Saturday, November 7, 2009

The Forever War of the Mind

Op-Ed Contributor
The Forever War of the Mind

By MAX CLELAND
Published: November 6, 2009

“EVERY day I was in Vietnam, I thought about home. And, every day I’ve been home, I’ve thought about Vietnam.” So said one of the millions of soldiers who fought there as I did. Change the name of the battlefield and it could have been said by one of the American servicemen coming home from Iraq or Afghanistan today. Wars are not over when the shooting stops. They live on in the lives of those who fight them. That is the curse of the soldier. He never forgets.

Health Guide: Post-Traumatic Stress Disorder

While the authorities say they cannot yet tell us why an Army psychiatrist would go on a shooting rampage at Fort Hood in Texas, we do know the sorts of stories he had been dealing with as he tried to help those returning from Iraq and Afghanistan readjust to life outside the war zone. A soldier’s mind can be just as dangerous to himself, and to those around him, as wars fought on traditional battlefields.

War is haunting. Death. Pain. Blood. Dismemberment. A buddy dying in your arms. Imagine trying to get over the memory of a bomb splitting a Humvee apart beneath your feet and taking your leg with it. The first time I saw the stilled bodies of American soldiers dead on the battlefield is as stark and brutal a memory as the one of the grenade that ripped off my right arm and both legs.

No, the soldier never forgets. But neither should the rest of us.

Veterans returning today represent the first real influx of combat-wounded soldiers in a generation. They are returning to a nation unprepared for what war does to the soul. Those new veterans will need all of our help. After America’s wars, the used-up fighters are too often left to fend for themselves. Many of the hoboes in the Depression were veterans of World War I. When they came home, they were labeled shell-shocked and discharged from the Army too broken to make it during the economic cataclysm.

So it is again, with too many stories about veterans of Iraq and Afghanistan ending up unemployed and homeless. Figures from the Department of Veterans Affairs show that 131,000 of the nation’s 24 million veterans are homeless each night, and about twice that many will spend part of this year homeless.

We know of the recent failures at Walter Reed Medical Center, where soldiers were stranded in substandard barracks infested with rats while awaiting treatment. I was in Walter Reed myself at that time seeking counseling for post-traumatic stress disorder, which, ignited by a barrage of Iraq headlines and the loss of my United States Senate seat, had simply consumed me.

I never saw it coming. Forty years after I had left the battlefield, my memories of death and wounding were suddenly as fresh and present as they had been in 1968. I thought I was past that. I learned that none of us are ever past it. Were it not for the surgeons and nurses at Walter Reed, I never would have survived those first months back from Vietnam. Were it not for the counselors there today, I do not think I would have survived what I’ve come to call my second Vietnam, the one that played out entirely in my mind.

When I was wounded, post-traumatic stress disorder did not officially exist. It was recognized as a legitimate illness only in 1978, during my tenure as head of the Veterans Administration under President Jimmy Carter. Today, it is not only recognized, but the Army and the V.A. know how to treat it. I can offer no better testament than my own recovery.

Weeks before the troubles at Walter Reed became public in 2007, my counselor put it to me simply. “We are drowning in war,” she said. The problems at Walter Reed had nothing to do with the dedicated doctors and nurses there. The problems had to do with the White House and Congress and the Department of Defense. The problems had to do with money.

When we are at war, America spends billions on missiles, tanks, attack helicopters and such. But the wounded warriors who will never fight again tend to be put on the back burner.

This is inexcusable, and it comes with frightening moral costs. There are estimates that 35 percent of the soldiers who fought in Iraq will suffer post-traumatic stress disorder. I’m sure the numbers for Afghanistan are similar. Researchers have found that nearly half of those returning with the disorder have suicidal thoughts. Suicide among active-duty soldiers is on pace to hit a record total this year. More than 1.7 million soldiers have served in Iraq and Afghanistan. Imagine that some 600,000 of them will have crippling memories, trapped in a vivid and horrible past from which they can’t seem to escape.

We have a family Army today, unlike the Army seen in any generation before. We have fought these wars with the Reserves and the National Guard. Fathers, mothers, soccer coaches and teachers are the soldiers coming home. Whether they like it or not, they will bring their war experiences home to their families and communities.

In his poem “The Dead Young Soldiers,” Archibald MacLeish, whose younger brother died in World War I, has the soldiers in the poem tell us:“We leave you our deaths. Give them their meaning.” Until we help our returning soldiers get their lives back when they come home, the promise of restoring that meaning will go unfulfilled.

Max Cleland, the secretary of the American Battle Monuments Commission, was a Democratic senator from Georgia from 1997 to 2003. He is the author, with Ben Raines, of “Heart of a Patriot: How I Found the Courage to Survive Vietnam, Walter Reed and Karl Rove.”

Comment

PTSD CAN be survived, as veterans are doing it every day - some better than others. Some, like cancer, it will consume.

A palpable strain on VA mental-health system

Washington Post

A palpable strain on mental-health system
Vows to boost care are falling short at Walter Reed, other military hospitals

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Nov. 6: The cousin of Army psychiatrist Nidal Malik Hasan, the suspect in the assault at Fort Hood, Texas, said Hasan was "ridiculed for being a Muslim." NBC's Jim Miklaszewski reports.
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Nov. 6: When the shooting started and the wounded fell at the Fort Hood Army Post Thursday, the soldiers who were spared did whatever they could to help save lives. NBC's Mark Potter reports.
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By Anne Hull and Dana Priest

updated 4:11 a.m. ET, Sat., Nov . 7, 2009
WASHINGTON - The instructions were simple: Talk about your feelings on the morning after learning that an Army major in Texas was believed to have gunned down 13 people and wounded another 38 at Fort Hood.

But here at Walter Reed Army Medical Center, in a group-therapy session for combat-stressed soldiers in the hospital's outpatient psychiatry unit, frustrations soon boiled over and Pfc. Sophia Taylor was out the door.

"You people don't listen," the Iraqi war vet said, as two clinicians followed her down the hall to the elevators.

"Sophia," one of them said.

Taylor was trembling and wiping tears from her face.

"Stop talking to me," she said. "This ward ain't gonna change until everyone else in the freakin' Army dies. You people don't listen to me. I'm tired of talking."

Falling short of promises

This scene at Walter Reed on Friday underscores the ongoing tensions, frustrations and problems in the military health-care system for troops returning from Iraq and Afghanistan with psychiatric problems.

More than two years after the nation's political and military leaders pledged to improve mental-health care, their promises have fallen short at military hospitals around the country, according to mental-health professionals, Army officials, and wounded soldiers and their families. Those hospitals include Walter Reed, where the man accused of the Fort Hood shootings, Nidal M. Hasan, spent four years as a psychiatric intern, resident and fellow.

What may have happened to Hasan during those four years is one of the things being investigated. But it isn't only Walter Reed that is under fresh scrutiny: Evidence of an undermanned, overworked health-care system stretches all the way to the Pentagon, where all of the top health-policy positions remain unfilled, leaving a void on an issue long fraught with inefficiencies and entrenched bureaucracies.

Vacant positions

The top civilian health position of assistant secretary of defense for health affairs is vacant and is being temporarily filled by Ellen Embrey, a hard-working career administrator who colleagues say lacks the authority of a political appointee to push the military services and the health-care bureaucracy in the right direction.

Three other top positions -- the principal deputy, the deputy for clinical programs and policy, and the chief financial officer post -- are also unfilled.

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The vacancies occur as the Army in particular struggles with a soaring suicide rate. In 2009 so far, 117 active-duty Army soldiers were reported to have committed suicide, with 81 of those cases confirmed -- up from 103 suicides a year earlier.

Fort Hood profiles
A look at some of the people involved in the deadly rampage at the Texas Army post.

Pentagon press secretary Geoff Morrell said the administration "is actively looking for the appropriate people to man the health-affairs staff," but that health care for soldiers is not suffering in the meantime because the interim staff is competent and the military services "have been doing a heck of a job."

"Are they perfect? Absolutely not . . . but we are offering more for soldiers than ever before." He said many soldiers simply do not understand all that is available to them. "There is clearly a disconnect between all we now do and people availing themselves of it."

Some 34,000 soldiers have been diagnosed with post-traumatic stress disorder since 2003, according to the Army surgeon general's office. In the wake of the Walter Reed scandal, soldiers receive increased health screening once they deploy, once they return and months after they are back home, according to a surgeon general's office fact sheet. In 2006, the Army also began a more intensive training program, which it says helps mitigate combat-related mental-health problems. On average, 200 behavioral-health personnel are deployed in Iraq and 30 in Afghanistan.

The military has also hired 250 additional behavioral-health providers and more than 40 marriage and family therapists in recent months. The Army currently has 408 psychiatrists for its force of 545,000 people.

At Walter Reed, the Army has added six psychiatrists, seven psychologists, 11 social workers and eight clinical nurse specialists since 2007 for a total of 124 mental-health providers, an increase of 35 percent, according to figures provided by Walter Reed.

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Sixty-five psychiatric residents are also included -- one of whom was Hasan.

Since the shooting, officials have been looking for warning signs in Hasan's career that could have tipped them off to his potential to carry out the attack. Some of his Walter Reed colleagues said patients complained that Hasan seemed uncomfortable talking about soldiers' emotional needs and was himself a loner. He was also not very productive but was gentle in nature and showed no signs of potential for violence, they said.

A former Walter Reed social worker, Joe Wilson, said problems in the mental-health department were usually not discussed openly. "Of course you miss the red flags, you can't talk openly about mental health," Wilson said. "You complain about it to each other, but not to anyone else." The opinion was shared by another mental-health worker who asked not to be named.

Switching a soldier who is unhappy with his psychiatrist to another doctor can backfire and delay the medical board process that determines whether the soldier remains in the service. "It's a complete disincentive to complain" about any particular health-care provider, Wilson said.

Shortages
At Walter Reed, some soldiers and health-care professionals complain that there are not enough mental-health providers, and senior Army officials have acknowledged that finding enough people to work with the military is a persistent problem. They say patients diagnosed with PTSD and other war-related emotional problems are far too likely to be treated with sleeping aids and mood-altering medications. Many still go without regular one-on-one therapy or meaningful group sessions.

The wife of an amputee soldier recovering at Walter Reed with traumatic brain injury and PTSD said that mental-health services are so uncoordinated and ineffective that the couple decided to pay for private psychotherapy sessions with a civilian provider at $130 an hour.

The couple sought private treatment elsewhere after spending a few minutes with a Walter Reed psychiatrist, who then referred the soldier to a social worker for treatment.

"It was a joke," said the wife, who asked not be identified because her husband, a sergeant, is still recovering at Walter Reed. "She was a lovely person, but we have a serious problem here and she just didn't get it . . . She essentially directed me to a Web site."


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Taylor, the soldier who abruptly left her group therapy session Friday morning, said mental-health patients still feel ignored or second-class compared with the more visibly wounded.

"The amputees get the great treatment," Taylor said. "Purple Hearts, money for losing their limbs. I have a lot of respect for them. But I lost my mind, and I couldn't even get a simple 'thank you for your service.' "

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Nov. 6: The father of a Fort Hood soldier described the scene relayed to him by his daughter as 13 men and women died in a hail of gunfire around her on Thursday. NBC's Lester Holt reports.
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Taylor, whose father was a veteran and whose older sister also served in Iraq, said the Army has begun to process her for a dishonorable discharge, which she will fight.

Her mother, Vernelda Taylor-Harris of Bowie, said she recently met with her daughter's command at Walter Reed to argue for treatment over punishment.

"She's had so much medication, how can you remember meetings on all that medication?" Taylor-Harris asked the command.

The mother told the officers that she hoped her daughter could get help now, before it's too late. "I don't want your flag and your condolences," she said.

Taylor returned to the outpatient ward Friday for the rest of her services. When she learned that President Obama will be visiting the nearby orthopedic ward, she asked a doctor, "What can we do to get him to see us?"

Comment

PTSD is a very difficult disorder to treat successfully. It didnt occur overnight andwill not go away overnight. there are several treatment modalities currently being used to treat PTSD. Studies have shown that behavioral treatment is more effective than others. I have experience with Vietnam era PTSD soldiers, and a little bit of success. I knew a veteran who I met in a bar and got to know over a period of 18 months or so, who had spent hours with a shotgun barrel in his mouth every day for years, trying to decide whether today was going to be THE DAY, or not. He told me of some horrible things he had witnessed in Nam, and some terrible things he had done, but now felt guilty about. For example, he had killed a toddler who came toward his patrol with a diaper full of poop. This guy was afraid that the diaper of poop was concealing a granade that would decimate his patrol so he eliminated the perceived threat before it could possible eliminate him and his buddies. Afterward, he found that the diapers had only poop in them and was overcome with guilt. He said,"Americans dont kill babies. It is not the American way of war. We kill the enemy, not babies" Several of his friends had been killed over time and he hadnt had enough time to properly grieve for them, so he was filled with sadness and survivor guilt. He has also killed women, and felt somewhat guilty about that but said that some of them deserved it because they were spies and had given information to the Viet Cong that got his buddies killed. I mostly listened for the first six months as he talked about more and more of his wartime experiences. He had fragged a second lieutenant who hadnt listened to him and led the squad into an ambush, getting 2 killed and 3 wounded. "He will never get any more of MY guys killed", he said, with satisfaction, and no remorse. Most of what he felt bad about was stuff that he had no control over ie "I should have known there was a sniper or a booby trap there". I tried to point that out as we went along, that there are always SOME things we cannot control. He didnt listen at first, but over time was able to forgive himself for not knowing how things would turn out ahead of time, or every possible type of booby trap or snipers nest. It was a pretty easy transition to eventually reframe the things he did, right or wrong, as survival behavior. He was a survivor. He IS a survivor, as I saw him about five years ago.

Friday, November 6, 2009

New treatment improving burned triplets’ scars

After months of innovative laser technique, more confidence and mobility

Burn treatment boosts triplets' confidence
Nov. 6: TODAY’s Matt Lauer and medical editor Dr. Nancy Snyderman check in with triplets Chandra, Jordan and Trae Berns, who have been undergoing a new treatment to remove a lifetime of scars.
Today show

Sisters through tragedy and triumph
The Berns triplets barely survived the fire that killed their mother when they were toddlers. They supported each other through a long process of healing and have now made tremendous progress with a new laser treatment.

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By Mike Celizic
TODAYShow.com contributor
updated 9:08 a.m. ET, Fri., Nov . 6, 2009
The three young women glowed like the fashion models they could be, walking advertisements for a new treatment for burn victims that is being hailed as a medical miracle.

Identical triplets Trae, Jordan and Chandra Berns, 22, had first visited TODAY’s New York studios last May to talk about the pioneering laser treatment that had begun to erase scars that they had carried for 20 years. Friday, they came back to show the remarkable healing they’ve experienced since undergoing several more treatments.

“Over the past few months, it’s pretty much a gradual improvement,” Chandra told TODAY’s Matt Lauer. “Our skin has gotten smoother. Our scars have gotten a lot smoother.”

Jordan, who had lived with limited mobility in her left arm because of scar tissue around her elbow, said, “It’s helped a lot.”

As the scars that covered up to 30 percent of their bodies have been lasered away, Trae said the sisters no longer self-consciously cover their damaged skin.

“We gained a lot more self-confidence than we had before,” Trae said.

Scarred by tragedy
The Berns triplets were just 17 months old when they were trapped in a fire in their Texas home that killed their mother. The little girls spent a long time in the hospital before being released to an extensive series of painful surgeries and skin grafts.

Despite their burns and the compressing bandages they had to wear, their childhood was remarkably normal.


From top, Jordan Berns’ left arm in March 2009 and then in September after undergoing innovative new laser treatments for scarring. The triplets not only feel more confident showing their skin; they have also regained some flexibility from their childhood burns.
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“When we were growing up, we didn’t notice that we had burns. We were regular children. We went out. The people that we grew up with, all the children, they pretty much knew what happened, and everybody pretty much accepted it,” Chandra told Lauer in May.

It was only when they got to high school and met new people that they were made acutely aware of their disfigurement by other children who pointed at them and called them vicious names.By the time they all went off to college, they thought they would have to live with their scars forever.

A new approach

Then the sisters heard about a pioneering laser treatment being used by Dr. Jill Waibel, a cosmetic surgeon in Palm Beach, Fla. The three drove from their Texas home to Florida to see if Waibel could help them. When Waibel met the three young women, she and Lumenis, the manufacturer of the laser, agreed to treat them free of charge.

New scar treatment gives triplets hope
May 28: A new laser procedure offers hope to 22-year-old triplets who were badly burned as toddlers.

After undergoing two rounds of treatments, the sisters showed off the results on TODAY. After two more rounds, they came back Friday with Waibel and NBC’s chief medical editor, Dr. Nancy Snyderman, to show off faces that now show virtually no visible signs of scarring.

Waibel said she’s treated hundreds of burn victims in addition to the Berns sisters. “These are typical results,” she said. “For burn patients, there’s great improvement, and we’re still studying it and learning more.”

“This is going to change the way we treat all kinds of things,” Snyderman predicted, from acne scars to wrinkles to ordinary scars and burns. “These guys are proof of the fact that this works.”

The triplets said that the treatment stings, but not badly. After two weeks, the skin peels like a sunburn. Over the course of months, new tissue grows, smoothing contours and evening colors.

The Bernses said they’ve had four treatments and will be having two more. Their skin will never be perfect, but it is dramatically improved.

Cheaper than surgery

The big benefit of the treatment, Waibel said, is that it costs from $500 to a couple of thousand for a single treatment. “A fraction of what surgery costs,” she said, “and better results.”

Web only: Dr. Waibel explains the procedure
May 28: Dr. Jill Waibel demonstrates how the ablative fractional laser can treat burn scars.
Today show


The treatment, called an ultrapulse fractional ablative laser, consists of two separate lasers. The first shoots tiny beams that penetrate less than a millimeter into the scar tissue, heating it to the boiling point, vaporizing it, and allowing healthy tissue and collagen to fill in the microscopic gaps created by the laser. The second laser flattens and evens out the texture and coloring of the remaining scar tissue.

The lasers were developed to treat serious acne scars, but Waibel has pioneered using them to treat burn victims. She said that doctors are not sure exactly how the lasers work to destroy scar tissue, but there is no arguing with the results.

Until the laser treatment came into use, burn victims had to live with often-serious scarring. In addition to disfiguring the victims, scar tissue could also seriously restrict movement. The laser not only erases much of the scarring, it also returns the elasticity to damaged skin.

Hope for others
Since appearing on TODAY, Waibel has been invited to travel the nation and the world to educate other doctors in use of the laser.

Sisters through tragedy and triumph
The Berns triplets barely survived the fire that killed their mother when they were toddlers. They supported each other through a long process of healing and have now made tremendous progress with a new laser treatment.
more photos

The TODAY appearance also allowed the Berns sisters to start a foundation, Three for Hope, to help other burn victims get the treatments. Helped by donations sent by TODAY viewers, the foundation has already assisted its first patient, the sisters said.

The foundation is headquartered in San Antonio. Its mission statement reads: “To empower and inspire other burn survivors to get past the tragedy in their lives and become the best people they can be. We will be providing reinforcement, hope, education, rehabilitation, treatment, and financial resources and support to survivors and their families.”

Let states lead the way

Washington's one-size-fits-all reform won't work

By Newt Gingrich and Rick Perry
Friday, November 6, 2009

Congress is on the verge of enacting the largest unfunded mandate in American history. At a time when most states are struggling with rising unemployment, declining tax revenue and the worst national economic climate in 30 years, Congress is demonstrating that it is more out of touch than ever.

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Let states lead the way
The House's better health-reform option
Making the young pay for health reform
The Democratic health "reform" bill in the Senate would require states to expand Medicaid to include all people earning up to 133 percent of the federal poverty level, or $29,327 for a family of four. House Democrats want to require expansion to 150 percent of the poverty level, or $33,075 for a family of four. Even Texas, which has a balanced budget and nearly $9 billion in its rainy-day fund, isn't prepared to absorb this type of blow.

Complaints from majorities of Republican and Democratic governors alike continue to fall on deaf ears. Congress seems intent on forcing a one-size-fits-all mandate on states, some of which actually have solutions to repair their health-care systems that Washington is preventing them from trying.

Texas, for example, has adopted approaches to controlling health-care costs while improving choice, advancing quality of care and expanding coverage. Consider the successful 2003 tort reform. Fewer frivolous lawsuits have attracted record numbers of doctors to the state as medical malpractice insurance premiums dropped by half. Christus Health, a large Catholic nonprofit system with a significant presence in Texas, spent about $100 million on liability defense payments in 2003. Last year, Christus spent $2.3 million on such payments. Much of that savings has gone into expanding health-care services in low-income neighborhoods.

You might think Washington would be curious about plans to provide more low-income Texans with insurance, reduce expensive emergency-room visits for basic care and make it easier to buy into employer-sponsored insurance. Unfortunately, Washington has failed for 18 months to give Texas permission to use Medicaid dollars for these policies.

Historically, the federal government has paid an average of 57 percent of state Medicaid costs. In a transparent attempt to bribe governors and state legislatures into accepting 15 million to 20 million new people nationwide onto Medicaid rolls, Congress is proposing a series of additional subsidies to states to cover 90 percent of the costs of the newly mandated populations. In true Washington form, these handouts would be debt-financed, through the generosity of foreign bankers, to be paid back by future generations of American taxpayers.

Expanding the Medicaid program in Texas alone to include an additional 2 million people would cost $20 billion to $30 billion over the next 10 years. Regardless of how that cost is shared between the federal and state governments down the road, we believe that level of new mandated spending is grossly unacceptable.

Even more stunning than this fiscal irresponsibility is Congress's disregard for the quality of the Medicaid program and the well-being of the people in it. Medicaid is the lowest payer in the health-care system. It reimburses physicians 20 to 30 percent less than even Medicare, which pays costs at a much lower rate than do private insurers. If a doctor or hospital is facing bills, staff salaries and medical malpractice premiums, it is obvious which patients will get preference.

We note with concern that the Government Accountability Office reported in January that Medicaid made an estimated $32.7 billion in improper payments in 2007, equal to a full 10 percent of the program. Sen. John Cornyn (R-Tex.) pointed out that the average improper payment rate for non-health government programs is 3.9 percent. He introduced an amendment in the Senate Finance Committee that would have prevented expansions of Medicaid until the secretary of health and human services could certify that its improper payment rate was equivalent to that of non-health programs, but that amendment failed on a party-line vote. The rate of improper payments needs to be addressed.

The Democratic health-care proposals do nothing to expand choice, lower costs and empower patients. They would add to, without reforming, bulky, overpriced programs that would in turn add to our already crushing burden of national debt. Reckless expansion would ultimately reduce the quality of U.S. medical care.

Such tragedies can be averted if the powers-that-be in Washington set aside their devotion to centrally planned, debt-financed, one-size-fits-all solutions and work cooperatively with those laboratories of innovation known as states. Otherwise, we'll end up with a one-size-hurts-all situation.

Newt Gingrich, founder of the Center for Health Transformation, was speaker of the House of Representatives from 1995 to 1999. Rick Perry is governor of Texas.

Cash Payments to Avoid Teen Pregnancy? Great Idea

November 05, 2009 02:06 PM ET | Bonnie Erbe | Permanent Link | Print
By Bonnie Erbe, Thomas Jefferson Street blog

It's not new, but it's newsy. There's a North Carolina program for younger sisters of teen mothers that pays these girls a dollar each day NOT to get pregnant. What a brilliant idea! And why aren't we doing that nationwide?

College Bound Sisters was launched to help protect teen girls in the highest-risk category from getting pregnant and dropping out of school. There are strict eligibility criteria as follows:

Is between the ages of 12-16
Has a sister who had a baby before age 18
Has never been pregnant
Wants to attend college
Is willing to attend a 1.5 hour meeting each week at [the University of North Carolina-Greensboro]
Two groups of girls (one between the ages of 12-14 and the other between 15-18) meet separately each week for 1.5 hours with adult leaders.

Meetings are held on the campus of the University of North Carolina-Greensboro in the School of Nursing and feature food, fun, fellowship, and education. Guest speakers, campus field trips, demonstrations, and an assortment of media covering a wide variety of topics help the program achieve its goals. In addition, quarterly meetings are held with parents of the program participants. These meetings provide a forum for discussion of issues related to adolescent girls.

One dollar per day for a couple of years is a pittance compared to the costs to society of raising the child of an unwed teen mother. Some info from opposingviews.com:

Teen pregnancies cost $9.1 billion annually, according to the National Campaign to Prevent Teen and Unplanned Pregnancy, or around $500,000 for each teen pregnancy for health care and welfare. College Bound Sisters costs just $75,000 a year to operate.

Opposition to programs such as College Bound Sisters apparently comes from the usual suspects: the abstinence-only crowd doesn't want these girls taught biologically-accurate sex education. Others, according to opposingviews.com, object to paying girls to do what's in their own self interest. The problem with that argument is, we pay for the children of unwed teen moms whether we want to or not. And we pay a lot, lot more than a dollar per day per girl for a couple of years.

Comment

Paying teens to NOT get pregnant is a new idea that makes financial sense but somehow doesnt sound right. Its like us paying other countries to NOT cut down their forests. They should do it because its in their best interests! I wonder if they are providing these girls with birth control too?

Thursday, November 5, 2009

Prostate Cancer - Nutrition Action, Sept 2009

One in six men will be diagnosed with prostate cancer in their lifetime. its the most prevalent cancer in the USA. If you are diagnosed with prostate cancer your odds of surviving 10 years are roughly 93%. And death rates have decreased since 1990. The bad news is that there still is no cure. There are two types of prostate cancer- one is a slow-growing tumor that doesnt bother people much over the years. The other is an aggressive, fast-growing and potentially very fatal.

Nutrition Action reviews the studies and finds that selenium does no good, and can harm, a patient with prostate cancer. If you have a certain AA gene type,, you might benefit from selenium. They also found scant proof that Vitamin E, calcium and dairy products, Vitamin D, meat or zinc. Obese patients were 54% more likely to develop prostate cancer than those with a normal weight.

The things that might help prevent prostate cancer are tomatoes and lycopene, flaxseed, green tea, pomegranate, diet and exercise, vegetables, and soy products. Its well worth reading, and gives the reference from which they made their conclusions.

Health Care Will Not Reform Itself

Posted: November 5, 2009 12:31 PM BIO Become a Fan Get Email Alerts Bloggers' Index
Point 2: Care is Inconsistent and Too Often Unsafe

Read More: Health, Health Care, Health Care Reform, Health Insurance, Health Reform, Obama Health Care, Universal Health Care, Universal Healthcare, Politics News

Know that health care in America is inconsistent, generally uncoordinated, almost entirely unmeasured, and far too often unsafe.

The death rate can vary by 60 percent for breast cancer surgery between two adjacent hospitals. The death rate can vary by more than 600 percent for heart surgery.

The number of crisis-level hospital admissions for kids with severe cases of asthma can vary by a factor of 10.

The famous Rand studies showed that even though patients with chronic conditions spend over 75% of the health care dollars in America, the American health care infrastructure gets care right for chronic-care patients barely half the time.

Diabetics, alone, consume roughly 32% of the total cost of Medicare, and the American health care infrastructure gets diabetic care consistently right about 8% of the time.

Roughly 2% of the patients admitted to California hospitals have sepsis or get sepsis while hospitalized. For California seniors who die in hospitals, sepsis causes 23% of the deaths. It's the number-one cause of death in California hospitals for patients of all ages. Many other states face similar sepsis death rates, and there is no organized program anywhere in America to bring the number of those deaths down.

No one who looks carefully at the available data on either safety or outcomes will say that American health care is doing the job we need it to do.

Asthma is the fastest-growing condition for kids in America. Asthma is the largest single care expense for young kids. Asthma is the number one cause of death for kids.

The American infrastructure of care gets care right for asthma barely 46 percent of the time.

So what should be done?

We should stop simply hoping that care will get better. We should stop passively and very ineffectively wishing that kids with asthma, or adults with congestive heart failure or diabetes were somehow getting better and more consistent care.

We need to address the issues of care improvement in America with a combination of courage, data and competence.

It can be done. "Health Care Will Not Reform Itself" tells how it can be done. We need to face the facts, understand the shortcomings, and count the heads of people needing various kinds of health care in America to see where we can add the most value in care improvement. And then we need to do what needs to be done to make care better for those patients.

We need to stop doing magical thinking -- hoping that a new tool or a new study will somehow point the way to better care -- and we need to stop hoping that caregivers will somehow notice the new tool or approach and decide for one reason or another to use it.

Wishful thinking and random attempts at care improvement have both obviously been inadequate strategies. We need to recognize the fact that barely 46% of the kids with asthma get right care, and we need to make their care right.

We need to have the integrity to clearly articulate the major problems of American health care, and we need the capability and the commitment to fix those problems.

That is tomorrow's post.

For today, we need to recognize that we spend more money in America on health care than any other country by a factor of two or three -- and we are not getting the consistent, high-quality care we should be getting for all the money we are spending.

Let's recognize that patients deserve to know when their likelihood of five-year survival from esophageal cancer is four times higher if they pick the right care team.

Let's stop pretending that getting chronic care right barely half the time is an acceptable place for American health care to be. And let's do something about it.

We need universal coverage for all Americans, and we need that universal coverage to be set up in a way that directly improves care.

More on that topic tomorrow.

Read more at: http://www.huffingtonpost.com/george-halvorson/point-2-care-is-inconsist_b_343924.html&cp

"Deed for Lease" program

WASHINGTON — Thousands of borrowers on the verge of foreclosure will soon have the option of renting their homes from Fannie Mae, under a policy announced Thursday.

The government-controlled company, through its new "Deed for Lease" program, will allow borrowers to transfer ownership to Fannie Mae and sign a one-year lease, with month-to-month extensions after that.

The program will "eliminate some of the uncertainty of foreclosure, keeps families and tenants in their homes during a transitional period, and helps to stabilize neighborhoods and communities," Jay Ryan, a Fannie Mae vice president, said in a statement.

But the effort is likely to affect a relatively small number of homeowners. In the first half of the year, Fannie Mae took back about 1,200 properties through this process, known as a deed-in-lieu of foreclosure. That pales in comparison to the 57,000 foreclosed properties the company repossessed in the period.

While neither option is particularly attractive for the homeowner, a deed-in-lieu does less harm to the borrower's credit record.

The rental program is designed to help homeowners who don't qualify for a loan modification under the Obama administration's plan, but still want to remain in their homes. Fannie Mae is not planning to market the homes for sale during the one-year rental period.

Fannie Mae has hired an outside company, which officials declined to identify, to manage the properties.

To qualify, homeowners have to live in the home as their primary residence and prove that they can afford the market rent, which would be determined by the management company. The rent can't be more than 31 percent of their pretax income.

Fannie Mae's sibling company, Freddie Mac, launched a similar effort in March. That policy, however, requires the foreclosure to be complete and only allows month-to-month leases. A Freddie Mac spokesman declined to say how many borrowers have participated.

Read more at: http://www.huffingtonpost.com/2009/11/05/fannie-mae-deed-for-lease_n_346988.html&cp

Comment

Sounds like a good idea but if people cant afford their mortgage payments how are they going to afford rent payments?

Long-term jobless face frayed safety net

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Out of work, out of savings and out of things to sell, Carolyn Johansen is running out of options to keep her home even as her unemployment benefits run out.

"By February I will be in a tent," said Johansen, from Fredericksburg, Va. “My big concerns are finding homes for my German shepherd Anna and my cat Tigra and a free place to store a thousand hardback and paperback books.”

For millions of out-of-work job seekers like Johansen, unemployment insurance is providing an increasingly tenuous financial lifeline.

With jobless benefits expiring for a record number of workers, some 7,000 a day, Congress is inching closer to approving an extending federal unemployment insurance after the Senate overwhelmingly pushed the package forward Wednesday. The measure comes as state unemployment insurance funds are running low, and tight budgets are fraying the safety net that jobless workers without benefits rely on.

After losing her job last October, Johansen figures she’s applied for over 300 jobs, but can’t find anything, not even seasonal work for the holidays. A single mom with a master’s degree and a career as a librarian, she applied for work at Blockbuster this week but couldn’t get an interview.

Johansen said she’s burned through her IRA and 401(k) savings and sold everything she could sell, including her jewelry. She applied for food stamps, but her $297 weekly jobless benefit, which expires Dec. 31, is $12 too high to let her qualify. She sent her teenage daughter to live with her older sister in Nevada; a disabled son who lives with her is scheduled to enter a residential treatment center in March.

Nearly two months after it was introduced in the House, the benefits extension has been delayed by debate over its cost and how to pay for it. Passage also has been complicated by added provisions that would extend tax credits for businesses and first-time home buyers.

As Congress has debated, weekly checks have run out for nearly 400,000 people. Friday’s looming employment report, expected to show another roughly 200,000 workers lost their jobs in October, has increased the political pressure on both parties to pass the measure.

“I just sent in my form requesting my last unemployment check,” Jim Schmitt, 58, of Apple Valley, Calif., said in an e-mail. “I have always voted Republican, and now I'm reading the Republicans are holding up the vote to extend the benefits. I might not be voting Republican again, even though the Democrats are no better.”

Under the Senate bill, jobless benefits would be extended by 14 weeks for workers who have exhausted their benefits. Those in states with jobless rates of 8.5 percent or more would get another six weeks of benefits, for a total of 20 weeks extra.

Unemployed workers would get more jobless benefits and homebuyers and businesses would get additional tax breaks under a bill that the U.S. Senate is likely to pass on Thursday. Here are the bill's key provisions:
• UNEMPLOYMENT INSURANCE
• HOMEBUYER CREDIT
• BUSINESS TAX CREDIT
• OTHER PROVISIONS

UNEMPLOYMENT INSURANCE
* Jobless workers who have exhausted their unemployment benefits would get an additional 14 weeks of aid.
* Workers living in states where the unemployment rate is above 8.5 percent would get an additional six weeks of benefits, for a total of 20 extra weeks of benefits.
As of September, 27 states, the District of Columbia and Puerto Rico had unemployment rates above 8.5 percent. Nationwide, unemployment stands at 9.8 percent, the highest since 1983, and analysts expect it to climb to 9.9 percent when figures for October are released on Friday.
About 3.4 million people now are receiving unemployment aid, according to the Labor Department.
* Roughly 600,000 workers may have already exhausted their benefits, according to the National Employment Law Project, and 1.3 million could do so by the end of the year.
* Some workers would now be eligible for up to 79 weeks of unemployment insurance, three times the 26-week limit that was in place before the current recession.
* The additional benefits would be paid for by extending a tax on employers through June 30, 2011.

The extension would help head off financial suffering for the hundreds of thousands who face the loss of benefits by year's end. It also would help shore up a frail economy in the very early stages of a recovery from the worst contraction since the Great Depression.

For millions of households, the outlook remains bleak. Roughly 6,600 new foreclosures are filed every day, or about one every 13 seconds. As of the end of September, some 2.6 million mortgages were in some stage of foreclosure and another 1.6 million loans were 90 days late and headed there. Another 6 million families could lose their homes over the next three years, according to the Treasury Department.

The rise in homelessness is straining state and local budgets, already reeling from lower tax receipts, as they try to cope with the increased need for social services. In Fredericksburg, Va., said Johansen, local nonprofits have take up some of the slack, but they’re still stretched.

“There are 80 beds in the homeless shelter, and every night they turn people away,” she said.

Though massive government spending has given the economy a lift, any recovery will be short-lived unless it’s followed by a sustainable recovery of consumer spending, which accounts for two-thirds of economic activity.

“It’s about supporting demand,” said Mark Zandi, chief economist at Moody’s Economy.com. “If unemployed workers have no social safety net, they have to significantly ramp back their spending. And in many cases they force everyone around them to ramp down, too. They’re borrowing money from their family and friends and putting financial pressure on everyone.”

FACT FILE Stimulus Bang for the Buck

Here's the estimated one-year dollar change in GDP for each dollar spent for various types of stimulus spending.

Spending Increases
Temporary increase in food stamps $1.74
Extending unemployment insurance benefits $1.61
Increased infrastructure spending $1.57
General aid to state governments $1.41
Temporary tax cuts
Payroll tax holiday $1.29
Across-the-board tax cut $1.02
Housing tax credit $0.90
Accelerated depreciation $0.25
Permanent tax cuts
Extend alternative minimum tax patch $0.51
Make dividend, capital gains tax cuts permanent $0.37
Make Bush income tax cuts permanent $0.32
Cut in corporate tax rate $0.32

Source: Moody`s Economy.com

Aside from easing financial suffering, extending unemployment benefits is one of the most efficient ways to stimulate the economy, say some economists. Zandi estimates that, with the exception food stamps, money spent to extend unemployment insurance gets the biggest bang for the buck, roughly $1.61 in added economic activity for every dollar spent. That’s because the payments are typically spent right away unlike, say, tax cuts which may be diverted into savings.

“They’ve gone through their savings,” said James Parrott, chief economist of the Fiscal Policy Institute, a New York state think tank. “You can pretty much expect that they will take every dollar they get in extended unemployment benefits and spend that money to cover basic essentials for living.”

An extension of benefits will help some but not all unemployed workers. For one thing, even an extra 13 weeks won't be enough for some job seekers.

As of September a record 5.4 million workers had been out of a job for 27 weeks or more, more than double year-ago levels and the highest since the government began tracking the data in 1948.

Laid-off workers eye the abyss
Metro jobless rates fell in September

Those numbers don’t include 2.2 million people who are considered “marginally attached to the labor force” — up from 615,000 a year earlier. These people don’t show up in the official unemployment numbers because they didn't look for work in the 4 weeks preceding the survey.

Having that many people without a financial safety net can put a serious damper on overall consumer confidence, said Zandi.

“Nothing is more debilitating than having no financial resources,” he said. “But it’s also very psychologically scarring on everyone around that unemployed person. It’s scary to see that happen. And confidence in a recession is so important — it’s the key to spending and investment and everything else that drives the economy forward.”

Tuesday, November 3, 2009

Open Wide: Your Oral Hygiene

Is mouthwash a must?
By Dr. Rob for MSN Health & Fitness

Q: Do I need to use mouthwash to maintain good oral hygiene? If so, which types are best?

A: Mouthwash isn't a must when it comes to good oral hygiene. The key to a healthy mouth is preventing tooth decay and gum disease. This is best accomplished by brushing twice a day, flossing daily, and visiting your dentist periodically (at least every six months). That said, several types of mouthwash might help to improve your oral health by controlling or treating conditions such as bad breath, gingivitis and plaque buildup. However, the use of mouthwash does not replace brushing and flossing.

Types of mouthwash

When considering a mouthwash, think about why you need one. For example, while some freshen breath, others may help to decrease the occurrence of gingivitis. Additionally, some types are only available by prescription.


Bing Search: Oral Health
View results for: Dental Health Care Dental Problems Choosing a Dentist
In general, mouthwash (or rinses) are categorized into one or a combination of the following categories:

Cosmetic—Temporarily mask bad breath and/or rinse away food and sugary debris that combine with bacteria to form plaque. These types of products may be labeled as antiseptic mouthwashes.

Therapeutic—These are regulated by the Food and Drug Administration and may assist in the battle against the formation of plaque and gingivitis. Additionally, some contain fluoride and have the potential to strengthen teeth against the process of decay.

Common oral health concerns

Referring back to your question, I'd like to stress the importance of establishing regular health screenings with a family dentist. This is key, as many health conditions (cardiovascular problems, diabetes, immune system disorders, anemia, etc.) and medications are linked to oral health. That's why your examination will include a thorough evaluation of your gums, tongue and teeth. Conditions of concern include the following:

Plaque—A sticky substance consisting of food debris and bacteria that can form within 20 minutes after a meal. It converts sugars from our diet into acid, potentially leading to tooth decay and gum disease. It cannot be rinsed off, but can be removed by brushing and flossing.
Tartar—If plaque is not removed it will harden into tartar. This combination (plaque and tartar) can lead to other conditions such as cavities, gingivitis and tooth loss. Visit your dentist to have this removed.
Gingivitis—Inflammation of the gums that may appear as painless bleeding during or right after brushing and flossing.
Periodontitis—A process causing the destruction of the ligaments and bone supporting the teeth, potentially leading to the loss of teeth.
Discoloration of the teeth, tongue or gums.
Ulcerations or other abnormal areas affecting the tissues of your mouth.
Foul breath—May be caused by tooth decay, certain foods, tobacco, medications and medical conditions such as post-nasal drip, sinusitis, infections of the throat and gastroesophageal reflux.
Pain or inability to use certain teeth.

Treatment plans

An individualized treatment plan should be discussed with your family dentist to improve and maintain your oral health. The plan might include the following:

A recommendation to brush your teeth at least two times per day, but preferably after each meal and snack.
Instruction on the proper technique to brush your teeth (type of bristle, length of time, angle to hold the brush, how often the brush needs to be replaced, etc.)
Daily flossing and/or use of an interdental cleaner (a device that cleans between the teeth)
Regularly scheduled teeth cleaning
Follow-up for any existing mouth or dental concerns
Proper care of dental appliances, including retainers and dentures
If a mouthwash is recommended, it may be aimed toward these goals:

Reducing the amount of potentially harmful bacteria in your mouth
Masking or temporarily neutralizing bad breath
Strengthening tooth enamel to fight off decay
Relieving pain from ulcers, tissue irritation, etc.
Helping to clean areas of the mouth that may be hard to brush or floss due to braces or other dental devices
Relieving dry mouth by stimulating the production of saliva (dry mouth can contribute to tooth decay)
Preventing bacterial build-up after oral surgery (temporary use)
Using mouthwash

Needless to say, the use of mouthwash may play a role in your oral health plan. However, it's important to follow the instructions, especially since that particular product may not be appropriate for young children. (Ingesting mouthwash is a leading cause of poisoning in children; they're attracted to the often brightly colored liquid.) Additionally, the overuse or abuse (drinking) of mouthwash or rinse containing alcohol, fluoride or other ingredients may trigger side effects such as:

Dry mouth and irritated gums (especially with products containing alcohol)
Discoloration of the tongue or staining of the teeth
Sensitivity in the roots of the teeth
Change in your ability to taste food, drinks and spices
Alcohol ingestion (many products contain high concentrations)
Mouth ulcers
Dental fluorosis in children
Numbness of the mouth and tongue

Lastly, our bodies are a system. If one area is compromised, it can affect other areas of our health. Please pencil in regular visits with your family dentist and family physician. The two will work together as part of your personal health care team.

For further information, please visit the American Dental Association, the American Dental Hygienists Association, and the American Dietetic Association for tips toward better dental health.


Find More on MSN Health & Fitness:

Conquering Canker Sores
A Little Fluoride Goes a Long Way
A Bad Taste in Her Mouth
Bing Shopping: Sonicare Toothbrushes
Bing Shopping: Mouthwash
Find all articles by Dr. Rob.

Do you have a health question you'd like to ask Dr. Rob? Send e-mail to experts@microsoft.com. Please include Ask Dr. Rob in the subject line.

Each of our experts responds to one question each week and the responses are posted on Mondays on MSN Health. We regret that we cannot provide a personalized response to every submission.

Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features.

St. Petersburg Times PolitiFact

Barack Obama Campaign Promise No. 240:

ThisTougher rules against revolving door for lobbyists and former officials
"No political appointees in an Obama-Biden administration will be permitted to work on regulations or contracts directly and substantially related to their prior employer for two years. And no political appointee will be able to lobby the executive branch after leaving government service during the remainder of the administration."

Sources: Obama ethics plan

Subjects: Ethics, PolitiFact's Top Promises, Workers

Updates:
Grassley demands waivers and recusals on former lobbyists in the Obama administration
Updated: Friday, June 12th, 2009 | By Angie Drobnic Holan

It's been about three months since we gave a Promise Broken to Barack Obama's pledge to restrict former lobbyists from serving in his administration. We found that the administration has granted waivers to several former lobbyists, allowing them to serve. The administration also allows recusals, where former lobbyists simply recuse themselves from discussions concerning whatever interest it is for which they used to lobby. The recusals have not been made public, and we don't know how many have been issued. (You can read more details on our ruling by scrolling down to our update of March 17, 2009.)

We haven't seen anything to make us change our ruling. But there's been a new development: Republican Sen. Charles Grassley of Iowa recently sent a letter asking for accountability about the recusals and waivers. (Grassley is one of four senators who voted against the nomination of William Lynn as a deputy secretary for defense; Lynn was a lobbyist for the defense contractor Raytheon.)

Grassley has asked Robert Cusick, director of the U.S. Office of Government Ethics, to require the Obama administration to release all waivers and recusals as they are issued and post the documentation to the Internet. Grassley said Cusick has that authority under the Ethics in Government Act.

"The American people deserve a full accounting of all waivers and recusals to better understand who is running the government and whether the administration is adhering to its promise to be open, transparent, and accountable," Grassley wrote. "I urge you to take immediate action to make any waivers and recusals public and ask for your response to my requests no later than June 19, 2009." (You can read Grassley's letter in its entirety here.)

We'll be watching for a full accounting of waivers and recusals in the Obama administration. Meanwhile, we're sticking to our ruling: Promise Broken.

Sources:

Letter from Sen. Charles Grassley to Office of Government Ethics Director Robert Cusick , June 10, 2009


Former lobbyist in the White House? It's okay if they say it's okay.
Updated: Tuesday, March 17th, 2009 | By Angie Drobnic Holan

Of the 513 promises we're tracking, this one has become the most controversial. It is the cornerstone of President Obama's campaign theme about limiting the influence of special interests.

During the campaign, Obama said many times that lobbyists would not run his White House, and the campaign delighted in tweaking rival John McCain for the former lobbyists who worked on McCain's campaign.

Obama's ethics proposals specifically spelled out that former lobbyists would not be allowed to "work on regulations or contracts directly and substantially related to their prior employer for two years." On his first full day in office, Obama signed an executive order to that effect.

But the order has a loophole — a "waiver" clause that allows former lobbyists to serve. That waiver clause has been used at least three times, and in some cases, the administration allows former lobbyists to serve without a waiver.

After examining the administration's actions for the past two months, we have concluded that Obama has broken this promise.

The waiver process in the executive order is certainly official-looking. But the waivers are granted by the Obama administration itself, and are little more than the administration saying a former lobbyist is okay. For a candidate who pledged to conduct business out in the open, there is little transparency about when a waiver is required. Even good-government advocates we spoke with who praised Obama's overall policy found the waiver process to be unclear.

By itself, the nomination of former Raytheon lobbyist William J. Lynn to be deputy defense secretary provides sufficient evidence for us to rate this a broken promise. Lynn's waiver requires that he not participate "personally and substantially" in any matter in which Raytheon is a party for one year, which directly contradicts Obama's campaign pledge and executive order to make ex-lobbyists wait two years.

But there's more than just Lynn. The administration's handling of other former lobbyists provides further evidence that the promise has been broken:

* In some cases, the White House apparently has decided that former lobbyists don't need waivers at all. If the former lobbyists simply recuse themselves from discussions concerning whatever interest it is for which they used to lobby, then that suffices.

* Recusals appear to have even less documentation than waivers. We have yet to see a recusal "order," despite having asked the White House for them. We know there are at least two recusals; there may be more. We're not sure how recusals specifically differ from waivers because the White House has said little about the policy.

* The White House is not prompt about releasing the waivers. For two nominees who didn't require Senate approval, waivers were released weeks after they were signed and after the people took their positions. These two waivers were also substantially less detailed than the waiver issued for Lynn.

The waiver for William Lynn

What we know about Lynn's waiver we've learned not from a transparent White House, but rather thanks to the Senate confirmation process he had to undergo.

Sen. Charles Grassley, R-Iowa, raised questions about Lynn's nomination in a letter to Peter Orszag, director of the White House's Office of Management and Budget. Grassley questioned whether the nomination undermined the goal of closing the "revolving door" for lobbyists working in government.

Lynn was a Raytheon lobbyist for six years, lobbying extensively on a broad range of defense-related issues, Grassley argued. If confirmed, Lynn would be the top operations manager at the Pentagon, with final authority on a number of contract, program and budget decisions.

"I simply cannot comprehend how this particular lobbyist could be nominated to fill such a key position at DOD overseeing procurement matters, much less be granted a waiver from the ethical limitations listed in the Executive Order," Grassley wrote in a letter to the White House. (Read Grassley's full letter .)

In response, Orszag said Obama's executive order included "some of the strictest rules ever imposed on executive branch personnel" and was "roundly praised by commentators and good-government advocates as the toughest ever of its kind." Orszag said Lynn was well-qualified because he'd been undersecretary of defense (as comptroller) under President Clinton, assistant to the secretary of defense for budget, a legislative counsel for defense and arms control to Sen. Edward Kennedy and a senior fellow at the National Defense University.

Orszag also provided details about Lynn's waiver. He said Lynn will not seek permission to participate in any of six programs for which he personally lobbied. Those programs include "the DDG-1000 surface combatant, the AMRAAM air-to-air missile, the F-15 airborne radar, the Patriot Pure Fleet program, the Future Imagery Architecture, and the Multiple Kill Vehicle." (Read Orszag's full letter .)

Grassley ultimately voted against Lynn's nomination, joined by two other Republicans and Democrat Claire McCaskill, who is normally a strong Obama ally. McCaskill said during Lynn's confirmation hearing that she was concerned about the revolving door between defense contractors and the government.

Two more waivers for former lobbyists

Lynn's position required confirmation by the Senate, which appears to have given Grassley the ability to extract more details from the White House. For two other former lobbyists who are now serving in the administration — without the need for Senate approval — there is significantly less information.

On March 10, the White House released brief details on two former lobbyists who were granted waivers to serve in the executive branch. The release begins with quotations from good-government groups praising Obama's executive order and goes on to describe at length the progressive causes for which the former lobbyists worked. (Read the release in full here .)

One of the lobbyists is Jocelyn Frye, who is now director of policy and projects in the Office of the First Lady. She previously lobbied for National Partnership for Women and Families from 2001 to 2008. The organization advocates for fairness in the workplace, access to health care and "policies that help women and men meet the dual demands of work and family." Many of the laws for which Frye lobbied are things Obama has supported. In 2008, for example, she was listed as lobbyist working for the Lilly Ledbetter Fair Pay Act , the first law Obama signed into law after becoming president.

The other lobbyist is Cecilia Muñoz, now director of intergovernmental affairs in the Executive Office of the President, managing the White House’s relationships with state and local governments. She has also been designated the administration's a principal liaison to the Hispanic community. Muñoz formerly lobbied for National Council of La Raza, a Hispanic civil rights and advocacy organization, between 1998 and 2008. Records show she lobbied on issues like the State Children's Health Insurance Program (SCHIP), improving Head Start and youth intervention programs.

The waivers for Frye and Muñoz make for fast reading. Here's Muñoz's waiver in full; Frye's is substantially similar:

"After consultation with the Counsel to the President, I hereby waive the requirements of paragraph 2 and paragraph 3 of the Ethics Pledge of Ms. Cecilia Muñoz. I have determined that it is in the public interest to grant the waiver because Ms. Muñoz's knowledge and expertise are vital to the functioning of the Office of Intergovernmental Affairs. I understand that Ms. Muñoz will otherwise comply with the remainder of the pledge and with all pre-existing government ethics rules."

The order is signed by Norman Eisen, one of the White House's attorneys and its designated ethics officer, and dated Feb. 20. Yet it took two weeks after that for the waivers to be posted to the White House blog as an "ethics update." The Lynn waiver has never been posted in full as far as we could find.

The Obama administration told us that the three waivers for Lynn, Frye and Munoz are the only waivers given out of approximately 800 appointees.

Waivers vs. recusals for former lobbyists

But it turns out that not all former lobbyists need to get a waiver to work in the Obama administration. Some apparently just need "recusals," where the former lobbyist agrees to simply recuse himself or herself from discussions related to former lobbying interests. How many former lobbyists are operating under recusals? We don't know.

Information about waivers and recusals comes out piecemeal, in response to media reports from places like Politico , Jake Tapper of ABC News , The National Journal , The Hill , the Los Angeles Times and The New York Times , among others.

Here at PolitiFact, we've repeatedly asked about the recusal for Mark Patterson, the chief of staff to Treasury Secretary Tim Geithner. Public records show Patterson worked as a lobbyist for Goldman Sachs in 2008. We're not certain what steps the recusal calls for, because the White House did not provide us with a copy, though we've been assured Patterson has not received a waiver, only a recusal.

Given Goldman Sach's central role in the finance industry, we find it difficult to see how the chief of the staff to the treasury secretary could recuse himself from all discussions that affect Goldman Sachs and still perform his job.

For example, the Treasury Department has used tens of billions of taxpayer dollars to rescue insurance giant AIG. And Goldman Sachs is one of the firms that benefited from AIG's credit default swaps, which were a key factor in last fall's economic collapse. And this is just one example of how Goldman Sachs has benefited from Treasury actions to shore up the financial system.

Simon Johnson, former chief economist of the International Monetary Fund and an economics professor at MIT, told Congress recently that the influence of financial lobbyists on economic policy is particularly troubling. Johnson testified March 12 that he believes that global economic growth requires a rebalancing away from the financial sector and toward other industries such as manufacturing, retail and health care.

"But this change in the allocation of resources is greatly complicated by the increased political power of the financial lobby," Johnson said. "During the boom years, large banks and their fellow travelers accumulated ever-greater political power. This power is now being used to channel government subsidies into the now outmoded (and actually dangerous) financial structure, and in essence to prevent resources from moving out of finance into technology and manufacturing across the industrialized world."

Obama's campaign rhetoric

Some ethics experts say a policy on lobbyists needs to be flexible. They say lobbyists bring valuable expertise from outside government that can help Obama get his agenda through Congress.

"Washington is not a nice place to walk in with just a lot of bright ideas. You have to be able to get things done," said David Vance, the communication and research director of the Campaign Legal Center, a nonpartisan organization that tracks government ethics. "The mistake of the administration was to use too broad a brush in vilifying lobbyists. The school lunch lobbyist is lumped in with the Halliburton lobbyist."

The Obama administration has set a higher standard for ethics that deserves praise, said Bill Allison, senior fellow with the open government group the Sunlight Foundation. But he said the way the administration is using waivers and recusals without releasing details publicly has muddied the issue of whether the administration is keeping its pledge.

"By trying to do this, they have made it more difficult on themselves," Allison said. "That information should really be public and publicly available."

Obama's promise about lobbyists was a regular part of his stump speech. He said it on the campaign trail again and again. He used it to sharply contrast himself with John McCain, who had former lobbyists on his campaign staff. Obama's comments against lobbyists were some of the biggest applause lines of his rallies, especially as the economy was roiled in September and October 2008.

"Make no mistake: We need to end an era in Washington where accountability has been absent, oversight has been overlooked, your tax dollars have been turned over to wealthy CEOs and the well-connected corporations," Obama said at an Oct. 1 campaign stop in Wisconsin. "You need leadership you can trust to work for you, not for the special interests who have had their thumb on the scale. And together, we will tell Washington, and their lobbyists, that their days of setting the agenda are over. They have not funded my campaign. You have. They will not run my White House. You'll help me run my White House."

We previously rated this promise a Compromise while we waited to see whether Lynn was confirmed and how the Obama White House handled its waiver process. Some have said that Lynn alone caused the promise to be broken, but we felt that a transparent, timely and objective waiver process might merit a ruling of Compromise. But the concerns about waivers and recusals outlined above have convinced us that this promise is not being kept in letter or in spirit, and a Compromise rating is no longer appropriate.

Obama was very clear with his promise. He said no lobbyists would "work on regulations or contracts directly and substantially related to their prior employer for two years." No means none. Promise Broken.

Sources:

White House Web site, "Ethics Update" blog post , March 10, 2009

U.S. Office of Government Ethics, Memo on ethics waivers , Feb. 23, 2009

U.S. Office of Government Ethics, Memo on ethics pledge , Feb. 10, 2009

U.S. Senate, Confirmation William J. Lynn, III, of Virginia, to the Deputy Secretary of Defense , Feb. 11, 2009

CQ Transcripts, Senate Armed Services Committee Holds Hearing, Jan. 15, 2009

Wall Street Journal, Nominee is questioned about Pentagon's revolving door , Jan. 15, 2009

U.S. Department of the Treasury, U.S. Treasury and Federal Reserve Board Announce Participation in AIG Restructuring Plan , March 2, 2009

Peterson Institute for International Economics, U.S. Foreign Economic Policy in the Global Crisis , March 12, 2008

Center for Responsive Politics, Securities & Investment: Long-Term Contribution Trends , 1990 - 2008

Center for Responsive Politics, Top Industries Giving to Members of Congress , 2008 Cycle

U.S. House of Representatives Committee on Foreign Affairs, Subcommittee on Terrorism, Nonproliferation and Trade, Hearing on U.S. Foreign Economic Policy in the Global Crisis , March 12, 2009

Point of Order (legal blog), It depends on the meaning of the word 'specific' , Feb. 6, 2009

Los Angeles Times, Likely Justice Department nominee faces ethics hurdle , Feb. 5, 2009

The Hill, Lobbyists slipping into Obama administration , March 5, 2009

The New York Times, Friendship Born at Harvard Goes on to White House , March 9, 2009

Politico, Lobbyists ban limits Obama's options , March 13, 2009

Washington Post, White House ethics? 'Mr. No' Knows , March 13, 2009

Center for Responsive Politics, National Partnership for Women and Families lobbying report , Jocelyn Frye, 2001 - 2008

Center for Responsive Politics, National Council of La Raza , Cecelia Munoz, 1998 - 2008

Huffington Post, Obama's Anti-Lobbyist Policy Causing Unintended Harm , March 5, 2009

ABC News, Another Lobbyist Headed into Obama Administration , Jan. 27, 2009

Center for Responsive Politics, Goldman Sachs lobbying filings , 2005-2008

Center for Responsive Politics, Raytheon lobbying filings , 2002-2008

White House Press Briefing , Jan. 22, 2009

Letter from Sen. Charles Grassley to OMB Director Peter Orszag , Jan. 29, 2009

Letter from OMB Director Peter Orszag to Sen. Charles Grassley , Feb. 3, 2009


Defense, Treasury appointees have conflicts
Updated: Thursday, February 5th, 2009 | By Angie Drobnic Holan

One of the first things President Obama did after he took office was sign an executive order setting rules on lobbying and serving in his administration. It included a general ban on appointments for people who had lobbied on related issues during the prior two years. We rated it Promise Kept.

But there was also a waiver clause, and when it became apparent that the administration would use waivers to employ former lobbyists in positions where they would have broad authority, we moved the meter to Compromise.

Since then, we've gotten many e-mail from readers on this issue, and we've been monitoring the developments to see if former lobbyists have received jobs in the administration.

Some appointments appear to follow his promise.This includes former lobbyists who haven't actively lobbied in two years, such as Attorney General Eric Holder . It includes people who lobbied on issues different from what they now do, such as Agriculture Secretary Tom Vilsack , who lobbied for the National Education Association.

But there are two appointments that appear to contradict Obama's promise. Mark Patterson, it has been widely reported, has been named chief of staff for the Treasury Department. Patterson is a former vice president for the financial giant Goldman Sachs , and was registered to lobby there from 2005 to 2008. (See public filings compiled by the nonpartisan Center for Responsive Politics.) And Goldman Sachs received $10 billion in money from the TARP program and is considered a key player in the financial industry.

According to the terms of Obama's executive order, we can only surmise that Patterson is receiving a waiver of some sort. We asked the White House press office and the Treasury Department what kind of waiver Patterson received and what its terms were. We received no response. Treasury Secretary Tim Geithner appoints the chief of staff and the position is not subject to Senate approval.

We've also learned new details about nominee William J. Lynn, who has been nominated to be an undersecretary at the Defense Department, even though he used to lobby for the defense contractor Raytheon . That position requires confirmation by the Senate.

Sen. Charles Grassley, R-Iowa, raised questions about Lynn's nomination in a letter to Peter Orszag, director of the White House's Office of Management and Budget. Under the terms of the executive order Obama signed, it's Orszag's office that dispenses waivers for former lobbyists.

In a four-page letter, Grassley wrote that the Lynn nomination undermined Obama's stated goal of closing the "revolving door" for lobbyists working in government:

"Mr. Lynn was a registered Raytheon lobbyist for six years. His lobbying reports clearly indicate that he lobbied extensively on a very broad range of DOD programs and issues in both the House and Senate and at the Department of Defense. If confirmed, Mr. Lynn would become the top operations manager in the Pentagon. He would be the final approval authority on most — if not all — contract, program and budget decisions. Surely, a number of Raytheon issues would come across his desk. ... Based upon President Obama's statements made during the presidential campaign and leading up to and following the signing of the Executive Order, I simply cannot comprehend how this particular lobbyist could be nominated to fill such a key position at DOD overseeing procurement matters, much less be granted a waiver from the ethical limitations listed in the Executive Order."

Grassley concluded that more waiver information needs to be made public: "Please bring transparency and accountability to Mr. Lynn's waiver and all future waivers of the Executive Order by providing details about why waivers have been granted and the criteria used to determine them." (Read Grassley's full letter .)

We asked the White House press office whether more information on the waivers would be made public, and if we could anticipate waiver information to be included in the online database of ethics and lobbying information that Obama promised during the campaign. Again, we received no response.

Orszag did respond to Grassley's questions, however. His letter of response began by hailing Obama's executive orders as "some of the strictest rules ever imposed on executive branch personnel ... roundly praised by commentators and good government advocates as the toughest ever of its kind."

He then reviewed Lynn's particular qualifications: undersecretary of defense (comptroller) under President Clinton; assistant to the secretary of defense for budget; legislative counsel for defense and arms control to Sen. Edward Kennedy; senior fellow at the National Defense University.

Finally, Orszag enumerated details about Lynn's waiver. It requires Lynn to divest his Raytheon stock within 90 days of his appointment and outlines additional detail on particular stock programs. The waiver also requires that he not participate "personally and substantially" in any matter in which Raytheon is a party for one year, unless he receives prior authorization. It says Lynn will not seek permission to participate in any of six programs for which he personally lobbied. Those programs include "the DDG-1000 surface combatant, the AMRAAM air-to-air missile, the F-15 airborne radar, the Patriot Pure Fleet program, the Future Imagery Architecture, and the Multiple Kill Vehicle."

In conclusion, Orszag wrote, "We do not believe the ethics compliance process described above will hinder Mr. Lynn from doing his job. The process strikes a reasonable balance under the circumstances." (Read Orszag's full letter .)

As of this writing, the Senate has not yet voted on Lynn's confirmation.

When asked about Lynn on Jan. 22, White House spokesman Robert Gibbs said a waiver process is necessary and that Lynn is "somebody who obviously is superbly qualified."

We understand that the examples we've examined here are just two positions out of thousands that the president has to appoint. However, they don't seem consistent with Obama's promise. Indeed, we can't find any mention of waivers prior to Election Day.

We've received numerous e-mails from readers making reasonable arguments that we should rate this a Promise Broken, but we want to wait and see what happens with the nominees. We are leaving this one as a Compromise and will keep a close eye on what happens.

Sources:

ABC News, Another Lobbyist Headed into Obama Administration , Jan. 27, 2009

Center for Responsive Politics, Goldman Sachs lobbying filings , 2005-2008

Center for Responsive Politics, Raytheon lobbying filings , 2002-2008

White House Press Briefing , Jan. 22, 2009

Letter from Sen. Charles Grassley to OMB Director Peter Orszag , Jan. 29, 2009

Letter from OMB Director Peter Orszag to Sen. Charles Grassley , Feb. 3, 2009

Waiver for former defense lobbyist moves the needle
Updated: Friday, January 23rd, 2009 | By Angie Drobnic Holan

On his first day, President Obama signed an executive order placing restrictions on lobbyists working in the White House, as he promised to do during the campaign. We rated it Promise Kept.

But we've since learned new information that is prompting us to keep a closer eye on Promise No. 240 and move the needle to Compromise.

The executive order Obama signed includes a waiver clause. The executive order says a waiver may be granted if "the literal application of the restriction is inconsistent with the purposes of the restriction" or "it is in the public interest. ... The public interest shall include, but not be limited to, exigent circumstances relating to national security or to the economy."

And a waiver seems to be in the works already — for William J. Lynn III, the appointee to be deputy secretary of defense. Lynn was formerly a lobbyist for the giant defense contractor Raytheon.

Sen. Carl Levin, D-Mich., chairman of the Senate Armed Services Committee, said the committee needs more information before confirming Lynn.

The committee wants to know "whether a waiver will be forthcoming and what the scope of the waiver will be," said Levin in a statement on Jan. 22, 2009.

White House spokesman Robert Gibbs, when asked about Lynn on Jan. 22, said the waiver process is necessary to allow uniquely qualified people to serve. "In the case of Mr. Lynn, he's somebody who obviously is superbly qualified," Gibbs said. "His experience going back to his Pentagon jobs during the Clinton administration make him uniquely qualified to do this."

Defense Secretary Robert Gates said he asked for an exception for Lynn because "he came with the highest recommendations of a number of people that I respect a lot." Gates spoke at a Defense Department news briefing on Jan. 22, 2009.

Another former lobbyist, William Corr, was tapped to be deputy secretary at the Department of Health and Human Services. He previously lobbied for the nonprofit Campaign for Tobacco-Free Kids. Corr has not yet been confirmed, but ABC News' Jake Tapper quoted a White House official saying that Corr intends to recuse himself from tobacco policy.

Perhaps a lobbyist who worked to keep kids from smoking could work at HHS without a conflict. But the nomination of a defense industry lobbyist to work at the Defense Department? Obama said that "no political appointees in an Obama-Biden administration will be permitted to work on regulations or contracts directly and substantially related to their prior employer for two years." Lynn's appointment contradicts that.

The waiver clause states that an exception to the rule should serve the public interest, and it has to be signed by the Director of the Office of Management and Budget. That might sound like an independent party, but OMB is part of the Obama White House, so it essentially means the administration would decide on its own who merits a waiver.

Since there’s only talk of one or two waivers now, we’re going to drop the Obameter rating a notch to Compromise. But we’ll be keeping a close eye to see if Obama seeks many waivers, and we might have to revisit our rating.

Sources:

Sen. Carl Levin Web site, Levin Statement on the Nomination of William Lynn to be Deputy Secretary of Defense , Jan. 22, 2009

Center for Responsive Politics, William J. Lynn profile , accessed Jan. 23, 2009

CQ Transcripts, Defense Department news briefing, Jan. 22, 2009

Center for Responsive Politics, William Corr profile , accessed Jan. 23, 2009

ABC News' Jake Tapper, Another Obama Nominee Seems to Run Afoul of Anti-Lobbyist Campaign Rhetoric , Jan. 13, 2009


Obama signs executive order on lobbyists
Updated: Wednesday, January 21st, 2009 | By Angie Drobnic Holan

In one of his first acts as president, Barack Obama kept a campaign promise to toughen ethics rules, signing an executive order on Jan. 21, 2009.

"If you are a lobbyist entering my administration, you will not be able to work on matters you lobbied on, or in the agencies you lobbied during the previous two years," Obama said at the signing ceremony. "When you leave government, you will not be able to lobby my administration for as long as I am president. And there will be a ban on gifts by lobbyists to anyone serving in the administration as well."

The title of the order is "Executive Order on Ethics Commitments by Executive Branch Personnel." (See the full text below.)

We rate his promise to institute tougher ethics rules as Promise Kept.

Sources:

CNN, "Vowing transparency, Obama OKs ethics guidelines ," Jan. 21, 2009

The White House, Executive Order -- Ethics Commitments by Executive Branch Personnel , Jan. 21, 2009

Barack Obama Campaign Promise No. 109:

Barack Obama Campaign Promise No. 109:

Fully fund the Veterans Administration

Fully fund "the VA so it has all the resources it needs to serve the veterans who need it, when they need it."

Sources: "Fulfilling a Sacred Trust with our Veterans"

Subjects: Health Care, PolitiFact's Top Promises, Veterans

Updates:
Congress votes to put VA health programs on a two-year budget
Updated: Monday, October 12th, 2009 | By Catharine Richert

President Barack Obama made the Veterans Administration a priority on the campaign trail, and under his watch, so is Congress.

On Oct. 8, 2009, the House of Representatives voted to put the VA's health care programs on a two-year budget cycle — an effort to make sure the government gets money to the program on time. In recent years, Congress has been late in approving funds for veterans' health care.

The Senate already approved the plan as part of the Veterans Health Care Budget Reform and Transparency Act of 2009.

Under the new plan, appropriations for VA medical programs would be approved one year ahead of time. Specifically, the advance cash would be for medical services, medical support and compliance, and medical facilities.

While this money is only one part of the VA's budget, the effort signals Obama is taking steps toward fulfilling his promise of fully funding the department. We advance his pledge to In the Works.

Sources:

Congressional Quarterly, House Approves Two-Year Budgeting for VA Health Programs, by Greg Vadala, Oct. 8, 2009 (subscription only access).

The Hill, Violante: The soldier's voice on Capitol Hill, by Roxana Tiron, Oct. 5, 2009

OpenCongress.org, H.R.1016 - Veterans Health Care Budget Reform and Transparency Act of 2009, accessed Oct. 12, 2009

Comment

The VA has taken some flack over the past year about their care of Iraq returning war veterans. This should help.

Promises Kept?

Barack Obama Campaign Promise No. 56:

Require children to have health insurance coverage

"Require that all children have health care coverage. Barack Obama and Joe Biden will expand the number of options for young adults to get coverage by allowing young people up to age 25 to continue coverage through their parents' plans."

Sources: Obama health care plan

Subjects: Children, Families, Health Care, PolitiFact's Top Promises

Updates:
Require children to have health insurance coverage
Updated: Thursday, July 16th, 2009 | By Angie Drobnic Holan

After months of talking about health care reform, the U.S. House of Representatives introduced major legislation to overhaul the nation's health care system. House Democrats unveiled the 1,000-plus-page bill, called America's Affordable Health Choices Act of 2009, on July 14, and it includes most of President Barack Obama's key proposals on health reform.

One of Obama's promises was to require children to have health insurance. The House bill goes a step further, establishing an individual mandate that requires all adults and their dependents to have insurance, or pay additional tax. Obama has said he will support the mandate as long as there is a hardship clause for people truly unable to afford health insurance. It's not clear yet whether a hardship clause would exempt children. (It seems likely such children could qualify for the State Children's Health Insurance Program.)

To be sure, there's a long way to go — maybe months — before the bill becomes law. It has to pass the House and get through the Senate, where many changes could be made.

Nevertheless, the bill marks significant, measurable progress on Obama's promise, and we rate it In the Works.

Sources:

Thomas, HR 3200 , introduced July 14, 2009

U.S. House of Representatives Energy and Commerce Committee, House Democrats Introduce Bill to Provide Quality, Affordable Health Care for All Americans , July 14, 2009

U.S. House of Representatives Committee on Ways and Means, Markup of H.R. 3200, America’s Affordable Health Choices Act , July 16, 2009

Comment

Obama made this campaign promise because kids are generally the healthiest and the cheapest to insure. Also by checking them early many problems can be addressed early, before the problems have gotten out of hand. Insuring kids up to the age of 25 will give them a good head start toward healthy lifestyles and healthy living. By the time they are 25 they should be working and eligible for work insurance. Insuring all the uninsured may not be politically feasible, but insuring the kids should be doable.