Worth Noting

GAO Warns of ‘Meaningless’ Genetic Advice on Internet

With the growing emphasis on genetic components of various diseases, some Internet sites are urging consumers to send samples of their genetic material in order to receive personalized nutrition and lifestyle guidance to address their genetic health risks. But in a report released July 27, the federal Government Accountability Office (GAO) said the advice being given to consumers by such web sites is "medically unproven and so ambiguous as to be meaningless." To conduct an investigation, the GAO created fictitious consumers and submitted their fictitious genetic information to various web sites. The websites advised the presumed consumers to use expensive dietary supplements, which were generally vitamins and antioxidants that can be found in any grocery store, and made generic recommendations such as "stop smoking" to reduce the risk of diseases such as type 2 diabetes, cancer, osteoporosis, high blood pressure, and heart disease. The GAO report, "Tests Purchased from Four Web Sites Mislead Consumers," GAO-06-9771, can be read and downloaded at www.GAO.gov.

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Youth Overweight Said to Increase Risk of Bone Fractures, Joint Pain

Children and adolescents who are overweight are more likely than their normal-weight counterparts to suffer bone fractures and have joint and muscle pains, according to a study published in the June 2006 issue of the journal Pediatrics. Researchers classified children as "overweight" if they had a body mass index above the 95^th percentile for their height and weight and used a technique known as Dual Energy X-Ray Absorptiometry to detect any effect of the overweight on feet, ankles, and knees. The researchers found that overweight youngsters were more likely to report impaired mobility and more likely to experience changes in how the bones of the thigh and leg meet at their knees. Also, the fact that overweight children generally had greater bone density than their normal-weight peers did not protect them from bone fractures in falls, perhaps because overweight boys, in particular may fall harder and have poorer balance predisposing to falls. Researchers advised overweight children and adolescents to engage in modes of physical activity, such as bicycle riding and swimming, that could alleviate the severity of lower extremity joint loading and discomfort.

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New ADHD Drug Seeks Schedule IV Approval

A new drug to succeed the big-selling Adderall XR for treating attention deficit hyperactivity disorder is still awaiting approval by the federal Food and Drug Administration and possible classification as a Schedule IV drug by the federal Drug Enforcement Administration (DEA). Currently called NRP104, the new drug is manufactured by a small biotechnology company, New River Pharmaceuticals, and would be marketed by Shire Pharmaceuticals, makers of Adderall, whose patent on that drug expires in 2010. A Schedule IV classification by the DEA would put NRP104 into the same category as Valium, allowing it to be prescribed for six months at a time. Existing stimulants for attention deficit disorder, including Adderall XR, Concerta, and Ritalin, are Schedule II drugs, the government’s most restrictive category of legal drugs, and require a new prescription every few months. NRP104 is an amphetamine and is claimed by its promoters to be less subject to misuse by people, including college students, who use stimulants to improve concentration and enable longer hours of study. NRP104 consists of a common amphetamine bound to lysine, an amino acid. When the drug is swallowed, enxymes in the digestive tract remove the lysine, freeing the mphetamine. But when NRP104 is snorted—methods that abusers employ to achieve quick highs from amphetamines—the lysine is not removed as easily, so there is less euphoric effect. "You can’t overdose on it," said Dr. Timothy Wilens, a pediatric psychopharmacologist at Massachusetts General Hospital. Shire Pharmaceuticals can be contacted at www.shirepharmaceuticals.com.

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June, July News Alerts

The following information appeared during the months of June and July 2006 in the News Alerts section of the website of the Center for Health and Health Care in Schools, at www.healthinschools.org.

June 2, 2006
Mumps Immunizations Updated to Two Doses
The Advisory Committee on Immunization Practices (ACIP) said June 1 that "acceptable presumptive evidence of immunity" to mumps now calls for students in grades K-12, college students, and healthcare workers to receive two doses of a live mumps vaccine. The new requirement upgrades a previous recommendation issued in 1998 that called for just one dose of mumps-containing vaccine and follows an outbreak of mumps in the United States between January and May this year. The ACIP said it issued the new two-dose recommendation "after reviewing data from the current outbreak and previous evidence on mumps vaccine effectiveness and transmission." The ACIP noted that all persons who work in healthcare facilities and were born during or after 1957 should receive two doses of the vaccine, with a second dose given to persons who had earlier received a single dose. Birth before 1957 is considered "presumptive evidence of immunity," but it would be a good idea to require older workers to present either physician diagnosis of their earlier mumps or laboratory evidence of immunity, the ACIP said. The full text of the updated mumps recommendations is available at http://www.cdc.gov/mmwr.

June 5, 2006
NIH Cites Need for HIV-AIDS Therapy Research

In a joint statement released today to mark the 25^th anniversary of the first reported cases of acquired immunodeficiency syndrome (AIDS), the directors of the National Institutes of Health and the National Institute of Allergy and Infectious Diseases joined with the director of AIDS research in NIH to call for "a sustained global response from all sectors of society" to continuing high rates of AIDS and HIV infection in the Unites States and worldwide. Elias Zerhouni, Anthony Fauci, and Jack Whitescarver said that despite immunology and virology breakthroughs in HIV/AIDS research, "important challenges remain in the area of therapeutics." They noted that many patients receiving antiretroviral therapy "do not fare well on their treatment regimens due to the development of drug resistance, drug toxicities, and side effects" and said NIH is committed to finding therapies that are less toxic and have fewer side effects. They also called for research to develop "the next generation of protective modalities," including topical microbicides that individuals could use to protect themselves against HIV infection and a possible vaccine. NIH currently has clinical trials under way for nearly 50 vaccine candidates, but the virus that causes HIV "is unusually well equipped to elude immune defenses," making vaccine research a complex challenge. The full text of the NIH statement is available online at http://www.nih.gov/news/pr/jun2006/niaid-01.htm.

June 8, 2006
Survey Finds High Schoolers Use Seat Belts More, Drink Less

There have been reductions in some risk behaviors by high school students, according to the 2005 National Youth Risk Behavior Survey (YRBS) released today by the Centers for Disease Control and Prevention (CDC), with more students reporting they wear seat belts when riding in a car and fewer students reporting current use of alcohol. The percentage of students who said they have never had sexual intercourse was roughly the same in 2005 as in 2003—47 percent—but that’s down from a high of 54 percent in 1991. In addition, 63 percent of sexually active students reported that they or a partner used a condom during last sexual intercourse, the same as in 2003 but an improvement over the 46 percent who reported condom use in 1991. Compared with white and Hispanic high school students, black high school students are least likely to use tobacco, alcohol, cocaine, and other drugs, but most likely to report sexual risk behaviors and sedentary behaviors such as watching television three or more hours a day. White students are less likely than black or Hispanic high school students to report physical fighting, sexual risk behaviors, and being overweight, but more likely to engage in frequent cigarette smoking and episodic heavy drinking. Hispanic students are more likely than black or white students to report attempted suicide and the use of drugs such as cocaine, heroin, and methamphetamines. The 2005 Youth Risk Behavior Survey data are available at www.cdc.gov/yrbs.

June 9, 2006
Vaccine Will Protect Against Some Kinds of HPV

A vaccine to protect women from four types of the human papillomavirus (HPV) known to cause most cervical cancers and genital warts was approved by the federal Food and Drug Administration (FDA) day for use in females 9 to 26 years of age. The vaccine, Gardasil, manufactured by Merck & Co. Inc., must be administered in three injections over a six-month period and is expected to protect against HPV types 16 and 18, which cause approximately 70 percent of cervical cancers, and against types 6 and 11, which cause approximately 90 percent of genital warts. Because females are not protected by the vaccine if they have become infected with HPV before vaccination, the drug is recommended for young girls before they become sexually active. Human papillomavirus is the most common sexually transmitted infection in the United States and over half of all sexually active men and women are believed to have become infected at some time in their lives. Often the body’s own defense system clears the infection, but some types of HPV can cause abnormal cells on the lining of the cervix that years later can turn into cancer. "The vaccine is a significant advance in the protection of women’s health in that it strikes at the infections that are the root cause of many cervical cancers," said FDA Acting Commissioner Andrew von Eschenbach. Further information is available at http://www.fda.gov/cber/products/hpvmer060806.htm.

June 13, 2006
Former FDA Head Testifies on Plan B

The Associated Press reported today that the Center for Reproductive Rights, which is suing the federal Food and Drug Administration (FDA) over delays in approving over-the-counter sales of the emergency contraceptive known as Plan B, has released a statement made by former FDA commissioner Lester Crawford in which he takes responsibility for delaying a decision on the contraceptive while the agency looked for a way to restrict over-the-counter sales to women 17 years and older. In a sworn deposition in the lawsuit, Crawford acknowledged he "took over" the Plan B issue after an advisory panel to the FDA recommended unrestricted over-the-counter sales, but said that was just so he could "get straight what the enforcement procedures would be." Crawford also said he had thought that the process of deciding on enforcement would take "six to nine months tops" from last August and that he doesn’t understand why the issue has not yet been resolved by the FDA. Crawford resigned as FDA commissioner in September last year, one month after announcing his decision to withhold approval of over-the-counter sales of Plan B. As of this month, the FDA has not yet announced a decision on the matter.

June 15, 2006
Foundation Launches ‘Caring Across Communities’ Grants

The Robert Wood Johnson Foundation today issued a first call for proposals in a program to address the mental health needs of underserved children and youth, with special emphasis on projects that help children of immigrant and refugee families overcome cultural and language barriers to mental health services. Up to 15 three-year grants of up to $100,000 a year will be awarded to either public or not-for-profit institutions as lead organizations for the project, with funded projects to involve elementary, middle, or high schools as either the sole sites for services or as significant providers in a network. The announcement notes that children from immigrant and refugee families are often faced with economic, social, and personal hardships associated with the relocation of their families and may lack access to health, mental health, educational, and social services. Brief proposals may be submitted online not later than July 28, 2006, and applicants will be notified by August 22 if they are invited to submit full proposals, with the deadline for receipt of full proposals September 14. Full information about Caring Across Communities: Addressing Mental Health Needs of Diverse Children and Youth is available online at http://www.healthinschools.org/cac/cfp.asp.

June 15, 2006
FDA Targets Unclear Medical Abbreviations

The federal Food and Drug Administration announced yesterday that it’s launching a national professional education campaign to reduce the number of preventable medication mix-ups caused by the use of unclear medical abbreviations, including such error-prone notations as U, which is often mistaken for a zero; IU, which is often mistaken for IV; missing decimal points; and names that look much alike, such as MSO4 and MgSO4. The Institute of Medicine estimates that 7,000 deaths a year are caused by medication errors that occur anywhere in the medication-use system, including hospitals, outpatient clinics, and home care. In yesterday’s announcement, the FDA recommends use of the list of abbreviations, symbols, and dose indicators developed by the Institute for Safe Medication Practices (ISMP), which is available online at http://www.ismp.org/PDF/ErrorProne.pdf.

June 19, 2006
Pain Killers Increasingly Abused, SAMHSA Reports

More people started using prescription pain relievers than either marijuana or cocaine in the year before a 2204 survey by the Substance Abuse and Mental Health Services Administration (SAMHSA). In a report released today, SAMHSA Administrator Charles Curie said that while overall drug use by young people continues to decline, the agency is concerned about the growing nonmedical use of pain medications by persons 12 years of age and older. "Abuse of prescription pain medication is dangerous and can lead to the destructive path of addiction," Curie said. The new report shows that 48 percent of new initiates used Vicodin®, Lortab®, or Lorcet®; 34.3 percent used Darvocet®, Darvon®, or Tylenol® with codeine; 20 percent used Percocet®, Percodan®, or Tylox®; 18.4 percent used generic hydrocodone; 14.3 percent used generic codeine; 8.4 percent used Oxycontin®; and 4.3 percent used morphine. Over half of the persons who initiated nonmedical use of pain medications were female. The SAMHSA report is available online at www.oas.samhsa.gov.

June 21, 2006
Obstetricians Announce Support for Emergency Contraception

The American College of Obstetricians and Gynecologists (ACOG) today announced a campaign to educate women about emergency contraception and to encourage them to get an advance prescription from their physicians, in case they ever need it. Calling emergency contraception "an important component of family planning," the organization said the public information campaign, called "Ask Me," was developed to help eliminate "logistical and political barriers that currently make it difficult for women to access emergency contraception." The announcement noted that it may be difficult for a woman who has unprotected sex to obtain emergency contraception in the short time the drug is effective, if she must first get a prescription from her physician. The announcement also noted that the federal Food and Drug Administration in 2004 denied an application from the manufacturer of an emergency contraceptive, Plan B, to make the drug available over the counter, citing lack of evidence that emergency contraception could safely be used by young teenagers. The FDA has yet to make a decision on a second application from the manufacturer to make Plan B available over the counter to women older than age 17. The ACOG said it has now joined a number of medical associations, including the American Academy of Pediatrics and the American Medical Association, in support of making Plan B available over the counter. The article, "Group Backs Emergency Contraception," is published in the June 21, 2006, issue of the Journal of the American Medical Association.

June 22, 2006
New Drugs for Diabetes, ADHD

Four new diabetes drugs and a new treatment for attention deficit hyperactivity disorder (ADHD) are expected this year. Two of the diabetes drugs are already approved by the federal Food and Drug Administration (FDA), and the manufacturer of a new ADHD treatment is hoping for approval by the FDA and the Drug Enforcement Administration (DEA).

A diabetes drug introduced in June last year and already in use, called Byetta, is an injection that stimulates the pancreas to produce more insulin and the liver to produce less blood sugar, according to the manufacturer, Eli Lily. Still awaiting FDA approval are two more diabetes drugs—Galvus, produced by pharmaceutical company Novartis and Januvia, which is manufactured by Merck--that work on the same principle, by increasing levels of a naturally produced hormone that stimulates the pancreas to produce more insulin and the liver to produce less blood sugar. Already approved by the FDA and expected to be on the market next month is a Pfizer drug called Exubera, billed as the first inhalable version of insulin.
Still awaiting FDA approval is an amphetamine for treating attention deficit hyperactivity disorder that would be sold by drug maker Shire Pharmaceuticals as the successor to its drug Adderall XR. The new drug, currently being called NRP104, is said to be effective when used to control ADHD but to be less likely to be snorted or injected by potential abusers. The manufacturer is applying to the Drug Enforcement Administration for Schedule IV classification, which would put the new drug in the same category as Valium. Current ADHD drugs such as Adderall XR, Concerta, and Ritalin, are so-called Schedule II drugs, the government’s most restrictive category for legal drugs.

The FDA can be contacted online at http://www.fda.gov. The Drug Enforcement Administration is at http://www.dea.gov.

June 26, 2006
Supreme Court Will Not Hear Generic Meds Case

The United States Supreme Court announced today that it will not consider an appeal by the Federal Trade Commission for review of a case involving payments by major pharmaceutical companies to keep generic versions of certain drugs off the market after the patents on those drugs expire. That leaves in place a federal appeals court ruling in favor of the Schering-Plough pharmaceutical company, which had been accused of paying competitors to delay marketing generic versions of a highly profitable blood pressure medicine. By law, drug makers are granted a period of patent protection for new medicines, during which time no competing generic drugs can be marketed. The Federal Trade Commission charged that increasingly pharmaceutical companies are entering into agreements with generics manufacturers that involve payments in return for promises to hold off bringing the generics to market. Generic drugs are typically cheaper for consumers to buy.

June 27, 2006
Surgeon General Cites Dangers of Secondhand Tobacco Smoke

In a report released today, U.S. Surgeon General Richard Carmona concludes that despite progress in tobacco control, millions of Americans are still exposed to secondhand tobacco smoke in their homes and workplaces, with the consequences especially bad for children. The report notes that children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome, acute respiratory infections, ear problems, and more severe asthma. "Smoking by parents causes respiratory symptoms and slows lung growth in their children," the report says. Surgeon General Carmona called the health effects of secondhand smoke for both children and adults "more pervasive than we previously thought" and suggested that the best way to prevent exposure is to ban smoking in all indoor spaces. Findings of the report include:

• Almost 60 percent of children aged 3 to 11 years are exposed to secondhand smoke;
• Secondhand smoke contains many chemicals that can quickly irritate and damage the linings of the airways;
• Ventilation technology and conventional air cleaning systems do not remove the smaller particles or gases found in secondhand smoke;
• In national surveys, 43 percent of U.S. nonsmokers have detectable levels of contine, a chemical that is a biomarker of secondhand smoke exposure.

The full report, "The Health Consequences of Involuntary Exposure to Tobacco Smoke," is available online at http://www.surgeongeneral.gov.

July 3, 2006
Federal FDA, USDA Mark 100^th Anniversaries

Two federal laws that were enacted in 1906 are celebrating their 100^th anniversaries this year. The Food and Drugs Act of June 30, 1906, created the Food and Drug Administration (FDA), the oldest consumer protection agency in the United States with responsibility for assuring the safety of food, human and veterinary drugs, medical devices, and cosmetics. In a resolution passed in June, Congress noted that the FDA "has been a pioneer in promoting the health and safety of citizens in the United States" and around the world. Also marking a 100^th anniversary this year is the Federal Meat Inspection Act (FMIA), which is administered by the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS). Signed into law by then-President Theodore Roosevelt on the same day as the FDA legislation, the FMIA is charged with inspecting meat products and assuring that slaughter houses and processing plants are operated under sanitary conditions. Impetus for the two laws is generally credited to books such as Upton Sinclair’s The Jungle, published in the early 1900s that exposed conditions in food, drug, and cosmetics industries and in meat processing plants.

July 5, 2006
Medicaid Recipients Must Show Proof of Citizenship

In a letter to state Medicaid directors, the U.S. Centers for Medicare and Medicaid Services has called attention to a provision of the 2005 Deficit Reduction Act that requires individuals to provide "satisfactory documentary evidence of citizenship or nationality" when initially applying for Medicaid or upon a first Medicaid re-determination. Specific documents that will be recognized as satisfactory documentary evidence of citizenship or nationality include:

• A U.S. passport or a certificate of naturalization;
• A state or local birth certificate;
• Non-governmental documents that show a place of birth, such as medical records or life and health insurance; or
• An affidavit supplied by at least two individuals, one of whom is not related to the applicant or recipient, attesting to personal knowledge of the events establishing the applicant’s or recipient’s claim of citizenship. People signing affidavits must be able to provide proof of their own citizenship and identity and may be asked to explain why the applicant cannot provide documentary evidence of his or her citizenship or nationality.

The new requirements went into effect July 1, but applicants may be given up to 45 days (90 days for persons with disabilities) to come up with the necessary documentation. Medicaid is available only to U.S. citizens and certain "qualified aliens," but up to now people who declared they were citizens did not have to support the claim. The letter to state Medicaid directors cautions that states may lose their Medicaid funds if they fail to enforce the new rules.
The letter to state Medicaid directors can be downloaded from http://www.cms.hhs.gov/MedicaidEligibility/05_ProofofCitizenship.asp.

July 10, 2006
Children Are Exposed to Lung-Damaging Air Pollution

Air pollution and children are an unhealthy mix, according to a research report and accompanying editorial in the July 6, 2006, issue of the New England Journal of Medicine. Carbon particles similar to those found in ambient air have been found in the airways of children, and increased levels of carbon correlate with decreased lung function in children, whose lungs develop steadily during childhood. In the past half-century, "we have learned a great deal about the effects of air pollution on health, through both controlled trials and epidemiologic studies," researcher point out, and although overall air quality in urban environments has improved as the result of vehicle emission controls and cleaner-burning fuels, children are often exposed to particularly dangerous levels of air contamination in schools built near busy roadways or other sources of pollution. The editorial concludes that currently ongoing research into the specific components of air pollution that are responsible for health effects may enable policymakers to institute more specific control strategies. "Our children’s health depends on it," the editorial summarizes. The research report, "Carbon in Airway Macrophages and Lung Function in Children," and the editorial, "Air Pollution and Children—An Unhealthy Mix," are published in the June 6, 2006, issue of the New England Journal of Medicine.

July 12, 2006
Mumps, Pertussis Cited as Re-Emerging Diseases

Low immunization coverage and waning immunity may be responsible for recent outbreaks of childhood diseases that were thought to have been eliminated, according to a report released today by the National Foundation for Infectious Diseases. While immunization is at the highest level ever recorded and the number of diseases targeted for prevention through routinely recommended childhood vaccinations increased to 15 as of early this year, outbreaks of forgotten diseases such as mumps and whooping cough are occurring in the United States, and on the international front, there has been a resurgence of paralytic polio in previously polio-free countries. The resurgence of these three vaccine-preventable diseases is a signal that "We can never become complacent, but must maintain strong programs and public confidence in vaccines and our immunization system," said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC)

July 14, 2006
Varicella Outbreak Raises Questions about Vaccination, Surveillance

After a school nurse notified the Nebraska Health and Human Services System of an outbreak of chickenpox in an elementary school in 2004, the state initiated a retrospective study to determine the extent of the outbreak and the severity of the illness in vaccinated and unvaccinated children. In a summary published in this week’s issue of the Morbidity and Mortality Weekly Report, the federal Centers for Disease Control and Prevention (CDC) notes that there has been a dramatic decline in cases of chickenpox since licensure of a vaccine in 1995 and implementation of a variety of school-entry varicella vaccination requirements in most states. To reduce additional virus transmission during an outbreak, the Advisory Council on Immunization Practices in 2005 recommended a second dose of varicella vaccine in outbreak settings for those who had previously received one dose of the vaccine. In addition, the Council of State and Territorial Epidemiologists recommended that by 2005, all states should established case-based varicella reporting by using either statewide surveillance or surveillance in sentinel sites. As demonstrated in the Nebraska outbreak, "schools are an ideal setting for varicella sentinel surveillance because of their readily available vaccination records and populations that can be surveyed easily," the CDC said. The report, "Varicella Outbreak Among Vaccinated Children—Nebraska, 2004," appears in the July 14, 2006, issue of Morbidity and Mortality Weekly Report at http://www.cdc.gov/mmwr.

July 18, 2006
Survey Finds Methamphetamine Number-One Drug Problem Across U.S.

In a survey released today by the National Association of Counties (NACo), county officials reported that methamphetamine continues to be the number-one drug problem in states including Arizona, California, Idaho, Nevada, New Mexico, Utah, Washington, and Wyoming, and that use of the drug is rapidly spreading across the country from west to east. Meth is increasingly linked to crimes such as robberies and burglaries and is more popular in many places than cocaine, marijuana, and heroin combined. A particular concern to many county law enforcement officials is an increase in meth-related identity theft, which is up 27 percent since 2005. The full text of the NACo survey is available www.naco.org.

July 19, 2006
Women’s Medical Group Opposes ‘Teen Endangerment’ Bills

The 13,00-member American Medical Women’s Association (AMWA) this week called attention to two bills pending in the United States Congress that the organization charged will, if enacted, "endanger the lives of girls and young women." The AMWA has signed on to a letter to federal lawmakers urging them to vote against the Child Custody Protection Act (S. 403) in the Senate and the Child Interstate Abortion Notification Act (H.R. 748) in the House of Representatives. S. 403 would make it a federal crime for anyone other than a parent to accompany a young woman to an out-of-state doctor for abortion if the home state’s parental-involvement requirement has not been met; and H.R. 748 imposes a complex patchwork of parental involvement laws on women and doctors that the AMWA calls "both complicated and unconstitutional." The full text of both laws and their current status in Congress are available at http://thomas.loc.gov.

Research Confirms Gene Variant Increases Diabetes Likelihood

In a report published in today’s issue of the New England Journal of Medicine, researchers are confirming that a variant in one gene predisposes people to type 2 diabetes. But the good news, researchers said, is that people at the highest genetic risk benefit as much as or perhaps more than those without the variant from changes in life style, including losing weight, reducing calories in diet, and increasing physical activity.

"This finding emphasizes that people at risk of diabetes, whether they’re overweight, have elevated blood glucose levels, or have this particular genetic variant, can benefit greatly by implementing a healthy life style," said lead author Dr. Jose Florez of Massachusetts General Hospital in Boston. The study that found the genetic predisposition to diabetes began in 1995 and was ended a year earlier than planned because the results were so clear, according to the National Institute of Diabetes and Digestive and Kidney Disease in the National Institutes of Health, which sponsored the study. The study population consisted of adults with blood glucose readings higher than normal but not yet in the diabetic range and reflected the racial and ethnic diversity typical of the U.S. population.

July 21, 2006
Senate Bill Would Continue Medicaid to Schools for Transportation, Administrative Expenses for Children with Disabilities

Legislation introduced in the Senate July 20 would continue Medicaid reimbursements to schools for the special costs they incur in transporting children with disabilities to school and for administrative expenses that schools incur in connection with Medicaid-reimbursable services for children with developmental, physical, or mental health needs. Noting that the Bush administration is proposing to deny Medicaid funding to schools for transportation or administration, Senator Ted Kennedy (D-MA) and co-sponsors said their Protecting Children’s Health Act "recognizes the importance of schools as a site of delivery of health care." Kennedy noted that the estimated value of Medicaid reimbursements to schools for transportation and administration is expected to be $3.6 billion over the next five years, and he said the decision by the administration to try to eliminate those payments "follows years of resisting Medicaid reimbursements, without clear guidance on how schools should appropriately seek reimbursement." The Senate bill, S. 3705, and similar legislation expected to be introduced in the House of Representatives, can be accessed at http://thomas.loc.gov.

July 24, 2006
FDA Approves New Implantable Contraceptive

The federal Food and Drug Administration July 17 approved an implantable contraceptive described as "about the size of a matchstick," which is inserted just under the skin of a woman’s upper arm, where it releases a low but steady dose of progestogen (etonogestrel) for a period of up to three years. Removal can occur at any time at the woman’s request, after which her fertility returns to pre-existing levels. The contraceptive, called Implanon, has been used by some 2.5 million women in more than 30 countries, according to the manufacturer, the pharmaceutical company Organon, which has offices in New Jersey and the Netherlands. Organon says it will now launch a nationwide training program in the U.S. to train healthcare professionals in insertion and removal procedures, and only professionals who have completed the training will be able to prescribe implantation for their patients. The manufacturer can be contacted at http://www.organon.com.

July 26, 2006
Senate Passes Bill Restricting Out-of-State Teen Abortion

The United States Senate yesterday passed legislation that makes it a federal crime for a person other than a parent to transport a minor across state lines for the purpose of obtaining an abortion, if the minor’s home state has a parental consent or notification law. During lengthy debate on the bill, S. 403, the Senate agreed to one amendment and rejected another. In a narrow limitation on parental rights, the Senate approved an amendment to "punish incestuous fathers" by imposing fines and imprisonment on any father who has "committed an act of incest" with a minor and then transports the minor across a state line for the purpose of obtaining an abortion. On the only other amendment proposed, the Senate rejected on a party-line vote a proposal to provide $100 million to localities for comprehensive sex education programs that would include information about contraception. The Senate bill does not mention whether the ban on interstate transportation for abortion applies if the health of a pregnant minor is at stake, a point on which state abortion bills have been found unconstitutional, but it does allow a minor to ask a court for permission for an interstate abortion without parental consent. Before the legislation passed yesterday can go to President Bush for signature, the Senate must confer with the House of Representatives, which passed a similar but not identical bill more than a year ago.