Years Pass, but Brooke Greenberg Remains a Toddler. No One Can Explain How or Why.
By BOB BROWN

June 23, 2009

Brooke Greenberg is the size of an infant, with the mental capacity of a toddler.

She turned 16 in January.

“Why doesn’t she age?” Howard Greenberg, 52, asked of his daughter. “Is she the fountain of youth?”

Such questions are why scientists are fascinated by Brooke. Among the many documented instances of children who fail to grow or develop in some way, Brooke’s case may be unique, according to her doctor, Johns Hopkins School of Medicine pediatrician Lawrence Pakula, in Baltimore.

“Many of the best-known names in medicine, in their experience … had not seen anyone who matched up to Brooke,” Pakula said. “She is always a surprise.”

Brooke hasn’t aged in the conventional sense. Dr. Richard Walker of the University of South Florida College of Medicine, in Tampa, says Brooke’s body is not developing as a coordinated unit, but as independent parts that are out of sync. She has never been diagnosed with any known genetic syndrome or chromosomal abnormality that would help explain why.
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Yesterday I visited the Centers for Disease Control in Atlanta and was taken inside the command center, where almost 100 staffers have been working around the clock to monitor and stem the current outbreak of flu.

I first spoke to Toby Crafton, the manager of the command center, who oversees the day-to-day operations. He and his team have been preparing for a possible pandemic of flu or another infectious illness for years. I also spoke to Michael Shaw, PhD, who heads up the virology labs that are studying the H1N1 virus causing the current outbreak. He’s spent a career learning the laboratory techniques that are so urgently needed right now. The third person I spoke to was Dr. Richard Besser, Acting Director of the CDC, who has been working at the agency for 13 years and is an extensively published expert in infectious diseases.

I mentioned that last week I had received an email notification from the New York City Department of Health (NYCDOH) about how I should be managing my patients with flu-like symptoms. The advice was actually not intuitively obvious to me. For example, the Department of Health said that for patients with mild illness, treatment with anti-viral meds like Tamiflu and Relenza was only recommended for patients who also had underlying conditions that increased their risk for complications due to influenza. Dr. Besser pointed out that it was especially important right now for physicians to stay up to date with the recommendations being made by public health officials. Doctors can contact their local department of health and sign up for the same type of email notification that I received.
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Dr. John Ghertner, MD

Medicare works for your parents, why not you?

It is time to encourage our elected officials in Washington to begin a serious open minded discussion about ways to improve our society’s health care system. We must implore them to listen to facts, ignore the lobbying noise from those who continue to profit inordinately from our damaged health care system and make a final decision that is practical, not ideological.

As a physician and nursing home operator in the Sodus and Williamson community for the last 30 years, I have become increasingly distressed with the state of the health care industry. I have witnessed first hand as insurance companies, physicians and hospitals have become part of a system that forces doctors to compromise patient care, institutions to disrupt the natural and needed patient advocacy role of primary care doctors and the growth of pharmaceutical companies who pay their way to billion dollar profits and misrepresent their products. Far too often the FDA protects the pharmaceutical industry and not us. Even editors of the major journals have made decisions first in the name of advertising income instead of the advancement of medical science.

The trouble that we are in is that by making health care a profit making business, those seeking profits make their profits by limiting their losses. In many ways, this quest for efficiency makes for innovation in health care. However, far more often, it results in cost cutting measures that slow down the delivery of services, limit certain valuable diagnostic procedures and drive up the cost of record keeping. We need to face the facts that this is not a partisan political problem. This problem is weakening our economy, taking money out of our pockets, forcing businesses to reduce benefits to workers, adding to poverty, and actually eroding the health of our people. In the United States, nearly one-third of every health care dollar is spent on private insurance bureaucracy and paperwork. Much of this could be eliminated with a single payer system.
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By Stephanie Desmon
Baltimore Sun
Legislators seek remedies before the situation gets even worse

When his longtime physician retired, Southern Maryland lawmaker Thomas “Mac” Middleton faced a predicament: The senator needed a new doctor but couldn’t find one who was taking new patients. “I had to go through three different doctor groups before someone would take me,” he said.

He ran right into the critical doctor shortage facing rural Maryland – to the west of Baltimore, to the south, on the Eastern Shore.

There are not enough primary-care doctors setting up practice in these areas, leaving some residents without access to basic health care and leading to more costly and serious illnesses, doctors say. Those doctors – and many specialists – are reluctant to leave the city for the country, where they typically get paid less, work more and find fewer job opportunities for their spouses, who aren’t always ready to give up the trappings of life near an urban area.

Middleton and other legislators in Annapolis are now seeking ways to recruit and retain physicians to care for people in large swaths of Maryland.

“We have areas where you just can’t get care – you have to leave and go to another jurisdiction,” said Gene Ransom III, executive director of the Maryland State Medical Society, or MedChi. “It’s a real problem for people, especially for people who can’t afford to do that.”

There used to be 10 obstetrician/gynecologists in Allegany County, for example; now there are four. There is just one psychiatrist in St. Mary’s County. The wait to see a new primary-care doctor on the Eastern Shore can be weeks – if that doctor is even seeing new patients.

Lawmakers – who worked on two task forces last year that looked at different parts of the issue – are considering both short- and long-term fixes. Solutions could include a loan forgiveness program for primary-care doctors and specialists in rural areas who agree to remain in those communities for a certain number of years. Newly qualified doctors come with as much as $200,000 in student loan debt, and earning enough to keep up with the payments can be difficult, especially in rural areas. (more…)

Remember the Seinfeld episode where word got around that Elaine was a difficult patient? That scenario might not be so far-fetched. For 30 years, studies consistently have found that doctors call one out of every five or six patient encounters “difficult.”

The latest, in today’s Archives of Internal Medicine, found that primary-care doctors who felt they had a high number of “difficult” patient encounters were younger and more likely to be women.

Researchers surveyed 449 general internists and family practitioners at 118 U.S. clinics, asking them to estimate how often they encountered patients with any of eight attributes ascribed to the most difficult.

A patient insisting on an unnecessary drug was the most frequently cited challenge, cited by more than a third of respondents.

About one in six respondents said they frequently saw patients who appeared to be dissatisfied with their care. One in seven said patients frequently had unrealistic expectations. “Difficult” patients also ignore medical advice, complain persistently, insist on unnecessary tests and do not express appropriate respect.
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