Health - Awaiting Health Law’s Prognosis

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• Awaiting Health Law’s Prognosis
• States Diverge on How to Deal With Health Care Ruling
• Recipes for Health: Slow-Baked Beans With Kale
• Senate Democrats to Allow Early Vote on Health Care Repeal
• Shaken-Baby Syndrome Faces New Questions in Court
• New Chief Revises Goals and Spending for Pfizer
• Group Releases Hidden Tapes of Planned Parenthood
• Books of The Times: Phantoms of the Mind, No Longer Shocking But No Less Haunting
• Concierge Medical Care With a Smaller Price Tag
• Federal Judge Rules That Health Law Violates Constitution
• Well: Caring for the Chart or the Patient?
• Well: More Bone (and Less Fat) Through Exercise
• Well: Focusing on the Stress of Prostate Cancer
• Well: What Are Your Relationship Deal Breakers?
• Mark Bittman: A Food Manifesto for the Future
• The New Old Age: Shingles: A Few Helpful Links
• The New Old Age: Walking Down Memory Lane
• Prescriptions: Health Care Is High Among Web Searches
• Recipes for Health: Beets, Spiced Quinoa and Yogurt
• Recipes for Health: Cabbage and Red Pepper Gratin
• After Video Exposé, Planned Parenthood Fires Employee
• Reporter’s Notebook: Tea Party Shadows Health Care Ruling
• F.D.A. Declines to Approve Diet Drug
• Ernest McCulloch, Crucial Figure in Stem Cell Research, Dies at 84

Awaiting Health Law’s Prognosis Posted: 01 Feb 2011 10:33 PM PST With a court decision on Monday declaring the health care law unconstitutional and Republicans intent on repealing at least parts of it, thousands of Americans with major illnesses are facing the renewed prospect of losing their health insurance coverage. Enlarge This Image Herb Swanson for The New York Times Hillary St. Pierre, who has Hodgkin’s lymphoma, nearly ran out of insurance because of lifetime limits. Multimedia Interactive Feature The Health Care Law: The Growing Legal and Political Opposition Document: Judge Vinson’s Ruling Related States Diverge on How to Deal With Health Care Ruling (February 2, 2011) Reporter’s Notebook: Tea Party Shadows Health Care Ruling (February 2, 2011) Enlarge This Image Leah Nash for The New York Times Last year, the bill was $800,000 for the clotting factor medicine that Alex Ell, a 22-year-old with hemophilia, needs. The legislation put an end to lifetime limits on coverage for the first time, erasing the financial burdens, including personal bankruptcy, that had affected many ailing Americans. For example, Hillary St. Pierre, a 28-year-old former registered nurse who has Hodgkin’s lymphoma, had expected to reach her insurance plan’s $2 million limit this year. Under the new law, the cap was eliminated when the policy she gets through her husband’s employer was renewed this year. Ms. St. Pierre, who has already come close once before to losing her coverage because she had reached the plan’s maximum, says she does not know what she will do if the cap is reinstated. “I will be forced to stop treatment or to alter my treatment,” Ms. St. Pierre, who lives in Charlestown, N.H., with her husband and son, said in an e-mail. “I will find a way to continue and survive, but who is going to pay?” As judges and lawmakers debate the fate of the new health care law, patients like Ms. St. Pierre or Alex Ell, a 22-year-old with hemophilia who lives in Portland, Ore., fear losing one of the law’s key protections. Like Ms. St. Pierre, Mr. Ell expected to reach the limits of his coverage this year if the law had not passed. In 2010, the bill for the clotting factor medicine he needs was $800,000, and his policy has a $1.5 million cap. “It is a close call,” he said. Exactly what will happen to the law’s specific provisions that prevent insurers from imposing lifetime limits and require them to phase out the annual limits now in place is unclear. While even Republicans concede that a full repeal is unlikely, Congress could strip certain elements of the legislation, like this one. As challenges to the law move through the courts, patients who have felt an immediate impact now confront added uncertainty. “We’ve got to protect people from catastrophic health problems,” said Ron Pollack, the executive director of Families USA, a consumer advocacy group that favored the law’s passage. “We don’t want people bankrupted.” Protecting people from facing these extremes is one of the main goals of the law, according to its proponents. Asked about the effect of the law on those who had encountered an insurance ceiling, Kathleen Sebelius, the health secretary, said in a statement: “The Affordable Care Act is freeing Americans from worrying about having their insurance benefits run out when they need them the most.” Before the law was passed, an estimated 20,000 insured Americans reached the lifetime limits of their coverage each year. Decades old, these restrictions were put in place when both medical care and health insurance were much less expensive than they are today, said Tom Wildsmith, an official with the American Academy of Actuaries. In recent years, many employers, if they still had caps, set them fairly high, so that it was rare for someone to exceed the benefits unless they were seriously ill and required expensive care. “This is the kind of thing that grabs a cancer survivor who has had several operations,” said Gary Claxton, an executive with the Kaiser Family Foundation, which studies employer coverage. Only the very sick were affected. “People don’t voluntarily use this level of services,” he said. Ms. St. Pierre nearly lost her insurance in 2008. After her first bone marrow transplant failed, she realized the coverage from her husband’s employer would run out before she could receive another transplant. She remembers reviewing her options and looking into treatments that would be less expensive. She enrolled in a clinical trial to test an unproved form of chemotherapy, for example, because it was free. She considered divorcing her husband, a move that could qualify her for Medicaid, or moving to Massachusetts, where she thought she might be able to afford and qualify for a policy. She has written about her experiences on her blog, called BaldiesBlog. But she was spared from making those decisions when her husband’s company was acquired, and she was able to enroll in a new health plan. “Luckily, the cap started over,” she said. Ms. St. Pierre also now qualifies for Medicare, the federal health insurance program, because she is disabled, but her husband’s plan remains her primary source of insurance. Medicare would still leave her with significant medical bills if she lost her husband’s coverage because she has no supplemental insurance. Without the lifetime cap, Ms. St. Pierre says she can now focus on what treatment makes the most sense rather than gamble that the most aggressive care will cure her and allow her to escape the maximum limits on coverage. “It opens up all sorts of options,” she said, including viewing her cancer as a chronic condition that she can afford to treat for many years. Cancer patients like Ms. St. Pierre who are concerned about running out of coverage often try to tailor their treatments to see if they can avoid hitting their lifetime caps, said Stephen Finan, senior director of policy at the American Cancer Society. “People have to think about what’s their strategy,” he said. 1 2 Next Page »

States Diverge on How to Deal With Health Care Ruling Posted: 02 Feb 2011 12:03 PM PST States took broadly divergent approaches on Tuesday to a federal judge’s ruling that invalidated the Obama health care law, while Congressional Republicans used the decision to build momentum for a vote on repealing the act. Enlarge This Image Drew Angerer/The New York Times Senator Mitch McConnell, the Republican leader, speaking Tuesday about the health care law. Multimedia Interactive Feature The Health Care Law: The Growing Legal and Political Opposition Related Reporter’s Notebook: Tea Party Shadows Health Care Ruling (February 2, 2011) Awaiting Health Law’s Prognosis (February 2, 2011) Related in Opinion Editorial: Judicial Activism on Health Reform (February 2, 2011) Enlarge This Image Ben Twingley/Pensacola News Journal, via Associated Press Judge Roger Vinson The Senate’s Democratic leaders answered the Republican challenge by saying they would stage a vote on the repeal measure on Wednesday, when they were certain it would be defeated. The House, where Republicans won a majority in November’s elections, approved the repeal last month. “We want to get this out of their system very quickly,” the Senate majority leader, Harry Reid of Nevada, said at a news conference in Washington. But in a few states that are party to the litigation, Republican governors and attorneys general declared the expansive health care law effectively null as a result of the judge’s ruling. They suggested they would suspend planning and implementation until appeals courts could rule, although they did not provide details about what precisely might change or whether they would refund federal planning grants already awarded. “We’re not going to spend a lot of time and money with regard to trying to get ready to implement that until we know exactly what is going to happen,” said Gov. Rick Scott, the new Republican leader of Florida, where the lawsuit was filed by elected officials from 26 states. “And I hope and I believe that either it will be declared unconstitutional or it will be repealed.” In Wisconsin, the state’s attorney general, J. B. Van Hollen, a Republican, said he was advising Gov. Scott Walker that “the federal health care law is dead — unless and until it is revived by an appellate court.” He added, “Effectively, Wisconsin was relieved of any obligations or duties that were created under terms of the federal health care law.” Aides to Mr. Walker, a Republican, did not respond to a request for comment. Jon Hanian, a spokesman for Idaho’s Republican governor, C. L. Otter, said that state now might cancel a meeting scheduled for March to study the establishment of a health insurance exchange, which the law requires in 2014. “I think it’s fair to say it’s an open question whether they’ll do that,” Mr. Hanian said. “We’ve had two rulings now that have struck this thing down.” But Democratic governors tended to echo Gov. Peter Shumlin of Vermont, who said his state was “moving ahead at full speed” to carry out the law. And in many states, even Republican officials who are party to the lawsuit chose to tread cautiously. “We’ll be required to move forward until such time relief is granted or an appellate decision is finalized,” said Gov. Nathan Deal of Georgia. “It’s a victory, but not a complete victory.” Judge Roger Vinson of Federal District Court in Pensacola, Fla., ruled Monday that the health care act’s requirement that Americans obtain insurance exceeded Congress’ authority to regulate interstate commerce. Unlike a Virginia judge who invalidated that provision in December, Judge Vinson struck down the entire health care act. Two other federal judges have upheld the law. Judge Vinson noted that Congress had failed to include language in the bill to legally sever portions found unconstitutional from the rest. That, the judge wrote, left him to determine whether other components could function independently of the insurance mandate and whether Congress would have approved the act without that provision. Comparing the law to “a finely crafted watch,” Judge Vinson wrote that there were “too many moving parts” for him to “dissect out the proper from the improper, and the able-to-stand-alone from the unable-to-stand-alone.” He issued a declaratory judgment against the entire law, and suggested that the Obama administration view it as the “functional equivalent” of an injunction to suspend its implementation. The judge acknowledged in a footnote that his reasoning on the question borrowed heavily from a friend of the court brief submitted by the Family Research Council, a conservative Christian advocacy group. States run a significant risk in suspending planning for the law’s implementation while awaiting a final judgment, presumably from the Supreme Court, in a process that could take up to two years. Under several major provisions, the federal government can step in if a state defaults. Most notably, the law says the federal government will take over the operation of health insurance exchanges, where people can compare and buy health plans, if states do not make adequate progress toward establishing them by Jan. 1, 2013. The White House has tried to emphasize that Judge Vinson’s ruling will not affect the law’s implementation, at least in Washington, until appellate courts can clarify the confusion. The Justice Department, which represents the administration in the case, is considering whether to request a stay of the ruling. Regardless, it plans to appeal to the Court of Appeals for the Eleventh Circuit, in Atlanta. Among other tasks, federal health officials are working to define “essential benefits” to be provided by all insurers, writing regulations for a new long-term care insurance program and weighing dozens of requests from states, employers and labor unions for exemptions from various requirements. “There has not been any effect on the work being done by this department,” said Richard Sorian, a spokesman for the Department of Health and Human Services. In Congress, the Senate Republican leader, Mitch McConnell of Kentucky, put forward the repeal measure as an amendment to an aviation industry bill that is now on the Senate floor. “For all those who supported the health care law, it’s an opportunity to re-evaluate your vote, to listen to your constituents,” Mr. McConnell said in a floor speech on Tuesday. He added, “You can say, perhaps: ‘This was a mistake. We can do this better.’ Or you can continue to dismiss the majority of people in this country as not knowing what they’re talking about.” Senate Democrats, however, dismissed the Republican repeal effort as futile and an unnecessary delay of work on the aviation bill. They said their willingness to consider the measure reflected both a recent agreement among Senate leaders to avoid procedural gridlock and their confidence that the health law would survive. Democrats said they still intended to work with Republicans to repeal one provision of the law that officials in both parties say would create onerous paperwork requirements for small businesses. “No one is saying that the health care bill should not be fixed in any way,” said Senator Charles E. Schumer of New York, the No. 3 Democrat.

Recipes for Health: Slow-Baked Beans With Kale Posted: 01 Feb 2011 10:14 PM PST Beans baked very slowly for several hours develop a creamy texture, while the liquid they cook in, which thickens to a syrup, acquires a caramelized flavor. The kale practically melts in this casserole, going from bitter to sweet. I love using lima beans in this dish because they’re so big and their texture is so luxurious. Recipes for Health Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. See All Recipes for Health » Visit Recipes for Health on Facebook. Related Recipes for Health: Vegetable Casseroles for Frigid Nights (January 31, 2011) Recipes for Health: Cabbage and Red Pepper Gratin (February 1, 2011) Recipes for Health: Beets, Spiced Quinoa and Yogurt (February 3, 2011) Recipes for Health: Potato and Chard Stalk Gratin (February 4, 2011) 1 bunch kale, stemmed and washed in two changes of water 3 tablespoons extra virgin olive oil 1 medium onion, chopped 1 carrot, chopped 1 rib celery, chopped 4 garlic cloves, minced 1 2/3 cups white beans (3/4 pound) or dried lima beans, picked over and soaked for at least four hours and drained 1 6-ounce can tomato paste, dissolved in 1 cup water 3 cups additional water A bouquet garni consisting of 4 parsley sprigs, 2 thyme sprigs and a bay leaf 1 teaspoon herbes de Provence Salt and a generous amount of freshly ground pepper 1/2 cup bread crumbs 1. Preheat the oven to 225 degrees. Meanwhile, bring a large pot of water to a boil, salt generously and add the kale. Blanch for two minutes, then transfer to a bowl of ice water. Drain, squeeze out water and cut into ribbons. Set aside. (I blanch the kale to extract some of the bitterness, but you can skip this step if you wish). 2. Heat 2 tablespoons of the olive oil over medium heat in a large ovenproof casserole. Add the onion, carrots and celery. Cook, stirring often, until the onion is tender, about five minutes. Add the garlic and cook, stirring, until fragrant, 30 seconds to a minute. Add the dissolved tomato paste, and bring to a simmer. 3. Add the drained beans, the remaining water, the bouquet garni and salt and pepper. Stir in the kale, bring to a simmer, cover and place in the oven. Bake three hours until the beans are tender and creamy. Taste and adjust salt. 4. Mix together the remaining olive oil and the bread crumbs. Sprinkle the bread crumbs over the beans, and continue to bake another 30 minutes to an hour until the bread crumbs are lightly browned. Remove from the heat and serve; or allow to cool slightly and serve. Yield: Serves six. Advance preparation: You can make this recipe through Step 3 and store it in the refrigerator up to four days ahead of serving. Top with the bread crumbs, and reheat in a 350-degree oven for 15 minutes until the beans are bubbling and the bread crumbs lightly browned. Nutritional information per serving (six servings): 370 calories; 8 grams fat (1 gram saturated fat); 0 milligrams cholesterol; 58 grams carbohydrates; 12 grams dietary fiber; 191 milligrams sodium (does not include salt to taste); 19 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Senate Democrats to Allow Early Vote on Health Care Repeal Posted: 01 Feb 2011 10:25 PM PST WASHINGTON — Senate Democrats, answering a challenge by Republicans pushing to overturn President Obama’s health care overhaul, said the Senate would vote soon, perhaps as early as Wednesday, on a repeal measure, and that they were certain that it would be defeated. Multimedia Interactive Feature The Growing Legal and Political Opposition Related Awaiting Health Law’s Prognosis (February 2, 2011) Reporter’s Notebook: Tea Party Shadows Health Care Ruling (February 2, 2011) The Senate Republican leader, Mitch McConnell of Kentucky, said he had put forward the repeal measure, which was approved overwhelmingly by the Republican-controlled House last month, as his first amendment to an aviation industry bill that was already on the Senate floor on Tuesday. “We pledged to the American people that we would seek to repeal this 2,700-page bill that seeks to restructure all of American health care and put the decisions in Washington,” Mr. McConnell said at a news conference. “I’m pleased to announce that all 47 of my members will be voting to repeal Obamacare.” The announcement of a showdown on the Senate floor came the day after a Federal District Court in Pensacola, Fla., ruled that the health care law was unconstitutional. The court said that Congress had exceeded its authority by requiring in the law that nearly all Americans to obtain insurance or face financial penalties, a provision generally known as the individual mandate. The willingness of Senate Democrats to allow the repeal measure to come to a vote reflected two factors: a recent agreement among Senate leaders to avoid procedural gridlock and limit the use of parliamentary warfare, and the confidence among Democrats that the health care law would ultimately survive challenges both in Congress and in the courts. The judge in Pensacola, Roger Vinson, ruled that the individual mandate provision could not be severed from the rest of the health care law, so it rendered the entire law unconstitutional. A federal court in Richmond, Va. issued a similar but more narrow ruling striking down the individual mandate in December. Both the Pensacola and Richmond judges allowed the law to remain in place while appeals of their decisions proceeded. Two other district courts, one in Lynchburg, Va. and another in Detroit, issued decisions upholding the law in cases that also brought constitutional challenges. The Senate majority leader, Senator Harry Reid of Nevada, said that Democrats wanted to vote on Mr. McConnell’s repeal amendment and any other Republican proposals, defeat them quickly, and move on to other issues, including the debate on the aviation bill that is now on the floor. Mr. Reid said that Democrats would challenge the repeal amendment based on its effect on the federal budget. The nonpartisan Congressional Budget Office has said that repealing the health care law would add more than $230 billion to federal deficits between 2012 and 2021. “We believe that the health care law which is now in effect is good for the American people,” Mr. Reid said. “We’re going to do everything we can to get rid of these amendments.”

Shaken-Baby Syndrome Faces New Questions in Court Posted: 02 Feb 2011 09:24 AM PST At 4 months, Noah Whitmer was an easy baby. Super tranquilo, remembers Trudy Eliana Muñoz Rueda, who took care of Noah at her home day care center in Fairfax County, Va. Rueda and Noah’s mother, Erin Whitmer, both noticed when he stopped taking his bottle well and napping as usual in the middle of his fifth month, in April 2009. Whitmer thought this was because Noah had just started eating solid food. She and Rueda talked about it early on April 20, both of them hunched over Noah in his car seat when Whitmer dropped him off. Enlarge This Image Eugene Richards/Reportage, for The New York Times CAREWORN Trudy Rueda at the Fluvanna Correctional Center for Women in Virginia. She was convicted of shaking Noah Whitmer and sentenced to 10½ years in prison. That afternoon, after a morning in which Noah didn’t nap and drank only a couple of ounces of formula, Rueda says she prepared a bottle for him while he lay on a mat. In her native Peru, Rueda, who is 46, ran a travel agency and taught college courses for prospective tour guides. Her husband was trained as a lawyer. After they moved to the United States in 2001, the couple had a second child, and three years later Rueda converted her basement into a home day care center so she could work while spending time with her two kids. When Rueda sat down to feed Noah, her 13-year-old daughter was at school, her 5-year-old was upstairs watching TV and the four other children in her care were taking naps. Rueda’s sister-in-law, who spent the morning with the children while Rueda was at a doctor’s appointment, had just left the house. “Everything was calm and quiet,” Rueda, who has soft features and dark hair, told me in Spanish while her lawyer translated. There are two irreconcilable versions of how that calm shattered. Rueda says that Noah was crying, and she picked him up, sat on the couch and gave him the bottle to help put him to sleep. While she was feeding him, she felt Noah’s arm go limp, and when she moved to take the bottle out of his mouth, he made a sound that she didn’t recognize. “I could tell something was happening,” she says. She stood up and put Noah on her shoulder, patting him on the back. “As I did this, his body tensed up in a ball. It was as if he was looking for air, and he couldn’t breathe.” Rueda put Noah on the floor and started C.P.R., at the same time reaching for her phone to call 911. She put the dispatcher on speakerphone so she could keep tending to Noah. “I said, ‘Please, please get someone here,’ ” she said. “I knew it could hurt him if there wasn’t enough oxygen going to his brain.” Erin Whitmer’s account of the moments before Noah lost consciousness is entirely different. “Around 2:30 on April 20, 2009, Noah was shaken,” she wrote on her blog Noah’s Road, on the one-year anniversary of the incident. “He’d been crying. He needed something that his day care provider wasn’t providing him. Maybe he was tired of lying on the mat where she’d had him. Maybe he needed a hug, a laugh, a kind touch. Instead, she picked him up, her fingers gripping him tightly, feeling the softness of his velour pants and his cotton onesie under her fingers, and she shook him.” Whitmer’s account of what Rueda must have done to Noah was based on evidence presented at Rueda’s trial and information from the doctors who treated him after he was rushed to Inova Fairfax Hospital. The doctors gave Noah a CT scan, which showed subdural hemorrhaging (bleeding in a space between the skull and the brain) and an ophthalmological exam revealed retinal hemorrhaging (bleeding at the back of the eyes). Also, his brain was swelling. For decades, these have been the three telltale signs linked to the kind of child abuse commonly called shaken-baby syndrome. Noah had no external marks on his body — no bruises or cuts or fractures, no sign that he was forcefully gripped and no evident neck injury that would seem to result from vigorous shaking. But an M.R.I. confirmed the CT scan findings and showed that the subdural bleeding was extensive. The doctors at Inova Fairfax tested Noah for clotting disorders that can cause these kinds of hemorrhages. The tests came back negative. The doctors told Erin and Michael Whitmer, who are both 32, that they strongly suspected Noah was violently shaken in the moments before he stopped breathing. While Noah lapsed into a coma, police went to question Trudy Rueda. A day later, Rueda was arrested. She was charged with two felony counts: abuse of a child causing serious injury and cruelty to a child. Before April 20, 2009, Noah was a healthy baby. Trudy Rueda also had nothing suspect in her past. In five years as a day care provider, she had a pristine record with state regulators — she had taken the classes required for her license and extra ones as well. She cared for a boy with autism and a girl with one arm, reportedly with calm and assurance. “She was more patient than all of us,” one mother testified at Rueda’s trial. A second said, “What she’s accused of now I could not begin to imagine Trudy doing.” And yet Noah emerged from her home with terrible and permanent injuries. Between 1,200 and 1,400 children in the United States sustain head injuries attributed to abuse each year. Most of them are less than a year old. Usually, there’s not much dispute that these children were abused, because doctors discover other signs of mistreatment — cuts, bruises, burns, fractures — or a history of such injuries. There is no exact count of shaken-baby prosecutions, but law-enforcement authorities think that there are about 200 a year. In an estimated 50 percent to 75 percent of them, the only medical evidence of shaken-baby syndrome is the triad of internal symptoms: subdural and retinal hemorrhage and brain swelling. For a year after Noah came out of his coma, he had as many as 32 seizures a day. Now he is 2, and his parents watch as his 1-year-old brother surpasses him developmentally. Noah sometimes nods his head “yes” and gives high fives, but he is not yet talking; doctors are not sure of his cognitive prognosis. Erin Whitmer, a slender woman with large brown eyes who chose Rueda for part-time day care after a careful search, cried when she found out that Rueda had been arrested. Now she says, “It will never completely leave me, the horror that I trusted my son with someone and she did this to him.” 1 2 3 4 5 6 7 8 Next Page » Emily Bazelon, a contributing writer, is a senior editor at Slate and the Truman Capote law-and-media fellow at Yale Law School.

New Chief Revises Goals and Spending for Pfizer Posted: 01 Feb 2011 09:08 PM PST Pfizer, the drug maker, announced plans Tuesday to slash its research spending by as much as $2.9 billion in the next two years, including closing the English labs that invented Viagra. The company stock soared 5.5 percent on Tuesday, to $19.22, helping lead the Dow Jones industrial average 1.25 percent higher, to 12,040.16. Analysts praised Pfizer’s cutbacks and a $5 billion stock buyback plan announced by Ian C. Read, the New York-based company’s new chief executive. In an interview on Tuesday, Mr. Read promised that Pfizer would stop “investing on hope,” and would focus its research on the most profitable ventures. The company said it would close its largest European research center, in Sandwich, Britain, by 2013, and abandon efforts there in allergy and respiratory drugs. The site had developed Viagra among others, and has 2,400 employees. “Extremely disappointing,” Vince Cable, the British government’s business secretary, said in a statement. Pfizer will also trim its research facility in Groton, Conn., by 1,100 people, to 3,400, while adding jobs in the university research hubs in Boston and Cambridge, England. Mr. Read, who replaced Jeffrey B. Kindler as chief executive in December, said the company was reviewing its core research strengths and planned to outsource more research. “Make bets where you can win and stop spending where you think you can’t,” he said. The company plans to reduce total research spending by 25 to 30 percent over the next two years, from $9.4 billion in 2010, to $8 billion to $8.5 billion this year, and to $6.5 billion to $7 billion in 2012. Pfizer faces declining sales of the cholesterol pill Lipitor, the world’s best-selling drug, as it loses United States patent protection in November. Pfizer acquired Wyeth for $68 billion in 2009, largely to restock its pipeline with products, including Premarin, Pristiq, Enbrel and Prevnar. The acquisition complicated efforts to compare the 2010 financial results to previous years. Pfizer reported fourth-quarter adjusted earnings of $3.77 billion, or 47 cents a share. They were 2 cents below the year-earlier quarter and 1 cent above consensus estimates, on better-than-expected sales of $17.56 billion. Seamus Fernandez, an analyst with Leerink Swann, said wholesalers probably stocked up in the fourth quarter, as Pfizer raised prices on Jan. 1. Pfizer predicted 2011 profits of $2.16 to $2.26 a share, about 9 cents below analysts’ consensus expectations, but maintained its 2012 guidance of $2.25 to $2.35 a share. The company described cost-cutting plans to offset a reduction in 2012 revenue goals by about $2 billion, to $63 billion to $65.5 billion. The guidance, the Credit Suisse analyst Catherine J. Arnold wrote investors, “should be met with a sigh of relief.” The new share repurchase plan increased the company’s commitment to $9 billion, with $5 billion to be spent in 2011. Pfizer stock has lost about a quarter of its value over the last five years while the broader pharmaceutical index has dropped about 5 percent.

Group Releases Hidden Tapes of Planned Parenthood Posted: 02 Feb 2011 09:40 AM PST An anti-abortion group seeking to discredit Planned Parenthood released an undercover video on Tuesday that appears to show a clinic manager advising a sex trafficker how to get medical care for prostitutes as young as 14. Related Times Topic: Planned Parenthood Federation of America In a statement responding to the video, the Planned Parenthood Federation of America said that immediately after the “highly unusual” visit to a clinic in Perth Amboy, N.J., by a man posing as a sex trafficker and a woman posing as a prostitute, it had notified legal authorities. But Stuart Schear, vice president for communications of the group, added, “What appears on edited tapes made public today is not consistent with Planned Parenthood’s practices, and is under review.” The federation’s central New Jersey branch said that “the behavior of our employee, as portrayed on the video, if accurate,” violated policies and that “appropriate action is being taken.” Planned Parenthood provides contraception, gynecological services and abortions, including to many low-income women. It has long been a target of the anti-abortion movement, which wants to end all federal and state financing for the clinics. Last week, Planned Parenthood said that people claiming to be sex traffickers had visited at least 11 of its clinics and that it had notified the Justice Department. The group also said that, based on an identification of one of the visitors, it had concluded that the visits were a hoax by the anti-abortion group Live Action. Planned Parenthood said the group had a history of using “surreptitious videotaping and manipulative editing” in a campaign to destroy it. The video from the clinic shows a woman identified as the office manager responding to an unseen man and woman. The man says he is involved in sex work and wants to bring girls, some only 14 or 15 and illegal immigrants, for medical exams. The manager seems ready to bend the rules to provide medical care to the girls and says the girls should be careful about admitting their ages, especially if they are under 15, which triggers extra reporting requirements. “For the most part, we want as little information as possible,” she says. Asked if the girls can obtain abortions, the manager replies that if they are under 15, they should go to another clinic where “their protocols are not as strict as ours.” “This proves beyond a shadow of a doubt that Planned Parenthood intentionally breaks state and federal laws and covers up the abuse of the young girls it aims to serve,” Live Action’s president, Lila Rose, said in a statement. Mr. Schear said, “We are as committed as ever to meeting the reproductive health needs of women in every community.” The video resembles those made in 2009 by a conservative activist, James O’Keefe, in which employees of the community group Acorn appeared to advise a prostitution ring how to avoid taxes. Ms. Rose, 22, has worked with Mr. O’Keefe on other undercover videos in Planned Parenthood offices.

Books of The Times: Phantoms of the Mind, No Longer Shocking But No Less Haunting Posted: 01 Feb 2011 07:00 PM PST Judith Guest’s 1976 novel, “Ordinary People,” and the 1980 film adaptation starring Timothy Hutton, were groundbreaking because they underscored Ms. Guest’s title. Mental illness could occur in the most ordinary families, these works suggested. It could happen to anyone. Enlarge This Image Martin Hunter Henry Cockburn HENRY’S DEMONS Living With Schizophrenia, a Father and Son’s Story By Patrick Cockburn and Henry Cockburn Illustrated. 238 pages. Scribner. $25. Enlarge This Image Martin Hunter Patrick Cockburn The appeal of the Irish journalist Patrick Cockburn’s distressing new memoir, written with his son Henry, is quite the opposite, because the large Cockburn family is completely extraordinary. “Henry’s Demons” is about how Henry Cockburn, in 2002, at the age of 20, received a diagnosis of schizophrenia. He was enrolled at the University of Brighton at the time. Trees began talking to him; he leapt naked into frozen lakes; he soiled his pants on a regular basis; he ate raw garlic; his hair became matted into a single mephitic dreadlock; he roamed the woods, his crotch becoming infested with insects; he began to resemble Jesus or a caveman. He would be in and out of mental institutions, all across England, for nearly the next decade. The charming young man his family had known was largely gone. This is an awful, hard-to-witness, downbound train of a story. The book’s last sentence, written by Henry, is as startling as the moment in a horror movie when the mutilated monster, long presumed dead, flicks opens its green eyes. We’ve become accustomed to memoirs of mental illness in recent years, as the public’s appetite for bleak and ungodly first-person narratives has increased, and as much of the stigma attached to these conditions has fallen away. Which is another way of saying that books of this sort don’t have the revelatory power they once did. “Henry’s Demons” is not a masterpiece of the genre. But it is never boring, and not only because Henry, a talented painter, has a beautiful mind (to borrow the title of Sylvia Nasar’s book about the mathematician John Nash, who also suffered from schizophrenia). It’s also a living, breathing book because nearly everyone in his shaggy, expressive family is worth getting to know. The Anglo-Irish Cockburns are well known in Britain; they’re an elite brood of left-leaning journalists, a kind of Kennedy clan of impious dissent. Patrick is a longtime foreign correspondent who now reports from Iraq for The Independent. His two older brothers, Alexander and Andrew, are also iconoclastic journalists; so was their father, Claud. Many of Patrick’s ancestors — politicians, church leaders, judges — wrote books as well. Evelyn Waugh is a distant cousin. In “Henry’s Demons,” father and son write roughly alternating chapters (though more of them are by Patrick), and Patrick’s wife, the academic Janet Montefiore, Henry’s mother, also contributes several diary entries that are so excellent that you wish there were far more of them. Patrick’s nomadic life gives the book part of its exotic tone. A typical sentence from him reads, “I came back for his half term, traveling through the Hindu Kush mountains with some difficulty.” But nearly every aspect of this family’s life is interesting and quasi-novelistic. They have good educations and are not afraid to put them to use. When Henry has a breakdown, he asks his mother “to sing him a protest hymn by James Russell Lowell, the 19th-century New England poet, critic and anti-slavery advocate.” When Henry was a small boy, he loved to watch Puccini’s opera “La Boheme” on television with his father; he called it “The Blue Hen.” (He referred to “The Barber of Seville” as “Babar of Seville.”) The family — Henry has a younger brother named Alexander — lives in Canterbury and from there travels the world together. At 12, Henry complained: “It’s no good, I’m not an intellectual, Mummy. You’re an intellectual, Daddy’s an intellectual, Alexander’s an intellectual — I’m not an intellectual.” Late in the book Henry tells us that the novelist David Mitchell was often his baby sitter. It’s a tribute to this book’s frank, frazzled tone that none of this information comes across as pretentious. “Henry’s Demons” is haunted by Patrick’s own illness as a young man. He contracted polio in 1956, at 6. “I have always had a severe limp, cannot run and do not drive,” he writes. The book is haunted more fully by his fear that his frequent absences, while reporting from the Middle East and elsewhere, contributed to his son’s breakdown. One recalls Calvin Trillin’s observation, in his memoir “About Alice,” about parenthood: “Your children are either the center of your life or they’re not, and the rest is commentary.” But surely as many children have had their lives stunted by parents who gave up too much, who exiled their own passions. Patrick clearly loves his son. But he was the product of boarding schools. He was comfortable with the idea of his children growing up largely apart from him. One thing that may have contributed to Henry’s schizophrenia, in addition to genetic factors, was his stoner childhood. “I took a lot of marijuana between the ages of 14 and 19,” Henry writes. Patrick says later in the book: “Jan and I were upset, but we both thought cannabis was fairly harmless. It wasn’t until Henry was in the hospital that we learned of its possible devastating impact on somebody genetically predisposed to schizophrenia.” Henry’s illness might have been less severe if he’d have been willing to take his medications while in various institutions, but often he wouldn’t. “To Henry, his voices and visions were quite real,” Patrick writes, “and what he heard and saw was often beautiful and revelatory.” Henry adds: “I wanted to live life to the fullest and felt that taking the medication would hinder me.” He referred to his worst breakdowns as his “polka-dot days.” His mother tries her best to keep up everyone’s good humor. After Henry makes one particularly paranoid comment, she looks at him and says, clearing the air, “Darling, you’re bonkers!” “Henry’s Demons” is a probing tour through the glories (and occasional idiocies) of the British health care system, through the history of schizophrenia and through the often barbarous ways patients have been treated. It’s a tour, too, through the psyches of two bright people watching their son unravel, the stitching pulled from his mind like wool from the bottom of a sweater. “I feel like someone playing an unwinnable game of Snakes and Ladders,” Ms. Montefiore writes in her diary after a bad day. “We’ve just painfully climbed a ladder, now we’re down a bloody great snake, back at square one, goddammit.” By the end of the book, Henry’s condition has somewhat improved. But it is among this book’s bedrock realizations that, as Patrick puts it: “We, as a family, will always have to cope with the consequences of his schizophrenia. But that, after all, is what families are for.”

Concierge Medical Care With a Smaller Price Tag Posted: 31 Jan 2011 09:50 PM PST SAN FRANCISCO — When Jennifer Contreras went to see her new physician, she had hardly arrived in the waiting room before she was called in — by the doctor herself. Enlarge This Image Michael Nagle for The New York Times ENTREPRENEUR Dr. Tom X. Lee founded One Medical Group, a new model for primary care. Enlarge This Image Michael Nagle for The New York Times THE DOCTOR WILL SEE YOU NOW The waiting room at One Medical Group in New York City looks more like the entrance to a day spa than a typical doctor’s office. That was a pleasant surprise, but it was just the beginning. Ms. Contreras, 40, was prepared for a short visit, but the physician seemed to have all the time in the world. Then came another surprise. After noting Ms. Contreras’s high blood pressure, the doctor told her to take her blood pressure daily using a home monitor and send her an e-mail with each result. “We did all the careful fine-tuning over e-mail until we got just the right dosage of blood pressure medication,” said Ms. Contreras, an associate dean at the University of San Francisco. “It wasn’t just ‘Oh, take this medication and I’ll see you later.’ It was ‘Let’s make sure we get this right.’ ” Ms. Contreras is a patient at One Medical Group, a new model for primary care that aims to set a nationwide example. With 31 physicians in San Francisco and New York, it offers most of the same services provided by personalized “concierge” medical practices, but at a much lower price: $150 to $200 a year. One Medical Group doctors see at most 16 patients a day; the nationwide average for primary-care physicians is 25. They welcome e-mail communication with patients, for no extra charge. Same-day appointments are routine. And unlike most concierge practices, One Medical accepts a variety of insurance plans, including Medicare. The group’s founder and guiding spirit is Dr. Tom X. Lee, a physician and entrepreneur best known as a co-founder of Epocrates, the online medical reference program popular among physicians. Dr. Lee, 42, trained as a general internist at the Harvard-affiliated Brigham and Women’s Hospital in Boston and quickly grew disillusioned. “As I went through my training,” he said, “I saw a growing chasm between the ideals of medicine and what’s actually practiced.” The time and financial pressures of primary-care medicine are alienating many young physicians just out of medical school. By some estimates, there will be a shortage of 45,000 primary-care physicians in the next 10 years as demand grows, and Dr. J. Fred Ralston Jr., president of the American College of Physicians, said that “those primary-care physicians already in practice are under such stress that they are looking for an exit strategy.” In 2005, with Epocrates already a success, Dr. Lee set out to reverse that trend. He began One Medical Group as a solo practice in a small office in San Francisco. Two years later, Dr. Lee, who has a master’s in business administration from Stanford, approached venture capitalists to help him expand; the Silicon Valley firm Benchmark Capital invested several million dollars, its first investment in health care services. Some experts say it remains to be seen whether Dr. Lee’s experiment is sustainable — in particular, whether he can continue to recruit physicians and deliver the same level of care without relying on new venture capital. Nor are they sure the One Medical model can be replicated on a broad scale. “I envision a small number of organizations that will be successful using models like this, and in general I think it’s great,” said Dr. Ashish Jha, an associate professor of health policy at the Harvard School of Public Health. “But whether such models can scale to cover a large swath of the population that is in greater need of health care is unclear.” Still, the wiry and intense Dr. Lee remains bent on reversing what he calls “bizarre habits that have been ingrained” in the world of primary care. When he started One Medical Group, he said, “it was very clear that health care organizations were lacking both the service hospitality mind-set of hotels and the operational efficiency you’d see in manufacturing industries.” Indeed, a One Medical waiting room could be mistaken for a lobby at a boutique hotel or day spa. Patients are greeted at a large, open reception desk, and phones have been relegated to an office in the back. “The people who greet you don’t seem frazzled,” said Bruce Dunlevie, a general partner at Benchmark Capital, “and there aren’t four people sneezing on you.” One Medical physicians say their jobs are like what they envisioned when they first went into the field — before they got their first job in a typical family practice, with its long waits and blizzards of paperwork. Dr. Andrew Diamond, a One Medical physician in San Francisco, says he now sees 16 patients a day, compared with 24 in his previous practice. “The most important thing you can do with that amount of time is build a rapport and make people feel at ease,” he said. “It’s when people are at ease that they can give you get the critical information you need to make a diagnosis.” In his old job, he went on, “when I’d finally see the patient, I would get this very frustrated vibe, which completely got in the way of caring for them.” Dr. Lee’s practice is not the first to offer more personalized primary care. Dr. Richard Baron, a former chairman of the American Board of Internal Medicine, runs Greenhouse Internists in Philadelphia, a practice with seven physicians that offers much of what One Medical offers, but without the fee. 1 2 Next Page »

Federal Judge Rules That Health Law Violates Constitution Posted: 02 Feb 2011 12:22 PM PST A second federal judge ruled on Monday that it was unconstitutional for Congress to enact a health care law that required Americans to obtain commercial insurance, evening the score at 2 to 2 in the lower courts as conflicting opinions begin their path to the Supreme Court. Enlarge This Image Tony Giberson/Pensacola News Journal, via Associated Press Judge Roger Vinson Multimedia Document Judge Vinson’s Ruling Interactive Feature The Growing Legal and Political Opposition Related Times Topics: Health Care Reform But unlike a Virginia judge in December, Judge Roger Vinson of Federal District Court in Pensacola, Fla., concluded that the insurance requirement was so “inextricably bound” to other provisions of the Affordable Care Act that its unconstitutionality required the invalidation of the entire law. “The act, like a defectively designed watch, needs to be redesigned and reconstructed by the watchmaker,” Judge Vinson wrote. The judge declined to immediately enjoin, or suspend, the law pending appeals, a process that could last two years. But he wrote that the federal government should adhere to his declaratory judgment as the functional equivalent of an injunction. That left confusion about how the ruling might be interpreted in the 26 states that are parties to the legal challenge. The insurance mandate does not take effect until 2014. But many new regulations are already operating, like requirements that insurers cover children with pre-existing health conditions and eliminate lifetime caps on benefits. States are also preparing for a major expansion of Medicaid eligibility and the introduction of health insurance exchanges in 2014. David B. Rivkin Jr., a lawyer for the states, said the ruling relieved the plaintiff states of any obligation to comply with the health law. “With regard to all parties to this lawsuit, the statute is dead,” Mr. Rivkin said. But White House officials declared that the opinion should not deter the continuing rollout of the law. “Implementation would continue apace,” a senior administration official said. “This is not the last word by any means.” At the same time, Stephanie Cutter, an assistant to the president, noted in a post on the White House blog that the ruling had struck down the entire law. She called it “a plain case of judicial overreaching,” and added, “The judge’s decision puts all of the new benefits, cost savings and patient protections that were included in the law at risk.” The Justice Department, which represents the Obama administration in the litigation, said it was exploring options to clarify the uncertainty, including requesting a stay of the decision, either from Judge Vinson or from the United States Court of Appeals for the Eleventh Circuit. On Capitol Hill, Republicans sent out a stream of e-mails praising the ruling, while Senator Richard J. Durbin, Democrat of Illinois, said he would convene a Judiciary Committee hearing on Wednesday to examine the constitutionality of the law. In his 78-page opinion, Judge Vinson held that the insurance requirement exceeded the regulatory powers granted to Congress under the Commerce Clause of the Constitution. He wrote that the provision could not be rescued by an associated clause in Article I that gives Congress broad authority to make laws “necessary and proper” to carrying out its designated responsibilities. “If Congress can penalize a passive individual for failing to engage in commerce, the enumeration of powers in the Constitution would have been in vain,” the judge asserted. In a silver lining for the Obama administration, Judge Vinson rejected a second claim that the new law violated state sovereignty by requiring states to pay for a fractional share of the planned Medicaid expansion. The judge’s ruling came in the most prominent of more than 20 legal challenges to the sweeping health law, which was signed last March by President Obama. The plaintiffs include governors and attorneys general from 26 states, all but one of them Republicans, as well as the National Federation of Independent Business, which represents small companies. Officials from six states joined the lawsuit in January after shifts in party control brought by November’s elections. The ruling by Judge Vinson, a senior judge who was appointed by President Ronald Reagan, solidified the divide in the health litigation among judges named by Republicans and those named by Democrats. In December, Judge Henry E. Hudson of Federal District Court in Richmond, Va., who was appointed by President George W. Bush, became the first to invalidate the insurance mandate. Two other federal judges named by President Bill Clinton, a Democrat, have upheld the law. Judge Vinson’s opinion hangs on a series of Supreme Court decisions that have defined the limits of the Commerce Clause by granting Congress authority to regulate “activities that substantially affect interstate commerce.” The plaintiffs characterized the insurance requirement as an unprecedented effort to regulate inactivity because citizens would be assessed an income tax penalty for failing to buy a product. Justice Department lawyers responded that a choice not to obtain health insurance was itself an active decision that, taken in the aggregate, shifted the cost of caring for the uninsured to hospitals, governments and privately insured individuals. In his decision, Judge Vinson wrote, “It would be a radical departure from existing case law to hold that Congress can regulate inactivity under the Commerce Clause.” If Congress has such power, he continued, “it is not hyperbolizing to suggest that Congress could do almost anything it wanted.” The Pensacola case is now likely to head to the Eleventh Circuit in Atlanta, considered one of the country’s most conservative appellate benches. The Richmond case is already with another conservative court, the United States Court of Appeals for the Fourth Circuit in Richmond, which has set oral arguments for May. That court will consider diametrically opposed rulings from courthouses situated 116 miles apart, as it was a judge in Lynchburg, Va., Norman K. Moon, who issued one of the two decisions upholding the law. Meanwhile, the United States Court of Appeals for the Sixth Circuit in Cincinnati is already receiving briefs on the other decision backing the law, which was delivered by Judge George C. Steeh in Detroit. Judge Vinson’s ruling further arms Republicans in Congress who are waging a fierce campaign against the health care act. The new Republican majority in the House voted this year to repeal the law, a largely symbolic measure that is given no chance in the Democratic-controlled Senate. The Obama administration argues that without the insurance mandate consumers might simply wait until they are sick to enroll, undercutting the actuarial soundness of risk pooling and leading to an industry “death spiral.” But the mandate’s legal and political problems have prompted a few Democratic senators to join Republicans in exploring alternatives that would encourage citizens to buy insurance without requiring it. For instance, people could be given a narrow window to enroll, and those who miss the deadline would face lengthy waiting periods for coverage. Alternately, those who apply late and are eligible for government tax credits under the law coverage could be penalized through a reduction of their subsidies. Sheryl Gay Stolberg contributed reporting. This posting includes an audio/video/photo media file: Download Now

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Recipes for Health: Beets, Spiced Quinoa and Yogurt Posted: 01 Feb 2011 08:36 AM PST I love the contrast between sweet beets and pungent, garlic-infused yogurt. With a layer of nutritious grains seasoned with sweet spices, this dish easily takes center stage on your plate. To save time, grind all of the spices together in a spice mill. Recipes for Health Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. See All Recipes for Health » Visit Recipes for Health on Facebook. Related Recipes for Health: Vegetable Casseroles for Frigid Nights (January 31, 2011) Recipes for Health: Cabbage and Red Pepper Gratin (February 1, 2011) Recipes for Health: Slow-Baked Beans With Kale (February 2, 2011) Recipes for Health: Potato and Chard Stalk Gratin (February 4, 2011) 2 tablespoons extra virgin olive oil 2 allspice berries, ground (about 1/8 teaspoon freshly ground allspice) 1/4 teaspoon freshly ground nutmeg 1/8 teaspoon freshly ground cardamom seeds 3 cloves, ground (1/8 teaspoon freshly ground cloves) 1/2 teaspoon ground cinnamon 1 teaspoon freshly ground coriander seeds 3 cups cooked quinoa (either red or regular; 3/4 cup uncooked) Salt and freshly ground black pepper to taste 5 to 6 roasted beets, yellow, red or a combination; peeled and sliced 1 cup drained yogurt 2 garlic cloves 1/4 cup chopped walnuts 1. Preheat the oven to 350 degrees. Oil a 2-quart baking dish or gratin. In a medium saucepan or a large, heavy skillet, heat 1 tablespoon of the olive oil, and add the spices. When they begin to sizzle, add the cooked quinoa. Stir together for one minute, and remove from the heat. Taste and adjust salt. Transfer to the baking dish, and spread in an even layer. 2. Arrange the sliced beets over the quinoa. Drizzle on the remaining olive oil, cover and place in the oven for 20 minutes or until hot. Meanwhile, place the garlic in a mortar and pestle with a generous pinch of salt, and mash to a paste. Whisk or stir into the drained yogurt. 3. Remove the quinoa and beets from the oven, and top with dollops of yogurt. Sprinkle with the walnuts, and serve. Yield: Serves four to six. Advance preparation: The cooked quinoa and the roasted beets will keep for three to four days in the refrigerator. You can assemble the casserole without the yogurt up to a day in advance. Cover tightly and refrigerate. Nutritional information per serving (four servings): 370 calories; 15 grams fat (2 grams saturated fat); 2 milligrams cholesterol; 48 grams carbohydrates; 8 grams dietary fiber; 134 milligrams sodium (does not include salt to taste); 14 grams protein Nutritional information per serving (six servings): 247 calories; 10 grams fat (1 gram saturated fat); 1 milligram cholesterol; 32 grams carbohydrates; 5 grams dietary fiber; 89 milligrams sodium (does not include salt to taste); 9 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Recipes for Health: Cabbage and Red Pepper Gratin Posted: 01 Feb 2011 08:38 AM PST Paprika contributes a spicy edge to this sweet, comforting gratin. Recipes for Health Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. See All Recipes for Health » Visit Recipes for Health on Facebook. Related Recipes for Health: Vegetable Casseroles for Frigid Nights (January 31, 2011) Recipes for Health: Beets, Spiced Quinoa and Yogurt (February 3, 2011) Recipes for Health: Slow-Baked Beans With Kale (February 2, 2011) Recipes for Health: Potato and Chard Stalk Gratin (February 4, 2011) 2 tablespoons extra virgin olive oil 1 medium onion, finely chopped 1 red bell pepper, cut in small dice 6 to 7 cups shredded cabbage (about 1 1/2 pounds) 1 tablespoon chopped fresh dill or 1 teaspoon dried dill weed 1 teaspoon sweet or smoky paprika 3 eggs 1/2 cup milk 2 ounces Gruyère, grated (1/2 cup) 1. Preheat the oven to 375 degrees. Oil a 2-quart gratin dish. Heat the olive oil over medium heat in a large, heavy nonstick skillet. Add the onion. Cook, stirring often, until tender, about five minutes. Add the red pepper. Cook, stirring, until the pepper is tender and the onion is beginning to color, about five minutes. Stir in the cabbage, dill and paprika. Add salt to taste, and cook, stirring, until the cabbage begins to wilt, about five minutes. Cover the pan, turn the heat to low and continue to cook for another five to 10 minutes until the cabbage is tender. Remove from the heat. 2. Beat the eggs in a large bowl, and whisk in about 1/2 teaspoon salt and freshly ground pepper to taste. Whisk in the milk, and stir in the cabbage mixture and the cheese. Scrape into the baking dish. 3. Bake 35 to 40 minutes until the top is lightly browned. Remove from the heat, and allow to cool for 10 minutes or longer before serving. Yield: Serves four to six. Advance preparation: You can make this through Step 1 hours or even a day before assembling and baking. The baked gratin will keep for a few days in the refrigerator, and it can be reheated in a medium oven. Nutritional information per serving (four servings): 233 calories; 16 grams total fat (5 grams saturated fat); 176 milligrams cholesterol; 13 grams carbohydrates; 4 grams dietary fiber; 135 milligrams sodium (does not include salt to taste); 12 grams protein Nutritional information per serving (six servings): 155 calories; 10 grams fat (3 grams saturated fat); 117 milligrams cholesterol; 9 grams carbohydrates; 3 grams dietary fiber; 90 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."

After Video Exposé, Planned Parenthood Fires Employee Posted: 02 Feb 2011 09:53 AM PST Planned Parenthood has fired a clinic manager who was caught on a videotape advising an apparent sex trafficker how to get medical care for underage prostitutes. Related Times Topic: Planned Parenthood Federation of America The videotape was filmed covertly in a New Jersey Planned Parenthood clinic by actors working for an anti-abortion group, Live Action. Its release on Tuesday has embarrassed Planned Parenthood, which provides contraceptives, gynecological care, cancer screening and abortions across the country, mainly to low-income women. It has also given new energy to abortion opponents who want to eliminate federal and state money for the agency. The Planned Parenthood Federation of America said that immediately after the “highly unusual” visit to a clinic in Perth Amboy, N.J., by a man posing as a sex trafficker and a woman posing as a prostitute, its affiliate had notified prosecutors. But Planned Parenthood officials expressed dismay at the statements of the office manager in Perth Amboy, N.J., in the videotape, and fired her on Tuesday night. “We were profoundly shocked when we viewed the videotape released this morning, which depicted an employee of one of our health centers behaving in a repugnant manner that is inconsistent with our standards of care and is completely unacceptable,” said Phyllis Kinsler, chief executive of the agency’s central New Jersey branch, in a statement late on Tuesday. Stuart Schear, vice president for communications of the national federation, said in an interview on Wednesday that Planned Parenthood had “zero tolerance” for dishonest or unethical behavior and he said he felt confident that the behavior filmed in the video was “very isolated.” But Mr. Schear added: “We cannot lose sight of the bigger picture that we have opponents who are in many cases opposed to birth control, honest sex education and legal abortion, and are coordinating with allies on Capitol Hill to defund Planned Parenthood.” Planned Parenthood has long been a target of the anti-abortion movement. On Wednesday, a large number of anti-abortion groups including Live Action announced a new campaign called “Expose Planned Parenthood,” tied to the new videotape, which will promote a bill now before the House of Representatives that would cut tens of millions in federal money that Planned Parenthood affiliates receive each year in family planning and other grants. Direct federal financing of abortion is already outlawed, but the critics, led by conservative Catholic and evangelical groups, attack Planned Parenthood for including abortions among its services, and some say its entire operations are immoral. “The horror exposed in the video released yesterday was not an isolated incident in the history of a group willing to be a chief ally in the exploitation of women and girls,” said Marjorie Dannenfelser, president of the Susan B. Anthony list, which is helping to organize the de-financing campaign. Mr. Schear of Planned Parenthood said that abortion accounts for only 3 percent of its health services. As for the federal money under attack, he said, “We’re not talking about abortion funds, it’s family planning and preventive health care for women, including many low-income women who have relied on our services for decades.” Last week, Planned Parenthood announced that people claiming to be sex traffickers had visited at least 12 of its clinics in six states in January and that it had notified the Justice Department. The group also said that, based on an identification of one of the visitors, it had concluded that the visits were a hoax by Live Action. Planned Parenthood said the group, which is led by Lila Rose, 22, had a history of using “surreptitious videotaping and manipulative editing” in a campaign to destroy it. The video from the clinic shows a woman identified as Amy Woodruff, the office manager, responding to an unseen man and woman. The man says he is involved in sex work and wants to bring girls, some only 14 or 15 and illegal immigrants, for medical exams. The manager seems ready to bend the rules to provide medical care to the girls and says the girls should be careful about admitting their ages, especially if they are under 15, which triggers extra reporting requirements. “For the most part, we want as little information as possible,” she says. Asked if the girls can obtain abortions, the manager replies that if they are under 15, they should go to another clinic where “their protocols are not as strict as ours.” The newly released video resembles those made in 2009 by a conservative activist, James O’Keefe, in which employees of the community group Acorn appeared to advise a prostitution ring how to avoid taxes. Ms. Rose has worked with Mr. O’Keefe on previous undercover videos in Planned Parenthood offices.

Reporter’s Notebook: Tea Party Shadows Health Care Ruling Posted: 01 Feb 2011 08:58 PM PST Among the legal commentariat, which blogs its instant analysis after each turn in the health care litigation, one assertion in Monday’s ruling against the law by Judge Roger Vinson is receiving particular attention. Enlarge This Image Mike Blake/Reuters Mandatory vegetables? Two judges have expressed that fear. Multimedia Document Judge Vinson’s Ruling Interactive Feature The Health Care Law: The Growing Legal and Political Opposition Related Awaiting Health Law’s Prognosis (February 2, 2011) States Diverge on How to Deal With Health Care Ruling (February 2, 2011) “It is difficult to imagine,” Judge Vinson, of Federal District Court in Pensacola, Fla., wrote in a central passage of his 78-page opinion, “that a nation which began, at least in part, as the result of opposition to a British mandate giving the East India Company a monopoly and imposing a nominal tax on all tea sold in America would have set out to create a government with the power to force people to buy tea in the first place.” Supporters of the health care act — which Judge Vinson invalidated after ruling it was unconstitutional to require citizens to buy health insurance — saw in the language a deliberate nod to the Tea Party movement. Whether that was the judge’s intent cannot be known. But legal scholars who disagreed with the ruling seized on it as evidence that Judge Vinson, who was appointed by President Ronald Reagan, a Republican, had infused his ruling with political bias. “On first read, the most striking aspect of Judge Vinson’s ruling today is not its remedy — striking the Affordable Care Act in its entirety — but the impression one gets that the opinion was written in part as a Tea Party manifesto,” Mark Hall, a law professor at Wake Forest University, wrote on the blog Health Reform Watch. Igor Volsky, a health policy analyst who writes on the blog ThinkProgress, also noted the judge’s reference. “It’s the kind of overreach that will do more to harm the Republican crusade against the law than help it,” Mr. Volsky offered. Not surprisingly, those who write from the right found Judge Vinson’s wording worthy of applause. Ilya Shapiro, a constitutional scholar at the Cato Institute, cited the tea passage in his review of the judge’s opinion, which he called “magisterial” and “breathtaking.” “The 78-page ruling,” Mr. Shapiro wrote, “is well theorized and engaging (Vinson’s opus is a joy to read compared to most stuff I have to wade through to understand what the courts are doing).” Vegetables Cited, Again Given the role that green vegetables have played in the health care litigation, it would have been disappointing had Judge Vinson not given broccoli its due. Throughout the health care legal proceedings in both Florida and Virginia, lawyers for the plaintiffs have argued that if Congress could force Americans to buy health insurance, it could require them to do most anything. And in each case, they have raised the specter of what this might mean — a government that can force you to buy a General Motors car, join a gym or even, horror of horrors, eat your vegetables. Judge Vinson seized on the analogy in a hearing in December and did so again in his ruling on Monday, while batting away the Obama administration’s contention that health care is a unique market because people cannot opt out of it. “There are lots of markets — especially if defined broadly enough — that people cannot ‘opt out’ of,” the judge wrote in opening a discussion of the market for food. “Congress could require that people buy and consume broccoli at regular intervals, not only because the required purchases will positively impact interstate commerce, but also because people who eat healthier tend to be healthier, and are thus more productive and put less of a strain on the health care system.” For Judge Henry E. Hudson of Federal District Court in Richmond, Va., the first judge to invalidate a part of the health law, it was not broccoli but asparagus that he feared would be shoved down America’s throat. “What this really distills down to,” Judge Hudson said during a hearing in October, “is whether or not you can compel someone to make a decision when they’re not inclined to do so otherwise. And that could apply to one’s decision to buy an automobile, to join a gym, to eat asparagus.” In California, which produces more broccoli and asparagus than any other state, growers might chafe at the notion that anyone would have to be forced to consume either vegetable. But Dave Kranz, a spokesman for the California Farm Bureau Federation, declared that when it came to green vegetables. there was no such thing as bad publicity. “Here in California, we produce a lot of different vegetables, and if somebody doesn’t like broccoli and asparagus, we’ve got Brussels sprouts and cauliflower,” Mr. Kranz said. “We’re happy to have people talking about vegetables. You’ll remember that the first President Bush was not a broccoli fan. The broccoli people weathered that, and they’ll weather this, too.” New Cast of Characters It was the attorney general of Florida who filed the lawsuit in Federal District Court in Pensacola, and it was the attorney general of Florida who stood before the cameras on Monday to declare victory: “It’s about our liberty. It’s about more than health care. And that’s what the judge said today.” But it was not the same attorney general. Bill McCollum, the man who began plotting the case months before the health care act passed, and who put together a plaintiffs’ coalition of Republican officials from 26 states, was working at home in Longwood, near Orlando, when the ruling came down. Mr. McCollum left office in early January after losing Florida’s Republican primary for governor last year. He was succeeded by Pam Bondi, also a Republican, who enthusiastically supports the case she inherited. Mr. McCollum said Ms. Bondi left him a congratulatory message but did not invite him to appear at her side in Tallahassee, a choice that Mr. McCollum said caused no offense. “I didn’t expect to be there,” Mr. McCollum said in a telephone interview. “I couldn’t have been. I had other obligations anyway. And she’s the attorney general.” Mr. McCollum, who is searching for his next job, did make appearances on local and national television shows. He said he was “very elated,” particularly for the staff lawyers in his former office who did much of the work. “Would I have enjoyed being there?” he asked. “Of course. But I really wasn’t dwelling on it.” As for the ruling, Mr. McCollum said he was particularly pleased that Judge Vinson had invalidated the entire law. “I was impressed with his opinion,” he said, “and I’d like to think that when appellate judges read it they will be, too.”

F.D.A. Declines to Approve Diet Drug Posted: 01 Feb 2011 08:27 PM PST The Food and Drug Administration has declined to approve yet another prescription diet pill, vanquishing nearly any prospect that a new obesity medicine will be available to overweight Americans this year. Enlarge This Image The Food and Drug Administration told Orexigen Therapeutics to prove that Contrave does not raise the risk of heart attacks. Add to Portfolio Vivus Inc Arena Pharmaceuticals Inc Orexigen Therapeutics Inc Abbott Laboratories JPMorgan Chase & Company Go to your Portfolio » In a rare move, the agency told the drug maker, Orexigen Therapeutics, that to win approval it must first do a long-term study to demonstrate that the drug, called Contrave, does not raise the risk of heart attacks. In doing so, the agency sent a strong signal that it was exercising considerable caution in assessing a new generation of diet medicines, after serious health problems, including deaths, caused by some older weight-loss pills. Contrave was the third of three obesity drugs that the F.D.A. has declined to approve in the last few months, citing safety concerns. After Orexigen announced the agency’s decision early on Tuesday, some experts and patient advocates warned that the action could further discourage, or even kill, efforts by pharmaceutical companies to develop medicines for obesity, one of the nation’s largest health problems. “The F.D.A. has decided that the most significant threat to public health will not be treated by any drug,” said Morgan Downey, editor of the online Downey Obesity Report, who is a patient advocate and has consulted for drug companies. “In the current environment, tap water could not be approved.” The F.D.A. decision was not totally unexpected since Contrave is only modestly effective in helping people lose weight. What was somewhat surprising, however, was the agency’s request for the large clinical trial to try to rule out the risk of heart attacks. Such a study could take years and cost tens or hundreds of millions of dollars, meaning the drug could be effectively dead. While company executives said they wanted to talk to agency officials about the requested trial, they added that no option, including dropping the drug altogether, was off the table. “This is clearly a worst-case scenario,” Cory Kasimov, an analyst at JPMorgan, wrote in a note to clients. Shares of Orexigen plunged 72.5 percent on Tuesday, to $2.50. The F.D.A., as a rule, does not comment on its reasons for rejecting a drug. The federal agency’s decision also represented a setback for Takeda Pharmaceutical of Japan, which had acquired the American marketing rights from Orexigen for an initial payment of $50 million. Analysts said Takeda might withdraw from the partnership. The last obesity drug approved was Xenical from Roche in 1999, and that little-used drug is now the only one available for long-term use. The F.D.A. last year turned down two other drugs, lorcaserin from Arena Pharmaceuticals and Qnexa from Vivus. It also forced the withdrawal from the market of Meridia from Abbott Laboratories. But hopes had been higher that Contrave would win approval or that the F.D.A. would impose only minor new requirements, delaying approval for a few months. Unlike the other two drugs, Contrave won an endorsement from an F.D.A. advisory committee, which voted 13 to 7 in favor of approval in December. While the committee called for more study of the potential cardiovascular risks of the drug, it voted 11 to 8 that such a study could be done after the drug was approved. “We are surprised and extremely disappointed with the agency’s requirement in light of the extensive discussion and resulting vote on this topic at the Dec. 7 advisory committee meeting,” Michael A. Narachi, the chief executive of Orexigen, said in a statement. Contrave is a combination of two existing drugs that together work to suppress food cravings, according to the company. One drug, bupropion, is an antidepressant known by the brand name Wellbutrin; it is also sold as Zyban to help people quit smoking. The second ingredient, naltrexone, is used to treat alcohol and drug addiction. Bupropion, which is the ingredient responsible for the possible heart risks, is already used by six million Americans a year. “These are drugs that doctors already have experience with,” said Dr. Robert F. Kushner, clinical director of the obesity center at Northwestern University and an adviser to Orexigen. He said the requirement for a huge new trial “sends a terrible, alarming message to the entire industry.” A spokeswoman for the F.D.A. said the agency had not yet decided whether cardiovascular risk trials would be required for all obesity drugs. The agency now generally requires such studies for diabetes drugs, and small drug companies, at least, are shying away from that field. In clinical trials, Contrave raised pulse rates and blood pressure slightly, a warning that it might increase the risk of heart attacks, strokes or other cardiovascular problems. Those who used Contrave did not have a higher rate of heart attacks and strokes than those getting the placebo, though the trials were too short and too small to detect anything but a huge extra risk. About a third of American adults are obese and another third merely overweight. Obese people have a higher than normal risk of death, heart attacks and various other diseases. Even a fairly modest weight loss can lower the risk of diabetes and some other health problems, experts said. But while various diet drugs, including Contrave, produce an improvement in risk measures like cholesterol and blood sugar, no study has shown that a diet drug lowers the risk of heart attacks or strokes. The F.D.A. could be basing its request for a cardiovascular study on the experience with Meridia, a weight loss drug by Abbott that it approved in 1997 despite signs that it increased blood pressure and heart rate. Only last year, a large trial ordered by European regulators showed the drug did raise the risk of heart attacks and stroke in people already prone to such problems. “It seems like the F.D.A. is heeding the lessons from the past,” said Dr. Sanjay Kaul, a cardiologist at Cedars-Sinai Medical Center in Los Angeles, who applauded the agency’s rejection of Contrave. “The F.D.A. is trying to send a message to the pharmaceutical industry that repackaging old drugs is not the way to go,” said Dr. Kaul, who was a member of the advisory committee minority that voted against Contrave in December. “You’ve got to come up with some new innovative ways of addressing this objective.” The possible cardiovascular risks of Contrave, combined with only modest effectiveness, left the advisory committee somewhat lukewarm about the drug even as it voted to recommend approval. In four clinical trials involving a total of about 4,500 people, those who took Contrave lost an average of 4.2 percentage points of their weight more than those getting a placebo. This is below the F.D.A. standard of 5 percent. However, the drug did meet a second requirement that twice as many patients on the drug as on the placebo lose at least 5 percent of their weight. Meeting only one of the two criteria is enough for approval.

Ernest McCulloch, Crucial Figure in Stem Cell Research, Dies at 84 Posted: 01 Feb 2011 09:20 PM PST Dr. Ernest A. McCulloch, a father of the stem cell research that scientists say holds promise for the treatment of many ailments, died on Jan. 20 in Toronto. He was 84. Enlarge This Image John Smock/Associated Press Dr. Ernest A. McCulloch in 2005. His death was announced by the University of Toronto, where he was an emeritus university professor. Dr. McCulloch died two weeks short of the 50th anniversary of the publication of a groundbreaking paper he wrote with Dr. James E. Till in the journal Radiation Research. The paper had an important role in research that the two began in the 1950s and that earned them an Albert Lasker basic medical research award in 2005 for “setting the stage for all current research on adult and embryonic stem cells.” Such stem cells are nonspecialized but can give rise to specialized cells like those in the brain, heart and other organs and tissues. Stem cells derived from embryos can develop into any cell type, whether in the heart, lung or another body part; stem cells derived from adult cells have already differentiated by body part and can develop only into the type of cells related to them. Many scientists now contend that with years of continued research, stem cells may help treat, if not cure, spinal cord paralysis, cancer, diabetes, Alzheimer’s disease, damaged hearts, kidneys and livers, and many other ailments. Dr. McCulloch and Dr. Till were a study in contrasts; where Dr. McCulloch was short, stocky and rumpled, Dr. Till was tall, trim and elegantly dressed. Yet they were the perfect research pair, balancing each other’s personalities, said Dr. Alan Bernstein, a former president of the Canadian Institute of Health Research, an organization analogous to the National Institutes of Health in the United States. “Clothes did not matter to Dr. McCulloch, and his clothes were often covered with chalk, which he often held in his mouth, ready to draw diagrams on a blackboard to push an idea to the extreme to see where it would take you,” said Dr. Bernstein, who now is executive director of the Global H.I.V. Vaccine Enterprise in New York City. “He reveled in thinking big about ideas and encouraged speculation.” Ernest Armstrong McCulloch was born in Toronto on April 27, 1926, and at some point acquired the nickname Bun (for Bunny). He went directly from Upper Canada College, a private high school in Toronto, to medical school at the University of Toronto. (Undergraduate degrees were not required to attend medical school at the time.) He received his medical degree with honors in 1948 and then trained in hospitals in Toronto as a specialist in internal medicine. He had a private practice in Toronto from 1954 to 1967. He began his research career by studying for a year at the Lister Institute in London. He went on to teach and conduct research in the University of Toronto’s department of biophysics and the Ontario Cancer Institute. From the turn of the 20th century, scientists had theorized that the body contained cells that could renew themselves, mature and specialize in various ways. But no one found them until Dr. McCulloch, a physician, and Dr. Till, a biophysicist, discovered the first stem cell, one in the blood-forming system, while conducting experiments on mice. That discovery was a product of both planned research and serendipity. When they began their line of research, scientists were trying to understand how and when radiation therapy stopped cancer, and the military was seeking ways to treat personnel exposed to radiation from nuclear weapons. Dr. McCulloch and Dr. Till designed a system to measure bone marrow cells’ sensitivity to radiation. They observed clumps on the spleens of mice, and through rigorous experiments showed that the spleen contained cells that divided into the three main types of blood cells: red, white and platelets. The findings led to a system for studying the factors that send the stem cells down different developmental paths, and helped transform the study of blood cells from an observational science to a more experimental one. In helping scientists learn how and why bone marrow transplants replenish blood cells, their work led to improvements in the procedure, one that can prolong the lives of people with leukemia and other blood-cell cancers. In addition to his wife, Ona, Dr. McCulloch, who lived in Toronto, is survived by four sons, James, Michael, Robert and Paul; a daughter, Cecelia E. MacIntyre; a sister, Tot Johnson; six grandchildren; and one great-grandson.

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