Tuesday, February 8, 2011

Health - Lymph Node Study Shakes Pillar of Breast Cancer Care

Health - Lymph Node Study Shakes Pillar of Breast Cancer Care

Lymph Node Study Shakes Pillar of Breast Cancer Care

Posted: 08 Feb 2011 01:09 PM PST

A new study finds that many women with early breast cancer do not need a painful procedure that has long been routine: removal of cancerous lymph nodes from the armpit.

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The discovery turns standard medical practice on its head. Surgeons have been removing lymph nodes from under the arms of breast cancer patients for 100 years, believing it would prolong women’s lives by keeping the cancer from spreading or coming back.

Now, researchers report that for women who meet certain criteria — about 20 percent of patients, or 40,000 women a year in the United States — taking out cancerous nodes has no advantage. It does not change the treatment plan, improve survival or make the cancer less likely to recur. And it can cause complications like infection and lymphedema, a chronic swelling in the arm that ranges from mild to disabling.

Removing the cancerous lymph nodes proved unnecessary because the women in the study had chemotherapy and radiation, which probably wiped out any disease in the nodes, the researchers said. Those treatments are now standard for women with breast cancer in the lymph nodes, based on the realization that once the disease reaches the nodes, it has the potential to spread to vital organs and cannot be eliminated by surgery alone.

Experts say that the new findings, combined with similar ones from earlier studies, should change medical practice for many patients. Some centers have already acted on the new information. Memorial Sloan-Kettering Cancer Center in Manhattan changed its practice in September, because doctors knew the study results before they were published. But more widespread change may take time, experts say, because the belief in removing nodes is so deeply ingrained.

“This is such a radical change in thought that it’s been hard for many people to get their heads around it,” said Dr. Monica Morrow, chief of the breast service at Sloan-Kettering and an author of the study, which is being published on Wednesday in The Journal of the American Medical Association. The National Cancer Institute paid for the study.

Dr. Morrow said that doctors and patients alike find it easy to accept more cancer treatment on the basis of a study — but get scared when the data favors less treatment.

The new findings are part of a trend to move away from radical surgery for breast cancer. Rates of mastectomy, removal of the whole breast, began declining in the 1980s after studies found that for many patients, survival rates after lumpectomy and radiation were just as good as those after mastectomy.

The trend reflects an evolving understanding of breast cancer. In decades past, there was a belief that surgery could “get it all” — eradicate the cancer before it could spread to organs and bones. But research has found that breast cancer can begin to spread early, even when tumors are small, leaving microscopic traces of the disease after surgery.

The modern approach is to cut out obvious tumors — because lumps big enough to detect may be too dense for drugs and radiation to destroy — and to use radiation and chemotherapy to wipe out microscopic disease in other places.

But doctors have continued to think that even microscopic disease in the lymph nodes should be cut out to improve the odds of survival. And until recently, they counted cancerous lymph nodes to gauge the severity of the disease and choose chemotherapy. But now the number is not so often used to determine drug treatment, doctors say. What matters more is whether the disease has reached any nodes at all. If any are positive, the disease could become deadly. Chemotherapy is recommended, and the drugs are the same, no matter how many nodes are involved.

The new results do not apply to all patients, only to women whose disease and treatment meet the criteria in the study.

The tumors were early, at clinical stage T1 or T2, meaning less than two inches across. Biopsies of one or two armpit nodes had found cancer, but the nodes were not enlarged enough to be felt during an exam, and the cancer had not spread anywhere else. The women had lumpectomies, and most also had radiation to the entire breast, and chemotherapy or hormone-blocking drugs, or both.

The study, at 115 medical centers, included 891 patients. Their median age was in the mid-50s, and they were followed for a median of 6.3 years.

After the initial node biopsy, the women were assigned at random to have 10 or more additional nodes removed, or to leave the nodes alone. In 27 percent of the women who had additional nodes removed, those nodes were cancerous. But over time, the two groups had no difference in survival: more than 90 percent survived at least five years. Recurrence rates in the armpit were also similar, less than 1 percent. If breast cancer is going to recur under the arm, it tends to do so early, so the follow-up period was long enough, the researchers said.

One potential weakness in the study is that there was not complete follow-up information on 166 women, about equal numbers from each group. The researchers said that did not affect the results. A statistician who was not part of the study said the missing information should have been discussed further, but probably did not have an important impact.

It is not known whether the findings also apply to women who do not have radiation and chemotherapy, or to those who have only part of the breast irradiated.

The results mean that women like those in the study will still have to have at least one lymph node removed, to look for cancer and decide whether they will need more treatment. But taking out just one or a few nodes should be enough.

Dr. Armando E. Giuliano, the lead author of the study and the chief of surgical oncology at the John Wayne Cancer Institute at St. John’s Health Center in Santa Monica, Calif., said: “It shouldn’t come as a big surprise, but it will. It’s hard for us as surgeons and medical oncologists and radiation oncologists to accept that you don’t have to remove the nodes in the armpit.”

Dr. Grant W. Carlson, a professor of surgery at the Winship Cancer Institute at Emory University, and the author of an editorial accompanying the study, said that by routinely taking out many nodes, “I have a feeling we’ve been doing a lot of harm.”

An H.I.V. Strategy Invites Addicts In

Posted: 08 Feb 2011 09:06 AM PST

VANCOUVER, British Columbia — At 12 tables, in front of 12 mirrors, a dozen people are fussing intently in raptures of self-absorption, like chorus line members applying makeup in a dressing room.

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UNDER WATCHFUL EYES Lawrence Golden-Brooks, 43, at Insite. The injection center offers clean needles as well as tests and treatment for H.I.V.

But these people are drug addicts, injecting themselves with whatever they just bought on the street — under the eyes of a nurse here at Insite, the only “safe injection site” in North America.

“You can tell she just shot cocaine,” Thomas Kerr, an AIDS expert who does studies at the center, said of one young woman who keeps readjusting her tight tube top. “The way she’s fidgeting, moving her hands over her face — she’s tweaking.”

Insite, situated on the worst block of an area once home to the fastest-growing AIDS epidemic in North America, is one reason Vancouver is succeeding in lowering new AIDS infection rates while many other cities are only getting worse.

By offering clean needles and aggressively testing and treating those who may be infected with H.I.V., Vancouver is offering proof that an idea that was once controversial actually works: Widespread treatment, while expensive, protects not just individuals but the whole community.

Because antiretroviral medications lower the amount of virus in the blood, those taking them are estimated to be 90 percent less infective.

Pioneering work by the British Columbia Center for Excellence in H.I.V./AIDS at St. Paul’s Hospital here demonstrated that getting most of the infected onto medication could drive down the whole community’s rate of new infections.

According to one of the center’s studies, financed by the United States National Institutes of Health, from 1996 to 2009 the number of British Columbians taking the medication increased more than sixfold — to 5,413, an estimated 80 percent of those with H.I.V. The number of annual new infections dropped by 52 percent. This happened even as testing increased and syphilis rates kept rising, indicating that people were not switching in droves to condoms or abstinence.

Studies in San Francisco and Taiwan found similar results. So last July the United Nations’ AIDS-fighting agency made “test and treat” its official goal — although it acknowledged that it is only a dream, since global AIDS budgets aren’t big enough to buy medication even for all those hovering near death.

It is also only a dream in the United States. Much of the American epidemic is now concentrated in poor black and Latino neighborhoods, where health insurance is less common and many avoid testing for fear of being stigmatized. However, the federal government is conducting a three-year study of “test and treat” in the Bronx and the District of Columbia.

Because the medication can have unpleasant side effects, many American doctors delay prescribing it until their patients have low counts of CD4 cells, a sign that their immune systems are weakening. Doctors often feel a greater commitment to each patient’s comfort than to the abstract idea of fewer infections in a given city. But Vancouver is a different story. Canadian medical care is free, doctors are expected to pursue public health goals and Vancouver’s provincial health department aggressively hunts for people to test.

“In 2004, I rebelled when the government people started to say, ‘We need to get control over the budget for your program,’ ” said Dr. Julio S. G. Montaner, director of the St. Paul’s program and a former president of the International AIDS Society. “I went to the ministries of finance and health and told them: The best-kept secret in this field is that treatment is prevention. You need to let us treat more people, not less. And it worked.”

Even $50 million spent on drugs, he said, ultimately saves $300 million because roughly 400 people a year avoid infection. (The estimated lifetime cost of treating a Canadian with AIDS is $750,000.)

Dr. Montaner also pushed for the creation of Insite. There, addicts get clean needles, which they are not allowed to share with anyone else.

In return, they are safe from robbery, which is common on the streets outside, and from arrest. Insite has a special exemption from Canada’s narcotics laws.

They also know that if they overdose, they won’t die. In Insite’s seven years of operation, there have been more than 1,000 overdoses inside, but not a single death. (Mild overdoses are treated with oxygen, serious ones with Narcan, an opiate blocker.)

Also, the staff nurses give medical care: They drain and bandage abscesses from dirty needles, hand out condoms, offer gynecological exams and treatment for sexual diseases, refer addicts to treatment and offer AIDS tests.

“We feel very positive about Insite,” said Dr. Patricia Daly, chief public health officer for Vancouver Coastal Health, the branch of the health system that covers this part of the country. “There are fewer overdose deaths, less open drug use on the street, and we know it’s brought more people into detox.”

While the city’s large gay community has more infected individuals, the drug-using community is harder to reach. Many addicts are mentally ill or barely educated; many are homeless. About a quarter are American Indians, who have historical reasons to view government testing with suspicion.

Also, addicts are often so consumed with finding their next hit of heroin, cocaine or methamphetamine that they ignore everything else and will sell anything, including their antiretrovirals.

Recipes for Health: Creamy Meyer Lemon Dressing

Posted: 08 Feb 2011 09:46 AM PST

This delicate, lemony dressing is wonderful with most lettuces, both delicate and robust. I especially like it with endive. If you can find it, lemon-scented olive oil, sold in some gourmet shops, will add a delicious flavor.

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

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2 tablespoons finely diced shallot

1/8 to 1/4 teaspoon kosher salt, to taste

1/4 cup freshly squeezed Meyer lemon juice

Freshly ground pepper

1/2 cup extra virgin olive oil (plus 1 to 2 tablespoons for thinning out, if desired)

1/4 cup buttermilk or plain yogurt

1 tablespoon lemon-scented olive oil (optional)

1. Soak the shallot in cold water for five minutes. Drain and dry on a doubled-over paper towel. Then combine with the salt and lemon juice in a small bowl. Let sit for 15 minutes. Add the pepper, then whisk in the olive oil and buttermilk or yogurt.

Yield: 1 1/3 cups.

Advance preparation: This dressing is best used shortly after making it, as the lemon juice and the shallot will not taste as bright after a few hours.

Nutritional information per 2 tablespoons: 101 calories; 2 grams saturated fat; 1 gram polyunsaturated fat; 8 grams monounsaturated fats; 0 milligrams cholesterol; 1 gram carbohydrates; 0 grams dietary fiber; 31 milligrams sodium (does not include salt to taste); 0 grams protein

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

18 and Under: Ensuring Domestic Tranquillity During Sleepovers

Posted: 07 Feb 2011 07:00 PM PST

In every iteration of the interminable discussion of the new book “Battle Hymn of the Tiger Mother,” someone inevitably brings up the crucial issue of the sleepover — the childhood ritual in which the author, Amy Chua, wouldn’t let her daughters take part.

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The sleepover, along with its cousin the slumber party, has apparently become an essential part of childhood, for boys as well as for girls.

“My impression is that sleepovers are a phenomenon of the suburbs and they started taking off in the ’50s and ’60s,” said Paula Fass, a professor of history at the University of California, Berkeley, and the editor of the Encyclopedia of Children and Childhood. In their big new suburban homes, she suggested, children for the first time had their own bedrooms, suitable for entertaining.

Some adults probably worried about strange houses or sleep deprivation, but children knew what they wanted, and the sleepover has thrived — no thanks to parents, pundits or pediatricians.

In a recent article for The Chicago Tribune, “Sleepover Survival Guide,” Heidi Stevens quotes an expert who notes that my own professional organization, the American Academy of Pediatrics, doesn’t offer age guidelines for sleepovers and slumber parties.

In fact, searching the archives of the journal Pediatrics, I found only a single reference to sleepovers, one that will make perfect sense to all those parents who distrust “strangers”: the academy recommends that after a sleepover, you check your child for head lice.

But there’s a reason that simple guidelines are next to impossible. Sleepovers raise a whole array of emotional issues for children and parents: separation, sleeping in a strange place, playing by another family’s rules. This is a case where you really have to know your own child, the other family, the whole situation — and the other family needs to know about your child, too.

Many children as young as 8 or 9 (or even younger) do fine with a good friend and a familiar family. But anxieties can loom at any age. The classic children’s book on the subject is “Ira Sleeps Over,” by Bernard Waber (Sandpiper, 1975), in which a boy worries about taking his beloved teddy bear to a sleepover while his older sister warns darkly that if he does he will be mocked.

“Clearly, kids who have some separation anxiety issues — it’s not a sleep disorder per se — may have some difficulty negotiating the sleepover experience,” said Dr. Judith Owens, a pediatrician who is director of sleep medicine at Children’s National Medical Center in Washington. “I certainly have had some kids come to our house who I ended up driving home at 10 at night.”

Then there is what Ms. Stevens’s article called “emotional bloodshed.” Bullying can happen anywhere, of course, but it can become particularly intense in a nest of sleep-deprived pre-teenagers. (This is not a new phenomenon. Another classic sleepover tale, Shirley Jackson’s short story “Pajama Party,” from 1957, revolves around the complexities of which 11-year-old girl is willing to sleep near whom after doing or saying what mean thing.)

Sleepovers also come up when you talk about nocturnal enuresis, or bed-wetting. Even occasional sufferers can see sleepovers as occasions of anxiety and humiliation — or just as impossible, forbidden activities, symbols of “normal childhood” from which they are excluded. Medications can be used at times to help older children stay dry through a sleepover night.

Other medications can complicate sleepovers. Drugs for attention deficit hyperactivity disorder, for example, can wear off as the evening wears on, and a highly impulsive, risk-taking child can be a potent addition to the slumber party mix. (I speak here as the host’s mother, who found herself in the middle of the night tending to some of the resulting injuries.) Here again, it is important to be sure that the host parents are fully apprised about any such issues.

In particular, “you definitely want to warn other parents if your child may sleepwalk or have a sleep terror,” said Dr. Jodi A. Mindell, a psychologist who is associate director of the Sleep Center at the Children’s Hospital of Philadelphia, and author with Dr. Owens of “Take Charge of Your Child’s Sleep” (Marlowe, 2005).

Sleep terrors, which are most common from 4 or 8, can persist until puberty. These episodes — in which a child sits up in bed, screaming, looking terrified, and does not respond to comfort or reassurance — tend to be more frightening for the observers than for the child, who typically doesn’t remember the episode by the next day.

Since sleep deprivation is a risk factor for such episodes, Dr. Owens said, they have an increased chance of occurring at a sleepover or the night after. In addition, she continued, “some kids are more likely to have sleepwalking episodes if they’re in a strange household.” Hosts need to be aware, so they can take precautions: hang a bell on the doorknob of the room where the child is sleeping, block off stairs, make sure the front door is locked.

Both sleep experts agreed that the rules for sleepovers and slumber parties should reflect common sense. “Do it in moderation,” Dr. Owens said. “Don’t have two sleepovers in a row on a weekend, think about planning ahead, maybe doing a prophylactic nap the afternoon before. Maybe planning the next day not to do anything that’s going to require too high-level cognitive process or emotional regulation.”

This night away from home, this now iconic childhood activity — a step toward mock independence and at the same time an intense exposure to peer standards and pressures — defies simple guidelines but calls for family conversations which range from individual medical issues to social norms and parental judgment. And that is probably why the sleepover has made such a handy vehicle for discussing the “tiger mother” questions of parental rules, rigor and responsibility.

Parents may see this as an opportunity for judgment and discussion; for their children, though, the sleepover has become something between a cultural totem and an ineluctable component of the pursuit of happiness.

“By the 1980s, you had to sleep over; otherwise your parents were oppressing you,” Professor Fass said. “It was already, by the 1980s, not a privilege but a right.”

A Conversation With : The Matriarch of Modern Cancer Genetics

Posted: 08 Feb 2011 08:44 AM PST

Dr. Janet Davison Rowley, 85, is the matriarch of modern cancer genetics. Without her 1970s finding that broken and translocated chromosomes were a factor in blood cancers, we might not have the treatments for leukemia that are commonplace today. We spoke earlier this winter at her University of Chicago offices and also at the Hyde Park home she shares with her husband of 62 years, Donald Rowley, a research pathologist. An edited and condensed version of the interviews follows.

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Q. You didn’t start out as a geneticist, but as a medical doctor. I take it your research career was accidental?

A. Absolutely. For much of the late 1950s, I worked a few days a week as a medical doctor at a Cook County Hospital clinic for retarded children. With young children at home, I would only work part time.

Then in 1961, my husband had a sabbatical from the University of Chicago to England. I needed something to do for the year we’d be over there. Because of my work with retarded children, I was interested in inherited diseases. It had recently been found that Down Syndrome was linked to an extra copy of chromosome 21. So, a friend arranged an introduction to Laszlo Lajtha, a hematologist in Oxford. He was doing groundbreaking work on the pattern of replication of bone marrow cells. Lajtha agreed to allow me to come to his lab to extend his work to replication of chromosomes, which I was interested in, and to learn more about his emerging field, cytogenetics.

Q. What was the state of genetics research in 1961?

A. The revolution was far from happening. This was less than a decade after Watson and Crick’s discovery. We were only beginning to have a notion of what DNA was like. There weren’t the right tools yet to stain it, cut it apart, examine and manipulate it.

Still, even with limited technology, there had been some advances. One of the most important came in 1960, when Peter Nowell and David Hungerford of Philadelphia discovered that one small chromosome was about half the normal size in many patients with CML, a type of leukemia. According to a convention at the time, this became known as the Philadelphia chromosome.

I enjoyed my laboratory work with Lajtha. I decided that when I returned to Chicago, I’d try to find another part-time job, though this time in research.

Q. How were you going to do that? You had few research credentials.

A. Well, I had a paper coming out in Nature with Lajtha on DNA replication in chromosomes. So at least I had that.

What I did was go to Leon Jacobson, the director of the Argonne Cancer Research Hospital, which was funded by a block grant from the Atomic Energy Commission; he had a pot of money. “I have a research project started in England that I’d like to continue with. Could I work here part time? All I need is a microscope and a darkroom. And by the way, will you pay me? I must earn enough for a baby sitter.” And he said yes to everything!

Once at the hospital, Dr. Jacobson, a hematologist, would sometimes ask me to look over the slides of his leukemia patients. Under the microscope, we’d see abnormal chromosomes — too many or too few in a group, though it would be hard to tell one chromosome from the other. The technology wasn’t there yet.

Q. Did this eventually lead to your important 1972 discovery of chromosome translocations?

A. It did. Though as luck would have it, I’d have to make another trip to England before that would happen.

In 1970, my husband took another sabbatical to Oxford. Just as we were leaving, this new technique of banding came out. With banding, genetic material is stained with special dyes before being examined under a fluorescent microscope. The bands on the chromosomes show up in contrast. You can see subtle differences, which you can use to identify the different chromosomes.

There was someone at Oxford who was really active with this technique. I was able to use his fluorescent microscope on nights and weekends to study things I was working on. By the end of the sabbatical, I knew it would be possible to learn more about those chromosomes we’d observed on the slides of Dr. Jacobson’s leukemia patients.

Q. And that’s how you discovered translocations?

A. Well, it was now possible to use the bands’ patterns to identify the different chromosomes.

Once I was in Chicago again, I looked at two different groups of similarly sized and shaped chromosomes from patients with AML-type leukemia. With them, chromosomes 8 and 21 were broken and had switched ends — the first known chromosomal translocation.

Later, I examined photographs of CML cells, one stained through banding and one not. You could see that chromosome 9 had an extra piece on it. This was the part of the Philadelphia chromosome that had broken off. Contrary to what had been thought, the Philadelphia chromosome didn’t represent a deletion of chromosomal material. The Philadelphia chromosome and chromosome 9 had each suffered breaks and swapped ends — the second translocation!

Q. And this was a revolutionary finding for genetics, right?

A. And cancer. More had to be known, of course. Why did this arrangement lead to leukemia? How consistent were these findings? In my lab, in 1977, we found a third specific translation in a rare type of leukemia, APL. So that showed what we’d observed with the other two wasn’t an anomaly. The third finding made me a believer. And by the late 1970s, there’d be common agreement: cancer is a genetic disease.

Q. It is sometimes said that the miracle drug Gleevec, which has proved so useful against CML and other cancers, could not have happened without your work. Is that true?

A. That’s very generous. But you had go through a lot of steps in between.

People accuse me of being too humble. But looking down a microscope at banded chromosomes is not rocket science. If I hadn’t found it, somebody else would.

Q. Do you think that the type of career you’ve had would be possible today?

A. No. I was doing observationally driven research. That’s the kiss of death if you’re looking for funding today. We’re so fixated now on hypothesis-driven research that if you do what I did, it would be called a “fishing expedition,” a bad thing.

O.K., we knew about the Philadelphia chromosome, and after banding we had the technology to discover gains and losses among the different chromosomes. But once you knew that, what were the implications of the gains and losses? That’s the “fishing,” because there wasn’t a hypothesis.

Well, if you don’t know anything, you can’t have a sensible hypothesis.

I keep saying that fishing is good. You’re fishing because you want to know what’s there.

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Global Update: Outbreaks: A Tool to Track Animal Diseases May Help to Protect Humans

Posted: 07 Feb 2011 09:30 PM PST

VIENNA — A new online mapping tool will enable scientists and the public to track outbreaks of animal diseases that might jump to humans.

The tool, known as Predict, will be at www.healthmap.org/predict. Created with a grant from the United States Agency for International Development, it is being produced by experts on human and animal diseases from a few institutions, scientists announced on Monday at a conference here on emerging diseases.

The consortium was put together in 2009, during the pandemic of H1N1 swine flu, which had a surprising mixture of genes from North American and Eurasian pigs but had never been detected in pigs before it was found in humans in Veracruz, Mexico.

It had become clear over the years that there was too little surveillance of animal diseases that can infect humans. For example, the virus that caused the outbreak of SARS and the family of viruses that include Ebola are all thought to have originated in bats.

The system will monitor data from 50,000 Web sites with many types of information, including World Health Organization alerts, online discussions by experts, wildlife trade reports and local news. How useful it is will depend on how well it filters that river of information.

“We strongly believe in public access to the data we collect,” said Damien Joly, an associate director of wildlife health monitoring for one of the institutions, the Wildlife Conservation Society, which runs New York City’s zoos and aquarium and has animal health projects around the world. “It doesn’t do public health much good to collect data and let it sit while it awaits publication.”

Q & A: Is Ripeness All?

Posted: 07 Feb 2011 09:20 PM PST

Q. How much nutritional loss is there from underripe fruit?

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A. There is a significant change in nutritional value as a fruit or vegetable ripens, but ripeness may not be the major factor in nutrition, said Jennifer Wilkins of the division of nutritional sciences of the Cornell University College of Human Ecology.

The change in value varies with factors like variety and post-harvest handling, she said. For example, a 2004 study of blackberries in The Journal of Agricultural Food Chemistry found that the level of anthocyanin pigments, which may have antioxidant benefits, increased more than fourfold as Marion blackberries went from underripe to overripe (to 317 milligrams per 100 grams, from 74.7 milligrams); for another variety, Evergreen, they rose a bit more than twofold (to 164 milligrams from 69.9).

While antioxidant activities also increased with ripening, they did not show such a significant change. And another nutrient class, phenolics, actually decreased slightly.

“For a lot of fruits and vegetables in the supermarket, ripeness is not the big issue,” Dr. Wilkins said. Even though a tomato may be harvested before peak maturity and shipped before vitamin C has a chance to develop fully, bigger factors may be what variety it is; if it’s chilled enough and quickly enough after harvest; what humidity and temperature it is exposed to in shipping; and how long it takes to get to market.

C. CLAIBORNE RAY

Readers are invited to submit questions by mail to Question, Science Times, The New York Times, 620 8th Avenue, New York, N.Y. 10018, or by e-mail to question@nytimes.com.

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Vital Signs: Fitness: A Walk to Remember? Study Says Yes

Posted: 07 Feb 2011 10:25 PM PST

In healthy adults, the hippocampus — a part of the brain important to the formation of memories — begins to atrophy around 55 or 60. Now psychologists are suggesting that the hippocampus can be modestly expanded, and memory improved, by nothing more than regular walking.

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In a study published on Jan. 31 in The Proceedings of the National Academy of Sciences, researchers randomly assigned 120 healthy but sedentary men and women (average age mid-60s) to one of two exercise groups. One group walked around a track three times a week, building up to 40 minutes at a stretch; the other did a variety of less aerobic exercises, including yoga and resistance training with bands.

After a year, brain scans showed that among the walkers, the hippocampus had increased in volume by about 2 percent on average; in the others, it had declined by about 1.4 percent. Since such a decline is normal in older adults, “a 2 percent increase is fairly significant,” said the lead author, Kirk Erickson, a psychologist at the University of Pittsburgh. Both groups also improved on a test of spatial memory, but the walkers improved more.

While it is hard to generalize from this study to other populations, the researchers were delighted to learn that the hippocampus might expand with exercise. “And not that much exercise,” Dr. Erickson pointed out.

People don’t even have to join a gym, he noted. They just need shoes. PAULA SPAN

Drugmakers’ Fever for the Power of RNA Interference Has Cooled

Posted: 07 Feb 2011 09:20 PM PST

When RNA interference first electrified biologists several years ago, pharmaceutical companies rushed to harness what looked like a swift and surefire way to develop new drugs.

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Billions of dollars later, however, some of those same companies are now losing their enthusiasm for RNAi, as it is called. And that is raising doubts about how quickly, if at all, the Nobel Prize-winning technique for turning off specific genes will yield the promised bounty of innovative medicines.

The biggest bombshell was dropped in November, when the Swiss pharmaceutical giant Roche said it would end its efforts to develop drugs using RNAi, after it had invested half a billion dollars in the field over four years.

Just last week, as part of a broader research cutback, Pfizer decided to shut down its 100-person unit working on RNAi and related technologies. Abbott Laboratories has also quietly shelved its RNAi drug development work.

“In 2005 and 2006, there was a very sudden buildup of expectation that RNAi was going to cure many diseases in a very short time frame,” said Dr. Johannes Fruehauf, vice president for research at Aura Biosciences, a small company pursuing the field. “Some of the hype, I believe, is going away and a more realistic view is setting in.”

The issue is that while drugs working through the RNAi mechanism can indeed shut off genes, it has been difficult to deliver such drugs to the cells where they are needed. At a time when hard-pressed pharmaceutical companies are already scaling back research expenditures, RNAi is losing out to alternatives that seem closer to producing marketable drugs.

“I have no doubt that at a certain point in time RNAi will make it to the market,” said Klaus Stein, head of therapeutic modalities for Roche. But he added, “When we looked into this, we came to the conclusion that we have opportunities that have higher priorities.”

The loss of appetite at the big companies is hurting smaller companies that specialize in RNAi. Alnylam Pharmaceuticals, widely considered the leader among these companies, cut a quarter of its work force late last year after Novartis did not extend a partnership. And several small companies failed to fulfill promises to investors that they would forge alliances with big pharmaceutical companies in 2010.

Still, many executives and scientists say progress is being made. Just last week, two midsize European drug companies signed small deals to explore development of RNAi drugs. While there has not yet been definitive proof that a drug using RNAi can effectively treat a human disease, there are now about a dozen RNAi drugs in clinical trials, more than ever before.

It is not unusual, the executives and scientists say, for the initial enthusiasm for a new technology to wane, even as the technology slowly is perfected. It took more than 20 years for the discovery of monoclonal antibodies in the mid 1970s to translate into huge-selling drugs like Avastin for cancer and Humira for rheumatoid arthritis.

“A lot of the excitement for RNAi was irrationally high to begin with, and now is irrationally low,” said David Corey, a professor of pharmacology at the University of Texas Southwestern Medical Center in Dallas.

RNA is a chemical cousin of the DNA in genes. Both are strings of chemicals called bases that spell out the genetic code and are usually represented by the letters A, C and G, plus T for DNA and U for RNA.

While it was once thought that RNA was merely a messenger, scientists now recognize that RNA plays a powerful role in turning genes on or off. The discoverers of RNAi, Andrew Z. Fire and Craig C. Mello, won the Nobel Prize in 2006, a mere eight years after publishing their seminal paper.

RNA interference is a natural phenomenon. When a cell senses a double strand of RNA, it acts to silence any genes with the corresponding sequence of bases. It is thought this is a defense against viruses because RNA is usually found as a single strand except in viruses.

The implications for drug companies were obvious. Virtually any disease-related gene could, in theory, be silenced by synthesizing a short snippet of double-stranded RNA — called a small interfering RNA, or siRNA — with the proper sequence of bases. Imagine disabling a gene that contributes to high cholesterol, or one that a pathogen needs to survive.

By 2005, three drugs were ready for clinical trials, a rapid turnaround by pharmaceutical industry standards.

But two of them — both aimed at treating the eye disease called age-related macular degeneration — have already been dropped after not working well enough. The third, aimed at treating a respiratory infection, has shown some signs of effectiveness, but conclusive trials are only now under way.

One obstacle is that the double-stranded RNA snippets, perhaps because they do resemble viruses, can wake up certain immune system sentinels and set off an immune response.

Such responses can be an unwelcome side effect in some cases. In other cases, like in treating cancer or infections, an immune response might be welcomed — but might also obscure whether the gene silencing itself is working.

Dr. Arthur M. Krieg, who runs RNAi research at Pfizer, said he looked at 35 studies in which RNAi drugs were reported to have shrunk tumors in animals. Only two of the studies used controls that could rule out the possibility that the tumor shrinkage was caused by an immune response, rather than a silencing of specific genes.

But the biggest challenge has been delivery. RNA is quickly broken down in the bloodstream. And even if it gets to the cells in the body where it is needed, it has trouble entering the cells.

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Pharmacies Besieged by Addicted Thieves

Posted: 07 Feb 2011 12:50 PM PST

BINGHAM, Me. — The orange signs posted throughout Chet Hibbard’s pharmacy here relay a blunt warning: We Do Not Stock OxyContin.

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“Outside hiring an armed guard to be in here 24/7, I don’t know what else to do.” CHET HIBBARD, a Maine pharmacist who has stopped selling OxyContin.

Mr. Hibbard stopped dispensing the highly addictive painkiller last July, after two robbers in ski goggles demanded it at knifepoint one afternoon as shocked customers looked on. It was one in a rash of armed robberies at Maine drugstores last year, a sharp increase that has rattled pharmacists and put the police on high alert.

“I want people to know before they even get in the door that we don’t have it,” Mr. Hibbard said of OxyContin, which the authorities say is the most common target of pharmacy robberies here. “Outside hiring an armed guard to be in here 24/7, I don’t know what else to do.”

Maine’s problem is especially stark, but it is hardly the only state dealing with pharmacy robberies, one of the more jarring effects of the prescription drug abuse epidemic that has left drugstores borrowing heist-prevention tactics from the more traditional targets, banks. In at least one case, a tiny tracking device affixed to a bottle let the police easily track a thief after a robbery.

More than 1,800 pharmacy robberies have taken place nationally over the last three years, typically conducted by young men seeking opioid painkillers and other drugs to sell or feed their own addictions. The most common targets are oxycodone (the main ingredient in OxyContin), hydrocodone (the main ingredient in Vicodin) and Xanax.

The robbers are brazen and desperate. In Rockland, Me., one wielded a machete as he leapt over a pharmacy counter to snatch the painkiller oxycodone, gulping some before he fled. In Satellite Beach, Fla., a robber threatened a pharmacist with a cordless drill last week, and in North Highlands, Calif., a holdup last summer led to a shootout that left a pharmacy worker dead.

The crime wave has spurred pharmacists to tighten security measures and add ones they may never have imagined. Many have upgraded their surveillance cameras; some have installed bulletproof glass and counters high enough to keep would-be robbers from jumping them, giving these pharmacies the aesthetic of an urban liquor store. In Tulsa, Okla., where there was a steep increase in drugstore robberies last year, at least one pharmacist now requires customers to be buzzed in the door.

Meanwhile, the police are quietly experimenting with new tools. In Lewiston, Me., last fall, a Rite Aid pharmacist handed a robber who threatened to shoot her five bottles of OxyContin, including one that contained a tracking device.

According to court records, the device led the police to the suspect’s home on a rural road shortly after he fled the store. They gathered evidence there, arrested the suspect a few days later and indicted him last month.

The Drug Enforcement Administration does not routinely investigate reports of pharmacy robberies, and therefore “it cannot be determined what factors are contributing to these types of thefts,” a spokeswoman said.

But some local law enforcement officials have been overwhelmed enough by the incidents to seek help. Thomas Delahanty II, the United States attorney in Maine, announced recently that the federal authorities would help investigate the heists from now on and prosecute some of the cases.

Federal charges could bring more prison time, Mr. Delahanty said, describing the surge in such robberies as “staggering numbers that can’t be ignored.” There were 21 in Maine last year, according to the D.E.A., up from two in 2008 and seven in 2009.

In Biddeford, Me., a city of 21,000 that has had seven pharmacy robberies since December 2009, Roger Beaupre, the police chief, said he was urging the stores to require customers to remove hoods and sunglasses before entering and to consider caging in their pharmacy counters.

Police officers there got free training in how to investigate pharmacy heists last month from Purdue Pharma, the maker of OxyContin. The company also trains pharmacists on how to prevent robberies and what to do should they fall victim to one, said Rick Zenuch, its director of law enforcement liaison and education.

“The very first tip we give them is comply, comply, comply,” Mr. Zenuch said. “Do exactly what the suspect wants, to end the encounter as soon as possible.”

In Washington State, where more than 100 pharmacy robberies have taken place over the last three years, law enforcement officials say the penalty for second-degree robbery, when the pharmacist may be threatened but no weapon is shown, is too weak. Dan Satterberg, the King County prosecutor, said he had submitted a bill to the Legislature to increase the minimum jail time to three years from three months.

“Word travels fast on the street about what an easy target the pharmacies are and how much profit can be made and what small punishment is attached,” Mr. Satterberg said.

OxyContin goes for $1 a milligram on the street, Mr. Satterberg and other law enforcement officials said, and the most popular pill is 80 milligrams.

Restaurant Nutrition Draws Focus of First Lady

Posted: 06 Feb 2011 11:32 PM PST

WASHINGTON — After wrapping her arms around the retail giant Wal-Mart and trying to cajole food makers into producing nutrition labels that are easier to understand, Michelle Obama, the first lady and a healthy-eating advocate, has her sights set on a new target: the nation’s restaurants.

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Michelle Obama last month announcing an agreement with Wal-Mart that is a part of her effort to influence dietary habits.

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A team of advisers to Mrs. Obama has been holding private talks over the past year with the National Restaurant Association, a trade group, in a bid to get restaurants to adopt her goals of smaller portions and children’s meals that include healthy offerings like carrots, apple slices and milk instead of French fries and soda, according to White House and industry officials.

The discussions are preliminary, and participants say they are nowhere near an agreement like the one Mrs. Obama announced recently with Wal-Mart to lower prices on fruits and vegetables and to reduce the amount of fat, sugar and salt in its foods. But they reveal how assertively she is working to prod the industry to sign on to her agenda.

On Tuesday, Mrs. Obama will begin a three-day publicity blitz to spotlight “Let’s Move!,” her campaign to reduce childhood obesity, which was announced one year ago this week.

She will introduce a public service announcement, appear on the “Today” show and deliver a speech in Atlanta promoting gardening and healthy-eating programs.

But as she uses her public platform to persuade children to eat healthier and exercise more, Mrs. Obama and her team are also quietly pressing the levers of industry and government. Over the past year she has become involved in many aspects of the nation’s dietary habits, exerting her influence over nutrition policy.

Her team has worked with beverage makers to design soda cans with calorie counts and is deeply involved in a major remake of the government’s most recognizable tool for delivering its healthy-eating message: the food pyramid.

Mrs. Obama persuaded Congress to require schools to include more fruits and vegetables in the lunches they offer, and she encouraged lawmakers to require restaurants to print nutrition information on menus, a provision that wound up in President Obama’s landmark health care law.

“They really want a cooperative relationship with the food industry, and they’re looking at industry to come up with ideas,” said Lanette R. Kovachi, corporate dietitian for Subway, the nation’s second-largest restaurant chain in terms of revenue. She said she had taken part in at least four conference calls with Mrs. Obama’s food advisers.

But in seeking partnerships with industry, Mrs. Obama runs a risk. While nutritionists and public health advocates give her high marks for putting healthy eating on the national agenda, many worry that she will be co-opted by companies rushing to embrace her without offering meaningful change.

“Can the food industry play a responsible role in the obesity epidemic? The answer isn’t no,” said Dr. David Ludwig, the director of the Optimal Weight for Life program at Children’s Hospital in Boston. “The point is that the best initiatives can be subverted for special interest, and it’s important to be vigilant when we form partnerships with industry.”

White House officials say Mrs. Obama has believed from the start that bringing industry to the negotiating table is critical to achieving her long-range goal of eliminating childhood obesity within a generation.

Melody Barnes, Mr. Obama’s domestic policy adviser and the chairwoman of a presidential task force on obesity, said industry has been eager to work with the White House. But Mrs. Obama does not lend her name to any plan or program, she said, unless it meets the recommendations of a task force report issued in May.

“If someone wants her support, we take a hard look at the data and the research to determine if the commitment meets our standards,” Ms. Barnes said. “And if the result is good for business as well as for the health of American children, we see that as a win-win.”

Still, Mrs. Obama has been treading carefully. As part of her anti-obesity campaign, she has called on food makers to design clear “front-of-package” labels to warn consumers about ingredients like salt, sugar and fat. But after months of negotiations with the White House, the companies insisted on a plan that would also spotlight healthy ingredients, like calcium or fiber.

The administration thought the new labels confusing, and they do not meet recommendations in a recent report by experts at the nonpartisan Institute of Medicine. When the food companies announced the plan, the White House put out a tepid statement calling it “a significant first step.” Mrs. Obama said nothing.

“She could have just added this to her list of things done, but she said, ‘Not good enough,’ ” said Dr. David Kessler, a commissioner of the Food and Drug Administration under President Bill Clinton “It was not done in a confrontational manner; she didn’t blast them, but she sent a very clear signal that it didn’t meet the mark.”

That, however, did not stop food industry executives from invoking Mrs. Obama’s name when they rolled out the labeling initiative last month and said they were responding to her call for action.

States Struggle to Disarm People Who’ve Lost Right to Own Guns

Posted: 07 Feb 2011 11:19 AM PST

By law, Roy Perez should not have had a gun three years ago when he shot his mother 16 times in their home in Baldwin Park, Calif., killing her, and then went next door and killed a woman and her 4-year-old daughter.

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California Attorney General's Office

Weapons seized from a man recently released from a mental facility.

Mr. Perez, who pleaded guilty to three counts of murder and was sentenced last year to life in prison, had a history of mental health issues. As a result, even though in 2004 he legally bought the 9-millimeter Glock 26 handgun he used, at the time of the shootings his name was in a statewide law enforcement database as someone whose gun should be taken away, according to the authorities.

The case highlights a serious vulnerability when it comes to keeping guns out of the hands of the mentally unstable and others, not just in California but across the country.

In the wake of the Tucson shootings, much attention has been paid to various categories of people who are legally barred from buying handguns — those who have been “adjudicated as a mental defective,” have felony convictions, have committed domestic violence misdemeanors and so on. The focus has almost entirely been on gaps in the federal background check system that is supposed to deny guns to these prohibited buyers.

There is, however, another major blind spot in the system.

Tens of thousands of gun owners, like Mr. Perez, bought their weapons legally but under the law should no longer have them because of subsequent mental health or criminal issues. In Mr. Perez’s case, he had been held involuntarily by the authorities several times for psychiatric evaluation, which in California bars a person from possessing a gun for five years.

Policing these prohibitions is difficult, however, in most states. The authorities usually have to stumble upon the weapon in, say, a traffic stop or some other encounter, and run the person’s name through various record checks.

California is unique in the country, gun control advocates say, because of its computerized database, the Armed Prohibited Persons System. It was created, in part, to enable law enforcement officials to handle the issue pre-emptively, actively identifying people who legally bought handguns, or registered assault weapons, but are now prohibited from having them.

The list had 18,374 names on it as of the beginning of this month — 15 to 20 are added a day — swamping law enforcement’s ability to keep up. Some police departments admitted that they had not even tried.

The people currently in the database are believed to be in possession of 34,101 handguns and 1,590 assault weapons, said Steven Lindley, acting chief of the firearms bureau in the state’s Department of Justice. He estimated that 30 percent to 35 percent of the people on the list were there for mental health reasons.

Despite the enforcement challenges, the state’s database offers a window into how extensive the problem is likely to be across the country. Concrete figures on the scope of the issue are difficult to come by because no other state matches gun purchase records after the fact with criminal and mental health files as California does.

“There are 18,000 people on California’s list,” said Dr. Garen J. Wintemute, director of the Violence Prevention Research Program at the University of California, Davis, who helped law enforcement officials set up the system and is working on a proposal to evaluate its effectiveness. “So we can roughly extrapolate there are 180,000 such people across the country, just based on differences across populations.”

By way of context, Dr. Wintemute said that in 2009 only about 150,000 people were prevented from buying a gun because they failed background checks, out of about 10.8 million who applied.

Only a handful of states, however, even have the ability to keep track of handgun purchases the way California does, by either requiring a license or permit to own one or simply keeping records of such purchases. Even fewer require a license or permit for other types of firearms.

California’s system came about through a 2002 law that was even supported by the National Rifle Association, in part because it was billed as a way to protect members of law enforcement. It finally got under way in earnest in 2007. But though gun control advocates consider it a model, it still has serious gaps.

Well: Timing of Baby Food Tied to Obesity Risk

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Personal Health: How to Keep Winter From Taking a Toll on Your Back

Posted: 07 Feb 2011 07:10 PM PST

This is your back speaking, and now is the winter of my discontent. With all the snow and ice and cold that have descended on much of the country, there are so many ways I can get hurt. So I want you to know what you can and should do to protect me and keep yourself out of debilitating and disabling pain, now and in the future.

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This is especially important if you’ve already experienced back pain or, worse, sciatica. But even if your back has been perfectly healthy until now, it’s important to know how to keep it that way.

Low back pain, with or without sciatica (leg pain when sciatic nerve roots are pinched), is extremely common, afflicting 70 percent of people at one time or another. Next to headache, it is the most common medical complaint, and next to the common cold, it is the most frequent reason for missed work.

Winter brings on more than the usual back hazards. There’s all that shoveling — especially this year, in the East and Midwest. There are the cars that get stuck and need to be pushed to freedom. There are the icy patches, including black ice and ice disguised by a thin layer of snow, on walkways and stairways and in crosswalks. And there is the tendency to hibernate and perhaps slack off on physical activities that can strengthen and tone muscles that support the back and protect it from injury.

The following guidance comes primarily from Dr. Preston J. Phillips, an orthopedist and sports medicine specialist in Tulsa, Okla., who happened to visit New York City during the mid-January storm that brought us 19 inches of snow, giving him firsthand knowledge of what real snowbirds face.

Dr. Phillips is co-author, with Dr. Augustus A. White III, professor of orthopedic surgery at Harvard Medical School, of “Your Aching Back: A Doctor’s Guide to Relief” (Simon & Schuster; updated in 2010), an extremely helpful book complete with drawings of safe ways to move and exercise that are easy to incorporate into nearly every life.

SHOVELING Cardiologists suggest that men over 50 and women over 60 should leave snow shoveling to younger folks. But yours truly, and many of my neighbors, pay no heed. In fact, despite my rather iffy back, I’ve found that shoveling, properly done, enhances my strength and muscle tone and actually protects my back.

The tricks, according to Dr. Phillips: Bend from your knees, not your back; don’t overload the shovel; remember that wet snow is heavier than the fluffy kind; shovel in short intervals and rest in between; and don’t twist.

Instead move your feet, put one foot forward and face the direction you’re going to throw the snow. Above all, as the doctor said in an interview, “don’t be macho — hire the kid down the street or use a snowblower.”

GETTING THERE Allow extra time to get places. Do not run or race-walk to catch a bus or train or to get to work on time. Be especially careful on stairs; use the handrail and watch your step. If you must use a bicycle for transportation, look for cleared roads to ride on, even if the route is longer. Black ice and slush are especially treacherous for cyclists.

STAYING UPRIGHT I’ve been appalled to see what some very elderly men and women have been wearing on their feet this winter — flimsy, treadless shoes that are herniated discs, fractured spines or broken hips (or worse) waiting to happen.

Soles of shoes or boots should grip the snow or ice. There are several products that can turn ordinary shoes into cleats. They include GripOns, Yaktrax Walkers, STABILicers and DryGuy MonsterGrips, sold in sporting-goods and shoe stores and on the Internet.

“A walking stick or cane can provide added stability,” Dr. Phillips said. And to avoid straining your back, use a long-handled shoehorn to put boots on — and a boot jack (a wood or iron device with a U-shaped mouth to grip the heel of the boot) to take them off.

PUSHING CARS First, try to improve traction using branches, cardboard, sand or cat litter under the wheels. If pushing is required, the doctor said, “get three or more people to push the car out.”

He also endorsed a good-neighbor policy: “If you see someone having difficulty, offer to help if you can — and if you’re the one who needs help, accept it when offered.” (When my loaded shopping cart got stuck in a mound of snow at an intersection, a kind — and strong — stranger picked it up and carried it over the obstacle.)

CARRYING When navigating uncertain surfaces, it’s critically important to watch where you’re stepping and keep your balance. Don’t carry too many packages from the store or car at once; better to make extra trips.

Also, equalize the load on both sides of your body. When lifting heavy packages from the car, first move them close to your body and bend from the knees to pick them up. If you must carry a young child, use a sling or backpack carrier. If instead the child is in a stroller or carriage, avoid sudden twists and watch for ice ahead.

CLEANING AND CLEARING Winter, when the body stiffens against the cold, is not the best time to clear your yard of tree limbs and branches. “Unless they’re obstructing your path or are a risk to your home,” Dr. Phillips said, “leave them until the weather warms up.”

If the roof develops a leak, call a professional; climbing on a wet, icy or snow-covered roof “is a recipe for disaster,” he said.

KEEPING STRONG Though it’s tempting to hibernate in the cold, this is no time to slack off on exercises that protect your back and your entire body, from your shoulders to your shoes.

“If you have good muscle tone over all, your muscles are better able to compensate for problems in the lower back,” Dr. Phillips said. As he and Dr. White wrote, the crucial components of a good exercise program are “regularity, trunk muscle strengthening and endurance, and palatability.”

They recommend walking, cycling (indoors or out) and swimming, in any combination, as the best all-around activities for people with back issues. Proper technique is critical; sit-ups should not be done with straight legs or feet hooked under something.

Isometric exercises that strengthen abdominal muscles can be done at almost any time: “Tighten your throat, bowel and bladder muscles; then press hard as if you were trying to have a bowel movement, and concentrate on tightening your abdominal muscles.”

Really?: The Claim: Whispering Can be Hazardous to Your Voice

Posted: 07 Feb 2011 07:10 PM PST

THE FACTS

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Ever have a bad case of laryngitis? To protect your voice, you may have felt the urge to whisper. But many otolaryngologists advise against this, warning that whispering actually causes more trauma to the larynx than normal speech. Singers in need of vocal rest are often given the same advice: Avoid whispering. It will damage your pipes.

But Dr. Robert T. Sataloff, chairman of the otolaryngology department at Drexel University College of Medicine, said this recommendation was based on “years of pronouncement and almost no research, like so much in medicine.”

So in 2006 Dr. Sataloff, who is also a professional opera baritone, sought out an answer in a large study, “Laryngeal Hyperfunction During Whispering: Reality or Myth?”With a team of colleagues, he recruited 100 subjects and examined their vocal cords with fiber-optic scopes as they counted from 1 to 10, first in a normal voice, then in a whisper.

Dr. Adam D. Rubin, a co-author, said that in 69 of the subjects, whispering put more strain on the vocal cords. “They were squeezing their vocal cords together more tightly to produce the whisper, which is more traumatic,” said Dr. Rubin, director of the Lakeshore Professional Voice Center in Michigan. Eighteen subjects showed no change. And in 13, whispering was easier on the vocal cords.

For people concerned about their voices, Dr. Sataloff recommends that they avoid whispering and simply talk softly — in “the voice you would use if you wanted to talk to somebody next to you without having other people in the room hear.”

THE BOTTOM LINE

For some people, whispering can be more traumatic to the larynx than normal speech. ANAHAD O’CONNOR scitimes@nytimes.com

The New Old Age: Drivers on Call

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Letters: Polio in the Balance (3 Letters)

Posted: 07 Feb 2011 07:00 PM PST

To the Editor:

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As a polio survivor, I have long imagined a world free of the disease. Today we are incredibly close to eradicating polio for good. Critics questioned that goal in your article “In Battle Against Polio, a Call for a Final Salvo” (Feb. 1).

I was 4 when I contracted polio. Six decades later, I get around with crutches and a scooter, and deal with access issues on a daily basis. No child born today should have to face the challenges I and so many others suffered.

If we stop the fight to end polio now, the virus will spread again. There is no excuse for a single case of polio anywhere. We have a powerful new vaccine and growing global support to achieve eradication.

Generations of children will imagine a future where they can realize their creative ambitions. We owe it to them to end polio now. Itzhak Perlman

New York

To the Editor:

In the late 1980s a small group of influential and well-intentioned but overzealous individuals, mostly American, pushed the World Health Organization against its better judgment (and existing priorities) into declaring support for a global program to totally eradicate poliomyelitis.

The program was sold as both being low-cost and low-risk with an “infinite” saving once polio immunization was no longer necessary.

In fact, there was good reason to believe at the time that none of those claims was true. Warning signs were heedlessly ignored.

Today, Bill Gates is simply (and rather nobly) trying to prevent the disastrous public-relations nightmare that the failure of this ill-conceived program is threatening to bring down upon the reputation of international public health.

William Muraskin

Queens

The writer is a professor of urban studies at Queens College and a researcher on global health.

To the Editor:

After my grandfather contracted polio, doctors and his mother counseled him to give up his political career. “Give up” was not in F.D.R.’s lexicon; he went on to win two elections for governor and four for president.

It would be tragic to give up on polio eradication now that we are 99 percent of the way there. Bill Gates and Rotary International should be commended, not second-guessed, for assuming the mantle of leadership.

Success in this campaign will energize the field of global health and ensure that other lifesaving vaccines are delivered to all of the world’s children.

James Roosevelt Jr.

Watertown, Mass.

The writer is president and chief executive of the Tufts Health Plan.

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Letters: In Defense of Energy Drinks (1 Letter)

Posted: 07 Feb 2011 07:00 PM PST

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To the Editor:

As Jane E. Brody correctly notes in her column “Scientists See Dangers in Energy Drinks” (Feb. 1), Red Bull Energy Drink contains about the same amount of caffeine as a cup of coffee. Health agencies around the world have deemed caffeine and the other ingredients in energy drinks to be safe, both alone and in combination.

Some consumers do mix our product with alcohol, just as they do with any number of mixers. But the common assertion that energy drinks stop a person from feeling intoxicated is just not true, according to a recent study at Boston University. Irresponsible drinking is not a result of the mixer. The scientists Ms. Brody cites ignore the vast amount of research concluding that our product is safe.

Patrice Radden

Santa Monica, Calif.

The writer is director of corporate communications, Red Bull North America.

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Letters: A Time to Weep (1 Letter)

Posted: 07 Feb 2011 07:00 PM PST

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To the Editor:

“A Mantra: No Crying in the CAT Scanner” (Cases, Feb. 1), Dr. Ellen D. Feld’s exquisite telling of her experiences during treatment for breast cancer, finally allowed me to let go of the tears I have been blinking back for many years.

As a physician at a cancer hospital, I am in awe of the patients’ stoicism and strength. If my patient cries, may I cry too? Will it help or hurt the patient to know I may have a dose of “unprofessional” sympathy?

Amina Hassan Abdeldaim, M.D.

New York

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Recipes for Health: Sesame Ginger Vinaigrette

Posted: 08 Feb 2011 09:40 AM PST

My decision to devote this week’s recipes to salad dressings was partly a reaction to my son’s request for a bottled sesame ginger dressing. “We don’t buy dressings in this house,” I said huffily.

Recipes for Health

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

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The next day I looked at a bottle of sesame soy ginger dressing at a local market and was horrified to see that the second listed ingredient was sugar. I thought: I can make something sort of sweet and do better than that.

And so I did. This dressing is great with green salads and cooked vegetables, as well as with noodles and grains.

1 garlic clove, finely minced or puréed

1 teaspoon finely minced ginger

3 tablespoons rice vinegar

1 teaspoon soy sauce

1 teaspoon brown sugar or agave nectar

5 tablespoons canola oil or light sesame oil

2 tablespoons sesame oil

1 tablespoon toasted sesame seeds

1. Place all of the ingredients in a minichop or blender (because the amounts are small, I prefer a minichop) and blend until homogenized.

Yield: Makes 2/3 cup.

Advance preparation: This dressing keeps for several days in the refrigerator.

Nutritional information per 2 tablespoons: 177 calories; 2 grams saturated fat; 6 grams polyunsaturated fat; 11 grams monounsaturated fats; 0 milligrams cholesterol; 1 gram carbohydrates; 0 grams dietary fiber; 58 milligrams sodium (does not include salt to taste); 0 grams protein

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

Recipes for Health: Salad Dressings: Hold the Guilt

Posted: 07 Feb 2011 02:50 PM PST

At the recent Worlds of Healthy Flavors conference, sponsored by the Harvard School of Public Health and the Culinary Institute of America, two prominent researchers called for an end to the use of the term “low-fat.”

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.

Dr. Ronald Krauss, director of atherosclerosis research at Children’s Hospital Oakland Research Institute, and Dr. Dariush Mozaffarian, an associate professor of epidemiology at the Harvard School of Public Health, have been involved in numerous studies measuring the effects of dietary habits on health. Few of those studies, they noted, have turned up reliable associations between one’s total intake of dietary fat and such diseases as cancer and heart disease. Nor have they turned up meaningful associations between total fat intake and obesity.

As most of us now know, it is the type of fat that matters most to health. A diet in which saturated fats are replaced by polyunsaturated fats, found mostly in plants, nuts and seafood, and monounsaturated fats, present in olive oil, may help protect against heart disease.

On the other hand, trans fats, created during the hydrogenation process, seem to increase heart disease risk. And saturated fats — found mostly in meat and dairy products, and in coconut and palm oils — raise blood levels of L.D.L., or “bad” cholesterol, also a risk factor for heart disease.

Scientists have been saying as much for years. But somehow we remain preoccupied with low-fat foods and diets, which are often high in sugar, refined flour and other simple carbohydrates, as well as in sodium, as salt is often added to low-fat foods to improve the flavor.

This week we’re going to try something different. Salad dressings by their nature are high in fat — but the ones we’re offering this week are high in the right fats. The nutrient values tell the tale: instead of total fat, this week they are broken down into polyunsaturated, monounsaturated and saturated fats.

Green Goddess Dressing

Green Goddess is a California classic. It makes a great dip for crudités and a wonderful dressing for robust lettuces like romaine hearts, but it’s too thick and intense for delicate spring mixes. Although I’ve made the anchovies optional, I recommend them because they add depth to the flavor. If salt is an issue for you, leave them out.

1 cup parsley leaves

1 cup packed watercress or spinach leaves, stemmed

2 tablespoons tarragon leaves, rinsed

3 tablespoons minced chives

1 garlic clove, roughly chopped

2 anchovy fillets, preferably salt-packed

3 tablespoons fresh lemon juice

1 tablespoon plus 1 teaspoon Champagne vinegar or sherry vinegar

1/2 cup canola oil or grapeseed oil

1/2 cup mayonnaise, preferably homemade (see note)

Kosher salt and freshly ground pepper

1. In a blender, combine the parsley, watercress or spinach, tarragon, chives, garlic, anchovies, lemon juice, vinegar and canola or grapeseed oil. Blend until smooth, about two minutes. Add the mayonnaise, and blend again until smooth. Season to taste with salt and pepper.

Note: To make your own mayonnaise, beat an egg yolk in a bowl. Wrap a damp dishtowel around the base of the bowl so that it will not move around on your work surface as you whisk. Drop by drop, whisk in 1/4 cup of canola or grapeseed oil. When the mixture looks emulsified and stable, add another 1/4 cup of oil (canola, grapeseed or olive oil) in a slow stream. Season to taste with salt and, if you wish, a drop of lemon juice.

Yield: Makes a little more than 1 1/2 cups.

Advance preparation: This dressing will keep for a couple of days in the refrigerator but tastes best when freshly made.

Nutritional information per 2 tablespoons: 155 calories; 1 gram saturated fat; 5 grams polyunsaturated fat; 10 grams monounsaturated fat; 12 milligrams cholesterol; 1 gram carbohydrates; 0 grams dietary fiber; 33 milligrams sodium (does not include anchovies or salt to taste); 1 gram protein

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

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