Health - Scientists See Success in Flu Vaccine Made by Faster Method

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• Scientists See Success in Flu Vaccine Made by Faster Method
• Ecuadorean Villagers May Hold Secret to Longevity
• Well: For Cold Virus, Zinc May Edge Out Even Chicken Soup
• Recipes for Health: Mushroom Hash With Black Rice
• England Finds 2012 Olympics Don’t Spur Exercise
• Report Details Sabotage of Birth Control
• Well: Web of Popularity, Achieved by Bullying
• Wariness on Surgery of the Mind
• Cases: Shedding a Protective Cocoon, Woven by Delusions
• Recalled Devices Mostly Untested, New Study Says
• First Mention: Pacemaker, 1933
• Pennsylvania Employees Fired in Clinic Inquiry
• Can Polio Be Eradicated? A Skeptic Now Thinks So
• Global Update: Zimbabwe: Fewer Extramarital Partners and Dollars Push Precipitous Decline in H.I.V. Rate
• Q & A: Cold, Hard Facts
• Vital Signs: Aging: Trials Exclude Patients Who May Benefit
• Vital Signs: Risks: Side Effects Fueled by High-Energy Drinks
• Well: After Menu Labels, Parents and Kids Order Same Foods
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• Well: Probiotics for Colicky Babies
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• The New Old Age: When the Battle With Cancer Can't Be Won
• The New Old Age: The Fog of Psychotropic Drugs
• Prescriptions: Job Worries Override Health Concerns
• Prescriptions: This Week's Health Industry News
• Letters: Massachusetts as Model (1 Letter)
• Letters: Breathe! (1 Letter)
• Letters: Go Ahead, Cry (1 Letter)
• Recipes for Health: Beet Greens and Potato Hash
• Recipes for Health: Brussels Sprouts and Roasted Winter Squash Hash
• Brody’s Cranberry-Pumpkin Muffins
• Recipes for Health: A Medley of Leftovers
• Sebelius Clears the Way for Arizona to Shed Adults From Medicaid
• Obama Proposes Health Agency Cut but Spares Medicare Fees
• States Aim Ax at Health Cost of Retirement
• What’s a Little Swine Flu Outbreak Among Friends?

Scientists See Success in Flu Vaccine Made by Faster Method Posted: 15 Feb 2011 10:40 PM PST A flu vaccine made by a new, faster method works just as well as existing products, researchers reported Tuesday. Related Health Guide: Influenza Vaccine The finding clears a hurdle in the government’s effort to move toward a manufacturing process that could allow for a more reliable supply of seasonal flu shots and quicker responses to pandemics. The new vaccine, which could become available in the United States in the next few years, is made by growing the influenza virus in cultures of animal cells rather than in the chicken eggs that have been used for more than half a century. Using animal cells could shave weeks off the six months or so that is now required to produce a vaccine for a pandemic. In the 2009 swine flu pandemic, large quantities of vaccine were not ready until after the wave of disease appeared to have crested. Using animal cells, which are grown in enclosed steel tanks, also reduces the risk of bacterial contamination, which has led to shortages of seasonal vaccines in some years. “I just think it’s an improvement in vaccine production that has been warranted for a long time,” said Dr. W. Paul Glezen, an influenza expert at the Baylor College of Medicine who wrote a commentary to accompany the report, which was published online Tuesday by The Lancet. “I just feel we’ve been sort of slow in implementing it.” Dr. Glezen said shorter production times would allow health officials to wait longer before deciding which strains to include in the next winter’s flu vaccine, a decision that now has to be made around February. That would increase the chance that the strains in the vaccine match the strains in circulation. In addition, Dr. Glezen said, when the virus grows in chicken eggs, it undergoes some changes. “It may not match the circulating virus as much as a vaccine made in mammalian cells,” he said. In a large clinical trial involving 7,250 healthy adults, the new vaccine was more than 70 percent effective in preventing the seasonal flu, according to researchers from Baxter International, the developer of the new vaccine. That rate is similar to what egg-based vaccines have demonstrated in past studies, the researchers wrote. The clinical trial was paid for by the Department of Health and Human Services, which awarded $1.3 billion to six companies in 2006 to develop cell-culture flu vaccines, including $242 million to Baxter and its partner, the DynPort Vaccine Company. The trial is the second to show a cell-culture influenza vaccine to be as effective as conventional ones. In November, a study involving a Novartis vaccine was published in Clinical Infectious Diseases. Experts say it is no surprise that the vaccines work. Still, proof is needed for them to win regulatory approval. Baxter began selling the vaccine in parts of Europe last October. The company, which is based in Deerfield, Ill., would not say when it would apply for approval in the United States. P. Noel Barrett, vice president for research and development in Baxter’s bioscience division, said the company was in discussions with the Food and Drug Administration about what kind of data would be needed for approval. The main issue, Dr. Barrett said, was that the clinical trial involved healthy volunteers ages 18 to 49 and compared the vaccine with a placebo. Yet children and the elderly are more vulnerable to severe problems from the flu, so for those populations it might be unethical to conduct trials using a placebo. Baxter therefore wants to show that the vaccine produces antibodies in children and the elderly at levels that correlate with those in the adults. “We are certainly committed to moving this forward into the U.S. as fast as possible,” Dr. Barrett said. Novartis won approval for its cell-culture vaccine in Europe in 2007 and plans to start the process leading to F.D.A. approval this year. With help from a nearly $500 million federal contract, the company has built a cell-culture vaccine factory in Holly Springs, N.C. Robin Robinson, the director of the Biomedical Advanced Research and Development Authority in the Department of Health and Human Services, said cell cultures would never completely supplant egg-based production. Two of the six companies that received the federal cell-culture awards in 2006 have dropped their efforts and given back the money, he said. Dr. Robinson said cell culture was an “interim solution” until even faster techniques come along that do not require growing the virus at all. Baxter’s flu vaccine is made in so-called Vero cells, derived from the kidneys of African green monkeys. The cells are already used to make other vaccines, including those for polio and rabies. The clinical trial was conducted in the United States during the flu season of 2008-9. Only 13 people, or 0.4 percent, of those getting the vaccine became infected with a flu virus matching one of the three strains in the vaccine, compared with 60 people, or 1.7 percent, of those getting the placebo. That translates to an effectiveness of 78.5 percent. Counting all strains of flu, even those not in the vaccine, the infection rates were 0.6 percent with the vaccine and 2.2 percent with the placebo, making the vaccine 71.5 percent effective. Side effects were similar to those of conventional vaccines, the researchers said.

Ecuadorean Villagers May Hold Secret to Longevity Posted: 16 Feb 2011 12:43 PM PST People living in remote villages in Ecuador have a mutation that some biologists say may throw light on human longevity and ways to increase it. Enlarge This Image Arlan Rosenbloom A 67-year-old man who has Laron-type dwarfism with his daughter, 5, and sons, 7 and 10. RSS Feed Get Science News From The New York Times » Enlarge This Image Arlan Rosenbloom A 32-year-old community leader and artist who has the rare dwarfism condition, with his bride, 17. The villagers are very small, generally less than three and a half feet tall, and have a rare condition known as Laron syndrome or Laron-type dwarfism. They are probably the descendants of conversos, Sephardic Jews from Spain and Portugal who were forced to convert to Christianity in the 1490s but were nonetheless persecuted in the Inquisition. They are also almost completely free of two age-related diseases, cancer and diabetes. A group of 99 villagers with Laron syndrome has been studied for 24 years by Dr. Jaime Guevara-Aguirre, an Ecuadorean physician and diabetes specialist. He first discovered them when traveling on horseback to a roadless mountain village. Most such villages are inhabited by Indians, but these were Europeans, with Spanish surnames typical of conversos. As Dr. Guevara-Aguirre accumulated health data on his patients, he noticed a remarkable pattern: Though cancer was frequent among people who did not have the Laron mutation, those who did have it almost never got cancer. And they never developed diabetes, even though many were obese, which often brings on the condition. “I discovered the population in 1987,” Dr. Guevara-Aguirre said in an interview from Ecuador. “In 1994, I noticed these patients were not having cancer compared with their relatives. People told me they are too few people to make any assumption — people said, ‘You have to wait 10 years,’ so I waited. No one believed me until I got to Valter Longo in 2005.” Valter D. Longo, a researcher on aging at the University of Southern California, saw the patients as providing an opportunity to explore in people the genetic mutations that researchers have found can make laboratory animals live much longer than usual. The Laron patients have a mutation in the gene that makes the receptor for growth hormone. The receptor is a protein embedded in the membrane of cells. Its outside region is recognized by growth hormone circulating through the body; the inside region sends signals through the cell when growth hormone triggers the receptor. The Laron patients’ mutation means that their growth hormone receptor lacks the last eight units of its exterior region, so it cannot react to growth hormone. In normal children, growth hormone makes the cells of the liver churn out another hormone, called insulinlike growth factor, or IGF-1, and this hormone makes the children grow. If the Laron patients are given doses of IGF-1 before puberty, they can grow to fairly normal height. This is where the physiology of the Laron patients links up with the longevity studies that researchers have been pursuing with laboratory animals. IGF-1 is part of an ancient signaling pathway that exists in the laboratory roundworm as well as in people. The gene that makes the receptor for IGF-1 in the roundworm is called DAF2. And worms in which this gene is knocked out live twice as long as normal. The Laron patients have the equivalent defect — their cells make very little IGF-1, so very little IGF-1 signaling takes place, just as in the DAF2-ablated worms. So the Laron patients might be expected to live much longer. Because of their striking freedom from cancer and diabetes, they probably could live much longer if they did not have a much higher than usual death rate from causes unrelated to age, like alcoholism and accidents. Dr. Longo said he believed that having very low levels of IGF-1 was the critical feature of the Laron patients’ freedom from age-related diseases. In collaboration with Dr. Guevara-Aguirre, he exposed human cells growing in a laboratory dish to serum from the Laron patients. The cells were then damaged with a chemical that disrupts their DNA. The Laron serum had two significant effects, the two physicians reported on Wednesday in Science Translational Medicine. First, the serum protected the cells from genetic damage. Second, it spurred the cells that were damaged to destroy themselves, a mechanism the body uses to prevent damaged cells from becoming cancerous. Both these effects were reversed when small amounts of IGF-1 were added to the serum. Dr. Longo said that some level of IGF-1 is necessary to protect against heart disease, but that lowering the level might be beneficial. A drug that does this is already on the market for treatment of acromegaly, a thickening of the bones caused by excessive growth hormone. “Our underlying hypothesis is that this drug would prolong life span,” Dr. Longo said. He said he was not taking the drug, called pegvisomant or Somavert, which is very hard to obtain. A strain of mice bred by John Kopchick of Ohio University has a defect in the growth hormone receptor gene, just as do the Laron patients, and lives 40 percent longer than usual. Dr. Longo said that his report had first been submitted to Science, a better-known journal, which turned down the paper because of an adverse report from one reviewer. Andrzej Bartke, a gerontology expert at Southern Illinois University, said that the new result was “very important” and that the authors had done a fine job in following the patients and generating high-quality data. “This fits in with what we are learning from studies in animals about the relationship of growth hormone to aging, because both cancer and diabetes are related to aging,” Dr. Bartke said. The longest-lived mouse on record is one studied by Dr. Bartke. It had a defect in its growth hormone receptor gene, just as do the Laron patients. “It missed its fifth birthday by a week,” he said. The mouse lived twice as long as usual, and won Dr. Bartke the Methuselah prize (which rewards developments in life extension therapies) in 2005. Dr. Guevara-Aguirre said he had been struggling to get sufficient IGF-1 to treat 30 of his patients before they reach puberty, at which point it will be too late. He said his group of Laron patients, the largest in the world, had provided essential data for drug companies making IGF-1, and chided the companies for not reciprocating by providing the drug for his patients. Dr. Arlan Rosenbloom, a pediatric endocrinologist at the University of Florida who has worked with Dr. Guevara-Aguirre, took a similar position. “Considering that the drug companies needed the initial studies to determine dosage and efficacy, it seems ironic that we should have so much difficulty getting the drug,” he said. Ownership of the drug has passed through several companies’ hands, so any initial obligation may have been weakened. Dr. Guevara-Aguirre also believes the government of Ecuador should do more to help get the drug for his patients. Dr. Harry Ostrer, a geneticist at New York University who is exploring the Laron patients’ degree of Sephardic ancestry, said that he had seen several of Dr. Guevara-Aguirre’s patients in Quito and that they were “remarkably youthful in appearance.” This posting includes an audio/video/photo media file: Download Now

Well: For Cold Virus, Zinc May Edge Out Even Chicken Soup Posted: 16 Feb 2011 03:22 AM PST

Recipes for Health: Mushroom Hash With Black Rice Posted: 15 Feb 2011 11:20 PM PST When I made this hash, I thought hard about adding cooked grain to the chopped mushrooms, as they’re so good on their own. You may choose to serve this without the black rice, but add it if you want a more substantial dish. 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: A Medley of Leftovers (February 14, 2011) Recipes for Health: Brussels Sprouts and Roasted Winter Squash Hash (February 15, 2011) Recipes for Health: Beet Greens and Potato Hash (February 17, 2011) Recipes for Health: Turkey and Red Pepper Hash (February 18, 2011) 2 tablespoons extra virgin olive oil 2 shallots, finely chopped 2 stalks celery, finely chopped 2 pounds mushrooms, stems trimmed, chopped 2 garlic cloves, minced 1/4 cup dry white wine 1 teaspoon fresh thyme leaves Salt and freshly ground black pepper 2 tablespoons tomato paste, dissolved in 1/4 cup water 1 cup cooked black rice (optional but recommended) 1/4 cup chopped flat-leaf parsley Poached eggs for serving (optional) 1. Heat the olive oil over medium heat in a large, heavy nonstick skillet. Add the shallots and celery. Cook, stirring, until tender, about three minutes. Raise the heat to high, and add the mushrooms. Cook, stirring often, until they begin to color and stick to the pan, about five minutes. Turn the heat to medium-high and cook, stirring often, until the shallots and celery are tender, juicy and fragrant, five to eight minutes. 2. Add the garlic and stir for a minute, then add the wine, thyme, salt and pepper. Cook over medium heat, stirring often, for five minutes. Add the diluted tomato paste, and cook for about five minutes, pressing the mixture down into the pan, then waiting for a minute until the surface begins to brown, then stirring and pressing it down until the surface browns again. The mixture should be lightly colored and the tomato paste no longer discernible. Taste and adjust seasoning. Stir in the rice and parsley, heat through and serve — topped with a poached egg if desired — with crusty bread and a salad. Yield: Serves four. Advance preparation: The hash will keep for three or four days in the refrigerator. Nutritional information per serving (without poached egg): 192 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 0 milligrams cholesterol; 23 grams carbohydrates; 4 grams dietary fiber; 54 milligrams sodium (does not include salt to taste); 9 grams protein Nutritional information per poached egg: 71 calories; 2 grams saturated fat; 1 gram polyunsaturated fat; 2 grams monounsaturated fat; 186 milligrams cholesterol; 0 grams carbohydrates; 0 grams dietary fiber; 81 milligrams sodium; 6 grams protein Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

England Finds 2012 Olympics Don’t Spur Exercise Posted: 16 Feb 2011 03:46 AM PST When London was awarded the 2012 Olympics, organizers promised an ambitious legacy: to get two million more people in England involved in sports and physical activity. Join the discussion with news, analysis and features from the 2010 Winter Games in Vancouver. Go to the Rings Blog Enlarge This Image Andrew Testa for The New York Times Children at soccer practice at Hyde Park. But with the Games in less than 18 months, that commitment now resembles a wheezing jogger, bent over and winded from a New Year’s resolution whose ambition could not be matched by exertion. London’s original pledge evolved into a plan to get one million more people around England playing sports three or more times a week for at least 30 minutes at a time, known as the 3x30 plan. Even that target is proving elusive. Figures issued in December by Sport England, the governing body for community sports, indicated that participation at the 3x30 level had increased by 123,000 since 2007-8, when the one million baseline was established. But that number increased by only 8,000 in the last year. At the current rate, the goal of one million new participants would not be reached in 2012-13 as hoped but more than a decade later in 2023-24. Meanwhile, in a country that is among the fattest in Europe, the number of couch potatoes apparently continues to grow. Surveys by Sport England indicate that the number of adults doing zero moderate sports activity rose by nearly 300,000 from 2005, when London was awarded the Olympics, to the fall of 2010. Inadequate planning, a change in government, severe funding cutbacks to sports organizations and an apparent overestimation of the impact the Olympics can have on mass participation have all forced a rethinking of England’s Olympic legacy. The latest plan, unveiled in November by the Conservative-Liberal Democrat coalition government, omitted the one million target figure. It spoke instead of encouraging more people to take up sports through Places People Play, a program sponsored by the National Lottery. “We haven’t yet dropped the target, but we’re looking at it fairly carefully,” Hugh Robertson, Britain’s minister for sport and the Olympics, said in a telephone interview. What is needed is a more sensible way to define and measure sports and physical activity, Mr. Robertson and other sports experts said. Does walking to the bus stop count? If someone plays a pickup soccer match for 90 minutes, does that count as one sporting session or three? Anecdotal evidence suggests that more people participate in sports than surveys reveal, Mr. Robertson said. But, he added, measuring participation involves a “slightly clunky mechanism.” All Olympic bids are required to show how the Games will provide lasting benefits. Each city is allowed to devise a legacy plan. There are no specific penalties for failing to reach a target, but the fallout can undermine the reputation of a particular Winter or Summer Games and bring political opprobrium. Some critics have accused Mr. Robertson of watering down London’s post-Olympic ambitions. He replied, “That’s emphatically what we’re not trying to do.” Darryl Seibel, a spokesman for the British Olympic Association, said sports and government officials were determined to leave a meaningful legacy from the London Games and to transform plans “from rhetoric to reality.” London is hardly the first host city to struggle with its Olympic legacy. In truth, international events like the Olympics and soccer’s World Cup leave a greater discernible impact on infrastructure than on sports. Roads, airports and rail systems are improved while a number of stadiums become white elephants and lingering sporting benefits remain indistinct. Six years after Albertville, France, hosted the 1992 Winter Olympics, the figure-skating arena and speed-skating oval there were fenced off and abandoned. The magnificent Olympic stadium showcased during the 2008 Beijing Games, known as the Bird’s Nest, was seldom being used a year and a half later. In London, there has been heated debate about whether its $854 million Olympic Stadium should be demolished after 17 days’ use and replaced with a soccer stadium or downsized and left as an arena that could host both soccer and track and field. The second option prevailed Friday in a vote by the company in charge of the Games’ legacy. Research on the Olympic Games stimulating mass participation in sports has not produced encouraging results. In 2007, the Culture, Media and Sport Committee of the British House of Commons concluded that “no host country has yet been able to demonstrate a direct benefit from the Olympic Games in the form of a lasting increase in participation.” A study of the 2000 Sydney Games showed that while seven Olympic sports experienced a slight increase afterward in Australia, nine showed a decline. After the 2002 Commonwealth Games, held in Manchester, England, “there appears to have been no recorded impact on sports participation levels” in the country’s northwest, Fred Coalter, a professor of sports studies at the University of Stirling in Scotland, wrote before London won the 2012 Olympic bid. 1 2 Next Page » This posting includes an audio/video/photo media file: Download Now

Report Details Sabotage of Birth Control Posted: 15 Feb 2011 03:27 AM PST Men who abuse women physically and emotionally may also sabotage their partners’ birth control, pressuring them to become pregnant against their will, new reports suggest. Several small studies have described this kind of coercion among low-income teenagers and young adults with a history of violence by intimate partners. Now, a report being released Tuesday by the federally financed National Domestic Violence Hotline says 1 in 4 women who agreed to answer questions after calling the hot line said a partner had pressured them to become pregnant, told them not to use contraceptives, or forced them to have unprotected sex. The report was based on answers from more than 3,000 women, but it was not a research study, those involved said. “It was very eye-opening,” said Lisa James, director of health at the Family Violence Prevention Fund in San Francisco, which worked with the hot line on the report. “There were stories about men refusing to wear a condom, forcing sex without a condom, poking holes in condoms, flushing birth control pills down the toilet. “There were lots of stories about hiding the birth control pills — that she kept ‘losing’ her birth control pills, until she realized that he was hiding them,” Ms. James added. One respondent described having to hide in the bathroom to take her pill. Another said that when she got her period recently, her partner was “furious.” The hot line’s report did not include a comparison group and did not gather information about the participants, who were questioned anonymously; nor was it published in a peer-reviewed journal. It was based on answers to four questions posed to 3,169 women around the country who contacted the domestic violence hot line between Aug. 16 and Sept. 26, 2010, who were not in immediate danger and who agreed to participate. About 6,800 callers refused to answer the questions. Of those who did respond, about a quarter said yes to one or more of these three questions: “Has your partner or ex ever told you not to use any birth control?” “Has your partner or ex-partner ever tried to force or pressure you to become pregnant?” “Has your partner or ex ever made you have sex without a condom so that you would get pregnant?” One in six answered yes to the question “Has your partner or ex-partner ever taken off the condom during sex so that you would get pregnant?” The questions were devised by Dr. Elizabeth Miller, an assistant professor of pediatrics at the School of Medicine at the University of California, Davis, whose earlier papers on reproductive coercion prompted interest in the subject. “It’s really important to recognize reproductive coercion as another mechanism for control in an unhealthy relationship,” Dr. Miller said. At the same time, she added, younger women and girls dating older men may be confused by the pressure to become pregnant. “If you can put yourself in the shoes of a 15-year-old dating an 18- or 19-year-old man, which is not an unusual scenario, and he says to her, ‘We’re going to make beautiful babies together,’ that’s pretty seductive.” But Dr. Miller said more research was needed to understand the men’s motivations. “One of the things that comes up a lot is: What are the guys thinking?” she said, adding that her own research suggested some answers. “Some have an intense desire for a nuclear family, and many who had experiences of a dysfunctional family home want something better,” she said. Some young men, she said, “want to leave a legacy, and say, ‘I’m not sure how long I’m going to be around.’ Gang-affiliated young men want the status that comes with having babies from multiple women.” Dr. Miller’s paper, published last year in the journal Contraception, reported that at five family planning clinics in Northern California, one-third of 683 female patients whose partners were physically abusive said the men had also pressured them to become pregnant or had sabotaged their birth control. Of 191 women who reported birth control sabotage, 79 percent also reported physical abuse, the study found. The associations help explain why young victims of violence by intimate partners are at an increased risk for unplanned pregnancies and for sexually transmitted diseases. Ms. James, of the Family Violence Prevention Fund, said that despite the new attention to reproductive coercion, she doubted it was a new phenomenon. “I just think not enough people have been asking the question,” she said.

Well: Web of Popularity, Achieved by Bullying Posted: 14 Feb 2011 03:52 PM PST

Wariness on Surgery of the Mind Posted: 15 Feb 2011 02:34 PM PST In recent years, many psychiatrists have come to believe that the last, best chance for some people with severe and intractable mental problems is psychosurgery, an experimental procedure in which doctors operate directly on the brain. Enlarge This Image Multimedia Interactive Feature Patient Voices: O.C.D. Related Health Guide: Obsessive-Compulsive Disorder Hundreds of people have undergone brain surgery for psychiatric problems, most in experimental trials, with some encouraging results. In 2009, the government approved one surgical technique for certain severe cases of obsessive-compulsive disorder, or O.C.D. For the first time since frontal lobotomy fell into disrepute in the 1950s, surgery for behavior problems seemed back on the road to the medical mainstream. But now some of the field’s most prominent scientists are saying, “Not so fast.” In a paper in the current issue of the journal Health Affairs, these experts say approving the surgery for O.C.D. was a mistake — and a potentially costly one. They argue that the surgery has not been sufficiently tested, that neither its long-term effectiveness nor its side effects are well known and that even calling it “therapy” raises people’s hopes well beyond what is scientifically supportable. “We’re not against the operation, we just want to see it tested adequately before it’s called a therapy,” said the paper’s lead author, Dr. Joseph J. Fins, chief of medical ethics at NewYork-Presbyterian/Weill Cornell hospital. “With the legacy of psychosurgery, it’s important that we don’t misrepresent things as therapy when they’re not.” Doctors who run programs offering the operation strongly object. “These patients are very capable of making informed decisions based on our experience with the surgery,” said Dr. Wayne K. Goodman, chairman of psychiatry at the Mount Sinai School of Medicine, “and I would not want to deprive them of the option, any more than I would deny someone with AIDS access to a promising therapy that has not been established yet. Their life has been so destroyed by O.C.D. that they might contemplate suicide” if the surgery were not available. The debate on this question — should experimental surgery be allowed, in some cases, before long, costly trials are completed? — will largely set the future course of modern psychosurgery. And it may turn on the interpretation of an arcane Food and Drug Administration regulation that allows manufacturers to put a device on the market without rigorously proving its effectiveness when it is intended to treat or diagnose a fairly rare condition. It was this exemption that the agency applied in 2009 to a device used to perform so-called deep brain stimulation, or D.B.S., for patients with obsessive-compulsive disorder who had not been helped by other treatments. In this procedure, a surgeon sinks wires deep into the brain and leaves them in place; a device like a pacemaker sends a current to the electrodes, interfering with circuits that appear to be hyperactive in people with the disorder. Deep brain stimulation has a proven track record in reducing the tremors and stiffness of Parkinson’s disease; and in studies, doctors have performed the operation on people with depression and Tourette’s syndrome, among other things. It is the most commonly used of several psychosurgery techniques available, the most familiar to doctors, and the one that experts say is most likely to set the expectations and public image of modern psychosurgery — for good or ill. The authors of the paper in Health Affairs say this is all the more reason to revoke the exemption and subject the technique to proper testing in studies of O.C.D. patients. Even if the device is the same, its effects on different diseases must be studied separately. And those studies must look at quality of life, not just the severity of the disease. In a 2008 study, Swedish researchers found that patients who had another type of surgery for O.C.D., called a capsulotomy, had symptoms of apathy and poor self-control for years after the procedure, even though they scored lower on a measure of severity. “Just because we recognize that there is a need for this doesn’t mean we don’t have to proceed in an agnostic, scientific manner to see whether, in fact, it improves people’s lives,” said a co-author of the Health Affairs paper, Dr. Helen S. Mayberg of Emory University, a neurologist who has pioneered the use of D.B.S. for depression. She and many of the other authors — including Dr. Bart Nuttin of the University Hospitals in Leuven, Belgium, who published the first report of using deep brain stimulation for O.C.D. about a decade ago — hold patents related to the procedure or have received industry support for their work. So have most others in the field, and the new paper argues that commercial interest has been working to push D.B.S. into the psychiatric market ahead of the science. Yet doctors who offer the surgery say most of the paper’s authors do not work extensively with obsessive-compulsive disorder. “I believe the F.D.A. acted correctly,” Dr. Benjamin D. Greenberg, a Brown University psychiatrist who directs the O.C.D. surgery program at Butler Hospital in Providence, R.I., wrote in an e-mail. “The data on effectiveness are not perfect, which is why we’re doing a controlled study. But they are substantial.” Whether surgery for behavior problems is confined to studies or continues to be offered through a regulatory exemption, everyone agrees that the field should set up a registry of all patients who have had surgery for psychiatric problems. Some patients may do better with time, for instance, and others crash: no one knows, because no one is systematically following a large enough group of patients for years. “Just because it looks good at first and everyone gets excited,” Dr. Mayberg said, “doesn’t mean it’s necessarily efficacious or your work is done.”

Cases: Shedding a Protective Cocoon, Woven by Delusions Posted: 15 Feb 2011 12:33 PM PST The woman described the sensation as a delicate flicker, like a moth trapped in a small gauze bag. She ran her slender fingers repeatedly over the spot in her slightly distended abdomen and said, “Doctor, right here.” Enlarge This Image Scott Bakal Related More Cases Columns Sometimes, she told me, the flicker gave way to a more forceful kick that rippled beneath her hand and then spread like a warm tide over her body. She felt contented and soothed as she imagined the baby growing inside. I was tempted to smile, but I kept still. An actual pregnancy would have been international news: the woman was 83 years old, recovering from a hip fracture and pneumonia. But her delusion was not unique. Indeed, our nursing home was having something of a baby boom. Just the day before, another woman who had recently suffered a stroke insisted that she had given birth to twin boys, who were now crying in the adjacent nursery. I reminded her that she was 90, but my words were no match for the force of her belief. She looked at me blankly and called again for her babies. Her husband, distraught, begged me to consider some pharmacologic remedy. But I was struck not by any mental suffering on the woman’s part, but by the opposite. In the face of terrible losses and confusion, her mind had found refuge in imaginary children. Their coos and cries brought comfort and hope. Pseudocyesis, as delusional pregnancy is called, is neither common late in life nor a normal response to aging or illness. It is a form of psychosis, and it can lead to severe anxiety or disruptive behavior that must be treated. But it is too easy to see pathology in what may actually be a protective mechanism in the aging brain. What a psychiatrist might call a symptom held deep meaning for each woman, and prompted them to focus on recovering from severe illness. In each case, I had to act in the opposite direction of my instinct as a doctor. Medication might have only sedated them and even taken away a protective cocoon. Instead I let time do its work: the delusions faded, and physical and mental recovery took hold. Such examples are relatively rare and, one might argue, easily romanticized. But they hold a larger lesson about the aging brain. What we perceive as a brain in flight or decline, disengaging from the world or tumbling into a netherworld of oldness, might actually be a more selective, creative and wiser brain. The paradox is that even as the normal aging brain loses capacity across numerous discrete skills — memory-processing speed, verbal reasoning and visuospatial ability, to name a few — it is simultaneously growing in knowledge, emotional maturity, adaptability to change and even levels of well-being and happiness. I witnessed this common phenomenon in a couple I know well. The woman is a sharp and active 82-year-old who only recently retired as a social worker. Her new husband, now 92, was a World War II bomber pilot and retired marketing genius who always prided himself on his mental discipline and physical stamina. Recently he began to complain bitterly of creeping short-term memory impairment and a general slowing of his motor functions. Both factors can bring him great unhappiness. During a recent meeting, however, I pressed him on his complaints, asking, “Is that all there is to growing old — decline, slowing and loss?” His bride interrupted and told how their relationship was unique because of old age, in many ways deeper and more intimate than either had experienced as younger people. Even as his memory declined, she said, his emotional maturity and wisdom had increased, opening perspectives and relationships he had never had before. Here was old age — and an aging brain — acting as a force that added even as it took away. In telling this tale as a relatively young doctor who works primarily with older individuals, I could easily be accused of painting an overly rosy picture of what I want growing old to be. If so, I plead guilty. But I do so in the spirit of the gerontologist Thomas Cole, who suggests that the ways in which we look at old age begin to constitute its reality. We will all grow old, and despite the inevitable changes we do have choices. Indeed, growing evidence suggests that the aging brain retains and even increases the potential for resilience, growth and well-being. I have seen this lesson lived in my friends, loved ones and older patients, whether free of illness or fettered by it. I saw it in the two older women whose imagined pregnancies brought needed hope at a time of threatened despair. Their fervent wishes, though unattainable, allowed them to achieve something better. Similarly, we can all hope for a vital and meaningful old age — for our elders, ourselves and our children. In the end, we may actually get what we wish for. Dr. Marc E. Agronin, a geriatric psychiatrist at the Miami Jewish Health Systems in Florida, is the author of the new book “How We Age.”

Recalled Devices Mostly Untested, New Study Says Posted: 14 Feb 2011 10:13 PM PST Most medical devices recalled in recent years by the Food and Drug Administration because they posed a high risk to patients were not rigorously studied before being cleared for sale, according to a study in a medical journal released Monday. Enlarge This Image Joe Marquette/Bloomberg News Dr. Steven E. Nissen of the Cleveland Clinic was one of the authors of the report. The study, which was posted on the Web site of The Archives of Internal Medicine, found that most medical devices that were the subject of high-risk recalls from 2005 to 2009 had been cleared through a regulatory pathway that requires little, if any, testing. The devices included external heart defibrillators, hospital infusion pumps and mechanical ventilators. The F.D.A. described the study’s findings as unoriginal, and a trade group representing medical device makers called the research flawed. Still, the report is coming out at a time when the Obama administration appears to be stepping back from what initially appeared to be a more aggressive approach to the regulation of medical devices. The study was written by Diana M. Zuckerman and Paul Brown, two officials from the consumer group the National Research Center for Women and Families, and Dr. Steven E. Nissen, a cardiologist at the Cleveland Clinic, who was among the first physicians to raise questions about the drug Vioxx. In a telephone interview, Dr. Nissen said that he was concerned that the administration had failed to take a more aggressive posture toward tightening the regulation of medical devices. In recent years, thousands of patients have been injured and some have died because of failed medical devices that were cleared for sale with little testing. “This is an area where the F.D.A. has failed the public,” Dr. Nissen said. In a statement, the F.D.A. said that the data was not new and reflected a similar analysis that had been presented last year at a public meeting held at the Institute of Medicine. Ms. Zuckerman said she was the one who presented data at that meeting. Recently, the agency announced a series of steps that it said would “strengthen” device regulation, though it deferred decisions on some other major proposals pending recommendations later this year from the Institute of Medicine. The F.D.A. uses two pathways to review medical devices. In one pathway, typically used for critical, life-sustaining products like implanted heart defibrillators, manufacturers must often run clinical trials to show that a product is safe and effective. But there is a less rigorous route, known as the 510K process, through which a manufacturer need only show that a new product is equivalent to one already on the market. Some devices implanted in the body like artificial hips and knees fall into this category, as do dozens of other products, including external defibrillators and infusion pumps. The study focused on these 510K devices. It reported that of the 113 high-priority recalls initiated by the F.D.A. from 2005 to 2009, 80 of the recalls, or 71 percent, involved devices cleared through the 510K process. In a statement, an industry trade group, the Advanced Medical Technology Association, described the findings as misleading. Among other things, the group said that it was not surprising that 510K devices accounted for the most recalls since most devices that F.D.A. allowed for sale went through that process.

First Mention: Pacemaker, 1933 Posted: 14 Feb 2011 10:30 PM PST On Sunday, June 11, 1933, The New York Times reported on a meeting of the American Medical Association that would begin the next day. Along with exhibits on “high-voltage X-ray treatment” of cancer, on instruments used in famous murder cases and on poisons removed from the organs of homicide victims, it said, “Here will be demonstrated the ‘artificial pacemaker,’ by which hearts that have stopped beating may sometimes be resuscitated.” Enlarge This Image The device and various successors were clearly not ready for prime time because it was not until April 28, 1955 that The Times was able to report that a professor of medicine at Harvard had kept a patient’s heart beating for 109 hours with an “electric pacemaker.” And in January 1958, it described an “artificial electrical pacemaker” used during surgery to restart a stopped heart and keep it beating until normal rhythm returned. Then, on Nov. 27, 1958, came a report of what was apparently the first successful long-term use of a pacemaker in a human heart. “Electrode in Heart Saves Man’s Life” read the headline above a picture of Pincus Shapiro, a 76-year-old retired clothing salesman who had had been kept alive on the device for more than three months. He was now being released from the hospital, detached from the machine, with his heart beating on its own. Mr. Shapiro (shown with his wife, Estelle, and his cardiologist, Dr. Seymour Furman at Montefiore Hospital in the Bronx) bears a distinct resemblance to Groucho Marx, an impression heightened by the cigar held between his teeth that Dr. Furman is helpfully lighting for him. On a table in the foreground sits a large box with a small viewing screen and about two dozen dials and switches. This was the device to which Mr. Shapiro had been attached for the previous 96 days by a 50-foot extension cord “attached to the heart catheter tube so that Mr. Shapiro could take short walks with his electronic safeguard still plugged in.” A portable pacemaker was soon developed. On June 23, 1959, The Times reported that a silverware salesman named Herman Nisonoff had walked out of Montefiore “with his heartbeat in his hand.” A picture shows Mr. Nisonoff with a device the size of a cigar box in his lap and wires running under his checkered sports coat. He was, the article said, “believed to be the first person ever to leave a hospital with his heartbeat permanently under the protection of an electronic device.” The batteries would be expected to last 120 days, and Mr. Nisonoff would be seeing his doctors at least once a week. Pincus Shapiro died in 1962. By the following year more than 3,000 people were living with implanted pacemakers the size of a large wristwatch, and on Oct. 24, 1965, an article on the first page of the Sunday business section noted that more than 10,000 Americans “are probably alive today because of a tiny device that has been implanted in their bodies called the electronic pacemaker.” Today, an estimated one million Americans have pacemakers, and about 200,000 new ones are implanted every year. NICHOLAS BAKALAR

Pennsylvania Employees Fired in Clinic Inquiry Posted: 16 Feb 2011 09:31 AM PST Gov. Tom Corbett of Pennsylvania said Tuesday that several state workers had been fired and the state’s abortion clinics would be subjected to stricter oversight as a result of an investigation into a Philadelphia clinic where, according to the district attorney, a woman and seven newborn babies were killed in deplorable conditions. Related Squalid Abortion Clinic Escaped State Oversight (January 23, 2011) Dr. Kermit Gosnell, 69, who ran the clinic, the Women’s Medical Society, was indicted by a grand jury last month on eight counts of murder. The grand jury report found that babies were born alive in the clinic but were killed when their spinal cords cut with scissors by clinic staff members. At least two women died during abortion procedures. “This doesn’t even rise to the level of government run amok,” Governor Corbett said in a statement. “It was government not running at all. To call this unacceptable doesn’t say enough. It’s despicable.” Governor Corbett ordered the state’s abortion clinics to be inspected at least once a year and said clinics that fail to meet basic state health standards would be closed, at least temporarily. Pennsylvania abortion clinics will also have unannounced inspections, including during evenings and weekends. The results will be posted online. Governor Corbett said 11 state employees had been dismissed or resigned since the conditions at Dr. Gosnell’s clinic became public. The clinic’s practices had been the subject of numerous complaints for at least a decade before it was closed.

Can Polio Be Eradicated? A Skeptic Now Thinks So Posted: 14 Feb 2011 09:40 PM PST Two weeks ago, at the end of an interview about whether polio really can be eradicated, Bill Gates muttered aloud to an aide escorting the interviewer: “I’ve got to get my D. A. Henderson response down better.” Related Gates Calls for a Final Push to Eradicate Polio (February 1, 2011) Health Guide: Poliomyelitis By that he meant that as long as he was committing his fortune and prestige to the battle against polio — as he did that day in an announcement at the former Manhattan home of Franklin D. Roosevelt — he would need a stronger riposte to journalists quoting Dr. Henderson’s powerful arguments that the virus is just too elusive to subdue. In a world of quotable medical experts, why does it matter what one particular expert thinks? Because, for better or worse, the mantle has been wrapped around the venerable 82-year-old Donald A. Henderson that he is “The Man Who Wiped Out Smallpox.” (In truth, the smallpox fight — the only successful one so far against a human illness — had many generals. One is Dr. William H. Foege, 74, a former director of the Centers for Disease Control who is now a senior adviser to the Bill and Melinda Gates Foundation and who fervently believes that polio can be eradicated. But over the years, Dr. Henderson has patiently explained his doubts, in persuasive detail, to many medical journalists calling him with questions about any disease eradication effort.) What neither Mr. Gates nor the reporter interviewing him knew was that Dr. Henderson had changed his mind two days before. “I see as much greatly augmented the probability that we can stop wild polio virus,” he said Wednesday in a follow-up interview — the opposite conclusion to the one he had given to the same reporter on Jan. 26, five days before the Gates interview. “I apologize,” he added. “It’s not my wont to turn on a dime like this. I don’t think I’ve done anything like this before.” What changed his mind, he said, was a conversation with Dr. Ciro de Quadros on Jan. 29. Dr. de Quadros, a former director of the Pan American Health Organization, has his own mantle: “The Man Who Found the Last Case of Smallpox in Ethiopia and Chased Polio and Measles Out of the Western Hemisphere.” While nothing has changed about the virus or the vaccine, several things Dr. de Quadros told him were persuasive, he said. “I was unaware of how committed Gates is,” he said. “He’s saying polio is his No. 1 priority.” Also, he said, he was impressed with the new nine-member monitoring board being set up to advise the World Health Organization. Polio has been driven down by 99 percent since 1985, but the last decade has been frustrating, with repeated outbreaks in countries where the virus had been eliminated. “There’s been too little dissent in the last 10 years,” he said of the approach used by the W. H. O. and its partners, much of which depended on endless new rounds of fund-raising. “Now the thinking and the muscle have changed,” he said. Also, Gates Foundation money will allow more experimentation with the oral vaccine used in poor countries. In theory, he said, the live virus in it can be weakened enough to prevent the one-in-two-million chance that it will mutate into a form that can paralyze, a problem known as vaccine-derived polio. (While one in two million sounds infinitesimal, it is not when 134 million children are vaccinated in one day, as happened in India in 1998.) And it may be possible to make a vaccine that needs no refrigeration. Vaccine going bad in the tropical sun is a major problem for rural vaccination teams. Also, he added, Dr. de Quadros himself taking a role will change the field. “I watched him perform in Ethiopia,” said Dr. Henderson, who recruited Dr. de Quadros into the smallpox campaign. “The obstacles were unbelievable — the emperor assassinated, two revolutionary groups fighting, nine of his own teams kidnapped, even a helicopter captured and held for ransom. He kept the teams in the field — and that helicopter pilot went out and vaccinated all the rebels.” Asked about Dr. Henderson’s change of mind, Mr. Gates said on Monday, “He’s right, and I’m looking forward to sitting down with him in the next month and getting his advice on this thing.”

Global Update: Zimbabwe: Fewer Extramarital Partners and Dollars Push Precipitous Decline in H.I.V. Rate Posted: 14 Feb 2011 09:46 PM PST Defying expectations in a region devastated by AIDS, rates of H.I.V. infection in Zimbabwe have fallen precipitously in the last decade. Related Times Topic: AIDS / H.I.V. In 1997, an estimated 29 percent of adults were infected. A decade later, 16 percent were. The basic explanation is simple, according to a new study published online last week by PLoS Medicine: Zimbabweans had less extramarital sex. Seeing other people die was the “dominant” reason for that, according to the study, which was based on large demographic surveys and interviews with more than 200 Zimbabweans. The second biggest factor was the collapse of the economy under President Robert Mugabe, which cost most citizens 90 percent of their purchasing power. Men said that left them less able to buy sex or pay for multiple girlfriends. “Concurrent relationships” — in which men and women have several sexual partners over the years, but infrequently — are considered a prime driver of the epidemic in southern Africa. Sexual norms also changed, the study said. Fewer women went to beer halls to meet men, and having a venereal disease became a badge of shame rather than proof of masculinity. AIDS education campaigns “probably” helped, the authors said. Condom use did not increase during the study period, though it was already close to 60 percent for extramarital sex. Also, Zimbabweans had more education and were more often married than people in nearby countries with high infection rates. They also more often watched relatives die at home.

Q & A: Cold, Hard Facts Posted: 14 Feb 2011 09:30 PM PST Q. My husband, in his late 80s, has already had three colds this year. You would think I would catch them, but I do not. Early in his career he would become anxious around the first of each month — and catch a cold. Does stress make colds more likely? Enlarge This Image Yvetta Fedorova Related More Q & A Columns RSS Feed Get Science News From The New York Times » A. Cold susceptibility can be stress-related, and one recent study suggests that colds linked to work stress may be gender-related, too. Many studies over the years have sought to quantify the relationship between different kinds of stress, from life events to self-reported psychological stress, and the likelihood of getting an upper respiratory virus. A mechanism for these observed effects is not known. A widely cited study, published in The New England Journal of Medicine in 1991, exposed 394 healthy adults to respiratory viruses or plain saline drops after they completed questionnaires on psychological stress levels. Infection rates were found to be highly correlated with reported stress levels, even after controlling for other factors. In the work-stress study, published last month in the journal Occupational Medicine, 1,241 workers had their stress levels assessed based on factors like the demands of the job, job control and social support. They were then followed to see if they got colds. Men who entered the study experiencing stress were significantly more likely to report colds, but for women, there was no significant association. C. CLAIBORNE RAY Readers are invited to submit questions by mail to Question, Science Times, The New York Times, 620 8th Avenue, New York, N.Y. 10018, or by e-mail to question@nytimes.com. This posting includes an audio/video/photo media file: Download Now

Vital Signs: Aging: Trials Exclude Patients Who May Benefit Posted: 14 Feb 2011 09:50 PM PST Older adults use a disproportionate share of medical services, yet one in five clinical trials examined in a study excluded patients because of their age, and almost half of the remaining trials used criteria likely to exclude older adults. Related More Vital Signs Columns The study, in The Journal of General Internal Medicine, analyzed 109 studies whose results were published in 2007 in The Journal of the American Medical Association, The New England Journal of Medicine, Lancet, Circulation and BMJ, among others. The average age of participants in the trials was 61. Many trials excluded participants who lived in nursing homes or had physical disabilities or existing medical conditions, all of which disproportionately affect older people. Fewer than 40 percent of the studies broke the results down by age subgroups, a type of analysis that suggests whether a treatment is as effective for older patients as for younger ones. Although including older patients with complicated conditions in clinical trials may make them more expensive and difficult to carry out, “the population in a clinical trial should reflect the population that will be treated in the real world,” said Dr. Donna M. Zulman, the paper’s lead author. Otherwise, she said, “we’re conducting large, expensive trials, and we can’t be certain whether the results apply to typical older patients, who are some of our most vulnerable and complicated patients.”

Vital Signs: Risks: Side Effects Fueled by High-Energy Drinks Posted: 14 Feb 2011 09:50 PM PST A wide-ranging review of the effects of high-caffeine energy drinks on children and young adults finds that they have been linked to an array of serious events — including heart palpitations, high blood pressure and even cardiac arrest and death — and may pose special risks to young people who take medication or have chronic illnesses. Related More Vital Signs Columns The paper, published in the journal Pediatrics on Monday, draws from case reports and scientific studies in the medical literature as well as newspaper articles, and outlines regulatory steps taken in other countries. (Denmark, Turkey and Uruguay have banned them; Norway prohibits sales to children under 15.) The study urges pediatricians to discuss the risks of energy drinks with patients, especially those with heart conditions and mood or behavioral disorders, like attention deficit hyperactivity disorder. The high amounts of sugar may pose risks to those with diabetes. An average energy drink contains 70 to 80 milligrams of caffeine per eight-ounce serving, about three times the concentration of cola drinks, but may derive extra caffeine from other ingredients, like kola nut, cocoa and guarana, the paper says. Officials with the American Beverage Association, a trade group, said that the study perpetuates misinformation about energy drinks, and that an average energy drink contains only half the caffeine of a cup of coffeehouse coffee.

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Personal Health: A Simple Map to the Land of Wholesome Posted: 16 Feb 2011 08:05 AM PST For the first time since it began issuing dietary guidelines, the government offered new recommendations last month that clearly favor the health and well-being of consumers over hard-lobbying farm interests. Enlarge This Image Yvetta Fedorova Related More Personal Health Columns Brody’s Cranberry-Pumpkin Muffins (February 15, 2011) The new science-based Dietary Guidelines for Americans, released Jan. 31 by the Departments of Agriculture and of Health and Human Services, are comprehensive, sensible, attainable and, for most people, affordable. They offer a wide variety of dietary options to help you eat better for fewer calories without undue sacrifice of dining pleasure. Now it’s up to consumers to act on this advice and put the brakes on runaway obesity and the chronic diseases that cost billions of dollars before they kill. It’s a lot easier than you may think, especially if you make the adaptations gradually and avoid declaring war on every deviation from the straight and narrow. Moderation, rather than constant deprivation and denial, is the key to a wholesome diet that you can stick with and enjoy. I say this with confidence because I’ve lived this way for most of my adult life and I’ve watched my sons do the same for more than four decades. Here is a summary of the guidelines, which combine the goals of fewer calories — and especially nutrient-poor calories from sugars, fats and refined grains — with more emphasis on nutrient-dense foods: • Eat lots more vegetables and fruits, filling half your plate with them. • Choose lean meats and poultry, and replace some of them with seafood. • Consume mainly nonfat or low-fat milk and other dairy products. • Choose low-sodium products and use less salt and salty ingredients in food preparation. • Eat more fiber-rich foods; replace most refined grains and grain-based foods with whole-grain versions. • Use vegetable oils like olive and canola oil instead of solid fats like butter and margarine, but remember that all fats have lots of calories. • Eat out less; cook at home more often. • Drink water, calorie-free beverages like coffee and tea, and 100 percent fruit juice instead of regular sodas, fruit drinks and energy drinks; limit alcoholic drinks to one a day for women, two for men. • Eat less and exercise more to achieve a better balance of caloric intake and output. Tips From the Trenches Here are some ideas to help you put the new guidelines into practice. Before you make any changes in your eating habits, keep a detailed food diary for a week. Write down everything you eat and drink, listing the amounts, the circumstances, your emotional state and anything else that may be relevant. That will give you a clearer picture of what you may need to modify and how to do it. Make less seem like more by eating on smaller plates. Pay attention to what you’re eating and eat slowly. Avoid distracted eating, while watching television for example. Eat only until you are satisfied, not full. But don’t think you are eating less if you take only a small portion at first, then repeatedly go back for more. You’ll have no idea how much you really consume. Eat more beans and peas, nuts and seeds for protein. Bake, broil or grill meats, poultry and fish. Discard skin and avoid breading. If I had to choose only one pan, it would be a stove-top grill pan with a nonstick surface. If I were allowed two, the other would be a nonstick wok-type skillet for stir-frying vegetables in a small amount of olive or vegetable oil. And if three, I’d choose a steamer. When fresh vegetables and fruits are out of season and expensive, switch temporarily to frozen ones (plain, not packaged in sauces or sugary syrup). Make sandwiches on those new whole-wheat or multigrain sandwich thins, only 100 calories each. Don’t be fooled by advertising. Some products that make health-related claims may be less than wholesome. Read nutrition facts on food packages (you may want to take a magnifying glass to the store). Note serving size, calories per serving, amounts of sugars, saturated and trans fats, and sodium in a serving, as well as health-promoting dietary fiber, protein and potassium. Also check the ingredients; contents are listed in order of amount (highest first). For desserts, rely more on fruits (fresh or dried), perhaps with nonfat or low-fat vanilla yogurt, than on ice cream or baked goods. Or bake your own with whole-grain flour, fruit purée and oil (a personal favorite is below). For another delicious and nutritious treat, press bite-size pitted prunes to form shallow cups and top each with a ball of finely chopped blanched almonds mixed with a little honey. Snacks can be the undoing of an otherwise healthful diet. Nutritious choices include unsalted nuts, in moderation, and cut-up vegetables with a yogurt-based dip or hummus. Satisfy a sweet craving with fresh fruit, unsweetened dried fruit or a small bowl of a lightly sweetened whole-grain dry cereal. When dining out, consider choosing two appetizers instead of a main course, or share an entree with a dining partner. If restaurant portions are over the top, take half home. Adjust your caloric intake to your needs. According to the report, the average sedentary man in his 40s needs 2,200 calories a day; one who is active needs 2,800. Comparable numbers for women are 1,800 and 2,200. If you are sedentary, start with 10-minute bouts of activity a couple of days a week and gradually build up to longer bouts more often and at a faster pace. (For an activity guide, go to www.presidentschallenge.org, click on “download tools and resources,” then on “fitness guides.” Or track your progress at www.health.gov/paguidelines, click on “be active your way,” then “keeping track of what you do each week.”) The best way to know whether you are consuming too many calories is to monitor your weight — if it’s creeping upward, you need to eat less or move more, preferably both. I weigh myself every day to keep within a range of two pounds up or down — a strategy favored by the “successful losers” in the National Weight Control Registry, a long-term study of how people stay trim. This posting includes an audio/video/photo media file: Download Now

Really?: The Claim: Probiotics Can Soothe a Colicky Baby Posted: 14 Feb 2011 09:50 PM PST THE FACTS Enlarge This Image Christoph Niemann Related More Really? Columns Colic is one of the most prevalent conditions of infancy: about 20 percent of all babies suffer the inconsolable bouts of crying that characterize it. Yet no one really understands what makes a baby colicky. Scientists have investigated a number of causes — allergies, hormones in milk, even stress in the womb. But some now think it may stem from inflammation in the gut, perhaps a result of too many harmful bacteria and not enough beneficial ones. A 2009 study, for example, found that colicky babies had gastrointestinal inflammation and traces of a bacterium in their guts that may have prompted it. Babies without colic had no inflammation and a greater diversity of beneficial bacteria. So could higher levels of gut-friendly bacteria make a difference? In a 2007 study, Italian researchers looked into this by examining 83 colicky babies who were breast-fed. Over 28 days, some of the infants were given simethicone, a medication that reduces gas; the others were given a supplement containing L. reuteri, one of the beneficial bacteria known as probiotics and often found in yogurt. At the end of the study, the babies who received the probiotic cried an average of 51 minutes a day, compared with about two and a half hours in the other group. A 2010 study had similar results. “Gut microbiota changes induced by the probiotic could be involved in the observed clinical improvement,” the researchers wrote. Still, experts say they would like to see more studies. THE BOTTOM LINE There is evidence that probiotics may help relieve colic. ANAHAD O’CONNOR scitimes@nytimes.com

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Letters: Massachusetts as Model (1 Letter) Posted: 14 Feb 2011 09:40 PM PST To the Editor: Re “An H.I.V. Strategy Invites Addicts In” (Feb. 8): You do not need to look to Canada to find a place where new H.I.V. infections have been cut in half. From 1998 to 2008, Massachusetts reduced new diagnoses 59 percent. We’ve accomplished this with aggressive outreach and behavioral interventions like needle exchange. But the key has been getting people with H.I.V. into care and treatment. Since 2001, an H.I.V. diagnosis has meant coverage under the state’s Medicaid plan, ensuring early access to treatment for thousands of low-income individuals. Since 2006, Massachusetts has had near-universal health insurance for every resident, greatly improving access to care. And the state government has invested in a strong public health infrastructure. We agree with Vancouver: care is prevention. Rebecca Haag Boston The writer is president and chief executive, AIDS Action Committee of Massachusetts. Science Times welcomes letters from readers. Those submitted for publication must include the writer’s name, address and telephone number. E-mail should be sent to scitimes@nytimes.com. Send letters to Science Editor, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018.

Letters: Breathe! (1 Letter) Posted: 14 Feb 2011 09:40 PM PST To the Editor: Re “How to Keep Winter From Taking a Toll on Your Back” (Personal Health, Feb. 8): While back injuries are a leading consequence of snow shoveling, heart attacks are a leading cause of death. And a leading cause of these heart attacks is the Valsalva maneuver — forcefully attempting to exhale against a closed glottis or windpipe, often before lifting something heavy. The best way to prevent heart attacks while shoveling snow is to remember not to hold your breath. Breathe! Barbara L. Kornblau Grand Blanc, Mich. Science Times welcomes letters from readers. Those submitted for publication must include the writer’s name, address and telephone number. E-mail should be sent to scitimes@nytimes.com. Send letters to Science Editor, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018.

Letters: Go Ahead, Cry (1 Letter) Posted: 14 Feb 2011 09:40 PM PST To the Editor: In response to “A Mantra: No Crying in the CAT Scanner” (Cases, Feb. 1), Dr. Amina Hassan Abdeldaim asks whether crying with her patient will help or hurt (Letters, Feb. 8). In a study I did on doctor-patient interaction, it was clear that the expression of the doctor’s feelings was a powerful variable in influencing the patient’s ability to hear, understand and even follow up on treatment. As one patient in my study said: “I like my doctor. He is not like a doctor. He is more like a real person.” Lawrence Shulman Grantham, N.H. The writer is former dean, School of Social Work, University at Buffalo. Science Times welcomes letters from readers. Those submitted for publication must include the writer’s name, address and telephone number. E-mail should be sent to scitimes@nytimes.com. Send letters to Science Editor, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018.

Recipes for Health: Beet Greens and Potato Hash Posted: 15 Feb 2011 09:29 AM PST This recipe begins as if you were making hash brown potatoes, but then you add beets and their greens and end up with a much more nutritious, and decidedly pink, dish. If you have leftovers and want to do something different with them, warm and toss this hash with a vinaigrette for a delicious potato salad. 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: A Medley of Leftovers (February 14, 2011) Recipes for Health: Brussels Sprouts and Roasted Winter Squash Hash (February 15, 2011) Recipes for Health: Mushroom Hash With Black Rice (February 16, 2011) 1 pound red boiling potatoes or baby Yukon golds, cut in small dice (about 1/2 inch) 1 bunch beets, roasted, peeled and cut in small dice (about 1/2 inch) 1 generous bunch of beet greens, stemmed and cleaned in 2 changes of water 2 tablespoons extra virgin olive oil 2 garlic cloves, minced 1 teaspoon fresh thyme leaves Salt and freshly ground pepper 1 tablespoon vinegar — sherry, red wine or Champagne (optional) Poached eggs, if desired, for serving (optional) 1. Place the diced potatoes in a steamer above an inch of boiling water. Cover and steam for 10 minutes. Add the beet greens to the steamer, and steam for five minutes until wilted; turn them halfway through so they cook evenly. Turn off the heat underneath the steamer. With tongs, remove the greens to a bowl, and rinse them with cold water. Drain, squeeze out excess water and chop. Set the potatoes aside. 2. Heat the olive oil over medium heat in a large, heavy nonstick skillet. Add the potatoes, turn the heat to medium-high, and cook, stirring from time to time, until the potatoes are lightly browned, about five minutes. Stir in the garlic, beets, greens, thyme, salt and pepper. Cook, stirring often, for another five minutes, pressing the mixture down into the pan so the edges brown. Taste, and adjust salt and pepper. Stir in the vinegar if using. Serve, topped with a poached egg if desired. Yield: Serves four to six. Advance preparation: This will keep for three or four days in the refrigerator, and it reheats well. Variation: You can add a finely chopped onion to this dish to make it more like a traditional hash. Cook for about five minutes in the oil, until tender, before adding the potatoes in Step 2. Nutritional information per serving (four servings): 221 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 0 milligrams cholesterol; 36 grams carbohydrates; 9 grams dietary fiber; 295 milligrams sodium (does not include salt to taste); 6 grams protein Nutritional information per serving (sox servings): 147 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 3 grams monounsaturated fat; 0 milligrams cholesterol; 24 grams carbohydrates; 6 grams dietary fiber; 197 milligrams sodium (does not include salt to taste); 4 grams protein Nutritional information per poached egg: 71 calories; 2 grams saturated fat; 1 gram polyunsaturated fat; 2 grams monounsaturated fat; 186 milligrams cholesterol; 0 grams carbohydrates; 0 grams dietary fiber; 81 milligrams sodium; 6 grams protein Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

Recipes for Health: Brussels Sprouts and Roasted Winter Squash Hash Posted: 15 Feb 2011 10:15 PM PST To this colorful winter hash I’ve added cooked black rice, which contributes a chewy texture and an earthy flavor that plays well against the sweetness of the squash and the seared brussels sprouts. 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: A Medley of Leftovers (February 14, 2011) Recipes for Health: Mushroom Hash With Black Rice (February 16, 2011) Recipes for Health: Beet Greens and Potato Hash (February 17, 2011) Recipes for Health: Turkey and Red Pepper Hash (February 18, 2011) 1 1/2 pounds winter squash, like butternut, halved, seeds and membranes scraped away 1 pound brussels sprouts, preferably small ones 2 tablespoons extra virgin olive oil 1 bunch scallions, sliced thin 2 garlic cloves, minced Salt and freshly ground pepper 2 tablespoons tomato paste, dissolved in 1/4 cup water 1 cup cooked black rice Poached eggs for serving (optional) 1. Preheat the oven to 425 degrees. Cover a baking sheet with foil, and lightly oil the foil. Brush the cut sides of the squash with olive oil, and set on the baking sheet with the cut sides down. Bake 30 to 40 minutes until easily pierced with a paring knife. Remove from the heat, allow to cool until it can be handled, and peel and dice. 2. While the squash is in the oven, trim away the bottoms of the brussels sprouts and cut into quarters. 3. Heat the oil over medium-high in a large, heavy skillet. Add the brussels sprouts. Cook, stirring often or tossing in the pan, until just tender and the edges are seared light brown, about five minutes. Add salt to taste, and stir in the scallions and garlic. Stir together for a few minutes until the scallions and garlic are fragrant. Stir in the squash. Cook, stirring often, until the squash has caramelized lightly, about 10 minutes. It’s fine if the squash falls apart in the pan. Season to taste with salt and pepper, and stir in the dissolved tomato paste. Continue to cook, stirring, until the tomato paste has caramelized, about five minutes. The tomato paste mixture will no longer be visible, but there should be rusty-colored traces on the bottom of your skillet. Stir in the black rice. Heat through, taste and adjust seasonings, and serve, topped with a poached egg if desired. Note: To cook black rice, combine 1 part rice with 1 3/4 parts water and salt to taste in a saucepan. Bring to a boil, cover and reduce the heat. Simmer 30 minutes until the water has been absorbed. Remove the lid, place a dish towel over the pot, return the lid and let stand 10 minutes. A cup of dry rice will yield 3 cups of cooked rice. Yield: Serves four to six. Advance preparation: You can keep this for about three days in the refrigerator and reheat. Nutritional information per serving (four servings, without the poached egg): 249 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 0 milligrams cholesterol; 43 grams carbohydrates; 12 grams dietary fiber; 55 milligrams sodium (does not include salt to taste); 7 grams protein Nutritional information per serving (six servings): 166 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 3 grams monounsaturated fat; 0 milligrams cholesterol; 28 grams carbohydrates; 8 grams dietary fiber; 37 milligrams sodium (does not include salt to taste); 5 grams protein Nutritional information per poached egg: 71 calories; 2 grams saturated fat; 1 gram polyunsaturated fat; 2 grams monounsaturated fat; 186 milligrams cholesterol; 0 grams carbohydrates; 0 grams dietary fiber; 81 milligrams sodium; 6 grams protein Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

Brody’s Cranberry-Pumpkin Muffins Posted: 14 Feb 2011 02:00 PM PST Related Personal Health: A Simple Map to the Land of Wholesome (February 15, 2011) More Personal Health Columns 1 1/2 cups whole-wheat flour 1 1/2 cups all-purpose enriched flour 1 cup sugar 1 1/2 teaspoons cinnamon 1 teaspoon baking powder 1 teaspoon baking soda 3/4 teaspoon allspice 1/2 teaspoon salt (optional) 1/2 cup canola oil 2 1/2 cups canned pumpkin purée 2 eggs, lightly beaten 2 cups fresh cranberries, halved. 1. Heat oven to 350 degrees. 2. In a large bowl, combine the flours, sugar, cinnamon, baking powder, baking soda, allspice and salt (if using) and mix well. 3. Add the oil, pumpkin and eggs and stir until just combined. Stir in the cranberries and spoon the batter into greased muffin cups. 4. Place the pans in the hot oven and bake for 40 minutes, or until a tester inserted into the center of the muffins comes out clean. Yield: 24 muffins.

Recipes for Health: A Medley of Leftovers Posted: 15 Feb 2011 01:29 PM PST When I was a kid, hash meant one thing: roast beef hash. 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: Brussels Sprouts and Roasted Winter Squash Hash (February 15, 2011) Recipes for Health: Mushroom Hash With Black Rice (February 16, 2011) Recipes for Health: Beet Greens and Potato Hash (February 17, 2011) Recipes for Health: Turkey and Red Pepper Hash (February 18, 2011) My family ate a lot of beef — huge steaks, fat hamburgers and standing rib roasts. I have fond memories of the hash that always came a day or two after the big meal, crusty and savory and sweet with ketchup. What tweaked my memory was a spicy lentil hash with farro that Dan Coudreaut, the executive chef at (are you ready?) McDonald’s, made in response to the following culinary challenge put to him at this year’s Worlds of Healthy Flavors conference at the Culinary Institute of America in Northern California: “What would you put on your breakfast menu if your V.P. of food and beverage said he wanted three new breakfast offerings that feature vegetables (including legumes)?” Mr. Coudreaut’s idea was to offer three vegetarian hashes topped with poached egg. Those dishes were more focused on legumes and grains than the hashes I developed for this week’s column. One of them is made with ground turkey breast, but the others are mixtures of diced vegetables, sometimes bulked up with grains. As I made these dishes, I sought the savory, caramelized crusty edge I so loved in the traditional hash of my youth. Ketchup had a lot to do with it, and I’ve included ketchup in one of this week’s recipes. But you can also get the same caramelization with tomato paste, a concentrated source of wonderful antioxidants and vitamins. The vegetable hashes can be served as a main dish if topped with a poached egg, and they make great side dishes. Hash is usually made with leftover meat and potatoes, so use these recipes to figure out how to reuse your own leftovers — vegetables, grains, legumes, lean meats and even fish. Let me know what you come up with. Vegetable Hash With Poached Egg This is a clean-out-the-refrigerator sort of hash. I used red onion, red pepper, carrot, celery, kohlrabi and parsnip, all lingering in the produce drawer of my refrigerator. I like the texture of the root vegetables, and because they brown in the pan and there’s ketchup involved, this dish tastes like traditional hash to me. 2 tablespoons canola oil 1 medium red onion, finely diced 4 cups finely diced vegetables (I used a mix of red pepper, carrot, celery, kohlrabi and parsnip) Kosher salt to taste 1 teaspoon cumin seeds, coarsely ground 2 teaspoons sweet paprika 2 tablespoons ketchup Freshly ground pepper to taste 4 poached eggs 1. Heat the oil over medium heat in a large, heavy nonstick skillet. Add the onion. Cook, stirring often, until it begins to soften, about three minutes. Add the remaining vegetables and a generous pinch of salt. Cook, stirring often, until the vegetables begin to soften, about five minutes. 2. Stir in the ground cumin seeds and the paprika, and combine well with the vegetables. Continue to cook, stirring often, for 15 minutes until the vegetables are crisp-tender. Add the ketchup, and continue to cook, stirring, for another five minutes. 3. Press the vegetable mixture down into a flat layer in the pan. Continue to cook on one side for five minutes. A crust should form on the bottom. Stir, then press down again and cook for another five minutes, until a crust forms again. Stir, taste and adjust salt, and add pepper. The vegetables should be thoroughly tender and the mixture nicely browned with a sweet edge. Remove from the heat. 4. Spoon the hash onto plates, press down in the center, lay a poached egg on top and serve. To poach an egg: Fill a frying pan with a tight-fitting lid (I use my omelet pan and a lid from a saucepan that fits perfectly), preferably nonstick, with water, and bring it to a boil. Add 1 teaspoon of vinegar to the water. Break an egg into a teacup, and tip into the boiling water. Immediately cover tightly, and turn off the heat. Let stand for four minutes, then remove from the water with a slotted spoon and drain on a kitchen towel. Keep in a bowl of water until ready to use. Yield: Serves four. Advance preparation: The cooked vegetables keep well for three or four days. Reheat on top of the stove. I’ve stirred leftovers into a pot of beans, a great thing to do if you have only a small amount of hash left or if you want to dress up a can of beans. Poached eggs will keep for a day in the refrigerator if you put them in a bowl of water. Nutritional information per serving: 195 calories; 2 grams saturated fat; 3 grams polyunsaturated fat; 6 grams monounsaturated fat; 186 milligrams cholesterol; 14 grams carbohydrates; 4 grams dietary fiber; 208 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.”

Sebelius Clears the Way for Arizona to Shed Adults From Medicaid Posted: 16 Feb 2011 09:11 AM PST The Obama administration gave a green light on Tuesday to Arizona’s plan to remove about 250,000 adults from its Medicaid rolls, instructing the state that it could circumvent a requirement in the new health care law that prohibits reductions in eligibility. In a letter to Gov. Jan Brewer, the secretary of health and human services, Kathleen Sebelius, wrote that Arizona’s expansion of Medicaid to cover low-income childless adults had been enacted a decade ago with special permission from the federal government, known as a waiver. That waiver, Ms. Sebelius wrote, is time-limited and expires Sept. 30. “Neither the Affordable Care Act nor Medicaid law or regulation prior to its enactment require a state to renew a demonstration beyond its expiration,” Ms. Sebelius wrote. “Arizona may choose to terminate its current demonstration on September 30, 2011, and either not pursue a new demonstration or pursue a different demonstration.” The secretary said explicitly that the removal of childless adults from the rolls would not constitute a violation of the health care law’s eligibility requirements. The law calls for a major expansion of Medicaid eligibility in 2014, when all states must begin covering low-income adults. A handful of states, including Arizona, have already been doing that, with the federal government agreeing to pay its usual matching share of the cost. Five other states currently cover childless adults on waivers that expire on a rolling basis over the next three years. Arizona’s expansion, which was approved in a referendum in 2000, initially was financed with proceeds from cigarette taxes and a tobacco lawsuit, but that money became insufficient in 2004. The state’s general fund has been making up the difference ever since. Eliminating the coverage would save $541 million, closing nearly half of Arizona’s budget gap for the coming year. Ms. Brewer proposed the cut, and the Legislature met in special session last month to approve the state’s request for a federal waiver of the health care act’s eligibility requirements. Other Republican governors have requested relief from the requirement. Ms. Sebelius’s letter essentially said that Arizona would not need a waiver, at least not to remove childless adults from the rolls. Last year, Arizona made other significant cuts to its Medicaid program by eliminating coverage of a number of services not mandated by federal law, including some organ transplants.

Obama Proposes Health Agency Cut but Spares Medicare Fees Posted: 14 Feb 2011 11:01 PM PST WASHINGTON — Spending by the Department of Health and Human Services would decline in 2012 for the first time in the agency’s 30-year history under President Obama’s budget request. Multimedia Interactive Feature Highlights of the Obama Budget Interactive Graphic The Proposal: How $3.7 Trillion Is Spent Related Obama’s Budget Focuses on Path to Rein in Deficit (February 15, 2011) Obama’s Budget Proposes a Significant Increase for Schools (February 15, 2011) Few Significant Changes in Energy-Area Spending (February 15, 2011) Clinton Says G.O.P. Cuts Would Hurt U.S. Interests (February 15, 2011) Related in Opinion Editorial: The Obama Budget (February 15, 2011) Room for Debate What Obama’s Budget Cuts Say How is the president positioning himself in the battle to define his party as fiscally responsible? Join the Discussion The proposed 2 percent cut, to $892 billion, is striking because the department’s two biggest programs, Medicare and Medicaid, have been growing more than 8 percent a year, and the department has myriad duties under the new health care law. The president’s budget does not propose fundamental changes to slow the growth in the two big entitlement programs, which together insure more than 100 million elderly, disabled and low-income people. Mr. Obama seeks to spare doctors from a deep cut in Medicare fees that they would otherwise face in January of next year. He would allocate $54 billion to freeze doctors’ payments in 2012 and 2013. He said he would offset the cost with savings in Medicare and Medicaid that would curb fraud, reduce spending on prescription drugs and limit states’ ability to tax health care providers. The president proposed further relief for doctors from 2014 to 2021, but did not say how he would pay the cost, which he estimated at $315 billion. The budget would eliminate a $318 million program that trains doctors at children’s hospitals. Lawrence A. McAndrews, president of the National Association of Children’s Hospitals, said the proposal would “jeopardize children’s access to physicians” and “exacerbate the current national shortage of pediatric specialists such as neurologists and surgeons.” Mr. Obama would offer $250 million to states in the next four years to test ways of curbing medical malpractice litigation. Food inspections and research into cancer, infectious diseases and new drugs would receive significantly more money under the president’s budget. But money to help states and cities prepare for health emergencies like pandemic flu would be cut. Mr. Obama seeks $31.8 billion for the National Institutes of Health in 2012, up $745 million from what was provided in 2010. Dr. Francis S. Collins, director of the health institutes, is expected by October to open a new center to accelerate the discovery of medicines for which the administration is requesting at least $100 million. The administration is asking that the budget of the National Institute of Allergy and Infectious Diseases, which finances much of the nation’s research on H.I.V. and AIDS, be increased by $100 million, to $4.9 billion. The budget of the National Cancer Institute would be increased by $95 million, to $5.2 billion. The Food and Drug Administration would have its budget increased by $1.07 billion, to $4.36 billion, from $3.29 billion in 2010. More than half of the increase, or $634 million, would come from fees paid by drug, tobacco, food and medical device companies. To help carry out a new law intended to safeguard the nation’s food supply, the president wants to increase spending for food inspections and other food safety services by $324 million, to a total of $1.4 billion. Mr. Obama would finance the inspections, in part, with fees imposed on food manufacturers under legislation he signed in January. He hopes to impose more such fees on manufacturers. The additional fees were included in a food bill that passed the House in 2009, but were dropped from the final version of the legislation. Republican senators signaled in the debate last year that they would not accept additional fees on the industry, and Republican House members have indicated that they would like to cut, not increase, the money devoted to food inspections.

States Aim Ax at Health Cost of Retirement Posted: 15 Feb 2011 09:10 PM PST Governors and mayors facing large deficits have set their sights on a relatively new target — the soaring expense of health benefits for millions of retired state and local workers. Enlarge This Image Leah Nash for The New York Times Ken Allen, a union official in Portland, Ore., says workers sacrificed to keep fully paid health care. As they contend with growing budget deficits and higher pension costs, some mayors are complaining that their outlays for retiree health benefits are rising by 20 percent a year — a result of the wave of retirements of baby boomers and longer life expectancies on top of the double-digit rate of health care inflation. The nation’s governors face a daunting $555 billion in unfunded liabilities to finance retiree health coverage. The Pew Center on the States calculated those long-term obligations last year, saying New Jersey had the largest amount, $68.9 billion, with California second, at $62.5 billion. “Up to now, the action taken to deal with this problem has been gradual, but it’s begun to explode,” said John Thomasian, director of the National Governors Association Center for Best Practices. “In 14 states, the state pays 100 percent of the health benefits for retirees. That’s very generous.” Michigan officials are stunned by the looming challenges of paying retirees’ health benefits, along with pension costs. “It’s pretty astronomical,” said John Nixon, the state’s budget director. “What’s happening with post-retirement health care is the biggest piece and biggest surprise.” “The issue isn’t to attack these folks or go after them,” he continued. “The main issue is how do we deal with this liability.” In state after state, the changes are occurring rapidly. For example, New Hampshire has stopped financing health insurance for many future retirees, while North Carolina has begun requiring state employees to work 20 years, up from five years, to qualify for full retiree health benefits. Michigan officials complain that retiree health obligations consume one-seventh of the state’s payroll costs, and New York City is slated to pay $2 billion toward retiree health next year. Over all, the Center for State and Local Government Excellence found that 68 percent of city and county officials surveyed said they were pushing to have retirees assume more of their health costs, while 39 percent said they had eliminated or planned to eliminate retiree health benefits for new hires. In many cases, states and municipalities are not required to negotiate these changes with retirees, and lawsuits challenging the cutbacks as a breach of contractual promises to retirees have resulted in mixed decisions. Many state or local workers retire before age 60, making them too young to turn to Medicare, prompting them to rely heavily on state and local plans for retirees. In Omaha, officials are seeking to work with their public-sector labor unions to have future retirees begin contributing toward their premiums. Omaha officials predict that their retiree health costs will quintuple, to $111 million, by 2020, at that point consuming nearly a third of the city’s budget. Richard O’Gara, Omaha’s director of human resources, put the numbers in perspective. “We’re going to reach a point where in five years, retiree health care will cost us more than employee health care,” he said, adding that was partly because the city was shrinking its work force and partly because retirees used far more medical services than active workers. Governors and mayors are also tackling the fast-rising health costs for the nation’s 19 million state and local workers, often focusing first on the government employees who pay nothing toward their health premiums for individual plans in 14 states. That is a benefit few private-sector workers have. In Oregon, Gov. John Kitzhaber, a Democrat, is demanding that state employees start paying part of their premiums. Oregon is the only state in which state employees do not contribute to any of their premiums for either family or individual health plans. “The bill is too big for us to pay,” Mr. Kitzhaber said. “Public employees should contribute to the cost of their health care premiums.” Just last Friday, Gov. Scott Walker of Wisconsin, a Republican, proposed that union negotiations should be limited only to wages and that workers pay 12.6 percent of their health care premiums, double the old average. In Jacksonville, Fla., Mayor John Peyton is insisting that police and firefighters begin paying 5 percent of the premiums toward their individual health plans, and the police union is balking. “In this budget crisis, taxpayers are becoming more concerned about where their tax payments are going,” Mr. Peyton said. “And many see a huge disconnect between what private-sector workers are getting on benefits and what the public sector is getting.” 1 2 Next Page » This posting includes an audio/video/photo media file: Download Now

What’s a Little Swine Flu Outbreak Among Friends? Posted: 15 Feb 2011 01:10 AM PST If you or your child came down with influenza during the H1N1, or swine flu, outbreak in 2009, it may not have happened the way you thought it did. Multimedia Graphic Tracking Flu Transmission Related Health Guide: H1N1 (swine) Influenza Vaccine A new study of a 2009 epidemic at a school in Pennsylvania has found that children most likely did not catch it by sitting near an infected classmate, and that adults who got sick were probably not infected by their own children. Closing the school after the epidemic was under way did little to slow the rate of transmission, the study found, and the most common way the disease spread was a through child’s network of friends. Researchers learned all this when they studied an outbreak of H1N1 at an elementary school in a semirural community in spring 2009. They collected data in real time, while the epidemic was going on. With this information on exactly who got sick and when, plus data on seating charts, activities and social networks, they were able to use statistical techniques to trace the spread of the disease from one victim to the next. Their report appears online in The Proceedings of the National Academy of Sciences. The scientists collected data on 370 students from 295 households. Almost 35 percent of the students and more than 15 percent of their household contacts came down with flu. The most detailed information was gathered from fourth graders, the group most affected by the outbreak. The class and grade structure had a significant effect on transmission rates. Transmission was 25 times as intensive among classmates as between children in different grades. And yet sitting next to a student who was infected did not increase the chances of catching flu. Social networks were apparently a more significant means of transmission than seating arrangements. Students were four times as likely to play with children of the same sex as with those of the opposite sex, and following this pattern, boys were more likely to catch the flu from other boys, and girls from other girls. The progress of the disease from day to day followed these social interactions: from May 7 to 9, the illness spread mostly among boys; from May 10 to 13 mostly among girls. “Our social networks shape disease spread,” said Simon Cauchemez, the lead author. “And we can quantify the role of social networks.” Thirty-eight percent of children 6 to 10 were infected, compared with 23 percent of 11- to 18-year-olds and 13 percent of those older than 18. Adults were only about half as susceptible as children, but when they got sick they were just as likely to transmit the virus to others. The school closed from May 14 to 18, but there was no indication that this slowed transmission. It may already have been too late — May 14 was the 18th day of the outbreak, and 27 percent of the students already had symptoms. The scientists found no difference in transmission rates during the closure and during the rest of the outbreak. This, they write, confirms earlier studies showing that a school has to be closed quite early in an epidemic to have any effect on disease transmission. Only 1 in 5 adults caught the illness from their own children, and this goes against one of the most common arguments for closing schools: that it will prevent the disease from moving from the school to households. “Here we find that most of the infected adults were not infected by one of the children in their household,” said Dr. Cauchemez, a research fellow at Imperial College London. “This information could be used to understand whether it might be better to close a school, or to close individual classes or grades.” Other experts were impressed with the work. “I think it’s a nice step,” said Ira M. Longini Jr., a professor of biostatistics at the Fred Hutchinson Cancer Research Center in Seattle. “It’s a beautiful analysis of an important dataset. This virus spreads very fast among school-age children, so the topic is important.”

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