Thursday, December 9, 2010

Health - Radiation Rules Differ for Humans and Pets

Health - Radiation Rules Differ for Humans and Pets

Radiation Rules Differ for Humans and Pets

Posted: 08 Dec 2010 11:14 PM PST

WASHINGTON — One group receiving treatment for a thyroid disorder is given a radioactive drug that makes the patients a potential hazard to children or pregnant women for several days. Still, doctors usually send them home immediately after treatment.

Yet another group of thyroid patients given the same drug in much smaller doses must be quarantined for two to five days under government rules, until the radiation the patients emit is sharply reduced.

What is the difference? The first group is made up of human patients, and the second is made up of cats and dogs.

In October, Representative Edward J. Markey, Democrat of Massachusetts, complained to the Nuclear Regulatory Commission that its policy on human thyroid patients was creating dilemmas for patients, some of whom are sent home immediately after radiation treatment to households with children or pregnant women.

Now, Mr. Markey is pointing out that the rules are much stricter for house pets, even though they usually get radiation doses 90 percent to 98 percent smaller than the ones given to humans. On Thursday, he plans to ask the commission to revisit the regulations.

“The public is more protected from a radioactive Fluffy than from a radioactive father who receives the very same treatment and is then just sent home,” said Mr. Markey, who is the chairman of a House subcommittee with jurisdiction over the nuclear commission.

“The N. R. C. needs to immediately change its nonsensical policy and act to protect public health instead of industry’s bottom line,” he said.

In an interview, a spokesman for the commission, David McIntyre, acknowledged the disparity in the regulations. Under the commission’s rules, radiation exposure to a person from a human patient is supposed to be limited to 500 millirems per treatment, while the exposure to humans from treated pets should be one-fifth that amount. (By comparison, the average American gets about 360 millirem a year from natural sources.)

But, Mr. McIntyre said, “The higher limit for humans is appropriate because of the benefits to the patient in being able to recover at home in the care and presence of loved ones, and because the risk of exposure to others can be managed by taking appropriate precautions.”

“The lower limit for animals is appropriate because it is more difficult to manage the exposure to humans,” he added.

Most of the radioactive material is eliminated from treated patients, animal or human, via saliva, urine or solid waste.

“With our veterinary patients, I can’t control where they salivate, urinate or defecate,” said Dr. Debra Gibbons, the chief of the nuclear medicine service at Colorado State University’s veterinary teaching hospital in Fort Collins, Colo.

“I can tell you to go to the bathroom,” she added. And humans can be told not to sleep in the same bed with another person, or not to cuddle people who might be vulnerable, including children or pregnant women.

“Animals, especially cats, do not follow directions well,” Mr. McIntyre said.

The difference in rules is obvious to veterinarians who specialize in treating cats, which are prone to thyroid disorders. Dr. David S. Herring, who co-founded Radiocat.com, which has 15 clinics around the country that have administered radioactive iodine to over 40,000 cats, keeps his patients for three to five days, depending on the state.

But when his former wife was treated for thyroid disease with radioactive iodine, she came home immediately, he said, even though the doses given to humans are “astronomically more” than the doses given to cats.

The problem, he added, is that the rules for pets are probably too strict.

“We have had a constant quest for reducing the amount of time the pets had to stay with us,” he said. Some of his patients are old, he said, and have never spent a night away from home. They would recover faster in familiar surroundings.

New York State recently changed its rules on radiation exposure, allowing shorter quarantines for pets if there are no children or pregnant women in the household they will return to.

Dr. Ned Dykes, a veterinary radiologist at the College of Veterinary Medicine at Cornell University, said that 20 years ago, when he began treating cats with radioactive iodine, the rules required that they be quarantined until their urine had the same radiation output “as tap water,” and that this sometimes took weeks.

He said that depending on the age of the people in the household, releasing house pets immediately would be appropriate.

But, Mr. Markey argued, human beings may not always follow directions either. And the divergence in regulations, he said, is “bizarre.”

The standards for people should be made “at least as protective as those that govern the release of cats and dogs,” he said.

Study Finds Setbacks in Women’s Health

Posted: 09 Dec 2010 12:03 PM PST

More women are binge drinking, saying they downed five or more drinks at a single occasion in the past month, and fewer are being screened for cervical cancer. Over all, more women are obese, diabetic and hypertensive than just a few years ago, and more are testing positive for chlamydia, a sexually transmitted disease linked to infertility.

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The latest health report card for women, issued on Thursday by the National Women’s Law Center and Oregon Health and Science University, paints a dismal picture, giving the United States an overall general grade of Unsatisfactory, with many F’s on specific goals set by the government’s Healthy People 2010 initiative.

“The takeaway message is that we’re really not where we should be,” said Dr. Michelle Berlin, an associate professor of obstetrics and gynecology at the Oregon Health and Science University School of Medicine and associate director of the university’s Center for Women’s Health. “We’ve had 10 years of doing this report card, and you would hope the needle would have moved more than it has.”

While screening rates for colorectal cancer and high cholesterol have improved since the last report card was issued in 2007, and fewer women are smoking and dying of stroke or coronary heart disease, obesity continues to be a growing problem, with 26.4 percent of women considered obese, up from 24 percent in 2007. The objective of Healthy People 2010 is to reduce that rate to 15 percent.

“It’s boring but it’s true,” Dr. Berlin said, noting that one-quarter of women are sedentary and get no leisure-time physical activity at all, and that the vast majority do not eat five fruits and vegetables a day.

The report card is the fifth issued since 2000, and it grades and ranks states and the District of Columbia on 26 health-status indicators, depending on how close they came to achieving goals set by the United States Department of Health and Human Services, with more general assessments on dozens of policy indicators, like whether state laws require insurance coverage of mammography or whether their Medicaid program covers smoking cessation.

Vermont and Massachusetts ranked highest on health status and were the only states to get the grade of Satisfactory Minus; Louisiana and Mississippi were 50th and 51st, respectively. New York ranked 22nd, and was among 37 states that drew an Unsatisfactory grade.

California and New Jersey ranked highest on state health policies; Idaho and South Dakota were at the bottom of the list.

Judy Waxman, vice president of health and reproductive rights at the National Women’s Law Center, said the new health care overhaul law had the potential to sharply improve women’s health through its myriad provisions, which expand Medicaid eligibility and bar gender rating on health insurance policies. The sharp increase in binge drinking, a behavior not commonly associated with women, was one of the report’s surprises: More than one in 10 women reported having had five or more drinks on at least one occasion in the last month, up from 6.7 percent in the 2007 report.

“This is very concerning especially when we think about what other things can happen when people engage in binge drinking: there are more sexual-assault problems, they’re more likely to acquire an S.T.D., and more likely to have accidents while driving,” Dr. Berlin said, suggesting the increase might reflect poor mental health and depression resulting from economic insecurity or unemployment.

She was at a loss to explain the drop in cervical cancer screening: 78 percent of women ages 18 to 64 had a pap smear in the last three years, down from 84.8 percent in 2007. The Healthy People 2010 goal is 90 percent.

While the increase in chlamydia infections might simply reflect more women being tested, Dr. Berlin said the drop in cervical cancer screening was disconcerting and might reflect either loss of health coverage or confusion over changing guidelines and the new vaccine (women who have been vaccinated must continue to have pap tests).

Recipes for Health: Pasta With Tomatoes and Beans

Posted: 09 Dec 2010 12:20 AM PST

This pasta is one reason I always keep a few cans of tomatoes and cannellinis in my pantry. Beans contribute protein to this pasta, which makes a great vegan dish if you serve it without the cheese.

Recipes for Health

Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat.

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2 tablespoons extra virgin olive oil

1 small onion, finely chopped

2 garlic cloves, minced

1 14-ounce can chopped tomatoes, with juice

Pinch of sugar

Salt and freshly ground pepper

1 15-ounce can cannellini beans, drained and rinsed

4 sage leaves or basil leaves, cut in slivers (optional)

3/4 pound pasta, any shape

1/4 cup freshly grated Parmesan (optional)

1. Bring a large pot of water to a boil.

2. Meanwhile, heat the olive oil over medium heat in a large skillet or saucepan. Add the onion. Cook, stirring, until tender, about five minutes. Add the garlic, and stir together until fragrant, about 30 seconds. Add the tomatoes with juice and a pinch of sugar. Raise the heat slightly, and cook, stirring, until the tomatoes are bubbling vigorously. Lower the heat to medium-low, and cook gently, stirring and mashing the tomatoes often with the back of your spoon until they have cooked down into a thick, fragrant sauce, 15 to 20 minutes. Stir in the beans and the herbs, and season to taste with salt and pepper. Keep warm.

3. When the pasta water comes to a boil, salt generously and add the pasta. Cook al dente, following the recommendations on the package but checking about a minute before the indicated time. When the pasta is just about done, check to see if the tomato sauce seems dry. If so, add up to 1/4 cup of the pasta water to the pan and stir. Drain the pasta, toss with the sauce and serve, passing the cheese for sprinkling.

Yield: Serves four.

Advance preparation: You can make the sauce several hours ahead of serving.

Nutritional information per serving: 493 calories; 9 grams fat; 1 gram saturated fat; 0 milligrams cholesterol; 86 grams carbohydrates; 7 grams dietary fiber; 431 milligrams sodium (does not include salt added during preparation); 16 grams protein

Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

J.&J. Is Ordered to Pay $1.8 Million in Levaquin Suit

Posted: 08 Dec 2010 06:00 PM PST

A federal court jury has ordered the pharmaceutical company Johnson & Johnson to pay damages of $1.8 million in the case of an 82-year-old Minnesota man who claimed that the antibiotic Levaquin had caused him severe tendon injuries.

John Schedin of Edina was prescribed Levaquin five years ago to treat bronchitis. After three days on the drug, both of Mr. Schedin’s Achilles’ tendons ruptured. In 2008, the Food and Drug Administration required Johnson & Johnson and makers of similar drugs to print warnings about the risk of tendon injuries.

That same year, Mr. Schedin sued Ortho-McNeil-Jansen Pharmaceuticals, the Johnson & Johnson unit that markets Levaquin. The Minneapolis jury on Wednesday decided the drug company must pay Mr. Schedin $700,000 in actual damages and $1.1 million in punitive damages. Actual damages will be reduced by $70,000 under the jury’s finding of 75 percent liability for the company.

The trial was the first of more than 2,600 lawsuits making similar claims.

Washington Rule Makers Out of the Shadows

Posted: 08 Dec 2010 11:30 PM PST

WASHINGTON — Federal rule makers, long the neglected stepchildren of Washington bureaucrats, suddenly find themselves at the center of power as they scramble to work out details of hundreds of sweeping financial and health care regulations that will ultimately affect most Americans.

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In Bethesda, Md., more than 200 health regulators working on complicated insurance rules have taken over three floors of a suburban office building, paying almost double the market rate for the space in their rush to get started.

Executives from the U.S. Chamber of Commerce have been meeting almost daily with financial rule makers to air concerns about regulations they say threaten to curtail commerce.

And at the White House, senior officials receive several status reports a week on a process that all sides agree has vast implications for the country as a whole and for the Obama administration’s political fortunes.

The boom in rule-making — the bureaucratic term for the nitty-gritty of drafting regulations — is a result of the mega-bills approved by Congress this year at the urging of President Obama: the health care bill signed into law in March, and the financial overhaul law signed in July.

“There has never been a period like what we are going through now, in terms of the sheer volume and complexity of rule-making,” said Paul Dennett, senior vice president of the American Benefits Council, a trade group for large employers.

And what was already shaping up as a rancorous lobbying battle over the rules is likely to become more contentious when Republicans take control of the House, having been swept to power on a pledge to influence health care and financial regulation.

At the very least, Republicans will be able to hold public hearings to spotlight financial regulations they see as too restrictive and health care rules they see as too disruptive, and they could pressure regulators to soften them.

The debate over federal spending has already slowed the development of financial rules, as hundreds of new rule-making positions have gone unfilled because of a lack of new financing.

Congress provided a road map for measures aimed broadly at getting more Americans covered by health insurance and providing more federal safeguards against risky financial practices. But the laws were so broad and complex that executive-branch regulators have wide leeway in determining what the rules should say and how they should be carried out.

In all, the bills call for drafting more than 300 separate rules on a rolling schedule by about 2014, plus dozens of other studies and periodic reports. That may be only the beginning. A recent report from the Congressional Research Service said the publication of rules under the health care law could stretch out for decades to come.

Regulators at various agencies are trying to answer questions like these:

¶How much should a credit-card company be able to charge a shopkeeper for administrative fees when you swipe your card for a purchase?

¶Which types of financial companies are so “systemically important” to the overall economy that they should be subject to greater federal oversight?

¶What services must be covered by all insurers as part of the “essential health benefits” package? And at what point would an increase in an insurer’s premiums be considered so “unreasonable” that state and federal regulators could step in?

These and many other questions are now in the hands of government lawyers, doctors, bankers, accountants, actuaries and other regulatory specialists. With the rules spread across agencies, no one is certain how many employees are working on them, but the number is certainly in the hundreds or higher.

At the Federal Reserve, for instance, most of more than 50 lawyers in the legal division are now spending significant parts of their days on rule-making issues, like the question of how to carry out and enforce the so-called Volcker Rule, named for Paul A. Volcker, the former Fed chairman, restricting banks from making certain types of speculative investments.

No longer are these considered arcane questions that draw scrutiny only from the few Washingtonians who read the “notices of proposed rule-making” in the Federal Register.

These days, the rule makers are attracting attention from Congressional officials, industry advocates and lobbyists, with dozens of executives from firms like Goldman Sachs, Mastercard, JPMorgan Chase and Credit Suisse meeting with federal regulators recently to give input on specific rules and try to influence the outcome, according to public online postings by federal regulators on many of the meetings.

“I wake up in the morning thinking about this stuff, and I go to sleep at night thinking about it,” said Tom Quaadman, a senior Chamber of Commerce executive who is leading a group of 10 staff members seeking to shape the financial rules.

The discussions are in the early stages.

But though all sides talk of finding consensus, conflicts have emerged.

The Chamber of Commerce and the Business Roundtable, made up of leading chief executives, are suing the Securities and Exchange Commission, arguing that a rule giving proxy access on corporate boards to small shareholders did not get a proper review and would undermine companies.

When these issues still rested with Congress this year, the chamber spent millions on glitzy advertisements opposing the health care and financial regulation. The chamber does not plan anything so showy as the debate shifts to the regulatory agencies, but is bracing for a long fight filled with low-key meetings and court filings.

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Children’s Hospitals Lose Some Drug Discounts

Posted: 08 Dec 2010 03:30 AM PST

WASHINGTON — In an unintended consequence of the new health care law, drug companies have begun notifying children’s hospitals around the country that they no longer qualify for large discounts on drugs used to treat rare medical conditions.

As a result, prices are going up for these specialized “orphan drugs,” some of which are also used to treat more common conditions.

Over the last 18 years, Congress has required drug manufacturers to provide discounts to a variety of health care providers, including community health centers, AIDS clinics and hospitals that care for large numbers of low-income people.

Several years ago, Congress broadened the program to include children’s hospitals. But this year Congress, in revising the drug discount program as part of the new health care law, blocked these hospitals from continuing to receive price cuts on orphan drugs intended for treatment of diseases affecting fewer than 200,000 people in the United States.

The reason behind the change is murky, though some drug makers had opposed expansion of the drug discount program. The discounts typically range from 30 percent to 50 percent, and children’s hospitals say the change is costing them hundreds of millions of dollars.

Under the new law, hundreds of rural hospitals became eligible for discounts for the first time, but the discounts are not available on orphan drugs, which account for a surprisingly large share of their outpatient pharmacy costs. At the same time, children’s hospitals lost access to discounts on the drugs.

In a typical letter to a children’s hospital, one company, Genentech, said that, because of the new law, it would not offer discounts on certain cancer medicines like Avastin, Herceptin, Rituxan and Tarceva, or on Activase, which is used to dissolve blood clots in heart attack and stroke patients.

Another drug maker, Allergan, cited the new law as a reason for denying discounts on Botox, which, besides removing wrinkles from the face, is used to reduce spasticity in patients with cerebral palsy and other neurological disorders.

Joshua D. Greenberg, vice president of Children’s Hospital Boston, said that loss of the discounts “jeopardizes our ability to care for some of the sickest children with the most complex health care needs.”

Robert A. Nordin, the pharmacy manager at Gillette Children’s Specialty Healthcare in St. Paul, said his hospital was losing hundreds of thousands of dollars’ worth of discounts on drugs like Botox and Rituxan.

Christina M. Barnes, the pharmacy director at Galion Community Hospital in rural Galion, Ohio, said she was excited when her hospital qualified for the discount program earlier his year. But, she said, she was dismayed to learn that many drugs would be excluded.

“We were given an advantage with one hand, and it was taken away with the other hand,” Ms. Barnes said.

William A. Sarraille, a lawyer at Sidley Austin in Washington who represents drug makers, said, “The discounts are huge and can have a very significant, very negative impact on the ability of manufacturers to develop new, better products that meet patients’ needs.”

The Food and Drug Administration classifies more than 350 medicines as orphan drug products. Manufacturers said they could not recover the costs of developing such drugs if they were required to sell them at deeply discounted prices.

A House Democrat who worked on the health care law said the situation had resulted from “an honest mistake in drafting,” and he added, “No one intended to take away any of the drug discounts that children’s hospitals already had.”

The discount program is widely known as the 340B program, after the relevant section of the Public Health Service Act.

Mary K. Wakefield, the administrator of the Health Resources and Services Administration, the federal agency that manages the program, said she shared the concerns of children’s hospitals. “We support a technical correction by Congress that will preserve access to discounted medications for more vulnerable Americans,” Ms. Wakefield said.

The House has voted to restore discounts for children’s hospitals. Similar legislation has been bottled up in the Senate, despite support from Republicans like Senator Scott P. Brown of Massachusetts and Democrats like Senator Sherrod Brown of Ohio. A version of the proposal was included in bipartisan health care legislation unveiled Tuesday by Senate leaders.

When Congress created the drug discount program in 1992, it said the purpose was to enable clinics and hospitals to “stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.”

In a last-minute change sought by some drug manufacturers, Congress stipulated in the new health care law that rural hospitals, children’s hospitals and certain free-standing cancer centers could not get discounts on orphan drugs through the 340B program. Ms. Barnes, at Galion Hospital in Ohio, said: “The list of orphan drugs is small, but it involves big dollars. Many, perhaps most, of our cancer patients receive at least one orphan drug during their treatment.”

Leonard M. Gulino of Cape Elizabeth, Me., said the discount program had substantially reduced the cost of Botox treatments for his son, Gregory, who has had multiple strokes and severe tightening of leg muscles because of a rare disease.

Elimination of the discounts for orphan drugs at children’s hospitals came as a surprise to federal health officials who work on the program. They said they learned of it only after President Obama signed the legislation in March.

Terence J. Hurley, a spokesman for Genentech, said the company was waiting for guidance from federal officials because “there remains significant lack of clarity regarding the orphan drug provisions” of the new law. Allergan and the Biotechnology Industry Organization, whose members produce many orphan drugs, declined to comment.

Drug companies said that the discount program was intended to help hospitals care for the uninsured, and that this need would diminish as millions of the uninsured gained coverage under Mr. Obama’s health care overhaul.

But Ted Slafsky, the executive director of Safety Net Hospitals for Pharmaceutical Access, a nonprofit group, said, “The exemption for orphan drugs undermines the mission and purpose of the drug discount program.”

Elizabeth Edwards, 1949-2010: A Political Life Filled With Cruel Reversals

Posted: 08 Dec 2010 04:23 AM PST

Elizabeth Edwards, who as the wife of former Senator John Edwards gave America an intimate look at a candidate’s marriage by sharing his quest for the 2008 presidential nomination as she struggled with incurable cancer and, secretly, with his infidelity, died Tuesday morning at her home in Chapel Hill, N.C. She was 61.

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Elizabeth and John Edwards in 2007. They separated this year after he admitted to fathering a child in an extramarital affair. More Photos »

Her family confirmed the death, saying Mrs. Edwards was surrounded by relatives when she died. A family friend said Mr. Edwards was present. On Monday, two family friends said that Mrs. Edwards’s cancer had spread to her liver and that doctors had advised against further medical treatment.

Mrs. Edwards posted a Facebook message to friends on Monday, saying, “I have been sustained throughout my life by three saving graces — my family, my friends, and a faith in the power of resilience and hope.” She added: “The days of our lives, for all of us, are numbered. We know that.”

In a life of idyllic successes and crushing reverses, Mrs. Edwards was an accomplished lawyer, the mother of four children and the wife of a wealthy, handsome senator with sights on the White House. But their 16-year-old son was killed in a car crash, cancer struck her at age 55, the political dreams died and, within months, her husband admitted to having had an extramarital affair with a campaign videographer.

The scandal over the affair faded after his disclosure in 2008. But in 2009, Mrs. Edwards resurrected it in a new book and interviews and television appearances, telling how her husband had misrepresented the infidelity to her, rocked their marriage and spurned her advice to abandon his run for the presidency, a decision in which she ultimately acquiesced.

Last January, on the eve of new disclosures in a book by a former political aide, Mr. Edwards admitted he had fathered a child with the videographer. Soon afterward, he and Mrs. Edwards separated legally.

Mrs. Edwards, a savvy political adviser who took on major roles in her husband’s two campaigns for the White House, learned she had a breast tumor the size of a half-dollar on the day after Election Day 2004, when the Democratic ticket — Senator John Kerry of Massachusetts and Mr. Edwards, his running mate from North Carolina — lost to President George W. Bush and Vice President Dick Cheney.

Radiation and chemotherapy appeared to put the cancer into remission. In a best-selling memoir, “Saving Graces: Finding Solace and Strength from Friends and Strangers” (Broadway Books, 2006), Mrs. Edwards chronicled her fight for survival. But in March 2007, with her husband again chasing a presidential nomination, this time against Senators Barack Obama and Hillary Rodham Clinton, Mr. and Mrs. Edwards disclosed that her cancer had returned.

They said it was malignant and in an advanced stage, having spread beyond the breast and lymph nodes into her ribs, hip bones and lungs. It was treatable but “no longer curable,” Mr. Edwards explained. But he said he would continue his bid for the presidency, and Mrs. Edwards said that she, too, would go on with the campaign. “I don’t expect my life to be significantly different,” she declared.

Mrs. Edwards had always been a dominant figure in her husband’s political life. Often called his closest adviser and surrogate, she reviewed his television advertisements and major speeches, helped pick his lieutenants, joined internal debates over tactics and strategy, and sometimes dressed down, or even forced out, campaign aides she thought had failed her husband.

A scathing portrait of Mrs. Edwards’s political role, based mainly on unnamed sources, was presented in “Game Change,” a book by John Heilemann and Mark Halperin published last January. “The nearly universal assessment” among campaign aides, they wrote, “was that there was no one on the national stage for whom the disparity between public image and private reality was vaster or more disturbing.”

Mrs. Edwards’s advanced cancer made her a riveting figure, at times overshadowing the candidate himself. In 2007, she was often mobbed by crowds that saw her as courageous. Inevitably, there were questions about putting their marriage on display. People wondered about their values, or whether they were in denial about the cancer. Some accused them of cynically using her illness for political gain.

But Mr. and Mrs. Edwards were undeterred. While she took a yellow chemotherapy pill once a day, her stamina seemed high, she often carried her own bags and put in 16-hour days, and she showed no signs of the disease: her hair was full, her skin color was robust, and she bustled with energy.

Political consultants said American voters yearned for authenticity and character in a candidate, and thought Mr. Edwards had a singular opportunity. But his aides worried, with some justification, that Mrs. Edwards on a podium was too compelling for his good. At a luncheon in Cleveland, some comments from the audience sounded like paeans to her.

Well: For Women's Health, a Poor Report Card

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The New Old Age: A Few Precious Hours

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Recipes for Health: Pasta With Tomatoes, Capers, Olives and Breadcrumbs

Posted: 07 Dec 2010 09:30 AM PST

Bread crumbs, crisped in olive oil with garlic, make a flavorful addition to just about any pasta. Make your own bread crumbs if you’ve got bread that’s drying out, and keep them in the freezer.

Recipes for Health

Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat.

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3 tablespoons extra virgin olive oil

3 garlic cloves, 2 sliced, 1 minced

1/2 cup fresh bread crumbs

1/4 teaspoon hot red pepper flakes

1 14-ounce can chopped tomatoes, with juice

2 tablespoons capers, rinsed and coarsely chopped

1/2 cup green or black olives, pitted and coarsely chopped (2 ounces)

Salt and freshly ground pepper

3/4 pound spaghetti, preferably a good whole-wheat brand

1/4 cup chopped fresh parsley (optional)

1/4 cup freshly grated Parmesan (optional)

1. Begin heating a large pot of water for the pasta. Meanwhile, combine 2 tablespoons of the olive oil and the sliced garlic over medium-low heat in a medium saucepan or skillet. Cook, stirring often, until the garlic turns golden, about two minutes. Do not let it take on any more color than this. Remove the garlic slices with a slotted spoon and discard, then add the bread crumbs to the pan. Turn the heat to medium, and cook, stirring, until the bread crumbs are crisp. Remove from the heat, and set aside.

2. Return the pan to medium heat, and add the remaining olive oil, the red pepper flakes and the minced garlic. Cook for about 30 seconds until the garlic smells fragrant, and add the tomatoes, capers and olives. Bring to a simmer, and simmer until the tomatoes have cooked down and smell fragrant, 15 to 20 minutes. Season with salt and pepper.

3. When the water comes to a boil, salt generously and add the spaghetti. Cook al dente, following the cooking recommendations on the package but checking about a minute before the suggested time. Drain, and toss with the tomato sauce. Sprinkle the bread crumbs and parsley on top, toss again briefly and serve, passing the Parmesan at the table.

Yield: Serves four.

Advance preparation: You can make the recipe through Step 2 several hours before cooking the pasta. The bread crumbs will keep for a couple of weeks in the freezer. Reheat and crisp in a dry pan over medium heat. The tomato sauce will keep for a few days in the refrigerator.

Nutritional information per serving: 450 calories; 14 grams fat; 2 grams saturated fat; 0 milligrams cholesterol; 70 grams carbohydrates; 10 grams dietary fiber; 718 milligrams sodium (does not include salt added during preparation); 12 grams protein

Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

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