Hospitals Pressured by Soaring Demand for Obesity
By MILT FREUDENHEIM
New York Times
Doctors and hospitals across the country are scrambling
to satisfy the booming demand for surgery that shrinks
the stomachs of severely obese people.
Dozens of hospitals are adding special operating suites
for the procedure, called bariatric surgery, which
attracted wide notice after public figures like Al
Roker of "Today" on NBC, Sharon Osbourne of "The
Osbournes" on MTV and Representative Jerrold Nadler, a
Manhattan Democrat, had it done. Some bariatric
surgeons are fully scheduled 12 months in advance, and
hundreds of doctors have jumped into the field recently
and started to advertise their availability.
Bariatric procedures -- meant for obese people who are
at extremely high risk of severe health problems, as
defined by a National Institutes of Health consensus --
surged more than 40 percent last year, to 80,000. This
year, the number is expected to climb to 120,000,
according to Frost & Sullivan, a consulting firm.
Spending on bariatrics is approaching $3 billion a
year, at an average cost of $25,000 for each procedure.
With the number of people eligible for the procedures
growing by an estimated 10 to 12 percent a year,
bariatric surgery can be profitable for hospitals --
and even more so for surgeons. But the costs are a
major concern for insurance companies and employer
health plans. Surgeons say that some insurers routinely
"The companies throw up roadblocks," said Dr. James
Rosser, a surgeon at Beth Israel Medical Center in
Manhattan. "They keep requesting more information.
Patients are left to really hound the insurance
companies to get the approvals."
Doctors and patients, meanwhile, are putting pressure
on insurers to lower the body-size threshold for paying
for the operation for people who have advanced problems
with diabetes and other weight-related diseases. That
could triple the number of people potentially eligible
for the operation to more than 30 million, a panel of
medical advisers to the national Blue Cross and Blue
Shield association was told recently.
One group having trouble winning access to treatment is
the poor, among whom obesity is an especially acute
concern. Doctors say that Medicaid programs in many
states have been reluctant to pay for the procedures.
At the University of California at Davis, for example,
Medi-Cal patients face a 12-year wait for bariatric
surgery, said Dr. Bruce M. Wolfe, a bariatric surgeon
and professor of surgery. Medi-Cal reimburses Davis for
the procedure at less than a third of the hospital's
"Basically they're not getting access to the care," he
said. "They will suffer the consequences of untreated
Most bariatric procedures produce weight loss by
restricting the intake of food. Part of the stomach is
partitioned off and the intestines are rerouted.
Afterward, many patients lose their outsize appetites.
"Patients can eat smaller amounts and feel satisfied,"
said Dr. Alan C. Wittgrove, a San Diego surgeon who is
president of the American Society for Bariatric
Surgery. But there can also be unpleasant consequences:
if they eat too much, patients may vomit.
The procedure is approved for patients at the upper end
of the body mass index, a measure of weight in relation
to height. Under National Institutes of Health
guidelines, widely followed by health plans, candidates
must first try diet and exercise regimens.
More than 10 million Americans, 4.7 percent of the
population, are eligible for the procedure, according
to the National Institute of Diabetes and Digestive and
Kidney Diseases of the National Institutes of Health.
In addition to the average cost of $25,000 for the
surgery and associated services, lifelong follow-up is
strongly recommended, adding to costs. "They need
support groups, follow-up by nurses, exercise
programs," Dr. Wittgrove said. Insurance companies
often do not pay for these programs or for counseling,
Dr. Rosser added.
For some patients, overall costs can be much more, up
to $100,000, said Helen Darling, president of the
Washington Business Group on Health. Her organization,
which represents large employers, recently opened a
campaign to encourage overweight workers to slim down.
A spokesman for that campaign, Dr. Vincent Kerr,
director of health care management at the Ford Motor
Company, estimates that obese workers cost employers
$12 billion annually in medical bills, reduced
productivity, increased absenteeism and higher
Heatwave Kills 12,000
By Kim Housego
Sunday 24 August 2003
Europe's relentless heatwave has officially killed 2000 people in countries outside France but in
France, the record temperatures are thought to have killed about 10,000 people, officials say.
Italy, which previously refused to release figures, has now agreed to investigate its toll, bowing to a
public outcry over increased deaths.
The Associated Press compiled death tolls and estimates in 18 countries. The highest official
estimates come from Portugal, with 1300 deaths, and the Netherlands, with 500 to 1000.
In Italy, city authorities reported unusually large numbers of deaths in August compared with last
year. But Europe is divided over how to go about the politically sensitive task of tallying heat deaths,
with some health officials dismissive of France's10,000-victim estimate.
The French compared mortality rates this summer to last and attributed the difference to the heat.
Some believe that if the same simple method is applied in Spain and Italy, their death tolls will soar.
The Italian health ministry previously insisted it was virtually impossible to establish a clear link
between deaths and high temperatures. But yesterday it promised an investigation, under pressure
from advocacy groups shocked by media reports that said death rates rose dramatically early this
FORWARDED: A MESSAGE FROM INTERNATIONAL CONCERNED FAMILY
AND FRIENDS OF MUMIA ABU-JAMAL---URGENT: MUMIA NEEDS YOUR
It is with great concern that we report to you that Mumia
has developed a potentially serious health condition
affecting his feet, which have swollen painfully, making
him unable to walk. Mumia suspects it may be due to blood
clotting, a situation which can be very dangerous.
Health conditions are serious matters for prisoners, and
blood clotting can be fatal. Please flood the prison's
phone lines and demand that Mumia be allowed to be
examined by an outside doctor of his choice.
SCI Greene prison: (724) 852-2902
During the Day from 8:00am to 5:00pm, ask for
During the Night, 5:00pm to 8:00am ask for Captain Hall.
If gone during late night, ask for current Shift Director.
In light of Mumia's health condition, please also contact
these elected officials who are supportive of Mumia and
ask that they put pressure on SCI Greene Prison and demand
that Mumia be allowed to be examined by an outside doctor
of his choice.
Remind them that even simple health conditions can turn
serious in prison conditions, and that sickness brought
about by incarceration is one of the leading killers of
prisoners. Mumia's condition should be considered very
serious until proven otherwise. If the swelling of his
feet is indeed being caused by blood clotting, this is
potentially life threatening situation.
Senator Vincent Hughes: <firstname.lastname@example.org>
Representative Harold James: 215-462-3308
Congressman Chaka Fattah: Go to e-mail form going to
<www.house.gov/htbin/wrep_findrep> and typing in 4601
Market, Phila, PA 19143-4616 to get to email form.
Send replies to <email@example.com>
BBC Launches Public Attack on Murdoch 'Imperialism'
By Vincent Graff
Monday 25 August 2003
The controller of BBC1 launched an unprecedented attack on Rupert Murdoch yesterday, calling the
media billionaire a "capital imperialist" who wants to destabilise the corporation because he "is against
everything the BBC stands for".
Lorraine Heggessey said Mr Murdoch's continued attacks on the BBC stemmed from a dislike of the
public sector. But he did not understand that the British people "have a National Health Service, a
public education system" and trust organisations that are there for the benefit of society and not driven
Her controversial comments, in an interview with The Independent, are believed to be the first time a
senior BBC executive has publicly attacked the motives of the media tycoon. They follow an
intensification of anti-BBC rhetoric from Mr Murdoch's side.
The BBC has been alarmed by the increasingly close relationship between the Government and Mr
Murdoch's British newspapers, at a time when the BBC's relationship with New Labour is strained as
never before. The frostiness of the relationship has raised speculation that the Government will
consider abolishing the licence fee in its forthcoming review of the BBC's charter.
Ms Heggessey's remarks will cheer supporters of the corporation who fear the BBC has kept quiet for
too long in the face of attack from Mr Murdoch and his most senior employees.
Her comments come in the wake of a speech to the country's senior broadcasting executives by
Tony Ball, chief executive of British Sky Broadcasting, in which Mr Murdoch's News Corporation is the
Mr Ball told the Edinburgh International Television Festival last week that the BBC ought to be forced
to sell its most successful programmes, such as EastEnders, Casualty and Have I Got News For You
to its commercial rivals, who would screen all future episodes instead. The money raised by such
sales should then be ploughed into experimental programming, he said.
Executives at the BBC and elsewhere see the plan as a Murdoch-inspired attempt to cripple the
corporation by depriving it of its most popular shows - and the large audiences that go with them.
Mr Ball told a questioner at the festival that it "would not be such a disaster" if the BBC were
eventually to become a marginal broadcaster.
But Ms Heggessey retorted: "It wouldn't be such a disaster for Sky because he hopes that the less
successful we become, the more people will subscribe to Sky. It would be a disaster for the BBC."
Supporters of the BBC say Mr Ball's proposal, intended to influence the Government's hand as it
considers the renewal of the BBC's charter, follows relentlessly negative reports in Mr Murdoch's
British newspapers about the BBC's conduct in the David Kelly affair. The Times and The Sun, in
particular, have come under attack for what is perceived as anti-BBC bias.
"I would suspect that everybody who works for Rupert Murdoch knows what he expects of them and
they know that if they don't deliver they will be booted out," said Ms Heggessey. Newspaper readers
"know when they are being peddled a line," she added.
In his speech, Mr Ball proposed two further restrictions to be placed on the BBC, which he argued
would prevent the corporation it from straying too far into territory he regards as the sole domain of
commercial broadcasters such as his own.
The BBC should be banned from buying any foreign-made material, he said. This would prevent the
BBC from pushing up the price of American sitcoms, Hollywood movies and Australian soap operas,
the staples of many commercial channels. "I really cannot see why public money is being diverted to
those poor struggling Hollywood studios," he said.
Ms Heggessey said BBC1 did not run any overseas-originated programmes during peak time but "the
audience expects us to run movies and we do"
EPA Watchdog Rips White House on NYC Air
By John Heilprin
Saturday 23 August 2003
WASHINGTON -- At the White House's direction, the Environmental Protection Agency gave New
Yorkers misleading assurances that there was no health risk from the debris-laden air after the World
Trade Center collapse, according to an internal inquiry.
President Bush's senior environmental adviser on Friday defended the White House involvement,
saying it was justified by national security.
The White House "convinced EPA to add reassuring statements and delete cautionary ones" by
having the National Security Council control EPA communications in the wake of the Sept. 11 terror
attacks, according to a report issued late Thursday by EPA Inspector General Nikki L. Tinsley.
"When EPA made a Sept. 18 announcement that the air was 'safe' to breathe, the agency did not
have sufficient data and analyses to make the statement," the report says, adding that the EPA had
yet to adequately monitor air quality for contaminants such as PCBs, soot and dioxin.
In all, the EPA issued five press releases within 10 days of the attacks and four more by the end of
2001 reassuring the public about air quality. But it wasn't until June 2002 that the EPA determined that
air quality had returned to pre-Sept. 11 levels -- well after respiratory ailments and other problems
began to surface in hundreds of workers cleaning dusty offices and apartments.
The day after the attacks, former EPA Deputy Administrator Linda Fisher's chief of staff e-mailed
senior EPA officials to say that "all statements to the media should be cleared" first by the National
Security Council, which is Bush's main forum for discussing national security and foreign policy
matters with his senior aides and Cabinet, the inspector general's report says.
Approval from the NSC, the report says, was arranged through the White House Council on
Environmental Quality, which "influenced, through the collaboration process, the information that EPA
communicated to the public through its early press releases when it convinced EPA to add reassuring
statements and delete cautionary ones."
For example, the inspector general found, EPA was convinced to omit guidance for cleaning indoor
spaces and tips on potential health effects from airborne dust containing asbestos, lead, glass fibers
James Connaughton, chairman of the environmental council, which coordinates federal
environmental efforts, said the White House directed the EPA to add and delete information based on
how it should be released publicly. He said the EPA did "an incredible job" with the World Trade
"The White House was involved in making sure that we were getting the most accurate information
that was real, on a wide range of activities. That included the NSC -- this was a major terrorist
incident," Connaughton said.
"In the back and forth during that very intense period of time," he added, "we were making
decisions about where the information should be released, what the best way to communicate the
information was, so that people could respond responsibly and so that people had a good relative
sense of potential risk."
Andy Darrell, New York regional director of Environmental Defense, an advocacy group, said the
report is indicative of a pattern of White House interference in EPA affairs. "For EPA to do its job well,
it needs to be allowed to make decisions based on the science and the facts," he said.
Marianne L. Horinko, EPA's acting administrator, said the White House's role was mainly to help
the EPA sift through an enormous amount of information.
"We put out the best information we had, based on just the best data that we had available at the
time," said Horinko, who headed the agency's Office of Solid Waste and Emergency Response, which
oversaw the World Trade Center environmental monitoring and cleanup.
"And it was using our best professional judgment; it was not as a result of pressure from the White
House," she said. "The White House's role was basically to say, 'Look, we've got data coming in from
everywhere. What benchmarks are we going to use, how are we going to communicate this data? We
can't have this Tower of Babel on the data.'"
The EPA inspector general recommended that EPA adopt new procedures so its public statements
on health risks and environmental quality are supported by data and analysis. Other recommendations
include developing better procedures for indoor air cleanups and asbestos handling in large-scale