| Unearthing Prehistoric Tumors, and Debate Posted: 27 Dec 2010 09:00 PM PST When they excavated a Scythian burial mound in the Russian region of Tuva about 10 years ago, archaeologists literally struck gold. Crouched on the floor of a dark inner chamber were two skeletons, a man and a woman, surrounded by royal garb from 27 centuries ago: headdresses and capes adorned with gold horses, panthers and other sacred beasts. Alena Sefcakova, Slovak National Museum, Bratislava, Slovakia ANCIENT DISEASE An X-ray of vertebrae from a 50â€"to 60â€"yearâ€"old man exhumed from an early medieval cemetery in Slovakia showed damage from what paleopathologists believe was metastatic carcinoma â€" a cancer that began in the soft tissues of the body and spread to the bone. Alena Sefcakova, Slovak National Museum DIAGNOSIS Evidence of tumors in the skull of a male skeleton exhumed from an early medieval cemetery in Slovakia. Often thought of as a modern disease, cancer has always been with us. But for paleopathologists — scholars of ancient disease — the richest treasure was the abundance of tumors that had riddled almost every bone of the man’s body. The diagnosis: the oldest known case of metastasizing prostate cancer. The prostate itself had disintegrated long ago. But malignant cells from the gland had migrated according to a familiar pattern and left identifiable scars. Proteins extracted from the bone tested positive for PSA, prostate specific antigen. Often thought of as a modern disease, cancer has always been with us. Where scientists disagree is on how much it has been amplified by the sweet and bitter fruits of civilization. Over the decades archaeologists have made about 200 possible cancer sightings dating to prehistoric times. But considering the difficulties of extracting statistics from old bones, is that a little or a lot? A recent report by two Egyptologists in the journal Nature Reviews: Cancer reviewed the literature, concluding that there is “a striking rarity of malignancies” in ancient human remains. “The rarity of cancer in antiquity suggests that such factors are limited to societies that are affected by modern lifestyle issues such as tobacco use and pollution resulting from industrialization,” wrote the authors, A. Rosalie David of the University of Manchester in England and Michael R. Zimmerman of Villanova University in Pennsylvania. Also on the list would be obesity, dietary habits, sexual and reproductive practices, and other factors often altered by civilization. Across the Internet, news reports made the matter sound unequivocal: “Cancer Is a Man-Made Disease.” “Cure for Cancer: Live in Ancient Times.” But many medical experts and archaeologists were less impressed. “There is no reason to think that cancer is a new disease,” said Robert A. Weinberg, a cancer researcher at the Whitehead Institute for Biomedical Research in Cambridge, Mass., and the author of the textbook “The Biology of Cancer.” “In former times, it was less common because people were struck down in midlife by other things.” Another consideration, he said, is the revolution in medical technology: “We now diagnose many cancers — breast and prostate — that in former times would have remained undetected and been carried to the grave when the person died of other, unrelated causes.” Even with all of that taken into account, there is a fundamental problem with estimating ancient cancer rates. Two hundred suspected cases may not sound like much. But sparsity of evidence is not evidence of sparsity. Tumors can remain hidden inside bones, and those that dig their way outward can cause the bone to crumble and disappear. For all the efforts of archaeologists, only a fraction of the human bone pile has been picked, with no way to know what lies hidden below. Anne L. Grauer, president of the Paleopathology Association and an anthropologist at Loyola University of Chicago, estimates that there are roughly 100,000 skeletons in the world’s osteological collections, and a vast majority have not been X-rayed or studied with more modern techniques. According to an analysis by the Population Reference Bureau, the cumulative total of everyone who had lived and died by A.D. 1 was already approaching 50 billion, and had nearly doubled by 1750. (The analysis refutes the oft-made assertion that more people are alive today than have ever lived on earth.) If those figures hold, the number of skeletons in the archaeological database would represent barely one ten-thousandth of 1 percent of the total. Within that minuscule sample, not all of the remains are complete. “For a long time archaeologists only collected skulls,” said Heather J. H. Edgar, curator of human osteology at the Maxwell Museum of Anthropology at the University of New Mexico. “For the most part, there’s no way to know what the rest of those people’s skeletons might have said about their health.” So how are scientists to evaluate, for example, the significance of the handful of fossilized examples of osteosarcoma, a rare bone cancer that mostly affects young people? (What may be the oldest case was found in 1932 by the anthropologist Louis Leakey in a prehistoric relative of man.) Today the incidence of osteosarcoma among people younger than 20 is about five cases per million per year. “You would need to screen 10,000 individuals to find a case,” said Mel Greaves, a professor of cell biology at the Institute of Cancer Research in England, and the author of “Cancer: The Evolutionary Legacy” (Oxford, 2000). Not enough teenage remains have been scrutinized, he said, to draw a meaningful conclusion. There is a further complication: more than 99 percent of cancers originate not in bone but in softer organs, which quickly decay. Unless they spread to bone, they will most likely go unrecorded. Ancient mummies would seem to be an exception. But here, too, the pickings have been slim. Only on rare occasions can pathologists get their hands on a comparatively recent mummy like Ferrante I of Aragon, king of Naples, who died in 1494. When his body was autopsied five centuries later, adenocarcinoma, which begins in glandular tissues, was found to have spread to the muscles of his small pelvis. A molecular study revealed a typographical error in a gene that regulates cell division — a G had been flipped to A — which pointed to colorectal cancer. The cause, the authors speculated, might have been gluttonous consumption of red meat. Over the years hundreds of Egyptian and South American mummies have turned up a few other cases. A rare tumor called a rhabdomyosarcoma was found on the face of a Chilean child who lived sometime between A.D. 300 and 600. |
| The New Old Age: Who Thrives After Surgery? Posted: 28 Dec 2010 10:06 AM PST |
| Difference Is the Norm on These Dating Sites Posted: 28 Dec 2010 10:52 AM PST Sherry Nevius, single and 52, is looking for a mate with all the important adjectives — caring, sincere, intelligent, funny. Oh, and one more thing: disabled. Share your thoughts on this column at the Well blog. Go to Well » This week: A road map of the brain, dating for the disabled, and size matters for cockroaches. Born with cerebral palsy, Ms. Nevius uses a wheelchair. She is independent and mobile, but would prefer to meet a man who could roll alongside her. “That way we’re on equal ground,” she said. Ms. Nevius has dated several perfectly nice able-bodied men, but none seemed willing to start a serious relationship. “I think they were a little bit scared because they didn’t know how to treat me,” she said. She lives in Normal, Ill., a town with few single men around her age, let alone familiar and comfortable with disability. “It’s hard enough to find someone with similar interests,” she said. “Finding someone O.K. with your disability just makes it harder.” So this fall Ms. Nevius took her search online. Several dating Web sites for singles with health problems have started up in the last few years. Ms. Nevius joined Dating 4 Disabled, a site for people with an array of disabilities, including paralysis and multiple sclerosis. Other sites include NoLongerLonely, for adults with mental illness, and POZ Personals, for people who are H.I.V.-positive. These sites are generally small and run by one person or a small group. They are usually free, although some have a few ads to cover costs. Michael T. Maurer, 57, a professor of applied psychology at New York University, came upon POZ Personals while doing research for his work and found it to be a welcoming community where it was easier to get to know someone. “As a gay man from Bucks County, Pa., I thought dating would be easy in New York, but it didn’t prove to be so,” Dr. Maurer said. He said the worst part of dating was the anxiety over disclosing his H.I.V. status. Getting to know someone in an online community of people with H.I.V. allows relationships to form without the burden of the big reveal hovering overhead. “Here everyone knows you have H.I.V.,” he said, “so it gets that barrier out of the way.” Another site, Prescription4Love, has communities dedicated to sexually transmitted diseases and physical disabilities, but also to other diseases that don’t conjure images of romance and intimacy, like diabetes and Parkinson’s. The site was created by Ricky Durham, whose late brother suffered from Crohn’s disease — a condition that came with literal baggage. “He was a good-looking boy,” Mr. Durham said. “But when do you tell a girl that you have a colostomy bag? The first date? The third? There’s no good time.” Awkward issues that come with an illness can be discussed frankly and openly in an online space in which everyone is dealing with something out of the ordinary. “Sexuality, travel, mobility, pain: Everything takes on a different dimension,” said Merryl Kaplan, who is in charge of member services for Dating 4 Disabled. The anonymity of the Internet allows people to be forthcoming and honest about what they are truly looking for in a companion. Among the almost 12,000 members of Dating 4 Disabled, for example, many specify the types of disabilities they would be open to dealing with in a long-term relationship. “Like anyone else, people with disabilities have different preferences,” Ms. Kaplan said. “Someone with good mobility may prefer someone also mobile; others don’t limit at all.” As for Ms. Nevius, the man of her dreams may be paralyzed or blind, but there is one potential deal breaker: He must be an animal lover. “My dog and I,” she said, “come as a package deal.” |
| Cases: A Doctor in Iraq, Watching a Faith Healer at Work Posted: 27 Dec 2010 09:20 PM PST IRBIL, Iraq — “Are you a Muslim, Dr. Amir?” The question took me aback, as it would any American psychiatrist wary of self-disclosure. But this was Iraq, where religion is central to people’s lives and identities. So after a slight pause, I responded with a halfhearted affirmative to the mullah I had come to see. Mullah Eskandar was a faith healer — a youngish, tanned, bearded man in a flowing white dishdasha and a matching skullcap. Seated on a rug in his reception area with an oversize poster of the sacred Kaaba in Mecca, he emanated authority and sageness despite his relative youth. I had heard about faith healers during my years of travel to Iraq. They were alternately maligned as charlatans who preyed on a superstitious population, and praised as filling a void, particularly in mental health care, in a country that had seen an exodus of physicians. So when an Iraqi colleague offered to introduce me to a faith healer, I jumped at the opportunity. The path of a faith healer is arduous, Mullah Eskandar told us, speaking in Kurdish. “Such a calling,” he said, “is best reserved for a religious and spiritual man.” He went on to recount his 15-year apprenticeship to a renowned senior healer, who taught him the basics of spiritual treatment and the essentials of Koranic law and prophetic traditions. His description reminded me of my own long and difficult years in medical school and residency training. “Over 80 percent of my patients are females,” he continued. “They struggle with insomnia, headache, depression and marital problems.” He took pains to explain that he did not accept money, nor did he sell any wares, unlike a nearby sheik “who sells honey to patients — he is in league with the devil.” “Ours is like your profession, which has both good and bad doctors,” he continued: “those who care about patients and those who are in it for worldly rewards.” The mullah explained that he worked as a salaried cleric at a mosque during the week and that his healing activities were reserved for Fridays, the day of rest. The only reward he sought, he said, was in the afterlife. Pleasantly surprised at the mullah’s seeming integrity, I accepted his invitation to my colleague and me to see his work firsthand. The first patient to enter his reception room was a young woman in red flowing garb typical of the rural inhabitants of eastern Kurdistan. She was bedecked in gold bracelets and earrings, her fingers covered in tattooed dots and henna. Like most unmarried Iraqi women, she was accompanied by family: a heavy-set, mustachioed father and a watchful mother. The mother explained that the day her daughter became engaged to a relative, she had developed fainting fits, nightmares, foul moods and an inability to walk. Her family had consulted a general practitioner, who referred them to a neurologist, to no avail. She continued to faint at the talk of marriage — even became agitated at the prospect of her younger sister’s impending betrothal. As the mother continued her narrative, my Iraqi colleague leaned over and whispered a diagnosis in my ear: “conversion disorder.” That disorder is well known to mental health professionals: once termed hysteria, it is usually touched off or worsened by a well-defined stressor like an engagement, and its symptoms often involve motor or sensory functions. Not unlike the young, secularizing middle-class Jewish women who sought Freud’s help in 19th-century Vienna, Iraqi women are often caught between ancient traditions and personal needs in a rapidly globalizing society — and they are increasingly turning to internists, psychologists and faith healers for relief of just such symptoms. Mullah Eskandar invited the young woman to sit on a raised chair (actually a tower of six stacked plastic lawn chairs) and began to chant a Koranic verse into her right ear, imploring God’s help and warning of the devil’s temptations. Then he explained that the young woman was possessed by a jinn, one of the race of evil spirits that the Koran blames for sowing mischief and illness in the world — in this case, spreading discord in the young woman’s family by disrupting her marriage. To banish the jinn, Mullah Eskandar prescribed a regimen of prayers, daily bathing and rosewater perfume. And he counseled the patient on the responsibilities of a daughter to marry and the happiness that awaited her once she had a family of her own. It struck me that Mullah Eskandar’s rituals, particularly his reassuring counsel, appeared to mimic our oft-practiced supportive therapy in Western medicine. His authoritative opinion and his apparent empathy, coupled with his ability to realign the young woman’s vision to a more positive outlook, appeared to give her some degree of comfort immediately. Moreover, blaming the jinn allowed the family to see the young woman’s misbehavior as aberrant and shifted responsibility from her to a supernatural being. My Iraqi colleague agreed that despite his own strongly secular perspective, he still believed that honest faith healers fulfilled an important role in a war-ravaged country with a severe shortage of mental health professionals. I came to Iraq deeply skeptical of its traditions of religious folk treatment. To my surprise, I found a concerned faith healer who was sometimes more successful in treating the mentally ill than the few medically trained psychiatrists and general practitioners in the country. Mullah Eskandar’s example shows us that psychiatric progress cannot be achieved by cutting-edge science alone — it can be attained only when patient-centered care leads the way. Dr. Amir A. Afkhami, an assistant professor of psychiatry and global health at George Washington University, is the author of the State Department’s Iraq Mental Health Initiative. |
| Living and Studying Alopecia Posted: 28 Dec 2010 09:28 AM PST Angela Christiano, 45, an associate professor of dermatology and genetics at Columbia University Medical Center, studies hair. Last summer, she announced the discovery of the genes implicated in alopecia areata, the hair-loss disease that she herself suffers from. We spoke for two hours in her Washington Heights laboratory and then later on the telephone. An edited version of the two conversations follows. Ruth Fremson/The New York Times HAND OF FATE Angela Christiano studied alopecia soon after her diagnosis. Q. When did you first learn that you had alopecia? A. In 1995, a time of big transitions in my life. After doing highly successful postdoctoral research on genetic blistering skin diseases at Jefferson Medical College, I’d arrived here at Columbia to start my own laboratory. I had just turned 30. I was getting a divorce. When you start your first lab, a researcher is expected to find something different from their postdoc work. For my first six months here, I sat thinking, “What am I going to do when I grow up?” In the midst of all this, I went to a beauty parlor and the stylist said: “What’s happened here? You have a big patch of hair missing from the back of your head.” I ignored that. But the next day at the lab, I asked a colleague to take a look. She let out a bloodcurdling scream: “You have a huge bald spot!” I immediately went over to the clinic here. They said: “Oh, you have alopecia. There’s not much we can do to treat it.” Q. Alopecia is genetic. Do you have relatives with it? A. My mom and her mother had hair loss from a young age. I have a cousin also who lost all of her hair. Ironically, hair is a big part of my family’s life. My grandfather was a barber in Italy and then later in New Jersey. And my mother was a hairdresser before retiring. I’m the first person in my family to go to college and graduate school: Rutgers. My mother now says, “You’re just another hair person — you just do it differently.” Q. How did this history lead to your research? A. In the months after my diagnosis, I went through panic and shock. Every morning, I’d wake up wondering if it was all going to fall out. And new spots did show up. I’d cover them with the most careful combing. Then there’d be a new one. It was like plugging holes in a dam. It finally stopped after two years. I began reading all the papers on alopecia. In my training, nobody had talked much about hair. I thought maybe the reason was because it had all been figured out. When I started digging, I saw the opposite was true. I thought, “Maybe this is the hand of fate directing me to a topic? This is a wide-open field.” If I could identify the genes involved in alopecia, then maybe we could figure out what they did, and that might be the way to a treatment. Having the chance to work it through in the lab was one of the things that kept me sane in this period of my life. The disease was very destabilizing. Q. Why had hair loss been so minimally researched? A. I suspect it’s because it’s seen as a “cosmetic” problem. It’s the life-threatening diseases that get priority — and money. The other problem was that in 1996, the tools weren’t ready. The Human Genome Project hadn’t finished its work. There were no road maps. Nobody had yet solved a complex disease where multiple genes are involved, which is what alopecia is. Q. So how’d you overcome that? A. You could see the tools were on their way. Every year, you’d go to conventions and there was excitement about what was coming. My plan was to get all the ducks in a row for when the genome was mapped. While we waited, we tried to lay some groundwork by trying to find single genes that control the normal hair growth cycle. By looking for rare hair-loss diseases where only one gene was the factor, we learned some of that. My lab found six such genes. The other thing we did was to line up a patient registry for alopecia. That way, when the time was right, we could compare the genomes of people with the disease to those of people without it. An advocacy group, National Alopecia Areata Foundation, N.A.A.F., helped us connect with patients. Q. When were you able to actually do the study? A. In 2008. We published our findings this past July. Ours was the first study of alopecia to use a genome-wide approach. By checking the DNA of 1,000 alopecia patients against a control group of 1,000 without it, we identified 139 markers for the disease across the genome. We also found a big surprise. For years, people thought that alopecia was probably the stepchild of autoimmune skin diseases like psoriasis and vitiligo. The astonishing news is that it shares virtually no genes with those. It’s actually linked to rheumatoid arthritis, diabetes 1 and celiac disease. Q. What will this new information mean for patients? A. It should have amazing benefits. There are existing drugs on the market for several of these diseases. Based on the overlapping genetics, we have a chance of pushing forward with clinical trials for potentially effective drugs much sooner than we’d thought. One approach would be as a new indication for an already approved drug. Going the other way, our research opens up possibilities for the three related diseases. With them, till now it’s been hard to study aspects of how the immune response goes wrong because it is difficult to biopsy the pancreas or a joint. But now researchers might be able to use a patient’s skin, a much more accessible organ. Already, the finding has helped with diagnosis. At Columbia, we have large clinics for diabetes and celiac disease. Since we’ve published our paper, those clinics are asking patients, “Have you experienced hair loss?” About 10 percent say, “Oh, yes, I lose hair in clumps.” Q. What does it feel like to have accomplished this? A. It’s wonderful, of course. This summer, I spoke at the patient conference of N.A.A.F. and told the young people there, for the first time, about their genes. Before I could finish my talk, they gave me a standing ovation. I was in tears. Many of them later said, “We wouldn’t wish this on you, but we’re glad you got this disease.” I understood what they meant. Without it, a serious geneticist might never have given their attention to what was thought of as a cosmetic disease. This posting includes an audio/video/photo media file: Download Now |
| A Writer Traces Illnesses Back to the Womb Posted: 28 Dec 2010 08:41 AM PST NEW HAVEN — When the medical journalist Annie Murphy Paul’s first son was a toddler, she started wondering how personality traits are passed from one generation to the next. So she did what any reporter would do: she delved into the scientific literature and talked to investigators. Christopher Capozziello for The New York Times NURTURE Annie Murphy Paul at home in New Haven with Teddy, 5, left, and Gus, 1. Then, in the course of her research, she became pregnant herself. “I originally wanted to write about the transmission of characteristics and behaviors in families,” Ms. Paul, 38, said in an interview over tea and a brownie at a cafe near her home here. “That definitely came out of having my first child and thinking about what I’d want to pass on from my family and from my husband’s family.” But then she became intrigued with new research suggesting that some important traits might be passed down in the womb, during gestation. “That struck me as an amazing idea,” she said. “Something between nature or nurture, or really both.” The idea led to her acclaimed new book, “Origins: How the Nine Months Before Birth Shape the Rest of Our Lives” (Free Press). Divided into nine chapters that mirror the nine months of Ms. Paul’s own pregnancies, it explores the notion that heart disease, diabetes and perhaps other illnesses may have their origins during pregnancy. This hypothesis is supported by a succession of studies. Some scientists have a hunch that a pregnant woman’s diet and her exposure to various chemicals turn on some fetal genes and turn off others. These switches play a vital role in the life of the adult-to-be, making the child more or less susceptible to disease, including mental illness. The ultimate goals of such research are twofold: to be able to fine-tune advice to pregnant women and to spot high-risk individuals early on, even at birth. That said, the field is still in its fetal stages. Still, Ms. Paul found the research reassuring. “People often ask me, ‘Did your research make you more anxious about your pregnancy?’ ” she said, “but I found just the opposite.” The first time, she added, she did not know what to believe, how seriously to take the warnings that every pregnant woman confronts. It’s worse “to have a little bit of knowledge, just enough to know to feel that you are always doing something wrong.” “When I delved into the research and talked to scientists,” she said, “I was able to put these findings into context and see the big picture. So that’s what I wanted to do for readers.” (Her sons are now 5 and 1.) Ms. Paul devotes each chapter to an environmental influence that can arise during the corresponding month of pregnancy. For example, she writes about findings that babies born to obese women used insulin less effectively than those whose mothers had weight-loss surgery before pregnancy. The findings hint that environment in the womb may play a part in diabetes that goes beyond genetics — as does a study finding that rats that binged on junk food were 95 percent more likely than others to have offspring that were disposed to overeat. Ms. Paul also describes methylation, the process by which a cluster of chemicals (a methyl group) sticks to genes and controls whether they turn on or off. Some foods act as methylators; a study of a species of fat mice prone to diabetes and cancer found that when they were put on a diet rich in methylators, their offspring grew up thin and without an increased risk of disease. This type of research has its origins in the work of Dr. David Barker, a professor at the University of Southampton in England, who connected malnutrition in women with an increased risk of heart disease and diabetes among their adult offspring. His ideas, developed in the 1980s, were widely dismissed at first, but now many of his critics have become colleagues and consider him the father of the field. Dr. Barker’s observations and the more recent experiments on gestational mechanisms are “a terrific combination of medical science coming together from two different directions,” said Dr. Alfred Sommer, emeritus dean of the Bloomberg School of Public Health at Johns Hopkins. His team has found that malnourished Nepalese women given vitamin A during pregnancy had babies with greater lung development, perhaps preventing disease later on. Ms. Paul said that during her first pregnancy, she was scared to eat fish because of potential toxic effects of mercury. During her second pregnancy, she read about a study that found that women who ate little seafood during pregnancy were more likely to have children who scored low on tests of verbal I.Q. She started eating sardines — low mercury, high omega-3 fatty acids. Her biggest critics, she said, have not been scientists but “ordinary women who say that this is going to make women more anxious and that you’re adding to the burden that pregnant women already feel.” “My answer to them is that the research is real, it’s happening and we are going to keep hearing about it,” Ms. Paul said. “We are in a kind of ‘worst of all worlds’ now, with women bombarded by these sensationalized messages from the media. If we can learn more about it and see the big picture, that is better than the other options: ignoring it or dismissing it or letting scare tactics drive us crazy.” Dr. Randi Hutter Epstein is the author of “Get Me Out: A History of Childbirth From the Garden of Eden to the Sperm Bank.†|
| Books: A Diet Manifesto: Drop the Apple and Walk Away Posted: 28 Dec 2010 08:45 AM PST Another year ends, and still the war drags on. In the final salvo of 2010, the combatants are lobbing fruit. WHY WE GET FAT And What to Do About It. By. Gary Taubes, Alfred A. Knopf. 272 pages. $24.95. Not literally, of course, though they might like to: The long war of the weight-loss diets has aroused passions just about as overheated as those of any military conflict. How is a person best advised to lose extra weight and retreat from diabetes and heart disease? Count calories, cut fat and fill up on fruits and vegetables? Or turn instead to a high-protein, high-fat regimen like the one popularized by Dr. Robert C. Atkins? The experts point vehemently in all directions. And so in one corner this month we find the chief executive of Weight Watchers — one of the calorie-driven, “balanced diet” options — gleefully announcing on the radio that he was giving out fruit baskets for Christmas in honor of his organization’s new “Plus Points” program, in which fruit can be freely eaten. In the opposite corner we have Gary Taubes, the science journalist who has thrown in his lot with the high-fat, high-protein crowd, arguing in his new book that the overweight should just put down their apples and walk away: “If we’re predisposed to put on fat, it’s a good bet that most fruit will make the problem worse, not better.” At this point all eaters, fat or lean, could be forgiven for slamming the door on all expert dietary input, forever. But those who are curious about the science behind it all could do worse than to pick up Mr. Taubes’s book “Why We Get Fat: And What to Do About It.” A few things to understand at the outset: First, despite the happy fact that unlike many in this field, Mr. Taubes is not out to sell you anything (other than his book), it is still a manifesto. Thus, though it is bursting with data, a reader has no way of knowing whether other data has been overlooked or minimized to support the author’s points. Second, the new book is not really a new book at all; it is a sort of CliffsNotes version of “Good Calories, Bad Calories,” a long, dense tome Mr. Taubes published in 2007. With the new, smaller and more focused version, Mr. Taubes openly admits he is aiming for a broader audience and bigger impact. Fair enough, although one does begin to wonder if a line of protein bars is not far behind. But all that aside, Mr. Taubes proceeds to stand the received wisdom about diet and exercise on its head in a particularly intriguing and readable synthesis. We’ve got the whole thing backward, he argues. The overweight are not lazy hogs who eat too much and exercise too little. The thin are not virtuous and disciplined. Rather, all of us are fulfilling a fixed biological mandate, just as growing children are. Our bodies have a nonnegotiable agenda, and our behavior evolves to make that agenda happen, he writes: “Eating in moderation and being physically active (literally, having the energy to exercise) are not evidence of moral rectitude. Rather, they’re the metabolic benefits of a body that’s programmed to remain lean.” In other words, you don’t haul your body off that couch and out to the gym; your body hauls you. Meanwhile, “those who get fat do so because of the way their fat happens to be regulated,” Mr. Taubes writes. “A conspicuous consequence of this regulation is to cause the eating behavior (gluttony) and the physical inactivity (sloth) that we so readily assume are the actual causes.” The actual causes, he argues, with a great deal of observational and experimental data to support his points, are the array of regulatory enzymes and hormones that move fuel, in the form of fat and sugar molecules, in and out of storage depots around the body. And the only one of these hormones under even a smidgen of voluntary control is insulin. At this point Mr. Taubes merges onto the narrative highway traveled by all low-carb advocates: The body’s insulin levels are largely determined by ingested carbohydrates, and for some people the high-carb foods that stimulate insulin secretion and cravings for more high-carb foods are, in this worldview, just so much poison. So that apple — a filling package of fiber and vitamins to the Weight Watchers folks — is just a serving of fructose to Mr. Taubes. Fructose is the problematic sugar our bodies turn to fat the most readily, and if you are programmed to be fat, an apple will make you that much fatter. Mr. Taubes draws an analogy to cigarette smoking: Not every long-term smoker gets lung cancer — in fact, only a minority do — but among people with lung cancer, smoking is by far the most common cause. “In a world without cigarettes, lung cancer would be a rare disease, as it once was,” he writes. “In a world without carbohydrate-rich diets, obesity would be a rare condition as well.” How to account for the fact that in virtually all head-to-head comparisons of various diet plans, the average long-term results have invariably been quite similar — mediocre all around? The party line holds that backsliding is universal. Mr. Taubes makes much of the addictive effect of carbohydrates: once you taste them you never forget them. But those studies report group outcomes. Every plan has its own rare, shining success stories as well. Sometime, a diet just clicks. Perhaps the remarkable diversity of the human organism — whose various sizes and shapes (double chins, giant thighs and all) are so clearly driven by such a vast array of different appetites and genetic cues — simply means that it is foolish to expect a single diet to serve all comers. There. A proposal to end the war, just in time for the new year. |
| Global Update: Malaria: A Disease Close to Eradication Grows, Aided by Political Tumult in Sri Lanka Posted: 27 Dec 2010 09:30 PM PST Malaria cases jumped 25 percent in Sri Lanka from 2009 to 2010, the country’s ministry of health is reporting. And while this year’s total is still small, at 580, the trend is unsettling to experts. Sri Lanka is a bellwether for the dream of malaria eradication — and Exhibit A for the argument that politics affects the disease more than climate or public health measures do. The country — the former British colony of Ceylon, famous for tea and cinnamon — is an island, so eradication is possible. That almost happened once. After independence arrived in 1948, Sri Lanka had an estimated one million annual cases. With DDT and chloroquine, it drove that down to 18 cases by 1963. But spraying was cut back as DDT fell into disfavor, and by 1969, there were more than 500,000 cases. Simultaneously, the country’s ethnic fabric fell apart. The majority Buddhist Sinhalese passed laws discriminating against the Hindu Tamils, who were favored under the British, leading to 30 years of civil war. The majority was also split for decades between pro-Soviet and pro-Western factions. Malaria persisted, with cases highest in the north and east, where the Tamil Tiger insurgency was strongest. Nonetheless, by 2005, the country was below 2,000 cases, though experts said they were undercounted in rebel areas. Last year, the rebellion was crushed, and malariologists hoped the new national reconciliation policy would lead to eradication. As cases ticked up, a ministry official blamed global warming — a weak argument in a wet tropical country. But he also said more clinics would be opened in former rebel areas. |
| Vital Signs: Perceptions: Positive Spin Adds to a Placebo’s Impact Posted: 27 Dec 2010 09:22 PM PST Can taking a placebo be effective even if the patient knows it is a placebo? A new report suggests the answer is yes. In a study published online last week in the online journal PLoS One, researchers explained to 80 volunteers with irritable bowel syndrome that half of them would receive routine treatment and the other half would receive a placebo. They explained to all that this was an inert substance, like a sugar pill, that had been found to “produce significant improvement in I.B.S. symptoms through mind-body self-healing processes.” The patients, all treated with the same attention, warmth and empathy by the researchers, were then randomly assigned to get the pill or not. At the end of three weeks, they tested all the patients with questionnaires assessing the level of their pain and other symptoms. The patients given the sugar pill — in a bottle clearly marked “placebo” — reported significantly better pain relief and greater reduction in the severity of other symptoms than those who got no pill. The authors speculate that the doctors’ communication of a positive outcome was one factor in the apparent effectiveness of the placebo. “The magnitude of effect here is very large,” said the lead author, Dr. Ted J. Kaptchuk, a researcher at Beth Israel Deaconess Medical Center in Boston. The goal, he added, would be to develop a clinical strategy to use the placebo effect ethically, without lying to a patient. |
| Vital Signs: Nutrition: At Home, Influence Wanes on Child Diets Posted: 27 Dec 2010 09:20 PM PST Parents may think they can set a good example for their children by eating a healthy diet themselves, but a new analysis finds that it may not work. Researchers reviewed 24 studies on parent and child dietary habits, using statistical techniques to combine their results. Their analysis, being published in the February issue of The Journal of Epidemiology and Community Health, found only a weak correlation between what parents and their children eat. They also found that the association diminished over time — later studies generally showed a weaker connection than earlier ones between child-parent pairs. The authors acknowledge that their conclusions were based on limited data, that only three of the studies were conducted in developing countries, and that methodologies varied. Still, the researchers, led by Dr. Youfa Wang, an associate professor of international health at Johns Hopkins, concluded that parents’ influence was apparently overwhelmed by other factors. Advertising, food supply and availability, the influence of peers, and opportunities to eat outside the home all contribute to making children’s diets very different from that of their parents. So what’s a parent to do? “Make healthier food available at home,” said Dr. Wang, the father of two young boys. “Put it on the table every day, and try different ways to prepare food, especially vegetables. Parents can still have an important impact.” |
| Vital Signs: Aging: Paying the Physical Price for Longer Life Posted: 27 Dec 2010 09:20 PM PST Americans are living longer, but those added years are more likely to be a time of disease and disability. An analysis of government data has found that while life expectancy has steadily increased over the past decade, the prevalence of heart disease, stroke, cancer and diabetes has also increased, and disability has grown as well. For example, in 1998 about 16 percent of men in their 70s had a mobility problem — that is, they failed one of four commonly used physical tests. By 2006, almost 25 percent failed at least one. Writing in the January issue of The Journal of Gerontology B, the authors conclude that people live longer not because they are less likely to get sick, but because they survive longer with disease. As a result, a 20-year-old man today can expect to live about a year longer than a 20-year-old in 1998, but will spend 1.2 years more with a disease, and 2 more years unable to function normally. The lead author, Eileen M. Crimmins, a professor of gerontology at the University of Southern California, said that while we have been very successful in increasing the length of life, it comes at a cost. “Longer life is what we want,” she said. “But we’re going to have to pay for it with more treatment of diseases and accommodations for disability.” |
| Q & A: Blood Will Tell Posted: 27 Dec 2010 09:00 PM PST Q. A friend has hemochromatosis, a common genetic disorder that is treated by regular drawing of blood. Can that blood be donated? A. Hereditary hemochromatosis results in iron overload, “which, if not reduced, can lead to cirrhosis, hepatocellular carcinoma, congestive heart failure and diabetes,” said Dr. Beth Shaz, chief medical officer of the New York Blood Center. Blood does not transmit the disorder, but there has been some concern that some patients would conceal other risk factors so they can keep receiving the treatment at blood centers. In 2001, the National Institutes of Health financed a large study, published in The Journal of the American Medical Association, concluding that “donors with hemochromatosis do not present a greater risk to blood safety than other donors.” Dr. Shaz says people with hemochromatosis are eligible to donate blood for transfusion if they otherwise meet Food and Drug Administration eligibility requirements and if the blood center has an F.D.A. variance from rules about labeling the blood as coming from a donor with hemochromatosis. The agency also requires that the blood drawing “be at no cost to all persons presenting with this diagnosis, even if they do not meet criteria to be an eligible donor.” The list of establishments with the variance can be found on the F.D.A.’s Web site. C. CLAIBORNE RAY Readers are invited to submit questions by mail to Question, Science Times, The New York Times, 620 8th Avenue, New York, N.Y. 10018, or by e-mail to question@nytimes.com. This posting includes an audio/video/photo media file: Download Now |
| Recipes for Health: Apple, Fennel and Endive Salad With Feta Posted: 28 Dec 2010 12:40 PM PST I love the way the sweet juice from the grated apples permeates this crunchy salad. Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. 1 Fuji apple 1 tablespoon fresh lemon juice 2 small or 1 medium fennel bulb, trimmed, quartered, cored and very thinly sliced 2 Belgian endives, very thinly sliced crosswise 2 teaspoons chopped fresh tarragon 2 ounces feta, crumbled (about 1/2 cup) 1 tablespoon sherry vinegar Salt and freshly ground pepper 3 tablespoons extra virgin olive oil 1. Peel the apple, and grate into a wide bowl on the large holes of a box grater. Add the lemon juice, and toss together. Add the fennel, endives, tarragon and feta. 2. Stir together the vinegar, olive oil, salt and pepper. Add to the salad mixture, toss together and serve. Yield: Serves four. Advance preparation: This salad keeps for a few hours, but the apples will make it juicier, which I don’t mind. I’ve enjoyed leftovers the next day. Nutritional information per serving (four servings): 185 calories; 12 grams fat; 4 grams saturated fat; 13 milligrams cholesterol; 15 grams carbohydrates; 6 grams dietary fiber; 191 milligrams sodium (does not include salt added during preparation); 4 grams protein Martha Rose Shulman is the author of “The Very Best of Recipes for Health.” |
| 2 Senators Raise Questions on Use of Medtronic Device Posted: 28 Dec 2010 08:52 AM PST Two senators are raising new questions about an experimental use of a Medtronic device in spinal surgery on veterans and soldiers at the Walter Reed Army Medical Center from 2002 to 2004. Senators Max Baucus, Democrat of Montana and chairman of the Senate Finance Committee, and Charles E. Grassley of Iowa, the committee’s ranking Republican, wrote the commanding general of Walter Reed on Dec. 17 to ask about safeguards in a study by three Army surgeons. Senator Grassley’s office provided the letter to The New York Times. The senators asked what the Army was doing to investigate certain back surgeries at Walter Reed and whether patients had been told they were receiving devices for uses not cleared by the Food and Drug Administration. They also asked how Army protocols could ensure proper review of medical tests involving soldiers and veterans. The surgeons, who have received money from Medtronic, had implanted and written about a Medtronic device called Hydrosorb Mesh, which contained a bone-growth material called Infuse. Hydrosorb was approved by the Food and Drug Administration for nonweight-bearing purposes but not for spines, the senators wrote. Doctors are free to use F.D.A.-approved medical devices for any purpose they see fit, but in this case, Army officials said the surgeons should have sought permission for the study. The Army doctors had implanted Hydrosorb Mesh in spinal fusion procedures for 35 patients in an 18-month period, according to a study published in the journal Neurosurgical Focus in 2004. The study covered 22 patients, including 15 active duty soldiers, to determine whether the bio-absorbable Hydrosorb was possibly preferable to similar titanium mesh. The study concluded, in glowing terms, that Hydrosorb might be “ideally suited” to spinal use. Medtronic has also made payments for consultancy or other services to the three doctors — Timothy R. Kuklo, Michael K. Rosner and David W. Polly Jr., all then with Walter Reed. Six years after the implants, however, Hydrosorb has still not been approved for that use. The senators expressed safety concerns. Mr. Baucus said in a statement, “Safety must come first, especially for America’s men and women in uniform, and putting soldiers’ health at risk is an unacceptable price to pay for medical advancements. This case raises serious questions about whether men and women in uniform always receive the best care — questions that need answers.” Col. Norvell V. Coots, commander of the Walter Reed Healthcare System, said last week that he would respond to the senators by Jan. 14 with assurances of improved controls over research and publication. Walter Reed plans no further action, he added, although investigators have concluded the doctors violated Army rules by failing to seek or receive permission to conduct research or publish the article. Walter Reed has located 15 of the patients who had received the experimental back surgery, he said, and found all had been appropriate candidates for back surgery and were doing well. “We never put our patients at risk,” he said. Medtronic, based in Fridley, Minn., is one of the world’s largest medical device makers with sales of $15.7 billion in the year ended Oct. 29. Marybeth Thorsgaard, a company spokeswoman, said Medtronic supported Walter Reed research through a grant to a foundation. Dr. Kuklo, a West Point graduate, was found by Army investigators in 2008 to have fabricated signatures of co-authors of another journal article on a different Medtronic product and presented data that did not match hospital records, though he contests the data charge. He left the Army in 2006. Medtronic has disclosed it had paid Dr. Kuklo $823,339 from 2001 until early 2009, when the company suspended his consultancy. Dr. Kuklo’s lawyer, Henry J. Dane, said Army doctors did not need to obtain permission for studies of fewer than 10 patients. The review of Hydrosorb cases included three doctors writing about 22 patients, he said, an average of seven each. Colonel Coots, however, said that is an incorrect reading of the rule. Mr. Dane also said Dr. Kuklo was a dedicated researcher whose work improved treatment for soldiers with severe injuries. Colonel Coots praised Dr. Kuklo as a good surgeon but said he did not obtain the required permission for some research. The issue was first raised in September 2009 by Dr. Charles D. Rosen, a clinical professor of orthopedic surgery at the University of California, Irvine. In a letter to the Army surgeon general, Dr. Rosen asked whether soldiers receiving the implants had been given informed consent. “I’m appalled that experiments are being done on our U.S. soldiers without their knowledge,” Dr. Rosen said on Monday. “And to not have follow-up is, I think, dropping the ball big time.” |
| In Pursuit of a Mind Map, Slice by Slice Posted: 28 Dec 2010 09:20 AM PST CAMBRIDGE, Mass — Dr. Jeff Lichtman likes his brains sliced thin — very, very thin. C.J. Gunther for The New York Times TEAM LEADER Dr. Jeff Lichtman, with a 3-D image of a section of mouse brain and a magnified section of a dendrite (red), in his office at Harvard. This week: A road map of the brain, dating for the disabled, and size matters for cockroaches. C.J. Gunther for The New York Times ILLUMINATING A section of a mouse brain about 30 nanometers thick, ready for an electron microscope at Harvard. Researchers liken the cutting to shaving off the surface of a football field at a thickness of one-hundredth of an inch. Dr. Lichtman and his team of researchers at Harvard have built some unusual contraptions that carve off slivers of mouse brains as part of a quest to understand how the mind works. Their goal is to run slice after minuscule slice under a powerful electron microscope, develop detailed pictures of the brain’s complex wiring and then stitch the images back together. In short, they want to build a full map of the mind. The field, at a very nascent stage, is called connectomics, and the neuroscientists pursuing it compare their work to early efforts in genetics. What they are doing, these scientists say, is akin to trying to crack the human genome — only this time around, they want to find how memories, personality traits and skills are stored. They want to find a connectome, or the mental makeup of a person. “You are born with your genes, and they don’t change afterward,” said H. Sebastian Seung, a professor of computational neuroscience at the Massachusetts Institute of Technology who is working on the computer side of connectomics. “The connectome is a product of your genes and your experiences. It’s where nature meets nurture.” The task is arduous and years from fruition, and even the biggest zealots acknowledge that their work may not pay off. But connectomics has gotten some meaningful financing: In September, the National Institutes of Health handed out $40 million in grants to researchers at Harvard, Washington University in St. Louis, the University of Minnesota and the University of California, Los Angeles, to pursue connectomics. Together, their research efforts comprise the Human Connectome Project. Since the 1970s, researchers have only had one connectome to play with — that of a worm with a measly 300 neurons. Now they are trying a mouse brain, with its 100 million neurons. So far the notion of creating a human-scale connectome — which would illuminate all of the connections among more than 100 billion neurons and unravel the millions of miles of wires in the brain — has proved too daunting. The task at hand is somewhat similar to trying to untangle a bowl of spaghetti. Each individual spaghetti strand may touch tens of other strands as it weaves in a contorted fashion through the bowl. In this case, the researchers want to do the equivalent of seeing where all the strands connect at the atom level. And because the brain’s wiring is so densely packed, building a connectome stands as one of the most formidable data collection efforts ever concocted. About one petabyte of computer memory will be needed to store the images needed to form a picture of a one-millimeter cube of mouse brain, the scientists say. By comparison, it takes Facebook about one petabyte of data storage space to hold 40 billion photos. “The world is not yet ready for the million-petabyte data set the human brain would be,” Dr. Lichtman said. “But it will be.” Neuroscientists say that a connectome could give them myriad insights about the brain’s function and prove particularly useful in the exploration of mental illness. For the first time, researchers and doctors might be able to determine how someone was wired — quite literally — and compare that picture with “regular” brains. Surgeons armed with a connectome might also be able to make more calculated cuts in the brain. “The connectome project is going to show where all the white matter — all the connecting fibers — are,” said Stanley Klein, a professor of optometry and vision science at the University of California, Berkeley. “The whole goal in something like a surgery for epilepsy is to delicately slice out some of the white matter without removing any cortex.” Dr. Klein says he has “zero question” that this type of surgery could benefit from developing a connectome. Other scientists doubt that the results will match the effort. The comparisons to the genome prove haunting, and critics suggest that the connectome fans are wasting valuable research dollars and setting themselves up for a huge letdown. “There are people that argue we still just don’t know enough about the brain to know where to look for insights,” said Bradley Voytek, a researcher at the Helen Wills Neuroscience Institute at the University of California, Berkeley. “They also contend that there is no possible way you can build a full connectome in any realistic time frame.” What’s more, even if the researchers succeed, they will only produce a static picture of a brain frozen in time, rather than something that shows how a brain responds to different types of stimuli. Scientists around the world, including Stephen J. Smith, a neuroscience professor at Stanford, and Gerald M. Rubin, a researcher with the Howard Hughes Medical Institute, have pushed past the naysayers and developed varying techniques for mapping the brains and nervous systems of human as well as other creatures. “There are some people who say, ‘Maybe you don’t need this information, and given the expense of it, maybe you should put it off,’ ” said Dr. Lichtman, a professor of molecular and cellular biology at Harvard. “It’s a fair controversy.” Harvard recruited Dr. Lichtman to push the connectome quest to its limits by tackling an entire mouse brain at the finest scale and allowed him to set up his own connectome research laboratory, staffed with four other people. In the basement quarters that house Lichtman Lab, the researchers go to work anesthetizing mice, slicing open their rib cages and using the animals’ circulatory systems to spread concoctions that preserve the flesh and tune it for the electron microscope. Now and again, a researcher will reach into a box of mouse food pellets littered around the lab for sustenance during the tedious work. “They’re not too bad,” said Bobby Kasthuri, one of the researchers. With the body prepared, the slicing can begin. This posting includes an audio/video/photo media file: Download Now |
| The Thinnest Cut: A Device for Discovery Posted: 27 Dec 2010 09:10 PM PST As a graduate student, Kenneth J. Hayworth had a most unusual hobby: He built brain-slicing machines in his Los Angeles garage. Mr. Hayworth, 39, had developed an interest in connectomics — the emerging science of mapping the brain — while conducting neuroscience research at the University of Southern California. He believed that the field needed better equipment. So he set to work building an apparatus that could cut and process mouse brains in a semiautomated fashion, sort of like a deli slicer, and prepare them for analysis under an electron microscope. Soon the contraption began to grow. “My wife put up with it,” Mr. Hayworth said. “I spent like $10,000 of our own money on the machine, with no hope of recouping it.” He sought to drum up interest in his project and secure financing to develop the machines, but no universities bought into the pitch. “I was trying to shop it around at graduate schools,” said Mr. Hayworth, a tall man who looks as thin as the brain slivers he produces. “But nobody wants a graduate student who has an idea of what they already want to do.” By chance, he met Jeff Lichtman, an encounter that united a researcher who had built a brain slicer with a Harvard professor who needed one for his connectomics work. They joined forces, got their financing and set off to build a mouse connectome. Meanwhile, Mr. Hayworth earned his doctorate from the University of Southern California. “Ken reminded me of Scotty from Star Trek,” Dr. Lichtman said. “I just kept asking for more juice — pushing him like a psychopath to slice thinner and thinner.” The custom machines in Dr. Lichtman’s lab cost millions of dollars, but Mr. Hayworth envisions a day when brain slicers and related software will be everyday tools. “We want neuroscientists to finally be able to see the circuits they have been working on for the last 20 years,” he said. On a personal level, he hopes that a proper map of the human brain — a connectome — will one day allow people to transfer their thoughts and personalities onto, well, computers. “The circuitry of the brain will be mapped,” Mr. Hayworth predicted. “We will understand how this network of neurons is connected, how it stores memories, how it preserves the skills a person has and how these connections give rise to emotion.” Mr. Hayworth goes so far as to suggest that a person’s brain map could be replicated in a computer one day. In essence, someone could download their brain structure into a machine and have his or her personality live on. “In 100 years, if we have the technology to bring someone back, it won’t be in a biological body,” he said. “It is these scanning techniques and mind-uploading that, I think, will bring people back.” Mr. Hayworth emphasized that his views were personal and not those of Lichtman Lab. “This is a taboo topic in the scientific community,” he said. “But we have a cure to death right here. Why aren’t we pursuing it?” This posting includes an audio/video/photo media file: Download Now |
| Target Cancer: Enlisting the Dying for Clues to Save Others Posted: 27 Dec 2010 10:47 AM PST LOS ANGELES — They had told him on his last visit: the experimental drug that had so miraculously melted his tumors was no longer working. His legs were swollen, the melanoma erupting in angry black lumps. The patient, a computer consultant in his 40s, had little time left. A Winding Road to Hope Articles in this series have chronicled the trial of an experimental melanoma drug through the eyes of doctors and patients. Ann Johansson for The New York Times TRYING TO UNLOCK THE SECRETS A tumor from a patient is placed in a vial. And now the man’s doctor, Roger Lo of the cancer center at the University of California, Los Angeles, was calling to ask whether they could harvest a slice of one of his resurgent tumors for research he would almost certainly not be alive to benefit from. He would need to fly to Los Angeles from Northern California at his own expense, subject himself to an injection of anesthetic and the slight risk of infection, and spend yet another afternoon in the hospital. “I was hoping,” Dr. Lo said that day last spring, “you would come in for a biopsy.” The hope lies in a new breed of cancer drugs that work by blocking the particular genetic defect driving an individual tumor’s out-of-control growth — in the case of Dr. Lo’s patient, a single overactive protein. If researchers can pinpoint which new genetic alteration is driving the cancer when it evades the blockade — as it nearly always does — similarly tailored drugs may be able to hold it off for longer. The crucial evidence resides in the tumor cells of patients who, like Dr. Lo’s, have relapsed. But the need to ask those who know their time is short to undergo another invasive procedure in the name of science is just one obstacle to what many oncologists see as the best chance to give future cancer patients a more permanent reprieve. A regulatory process that can take years to approve a drug for sale means that instead of thousands of patients to draw on, only the few hundred who receive the drug through clinical trials are available for such research. Ethical review boards frown on any procedure that exposes patients to unnecessary risk, like the rupturing of a blood vessel or puncturing of a lung. Some hard-won tumor samples prove unsuitable for research. Then there is the question of who will pay for the biopsies, which cost as much as $5,000 and typically cannot be billed to insurance. Dr. Lo, for one, covered the costs when there was no other means to pay. As drugs tailored to the genetics of particular tumors make their way through early clinical trials, similar quests to improve on them are being undertaken by researchers in the various forms of a disease that kills more than a half-million Americans and millions more people worldwide every year. Dr. Lo’s quest to understand how melanoma forges its resistance to the drug PLX4032, made by Roche, illustrates the Herculean effort required to take even a baby step toward a cure for cancer. Finding a single clue that could lead to the testing of one new drug that might help a small fraction of patients took two long years. But it also shows how such progress emerges, from a complex mix of academic ambition, collaboration and competition among scientists, and, especially, the willing participation of dying patients. When the man Dr. Lo had called arrived in his office a week later, tumors covered his legs from the bottom of his feet to his groin. Some of them were infected, their odor so overwhelming that the doctor put on a mask before administering an anesthetic and cutting into his left thigh. A Researcher’s Trials Dr. Roger Lo, 38, was an unlikely player in the scramble to improve on the Roche drug, which had been given to only a handful of patients when its successes began to grab the field’s attention in late 2008. An assistant professor in dermatology, he had started his own laboratory only a few months earlier and had been advised by senior colleagues to avoid high-risk projects until he secured a steady source of financial support. But like others in the field, he was galvanized by watching melanoma patients respond to the Roche drug, the first to reliably slow a disease that typically kills within a year of diagnosis, and rarely responds to chemotherapy. Studying how to prevent a relapse, he argued in a grant proposal in early 2009, was “of paramount importance.” Impressed by his drive, and equally eager to realize the full promise of the drug’s approach, Dr. Antoni Ribas, the melanoma oncologist running U.C.L.A.’s arm of the drug’s clinical trial, agreed to collaborate with Dr. Lo. Bigger, better-financed laboratories pursuing the same question might reach an answer first, Dr. Ribas warned. But Dr. Lo had reason to hope the results would be published in a leading journal if he was the first to find the culprit responsible for reigniting the cancer, among the many possibilities. That could prompt drug companies to speed the development of a new therapy. |
| Medicaid Bonuses to Reward States for Insuring More Children Posted: 27 Dec 2010 07:05 AM PST The Obama administration plans to announce Monday that it will make $206 million in bonus Medicaid payments to 15 states — with more than a fourth of the total going to Alabama — for signing up children who are eligible for public health insurance but had previously failed to enroll. Alex Wong/Getty Images Kathleen Sebelius, the health and human services secretary, has called the matter “a moral obligation.†The payments, which were established when Congress and President Obama reauthorized the Children’s Health Insurance Program in 2009, are aimed at one of the most persistent frustrations in government health care: the inability to enroll an estimated 4.7 million children who would be eligible for subsidized coverage if their families could be found and alerted. Two of every three uninsured children are thought to meet the income criteria for government insurance programs. Kathleen Sebelius, the secretary of health and human services, has called the matter “a moral obligation” and has challenged health care providers, state and local governments and community groups to seek out eligible children. The stubbornness of the problem is one reason the government expects millions of people to remain uninsured even after 2014, when the new health care law requires most Americans to have coverage and vastly expands government programs to make it affordable. The bonus grants are distributed according to a formula. To qualify, states must have adopted at least five of eight measures aimed at streamlining enrollment for children in public insurance programs and have recorded Medicaid caseload increases that could not be attributed solely to a worsening economy. Thirty-two states did not even apply for the grants. Three of the 18 that did apply did not qualify for payments. Alabama will receive a $55 million bonus, more than twice as much as any other state, for having 133,000 more children on its Medicaid rolls than projected by a formulated base line, according to the Department of Health and Human Services. The 15 states that will receive bonuses reported a total of 874,347 children above the baseline, which factors in population growth and, to some degree, demand driven by the economy. To make enrollment easier, Alabama has eliminated asset tests for children, ended requirements for an in-person interview and allowed children to remain eligible for a year without renewal. It also sends out renewal forms with blanks filled in when data is known, and allows applicants to verify their forms with an electronic signature. The state has adopted “express lane eligibility” so that Medicaid application processors can use income findings from other safety net programs to validate eligibility. “We are absolutely ecstatic about the $55 million,” said Lee A. Rawlinson, Alabama’s deputy Medicaid commissioner. “It just could not have come at a better time for the state. And had we not had all these streamlining efforts we would never have been able to get to these applications and get all these children awarded.” Oregon, which will receive a $15 million bonus, made many of the same refinements, while also extending coverage to more children. “Without these efforts to make enrollment simplified, the resources we put into outreach and marketing would be wasted,” said Cathy H. Kaufmann, administrator of Oregon Healthy Kids, which encompasses both Medicaid and the Children’s Health Insurance Program. “We’d have driven thousands of people to the front door but many of them wouldn’t be able to get in.” Because of the formula’s requirements, none of the money will go to California, Texas or Florida, which account for nearly 40 percent of all uninsured children. Nor will any go to the four states that do the best job of signing up eligible children — Massachusetts, Vermont, Maine and Hawaii. A study published in the journal Health Affairs estimated the national participation rate among children eligible for Medicaid and the Children’s Health Insurance Program at 82 percent in 2008. Thirteen states had rates below 80 percent, with Nevada at only 55 percent. Ms. Sebelius said in an interview that it would be “a huge win for kids” if the rate could be pushed to 90 percent. A third of all children are now insured by two programs, compared with 10 percent of nonelderly adults, according to the Kaiser Family Foundation. Medicaid covers 24 million children, most of them living below the poverty line, and the Children’s Health Insurance Program, or CHIP, picks up nearly eight million in families with slightly higher incomes. The programs’ costs are shared by the federal government and the states. Washington sets income-based eligibility thresholds, which states can exceed. This posting includes an audio/video/photo media file: Download Now |
| Obama Returns to End-of-Life Plan That Caused Stir Posted: 26 Dec 2010 10:10 PM PST WASHINGTON — When a proposal to encourage end-of-life planning touched off a political storm over “death panels,” Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1. The latest on President Obama, the new Congress and other news from Washington and around the nation. Join the discussion. Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment. Congressional supporters of the new policy, though pleased, have kept quiet. They fear provoking another furor like the one in 2009 when Republicans seized on the idea of end-of-life counseling to argue that the Democrats’ bill would allow the government to cut off care for the critically ill. The final version of the health care legislation, signed into law by President Obama in March, authorized Medicare coverage of yearly physical examinations, or wellness visits. The new rule says Medicare will cover “voluntary advance care planning,” to discuss end-of-life treatment, as part of the annual visit. Under the rule, doctors can provide information to patients on how to prepare an “advance directive,” stating how aggressively they wish to be treated if they are so sick that they cannot make health care decisions for themselves. While the new law does not mention advance care planning, the Obama administration has been able to achieve its policy goal through the regulation-writing process, a strategy that could become more prevalent in the next two years as the president deals with a strengthened Republican opposition in Congress. In this case, the administration said research had shown the value of end-of-life planning. “Advance care planning improves end-of-life care and patient and family satisfaction and reduces stress, anxiety and depression in surviving relatives,” the administration said in the preamble to the Medicare regulation, quoting research published this year in the British Medical Journal. The administration also cited research by Dr. Stacy M. Fischer, an assistant professor at the University of Colorado School of Medicine, who found that “end-of-life discussions between doctor and patient help ensure that one gets the care one wants.” In this sense, Dr. Fischer said, such consultations “protect patient autonomy.” Opponents said the Obama administration was bringing back a procedure that could be used to justify the premature withdrawal of life-sustaining treatment from people with severe illnesses and disabilities. Section 1233 of the bill passed by the House in November 2009 — but not included in the final legislation — allowed Medicare to pay for consultations about advance care planning every five years. In contrast, the new rule allows annual discussions as part of the wellness visit. Elizabeth D. Wickham, executive director of LifeTree, which describes itself as “a pro-life Christian educational ministry,” said she was concerned that end-of-life counseling would encourage patients to forgo or curtail care, thus hastening death. “The infamous Section 1233 is still alive and kicking,” Ms. Wickham said. “Patients will lose the ability to control treatments at the end of life.” Several Democratic members of Congress, led by Representative Earl Blumenauer of Oregon and Senator John D. Rockefeller IV of West Virginia, had urged the administration to cover end-of-life planning as a service offered under the Medicare wellness benefit. A national organization of hospice care providers made the same recommendation. Mr. Blumenauer, the author of the original end-of-life proposal, praised the rule as “a step in the right direction.” “It will give people more control over the care they receive,” Mr. Blumenauer said in an interview. “It means that doctors and patients can have these conversations in the normal course of business, as part of our health care routine, not as something put off until we are forced to do it.” After learning of the administration’s decision, Mr. Blumenauer’s office celebrated “a quiet victory,” but urged supporters not to crow about it. “While we are very happy with the result, we won’t be shouting it from the rooftops because we aren’t out of the woods yet,” Mr. Blumenauer’s office said in an e-mail in early November to people working with him on the issue. “This regulation could be modified or reversed, especially if Republican leaders try to use this small provision to perpetuate the ‘death panel’ myth.” This posting includes an audio/video/photo media file: Download Now |
| Californians Are Smoking Less and Less Posted: 25 Dec 2010 08:09 PM PST LOS ANGELES — Californians are smoking less than most other Americans. According to a study released last week by the California Department of Public Health, just 13.1 percent of California residents reported smoking last year, compared with 20.6 percent nationally. California now has the second-lowest smoking rate in the country, trailing only Utah. The declining rate here reflects a culture that is especially conscious of health and the environment, and it was hailed by state officials as evidence of the success of a strategy to demonize smoking. In 1988, the state increased the tax on cigarettes, using part of the proceeds to finance an antitobacco campaign, and began instituting bans on smoking in public places — first on planes and buses, then in indoor workplaces and bars. The health department has also used media campaigns, including graphic antismoking advertisements, like a 1997 television commercial that showed a woman smoking a cigarette through the laryngectomy hole in her throat. “In California, we are very proud of our leading role in this revolution of how people view smoking,” said Colleen Stevens, the chief of the state’s Tobacco Control Media Campaign. “People are coming to the realization that smoking is not part of a healthy lifestyle.” Since 1988, California’s smoking rate has dropped from 22.7 percent to its current level, and the campaign has become a model for many other states. Critics say the public smoking bans have, in effect, simply made smoking illegal; at the least, they have made life ever more difficult for smokers. Health officials, however, argue that California’s sustained campaign has led not only to lower smoking rates, but also to public health benefits. They point out that lung cancer rates are going down more than three times as fast in California than in the rest of the country, and that the state has saved an estimated $86 billion in health care costs. |
| Noticed: Salvia Takes a Starring Role Posted: 25 Dec 2010 08:00 PM PST SEVERAL weeks after Miley Cyrus turned 18 in November, a video surfaced showing the pop singer and actor celebrating her adulthood with uncontrollable laughter, garbled speech and a shapely bong. It was neither marijuana nor hashish in the pipe, she explained in the face of public furor, but Salvia divinorum, a powerful hallucinogenic that adults can legally use in California. TMZ Images of Miley Cyrus smoking Salvia divinorum spread quickly on the Web. The controversy involving Ms. Cyrus, the former child star from “Hannah Montana,” has led to new interest in this psychoactive Mexican herb. Google searches for “salvia” in the United States spiked 600 percent in the days that followed, Twitter went aflutter, and “Saturday Night Live” spoofed the incident last weekend. However inadvertent, salvia now has a celebrity endorsement. Since the video was leaked, Black Myst Smoke Shop, a store in Los Angeles that sells the drug by the gram for $10 to $60, has seen a surge in business. “We used to sell one or two a day,” said Steve Kinsman, an employee of the shop. “Now it’s 10 or 15. We’ll get a bunch of young people coming in, then a creepy 40-year-old who’s obviously a Miley fan.” Once the domain of Mazatec shamans in Oaxaca, Mexico, Salvia divinorum — a name that means “divining sage” — has spent the last decade crawling from stoner novelty to the fringes of the mainstream. Evidence of its popularity is online: a YouTube search for “salvia” reveals thousands of clips showing young people cackling, moaning and tripping out of their gourds under the herb’s influence. “After two or three hits, I spat everywhere and was coughing and laughing and drooling,” said Lee, a 22-year-old from Brooklyn who tried the drug while attending a university in upstate New York, and who requested that only his first name be used for anonymity. “I started yelling random words, then my legs gave out, and I dropped to the floor.” While the intense, 15-minute highs are often described as otherworldly, it’s not an experience that everyone is eager to repeat, or try. Several states have banned the herb because of its psychoactive effects; several more have set limits on possession or consumption. Meanwhile, the Drug Enforcement Administration deems it a “drug of concern” rather than a controlled substance. “Just because something is not controlled under federal law doesn’t mean it’s wise to ingest or smoke,” said Rusty Payne, a spokesman for the drug administration. “It does have hallucinogenic effects, and that’s never good.” The attention given to salvia has provided ammunition for those who insist salvia is a public menace. “In a weird way, the Miley Cyrus thing has helped to highlight some of the issues,” said State Senator John J. Flanagan, Republican of Long Island. He plans to reintroduce a bill next year to render salvia illegal in New York State. Although salvia has been sold in places like head shops for years, levels of salvia use appear static. A recent Monitoring the Future survey by the National Institute on Drug Abuse reported a slight dip to 5.5 percent in usage from 2009 to this year among high school seniors. “It doesn’t appear to be a problem,” said Dr. Lloyd D. Johnston, a professor at the University of Michigan who worked on the study. A rush to regulate may also stifle medical opportunity, some researchers say. The herb’s active component, a complex molecule called salvinorin A that affects the brain’s Kappa receptors, could be useful in understanding Alzheimer’s disease, cocaine addiction and chronic pain. “We stumbled across a gem,” said Dr. Matthew W. Johnson, an assistant professor at Johns Hopkins University School of Medicine who has studied salvia. He believes it is nonaddictive and free of neurotoxicity. “It could be that this is our first glimpse into a whole therapeutic pathway.” Whether salvia is characterized as a medical wonder or a vicious hell-weed that will transform the nation’s youth into chortling zombies, it seems unlikely Ms. Cyrus will be a catalyst for nuanced conversation. Despite the hype, salvia’s new popularity may be as short-lived as a puff of smoke. Shortly after the scandal erupted, one Web site began offering T-shirts with a picture of Ms. Cyrus and the phrase, “Salvia: all the cool kids are doing it!” According to the site’s owner, at press time the company had yet to sell a single shirt. |
| Well: The Tans That Bond Posted: 28 Dec 2010 09:01 AM PST |
| Well: A Hair Loss Researcher With Purpose Posted: 27 Dec 2010 03:45 PM PST |
| Well: Online Dating With a Difference Posted: 27 Dec 2010 01:00 PM PST |
| Well: Devices Help the Blind to Read Posted: 27 Dec 2010 09:43 AM PST |
| Well: Steam Heat for Colds Posted: 27 Dec 2010 08:58 AM PST |
| Personal Health: Just Because One’s Vision Is Waning, Hope Doesn’t Have To Posted: 27 Dec 2010 09:00 PM PST Jim Vlock is on a mission. Afflicted 15 years ago with macular degeneration, a retinal disorder that erodes central vision and thus the ability to drive, read, watch television and recognize faces, Mr. Vlock is determined to spread the word about the many devices that can help people like him live more fulfilling, independent and productive lives. Share your thoughts on this column at the Well blog. Go to Well » Mr. Vlock, now 84 and a longtime resident of Woodbridge, Conn., told me in an interview that he sought help at three of the country’s best medical centers: Yale, the Cleveland Clinic and Columbia. And though they tried to treat his vision problem, none told him there were ways to improve his life within the limits of his visual loss. “These institutions attempt to cure, but they are not particularly interested or knowledgeable about providing ways to overcome low vision,” he said. His wife, Gail Brekke, said: “We had been spending all our time focusing on a possible cure — stem cells, laser treatments, injections — we were willing to go to the ends of the earth. We didn’t want to live in a land of resignation. We thought there must be something out there to help. But like most of medicine, the specialists we consulted were not knowledgeable about helping you live your life without a pill or scalpel.” Seeking Out Helpful Tools Spurred by his distress over having to give up reading and television, as well as driving and playing tennis, Mr. Vlock, a retired steel executive who describes himself as “a proactive person,” found what he needed on his own. A technician who teaches people with visual impairment how to use computers suggested he seek help at the Veterans Health Administration’s medical center in West Haven, Conn., where he was entitled to free care as a Navy veteran of World War II. With Mr. Vlock, I visited this full-service center, where he said he underwent “the longest and most comprehensive evaluation” he’d yet received — a full six hours of testing — along with a plethora of visual aid devices, including six pairs of specialized glasses for different tasks, a talking watch and a magnified travel mirror to help him shave. Most important, he learned to use a computer with an enlarged keyboard and magnified screen for reading text and e-mail; if he can’t make out what’s on the screen, it will read to him out loud. (He has since donated three of these computers to the public library and local residences for the elderly.) Now Mr. Vlock can again read and enjoy television, theater, ballgames and e-mail. Not only did the V.A. provide the tools to make this possible; it also gave him the instruction and training he needed to function well at home and at work, where he is a consultant to Fox Steel, the Connecticut company he previously owned. He learned of still other services through a chance meeting with David Lepofsky, a lawyer in Toronto who has been blind since he was a teenager yet completed law school and a master’s degree at Harvard. In a long e-mail to Ms. Brekke, Mr. Lepofsky wrote, “There is no reason why, despite his vision limitations, Jim should not be able to read what he wants, including daily newspapers, in a relaxing way and without having to become a high-end computer scientist.” With Mr. Lepofsky’s guidance, Mr. Vlock acquired a Victor Reader Stream, a device that downloads and plays all manner of audio books. He gained access to the National Federation of the Blind’s newsline; using his telephone touch pad, he can listen to articles from newspapers throughout the country as early as 8 a.m. each day. “This was a transformative experience,” he said. “I’m now able to do all these things.” The V.A. rehabilitation programs are meant to help blind and low-vision veterans and active service members regain their independence and quality of life and to function as full members of their families and communities. Lisa-Anne Mowerson, acting chief of the agency’s Eastern Blind Rehabilitation Center in West Haven, calls the center “the best-kept secret.” “It’s hard for people to find us,” Ms. Mowerson told me. “A person’s vision problem doesn’t have to be service-connected for them to receive care here. Their vision problem could be due to diabetes or glaucoma” — or, as in Mr. Vlock’s case, macular degeneration, a familial condition that had afflicted his father and two uncles. There are 10 advanced-care vision centers for veterans around the country. The center Ms. Mowerson runs serves the entire Eastern Seaboard, with referrals from 13 veterans’ centers that provide more basic low-vision services. “We don’t just give devices, we give training inpatient and out, at home and at work,” Ms. Mowerson said. “We may spend 20 hours with individuals to make sure they know how to use the devices properly and can cope independently, which takes training and practice. These devices are available in the community, but people are not trained how to use them.” Mr. Vlock said, “There’s a dedication here — you don’t feel like you’re inconveniencing anyone.” Insurance Stops Short For nonveterans with visual impairments, more is lacking than just adequate training. Also absent is insurance coverage. As with hearing aids, neither Medicare nor private insurance covers these tools and services, a failure of our penny-wise and pound-foolish medical care system that often ends up costing society far more in lost wages and personal care. “The private sector has to step up,” said Kara Gagnon, director of low-vision optometry at the V.A. in West Haven. “Success is directly tied to the quality of the exam and the training — two hours doesn’t do it. “We teach patients where their sweet spot is — the part of their remaining vision through which they can see best — and how to access it so they can see faces and read fluently. Too often we get patients who’ve been unable to read for 20 years, who’ve lost their jobs, their wives, their homes. “Our philosophy is to get patients to do things for themselves, including cooking and laundry, so they can cycle out of depression and feel fulfilled. We ask about their goals, what they enjoyed doing before they became visually impaired. I can get them back to everything except driving a car and flying a plane.” This is the second of two columns on vision loss. This is the second of two columns on vision loss. |
| Really?: The Claim: Hot, Humidified Air Can Help to Cure a Cold Posted: 27 Dec 2010 09:20 PM PST THE FACTS Using heat to conquer a cold sounds like a no-brainer. Share your thoughts on this column at the Well blog. Go to Well » Inhaling steam or humidified air — a cold remedy as old as the steam kettle — supposedly clears congestion, improves breathing and kills off cold viruses, which are sensitive to heat. Laboratory studies show, for example, that the rhinovirus, the most common cause of colds, is inactivated at temperatures above 109 degrees Fahrenheit. Yet a number of studies have failed to find strong evidence that a dose of heated, humidified air makes any difference for sniffling, sneezing cold sufferers. In 2006, a report in The Cochrane Database of Systematic Reviews examined the remedy by combining data from previous studies. The report included six randomized controlled trials in which cold sufferers were exposed to heated water vapor. Three of the studies showed benefits, while the others found either a worsening of symptoms or no change at all in antibody levels or shedding of viruses. One of those studies, carried out at the Cleveland Clinic and published in The Journal of the American Medical Association in 1994, had 68 cold sufferers sit through 60-minute steam treatments that raised the temperature inside the nose to the required 109 degrees Fahrenheit. The treatments had no effect on symptoms like congestion and sneezing. Ultimately, the Cochrane report concluded that steam inhalation should not be recommended as a remedy for colds until more double-blind studies bear out its usefulness. THE BOTTOM LINE The evidence for heated or humidified air as a cold treatment is lacking. ANAHAD O’CONNOR scitimes@nytimes.com |
| Prescriptions: This Week's Health Industry News Posted: 27 Dec 2010 10:31 AM PST |
| The New Old Age: When Traditions Must Change Posted: 27 Dec 2010 07:17 AM PST |
| Letters: If the Warm Feeling Lasts (1 Letter) Posted: 27 Dec 2010 09:10 PM PST To the Editor: “Basking in a Workout’s Long, Mysterious Afterglow” (Personal Best, Dec. 21) describes a syndrome known as exertional hyperthermia, in which body temperature remains elevated for several hours after intense exercise. The condition is not necessarily benign. People who have experienced it may be susceptible to malignant hyperthermia, a similar, potentially fatal syndrome that can be touched off by certain anesthetic agents. The test for susceptibility, called CHC for caffeine-halothane contracture, is considered the gold standard. When patients with a history of exertional hyperthermia are facing surgery, they should be sure to inform the anesthesiologist. Hoshang J. Khambatta, M.D. Englewood, N.J. Science Times welcomes letters from readers. Those submitted for publication must include the writer’s name, address and telephone number. E-mail should be sent to scitimes@nytimes.com. Send letters to Science Editor, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018. |
| Letters: A Deadly Oversight (1 Letter) Posted: 27 Dec 2010 09:10 PM PST To the Editor: “How a Torn Aorta Can Do Lethal Damage” (Dec. 21) mentions that aortic tear may be unfamiliar to most people. In addition, its varied size and location make it difficult for many a physician to diagnose. Malpractice files are replete with cases of missed diagnoses of aortic dissection. Tristram C. Dammin, M.D. Boston Science Times welcomes letters from readers. Those submitted for publication must include the writer’s name, address and telephone number. E-mail should be sent to scitimes@nytimes.com. Send letters to Science Editor, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018. |
| Recipes for Health: Watercress and Endive Salad With Pears and Roquefort Posted: 27 Dec 2010 12:01 PM PST Pears go wonderfully with all types of blue cheese, whether Roquefort, Stilton, Gorgonzola or an American blue such as Maytag. Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. 1 large, ripe but firm Comice or Bartlett pear 2 teaspoons fresh lime juice 2 tablespoons pecans (1 ounce), lightly toasted 1 bunch watercress, trimmed (about 4 ounces) 2 endives, broken into leaves 2 ounces Roquefort, Stilton or another blue cheese, crumbled 2 teaspoons chopped fresh tarragon 1 tablespoon sherry or Champagne vinegar 1/2 to 1 teaspoon Dijon mustard, to taste Salt and freshly ground pepper 3 tablespoons extra virgin olive oil 1 tablespoon walnut oil 1. Peel, core and thinly slice the pear. Cut the slices in half so they’re not too long. Toss with the lime juice. 2. Combine the pears, pecans, watercress, endive, blue cheese and tarragon in a large bowl. Whisk together the vinegar, mustard, salt, pepper, olive oil and walnut oil. Toss with the salad, and serve. Variation: Substitute baby spinach for the endive and watercress. Yield: Serves four. Advance preparation: You can prepare all of the ingredients except the pears several hours ahead of serving. Prepare the pears and toss the salad shortly before serving. Nutritional information per serving (four servings): 246 calories; 20 grams fat; 5 grams saturated fat; 13 milligrams cholesterol; 14 grams carbohydrates; 5 grams dietary fiber; 283 milligrams sodium (does not include salt added during preparation); 5 grams protein Martha Rose Shulman is the author of “The Very Best of Recipes for Health.” |
| Recipes for Health: Turkey: Not Just for Thanksgiving Posted: 27 Dec 2010 09:40 AM PST To often, cooks think about what to make with turkey only when faced with a deluge of Thanksgiving leftovers. Your refrigerator may still be stuffed with them even now, well after the holiday. But there are plenty of other reasons for cooks to get better acquainted with turkey. Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. Above all else, turkey is versatile. Combining turkey with grains is one way to make meals high in protein and low in fat. Toss shredded turkey with grain pilaf, celery, fresh herbs, a vinaigrette and a few vegetables, and you’ve got a terrific main-dish salad. You can use turkey in a risotto. Or how about a casserole? The turkey casserole I’ve chosen this week is Middle Eastern, spiced with allspice and cinnamon and topped with thick yogurt. Turkey also can substitute for chicken in your favorite tacos and enchiladas, salads, chilaquiles and soups. A while back, I devoted a week of columns to dishes you can make with shredded poached chicken breasts; turkey will work in any of those dishes just as well. Turkey Tacos With Green Salsa The tacos are easily thrown together, whether you make your own salsa or use bottled. 2 cups shredded turkey 1 cup green salsa, bottled or homemade 4 radishes, thinly sliced or cut in julienne 1/4 cup chopped cilantro 1 small ripe avocado, diced Salt 8 corn tortillas 1 cup shredded lettuce Juice of 1 lime 1/3 cup queso fresco 1. Combine the turkey, salsa, radishes, cilantro and avocado in a bowl. Season with salt to taste. 2. Heat the tortillas individually in a dry pan or microwave, or wrap them in a kitchen towel and place them in a steamer above 1 inch of boiling water for one minute. Turn off the heat, and let them sit covered for 10 minutes. 3. Place two tortillas on each plate, and top with the turkey mixture. Top the turkey mixture with shredded lettuce, squeeze on some lime juice, sprinkle with queso fresco and serve. Yield: Four servings. Advance preparation: This is thrown together just before serving. Homemade salsa will keep for a couple of days in the refrigerator. Nutritional information per serving: 303 calories; 12 grams fat; 3 grams saturated fat; 60 milligrams cholesterol; 23 grams carbohydrates; 6 grams dietary fiber; 129 milligrams sodium (does not include salt added during preparation); 26 grams protein Martha Rose Shulman is the author of “The Very Best of Recipes for Health.” |
| Recipes for Health: Turkey: Not Just for Thanksgiving Posted: 28 Dec 2010 10:08 AM PST To often, cooks think about what to make with turkey only when faced with a deluge of Thanksgiving leftovers. Your refrigerator may still be stuffed with them even now, well after the holiday. But there are plenty of other reasons for cooks to get better acquainted with turkey. Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. Above all else, turkey is versatile. Combining turkey with grains is one way to make meals high in protein and low in fat. Toss shredded turkey with grain pilaf, celery, fresh herbs, a vinaigrette and a few vegetables, and you’ve got a terrific main-dish salad. You can use turkey in a risotto. Or how about a casserole? The turkey casserole I’ve chosen this week is Middle Eastern, spiced with allspice and cinnamon and topped with thick yogurt. Turkey also can substitute for chicken in your favorite tacos and enchiladas, salads, chilaquiles and soups. A while back, I devoted a week of columns to dishes you can make with shredded poached chicken breasts; turkey will work in any of those dishes just as well. Turkey Tacos With Green Salsa The tacos are easily thrown together, whether you make your own salsa or use bottled. 2 cups shredded turkey 1 cup green salsa, bottled or homemade 4 radishes, thinly sliced or cut in julienne 1/4 cup chopped cilantro 1 small ripe avocado, diced Salt 8 corn tortillas 1 cup shredded lettuce Juice of 1 lime 1/3 cup queso fresco 1. Combine the turkey, salsa, radishes, cilantro and avocado in a bowl. Season with salt to taste. 2. Heat the tortillas individually in a dry pan or microwave, or wrap them in a kitchen towel and place them in a steamer above 1 inch of boiling water for one minute. Turn off the heat, and let them sit covered for 10 minutes. 3. Place two tortillas on each plate, and top with the turkey mixture. Top the turkey mixture with shredded lettuce, squeeze on some lime juice, sprinkle with queso fresco and serve. Yield: Four servings. Advance preparation: This is thrown together just before serving. Homemade salsa will keep for a couple of days in the refrigerator. Nutritional information per serving: 303 calories; 12 grams fat; 3 grams saturated fat; 60 milligrams cholesterol; 23 grams carbohydrates; 6 grams dietary fiber; 129 milligrams sodium (does not include salt added during preparation); 26 grams protein Martha Rose Shulman is the author of “The Very Best of Recipes for Health.” |
| Recipes for Health: Greens With Fruit and Cheese Posted: 28 Dec 2010 12:40 PM PST One of my favorite winter dishes is an endive, apple and walnut salad, just one of many ways to combine fruit, cheese, greens and nuts in a healthful meal. Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. Some combinations work better than others, I’ve learned. Pears and blue cheeses, like Gorgonzola and Roquefort, are best served with dark leafy greens, like spinach and watercress. Apples go well with endive and Gruyère, blue cheese or Cheddar, as well as with such crunchy vegetables as fennel and celery. Salty cheeses, like feta and ricotta salata, contrast nicely with very sweet persimmons and complement just about any type of green, particularly bitter greens like frisée. Citrus, a welcome addition to many winter salads, is a bit trickier to match with a cheese. One that works: fresh ricotta. For salads, I usually rely on walnuts, pecans, almonds and pine nuts. I’m not a fan of candied nuts, and not just for reasons of health. The fruits in this week’s combination salads contribute more than enough sweetness. Spinach Salad With Persimmons, Goat Cheese and Walnuts I was never crazy about persimmons until I made this salad with the crunchy Fuyu variety. I love the contrast of sweet persimmons with earthy spinach. 2 Fuyu persimmons 1/4 cup broken walnuts (1 1/2 ounces) 2 ounces goat cheese, crumbled (about 1/2 cup) 1 bag baby spinach 1 tablespoon plus 1 teaspoon fresh lime juice Salt to taste 3 tablespoons plus 1 teaspoon walnut oil Fleur de sel (optional) 1. Peel the persimmons, and cut in wedges; if there are any seeds at the core, cut away the cores. Combine with the walnuts, goat cheese and spinach in a salad bowl. 2. Whisk together the lime juice, salt and walnut oil. Toss with the spinach mixture, and serve, sprinkling a tiny amount of fleur de sel over each serving if desired. Yield: Serves four to six. Advance preparation: Don’t toss the salad until you’re ready to serve it, but you can assemble it and keep it in the refrigerator for a few hours. Nutritional information per serving (four servings): 290 calories; 22 grams fat; 5 grams saturated fat; 15 milligrams cholesterol; 20 grams carbohydrates; 5 grams dietary fiber; 106 milligrams sodium (does not include salt added during preparation); 8 grams protein Nutritional information per serving (six servings): 193 calories; 14 grams fat; 3 grams saturated fat; 10 milligrams cholesterol; 13 grams carbohydrates; 3 grams dietary fiber; 71 milligrams sodium (does not include salt added during preparation); 5 grams protein Martha Rose Shulman is the author of “The Very Best of Recipes for Health.” |
| News Analysis: In ‘Daily Show’ Role on 9/11 Bill, Echoes of Murrow Posted: 26 Dec 2010 11:26 PM PST Did the bill pledging federal funds for the health care of 9/11 responders become law in the waning hours of the 111th Congress only because a comedian took it up as a personal cause? Kimihiro Hoshino/Agence France-Presse â€" Getty Images Mr. Stewart declined to comment on the passage of the bill. And does that make that comedian, Jon Stewart — despite all his protestations that what he does has nothing to do with journalism — the modern-day equivalent of Edward R. Murrow? Certainly many supporters, including New York’s two senators, as well as Mayor Michael R. Bloomberg, played critical roles in turning around what looked like a hopeless situation after a filibuster by Republican senators on Dec. 10 seemed to derail the bill. But some of those who stand to benefit from the bill have no doubt about what — and who — turned the momentum around. “I don’t even know if there was a deal, to be honest with you, before his show,” said Kenny Specht, the founder of the New York City Firefighter Brotherhood Foundation, who was interviewed by Mr. Stewart on Dec. 16. That show was devoted to the bill and the comedian’s effort to right what he called “an outrageous abdication of our responsibility to those who were most heroic on 9/11.” Mr. Specht said in an interview, “I’ll forever be indebted to Jon because of what he did.” Mr. Bloomberg, a frequent guest on “The Daily Show,” also recognized Mr. Stewart’s role. “Success always has a thousand fathers,” the mayor said in an e-mail. “But Jon shining such a big, bright spotlight on Washington’s potentially tragic failure to put aside differences and get this done for America was, without a doubt, one of the biggest factors that led to the final agreement.” Though he might prefer a description like “advocacy satire,” what Mr. Stewart engaged in that night — and on earlier occasions when he campaigned openly for passage of the bill — usually goes by the name “advocacy journalism.” There have been other instances when an advocate on a television show turned around public policy almost immediately by concerted focus on an issue — but not recently, and in much different circumstances. “The two that come instantly to mind are Murrow and Cronkite,” said Robert J. Thompson, a professor of television at Syracuse University. Edward R. Murrow turned public opinion against the excesses of Senator Joseph McCarthy in the 1950s. Mr. Thompson noted that Mr. Murrow had an even more direct effect when he reported on the case of Milo Radulovich, an Air Force lieutenant who was stripped of his commission after he was charged with associating with communists. Mr. Murrow’s broadcast resulted in Mr. Radulovich’s reinstatement. Walter Cronkite’s editorial about the stalemate in the war in Vietnam after the Tet Offensive in 1968 convinced President Lyndon B. Johnson that he had lost public support and influenced his decision a month later to decline to run for re-election. Though the scale of the impact of Mr. Stewart’s telecast on public policy may not measure up to the roles that Mr. Murrow and Mr. Cronkite played, Mr. Thompson said, the comparison is legitimate because the law almost surely would not have moved forward without him. “He so pithily articulated the argument that once it was made, it was really hard to do anything else,” Mr. Thompson said. The Dec. 16 show focused on two targets. One was the Republicans who were blocking the bill; Mr. Stewart, in a clear effort to shame them for hypocrisy, accused them of belonging to “the party that turned 9/11 into a catchphrase.” The other was the broadcast networks (one of them being CBS, the former home of Mr. Murrow and Mr. Cronkite), which, he charged, had not reported on the bill for more than two months. “Though, to be fair,” Mr. Stewart said, “it’s not every day that Beatles songs come to iTunes.” (Each of the network newscasts had covered the story of the deal between the Beatles and Apple for their music catalog.) Each network subsequently covered the progress of the bill, sometimes citing Mr. Stewart by name. The White House press secretary, Robert Gibbs, credited Mr. Stewart with raising awareness of the Republican blockade. Eric Ortner, a former ABC News senior producer who worked as a medic at the World Trade Center site on 9/11, expressed dismay that Mr. Stewart had been virtually alone in expressing outrage early on. “In just nine months’ time, my skilled colleagues will be jockeying to outdo one another on 10th anniversary coverage” of the attacks, Mr. Ortner wrote in an e-mail. “It’s when the press was needed most, when sunlight truly could disinfect,” he said, that the news networks were not there. |
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