| In Film, Stuttering Symptoms Reflect Current Research Posted: 25 Feb 2011 11:36 AM PST In the Oscar-nominated movie “The King’s Speech,” King George VI begins stuttering at 4 and struggles with it throughout his life. But he rarely talks like the stereotypical stutterer, Porky Pig, rapidly repeating letter sounds; usually the king has trouble getting sounds out from the get-go, blocked by sputtering pauses. His stutter is aggravated by stressful situations, like confronting his brother or addressing the public. He speaks better when playing with his daughters, singing words or inserting profanity, or when music blaring in his ears keeps him from hearing himself. These are complicated symptoms, but experts say these details, devised by a screenwriter who stuttered, mirror many aspects of actual stuttering. In that complexity are clues to this often devastating disorder’s cause, say scientists who are starting to untangle the underpinnings of stuttering in hopes of finding better treatment. Dispelling longstanding misconceptions that the underlying causes of stuttering are language problems or psychological problems like anxiety or trauma, researchers say stuttering is really a speech-production problem: a snag in the cascade of steps that our brains and bodies undertake to move the proper muscles to produce words. “People who stutter have motor difficulties in producing fluent speech,” said Luc De Nil, a speech-language pathologist at the University of Toronto. “They don’t have difficulty developing words or syntax, although they may process language differently. They have difficulty with efficient coordination of motor movements, and speech is such a high-demand fine-motor skill that requires extremely fast sequencing and timing.” Speaking involves brain areas responsible not only for language, but for hearing, planning, emotion, breathing and movement of the jaw, lips, tongue and neck. Anne Smith, a stuttering expert at Purdue University, said that in stutterers, “the generals in the brain, who control soldiers which are the muscles, aren’t sending out the right signals to the soldiers, so they just get all mixed up and run around.” Stuttering, which affects about 5 percent of children, usually begins between age 2 and 6. While about 50 percent of stutterers have family members who stuttered, it is so far impossible to know who will develop it. One of the disorder’s most intriguing characteristics, scientists now say, is that a child exhibits no signs of the disorder until it strikes, usually when talking becomes more complicated. While communication disorders and speech delays may be predicted from a baby’s babble or developmental trajectory, “we really have not been able to find indicators of stuttering before the first day it emerges,” said Nan Ratner, an expert at University of Maryland. “Everything looks fine and suddenly it doesn’t look fine.” The late start contributed to myths that bad parenting could cause stuttering, she said. Stuttering usually begins not with a child’s first words, she said, and “not even with two-word utterances like ‘doggie bark,’ ” but “when you’re starting with the grammar of the language, prepositions and helping verbs and little words of the kind that you leave out” when composing a text message. The complexity of grammar, in fact, seems to be part of the hang-up. Dr. Smith has monitored the brain waves of children watching cartoons in which sentences with meaning errors (“Daddy puts the horse in his coffee”) and grammatical errors are inserted. Stutterers’ brains respond to meaning errors as normal speakers’ brains do, but have a much lower response to grammatical errors, she said. For unclear reasons, boys are twice as likely to stutter, and up to four times as likely to continue stuttering into adulthood. About 75 percent of children eventually stop stuttering, some with therapy and some without, but there is no predicting who will recover. So far, drugs have shown unimpressive results, or caused side effects more severe than the stuttering, and experts say the problem is so complex that a single pill is unlikely to cure all stuttering. Scientists are finding some answers, though. By examining images of the brains of people who began stuttering as children and people who started stuttering after a stroke, Dr. De Nil has found excess activity in areas involved in speech motor control and coordination of the movements needed for speech. |
| Vital Signs: Having a Baby: Stress Doesn’t Hamper Fertility Treatment, Researchers Conclude Posted: 25 Feb 2011 11:32 AM PST Women taking fertility treatments can relax, researchers say: Despite the common wisdom, being worried or tense does not affect one’s chances of becoming pregnant. British researchers reviewed 14 prospective studies from 10 countries covering 3,583 infertile women who underwent a cycle of fertility treatments. Many studies on the subject with widely varying methodologies have been done, but this review, published online in BMJ, considered only those that rated emotional distress before treatment, and compared the rates in women who did and did not become pregnant afterward. There is no question that fertility treatment can be stressful, and according to background information in the article, 30 percent of couples stop treatment because of the psychological burden. But no matter how they looked at the data, the researchers could find no association between high emotional stress and failure of the completed fertility treatment cycle. The authors acknowledge that their review could not exclude the possibility that some biological mechanism connecting stress to fertility might be found using other methods or studying different populations. But the lead author, Jacky Boivin, a professor of health psychology at Cardiff University in Wales, said stress was probably not the problem for women trying to conceive. “Dealing with stress,” she said, “should be more about improving people’s quality of life rather than improving their chances of conception.” |
| Vital Signs: Safety: Wound Care May Matter More Than Antibiotics Posted: 25 Feb 2011 10:05 AM PST Preventing infection in a wound may depend less on choosing the right antibiotic than on simply keeping it clean. Researchers writing in the March issue of Pediatrics studied 200 children ages 6 months to 18 years. Each had a skin infection (generally from allergies, diaper rash or eczema), and 137 tested positive for methicillin-resistant staphylococcus, or MRSA. The subjects were randomly assigned to receive either clindamycin, an antibiotic that is effective against MRSA, or cephalexin, one that is less active against it. The choice of antibiotic made no difference. After two to three days, 97 percent of the children on clindamycin showed improvement or complete healing, and so did 94 percent of those on cephalexin. Of the nine children whose infections were worse at this point, three were on clindamycin and six on cephalexin, an insignificant difference. There was a significantly lower rate of improvement among children under a year old, no matter which drug they were given. The lead author, Dr. Aaron E. Chen, an assistant professor of pediatrics at Johns Hopkins when the study was done (he is now at the University of Pennsylvania), said he was not prepared to conclude that antibiotics are useless in treating these skin infections. But he added: “The most important part is good wound care, drainage of lesions and close follow-up. Antibiotics are probably not as important as we think they are, but we need larger studies to answer that question.” |
| Recipes for Health: Red and Black Rice With Leeks and Pea Tendrils Posted: 25 Feb 2011 12:30 AM PST I made this on impulse when I found pea tendrils at the farmers’ market this week, but you don’t have to put aside the recipe until spring brings them to your markets — use baby spinach instead. The dish is inspired by a recipe for farro and black rice with pea tendrils from Suzanne Goin’s “Sunday Suppers at Lucques." Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. 3 tablespoons extra virgin olive oil 2 leeks, white and light green parts only, halved lengthwise, cleaned and sliced thin Salt to taste 2 teaspoons thyme leaves 3 cups cooked Wehani rice or Bhutanese red rice 1 cup cooked black rice, either Japonica or Chinese black rice 1 6-ounce bunch pea tendrils, ends trimmed, washed and spun dry, or 1 6-ounce bag baby spinach Salt and freshly ground pepper 1. Heat 2 tablespoons of the olive oil over medium heat in a large, heavy skillet, and add the leek and a pinch of salt. Cook, stirring, until the leeks soften, about three minutes. Stir in the pea tendrils or spinach. Cook, stirring, until they wilt, about three minutes for pea tendrils and one minute for baby spinach. Season to taste. Add the thyme, the remaining olive oil and rice, and stir until the mixture is combined. Season with freshly ground pepper, adjust salt and serve. Yield: Serves four to six. Advance preparation: The dish will keep for three to four days in the refrigerator and can be frozen. Nutritional information per serving (four servings): 354 calories; 2 grams saturated fat; 2 grams polyunsaturated fat; 8 grams monounsaturated fat; 0 milligrams cholesterol; 59 grams carbohydrates; 5 grams dietary fiber; 48 milligrams sodium (does not include salt to taste); 7 grams protein Nutritional information per serving (six servings): 236 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 0 milligrams cholesterol; 39 grams carbohydrates; 4 grams dietary fiber; 32 milligrams sodium (does not include salt to taste); 5 grams protein Martha Rose Shulman is the author of “The Very Best of Recipes for Health.” |
| Change in Kidney Transplant Policy Would Favor Younger Patients Posted: 25 Feb 2011 12:40 AM PST Younger patients would be more likely than older ones to get the best kidneys under a proposal being considered by the nation’s organ transplant network. The new policy would replace the present first-come-first-served system and is intended to provide better matches between the life expectancies of recipients and the functional life of donated kidneys. “Right now, if you’re 77 years old and you’re offered an 18-year-old’s kidney, you get it,” said Dr. Richard N. Formica, a transplant surgeon at Yale University and a member of the panel that wrote the proposed policy. “The problem is that you’ll die with that kidney still functioning, while a 30-year-old could have gotten that kidney and lived with it to see his kids graduate from college.” Under the proposal, patients and kidneys would each be graded, and the healthiest and youngest 20 percent of patients and kidneys would be segregated into a separate pool so that the best kidneys would be given to patients with the longest life expectancies. The remaining 80 percent of patients would be put into a pool from which the network that arranges for organ matches, called the United Network for Organ Sharing, would try to ensure that the age difference between kidney donors and recipients is no more than 15 years. While the proposal is widely supported by transplant surgeons and medical ethicists, it faces an uncertain reception by kidney transplant patients and legislators. A previous proposal to better match the health of patients and donor kidneys was scrapped in 2005 after the network was flooded with negative comments. The network is hoping that this effort, which relies on a less complex formula than the earlier one, will get a better reception. News of the latest proposal was first reported in The Washington Post. |
| The Texas Tribune: As Mental Health Cuts Mount, Psychiatric Cases Fill Jails Posted: 24 Feb 2011 09:00 PM PST Dressed in an orange Harris County Jail-issued jumpsuit, Sterling Shepherd sat at a metal picnic table and described what got him into this situation — again.  Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go to texastribune.org. Todd Wiseman/The Texas Tribune Christopher Ajayi, a psychiatric technician, makes his rounds at the jail, which has a special unit with 108 beds for the severely mentally ill. “I’m extremely mentally ill and extremely intelligent,” said Mr. Shepherd, a 43-year-old with intense brown eyes and a big grin. During a 12-minute interview on Feb. 15, Mr. Shepherd veered in and out of reality, talking at times lucidly about taking medication for his severe bipolar disorder and at others describing how Vice President Joseph R. Biden Jr. spoke to him through the television and explaining that Pope Benedict XVI is his grandfather. It was Mr. Shepherd’s eighth stay at the Harris County Jail, a Houston facility the size of two football fields that houses more than 10,000 inmates. He is one of about 2,400 inmates taking psychotropic medications. The jail is the largest mental institution in the state. It has a special unit with 108 beds for the severely mentally ill, where guards wear less-intimidating uniforms, nurses are on duty 24 hours a day and inmates undergo intensive psychiatric treatment. “We’ve done everything we can do to make it therapeutic,” said Sgt. Bernard Kelly, a supervisor in the jail’s mental health unit. Some inmates say it is the best mental health care available to them in Houston, and it costs the county about $27 million a year. Harris County officials have seen the number of mentally ill inmates explode since 2003, the last time Texas had a budget crisis and made major cuts. Then, there were fewer than three full-time psychiatrists at the jail. Now, there are more than 15. Often they see the same mentally ill inmates repeatedly. “It just becomes a chronic cycle,” said Sylvia Muzquiz-Drummond, medical director of the mental health division of the Mental Health and Mental Retardation Authority of Harris County. As lawmakers consider deeper cuts this year to deal with a budget shortfall estimated at $15 billion to $27 billion, jail officials across Texas are deeply concerned that proposed reductions in community-based mental health treatment will worsen the problem. Without resources in the community, more mentally ill Texans are likely to end up on the streets, in emergency rooms and behind bars, and it will cost local taxpayers even more to care for them. “We can’t not respond,” said Dr. Michael Seale, executive director of health services at the Harris County Sheriff’s Office. “We can’t not put people in jail.” Although he disdains the idea of further cutting mental health funding, Representative Garnet Coleman, Democrat of Houston, said lawmakers who are determined to close the budget gap without raising taxes have few other options when it comes to reducing health care expenditures. “Unfortunately for mental health, at this moment, there isn’t an alternative,” Mr. Coleman said. State lawmakers are considering proposals that would reduce community-based health care services for adults and children and for community mental hospitals by about $152 million in 2012 and 2013. It is roughly a 20 percent reduction in financing from the previous two-year budget. For community mental hospitals, financing would fall about 3 percent, but the money would be split among five facilities instead of three. By 2006, Texas already ranked 50th among the states in per capita spending on mental health care, according to the Henry J. Kaiser Family Foundation. The strained budget allows the Harris County mental health agency to serve only about 25 percent of the adults in need and about 18 percent of the children, said Betsy Schwartz, president and chief executive of Mental Health America of Greater Houston. Currently, about 2,000 people with schizophrenia, bipolar disorder and serious clinical depression are on the agency’s waiting list. “We’re already talking about a system that was hemorrhaging,” Ms. Schwartz said, adding that in Houston alone, the proposed cuts would mean up to 2,000 of the 8,500 adults who now receive community-based services would be turned away. Cutting those services would take a devastating human toll, Ms. Schwartz said, and at an enormous financial cost. When people with untreated mental health problems fall into crisis, it is much more expensive to provide care in an emergency room, jail or crisis center. The Harris County Neuropsychiatric Center saw a 45 percent increase in crisis patients entering the center from 2008 to 2010, she said. Every time a patient walks into the center in crisis, it costs $800 to perform an initial exam, Ms. Schwartz said. By comparison, it costs about $12 a day for community-based mental health care services. “It’s not like people are going to disappear and the needs are going to go away,” she said. “It may shift the burden from state dollars to county dollars.” Patty Wood knows that she would probably be back in jail without the community-based services that help her stay on medication. “I’ve been incarcerated a lot, because it’s illegal to self-medicate,” said Ms. Wood, 48, who has bipolar and schizoaffective disorders. As of last week, though, Ms. Wood had been clean for about seven months with the help of mental health agency. She is hopeful she can get a job and end the incarceration cycle. “I’m just a person trying to make it,” she said. Mr. Shepherd, who landed back in jail on Super Bowl Sunday after he attacked a staff member at the Harris County Psychiatric Center, said he hoped that this stint behind bars would be his last. The jail psychiatrist, he said, is adamant that he take his medication. And the jail staff said last week that Mr. Shepherd was more stable than when they had seen him in the past. If he can get help and keep taking his medications on the outside, Mr. Shepherd said, he thinks he can stay stable. “I’m praying to the Lord Jesus Christ not to come back,” he said. Jail officials and mental health providers are praying, too, that all the work they have done to help people like Mr. Shepherd and Ms. Wood is not undone by state lawmakers’ budget decisions. If community-based services are not around to help, said Sergeant Kelly, who has worked in the Harris County Jail for more than a decade, he knows he will see them again. “We let them out the door only to crash and burn,” he said. “We’re setting them up for disaster.” bgrissom@texastribune.org |
| Skin Deep: Tattoos as Makeup? Read the Fine Print Posted: 23 Feb 2011 09:37 PM PST AURI REYNOSO, a hairstylist in Englewood, N.J., says she wanted to roll out of bed “looking beautiful.” So three years ago, she asked Melany Whitney, a certified permanent-cosmetics professional based in New York, New Jersey and Florida, to tattoo eyeliner and defined brows onto her face. Chip Litherland for The New York Times Shots at John Hashey’s Advanced School of Permanent Cosmetics. Chip Litherland for The New York Times Mr. Hashey. Chip Litherland for The New York Times A client studies her permanent eye shadow. James Leynse for The New York Times (left); Heidi Schumann for The New York Times (right) Auri Reynoso, left, is pleased with her permanent makeup application. Nancy Erfan, right, had a bad reaction a few years ago. Though the procedure was “a little uncomfortable,” said Ms. Reynoso, now 39, she was delighted with the results. “Everything for beauty,” she said. “It’s amazing how you can wake up looking absolutely fabulous and get ready in five minutes. I just apply blush, lip gloss and mascara and I’m done.” Permanent makeup, also known as micropigmentation or cosmetic tattooing, dates back to the early 1980s, when it was developed to address alopecia, a condition that causes hair loss (including eyebrows). Since then, the field has expanded to include burn victims and cancer survivors, patients with arthritis and Parkinson’s disease who have difficulty putting on makeup and people like Ms. Reynoso, who would simply rather limit the amount of time spent in front of a mirror. But while many are thrilled with their outcomes, all is not rosy in the world of needles and ink. The word “permanent” is a misnomer because the color fades with time. Some patients develop granulomas, keloids, scars and blisters, and they report burning sensations when they undergo an M.R.I. What’s more, although the inks used in permanent makeup and the pigments in these inks are subject to the scrutiny of the Food and Drug Administration, regulations for practitioners (electrologists, cosmetologists, doctors, nurses and tattoo artists) vary by state. “You can go on eBay and buy machines and pigment and go in the garage and set up shop,” said Dr. Charles Zwerling, an ophthalmologist in Goldsboro, N.C., and an author of the forthcoming book “Micropigmentation Millennium.” He founded the American Academy of Micropigmentation, a nonprofit professional organization that offers certification for practitioners, in 1992. “We see thousands of faces being destroyed by people who don’t get trained properly, and that’s the biggest problem in permanent cosmetics,” said John Hashey, the owner of John Hashey’s Advanced School of Permanent Cosmetics in Oldsmar, Fla. Mr. Hashey said that 90 percent of his business is fixing mistakes. “Your average cosmetologist who cuts hair has to do 1,200 to 1,500 hours just to do that,” he said. “How is that any more important than taking a needle to someone’s eye?” The adverse reactions to micropigmentation include infections like H.I.V., hepatitis, staph and strep from dirty needles, and allergic reactions to the permanent dyes, said Dr. Jessica J. Krant, a dermatologist in Manhattan and an assistant clinical professor of dermatology at the SUNY Downstate Medical Center in New York. A report in this month’s issue of Clinical Infectious Diseases reported an outbreak of mycobacterium haemophilum, a nontuberculous mycobacterium that causes skin, joint, bone and pulmonary infections, after permanent makeup was applied to patients’ brows. A study last September in Contact Dermatitis, a medical journal, investigated severe adverse reactions like swelling, burning, and the development of papules in four patients who had had at least two permanent-makeup procedures on their lips. “In light of the severe and often therapy-resistant skin reactions, we strongly recommend the regulation and control of the substances” used in the colorants, the authors wrote. Nancy Erfan, a real estate agent in Monterey, Calif., had a bad experience. In November 2003, Ms. Erfan, now in her 30s, had permanent color applied to her lips and eyes. The technician told her she would be swollen for a few days, and gave her a cream to help. But the swelling worsened, Ms. Erfan said, and soon she had “big bumps” around her eyes and lips. “I could barely open my mouth to eat or speak,” she said. She visited a variety of dermatologists and plastic surgeons, but found no remedy. “They said I was obviously having an allergic reaction, but they didn’t know what to do.” It turned out that the colors used in one of the dyes by Premier Pigments, a manufacturer, was tainted; after the F.D.A. received more than 150 complaints, the company eventually recalled the entire line. Finally Ms. Erfan found Dr. Mitchel Goldman, a dermatologist in San Diego who specializes in laser removal of tattoos. He did six treatments over a year, for a total of about $10,000, which insurance did not cover. Acupuncture and Chinese herbal medicine helped with facial pain and swelling, she said. Dr. Goldman would like greater F.D.A. supervision of permanent makeup. “I’ve had patients who have infections on their lips and eyebrows because these tattoo artists are totally not regulated,” he said. “They use equipment that’s not sterile. A lot of infections also come from the tap water. They dip their needles in and transfer infections. The pigment goes to lymph nodes. Who knows if 20 years down the line patients will have lymphoma or cancer because of these carcinogens in tattoo pigment?” Mr. Hashey thinks practitioners should be regulated nationally and required to get 600 to 1,500 hours of training. Elizabeth Finch-Howell, the owner and founder of Derma International, a permanent cosmetics manufacturer in Kempton, Pa., believes a minimum of 100 hours is enough. (She got a tattoo that matched her skin tone to cover up a port-wine colored birthmark on half of her face, performing the procedure herself because “I didn’t trust anyone else,” she said.) As for Ms. Erfan, she is still angry, years later. It took her more than a year and a half to recover, she said, and she still has scars on her lips. She must wear makeup to cover the scars and white lines above her mouth, and the facial pain persists. “Applying makeup is one thing, but injecting it into your body? I feel stupid,” she said. “But everything I read about permanent makeup was positive, how even Cleopatra was tattooing her eye liner and lip liner. I thought it was safe.” |
| U.S. Presses Tobacco Firms to Admit to Falsehoods About Light Cigarettes and Nicotine Addiction Posted: 23 Feb 2011 10:11 PM PST A federal judge on Wednesday unsealed a government proposal that outlines what it wants tobacco companies to say in national advertising and on cigarette packages — that they lied to the American public about so-called light cigarettes and the addictiveness of nicotine. Judge Gladys Kessler of the United States District Court in Washington denied a request by the tobacco companies that the recommendations, by the Justice Department, be kept secret until they submitted a response. The so-called corrective statements were ordered as part of a civil racketeering judgment in 2006 in which Judge Kessler ruled against the tobacco companies, saying they had lied for 50 years. The statements are to appear in newspaper and magazine advertising and in attachments to cigarette packages. Judge Kessler is also deciding how the advertisements should be displayed at retail outlets. She is expected to set a schedule Thursday for the response from the companies and her decision. The Justice Department’s proposed statement are blunt, and are being met with stiff resistance from the tobacco companies. One would have the tobacco companies buy ads saying in part: “We falsely marketed low tar and light cigarettes as less harmful than regular cigarettes to keep people smoking and sustain our profits. We knew that many smokers switch to low tar and light cigarettes rather than quitting because they believe low tar and lights are less harmful. They are NOT.” Another would say in part: “We told Congress under oath that we believed nicotine is not addictive. We told you that smoking is not an addiction and all it takes to quit is willpower. Here’s the truth: Smoking is very addictive. And it’s not easy to quit. We manipulated cigarettes to make them more addictive.” Philip Morris USA, the largest United States tobacco company, said on Wednesday that the government’s proposals “go beyond factual and scientific information.” The company, which makes Marlboro cigarettes and is owned by the Altria Group, signaled it would appeal to higher courts if necessary. “The Department of Justice proposal would compel the companies to admit wrongdoing under threat of contempt,” Murray Garnick, Altria associate general counsel, said in a statement. “Such a proposal is unprecedented in our legal system and would violate basic constitutional and statutory standards.” The tobacco companies will be proposing their own versions for the judge to consider. |
| A Suicide, a Last Request, a Family’s Questions Posted: 23 Feb 2011 07:47 AM PST SUNNY ISLES BEACH, Fla. — The words came up on Alicia Duerson’s cellphone as blithely as text messages typically do, but this one was different: her former husband, the former Chicago Bears star Dave Duerson, asked her to donate his brain for research. 
The latest news, notes and analysis of the N.F.L. playoffs. Marc Serota for The New York Times In a suicide note, Dave Duerson repeated an earlier request he made in text messages to have his brain donated for research. She texted back and heard nothing, then called their son, Tregg, who was just ending his workday as a bank analyst in Chicago. They called again and got voice mail. The next and last message they received from Dave Duerson was meant for them, their family and perhaps all of professional football. It was written in his hurried hand, repeating his text message in case it had not been received, and found in the South Florida condominium where he placed a gun to his chest and shot himself to death last Thursday. “Please, see that my brain is given to the N.F.L.’s brain bank.” Alicia and Tregg Duerson cannot know and do not care to guess what his intentions were in this final request. What they do know is that, they said, it brings them some solace in a sad and confusing time. “I think it’s just an example of the type of person he is,” Alicia Duerson said. “In his time, he put the future in front of him — future generations of football players in front of him. I’m just so proud of him at this moment.” His family said that Duerson, the 50-year-old former Bears safety who graduated from Notre Dame, had been finding it hard to remember names and to put words together. They described a devoted father of four who had spent countless hours with the football players union, where he became familiar with the plight of retired players dealing with physical decline and dementia. Sitting with his mother on the deck of his father’s building Monday night, Tregg Duerson sobbed. “He was looking for an answer,” Tregg said. “And he was hoping to be a part of an answer.” The pertinent question is whether Duerson had chronic traumatic encephalopathy, the degenerative brain disease recently found posthumously in about 20 retired players, a disease that has been linked to depression, cognitive impairment and occasionally suicide. That determination will be made over the next several months by doctors at the Boston University Center for the Study of Traumatic Encephalopathy, who recently began receiving financial support from the N.F.L. The broader issue, given the growing number of football players developing dementia or other cognitive problems, is what the cost of football will eventually be for generations of retired players, and how the game might be made safer for active players, from professionals to children’s leagues. Duerson’s final letter, consisting mostly of personal comments that relatives declined to make public, did describe blurred vision and pain, Alicia Duerson said, “on the left side of his brain.” The implication, by pledging his brain to research, was that his problems, and perhaps his suicide as well, stemmed from his football career. “I would have to guess it was a statement about football and its impact on the brain,” said Robert Smith, a former N.F.L. running back, who served with Duerson on the panel that considers former players’ disability claims. “It had to be. And, his belief that it contributed to his final despair.” A hard-hitting but nimble defensive back from Muncie, Ind., Duerson was an all-American at Notre Dame and a two-time Super Bowl champion, first as part of the 1985 Bears’ famed 46 defense, then five years later with the Giants. He met Alicia during his freshman year at Notre Dame; they divorced last year. “He was hitting so strong and hard, and he was so aggressive as a defensive back that after the game I was really afraid to go up to him,” she said of their first meeting, after a Notre Dame football game. “He was like: ‘What’s wrong with you? Come over here, let me give you a hug.’ He was so sweet and kind. He could leave the game on the field and go back to being Dave.” When Duerson left the field for good after the 1993 season with the Arizona Cardinals, he was succeeding in the food service business. He also stayed active in players union affairs. Duerson eventually joined the six-man volunteer panel that considered retired players’ claims under the N.F.L.’s disability plan, in addition to the 88 Plan, a fund that has assisted more than 150 families caring for retired players with dementia since its inception in 2007. Duerson read applications, testimonies and detailed doctors’ reports for hundreds of players with multiple injuries, including those to the brain that in some cases left players requiring full-time care. He had to vote on whether these people received financial assistance. In 2007, two Congressional committees held hearings into whether the disability board was unfairly denying benefits. Duerson testified before the Senate Commerce Committee alongside Brent Boyd, a former Minnesota Vikings lineman whose depression and cognitive impairment had been ruled unrelated to his playing career, therefore warranting significantly lower benefits. It is unknown how Duerson voted on Boyd’s case. He did get into a testy exchange when Boyd, then 50, asserted that his condition — and that of other players with dementia — was caused by football. “In regards to the issue of Alzheimer’s, my father’s 84, and, as I had mentioned earlier, Senator, spent 30 years at General Motors,” Duerson said, according to the hearing transcript. “He also has — he also has Alzheimer’s and brain damage, but never played a professional sport. So, the challenge, you know, in terms of where the damage comes from, is a fair question.” Around this time, Duerson’s life began changing course. His company, Duerson Foods, was forced into receivership. His 17-room home in Highland Park, Ill. — the one with “NFL22” carved on a driveway pillar — went into foreclosure. He pleaded guilty to a misdemeanor domestic-battery charge after pushing Alicia during an argument, leading him to resign from Notre Dame’s board. Duerson filed for personal bankruptcy last September. |
| A Third Judge Validates Health Care Overhaul Law Posted: 23 Feb 2011 07:59 AM PST A third federal judge upheld the constitutionality of the Obama health care law on Tuesday, reinforcing the divide in the lower courts as the case moves toward its first hearings on the appellate level. Judge Gladys Kessler of Federal District Court for the District of Columbia became the third appointee of President Bill Clinton, a Democrat, to reject a constitutional challenge to the Affordable Care Act. Two other federal district judges, both appointed by Republican presidents, have struck down the law’s keystone provision, which requires most Americans to obtain health insurance starting in 2014. One of those judges, in a case filed in Florida, ruled that the rest of the law could not be severed from that provision, and suggested that the entire act was therefore invalid. The Justice Department, which represents the Obama administration in the cases, has asked the judge for clarification of his ruling, which left states confused about whether to continue carrying out the law. Although the issue will almost certainly be determined by the Supreme Court, each lower court ruling contributes to the balance of legal opinion that the justices will consider. More than 20 challenges to some aspect of the sprawling act have been filed around the country. Oral arguments in the first appellate reviews are scheduled for May and June. The District of Columbia case was filed by five individuals represented by the American Center for Law and Justice, a conservative Christian legal group. Judge Kessler adopted the government’s position on whether Congress’s authority to regulate interstate commerce is so broad that it can require people to buy a commercial product. Past Supreme Court decisions have established the standard that Congress can control “activities that substantially affect interstate commerce.” The judge suggested in her 64-page opinion that not buying insurance was an active choice that had clear effects on the marketplace by burdening other payers with the cost of uncompensated medical care. “Because of this cost-shifting effect,” she wrote, “the individual decision to forgo health insurance, when considered in the aggregate, leads to substantially higher insurance premiums for those other individuals who do obtain coverage.” Judge Kessler added: “It is pure semantics to argue that an individual who makes a choice to forgo health insurance is not ‘acting,’ especially given the serious economic and health-related consequences to every individual of that choice. Making a choice is an affirmative action, whether one decides to do something or not do something.” The judge also tossed out a claim that the law restricted the plaintiffs’ exercise of religious freedom because the mandate to buy health insurance conflicted with their belief that God would provide for their well-being. She wrote that such a burden, if it existed at all, was too minor to require invalidation of the law. This posting includes an audio/video/photo media file: Download Now |
| Justices Reject Suit Faulting a Vaccine Posted: 22 Feb 2011 10:11 PM PST WASHINGTON — People injured by vaccines that they say were improperly designed must rely solely on a compensation system created by a 1986 law and may not sue vaccine manufacturers, the Supreme Court ruled on Tuesday. The vote was 6 to 2. Justice Elena Kagan recused herself because of her work on the case as United States solicitor general. Justice Antonin Scalia, writing for the majority, said Congress had meant to establish a societal bargain in the 1986 law. “The vaccine manufacturers fund from their sales an informal, efficient compensation program for vaccine injuries,” he wrote. “In exchange they avoid costly tort litigation and the occasional disproportionate jury verdict.” In a vigorous dissent, Justice Sonia Sotomayor accused the court majority of imposing “its own bare policy preference over the considered judgment of Congress” depriving “vaccine-injured children of a key remedy that Congress intended them to have.” The issue in the case was whether the compensation system created by the 1986 law displaced, or pre-empted, ordinary injury suits brought under state law. The Roberts court has been hearing many pre-emption cases under other laws, and decisions on ones concerning immigration, arbitration and seat belts are expected this term. The case before the court, Bruesewitz v. Wyeth, No. 09-152, was brought by the parents of Hannah Bruesewitz, who received a vaccine known as D.T.P. as an infant in 1992. The vaccine offers protection against diphtheria, tetanus and pertussis, or whooping cough. She suffered seizures and has had developmental problems and seizure disorders since. Ms. Bruesewitz’s parents filed a petition under the compensation program created by the 1986 law. They lost, on the ground that they had not proved that the vaccine caused their daughter’s injuries. Then they sued in state court in Pennsylvania. The case was moved to the federal courts, which have ruled that their claims are pre-empted by the 1986 law. The case turned on the proper interpretation of a provision of the law that bars ordinary lawsuits “if the injury or death resulted from side effects that were unavoidable even though the vaccine was properly prepared and was accompanied by proper directions and warnings.” Justice Scalia acknowledged that “Congress could have more tersely and more clearly pre-empted design-defect claims.” But he said the meaning of the passage was not in doubt. “If a manufacturer could be held liable for failure to use a different design,” Justice Scalia wrote, “the word ‘unavoidable’ would do no work.” Chief Justice John G. Roberts Jr. and Justices Anthony M. Kennedy, Clarence Thomas, Stephen G. Breyer and Samuel A. Alito Jr. joined the majority opinion. Justice Breyer also wrote a separate concurrence. “The textual question considered alone is a close one,” he said. But other factors — the drafting history and purpose of the law, the views of a federal agency and “expert medical opinion” — supported the majority’s conclusion, Justice Breyer wrote. Allowing a jury to make decisions about vaccine design, he said, would “substitute less expert for more expert judgment.” Justice Sotomayor, joined by Justice Ruth Bader Ginsburg, said the majority opinion “disturbs the careful balance Congress struck between compensating vaccine-injured children and stabilizing the childhood vaccine market.” Justice Sotomayor said she understood the word “unavoidable” differently in the context of the law than Justice Scalia did. She said it indicated that Congress must “have intended a vaccine manufacturer to demonstrate in each civil action that the particular side effects of a vaccine’s design were ‘unavoidable.’ ” The effect of Tuesday’s decision, Justice Sotomayor continued, was to leave “a regulatory vacuum in which no one ensures that vaccine manufacturers adequately take account of scientific and technological advancements when designing or distributing their products.” In a final footnote, Justice Sotomayor wrote that a concern about an asserted link “between certain vaccines and autism spectrum disorders” appeared to “underlie the majority and concurring opinions in this case.” Wyeth, the defendant in the case, had told the justices that some 5,000 pending petitions concerned autism-related injuries and that it feared a “crushing wave” of litigation. Justice Sotomayor said she discounted those “doomsday predictions.” In any event, she said, “Congress intended to leave the courthouse doors open for children who have suffered severe injuries from defectively designed vaccines.” |
| The Doctor’s World: When Alzheimer’s Waited Outside the Oval Office Posted: 21 Feb 2011 10:09 PM PST WASHINGTON — Ron Reagan’s new memoir, “My Father at 100,” has touched off sensational headlines with its suggestion that President Ronald Reagan might have begun showing hints of Alzheimer’s disease while still in the White House. Bob Galbraith/Associated Press MENTAL STATE A memoir has rekindled debate about Ronald Reagan. Shayna Brennan/Associated Press MISUNDERSTANDING Ron Reagan says he never meant to suggest in his memoir that his father, here in 1994 with his wife, Nancy, had dementia while in the White House. But in two interviews this month, the younger Mr. Reagan said he never meant to suggest that his father had dementia before leaving office in 1989. And he graciously took the blame for not being more explicit in a passage that described a few personal observations along with comments from the former president’s doctors. A “rather small section of the book has attracted outsize attention,” he said in a telephone interview from Seattle, where he lives. All he meant, he continued, was that the amyloid plaque characteristic of Alzheimer’s can start forming years before it leads to dementia. The former president’s diagnosis was made in 1993, four years after he left office. “Given what we know about the disease,” his son told me, “I don’t know how you could say that the disease wasn’t likely present in him during the presidency.” Had it been stated that way, the assertion about Alzheimer’s would have stirred little if any debate. Still, the issue is important for anyone — including candidates for office — because of the difficulty of distinguishing the initial symptoms of Alzheimer’s from, say, simple forgetfulness. The disease occurs most frequently after 70, but it can strike younger people. Dr. Alois Alzheimer, a German psychiatrist, diagnosed the first case in a 51-year-old woman. It is now recognized as one of a number of types of dementia. And diagnosing it with certainty requires a brain biopsy, rarely done while a patient is still alive. Mr. Reagan’s mental state was an issue even before he became the oldest man elected president, at 69, in 1980. Adversaries were fond of attributing his penchant for contradictory statements, forgetting names and general absent-mindedness to Alzheimer’s. I reported on Mr. Reagan’s health, and he told me that his mother, Nelle, had died of senility — and that if he were to develop it in office he would resign. As a follow-up to questions about Alzheimer’s, my extensive interviews with his White House doctors, key aides and others, I found no evidence that Mr. Reagan exhibited signs of dementia as president. The interviews did not include family members. Moreover, until Ron Reagan’s memoir appeared, no other family member — and not Edmund Morris, the official biographer who spent seven years with Mr. Reagan in the White House — publicly hinted that he showed evidence of Alzheimer’s as president. “My Father at 100” (Viking) is an affectionate, often lighthearted account of a son’s attempt to uncover his father’s character by going back to his early days. It is generally well written, except for portions of the closing chapter about Alzheimer’s — which Ron Reagan acknowledged were flawed because he “relied on memory” without checking facts about when and where the suspicion of his father’s Alzheimer’s was first raised. He writes, for example, that after the former president fell from a bucking horse in Mexico in 1989, his doctors detected probable signs of Alzheimer’s in removing a blood clot that formed between his skull and brain. But such a procedure does not involve a brain biopsy that doctors would need to diagnose dementia. Moreover, Mr. Reagan was flown to a military hospital near Tucson — not taken to San Diego, as his son writes — and the blood clot, a subdural hematoma, was removed weeks later at the Mayo Clinic in Rochester, Minn. In the interviews, Ron Reagan genially acknowledged the errors and said that if he had anticipated the controversy he created, he “would have done more due diligence in terms of pinning down dates.” When his father was president, Mr. Reagan, then a professional dancer with the Joffrey Ballet, visited him two or three times a year. Now 52, the younger Reagan has been a radio and television talk show host, commentator and magazine writer. In the book, he writes that he did not want his father to run for a second term, partly because of political differences (Ron has long been liberal) and partly because of his concern about Mr. Reagan’s health — not the possibility of Alzheimer’s, but the near-fatal gunshot wound he sustained in a 1981 assassination attempt. Understandably, the son’s memories about his father’s Alzheimer’s focused on when it first produced symptoms. The anecdotes that he cites are either well known or lack convincing evidence for Alzheimer’s. For example, he recounts the 1984 re-election campaign, when his father performed dismally as he floundered through his responses and was lost for words in his first debate with his opponent, Walter F. Mondale. But Mr. Reagan performed well in the second debate, 11 days later. While spending a day in the Oval Office in 1987, the younger Reagan noticed that aides were providing his father with scripted index cards — a technique he often used when giving speeches — for phone calls lasting five minutes at most, implying signs of a failing memory. But in an interview, Mr. Reagan said it was “hard to know what to make of that” — and laughed as he said he was using similar notes in our conversation. The son noted little things that he could not explain and to which he did not attach a name at the time. Based on knowing his father’s demeanor and cognition over a lifetime, the observations created an impression “that something was amiss.” But, he wrote, he did not want to leave an impression that his “father was catatonic or mumbling incoherently” at any period in the White House. |
| Studying Aging, and Fearing Budget Cuts Posted: 21 Feb 2011 09:45 PM PST Dr. Richard J. Hodes presides over the nation’s prime source of grants for studies of aging at a worrisome time for researchers. Just when the cohort of elderly Americans is surging, many scientists fear that government budget cuts may hamper a broad array of research efforts on Alzheimer’s and other diseases of aging — not to mention the eye-catching recent progress on reversing age-related decline in genetically altered mice. Brendan Smialowski for The New York Times THE SCIENTIST Dr. Richard J. Hodes, 67, is the director of the National Institute on Aging at the National Institutes of Health. Dr. Hodes, 67, has been the director of the National Institute on Aging at the National Institutes of Health for 17 years. Although its budget has grown to $1.1 billion on his watch, his agency would get only $20 million more under President Obama’s 2012 budget proposal. (Other agencies within the N.I.H. spend about $2 billion combined on age-related research.) A low-key laboratory scientist himself, he dresses the part, often coming to work without a tie and in short sleeves. Former colleagues describe him as a model citizen who works long hours and practices what he preaches, eating a careful diet and lifting weights three times a week. Born in New York on Dec. 31, 1943, just ahead of the baby boom, he graduated from Yale and Harvard Medical School, and then spent most of his professional life as a researcher at the National Cancer Institute. Indeed, he held onto his lab there after being named director of the National Institute on Aging in 1993. He leads a group that is experimenting with telomeres, the tips of chromosomes in cells, hoping to understand aging and cancer. Geriatric scientists say there has been tremendous growth in recent years in understanding the biology of aging, and they credit Dr. Hodes with supporting a broad range of studies that include lifestyle and psychological issues, starting from the premise that there are no magic solutions in the offing. In the following excerpts from a telephone interview and follow-up exchanges by e-mail, Dr. Hodes discusses some of the latest important developments in aging research. Q. What is the latest in aging research? A. The challenging question has to do with the aging process itself. The research includes some exciting discoveries showing that genetic mutations in species that range from yeast to worms to flies to mice can extend longevity. But the ultimate question, of relevance to humans, remains unanswered. Recently there was a report about reversing the aging process in laboratory mice. The study, supported in part by N.I.H., involved telomeres — structures on the ends of chromosomes that shorten with age, causing disrupted function of the chromosomes. In mice, if you knock out the gene that encodes for an enzyme that regulates telomere length and function, these mice over time have decreased function and life expectancy. Scientists used a genetic manipulation to turn the enzyme called telomerase back on in these mice. This restored telomere function and reversed many of the signs of aging. This study gained serious attention by suggesting an intervention that might be feasible using restoration of telomerase activity and telomere function. Q. What is the latest on diet and exercise? A. The evidence that lifestyle makes a difference is abundant in many areas. One of the best examples was in a diabetes prevention study supported by the aging and diabetes institutes. Researchers compared strategies for reducing diabetes in individuals who were at high risk for developing the disease. One group was provided the best information about good treatment; a second took metformin, a drug that lowers blood sugar; and a third “lifestyle” group followed an exercise and diet regimen. Age was a variable. In younger adults, both the lifestyle and drug treatments were effective. For those aged 60 and older, the drug had no effect, but the lifestyle intervention reduced new cases of diabetes by 71 percent. In 2009, a follow-up study showed the older group had maintained some of the weight loss and activity along with some of the benefits in glucose metabolism. The study is continuing. Q. And exercise research specific to aging? A. The epidemiology is certainly awfully strong and suggestive that physical activity and exercise correlate with a lower risk of death, heart disease and disability. However, it will be important to test these correlations in clinical trials, to make sure we know what is really cause and effect. We have a major clinical trial now in progress that compares one group that gets only information about a healthy lifestyle with a group of similar individuals on a very strict exercise regimen. We will know by the end of this study, in about three years, whether this specific exercise intervention kept people from being disabled — a huge step, beginning from the strong epidemiologic studies and some other short-term studies to determine whether we have an intervention that will prevent disability long term. The study will also determine whether the exercise affects cognitive change, whether physical activity can preserve cognitive function with age, and whether it might affect Alzheimer’s and dementia. Studies in mice are quite fascinating. Exercise in their cages actually improves their ability to generate new brain cells. What we don’t know is whether we have an exercise intervention that will actually make a difference in cognitive function over many years. Q. What are the latest high points in Alzheimer’s research? |
| Long-Term Care Needs Changes, Officials Say Posted: 21 Feb 2011 10:53 PM PST WASHINGTON — One of Senator Edward M. Kennedy’s legacies in the new health care law, intended to allow the chronically ill and people with disabilities to continue living in their homes, is too costly to survive without major changes, Obama administration officials now say. Jim Lo Scalzo/European Pressphoto Agency Kathleen Sebelius, the health secretary, says she can fix the long-term care program in the Obama administration’s health care reform package. Jim Lo Scalzo/European Pressphoto Agency Senator John Thune says Congress did not give the Obama administration so much flexibility in the long-term care insurance program found in its health law. Republican lawmakers, who have vowed to repeal the health care law, cite the administration’s acknowledgment as yet another reason to do so. But the health and human services secretary, Kathleen Sebelius, says the law gives her plenty of authority to make the necessary changes to the program without Congressional action. To make the program viable, Ms. Sebelius said, she is considering changes in the eligibility criteria, including employment and earnings requirements, to ensure that only active workers may enroll. She also said she favored adjusting premiums to rise with inflation. Senator Tom Harkin, Democrat of Iowa and chairman of the Senate health committee, encouraged the administration to make any changes that might be required to keep the program fiscally sound, so “no one with a disability will be forced to live in an institution.” Under the current law, the program will allow workers 18 and older to buy insurance from the government to cover the costs of long-term care. After paying premiums for at least five years, they are then eligible for benefits if they become unable to perform basic activities of daily living because of chronic illness or crippling injury. The program is meant for people with severe disabilities who want to live in the community, though benefits can also be used to help pay for nursing home care or assisted living. An employer can arrange for workers to be enrolled automatically, with premiums paid through payroll deductions. An employee can opt out at any time and, apparently, re-enroll later. Advocates for older Americans and for people with disabilities say the need for such help will explode as baby boomers age. President Obama’s 2012 budget seeks $93.5 million for a huge “information and education” campaign, with the goal of having 7.7 million people in the long-term care insurance program by 2015. In debate on the health care bill in late 2009, Republicans and moderate Democrats repeatedly warned that sicker people were more likely than healthy ones to sign up for the long-term care plan. Enrollment is voluntary, but the law stipulates that premiums must be set high enough to guarantee the solvency of the program over 75 years. Higher premiums would discourage healthier people from participating, economists and actuaries say. Administration officials, who played down such concerns 15 months ago, say they now share them. Under questioning by a Republican at a Senate hearing last week, Ms. Sebelius said the original version of the program, known as Community Living Assistance Services and Supports, or Class, was “totally unsustainable.” She told the House Ways and Means Committee, “We very much share the concerns that have been expressed that, as written into law, the framework of the program was not sustainable.” But Ms. Sebelius resisted Republican demands for the program’s repeal. Instead, she said, she is considering changes to make the program “significantly different than the framework that the law itself describes.” A main goal, she said, is to attract more healthy people, thus spreading the financial risk across a larger group. For example, Ms. Sebelius said, she may alter eligibility criteria, including employment and earnings requirements, to make sure people are established workers when they enroll. Federal officials have not specified the amount of premiums or benefits. The Congressional Budget Office estimated that nearly 10 million people might enroll in the program by 2019 and said that premiums would start at $123 a month for benefits expected to average $75 a day. Medicare actuaries estimated that 2.8 million people would participate within three years and said premiums needed to be about $240 a month to cover program costs. Under the current law, Ms. Sebelius said, a person’s premiums will generally stay the same, but cash benefits will increase with inflation. She said she favored adjusting premiums to rise with inflation, a change that could deter some workers from participating. Federal officials said they were also looking for ways to discourage workers from dropping out and re-enrolling. The law governing the program specifies that “no taxpayer funds shall be used for payment of benefits,” a provision Ms. Sebelius said was “nonnegotiable.” The health secretary can, however, adjust premiums as needed to maintain the program’s solvency. Her power to revamp it in other ways is unclear. “Secretary Sebelius seems to believe that she has more flexibility to change the program than Congress gave her,” said Senator John Thune, Republican of South Dakota. The law also says that up to 3 percent of the program’s premiums may be used to pay administrative expenses, but since no premiums have been paid, Mr. Obama is seeking the $93.5 million to publicize the program. “The program’s financial solvency and viability will depend on the enrollment of large numbers of participants,” the White House said in its 2012 budget request. “Employers and individuals will need to have access to information about the need for long-term services and supports and the benefits of the program. It will be crucial to educate employers about how to enroll their employees and to inform individuals about how to enroll directly.” Public confidence in the program is essential if the government expects millions of people to enroll starting next year. But economists and actuaries have raised many questions. Richard S. Foster, the chief actuary at the federal Centers for Medicare and Medicaid Services; Alicia H. Munnell, director of the Center for Retirement Research at Boston College; and leaders of the American Academy of Actuaries all said the program would be unstable if, as expected, it attracts disproportionate numbers of people with health problems. Mr. Foster said his analysis showed the program faced “a significant risk of failure” because people who are or expect to be sick or disabled were more likely to sign up. In a study issued this month, Ms. Munnell, an economic adviser to President Bill Clinton, said more stringent work requirements and an effective national advertising campaign could help attract young, healthy people to the insurance pool. Even so, she said, “premiums may never reach an affordable level for middle-class households,” so “the program faces enormous challenges.” Mr. Obama’s debt-reduction commission, a bipartisan advisory body, said in its report late last year that Congress should “reform or repeal” the program. “The program’s earliest beneficiaries will pay modest premiums for only a few years and receive benefits many times larger,” the panel said, “so that sustaining the system over time will require increasing premiums and reducing benefits to the point that the program is neither appealing to potential customers nor able to accomplish its stated function.” |
| Books: Symphony of Pain in Two Accounts of Schizophrenia Posted: 24 Feb 2011 08:59 AM PST Every book is born alone, but sometimes a pair will surface in accidental synchrony, a single theme creating an impromptu pas de deux. Patricia Wall/The New York Times HENRY'S DEMONS Living With Schizophrenia, a Father and Son’s Story. By Patrick Cockburn and Henry Cockburn 256 pages. Scribner. $25. THE MEMORY PALACE A Memoir. By Mira Bartok. 305 pages. Free Press. $25. Patricia Wall/The New York Times Such is the case with two new memoirs of schizophrenia. There is hardly a shortage of such books, but Mira Bartok and Patrick Cockburn have created mirror-image story arcs, one by the daughter of a schizophrenic mother, the other by the father of a schizophrenic son. Each is a model of narrative restraint, but in combination they combust, conveying the intensely painful experience of this disease in the literary equivalent of quadraphonic sound. A foreign correspondent for the British press, Patrick Cockburn was on assignment in Afghanistan in the winter of 2002 when his son Henry, 20, was fished fully clothed out of an icy river back home. Henry’s mother had noted “sinister changes” in his behavior for months, but this was the big break, with hallucinatory voices and visions so threatening that the river seemed the best place to hide. He was taken to a mental hospital and since then has never lived unsupervised or entirely free of disease. The Cockburns are a prominent Irish family of letters — Mr. Cockburn’s brother Alexander is the noted political journalist — and Henry, until his “final decline,” in Mr. Cockburn’s words, fell into the expected mold of verbal, artistically talented British schoolboy. The elder Mr. Cockburn dispassionately reconstructs his own mental journey in the intervening years, from his first naïve assumptions that Henry would recover and resume his previous life, to his final stark, resigned descriptions of Henry at age 27, living in a halfway house in London, a person who “spent a lot of his waking life thinking about where he could get his next cigarette and where he could smoke it.” Mr. Cockburn moves through the usual soul-searching — was his own peripatetic nonpresence to blame for Henry’s illness? Were family genes at fault? He muses at some length on the case of his father-in-law, a scion of the eminent Anglo-Jewish Montefiore family, who converted to Christianity after a teenage vision of Jesus: could that be construed as a family history of psychosis? Meanwhile, Henry contributes his own version of the story in flat staccato prose, highlighting his obsessive need to be outdoors (he has escaped from even top-security facilities dozens of times) and his profound reluctance to medicate all his vivid hallucinations away. “The forest would come alive and speak to me,” he writes. “The tree roots would move at the touch of my finger.” Indeed, the book’s ending suggests that although Henry has made an uneasy peace with his meds, the trees are still not entirely silent. Mira Bartok’s narrative begins almost exactly where the Cockburns’ ends, with an unstable young adult and her unnerved family. Her mother, Norma Herr, had been a piano virtuoso as a child, but at 18 the voices inside her head “arrived unannounced in all their terrible glory.” Products of a brief marriage, Mira and her sister had a childhood punctuated by their mother’s agitated pacing, her fierce conversations with herself, her suicide attempts. Occasional family trips to the symphony were invariably cut short because “something inexplicable” happened that made their mother whisper obscenities in the aisle. The girls grew up and moved far away, but their mother tracked them down by mail, by phone or sometimes in increasingly disheveled person. “Have I been a bad mother to you? Do you still love me? I need you here. We have things to discuss.” She wielded knives, a broken bottle. Finally, in desperation, both daughters changed their names (“She took Isaac Bashevis Singer’s last name, I took Bela Bartok’s”) and severed all contact with their now homeless mother. Or such was the plan; Ms. Bartok never quite managed to pull it off. She continued to send her mother letters and small presents for years, even as she concealed her own address and phone number. But only as her 80-year-old mother lay dying of cancer did they meet again, and did Ms. Bartok, by then an artist and prolific author of children’s books, experience once again the disease’s tangled words and thoughts. That was not so much through her mother’s physical presence as through the wealth of diaries she found in a storage bin, with decades of entries stumbling back and forth along a thin edge of reason: “I see that little bits of my life in distorted form have gotten into movie stories. I still have received no compensation for that. Ultimately, what I do know is this: I am a homemaker, my records have never been straightened out, and my need for privacy and house is greater than ever. I write this in a motel room looking out onto garbage bins.” As with the Cockburns’ book, the intertwined voices of grief-stricken, articulate sanity and not-so-sane but often quite poetic illness make a duet both wonderful and terrible. Sadly, it is not nearly so terrible as the worst detail of both books: the failure of the medical system to help much with the pain of either set of writers. In the 60-odd years separating Ms. Herr’s psychotic break from Henry Cockburn’s, mental hospitals have closed in droves, community-based services have proliferated, generations of antipsychotic drugs have been patented. The disease, at least in the severe form represented here, remains undaunted. It is hard to think of one that requires more courage from patients or their families. |
| Findings: The Threatening Scent of Fertile Women Posted: 22 Feb 2011 07:22 AM PST The 21-year-old woman was carefully trained not to flirt with anyone who came into the laboratory over the course of several months. She kept eye contact and conversation to a minimum. She never used makeup or perfume, kept her hair in a simple ponytail, and always wore jeans and a plain T-shirt. Each of the young men thought she was simply a fellow student at Florida State University participating in the experiment, which ostensibly consisted of her and the man assembling a puzzle of Lego blocks. But the real experiment came later, when each man rated her attractiveness. Previous research had shown that a woman at the fertile stage of her menstrual cycle seems more attractive, and that same effect was observed here — but only when this woman was rated by a man who wasn’t already involved with someone else. The other guys, the ones in romantic relationships, rated her as significantly less attractive when she was at the peak stage of fertility, presumably because at some level they sensed she then posed the greatest threat to their long-term relationships. To avoid being enticed to stray, they apparently told themselves she wasn’t all that hot anyway. This experiment was part of a new trend in evolutionary psychology to study “relationship maintenance.” Earlier research emphasized how evolution primed us to meet and mate: how men and women choose partners by looking for cues like facial symmetry, body shape, social status and resources. But the evolutionary mating game wasn’t just about finding a symmetrical face in the savanna’s equivalent of a singles bar. Natural selection favored those who stayed together long enough to raise children: the men and women who could sustain a relationship by keeping their partners happy. They would have benefited from the virtue to remain faithful, or at least the wiliness to appear faithful while cheating discreetly. It’s possible that some of the men in Florida were just trying to look virtuous by downgrading the woman’s attractiveness, the way a husband will instantly dismiss any woman pointed out by his wife. (That Victoria’s Secret model? Ugh! A skeleton with silicone.) But Jon Maner, a co-author of the study, says that’s unlikely because the men filled out their answers in private and didn’t expect the ratings to be seen by anyone except the researchers. “It seems the men were truly trying to ward off any temptation they felt toward the ovulating woman,” said Dr. Maner, who did the work with Saul Miller, a fellow psychologist at Florida State. “They were trying to convince themselves that she was undesirable. I suspect some men really came to believe what they said. Others might still have felt the undercurrent of their forbidden desire, but I bet just voicing their lack of attraction helped them suppress it.” It may seem hard to believe that men could distinguish a woman who’s at peak fertility simply by sitting next to her for a few minutes. Scientists long assumed that ovulation in humans was concealed from both sexes. But recent studies have found large changes in cues and behavior when a woman is at this stage of peak fertility. Lap dancers get much higher tips (unless they’re taking birth-control pills that suppress ovulation, in which case their tips remain lower). The pitch of a woman’s voice rises. Men rate her body odor as more attractive and respond with higher levels of testosterone. “The fascinating thing about this time is that it flies under the radar of consciousness,” says Martie Haselton, a psychologist at U.C.L.A. “Women and men are affected by ovulation, but we don’t have any idea that it is what is driving these substantial changes in our behavior. It makes it clear that we’re much more like other mammals than we thought.” At this peak-fertility stage, women are more interested in going to parties and dance clubs, and they dress more attractively (as judged by both men and women). Some women’s attitudes toward their own partners also change, according to research by Dr. Haselton along with a U.C.L.A. colleague, Christina Larson, and Steven Gangestad of the University of New Mexico. “Women who are in steady relationships with men who are not very sexually attractive — those who lack the human equivalent of the peacock’s tail — suddenly start to notice other men and flirt,” Dr. Haselton said. “They are also more critical of their steady partners and feel less ‘one’ with them on those few days before ovulation.” But that doesn’t mean they’re planning to walk out. “These women don’t show any shifts in feelings of commitment,” Dr. Haselton said. “They don’t want to leave their steady partners. They just want to look around at other men and consider them as alternative sex partners.” This fits the “good genes” evolutionary explanation for adultery: a quick fling with a good-looking guy can produce a child with better genes, who will therefore have a better chance of passing along the mother’s genes. But this sort of infidelity is risky if the woman’s unsexy long-term partner finds out and leaves her alone to raise the child. So it makes sense for her to limit her risks by being unfaithful only at those times she’s fertile. By that same evolutionary logic, it makes sense for her partner to be most worried when she’s fertile, and that’s just what occurred in the relationships tracked by Dr. Haselton and Dr. Gangestad. The unsexy men became especially jealous and engaged in more “mate-guarding” during the stage of high fertility — perhaps because they sense the subtle physical cues, or maybe just because they could see the overt flirting. One safe way for both men and women to stay in a relationship is to avoid even looking at tempting alternatives, and there seem to be subtle mental mechanisms to stop the wandering eye, as Dr. Maner and colleagues at Florida State found in an experiment testing people’s “attentional adhesion.” The men and women in the experiment, after being primed with quick flashes of words like “lust” and “kiss,” were shown a series of photographs and other images. The single men and women in the study couldn’t help staring at photographs of good-looking people of the opposite sex — their gaze would linger on these hot prospects even when they were supposed to be looking at a new image popping up elsewhere on the screen. But the people who were already in relationships reacted differently. They looked away more quickly from the attractive faces. The subliminal priming with words related to sex apparently activated some unconscious protective mechanism: Tempt me not! I see nothing! I see nothing! This is good news for fans of fidelity, but there’s one caveat from a subsequent study by Dr. Maner along with C. Nathan DeWall of the University of Kentucky and others. This time, the researchers subtly made it difficult to pay attention to the attractive faces. Both men and women responded by trying harder to look at the forbidden fruit. Afterward, they expressed less satisfaction with their partners and more interest in infidelity. The lesson here seems to be that too much “mate-guarding” can get in the way of “relationship maintenance.” “We shouldn’t want our partner to be looking at lots of other people, because that’s bad for the relationship,” Dr. Maner said. “At the same time, preventing them from looking doesn’t help either, and can backfire.” Left to their own devices, conscious or unconscious, they might just manage to restrain themselves. This posting includes an audio/video/photo media file: Download Now |
| Edwin Kilbourne, Flu Vaccine Expert, Dies at 90 Posted: 24 Feb 2011 09:50 PM PST Dr. Edwin D. Kilbourne, a medical researcher who figured out how to outwit fast-evolving flu germs, developing a new vaccine each year by intermingling genes of different disease strains, died Monday in Branford, Conn. He was 90. Associated Press Dr. Edwin Kilbourne in 1973. The latest on President Obama, the new Congress and other news from Washington and around the nation. Join the discussion. His family announced the death. He lived in Madison, Conn. For all his prestigious discoveries, awards and positions, Dr. Kilbourne had his greatest visibility during the swine flu epidemic of 1976. When a soldier died at Fort Dix, N.J., after being infected by a particularly virulent flu virus, Dr. Kilbourne wrote an Op-Ed article in The New York Times warning of a worldwide flu pandemic, and personally led in developing a vaccine to meet its challenge. President Gerald R. Ford ordered 200 million doses of the vaccine to be administered to that many Americans. Dr. Kilbourne was a principal adviser to the president on the program. But even as the disease seemed to subside on its own, several hundred people who received shots contracted a kind of paralysis. Some died. Time magazine asserted that “election-year fever” had prompted the president to move quickly, while The Times called Mr. Ford’s scientific advisers “panicmongers.” The program was stopped after 43 million vaccinations. A causative connection between the vaccinations and the paralytic syndrome was never proved. And Dr. Kilbourne remained convinced that the mass vaccinations were the right policy, pointing out that the virus that killed the soldier bore a sinister resemblance to the pandemic of 1918-19, which infected two billion people around the world and killed 20 million to 40 million. He also warned that the disease could be hibernating, which he had proved it could do. “Better a vaccine without an epidemic than an epidemic without a vaccine,” he said years later. He called the episode “my 15 minutes of infamy.” Although Dr. Kilbourne never stopped believing that Mr. Ford’s aggressive actions were warranted, only 230 cases of flu were diagnosed at Fort Dix, and none elsewhere. Of the 43 million who got flu shots, 535 came down with the paralytic syndrome known as Guillain-Barré; 23 of them died. Dr. Kilbourne’s early research examined links between hormones and viruses, but it was his work on the flu that earned him global note as early as the mid-1950s. His goal was to find weapons to combat the flu virus comparable to the way penicillin fights bacterial infections. He was up against one of the most fickle, enigmatic, persistent microbes to attack man or beast. These microbes are capable of changing their surface characteristics to elude barriers the body has erected against them. Dr. Kilbourne’s solution was to mix, or “recombine,” the genes of different strains of the virus to “persuade” the body to come up with new defenses. “This accomplishment represents the first deliberate genetic engineering of any vaccine,” the New York Academy of Medicine said in presenting Dr. Kilbourne with its highest award in 1983. For years after, he created annual versions of flu vaccine targeted at emerging viruses. In 1973, Dr. Kilbourne proposed that worldwide epidemics might be terrestrial “Andromeda strains” coming to man from the barnyard and then retreating to await the next great outbreak. “The Andromeda Strain” in Michael Crichton’s novel of that name is an organism from outer space that Earth is not prepared to handle. In delivering the R. E. Dyer lecture to the National Institutes of Health in 1973, Dr. Kilbourne suggested that two conditions must be met for a new viral strain to go from swine or other animals to man. One was the random recombination of a virus, making it infectious to man. The other was an ecological niche for the virus in a human population unprepared to fight back. “If my hypothesis is correct,” he said, “the pandemic viruses of tomorrow and of remote yesterdays may already exist in our domestic animals today.” Edwin Dennis Kilbourne was born on July 10, 1920, in Buffalo. He graduated from Cornell University in 1942 and Cornell Medical College in 1944. For the next two years he served in the Army, where he became intrigued with influenza while treating soldiers. He next worked as a researcher at the Rockefeller Institute before working at four medical schools: Tulane, Cornell, Mount Sinai (as chairman of the microbiology department) and New York Medical College. Dr. Kilbourne is survived by his wife of 58 years, the former Joy Schmid; his sister, Sylvia Hosie; his half-sister, Lynn Norton; his sons, Edwin, Richard, Christopher and Paul; and eight grandchildren. Over the desk in Dr. Kilbourne’s laboratory, the most prominent award, obscuring honors like his membership in the National Academy of Sciences, was a plaque honoring his contribution to his team’s 1988-89 victory in a men’s bowling league in Ho-Ho-Kus, N.J. He was also a published poet, devoted to extolling the bizarre mating habits of animals like hairy-legged fruit flies. A paean to the bighorn ram illustrates: His wooly wooing is neither smooth nor is it unctuous, And therefore can be fairly termed rambunctious. |
| National Briefing | SOUTH: Virginia: Restrictions on Abortion Clinics Approved Posted: 24 Feb 2011 11:30 PM PST The latest on President Obama, the new Congress and other news from Washington and around the nation. Join the discussion. Lawmakers approved a bill on Thursday with new rules for abortion clinics. Democrats and abortion rights supporters said the rules were likely to force the closing of most of Virginia’s 21 abortion clinics. Gov. Bob McDonnell, a Republican and Catholic, supports the measure and when he signs it, Virginia will become the first state to require clinics that provide first-trimester abortions to meet the same standards as hospitals. That could include anything from widening halls to buying equipment the clinics do not have. |
| Global Update: Addiction: A First in Sub-Saharan Africa: Methadone Maintenance Program Posted: 21 Feb 2011 07:29 PM PST With the help of the American government, the first methadone maintenance program in sub-Saharan Africa opened this month in a hospital in Dar es Salaam, Tanzania. While heroin use is not common in Africa, it has been growing recently in Tanzania’s port cities, which are used to ship the drug, usually from Afghanistan to Europe. Drug couriers may be paid in heroin, creating a new group of addicts. Tanzania now has an estimated 25,000 drug injectors, 40 percent of them infected with H.I.V., according to the Pangaea Global AIDS Foundation, a San Francisco-based group that is advising the Tanzanian government on the program. The United States President’s Emergency Plan for AIDS Relief, created by President George W. Bush, is paying for it. Needle-sharing spreads both H.I.V. and hepatitis. Last year, an American researcher reported finding Tanzanians practicing “flashblood,” in which one addict injects herself with another’s blood in the hopes of sharing the high. In Africa, fear of the unfamiliar often leads to accusations of witchcraft, and if heroin use is unfamiliar, methadone is even more so. Methadone is even more addictive than heroin, though it is given in oral doses meant to be small enough to produce no high. In announcing the opening of the program at Muhimbili Hospital, the American Embassy in Tanzania said it was “fully aware that challenges will likely be encountered whilst services are being established.” |
| Colorado Faces a Fight Over Naturopathy Posted: 21 Feb 2011 07:40 PM PST DENVER — For more than a decade, Mark Cooper has had a bustling naturopathy practice in Colorado Springs, treating everything from chronic headaches to digestive problems to insomnia. Mr. Cooper has a license in Montana to practice naturopathy, which uses natural herbs and remedies to treat medical conditions and which concentrates on dietary and lifestyle habits. But in Colorado he is unable to get a license because no regulatory system for naturopaths exists. “The whole issue is fear-based ignorance,” said Mr. Cooper, who sits on the board of the Colorado Association of Naturopathic Doctors, which has proposed a bill this year that would allow naturopaths to get licenses and create training and treatment requirements for practitioners. “Once somebody fully understands what our medical training is and what we actually do, they look at us and say, ‘Oh, my gosh, I didn’t realize that,’ ” he said. Not everyone agrees. Efforts to license naturopaths in Colorado have failed in the past, and there are committed opponents. The Colorado Medical Society has lobbied against licensing, arguing that it would allow naturopaths to treat and diagnose illnesses in patients beyond their level of expertise. “They want to diagnose medical conditions, and we don’t believe they are qualified and that they have the education to do that,” said Diana Protopapa, the medical society’s director of political affairs and education, adding that there is little evidence naturopathy is either safe or effective. The other main organization opposed to licensing in the state is the Colorado Coalition for Natural Health, a group of natural health practitioners. Many members of that group did not attend one of the few accredited naturopathy colleges in the United States, and they fear they could be out of work if they were suddenly required to do so. The Colorado proposal would prohibit people who did not attend one of the schools from calling themselves naturopathic doctors. Joanie Coffey, president of the coalition, said that the naturopaths who want a licensing system really want the same rights as medical doctors. Much like the Colorado Medical Society, Ms. Coffey says her colleagues are not qualified. “We’re not involved in the practice of medicine. We do not use drugs and pharmaceuticals. We do not perform surgeries. That has nothing to do with naturopathy,” Ms. Coffey said. Driven by a jump in the number of people studying naturopathy over the past few years — and an increase in those seeking naturopathic treatment — a push to create statewide licensing systems has emerged across the country. Just 15 states and the District of Columbia license naturopaths, according to the American Association of Naturopathic Physicians. That process requires completion of a four-year accredited, specialized school, passing an exam and a certain amount of clinical training. This year, at least 11 states are trying to pass licensing legislation, according to the group. Naturopaths who favor licensing say they are not interested in becoming medical doctors, and say properly trained naturopaths frequently refer patients to doctors for conditions they are not trained to treat. Moreover, they contend that it is dangerously easy to get a certificate that shows expertise in naturopathy and people need some way of discerning between a knowledgeable naturopath and a quack. “No longer will people who don’t go to naturopathic medical school be able to hang up a shingle that says, ‘I’m a naturopathic doctor,’ ” said Karen Howard, executive director of the American Association of Naturopathic Physicians. “It’s a patient access and patient safety issue.” |
| Books of The Times: ‘Friends’ Without a Personal Touch Posted: 23 Feb 2011 07:18 AM PST Teenagers who send and receive six to eight thousand texts a month and spend hours a day on Facebook. Mourners who send text messages during a memorial service because they can’t go an hour without using their BlackBerries. Children who see an authentic Galapagos tortoise at the American Museum of Natural History and can’t understand why the museum didn’t use a robot tortoise instead. High school students who wonder how much they should tilt their Facebook profiles toward what their friends will think is cool, or what college admissions boards might prize. Erik Jacobs for The New York Times Sherry Turkle As Sherry Turkle notes in her perceptive new book, “Alone Together,” these are examples of the ways technology is changing how people relate to one another and construct their own inner lives. She is concerned here not with the political uses of the Internet — as manifested in the current democratic uprisings in Egypt and other countries in the Middle East — but with its psychological side effects. In two earlier books, Ms. Turkle — a professor of the social studies of science and technology at the Massachusetts Institute of Technology and a clinical psychologist — put considerable emphasis on the plethora of opportunities for exploring identity that computers and networking offer people. In these pages, she takes a considerably darker view, arguing that our new technologies — including e-mail messages, Facebook postings, Skype exchanges, role-playing games, Internet bulletin boards and robots — have made convenience and control a priority while diminishing the expectations we have of other human beings. Ms. Turkle’s thesis here — some of which will sound overly familiar, but some of which turns out to be savvy and insightful — is that even as more and more people are projecting human qualities onto robots (i.e., digital toys like the Furby and computerized companions like the Paro, designed to provide entertainment and comfort to the elderly), we have come to expect less and less from human encounters as mediated by the Net. Instead of real friends, we “friend” strangers on Facebook. Instead of talking on the phone (never mind face to face), we text and tweet. Technology, she writes, “makes it easy to communicate when we wish and to disengage at will.” In writing this book, Ms. Turkle interviewed hundreds of children and adults about technology, and her anthropological generalizations sometimes seem based on largely anecdotal evidence; we often never know just how representative her examples really are. Still, the author has spent decades examining how people interact with computers and other devices — her first book on computers and people, “The Second Self,” was published in 1984; the next, “Life on the Screen,” in 1995 — and by situating her findings in historical perspective, she is able to lend contextual ballast to her case studies. Many of the adolescents cited in her book express a decided distaste for using the phone. One high school sophomore says telephone calls mean you have to have a conversation and conversations are “almost always too prying, it takes too long, and it is impossible to say ‘good-bye.’ ” Another student says: “When you talk on the phone, you don’t really think about what you’re saying as much as in a text. On the telephone, too much might show.” Texts, in other words, offer more control — and the ability to keep one’s feelings at a distance. Many young people “prefer to deal with strong feelings from the safe haven of the Net,” Ms. Turkle writes. “It gives them an alternative to processing emotions in real time.” While teachers must contend with distracted students, who may be texting or surfing the Web in class, says Ms. Turkle, young people must contend with distracted parents — who with their BlackBerries and cellphones may be physically present but “mentally elsewhere.” Noting that the psychoanalyst Erik Erikson regarded identity play as part of the work of adolescence, she argues that the Net not only supplies teenagers with lots of opportunities to explore who they are and what they aspire to but also generates added anxiety, heightening peer pressure and encouraging many to construct, edit and perform a “self” in an effort to win friends and influence. Of an interview subject she calls Brad, Ms. Turkle writes: “Brad says, only half jokingly, that he worries about getting ‘confused’ between what he ‘composes’ for his online life and who he ‘really’ is. Not yet confirmed in his identity, it makes him anxious to post things about himself that he doesn’t really know are true. It burdens him that the things he says online affect how people treat him in the real. People already relate to him based on things he has said on Facebook. Brad struggles to be more ‘himself’ there, but this is hard. He says that even when he tries to be ‘honest’ on Facebook, he cannot resist the temptation to use the site ‘to make the right impression.’ ” As Ms. Turkle sees it, online life tends to promote more superficial, emotionally lazy relationships, as people are “drawn to connections that seem low risk and always at hand.” This tendency to treat other people as objects that can be quickly discarded, she says, is embodied at its most extreme by the social Web site Chatroulette, “which randomly connects you to other users all over the world”: “You see each other on live video. You can talk or write notes. People mostly hit ‘next’ after about two seconds to bring another person up on their screens.” There are other consequences to constant networking as well. When we are always tethered to our offices, our families, our friends — even when hiking in the woods or walking by the ocean — then solitude becomes increasingly elusive, and creative, contemplative, carefully considered thought increasingly gives way to immediate, sometimes ill-considered reactions. At times, Ms. Turkle can sound primly sanctimonious, complaining for instance that the sight at a local cafe of people focused on their computers and smartphones as they drink their coffee bothers her: “These people are not my friends,” she writes, “yet somehow I miss their presence.” Such sentimental whining undermines the larger and important points she wants to make in this volume — the notion that technology offers the illusion of companionship without the demands of intimacy and communication without emotional risk, while actually making people feel lonelier and more overwhelmed. “Once we remove ourselves form the flow of physical, messy, untidy life — and both robotics and networked life do that — we become less willing to get out there and take a chance,” she writes. “A song that became popular on YouTube in 2010, ‘Do You Want to Date My Avatar?’ ends with the lyrics ‘And if you think I’m not the one, log off, log off, and we’ll be done.’ ” |
| Nevada Seeks to Cut Funds for Treating Gambling Addiction Posted: 22 Feb 2011 05:23 PM PST Gordie Greco was hooked on gambling almost from the first time he shot dice at age 16. And for 35 years, gambling was his life: he worked in the industry and made his own bets on sports and horses. But when he was laid off in 2006, he made his way to the Las Vegas Problem Gambling Center, and it has now been years since he placed a bet. Treatment programs for gambling addicts in the nation’s casino capital are in jeopardy, however, as Nevada lawmakers look for ways to close the state’s huge budget shortfall. The governor has proposed cutting financing for organizations like the center, which could leave those trying to quit with few places to turn. “Getting help was the best thing I’ve ever done,” said Mr. Greco, 61, who now volunteers helping other gambling addicts. “These cuts are going to cause a lot of despair. Gamblers don’t have any money for treatment.” More than 5 percent of Nevada’s residents are either pathological or problem gamblers, according to a 2002 study — almost twice the rate of the nation’s overall population. Since 2005, a $2 fee on slot machines has helped pay for research, prevention and treatment programs for problem gamblers. In 2009, the slot machine fees brought in about $1.5 million. But with a budget deficit of $1.5 billion — almost half of the state’s total operating budget from the previous fiscal year — Gov. Brian Sandoval, a Republican, has proposed redirecting half of that revenue to the general fund. The move would make permanent a stopgap measure that the Legislature took last year. Other lawmakers want to cut spending on problem gambling treatment entirely. State Senator Ben Kieckhefer has proposed redirecting the other half of the slot machine money toward autism treatment programs that might also be on the chopping block. “Treatment for problem gamblers is a needed service, but there are private treatment options,” said Mr. Kieckhefer, a Republican from Reno. “When it comes to prioritizing the budget, I will take an autistic child over a problem gambler any day of the week.” The Problem Gambling Center offers outpatient counseling virtually free of charge to hundreds of patients each year. Private donations, including contributions from gambling companies, make up more than half of the organization’s annual $410,000 budget. “By any measure, we’re a shoestring operation, which is ironic given that Las Vegas is the gambling mecca of the world,” said Robert Hunter, the center’s clinical director. “If we lost state funding, it wouldn’t kill us, but we would be forced to make some dramatic cuts.” Still, Prof. Bo Bernhard, a sociologist at the University of Nevada, Las Vegas, said: “Problem gambling treatment works in Nevada, not only in reducing gambling, but with housing and employment situations. “Unfortunately, this is the sort of thing that gets cut during down times.” |
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| Personal Health: Tackling Care as Chronic Ailments Pile Up Posted: 21 Feb 2011 07:30 PM PST Anyone seriously interested in improving the health of Americans and reducing the costs of health care must be willing to tackle a growing and underappreciated problem: the vast number of patients with more than one chronic illness. The problem is actually two problems: delivering more efficient care to these patients and helping them not to get sick in the first place. Both tasks require the cooperation of patients and caregivers, as well as the providers of health care and the agencies that pay for it — and, at least as important, a public willing to take proven steps to reduce the risk of chronic disease. The statistics, as reported in December in a strategy report from the Department of Health and Human Services, say it all. More than 25 percent of Americans have two or more chronic conditions — which, by definition, require continuing medical care, and often limit their ability to perform activities of daily living. (The conditions include heart disease, diabetes, obstructive lung disease, high blood pressure, kidney disease, osteoporosis, arthritis, asthma, H.I.V., mental illness and dementia, among others.) As people age, their chances of having two or more chronic conditions rises, and Medicare expenditures rise with them. Two-thirds of Americans over 65 and three-fourths of those over 80 have multiple chronic diseases, and 69 percent of Medicare dollars are spent on people with five or more of them. And the number of patients is expected to rise sharply in the coming decade as more and more baby boomers enter their late 60s and early 70s. By 2020, the number of people with multiple chronic conditions is expected to increase to 81 million, up from 57 million in 2000. The new report, “Multiple Chronic Conditions: A Strategic Framework,” was created to provide “a road map for the nation to foster changes in the health care system that can reduce poor health outcomes, improve patients’ quality of life and reduce costs,” said Dr. Anand K. Parekh, an assistant secretary of health who was in charge of the report. “With an aging population, the persistence of risk factors for disease and the marvels of modern medicine, more people are living with multiple chronic conditions,” Dr. Parekh said in an interview. “New care models are needed to provide coordinated care.” The Problems It’s not just the number of conditions people have, nor the number of people who have them. Because of the way medicine is typically practiced these days, people with multiple chronic diseases commonly receive disjointed, often conflicting care. That can lead to preventable hospitalizations and a host of avoidable complications, adverse reactions to treatment, and duplication of expensive, sometimes hazardous tests. Clinical practice guidelines have been developed to help doctors treat patients with many individual chronic conditions, but not for treating common combinations of them. As a result, what is recommended for one disease may counteract what should be done for another. Dr. A may prescribe something for a heart problem that reacts badly with what Dr. B prescribed for the same patient’s asthma or what Dr. C prescribed for arthritis or osteoporosis. When no one doctor coordinates and oversees a patient’s total care, or when patients neglect to report all the other prescribed and over-the-counter remedies they take, medical cocktails can become Molotov cocktails. Often, patients have no idea that a particular treatment is the cause of distressing new symptoms, which can result in an emergency room visit, hospitalization and a raft of costly tests. Even without such emergencies, patients with multiple conditions are often subjected to the same tests by different doctors, contributing further to needless medical expense. Medications can often be avoided with self-care activities like reducing salt, eating lots of vegetables and fruits and getting regular exercise. But the doctors’ offices seldom have anyone on staff to help patients develop such routines and stick with them. And medical insurance rarely covers the services of nutritionists and exercise physiologists. And Some Solutions Dr. Mary E. Tinetti, a geriatrician at the Yale School of Medicine, says patients with multiple conditions should always be asked what their goals are: to live as long as possible, to be as functional as possible or to be as free of symptoms as possible? “There’s always a trade-off; you can’t have it all,” Dr. Tinetti said in an interview. “You have to decide what’s most important to you and let the doctors and nurses know your goal. You have to ask, ‘Given all my diseases, what’s the best way to reach my goal?’ ” When more than one disease is involved, she said, “what may be good for a given disease may not be good for the patient.” The doctor’s job is to choose “a combination of treatments that is most likely to help and not hurt.” And since “every treatment a patient gets may make something else worse,” Dr. Tinetti said, when a new remedy is prescribed, the patient or caregiver should ask, “What’s this going to do to my other health problems?” Dr. Parekh stressed the importance of having a single doctor — usually a primary care physician — to serve as “the quarterback of care for individuals with multiple chronic conditions,” the overseer who can coordinate all the patient’s conditions, medications, tests and specialists. Electronic health records, which store all a patient’s information in one place, are critical to enhancing communication between providers and avoiding adverse drug interactions, said Christine Vogeli, a health policy expert at Massachusetts General Hospital. And after any hospitalization, she said, patients should have “a face-to-face visit” with their primary care doctor, who can reconcile any contradictory treatments and reduce the risk of rehospitalization. In one medical model being fostered under the new federal health care law, so-called accountable care organizations of family physicians and specialists (and sometimes hospitals) join forces to improve care and reduce costs, with financial rewards for those who meet performance goals. In another model, several primary care physicians may practice together, assisted by nurse practitioners who periodically check on patients to be sure they follow prescribed remedies and to uncover problems before they become medical crises. But patients also have a critical role, Dr. Parekh said. They need to learn as much as they can about their conditions; tell the doctor about every medication and test taken, along with behavioral health problems like mental illness and substance abuse; and avoid risk factors like poor nutrition, smoking, alcohol abuse and lack of physical activity. “The same risk factors that cause a chronic condition can also make it worse,” he said. This posting includes an audio/video/photo media file: Download Now |
| Really?: The Claim: A Fake Smile Can be Bad for Your Health Posted: 21 Feb 2011 07:20 PM PST THE FACTS Share your thoughts on this column at the Well blog. Go to Well » When was the last time you flashed a fake smile at the office? For some, it may be just another mundane aspect of work life — putting on a game face to hide your inner unhappiness. But new research suggests that it may have unexpected consequences: worsening your mood and causing you to withdraw from the tasks at hand. In a study published this month in the Academy of Management Journal, scientists tracked a group of bus drivers for two weeks, focusing on them because their jobs require frequent, and generally courteous, interactions with many people. The scientists examined what happened when the drivers engaged in fake smiling, known as “surface acting,” and its opposite, “deep acting,” where they generated authentic smiles through positive thoughts, said an author of the study, Brent Scott, an assistant professor of management at Michigan State University. After following the drivers closely, the researchers found that on days when the smiles were forced, the subjects’ moods deteriorated and they tended to withdraw from work. Trying to suppress negative thoughts, it turns out, may have made those thoughts even more persistent. But on days when the subjects tried to display smiles through deeper efforts — by actually cultivating pleasant thoughts and memories — their overall moods improved and their productivity increased. Women were affected more than men. Dr. Scott suspected cultural norms might be at play: women are socialized to be more emotionally expressive, he said, so hiding emotions may create more strain. THE BOTTOM LINE Research suggests that an inauthentic smile to hide unhappiness can further worsen your mood. ANAHAD O’CONNOR scitimes@nytimes.com |
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| Letters: The Wages of Bullying (1 Letter) Posted: 24 Feb 2011 01:19 PM PST To the Editor: “Web of Popularity, Achieved by Bullying” (Well, Feb. 15) addresses the way bullying is ingrained in the social fabric of life for middle- and high-school students. The research cited shows clearly that bullying is not simply a function of troubled children struggling with their own aggression. Unchecked, a vicious cycle of bullying where children are jockeying for ever higher levels of social status can extend well into adulthood, damaging both personal and professional relationships. Psychiatrists and mental health professionals spend countless hours helping adult patients cope with childhood experiences of bullying that are frequently replayed in their adult lives, with much pain and suffering. It is critical that school administrators acknowledge the ubiquitous nature of bullying and work with experts in remediation and prevention to short-circuit this vicious cycle. Thomas S. Zaubler, M.D. Morristown, N.J. The writer is chairman of psychiatry at Morristown Memorial Hospital. 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. This posting includes an audio/video/photo media file: Download Now |
| Letters: All Heart (1 Letter) Posted: 24 Feb 2011 01:18 PM PST To the Editor: It was with great pleasure that I read your First Mention report on pacemakers (Feb. 15), which reproduced a 1958 New York Times picture showing Pincus Shapiro, who had been kept alive for three months with a pacemaker, and his wife, Estelle. Those were my grandparents! I was 6 ½ when my grandfather was in the hospital with the pacemaker. I can still remember the long drives from Brooklyn to Montefiore Hospital in the Bronx so my parents could visit him. (As kids, we weren’t allowed in to see him.) At one point, his picture was the front page of The Daily News. My father, Daniel Shapiro, kept that hanging in his office until he retired in 1989. Somehow it got lost when he closed his store, so seeing the photo and the article brought back fond memories. Richard Shapiro Saranac Lake, N.Y. 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. This posting includes an audio/video/photo media file: Download Now |
| Recipes for Health: Fried Red Thai Jasmine Rice With Shrimp Posted: 23 Feb 2011 11:20 PM PST Thai-style fried rice is an addiction in our household. If you cannot find Alter Eco’s ruby red jasmine, you can make this dish with red Bhutanese rice or with regular jasmine rice. This may seem like a lot of fried rice, but believe me, you’ll finish it in one sitting. Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. 2 tablespoons canola or peanut oil 8 garlic cloves, minced 1 large carrot, peeled and cut in 1-inch long julienne 8 medium or large shrimp (about 6 ounces), peeled, deveined and chopped 6 cups cooked ruby red jasmine rice, red Bhutanese or regular jasmine rice (2 cups uncooked) 1 bunch scallions, trimmed, cut in half lengthwise and then into 1-inch lengths 2 tablespoons Thai or Vietnamese fish sauce (omit if sodium is an issue; the high sodium content in this recipe comes from the fish sauce) 2 to 4 tablespoons chopped cilantro For garnish (optional): Chopped cilantro Thinly sliced cucumber Lime wedges Scallions Fish sauce with hot chilies (nam pla prik) Chopped roasted peanuts 1. Heat a large wok or large, heavy nonstick skillet over medium-high heat until a drop of water evaporates upon contact. Add the oil, tilt to spread across the pan, and add the carrot and shrimp. Stir-fry until the shrimp is pink and opaque, about two minutes. Add the garlic, and stir-fry just until golden, 15 to 30 seconds. Add the rice. Stir-fry for about two minutes by scooping the rice up, then pressing it into the pan and scooping it up again. The rice should have a seared taste. Add the scallions and fish sauce, stir together for a half-minute to a minute and transfer to a platter. Sprinkle the cilantro over the top, and serve, passing the garnishes of your choice. Diners should squeeze lime juice onto their rice as they eat. Yield: Serves four generously as a one-dish meal. Advance preparation: Cooked rice will keep for three or four days in the refrigerator and can be frozen. The dish is a last-minute stir-fry. Nutritional information per serving: 484 calories; 1 gram saturated fat; 2 grams polyunsaturated fat; 4 grams monounsaturated fat; 68 milligrams cholesterol; 82 grams carbohydrates; 7 grams dietary fiber; 900 milligrams sodium (does not include salt to taste); 16 grams protein Martha Rose Shulman is the author of “The Very Best of Recipes for Health.” |
| Recipes for Health: Purple Barley Risotto With Cauliflower Posted: 22 Feb 2011 11:50 PM PST Purple prairie barley is an heirloom grain that originated in Tibet. High in protein, the grain has the chewy texture of regular barley but with a dark purple hue. If you can’t find purple barley, make this delicious risotto with the regular type, preferably whole hulled barley that has not been pearled. (Pearl barley cooks more quickly, but many of the nutrients are lost when it’s pearled.) Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. Whichever you use, cook the barley ahead of time so that the dish doesn’t take too long to make. Purple prairie barley takes about one and a half hours to cook if unsoaked, about one hour if soaked. A cup yields just under 4 cups cooked barley. 2 tablespoons extra virgin olive oil 1/2 cup finely chopped onion 2 garlic cloves, minced 1 small head cauliflower, separated into small florets, then broken into smaller pieces or sliced 1/2 inch thick (about 4 heaped cups) 1/2 cup fruity red wine, such as a Côtes du Rhone 4 cups cooked purple prairie barley (1 cup uncooked) or hulled barley 2 cups vegetable or chicken stock 1 cup thawed frozen or fresh peas Salt and freshly ground pepper 1/4 cup chopped fresh parsley 2 ounces Parmesan, grated (1/2 cup) 1. Heat the oil over medium heat in a large, heavy nonstick skillet or saucepan, and add the onion. Cook, stirring, until tender, about five minutes. Add the garlic and cauliflower. Cook, stirring, for a minute until the garlic is fragrant. Stir in the barley and red wine. Cook, stirring, until the wine has evaporated, leaving the cauliflower tinted. 2. Add 1 1/2 cups of the stock, and cook, stirring often, for 10 minutes. Add the peas, and continue to simmer until the cauliflower and peas are tender and most of the stock has evaporated, about 15 minutes. There should still be some creamy liquid surrounding the grains of barley. If the mixture dries out before the cauliflower is tender, or if the grains are not suspended in some liquid at the end of cooking, add some of the additional 1/2 cup of stock. Add pepper, and adjust salt. 3. Stir in the parsley and Parmesan, remove from the heat and serve. Yield: Serves four to six. Advance preparation: Unlike regular risotto, the grains will not continue to soften after you remove this from the heat. If you need to have the dish made ahead of serving, you can cook it through Step 2 and reheat. I would cook the peas separately, however, and add them when you reheat, because their color will fade due to the acid in the red wine. You may want to add some more broth when you reheat. Nutritional information per serving (four servings): 384 calories; 3 grams saturated fat; 1 gram polyunsaturated fat; 6 grams monounsaturated fat; 12 milligrams cholesterol; 48 grams carbohydrates; 12 grams dietary fiber; 306 milligrams sodium (does not include salt to taste); 16 grams protein Nutritional information per serving (six servings): 256 calories; 2 grams saturated fat; 1 gram polyunsaturated fat; 4 grams monounsaturated fat; 8 milligrams cholesterol; 32 grams carbohydrates; 8 grams dietary fiber; 204 milligrams sodium (does not include salt to taste); 11 grams protein Martha Rose Shulman is the author of “The Very Best of Recipes for Health.” |
| Recipes for Health: Black Rice and Soy Salad With Asian Dressing Posted: 25 Feb 2011 09:36 AM PST I’ve made this salad with Chinese black rice and with Lundberg’s Japonica, and both work well. It’s a salad high in omega-3 fatty acids and plant proteins — contained in the tofu, edamame and rice — and it packs well in a lunch box. Whichever type of rice you use, just follow the cooking instructions on the bag. Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. 3 cups cooked black rice (1 cup uncooked) 1 red bell pepper, diced 1/3 cup walnut pieces 1 cup edamame 1/2 pound tofu 1 tablespoon soy sauce 2 tablespoons minced chives 1/4 cup chopped cilantro 1/2 to 2/3 cup (to taste) sesame ginger vinaigrette 1. In a large bowl, combine the rice, diced bell pepper, walnut pieces and edamame. 2. Slice the tofu about 1/2 inch thick, and blot with paper towels. Cut into 1/2-inch dice, and toss with the soy sauce. Add to the rice along with the chives and cilantro. 3. Just before serving, toss with the vinaigrette. Yield: Serves six. Advance preparation: The rice will keep in the refrigerator for three or four days, and it freezes well. The salad can be assembled several hours before serving, but don’t toss the tofu with the soy sauce until you’re ready to serve it. If you want the rice to be extra flavorful, toss it with the dressing and marinate for a few hours. You can even freeze it in the dressing. Nutritional information per serving: 389 calories; 2 grams saturated fat; 10 grams polyunsaturated fat; 11 grams monounsaturated fat; 0 milligrams cholesterol; 31 grams carbohydrates; 4 grams dietary fiber; 208 milligrams sodium (does not include salt to taste); 11 grams protein Martha Rose Shulman is the author of “The Very Best of Recipes for Health.” |
| Recipes for Health: Put Away the White Rice Posted: 22 Feb 2011 09:03 AM PST Many years ago, after I decided to stop eating meat (I am not a strict vegetarian now, though that’s the way I usually eat), I walked down the street to look over whole grains at my local health food store in Austin, Tex. There wasn’t much of a selection; still, it was all new to me, and I bought some of the grains sold in bulk bins: brown rice, millet, kasha and wheat berries. Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. I learned to cook them and, eventually, to use them in both traditional and unusual ways. (All but millet, that is — there’s a grain I never have been able to find too much use for.) Today the choice of whole grains on the shelves at has grown exponentially, and I am feeling the same curiosity and excitement I felt all those years ago. There’s a new culture around grains — they’re interesting to all cooks, not just vegetarians. I see exotic cereals on the menus of high-end restaurants all the time now. So last week I became a grains novice again. I bought five grains I’d never cooked before: three types of rice, one variety of barley and amaranth, the seed of a green that I’ve written about before. The rices were red and black, and the barley purple, pigments that indicate the presence of polyphenols, which some researchers believe have health-promoting properties. Most of this week’s recipes call for cooked grain. I used the cooking instructions on the packages unless otherwise noted. All of these cooked grains keep well in the freezer or in the refrigerator for three or four days. I suggest you cook a double batch, transfer the leftovers to freezer bags, and store them in convenient quantities (1 to 4 cups each, depending on the size of your family and your own needs). Here’s a quick look at this week’s selection of grains: LUNDBERG WEHANI This reddish-brown whole-grain rice has a slightly chewy texture and a nutty, savory flavor. To cook, combine 1 part rice with 2 parts water and salt to taste ( ½ to ¾ teaspoon per cup of rice). Bring to a boil, reduce the heat, cover and simmer 50 to 60 minutes until the rice has absorbed all the water. Turn off the heat, remove the lid, place a towel over the pot and return the lid to the pot. Let sit 10 minutes, and then serve. For a nuttier taste, before adding the water sauté the rice in 1 tablespoon olive oil or canola oil until the rice smells toasty. A cup of raw rice yields about 3 1/3 cups of cooked rice. LUNDBERG BLACK JAPONICA RICE A combination of medium-grain mahogany rice and short-grain black rice. Cook it like Wehani rice, above. A cup of raw rice yields about 3 ¾ cups cooked rice. RUBY RED JASMINE RICE This red long-grain rice is distributed by a company that specializes in fair-trade products. The package says to cook 1 part rice in 2 ½ parts water, but I found a ratio of 1 to 2 worked better. Cook like the Wehani rice, above. A cup of raw rice yields about 3 cups of cooked rice. PURPLE PRAIRIE BARLEY This hearty dark purple barley originated in Tibet. It takes 1 ½ hours to cook — 1 hour if you soak it overnight, which I recommend. Cook 1 part grain in 2 ½ parts water with salt to taste. Place a strainer over a bowl, and drain the soaked rice. Combine the soaking water (you don’t want to lose the pigment in it) with more water to make 2 ½ parts. Add salt to taste ( ½ to ¾ teaspoon per cup of grain), and bring to a boil. Reduce the heat, cover and simmer 1 hour or until the barley is tender and beginning to splay. A cup of cup raw rice yields just under 4 cups of cooked rice. AMARANTH Amaranth is the tiny seed of a green native to the Americas. In Mexico, both the seeds and the greens are eaten. It’s very nutritious: high in protein, and very rich in the amino acid lysine, which most grains lack. Cook 1 part amaranth in 3 parts water, and stir often. Amaranth Porridge When you cook amaranth, it releases a starch that gives the cooked grain a porridgelike consistency, so its flavor and texture resemble that of a breakfast cereal. Be sure to stir from time to time as you cook, as amaranth tends to stick to the bottom of the saucepan. 1/2 cup amaranth 1 1/2 cups water 1/4 cup milk, almond milk or rice milk (more to taste) 2 teaspoons maple syrup or brown sugar or, if available, Mexican piloncillo Pinch of salt 1. Combine the amaranth and water in a small saucepan, and bring to a boil. Reduce the heat to low, cover and simmer 30 minutes. Stir every once in a while, as the amaranth may stick to the bottom of the pan. 2. Stir in the milk, syrup or brown sugar, and a pinch of salt. Stir vigorously until the porridge is creamy. Remove from the heat and serve. Variation: Add a handful of raisins or other dried fruit, or stir in chopped apples or pears. Sprinkle a few grains of fleur de sel over the top. Yield: Serves two. Advance preparation: You can make more than you need and keep the remainder in the refrigerator for a couple of days. Amaranth reheats well. I add a little more milk when I reheat. Nutritional information per serving: 209 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 1 gram monounsaturated fat; 2 milligrams cholesterol; 37 grams carbohydrates; 3 grams dietary fiber; 21 milligrams sodium (does not include salt to taste); 8 grams protein Martha Rose Shulman is the author of “The Very Best of Recipes for Health.” |
| New Kidney Transplant Policy Would Favor Younger Patients Posted: 24 Feb 2011 11:40 PM PST Younger patients would be more likely than older ones to get the best kidneys under a proposal being considered by the nation’s organ transplant network. The new policy would replace the current first-come-first-served system and is intended to provide better matches between the life expectancies of recipients and the functional life of donated kidneys. “Right now, if you’re 77 years old and you’re offered an 18-year-old’s kidney, you get it,” said Dr. Richard N. Formica, a transplant physician at Yale University and a member of the panel that wrote the proposed policy. “The problem is that you’ll die with that kidney still functioning, while a 30-year-old could have gotten that kidney and lived with it to see his kids graduate from college.” Under the proposal, patients and kidneys would each be graded, and the healthiest and youngest 20 percent of patients and kidneys would be segregated into a separate pool so that the best kidneys would be given to patients with the longest life expectancies. The remaining 80 percent of patients would be put into a pool from which the network that arranges for organ matches, called the United Network for Organ Sharing, would try to ensure that the age difference between kidney donors and recipients was no more than 15 years. News of the latest proposal was first reported in The Washington Post. The proposal is supported by many transplant surgeons and medical ethicists, but it faces an uncertain reception by kidney transplant patients and legislators. A previous proposal to better match the health of patients and donor kidneys was scrapped in 2005 after the network was flooded with negative comments. The network is hoping that this effort, which relies on a less complex formula than the earlier one, will get a better reception. Donation systems for livers, hearts, lungs and other organs have already been reformed or changed in recent years, said Anne Paschke, a spokeswoman for the organ network. However, kidney donations are by far the most common. The kidney proposal does nothing to fix geographic disparities that cause patients in New York and Chicago to wait years longer than those in Florida. Such local distribution results not only from concerns that far-away organs might not arrive in time but also because of distribution issues and turf battles between transplant centers. Dr. Lainie Friedman Ross, associate director of the McLean Center for Clinical Medical Ethics at the University of Chicago, said she opposed the new kidney transplant policy because “the biggest problem is geography, and they’re doing nothing to fix that.” Dr. Ross said she also worried that any policy that favored young patients for the provision of kidneys from dead donors might reduce or redirect to the elderly donations from living donors, who are unaffected by the proposed policy. Dr. Trent Tipple, a 37-year-old neonatologist from Columbus, Ohio, who got a kidney transplant when he was 21 and is again on a transplant waiting list after his donated kidney failed, said he favored the proposal. As the scope of kidney transplants expanded in recent years, older patients began to crowd out younger ones from waiting lists, “and I think there has to be some degree of reset,” he said. Dr. Tipple would benefit under the new proposal. Medical rationing in the United States is common but is usually done by default. Proposals to systematize rationing are rarely embraced, and Dr. Formica and others involved with the proposal took great pains to explain that it would not disadvantage most patients on waiting lists. Dr. Formica admitted, however, that older patients would have a harder time getting a kidney under the proposal. Dr. Ross was even more blunt: “Under this policy, if you’re 65, you might as well give up before you even get on the wait list.” The most common causes of kidney failure are hypertension and diabetes, so some of those waiting for kidney transplants got there because of their own poor choices. Both diabetes and hypertension are linked with genetic and lifestyle factors. Nearly 90,000 people are currently waiting for kidney transplants. In 2009, there were 10,442 kidney transplants from dead donors and another 6,387 from live donors who generally specify the recipient. The intent of a system that favors the youngest and the healthiest is to ensure the best and longest use of donated kidneys. But its effect will likely be to favor those for whom lifestyle choices are less likely to have played a role in their illness. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, said the proposed policy was sensible. “If it’s a choice between saving grandpa or granddaughter, I think you save granddaughter first,” Dr. Caplan said. “It doesn’t make sense to give people equal access to something if some people fail to benefit.” |
| Court Weighs the Power of Congress Posted: 25 Feb 2011 10:26 AM PST WASHINGTON — The Supreme Court heard arguments on Tuesday in a case that touched on the most pressing constitutional question of the day: just how much power does Congress have to regulate matters ordinarily left up to the states? The fate of President Obama’s health care law will turn on how that question is answered. The latest on President Obama, the new Congress and other news from Washington and around the nation. Join the discussion. But based on the justices’ comments, the lurid facts of the case and the odd posture in which it reached the court, the eventual decision will probably offer only limited guidance on the health care law’s prospects. The case heard Tuesday, Bond v. United States, No. 09-1227, arose from a domestic dispute. Carol A. Bond, a Pennsylvania woman, did not take it well when she learned that her husband was the father of her best friend’s child. She promised to make her former friend’s life “a living hell,” and she drew on her skills as a microbiologist to do so. Ms. Bond spread harmful chemicals on her friend’s car, mailbox and doorknob. The friend suffered only a minor injury. Such matters are usually handled by the local police and prosecutors. In Ms. Bond’s case, though, federal prosecutors charged her with using unconventional weapons in violation of the Chemical Weapons Convention of 1993, a treaty concerned with terrorists and rogue states. At the argument, Justice Samuel A. Alito Jr. suggested that Congress had gone too far. Suppose, he said, that Ms. Bond had “decided to retaliate against her former friend by pouring a bottle of vinegar in the friend’s goldfish bowl.” “As I read this statute, Justice Alito said, “that would be a violation of this statute, potentially punishable by life imprisonment.” Ms. Bond’s lawyer, Paul D. Clement, said that a chemical used by his client was not much more exotic than vinegar. “There is something sort of odd about the government’s theory that says that I can buy a chemical weapon at Amazon.com,” he said. In her appeal to the federal appeals court in Philadelphia, Ms. Bond argued that Congress did not have the constitutional power to use a chemical weapons treaty to address a matter of a sort routinely handled by state authorities. She cited the 10th Amendment, which says that “the powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people.” The appeals court ruled that Ms. Bond did not have standing to raise a 10th Amendment defense. Only states, it said, can invoke the amendment. Federal prosecutors initially embraced that line of argument, but the Justice Department abandoned it in the Supreme Court, now saying that Ms. Bond was free to try to mount a defense based on the amendment. Since Ms. Bond and her nominal adversary agreed on the central issue in the case, the court appointed a lawyer, Stephen R. McAllister, to argue for the position the government had disowned. The outcome of the case on the standing point did not seem in much doubt on Tuesday. Chief Justice John G. Roberts Jr., for instance, said it would be “pretty harsh” to forbid Ms. Bond from challenging her conviction on the ground that the law under which she was convicted exceeded Congressional authority. But the justices struggled with two other distinctions. One was how to disentangle claims that Congress had exceeded its enumerated powers in Article I of the Constitution from ones based on the 10th Amendment. The other was whether there were at least some 10th Amendment claims that could be pressed only by states. Justice Elena Kagan suggested that the case could be decided simply on the ground that Congress had exceeded the powers listed in Article I of the Constitution. “Are there any peculiarly 10th Amendment claims that you’re making?” she asked Mr. Clement. He replied that Ms. Bond relied “principally” on the argument that Congress had exceeded its powers but that it was possible the 10th Amendment played a role as well. Justice Anthony M. Kennedy added that individuals had a role to play in cases that at first blush seem to implicate only a clash between federal and state sovereignty. “Your underlying premise,” Justice Kennedy told Mr. McAllister, “is that the individual has no interest in whether or not the state has surrendered its powers to the federal government, and I just don’t think the Constitution was framed on that theory.” |
| Cuomo Adviser Takes Pay From Health Industry Posted: 23 Feb 2011 04:30 AM PST When Andrew M. Cuomo married Kerry Kennedy in 1990, Jeffrey A. Sachs served as an usher. When Mr. Cuomo’s daughter Michaela was born, he asked Mr. Sachs to be her godfather. When his marriage fell apart years later, Mr. Cuomo stayed in Mr. Sachs’s triplex near the United Nations. Patrick McMullan/PatrickMcMullan.com Jeffrey A. Sachs, left, and Andrew M. Cuomo in 2006. Mr. Sachs is a leader of Governor Cuomo’s Medicaid redesign team. Since Mr. Cuomo’s election as governor last fall, Mr. Sachs, 58, has taken on a powerful role among his health care advisers as the administration confronts crucial decisions, including how to overhaul New York’s $53 billion Medicaid program. But at the same time, Mr. Sachs, known to many in Albany as “Andrew’s best friend,” is working as a paid consultant to some of the biggest players in the New York health care industry, including Mount Sinai Medical Center, NYU Langone Medical Center and the state’s largest association of nursing homes, all of which have financial interests at stake in the coming Medicaid changes. Mr. Sachs, whose firm is named Sachs Consulting, has never registered as a lobbyist, which would require him to divulge his clients and fees to the state ethics commission. Through a spokesman, Mr. Sachs said that none of his contacts with state officials constituted lobbying under state law, which broadly excludes anyone who advises clients on how to influence public policy, among other exceptions. After inquiries from The New York Times, a spokesman for Mr. Sachs released a statement late Tuesday saying that Mr. Sachs had “frozen all contact on behalf of clients with state officials for the duration of the Cuomo administration.” Mr. Sachs will remain a health care adviser to the governor, and the spokesman, Jesse Derris, did not rule out Mr. Sachs’s participating, if asked, in general discussions of health care policy. Mr. Cuomo’s spokesman, Josh Vlasto, issued a statement soon after Mr. Derris, saying, “Nobody in the administration knows his clients, nor could it possibly matter, since Mr. Sachs has said he won’t represent anyone before the state, so the innuendo of the story is totally irrelevant.” The influence Mr. Sachs has been wielding since Mr. Cuomo’s election on Nov. 2 has startled some in the state’s tight-knit health care world. In December, according to correspondence obtained by The Times, the director of a state-run psychiatry institute said that he was fired after Mr. Sachs, unhappy that the director had clashed with one of his clients, pressured a top state official to dismiss him. And, as Mr. Sachs advised Mr. Cuomo on his transition and health care policies, state officials have made decisions that surprised many in the health care industry but were favorable to Mr. Sachs’s clients. After inquiries from The Times, the administration abruptly rescinded one of the decisions. In addition to helping Mr. Cuomo recruit senior staff, Mr. Sachs has quickly emerged as a leader on the governor’s 27-person Medicaid redesign team, the group that is drawing up the governor’s plan to pare billions in spending from the program. “His membership on the Medicaid team is worrisome to us because he has clients that are not disclosed,” said Judy Wessler, director of the Commission on the Public’s Health System, a nonprofit group that opposes Mr. Cuomo’s proposed cuts. The Cuomo administration appears sensitive about the governor’s relationship with Mr. Sachs. When Mr. Cuomo announced the members of the Medicaid redesign team, Mr. Sachs was identified only as “chairman of the John F. Kennedy Jr. Institute for Work Education,” a nonprofit development organization, omitting his work at Sachs Consulting. Mr. Sachs, a nonpracticing dentist who earned his degrees at the State University at Stony Brook, is known as much for his cultivation of the powerful and famous — he was a friend of the late John F. Kennedy Jr. and a board member of the Leonardo DiCaprio Environmental Foundation — as for his shrewd understanding of health care systems. His influence began to build late last year, as the Albany establishment, especially officials in the Paterson administration who wished to remain in state government, prepared for Mr. Cuomo’s arrival. Though he was never formally named to Mr. Cuomo’s transition team, Mr. Sachs played a major role, participating in interviews of candidates for top health care jobs and running some of the interviews, according to people involved in the process. Mr. Sachs was also an early advocate of the “Wisconsin model” of Medicaid, under which the governor would set a target for spending reductions and then appoint a task force of industry stakeholders to apportion the cuts. The approach has political appeal for the governor, in that it entices would-be opponents of spending reductions to participate in the plan rather than protest it. But it also endows the unelected team members with immense power. Mr. Sachs made recommendations to Mr. Cuomo and his aides about whom to appoint to the Medicaid team, which Mr. Cuomo formed through an executive order in January. During the transition, Mr. Sachs also helped assemble a four-person policy team to begin meeting with state agencies about the best approach to reducing Medicaid spending. The team included James Introne, an executive at ArchCare, the Roman Catholic hospital network, and Bruce E. Feig, an executive deputy commissioner at the state’s Office of Mental Health. Mr. Sachs knew them both well: Mr. Introne was his former boss and mentor and Mr. Feig his assistant in the Carey administration. Mr. Feig later worked for Sachs Consulting before taking his current job in 2007. |
| A Bush Rule on Providers of Abortions Is Revised Posted: 22 Feb 2011 02:47 PM PST WASHINGTON — The Obama administration on Friday rescinded most of a 2008 rule that granted sweeping protections to health care providers who opposed abortion, sterilization and other medical procedures on religious or moral grounds. Kathleen Sebelius, the secretary of health and human services, said the rule, issued in the last days of the Bush administration, could “negatively impact patient access to contraception and certain other medical services.” Federal laws make clear that health care providers cannot be compelled to perform or assist in an abortion, Ms. Sebelius said. The Bush rule went far beyond these laws and upset the balance between patients’ rights to obtain health care and “the conscience rights of health care providers,” she added. The Obama administration retained and updated part of the 2008 rule that established procedures to investigate complaints from health care workers who believe they have been subjected to discrimination or coercion because of their “religious beliefs or moral convictions.” Although the Bush rule is still on the books, the Obama administration has not enforced it. Eight states and several organizations filed a lawsuit in Federal District Court in Connecticut challenging the 2008 rule as vague and overly broad. The court suspended proceedings in the case, pending issuance of the rule published Friday. The Roman Catholic Church and some Republicans, like Representative Joe Pitts of Pennsylvania, criticized the Obama administration’s decision to revoke the Bush rule. But advocates for abortion rights welcomed it. “The administration’s action today is cause for disappointment,” said Deirdre A. McQuade, a spokeswoman for the Pro-Life Secretariat at the United States Conference of Catholic Bishops. Senator Richard Blumenthal, Democrat of Connecticut, said: “I applaud the Obama administration for ensuring that women will have access to the information and services they need while still protecting the conscience rights of health care providers. The Bush rule clearly went too far and threatened the health and well-being of millions of patients.” The 2008 rule provoked a torrent of criticism from doctors, pharmacists, hospitals and state officials. Pharmacies said the rule would allow their employees to refuse to fill prescriptions for contraceptives. State officials said the rule could void state laws that require insurance plans to cover contraceptives and require hospitals to offer emergency contraception to rape victims. Clare M. Coleman, president of the National Family Planning and Reproductive Health Association, which represents hundreds of family planning clinics, said President Obama was rescinding “the most harmful elements” of the Bush rule. The Obama administration said the 2008 rule might have mistakenly suggested that health care providers could refuse to treat entire groups of people on account of the providers’ religious or moral beliefs. Federal laws provide no protection for such refusals, the administration said. The bishops conference and the Catholic Health Association, representing Catholic hospitals, had supported the Bush rule as a way to protect health care providers against pressure to perform abortions. Sister Carol Keehan, president of the Catholic Health Association, said that in recent years “we have seen a variety of efforts to force Catholic and other health care providers to perform or refer for abortions and sterilizations.” In response to such concerns, the Obama administration said, “Roman Catholic hospitals will have the same statutory protections afforded to them for decades” because the laws were not affected by the cancellation of the Bush rule. |
| Charles Epstein, Leading Medical Geneticist Injured by Unabomber, Dies at 77 Posted: 23 Feb 2011 10:44 PM PST Dr. Charles J. Epstein, a prominent medical geneticist who in 1993 was seriously injured in an attack by the Unabomber but was later able to continue his research on Down syndrome and other genetic conditions, died on Feb. 15 at his home in Tiburon, Calif. He was 77. National Down Syndrome Society Dr. Charles J. Epstein The cause was pancreatic cancer, said his wife, Lois, a physician and cancer researcher who sometimes collaborated with her husband. A medical doctor, Dr. Epstein (pronounced EP-styne) was widely credited with helping to make medical genetics — an extremely new field when he began his career — an accredited medical subspecialty. At his death he was emeritus professor of pediatrics at the University of California, San Francisco, where he had taught for more than 40 years. Dr. Epstein was best known for his work on Down syndrome, a chromosomal condition that affects roughly 1 in 700 newborns. The genetic abnormality that causes Down syndrome — an extra copy of Chromosome 21 — was first identified in 1959 by the French geneticist Jérôme Lejeune. Dr. Epstein and his associates were interested in learning specifically what it was about having the extra chromosome that resulted in the constellation of anomalies associated with Down syndrome. Besides cognitive impairment, these can include heart and respiratory problems as well as changes in the brain over time that resemble those in patients with Alzheimer’s disease. In work begun in the 1970s, Dr. Epstein posited that the anomalies were caused by an overabundance of proteins generated by the extra chromosome. His hypothesis was later borne out by his own laboratory research and that of others. With his wife and their colleague David Cox, Dr. Epstein also created the first model of Down syndrome in mice. By inserting an extra chromosome into mouse embryos (they used mouse Chromosome 16, a portion of which is analogous to human Chromosome 21), they produced a mouse that exhibited many of the characteristics of Down syndrome. Such mice have furthered close study of the chromosomal roots of Down syndrome. “That was the beauty of trying to make a mouse model, because it’s very difficult to try to figure out these things on live human beings,” Lois Epstein said Tuesday. Charles Joseph Epstein was born in Philadelphia on Sept. 3, 1933. He earned a bachelor’s degree in chemistry from Harvard in 1955 and a medical degree from Harvard in 1959. He later took up a fellowship in medical genetics at the University of Washington, where he worked with Arno Motulsky, a founder of the field. Dr. Epstein joined the University of California, San Francisco, in 1967 as the head of the division of medical genetics in the department of pediatrics. There he treated children with genetic conditions in his clinical practice and established a genetic counseling program that became a model for others around the country. In 1997 he was named a director of a new universitywide program in human genetics. For reasons that have never been entirely clear, Dr. Epstein’s work somehow caught the attention of Theodore J. Kaczynski, the antitechnology ideologue and serial terrorist who came to be known as the Unabomber. In June 1993, a package addressed to Dr. Epstein at his home exploded as he opened it. He sustained hearing loss, damage to his right hand and internal injuries. Dr. Epstein was one of more than 20 people injured by Mr. Kaczynski — three others were killed — in a series of mail bombings between 1978 and 1995. Apprehended in 1996, Mr. Kaczynski pleaded guilty in 1998 and is serving a life sentence at the federal maximum-security prison in Florence, Colo. After extensive surgery and rehabilitation, Dr. Epstein was able to resume not only his scientific career but also playing the cello, an art he had pursued passionately since boyhood. Besides his wife, the former Lois Barth, whom he married in 1956, Dr. Epstein is survived by four children, David, Jonathan, Paul and Joanna Epstein; two brothers, Edwin and Herbert; and six grandchildren. Dr. Epstein’s other work included research on Alzheimer’s disease and Werner syndrome, which results in premature aging. His many books include “The Consequences of Chromosome Imbalance: Principles, Mechanisms, and Models” and “The Neurobiology of Down Syndrome,” a volume he edited. |
| Vital Signs: Childhood: Falls From Cribs Injure Dozens a Day Posted: 21 Feb 2011 07:30 PM PST A crib should be a safe place to leave an infant, but every day dozens of babies are injured in falls from cribs, according to what may be the first study focusing on nonfatal crib-related injuries in children younger than 2. In 9 of 10 cases, the child was alone when the fall occurred; most of the injuries were to the head and neck. Injuries increased with the children’s age, said the paper’s senior author, Dr. Gary A. Smith, director of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio. “As the child gains mobility, they’re able to climb out,” Dr. Smith said. Caregivers are supposed to adjust the height of the mattress when babies start to pull themselves up, but Dr. Smith said parents might be “caught off guard — the child is not standing one day, and then the next day off they go.” The study, published in the journal Pediatrics, analyzed nationally representative data gathered by the National Electronic Injury Surveillance System for 181,654 injuries related to cribs, playpens and bassinets from 1990 through 2008. Of those injured, 2,140 children, or 1.2 percent, died — most from becoming caught or wedged in the crib. Beginning in June, new mandatory safety standards go into effect for cribs, including a ban on traditional drop-side railings. |
| Vital Signs: Diet: High Fiber to Combat Death and Disease Posted: 21 Feb 2011 07:30 PM PST A study of almost 400,000 people aged 50 to 71 has found a strong link between a high-fiber diet and a longer life. Specifically, subjects who ate a diet rich in whole grains, fruits and vegetables (adding up to 29 grams of fiber per day for men, 26 grams for women) were 22 percent less likely to die after nine years than those who ate the least fiber (13 and 11 grams per day), according to the study, in Archives of Internal Medicine. Those in the high-fiber group were less likely to die of cardiovascular disease, infectious disease and respiratory disease; a high-fiber diet was also associated with fewer cancer deaths in men, though not in women. The lower death rates were associated with dietary fiber from whole grains, said the lead author, Dr. Yikyung Park, a staff scientist at the National Cancer Institute. “One of our findings was that fiber has anti-inflammatory properties,” Dr. Park said, adding that grains are also rich in beneficial vitamins, minerals and chemicals. People who ate more fiber were generally healthier, more educated and more physically active to begin with, the authors noted. But the study adjusted for these differences. At the start of the study, all participants filled out 124-item food frequency questionnaires. Nine years later, 20,126 men and 11,330 women had died. |
| Vital Signs: Behavior: Videos of Self-Injury Find an Audience Posted: 21 Feb 2011 07:30 PM PST YouTube videos are spreading word of a self-destructive behavior already disturbingly common among many teenagers and young adults — ‘cutting’ and other forms of self-injury that stop short of suicide, a new study reports. Share your thoughts on this column at the Well blog. Go to Well » As many as one in five young men and women are believed to have engaged at least once in what psychologists call nonsuicidal self-injury. Now the behavior is being depicted in hundreds of YouTube clips — most of which don’t carry any warnings about the content — that show explicit videos and photographs of people injuring themselves, usually by cutting. They also depict burning, hitting and biting oneself, picking at one’s skin, disturbing wounds and embedding objects under the skin. Most of the injuries are inflicted on the wrists and arms and, less commonly, on the legs, torso or other parts of the body. Some of the videos weave text, music and photography together, which may glamorize self-harming behaviors even more, the paper’s authors warn. And the videos are popular. Many viewers rated the videos positively, selecting them as favorites more than 12,000 times, according to the new study, in the March issue of the journal Pediatrics, whose authors reviewed the 100 most-viewed videos on self-harm. Stephen P. Lewis, assistant professor of psychology at the University of Guelph in Ontario and the paper’s lead author, calls the YouTube depictions of self-harm “an alarming new trend,” especially considering how popular Internet use is among the population that engages most in self-injury already: teenagers and young adults. “The risk is that these videos normalize self-injury, and foster a virtual community for some people in which self-injury is accepted, and the message of getting help is not necessarily conveyed,” Dr. Lewis said. “There’s another risk, which is the phenomenon of ‘triggering,’ when someone who has a history of self-injury then watches a video or sees a picture, his or her urge to self-injure might actually increase in the moment.” Only about one in four of the 100 most-viewed videos sent a clear message against self-injury, the paper’s analysis showed, and about the same proportion had an encouraging message that suggested the behavior could be overcome. About half the videos had a sad, melancholic tone, while about half described the behavior in a straightforward and factual manner. About a quarter of the videos conveyed a mixed message about self-injury, while 42 percent were deemed neutral and 7 percent were clearly favorable toward self-injury. Only 42 percent of the videos warned viewers about the content. |
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