The death of a 13-year-old Tucson middle school student brings Arizona’s swine flu death toll to three, according to the Pima County Health Department.

Nationwide, it’s up to seven.

The most recent Arizona deaths were the Tucson teen who died Friday and a 57-year-old Pinal County woman who died earlier this week, according to the Health Department and the Associated Press.

Arizona’s confirmed cases have risen to 476, which adds to the more than 1,650 confirmed cases in the four states that border Mexico, according to the U.S. Centers for Disease Control.

Texas leads the border states with 556; California clocks in second with 553; and New Mexico has 68.

A total of 5,100 cases are confirmed nationwide.

The state with the most?

Illinois with 696, followed by Wisconsin at 616, according to a report in BizJournals.com.

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How are your protecting against swine flu?

Does anyone you know have swine flu?

A Phoenix school has been ordered closed for a week by Maricopa County health officials due to an apparent flu outbreak.

County public health director Dr. Bob England says Lowell Elementary School has been “experiencing a much higher than normal rate of absenteeism due to illness that looks like flu.”

England ordered the school closed as a precaution until May 26.

He says with swine flu and seasonal flu behaving much the same way, it’s not recommended that students already home with mild illness be tested for swine flu. So, England says it’s likely that the strain of flu will remain unknown.

Lowell Elementary School spokeswoman Sara Bresnahan said officials saw a spike of absences on Monday among the school’s 700-student population. About 20 percent of the student body called in sick.

England ordered three schools closed April 29 after students contracted swine flu. A few days later, he announced he wouldn’t order new closures unless a particular school had a widespread outbreak.

Az doc-to-patient ratio below national average

Medical student Nathaniel Rial checks on patient Rachel Trefry at the UA College of Medicine on Tuesday morning. Rial will graduate Friday.

It’s a choice fewer young doctors make.

When they recite the Hippocratic Oath on Friday, University of Arizona College of Medicine graduates Erica Lindsey and Nathaniel Rial will pursue residencies as primary care physicians. Generalists in an industry dominated by specialists, primary care doctors make hundreds of thousands of dollars less than cardiologists or neurosurgeons and work less-than-predictable hours.

Rial will remain in Tucson, beginning a three-year residency in internal medicine that will have him seeing patients at University Medical Center, Tucson Medical Center and the Southern Arizona VA Health Care System.

He spent his last week as a medical student studying for exams and working in a lab at the Arizona Cancer Center.

This summer, Lindsey will begin a three-year residency in primary care at St. Joseph’s Hospital and Medical Center in Phoenix. She spent much of the past two weeks moving into a new place.

The pair will gut out long hours, which, in the end, probably will reduce their salaries to “a little more than minimum wage,” Lindsey joked.

In recent interviews, both of the doctors-to-be said they entered primary care to fill a need.

Nearly half of the 124 students who will graduate from the UA medical school on Friday will remain in Arizona for at least the next three years, as they complete residencies at hospitals throughout the state. More than a third of the class of 2009 will go into primary care.

These are not insignificant numbers given the state’s overall shortage of doctors.

Arizona has 214 physicians per 100,000 patients, a ratio well below the national average of 250 doctors per 100,000 patients. A 2007 study by the Association of American Medical Colleges ranked Arizona 33rd out of 50 states based on that doctor-to-patient ratio.

The state’s ranking drops to 39th when the focus shifts to primary care.

In 2007, the latest data available, Arizona had 4,719 primary care physicians, a ratio of about 77 per 100,000 patients. Nationwide, the number of primary care physicians per 100,000 patients stood at 88 in 2007.

“We have more of a shortage than is found nationally,” said T. Philip Malan Jr., vice dean for academic affairs at the UA medical college. “I like it when our students go into primary care.”

As an area of practice, primary care requires physicians to do a little of everything – pediatrics, family and internal medicine, general surgery and obstetrics and gynecology.

No one can predict how many of the 43 UA medical school graduates will remain in primary care after completing their residencies.

A 2008 report by the Council on Medical Education found that 55 percent of the nation’s internal medicine residents in 2006 chose to enter a subspecialty the following year. Nearly 40 percent of pediatric residents chose to specialize as well.

A residency in primary care or internal medicine constitutes a “gateway” to specialty practices, Rial said.

He has yet to decide whether he will remain in primary care after completing his residency. Because the tuition at UA – around $18,000 a year – remains cheaper than at two-thirds of the nation’s medical schools, Rial said he has the “flexibility” to weigh his options.

“I think another way to look at why so few are going into (primary care), so many are following other pathways, is for lifestyle or quality-of-life issues,” Rial suggested.

The Council on Medical Education report found that nearly three-quarters of medical school graduates “reported that lifestyle had a strong influence on their choice” of specialty.

Mounting debt also factors heavily in medical students’ after-graduation decisions, according to the study. The average U.S. medical student had about $127,000 in debt in 2007, up 43 percent from 2000.

“You have a house in your brain by the time you’re done,” Lindsey said of the cost to complete four years of medical school.

The debt graduates must repay likely forces many of them into more lucrative specialties, she said..

“We don’t compensate (primary care doctors) well,” said Steve Nash, executive director of the Pima County Medical Society.

According to the U.S. Bureau of Labor Statistics, a family or general practitioner in Tucson can earn an average of $148,030 annually. Doctors in other specialties earn on average $52,000 more per year.

“One can live pretty well as a doctor in any specialty,” Malan said. “A student has to have a passion for primary care.”

The 43 UA graduates headed into primary care this year represent 35 percent of the graduating class.

“That’s about average for us,” Malan said.

It’s about twice the average in Pima County.

Of the 2,800 or so physicians practicing in PIma County, about 500 – 18 percent of them – focus on primary care, according to Nash. That’s about 50 primary care doctors per 100,000 patients, or 38 below the national average.

In rural or impoverished areas, like the Navajo reservation where Lindsey grew up, the average can be much worse.

“There’s a big need for primary care doctors,” Lindsey said. “It’s kind of always been the focus for me.”

Because Rial and Lindsey will remain in Arizona for their residencies, they are more likely to stay in the state afterward.

Arizona ranks 12th in the nation based on the number of its doctors who studied and completed residencies in the state, according to the Association of American Medical Colleges.

The UA medical school hopes to incrementally increase the number of doctors it trains annually, Malan said, by increasing its enrollment to 115 students per year, up from 110. “It’s all about training more physicians,” he said.

It’s long been a rule of thumb in medical circles that a doctor stays where he or she trains.

Lindsey said there’s a simple reason for that: life.

“You’re almost 30, you have a family or are thinking about starting one,” she said. “You’ve got relationships with the doctors you’ve worked with.”

Rial and his wife moved to Tucson 12 years ago.

“We’ll be here at least three more years,” he said.

Source: Association of American Medical College’s “2007 State Physician Workforce Data Book”

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BY THE NUMBERS

The University of Arizona College of Medicine will confer doctor of medicine degrees during a ceremony on Friday. The 2009 class includes:

• 124 graduates

• 66 women

• 58 men

• 17 Hispanics

• 2 Native Americans

• 61 who will remain in Arizona for their residencies

• 43 who will go into primary care

Source: University of Arizona College of Medicine

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Arizona Doctor Shortage

The University of Arizona produces about 100 medical school graduates per year, according to the Association of American Medical Colleges. Nationwide, about 16,000 graduate from medical school every year, not nearly enough to keep pace with the country’s growing population, most observers say. Compared to national averages, the shortage of doctors in Arizona is more pronounced.

Active physicians per 100,000 patients

U.S.: 250

Arizona: 214

Arizona’s national rank: 33

Active primary care physicians per 100,000 patients

U.S. 88

Arizona: 77

Arizona’s rank: 39

Percent of active physicians in each state who completed undergraduate medical education in the state

U.S. average: 29 percent

Arizona: 10 percent

Arizona’s rank: 41

Percent of active physicians in each state who completed a residency or fellowship in the state

U.S. average: 45 percent

Arizona: 25

Arizona’s rank: 38

Percent of active physicians who graduated medical school and practice in the same state

U.S. average: 39 percent

Arizona: 47 percent

Arizona’s rank: 14

Percent of active physicians who completed graduate medical education and practice in the same state

U.S. average: 47 percent

Arizona: 47 percent

Arizona’s rank: 18

Percent of active physicians who graduated from medical school, completed graduate medical education and practice in the same state

U.S. average: 66 percent

Arizona: 73 percent

Arizona’s rank: 12

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Convocations and graduation

The University of Arizona’s colleges and schools began holding convocation ceremonies Wednesday. The College of Medicine convocation for candidates for a degree in medicine, will be at 5 p.m. Friday at Centennial Hall.

The campuswide commencement ceremony is 8 a.m. Saturday at McKale Center.

The following are the remaining school and college ceremonies scheduled for this weekend.

Friday:

Eller College of Management, undergraduates, 1 p.m. at McKale Center

College of Nursing, 1 p.m. at Centennial Hall

College of Social and Behavioral Sciences, 2 p.m. at Tucson Convention Center arena

University College, 3 p.m. at Integrated Learning Center

College of Optical Sciences, 5 p.m. at Integrated Learning Center 130

Saturday:

College of Agriculture and Life Sciences, 11 a.m. at Centennial Hall

College of Architecture and Landscape Architecture, 11 a.m. at Crowder Hall

College of Medicine, physiology undergraduates, 11 a.m. at Student Union Memorial Center

College of Law, 2 p.m. at Centennial Hall

Eller College of Management, graduate students, 5 p.m. at Centennial Hall

For more information on each college convocation, visit commencement.arizona.edu/collegeconvocations

PHOENIX – A woman in Arizona suffering from a lung condition has apparently become the fourth person in the nation to die with swine flu.

The Maricopa County Health Department reported Thursday that the woman, in her late 40s, died last week of what appears to be complications of the new strain of influenza.

Laboratory tests confirmed that the woman was infected with the flu strain. Health department spokeswoman Jeanene Fowler says the federal Centers for Disease Control and Prevention is expected to add her to the official national tally on Friday.

The case would bring the number of swine flu deaths in the nation to four and put the worldwide death toll at 70, with an estimated 6,672 cases in 33 countries.

Ginger, long used as a folk remedy for soothing tummyaches, helped tame one of the most dreaded side effects of cancer treatment – nausea from chemotherapy, the first large study to test the herb for this has found.

People who started taking ginger capsules several days before a chemo infusion had fewer and less severe bouts of nausea afterward than others who were given dummy capsules, the federally funded study found.

“We were slightly beside ourselves” to see how much it helped, said study leader Julie Ryan of the University of Rochester in New York.

Results were released Thursday by the American Society of Clinical Oncology and will be presented at the group’s annual meeting later this month.

But don’t reach for the ginger ale. Many sodas and cookies contain only flavoring – not real ginger, Ryan said. Her study tested a druglike ginger root extract, and it’s not known if people could get the same benefits from ginger teas or the powdered ginger sold as a spice.

The study involved 644 patients from cancer centers around the nation who had suffered nausea in a previous round of chemotherapy. Two-thirds had breast cancer and the rest, other forms of the disease. They were placed in four groups and given one of three doses of ginger (the equivalent of one-half, 1 or 1 1/2 grams of ginger per day) or dummy capsules in addition to standard anti-sickness medicines.

Patients took the capsules for six days, beginning three days before chemo treatment. They rated their nausea symptoms on a seven-point scale.

Offer is good for a year, with restrictions

Sales of Lipitor hit $12.4 billion for Pfizer Inc. in 2008, making it the company's top-selling prescription drug.

TRENTON, N.J. – Pfizer Inc. says it will provide 70 of its most widely prescribed prescription drugs including Lipitor and Viagra for free to people who have lost their jobs and health insurance.

The world’s biggest drugmaker said Thursday it will give away the medicines for up to a year to Americans who lost jobs since Jan. 1 and have been on the Pfizer drug for three months or more.

The announcement comes amid massive job losses caused by the recession and a campaign in Washington to rein in health care costs and extend coverage. The move could earn Pfizer some goodwill in that debate after long being a target of critics of drug industry prices and sales practices.

The program also likely will help keep those patients loyal to Pfizer brands.

“Everybody knows now a neighbor, a relative who has lost their job and is losing their insurance. People are definitely hurting out there,” Dr. Jorge Puente, Pfizer’s head of pharmaceuticals outside the U.S. and Europe and a champion of the project, told The Associated Press in an exclusive interview Wednesday. “Our aim is to help people bridge this point.”

The idea for the program came just five weeks ago, at a leadership training meeting, as the workers discussed how many patients are struggling, Puente said.

He said he urged top management to approve the program, presenting a recent Associated Press article about how newly uninsured diabetics are suffering serious complications because they can no longer afford the medicines and testing supplies. Approval came quickly.

“It was my idea,” he said. “I floated it, and the reception it got was so dramatic that it very quickly became our idea.”

Colleagues suggested employees could donate to a fund to help support the effort, Puente said. He said some employees had tears in their eyes when discussing how they could help people who had lost jobs.

Officials for New York-based Pfizer said they don’t know how much the program will cost and haven’t put a cap on spending for it.

Applicants will have to sign a statement that they are suffering financial hardship and provide a “pink slip” or similar employer notice. Applications will be accepted through Dec. 31, with medication provided for up to 12 months after approval, or until the person becomes insured again.

Starting Thursday, patients can call a toll-free number, 866-706-2400, to sign up, and those whose drugs are not included in the program will be referred to other company aid programs. Starting July 1, patients can also apply through the Web site, www.PfizerHelpfulAnswers.com, which has information about the other Pfizer aid programs.

Pfizer and the rest of the drug industry are trying to have a voice in the debate over how to overhaul the U.S. health care system, partly by joining in a pledge this week to help hold down inflation of health costs.

Pfizer’s program comes at a time when many drugmakers, including Pfizer, have been raising prices on their drugs, partly to offset declines in revenue as the global recession reduces the number of prescriptions people can afford to fill.

The 70-plus drugs covered in the program include several diabetes drugs and some of Pfizer’s top money makers, from cholesterol fighter Lipitor and painkiller Celebrex to fibromyalgia treatment Lyrica and Viagra for impotence. Drugs from several other popular classes such as antibiotics, antidepressants, antifungal treatments, heart mediations, contraceptives and smoking cessation products also are included. Cheaper generic versions are available for quite a few of the drugs.

Pfizer said that from 2004 through 2008, its patient assistance programs helped 5.1 million people get 51 million Pfizer prescriptions for free or at reduced cost, with a total value of $4.8 billion.

Tucson International Airport’s Concourse P is living up to its name with a designated pet area where visiting canines can relieve themselves.

Thanks to an amendment to the Air Carrier Access Act that went into effect Wednesday, the Prickly Paws Pet Stop can be found just outside the terminal building on its east side.

Danielle McBurnett has had people compare her to the main character in the old television show “Doogie Howser, M.D.,” about a teenage doctor.

The first time she heard that comparison, however, someone had to explain to her who Doogie Howser was. The show was canceled in 1993, when she was just 1 year old.

On Wednesday, McBurnett, 17, became the youngest person ever to receive a bachelor of science degree from Arizona State University’s College of Nursing and Healthcare Innovation. She graduated summa cum laude from the program and plans to enroll in the school’s doctoral program in nursing practice in the fall.

McBurnett lives in Chandler with her parents, Ray and Lori, and three siblings. She was home-schooled, but at age 12 she started taking classes at Chandler-Gilbert Community College.

She received her associate degree (4.0 grade-point average) and high-school diploma at the age of 15 and enrolled at ASU.

She said she has never let her age stand in the way of accomplishments.

“Most people (when told her age) have just said, ‘Wow, that’s amazing.’ When I meet people, I don’t wear a big name tag that says, ‘Hi, I’m Danielle, I’m 17.’ I’ll tell some people when it’s pertinent information, but I don’t let my age dictate who I am.”

McBurnett has always carried herself in a mature fashion, said her mother, Lori McBurnett.

“She was born an adult, that’s the world she wanted to live in,” she said. “When she was very, very small, she wanted to talk with the adults and be with the adults. She didn’t want to play with toys. That was her nature.”

Danielle McBurnett has also been active in performing arts: She plays piano and has acted in a variety of plays. That training has helped boost her confidence and allowed her to project herself in a more dynamic fashion.

She said college just sharpened her focus on a goal she has held since she was 10 years old.

“I knew I wanted to be a nurse,” McBurnett said. “Now, I’m more focused on what I want to be on top of that and the next degrees I want to get. Now, I want to be a nurse practitioner. After that, I’m even considering going to law school, too.”

McBurnett said she didn’t want to become a doctor because she wanted a closer relationship with patients and the doctor’s career path didn’t offer as much flexibility.

“Nurses really get to interact with patients more than doctors, typically,” McBurnett said. “I really want that human, patient interaction. Also, I want to have the ability to do lots of things. I don’t want to be confined to just being a doctor, and I feel like I can do that better as a nurse practitioner. And I want to possibly spend more time with my own children, some day in the future, and I feel I’d be better able to do that as a pediatric-nurse practitioner.”

She wants to eventually be an advocate for children, both domestically and abroad, which is why law school may be part of her future.

She has opinions on subjects ranging from the health-care system to tort reform that may make her seem mature beyond her years, but she has also taken part in more typical activities for girls her age.

“I did go to prom,” she said with a laugh. “The home-school community has its own prom. I’ve been to a number of dances, and I feel like I participated in every high school opportunity out there.”

NEW YORK – New York City has closed three schools in response to a swine flu outbreak that has left an assistant principal in critical condition and sent hundreds of kids home with flu symptoms, in a flare-up of the virus that sent shock waves through the world last month.

Mayor Michael Bloomberg said that four students and the assistant principal have documented cases of swine flu at a Queens middle school. More than 50 students have gone home sick with flulike symptoms at the school, he said. At another middle school in Queens, 241 students were absent Thursday. Dozens more were sick at an elementary school.

The Health Department said the assistant principal from the Susan B. Anthony middle school is on a ventilator, marking the most severe illness in the city from swine flu to date. The students who have fallen ill in this latest surge of illness appear to be experiencing mild symptoms, similar to routine flu.

The assistant principal, identified by colleagues as Mitch Weiner, may have had pre-existing health problems, the mayor said. In many other swine flu cases that turned critical, patients had pre-existing conditions.

The mayor said that the sick assistant principal may have had pre-existing health problems. In many other swine flu cases that turned critical, patients had pre-existing conditions.

Bloomberg said that three schools — with more than 4,000 students altogether — would be closed for at least a week because “there are an unusually high level of flulike illnesses at those schools.”

“There are documented cases of H1N1 flu at one of them,” the mayor said, using the formal name for swine flu.

New York City’s first known cases of swine flu appeared in late April, when hundreds of teenagers at a Roman Catholic high school in Queens began falling ill following the return of several students from vacations in Mexico, where the outbreak began.

At first, the virus appeared to be moving at breakneck speed. An estimated 1,000 students, their relatives and staff at the St. Francis Preparatory School fell ill in a matter of days. A limited number of kids had confirmed cases of swine flu because the Health Department tested only a small amount of students.

City health officials became aware of the outbreak on April 24. The school closed and health officials began bracing for more illnesses throughout the city.

But the outbreak then seemed to subside. Additional sporadic cases continued to be diagnosed, but the symptoms were nearly all mild. The sick children recovered in short order. St. Francis reopened after being closed for a week.

The middle school with the confirmed cases is two miles from St. Francis.

People at the school said students started going home sick on Tuesday and Wednesday, alarming parents.

“I’m worried,” said Dino Dilchande, whose sixth-grade son goes to the school. “The city should have taken more precautions. We should have been notified earlier.”

At the Susan B. Anthony, administrators posted a sign on the door from the Health Department informing students and teachers that the school would be closed for a week. The school is in the Hollis section of Queens, a neighborhood known for producing several rappers including the group Run-DMC.

A knock on the door of an address for a Mitch Weiner in the neighborhood of the school went unanswered.

Dr. Isaac Weisfuse, a deputy commissioner of the health department, said investigators are trying to learn more about why the disease has spread erratically, moving quickly through a few schools but slowly everywhere else.

“We’re trying to answer some of those questions,” he said.

Schools are a good incubator for illness in general, he said, because space is tight and youngsters often don’t practice the best hygiene.

Across the country, most of the people getting the illness have been young. Some experts have speculated that older people might have some immunity to the virus because of genetic similarities to more common types of flu.

At the start of the flu outbreak in the United States, government health officials recommended that schools shut down for two weeks if there were students with swine flu. But when the virus turned out to be milder than initially feared, the Centers for Disease Control and Prevention dropped that advice but urged parents to keep children with flu symptoms home for a week.

So far, the virus has not proved to be more infectious or deadly than the seasonal flu.

CDC officials said schools may decide to close if there is a cluster that’s affecting attendance and staffing.

Kececioglu

Someday, genomic sequence testing will help doctors identify whether newborns will develop health problems later in life.

That may seem like science fiction now, but improved technologies and techniques are making genetic sequencing quicker and far less expensive.

Mapping the human genome the first time cost about $3 billion, said John Kececioglu, University of Arizona associate professor of computer science and BIO5 Institute member. Some operations have brought the price down to $5,000.

Kececioglu is conference chair for RECOMB2009, an international conference on computational molecular biology research that will run Sunday through Thursday in Tucson.

Genomic sequencing determines the order of key components in genetic material. Abnormalities such as mutations can mean certain diseases are likely to develop.

All biological processes are governed by the 3 billion lettered segments and their order in human DNA, he said.

“There is a goal to have a $1,000 genome test that a person can actually purchase,” Kececioglu said. “Companies are making use of this data to uncover what disease susceptibilities an individual has.”

Genomics and the environment, including such behaviors as smoking and drinking, contribute to disease, and researchers are trying to offer insights on DNA’s role in the equation, he said.

In addition to identifying the diseases a person is likely to get, markers in a sequenced genome can offer information on which drugs and therapies will best help a person prevail against a specific type of cancer or other disease, he said.

“It’s key to prevention,” Kececioglu said. “It could make health care much more efficient and effective.”

“It’s certainly becoming affordable,” he said. “You do it once in a lifetime. Your genome does not change.”

Continued decreases in price could make use of the tests more commonplace.

If the cost drops to $1,000, it could make economic sense to sequence DNA on all 4 million children born in the United States each year, said Rade Drmanac, chief scientific officer and co-founder of Complete Genomics Inc.

Drmanac will participate in a RECOMB2009 industry panel discussion on personalized genomics.

His Mountain View, Calif., company offers sequencing to research organizations and drug discovery firms for $5,000.

Sequencing efficiencies are expected to increase in the next two to three years, he said, and costs will continue to go down, opening the door for widespread use of the technology.

“The bottom line is we know that having complete and accurate genome sequencing is an absolutely necessary basis for the advance of low-cost health care,” Drmanac said. “We need to do complete genome sequencing to find the genomic basis for disease.”

Pre-diagnosis leading to targeted checkups and early detection can save lives.

Although information from sequencing can benefit health, some fear it could also be used by insurance companies to deny coverage, Kececioglu said.

“The privacy issues are very important. That information is not shared with anyone besides the patient,” he said.

RECOMB2009 will attract 275 top researchers in the computational, mathematical and biological sciences coming from 18 nations, Kececioglu said. It is not open to the public, however.

The BIO5-hosted event, he said, will offer the latest information on how computers help make sense of the huge amount of bioresearch data being produced.

MEXICO CITY – Swine flu has infected Mexico’s relations with China and other countries that have canceled airline flights and halted some trade. But its most prickly neighbor — the United States — now seems like the country’s most loyal friend.

Mexico is smarting from what it considers discriminatory actions by countries it had considered friendly, insisting the world should be grateful for its open and aggressive efforts to stem the spread of swine flu. The shutdown of public life cost Mexico $2.2 billion in the first 10 days after the epidemic was announced.

The government sent a plane to pick up 70 of its citizens quarantined in China. It rebuked Cuba, Ecuador, Argentina and Peru for banning flights to Mexico, saying they were acting “incongruously with our traditional ties of friendship.”

France tried — and failed — to win a European Union-wide ban on flights to Mexico.

Particularly insulting for Mexico: Haiti rejected a Mexican ship last week carrying 77 tons of much-needed food aid because of swine flu fears.

All of that put the U.S. response in a very favorable light. Neither the United States nor Canada banned flights or restricted trade with Mexico. The three countries are partners in the North American Free Trade Agreement.

President Obama forcefully rejected the idea of closing the border, despite arguments from conservative talk show hosts that swine flu showed immigration from Mexico was a threat.

The Obama administration cast the decision as a recognition of reality: Homeland Security Secretary Janet Napolitano said sealing the border would be extremely costly and pointless since the virus was already in the United States. Obama likened the idea to “closing the barn door after the horses are out.”

Even so, it was symbolically significant in Mexico, which protested when the U.S. began building a border fence under former President George W. Bush.

While Obama has also beefed up border security, he has pledged to renew efforts to push through immigration reforms that eluded the Bush administration, including extending a citizenship path for illegal immigrants. His emphasis on open borders during the swine flu outbreak could help set the tone.

“There was a very explicit recognition that the U.S. and Mexico cannot close their borders,” said Andrew Selee, director of the Mexico Institute at the Washington-based Wilson Center. “Maybe that tells you that Mexico is really more integrated with its neighbors to the north than the rest of Latin America.”

Mexico took note. The Foreign Relations Department held a special ceremony to thank the U.S. government both for keeping the border open and for providing aid and medical expertise.

“The way in which the border between Mexico and the United States stayed not only open but alive in the past days has been exemplary,” said Carlos Rico, Mexico’s deputy secretary for North American relations. “The open border is something that has not been recognized enough.”

Even members of the opposition leftist Democratic Revolution Party — long known for its nationalistic wariness of the United States — were impressed.

“I thought the reaction and response from the three countries — Mexico, the United States and Canada — was definitely laudable,” said Alfonso Suarez de Real, a lawmaker from the party. “It contrasted with the reaction that other countries have had.”

The experience added momentum to increasingly warming relations, coming on the heels of Obama’s April 16 visit to Mexico and his acknowledgment that Americans share the blame for violence south of border because of drug consumption and gun trafficking. Mexico, for its part, has set aside traditional sovereignty concerns in welcoming increased U.S. border security and even U.S. training for Mexico’s navy.

In contrast, relations with China have been frayed, threatening to undermine trade and investment between the two countries just as it has been picking up, said Hector Cuellar, president of the recently formed Mexico-China Chamber of Commerce.

Prominent Mexican companies have started opening operations in China in the last three years, while Mexican exports to China have jumped ninefold over the past decade to some $2 billion.

But Mexicans were angered when China banned the direct flights that leading Mexican airline Aeromexico started offering in October, and then quarantined Mexican travelers. Mexico canceled its participation at a Shanghai trade fair where it had meant to showcase its pork products — now banned in China and at least four other nations even though health experts say people can’t catch swine flu from meat.

The epidemic also set back Mexico’s efforts to improve ties with Cuba, which soured during the 2000-06 presidency of Vicente Fox, when Mexico voted at the U.N. in favor of monitoring human rights on the communist island.

Fox’s successor, Felipe Calderón, had planned a conciliatory trip to Cuba this year. That’s up in the air after Calderon said he may have to cancel because Cuba grounded flights to and from Mexico.

Mexican officials also didn’t take kindly to Fidel Castro lashing out after Cuba confirmed its first swine flu case, accusing Mexico of waiting to disclose the epidemic until after Obama visited, even though Canadian and U.S. scientists did not identify the virus in Mexican patients until a week later.

In Europe for a summit Tuesday, Foreign Relations Secretary Patricia Espinosa told Cuba’s foreign relations minister, Bruno Rodriguez, that such remarks “hurt bilateral relations.”

Deputy Health Secretary Mauricio Hernandez said Wednesday that Mexico would support a global compensation fund for countries that suffer from epidemics, and warned that the threat of trade and travel restrictions could provoke governments to hide future outbreaks.

“We were responsible, and we ended up with trade sanctions — we were discriminated against,” Hernandez said at an academic forum on swine flu. “So, the question is: What is the incentive (for countries to be open)?”

Leslie Boyer, director of the Venom Immunochemistry, Pharmacology and Emergency Response Institute, holds a tube containing a dead bark scorpion at her office at Drachman Hall, 1295 N. Martin Ave.

Dawn Bray worried she might lose a second child to a scorpion’s sting.

A bark scorpion stung her 6-year-old son Morgan last May. As the family rushed him to the hospital in Globe, a wave of fear came over Bray. Six years earlier, in May 2002, she lost her 2-year-old son Dally to a bark scorpion’s sting.

“When Morgan got bit, I was thinking that it was happening again,” Bray recalled this week. “With another son, we would have the same outcome.”

From Globe, doctors flew Morgan to Tucson for treatment. He received a dose of Anascorp, a scorpion antivenin used widely Mexico but not approved for general use by the U.S. Food and Drug Administration.

Morgan made a speedy recovery. Just hours after his treatment, the Brays ate dinner together at a McDonald’s before making the two-hour drive back to their home about 25 miles south of Globe.

Morgan’s survival means that his brother “did not die in vain,” Bray said.

After Dally’s death, the Brays met with Leslie Boyer, director of the University of Arizona’s Venom Immunochemistry, Pharmacology and Emergency Response Institute. Dally received an antivenin but died anyway, his mother said. The family wanted answers.

Of the 60 scorpion species and subspecies in the U.S., only the Arizona bark scorpion is dangerous to humans; consequently, scorpion sting deaths are exceedingly rare in the United States, with fewer than a half-dozen in the past decade. But in equatorial countries more people die of scorpion stings than venomous snake bites. More than 1,000 people a year die from scorpion stings in Mexico, according to an article in eMedicine, an online medical journal.

Two years after Dally’s death, Boyer and a team of UA researchers began studying Anascorp, a drug Mexican doctors used regularly to treat those severely affected by scorpion stings. The UA researchers published their findings in the May 14 issue of The New England Journal of Medicine.

The study focused on 15 children hospitalized for severe reactions to scorpion stings in 2004 and 2005. Eight received Anascorp, which the FDA considers an “investigational drug.” Seven received a placebo.

Symptoms of nerve poisoning disappeared in less than four hours in the children treated with the antivenin. In the placebo group, symptoms lasted for several hours. Children not treated with Anascorp required sedation and longer hospital stays, the study found.

Bark scorpion venom “goes to every nerve of the body and tells them, ‘Fire!’ ” Boyer said.

In the worst cases, the bark scorpion’s venom can cause respiratory failure.

Scorpions sting about 8,000 people in Arizona every year. In Mexico, where Anascorp is widely available, scorpions sting 250,000 people a year.

In about 200 cases a year in the U.S., usually involving children, nerve poisoning becomes severe enough to require hospitalization.

Children in Tucson can go to a hospital emergency room for treatment, Boyer said. “But what about the baby in Morenci, the toddler in Globe?”

The UA study has expanded to include 24 Arizona hospitals. About 600 patients have received Anascorp since 2004, Boyer said.

Even in rural areas, severely affected children can receive the treatment within an hour of getting stung, the doctor said.

Whether the study’s findings will lead to FDA approval remains unclear. “We’re the only state in the country where this is important,” Boyer said.

For the Brays, it was a matter of life and death.

“Dr. Boyer was our angel,” Bray said. “If she trusted it, we trusted it.”

Dr. Leslie Boyer holds a tube containing a dead bark scorpion.

Misinformation serves as placebo rather than actually curing our health care system

The Senate Finance Committee held a hearing Tuesday on overhauling the heath care system. Among those testifying was Steven Wojcik (left), vice president of public policy for National Business Group Health.

The country is about to have a very frustrating debate over health care, characterized more by misdirection than an honest discussion of the alternatives.

A good illustration was provided by the Monday confab at the White House, in which health care executives committed to reduce expenditures by $2 trillion over the next decade.

Or did they?

President Obama, in his remarks, said that they did: “They are pledging to cut the rate of growth of national health care spending by 1.5 percentage points each year – an amount that’s equal to over $2 trillion.”

The actual letter signed by the executives, however, says something importantly different:

“We will do our part to achieve your administration’s goal of decreasing by 1.5 percentage points the annual health care spending growth rate – saving $2 trillion or more.”

“Our part” is much different, and far more ambiguous, than “we will do the whole thing.”

This is best seen as collusion by the health care industry and the Obama administration to misdirect the American people.

In the first place, what health care expenditures will be over the next 10 years is unknowable. So, the “pledge” is written on water.

More importantly, the commitment was made by trade associations that don’t actually deliver health care. What happens on the ground with health care costs is unaffected by press events held by politicians and lobbyists.

Most important, what happens on the ground already provides incentives for true economies. There are serious distortions in the health care marketplace, but market share can still be gained by reducing costs and prices.

The real significance of the press event wasn’t the phony pledge of cost savings. The event signaled the political capitulation of the health care industry. They will now accept whatever role in the health care system the politicians assign them.

The more substantive event that happened that day was the release of an “options” paper for health care reform by Senate Finance Chairman Max Baucus and Ranking Member Chuck Grassley.

But, again, “options” is a misnomer. This paper doesn’t really spell out fundamentally different approaches. Instead, the choices are all a variation on a single theme: a government-managed system of private health insurance.

Existing plans would be grandfathered in. But all future health insurance would have to be purchased through a government exchange.

The government would decide the benefit options insurers could offer, and insurers would have to offer all options. Pricing would be strictly circumscribed. Medical underwriting would be prohibited.

The fight over whether there would be a “public option,” a health plan actually administered by the government, is misplaced. If government controls the benefits and pricing of private plans, politicians and bureaucrats are in charge irrespective of whether there is a formal public plan.

The political need for action is driven by the uncertainty over coverage in the American system. The gaps in coverage are hugely worrisome even for those who currently have good insurance.

This uncertainty, however, is easily eliminated at no cost to the taxpayers. There already is a national health care plan, Medicaid for the low income. Universal access could be provided simply by allowing any legal resident to buy into Medicaid at the government’s cost.

The system as a whole, however, makes no sense. Obtaining health insurance through your employer is an artifact of World War II wage and price controls.

Some Republicans want to eliminate this dependence and stimulate a market for individual health insurance. That makes more sense, but the public is unlikely to be comfortable with such a radical restructuring without a government backstop, such as the ability to buy into Medicaid.

This debate will be sad and frustrating.

And the end result will probably be neither fish nor fowl – a system that provides neither the certainty and security of a European-style national health care system, nor the choice and freedom of a vigorous individual health insurance market.

Robert Robb, an Arizona Republic columnist, writes about public policy and politics in Arizona. E-mail: robert.robb@arizonarepublic.com

ATLANTA – The percentage of births to unmarried women in the United States has been rising sharply, but it’s way behind northern European countries, a new U.S. report on births shows.

Iceland is the leader with 6 in 10 births occurring among unmarried women. About half of all births in Sweden and Norway are to unwed moms, while in the U.S., it’s about 40 percent.

France, Denmark and the United Kingdom also have higher percentages than the United States, according to the report from the U.S. Centers for Disease Control and Prevention.

The U.S. and at least 13 other industrialized nations have seen significant jumps in the proportion of unmarried births since 1980, said Stephanie Ventura of the CDC’s National Center for Health Statistics.

Rates have doubled and even tripled in these countries, according to the CDC report released Wednesday.

“Basically we’re seeing the same patterns,” Ventura said, noting the trend has accelerated in the last five years.

Experts are not certain what’s causing the trend but say there seems to be greater social acceptance of having children outside of marriage.

“The values surrounding family formation are changing and women are more independent than they used to be. And young people don’t feel they have to live under the same social rules that their parents once did,” said Carl Haub, a demographer at the Population Reference Bureau in Washington, D.C.

But there are differences in how unmarried pregnancies are viewed in different countries.

In the United States, unmarried mothers are more likely to be on their own and traditionally they are more likely to be poor and uneducated, experts said.

In northern Europe, men and women more often live together in unmarried, long-term, stable relationships, Haub said.

Because of declining birth rates in some European countries, people tend to be more focused on whether the baby is born healthy instead of whether the mother is married, Haub said.

The CDC previously has reported on the percentage of U.S. births to unmarried mothers. The new report gathers previously released information from other countries to make an international comparison.

The report shows trends from 1980 to the most recent years available – 2007 for the United States and most of the other countries, but 2006 for six nations.

Japan had the lowest percentage of unmarried births, with 2 percent in 2007, up from 1 percent in 1980.

Increases were much more dramatic in the other countries, with Italy rising from 4 percent to 21 percent, Ireland from 5 percent to 33 percent, Canada from 13 to 30 percent, and the United Kingdom from 12 percent to 44 percent.

LONDON – As swine flu cases hit 6,500 worldwide, World Health Organization officials were meeting with vaccine manufacturers and other experts in Geneva on Thursday to discuss making a vaccine to fight the virus.

The meeting focused on the major questions surrounding a possible swine flu vaccine, such as how much should be produced, how it will be distributed and who should get it.

The expert group’s recommendations will be passed to WHO Director-General Margaret Chan, who will issue advice to vaccine manufacturers and the World Health Assembly next week.

But some experts feel the main decision has already been made.

“It’s a foregone conclusion,” said David Fedson, a vaccines expert and former professor of medicine at the University of Virginia. “If we don’t invest in an H1N1 (swine flu) vaccine, then possibly we could have a reappearance of this virus in a mild, moderate, or catastrophic form and we would have absolutely nothing.”

Flu vaccine companies can only make one vaccine at a time: seasonal flu vaccine or pandemic vaccine. Production takes months and it is impossible to switch halfway through if health officials make a mistake.

Vaccine makers can make limited amounts of both seasonal flu vaccine and pandemic vaccine — though not at the same time — but they cannot make massive quantities of both because that exceeds manufacturing capacity.

Seasonal flu kills up to 500,000 people a year. At the moment, health officials aren’t sure how deadly swine flu is, and whether they will need more seasonal flu vaccine or swine flu vaccine. And if the swine flu mutates, scientists aren’t sure how effective a vaccine made now from the current strain will remain.

WHO estimates that 1 to 2 billion doses of swine flu vaccine could be produced every year, though the first batches wouldn’t be available for 4 to 6 months.

The U.S. Centers for Disease Control and Prevention is currently working on a “seed stock” to make the vaccine, which should be ready in the next couple of weeks. That will be distributed to manufacturers worldwide so they can start producing the vaccine.

WHO is also negotiating with vaccine producers to save some of their swine flu vaccine for poorer nations. Many rich nations like Britain, Canada, Denmark, France, Switzerland and the United States signed deals with vaccine makers years ago to guarantee them pandemic vaccines as soon as they’re available.

As of Thursday, at least 33 countries reported nearly 6,500 cases of swine flu worldwide, with 65 deaths. According to WHO’s pandemic alert level, the world is at phase 5 — out of a possible 6 — meaning that a global outbreak is “imminent.”

“It’s a no-brainer,” Fedson said of the decision to make swine flu vaccine. “All that’s being discussed now is the details of how to make sure you have enough seasonal flu vaccine and the logistics of making the switch to H1N1 vaccine production.”

North America has been the hardest-hit continent. The United States has reported 3,352 laboratory-confirmed cases of swine flu, including three deaths. Mexico has 2,446 cases and 60 deaths, while Canada has 389 cases with one death, according to WHO figures.

Spain and Britain have the most cases in Europe, at 100 and 71 respectively.

In Central America, Costa Rica has eight cases and one death and Panama has 29 cases.