Friday, March 24, 2006

More meth--->HIV

The current issue of MMWR (2006;55(10):273-277) includes research on the link between methamphetamine use and the risk of HIV transmission for heterosexual males. A summary of the study from CDC's e-news highlights the significance:


The California Office of AIDS funded the study, in which researchers spent two years interviewing men in low-income districts of San Francisco, Alameda, Contra Costa, San Mateo and San Joaquin counties. Of 1,000 participants, 6 percent reported meth use in the past six months, which is half the rate reported in national surveys of gay men. Anal sex with female partners was reported by 30 percent of meth-using heterosexual males, compared to 12 percent of non-users; 57 percent of meth users reported multiple partners, compared with 26 percent of non-users; and 16 percent of meth-users received money or drugs for sex, compared with 4 percent of non-users.

The data are important in the light of national reports showing increasing rates of heterosexual HIV infection in low-income communities, said Christopher Krawczyk, the study's lead author and a research scientist for the state Office of AIDS.

The study suggests that straight men in low-income neighborhoods might benefit from the type of linked meth- and HIV-prevention programs in use in the gay community.

The plague of meth is moving inexorably from west to east and has become a significant problem in Texas. According to the Texas Dept. of Public Safety,

meth lab seizures have quadrupled in recent years. The number of meth users entering treatment centers in Texas has increased from 1,800 in 2000 to 11,200 in 2004 — a six-fold increase.

We've talked about this issue before. Now I can't help adding:


Counterfeit drugs and the costly war against 'em

The World Health Organization estimates that 10 percent of medications distributed worldwide are counterfeit. Gary Coody, National Health Fraud Coordinator for the FDA, says that that number is only about 1 percent in the US. According to Arthur D. Little,
This country devotes just 1.4 percent of its GDP to pharmaceutical expenditures, which is about average among the major industrialized nations.

That 1.4 percent of GDP translated to $214.5 billion in 2004, and 1 percent of that would be $2.1 billion in counterfeit medications.

GlaxoSmithKline is participating in a pilot project to combat this type of fraud by adding tracking tags to the packaging for Trizivir. This will, of course, add to the cost of the medication, making the overall cost of meds higher for us all if this technology is more widely adopted.

The technology will allow, I'm guessing, for better tracking of inventory (a boon for pharmacies?) and may even play a role in reducing medication errors (a long shot), but I'm still a bit conflicted about the cost benefit in all of this. While I'd like to see more resources given to ending health fraud, and I deem the production and sale of counterfeit medications as a particularly heinous fraud, I am a bit concerned about the impact of the costs on down the road.

I know that's a little too cynical for my normal mode of thinking. There are, after all, human lives at risk when counterfeit medications are being used. And HIV/AIDS has been hard hit by this type of fraud; counterfeit versions of Combivir, Serostim, Epogen, Procrit, Retrovir, and, no doubt, others have been identified. My angst comes, of course, from the fact that this is just one more thing to hack away at the all too limited resources that are being given to HIV treatment in the U.S.

How to resolve it? Counterfeit drugs are a bad thing. Fighting the counterfeit drugs is a good thing. Adding the tracking technology to fight the counterfeit drugs is a good thing. Raising the cost of medications is a bad thing. Maybe the manufacturers will look at the cost of adding the new tracking technology as being offset by their savings from eliminating the counterfeits? After all, it's not like they didn't raise the cost of medications to offset their losses from counterfeits.

Red flags for confidentiality at CMS

The Government Accountability Office (GAO) has released a new report (PDF file) on cybersecurity for the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) that says the agencies do a poor job of guarding the security of its clients' online health records. An excerpt from the abstract (formatting applied):

HHS and CMS have significant weaknesses in controls designed to protect the confidentiality, integrity, and availability of their sensitive information and information systems. HHS computer networks and systems have numerous electronic access control vulnerabilities related to network management, user accounts and passwords, user rights and file permissions, and auditing and monitoring of security-related events. In addition, weaknesses exist in other types of controls designed to physically secure computer resources, conduct suitable background investigations, segregate duties appropriately, and prevent unauthorized changes to application software. All of these weaknesses increase the risk that unauthorized individuals can gain access to HHS information systems and inadvertently or deliberately disclose, modify, or destroy the sensitive data that the department relies on to deliver its vital services. A key reason for these control weaknesses is that the department has not yet fully implemented a departmentwide information security program. While HHS has laid the foundation for such a program by developing and documenting policies and procedures, the department has not yet fully implemented key elements of its information security program at all of its operating divisions. Specifically, HHS and its operating divisions have not fully implemented elements related to

  1. risk assessments,
  2. policies and procedures,
  3. security plans,
  4. security awareness and training,
  5. tests and evaluations of control effectiveness,
  6. remedial actions,
  7. incident handling, and
  8. continuity of operations plans.

Until HHS fully implements a comprehensive information security program, security controls may remain inadequate; responsibilities may be unclear, misunderstood, and improperly implemented; and controls may be inconsistently applied. Such conditions may lead to insufficient protection of sensitive or critical resources and disproportionately high expenditures for controls over low-risk resources.

USA Today puts it a little more bluntly:

Investigators for the GAO reviewed management and audit reports from 2004 and 2005 that outline security practices at 13 HHS divisions and found:

  • Anti-virus software not installed or up to date.
  • Lack of adequate control over computer passwords.
  • Employees and contractors serving without background checks.
  • Inadequate physical controls to prevent spying or theft, such as non-working surveillance cameras and unrestricted access to a data center.
Confidentiality and the lack thereof are critical factors in the lives of people with HIV/AIDS. That these major providers of essential medications and health care services could fail to carry out critical steps in maintaining confidentiality is appalling. Makes you wonder what HIPAA was all about.

Thursday, March 23, 2006

HHSC meeting with TIES, Part D, and Medicaid cost sharing reports

The Texas HHSC Council will meet tomorrow. Three key reports will be discussed:
  • Integrated Eligibility and Enrollment Update--enrollments are down; there aren't enough state employees, who have been and will be laid off because of the outsourcing of program elements, to do the work required for the transition; oopsie!
  • Medicare Rx Update--Texas has paid out about $7.2 million for Medicare prescriptions, which will be reimbursed under the waiver (which expires at the end of the month); there are still problems with covered medications to be resolved; oopsie!
  • Deficit Reduction Act Report--there's still some blood in the Texas turnip, but not as much as Congress thought (could that be because Texas Medicaid is one of the cheapest in the country?).

Could be a painful meeting for compassionate conservatives. For the Texas HIV/AIDS community, the pain has been there for a while.

The roots of health fraud

I'm just back from another "road" trip, although this one included a bumpy ride via a Southwestern bird (I thanked the pilot for landing us), and several interesting conversations in taxicabs. I was meeting with some folks to talk about health fraud, which you know is a concern here at Texas AIDS Network. While the ostensible purpose of the meeting was to plan a conference for FDA-sponsored health fraud task forces to be held later in the year, a recurring issue in the general discussion related to the roots of health fraud, or, more specifically, why does America provide such fertile soil for health fraud?

The discussion took two not entirely opposing points of view: that there is something in human nature that allows openness to fraudulent products more or less versus the viewpoint that there are social and cultural factors that provide for that openness. No doubt these viewpoints and the issues that they reflect will be addressed more fulsomely at the conference.

In the meantime, here are some thoughts that arise from that maddenly brief discussion of the roots of health fraud.

  1. Barriers to health care become an open door for health fraud. When people are denied access to health care or that access is difficult, the need to deal with their health problems still remains. They will look for alternatives to which they can have easy or affordable access, and many of these alternatives may be fraudulent. We have discussed barriers to care elsewhere. These same barriers provide, I think, social and cultural factors that promote health fraud.
  2. Social demography promotes, or at least predicts, health fraud. As we look at those who are most often the victims of fraud, no matter whether it is health fraud or some other kind of scam, the pattern seems to show that some demographic groups have some predictable vulnerabilities to fraud. Age, for example, may predict vulnerability to health fraud. The elderly are usually retired, available during business hours to telemarketers who may target them for various scams. The elderly may often be isolated from social contacts and look to scam promoters as a source for social relationships, making them vulnerable to exploitation. Similarly, the young, for very different reasons, have vulnerabilities because of their lack of experience and knowledge and their special susceptibility to peer pressure.
  3. Beliefs and belief systems promote health fraud. Where disease comes from is defined by our belief system, which may tell us that bacteria and viruses are culprits. Our belief system may just as easily attribute disease to supernatural causes ("evil spirits," "God's will," "broken tabus"). Similarly, specific cultural beliefs that value such things as antiquity may lead us to think that something that is "ancient" has special significance or value. Such beliefs open the door to snake oil and quackery.

This is a matter that intrigues me. Its importance for the Texas HIV/AIDS community lies in the fact that AIDS health fraud is big business everywhere, including Texas. We have several ethnic communities with vulnerabilities to health fraud because of their belief systems. We have several small businesspersons actively promoting products that are harmful to persons with HIV/AIDS. We clearly have numerous barriers to health care, including access to HIV/AIDS medications, in Texas. No doubt you'll be reading more on the subject in the days ahead.

Center for Public Policy Priorities

On the previous story, I was searching for something on the Center for Public Policy Priorities' web site that was, I thought, prepared by that organization and relevant to the discussion of access problems during the transition for Medicare Part D. Couldn't find it. But the act of searching does give me an opportunity to highlight CPPP's redesigned web site (very spiffy) and the access that it provides to all of the good work that they are doing. While HIV/AIDS is not so much on their radar, poverty and family issues are. So is the work that Anne Dunkelberg, in particular, does on access to medications. While she is often looking at access from a different perspective, she is looking at the same systems that matter to people with HIV/AIDS. I recommend a visit to the site and a look at Anne's work if you want to see more on the nuts and bolts of health care for poor folks in Texas.

Medicare to resume paying for dual eligibles on April 1

The Texas Health and Human Services Commission has announced that the state will no longer be reimbursed by Medicare for the cost of prescriptions for dual eligible clients under Medicare Part D effective April 1.

Specifically, for dates of service after March 31, 2006, the Medicaid system will reject outpatient prescription drug claims that are eligible for coverage under Medicare Part D for dual eligible clients. Medicaid will continue to pay for certain drugs that are in the categories of drugs excluded from coverage under Medicare Part D, including benzodiazepines, barbiturates, some non-legend drugs, some vitamins and minerals, some products used in the treatment of a cough or cold and some appetite stimulants. Prescription claims for Medicare covered drugs will be denied with an error code 41 - "Medicare is Primary is Primary Payer. Medicaid is Secondary."

While this suggests that Medicare now thinks that it has the system for dual eligibles under control, April 1 (no irony intended, I'm sure, but there it is) will be another transition date that holds the potential for more snafus.

HHSC has alerted Texas pharmacies, which have been caught in the middle of the need to help their clients and the bureaucratic foul ups of the Part D transition debacle, to several scenarios that may yet present themselves with instructions on what to do:
  • What if a dual eligible beneficiary (Medicare and Medicaid) presents at the pharmacy and does not know what plan into which he or she has been auto enrolled?
  • What if a dual eligible beneficiary who has been auto enrolled presents at a pharmacy with a plan acknowledgement letter indicating that the beneficiary has switched plans?
  • What if a dual eligible beneficiary who has been auto enrolled presents at a pharmacy without a plan acknowledgement letter, but indicates that he or she has switched plans?
  • What if a beneficiary presents at a pharmacy with a Medicaid card and appears to be Medicare eligible, but the pharmacist cannot determine that the beneficiary has been auto-enrolled in any plan?
Let's hope that April Fool's Day is full of good clean fun this year and not the trainwreck that we saw on New Year's Day.

Thursday, March 16, 2006

Mediocre care

The Barre-Montpelier (VT) Times Argus reports on a study published in the most recent issue of the New England Journal of Medicine that says we are are all getting mediocre medical care. Because of the study's importance, NEJM is making the entire text available online for free, so you can click the link and read away.

The short version is basically this: while there may be striking disparities in access to health care, once someone gets into care, there are fewer disparities among various demographic groups, whether defined by gender, ethnicity, or economic level. The real disparity in this situation is between the quality of care given and the current standards of care for any given medical condition. In general, everyone, pretty much across the board, is getting substantially less than the optimal standard of care.

Why?

Health experts blame the overall poor care on an overburdened, fragmented system that fails to keep close track of patients with an increasing number of multiple conditions.

What to do?

Quality specialists said improvements can come with more public reporting of performance, more uniform training, more computerized checks and more coordination by patients themselves.

Me, I don't know the answer. However, that last phrase--more coordination by patients themselves--struck a chord. One thing that has distinguished the HIV epidemic since the beginning (as we know it) has been the role that the individual patient has played in his/her own health care. People with HIV have consistently been involved in their care, from demanding more research to demanding that their physicians participate in that research to learning the hard words that go with the hard realities of AIDS and partnering with their physicians (no matter how reluctant the physicians may have been to become partners) in making treatment decisions.

Consumer involvement in HIV care is more than something to be proud of--it's a "tradition" that has saved lives. The epidemic has changed, however. I see changes in advocacy, in provision of services, in public attitudes. Everywhere the tendency is toward complacency, and, in recent years, there's a greater sense of powerlessness.

So here's my question(s): How's that working out? Are the hard won victories of the past slipping away? Is the old model of paternalistic health care being recreated by passivity in the presence of an array of treatment options? And where does that leave us in meeting the standard of care for HIV? Just asking.

Monday, March 13, 2006

More on health savings accounts

Appropos of our earlier discussion of Medicare health savings accounts, Amy Goldstein wrote in yesterday's WaPo (sub. req.) about the current version of health savings accounts that are underwhelming the nation. The sub-head for the story says that "early reaction is two-sided," but everything that critics have said about the program seem to be being borne out:
  • These plans are more attractive to those with higher incomes;
  • People in the midst of a health crisis are not likely to be savvy shoppers for cheaper alternatives;
  • The "smart shopping" generally translates into doing without health care;
  • The plans tend to save money for people who are healthy (i.e., don't need health care).

So why is it that anyone thinks we ought to (re-)impose this policy on the elderly and disabled who are eligible for Medicare? Is it even vaguely possible that someone who qualifies for both Medicare and Medicaid, who can't afford the cost of the current Medicare co-pays and premiums, would be able to start saving for the rainy day on which they might need healthcare? By definition, the disabled who are eligible for Medicare need it--now. The elderly, well, maybe not so much--until they do.

Instead of trying to find ways to wiggle out of paying for treatment for, among others, people with HIV, how about a little more focus on prevention?

AIDSWatch 2006

AIDSWatch is an annual advocacy event, held in Washington, DC. People come from all over the country to learn about HIV/AIDS issues and meet with their congressional representatives to talk about those issues. I've attended several of these events and always found them to be energizing and inspirational. It's a chance to meet advocates from other states, share experiences, learn new techniques, make new friends.

This year's event is sponsored by the National Association of People with AIDS (NAPWA). It is scheduled for May 8-10.

Registration is free. This year there are no scholarships for travel, and hotel prices are so expensive in DC that you are being advised to stay outside of DC proper and commute via the Metro (easy even for Texans who are used to driving everywhere).

This is no hill for a stepper. Do a little fundraising locally for your housing and meal costs, see if the airlines will help you out with a ticket--but try to attend. We certainly need your voice in DC.

If all else fails, however, grab the briefing materials from the NAPWA web site and set up visits with your congressional representatives in their district offices. NAPWA suggests that you visit during the dates of AIDSWatch, but you might also note that there are "district work periods" in both April and May/June when your representatives may be personally available for meetings. And don't forget to check out this presentation on "The District Visit" for some tips.

Friday, March 10, 2006

New web host (plan)

We have upgraded our web hosting plan for Texas AIDS Net to gain more server space and bandwidth. The transition includes moving our web site from one server to another (why, I don't know) and has not been without its little glitches.

Plans for the new site include adding subdomains for various projects and, eventually, moving Texas AIDS Blog to the web site. While we make the transition, there are little things like missing sidebars and "where did that page go?" to contend with. One always hopes that these things don't show up in public, but, given my web talents, my slip will probably be showing. It won't be the first time. [sigh]

Wednesday, March 08, 2006

Mothers

In a roundabout route from Social Science & Medicine to Women's Health Weekly, the CDC prevention newsletter highlights a study that was first available online last June but only published in December. Well, better late than never, I say, especially since the article ("Pediatric Adherence: Perspectives of Mothers of Children with HIV") provides helpful insight into matters affecting adherence for children living with HIV. From the abstract:

We found that adherence practices were impacted in a positive way by mothers’ commitment to adherence, and in a negative way by feelings of stigma and guilt, by the effects of bereavement on children and by children adopting their mothers’ attitudes about medications. The interactive process of giving medication was shaped by children's behavior, mothers’ developmental expectations for children, and, for mothers with HIV, their adherence for themselves. We found that pediatric adherence often came at a cost to the caregiving mother's well-being. [emphasis added]

As happy as we often are to see our points validated by research, it's heartbreaking to see this one.

Medicare Part D: Fraud bait

Not doubt this is one of many alerts that CMS will need to issue about scams designed to take advantage of consumers as they try to negotiate the enrollment maze. While this particular scam has not yet been reported in Texas, these things tend to come in waves. Knocked down in one state, they often move on to another state to do the same thing.

No Medicare drug plan can ask a person with Medicare for bank account or other personal information over the telephone. No beneficiary should ever provide that kind of information to a caller. They should contact their local police department if they believe someone is trying to take money or information from them illegally.
. . .
In addition, legitimate Medicare drug plans will not ask for payment over the telephone or the Internet. They must bill the beneficiary for the monthly premium. Typically, that amount is set up as an automatic withdrawal from the beneficiary’s monthly Social Security check. Beneficiaries may also opt to pay the monthly premiums in other ways such as writing a check or setting up automatic payments from their checking accounts.

News snark: Medicare, federal budget

For some reason, I am buried in email from the past couple of weeks. Being away from the keyboard didn't help. That means that I am bouncing between more or less old news (March 1) and today's pile, and the process is making me a bit cranky. Perhaps that's why my reaction to today's news brief from the Kaiser Family Foundation runs thusly:

  • Senate Budget Committee Budget Proposal Thought To Drop Many of President Bush's Planned Spending and Tax Cuts AP/Houston Chronicle

Senate Budget Committee Chairman Judd Gregg, R-N.H., said Tuesday that after shepherding through a five-year, $39 billion benefit-cut bill last year, he didn't have the votes for a second round of cuts to entitlement programs like Medicare.

Ya think? Indeed, let us hope so.

  • Medicare Drug Benefit Program To Feature Fewer Plans Next Year, CMS Administrator McClellan Says AP/Long Island Newsday

"I think you'll see significantly fewer choices available next year, but they will be choices dictated by the market, by what consumers want," Mark McClellan, administrator for the Centers for Medicare and Medicaid Services, said in an interview with The Associated Press. [emphasis added]

Or by plan providers bailing out after taking losses. What consumers want is, yes, a simpler system, but it is also a system that provides all of the medications that they need at a fair price combined with minimal hassle. It speaks volumes that CMS is not going to take a leadership role in making that happen but will instead wait for "the market" to shake things out. Does that mean that the market will provide an effective program that promotes healthy outcomes for consumers (or investors)?

Well, I said I was cranky, so I may as well argue with this little tidbit as well:

McClellan also touched on issues other than the drug benefit during the hourlong interview. He said the administration is looking for ways to bring health savings accounts to the Medicare program. The Bush administration wants to expand the use of the accounts and has proposed tax breaks designed to make them more popular.

"As HSAs have become much more popular in the under-65 market, it's time to make them available in Medicare as well," McClellan said.

Erm, Mark, these were already authorized by the Balanced Budget Act of 1997. The reason they don't seem to be available right now is because nobody wants them.

Maybe another cup of coffee . . .

Tuesday, March 07, 2006

New (MedScape) format and new medications

MedScape (reg. req.) is presenting a new CME course called "Management of Treatment-Experienced Patients." This, of course, is a key issue in AIDS care today, so there is likely to be some interest in this course. What is unique (and presumably a new strategy for MedScape) is the multimedia format for this course. Not only are we provided with slides, in itself unusual for MedScape, we are also provided with the audio narrative that accompanies the slides. You can skip the audio, if you want to, since a transcript is provided, but the audio does rather give it a "you are there quality."

Format aside, the course provides some up-to-date information about treatment strategies and new medications still in the approval pipeline.

Hep C sign-on letter

The Hepatitis C Appropriations Partnership and the National Hepatitis C Advocacy Council is requesting that organizations serving people with or at risk for viral hepatitis sign on to the following letter by March 15. Consent to sign-on should be sent (with organization name and address) to lorren AT hepcchallenge.org.

=================================================

President George W. Bush
The White House
Washington, DC 20500

RE: National Hepatitis Awareness Month 2006

Dear Mr. President,

We write to you today requesting a Presidential Proclamation demonstrating your administration’s support of May 2006 as National Hepatitis Awareness Month. Our country is in the throes of a largely unrecognized epidemic with the hepatitis C virus (HCV). At least 5 million Americans have already been infected, with 75% to 85% becoming chronically infected. The number of Americans with hepatitis C now outnumbers those living with HIV/AIDS by 5-to-1.

Chronic hepatitis C is the leading indication for adult liver transplantation in the U.S., and the demand for liver transplants for this indication has increased by a least 12-fold since 1990. Similarly, chronic liver disease (the vast majority of which is caused by chronic infection with hepatitis C and/or hepatitis B) is now among the top ten causes of death for Americans age 25 years and older and is a leading cause of death for those infected with HIV.

In 2004, the Eleventh Report on Carcinogens issued by the National Institutes of Health added the hepatitis C and hepatitis B viruses to the list of known human carcinogens; these viruses increase the risk of liver cancer by more than 10-fold. The incidence of liver cancer among Americans more than doubled between 1975 and 1998. The number of new cases of liver cancer and the associated number of liver cancer deaths are expected to double again in the U.S. over the next 10 to 20 years.

The social and fiscal costs associated with chronic viral hepatitis are increasing exponentially. An actuarial study conducted in 2002 estimated total medical expenditures for people with HCV at $15 billion per year. Without immediate intervention, the hepatitis C epidemic in the U.S. is expected to result in 3.1 million years of life lost by 2019. The projected direct and indirect costs of the current HCV epidemic, if left unchecked, will be over $85 billion for the years 2010 through 2019.

Despite the staggering magnitude of the social, medical, and fiscal repercussions of chronic viral hepatitis on our citizens, many Americans are unaware of the personal and public health threats posed by chronic viral hepatitis. Unlike most viral illnesses, effective medical treatments are available to limit the long-term, devastating consequences of chronic viral hepatitis for many patients. But early diagnosis and medical management hinge upon increased public awareness.

At least 18 states have already issued or are working on proclamations recognizing May 2006 as Hepatitis Awareness Month. We respectfully request and urge you to help us educate the American public and thereby begin the process of turning the tide on chronic viral hepatitis in our country by issuing a Presidential Proclamation recognizing May 2006 as National Hepatitis Awareness Month.

Respectfully,

Your organization here!

Cultural blindness

Long years ago, many of us read The Ugly American and saw how often the blindness that the U.S. shows in its foreign ventures could often turn into something not only unintended but completely opposite from what was planned. Still catching up with my inbox for the last few days, I found a link to a news story about the need for bicycles in fighting AIDS in Africa. The story makes a simple point that strictures on how the billions being sent to Africa to fight the epidemic seem to miss the point about existing infrastructure and the capacity to use the funds as they might be used in the West. Bicycles are a means of entertainment and exercise here; in Africa, they are a means of transportation.

This cultural blindness is seen here at home, too, is it not? The politically dominant seek to end the epidemic in their own terms without regard for the realities of how prevention messages or systems of care need to be shaped to fit the "infrastructure and capacity" of the communities that need those messages or systems.

On one of my dinkarounds on the web, I ran across a couple of interesting presentations by Dr. Rose Jones, a medical anthropologist who works with the Texas Oklahoma AIDS Education and Training Center. Dr. Jones, a delightful speaker, presents some challenges in Sex, Culture & AIDS and Women, Culture & HIV/AIDS. (You'll get more out of the presentations if you download them so that you can read the speaker's notes.) Jones' work is a good starting point to begin thinking about how our cultural blindness is limiting and hindering our ability to effectively address the HIV epidemic in Texas.

Texas Primary Day

Today is Primary Election Day in Texas. If you haven't voted yet, now is the time to scoot out the door and make a difference.

Texas AIDS Network, as you know, is a charitable organization, which means that we are prohibited from participating in election campaigns. Reminding you to go vote is just about all we can do. However, we can also tell you a couple more facts about primaries and elections in Texas.

One, a large number of incumbent legislators have no opposition in the fall election or in their primary. They are, in effect, already elected to the 80th Texas Legislature. That means that, if you want to start talking to your legislator about issues that concern you, such as HIV funding or prevention, they are not distracted by re-election activities nor by the uncertainty of whether they will be around to help you when the legislative session begins.

Two, a smaller number of incumbent legislators have no opposition in the fall but do have opponents in their primary. Today's election will tell the tale for their re-election hopes. Whoever wins the primary in these races will be elected to the 80th Texas Legislature in November and should, whether incumbent or new, be open to your visit to discuss your issues.

In the other races, you have two or more candidates, many of whom are incumbents, who should be really receptive to constituent concerns. You'll have to do more talking, but they are likely to be doing more listening.

So go vote, and then start talking, why doncha?

Road trips and other delays

Sorry for the erratic posting. A grant proposal, a road trip, and some intense work on a new project got in the way of the blog. Things should be more settled now, and we can get back on track. Mea culpa.