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HealthWeek No. 211

ANNOUNCER: Funding for HealthWeek is provided by the Teresa and H. John Heinz III Foundation, and the Heinz Endowments.

SHARYL ATTKISSON: Today on HealthWeek... What's sprayed on your lawn may be ending up here, and here. Protecting kids from indoor pesticide hazards. Can eating your veggies help save your eyesight? He's betting it can.

TIM BRANTON: "I've become a Popeye. I eat half-a-head of spinach every day."

SHARYL ATTKISSON: New ways to prevent a leading cause of blindness. And teens talking to teens...

PSA ANNOUNCEMENT: "We know you've been targeting us. Getting us to replace the 1,000 smokers that quit every day."

SHARYL ATTKISSON: You won't believe who's footing the bill for this anti-smoking campaign.


Hello, I'm Sharyl Attkisson. Welcome to HealthWeek. What would you do if a loved one died because an HMO wouldn't cover a life saving treatment? You might think, "I'd sue!" But here's what you might not know --Under current federal law, most Americans can't sue their HMOs for damages. In our "Behind the Headlines" segment, the battle shaping up in Congress over whether Americans should have the right to sue their HMOs. HealthWeek's Marcia Brazda has details.

"Hi, Donna. I have this claim..."

MARCIA BRAZDA: Working in a hospital billing department, Carol Anderson sees lots of examples of HMOs refusing to pay for care. She even experienced it herself when she got breast cancer.

CAROL ANDERSON: After my mastectomy, I was in the middle of the reconstruction plan when I received the denials that they were not going to cover my surgery. I was told previously that they would. This was before I even joined the plan, so that angered me enough that I wanted to sue.

MARCIA BRAZDA: But she couldn't. That's because the law shields HMOs from being sued if the patient gets health insurance through an employer. The White House wants to change that, and this week President Clinton stepped up pressure to pass his "Patients Bill of Rights," which among other things would give patients the power to sue managed-care plans.

PRESIDENT CLINTON: There are only 37 working days left in this session of Congress, but that's no excuse for failing to act, and millions of Americans are looking to us for the right kind of action.

MARCIA BRAZDA: Action that many consumer groups say is long overdue.

TERRE HALL, CENTER FOR PATIENT ADVOCACY: When that HMO denies a treatment they're making your medical decisions and they should be held accountable. Doctors are accountable. Nurses are accountable. Every medical professional is accountable for their actions except an HMO.

MARCIA BRAZDA: But health insurers argue that lawyers, not patients, would be the main beneficiaries of the bill.

SHARON COHEN, HEALTH INSURANCE ASSN.. OF AMERICA: Allowing individual patients to sue their HMO is a completely wrong-headed idea. When individuals are allowed to sue and you get into these multi-million dollar awards, potentially, somebody has to pay for that. And either the employer is going to pay for it, or ultimately the consumer is going to have to pay for it.

CAROL ANDERSON: "Yes, we received a letter of denial."

MARCIA BRAZDA: But people like Carol Anderson see another cost, a human cost of keeping things as they are.

CAROL ANDERSON: You have all of these frustrating feelings that you're trying to deal with along with trying to deal with your disease. Insurance plans need to be held accountable for the decisions that they make.

SHARYL ATTKISSON: Joining us now is Julie Rovner who's covering the issue for Congress Daily. Julie, we've heard a little bit about President Clinton and the Democrats' plan. What other ideas are floating around on Capitol Hill?

JULIE ROVNER, CONGRESS DAILY: Well, now the Republicans in both the House and Senate are putting together their own proposals that would address some of the managed care issues, and some other issues as well that would try and help more people get health insurance.

SHARYL ATTKISSON: What are the differences between what the Republicans are pushing and the Democrats?

JULIE ROVNER: Well, I think the key difference is what the piece talked about, which is this issue of whether or not you should be able to sue your health plan if you have a problem. The Democrats' bills would allow you to do that and the Republicans' bills would not.

SHARYL ATTKISSON: Let's talk about some of the similarities, because if there are components to the Democrats' and the Republicans' plans, those are things, I guess we can assume one way or the other, we will get. What are they?

JULIE ROVNER: Well, that certainly seems likely. There are several areas that are really in common between the Democrats and the Republicans. They all agree, for instance, that patients should have easier access to medical specialists, that doctors should not be prohibited from talking about treatments or other doctors that aren't covered by a health plan. And that patients should be able to go to the emergency room and get it paid for if they think they're having a heart attack or some other serious condition.

SHARYL ATTKISSON: In the absence of any additional legislation right now, what should a patient do if they are having a problem getting coverage that they need or they think they deserve from an HMO or managed care?

JULIE ROVNER: Well, I think every expert agrees that the first thing you need to do is not take "no" for an answer. That insurance companies almost routinely deny care that they may ultimately pay for. So complain. Get help. Enlist the aid of your employer, your employee benefits department if you have insurance through your job. Get your doctor to help, to make phone calls, to write letters. And I think most importantly, keep records. Every time you talk to or write to your insurance company write it down, have a record. Usually if you are persistent you can get what you need.

SHARYL ATTKISSON: Sounds like good advice. Thanks so much, Julie Rovner.



BRUCE DAN, MD: I'm Doctor Bruce Dan. Watching fish swim around in an aquarium can be a pleasant way to relax, but you might not want to relax when it comes time to clean that fish tank. In a recent study in the Journal of Accident and Emergency Medicine, British doctors described the cases of five people who came to the E.R. with wart like swellings on their hands and arms. The common denominator... All the patients had recently dipped their bare hands into tropical fish tanks. And further test revealed all were infected with microbacterium marinum. A waterborne germ that enters the body through tiny cuts or scrapes. Antibiotics can clear up the infection, but prevention is far simpler. A pair of long rubber gloves or some long handled tools should be all the aquarium owner needs to keep themselves and their fish feeling ship shape. With Doctor's Corner, I'm Doctor Bruce Dan.


SHARYL ATTKISSON: Many people take their eyesight for granted, but a number of conditions can threaten it. One of the most common is called macular degeneration. It's the leading cause of blindness in people age 65 and older. There's not much you can do to change two of the major contributors, aging and genetics, but new research indicates there is something you can change that may help reduce the risk. HealthWeek's Andrew Holtz explains.

ANDREW HOLTZ: Tim Branton eats kale and broccoli, other greens and fruits, but mostly a lot of spinach!

CARTOON: Gotta eat your spinach if you wants to be strong...

TIM BRANTON: I've become a Popeye. I eat half-a-head of spinach every day as a salad.

DAVID GUYER, MD: Everything looks stable. No bleeding.

ANDREW HOLTZ: He's not trying to build battleship muscles, he's trying to save his eyes from macular degeneration, which has already destroyed his left eye's ability to read or focus on details. Macular degeneration involves damage to the macula, an area of the retina in the back of the eye responsible for sharp central images. Nine of ten cases are so-called "dry" macular degeneration, a slowly developing breakdown of the light-sensing cells. In the less common "wet" form of the disease, abnormal growth of new blood vessels and bleeding damage the macula, often leading to major vision loss. While the cause is not fully understood, some studies hint light and other environmental factors may contribute to the damage.

DAVID GUYER, MD, MANHATTAN EYE, EAR & THROAT HOSPITAL: Often it's manifested by waviness or distortion, that is, lines or sides of buildings become wavy or curvy rather than straight, or sometimes they just notice the general vision, the quality of their vision is down.

ANDREW HOLTZ: Spinach and other green leafy vegetables contain compounds called lutein and zeaxanthin. They are so-called antioxidants which help protect cells from environmental damage, and thus may help prevent macular degeneration.

JOHANNA SEDDON, MD: "This slide shows the more advanced pigmentary irregularity."

ANDREW HOLTZ: One of the most encouraging studies was led by Doctor Johanna Seddon. She found that people who ate the most antioxidant-rich greens had about a 40% lower risk of macular degeneration than those who ate the fewest of these vegetables.

JOHANNA SEDDON, MD, HARVARD MEDICAL SCHOOL: For example broccoli, spinach, peas, and some other types of vegetables, collard greens, mustard greens. And in this particular study it suggested that these vegetables might be beneficial and might be protective.

ANDREW HOLTZ: Spurred by such results, the National Institutes of Health have launched a large follow-up study of macular degeneration, diet and supplements. It'll be a couple more years before the current study has any findings as to whether antioxidant pills make any difference. Yet some companies aren't waiting for definitive results, and they already market supplements aimed at people concerned about their vision. Some products specifically promote their lutein and zeaxanthin content. And that's just fine with ophthalmologist Steven Pratt, who gives speeches on behalf of a lutein supplement manufacturer.

STEVEN PRATT, MD, SCRIPPS MEMORIAL HOSPITAL: Unfortunately, only one percent of Americans consume a green, leafy vegetable which is high in lutein and zeaxanthin on a daily basis. That leaves 99% of the population deficient. So for those reasons I recommend a supplement which contains lutein and zeaxanthin.

ANDREW HOLTZ: While lutein and zeaxanthin appear safe in low doses, some doctors still worry about patients gobbling too much of these and other antioxidant supplements.

DAVID GUYER, MD: Without any question, they should not be overdosing on them because vitamin toxicity certainly could be a major problem, and especially without us knowing there's any efficacy to these vitamins, the last thing we want to do is create a systemic side effect.

ANDREW HOLTZ: Dr. Guyer would rather people focus on more proven ways to protect their eyes.

DAVID GUYER, MD: One is the use of ultraviolet filtration in sunglasses. Also, we know cigarette smoking, without any question, is harmful for people with macular degeneration.

ANDREW HOLTZ: While researchers continue their studies, Tim Branton says he'll continue munching on plenty of spinach.


SHARYL ATTKISSON: The only approved treatment for macular degeneration is laser surgery, but that only works for the so called "wet" form. And then only for a small percentage of patients. Still there are devices that can help anyone with eyesight problems make the most of the vision they have left. Here with some suggestions are eye doctor Bruce Rosenthal and Jacques Muhr, manager of the Lighthouse Spectrum Store.

JACQUES MUHR, THE LIGHTHOUSE SPECTRUM STORE: People with low vision can come into our store and they can find many, many different types of devices that can help then in school, in the home setting, or even on the job. We have things like large print phones. We have a large print New York Times. A whole collection of large print books. We have things for the kitchen, timers that make an audible sound. We even have a large remote for the television that is just easier to see and easier to use, and you are not going to lose it. And there are certain helpful devices that can only be prescribed by a low vision specialist.

BRUCE ROSENTHAL, OD, LOW VISION SPECIALIST: This is a new way that we're testing vision. What we are trying to do is to get them back to doing what they used to do, and I do that through the use of special low vision devices. The primary ones that we are working on are reading devices. And if you looked at this from the side, it's a rather thick lens. This is actually four lenses made into one. And in effect, it's a very good optical quality lens, like a very good camera lens, because you want to get the most words in at one time. What's different about this lens, when you are reading it may focus at four inches, or two inches, or one inch... Can you pick out the top line?

PATIENT: "Oh, yes. I can go on down to the fourth line."

BRUCE ROSENTHAL, OD: This is a distance type of device that can be used if you went to the theater, or if you went to the ball game, or if you went to the museum and wanted to see a painting. And the telescope focuses from a distance of 20 feet and beyond, all the way down to a couple of feet. What I have here is a hand-held closed circuit television. This actually adapts into your own television set using it as the monitor. And one of the advantages is, I can not only blow up the letters to a very large size, and you can see as I increase I can increase the magnification, but I have white letters on a black background, which offers me much greater contrast. What's nice about this is that I can take this little unit wherever I'm traveling and plug it into a television when I get there. Most people come in and they in some ways feel depressed because they think they are going to lose all of their vision, and that's very far from the truth. So we are trying to get early referral, early awareness that people have this problem and they can be helped.

SHARYL ATTKISSON: For more information on coping with vision loss, or any other HealthWeek story, you can call our toll-free number shown at the end of the program.


Now it's time for another HealthWeek quiz. This week we ask... Where is pesticide use heaviest per acre? Is it... A)Lawns? B)Farms or C)Forests? Believe it or not, the correct answer is lawns! In fact, the typical acre of American lawn receives anywhere from three to ten pounds of pesticide each year. That's considerably more than the two-and-a-half pounds applied to an acre of farm land. Those pesticides may keep your grass looking lush, but they could also be threatening your children's health in more ways than you think. HealthWeek's Al Dale explains.

AL DALE: Elaine Cohen Hubal always makes sure six-month-old Jaren has safe toys and a safe place to play with them. But hidden on those soft toys and comfy carpet there may be a potential hazard --pesticide residues.

ELAINE COHEN HUBEL: I would be bothered if I found out there was a some huge concentrations of pesticides in my home. That would bother me.

AL DALE: Those who manufacture pesticides, and professional exterminators who use them, say they're safe when used correctly.

EXTERMINATOR: My main concern is safety. We try to minimize the usage of chemicals in open spaces.

AL DALE: But researchers say the problem isn't just from applying pesticides inside the home --It's from those used outside as well.

LINDA SHELDON, PhD, ENVIRONMENTAL PROTECTION AGENCY: The most common way they come into the house is really by people walking on the lawn, touching plants, touching home gardens, that kind of material, and then carrying it into your house.

AL DALE: And once pesticides are in your home...

ROBERT LEWIS, PhD, ENVIRONMENTAL PROTECTION AGENCY: They persist for a long period of time, perhaps years and accumulate.

AL DALE: Robert Lewis is a scientist with the Environmental Protection Agency, which has been collecting samples of pesticide residues from carpets and other surfaces inside the home And also outdoors, from lawns. The samples are then sent to the E.P.A.'s national exposure lab in North Carolina where researchers have found that common lawn and garden pesticides reached indoor levels that are up to 100 times greater than those outdoors.

ROBERT LEWIS, PhD: Looks like there might be some Diazinon as well.

AL DALE: Dr. Lewis says that happens because, inside, there is no sun and rain to break down pesticides. Researchers have found that when a pesticide is sprayed indoors it too can end up in places you don't expect or want.

NATALIE FREEMAN, PhD, ROBERT WOOD JOHNSON MED. CTR.: It will cling to toys if there are toys in the room, and if the child then plays with it, the pesticides get on their hands. If they mouth the toys, they can ingest the pesticide.

WOMAN: "They love to crawl on the floors, under the table..."

AL DALE: Natalie Freeman and her colleagues at the Robert Wood Johnson Medical Center in New Jersey are studying videotapes of children, to see how they are exposed to pesticide residues.

NATALIE FREEMAN, PhD: If a child is lying on the carpet watching television or playing with their toys, they are in much closer physical contact with this than any adult would be.

AL DALE: And that's a concern because children are especially susceptible to pesticide's effects.

NATALIE FREEMAN, PhD: You really don't want to have young children whose nervous systems are developing exposed to things that might be harmful.

AL DALE: Various studies have linked pesticides to children's health problems, including memory and behavioral deficits, leukemia and brain cancer. But not everyone agrees that exposure to these residues is harmful. John Spencer is an environmental consultant.

JOHN SPENCER, ENVIRONMENTAL CONSULTANT: Based on my experience in measuring, doing exposure assessments of pesticides in homes, the standard and approved application techniques, you don't see levels that are sufficient to cause harm in children or adults.

AL DALE: Still, Elaine is concerned about Jaren's exposure to pesticides.

ELAINE COHEN HUBEL: I am uncomfortable knowing that my neighbors use it, and there's nothing I can do about it.

AL DALE: But one thing Elaine can do inside her home is to avoid the use of pesticides.

ELAINE COHEN HUBEL: I just feel like children are more susceptible to a lot of things, but I try not to use them, especially now that I have a child.

SHARYL ATTKISSON: Here with some tips on reducing the pesticide levels in your home is Alan Cohen, an expert on controlling pests without pesticides. So, maybe you're doing the best you can in your lawn. What can you do to keep your kids from being exposed to pesticides and tracking it into your house?

ALAN COHEN, BIO-LOGICAL PEST MANAGEMENT: One important thing is to work with your neighbors and educate them about the need to go for a low pesticide or even a no pesticide policy in the neighborhood. You can work on that together. And then when the kids come in the house, make sure they remove their shoes, have inside shoes and outside shoes, or no shoes at all in the house.

SHARYL ATTKISSON: So they're not tracking it around.

ALAN COHEN: That's right.

SHARYL ATTKISSON: Going to the inside of the house, say you want to control roaches, ants, or whatever the pests may be, but not spread pesticides around where you don't want it. What do you recommend?

ALAN COHEN: This is my number one tool --caulk gun. Caulk up the holes in the house where pests can get in. Whether there are earwigs or sow bugs, whatever. You can go down in your basement where there is a foundation meeting the house, fill that in with a caulk. You can make sure your door has a good weather strip on it, and a good door strip at the bottom. You don't want to have a red carpet for the insects. You want to keep them out.

SHARYL ATTKISSON: You're sealing off the points of entry where you can.

ALAN COHEN: Seal it off. That's right.

SHARYL ATTKISSON: What's the peanut butter and jelly for?

ALAN COHEN: If they do get in, and you have a line of ants coming in, you can make your own gel that's similar to the one a pest control operator will use. By using mint apple jelly, nine parts of that and one part of boric acid. Or if they seem to be eating grease and peanut butter, protein kind of things, you can use the peanut butter and one part of the apple jelly.

SHARYL ATTKISSON: And you just put globs of this around the house?

ALAN COHEN: No, you have to put it in places where kids and pets won't reach it. You put it in, behind, in surfaces high up, in surfaces where they are not going to be able to reach it.

SHARYL ATTKISSON: And that attracts the ants and they carry the poison back.

ALAN COHEN: They carry the poison back. And it's much more effective than a spray, and that's why the industry is moving towards baits because it is more effective, it doesn't have the resistance that a spray has, and you are also attacking the queen, the reproductive unit, not just the foragers.

SHARYL ATTKISSON: What are some other effective baits that you can buy rather than make?

ALAN COHEN: You can buy the same ingredient, boric acid, in roach and ant traps. You can also by hydromethanone, which is a bait also available to pest control operators, but you can also buy it in the store.

SHARYL ATTKISSON: Suppose with all of that having been said, someone decides they really need professional extermination, how can you find the right kind of company that will not over apply pesticides?

ALAN COHEN: Well, make sure, unlike in the piece where he has that can out, make sure the first tool he takes out is, or she takes out, is a flashlight. You want to make sure that they know about scouting. They know about the principles of integrated pest management. And I.P.M. doesn't mean increased pesticide marketing. It doesn't mean you spray every month. Go away from a monthly spray schedule and get someone to solve the problem in the first place with these kinds of tools. The caulk and the sealing up your house. And then they can go for baits. They can have things like this, which are pheromone traps for roaches. They can use the gel baits. This is a granular bait for ants and cockroaches. All kinds of wonderful tools available now that weren't available a few years ago.

SHARYL ATTKISSON: Find a company that's willing not just to spray pesticides.

ALAN COHEN: Exactly. And make sure they are well educated, and licensed, too.

SHARYL ATTKISSON: Alan Cohen, thank you for the tips.

ALAN COHEN: Sure. Thank you.


NANCY SNYDERMAN, MD: Hello, I'm Doctor Nancy Snyderman with this week's healthful hint. Good news for cooks who are short on time, but long on health concerns. The government now says that some frozen fruits and vegetables can be as nutritious, even more nutritious than fresh produce. But it's more complicated than just throwing a box of cheese covered cauliflower into your shopping cart. When frozen food is allowed to freeze and re-thaw, it loses many vitamins. So next time you're in the supermarket, check those packages for signs of thawing. Vegetables like peas or corn should feel loose or break apart easily in the bag. Not feel like a solid chunk of ice. And boxes of spinach and other greens should have their weight evenly distributed, not all lumped to one side. Another tip... Think plain. Those fancy sauces not only add to your grocery bill, they can add a lot of fat and sodium to an otherwise healthy serving of veggies. Once you've made your choices, don't waste any time getting them home and into your freezer. If you set the temperature at zero they should stay fresh for up to six months. With healthful hints, I'm Doctor Nancy Snyderman.


SHARYL ATTKISSON: Over the years there have been lots of anti-smoking ads. Some more effective than others. But a new ad campaign aimed at kids in Florida is getting national attention not only because of its message, but because of who's paying for it. HealthWeek's Robert Davis gives us a sample.

PSA ANNOUNCEMENT: We know you've been targeting us. Getting us to replace the 1,000 smokers that quit every day. You know, because they died. So we thought we should meet you face-to-face.

ROBERT DAVIS, PhD: The ads are in-your-face and irreverent. They are part of the recently launched "Truth" campaign. All over Florida, billboards equate tobacco with murder. And TV commercials feature defiant teens calling and antagonizing adults who sell or promote cigarettes.

PSA ANNOUNCEMENT: Hi, this is Jared and I'm here with my friend Joshua, and we have a message for you, we just wanted to congratulate you on being such a successful tobacco advertising company. [phone disconnects] Hello?

JARED PEREZ: "We called them and tried to see if they would or could defend their positions, and what we saw is really that they can't and they won't."

ROBERT DAVIS, PhD: 17-year-old Jared Perez appears in several ads.

JARED PEREZ: We're taking a different message and we're putting it out there, one of industry manipulation, that the youth of America have been targeted for a long, long time by the tobacco industry to try and get them to smoke.

ROBERT DAVIS, PhD: Remarkably, this anti-tobacco ad campaign is being funded with tobacco money. Last year Florida settled its lawsuit with cigarette companies for $11 billion, and now the state is using $200 million of that to fund various anti-smoking measures, including the ads. What's also unusual about the campaign, is that much of the planning is done by teens, like Jared and 18-year-old Jenny Lee.

JENNY LEE: I know what my friends are thinking. My friends know what would have made them not start smoking. I think that's the most important aspect of this program.

CHUCK WOLFE, FLORIDA TOBACCO PILOT PROGRAM: If you want to reach teens you don't need adults talking to teens, you need teens talking to teens. So the concept in Florida was, we want the customer in from the very beginning. We want them developing what we're doing.

ROBERT DAVIS, PhD: That means kids like Jenny and Jared not only come up with many of the ideas, they also have final say over what's released. Their most recent approval premiered this week.

JARED PEREZ: It's the kind of thing that people will talk about, "Have you seen that Brady Bunch spot yet?"

PSA ANNOUNCEMENT: Here's a story of chain-smoking parents who smoked around their six non-smoking kids. There was asthma, bronchitis, and pneumonia. They were always sick! Second-hand smoke, second-hand smoke. That's the way they became affected by second-hand smoke.

SHARYL ATTKISSON: It's a way to make a point. That's all for this week. You can visit us throughout the week at our site on the World Wide Web. To reach the HealthWeek home page go to PBS online at the Internet address on your screen, which is Next time on HealthWeek... Doctors in the courtroom. We'll look at efforts to make sure all those medical hired guns tell the truth. We'll also show you some amazing developments in artificial skin. And take you to a summer camp that's just for grown-ups. Until then, I'm Sharyl Attkisson. Be well.

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