Health Insurance Lead

GENEVA (AP) -- The world's most comprehensive legalized heroin program became permanent Sunday with overwhelming approval from Swiss voters who simultaneously rejected the decriminalization of marijuana.

The heroin program, started in 1994, is offered in 23 centers across Switzerland. It has helped eliminate scenes of large groups of drug users shooting up openly in parks that marred Swiss cities in the 1980s and 1990s and is credited with reducing crime and improving the health and daily lives of addicts.

The nearly 1,300 selected addicts, who have been unhelped by other therapies, visit one of the centers twice a day to receive the carefully measured dose of heroin produced by a government-approved laboratory.

They keep their paraphernalia in cups labeled with their names and use the equipment and clean needles to inject themselves - four at a time - under the supervision of a nurse, and also receive counseling from psychiatrists and social workers.

The aim is to help the addicts learn how to function in society.

The United States and the U.N. narcotics board have criticized the program as potentially fueling drug abuse, but it has attracted attention from governments as far away as Australia and Canada, which in recent years have started or are considering their own programs modeled on the system.

The Netherlands started a smaller program in 2006, and it serves nearly 600 patients. Britain has allowed individual doctors to prescribe heroin since the 1920s, but it has been running trials similar to the Swiss approach in recent years. Belgium, Germany, Spain and Canada have been running trial programs too.

Sixty-eight percent of the 2.26 million Swiss voters casting ballots approved making the heroin program permanent.

By contrast, around 63.2 percent of voters voted against the marijuana proposal, which was based on a separate citizens' initiative to decriminalize the consumption of marijuana and growing the plant for personal use.

Olivier Borer, 35, a musician from the northern town of Solothurn, said he welcomed the outcome in part because state action was required to help heroin addicts, but he said legalizing marijuana was a bad idea.

"I think it's very important to help these people, but not to facilitate the using of drugs," Borer said. "You can just see in the Netherlands how it's going. People just go there to smoke."

Sabina Geissbuehler-Strupler of the right-wing Swiss People's Party, which led the campaign against the heroin program, said she was disappointed in the vote.

"That is only damage limitation," she said. "Ninety-five percent of the addicts are not healed from the addiction."

Health insurance pays for the bulk of the program, which costs 26 million Swiss francs ($22 million) a year. All residents in Switzerland, which has a population of 7.5 million, are required to have health insurance, with the government paying insurance premiums for those who cannot afford it.

Parliament approved the heroin measure in a revision of Switzerland's narcotics law in March, but conservatives challenged the decision and forced a national referendum under Switzerland's system of direct democracy.

Jo Lang, a Green Party member of parliament from the central city of Zug, said he was disappointed in the failure of the marijuana measure because it means 600,000 people in Switzerland will be treated as criminals because they use cannabis.

"People have died from alcohol and heroin, but not from cannabis," Lang said.

The government, which opposed the marijuana proposal, said it feared that liberalizing cannabis could cause problems with neighboring countries.

On a separate issue, 52 percent of voters approved an initiative to eliminate the statute of limitations on pornographic crimes against children before the age of puberty.

The current Swiss statute of limitations on prosecuting pedophile pornography is 15 years. The initiative will result in a change in the constitution to remove that time limit.

© 2008 The Associated Press.

LONDON (AP) -- As World AIDS Day is marked on Monday, some experts are growing more outspoken in complaining that AIDS is eating up funding at the expense of more pressing health needs.

They argue that the world has entered a post-AIDS era in which the disease's spread has largely been curbed in much of the world, Africa excepted.

"AIDS is a terrible humanitarian tragedy, but it's just one of many terrible humanitarian tragedies," said Jeremy Shiffman, who studies health spending at Syracuse University.

Roger England of Health Systems Workshop, a think tank based in the Caribbean island of Grenada, goes further. He argues that UNAIDS, the U.N. agency leading the fight against the disease, has outlived its purpose and should be disbanded.

"The global HIV industry is too big and out of control. We have created a monster with too many vested interests and reputations at stake, ... too many relatively well paid HIV staff in affected countries, and too many rock stars with AIDS support as a fashion accessory," he wrote in the British Medical Journal in May.

Paul de Lay, a director at UNAIDS, disagrees. It's valid to question AIDS' place in the world's priorities, he says, but insists the turnaround is very recent and it would be wrong to think the epidemic is under control.

"We have an epidemic that has caused between 55 million and 60 million infections," de Lay said. "To suddenly pull the rug out from underneath that would be disastrous."

U.N. officials roughly estimate that about 33 million people worldwide have HIV, the virus that causes AIDS. Scientists say infections peaked in the late 1990s and are unlikely to spark big epidemics beyond Africa.

In developed countries, AIDS drugs have turned the once-fatal disease into a manageable illness.

England argues that closing UNAIDS would free up its $200 million annual budget for other health problems such as pneumonia, which kills more children every year than AIDS, malaria and measles combined.

"By putting more money into AIDS, we are implicitly saying it's OK for more kids to die of pneumonia," England said.

His comments touch on the bigger complaint: that AIDS hogs money and may damage other health programs.

By 2006, AIDS funding accounted for 80 percent of all American aid for health and population issues, according to the Global Health Council.

In Ethiopia, Rwanda, Uganda and elsewhere, donations for HIV projects routinely outstrip the entire national health budgets.

In a 2006 report, Rwandan officials noted a "gross misallocation of resources" in health: $47 million went to HIV, $18 million went to malaria, the country's biggest killer, and $1 million went to childhood illnesses.

"There needs to be a rational system for how to apportion scarce funds," said Helen Epstein, an AIDS expert who has consulted for UNICEF, the World Bank, and others.

AIDS advocates say their projects do more than curb the virus; their efforts strengthen other health programs by providing basic health services.

But across Africa, about 1.5 million doctors and nurses are still needed, and hospitals regularly run out of basic medicines.

Experts working on other health problems struggle to attract money and attention when competing with AIDS.

"Diarrhea kills five times as many kids as AIDS," said John Oldfield, executive vice president of Water Advocates, a Washington, D.C.-based organization that promotes clean water and sanitation.

"Everybody talks about AIDS at cocktail parties," Oldfield said. "But nobody wants to hear about diarrhea," he said.

These competing claims on public money are likely to grow louder as the world financial meltdown threatens to deplete health dollars.

"We cannot afford, in this time of crisis, to squander our investments," Dr. Margaret Chan, WHO's director-general, said in a recent statement.

Some experts ask whether it makes sense to have UNAIDS, WHO, UNICEF, the World Bank, the Global Fund plus countless other AIDS organizations, all serving the same cause.

"I do not want to see the cause of AIDS harmed," said Shiffman of Syracuse University. But "For AIDS to crowd out other issues is ethically unjust."

De Lay argues that the solution is not to reshuffle resources but to boost them.

"To take money away from AIDS and give it to diarrheal diseases or onchocerciasis (river blindness) or leishmaniasis (disfiguring parasites) doesn't make any sense," he said. "We'd just be doing a worse job in everything else."

© 2008 The Associated Press.

BEIJING (AP) -- Chinese health authorities and the U.N. AIDS agency pledged to fight discrimination against people with the disease in China with the unveiling Sunday of a massive red ribbon, the symbol of AIDS awareness, at the Olympic Bird's Nest stadium in Beijing.

Organizers said the fear of being stigmatized at work or in their communities is discouraging many people at risk of HIV infection from being tested. HIV is the virus that causes AIDS.

After years of denying that AIDS was a problem, Chinese leaders have shifted gears in recent years, confronting the disease more openly and promising anonymous testing, free treatment for the poor and a ban on discrimination against people with the virus.

State television Sunday showed Chinese Premier Wen Jiabao visiting a village hit particularly hard by AIDS in eastern China's Anhui province. Wen, who makes such annual visits to mark World AIDS Day, observed Monday, held hands with children orphaned by AIDS and spoke to patients in beds.

The topic, however, still remains very sensitive and authorities regularly crack down on activists and patients seeking more support and rights.

"About half of all Chinese would not want to share a meal with a person with HIV/AIDS, and a quarter would not want to shake hands," said Dr. Bernhard Schwartlander, country coordinator of UNAIDS in China. "People will not come forward to be tested. They won't benefit from treatment. They won't talk to their partners and colleagues about HIV/AIDS - putting themselves and others potentially at risk for HIV."

Schwartlander was speaking at the Bird's Nest stadium, a main Olympic venue, during the unveiling of a 66-foot by 50-foot (20-meter by 15-meter) banner on which the red AIDS awareness ribbon was printed.

"Stigma and discrimination are major obstacles in an effective response to AIDS. We need to engage all sectors of society in China to combat these issues and work together to stop the disease," said Minister of Health Chen Zhu. He did not specify any steps they would take.

Official estimates put the number of people living with HIV in China at about 700,000, with around 85,000 people with full-blown AIDS, UNAIDS said in a statement. But the number of officially reported HIV cases remains only 264,302 - far lower than the estimated total, in part because of reluctance to seek testing.

© 2008 The Associated Press.

FORT CAMPBELL, Ky. (AP) -- Some 15,000 soldiers are heading home to this sprawling base after spending more than a year at war in Iraq and Afghanistan, and military health officials are bracing for a surge in brain injuries and psychological problems among those troops.

Facing prospects that one in five of the 101st Airborne Division soldiers will suffer from stress-related disorders, the base has nearly doubled its psychological health staff. Army leaders are hoping to use the base's experiences to assess the long-term impact of repeated deployments.

The three 101st Airborne combat brigades, which have begun arriving home, have gone through at least three tours in Iraq. The 3rd Brigade also served seven months in Afghanistan, early in the war. Next spring, the 4th Brigade will return from a 15-month tour in Afghanistan. So far, roughly 10,000 soldiers have come back; the remainder are expected by the end of January.

Army leaders say they will closely watch Fort Campbell to determine the proper medical staffing levels needed to aid soldiers who have endured repeated rotations in the two war zones.

"I don't know what to expect. I don't think anybody knows," said Gen. Peter Chiarelli, vice chief of staff of the Army, as he flew back to Washington from a recent tour of the base's medical facilities. "That's why I want to see numbers from the 101st's third deployment."

What happens with the 101st Airborne, he said, will let the Army help other bases ready for similar homecomings in the next year or two, when multiple brigades from the 4th Infantry Division and the 1st Cavalry Division return.

Noting that some soldiers in the 101st Airborne units have been to war four or five times, Chiarelli said he is most worried the military will not be able to find enough health care providers to deal effectively with the troops needing assistance.

Many of the military bases are near small or remote communities that do not have access to the number of health professionals who might be needed as a great many soldiers return home.

More than 63,600 active duty Army soldiers have done three or more tours in Iraq or Afghanistan. That is a nearly 12 percent of the total number of soldiers who have deployed at least once. Roughly four in 10 soldiers who have gone to war have served more than one deployment - and that number is growing steadily.

One solution under discussion is the formation of mobile medical and psychological teams that can go to Army bases when they are expecting a surge in activity from returning units.

At Fort Campbell, the director of health services, Col. Richard Thomas, has roughly doubled his authorized staff of psychologists and behavioral specialists to 55 and is trying to hire a few more.

"I think we have enough staff to meet the demands of the soldiers here, but I could use more, and I'll hire more if I can," said Thomas. "I'll hire them until they tell me to stop."

He said he expects the increased staffing levels to last at least through next year.

For the first time, Thomas said, every soldier returning home will have an individual meeting with a behavioral health specialist and then go through a second such session 90 days to 120 days later.

The second one is generally the time when indications of stress surface, after the initial euphoria of the homecoming wears off and sleeplessness, nightmares, and other symptoms show up.

"We're seeing a lot of soldiers with stress related issues," he said. "They're not bipolar or schizophrenic. But they're deploying three and four times and the stress is tremendous. They're having relationship issues, financial issues, marital problems - all stress related."

According to Dr. Bret Logan, deputy commander for managed care at the base, extended war zone stints that have lasted as long as 38 months over the course of the wars in Afghanistan and Iraq have taken a severe toll.

More than 3,000 of the 15,000 troops returning home, Logan estimated, probably will experience headaches, sleep disorders, irritability, memory loss, relationship strains or other symptoms linked to stress disorder.

Medical staff at Fort Campbell say they also worry that there will be a new surge of suicides - an escalating problem in recent years, largely related to the stresses of war.

Jon Soltz, an Iraq war veteran and chairman of VoteVets.org, said more soldiers will have stress-related problems, and the military must be vigilant in diagnosing and treating post-traumatic stress disorder to head off more serious issues.

"The longer you are there (at war), the more PTSD you're going to see. You wonder when it's going to be your time," he said.

Each returning soldier is evaluated through a seven-day reintegration program. It includes medical checkups, tests, lectures on suicide prevention and relationships, and other sessions to help them transition back into life at the base and with their families.

During his visit to Campbell, Chiarelli took a spin on one of the base's simulators, which are used for soldiers having neurological or stress problems. The simulator can be used to test soldiers' reflexes or as a way to work someone back into everyday situations.

With occupational therapist Eileen Hayes watching over his shoulder, Chiarelli adeptly negotiated the city streets, sudden turns and other obstacles moving at him on the small screen.

The simulators said Logan, put patients in high stress scenarios to test their decision-making ability while under duress.

While soldiers have been routinely deploying for 15-month tours, most Marines serve about seven months and airmen deploy for about four months, although some may serve for tours of six months or longer.

Late this past summer, Pentagon leaders ordered a change, saying any soldier who deployed in August or after would serve 12-month tours. Army leaders say they want to reduce that to nine months, but doing so will be difficult considering the strains of fighting two wars at once.

Logan said that some 85 percent of those soldiers with stress disorder symptoms will recover with the help of some treatment or medication. But the other 15 percent will require more intensive help.

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On the Net:

Defense Department: http://www.defenselink.mil

Fort Campbell: http://www.campbell.army.mil/crisis/index.html

© 2008 The Associated Press.

NEW YORK (AP) -- The off-color jokes flew around the room. As the anecdotes got bawdier, the laughter intensified. Some recited from memory, others read from notebooks they brought along.

The setting for the hilarity was the Montefiore Einstein Cancer Center at Montefiore Hospital. The participants were cancer patients, some with advanced stages of the illness.

They were taking part in the hospital's monthly "Strength Through Laughter" therapy. It is one of several types of laughter or humor therapy being offered by medical facilities around the country for patients diagnosed with cancer or other chronic diseases.

The programs feature joke sessions, clown appearances and funny movies.

While the verdict is out on whether laughter plays a role in healing, the American Cancer Society and other medical experts say it reduces stress and promotes relaxation by lowering blood pressure, improves breathing and increases muscle function.

On a recent day before Halloween, many of the two dozen patients at Montefiore arrived in costume to "spook cancer."

"The session makes you feel better," said Luz Rodriguez, 57, a breast cancer patient now in remission, who came disguised as a security officer. "I feel healthy when I laugh."

The laughs generated a warmth among the group that was palpable, particularly when Rodriguez changed into an angel costume and went around offering a red rose and a hug or kiss to each of the participants.

Their facilitator, senior oncology social worker Gloria Nelson, started the session five years ago to help cancer patients focus on living, instead of dying.

"They have such amazing strength, but it's a constant challenge, the fear of it coming back, how to go on living knowing you have cancer," said Nelson, who came dressed as the mother of the bride. "Every time they laugh, it's like kicking cancer out the door. You're taking control, you're saying it's not controlling me."

The most famous case of laughter's therapeutic effects on the body was described by Norman Cousins, editor of the Saturday Review, in his 1979 book, "Anatomy of an Illness." He claimed that a combination of laughter and vitamins cured him of a potentially fatal illness.

"I made the joyous discovery that 10 minutes of genuine belly laughter had an anesthetic effect," he wrote.

Still, laughter therapy is not for everyone. Some cancer patients are so overwhelmed with their diagnosis that they are unable to participate. Medical experts stress that laughter and other complementary therapies like acupuncture, massage and meditation are not substitutes for traditional medical treatment but can be used to help relieve the anxiety brought on by the disease.

At the Cancer Treatment Centers of America in Zion, Ill., patients experience another form of laughter therapy that bypasses jokes. In this version, patients practice laughter sounds like "he-he," "ha-ha," and "ho-ho," greet each other with laughter instead of words and engage in games like a pretend snowball fight until laughter overtakes them.

The staff at the center first tried it in 2004. They felt "weird and silly" but when they tried it out with patients the next day, the laughter soon because contagious, said Katherine Puckett, a licensed clinical social worker and a mind-body medicine expert.

The therapy has since been integrated into the culture of the hospital, and is also offered at the center's facilities in Philadelphia, Tulsa and Seattle.

Steve Wilson, a psychologist who runs the World Laughter Tour, which also trains and certifies laughter club leaders, said about two dozen hospitals around the country have asked to be trained in the method in the past two to three years. One hospital wants to try the therapy with lung transplant patients because laughter allows more oxygen to move through the body.

An international program with a similar goal but totally different approach is "Caring Clowns." The Thomas Jefferson University Hospital in Philadelphia uses the program of costumed volunteers to get patients to giggle - or at least smile - and open up.

"One of the challenges of being diagnosed with cancer is preserving your dignity ... when we tell you to put on a gown where the back half is missing and everyone's examining you and asking about bodily functions," said Dr. Richard Wender, former president of the American Cancer Society and the hospital's chief of family medicine.

The clown volunteers, he said, create a sense of comfort that helps narrow the "interpersonal gap" between patient and medical staff.

Robbie Robinson, 52, a non-Hodgkin's Lymphoma survivor, became a certified laughter leader after witnessing the "coping mechanism" laughter offered him as a patient at CTCA.

"Some people came in wheelchairs, some were helped by family and friends. You could tell people were down ... then I noticed that through some stimulated laughter, people started smiling. They forgot their troubles. You could see the pressure come off them."

The nonprofit Rx Laughter, meanwhile, focuses on managing patient pain and improving mental health through comic entertainment, including films and TV clips. It is a unique collaboration between the entertainment and medical fields that was founded in 1998 by Sherry Dunay Hilber, one-time director of prime time programming for ABC and CBS.

Rx Laughter's participation in two large medical studies discovered that patients who watched funny videos during certain painful procedures were more relaxed and tolerated the pain longer. It also found that cancer patients had less pain and slept better after such entertainment. The organization offers a variety of programs for hospitals, nursing homes, cancer support groups and rehabilitation clinics.

"Comic entertainment is at our fingertips 24/7. ... Watching our favorite shows and films can get us through very stressful times - all the more important in light of the cost of psychotherapy that many people cannot afford, and the problematic side effects of too many pain killers," said Hilber.

© 2008 The Associated Press.