HEALTH

CHARLES N. KAHN, Federation of American Hospitals President, February 19, 2002
CZIKOWSKY: States will be allowed to expand their children’s health insurance programs to include coverage for pregnant women without health insurance. Yet, some analysts note state budgets will not have the funds to pay for such expansion. Do you have any thoughts on this?
KAHN: The states are in a bad way fiscally right now. That is not good for health coverage. But, so much is tied to the economy. If the economy gets moving again, that would solve some of this problem. This is a fiscal not a health issue.

ABIGAIL TRAFFORD, Washington Post Columnist, and ED LOWENSTEIN, Harvard University Professor, March 12, 2002
CZIKOWSKY: Do you see any significant improvements in the dissemination and understanding of information, as understood by the medical community, to the political community. It is often difficult for policy makers to understand medical information. Especially when there is often conflicting information. In addition, policy makers need to be attentive to other communities. These communities may further fail to properly understand that which is accepted by the medical community. What can be done to create greater understanding of complex medical information?
TRAFFORD: You raise good points. Basically health is a very political issue. So you have politicians making health policy and health professionals recommending political solutions. But this gests very dicey when the subject is a particular medical practice such as end of life care. Dr. Lowenstein, when should politicians stay out of medicine---and vice versa, when should physicians stay out of politics?
LOWENSTEIN: I would guess there is more medical information in the public domain today than even in the past. One of the problems medicine has with many other constituencies is it does not speak with a single voice, for all sorts of reasons, but certainly reflecting the many differences individual physicians have. For instance, less than half of the physicians in the United States belong to the American Medical Association, but many assume the AMA speaks for all doctors.
I agree it would be more effective if we spoke with a single voice to the policy officials, and I hope we can figure out how to do this better in the future.
On the other hand, it may be even more important that physicians and their patients are the one who are in the driver’s seat rather than politicians.

DEIRDRE THORNLOW, American Association of Colleges of Nursing Program Director, July 18, 2002
CZIKOWSKY: There is a shortage of nurses. State governments are responding by providing more funds to nursing schools to increase their enrollments. Do you believe this would be helpful, or would it be more useful to direct such funds to more scholarships or in some other way?
THORNLOW: The funds are dispersed in many ways. Some of the money does to go fund student enrollment and student tuition, yet other funds are directed to faculty development and infrastructure improvement. All are important for ensuring a quality education. AACN is working with local, state, and federal legislators to secure more financial assistance for students.

BILL FRIST, United States Senator, July 18, 2002
CZIKOWSKY: Do you think it would be beneficial to district potassium iodide to residents living near nuclear power plants?
FRIST: Generally, the first rule is to evacuate. However, if the tables are available they can be taken, but offer only very limited and partial protection---just to the thyroid gland. Again, evacuation is the first priority.
No protection against dirty nuclear bombs.

DAVID MURDOCH, Frontline Producer, October 18, 2002
CZIKOWSKY: What is the state of mental health care in most prisons? What types of mental health care are lacking and what do you believe, if anything, should be done?
MURDOCH: I think it’s safe to say that it’s a problem for prisons across the country. They’re stretched. In society in general, the mental health system is stretched. And to take that system and put it in a correctional system, you can imagine. Their primary concern is controlling the inmates, whether they have mental health problems or not. When you go to the hospitals for the most severely mentally ill, and they’re treating these patients, their aim it to return this person to prison---not to society. So their aim is to stabilize and make the person more controllable.

ORRIN HATCH, United States Senator, October 22, 2002
CZIKOWSKY: Thank you for your support of stem cell research. It would mean so much to so many people who suffer, and may prevent suffering, from several medical conditions. What is the current political mood on stem cell research? Do you see the public becoming more supportive of such research as they learn more about the details of this issue?
HATCH: I believe the public will become more supportive and I believe the Congress will do so as well as more and more scientific research is explained. I believe we have at least 60 votes in the Senate to allow participation of the Government/

HENRY J. AARON, Brookings Institution Senior Fellow, November 25, 2002
CZIKOWSKY: A claim was made during the last campaign that the amount of deficit created by the Bush Administration could have paid for national health care. Is this true or is this rhetoric? How much health care could be purchased by the amount of the Federal budget deficit?
AARON: The revenue cost of the tax cut could easily have paid for both Medicare reform (a prescription drug benefit, long term care, and reduced and rationalized cost sharing) and for health insurance coverage for the uninsured. The decision not to use these funds for these purposes or to address other domestic needs (such as closing the projected long-term deficit in Social Security) was, in my view, a major lost opportunity.

MICHAEL J. THUN, Vice President of Epidemiology and Surveillance Research, American Cancer Society, January 31, 2003
CZIKOWSKY: Have there been any recent studies on whether there is any correlation between nuclear radiation leaks and cancer? Legally, the courts have answered and stated there is no correlation. Yet, for those of us in the Harrisburg area who wonder if our cancer rates indeed are normal, or whether there are long term affects to the Three Mile leakages, questions continue. These concerns remain, especially when we observe that questions of increased infertility were never addressed, nor does there seem to be much of an effort to obtain data from people who lived in the area and then moved away. Do you have any thoughts on the effects of radiation as a cancer risk?
THUN: Yes. Since I grew up within 50 miles of Harrisburg I share your interest in Three Mile Island. Several large studies of the episode have not found any relationship with cancer. Radiation is carcinogenic, but the affect is related to dose. Unlike the catastrophic release at Chernobyl, the type and amount at the Three Mile Island episode has not resulted in a detectable uptick in cancer.

CECI CONNOLLY, Washington Post Staff Writer, May 23, 2003
CZIKOWSKY: There were flu outbreaks in the 1950s and 1960s that killed millions of people worldwide. While it is tragic that so many people died from SARS, it has not reached these proportions. How concerned are experts that it could potentially blossom into a greater epidemic of similar proportions?
CONNOLLY: Experts are very concerned about SARS because there are many unknowns at this point. In addition, as NIH’s Anthony Fauci has pointed out in recent Congressional testimony, the death rate for SARS is much higher than influenza. In a typical years, flu kills 1 percent of people infected and during the pandemic of 1918-191 the death rate reached almost 4 percent. By contrast, the SARS mortality rate at this point appears to be 8 percent and could rise as high as 15 percent.

NORMAL ROSENTHAL, Clinical Professor, Georgetown University, May 28, 2003
CZIKOWSKY: How are people in far northern parts of the world affected by seasonal disorders when sunlight is present and then absent for long periods. Do they adjust, or do they tend to show signs of health disruptions?
ROSENTHAL: Many people in the far north suffer year after year, whereas others such as the Icelanders seem particularly protected against the effects of SAD (Seasonal Affective Disorder).

JON PALFREMAN, FRONTLINE Producer, June 20, 2003
CZIKOWSKY: There is a Pennsylvania state legislator who arranges bus trips for senior citizens in his district to travel to Canada so they may save money on purchasing pharmaceuticals. At least people in Maine are closer to Canada. I know your film addresses this, still, doesn’t this tell us something when the same company charges two different prices for the same drug?
PALFREMAN: The reason drugs are cheaper in Canada is because the Canadian government, the provinces, determine the prices. If a drug company can lump it or leave it, the state of Canada is free to take out a compulsory license so the Canadian company can make the drug anyway. So there’s not much the drug companies so do. The U.S. market is the last unregulated market in the world. That is why they are so scared and why they’ll do anything to prevent schemes like Maine’s.

PAUL ZEITZ, Global AIDS Alliance Director, July 28, 2003
CZIKOWSKY: AIDS has been alternately described as a very difficult disease to transmit, and also as one of the fastest spreading diseases in history. Yet, these two comments do not necessarily conflict. Would you please explain, in layperson’s terms, how a disease that is difficult to get is so widespread? Is it that people engaging in risky behavior are statistically more apt to be infected? Is the body able to fight infection and it is as repeated infections build up that AIDS develops, or is it that a one time infection means a person will likely gets AIDS?
ZEITZ: Thanks for your question.
HIV is a very fragile virus that only survives in bodily fluids like blood, saliva, and sexual fluids. The virus is only transmitted through these fluids. It can be transmitted through blood, via blood transfusions, needle sticks. While the virus is found in saliva is very rarely it at all causes an HIV infection. The most common form of HIV is through sexual fluids. Only viruses like the flu are air borne and can spread by breathing in the virus, thus it is much more easily spread.
As sexual behavior needs to change to stop HIV transmission, HIV/AIDS is spreading rapidly in many parts of the world, including here in the USA.

BRUCE LEFF, Associate Professor of Medicine, John Hopkins University, August 6, 2003
CZIKOWSKY: It used to be that I was hesitant to ask public leaders about health care because it was a difficult issue to follow. Yet, after hearing Uwe Reinhardt, I now realize I should not be afraid to ask about health care policies because the reason it is so difficult to understand is what makes the system a total mess. One needs to take a course in learning who is covered by want, and even then, it is not certain. No one would sanely have designed such a confusing system if it were designed from scratch. The irony now is: if we had a single payer system, it would probably not be any more expensive because so many administrative costs would be eliminated. Is there any way we can make the healthcare system something that most Americans can at least understand their benefits?
LEFF: You raise a terrific point and I wish I knew the answer to it. Unfortunately, most people don’t understand their benefits. I can’t tell you how many times in my practice that I talk with people who believe that Medicare covers long term nursing home care.
Perhaps we need to demand more from our elected officials…

MATIAH BURTON NELSON, former professional basketball player, August 12, 2003
CZIKOWSKY: Do you have advice on when a second medical opinion should be sought? When something is misdiagnosed or made to seem less serious than it really is, what should tell someone to seek a second opinion, and what should tell us that we’re being foolish in doing so?
NELSON: Seek a 2nd opinion:
1) If you feel like it
2) If you’re facing a major decision
3) If you want to be sure, even though you trust your doctor. S/he could be wrong.
As for foolish—who cares? Do what you need to do to get informed and reassured. Also—I told the first doc that I was seeking a second opinion. No reason not to let them know, and even to compare notes afterward, ie The second doc said this, what do you think about that? THIS IS YOU BODY YOU’RE TALKING ABOUT…do whatever seems right to YOU.

LINDA PERLSTEIN, Washington Post Staff Writer, September 9, 2003
CZIKOWSKY: Your article contained excellent anecdotal information. In your book, do you have some statistics and studies to support that your observations are part of a growing national trend? In sum, are middle age children growing up faster than in previous generations?
PERLSTEIN: Statistics and studies are cited in the notes and bibliography of “Not Much, Just Chillin’.” In some ways, middle age children are growing up faster—“The Hurried Child” by David Elkind and “The Disappearance of Childhood” by Neil Postman are excellent books on the subject. But in some ways, they’re staying pretty much the same. According to some studies, for example, the number of teens preparing in sexual activity has plateaud.

SALLY SQUIRES, Washington Post Health and Nutrition Writer, September, 9, 2003
CZIKOWSKY: I have a friend (honest, it is a friend, not me) who has started a diet where he fasts every other day. I believe it is better to eat less every day. Are there any health risks to this type of fasting diet? If one pursues such a diet, do you have any suggestions on how to make it more successful? Or, would you advise him to abandon it entirely? (For the record, he claims it is working well for him.)
SQUIRES: If your friend doesn’t have any health problems, there’s probably no great harm in fasting every other day. It would be most important on the days when your friend does eat to have a balanced diet that meets as many essential nutrients as possible. And a multivitamin, plus some calcium might not be a bad idea. Also plenty of water would be prudent.

JOHN M. SPRATT, JR., Member of Congress, Februaryu 3, 2004
CZIKOWSKY: What is President Bush proposing for prescription medication assistance? Are Democrats prepared to note the inequities in his proposals?
SPRATT: What we would like to do is make a completely new proposal and we will begin with cost containment by calling upon the government to use its clout to bargain for lower prescription drug prices. It is no wonder that OMB estimates the cost at $135 billion more than CBO, because they have minimal cost containment provision and literally prohibit the Federal government from negotiating lower drug prices.

ROBIN HERTZ, Phizer Inc. Population Studies Senior Director, February 25, 2004
CZIKOWSKY: Let me please ask your thoughts on the widely debated topic of the time and expense required to research and develop medications for so many diseases, while at the same time attempting to keep costs affordable so they may benefit large numbers of people around the world. What are the criteria you believe should exist in finding the balance between the need for timely research versus the need for cheap and swift delivery of medicine to people who need help?
HERTZ: You’re right. It is expensive and time consuming to develop medicines. But cheap and quick is not the answer. While we need to shorten the process, let’s not overlook quality. We need quality medicines that are effective, safe and easy to use. Staying on treatment and adhering to the treatment regimen is essential.
CZIKOWSKY: Medical schools and other medical related schools are very competitive and difficult to enter. Yet, isn’t there a looming major shortage of health care professionals? How should we respond to get more people to work in health care?
HERTZ: There is a shortage of healthcare professionals. What we’re doing right now as part of the ACOVE program is working towards getting medical students, interns, and residents the right kind of information about taking care of older adults. It’s not an issue of quantity; it’s also an issue of education.

MELISSA JOHNSON, President’s Council on Physical Fitness Executive Director, March 30, 2004
CZIKOWSKY: What exercise opportunities are available in the office where you work?
JOHNSON: The Health and Human Services Building here in Washington, D.C. (Humphrey Building) offers an on-site fitness center complete with cardio and weight training equipment, as well as all kinds of fun fitness classes (yoga, dance, toning, etc.). It’s open all day and into the evening, which allows employees to work out before or after work or on their lunch hour. Secretary Thompson encourages all employees to be active on a regular basis. We even had a “Secretary’s Challenge” here in the building, which was a six week program that used our President’s Challenge websit program as the tool to get people moving. We tracked our activity on-line. Check out www.presidentschallenge.org , and you can do the same! Many corporations are adopting this program at their company wellness program.

SUZ REDFEARN, writer, June 29, 2004
CZIKOWSKY: Let me begin by stating I had a neighbor who was paralyzed for ten years who tried every treatment he could, and finally it was acupuncture that relieved his paralysis. So, I am definitely open to the idea that acupuncture has benefits. Would you please explain what acupuncture does that overcomes some types of infertility. How does it work?
REDFEARN: The classic traditional Chinese explanation goes something like this: energy (or “qi”, pronounced chee) runs in river-like patterns through the body. Any obstruction in the energy flows acts like a dam that stops energy from flowing in the right direction. TCM practitioners believe this can lead to disease. Sticking needles in at very specific points in the body is said to reestablish the flow of qi. As for fertility, small studies have shown that it can help balance the endocrine system as well as bring more blood to the uterus and ovaries, which are often blood-starved in infertile woman, apparently. Let’s hope it’s so!

GEORGE McGOVERN, Former Presidential Candidate, July 28, 2004
CZIKOWSKY: You wrote a very touching book about a deeply personal tragedy regarding your daughter’s alcoholism and death. For readers who did not reach your book, would you please summarize some of the excellent points you mentioned: about how we need to be available for an alcoholic to reach out, even when they claim they don’t want help, so that when they are ready to admit they need help, there is someone there to help, along with any other useful advice you may wish to provide.
McGOVERN: I think the important thing to keep in mind is that alcoholics are desperately ill. We are dealing with a disease that is as real as cancer. I learned from my daughter’s tragic death the importance of reassuring the alcoholic of our love for them even when we find their conduct revolting. I wish that we were investing more in determining the cause of alcoholism and in the best possible treatments for it.

FRANK BEADLE DE PALOMA, Academy for Educational Development Center on AIDS and Community Health, July 30, 2004
CZIKOWSKY: Do you have an estimate as to what the annual cost to the United States would be to achieve the goals you seek from us? Personally, I believe we should be making these efforts, yet for those who insist it costs too much, I wonder how the bottom line compares to how much we spend on other areas such as the war in Iraq.
BEADLE DE PALOMA: In 2001, Brookings Institute said we needed $5 billion/year globally to mitigate AIDS.
In 2004, UNAIDS estimated that we would need $10 billion a year by 2005, and $15 billion a year by 2007.
Currently, $130 billion has been committed for war in Iraq through appropriations.
These are daunting numbers, but it does seem that where there is a will, there is a way…

CHRIS MOONEY, “American Prospect” Senior Correspondent, December 15, 2004
CZIKOWSKY: It seems as if state governments such as California are becoming more of a source of funding for stem cell research. Is it the proper role of state governments to invest in such research?
MOONEY: The states are certainly playing their role as “laboratories of democracy” on this question—what a fitting phrase that turns out to be true. I recommend that you read William Safire’s column today about this. It’s not just California: Other states are hopping on the stem cell wagon, hoping to prevent their best researchers from packing up their bags and heading west. Is this the “proper” role for states? Well, I think most people would consider the National Institutes of Health to be a stellar research institution and the first choice for funding this research. But because of the current Federal policy, that hasn’t happened at a level that scientists, disease advocates, and others consider necessary. So states are filling the gap, and apparently they can afford it.
So this strikes me as little more than a new development in our long tradition of federalism. I do see some possible grounds for concern, in that these states don’t have the long tradition of sponsoring major research that the Federal government has through the National Institutes of Health and other agencies. They’re starting from scratch. That’s definitely a challenge, and we have to hope that they will proceed with care and draw lessons from the NIH, universities, and so forth.
There’s also an irony there that I can’t resist remarking upon. Federalism used to work against the scientific community; local control of education, for example, facilitated creationist attempts to control Biology curricula. But now, it turns out that states are helping scientists get around a policy at the national level that they don’t like.

ROBERT KRULWICH, NOVA scienceNOW correspondent, February 23, 2005
CZIKOWSKY: What are your thoughts on the warning that the flu could mutate into a virus that could kill millions? Is this a theory that has been given too much media attention, or do you think this is a serious fear that requires urgent actions? While people panic when hearing about the flu of 1917, there were over a million who died from the flu as recently as 1968, if I recall correctly.
KRULWICH: Ahhh.
Now this is, maybe, the single biggest thing we have to worry about. I have not read it yet, but Michael Spector, a very good reporter, has a big fat story in this week’s New Yorker magazine which asks the key question: How likely is it that a dangerous virus, moving from bird to bird will somehow spread to people and then mutate so fast it will pass through the air from person to person.
So you start with a chicken, or duck, or goose. The germs move from birds to people, where they are new to humans, and very, very harmful. Deadly even.
Then people start infecting other people through the air, like the flu you mentioned from the last century, and then lots of people, tens of millions, get sick. And many of them, maybe most of them, die. Sounds like a remote nightmare, I know. But, even without reading Michael’s article, I am very nervous.
I am nervous cause humans and birds live so closely together, so intimately. I was knocked out a few months ago when I read in New Scientist Magazine about a kid in Thailand who raises cocks to fight. Cockfighting goes on everything. That’s almost normal. But this kid feeds his birds FROM HIS OWN MOUTH. He puts his mouth over their beaks and food passes between them. Not just food, germs, bacteria, and, maybe one day, a horrible disease.
I don’t know this stuff. Now I worry about it.

ANDREW P. HARRIS, Maryland State Senator, March 10, 2005
CZIKOWSKY: If these embryos are not used for research, what would happen to them? Would we be able to produce a human for each unused embryo?
HARRIS: Absolutely. We had a couple at the hearing, a paraplegic and his wife, with their two year old daughter who was a donated frozen embryo. I hope we can all agree that’s the best outcome for a frozen embryo. It’s called the “snowflake” program, encouraging couples to donate their “extra” embryos to those who can’t have their own.
CZIKOWSKY: How would you feel if there was a guarantee that cancer research funding would not be affected by stem cell research?
HARRIS: A good question, but I and other Senators have to consider the implications in their entirety. There are several levels of objection to this approach. These other objections still exist, and in my mind, still would lead me to conclude that this is not good policy for Maryland. You should look into the most recent research that would allow that creation of embryonic stem cells without killing a living “embryo”!

JOHN GEARHART, Johns Hopkins Medicine Professor, March 10, 2005
CZIKOWSKY: If these embryos are not used for research, what would happen to them? Would we be able to produce a human for each unused embryo?
GEARHART: IVF patients must decide what to do with embryos that are stored and will no longer be used by them. Options can be (depending on the facility) that they are discarded, used by other couples, or used for special research projects.
Your question is difficult to answer. Certainly some of these embryos could successfully produce a child. Not every embryo placed in the uterus results in a pregnancy or a newborn.

ARTHUR CAPLAN, University of Pennsylvania Bioethnics Professor, April 12, 2005
CZIKOWSKY: Medical malpractice is a major issue at both the state and federal levels. It seems to be many doctors want to limit the ability to be sued, but do not want any further intrusion into their work records. Isn’t it possible that systems be implemented that can understand both the risk of the type medical work done and the error rate of the medical work done so we can flag whenever there appears to be physicians than have higher than expected error rates? At what point should these physicians be removed from performing certain procedures? Wouldn’t that then lower medical insurance when those creating most of the errors and lawsuits are removed from practice?
CAPLAN: We don’t have to argue about marginal cases or people with higher than average error rates. The Post series revealed just how incompetent and dangerous doctors are out there. Let’s focus on getting rid of them, then we can focus on those doctors who have above error rates. Right now the system can’t even get rid of the manifestly and indisputably incompetent and inept!!! I once proposed a simple test to get rid of the blatantly incompetent physician. To keep your license every doctor could be required to simply return a postcard answering 10 or 12 basic questions. That simple test would do more to weed out mentally ill, drug addicted, and senile physicians than the current system in place!

HANK McKINNELL, Pfeizer Inc. Chairman and CEO, June 223, 2005
CZIKOWSKY: The health care system is spiraling out of control. I know economists who state they are not worried about social security because any projected deficits in social security are within the margin of error for what they predict the deficit will be in attempting to continue to pay for our health care. We spend more on the administrative costs of health care than we do on pharmaceuticals. Wouldn’t it make sense to have just one health care insurance, whether a combination of private insurers in one big pool or a national plan, so we can significantly reduce the administrative costs so we may free up more money to devote to preventive and necessary health treatments?
McKINNELL: There is no question we face a crisis, but it’s not in health care, it’s in sick care. I have written a book on this topic, “Call to Action, Taking Back Healthcare” for future generations. We need to spend less treating heart attacks and strokes and spend more on prevention and wellness to avoid people having to be treated for those heart attacks and strokes. That is one of ten “Calls to Action” in my just published book.
CZIKOWSKY: Would you favor an increased government role, and/or increased government contracts with academic and research centers, in pharmaceutical research so that private pharmaceutical research costs could be lowered and, in turn, the costs to consumers of pharmaceuticals could be reduced?
McKINNELL: You’re kidding. Can you think of anything where government does it cheaper or better? National Defense is a good start, but it’s a short list.

JARED DIAMOND, University of California, Los Angeles Professor of GeograPhy, July 21, 2005
CZIKOWSKY: Do you have any thoughts on the fears of another flu epidemic hitting humans, particular the Avian flu concerns that exist now in Southeast Asia?
DIAMOND: Yes, there could be another flu epidemic, but I’m not worried about the risk of its wiping out the human race or our economies. The big threats to the human race and our economies are not flu, but environmental and population problems and their political consequences.

JOHN E. WENNBERG, Dartmouth University Physician, July 27, 2005
CZIKOWSKY: If we could go to a single health insurer, do you think it might become easier to create a sensible reimbursement to hospitals?
WENNBERG: It would be easier to deal with incentives and fairness issues; whether the system would be better depends on how the incentives are designed.
CZIKOWSKY: Would an unscrupulous hospital administrator encourage reporting of poor practices to deliberately receive additional money?
WENNBERG: Can’t tell from the data; but it sounds like a good definition of unscrupulous behavior.

MICAH FINK, producer, September 21, 2005
CZIKOWSKY: Some of the worse case scenarios come from an interesting source: “Foreign Affairs” magazine, which almost reads like a horror novel. It almost seems as if the mainstream press is downplaying the potential affects of a major flu outbreak while the professional journals are warning of potential disaster. I hate to use this analogy, but are we potentially repeated what happened in New Orleans: we are aware of a disaster, but because the costs of preventing the disaster are high the odds of disaster low, we prefer to look away and go with the odds and just hope the disaster never happens?
FINK: I think your sense is right. The professional journals and websites (like promed) have been keeping a very close watch on the avian flu virus for the last few years, but the main stream media---perhaps because the evolution of the virus seems like such a technically complex issue---have until recently avoided the issue. Also, to be fair, terrorism and the war in Iraq have dominated much of the foreign coverage and the news hole, never large for international affairs, has been filled. That said I agree that this is a pressing and important issue (or else would not have proposed the program “H5N1: Killer Flu”) and I think we should be doing much more than we are doing now. Antiviral supplies are very small (and the patents are held by just a few corporations) and even in the best case scenario, will not be available on a large scale if a pandemic strikes. Not even in the U.S.---if ever there was a time for patent sharing, it would seem like now is a good moment---to allow the world to prepare. Also most of the Federal money in the U.S. these days seems to be getting spent on terrorism related issues---which may be very short sighted.

ALAN CASSELS, author, September 21, 2005
CZIKOWSKY: Do we need all these medications? I keep seeing an ad for curing a yellow toenail and then the side effects are mentioned. If I had the side effects, I would rather take medication to get rid of them with a yellow toenail being the side effect. Isn’t advertising just creating new things to be fearful of that probably aren’t urgent needs for medication?
CASSELS: There are more than 20,000 drugs on the market in the U.S. The World Health Organization keeps a list of “Essential Drugs” that any nation needs to provide to its people. Guess how many drugs are on the WHO Essential Drugs List? 306.
As for the toenail thing, my mother took that drug and when I explained the rare but serious side effects she still chose to take it. At the end of the day people need to be fully informed as to a drug’s risks and benefits and when they have that information, whether or not they take the drug is up to them.

DAN FROOMKIN, Washington Post White House Briefing Columist, September 21, 2005
CZIKOWSKY: There are warnings of a potential avian flu crisis. Have you learned our lesson from the Gulf Coast hurricane and will the White House be better prepared, or will we, line in deciding not to repair the levees and hope a disaster never strike, turn away and hope this potential flu crisis never hits? Should we have Federal legislation to require patent sharing and should the Federal government be prepared to respond to be able to rapidly produce enough of the correct flu shot, if and when so required?
FROOMKIN: Hey, remember last year’s flu season , when we couldn’t get enough vaccines for something entirely predictable?
The avian flu, should it strike, would be a total disaster000and the end for all practical purposes of the Bush Administration---unless some action is taken right quick.
Over on my Niemanwatchdog.org site, the Harvard School of Public Health Professor Marc Lipsitch raised this point six months ago.
Michael A. Babcock, a professor who has written about pestilence in the late Roman Empire, writes today in the Houston Chronicle that Bush’s mention of avian flu last week in his speech to the United Nations might possibly be a turning point. We’ll see.

JILLIAN MICHAELS, “The Biggest Loser” TV show personal trainer, September 26, 2005
CZIKOWSKY: Are you ever concerned that someone might lose weight too quickly just to help the team on the television show? How do you monitor that people are losing weight properly?
MICHAELS: Good question. I love this one because it allows me to dispel dieting myths which is one of my favorite things. I dedicate an entire chapter to explaining questions like this in my book.
We’ve all heard that saying, “losing one to two pounds a week is healthy”. Not so…it’s REALISTIC. That’s the difference.
Losing weight quickly when done through exercise and not starvation is not dangerous at all. In fact there is no true scientific evidence to suggest otherwise. The only complication that could occur are gallstones, however if the person is taking in plenty of fiber, exercising, and staying hydrated the chance of a gallstone is next to none.
In fact, I think the evidence has show quite the opposite. If you look at our contestants on the show they come in with all kinds of afflictions: type 2 diabetes, high blood pressure, sleep apnea, etc. When they leave the show they are in better shape then me and off of all their various medications.

PHILIP J. HILTS, author, November 2, 2005
CZIKOWSKY: Have you explored the topic of the need for medical researchers and pharmaceutical company executive to better share data and information, on an international basis?
HILTS: I have done some reporting on that issue, but not for this book (“Rx for Survival”). It is a real problem, and in fact I was thinking of taking on medical information and its control for my next book. The system is broken, and it is time to address it, I think.

ALFRED SOMMER, Johns Hopkins School of Public Health Professor, November 4, 2005
CZIKOWSKY: I would like to learn your opinion on fluoridated water. I agree that it has helped reduce cavities. Yet, there are claims it may increase cancer risks. Are these cancer risks real, and if so, are they significant?
SOMMER: There is no good scientific evidence that fluoridation causes cancer. In areas of the country where fluoride naturally occurs in high concentration in the water there can be some mottling of teeth and bones but this is not harmful. At levels at which it is added to water, it does not cause this and simply reduces cavities, which is an important public health advance.

STEVEN PEARLSTEIN, Washington Post Columnist, January 18, 2006
CZIKOWSKY: Let me state the obvious. The health care system is too complicated. Even experts do not understand it. I recall an audit of health insurance forms in Harrisburg that found an extremely high error rate (I believe there was at least one error on just about every form). If the experts either don’t know the system or at least can’t handle the paperwork, how can we expect the public to understand it? Most reforms tinker at the edges, and maybe reforms will improve things, but isn’t there a bottom line here: how does it help a complicated system by making it even more complicated? Is there any way we can just make health care understandable, serfices knowable and guaranteed, and affordable?
PEARLSTEIN: The administrative paperwork is obviously more complicated than it has to be. But I’m not sure you can avoid some level of complication in health care, because the answers aren’t always easy and obvious, there’s lots of judgments and emotion and risk involved, and the sums of money shelled out by people other than patients themselves are very large, so there is a need for accountability. It is true that we spend as much as 20 percent in our private sector system on administrative paperwork, and that is way, way, way too high. Making better use of simpler reimbursement mechanisms and information technology should be able to cut that in half.

JAMES RESTON, JR., author, March 7, 2006
CZIKOWSKY: It was sad reading what happened to your daughter and how this changed her life. I was surprised that your daughter Hillary’s condition remains a mystery to medical expert. In your opinion, what are some of the best theories as to what happened?
RESTON: As you’ll see when you read the book (“Fragile Innocence”), we were given a number of explanations, some of which were just general but complicated words like encephalitis (which just means brain disease) or stroke. The word “stoke” too we later learned is just a general term and not a specific diagnosis. But that word has been the most useful, at least to the question our friends ask.
“What happened to your daughter when she was two years old?”
“Oh”, we answer, “she had a stroke.”

MARC EMERY, Cannabis Culture magazine publisher, March 21, 2006
CZIKOWSKY: I am one who believes that dangerous substances such as alcohol, tobacco, and pot should be regulated strongly but not illegal. Would you agree this is a consistent and logical position to take?
EMERY: Cannabis might more accurately be regulated like coffee, although coffee is less value-added in that coffee workers are thought to be underpaid, exploited. Cannabis growers typically receive the highest price in the market of any cash crop.
Alcohol and tobacco kill hundreds of thousands each year, cannabis kills no one. Is the alcohol and tobacco paradigm really applicable? I think not.
Cannabis is subtly consciousness changing, but I don’t think it is mind altering. One thing I tell young people, alcohol when consumed will have a person acquiesce to any kind of immorality, but pot does not change any moral parameters. For example, on alcohol, standards drop rapidly and women often end up having sex with someone they ordinarily wouldn’t have sex with. On marijuana, that never happens. Pot never has you do something that goes against your moral beliefs when sober. Pot will have you enjoy more what you would already do. Alcohol will have you do things you would never do ordinarily.
They are not similar. Alcohol is dangerous. Marijuana, if it has undesirable effects, subsides quickly and with no long term damage.

CHARLES P. GERBA, University of Arizona microbiologist, April 3, 2006
CZIKOWSKY: Is exposure to germs good? Do our bodies build resistances to germs as our bodies are exposed to them? Or is it better to avoid the germs as best as possible?
GERBA: Some people have suggested that exposure to disease causing germs is good and may help build up the immune system to better fight off other infections. This has been referred to as the hygiene hypothesis. It has not been proven. A good life style and nutrition are the best things to maintain your immune system.

RICHARD P. ALLEN, Johns Hopkins Bayview Medical Center Co-Director, June 13, 2006
CZIKOWSKY: Are dreams mostly the filing of information in our brains? Do dream analysts over emphasize what things mean?
ALLEN: Yes, dream analysts over emphasize.
But then some also under emphasize the importance of dream contents. They have some limited meaning for normal psychological status when awake.

GAIL H. JAVITT, Genetics and Public Policy Center Law and Policy Director, June 13, 2006
CZIKOWSKY: It is possible to purchase a DNA test, but how reliable are these laboratories?
JAVITT: Any laboratory that is offering genetic testing is required, at a minimum, to be certified under the Clinical Laboratory Improvement Amendments. But, there is no easy way for a consumer to know if a lab is CLIA certified, since the government does not make this information easily available. We are aware of genetic tests offered directly to consumers by non-CLIA certified laboratories.
Even if a laboratory is CLIA certified, CLIA does not address the clinical validity of tests, meaning whether they provide information that is relevant to disease or future disease or condition.

JENNIFER HUGET, Washington Post Contributing Writer, October 3, 2006
CZIKOWSY: What do you believe would qualify someone to teach yoga?
HUGET: That is a great question. There’s no universally accepted—or required—set of qualifications for yoga teachers, and only in recent years have certification programs been offered. Though I personally felt comfortable knowing my teacher had been through a rigorous training at a well-regarded school, I also know that there are older teachers around who have been self-taught and practicing for years and years, and I imagine their insights and skills match or beat those of, say, a much younger person just out of teacher training. I suppose this is an area where you just have to trust your gut.

HARRIET A. WASHINGTON, author, January 9, 2007
CZIKOWSKY: Doesn’t the past history create continued suspicions within the African American community? I have met people who were convinced that infertility drugs were put into fried chicken and who have heard the rumors about AIDS being a plot to kill Blacks. Does your book (“Medical Apartheid”) cover how the past real incidences lead to these suspicions?
WASINGTON: That is * the * crucial question, and the answer is that you are absolutely correct. The legacy of medical abuse and exploitation has created a climate of distrust and one important manifestation of this is the proliferation of fears that are logical and factual, but also fears that are mythical, such as the belief that reproductive agents have been infused into soda sold into Black communities and into delicacies associated with Blacks, such as fried chicken.
I do address directly medical-research fears such as the prevalent belief that the subjects of the USPHS Tuskegee syphilis study were injected with syphilis, which was a logical belief. But there was no need for me to revisit the non-medical beliefs such as those you cite because they already been very ably analyzed and discussed in a book entitled “I Heard It Through the Grapevine: Rumor in African-American Culture” (1998, University of California Press).It’s very well written, is available via Amazon for about $20, and I think you would enjoy it.
I want to point out that some suspicions that sound like paranoia are later found to be true or mostly true. Most have at least some kernel of truth, although they may be wildly overblown. There is a lot of myth that needlessly frightens people from medical care but there are also some pretty unbelievable medical transgressions I am much slower than I used to be to reject oral warnings as myth until I’ve had a chance to investigate them myself.

DAVID M. DOSA, Brown University Medicine Assistant Professor, July 27, 2007
CZIKOWSKY: We have dogs that can sniff out tumors. Is there possible something the cat can physically sense about impending death that we can’t tell with out senses?
DOSA: My sense is that the cat responds to a pheromone or smell that we simply, as humans, cannot recognize. Of course others have ascribed Oscar’s unique abilities to everything from behavioral mimicking to higher powers. I’ll leave it for the experts to figure out.

LIZ KELLY, washingtonpost.com celebritology blogger, August 16, 2007
CZIKOWSKY: I just want to say one serious message about rehab that I believe is getting lost in the celebrity news: Rehab can work, but everyone is different. For some people, all it takes is one visit to rehab and they’ll never drink alcohol or do drugs ever again. For many people, they lapse back. That still does not mean that they can’t eventually kick their addictions. In fact, drug and alcohol addicts have little better odds at following their doctor’s instructions after hospitalization than do asthmatics or diabetics. Yet, many do not follow instructions, and even some who do follow instructions may have a setback. Do not give up on people. Unfortunately, it may take several chances. Addicts, whether or not they are celebrities, need help, some more than others.
KELLY: Thanks for sharing this. You’re absolutely right. I was having this conversation just yesterday with someone. Most of the time, it takes several tries at rehan before a true life change actually kicks in. The only difference with Lilo and Brit and Amy Winehouse is that they have, for better or worse, the world watching them fall and pick themselves up over and over again.

HOCHANG BENJAMIN LEE, Johns Hopkins University Psychiatry and Behavioral Sciences Professor, September 6, 2007
CZIKOWSKY: I am reminded of the episode of “The Sopranos”, where art imitates life, on how it is considered weakness than an Italian American would get mental health assistance, and Tony Soprano has to gently break the news before the rumor gets out that he is seeing a psychiatrist. I like how Paulie Walnuts comes to his rescue where just about the most psychotic character in TV history admits that even he “has issues”. Does television portraying people like Tony Soprano seeing a psychiatrist help send a message to viewers that it is alright to get help, and maybe TV helps break down some of these barriers?
LEE: I haven’t been keeping up with the HBO specials, but mass media does play a major role in lifting the stigma attached to mental disorders. I certainly hope that the biological aspect of psychiatric disorders continues to be highlighted in the mass medial to emphasize the need for health services.
CZIKOWSKY: There are parents in Philadelphia asking judges to adjudicate their children because the only available mental health programs are in correctional facilities. Thus, I guess it would be harder to immigrants who have difficulty understanding our mental health operations to even understand these intricacies where people have to bend the system to get help?
LEE. Yes, I agree.

SANJAY GUPTA, CNN Medical Correspondent, September 27, 2007
CZIKOWSKY: What are some basic dietary changes most of us could make that could improve our lives?
GUPTA: Great question and I wrote almost an entire book of this topic but let me tell you some of the pearls that I learned.
Caloric restriction, restricting the number of calories, does seem to make a difference. Maybe that’s obvious but in animals a calorie-restricted diet can increase life span by up to 35 percent. There is now a study going on in humans to see if that same thing applies.
I don’t put a lot of focus on supplements, mainly because I believe it is hard to get “the good stuff” out of foods and put it into a pill form. I recommend eating seven different colored foods a day (we’re not talking about jelly beans here). If you eat seven different colored foods you’ll probably get all the good stuff you need.
CZIKOWSKY: I notice there seems to be differences on studies in America versus studies published in Asia over the health benefits of such things as ginseng, green tea, acupuncture, etc. where the American studies claim they do not find the same extent of health benefits as the Asian studies do. Why do these studies seem to differ and what do you think is the truth as to the health benefits of ginseng, green tea, and acupuncture?
GUPTA: First of all, I have spent a lot of time both in China and in the U.S. looking at these studies. I am not sure which specific studies you’re referring to in the world of TCM or traditional Chinese medicine. I have spent time with professors of TCM and most acknowledge that they wish they had better data. Having said that, I was definitely interested to learn that TCM, which has been around over 1,000 years, has been able to withstand the test of time. I believe that many things including ginseng, the antioxidant properties of green tea and even acupuncture have benefit. It will be some time before controlled trails and the associated science catch up. Many people don’t want to wait.

JOSHUA MENDELL, Johns Hopkins University Genetics Researcher, November 13, 2007
CZIKOWSKY: What is RNA and what is the research about at the University of Pennsylvania where they are injecting RNA into cancer cells and they hope it will fight cancer?
MENDELL: RNA is a molecule that is similar to DNA. All organisms use DNA to store genetic information. When a cell needs to utilize the instructions stored in DNA, it first makes a copy as RNA. Cells use RNA for many purposes. For example, RNA carries the instructions to make proteins (called messenger RNA). There are other forms of RNA that function to regulate messenger RNAs (for example, a type of RNA called microRNAs). Over the last five years, cancer researchers have become increasingly interested in microRNAs because these molecules exist at abnormal levels in cancer cells. This causes abnormal amounts of other proteins to be made than can promote tumor formation. Several labs are indeed trying to restore normal microRNA levels to tumor cells as an experimental therapy. These approaches have shown early promise in the lab, but there are still years away form being used in actual patients.

CHARLES BARBER, Yale School of Medicine Lecturer, March 4, 2008
CZIKOWSKY: What percent of high school students are on prescription medication or psychological reasons? Is this leading to any changes, positive or negative, on their abilities to learn?
BARBER: The rates have gone up dramatically in recent years, including for drugs that were rarely prescribed for young people before, like antipsychotics. It used to be true a long time ago that the use of these kinds of meds for young people was all but taboo—those days are long gone. The ADD/ADHD drugs can be very effective, and help kids learn. But again, I think they are over-prescribed and parents are sometimes not looking at commonsensical issues like diet and parenting styles.
CZIKOWSKY: Is there any data indicating the number f violent incidents that are increasing due to people who are under medication? Is it possible to hypothesize that some types of violence in our society are related to side effects of legal medication?
BARBER: I don’t have the data on that. I’ll just make a general comment.
Violence perpetrated by the mentally ill is vastly over-reported and sensationalized by the media. The true risk for violence with the mentally ill is hurting themselves, not other people. I ran facilities for people with schizophrenia for many years—we had one aggressive incident by a client, but we have three suicides. I don’t worry about my clients hurting other people, I did worry about them hurting themselves.
Research has also shown that it is not mental illness that makes people violent; it is the addition of substance abuse with mental illness that can increase the violence. I quote a study in the book (“Comfortably Numb”) of people leaving a psych hospital. They were no more violent than their neighbors, but when substance abuse was added, the rates of violence were higher.
Also, people with mental illness are about 11 or something more likely to be murdered and have violence perpetrated on them than the average person.

J. PAUL ROBINSON, Purdue University Immunopharmacology and Biomedical Engineering Professor, and DAVID BROWN, Washington Post Staff Writer, April 8, 2008
CZIKOWSKY: Do you have a rough estimate oh now long it will take these cell technologies and advances in research to be applied towards the public health? I realize numerous tests need to be conducted, yet I am often sympathetic to the terminally ill who are often denied potentially life-saving procedures because they are not approved and ready for use.
ROBINSON: This is an interesting question. For many years we have talked about “next gen” technologies that will change public health. I believe in the next five years, there will be a revolution in these technologies driven by the basic electronic consumer products that are now very cheap and accessible. These low cost consumer products will become the bases for the true next gen public health tools particularly in diagnostic and basic tests.
BROWN: I should make it clear that cell-counting and cell-sorting is in clinical use today, with the best example being the CD4-cell counts (also known as T-cell counts) routinely done for people infected with HIV. It is also used clinically for people with some forms of cancer, especially blood-cell cancers.

MARY-FRANCES O’CONNER, UCLA Researcher and ROB STEIN, Washington Post staff writer, August 4, 2008
CZIKOWSKY: Is it normal to mourn the death of a pet from 28 years ago? The sadness does not affect my ability to act in life, but every now and then I recall and it makes me sad. I’d hate to think I would ever forget. Is this normal?
O’CONNOR: I am sorry to hear about your pet—and it is a relationship that many experience: grief after losing. I would say that you have hit the nail on the head—it doesn’t affect your ability to act in life (which it would if it were complicated grief). But I would have to think anyone would forget a person or being that they loved! It is very common to remember those who we have lost with sadness, even tears, especially around holidays and times of remembrance.
STEIN: Yes, having lost a dear pet myself recently, I can attest to how sad that can be. I’m sure that I will thinking about our dog for a very long time.

CECI CONNOLLY, Washington Post staff writer, August 7, 2008
CZIKOWSKY: When might we get the international community to send underfunded AIDS assistance to the nation’s capital with the highest rate of AIDA of any national capital city in the world? And, yes, this is a trick question, yet still a serious one.
CONNOLLY: Okay, it is a bit of a trick question. But a good one! DC’s epidemic is on par with sub-Saharan Africa, so is the AIDS rate in other Africa-American communities in the states. Interestingly, former President Clinton mentioned this in his speech to the conference. He had no details, but expressed an interest in getting his foundation involved in AIDS work at home.

JESSE PINES, University of Pennsylvania Medicine School Assistant Professor, and ZACHARY F. MEISEL, University of Pennsylvania Physician, September 18, 2008
CZIKOWSKY: How much is the shortage of health care professionals contributing to the increased use of emergency rooms?
PINES :While there are shortages across the board for healthcare professionals (nurses, doctors), the major shortage is in primary care physicians. This is because the economics: primary care does not allow them to be paid a large amount per patient they see. As a result, they have to book their clinics at 100% to pay their staff. When clinics are 100% booked, there is little room for urgent patients or extra time to spend with those who are more complex. Most people don’t plan on getting sick. Therefore, clinic overflow and more complex patients at directed squarely to the ERs/
MEISEL: There is some debate among economists about the physician supply. In Philadelphia, if you can pay or have coverage you can find good primary care. However, other communities do struggle with primary care shortages. In our Slate piece, we are particularly interested in why patients who are covered and have doctors still choose (or are sent) to come to the ED when they may not have to.

GENE WEINGARTEN, Washington Post Staff Writer, October 28, 2008
CZIKOWSKY: Is it true that in many breast enlargement surgeries that some women lose nipple feeling? In other words, the woman has decreased abilities for sensual pleasure, all in exchange for supposedly making herself more attractive to men? (Only to learn that, for a lot of men, that is not an issue?) If this is so, shouldn’t there be greater warnings to women, or do they know this and proceed with the surgeries anyway?
WEINGARTEN: A quick Google search confirms this. Permanent loss of sensation is not uncommon. As you point out, the irony here is disturbing.
I don’t get the whole breast enhancement thing, but I’m not a woman and don’t pretend to understand the calculus behind it.

JEAN JOLLY, Remote Area Medical Volunteer Corps Volunteer Coordinator, November 10, 2008
CZIKOWSKY: Will telehealth and telemedicine help provide access to underserved areas? Could patients be able to show symptoms through web cameras, people monitored by remote devices etc? True,, there will still be a need for doctors to see patients up close even for periodic reviews, yet not every case needs to see a doctor. Isn’t there a good future for telehealth and, if so, how could it be used?
JOLLY: Thanks for this important question! We do use Telemedicine at RAM’s largest domestic event each July in Wise, VA. Because we move to different areas each month and hold each clinic for a weekend, setting up Telemedicine can be a difficult task. However, as we are invited to return to locations and as we work with our host communities, we would like to see and use more of the benefits which Telemedicine can provide. It certainly can be most useful and even life-saving for very rural and underserved areas. Being recognized, set up, and used by local communities is the challenge.