of the building are found by “turning toward the direction in which the sun rises.”31 That is, liturgical east is founded anew. The second action is the founding of the primary dimension out of which all others are derived, that of the internal width of the chapel: “The building has its exact law and rules of organization, since all components must correspond to the work, and the entire work must reciprocally correspond to the components. The choir is taken as the foundation and basic regulation of the whole building.”32 A geometric procedure known as Quadratur,33 which is an order of rotated, inscribed squares, was then used to extrapolate from the primary dimension measurements required for building components at all scales, from overall internal dimensions to the length of vaulting ribs, wall thicknesses, and even window mullions. The following interpretation of the Dombauhutte is made with its medieval precedent kept in mind.

Computer drawings based on Behrens’s final drawings serve to recover the geometric system he used (Fig. 11). The fine dimensioning of the original plans made it possible to test the accuracy of reconstructions with a great deal of certainty. It becomes apparent that the geometric system is actually a composite of separate initiatives. The first configuration is an order of rotated squares, devolving from the Quadratur method of the medieval masons (Fig. 12),34 which resulted in a square grid rotated through 45 degrees that successfully coordinated the disposition of the plan: overall interior and exterior dimensions, wall thickness, location and dimensions of the buttresses and attached piers, location of openings, and location and dimension of the floor mosaics. The central square of each mosaic is exactly one grid unit, furnishing a discreet pointer to the grid’s existence and its symbolic centrality. The near miss in respect to medieval (Quadratur configurations is provocative, as though Behrens wanted it to be like the medieval precedent without being the precedent. The question arises why the figures and grid matter, and, just as significantly, why they were so well hidden. A solitary clue exists in an early floor plan that hosts diamond shapes very faintly sketched in pencil (Fig. 13). Perceptually, the grid remains an implicit phenomenon. Speaking more generally, a grid can be read as an extensive matrix that is the first step in wresting order from chaos, constituting a new beginning. In this instance, however, the grid is a secondary derivation from the primary rotated square figures. These kinds of intensive geometric figures are qualitatively different, participating in fundamental symbolic orientation, driven by dialectics such as up-down and center- periphery. Examples are masons’ marks, mandatas, and labyrinths. When writing on Behrens’s Kunsthalle at the Nardwestdeutsche Kunstausstellung, Oldenburg, Julius Meier-Graefe points out that “it is not numbers that are used as generators of space, but rather geometric figures. … relationships are not determined through calculation but rather through the underlying disposition of the geometric entities… “35

H. P. Berlage’s Nieuwe Beurs te Amsterdam (New Amsterdam Stock Exchange, 1903) is a precedent famously based on a similar 45- degree grid (Fig. 14). It is often labeled a proportional system, though it is rather a relatively simple means of establishing the general sizing of elements within a field. The 1905 Kunsthalle Oldenburg presents an early example in Behrens’s own work. Hoeber tells us that thorough mathematical deliberation suffuses the site in plan and elevation, and he provides a drawing of the geometric framework for the elevation of the Kunsthalle (Figs. 15, 16), noting that “a comprehensively applied system of parallel diagonals determines many of the outer and inner corner points of the body of the building and the outline of the facade as well as all openings. . . .”36 This geometric derivation is made very explicit in the finished building by the black lines scored and painted in the white stucco facade. Two further studies demonstrate instances prior to the Dombauhutte of a rotated elevational grid in Behrens’s architecture. Annemarie Jaeggi has reconstructed the geometry underlying the facade of the Arbeiterhaus auf Golzengut (Worker’s House at Golzengut), Pommern, 1910, offering a preliminary pencil drawing sufficient to suggest the schema.37 A more conclusive study is given by Fritz Neumeyer for the Wiegand House in Berlin-Dahlem, 1911.38 His reconstruction demonstrates that facade elements conform closely with intersections of an underlying grid. It is significant that the grid functions as a regulating field, and also that larger figures are traced to establish controlling dimensions, as in the Dombauhutte.

A second geometric reconstruction saw fundamental dimensions of key elements in the Dombauhutte plan bearing a distinct visual resemblance to a hypothetical reconstruction of the geometry underlying the Osirion, the temple dedicated to Osiris, at Abydos in Egypt, unearthed in 1901.39 The reconstruction claims the plan was governed by the golden section. This is doubtful, since it predates Euclid by centuries and it has not been proven that the golden section was used systematically before his time. The question of archaeological truth, however, is irrelevant here, since the concern is not whether ancient Egyptians used the golden section but whether Behrens believed they did. In the late nineteenth and early twentieth centuries, Egyptian art and architecture became the focus of broad aesthetic speculation, particularly for artists and authors associated with the Beuron monastery in southern Germany, with whom Behrens had an enigmatic affiliation.40 In 1898 Peter Desiderius Lenz, co-founder of the monastery, published Zur Asthetik der Beuroner Schule (Concerning the Aesthetic of the Beuron School). In this summary document of his aesthetic principles, he writes that “one must go back a long way to find the element that embodies above all the soul of religious art: typical, yet great in variation, serious, measured and built in harmony. We find it at the beginning of all art, in Egypt.”41 What is immediately striking in the Osirion reconstruction in respect to the Dombauhutte is the graphic correlation of fundamental dimensions. This resemblance was examined by drawing the Dombauhutte plan following the logic of the Osirion plan (Fig. 17), which derives from the golden section progression 1, 1/phi, 1/phi^sup 2^.42 The internal width of the nave was adopted as the base dimension. When superimposed on the Osirion plan, the correlation is remarkably precise, revealing a discrepancy of only 0.61 percent (10 over 1639 centimeters, or 3 7/8 inches over 53 feet 9 1/4 inches). This suggested that Behrens likely had in mind application of the golden section in some manner. It will be demonstrated that he deployed the Fibonacci sequence to achieve a serviceable approximation of the golden section.43 It is necessary to further describe the overall geometric order before articulating how this was achieved. I began the third geometric reconstruction by scrutinizing the plan for a rational dimension. I identified the overall end width of the building as 7.6 meters (24 feet 11 1/4 inches), and constructed a square out of it (Fig. 18).44 The result is that all significant dimensions may be rationalized as twelfths of the original 7.6 m square and simply expressed as the nominator (Fig. 19), then disposed on a grid.

It is worth noting how very little true dimensions matter during the entire design process in each of the reconstructions, a characteristic that evidently contributes to the “scalelessness” of the building. In fact, assignment of a governing dimension could have been one of the concluding acts of design. An unusual circumstance in modern architecture, this is in agreement with medieval practice. Medieval plans were never dimensioned; instead, all measurements were expressed as proportions of the primary measure: the width of the nave. As the nave became broader, the walls would become stronger in direct proportion in order to support the heavier vault above. This logic holds for the Dombauhutte.

The second grid accords with the rotated grid of the first geometric reconstruction in that it could be generated out of it by projecting vertical and horizontal lines through the points of the grid diamonds (Fig. 20). That both the rotated square and primary square geometric reconstructions, which have symbolic meaning, are “generalized” and disposed as a grid is highly provocative. It implies a geometric framework more akin to the rational, instrumental planning of Jean-Louis-Nicolas Durand, which exemplifies the application of number and geometry in architecture as technical instruments,45 than it does to the geometric figures associated with the medieval masons, which were always seen as bearers of transcendental meaning. Yet it is obviously more complex than Durand’s axes and subaxes keyed to circulation, thus demanding to be seen in some sort of larger light. A grid would certainly negate both the medieval Quadratur geometry and the golden section in their pure forms, as irrational numbers make a mockery of all systems developed on multiples of regular increments. The Fibonacci sequence emerges as a locus for reconciliation, making it possible to demonstrate why Behrens’s plan corresponds so closely with the ideal golden section Osirion plan. The ideal sequence 1, 1/phi, 1/ phi^sup 2^ is approximated by the Fibonacci sequence 5:3:2. The ratio of the building’s internal width to internal length provided by the golden section method equals approximately 1:2.61803. The ratio provided by the modules method is 1:2.60. Other relationships conceivably governed by the Fibonacci sequence can be identified (Fig. 21). Where Behrens discovered such an excellent system of approximating dimensions derived from the golden section is uncertain. It bears resemblances to Le Corbusier’s final geometric figure from his book The Modular and his use of the Fibonacci sequence as a serviceable approximation of the golden section.46 As a reconciliation of the incommensurability of the golden ratio with whole numbers, the Fibonacci sequence has tremendous symbolic and practical allure. The ratio of two successive numbers oscillate around phi, becoming increasingly accurate as the sequence progresses. This characteristic of striving toward unattainable perfection is significant. It adopts the human tendency to operate with whole numbers as the point of departure for activity that has the ambition of moving toward something more universal. It is also emblematic of growth, which is a theme developed in a number of ways in the Dombauhutte.

Given the absence of direct documents from Behrens anchoring the elaborate world of correspondences and echoes through geometry, the project of geometric reconstruction is problematic. That several independent configurations explain the fundamental composition of the building, without violating alternatives, produces the impression that he made several separate initiatives. He appears to have aspired to a synthesis of the medieval Quadratur operations, the golden section, and a planning grid, which would have been regarded as a significant accomplishment in a context arguing at once for revival of lost traditions and for a new contemporary architecture. The three geometric propositions can in fact be seen to aspire to be one.

The opening quotation from “Die Dombauhutte” demonstrates Behrens’s conviction that medieval masons possessed rules and regulations they guarded as “strict secrets.” Fritz Schumacher furnishes further anecdotal evidence: “I once sat together with him for a number of hours on a train and eventually realized that he had just come from the Beuron monastery, which was rumored to possess medieval formulas for beauty. He spoke in a secretive manner of a booty about which one must remain silent.”47 Throughout his career, Behrens divulged little about his way of designing. Le Corbusier offered insight into contemporary understanding of the medieval cathedral builders’ maintenance of secrets: “These rules of harmony are complicated, delicate. . . . Speak of them openly? That would be to put them in errors of fact and of understanding; after three generations they would have become grotesque. . . .”48

In contrast to the plan, the elevation of the Dombauhutte, dominated by the chevrons rising from the ground to the apex of the gables, presents a very different proposition. These major diagonals appear to represent light within the dark mass of brickwork. They would likely mark any primary geometry, playing in elevation a role similar to that of the floor tiling in the plan. The angle, however, measures 66 degrees from the horizontal, apparendy completely unrelated to the orthogonal order of the plan. Nonedieless, when the plan and elevation are overlaid, in conjunction with the rotated grid, correspondences emerge. My analysis determined that Behrens set a stretched diamond grid for the elevation by distorting the plan grid vertically by a factor of 9/4 (2.25) (Fig. 22).49 This result can be verified by cross-referencing it with one of Behrens’s dimensioned 1:100 elevation drawings (Fig. 23). Both the drawing dimensions and the units derived geometrically arrive at an angle for the chevrons of 66.0375 degrees.

The act of elongating the elevation can be seen as an application of anamorphosis, referring to a drawing technique showing a distorted image that appears in natural form when viewed from a privileged viewpoint.50 Explanations of anamorphosis as an autonomous technique based on a diorough understanding of the principles of perspectiva artificialis appeared in the early seventeenth century, but primitive or linear anamorphosis was used well before this time.51 In primitive anamorphosis, images are simply deformed along a single axis, having the effect of collapsing or stretching reality by adjusting the relative ratio of vertical and horizontal dimensions. This is the type of distortion encountered in the Dombauhutte. Bearing in mind the overt Christian iconography elsewhere, this act of distortion may be an allusion to excessively elongated Gothic sculpture, of which the biblical figures located around the triple entrance in the west facade of Chartres Cathedral are exemplary. They mediate between divine and earthly realms and are accordingly represented as “stretched” between the two. This suggestion is supported by the fact that Behrens had originally planned to install figural sculptures on the corbels in the interior.

Only once both the plan and anamorphic grids have been discovered can the primary dimensioning of the choir be resolved. In the medieval precedent, the choir is the place of highest symbolic import and the location of most sustained architectural mediation between the one and the many, traced by the vaulting ribs that rise from the periphery to the center. Though the Dombauhutte choir is not polygonal and is devoid of vaulting, one would expect particular care to be taken in its proportioning. It does, indeed, reveal itself as the locus of synthesis. Rotating the end elevation 90 degrees and superimposing it on the plan establishes the depth. The distance from the midpoint of the nave to the far wall of the choir corresponds identically to the overall height of the building (Fig. 24). The width is governed by the intent to key into the diagonals established in the exterior end elevation. Remembering that anamorphosis presumes an undistorted original condition, I compressed the final elevation, which has a vertical ratio of 1:2.25, back to 1:1 (Fig. 25), bringing the chevron angle back to 45 degrees. The second part of the drawing (below) commences with the first Quadratur-like plan geometry reconstruction. The compressed elevation is superimposed such that the chevron bands align with the largest rotated square. The base of the elevation aligns with the inside face of the nave wall to the top of the page. The stretched elevation sits on the inside face of the opposite nave wall. Therefore, the elevation has been “stretched” by the width of the nave. It stabilizes the degree of anamorphosis, reinforcing its status as a controlling dimension in accord with the medieval precedent.

If the compressed elevation is rotated and superimposed on the plan, major dimensions correlate exactly (Fig. 26). The overall height of the elevation is eight modules, which is the distance between buttresses in plan. The final anamorphically distorted elevation is eighteen modules, again a ratio of 1:2.25. The ridge now aligns with the inner face of the entry facade. It is significant that the elevation “grows” from the buttresses, which will later be adduced as the bases of metaphoric trees. Once the degree of distortion is stabilized, it is used with conviction, governing both the structure and ornamentation of the body of the building and of secondary elements such as niches.

In a further representation, the compressed elevation is once more brought into dialogue with the rotated square geometry, but here it is circular arrayed (Fig. 27). Again, the importance of the inside face of the nave walls in all directions is apparent. What also emerges is the prominence of the central square, which is the width of the nave. The sides of the nave square are ten modules long and the walls are one module thick, for a proportion of 1:10. This is exactly the proportion stipulated in all three of the early- sixteenth-century texts known collectively as Werktwisterbucher, which concern the correct planning and execution of church buildings, from the disposition and dimensioning of the building as a whole to the proportioning of details.52 This lends weight to an argument that geometric reconstructions for which the inside face of the nave is determinative are correct. That generation of the plan comes before the elevation concurs with medieval precedent. The elevation was always “drawn out of (ausgezogen) the plan. Similarly, Le Corbusier stipulated that “the plan is the generator.”53

Omission of a vesica piscis in the adduced geometries of the Dombauhutte is perplexing in a context arguing for continuity with medieval practice.54 In fact, there is a complete absence of circles and arcs. The nave square, when rotated through 45 degrees, equals the distance between extremities of the buttresses across the nave. It is possible that Behrens intended these rotated squares to represent a modern vesica piscis. Another reconstruction concerns the long elevation and identifies resonances between the masonry bands in elevation and the rotated squares in plan (Fig. 28). The ridge of the upright elevation is aligned with the inside face of the nave wall, and the inverted elevation has been mirrored along the axis of the nave. The bands trace exactly the rotated squares governing the nave width and the floor mosaics. This confirms the initial supposition that the bands play in elevation the same role of “light” within a dark field that the mosaics play in plan.

Drafting the facade at the outset in the nondistorted form would have been of great practical benefit. The elevation could have been drawn over the plan with a standard 45-degree set square, distinguishing and selecting relations and resonances in plan and elevation. Once the elevation was complete, all dimensions could have been multiplied by 2.25 or else plotted on a distorted grid. The resulting anamorphically distorted elevation masks and sublimates the original accord between plan and elevation. The most interesting aspect of the anamorphic operation is that it is a mixture of the arbitrary and the consistent. On the side of the arbitrary, one could take the point of a polygon and, imagining the sides to be elastic, push the point around at will before fixing it in place. On the side of consistency, there is the memory of the original figure, which is still present in the anamorphically distorted form in some way. The stretched geometry has a vulnerable, human quality. It represents continuity of shape and identity along the lines of extension, and as such becomes a metaphor for analogy. It only alludes to the universality of pure geometric transformation, such as we have seen in the Quadratur. Behrens has produced a purely geometric construction in plan, then a second- order manipulation that acts as a bridge between pure geometry and building.

Linked to the geometry, a major horizon is established in the building that marks the division between the realm of the earthly observer looking at objects and that of symbolic heavenly light (Fig. 29). It is established at the height of one stretched diamond of the elevational grid from the ground (Fig. 22). A number of elements demarcate this horizon: buttresses meet the wall, ornament folds around the edges of the building, and the entry door soffit and windowsills align. Below the horizon one finds artifacts of art: transformations of material through craft into metaphor and symbol. They are disposed like islands of an archipelago, blurring museum and Christian worship. The window-corbel-window-corbel rhythm further amplifies and animates the horizon, as earth and light are alternately asserted. The crucifix is the major element that rises above the horizon,55 appropriate for Christ’s mediating role between the God-given remoteness of ultimate reality and human history.

Behrens further endeavored to synthesize two apparently irreconcilable ambitions, that of a return to origins and a continuation of tradition. One of the ways he does this is by deploying cloth symbolism:

The appeal of the masonry wall is effected by the careful work of the bricklayer. … In order that the wall becomes a surface invested with life, it requires not only the plumb bob and right angle, rather also the understanding and sensibility of the bricklayer, who can elevate the characteristics of our brickwork, insofar as he mixes it to its advantage, setting dark against light, creating small shadows through setting forward or recessing the masonry, and in this way lends the wall the character of a textile.56

A notion that enjoyed broad acceptance in nineteenth- and early- twentieth-century German art history placed the origin of ornament in the textile art of weaving. Gottfried Semper first sought to trace linear ornamentation back to textile techniques as part of his thesis that clothing or cladding was the original architectural act.57 By appropriating this reading of the weaving of textile as the very first artistic act, Behrens could situate himself at the wellspring of human endeavor and conform to his expressed aspirations for cultural renewal out of handicraft. Further, the Dombauhutte served an exhibition of applied arts, for which weaving is emblematic. Treatment of the walls as a textile is best observed in a drawing at 1:50 comprising a partial elevation and a wall section (Fig. 30). Dimensioning of the brickwork is deliberate and thorough. Short equations at the top left-hand side of the page calculate the number of bricks per meter height of wall and the sizes of mortar joints. The width of each chevron is composed of six “strands” of brick. The two outer strands are header bricks and the internal strands are stretcher. A chevron thereby appears as a ribbon “gathered” along its edges. Three simple, local plans illustrate small steps in depth providing the impression of the facade having been “woven” in a single plane but from different- gauge yarns more tightly or loosely knit. The facade, in fact, credibly appears as a translation of textile into architecture.

The second cloth symbolism motif is that of the biblical Tabernacle, whose purpose and fabrication are narrated in Exodus 25- 40. The tent symbolism is very clear, especially in the end elevation as drawn. The dominant characteristic of orthogonal geometry is to telescope perspectival depth, presenting in a single plane elements that in reality are closer or further away from the viewer. The end elevation is dominated by a triangle whose sides appear to stretch from the ground to the top of the gables, resembling a tent (Fig. 31). The elements that comprise this triangle-the chevrons of the end elevation and the buttresses close to the middle of the long facade-are, however, in reality considerably separated spatially. The form of the building as experienced is rectilinear, whereas its ideal presentation in drawings is, rather, triangular. This would suggest sublimation of the Tabernacle. The translation of the Tabernacle into masonry further strengthens the earlier assertion of the Temple of Solomon as a motif.

With the primary architectural motifs identified, secondary motifs may be provisionally ascertained. Some are circumstantial, arising from Behrens’s immediate circumstances. It is plausible that the articulation of the east elevation was prompted by Koloman Moser’s 1903 Wiener Werkstatte monogram. The graphic correlation is striking (Fig. 32). Commencing his working life as a graphic designer, Behrens was receptive to the medium as a resource. He combined explicitly graphic elements into the architecture of the Oldenburg Kunstausstettung, as we have seen. Further, it could be a small tribute both to Vienna, where he had recently relocated to become Otto Wagner’s successor as professor at the Meisterschule fur Architektur an der Wiener Akademie, and to the Wiener Werkstatte, which had great affinity with the Deutscher Werkbund. The rhomboid grid and the chevrons imply diamonds. The diamond, a Nietzschean motif Behrens regularly deployed in both his architecture and graphic work, is a regular feature elsewhere in Expressionism.58 It symbolizes the virtues of structural integrity, material unity, and original geometry. Formed by the powers of the earth, it also recalls the alchemical idea of the transmutation of base matter into a noble material. Light is important in the crystal motif, typically appearing as radiant beams in Expressionist drawings, such as those produced by architects associated with the Glaserne Kette (crystal chain) initiated by Bruno Taut. The polychromatic aspects of the Dombauhutte as well as the recollection of medieval themes of light and ontology through geometry indicate that Behrens was consciously operating with the crystal motif.

The connection with Friedrich Nietzsche may signal his appeal to Behrens as one who insisted on the thematic of making as a fundamental dimension of creativity, and creativity as a fundamental mark of being human. A discussion on the themes of materiality and construction is central to gaining a proper understanding of the architectural nature of the Dombauhtte as embodied. Masonry is the leitmotif. It contains an overwhelming chthonic component that effaces the technological apparatus surrounding the fabrication of steel buildings, which had previously so interested Behrens. He wrote that “the opportunity appeared to be presented to us by this building [the Dombauhatte], for once to create the opposite of industrial and machine-driven work.”59 The ground is granted a specific value for orientation, stability, and beginnings, divided between the radically unknown site as a whole and, secondly, a stylobate (Fig. 29). The stylobate, the plane of geometric construction, is an assertion of purified earth: a small acropolis elevating the building out of the landscape. Significantly, its perimeter violates all geometries, affirming its status as a stage between metamorphic earth and sophisticated form. All ground outside the 12-centimeter (4%-inch) stylobate is contingent, subject to history, unknown, and imperfect. The canted buttresses project beyond, lending the whole the impression of having emerged from the ground. Seen against the heavily wooded background, the building recalls the Expressionist paintings of artists associated with Die Brucke. August Wiedmann found that the nature depicted in their work is “not yet disfigured by the ‘ravages’ of civilization, the deformities of a technological culture… . Firmly rooted in the earth, these figures grow out of it to fuse with the surrounding.. . .”60

An unusual clay model of the Dombauhutte further amplifies the chthonic component (Fig. 33) .61 Produced at an intermediate stage of design,62 it embodies a direct transformation from raw earth to sophisticated form, accomplished by the guiding hand of the artist whose fingerprints remain on the work. It is a solid mass, with openings recessed into the body of the building. The masonry is exactly identified and precisely combed in place. The exception is a wild sculpture surrounding the entry, possibly alluding to the amorphous subterranean world of a grotto. Closer inspection reveals this sculpture to be approximately symmetrical, implying draped fabric drawn away for entry, further strengthening the Tabernacle motif.

A couple of instances serve to illustrate Behrens’s display of virtuosity through the masonry. Drawings specify in such great detail the sizing and construction methods to be employed that the mason required only manual rather than intellectual dexterity, nullifying to some extent the architect’s claims for the skill of the mason. A drawing that works out the intersection of the attached piers with the buttresses calculates every special brick to be cast or cut, at a scale of 1:10 (Fig. 34). Another strategy concerning the brickwork deliberately contributed to the ambiguous scale of the building, which appears at once diminutive and monumental.63 Behrens used squat bricks (in the Oldenburger format of 22 by 10.5 by 5.2 centimeters or 8 5/8 by 4 1/8 by 2 inches), amplifying the apparent vertical dimension of the building, while the header-bond jambs of the entry door provide an illusion of greater thickness. The ambiguity of scale is also in part the result of the building’s representation in exterior photographs, none of which contain people and which are taken from approximately the same vantage point. This manipulation embodies the conflation of cathedral and Bauhutte, which is also implied in the name Dombauhutte. The relation is no longer associative or dialectical, as it was in the original medieval situation; rather, an architectural synthesis is sought.

The bricks themselves were a type called Bockhorner Ringofenklinker, produced in the 1920s by the Vereinigte Oldenburger Klinkerwerke in a color spectrum from red and blue through to deep brown-black. As only black-and-white photographs of the Dombauhhutte exist, it is impossible to confirm the actual colors employed. It is tempting to infer the color range from the Hochst AG Technical Administration Building, although it is unlikely that he employed the same violent polychromy that represented this building’s function as a dye works. The color range probably related more to the modestly modulated deep browns of Fritz Hoeger’s Hamburg Chilehaus (1922-24), which, according to the firm producing the bricks, is a very good example of Bockhorner Ringofenklinker contemporary with the Dombauhutte.64 What we can deduce is that changes in the color or tone of bricks carefully articulate the facade as a patterned tapestry. The ultimate authority regarding masonry, for both the Dombauhutte and the Chilehaus, are the Backsteingotik brick cathedrals of northern Germany, which often served as inspiration for Gothic Revival works in that country.

There are a number of ways in which Behrens explored and expressed the latent representational qualities inherent in masonry construction. Contrary bonding patterns are made to adjoin, bricks are cut and set at angles, and projections and niches enliven the facade and interior. The chevrons are set in what can best be described as a canted stack bond. Laid horizontally, they are structurally keyed into the main stretcher bond wall, while remaining visually independent. The chevrons are further accentuated by a different tone of mortar and project marginally forward such that a shadow line is cast. There is a great deal of sophistication in the way that window and door soffits are formed. They are actually flat gauged arches that would have required centering over which the voussoir bricks were bedded. In a temporary modern building, it would have been customary to form the soffits by soldier courses supported on a hidden steel lintel. On the interior, the chancel arch bricks are laid at an angle perpendicular to the perimeter of the “arch,” following the visual line of thrust and approximating the setting of voussoirs in a Gothic vault.

The material other than masonry extensively employed with a representative function is timber. Here Behrens changed tack. The practical dexterity of the mason is replaced by the rustic efficiency of the roof builder. There is nothing sophisticated about the timberwork (either in representation or detail); the emphasis is on direct expression. Joints are solved in a straightforward manner rather than discreetly hidden. Significantly, all timberwork was carried out by the firm of Adolf Sommerfeld, a Berlin sawmill owner and contractor who was the most important patron of the Bauhaus in the postwar years. He was the client for the Sommerfeld residence (Berlin, 1920-21), designed by Walter Gropius and Adolf Meyer (Fig. 35) .65 Constructed just prior to the Dombauhutte, the house evidences similar ambitions: it was heavily and ostentatiously crafted from solid timber and was very much a collective enterprise.66

The Dombauhutte’s roof work is exposed internally, giving the appearance of the construction above the vaulting of a medieval chapel, introducing a motif of incompleteness (Fig. 9). This motif is reinforced by the inverted half pyramids toward the extremities of the facades supporting the “gargoyles,” which can be read as vestigial buttresses. They also express structural honesty in that their corbels support the reduced load of the outermost, attenuated bays. At the same time, Behrens conflated the typical vault-roof elements of a Gothic chapel, in which the stone vault ribs and the timberwork supporting the roof were entirely independent.67 The absence of a fully articulated vault and the prominence of the timberwork remove some of the chapel iconography and assert the Bauhutte.

Via the buttresses, the roof reaches outside the perimeter of the building, converting the buttress-roof trusses into metaphoric trees, reaching beyond the pure confines of the stylobate to recover “nature” as a metaphor. In a quarter bay of the Dombauhutte, centered on a buttress, a rigorous structural logic is apparent (Fig. 36). The loads carried by rafters are canceled at a “branch,” passing to a corbel and down through the buttress to the deep ground. The tree metaphor is further amplified as the roof-canopy “peels away” from the rafters approximately halfway down from the ridge to the exterior walls, introducing light into the branches.

There is an analogical dialogue between Ludwig Gies’s raw Expressionist timber sculpture of Christ on the cross, Kruzifixus, high in the roof space, and the rudimentary roof construction. A striking visual correspondence can be seen between the acute angle produced by Christ’s arms with the horizontal member of the cross on which he is nailed and the way the splayed rafters lean out from the wall (Fig. 2). Rotated through 90 degrees, the angles are almost identical. Further, Behrens indicated that the members of the roof work were to be “pinned together,” recalling Christ’s hands nailed to the cross (Fig. 37). Though Christ’s body slumping in death and the strong rafters confirming the vitality of the building appear contrary, they can be seen as extremities of a death-rebirth cycle, as the wooden cross has always symbolized resurrection. Further, the accord between sculpture and building asks that one consider the production of “art” (sculpture) and “craft” (roof structure) together, promoting the effectiveness of the former and elevating the cultural status of the latter. The interior is dimly lit by three narrow stained-glass windows on either side of the nave, and the rafters recede into the darkness of the roof space inhabited by Gies’s Christ. There is no evidence of electric light, and Redslob speaks of the “rafters blackened by candles.”68 This peculiar condition warrants particular mention, considering Behrens’s pioneering industrial design work with the AEG (General Electricity Company), including the design of electric lights.69 Such negative gestures demonstrate a primitivism that is the product of a sophisticated urban culture. The general darkness of the body of the building directs orientation toward the choir, which, in contrast to the exposed-brick walls, is smoothly rendered white. Skylights invisible from the nave illuminate it from above. Luminous and scaleless, the color and materiality of the apse partake of the celestial while the remainder of the building is most emphatically rooted in the chthonic.

The appeal to the dignity of medieval handicraft has a long history in modernity, from the Arts and Crafts movement, through to associations such as the Wiener Werkstatte and the Deutscher Werkbund.70 Though each association had distinct interests and aspirations, they generally shared a belief that craft embodies a residually common world of a culture under threat from industrialization. Craft was the locus of aspirations for creative salvation, tied to the desire to overcome the modern division of art and technology. This is the background to Behrens’s statement at the opening of the Dombauhiitte that it is his “dearest wish no longer to speak of art, rather, that we, those of us who concern ourselves with the field, had the right to call ourselves craftsmen.”71

As critical as Behrens is of the self-sufficient technology of the engineer operating autonomously from a background culture, he is equally scathing of the autonomy of the fine arts, though he confusingly hopes to sublimate the former into the latter: “Technology cannot continually be employed as its own independent means to an end, it only attains worth and meaning when it is recognized as an important means to culture. A ripe culture is only recognizable through its art.”72 In Behrens’s vocabulary, KuUw is the highest good: “And if the ideal that I have announced to you is achieved .. . then we will have a master-student relationship like that of the middle ages. And that will mean nothing less than that we have again achieved a culture.”73

Another concept related to the hope of recovering cultural continuity, as constituted in the visual domain, is the notion of a Gesamtkunstwerk.7* Clearly present in the Dombauhutte, this concept arises frequently in Behrens’s oeuvre, dating from the Darmstadt artists’ colony. Whereas the theater, following Richard Wagner, was the locus for synthesis of the arts at Darmstadt, by the time of the Dombauhutte, Behrens had adopted a much more physicalist approach, reminiscent of the sentiments expressed by Goethe in VOn deutscher Baukunst, where he identified Strasbourg Cathedral as a hewn artifact and where he found the Gothic to be emblematic of complete aesthetic unity. Scheffler wrote in 1917 that “the Gothic knows only the Gesamtkunstwerk; she is a mother-art and for exactly this reason an art of the people in the highest sense.”75 Behrens was very concerned that the works presented in the Dombauhutte “belong” to the architecture:

It doesn’t want to be regarded as an “exhibition object,” in the usual sense of the term. It is not to be a gathering and arranging of available objects in a location that temporarily provides a favorable framework for external presentation; rather, we were guided in our work by the idea of creating something genuine and lasting.76

The Dombauhutte was indeed an emphatically collective effort. The original exhibition catalog lists thirty-three individual artists and craftsmen as having contributed to either the architecture or furnishings.77 Though the artifacts were completed in isolation by a diverse range of artists from across Germany, they all exhibit primitive religiosity, and the whole is lent coherence by an Expressionist conviction that had by this time taken on distinctive formal qualities. They are also securely received by the architecture. One sectional drawing in the Berlin Kunstbibliothek folio is entirely dedicated to locating exhibits. As early as 1905, Meier-Graefe noted that, in general, for Behrens “the position where the ornament sits is disproportionally more important than the nature of the ornament itself. Not the ornamental lines, rather the relationships that determine the dimensions are decisive.”79

The three large, axially arrayed, mandalalike mosaics clearly reference the labyrinths of medieval cathedrals (Fig. 2). They are securely keyed in to the primary architectural order, situated directly below the nave-bay crossings. The floor tiling outside the mandalas is also carefully articulated. The dark floor tiles of the nave extend the diamonds beyond the geometry of the grid, expanding out in eddies toward the walls. The tiling of the choir, elevated three steps above the nave, is of a different order. It is composed of large white tiles with heavy black borders, set orthogonally (Fi

Flatboat, Young ‘Abe’ Start River Trip

By RICH DAVIS Courier & Press staff writer 464-7516 or [email protected]

A 60-foot replica of an early 19th century flatboat takes off from Rockport, Ind., today, retracing a trip Abraham Lincoln took in 1828 when he was taking a load of produce to New Orleans for a local merchant.

This time, the flatboat will be carrying heritage: the people of Spencer County, Ind., where Lincoln lived from ages 7 to 21, will share their story with folks in roughly 20 towns in eight states along the way. They’ll even have a man onboard portraying Young Abe.

The public is invited to attend the send-off for “Lincoln’s Journey of Remembrance,” starting at 11 a.m. on the Ohio River bluff in Rockport. The keynote speaker will be State Treasurer Richard Mourdock.

The 50,000-pound flatboat, owned by Ron Drake, a Washington, D.C., attorney with Hoosier roots, will stop in English Park in Owensboro, Ky., at 2 p.m., with Indiana first lady Cheri Daniels aboard.

Also participating in the first leg will be several members of the original Rockport Jaycees crew who built a simpler Lincoln flatboat in 1958 and floated it to New Orleans.

The flatboat then travels downriver to Evansville, where it will be on display at Dress Plaza from 11:30 a.m. to 8 p.m. Wednesday and again Thursday until 1 p.m.

The public can view the flatboat and learn about the trip, and activity book

lets will be available for children. The Chamber of Commerce of Southwestern Indiana also is hosting a luncheon at 11 a.m. Thursday at the Riverfront.

The boat will stop in Henderson, Ky., Thursday afternoon and be in Mount Vernon, Ind., at noon Friday to kick off that city’s two- day River Days Festival.

The 2008 journey is far more sophisticated than the 1958 trip, said Melissa Miller of the Spencer County Visitors Bureau. A manufacturer has donated high-speed engines (discreetly placed), and Toyota is providing a 2008 Sequoia to serve as a support vehicle on land. There’s a certified river pilot aboard, along with the boat’s builder, John Cooper of Tennessee.

There will be a daily blog at www.LincolnsJourney.org for online fans.

Helping compose the blog will be Casey McCoy, a journalism major at the University of Southern Indiana. He’s serving as an intern, but since he’s 6-foot-4 (and shares Lincoln’s Feb. 12 birthday) organizers plan to let him portray the young Lincoln.

Miller estimated the total cost of the project at more than $100,000, including the SUV and outboard engines. She said Drake has offered to pay for the boat’s expenses, and the Indiana Abraham Lincoln Bicentennial Commission is providing $30,000 for educational and promotional materials. The latter includes an information tent for a portable exhibit, media kits, newspaper ads and the activity booklets for kids.

“It’s going to be a month of excitement,” predicted Miller.

TRI-STATE STOPS

n Owensboro, Ky., 2 p.m. today at English Park

n Evansville, 11 a.m. to 8 p.m. Wednesday, Thursday until 1 p.m. at Dress Plaza

n Henderson, Ky., 3 p.m. Thursday at the Second Street boat ramp. Author H. Donald Winkler, who wrote “Lincoln’s Ladies: The Women in the Life of the Sixteenth President,” will be at Henderson’s riverfront visitor center from 1 to 3 p.m. for a lecture and book signing.

n Mount Vernon, Ind., noon Friday through Saturday morning. This kicks off the town’s inaugural River Days Festival featuring music, food booths, a Mr. and Mrs. Lincoln Look-A-Like Contest and a booth selling the book “Judge Lynch.”

n Cave in Rock, Ill., 2 p.m. Saturday at the Cave-in-Rock State Park, departing at 4 p.m.

n Elizabethtown, Ill., 5:30 p.m. Saturday, with a barbecue on the lawn of the Rose Hotel.

n Paducah, Ky., 3 p.m. Monday

n Metropolis, Ill., 1 p.m. Sept. 16 at Fort Massac State Park.

(c) 2008 Evansville Courier & Press. Provided by ProQuest LLC. All rights Reserved.

Man Hit By Train in Prairie Du Chien

PRAIRIE DU CHIEN, Wis. – A 22-year-old Fargo, N.D., man was in good condition at a La Crosse hospital Wednesday afternoon following a train-pedestrian collision late Tuesday night.

Ahmed Said Haji was taken to Prairie du Chien Memorial Hospital and later transferred to Gunderson Lutheran Hospital in

La Crosse for the treatment of what EMS personnel initially termed suspected extremely serious internal injuries.

Prairie du Chien police responded at 11:47 p.m. to a report of an unresponsive adult male lying on the train tracks at the Iowa- Illinois Street Burlington Northern Santa Fe grade crossing.

Police said Haji was attempting to illegally board a northbound BNSF freight train when he was injured.

The investigation continues.

(c) 2008 Telegraph – Herald (Dubuque). Provided by ProQuest LLC. All rights Reserved.

Woman is Airlifted to Hospital

An elderly woman was taken to hospital by air ambulance after a road collision involving a postal van yesterday.

The 77-year-old, who was driving a Mini, suffered spinal injuries in a collision at Park Drain crossroads, on Doncaster Road, Westwoodside.

The Nottinghamshire and Lincolnshire Air Ambulance transported her to Scunthorpe General Hospital.

Another woman in the Mini developed chest pains chest pains and was taken to hospital by ambulance, according to East Midlands Ambulance Service.

The male driver of a Royal Mail van involved in the crash was not injured.

A Royal Mail spokesman said: “We are helping the police with their inquiries into this road traffic accident.”

For the full story, buy today’s Scunthorpe Telegraph.

(c) 2008 Scunthorpe Evening Telegraph. Provided by ProQuest LLC. All rights Reserved.

Welborn Clinic the Issue

In name, one of the Tri-State’s finest old institutions is passing on. It was announced last week that Deaconess Health System is purchasing the majority of assets of the doctor-owned Welborn Clinic, and the network of clinics will soon become know as Deaconess Clinic.

It is no small merger. It was reported Monday that 45 of Welborn Clinic’s 57 doctors will be employed at Deaconess Clinic. In all, the expanded organization will have more than 80 physicians and more than 500 employees.

The merger is the latest step in the evolution of health care in Evansville, spurred on by the competition between hospitals and health care groups that was so fierce in the 1990s and included the closing of one hospital. Not too many years ago, Evansville had three hospitals, Deaconess, St. Mary’s Medical Center and Welborn Baptist Hospital, and residents swore by their trusted favorites.

But in 1999, it became advantage to St. Mary’s when the East Side hospital purchased Welborn Baptist Hospital, located in the Downtown area, and, over the ensuing years, shut it down.

It was a controversial move, criticized by those who said that near-Downtown residents were being denied close-by medical care, especially emergency care. On the positive side, and as a result of the sale, the Welborn Baptist Foundation was created and has been a boon to the area. Last November, the foundation gave out $4.4 million in grants to Tri-State nonprofit groups.

The competition then narrowed to the two remaining hospital groups, Deaconess and St. Mary’s, with much focus on luring better- off East Side, Warrick County patients, and with the remarkable development of medical facilities on the Warrick/Vanderburgh County line.

All the while this was going on, Welborn Clinic remained as it had been for decades, an independent, physician-owned medical clinic that happened to share the same name as Welborn Baptist Hospital, as well as proximity in the Downtown.

While a lot of people thought they had the same owner, they were separate medical businesses. That’s why the clinic was not a part of the hospital sale to St. Mary’s.

According to the clinic’s own history, available on the Internet, its roots trace back to 1894, when a group of physicians founded the Evansville Sanitarium, which was later named Walker Hospital. There, the doctors rented office space. Then, in 1947, the physicians reorganized and drew up plans for a facility of their own in Downtown Evansville. Welborn Clinic’s first building, a one-story structure, was completed in late 1951. Today, it has satellite facilities throughout the Evansville area and Southern Indiana.

The thing about Welborn Clinic is that thousands of individuals and families have gone there for their medical care since the 1950s. They have built up a trust in the doctors, nurses and staff there, so it is not so easy to make the transition, even if it is mainly in name. Most, but not all, of the physicians and staff from Welborn will still be there when the switch is made in October.

Five years ago, the clinic prepared a report which said that its eight locations were providing medical care to nearly 25 percent of the local population. That included 44 percent of Vanderburgh residents age 65 and older. When you combine Welborn Clinic physicians with the Deaconess physicians, it becomes an impressive group.

As for the hospital wars, this advantage goes to Deaconess as it takes Welborn Clinic under its umbrella of care.

While some among us are disappointed to see the Welborn name headed into history, we recognize that Evansville is fortunate to have outstanding medical care centered around St. Mary’s and Deaconess.

That is something that should not be affected by this latest development.

(c) 2008 Evansville Courier & Press. Provided by ProQuest LLC. All rights Reserved.

Novel Compound Shows Promise for Treatment of Alcoholism

BIRMINGHAM, Ala., Sept. 11 /PRNewswire-USNewswire/ — Southern Research Institute and Gallo Research Center today announced that peer-reviewed results from a study testing Naltrexone-derived pyridomorphinan (SoRI-9409) will be published in the December 2008 issue of the journal Biological Psychiatry. The publication is available online today at the journal’s website, and suggests that a new compound that causes selective and long-lasting reduction in ethanol consumption might be a promising candidate as a novel treatment for alcoholism.

The article, “A Novel Delta Opioid Receptor Antagonist, SoRI-9409, Produces a Selective and Long-Lasting Decrease in Ethanol Consumption in Heavy-Drinking Rats” by Selena Bartlett, BPharm PhD, Director of Preclinical Development Group at the Gallo Research Center at University of California San Francisco, et al presents the effects of SoRI-9409 on ethanol consumption. These are promising developments for the treatment of alcoholism. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimates 15.1 million people are alcohol-abusing or alcohol-dependent individuals. There are currently only three FDA-approved options for the treatment of alcoholism.

The compound, SoRI-9409, was first designed and synthesized in Southern Research’s Drug Discovery research division by Dr. Subramaniam (Sam) Ananthan under U.S. Government Grant DA008883. “Southern Research has been particularly interested in ligands that interact with opioid delta receptor subtype since such ligands hold promise as therapeutic agents for treatment of drug addictions and other disorders,” said Dr. Ananthan, senior scientist and manager of Computational Chemistry and CNS Discovery Chemistry at Southern Research Institute. “The present findings by Dr. Bartlett and her group on the effect of SoRI-9409 on its ability to reduce alcohol intake not only provides us with a new drug lead, but also serves as the impetus for further research aimed at discovery of new therapeutic compounds for treating alcoholism and related disorders.”

The Preclinical Development Group that Dr. Bartlett leads at the UCSF-affiliated Gallo Center was established to develop new treatments and bridge the gap between research and clinical treatment. The purpose of the study was to find improved compounds for the treatment of alcoholism. “The study results demonstrate that this compound causes selective and long-lasting reductions of ethanol consumption and suggests the compound might be a promising candidate as a novel treatment for alcoholism. This study indicates that compounds with a higher affinity for delta opioid receptors and reduced affinity for mu opioid receptors might be better treatment candidates than Naltrexone, the current FDA approved treatment for alcoholism”, said Dr. Bartlett.

“The study on SoRI-9409 and alcohol cessation has yielded vital data that will help fuel novel treatments for a devastating and very difficult-to-treat illness,” said Dr. Bartlett. “To date, we have considered and evaluated other compounds, and theories, but the information yielded from this study, along with previous research on this particular compound, has proven to be the most promising to date. We are looking forward to collaborating with our partner, Southern Research, to enter the next phase of research.” The research was also supported by the State of California for Medical Research on Alcohol and Substance Abuse and Department of Defense.

Southern Research operates a successful drug discovery research program resulting in six FDA approved drugs with six additional drug candidates in late-stage preclinical and early clinical development.

“Much of our success stems from having a highly successful medicinal chemistry group, and seeking out collaborators who are driven to help us develop new lead compounds and bring those drugs to market,” said David Harris, director of Business Development for the Drug Discovery Division at Southern Research. “We’re happy to be working with Gallo on this promising new drug to treat alcohol addiction. It is another example of Southern Research’s commitment to finding therapies for some of our society’s most challenging diseases.”

First author on the paper is Carsten Nielsen, PhD, a postdoctoral scientist working with Bartlett. Co-authors are Jeffrey A. Simms, Haley B. Pierson, Rui Li at the Gallo Clinic and Research Center and Surendra K. Saini and Subramaniam (Sam) Ananthan at Southern Research Institute.

About Southern Research Institute

Southern Research Institute is a not-for-profit organization that conducts basic and applied research in the areas of preclinical drug discovery, vaccine and drug development, advanced engineering, environmental research and energy production. To date, Southern Research has discovered six FDA-approved cancer drugs and discovered six additional drugs that are currently in late stage preclinical and early clinical trials. No other company or institution has brought six of its own cancer drug discoveries to market. For more information, please visit http://www.southernresearch.org/.

About the Gallo Research Center

The Ernest Gallo Clinic and Research Center (Gallo Center) is one of the world’s preeminent academic centers for the study of the biological basis of alcohol and substance abuse. Gallo Center discoveries of potential molecular targets for the development of therapeutic medications are extended through preclinical and proof-of-concept clinical studies. The Center is part of the UCSF Department of Neurology. UCSF is a leading university that advances health worldwide by conducting advanced biomedical research, educating graduate students in the life sciences and health professions, and providing complex patient care. For more information, please visit http://www.galloresearch.org/ and http://www.ucsf.edu/.

   Rhonda Jung, 205-337-9634   Southern Research Institute   [email protected]    Amanda Lazaro, 781-684-0770   Schwartz Communications, Inc.   [email protected]    Kristen Bole, 415-476-2557   University of California, San Francisco   [email protected]  

Southern Research Institute

CONTACT: Rhonda Jung of the Southern Research Institute,+1-205-337-9634, [email protected], Amanda Lazaro of SchwartzCommunications, Inc., +1-781-684-0770, [email protected] or KristenBole of the University of California, San Francisco, +1-415-476-2557,[email protected]

Web Site: http://www.galloresearch.org/

Direct Flow Medical Appoints Paul LaViolette to Board of Directors

Direct Flow Medical, Inc., (www.directflowmedical.com) a privately held, medical device company developing a next generation, minimally invasive implant to treat patients with heart valve disease, announced today the appointment of Mr. Paul A. LaViolette to serve on the Company’s Board of Directors.

The Company has developed a catheter-based system to replace the aortic valve percutaneously in patients with valvular disease. The investigational device is an implantable, non-metallic pericardial tissue valve that allows delivery via a transfemoral approach. The product’s added features allowing positioning (or repositioning) and retrieval features are intended to enable physicians to correctly size and place the device in its targeted location providing a new level of safety for the patient.

“We are extremely excited and honored to welcome Paul to the Company’s Board. Paul brings not only tremendous operating experience in interventional medicine to Direct Flow Medical, but vast relationships with key physicians in the field of interventional cardiology and minimally invasive surgery. Having worked with Paul in the past, I know he will significantly lift our developmental and clinical efforts and help us move forward toward regulatory approval and commercialization of our technology,” stated Bernard Lyons, President and CEO of Direct Flow Medical, Inc.

“I am very impressed with the unique product design, experienced team assembled, strong financial position and potential of Direct Flow Medical. Their ability to improve upon the early results of the first generation devices is quite evident in their progress to date. I look forward to joining the Board and helping Direct Flow compete successfully in this rapidly emerging marketplace,” said Mr. LaViolette.

Mr. LaViolette is a Senior Advisor at Boston Scientific Corporation where he has been employed for 15 years. Since 2004, he was Chief Operating Officer where he had global responsibilities for all business units except Cardiac Rhythm Management. He was previously Group President of the Cardiovascular and Interventional Cardiology for a period of over 6 years. Prior to joining Boston Scientific Corporation, he spent 10 years with C.R. Bard, his last position being the President of the Cardiology Division.

About Direct Flow Medical, Inc.

Direct Flow Medical was founded in 2004 by Gordon Bishop and Randy Lashinski. The Company is headquartered in Santa Rosa, California and currently employs over 50 people. Direct Flow Medical has raised $35 million in 2 rounds of private equity financing from EDF Ventures, Spray Venture Partners, New Leaf Venture Partners, Johnson & Johnson Development Corporation, Foundation Medical Partners, Vantage Point Partners and ePlanet Ventures.

Helping Choose the Right Doctor for You ; Vitals.Com CEO Found Inspiration in the OR

By JOAN VERDON, STAFF WRITER

How many chief executives can say they were inspired to start a business while lying on the operating table? That’s how Vitals.com was born, but we’ll let Mitchel Rothschild tell you about it.

Rothschild is CEO of MDx Medical in Lyndhurst, the parent company behind Vitals.com, a Web site that provides consumers with information on 720,000 doctors. The site, introduced in January, contains information about medical training, board certifications, publications and malpractice cases. It also lets consumers post comments about doctors. Vitals.com has a staff of 14 and revenue “in the seven figures” that’s as specific as Rothschild will get. (Interview condensed and edited for space.)

Q. How would you describe Vitals.com?

We view ourselves as a matching site, like eHarmony or Match.com. Our job is to match patients with the doctor that is right for them. Right for them means the right type of doctor, at the right distance, within the right insurance, with the characteristics they choose. Some people are snobs about education, other people want to have good hospital affiliations. Some care about language, some care about good bedside manner. Some want doctors that are very experienced, others want doctors that are less experienced but are more cutting edge.

Q. How did you get all this information?

We spent a year and a half compiling it, from literally tens of thousands of sources. We took a Google-esque approach we went out on the Web and found hospital information, medical-school information, association information, practice information. We went to every state and federal organization that licenses doctors. We’re up to 1.4 billion pieces of information about doctors.

Q. I hear you have an interesting story that inspired all this.

Yes. I am a weekend warrior who is totally not convinced that I’m the age I really am.

Q. Which is?

Fifty-three, according to the government, 23 according to my own measure. So I tore my Achilles [tendon] in a basketball game. I went to the doctor, and literally on the operating table, he said, “Well, I’m pretty excited about this operation. I don’t get to do that many of these in a year.” I wasn’t going to turn back at the time, but that was obviously information I felt I should have known at the time. It is amazing when you talk to people how little information they have about what are arguably the most important decisions they’re going to make in their life.

Q. Did you leave the hospital and right away start working on the Web site?

My background is as a marketing and database guy, and I couldn’t believe that in such a finite set there’s only 720,000 practicing doctors in this country that you couldn’t get detailed information about them. Talk to most people, they need a doctor, they’re going to open their provider directory, they’re going to go to Dr. Aardvark, because he’s the first on the list. That’s not the way to pick your medical care.

Q. There must be other Web sites that do the same thing as Vitals.

There are a couple of others. Our main competitor charges $30 for a report.

Q. How many hits do you get?

The day after Labor Day, we got 50,000 hits. We’re close to about a million a month.

Q. Can a doctor come to you and say, “I don’t want you putting on the Web site that I went to Podunk University. I don’t want people to know where I went to medical school”?

Doctors can edit their profile, and we have people here who deal primarily with doctor issues. Having said that, there are two basic elements to the site. One is a directory of every doctor, and the other is we help you find a doctor. Doctors can choose to extract themselves from the finding element they can say, “I don’t want any new patients.” However, if somebody wants to check up on a doctor, we’ll have them in the database. Some facts a doctor cannot edit. If a doctor went to Guadalajara, they can’t write that they went to Harvard.

Q. But can they take off Guadalajara?

No. They can take off a particular hospital that they’re no longer affiliated with. They can take off procedures they no longer do. They can take off areas of expertise.

Q. Are you making any revenue yet?

Yes. Absolutely.

Q. How much?

We’re two years old, and we’re a seven-figure revenue company and growing pretty nicely. Our business is a combination of established revenue streams, such as advertising and publishing, and newer-wave stuff like online appointment setting. One of the big initiatives we have is to be the intel inside for a lot of other sites – to be their doctor finder.

Q. Are you someone who goes to a lot of doctors? Thinks about this a lot?

I’m not a cyber-chondriac.

Q. That is a problem – people go online and scare themselves with what they find.

I do believe that one of the big weaknesses of our society is that preventive medicine is way underutilized.

Q. What about alternative medicine? Could I search for a naturopath or acupressurist?

We are now mapping five new areas of specialization – alternative medicine being one, faith-based medicine being another. It’s fascinating. If your doctor comes to you right before surgery and says “Come, let’s get down on our knees and pray,” for some people that’s incredibly reassuring, for others it’s completely the wrong thing to say. That’s why we say get the doctor that’s right for you.

***

Mitchel Rothschild’s ‘Vitals’ statistics

Titles: Chief executive officer of MDx Medical; founder of Vitals.com; founder of marketing firm Raspberry Red; and founder of Web retailers Awards.com and TuffRhino.com.

Education: Bachelor’s degree from Queens College; master’s degree in business administration from Columbia University.

Expertise: More than two decades of marketing experience, starting with magazine marketing and then moving into educational films and videos and Web sites.

***

Exec Access appears on Wednesdays. E-mail: [email protected]

(c) 2008 Record, The; Bergen County, N.J.. Provided by ProQuest LLC. All rights Reserved.

Wolters Kluwer Health Appoints Scott Lubeck Vice President, Technology of Its Professional & Education Unit

CONSHOHOCKEN, Pa., Sept. 11 /PRNewswire/ — Wolters Kluwer Health, a division of Wolters Kluwer, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry, announced today the appointment of Scott Lubeck Vice President, Technology of its Professional & Education Unit.

Lubeck comes to Wolters Kluwer Health from Newsstand Inc., where he served as Vice President/General Manager. Newsstand produces, markets, and distributes online editions of global newspapers and magazines to consumers worldwide.

“We are rapidly transforming to serve our customer’s mission critical information and learning needs; managing our rich repository of authoritative, peer-reviewed content so it is more usable, relevant and valuable,” said Gordon Macomber, president and CEO of the Wolters Kluwer Health Professional & Education unit. “Scott brings the skill-set needed to better serve the customer and we’re extremely pleased to have him join the team.”

Lubeck has extensive digital publishing experience having served as Chief Technology Officer at Harvard Business School Publishing, where he led the design and implementation of the organization’s digital publishing value chain. He previously served in senior technology and executive roles at Perseus Books Group, Electric Press, and National Academies Press. In addition, Scott founded Newrivers, Inc., a firm that developed and marketed web-based software and services for online delivery of legacy documents.

Macomber continues, “I look forward to Scott’s positive impact on our customers and our organization as he will be joining a strong management team increasing our potential to accelerate growth and competitiveness through the use of transformative technology.”

Lubeck will be based in Philadelphia and has an A.B. degree from Brown University and an M.A. from the University of Texas.

About Wolters Kluwer Health

Wolters Kluwer Health (Conshohocken, PA), a division of Wolters Kluwer, is a leading provider of information and business intelligence for students, professionals and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry. Major brands include traditional publishers of medical and drug reference tools and textbooks, such as Lippincott Williams & Wilkins and Facts & Comparisons(R); electronic information providers, such as Ovid, Medi-Span(R) and ProVation(R); and pharmaceutical information providers such as Adis International and Source(R). Wolters Kluwer Health has annual revenues (2007) of $1,044 million (euro 761 million) and employs approximately 2,700 employees globally. For more information, visit http://www.wkhealth.com/ .

Wolters Kluwer Health

CONTACT: Robert Dekker, Director of Communications of Wolters KluwerHealth, +1-610-234-4533, [email protected]

Web site: http://www.wkhealth.com/

Circassia Reports Positive Data From Phase II Study of Anti-Allergy Technology

Circassia, a specialty biopharmaceutical company, has announced positive results from a Phase II clinical study of its anti-allergy technology, ToleroMune, in the field of cat allergy.

The trial showed that ToleroMune treatment can substantially reduce allergic reactions to the allergen that causes most cat allergies, and importantly was well tolerated by all patients.

Circassia conducted the double-blind study in Germany, where patients with a confirmed history of cat allergies received a single dose of ToleroMune therapy or placebo. The 88 study participants were divided into groups, with each receiving a different dose, either via subcutaneous or intradermal injection to compare the two routes of administration.

To test the effect of the treatment, patients received a microscopic dose of cat dander (the main allergen responsible for cat allergies) into their skin several weeks later.

Patients who received ToleroMune therapy via the most effective administration route had markedly reduced skin reactions to the cat allergen at all of the five dose levels tested compared with placebo. The most effective dose reduced reactions by over 40%, compared with 10% for placebo.

Throughout the study the ToleroMune treatment proved well tolerated, with no serious or severe adverse events experienced in any of the groups, despite the steadily increasing doses.

Steve Harris, Circassia’s CEO, said: “Our goal for ToleroMune is to provide a range of allergy therapies that effectively and quickly treat the underlying disease while also offering excellent safety. Consequently, these positive clinical results will not only contribute to the development of our cat allergy product, but will also provide the foundations for our other allergy programs that utilize our ToleroMune technology.”

Tacoma, Washington Renews Rural/Metro’s Exclusive 911 Ambulance Services Contract

Rural/Metro Corporation (NASDAQ: RURL) announced today that the Tacoma, Washington, City Council voted unanimously this week to renew the Company’s contract as the exclusive provider of 911 ambulance services.

Jack Brucker, President and Chief Executive Officer, said, “We are honored to continue serving the City of Tacoma and look forward to another year of exceptional service to the citizens of this growing community. We are focused on the delivery of responsive, reliable, efficient ambulance services and believe this approach is the foundation for our continuing success.”

Rural/Metro was first awarded the Tacoma 911 contract in 2004, following a decision by city leaders to consolidate emergency ambulance services under one provider. The contract renewal awarded this week represents the second of three 1-year extension terms. The 911 contract alone generates an estimated $4.0 million annually.

Boo Heffner, President of the Company’s West Emergency Services Group, said, “We are proud to be the trusted 911 partner to the City of Tacoma and the Tacoma Fire Department and remain committed to providing the highest levels of care and service to our patients and customers.”

Tacoma is Washington’s third-largest city and is home to more than 200,000 residents. Rural/Metro employs 135 ambulance service professionals in the area who provide more than 30,000 patient transports each year.

Roger Edington, Medical Services Officer and Contract Administrator for the Tacoma Fire Department, said, “We continue to appreciate Rural/Metro’s efforts to provide quality service to the citizens of Tacoma. Rural/Metro-Tacoma continues to meet our high performance levels, and this has helped the Tacoma Fire Department to continue to provide excellent service to our citizen calls for medical assistance.”

About Rural/Metro

Rural/Metro Corporation provides emergency and non-emergency ambulance services and private fire protection services in 22 states and approximately 400 communities throughout the United States. For more information, visit the Company’s web site at www.ruralmetro.com.

SAFE HARBOR PROVISIONS FOR FORWARD-LOOKING STATEMENTS

This press release contains forward-looking statements that involve risks and uncertainties that could cause actual results to differ materially. These risks and uncertainties include, among others, the company’s ability to collect its accounts receivable, secure new contracts, retain existing contracts, and improve earnings and operating margins. Although Rural/Metro believes that the expectations reflected in such forward-looking statements are reasonable, it can give no assurance that such expectations will prove to have been correct.

Reference is made to a more complete discussion of forward-looking statements and applicable risks that may cause actual results to differ materially from those contemplated by such forward-looking statements (“Cautionary Statements”) that include, among others, those identified under the captions “Forward-Looking Statements” and “Risk Factors” in the Company’s annual report on Form 10-K for the fiscal year ended June 30, 2007, which is available free of charge on the website of the Securities and Exchange Commission (the “SEC”) at www.sec.gov or on the Company’s website at www.ruralmetro.com. All subsequent written and oral forward-looking statements (or statements that may be attributed to the Company) are expressly qualified by the Cautionary Statements. The Company’s forward-looking statements are based on information available today, and it undertakes no obligation to update these statements, whether as a result of new information, future events or otherwise, except as required by the securities laws.

(RURL/G)

 CONTACT:  Liz Merritt Rural/Metro Corporation (480) 606-3337  Sharrifah Al-Salem FD Ashton Partners (415) 293-4414  

SOURCE: Rural/Metro Corporation

Oculus Innovative Sciences and Sinopharm Announce Introduction of Dermacyn(TM) to Hospitals in China

Oculus Innovative Sciences, Inc. (NASDAQ:OCLS) today announced the launch of its Dermacyn(TM) product in China through one of its key Chinese distributors, Sinopharm. Dermacyn was introduced at the Health Tech Forum 2008 and New Drugs China Expo 2008 held this past week in Yantai City, Shandong Province. Dermacyn is initially being sampled to hospitals in as many as 10 provinces in China for treatment of various acute and chronic wounds including ulcers, cuts, contusions and burns.

“The sampling of Dermacyn in hospitals across China marks an important milestone in the implementation of our commercial strategy,” said Hoji Alimi, CEO and founder of Oculus. “Our alliance with China National Bohai Pharmaceutical Group Corp (Sinopharm) along with an additional 20 sub-distributors provides a strong entry into a market with enormous potential, and positions Dermacyn as a high-quality, effective alternative to current treatments. Our commercial plans in China call for entry into the retail pharmacy market as well.”

In March 2008, the Chinese State Food and Drug Administration (SFDA) approved Microcyn(R) Technology for treatment of various acute and chronic wounds including ulcers, cuts, contusions and burns, allowing the Microcyn Technology to be promoted as a moist environment for wounds and accelerating wound healing through the reduction of microorganisms in wounds. This approval followed the completion and submission in December 2007 of two randomized controlled clinical trials conducted in China, including a burn wound study with 162 patients and a chronic wound treatment study with 35 patients.

About Dermacyn

Dermacyn is a topical formation based upon the Microcyn Technology platform. Microcyn Technology is capable of producing a potent broad-spectrum antimicrobial designed to treat a wide range of pathogens, including viruses, fungi, spores and antibiotic-resistant strains of bacteria such as Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococcus (VRE), all of which cause disease or inhibit the healing in both acute and chronic wounds. Microcyn is a non-irritating, shelf-stable solution containing oxychlorine compounds; its safety profile has been established as comparable to saline through treatment of more than 750,000 patients to date, and efficacy has been reinforced through 25 clinical studies.

Microcyn is capable of producing a pH-neutral, non-irritating solution of shelf-stable oxychlorine compounds that replicate the action of the body’s neutrophils. Neutrophils are the most abundant type of white blood cells in humans and form an integral part of the immune system. The mechanism of action of oxychlorine compounds against single-cell organisms, due to their reactivity with lipids and proteins in cell membranes, can cause these organisms to rupture and die rapidly as demonstrated via in vitro test models. Meanwhile, the product remains biocompatible to mammalian cells, which have evolved mechanisms to tolerate and regulate the active ingredients in Microcyn. Pathogens lack this capability. It has also been reported in research studies that Microcyn induces vasodilation and has demonstrated biocompatibility with fibroblast and granulation tissue.

Chinese Healthcare Market

According to Journal of the American Medical Association, as is the case in much of the rest of the world, the aged proportion of China’s population is increasing. The population older than 65 years included 100.4 million persons, or 7.69% of China’s total population, in 2005 and is expected to increase at an annual rate of 3.28%. With this increased aged population, total health care needs and expenditures will increase as well. China’s proportion of GDP allocated to health care, currently about 5.55%, is likely to increase steadily to become closer to that of developed countries, most of which have comparable rates of 8% to 11%, up to nearly 16% in the United States.

Decision Resources, one of the world’s leading research and advisory firms focusing on pharmaceutical and healthcare issues, finds that the prevalence of type 2 diabetes in China is staggering, rivaling that of the United States, Europe, and Japan combined. According to a new Emerging Markets-China report entitled Type 2 Diabetes in China, the type 2 diabetes drug market in China will reach $1.3 billion in 2010. The report also finds that increasing economic power in China has led to growing numbers of patients with supplementary healthcare insurance and an improved ability to afford Western-branded drugs.

About Sinopharm

Sinopharm (www.sinopharm.com/en) is China’s largest pharmaceutical group. Incorporating research with production and service trade, the company has under its jurisdiction 10 wholly owned subsidiaries or shareholding companies. In 2004, its sales revenue from medicines and medical equipment totaled RMB 18 billion and its imports and exports volume reached $500 million USD.

About Oculus

Oculus Innovative Sciences develops, manufactures and markets a family of products based upon the Microcyn Technology platform, which is intended to help prevent and treat infections in chronic and acute wounds. The Microcyn Technology platform features a biocompatible, shelf-stable solution containing active oxychlorine compounds that is currently commercialized primarily in Europe, India and Mexico for the treatment of infected wounds. The solutions derived from this platform have demonstrated, in a variety of research and investigational studies, the ability to treat a wide range of pathogens, including antibiotic-resistant strains of bacteria (including MRSA and VRE), viruses, fungi and spores. A recent Phase II clinical trial of Microcyn Technology conducted in the U.S. met its primary endpoints of safety and efficacy for the treatment of mildly infected diabetic foot ulcers.

Oculus also develops, manufactures and markets a number of devices and products under 510(k) regulatory approvals to professionals and consumers. The company’s headquarters are in Petaluma, California, with operations in Europe, Latin America and Japan. More information can be found at www.oculusis.com.

Forward Looking Statements

Except for historical information herein, some matters set forth in this press release are forward-looking within the meaning of the “safe harbor” provisions of the Private Securities Litigation Reform Act of 1995, including statements about the company’s commercial plans and market opportunity for Dermacyn in China, Oculus’ ability to penetrate both the Chinese hospital and pharmacy market, Microcyn’s safety, efficacy and wound healing capabilities, and the ability of Microcyn to become a new type of drug for comprehensive treatment of diverse inflammatory conditions. These forward-looking statements are identified by the use of words such as “being sampled,””implementation,””provides,” and “entry,” among others. Forward-looking statements in this press release are subject to certain risks and uncertainties inherent in the Company’s business that could cause actual results to vary, including risks inherent in the development and commercialization of potential products, the risk that regulatory clinical and guideline developments may change, the risk that scientific data may not be sufficient to meet regulatory standards or receipt of required regulatory clearances or approvals, the risk that clinical results may not be replicated in actual patient settings, the risk that protection offered by our patents and patent applications may be challenged, invalidated or circumvented by our competitors, the risk that present trends will continue and that the available market for our products will not be as large as expected, the risk that our products will not be able to penetrate one or more targeted markets, the risk that revenues will not be sufficient to fund further development and clinical studies, the Company’s future capital needs, and its ability to obtain additional funding and other risks detailed from time to time in the Company’s filings with the Securities and Exchange Commission including the annual report on Form 10-K for the year ended March 31, 2008. Oculus Innovative Sciences disclaims any obligation to update these forward-looking statements.

Oculus, Microcyn and Dermacyn are trademarks or registered trademarks of Oculus Innovative Sciences, Inc. All other trademarks and service marks are the property of their respective owners.

Shoppers Can Help Fight Cancer

DARE COUNTY | Tanger Outlet Centers will be selling a special Pink Card beginning Wednesday that will give customers a 25 percent discount at participating Tanger stores .

The Pink Cards will be available through Oct. 19 for a $1 donation at the Tanger Customer Service Center .

Proceeds from the sale of the cards will benefit a local breast cancer organization.

In addition, Tanger has expanded its efforts to fight lung, colon and prostate cancer. Each time a Tanger shopper purchases the Tanger “Cure Card,” a specially designed gift card, Tanger will donate 10 percent of the purchase price to fight these cancers.

These cards will be available through Dec. 31 .

Dare County

Aquarium to hold trick or treat

The North Carolina Aquarium on Roanoke Island is offering businesses an opportunity to promote and participate in the sixth annual Trick or Treat Under the Sea from 6 to 8:30 p.m. Oct. 30.

Booth reservations are $25 for Outer Banks Chamber of Commerce and Roanoke Island Business Association members and $35 for others.

The deadline for registration is Sept. 30. Space is limited.

Call (252) 473-3494, ext. 258 or 247.

Employee of the month named

The Outer Banks Hospital has selected nurse Heather Cobb as its Employee of the Month.

Cobb works on the medical/surgical floor and has been recognized by her peers for her commitment to the hospital and its patients.

Cobb received her nursing degree from Cape Fear Community College in 2002. She lives with her husband, Ben, whom she met at a Rodanthe campground one summer while vacationing with her family.

pirate festival starts monday

The third a nnual Outer Banks Pirate Festival will take place at local businesses beginning Monday.

Pirates will invade various businesses along the Outer Banks. Capt. Jack Sparrow will be at the Kitty Hawk Kites locations from Corolla to Hatteras ( 4 p.m. Monday at Nags Head and 4 p.m. Wednesday in Corolla). Capt. Jack and his crew will visit Jolly Roger at 6 p.m. Thursday.

On Friday, the crew will be at Big Al’s Soda Foundation & Grill at noon and will invade Roanoke Island Festival Park in Manteo from 2 to 5 p.m. A free movie will be shown at 8 p.m. at Kitty Hawk Kites in Nags Head.

The festival will conclude from 10 a.m. to 4 p.m. Sept. 20 at Kitty Hawk Kites in Nags Head.

Pasquotank County

taylor mueller honors agent

Taylor Mueller Realty has named George Bright as Listing Agent of the Month and Sales Agent of the Month for August.

SunTrust named preferred lender

Taylor Mueller Realty has announced that SunTrust Mortgage is its in-house preferred lender.

Loan officers are available in the Taylor Mueller Realty office to discuss different types of loans and to assist customers with choosing the loan that is right for them.

small-business summit is free

A full-day Small Business Resource Summit will be held from 9 a.m. to 4 p.m. next Thursday at Elizabeth City State University’s K. E. White Graduate Center.

The summit will be hosted by the Federal Deposit Insurance Corp. Atlanta Region and the North Carolina Rural Economic Development Center.

The free event will bring together 30 providers of small- business loans, grants, and technical and educational services to allow prospective and current small-business owners to have a one- stop shopping forum to learn about the resources available to them.

The summit will include presentations on topics of interest to small-business owners.

For more information, call John Meeks at (919) 787-8727, ext. 4915, or Carolyn Perry at (919) 250-4314, ext. 4251.

Assistant estimator named

Tom Jennings, a native of Elizabeth City, has joined the Raleigh office of Geo. Raper & Son Inc. as an assistant estimator.

Jennings will be responsible for researching and assembling price estimates for potential construction projects, rainwater harvesting installation and customized design-build prototypes.

He previously worked with State Utility Contractors and Quality Builders and completed the Estimators Training Program at the Construction Estimating Institute and the Carolinas AGC Project SuperVISION program.

He earned his bachelor’s degree in business administration from Western Carolina University.

Perquimans County

Hardee’s will open Tuesday

A new Hardee’s restaurant will open Tuesday in Hertford at 2000 Ocean Hwy.

It will open at 6 a.m. with the breakfast menu.

The hours of operation are 5 a.m. to 10 p.m. Monday through Thursday and until 11 p.m. on Friday and Saturday nights. On Sunday, it will be open from 6 a.m. to 10 p.m.

meetings + events

DARE COUNTY

Ribbon cutting 11:30 a.m. Sept. 18, Farmer2Fork, 3723 N. Croatan Hwy., Ocean Plaza.

Karen Santos, (252) 338-2590,

[email protected]

agent honored

Taylor Mueller Realty has named George Bright as Listing Agent of the Month and Sales Agent of the Month for August.

(c) 2008 Virginian – Pilot. Provided by ProQuest LLC. All rights Reserved.

Independent Natural Health News Website Achieves One Million Reader Milestone: NaturalNews.Com

TUCSON, Ariz., Sept. 11 /PRNewswire/ — NaturalNews.com, the independent natural health news and product review website, has reported it is now reaching well over one million unique readers a month. The popular website publishes 10 natural health news stories daily, relying on in-house writers and a network of more than 85 contributing writers to cover stories about natural remedies, nutrition and superfoods, green living and the dangers of conventional medicine.

The website features daily articles, podcasts, videos, cartoons, product reviews and exclusive interviews with natural health pioneers like Dr. Julian Whitaker, Dr. Joel Fuhrman, author Bruce Lipton, raw foods pioneer David Wolfe and many other industry leaders. It also features daily breaking news and a daily e-mail alert that keeps readers informed of the latest developments in the natural health industry.

The NaturalNews editor is Mike Adams, “the Health Ranger,” whose harsh criticism of Big Pharma and the FDA has received widespread praise by natural living consumers. Adams describes the FDA as a “criminal organization” that protects Big Pharma’s medical monopoly at the expense of public safety. Adams is also the founder of the Honest Food Guide (http://www.honestfoodguide.org/) and the co-founder of Health Book Summaries (http://www.healthbooksummaries.com/).

The NaturalNews website covers topics like superfoods, nutrition, natural remedies, medicinal herbs, naturopathic medicine, dangerous food ingredients and the dangers of chemotherapy and popular pharmaceuticals. The site famously created an online “Disease Mongering Engine” (http://www.naturalnews.com/disease-mongering-engine.asp) that allows readers to randomly generate their own fictitious diseases, just like the drug companies do!

NaturalNews readers are well-informed, critical-thinking consumers who enjoy the site’s independent, honest journalism, product recommendations and biting satire. Learn more at http://www.naturalnews.com/

NaturalNews.com

CONTACT: Steve Diaz of NaturalNews.com, +1-520-232-9300,[email protected]

Web Site: http://www.healthbooksummaries.com/

Cardio Infrared Technologies Adds New Sales Person With Additional Sales

LAS VEGAS, Sept. 11, 2008 (GLOBE NEWSWIRE) — Cardio Infrared Technologies, Inc. (Pink Sheets:CIRT) www.cardio-cor.com, a leading Health and Wellness technology and marketing company, announced today the addition of a new sales associate, Mr. Julian Nwadike, specializing in the area of personal training and weight loss.

Wayne Bailey, President and CEO of Cardio Infrared Technologies, Inc., stated, “The addition of Julian Nwadike to the sales team at Cardio Infrared Technologies, Inc. will be a major boost in sales to the personal training and weight loss division of the industry. Julian purchased a Cardio-Cor unit a year ago and within 6 months the Cardio-Cor was responsible for over 70% of the revenue of his personal training and weight loss business! In June 2009 he partnered with another personal trainer in the Miami area and moved the unit into a larger facility. Since that time the Cardio-Cor unit has been sold out 95% of the time. The unit is being used in the personal training and weight loss facility and Doctors from the area are sending them clients. Julian has continued to expound on the benefits of the Cardio-Cor unit to Doctors and other personal training and weight loss centers all around Florida.”

Mr. Bailey continued, “Julian was offered a sales position with the company in September and he accepted the position. Julian immediately contacted people he knew that were interested in the Cardio-Cor and offered to help them get set up in their own Cardio-Cor business. Mr. Nwadike now has 3 sales working for the Cardio-Cor unit. All the sales are in the process of final stages of financing and Julian will schedule the delivery and installation of his first 3 units. We are very pleased to have Mr. Nwadike join our growing sales team.”

Julian has a BBA in Computer Information Systems from the University of Miami, Florida. Julian is certified through AFAA, and has 9 years of personal training experience. His past clients range from the petite to the athlete and from teenagers to senior citizens. In addition Julian has trained clients who specifically were trained in order to gain entrance into the Metro Dade Fire Department, Metro Dade Police Department, FBI, full marathons, Swimming competitions and Beauty pageants (Miss Puerto Rico & Miss Columbia), Sabado Gigante female hostess, Weight loss Center Clients, and Cardiac Clients. Julian served as the General Manager for the trainers of Miami Gardens LA Fitness from May 2005 to Dec. 2006. He has been featured on NBC6 Health and On Y-100 local radio station. He has owned and operated his personal training studio from Dec. 2006 to present.

About Cardio Infrared Technologies, Inc.

Cardio Infrared Technologies, Inc. is a technology and marketing company, which is focused on developing the revolutionary and evolutionary process of combining exercise equipment with medical benefits that go far beyond the normal benefits of standard exercise equipment. Cardio Infrared Technologies, Inc. is committed to continue to market this equipment to the exercise and medical markets and to aggressively expand the market to every country around the world. The equipment has already been featured on Good Morning America and The View. Cardio Infrared Technologies, Inc. also has an aggressive growth plan that includes acquisitions and development of innovative new equipment and programs in the exercise and medical industries.

This news release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. The words or phrases “would be,””would allow,””intends to'””will likely result,””are expected to,””will continue,””anticipate,””expect,””estimate,””project,””indicate,””could,””potentially,””should,””believe,””considers,” or similar expressions are intended to identify “forward-looking statements.” Actual results could differ materially from those projected in the forward-looking statements as a result of a number of risks and uncertainties. These include the company’s historic lack of profitability, end user customer acceptance and actual demand, which may differ significantly from expectations, the need for the company to manage its growth, the need to raise funds for operations and other risks within the regulation of the industry. Statements made herein are as of the date of this press release and should not be relied upon as of any subsequent date. The Company’s past performance is not necessarily indicative of its future performance. The Company does not undertake, and the Company specifically disclaims any obligation, to update any forward-looking statements to reflect occurrences, developments, events or circumstances after the date of such statement.

This news release was distributed by GlobeNewswire, www.globenewswire.com

 CONTACT: Cardio Infrared Technologies, Inc.          Wayne Bailey          [email protected]          www.cardio-cor.com 

Zosano Pharma, Inc. Announces Positive Results of Phase 2 Trial With PTH Transdermal Patch in Osteoporosis

Zosano Pharma, Inc., a privately held pharmaceutical company developing a novel transdermal delivery technology, today announced that an abstract detailing results of its Phase 2 study of Zosano PTH Patch, a proprietary transdermal patch formulation of parathyroid hormone (PTH) for the treatment of established osteoporosis, has been accepted as a late-breaking poster presentation at the 2008 American College of Rheumatology Annual Scientific Meeting. In the study to be presented, treatment with the Zosano PTH patch was significantly better than placebo in increasing BMD (bone mineral density) values measured for the lumbar spine, which was the primary endpoint. Overall, treatment with the Zosano PTH patch was very well tolerated.

The study results, titled “Transdermal Delivery Of hPTH (1-34) (zp-pth) is Effective in Increasing Bone Mineral Density of the Lumbar Spine and Hip in Postmenopausal Women with Osteoporosis” will be presented on Monday, October 27th, 2008 at 9:00 AM. Dr. Nancy E. Lane, director and endowed professor, aging center, medicine and rheumatology, at the University of California at Davis Medical Center will make the presentation on behalf of the study’s participating investigators.

The Phase 2 program evaluated the safety and bone mineral density changes of three doses of the Zosano PTH Patch formulation relative to placebo and injectable Forteo(R) in postmenopausal women. The study enrolled 165 patients between 50 and 81 years of age with severe osteoporosis and was conducted at multiple sites across North and South America.

“Zosano is pleased to present important data from our first long-term trial assessing bone mineral density improvements with the Zosano PTH Patch, and we look forward to further exploring the products’ clinical advantage in our Phase 3 program,” stated Gail Schulze, Zosano’s chair and CEO.

About Osteoporosis

Osteoporosis is a disease characterized by low bone mass and the deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures. While any bone can be affected, fractures of the hip, spine and wrist are especially common. Osteoporosis is a major public health issue, affecting 55% of people 50 years or older in the U.S.(1) Approximately 80% of those affected are women.(2) By 2025, experts predict that osteoporosis-related fractures will be responsible for an estimated $25.3 billion in medical costs,(3) an economic burden comparable to other major chronic diseases.

About Zosano Pharma, Inc.

Zosano Pharma, Inc. is a privately held pharmaceutical company developing a novel transdermal delivery technology for a broad range of therapeutic indications. Its lead clinical program is evaluating a parathyroid hormone (hPTH 1-34) transdermal patch for the treatment of established osteoporosis. Zosano’s transdermal delivery technology is capable of delivering peptides, proteins, small molecules and vaccines by permeating the skin’s outer layer and allowing transport of macromolecules, thus ensuring significant therapeutic effect. This proprietary transdermal delivery technology offers several key benefits, including efficacy and safety comparable to approved injectables, needle-free delivery, a self administered patch, rapid onset of action and stability at room temperature. Zosano’s transdermal delivery technology has been clinically tested in over 400 patients with four different peptides and a vaccine. Zosano aims to develop products based on its transdermal delivery technology both independently and through strategic licensing and co-development arrangements. Founded in 2006 as an ALZA Corporation spin-out led by Nomura Phase4 Ventures, Zosano is funded by New Enterprise Associates, Nomura Phase4 Ventures, HBM BioVentures and ProQuest Investments. The company is headquartered in Fremont, California. For more information, please visit www.zosanopharma.com.

(1) (2) (3) Source: National Osteoporosis Foundation

GHX to Become GDSN-Certified Data Pool to Accelerate Use of GS1 Standards in Healthcare

WESTMINSTER, Colo., Sept. 11 /PRNewswire/ — GHX, LLC has announced plans to become part of GS1’s Global Data Synchronization Network (GDSN) as a GDSN-certified data pool for the healthcare industry. GHX’s existing infrastructure connecting hospitals and suppliers, along with its experience and expertise in data integrity and synchronization, will enable healthcare organizations to more readily utilize GS1 standards and realize their benefits quickly and cost effectively.

Awareness of the importance of standards in the healthcare industry has grown significantly in recent years. As a result, many of the healthcare organizations working with GHX have recognized the value of GHX becoming a GDSN-certified data pool and leveraging the existing GHX infrastructure. “Use of GS1 standards can clearly benefit healthcare, but we need to be able to adopt standards without significant implementation costs,” says Bill Francis, vice president of GPO Operations, Healthtrust Purchasing Group. “By building upon the existing GHX network and strong industry participation, GHX can help minimize many of those costs and maximize the value of the investments its owners and members have already made in e-business and data integrity.”

Once GHX is certified as a data pool, manufacturers can utilize their existing connectivity to GHX to provide product data, including GS1’s unique product identifier — the Global Trade Identification Number (GTIN) — to the GDSN in a manner compliant with global standards. Similarly, providers connected to GHX will be able to more easily access data from the GDSN, rather than having to establish new, separate connections. Healthcare suppliers and providers not integrated to GHX will have the option to participate in the GHX data pool as a standalone service.

“GS1 Healthcare welcomes GHX’s participation as a data pool for the healthcare industry and looks forward to its certification in 2009. By working together, with our expertise as an international standards body and global network, and GHX as a trusted partner in the global healthcare supply chain, we can deliver on the promise of standards to healthcare faster and more efficiently,” said Michel van der Heijden, president, New Sectors & Healthcare, GS1 Global Office.

Globally, GHX is connected to over 5,000 hospitals in North America and nine European countries. This includes hospitals representing more than 80 percent of the licensed beds in the US and the suppliers that sell more than 85 percent of the products purchased regularly by hospitals. On a global basis, participating hospitals and suppliers recognize the importance of standards for both clinical and business reasons and the role GHX can perform in accelerating their use.

“Product identification coding that is digitally stored and synchronized from the manufacturer right through to the patient allows the supply chain to benefit from absolute data accuracy,” says Steve Capel, Covidien’s director of eBusiness for Europe, the Middle East and Africa. “GHX as a GDSN-certified data pool will ensure that hospital procurement and eHealth systems can use the identification data to streamline the purchasing process. This, in turn, allows the product to be uniquely identified at the point of use. It also creates a positive impact on supply chain efficiency and patient safety.”

GHX will build out its current infrastructure to meet specific GS1 GDSN requirements, with certification as a data pool expected in 2009. “As GHX becomes GS1-certified, it will deliver greater efficiencies to the healthcare supply chain, adding more electronic interoperability, streamlining trading partner processes, and improving patient safety,” said Charlie Colpo, executive vice president, Administration, Owens & Minor. “As a major distributor of medical supplies for the U.S. market, Owens & Minor depends on having accurate product data. GHX will further enhance the quality and accuracy of our data through the implementation of standards.”

“The healthcare industry has recognized that adopting GS1 standards for product and organizational identification and synchronizing data through the GDSN can address many of the most challenging problems facing the healthcare supply chain,” says GHX Chief Executive Officer Bruce Johnson. “GHX is pleased to help accelerate GS1 standards adoption by not only becoming a data pool, but also through our membership and participation in global and local GS1 working groups.”

About GHX

As the business hub for healthcare, GHX enables healthcare providers and suppliers in North America and Europe to reduce costs and improve margins by automating processes, reducing operating expenses and increasing knowledge-based decision making. Products and services include trading partner connectivity, order and contract management and validation, data synchronization, sales force automation and business intelligence. Equity owners of GHX are Abbott Exchange, Inc.; AmerisourceBergen Corp.; Baxter Healthcare Corp.; B Braun Medical Inc.; Becton, Dickinson & Co.; Boston Scientific Corp.; Cardinal Health, Inc.; Covidien; C.R. Bard, Inc.; Fisher Scientific International, Inc.; GE Healthcare; HCA; Johnson & Johnson Health Care Systems Inc.; McKesson Corp.; Medtronic USA, Inc.; Owens & Minor; Premier, Inc.; Siemens; University HealthSystem Consortium; and VHA Inc. For more information, visit http://www.ghx.com/

GHX

CONTACT: Karen Conway of GHX, LLC, cell, +1-303-564-2147, voicemail,+1-720-887-7215, [email protected]

Web site: http://www.ghx.com/

Pfizer: Withdraws Zeven Marketing Applications

Healthcare giant Pfizer has announced that the marketing applications for its skin infection treatment Zeven (dalbavancin) are to be withdrawn, pending another multi-center trial for the drug. This setback could cost Pfizer dearly: another trial could push the drug’s launch date out to September 2010, five full years after its proposed launch date and just two years before its first patent expiry.

Pfizer’s decision to invest in another Phase III trial for Zeven will have been painful. There has been a substantial delay since the FDA’s second approvable letter, issued in December 2007, in which the regulator requested additional non-inferiority data. Pfizer will undoubtedly have been looking for ways to provide this through novel cuts of existing trial data, but it seems that the company has seen an additional trial as the only way to satisfy the FDA’s request.

Perhaps the most significant drawback for Pfizer is the potential time lag implied by further trials, which could run to another two years (based on the time taken for Versicor to run a relatively small 150 patient trial to supplement the drug’s original two core Phase III trials, combined with an additional FDA review period). However, the opportunity costs of the drug not being on the market extend beyond lost revenues during this period.

Combined with delays in gaining approval to date, this setback will further erode the drug’s patented life. The original molecule patent expires in 2012, and, following the drug’s guaranteed five years of exclusivity post-launch, process and dosage patents are likely to be eagerly contested by the generics industry. However, it may be protected by a manufacturing process patent until 2017 and a novel dosage patent which Versicor secured in 2005.

This additional delay will disadvantage Zeven in an era where skin and soft tissue infection prescriptions are being hotly contested by currently marketed products (e.g. AstraZeneca’s Merrem, Cubist’s Cubicin and Pfizer’s Zyvox), in the run up to new competition from Astellas (Arbelic), Johnson & Johnson (Zeftera), Arpida (iclaprim) and Targanta (Nuvocid). Pfizer already has a key competitor on the market in the form of Zyvox, and Astellas and Johnson & Johnson have also faced regulatory delays with their own treatments (Arebelic and Zeftera). However, this may be little consolation for Pfizer, should new market entrants gain a stronger foothold during Zeven’s extended development.

Kempthorne Starts Preparation of Next OCS 5-Year Plan

By Snow, Nick

Citing dramatically higher prices, US Department of the Interior Secretary Dirk A. Kempthorne started the Minerals Management Service’s next 5-year Outer Continental Shelf lease plan preparation 2 years ahead of schedule. “When our current 5-year plan was launched in July 2007, oil was selling for $64/bbl. Today, a barrel of oil costs more than $ 120, almost double the price a year ago. Clearly, today’s escalating energy prices and the widening gap between US energy consumption and supply have changed the fundamental assumptions on which many of our decisions were based,” he said July 30.

“Areas that were considered too expensive to develop a year ago are no longer necessarily out of reach based on improvements to technology and safety. The American people and [US President George W Bush] want action and this initiative can accelerate an offshore exploration and development program that can increase production from additional domestic energy resources,” Kempthorne said.

He said he directed MMS to take the initial steps by issuing a call for information from all parties on what the next 5-year OCS leasing plan should consider. It is seeking comments to ensure all interest and concerns are considered, Kempthorne said. The governors of all 50 states will be specifically asked for their comments, particularly on issues unique to each state, he indicated. The call for information appeared in the Aug. 1 Federal Register. Comments will be accepted through Sept. 15.

“The president believes coastal states should have a voice in how OCS resources are developed off their shores while ensuring those environ- ments are protected. Also, Congress should provide a way for the federal government and states to participate in revenue sharing from those new leases,” Kempthorne said.

‘Send a clear signal’

On July 14, Bush lifted the executive OCS withdrawal which his father, President George H.W Bush, instituted 18 years earlier, but congressional oil and gas leasing moratoriums which have been in place for up to 26 years in some cases remain on 85% of the OCS. “Now, its up to the United States Congress to make a decision as to whether or not you’re going to continue to face high gasoline prices at the pump or whether or not the United States will send a clear signal to the world that we’re tired of being dependent on oil from overseas and we’re going to find it right here,” the current president told an audience in Euclid, Ohio, on July 30.

President Bush said, “The American people must understand that new technologies make it easier to protect coral reefs, for example, when we drill offshore. New technologies enable us to explore for oil and gas in ways that were not possible 20 years ago. You can have one platform and directionally drill from it. So I signed an executive order that said: Why don’t we explore for oil and gas offshore? If we’ve got a problem with not having enough oil, let’s go after some right here in the United States of America in environmentally friendly ways.”

The current 5-year OCS plan runs from July 1 , 2007, through June 30, 2012, and includes 21 lease sales in eight of the 26 OCS planning areas in the Gulf of Mexico, Alaska, and the Atlantic Ocean, according to DOI. It does not include any areas covered by congressional bans with the exception of a single sale in 2011 off Virginia, which MMS added after the state included possible OCS activity in a comprehensive energy strategy Gov. Timothy M. Kaine signed into law in early 2006.

Kempthorne noted that the next 5-year OCS plan could consider any part of the OCS although leasing of any area currently covered by a moratorium would require congressional action. Currently banned OCS portions contain an estimated 18 billion bbl of oil and 76 tcf of natural gas, according to DOI.

It said that Kempthorne used authority under the 1978 OCS Lands Act Amendments which allows the Interior secretary to develop “out of cycle” leasing programs and requires various procedural steps, including several public comment rounds and multiple environmental reviews.

Initial reactions

National Ocean Industries Association Pres. Tom Fry, a former director of MMS and the US Bureau of Land Management, said Kempthorne’s action will allow DOI “to reverse two decades of poor public policy where we have refused to even consider the energy available on the vast majority of our public submerged lands.”

Fry said, “It’s as if we’ve been bypassing several large grocery stores with a wide selection to shop instead at a small convenience store with a limited selection.”

Fry said the OCS s energy resources are vital to US economic prosperity, and safety records show that they can be produced in an environmentally responsible manner. “Now, with global demand for oil increasing, gasoline prices soaring and an American public looking for relief at the pump, we must consider the entire offshore area that is owned by all the American people,” he said.

The Institute for Energy Research (1ER) applauded DOI ‘s plan to include OCS areas currendy under moratoriums in its next 5-year leasing plan. 1ER Pres. Thomas PyIe said, “Assuming the congressional ban expires, this decision sets the stage for the opening of hundreds of millions of offshore federal lands that have never been explored for their energy potential. It’s the kind of proactive step we rarely see the government take, but given the urgent need to increase domestic energy supplies, it’s the right thing to do. The United States has been fighting its economic and energy battles with one hand tied behind its back for too long.”

US Senate Energy and Natural Resources Committee Chairman Jeff Bingaman (D-NM) , said, “This is very good news. The administration has embraced the proposals that Senate Democrats have been calling for all this week. Recently, I praised Secretary Kempthorne for speeding up lease sales in the National Petroleum Reserve- Alaska. Secretary Kempthorne appears to be using his authority wisely.”

An ‘unworthy’ hoax

Other congressional Democrats reacted more to Bush’s remarks than to Kempthorne’s action. US House Speaker Nancy Pelosi (D-Calif.) called the president’s proposals to expand OCS oil and gas leasing “a hoax unworthy of the serious debate we must have to relieve the pain of consumers at the pump and to promote energy independence….” She said, “Americans know that, thanks to the two oilmen in the White House, consumers are now paying $4/gal for [gasoline] . But what Americans should realize is that what the president is calling for is drilling as close as 3 miles off of America’s pristine beaches and in other protected areas.”

US Senate Majority Leader Harry M. Reid (D-Nev.), noted: “If the president truly cares about Americans paying record-high energy prices to fill their tanks and heat their homes and wants to make them more secure, he can release oil from the Strategic Petroleum Reserve, accelerate production in the 68 million acres already open for drilling, open up new leases in areas that are not environmentally protected, crack down on greedy oil traders who artificially in- flate energy prices, and support efforts in Congress to extend renewable energy tax credits that spur investment in clean energy sources. Unfortunately, he has shown no interest in doing anything but continuing more of the same failed policies that have produced the highest oil and gas prices ever.”

Congressional Republicans continued to press Pelosi and Reid (D- Nev.) to allow votes on proposals to remove leasing bans on the OCS and elsewhere before Congress recesses on Aug. 1. House Minority Leader John Boehner (R-Mo.) said, “The American people understand that the only ones standing in the way of lower [gasoline] prices are the Democrats in charge of Congress. Rank-and-file Democrats have a choice this week: Vote to leave town for 5 weeks, or join us in demanding a vote.”

Senate Minority Leader Mitch McConnell (R-Ky.) said, “The Democrat leadership has already tried to take us off this issue four times in the last 5 days. About eight in 10 Americans disagree with them. The American people think $4/gal gasoline is a crisis that must be dealt with now.”

After the House formally voted to adjourn a week earlier than originally scheduled, Republican Conference Chairman Adam Putnam (Fla.) said Democrats “should be held in contempt for voting to skip town without dealing with America’s energy crisis,” adding, “Democrats are out of touch, out of support, out of excuses and out of time.”

“Areas that were considered too expensive to develop a year ago are no longer necessarily out of reach based on improvements to technology and safety. The American people. . . want ction and this initiative can accelerate an offshore exploration and development program that can increase production from dditional domestic energy urces.”

– US Department of the Interior Secretary Dirk A. Kempthorne

Nick Snow

Washington Editor

Copyright PennWell Corporation Aug 11, 2008

(c) 2008 Oil & Gas Journal. Provided by ProQuest LLC. All rights Reserved.

Response-to-Intervention: Separating the Rhetoric of Self- Congratulation From the Reality of Specific Learning Disability Identification

By Kavale, Kenneth A Kauffman, James M; Bachmeier, Randy J; LeFever, Gretchen B

Abstract. The policies underlying the specific learning disability (SLD) regulations in the 2004 reauthorization of the Individuals with Disabilities Education Act (IDEA) are analyzed. The analysis focuses on the Response-to-Intervention (RTI) provision (“if the child responds to scientific, research-based intervention”) as a diagnostic model, revealing that it is conceptually flawed, practically inadequate, and politically rather than scientifically motivated. It is argued that RTI is best described as a model for providing remedial reading (prereferral) services for students experiencing early reading failure. To achieve a reliable and valid diagnosis of SLD under IDEA, it is argued that a comprehensive psychometric assessment is required. With a model that combines RTI and cognitive assessments, it is possible to provide an identification process that closely aligns with the best current conceptualizations of SLD.

The field of special education is facing a significant policy debate about the identification procedures used for specific learning disability (SLD). The debate surrounds a process termed Response-to-intervention (RTI), which is a “comprehensive assessment and intervention process utilizing a problem-solving framework to identify and address student academic difficulties using effective, efficient researched-based instruction” (Cortiella, 2006, p. 2). Although proposed in the IDEA provisions for SLD identification, implementation of RTI appears to have transcended the boundaries of special education to include significant implications for general education. Consequently, perhaps up to one third of students in the public schools will be directly affected by RTI, with more indirect implications for the remaining two thirds.

Kavale and Forness (2000) demonstrated how inclusion escalated into debate, not only about students with disabilities, but about the education of all students. Kavale and Forness also demonstrated that support for inclusion was primarily ideological and political rather than strictly empirical. As such, the debate becomes what Sowell (2002) termed a “conflict of visions” – different views of how the world works that set the agenda for both thought and action. Sowell suggested that a vision “is what we sense or feel before we have constructed any systematic reasoning that could be called a theory … a vision is a sense of causation” (pp. 4-6).

According to Sowell (1995), at times, one vision may come to predominate over others to such an extent that it represents the prevailing vision for that time and place, usually because of the presumed authority position of an elite intelligentsia. This is termed the “vision of the anointed,” while all others are said to hold the “vision of the benighted.” Because of its ascendancy, the vision of the anointed is preferred in formulating policy, while the vision of the benighted is to be ignored because it is “at best ‘perceptions,’ more often ‘stereotypes,’ and more bluntly ‘false consciousness'” (p. 187).

Particularly for special education, the vision of the anointed is to be preferred because it also includes assumptions about compassion and caring, which are viewed as their special province. Thus, the vision of the anointed is “not merely factually correct but morally on a higher plane” (p. 23). In contrast, the vision of the benighted should not be considered because “the benighted are to be made ‘aware,’ to have their ‘consciousness raised,’ and the wistful hope is held out that they will ‘grow'” (p. 3).

Kavale and Forness (2000) demonstrated how the inclusion debate was dominated by the vision of the anointed. Beginning with the least restrictive environment articulated in PL 94-142, the Regular Education Initiative where education was viewed as a “shared responsibility” (Will, 1986), through “full inclusion” (Gartner & Lysky, 1989), the vision of the anointed dominated position statements of professional organizations (e.g., Association of Persons with Severe Handicaps, 1992; Council of Chief State School Officers, 1992; National Association of State Boards of Education, 1992). Hence, inclusion was the preferred policy because it was viewed as a “good thing” (just, essential, democratic, liberating), even though “‘reality’ painted a less sanguine picture about the general education classroom being the sole placement option for educating students with disabilities” (Kavale & Mostert, 2003, p. 203).

The RTI debate is also predicated on it being a “good thing.” As Sowell (1995) suggested, the vision of the anointed “is a vision of differential rectitude [where] problems exist because others are not as wise or as virtuous as the anointed” (p. 5). Consequently, any different rendering of reality must be dismissed as either uninformed or irresponsible, and superseded by the vision of the anointed, usually through the power of government.

The purpose of this paper is to analyze the RTI debate as a conflict of visions. Proponents of RTI will be assumed to hold the vision of the anointed, while the authors will represent the vision of the benighted.

RESPONSE-TO-INTERVENTION: THE WHAT AND HOW

The foundation of the vision of the anointed surrounds RTI, the core concepts of which include the systematic (a) application of scientific, research-based interventions in general education settings, (b) measurement of a student’s response to those interventions, and (c) use of data to inform instruction (Mellard, 2004). Basically, RTI serves an accountability function to answer the question: Does instruction result in increased learning and acceptable progress?

The RTI concept grew out of concerns expressed about SLD identification (e.g., misidentification, over-identification, problematic criteria) (Bradley, Danielson, & Hallahan, 2002; Donovan & Cross, 2002; Finn, Rotherham, & Hokanson, 2001; Learning Disabilities Roundtable, 2005; Pasternak, 2002; President’s Commission on Excellence in Special Education, 2002). The primary concern focused on problems with the discrepancy model, which led to a “paradigm shift” (i.e., a new vision) (Reschly, 2004) centering on the concept of treatment validity, whereby it is possible “to simultaneously inform, foster and document the necessity for and effectiveness of special treatment” (L. Fuchs & D. Fuchs, 1998). With respect to SLD classification, Berninger and Abbot (1994) explored

going beyond defining learning disability as a discrepancy between achievement and ability (based on static, one-shot assessment of either IQ or listening comprehension) to a broader view of learning disability based on dynamic assessment failure to respond, over time, to validated intervention protocols. (p. 165)

Gresham (2002) reinforced this view at the LD Summit by suggesting that “children who fail to respond to empirically validated treatments implemented with integrity might be identified as LD” (p. 499). The Learning Disabilities Roundtable (2005) affirmed the importance of RTI and recommended that IDEA regulations “require that the essential core concepts of a responsiveness-to- intervention process have been employed.” Accordingly, the reauthorization of IDEA 2004 (PL 108-446) indicated that: “a local educational agency may use a process that determines if the child responds to scientific research-based intervention as a part of the evaluation procedures.” Thus, the reauthorization of IDEA in 2004 described RTI as an intervention that provides (a) data for more effective and early identification of students with SLD, and (b) a systematic way to ensure that students experiencing educational difficulties receive more timely and effective support (Boardman & Vaughn, 2007; National Joint Committee on Learning Disabilities [NJCLD], 2005).

To aid implementation of RTI procedures for SLD identification, the National Research Center on Learning Disabilities (NRCLD) was established (e.g., Deshler, Mellard, Tollefson, & Byrd, 2005; D. Fuchs, Deshler, & Reschly, 2004; Mellard, Byrd, Johnson, Tollefson, & Boesche, 2004). The NRCLD was charged with addressing the following questions: (a) How is RTI used in the process of SLD identification? and (b) Does RTI enhance SLD identification? Another stipulated purpose of RTI was to “redefine” SLD as inadequate response to instruction that would permit (a) identification of students using a risk rather than a deficit model; (b) early identification and instruction of students with SLD; (c) reduction of identification bias (i.e., higher probability that identified students are truly those with greatest academic needs); and (d) connecting identification assessment with instructional planning and progress monitoring (Vaughn & L. Fuchs, 2003, pp. 139-141).

Although originally focused on SLD identification as outlined in IDEA 2004, RTI was soon viewed as a means whereby “schools don’t wait for formal identification of a learning disability, but instead start providing targeted interventions early on” (West Ed, 2006, p. 1). The School Social Work Association of America (SSWAA, 2006) expanded the scope of RTI by terming it “a systematic, multi-tiered approach to helping all [italics added] students achieve school success” (p. 1). The National Association of School Psychologists endorsed this view of the RTI process by indicating that it is a “provision of scientific research-based instruction and interventions in general education [that] provides an improved process and structure for school teams in designing, implementing, and evaluating educational interventions [that may be] part [italics added] of the evaluation procedures for special education eligibility” (Klotz & Canter, 2006, pp. 1-2). Finally, a group of 13 national organizations (Collaborative Project, 2006) issued a report entitled “New roles in response to intervention: Creating success for schools and children” (2006), wherein RTI was described as follows, “To meet the needs of all students, the educational system must use its collective resources to intervene early and provide appropriate interventions and supports to prevent learning and behavioral problems from becoming larger issues” (p. 2). When the vision of the anointed is examined, it appears that the primary intent of RTI is not perceived uniformly. From one perspective, the purpose of the NRCLD was to provide “assistance on issues in the area of identification and assessment of children with learning disabilities” (Deshler et al., 2005, p. 484). Bradley, Davidson, and Doolittle (2005) endorsed this view by indicating that the Learning Disabilities Initiative “has been focused on a more efficient and effective process for determining specific learning disability eligibility” (p. 485). Yet, statements from major organizations suggest another perspective, whereby SLD identification is not viewed as a major purpose of RTI. For example, in a joint paper by the National Association of State Directors of Special Education (NASDSE) and the Council of Administrators of Special Education (case) (2006), the stated goal of RTI is “to engage the general education community in conversations and strategies to provide knowledge and technical assistance to help implement this successful approach [i.e., RTI] to teaching all children, including students with disabilities” (p. 1). The focus shifted to general education where the NASDSE/case paper represents “a call from the special education community to the general education community to join together to commit to a uniform system of education, where RTI plays a key role in identifying and working with struggling learners in any setting …” (p. 2). In fact, NASDSE (2006) clearly stated that, “Special education eligibility decisions can be a product of these efforts, but is not the primary goal” (p. 1).

The vision of the anointed appears not to be uniform with respect to the goal of RTI. On one hand, the goal of RTI is to deliver evidence-based interventions and use students’ response to determine educational needs (e.g., NASDSE, 2006) while, on the other hand, the goal is to redefine SLD through operationalizing RTI procedures (Vaughn & L. Fuchs, 2003). With different views about the purpose of RTI, emerging models may differ significantly in form and function and thus may not be compatible. Will agencies have to choose the purpose they prefer? If the delivery of instruction is primary, how will SLD be identified? If SLD identification is primary, then why include all children in RTI, even students with disabilities, who presumably have already been identified?

We believe that enhanced SLD identification is not a goal of the RTI anointed. Support for this view is found in statements noting the presumed advantages of RTI: “Most significant is that the focus shifts from eligibility to concerns about providing effective instruction” (Fletcher, Coulter, Reschly, & Vaughn, 2004, p. 311; see also Boardman & Vaughn, 2007). Although the goal of providing effective instruction is meritorious, we believe the real goal of RTI is to foster greater collaboration with general education and essentially create a unified system without an independent special education (see Batsche et al., 2005). Hollenbeck (2007) stressed the general education aspect of RTI: “With its emphasis on improving general education for all learners, RTI has the potential to positively impact students across educational settings” (p. 144). Fletcher et al. (2004) endorsed the general education emphasis in RTI by suggesting that RTI “approaches facilitate the integration of general and special education around instruction, line up IDEA with the laudatory goals of NCLB, and lead to federal regulations and conceptual models of LD consistent with our best research about teaching and learning” (p. 327). IDEA appears to be referenced only because RTI must be perceived as a special education initiative in which the enduring problems associated with SLD identification provide convenient cover for deforming the SLD category and altering long-standing special education roles and responsibilities.

FEDERAL LEGISLATION AND RESPONSE-TO-INTERVENTION

We believe that the impetus for promoting RTI is not found in IDEA but rather in No Child Left Behind (NCLB) (2001) legislation (PL 107-110). The NCLB foundation provides the reason for general education embracing RTI when historically many special education initiatives (e.g., inclusion) have not been so readily embraced (see Kauffman & Hallahan, 2005). Implementation of NCLB implicitly assumes that all children will succeed, or that no child will be left behind, which will require progress levels that many students simply will not attain. Although commendable in its goal, NCLB, because it ignores important realities, seems doomed to failure and may do more harm than good (Kauffman, 2004, 2005; Kauffman & Konold, 2007).

Inevitably, schools must deal with less proficient students. NCLB legislation mandates that schools failing to make adequate yearly progress (AYP) must provide students the opportunity to attend a better performing school. If this change is not successful and subsequent AYP standards are not met, increasingly severe sanctions may be leveled. Kauffman and Konold (2007) commented on the counterproductive nature of removing resources from students who fail to meet AYP goals:

These schools and the students that comprise them are placed in even greater danger to fail, thereby contributing to a widening achievement gap, rather than a narrowing of it. Moreover, the ‘successful’ schools to which students are transferred from ‘failing’ schools will inevitably encounter the very same statistical realities and will predictably, fail in future years. The very policy itself is internally destructive to the goals it has laid out. (p. 79)

The RTI process ostensibly provides a means to achieve the unrealistic requirement that all students achieve a minimum standard regardless of their inherent limitations: “RTI is partly a reflection of a greater commitment to the philosophical ideal that all children can learn” (Cruey, 2006, p. 1). Thus, the vision of the anointed seems to endorse instructing less proficient students in general education in order to be consistent with NCLB mandates, not IDEA regulations (e.g., Barnett, Daly, Jones, & Lentz, 2004; Fletcher et al., 2004; D. Fuchs & L. Fuchs, 2006).

For example, the claim by Sternberg and Grigorenko (2002) that “by excluding from remediation those poor readers who do not show IQ- based discrepancies, we effectively take away their only chance to become better readers” (p. 80) appears logically flawed. First, the word “remediation” implies a cause of failure other than disability (e.g., inadequate instruction), which places both the origin of the problem and its resolution within the realm of general education, not special education. Second, it is assumed (falsely) that changing the operational definition of SLD is the “only” way to help non- discrepant struggling readers, which obviously it is not. Rather, if the purpose of RTI is “to identify a subset of children at risk for poor outcomes due to their unresponsiveness” (Vaughn & L. Fuchs, 2003, p. 138), we have a general education activity that will be funded with special education monies since IDEA permits an LEA to allocate 15% of its federal funding to develop and implement early intervention services (i.e., RTI). Without the promised “full funding” for special education, the diverted monies mean that special education funds will be used for non-special educational activities. How is lost funding a benefit for students truly needing or already receiving special education services?

Since 1975, special education policy has been guided by IDEA but, upon examination, its provisions appear incompatible with the objectives of NCLB. Johns (2004) described it as follows.

It is most difficult over the long term to be both ‘equal’ and ‘unequal’ at the same time. IDEA allowed (even demanded) unequal treatment. It demanded individualization – not one size fits all. NCLB demands equal treatment with once-a-year tests in reading and math as the measuring instruments. IDEA focuses entirely on the individual. NCLB focuses entirely on the group. (p. 89)

The lack of individualization in both instruction and assessment means that the essence of special education is lost, and illustrates the danger in trying to create a single system where NCLB gains priority over IDEA.

PROFESSIONAL REPORTS AND THEIR INFLUENCE ON RESPONSE-TO- INTERVENTION

The President’s Commission on Excellence in Special Education and RTI

A number of reports (e.g., Learning Disabilities Summit, President’s Commission on Excellence in Education) stressed the problems associated with the discrepancy criterion and focused attention on RTI as a viable alternative. The RTI anointed point out that their views are based on “participation in three recent consensus reports in special education, each of which addresses the identification of SLD. The reports represent diverse groups of researchers, policy makers, practitioners, and advocates …” (Fletcher & Reschly, 2005, p. 11). We believe the reports disguised the real purpose of RTI and represent examples of how the vision of the anointed is assumed to be both factually correct and on a higher moral plane. Thus, the reports appear to provide a false rectitude because “they reveal more about foregone conclusion and ideological dogma than evidence-based recommendation” (Kavale, Kaufman, Naglieri, & Hale, 2005, p. 23). The vision of the anointed refers to the President’s Commission on Excellence in Special Education (PCESE) (2002) as a guiding report, but this effort has been criticized (Kauffman, 2004; Kauffman & Wiley, 2004). The PCESE attempted to reconcile IDEA and NCLB by calling for a school climate in which accountability is primary. The PCESE emphasized the need to close the achievement gap, which may mean either (a) the gap between the achievement of every student in special education and the achievement of the typical student in general education, or (b) the gap between the average achievement of students in special education and the average achievement of students in general education. These distinctions are without merit because, “Either way, there is a huge chasm between the expressed desire and the nature of disability. The gap to which the PCESE refers is simply not closable for reasons obvious to anyone with a rudimentary understanding of statistics and disability” (Kauffman, 2004, p. 309).

Kauffman and Wiley (2004) also questioned the PCESE recommendations regarding identification of students with disabilities and prevention. The PCESE (2000) report concluded that present identification methods lack validity and, that consequently misidentification is rampant: “Many children who are placed in special education are essentially instructional casualties and not students with disabilities” (p. 26).

Misidentification may be avoided if special education were to adopt a model based on prevention; that is, identification precedes failure. Although a noble goal, it may not be possible to achieve without some basis for anticipating failure: Who are the children we should identify in order to prevent disability? Problems associated with identification (e.g., “false positives”) are not resolved, and may be made worse because “a prevention model increases false positives – always, inevitably, with mathematical certainty” (Kauffman, 2004, p. 313; see also Kauffman & Konold, 2007). Thus, the two ideas, that is, assertions about misidentifications and adoption of a prevention model, “are logical contradictions. The logical conclusion is that the PCESE hasn’t thought through its findings or its recommendations…” (p. 314). In fact, it is possible that the earlier the prevention efforts take place, the less precise the identification process becomes, which creates the potential for yielding even more false positives (Gersten & Dimino, 2006).

In concluding their analyses, Kauffman and Wiley (2004) suggested that the PCESE “systematically devalues what special education is and what special education does” (p. 5). We, therefore, see no reason to be impressed by the PCESE and its support for RTI. In evaluating the validity of PCESE recommendations, Kauffman (2004) warned that, “The truth of a statement is not determined by who makes it” (p. 308). Although the anointed (e.g., Fletcher & Reschly, 2005) influenced the PCESE, we side with those who question the wisdom of the PCESE report.

The Summit on Learning Disabilities and RTI

The Summit on Learning Disabilities sponsored by the Office of Special Education Programs (see Bradley et al., 2002) is included in the vision of the anointed to support recommendations about RTI for SLD identification. The title of the Summit report alludes to an enduring problem surrounding terminology. In IDEA, the category defined is “specific learning disability,” connoting a singular and particular condition. Yet, the vision of the anointed continually refers to the plural form “learning disabilities,” a designation that moves the condition from the specific to the general. As SLD becomes increasingly generalized, the construct tends to lose meaning until a point is reached where the term “learning disabilities” may or may not include SLD.

The vision of the anointed assumes that there are many “learning disabilities” because of the problems created by the heterogeneity found in the SLD population (Kavale & Forness, 1995). In reality, the “problem” of heterogeneity is also found in other high- incidence, mild disability groups (e.g., MR and EBD), and should be taken to simply mean that no two students with SLD are alike. The fiction surrounding heterogeneity is necessary in order for the special education category of SLD to include students who may not be SLD.

Consequently, the vision of the anointed seems misinformed by suggesting that, “LD is rarely conceptualized as a single disorder, but instead is represented as a general category composed of disabilities in any one or combination of several academic domains” (Fletcher et al., 2002, p. 206). This misleading statement is readily negated if SLD is properly conceptualized as a single condition likely to manifest a variety of symptoms. The very designation “specific” indicates that SLD is not a general category, but for the vision of the anointed to be achieved, SLD needs to be transformed into a generic and ill-defined entity that may include any form of academic failure under the SLD label (Kavale & Forness, 1998).

Because of the way RTI has focused almost exclusively on reading achievement, the SLD concept has essentially morphed into reading disability (RD). The problem is that reading difficulties represent only one potential symptom, or indicator, of SLD. Although a large proportion of students with SLD manifest reading difficulties, there is little justification for focusing identification efforts solely on assessment of reading progress. According to Occam’s Razor (“No more things should be presumed to exist than are absolutely necessary”), discussion about RD should not be a primary factor in deliberations about SLD status. Although RD itself is a legitimate concept, it is not what makes SLD what it is. The presence of RD does not represent the essence of SLD, which is better articulated in, for example, constructs like unexpected school failure and processing deficits (Kavale & Forness, 2000). If SLD and RD are viewed as equivalent, only one designation would be necessary. The emphasis on reading in the vision of the anointed suggests that RD is the favored concept, but then the practical problem arises about how to provide special education services for students with RD, which is not a category defined in IDEA.

Because of problems surrounding definition, the reality of SLD has often been called into question by terming it a “myth” (McKnight, 1982) or “imaginary disease” (Finlan, 1993). With the integrity of SLD undermined, it becomes possible to blur distinctions between SLD and RD, thus providing students with RD convenient entry to special education. In the vision of the anointed, SLD and RD appear interchangeable, as evidenced in a paper entitled “Identifying reading disabilities [italics added] by responsiveness-to-instruction: Specifying measures and criteria” (D. Fuchs, L. Fuchs, & Compton, 2004), whose abstract begins: “We describe two types of assessment (problem solving and standard treatment protocol) within a ‘responsiveness-to-instruction’ framework to identify learning disabilities” [italics added] (p. 216). Thus, the vision of the anointed appears to view SLD and RD as equivalent, but such a counterfactual conception is inconvenienced by a simple actuality: RD is not equivalent to SLD (Kavale & Forness, 1995).

The LD Summit report included several consensus statements, some of which are important for discussions about RTI. One statement concerned the SLD concept and indicated that, “Strong converging evidence supports the validity of the concept of specific learning disabilities (SLD)” (Bradley et al., 2002, p. 792). Although a seemingly positive statement, it illustrates the tendency to use the plural (“disabilities”) when referring to what should be the singular (“disability”). IDEA clearly defines “specific learning disability,” but the persistent use of the plural, although linguistically easier, moves the construct conceptually in a direction that makes it less precise and open to varying interpretations. The use of the plural form appears to support the view that meaning resides, not in language itself, but in individuals who interpret language based upon their own unique perspective (i.e., vision of the anointed) (Grenz, 1996). Consequently, when the vision of the anointed supports the use of the term SLD “to emphasize the difference between children with SLD and those with general learning difficulties” (p. 793), it seems disingenuous since the vision of the anointed moves the SLD construct away from its original conceptualization in order to accommodate a new class of students who possess primarily reading problems but are not otherwise SLD in any significant sense. In essence, “SLD will be SLD in name only. … The RTI process would move SLD in a direction that further removes it from any of its conceptual foundations” (Batsche, Kavale, & Kovaleski, 2006, pp. 24- 26).

Although attempts to obscure categorical distinctions would be denied in the vision of the anointed (e.g., Fletcher et al., 2004; D. Fuchs & L. Fuchs, 2006), Mastropieri and Scruggs (2005) contended that,

If elimination of the category of [S]LD is sought, then this specifically should be the topic of discussion. If it is not, then discussion is needed that demonstrates how RTI identification procedures will preserve the category of [S]LD while improving identification of students with [S]LD. (p. 529)

A major focus of the LD Summit was on the ability-achievement discrepancy, the primary criterion for SLD identification since 1977. The vision of the anointed included a polemical campaign to eliminate discrepancy from SLD identification procedures (e.g., Aaron, 1997; Stanovich, 2005; Sternberg & Grigorenko, 2002). One LD Summit paper, however, concluded that ability-achievement discrepancy was a legitimate construct that was psychometrically defensible (Kavale, 2002). As the operational definition of underachievement, discrepancy represents a critical marker for SLD determination that permits its differentiation from low achievement (see Kavale & Forness, 2000). The vision of the anointed included a consensus statement indicating that, “IQ/achievement discrepancy is neither necessary nor sufficient for identifying individuals with SLD” (Bradley et al., 2002, p. 796). However, it was accompanied by a minority statement indicating that, “Aptitude/achievement discrepancy is an appropriate marker of SLD” (p. 796). Consequently, discrepancy was not eliminated in the reauthorized IDEA but modified to indicate that “a local educational agency shall not be required to take into consideration whether a child has a severe discrepancy between achievement and intellectual ability” (PL 108-446, Sec. 614 (b)(6)). With ability-achievement discrepancy not eliminated, the vision of the anointed incorporated contorted forms of discrepancy in order to maintain the concept but alter its traditional meaning (Fletcher, Denton, & Francis, 2005). For example, Peterson and Shinn (2002) described an “absolute achievement discrepancy” defined by severe low achievement “operationalized as a discrepancy between average national achievement; e.g., 50th percentile and actual student achievement on commercially available norm-referenced achievement tests” (p. 462), and a “relative achievement discrepancy,” defined by a severe achievement discrepancy from a local achievement standard (p. 463). In another iteration, L. Fuchs (2003) described a “dual discrepancy” model that assessed both intervention efficacy and progress in reading growth. Children who are below peers in both intervention outcome level and slope of reading progress would be considered SLD (e.g., Burns & Senesac, 2005; D. Fuchs, L. Fuchs, McMaster, & Al Otaiba, 2003; Speece, Case, & Molloy, 2003). In reality, however, the intended meaning and purpose of the ability-achievement discrepancy criterion is not captured in any of these alternative forms (Kavale, 2002).

In evaluating the potential of RTI, the LD Summit indicated that, “Response to quality intervention is the most promising method of alternative identification and can promote effective practices in schools and help to close the gap between identification and treatment” (Bradley et al., 2002, p. 798). Descriptions of RTI emphasize its instructional aspects but, at the same time, indicate that RTI represents “one way of conceptualizing learning disabilities (LD) is to apply research-validated interventions and then identify the small subset of children who do not respond as having LD” (L. Fuchs, 2003, p. 172).

D. Fuchs and L. Fuchs (2005) illustrated the RTI identification process by presenting four case studies. After describing reading instruction at Tier 1 and Tier 2, and the measure (curriculum-based measurement – word identification fluency), one student was not at risk, two students were at risk but responsive, while one student was unresponsive and deemed as having a disability. After excluding MR and EBD with brief screening measures, the student was classified as SLD. However, questions arise about the validity of the SLD classification: What essential markers of SLD were evaluated? What is the basis for SLD classification? How was RTI diagnostic of anything other than early reading failure? As suggested by Kavale (2005),

In reality, there is [no basis for SLD classification] unless there is some legerdemain in which all RD magically transforms itself into SLD. The real problem with the RTI model lies not in the procedures themselves but rather in the leap of faith necessary for unresponsiveness to become SLD. (p. 559)

The vision of the anointed includes a favorable view of RTI because the primary concern appears not to be with valid SLD identification but to ensure that (a) students receive good instruction (something that all of us would like to see), (b) students who are not performing as desired get extra instruction immediately (something that no one can argue against), and (c) the SLD category becomes the convenient home for those who otherwise might be left behind (something that perverts the category and is consistent only with the fantasy world of NCLB). Two out of three may seem like a convincing case, but as Kauffman and Konold (2007) argued, only one proposition not grounded in reality is sufficient to undermine an otherwise good policy.

THE ROLE OF RTI IN THE IDENTIFICATION PROCESS

Defining Response-to-intervention and Specific Learning Disability

If the vision of the anointed was really focused on enhancing SLD identification, attempts to resolve the long-standing problem of SLD definition would have been attempted (see Kavale & Forness, 2000). The number of SLD definitions proposed over the past decades suggests that no single effort has achieved consensus status. Consequently, the definition first proposed in 1968 and codified in 1975 has been maintained almost unchanged in federal legislation.

In commenting on the definition of SLD, Willis and Dumont (2006) asked, “Has Congress provided us with a better definition leading to more appropriate diagnosis of SLD, or has the definition just gotten worse?” (p. 907). With no substantive change in the SLD definition, neither view seems correct, and it appears that the SLD definition will continue to fail to provide “two critical elements: understanding – a clear and unobscured sense of SLD – and explanation – a rational exposition of the reasons why a particular student is SLD” (Kavale & Forness, 2000, p. 240). As suggested by Kavale (2005), “The present SLD definition is too broad to be wrong and too vague to be complete” (p. 553). Consequently, it seems curious that the LD Summit did not provide a rationale for either modifying or maintaining the present contentious definition while, at the same time, sanctioning the SLD concept. What SLD construct was there consensus about at the LD Summit?

Technically, it seems incorrect to suggest that RTI may be the basis for “redefining learning disabilities” (see Vaughn & L. Fuchs, 2003). To be used in practice, a formal definition must be translated into an operational definition: rules stipulating how a concept is to apply in a particular case if specified actions yield specified characteristic results (Bergmann, 1961). In a scientific sense, an operational definition possesses a logical and rational relationship to elements described in the formal definition. Otherwise, the risk of proposing spurious operations is substantial. Consider the example provided by Kavale and Forness (2000) of the Learning Disability Coefficient (LDC) operationally defined as white blood cell count multiplied by body weight divided by hat size. The LDC is absurd because,

it would possess little meaning or significance because a good deal is known about LD, and the LDC does not ‘fit’ with any of the existing knowledge. Thus, it is possible to operationalize anything, but whether it ‘makes sense’ is a different matter. (p. 247)

For SLD, however, the process of developing an operational definition appears to have been neither logically nor rationally sufficient to maintain scientific integrity. For example, the federal SLD definition contains no reference to underachievement, which would have provided a valid basis for including its operational definition of discrepancy. For a complex phenomenon like SLD, it seems unlikely that any single element (e.g., discrepancy) can capture that complexity (Lloyd, 2002). Thus, statements suggesting that SLD identification “hinges on an implicit classification of underachievers into those with LD and those with other forms of low achievement” (Francis et al., 2005, p. 103) demonstrate significant confusion: SLD is the only defined special education category that includes the concept of underachievement.

The replacement of discrepancy with RTI as the operational definition of SLD will not resolve the problem of basing a classification on a single indicator not specifically articulated in the definition. Consequently, it is difficult to discern how the vision of the anointed can suggest that, “the deceptive ease of simple univariate (i.e., low achievement) and bivariate (IQ- achievement discrepancy) endpoint approaches to the identification of LD cannot be mistaken for validity or conceptual clarity” (Francis et al., 2005, p. 104), while that same vision can also suggest that “nonresponders represent a better indicator of the construct of LD” (p. 107).

In an unintended miscalculation, the vision of the anointed was correct in concluding that “IQ and achievement scores are not sufficient” (p. 95) for SLD identification. The simple fact is that discrepancy is not a proxy for SLD and represents a necessary but not sufficient criterion for valid SLD classification (Kavale, 2002). Likewise, RTI is not a proxy for SLD but, unlike discrepancy, which validates the presence or absence of an accepted construct (i.e., underachievement), RTI can only validate the self-evident fact that a student is experiencing reading problems. The NRCLD (Johnson, Mellard, D. Fuchs, & McKnight, 2006) acknowledged this view by indicating that “RTI should be considered to be one important element within the larger context of the SLD determination process. RTI as one component of SLD determination is insufficient as a sole criterion for accurately determining SLD” (p. 3).

The inadequacy of an approach focusing exclusively on a low achievement criterion is seen in the diagnostic criteria for SLD proposed by Dombrowski, Kamphaus, and Reynolds (2004) in After the demise of discrepancy: Proposed learning disabilities diagnostic criteria. Why is it inadequate? First, SLD is given a new name – developmental learning delay; this is not the way to fortify the existing SLD definition. second, the proposed diagnostic framework includes only a one standard achievement score cutoff (i.e., 85 or below) with no appraisal of the presence or absence of either underachievement or processing deficits. Essentially, this is an absolute low-achievement definition that fails to capture consequential elements of SLD. As suggested by Mather and Gregg (2006), “The Dombrowski et al. diagnostic framework does not take into account and incorporate findings from current research or historical and clinical perspectives regarding identification of individuals with LD” (p. 99). What Is Response-to-intervention?

RTI is best viewed as an instructional model, not an identification model. Consequently, it should not be the basis for SLD identification even though the vision of the anointed indicates that RTI has “the potential to be as good as traditional measures in regard to eligibility determination” (Reschly, 1988, p. 498). In reality, classroom teachers have always been aware of students experiencing difficulties in learning to read and have usually sought accommodations for those students.

Since the 1980s, support for general education interventions as an alternative to special education has been termed “prereferral,” which has been articulated in several models (e.g., school-based intervention teams, teacher assistance teams, instructional support teams) (e.g., Buck, Polloway, Smith-Thomas, & Cook, 2003; Truscott, Cohen, Sams, Sanborn, & Frank, 2005). In general, prereferral activities have produced positive outcomes (Burns & Symington, 2002), but problems have been noted surrounding limited guidance about professional roles and responsibilities, lack of validated intervention strategies, inconsistent progress monitoring, and increased costs (e.g., Buck et al., 2003; Ross, 1995; Truscott et al., 2005).

Although the mechanics of RTI as an SLD identification process remain vague, most descriptions of RTI connote resemblance to prereferral activities, whose potential benefits include “increased achievement school wide, because struggling children are identified proactively and immediate help is provided to determine whether or not more intensive help is needed, as well as a coherent and flexible system of services” (VanDerHeyden, Witt, & Barnett, 2005, p. 339). In fact, VanDerHeyden, Witt, and Gilbertson (2007) demonstrated the positive effects of an RTI model, whose purpose “was to identify early those students at-risk for academic problems [and] to enable teams to more accurately determine who should be referred for evaluation and eligibility determination” (p. 249). Thus, “The RTI model appears to be prereferral writ large with greater specification about the types of reading interventions and outcome assessments that should be used” (Kavale, 2005, p. 557), which should serve to improve consistency in implementation (see Burns, Vanderwood, & Ruby, 2005). Yet, NASDSE (2006) indicated that a vision that suggests RTI as only prereferral is mythical because, “RTI is more than prereferal [sic] services; it is a comprehensive service delivery system that requires significant changes in how a school serves all students” (p. 2). Unfortunately, those changes involve undermining special education and contorting the nature of the SLD category.

Even if viewed as a prereferral process, RTI is not seen as being related to SLD identification or special education, as suggested by NASDSE (2006): “When thought of as a prereferral system, [RTI] remains the province of special education and the desired integration of general education and special education services around the goal of enhanced outcomes for all [italics added] students will not [italics added] be achieved” (p. 2). Thus, the emphasis on all students suggests that the goal of enhanced SLD identification is a limited concern.

Could the emphasis on service for all children explain the dearth of information about RTI as an identification process? Although the special education literature is replete with discussions about instructional aspects of RTI (e.g., Denton, Vaughn, & Fletcher, 2003; Noell & Gansle, 2006; Olinghouse, Lambert, & Compton, 2006), technical aspects (e.g., measurement) of RTI (e.g., Barnett et al., 2006; D. Fuchs, L. Fuchs, & Compton, 2004; L. Fuchs, 2003), and development of RTI instructional models (e.g., Ardoin, Witt, Connell, & Koenig, 2005; McMaster, D. Fuchs, L. Fuchs, & Compton, 2005; Vaughn, Linan-Thompson, & Hickman, 2003), descriptions of how RTI functions as an identification procedure are lacking. Even the NCRLD says little about RTI as an SLD identification process (e.g., Mellard et al., 2004; Mellard, Deshler, & Barth, 2004). The Collaborative Project (2006), in “New roles in response to intervention,” although indicating that “RTI may be used as part of a process to identify students with [SLD] rather than relying on the use of a discrepancy model as a means of identification” (p. 2), offers no insight into how RTI functions as an identification procedure.

Instead, the vision of the anointed places emphasis on how “the educational system must use its collective resources to intervene early and provide appropriate interventions and supports to prevent learning and behavioral problems from becoming larger issues” (Collaborative Project, 2006, p. 2). We agree that early intervention is important, but the RTI model cannot deliver the defining feature of special education – individualized instruction. Instead, RTI delivers a “one size fits all” approach that focuses on methods for determining treatment validity and says little about selecting interventions, ensuring treatment integrity, or evaluating whether interventions are indeed effective or generalizable. As suggested by Kavale et al. (2005), “scientific, research-based intervention [in RTI] translates into Try something, anything, try to measure it well, make sure the teacher does what might or might not help, and if the child doesn’t get better, then he’s [sic] SLD'” (p. 21).

Response-to-intervention and Identification of SLD

With the vision of the anointed providing little insight into the mechanics of RTI in SLD identification, why should it be discussed as a diagnostic procedure? Although nonresponsiveness may possess “ecological validity” (see Dean, Burns, Grialov, & Varro, 2006), because RTI models “demonstrated strong effects in improving student learning and systematic variables” (Burns, Appleton, & Stehouwer, 2005, p. 389), the failure to respond is of little import for SLD identification unless it is deemed that nonresponsiveness equals SLD. Ecological validity only serves to support RTI as a prereferral activity.

The absurdity of a “diagnosis by fiat” scenario in SLD identification can be readily avoided if RTI activities are properly viewed as prereferral. With its rigorous and systematic procedures, RTI can enhance the prereferral process and achieve the aim of reducing the number of unnecessary referrals. As prereferral, RTI models can avoid having to answer a question for which few answers presently exist: What do practitioners do after the RTI process concludes that a student is a treatment resister? Although the student is deemed to have an SLD, this conclusion must be placed in the context of having neither uniform teaching techniques, assessment tools, expected outcomes, nor formal timelines, but only the assumption that the teaching has been “scientifically validated.” Consequently, RTI is not falsifiable – no one can demonstrate that RTI methods were ineffective. We can, therefore, blame any child’s failure to respond on the child because instruction is held blameless (Kavale et al., 2005).

To avoid a situation where a student is simply declared to have SLD, RTI procedures should be combined with psychometric testing. Wodrich, Spencer, and Daley (2006) provided reasons why RTI needs to be combined with psychoeducational assessments. Specifically, use of RTI alone makes it difficult to (a) distinguish SLD from mild mental retardation, (b) distinguish students with SLD from slow learners, (c) identify intra-individual differences, (d) determine the meaning of a positive RTI, and (e) identify the best means to implement effective interventions. Models that combine RTI and psychometric assessment have been described (e.g., Flanagan, Ortiz, Alfonso, & Dynda, 2006; Kavale & Flanagan, 2007), and are necessary because, “An RTI model without a comprehensive evaluation cannot identify SLD because it is not aligned with the construct of SLD” (Ofiesh, 2006, p. 887).

Cognitive processing assessment aligns diagnostic procedures with a clearly articulated SLD definitional component: a disorder in one or more of the basic psychological processes. Willis and Dumont (2006) noted that the federal government has paid scant attention to disorders of processing even though such disorders define SLD: “Practitioners have been given the regulatory definition of what a specific learning disability is, but then, in essence instructed to ignore it” (p. 907). With “intrinsic processing weaknesses” as an important component of SLD (see Torgesen, 2002), “We believe children with ‘true’ SLD have cognitive deficits and integrities in the basic psychological processes, which often lead to academic failure” (Kavale et al., 2005, p. 17). A major problem is in understanding how RTI can identify processing disorders but can be avoided if SLD identification includes procedures to “identify the specific cognitive and/or linguistic correlates that appear to be related to the identified area of underachievement or relative difficulty” (Mather & Gregg, 2006, p. 103).

The process is aided by modern conceptualizations of cognitive processing that have moved well beyond outmoded perceptual-motor theories (e.g., those of Newell Kephart or Marianne Frostig) and now provide far more dynamic views of cognitive ability than previous conceptions, which were based on a singular global ability (g). A. Kaufman and N. Kaufman (2001) detailed an array of well-validated cognitive ability tests that have incorporated advances in multifactorial intelligence theory and neuropsychological assessment practices. Although the vision of the anointed suggests intelligence tests are irrelevant (D. Fuchs & Young, 2006), the value of modern tests of cognitive processing is found in their ability both to predict academic performance (Naglieri & Bornstein, 2003), and to identify processing strengths and weaknesses that have relevance for both identification and intervention (Hale & Fiorello, 2004; Naglieri, 2003). A comprehensive assessment also offers the possibility of distinguishing students with SLD from those who are failing to achieve for other reasons (e.g., MR, EBD). Although pervasive criticism has created the perception that SLD does not exist, “LD is real and … describes problems that are distinct from other conditions subsumed under the broad category of problems in learning and achievement” (Keogh, 2005, p. 107). As Bateman (2007) noted, IDEA is built on the presumption that the disabilities listed in the law are real and can be defined and identified. Consequently, it is misleading to suggest that students with SLD are simply “victims of ‘poor teaching’ [or] that many children identified as LD are ‘teaching disabled'” (Wright & Wright, 2007, p. 1).

Without a comprehensive assessment, it would not be possible to document the presence or absence of under-achievement, the critical SLD marker operationally defined by discrepancy. Without the ability- achievement discrepancy criterion, the notion of SLD as unexpected learning failure in the presence of average or above-average cognitive ability cannot be verified. Although the vision of the anointed does not view discrepancy as a necessary element (see Speece & Shekitka, 2002), valid SLD identification demands that discrepancy remain an essential component for documenting unexpected learning failure (Keogh, 1987; Mastropieri & Scruggs, 2002). How is one to estimate what a student should be able to achieve if not by using a test of ability? Are we simply to make the obviously absurd assumption that all children have the same ability to achieve at an average level, although some do not? Or are we to rely simply on teacher estimates with all their known subjectivity and vagaries?

The RTI approach, with its nonresponsiveness criterion and absence of cognitive ability testing, essentially excludes unexpected learning failure as a parameter of SLD. In reality, efforts by the RTI anointed to attenuate the SLD category have led to a situation in which “the logical relation shifts from All students with SLD have learning problems to All students with learning problems have SLD” (Kavale, 2005, p. 554). With the shift to generalized learning problems instead of SLD, the RTI anointed are satisfied in suggesting that,

If RTI is done thoroughly and correctly there should not be a need for a comprehensive evaluation. In fact your ‘hit rate’ for students in need of special education services will be better under a data based RTI approach than if using the traditional method of discrepancy. (LD Talk, 2007, p. 10)

Although the “hit rate” for students needing special education will be much improved, the “hit rate” for SLD will not be known.

When a student does not meet the discrepancy criterion and, therefore, cannot be deemed an underachiever, there is the strong possibility that the student is a “slow learner” (SL; i.e., a student with an IQ level between about 70 and 85). About 14% of the school population may be deemed SL, but this group does not demonstrate unexpected learning failure, but rather an achievement level consonant with IQ level. Although NCLB makes such low achievement problematic, slow learner has never been a special education category, and “What should not happen is that a designation of SLD be given to a slow learner” (Kavale, 2005, p. 555).

The discrepancy criterion provides the means to differentiate SLD and SL. RTI offers no such mechanism. Consequently, RTI cannot answer a critical question posed by Mastropieri and Scruggs (2005), “If RTI cannot discriminate, how can it classify?” (p. 528). In fact, RTI cannot classify, but the vision of the anointed finds SLD “a tempting target for their goal of creating a category for children experiencing academic failure who, without additional instruction might be ‘left behind'” (Kavale et al., 2005, p. 21). “If your child’s IQ is between 76 and 90 (that’s between 15% and 20% of all kids), the Response to Intervention model probably brings them help they’re not getting now” (Cruey, 2006, p. 1). The humanistic plea for additional academic support in the vision of the anointed has led to RTI being improperly viewed “as a means of reallocating resources – away from discrepant, middle class children of dubious disability to nondiscrepant, low-socioeconomic-status, low-achieving students [with no disability]” (D. Fuchs & L. Fuchs, 2006, p. 96).

The predominance of the vision of the anointed has fostered poor diagnostic practice, resulting in the de facto inclusion of both SLD and SL individuals in the same category. Instead of continuing to subvert the SLD category, policy “should be directed at establishing SLD as the particular disability class originally intended when first introduced into special education” (Kavale et al., 2005, p. 21).

RTI: Questions and Answers

A special issue of Assessment for Effective Intervention (Burns & VanDerHeyden, 2006) was devoted to the topic “Using response to intervention to assess learning disabilities.” One article presented a dialogue where “Kovaleski poses key questions about the meaningfulness and utility of RTI as a diagnostic tool. Batsche and Kavale each respond, representing dichotomous views [i.e., a conflict of visions]” (pp. 3-4). The questions covered several topics, including basic premises of RTI, research base for RTI, implications of RTI for the SLD construct, and impact of RTI in the general-special education system. Although a majority of responses revealed disagreement, Kovaleski also noted that,

Both Batsche and Kavale appear to agree that the RTI procedures should be adopted in general education to help structure the support system for improved learning for all students [i.e., prereferral]. The difference of opinion emerged when RTI was proposed as a basis for diagnosing SLD. (Batsche et al., 2006, p. 17)

Kovaleski went on to suggest that, “the paradigmatic differences between the positions illustrated in this article are perhaps irresolvable, in that underlying the two positions are decidedly different viewpoints regarding the basic nature of SLD” (Batsche et al., 2006, p. 17).

The different viewpoints are illustrated in a response to the conversation offered by Vaughn and L. Fuchs (2006), who subtitled their paper “Why response to intervention is necessary but not sufficient for identifying students with learning disabilities [italics added].” We believe the focus should be on identifying students with specific learning disability (SLD), the category defined in the law; students with (general) learning disabilities are relatively easy to identify but those with a SLD are not.

The widespread use of the term “learning disabilities” seems predicated on a conventional wisdom that questions the validity of SLD as a distinct classification. The origins are found in research conducted by Ysseldyke, Algozzine, Shinn, and McGue (1982) who, citing significant group overlap on psychoeducational assessments, suggested that SLD had become primarily a category of low achievement (LA): “The results of this investigation raise serious concerns regarding the differential classification of poorly achieving students as either LD or non-LD” (p. 82). However, Kavale, D. Fuchs, and Scruggs (1994) demonstrated, using the Ysseldyke et al. data, that students with LD and LA could be reliably distinguished from each other, with the LD group being the lowest of the low achievers but equivalent to the LA group on ability (i.e., IQ). Consequently, SLD and LA “represent two distinct populations … defined by an ability-achievement distinction” (Kavale, 1995, p. 146). Thus, failure of the vision of the anointed to recognize SLD as a distinct classification is necessary because RTI can only identify achievement differences when, in fact, valid SLD classification requires both achievement and cognitive ability information.

Vaughn and L. Fuchs (2006) suggested that the conflict of visions may be related to what they term “connectedness”:

Batsche and other RTI proponents seem primarily concerned about RTI as a prevention mechanism, and this is where the bulk of the RTI evidence resides. By contrast, Kavale and fellow opponents seem to focus their attention on how RTI will affect the integrity of the LD classification, and this is where much less research has been conducted, (p. 60)

We agree with the above and believe it is, therefore, incumbent on RTI proponents to demonstrate how RTI can function as a diagnostic procedure for SLD as defined in IDEA, and not focus on general, non-specific learning problems. Although SLD identification continues to be a major RTI theme, in reality, identification appears to be, at best, a secondary concern while the goal of prevention seems primary.

IDENTIFICATION OF SPECIFIC LEARNING DISABILITY AND RESPONSE-TO- INTERVENTION

The dearth of research literature on RTI as an identification process suggests either that RTI is difficult to conceptualize as a diagnostic model or that there is limited interest in doing so. Both explanations seem reasonable considering the lack of research on RTI as a diagnostic process and the focus on prevention that aligns RTI with NCLB instead of IDEA. Given the present status of RTI research, and to resolve the conflict of visions surrounding RTI, we make the following recommendations: 1. Reform RTI into what it is: prereferral intervention.

2. Make RTI activities the exclusive province of general education.

3. Involve special education only after there is RTI failure, when the process shifts from prevention to identification.

4. Base identification on a comprehensive psychometric assessment that is designed to provide both diagnostic and instructional data.

5. Change regulations to (a) require use of abilityachievement discrepancy as the first (but not only) marker for SLD, (b) require use of “a process that determines if the child responds to scientific, research-based intervention” before SLD evaluation procedures, and (c) eliminate the 15% special education funding for RTI development and implementation.

CONCLUSIONS

The recommendations for policy change offered here provide a means whereby prevention is followed by increased confidence in the validity of SLD classification (Zach, 2005). A focus on enhanced SLD identification will eliminate potential “diagnostic chaos [in which] the number of false positives and false negatives may increase significantly because of a failure to know what a true positive should be” (Kavale, 2005, p. 560). A revised policy that incorporates the best of both visions (anointed and benighted) eliminates a polarizing either/or perspective about the value of RTI and cognitive testing where “never the twain shall meet” (Willis & Dumont, 2006, p. 901).

Scruggs and Mastropieri (2002) provided validity criteria for identification procedures that are not met when RTI is used as the exclusive identification procedure. Similarly, Keogh (2005) discussed three criteria for determining the adequacy and utility of identification procedures: (a) homogeneity, similarity of those included in a category; (b) reliability, degree of agreement when placing individuals in a category; and (c) validity, how well category membership informs treatment.

In reality, RTI can only meet these criteria when combined with a comprehensive psychometric evaluation. As Keogh (2005) suggested, cogent identification procedures “require careful and critical thinking and discussion, and a great deal of empirical work” (p. 102). Presently, RTI does not possess the requisite research base: “the research base on RTI is presently very limited, especially compared to the expansive claims being made for the procedures” (Scruggs & Mastropieri, 2006, p. 61). Fuchs and Deshler (2007) argued against accepting a “we-know-all-we-need-to-know message about RTI and then discussed the importance “of knowing what we don’t know” (p. 130). They also cautioned against characterizing “those raising questions about RTI [the benighted] as uninformed or (worse) temporizing or (much worse) attempting to obstruct wider use of RTI through passive-aggressive intellectualizing” (p. 129). Like the “ideology of full inclusion [that] influenced policy and practice disproportionately to its claims of efficacy” (Kavale & Mostert, 2003, p. 191), RTI must not transcend its ability to support recommendations about SLD identification.

Resolution of the conflict of visions would necessitate the RTI anointed relinquishing the following: exclusive focus on intervention activities, engaging in general education instructional responsibilities, endorsing a more discrete and independent status for the SLD category, and embracing cognitive ability assessment. Because their vision assumes “a special state of grace for those who believe it [and] those who disagree with the prevailing vision are seen as being not merely in error, but in sin” (Sowell, 1995, pp. 2- 3), the RTI anointed are unlikely to abandon any part of their vision, and instead conclude that, “It is unlikely that the minds of these ‘true believers’ [i.e., the benighted] will be changed in the near future” (Reschly, 2005, p. 513). Consequently, recommendations from the benighted are dismissed and “characterized as the opinion of four people with vested interests in current practices who formed what they described as an ad hoc committee that met over a weekend” (Fletcher & Reschly, 2005, p. 14). Any disagreement with the RTI anointed’s vision is viewed as “outright hostility [from] those who personally profit substantially from a traditional refer-testplace system. … The biases and vested interests of these critics should be considered in evaluating their claims” (Reschly, 2004, p. 412).

We urge similar scrutiny of the vision of the anointed for anyone concerned with the probity of special education. The problem surrounds the vision of the anointed failing to recognize that “our collective ‘vested interest’ is upon promoting the accurate identification and timely treatment of individuals with SLD” (Mather & Kaufman, 2006, p. 751). By not acknowledging the vision of the benighted, the vision of the anointed becomes perilous, “because insulation from evidence virtually guarantees a never-ending supply of policies and practices fatally independent of reality” (Sowell, 1995, p. 241). Under the circumstances, the vision of the anointed is “a badge of honor and a proclamation of identity: To affirm it is to be one of us and to oppose it is to be one of them” (p. 241).

Such a divide is unnecessary and should be replaced by a “vision of the rational” (Kavale & Forness, 2000, p. 290) that incorporates facets of both visions (anointed and benighted) into a single vision where extreme positions are avoided. The vision of the rational can create a model where “RTI has us look through a wide-lens telescope at the entire school population whereas cognitive assessments provide a microscope with a direct intensive focus on an individual’s specific needs” (Mather & Kaufman, 2006, p. 751).

As individual states respond to the RTI mandate, a rational vision creates a situation where “both RTI and cognitive assessments can serve to meet the eligibility guideline

Ground-Breaking Surgery Sight and a Vision of the Future

We’re all guilty of taking our eyesight for granted.

As you read this, some of you will wear glasses, some of you will wear contact lenses – but almost all of you will be unable to imagine not being able to read the headline on this page.

For some people however, this disturbing notion is slowly becoming a reality.

Age-related macular degeneration (AMD) is the most common cause of legal blindness in the UK in people over the age of 55.

The macula is a small point on the retina onto which light is focussed by the ocular lens.

Here, a dense collection of light-sensitive cells allow us to see straight-ahead and are needed to read, sew, drive and see fine details.

With AMD, small blood vessels can begin to grow abnormally behind the macula, encouraging the growth of scar tissue and destroying the cells which translate light into neural impulses.

This ‘wet’ AMD is found in about 10 to 15 per cent of cases and in some circumstances treatment may be available on the NHS to halt its progression, which is often rapid.

In the more common ‘dry’ form of AMD, yellow deposits called drusen accumulate under the retina, destroy macular cells and blur central vision.

For this, there is no cure and patients may gradually lose central sight in the affected eye, leaving a blank spot in the middle of their vision.

As it progresses, some patients will be unable to drive, read, see close-up detail or even recognise faces.

Until now, no treatment has been able to restore sight lost as a result of AMD.

However, for some patients a new surgical procedure promises a beacon of hope.

Seventy-three-year-old grandmother Mary Johnson first developed the wet form of the disease in her right eye four years ago.

She said: “At that time there wasn’t a lot they could do about it, but I had treatment and it’s improved a lot.

“Then, last April, I started having problems with my left eye as well.”

As Mary’s sight worsened, her husband Jack (80) became her eyes.

He said: “When you have macular degeneration simple things like eating become very difficult.

“You might go to a restaurant where they have green napkins and think it was a piece of lettuce!”

Mary adds: “My ten-year-old grandson kept telling me he was going to get me a guide dog. I could hardly see anything.

“In the end, I was registered partially-sighted and referred to Mr Aftab.”

Consultant ophthalmic surgeon Mr Sakkaf Ahmed Aftab, who runs a clinic from Grimsby’s St Hugh’s Hospital, was one of the first surgeons to be trained in the IOL Vip (intra-ocular lens for visually impaired people) procedure.

The surgery is very similar to a cataract removal, in which the ocular lens is replaced with an artificial one behind the iris.

However, a second lens is also placed in front of the iris – creating a slightly magnified image much like a telescope. As a result, light entering the eye is directed to a healthy part of the retina and away from the macular scar, giving patients back some of their useful vision.

The procedure is painless, easy to carry out, and the effects are almost immediate.

Mary, of Kenmar Road, Laceby, was recently the first patient in the entire region to benefit from the ground-breaking surgery.

She said: “I noticed the difference more or less straightaway.

“When you have macular degeneration you no longer take your sight for granted, and being able to get out in the garden to pick up the weeds has meant so much to me.

“One day I was walking through town with my husband and I said: ‘Look! I can see House of Fraser!’ I was so excited that I was able to read the sign.

“Hopefully, with time, my sight will improve even more. But if I stay as I am now I will be satisfied.

“It’s made a huge difference to my life and I can’t praise Mr Aftab enough – he really is a wonderful surgeon and takes great joy in giving people their sight back.”

Medical science is constantly striving to detect and treat AMD, but advances in this area are slow to reach the general public and are often prohibitively expensive for the majority of patients.

In many cases, a patient’s eyesight has to deteriorate sufficiently for NHS-funded treatment to become available, although this policy can differ among Primary Care Trusts.

Mary said: “When I first heard about it my family said I must go for it. Your sight is so important, and they all backed me up.

“At first I thought it was too much money, but when I got home from the clinic that day Jack said you can’t put a price on your eyesight.

“And although I’ve had to pay for it, it’s been worth every penny.”

Mary paid pounds5,900 for her surgery, but Mr Aftab is hopeful that the National Institute for Clinical Excellence – the state rationing body for health – will someday licence the treatment for use on the NHS.

He said: “When I first came to Grimsby in 2002 I brought a treatment with me called photodynamic therapy (PDT), which at that time was the latest treatment available for macular degeneration.

“But, it took two or three years for PDT to become available on the NHS.

“Likewise, it was several years before American drugs for AMD were licensed for use here.

“NICE has just started looking into getting the procedure licensed and hopefully, as more and more patients receive it, it will put the pressure on them to approve it.”

Mr Aftab is quick to point out the surgery is not suitable for everyone, is not a miracle cure, and is only appropriate for patients who have lost a significant level of vision.

However, it can restore enough of a patient’s sight to drastically improve their quality of life.

“This is a procedure for people who cannot see,” he said.

“There’s no way that after having this you would be able to read small print or start driving again.

“But that’s why this work is so rewarding – because you are giving people back their vision when before they had none at all.”

(c) 2008 Grimsby Telegraph. Provided by ProQuest LLC. All rights Reserved.

Business Support Wanted for Children’s Charity Ball

By pHIL SKELTON

The parents of Matthew Hall are staging a charity auction to celebrate their son and thank the nurses who handed them a lifeline.

Melanie and Chris, from Bishop’s Cleeve, are hosting the Matthew Hall Ball at Hatherley Manor Hotel, Down Hatherley, on Saturday.

They have already sold out of tickets for the ball to raise money for charities the James Hopkins Trust and Make a Wish Foundation, which support children with disabilities.

But the pair are hoping for more support and donations from businesses.

Melanie decided to organise the ball following the diagnosis of her five-year-old son Matthew with a rare and devastating disease.

He was a healthy boy until the age of three but over the course of two years started to have seizures.

He began to lose skills and investigations began between Cheltenham General and Great Ormond Street hospitals.

His condition worsened and he can no longer see, walk or talk due to Late Infantile Batten’s Disease.

Melanie said: “No one expects this to happen to their child and it has been hard to come to terms with.

“But with the help of the James Hopkins Trust we have been given respite care and made the most amazing friends. They have proved a lifeline to us.

“We have nine hours of nurse care each week and this enables me to go and pick up my other son Tom from school. We can have fun time together – have a coffee or cinema.

“We adore both our sons and we take each day at a time.”

Melanie completed a charity parachute jump in May and her sister- in-law ran the London Marathon but they wanted to do more to raise money for the James Hopkins Trust and Make a Wish Foundation.

“We are delighted that 250 family and friends have bought tickets to celebrate a special little boy,” said Melanie.

“I hope local businesses will want to come forward to help poorly children like Matthew and in turn support two fantastic children’s charities.”

To support the family in raising funds, call 07875 340840 or email [email protected].

(c) 2008 Gloucestershire Echo, The. Provided by ProQuest LLC. All rights Reserved.

Candidates to Discuss Mental-Health Issues

Iowa Senate and House candidates will discuss mental-health issues at a forum taking place 6:30 to 8 p.m. Tuesday, Sept. 16, at the Dubuque Community School Forum, 2300 Chaney Road.

The forum will be conducted by the Dubuque League of Women Voters and is co-sponsored by the Dubuque County chapter of Mental Health America and National Alliance on Mental Illness Dubuque.

Questions can be submitted by the audience and will be limited to areas of mental health, substance abuse and criminal justice as it applies to mental-health issues.

(c) 2008 Telegraph – Herald (Dubuque). Provided by ProQuest LLC. All rights Reserved.

Air France to Launch ‘Quicker’ Train to Paris As Eurostar Monopoly Ends

By Michael Savage

FARES AND journey times for passengers travelling to Europe could fall in just two years after an announcement by Air France that it is to compete with Eurostar by running a high-speed rail service to Paris.

The trip from London could take less than two hours under the company’s plan to bring a new generation of high-speed trains to St Pancras station. They will be capable of a maximum speed of 224mph, 38mph faster than the current top speed of trains running to France.

Eurostar’s monopoly will come to an end at the start of 2010, when new “open access” laws come into force.

The economic downturn has hit airlines hard, while the popularity of high-speed rail travel has been booming. Eurostar saw passenger numbers rise by 18 per cent in the first half of this year.

Eurostar came out fighting last night, saying that it welcomed competition and interest from airlines “had been expected”. It added that airlines had “a lot to learn” before they could compete.

“This shows that airlines now realise that high-speed rail is increasingly the natural choice for business and leisure journeys across Europe,” a spokesman said.

“It’s no surprise that airlines hit by high oil prices and congested airports are trying to turn themselves into train operators. We will continue to compete with them whether they use wings or wheels.”

It was also dismissive of Air France’s claims that it could reach Paris in under two hours, saying that the current top speed of 186mph had been introduced because of the limitations of the track, rather than its train’s capabilities.

But a source involved in the development of St Pancras’ track disagreed. “It is no longer the track that is holding back train speeds, but the trains,” said the source. “With a few modifications and testing, I see no reason why the new generation of TGV trains cannot run on the track.”

Air France-KLM, which is also planning a service between Paris and Amsterdam, said it hoped to launch its London to Paris service by October 2010.

An industry insider said: “Just imagine arriving at the station and being able to pick from destinations from all over Europe such as Prague, Cologne and Frankfurt. Competition will be great news for consumers.”

Virgin Atlantic is also thought to be interested in setting up a European high-speed rail service under the liberalisation plan, while the German operator Deutsche Bahn has expressed interest in running a service from London to Cologne. From there, passengers would have easy access to cities including Frankfurt, Stuttgart, Munich, Berlin and Hamburg.

(c) 2008 Independent, The; London (UK). Provided by ProQuest LLC. All rights Reserved.

‘We Need to Understand This Disease to Fight It’

By chris peregine

They are often seen as poor relations in the world of medical research.

Lung disease may be common enough in most people’s perception, but experts in the field know a lot more can be done to get to grips with a particular group of conditions within that category.

The conditions come under the umbrella of pulmonary fibrosis, which causes scarring of the lungs, and there are around 200 of them.

And even though it is still not known what causes these diseases, there is nowhere near enough research or treatment being funded for them. That is despite the fact they can have a severe impact on patients’ lives, not to mention clogging up hospital beds. More specialist doctors and nurses would also help.

Anything like that would be welcome to people such as Meidrim Thomas.

The former purchasing manager at Swansea’s Dragon Hotel has been going to the city’s Morriston Hospital for 15 years to get help with his condition.

“I have a shortness of breath, tightness of the chest, a bit of bronchitis and a cough,” said 79-year-old Mr Thomas, of Banwen Place in Lower Brynaman. “I use a ventilation puffer to relieve the bronchitis.”

Unfortunately, there is no effective treatment to help the lung fibrosis.

Nowadays he only has to pop into the hospital once a year for the equivalent of an MOT on the condition.

“It keeps an eye on me,” said Mr Thomas, who until two years ago was still able to carry out his duties as a course ranger at Glynhir Golf Club in Llandybie.

This breathlessness and cough, which gets slowly worse over time, is typical of lung fibrosis. He has lived with his condition for years but feels that more research should be carried out. In short, it should climb up the priority list.

“Definitely more needs to be looked into,” he said.

At Morriston he is grateful for the work of Kim Harrison and Mat Jones who are conducting their own research into the subject.

Dr Harrison chairs the British Association for Lung Research and is a member of the UK Respiratory Research Collaborative. He has been on the research trail for eight years and was joined by his colleague last January as the work continued.

“Pulmonary fibrosis is the medical term for scarring of the lungs,” said Dr Harrison. “People who develop these diseases usually suffer from breathlessness and many also complain of a dry cough. In some people we are able to identify a cause, such as asbestos, but in many cases the cause is completely unknown and the condition is known as idiopathic pulmonary fibrosis (IPF).

“IPF and conditions like it get relatively little publicity although, in fact, they account for about 15 per cent of a chest specialist’s workload. Approximately 4,000 people a year develop IPF in the UK and it appears to be becoming more common.

“IPF causes about as many deaths as say, cancer of the stomach or cancer of the uterus, but despite this, there has been very little research into treatments for people who develop it.”

Previous studies at the hospital by Dr Harrison and his colleagues have shown there are chemical imbalances in the lungs of patients with IPF, which might be responsible for the cough but a cure remains elusive.

The two doctors are now carrying out more research into coughs and IPF.

“Patients lose on average seven years of life,” said Dr Harrison. “It is a disease that is out there. There are more than 80 patients with the condition who come to my clinic at Morriston Hospital.

“People are usually given steroids and small doses of anti- cancer drugs but the proof that there are clear benefits is not very strong. More research is needed to treat the disease’s progression and the cough.”

Slowing progression rather than curing it is more realistic.

“Once lungs have a scar, it is irreversible,” he said. “It is very much a neglected condition. Chest specialists who form the UK Respiratory Research Collaborative identified pulmonary fibrosis as one of five key areas which are in urgent need of more research.”

The others were COPD, asthma, lung cancer and respiratory diseases of childhood. “I am very pleased that finally the need for more attention to be paid to pulmonary fibrosis has been recognised,” said Dr Harrison.

Government funding is not the issue, though.

“This has changed considerably in the last couple of years and the funding is out there,” said Dr Harrison. “I believe what is required for IPF is specialist centres, like Morriston, to develop across Wales to provide expertise in caring for patients, training doctors for the future and participating in clinical trials of new treatments.

“If such centres worked together, we could learn a lot more about IPF and how to treat it.”

(c) 2008 South Wales Evening Post. Provided by ProQuest LLC. All rights Reserved.

Sense of Touch Can Help to Relieve Pain

By Steve Connor

Scientists have discovered a distinct set of “pleasure nerves” in the skin that can alleviate pain when gently stroked. They believe the discovery could lead to new treatments for conditions ranging from chronicitching to depression.

The nerves respond to being brushed slowly and they appear to be sensitive to the type of stroking and cuddling provided by a mother to an upset child, scientists said yesterday.

Tests on human volunteers have found that a painful stimulus applied to the skin can be eased significantly by gently stroking the pleasure nerves in a nearby part of the body, said Professor Francis McGlone of Unilever and Liverpool University. The nerves are part of the so-called C fibres of the nervous system, which are known to be responsible for producing the sensation of pain in the skin. But instead of stimulating pain, a subset of the fibres also appear to stimulate pleasure.

“If you get a piece of grit in your eye, have a toothache, or bite your tongue, it hurts so much because there are more C fibres there. The research we have been doing is building evidence for another role of C fibres in the skin that are not pain receptors, but are pleasure receptors,” Professor McGlone said.

“There is another sensory nerve fibre system in human skin that appears to code for the pleasant and affiliative aspects of touch we are all familiar with, such as when grooming or being cuddled,” he added.

There is growing evidence that touching the skin and gentle stroking of the body stimulates an evolutionary ancient part of the nervous system that makes people feel good when cuddled by a loved one or groomed by themselves.

“Grooming behaviours are not at a functional level for removing dirt. I think we groom primarily to feel good. Grooming is a rewarding behaviour that aids well-being… One of the hallmarks of clinical depression is that people stop looking after themselves, they stop grooming,” he told the British Association for the Advancement of Science at Liverpool University.

Some parts of the body are richer in the pleasure nerves than others. They are not present at all, for instance, on the palms of the hands or the soles of the feet. “We’ve tested everything from forehead, forearm, upper leg and the face and we find heterogeneity in response to touch. They haven’t been found in the genitalia, but I think another system is responsible for tactile reward in that area,” Professor McGlone said.

“With pain it has been clearly established that without such a sense we would not survive, and now we are beginning to understand that without a sense of pleasure, or reward, behaviours that we take for granted, like the caress between lovers and the nurturing of babies we would also not survive,” he said.

Doctors have already realised that premature babies do better when cuddled straight after birth, and there may be many other medical conditions that could benefit from a better understanding of the pleasure nerves of the skin.

Originally published by By Steve Connor Science Editor.

(c) 2008 Independent, The; London (UK). Provided by ProQuest LLC. All rights Reserved.

Job Axe Fears at Rural Surgeries

By Mark Branagan

The concerns about healthcare provision, especially in the remote communities of North Yorkshire, will come under the spotlight at the next meeting of the county council’s scrutiny of health committee on Friday.Top of the agenda will be the public consultations on a Government White Paper setting out proposals for expanding high- quality pharmaceutical services and developing the role of pharmacists as a leading clinical profession within primary care.North Yorkshire has a high percentage of GP practices in areas such as Hambleton and Richmondshire, where 14 out of 18 of the surgeries fill their own prescriptions, compared to a national average of five per cent.Concerns are now growing about the impact of the changes in North Yorkshire’s communities where traditionally revenues from dispensing help to fund extra healthcare services from the surgeries.These come when anxiety about local patient care is already high amid a review by North Yorkshire and York Primary Care Trust (PCT) and the South Tees Hospitals Trust.The review is looking at the accident and emergency and maternity services at the Friarage Hospital in Northallerton and out of hours services at Catterick Garrison.County councillor John Blackie, who chairs the scrutiny of health committee, said: “We understand it is more costly to deliver healthcare services to rural areas.”However, local people rightly expect the peace of mind that comes from knowing core services such as accident and emergency, maternity and out of hours care are available within reasonable travelling distance.”As it stands now the Friarage Hospital already serves communities 40 miles away. I hope the NHS officers can re-assure us that these essential services are safe for the future.”One impact of shifting the focus from GPs to pharmacists could be cuts to services provided over 600 square miles by The Central Dales Practice based in Hawes. It estimates it would have to reduce its four doctors to two, and its two surgeries to just one, Coun Blackie added.A spokesman for the North Yorkshire and York PCT has underlined that the consultation is being run centrally and the trust had no real involvement at this stage.Public Health Minister Dawn Primarolo has told the House of Commons that the Government recognises the importance of the role of the dispensing GP and did not propose to end it.She said: “I know some dispensing GPs have expressed doubts about their future. It is not, and never has been, the Government’s intention to disband or remove the services.”However, the system of GP dispensing contains anomalies and inconsistencies, and we want to seek views on how to deal with that.”The Government was not pre-judging the issue and there was no suggestion that dispensing by GPs would cease. They would play a vital part in the consultation process, she added.However, Coun Blackie said: “If revenues from dispensing are lost to GP practices it appears there could be drastic reductions in GP healthcare provision across large areas of the county.”Storm clouds may be back on the horizon yet again for many of our rural communities in North Yorkshire.”Friday’s meeting at the Allerton Court Hotel in Northallerton starts at 10am and is open to the public to make statements and ask questions of senior officials.

(c) 2008 Yorkshire Post. Provided by ProQuest LLC. All rights Reserved.

Mediware Announces Prestigious Speakers for Annual Customer Conference

Mediware Information Systems, Inc. (NASDAQ: MEDW) announced that it will host its annual customer conference on October 8, 2008, following the American Association of Blood Banks (AABB) conference in Montreal. The event will feature prestigious industry speakers as well as best practice sessions that deliver continuing education credit to participants. More than 150 attendees are expected and all Mediware hospital blood management and blood center customers are eligible to attend. Registration information is available on Mediware’s web site, www.mediware.com.

Headlining the event is Dr. James AuBuchon, who on September 1 assumed the position of President and Chief Executive Officer of Seattle’s Puget Sound Blood Center, one of the world’s largest centralized transfusion services. Dr. AuBuchon, who previously led transfusion medicine at the prestigious Dartmouth Hitchcock Medical Center, has been a long time advocate for the effective management and use of blood. He is also one of the thought leaders behind the U.S. Biovigilance Network, a program that is developing through the cooperation of industry trade groups, corporations, healthcare institutions and the federal government.

Dr. AuBuchon will bring his unique background to the Mediware customer conference audience, which will include both blood center and hospital blood bank professionals. His presentation will consider the future of a demand-driven blood supply and the possibility of recruiting, tracking and delivering the exact blood products needed for specific patients and procedures. He’ll trace the process of a patient from doctor’s office visit through surgery and contemplate the systems, departmental and organizational coordination required.

Dr. AuBuchon’s topic is of particular interest to Mediware and its customers because of its applicability to the company’s stated growth programs. These include the integrated blood center through Mediware’s Blood Center Technologies group (BCT) as well as Mediware’s latest hospital blood products, including HCLL(TM) Transfusion, BloodSafe(TM) and BiologiCare(TM).

Also on the agenda for the customer conference is Dr. Cassandra Josephson of Emory University Hospital. Dr. Josephson specializes in pediatric transfusion safety and will speak specifically about her experience launching centralized tissue management in her hospital and how this has improved the safety and efficiency surrounding these products. Centralized tissue management is an emerging trend for hospitals and the driving force behind Mediware’s newest product, BiologiCare(TM).

Other featured speakers include:

— Dr. Jeannie Callum, Director of Transfusion Medicine and Tissue Bank at Toronto’s Sunnybrook Health Sciences Centre, and Lyn Sharman, president of Neoteric Technology Ltd., will co-present product results relating to remote blood storage and point-of-care transfusion administration.

— Rose Campbell, president of RBC Technologies, will present best practices for validating blood bank systems requiring FDA clearance for use.

The Mediware customer conference will be held at the Fairmont Queen Elizabeth hotel in Montreal and is open to all current customers of Mediware’s hospital and blood center technology products. Prior to the October 8 event, Mediware will be demonstrating all of its latest products in AABB booth #1811.

For additional information on Mediware products or the annual blood management customer conference, visit www.mediware.com.

About Mediware

Mediware delivers blood and medication management software systems that encapsulate information supporting patient therapies, reinforce patient safety practices and improve efficiencies to lower costs. Mediware’s customers include prestigious hospitals, clinics, correctional institutions, blood centers and other public and private health care institutions throughout the world.

Certain statements in this press release may constitute “forward-looking” statements within the meaning of the Private Securities Litigation Reform Act of 1995, as the same may be amended from time to time (the “Act”) and in releases made by the SEC from time to time. Such forward-looking statements are not based on historical facts and involve known and unknown risks, uncertainties and other factors disclosed in the Company’s Annual Report on Form 10-K for the year ended June 30, 2008, which may cause the actual results of the Company to be materially different from any future results expressed or implied by such forward-looking statements. The Company disclaims any obligation to update its forward-looking statements.

 Contact: John Van Blaricum 913.307.1017  

SOURCE: Mediware Information Systems

Englewood Hospital Among Top Three Hospitals Nationwide for Heart Attack Patient Survival Rate

ENGLEWOOD, N.J., Sept. 10 /PRNewswire/ — Englewood Hospital and Medical Center was among the top three hospitals in the U.S. for the lowest heart attack mortality rate, according to new government data. According to newly released statistics from the Center for Medicare Services (CMS), heart attack patients with Medicare coverage who received treatment at Englewood Hospital and Medical Center had a better chance of surviving over a 30-day period than those treated at any other hospital in New Jersey. According to the data, Englewood Hospital’s 30-day mortality rate for heart attack patients was 12.4 percent–significantly better than the national average of 16.1 percent cited by the Medicare study.

“Our exceptional interventional cardiology team provides exemplary treatment to heart attack patients,” said Richard Goldweit, MD, FACC, Chief of Cardiology and Director of Interventional Cardiology for Englewood Hospital and Medical Center. “Our door-to-balloon time–the time it takes from when a patient arrives at the hospital to when a coronary intervention is performed to open the arteries–is currently 55 minutes and continues to go down. That’s significantly below the 90-minute timeframe recommended by the government.”

The door-to-balloon (DTB) metric is crucial in measuring cardiac care quality and translates into higher survival rates and improved quality of life. “Time is muscle,” noted Dr. Goldweit. “The quicker you restore blood flow and open the artery, the less damage there will be to the heart.”

The one-month mortality statistic–which is the most important measure of clinical performance for the patient–reflects well on all involved with the care of heart attack patients at Englewood Hospital, from the highly qualified paramedics and Emergency Department staff to the catheterization laboratory staff, non-invasive cardiology and cardiac rehabilitation, Dr. Goldweit pointed out.

“For instance, the paramedics in our mobile intensive care units and the care providers in our Emergency Department are experts in quickly recognizing the signs of heart attack and responding accordingly, even when a patient’s symptoms may not be ones generally associated with a heart attack,” said Dr. Goldweit. “That helps get the patient to us faster–a critical factor in achieving a successful outcome.”

In addition, highly qualified nursing teams in the Medical Center’s intensive care cardiovascular unit and step-down unit provide individualized care to patients during their hospital stay. They also clearly communicate to patients the appropriate ongoing drug therapy, lifestyle changes and follow-up care needed to enhance survival after discharge.

“The efforts of our interventional cardiology team result in nearly a 25% reduction in the risk of death compared to the national average,” said Dr. Goldweit. “We’re very proud of the high level of cardiac care we offer, but we’re never satisfied to stay with the status quo. We engage in an ongoing process of improvement that involves analyzing feedback on how we’re performing, evaluating the latest research and studies on developments in cardiac care, and acting on that information to continually improve and stay on the cutting edge of advancements. Our well-attended weekly cardiology conference is one reflection of this effort.”

“All of us at the Medical Center are very proud of this national recognition by CMS,” said Douglas A. Duchak, President and CEO of Englewood Hospital and Medical Center. “This data is one of many yardsticks confirming our hospital’s outstanding performance in carrying out our mission of providing world-class medical care to the communities we serve.”

The Medical Center’s interventional cardiologists are part of the hospital’s comprehensive Heart & Vascular Institute of New Jersey, which also includes General Cardiology, Electrophysiology, Cardiac Surgery, Vascular Surgery, and Cardiac Rehabilitation.

The data for the CMS study was collected on Medicare patients discharged between July 2006 and June 2007. The government released the statistics as part of a first-ever accounting of mortality rates at thousands of hospitals across the U.S.

A searchable database of hospital mortality rates is available at the Centers for Medicare & Medicaid Services’ Hospital Compare website at http://www.hospitalcompare.hhs.gov/hospital/mortalitytool.

Englewood Hospital & Medical Center

CONTACT: Cynthia Valentino, Englewood Hospital and Medical Center,+1-201-894-3486, [email protected]

Web Site: hhtp://www.englewoodhospital.comhttp://www.hospitalcompare.hhs.gov/hospital/mortalitytool

‘Jogging Joe’ Collapses During Morning Run

By HEATHER RAWLYK Staff Writer

As he’s done countless mornings before, “Jogging Joe” Shafran trotted down Jennifer Road on Saturday, stopping for a quick chat with the chief of West Annapolis Volunteer Fire Company.

His route then took him past the station’s sign, which displays a smiling caricature of the local fitness personality. He jogged uphill, past a row of fuel pumps by the Jennifer Road Detention Center.

Then Mr. Shafran collapsed to the street.

Volunteer Chief Bobby Vice saw Mr. Shafran, 81, fall to the ground, said Battalion Chief Matthew Tobia, a county Fire Department spokesman. He jumped out of his vehicle and ran to Mr. Shafron’s side, screaming for firefighters inside the station for help.

Mr. Shafran, a columnist for The Capital, was not breathing when firefighters arrived at his side. He had no pulse, no blood pressure, and was in full cardiac arrest, Chief Tobia said.

Crews worked on Mr. Shafran, and within minutes were able to restore his pulse and blood pressure using a monitored heart defibrillator.

He was unconscious, Chief Tobia said. Still, Mr. Shafran was essentially, “brought back to life.”

Mr. Shafran was taken by ambulance to nearby Anne Arundel Medical Center in Parole. He remains in the hospital’s critical-care unit this morning, said Justin Paquette, an AAMC spokesman.

His wife, Jerri Shafran, said it was fortunate her husband collapsed near the fire station.

Mr. Shafran has a close relationship with the county and city’s firefighters, and has been working with them to promote the “Partners for Life” program, along with the Annapolis Athletic Club. The program encourages joggers, walkers, and bicyclists to wear wristbands when they’re out and about. The wristbands include identification information to help medical personnel should the exerciser have an emergency, like Mr. Shafran had Saturday morning.

The wristbands are just the latest fitness venture for Mr. Shafran, who moved to Annapolis in 1995.

He’s an exercise columnist for The Capital, is a member of the Governor’s Council for physical fitness, has a radio show “Let’s Shape Up” on WBIS, sells exercise equipment at Sears, and volunteers his time promoting physical fitness in Annapolis and Anne Arundel.

The involvement in fitness has earned him the loving nickname, “Jogging Joe.”

Mrs. Shafran said her husband has been writing his exercise column for more than five years.

“Every time he writes a column he gets so much pleasure out of it,” she said. “He just loves it. He’s always looking for things that will be of interest in his column. He gets very excited about it.”

His editor, Gerry Jackson, said Mr. Shafran is always trying to get people to live a healthy lifestyle. Mr. Shafran is also known to bring a basket of apples to The Capital newsroom every fall, he said.

“When he comes in, he always makes the rounds saying hello to everyone,” he said. “He was just in here Friday he said he’d just finished a 7-mile jog.”

His family said they hope this is “just a glitch” and that Mr. Shafran will pull through.

“We are all just hoping for the best and praying of course that he’s going to rally and continue to do what he’s always been doing,” Mrs. Shafran said. “He’s tough. I pray he’s going to come through this and he’ll be back out there waving to everybody on the street.”

Mrs. Shafran said she keeps expecting her husband to jump up and throw on his running shoes.

“We’re expecting him to sit up and say, ‘OK. It’s time for me to take a run. It’s been three days now. I’m off schedule.’ “

She said her husband is not one to take it easy.

“I tell him he needs to slow down,” she said. “He’ll say, ‘No, no, no. I’m not happy when I slow down. I need to keep going, keep running.’ He really is full of so much life. I’m sure he’s saying to himself, ‘I need to get back.’ “

Mayor Ellen O. Moyer said she “loves Jogging Joe” and wishes him a full recovery.

“He’s been an inspiration to so many people and we sincerely hope he comes out of this and we’ll see him jogging again soon,” she said.

Ray Weaver, a city spokesman, said Mr. Shafran has personally inspired him.

“I just did an interview with him two months ago, and he’s a big inspiration,” he said. “He’s a great guy, and he’s a character.”

Mr. Jackson said Mr. Shafran is the “most inquisitive guy” he knows.

“For a guy that age, you’d think you’d be asking him the questions,” he said. “And he’s just asking you about this and that.”

He’s even known to bring a list of questions to a lunch to learn more about a person’s job or a project they were working on, which could be a holdover from his days as a news man.

Mr. Shafran is a former ABC News director and anchor in Ohio, his wife said. In 1977, the Shafrans moved to Washington, D.C., where Mr. Shafran worked as a press secretary. He and his wife then started a media relations business, which they ran for 20 years, she said.

Of all the things he’s done, Mrs. Shafran said her husband’s happiest times have been in Annapolis.

“Living in Annapolis has been some of the happiest years of his life,” she said. “He’s got lots and lots of friends all over the place. And he just loves what he does.” {Corrections:} {Status:}

REMAINS IN CRITICAL CONDITION AT AAMC

(c) 2008 Capital (Annapolis). Provided by ProQuest LLC. All rights Reserved.

Writing an Open Letter to the Health Minister Seemed the Only Way to Get Our Point Across ; Cancer Patient’s Daughter Explains Dad’s Drug Plight

By Martin Shipton

A DAUGHTER whose father suffers from cancer has today appealed directly to Health Minister Edwina Hart for those in his position to be given the drugs that could prolong their lives.

Anna Wolfenden’s open letter to Ms Hart calls for a swift decision to be made about the availability of drugs such as Sunitinib that are widely available for patients with kidney cancer in the United States and other countries but have failed to secure the recommendation of NHS bodies in the UK amid concerns they are too expensive.

Sunitinib costs around pounds 13,500 a month.

Ms Wolfenden’s letter, published below, also calls into question the morality of denying access to NHS treatment for patients driven by desperation to pay for drugs themselves.

Her father, John Jones, 62, was diagnosed with kidney and lung cancer earlier this year and has recently been undergoing radiotherapy after the disease spread to his brain.

Mr Jones’ consultant at Ysbyty Gwynedd, Bangor, is expected to apply to the Gwynedd local health board for permission to prescribe Sunitinib.

However, the National Institute of Health and Clinical Excellence (Nice) issued a draft ruling last month that Sunitinib is not cost effective, though a full report has yet to be published.

Mr Jones, from Menai Bridge, runs a family kitchen and bathroom business in Bangor with his wife Mair. His daughter, from Porthaethwy, Anglesey, also works for the business.

Ms Wolfenden said: “We have been so shocked by the way deserving patients have been denied access to drugs that are readily available elsewhere that writing an open letter to the Health Minister seemed the only way to get our point across.

“Obviously I would like my father to be prescribed the drug, but the family realises that there are many other people in a similar position.

“It can’t be right to deprive people of drugs when the doctors caring for them believe they would benefit.

“What is really scandalous is the statement made by the Minister that patients could be denied NHS treatment if, out of desperation, they paid for drugs themselves. So far as we are concerned that is totally unacceptable.

“I really hope that putting the position in such stark terms will help persuade those in a position to make crucial decisions that life-prolonging drugs should not be denied to patients when they could benefit from them.”

Last month, the ‘Western Mail reported how former Brecon mayor Chris Lewis, who has been diagnosed with terminal kidney cancer, was planning to refuse the drug even if he is prescribed it in protest at the Government’s refusal to allow it to be given to all NHS patients whose consultants say they would benefit from it.

Drugs that are not deemed clinically effective or cost effective are not recommended for use on the NHS.

However, if a clinician feels there are extenuating circumstances, they can request that their local health board considers providing the drug.

Responding to Ms Wolfenden’s open letter, an Assembly Government spokesman said: “Although we cannot comment on individual cases, until Nice publishes its final guidance the availability of drugs such as Sunitinib is a matter for local determination based on the needs of individual patients and the advice of local clinicians.

“The chief executive of the NHS in Wales wrote to trusts earlier this year to clarify that where treatment is not available from the NHS, a patient may choose to access it privately.

“The exercise of this choice should not jeopardise the patient from returning to NHS care, provided that care is within a different episode of care.

“As the Health Minister has previously said, she is already considering the broader issues surrounding the availability of drugs on the NHS and will carefully consider what additional guidance might be needed.”

Anna Wolfenden’s letter to Welsh Assembly Health Minister Edwina Hart

Dear Minister

I had not intended to write to you in such a public way and I apologise for doing so.

However, I feel I have no choice but to air my views in this way as I fear that further delays may contribute to my father’s medical demise.

My father is suffering from kidney cancer which the doctors say is inoperable. Worse, he has secondary cancer to the lungs and recently we were given the devastating news that the cancer had spread to the brain.

Dad is only 61 years of age and our family has been truly traumatised by the discovery that this dreadful disease has taken such a toll in such a short space of time. All this has happened in the space of six months.

He has recently undergone radiotherapy treatment for the tumours to his brain and seems to be responding well and the last scans showed that the kidney and lung tumours had not grown.

In the next two weeks his consultant will, hopefully, begin the process of applying to the local health board for the kidney cancer drug Sunitinib.

We appreciate that this process, in part, is governed by complicated medical calculations by the drug regulator NICE, but there is confusion in our minds as to what might happen if he is denied the drug, now widely regarded by the medical profession as being beneficial to certain patients.

In our opinion this drug should be given freely to my father and other cancer sufferers throughout Wales. To deny them these drugs is cruel in itself, but we now learn that we may face further obstacles if, having been denied the drug on the NHS, we decided to try to raise the money to pay for it ourselves.

I understand that you have stated that sufferers who opt to top up their care with private drugs are not able to receive NHS treatment for the same episode of care. What exactly does that mean?

This seems to us to be undermining the very principles of the NHS. Every time we turn a corner in our efforts to help my father we are faced with obstacles, and in our desperation to do something we turn to you and implore you to act.

To deny a patient these drugs is cruel, but to deny them the right to pay for a recognised private drug without being penalised and denied further necessary care is nothing short of scandalous and a cause for shame in a civilised society.

For 35 years my dear father has guided and supported me and made me the strong independent woman that I am today, but now he needs my help.

More importantly, Minister, he – and many like him – needs your help and guidance.

Enough is Enough! Digon yw Digon! Please Act Now.

Anna Meleri Wolfenden Porthaethwy Ynys Mon

(c) 2008 Western Mail. Provided by ProQuest LLC. All rights Reserved.

Kaiser Permanente Celebrates Grand Opening of Eco-Friendly Pasadena Medical Office Building

From the medical office waiting rooms, visitors might think they’re looking out at the lush foliage of a rainforest instead of a courtyard atrium. Welcome to Kaiser Permanente’s new Pasadena Medical Office Building.

“The eco-friendly design and construction demonstrate our commitment to wellness, healing, and the environment,” says Jimmy Wannares, manager of the Pasadena facility. “We’re also excited about being able to provide several new services that we know will improve the entire care experience for our members.”

Conveniently located at 3280 East Foothill Boulevard, on the corner of Sierra Madre Villa Avenue, the location is ideal because it will continue to serve the health care needs of the members who have been going to their physicians at the Lake street site, as well as accommodate six new physicians ready to welcome new members living in the Baldwin Park area. The facility is easily accessed from both the 210 freeway and the Metro Gold Line.

The total staff of more than 150 physicians, medical specialists and support personnel will provide family medicine, obstetrics/gynecology, podiatry, allergy immunotherapy, internal medicine, dermatology, pediatrics, sports medicine, a walk-in nurse clinic, and state of the art laboratory and pharmacy. The services will be complemented with the latest technologies for bone density scanning, digital imaging radiology (x-ray), and mammography screenings.

“Everything at this facility is brand new,” says Jo-Dee Becker, capital projects team manager for Kaiser Permanente’s national facilities services in Southern California. “It has a beautiful atrium open to the sky, and all the waiting areas are open to a canopy of trees.” Completing the design team is general contractor Hamilton Construction, and HMC Architects for architecture and interior design.

The medical offices also boast an eco-friendly design and construction that demonstrates Kaiser Permanente’s commitment to the environment and to the community. Automated mechanical control systems change temperature throughout the day, adjusting based on occupancy. Natural light in the central lobby reduces the need for artificial light. Automatic light shut-off switches and fluorescent light fixtures decrease the energy usage throughout the building. Flooring consists of non-PVC backed carpet as well as rubber flooring that includes recycled material and requires no compounds or cleaners for daily maintenance. The products also contribute to the internal air quality; they don’t hold dust or other allergens and help prevent the growth of bacteria and mold.

Being able to get lab results, immunizations records, and email your physician from home are all access features that are appealing to Kaiser Permanente members. And if a member does travel away from their favorite physician and Pasadena medical offices, they can be assured that no matter which Kaiser Permanente facility they visit – from Kern County to San Diego – all physicians, nurses, and other caregivers will have access to all their prescription and other medical information, thanks to Kaiser Permanente’s new electronic health record system, KP HealthConnect. When they travel outside Southern California, they will have access to their Personal Health Record, on kp.org, through an internet connection from anywhere in the world. Adds Wannares: “Pasadena and Baldwin Park members do indeed have a lot to celebrate.”

ABOUT KAISER PERMANENTE

Kaiser Permanente is one of the nation’s leading integrated health plans. Founded in 1945, it is a nonprofit, group practice prepayment program with Southern California headquarters in Pasadena, California. Kaiser Permanente serves the health care needs of 3.3 million members in Southern California. Today it encompasses the nonprofit Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and their subsidiaries, and the for-profit Southern California Permanente Medical Group. Kaiser Permanente’s Southern California Region includes more than 55,800 technical, administrative and clerical employees and caregivers, and more than 6,400 physicians representing all specialties. More information about Kaiser Permanente can be found at www.kaiserpermanente.org.

Schering-Plough Announces European Launch of BRIDION(R) (Sugammadex)

KENILWORTH, N.J., Sept. 10 /PRNewswire-FirstCall/ — Schering-Plough Corporation today announced that the European launch of BRIDION(R) (sugammadex) injection has begun with its introduction this week in Sweden, and that the product is expected to be available soon in the United Kingdom and Germany, with several other European markets to follow by the end of the year and in early 2009.

“The introduction of BRIDION in Europe represents an important advance for anesthesiologists and the patients they care for during surgery, and is a significant achievement for Schering-Plough, as we bring our first product to market since combining with Organon BioSciences,” said Fred Hassan, chairman and CEO. “BRIDION has the potential to transform the practice of anesthesia, and it is a tremendous example of our company’s innovation and leadership in this field.”

BRIDION was discovered by researchers at the company’s facility in Newhouse, Scotland, and was approved for marketing by the European Commission on July 29. It is the first and only selective relaxant binding agent (SRBA) and represents the first major pharmaceutical advance in the field of anesthesia in two decades. BRIDION is indicated for routine reversal of the commonly used muscle relaxants rocuronium or vecuronium and for immediate reversal of rocuronium in adults, and for routine reversal following rocuronium in children and adolescents (2-17 years of age). Rocuronium and vecuronium are given as part of general anesthesia to relax a patient’s muscles during surgery.

BRIDION works in an entirely novel way by encapsulating the muscle relaxant molecule and rendering it inactive. It was specifically designed to reverse within minutes both moderate and deep muscle relaxation induced by rocuronium or vecuronium during general anesthesia. As a result, BRIDION can give anesthesiologists greater control in managing the depth of muscle relaxation through to the end of a surgical procedure. This may help improve surgical conditions in the millions of procedures where these agents are used.

A muscle relaxant plays several critical roles in general anesthesia. Anesthesiologists use muscle relaxation to improve surgical conditions and to facilitate intubation and mechanical ventilation. Reversal agents reverse the effects of muscle relaxants, enabling patients to regain normal muscle function sooner and breathe on their own. Current reversal agents are slow and are associated with certain undesirable side effects, including cardiac rhythm disturbances and gastrointestinal and pulmonary side effects.

Schering-Plough acquired BRIDION (sugammadex) through its combination with Organon BioSciences in November 2007.

Important Safety Information About BRIDION

BRIDION (sugammadex) should only be administered by or under the supervision of an anesthesiologist. The use of an appropriate neuromuscular monitoring technique is recommended to monitor the recovery of neuromuscular blockade. The use of sugammadex in patients with severe renal impairment is not recommended.

In clinical trials, the most commonly reported adverse reaction was metal or bitter taste. Also commonly reported were anesthetic complications, indicative of the restoration of neuromuscular function, including movement of a limb or the body or coughing during the anesthetic procedure or during surgery, grimacing, or suckling on the endotracheal tube. In a few individuals, allergic-like reactions (i.e. flushing, erythematous rash) following sugammadex were reported.

   For full Prescribing Information please go to http://www.bridion.com/.    About Schering-Plough  

Schering-Plough is an innovation-driven, science-centered global health care company. Through its own biopharmaceutical research and collaborations with partners, Schering-Plough creates therapies that help save and improve lives around the world. The company applies its research-and-development platform to human prescription and consumer products as well as to animal health products. Schering-Plough’s vision is to “Earn Trust, Every Day” with the doctors, patients, customers and other stakeholders served by its colleagues around the world. The company is based in Kenilworth, N.J., USA, and its Web site is http://www.schering-plough.com/.

SCHERING-PLOUGH DISCLOSURE NOTICE: The information in this press release includes certain “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995, including statements relating to the plans for, the potential of and the potential market for BRIDION. Forward-looking statements relate to expectations or forecasts of future events. Schering-Plough does not assume the obligation to update any forward-looking statement. Many factors could cause actual results to differ materially from Schering-Plough’s forward-looking statements, including market forces, economic factors, product availability, patent and other intellectual property protection, current and future branded, generic or over-the-counter competition, the regulatory process, and any developments following regulatory approval, among other uncertainties. For further details about these and other factors that may impact the forward-looking statements, see Schering-Plough’s Securities and Exchange Commission filings, including Part II, Item 1A, “Risk Factors” in the company’s second quarter 2008 10-Q.

Schering-Plough

CONTACT: Media: Robert J. Consalvo, +1-908-298-7409; or Investors: JanetBarth, +1-908- 298-7436 or Joe Romanelli, +1-908-298-7436

Web site: http://www.schering-plough.com/http://www.bridion.com/

Company News On-Call: http://www.prnewswire.com/comp/777050.html

Verizon Worker Charged in 5,000 Illicit Sex Calls

By WILLIAM LAMB, STAFF WRITER

A former Verizon technician racked up $220,000 in calls to sex chat numbers by tapping into the land lines of nearly 950 customers, authorities said Tuesday.

Joseph R. Vaccarelli, 45, of Nutley used customer accounts to make about 5,000 calls to sexually explicit 900 numbers lasting a combined 45,000 minutes, Bergen County Prosecutor John L. Molinelli said in a news release.

The calls were placed over the last 10 months from residential and commercial accounts in about 30 Bergen County municipalities, authorities and Verizon officials said.

Vaccarelli worked for 10 years as a Verizon facilities technician, installing telephone service and repairing damaged or faulty equipment, said Rich Young, a Verizon spokesman.

Vaccarelli resigned last month after Verizon officials told him he was the target of an internal investigation that began after several customers complained about unauthorized charges, Young said.

Bergen County authorities began a criminal investigation after they were contacted by Verizon’s security department.

“We’re saddened and, frankly, stunned that any Verizon employee would allegedly engage in this sort of behavior,” Young said.

Verizon is working with the affected customers to resolve any fraudulent or disputed charges, he said.

“We believe this was a highly isolated incident by an errant individual,” Young said. “It should not reflect on the overwhelming majority of our workforce, who bring pride and respect to their jobs every day.”

Vaccarelli was charged with theft by deception and theft of services, both second-degree crimes. He was due to be arraigned today in central municipal court in Hackensack.

(c) 2008 Record, The; Bergen County, N.J.. Provided by ProQuest LLC. All rights Reserved.

TrimGen Launches New KRAS Assay Test for Colon Cancer Patients

TrimGen Corporation, a U.S. molecular diagnostic company focused on developing advanced genetic tests, today announced the release of Mutector II(TM) KRAS kit. The new assay screens all 12 mutations in codons 12 and 13 of the KRAS gene with 1% detection sensitivity, which has significant implications for patients with colon cancer receiving chemotherapy.

There are 12 possible mutations in codons 12 and 13 of the KRAS gene that may affect chemotherapy. Sequencing is the most common method used to screen these mutations, however, it cannot detect low-level mutations due to lack of sensitivity. Other KRAS assays do not cover all 12 mutations, whereas TrimGen’s KRAS assay can detect all these mutations with conclusive results.

Thirty to 40% of colorectal cancer patients carry KRAS mutations. Through screening, doctors can effectively determine a treatment plan, avoiding harmful side effects and unnecessary expenses.

“This test marks an advancement of personalized medicine in colon cancer therapy,” commented Dr. James Wang, president of TrimGen Corporation. “The same assay can also be applied to other types of cancer, such as lung and pancreatic cancers. The test not only benefits patients, it also provides valuable information to the pharmaceutical industry to develop better drugs.”

KRAS serves an important role in the EGFR-tyrosine kinase pathway and the growth of cancer cells. Recent clinical trial data indicate that patients who carry a normal KRAS gene show promising responses to the chemotherapy drugs cetuximab (Erbitux(R)) and panitumumab (Vectibix(R)), whereas patients with KRAS mutations are unlikely to benefit from treatment with these drugs.

About TrimGen

TrimGen is a molecular diagnostic company focused on developing advanced genetic tests to transform traditional medicine into personalized medicine. The company pursues early detection of disease related genetic markers, utilizing proprietary nucleic acid-based technologies. Shifted Termination Assay technology, used by the Mutector(TM) platform, is a unique mutation enrichment approach for detecting low-level mutations in clinical specimens. The other proprietary technology, eQ-PCR(TM), is a special approach to enhance gene amplification signals to detect low levels of target genes. The company provides more than 100 molecular tests for cancer, leukemia and infectious diseases.

All third-party trademarks are the property of their respective owners.

 Contacts: TrimGen Corporation Scott Rediker 410-472-1100 [email protected]

SOURCE: TrimGen Corporation

Girls With Absent Fathers Start Puberty Earlier

High stress levels in families, especially those without a father, appear to influence early puberty in girls, a risk factor for their health.

A study by a University of Arizona researcher and a colleague offers some insight on a phenomenon affecting girls who grow up in homes minus their biological fathers, and why they tend to go through puberty at an earlier age than their peers in intact families.

Professor Bruce J. Ellis, the John and Doris Norton Endowed Chair in Fathers, Parenting and Families at the UA Norton School of Family and Consumer Sciences, and Jacqueline M. Tither at the University of Canterbury in Christchurch, New Zealand, have just published their study in the journal Developmental Psychology.

Ellis and Tither’s study sought to unravel several competing theories about how this happens.

Those theories vary from whether dysfunctional families and absent fathers are the cause of early puberty, or underlying environmental factors that cause family stress, such as poverty, or whether there might be a genetic link.

Understanding what triggers early puberty could give health care officials an advantage in dealing with issues that sometimes accompany it. Early puberty is often cited as a risk factor for young women, linking them to early pregnancy and an array of health problems, such as breast cancer.

Ellis and Tither interviewed sisters in the same family who differed in age. The sample included 90 intact families and 70 families where the parents had divorced. Questions centered around family composition, who the girls were growing up with and when, the nature of the father’s involvement and paternal warmth.

“Our goal was to test for the causal effect of family environments and particularly the father’s role in the family on a daughter’s age of puberty,” Ellis said. “We looked at families in which one daughter might be five and the other 12 when a divorce occurred. So the youngest daughter had seven more years living in a disrupted family without her father, compared to her older sister. Our study showed that more exposure to father absence was linked to earlier puberty.”

Ellis said lots of research over the years, including his own, has documented the effect, but left a basic unanswered question.

“That is, there has always been a basic alternative explanation for this finding. The theory that we’re working from suggests that something about children’s experiences in their families, and particularly about the presence of different members of the families in the home, actually alters the reproductive axis and timing of puberty,” Ellis said.

“The idea is that children adjust their development to match the environments in which they live,” Ellis said. “In the world in which humans evolved, dangerous or unstable home environments meant a shorter lifespan, and going into puberty earlier in this context increased chances of surviving, reproducing and passing on your genes.”

Ellis said an alternative explanation suggests the whole thing is spurious, that it may not be that growing up without a father causes early puberty in girls.  It may be some third variable out there causes both family disruption and early puberty.  And that could be genetic in origin.

“We know that father absence and early puberty go together. But we don’t know why and we don’t know how.  This study was meant to figure out that issue.  The importance of this research was to show that the link is real: exposure to fathers can actually alter their daughters’ sexual development.”

Ellis noted that divorced families can have other factors that stress its members, such as alcoholism, drug use, depression, family violence or criminal activity. More important than the absence of a father are the characteristics of the father and what he did. “It’s not enough to simply have a cardboard cut-out of a father sitting on the couch. What the father does is critical,” said Ellis.

Ellis said the most dramatic finding of the study was that in divorced families with a father who had a history of socially deviant behavior, that the younger sisters who had less exposure to their fathers tended to go through puberty nearly a year earlier than their older sisters. They also went through puberty nearly a year earlier than other younger sisters who were not exposed to dysfunctional fathers.

“We found that girls with very high levels of exposure to stress early in life, who then had that stressor removed, tended to go through quite early puberty,” he said. “This actually concurs with international adoption studies showing that girls from third-world countries who had a lot of stress in early childhood and were adopted into Western societies tend to have very high rates of early puberty. It is consistent with there being a sensitive period for changes in stresses and life situations. And that could be relevant for parents.”

Ellis and Tither’s research was supported by a grant from Fathering the Future Trust, Christchurch, New Zealand.

On the Net:

Grifols Launches PediGri(R) On Line for Its US Plasma Therapies

LOS ANGELES, Sept. 10 /PRNewswire/ — Today, Grifols launched in the US its proprietary PediGri(R) On Line system that gives healthcare providers access to quality and safety information about the plasma used in the production of Grifols’ therapies. Through a web portal at http://www.pedigrionline.net/ registered healthcare providers (including physicians, nurses and pharmacists) can access lot specific information about the individual plasma sources that contributed to each product vial. Grifols USA is the US sales and marketing division of Grifols, SA a global healthcare company based in Barcelona, Spain that specializes in the production of life-saving plasma therapies.

The Grifols PediGri(R) system provides full traceability from donation to final product. “Today, it is more important than ever that healthcare providers have confidence in the source of the medications they prescribe and administer,” commented Bill Stopher, President of Grifols USA. “Grifols PediGri(R) provides an unparalleled level of information about the source and quality of the plasma used to produce Grifols’ therapies,” continued Mr. Stopher. By simply entering the lot number found on the product vial, healthcare providers can view specific quality and safety information about each plasma donation used in the production of that vial, the complete certificate of analysis for the lot, and the package insert. To use the system, healthcare providers must register on line at http://www.pedigrionline.net/ and obtain a confidential username and password prior to accessing the PediGri(R) On Line web portal.

“As a physician who prescribes and administers plasma therapies, I believe healthcare providers will embrace PediGri(R) On Line,” said Laurence Logan, MD, Medical Director for Grifols USA. “This level of transparency underscores Grifols’ commitment of quality and safety to the healthcare community,” continued Dr. Logan. Patients who use Grifols’ therapies can access PediGri(R) On Line through consultation with their healthcare provider.

Introduction of PediGri(R) On Line is consistent with the Company’s long history of providing innovative products and services to healthcare providers and healthcare consumers. In the 1950’s Grifols pioneered the process of extracting blood plasma, called plasmapheresis, which has given rise to the widespread availability of life-saving plasma therapies. Grifols’ PediGri(R) has been available in Europe for nearly a decade and will now be made available for all Grifols’ plasma therapies marketed and sold in the US. All Grifols’ therapies marketed and sold in the US are produced exclusively from plasma obtained at FDA licensed and inspected donor centers located in the US.

About Grifols

Grifols SA (Grifols) is a global healthcare company based in Barcelona, Spain since 1940, that today provides products and services in more than 90 countries around the world. Grifols specializes in the production of plasma therapies to treat a variety of life-threatening diseases and conditions. Grifols operates manufacturing facilities in Barcelona, Spain and Los Angeles, California in addition to 80 FDA licensed and inspected plasma donor centers throughout the US. For more information about Grifols please visit http://www.grifols.com/

Grifols SA

CONTACT: Chris Healey of Grifols, Inc., +1-703-351-5004, or fax,+1-703-276-9052, [email protected]

Web site: http://www.grifols.com/http://www.pedigrionline.net/

Park Nicollet Hosts Conference to Explore the Best Treatment of ‘Diabulimia’

ST. LOUIS PARK, Minn., Sept. 10 /PRNewswire/ — Leaders in the fields of diabetes and eating disorders from across the U.S. and Canada will convene in Minneapolis to begin the process of setting international standards for treatment of the dual diagnosis of these two disorders. Organizers want to raise awareness, collect current best practices, define research questions and submit a peer reviewed paper to a major medical journal critically reviewing this field. They also hope to identify international centers for treatment and establish an ongoing collaborative network.

“It’s time to get the experts together, not only to review the research, but to learn from each other,” says Richard Bergenstal, MD, Executive Director of the International Diabetes Center at Park Nicollet, and co-host of the conference.

Panelists include Ovidio Bermudez, MD from the Laureate Psychiatric Hospital in Tulsa; Gary Rodin, MD from Toronto; William Polonsky, PhD, of the Behavioral Diabetes Institute at the University of California, San Diego; Patricia Colton, MD from Toronto General Hospital; Scott Crow, MD from the University of Minnesota; Ann Goebel-Fabbri, PhD, from the Joslin Diabetes Center in Boston; and Juliet Zuercher, RD, from Remuda Ranch Treatment Centers in Phoenix.

What is “diabulimia”?

The public calls it “diabulimia” and clinicians call it “Dual Diagnosis.” Either term describes the potentially deadly combination of diabetes and eating disorders. Patients withhold insulin injections-the drug they need to treat type 1 diabetes-so their bodies will pass the sugars and carbohydrates they eat without processing them. It may make them thin in the short run, but over time it can lead to increased rates of blindness, loss of limbs, kidney disease, heart disease and death. Research shows the mortality rate is 33% (Mortality in Concurrent Type 1 Diabetes and Anorexia Nervosa, Diabetes Care 25:309-312, 2002).

Currently there is no established best-practice protocol for treatment. Patients often go back and forth between specialists in the two areas with little or no coordination. Park Nicollet Health Services-one of the first health systems in the nation to develop a comprehensive combined treatment program-is determined to change that by hosting an international conference to establish new standards for treatment of eating disorders and diabetes. “We want to bring together a team of experts and establish guidelines for the treatment of this potentially lethal illness,” says Joel Jahraus, MD, Executive Director of the Park Nicollet Methodist Hospital Eating Disorders Institute.

“There is great irony in a dual diagnosis,” says Dr. Bergenstal. “Our diabetes patients are taught to count carbohydrates and calories and keep track of what they’re eating. But doing that may also trigger an eating disorder.” That medical catch-22 is one of the many unique challenges that experts will wrestle with this fall.

“Recently we’ve seen an increase in numbers of individuals with dual diagnosis illness seeking treatment at the Eating Disorders Institute and the International Diabetes Center,” says Dr. Jahraus. “This has caused us to collaborate internally and rethink our approach to the dual diagnosis of an eating disorder and diabetes. Now is the time to bring together a larger audience of clinicians and researchers to develop useable, comprehensive treatment plans. It just can’t wait any longer.”

   For more information, visit:   http://www.parknicollet.com/methodist/edi   http://www.parknicollet.com/Diabetes    

International Diabetes Center at Park Nicollet provides world-class diabetes care, education and clinical research to meet the needs of people with diabetes, their families and the health professionals who care for them. Located in suburban Minneapolis, the center is recognized internationally for its range of clinical and educational programs, products and services. International Diabetes Center is part of Park Nicollet Institute, a division of Park Nicollet Health Services.

Park Nicollet Methodist Hospital Eating Disorders Institute (EDI) is a nationally recognized program treating people struggling with anorexia nervosa, bulimia nervosa and binge-eating disorder. EDI collaborates with each client and family to develop an individualized treatment plan, using a multidisciplinary approach to treatment, including physicians, dietitians, psychologists, psychiatrists and other specialty disciplines. EDI offers a full continuum of care including inpatient, partial hospital program, and outpatient programs.

Park Nicollet

CONTACT: Steve McCarthy of Park Nicollet, +1-952-993-6726, pager,+1-952-231-5029

Web site: http://www.parknicollet.com/

Dr. Harry L. Leider, Renowned Healthcare Expert, Joins Ameritox As Chief Medical Officer

Ameritox, the U.S. leader in pain prescription monitoring, is pleased to announce that Dr. Harry L. Leider, MD, MBA, FACPE, has joined the company as chief medical officer and senior vice president. Dr. Leider will lead a variety of progressive initiatives, ranging from clinical research, to physician education, as well as strategic programs related to product development and payor partnerships.

For more than 20 years, Dr. Leider has been an effective and widely-respected force for change in the healthcare industry, helping to develop and establish the disease management specialty for Medicare recipients and other populations with special medical needs. He has held senior leadership roles with a diverse range of healthcare companies, including XLHealth, Care Improvement Plus, IFI Health Solutions, and Harvard Community Health Plan.

Dr. Leider also has held numerous national healthcare leadership roles. He is currently an officer on the Board of the American College of Physician Executives serving as the organization’s president-elect. He was a founding board member of the Disease Management Association of America (DMAA) and currently chairs its Medicare Committee. He serves on the Board of the Institute of Aging at the University of Pennsylvania. A frequent speaker at universities, medical schools, and national conferences, Dr. Leider has authored numerous peer-reviewed articles as well as chapters in multiple books, including The Essentials of Medical Management and Practicing Medicine in the 21st Century.

“Dr. Leider has inspired and educated other physicians in leadership positions on how to best manage and achieve success for their own practices and organizations. With his experience and insight, he is uniquely qualified to move Ameritox forward in achieving its next level of growth and sophistication,” said Ancelmo E. Lopes, Ameritox CEO. “I am personally very excited and pleased to have him with us.”

Dr. Leider obtained a BA from Pennsylvania State University and earned his MD from the University of Pennsylvania School of Medicine. While he was a Robert Wood Johnson Clinical Scholar, he earned his MBA from the University of Washington. In addition to being board-certified in Internal Medicine, he is board-certified in Medical Management and is a fellow of the American College of Physician Executives. He served for six years as an attending physician at Brigham and Women’s Hospital in Boston and as a faculty member at Harvard Medical School. Dr. Leider is currently a Senior Scholar in the Department of Health Policy and Outcomes at Thomas Jefferson University.

About Ameritox

Ameritox is the nation’s leader in pain prescription monitoring. Only Ameritox offers RxGuardian(SM), the most thorough and personalized lab report available, and the only report that can help physicians assess whether a patient is taking their pain medication consistent with the prescribed dosage plan. By comparing normalized values to expected prescription-specific ranges, RxGuardian assists pain practitioners in protecting their patients by providing information to help assess compliance based on prescription regimens. RxGuardian also provides peace of mind to physicians and protection to their practice by providing data to help ensure that patients are taking pain medications as prescribed. With its headquarters in Baltimore, MD and with laboratory facilities in Midland, TX, Ameritox processes thousands of specimens everyday. For additional information about the Company, please visit our website at www.ameritox.com.

Wrap Comes Off Mercy’s Fore River Campus Today

By MATT WICKENHEISER

Mercy Health System of Maine is set to officially open its Fore River campus in Portland today, a 42-acre site that now dominates the cityscape as drivers travel north on Interstate 295.

The first phase of the $100 million project consists of a 151,000- square-foot hospital and an 80,000-square-foot, privately owned medical office building. Construction on the site, which overlooks the Fore River, began two years ago this month.

While Mercy’s site on State Street will continue to house the emergency room, outpatient cardiology, critical care and administrative offices, the new campus will provide some breathing room, said Tim Prince, vice president of planning for the hospital, which is overseen by the Sisters of Mercy. The State Street site has 230,000 square feet of building space -split by two city streets – on a three-acre campus. Half of the building was built in 1942, the other half in 1952.

“The ingenuity with which we’ve overcome the barriers of this facility has been exhausting … we’ve shoehorned things in,” said Prince. “The types of amenities you need in a facility to make it the kind of healing environment can’t be accommodated here.

“Even though our staff provides great care, the facility is a barrier to that,” he said.

There are people who use closets as office space at State Street, Prince said. The smallest operating room at the new facility is bigger than the largest operating room on State Street, he said.

Portland City Manager Joseph Gray Jr. is intimate with the hospital’s State Street facility, having gone through treatment for both prostate and colon cancer there. The building is obviously outdated, said Gray, with small rooms and undersized layouts.

He has visited the new campus’ medical office building, found it easy to access and said, “Mercy will have a state-of-the-art facility.”

“Our intention is to have a beautiful campus that’s reflective of our faith-based heritage as well as our focus on a nurturing and caring environment,” Prince said. “We’re proud to have the opportunity to have beautified this industrial site that was an old railroad bed.”

Godfrey Wood, chief executive officer of the Portland Regional Chamber, said the new facility is “certainly a new landmark.”

Wood noted that recent expansions at both Mercy and Maine Medical Center draw people who are looking to move to Portland.

“One of the things people think most about when they’re looking to move or live in a community is good hospitals,” Wood said. “(The expansions) accentuate the notion that we offer fantastic health care here.”

The new hospital houses diagnostic imaging, laboratories, inpatient and outpatient surgical services, and The Birthplace – Mercy’s childbirth facilities. Mercy expects to treat its first patients at the hospital in about two weeks.

The buildings run on a north-south axis, which gives all patients’ rooms a view of the Fore River. All Birthplace suites feature Jacuzzi tubs, and the campus is connected to the Portland Trails network.

The office building was built by Landmark Healthcare Facilities Inc. of Milwaukee. It already houses Fore River Urology and New England Foot and Ankle Specialists, which are departments of Mercy Hospital. Moving in with them are Mercy’s Oncology/Hematology Center, Breast Care Specialists of Maine, the Lymphedema Treatment Center and Fore River Family Practice, bringing the building to just over 90 percent occupation, Prince said.

Landmark spent about $16 million to build the office building, and leases the land from Mercy.

Mercy spent $85.3 million on the land, site work and building. Of that, $7.2 million was cash released by the hospital’s board of directors, $16 million came from fundraising in the community and the rest came from a bond held by Mercy and issued through the Maine Health Care/Higher Education Finance Authority.

Phase two of the project would begin with construction of a 700- to 900-car parking garage on the site, followed by the addition of a 200,000-square-foot building onto the back of the Fore River hospital. Mercy expects to begin that phase between 2012 and 2015.

That next phase would allow Mercy to move the rest of its State Street operations to the Fore River campus.

Today’s grand opening is open to the public. It will begin at 10 a.m. with a dedication and blessing by Bishop Richard J. Malone, followed by a ribbon-cutting ceremony at 11:30 a.m.

Staff Writer Matt Wickenheiser can be contacted at 791-6316 or at:

[email protected]

Originally published by By MATT WICKENHEISER Staff Writer.

(c) 2008 Portland Press Herald. Provided by ProQuest LLC. All rights Reserved.