Health - Dangers of Leaving No Resident Behind

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• Dangers of Leaving No Resident Behind
• Radiation, Once Free, Can Follow Tricky Path
• Well: After a Diagnosis, Wishing for a Magic Number
• Riddled With Metal by Mistake in a Study
• Rear-Facing Car Seats Advised at Least to Age of 2
• A Panel Decides Washington State’s Health Care Costs
• G. A. Marlatt, Advocate of Shift in Treating Addicts, Dies at 69
• Global Update: Bangladesh Bans Sale of Palm Sap After an Unusually Lethal Oubreak
• First Mention: In Vitro Fertilization, 1974
• Observatory: For the Brain, a Race To Recall the Details
• Observatory: Canine Genetic Wrinkle Has Human Potential
• Recipes for Health: Frittata With Grated Zucchini, Goat Cheese and Dill
• Well: Sex in Long-Term Relationships
• Well: When God Is Part of Therapy
• Well: The Family Pet Slide Show
• Well: Flaxseed for Hot Flashes?
• Well: A Decade of Boosting Breast Size
• Personal Health: A Guide to Smarter, Safer Antibiotic Use
• Really?: The Claim: Eating Flaxseed Can Help Relieve Hot Flashes
• Q & A: Behind the Mask
• The New Old Age: Cleaning Out a Condo
• Prescriptions: This Week's Health Industry News
• Recipes for Health: A Better Way to Serve Eggs
• S.D. Requires Visit to Pregnancy Center Before Abortion
• Trial to Open in Lawsuit Connected to Hospital Deaths After Katrina
• Health Law Waivers Draw Kudos, and Criticism

Dangers of Leaving No Resident Behind Posted: 22 Mar 2011 08:24 AM PDT When the Three Mile Island nuclear generating station along the Susquehanna River seemed on the verge of a full meltdown in March 1979, Gov. Richard L. Thornburgh of Pennsylvania asked a trusted aide to make sure that the evacuation plans for the surrounding counties would work. This week: A tight focus on the earthquake and nuclear calamity in Japan. Related Blindsided by Ferocity Unleashed by a Fault (March 22, 2011) The aide came back ashen faced. Dauphin County, on the eastern shore of the river, planned to send its populace west to safety over the Harvey Taylor Bridge. “All well and good,” Mr. Thornburgh said in a recent speech, “except for the fact that Cumberland County on the west shore of the river had adopted an evacuation plan that would funnel all exiting traffic eastbound over — you guessed it — the same Harvey Taylor Bridge.” Nearly 250,000 people would have been sent in opposite directions over the same narrow bridge. Mr. Thornburgh quickly corrected the plans, but more problems would soon arise — just as they have in many other disasters. As the Japanese are learning, the science behind herding thousands, sometimes millions, of people from danger to safety is uncertain at best. And the lessons learned from one disaster can both hurt and help with the next. For instance, not enough people left New Orleans and the surrounding areas before Hurricane Katrina struck on August 29, 2005, and more than 1,800 people died. At least part of the cause may have been that Mayor Ray Nagin of New Orleans waited until the day before the storm hit to order a mandatory evacuation. The lesson of Katrina? Get everybody out, and get them out early. Three weeks later, a second major storm, Hurricane Rita, came barreling toward the Gulf Coast. Mayor Bill White of Houston, intent on avoiding the mistakes that plagued New Orleans, told everybody in the city to get out, and get out now. “The time for waiting is over,” he said. Oops. Within hours, the interstates around Houston were at a standstill. When mandatory evacuations were later ordered for areas most at risk, those residents could not get out of harm’s way because the interstates were already packed with people from low-risk areas. Some spent days in their cars. The state police set about turning inbound lanes into outbound ones, but that took hours. More people died or suffered health problems from the bungled evacuation than from the storm itself. The lesson of Rita? Limit evacuations only to those most at risk, and have plans in place well in advance to reverse traffic flow patterns on major arteries. Every one of the nation’s 104 nuclear power plants is required to have detailed evacuation and incident plans in place before operating. The plans are reviewed by federal, state and local authorities. But problems crop up and almost certainly keep being created. Brian Wolshon, the director of the Gulf Coast Center for Evacuation and Transportation Resiliency, said that he was analyzing one county’s emergency plans that seemed to have every detail covered. “It was a wonderful report, with plans to move senior citizens out of care facilities and even out of hospitals, and they had signed contracts with bus and ambulance providers,” said Dr. Wolshon, who is also a professor at Louisiana State University. “But that same low-cost provider had the same contract with the county next door, and they had the capacity to evacuate only one of these counties.” Indeed, emergency authorities have only in recent years begun to realize that evacuations are often regional and even multistate events. Evacuating almost any city in the United States requires significant preparation and resources in surrounding cities. And some events are simply too resource-intensive or too complicated to plan for. “What if you had a tsunami warning in the Atlantic Ocean and had to evacuate the Eastern Seaboard? You’re talking about tens of millions of people. Where are you going to put those people? How are you going to get them there? Good luck with that,” Dr. Wolshon said. Residents in the 10-mile radius surrounding a nuclear power plant are supposed to receive evacuation plans routinely. Those near the Indian Point plant in Buchanan, N.Y., receive such plans annually, according to officials there. The plans are also posted on local government Web sites. And municipal authorities in towns around such plants often have stores of potassium iodide. Potassium iodide can protect people by ensuring that the thyroid gland does not take up radioactive iodine, which can cause cancer. But Kelly Classic, a physicist at the Mayo Clinic and spokeswoman for the Health Physics Society, warned that people should not take these pills unless instructed to do so. Potassium iodide can cause problems in those with shellfish allergies or kidney, thyroid or heart ailments, she said, and its benefits are fairly short-lived. Federal health officials warned recently that consumers who try to buy the pills on the Internet may get ineffective or dangerous pills. Radioactive fallout in Japan has so far been almost entirely confined to the 19-mile zone around the Fukushima Daiichi plant that the authorities have designated as posing the highest risk. But weather modeling has suggested that fallout from the disaster could circulate as far as Alaska and Southern California, although officials have said that there is little cause for concern. “It won’t even be at the level of a chest X-ray,” Ms. Classic said. Still, there may be some reasons for worry. A study of Swedish children who were in utero at the time of the Chernobyl accident in 1986 found that they fared worse on standardized academic tests than a control group of subjects. Children in the most affected parts of Sweden — hundreds of miles from the accident site — fared particularly poorly, showing scores about 5 percent lower than the control group. There is no hard evidence, however, of cause and effect. The developing fetus is particularly sensitive to the effects of radiation. Evacuation planning at nuclear power plants focuses mostly on residents within 10 miles because they are most at risk for direct exposure in an accident, either through inhalation or contact, said Scott Burnell, a spokesman for the Nuclear Regulatory Commission. But the plans include possible measures in a secondary zone extending 50 miles from the plant to protect against contaminated foods or water, Mr. Burnell said. Farmers and ranchers in this area may be instructed during an accident to put their animals in barns and use stored feed instead of allowing them to graze. President Obama recently asked the nuclear commission to review the safety of all of the nation’s nuclear power plants, but whether that review will include evacuation plans is as yet unknown, Mr. Burnell said. For Mr. Thornburgh, the lessons of the Three Mile Island accident were to restrain emergency personnel who wanted to act even if such action was not warranted; to resist what he called “emergency macho,” or the tendency to stay up all night so as to be able to brag about it later; and to stay calm. “Not helpful in this effort was the fact that the newly released film ‘The China Syndrome’ had just opened in the area, including its description of the consequences of a nuclear meltdown as rendering permanently uninhabitable an ‘area the size of the state of Pennsylvania,’ ” he said. “This was not a message calculated to put people’s minds at ease.” This posting includes an audio/video/photo media file: Download Now

Radiation, Once Free, Can Follow Tricky Path Posted: 22 Mar 2011 08:25 AM PDT Ten days after an earthquake and tsunami crippled a nuclear plant in Japan, officials are detecting abnormal levels of radiation in what may seem like a scattershot assortment of foods: milk from Fukushima Prefecture, where the reactors sit; spinach from Ibaraki Prefecture to the south; canola from Gunma Prefecture to the west; and chrysanthemum greens from Chiba to the south. Shipments of the milk and spinach have been banned. Enlarge This Image Ken Shimizu/Agence France-Presse â€" Getty Images A farm in Fukushima Prefecture, about 30 miles west of the damaged nuclear plant. Radiation has been found in milk in the area. Multimedia This week: A tight focus on the earthquake and nuclear calamity in Japan. Related Japan Extended Reactor’s Life, Despite Warning (March 22, 2011) A blog about energy and the environment. Go to Blog » Enlarge This Image Stephen Morrison/European Pressphoto Agency A supermarket in Iwate Prefecture in northeastern Japan. Contaminated spinach has been found in an area south of the plant. Experts hesitate to predict where the radiation will go. Once radioactive elements that can harm health are released into the outdoors, their travel patterns are as mercurial as the weather and as complicated as the food chains and biochemical pathways along which they move. When and where radioactive contamination becomes a problem depends on a vast array of factors: the specific element released, which way the wind is blowing, whether rain will bring suspended radioactivity to earth, and what types of crops and animals are in an exposed area. Research related to the 1986 Chernobyl accident makes clear that for decades, scientists will be able to detect the presence of radioactive particles released by the crippled Japanese reactors thousands of miles away. Scientists and doctors in Japan and abroad will be monitoring the results to see if those measurements reach dangerous levels. So far there is no indication that anyone has been harmed by eating contaminated food. “It’s natural that people worldwide will be monitoring for this — just in case it is far worse than we now expect,” said F. Ward Whicker, a professor emeritus at Colorado State University who developed a leading model for following radiation through the food chain. When radiation is released with gas, as it was at the Japanese reactors, the particles are carried by prevailing winds, and some will settle on the earth. Rain will knock more of the suspended particles to the ground. “There is an extremely complex interaction between the type of radionuclide and the weather and the type of vegetation,” Dr. Whicker said. “There can be hot spots far away from an accident, and places in between that are fine.” The principal elements that have been released from reactors at the Fukushima Daiichi plant are iodine 131 and cesium 137. Cesium is dangerous because it is long-lived and travels easily through the food chain, continuing to emit particles for centuries once it is released. More than 15 years after the Chernobyl accident in what is now Ukraine, studies found that cesium 137 was still detectable in wild boar in Croatia and reindeer in Norway, with the levels high enough in some areas to pose a potential danger to people who consume a great deal of the meat. While iodine 131 is much shorter lived — its radioactive potency is halved every eight days — it is dangerous because it concentrates in the thyroid gland, resulting in high radiation doses to that vulnerable organ. The thyroid is such an iodine magnet that Dr. Whicker recounts that a week after a nuclear weapons test in China, iodine 131 could be detected in the thyroid glands of deer in Colorado, although it could not be detected in the air or in nearby vegetation. Initially, some plants will collect more radiation than others: those with big leaves like lettuce, spinach and other greens will naturally collect more radiation than apples, oranges or potatoes, he said. Foods like rice and corn whose edible portion is protected by husks or leaves are relatively safe in this early stage. But over a period of weeks, the radioactivity particles enter the food chain when they are ingested by animals or settle into dirt where they can be absorbed by the roots of growing plants. Soils with high clay content tend to bind radioactive elements and hinder their travel, while sandy soils allow more of the radiation to pass into growing food. Long-lasting particles of cesium 137 can cycle through an ecosystem for decades, entering plants when they are taken up by root systems and returning to the earth when the plant dies. For the first time on Monday, Japanese nuclear officials said that some of the water used to douse and cool the damaged reactors had reached the ocean, raising the possibility that seafood might eventually be at risk, too. The officials said they would monitor the situation. Scientists generally measure radioactivity of local mussels and seaweed to assess the level of contamination. Experts suggest that levels would have to be watched closely because cesium 137 concentrates in fish muscle much as mercury does when it moves up the food chain from plankton to small fish to big fish. “I would definitely be monitoring fish populations in the area, since there may be certain items that should be avoided,” said Nicholas Fisher, a professor of marine sciences at the State University of New York at Stony Brook. In a worst-case scenario, said Paul Falkowski, a professor of marine sciences and geology at Rutgers University, a major ocean current that travels up the coast of Japan, across the Pacific and into the Gulf of Alaska could carry radiation to Alaska fisheries months from now. He said the International Atomic Energy Agency should monitor such movements, although he and other experts considered it highly unlikely that the current would take the radiation to Alaska unless the leak became far worse. Many fish and the oceans already contain radiation, both naturally occurring and as a result of prior nuclear testing, said Dr. Fisher, who said that added current levels from the damaged reactors were not likely to be significant in terms of human health. But he and other experts say that vigilance is crucial because problematic levels of radiation can turn up unexpectedly. After the Chernobyl accident, some relatively distant villages were contaminated with fallout of iodine 131, and local cows ate grass that contained the radiation. Children who drank milk from those cows ended up with high rates of thyroid cancer.

Well: After a Diagnosis, Wishing for a Magic Number Posted: 22 Mar 2011 08:27 AM PDT

Riddled With Metal by Mistake in a Study Posted: 22 Mar 2011 08:35 AM PDT Women participating in a study of patients with breast cancer have been inadvertently left with hundreds of tiny particles of the heavy metal tungsten in their breast tissue and chest muscles. The particles came from a device used during surgery. The device has since been recalled. Related Health Guide: Breast Cancer Enlarge This Image An X-ray showing tiny particles of tungsten in breast tissue. It is not known if the metal is dangerous to health because relatively little research has been done on its long-term effects in the body. But it shows up on mammograms, and may make them difficult to read, an especially troubling effect for women who have already had breast cancer and worry about recurrences. (The particles resemble calcium deposits, which can indicate cancer.) About 30 women have been affected, according to the manufacturer of the device that caused the problem, the Axxent FlexiShield Mini. The women are in a quandary. At least one, fearing that the tungsten could cause cancer or another illness, is trying to decide whether to get rid of the particles by having her breast and its underlying tissue removed in a radical and disfiguring operation. Twenty-seven of the cases occurred at Hoag Memorial Hospital Presbyterian in Newport Beach, Calif. Eleven of those women have had mammograms, and all 11 showed tungsten. Hospital officials declined interviews, but issued a statement acknowledging that the problem had occurred. Two other women were treated in a study at Karmanos-Crittenton Cancer Center in Rochester Hills, Mich. A hospital spokeswoman said that both patients had been informed of the recall and the potential problem but had not returned to the hospital. The episode casts doubt on the safeguards for people who participate in medical research and on the Food and Drug Administration’s ability to protect the public from flawed medical devices. The Axxent FlexiShield Mini had been cleared by the agency in June 2009 in an abbreviated process used for devices that are considered equivalent to products already on the market. That process, known as 510(k), takes less time than the procedure used to approve a new device, and it generally does not require tests on humans. The FlexiShield Mini equipment was recalled last month. Neither its manufacturer nor the F.D.A. could explain what went wrong with the device. Karen Riley, a spokeswoman for the agency, said it was just beginning its review of the device and the recall. So far, she said, F.D.A. toxicologists had found no evidence that the tungsten was toxic or that patients were harmed. Ms. Riley said the 510(k) process was used to avoid “reinventing the wheel” for products that were essentially the same as others that had already passed muster with the agency. The women who were exposed to the tungsten were taking part in a study of a radiation technique that some doctors predicted would be a big advance in the treatment of breast cancer. Unlike the usual five to seven weeks of daily radiation sessions, the newer method delivers the entire course of treatment in one dose while the woman is still in the operating room after undergoing a lumpectomy for breast cancer. But in the study, a device that was temporarily placed in the women’s incisions during the radiation treatment was apparently flawed, and riddled their breasts with tungsten. The Axxent Flexishield Mini, a $100 disk made of tungsten and silicone, was used to shield healthy tissue from the radiation. The first patient to take part in the study at Hoag said the events had shattered her faith in the vigilance of the drug agency, the hospital and her surgeon, who she said enthusiastically talked her into participating, emphasizing how convenient it would be to finish radiation treatment before she even woke from surgery. “I do work, so it was appealing,” said the woman, a 57-year-old psychologist with a busy practice who did not want her name used for privacy reasons. The purpose of the study was not to test the new radiation treatment itself, but rather to determine whether imaging studies could correctly predict which women would be candidates for it. The device’s manufacturer did not pay for the study. It never occurred to the first patient that the equipment might be faulty, she said, because she knew that it had been approved by the F.D.A. She also trusted the doctor and hospital to ensure that the study was safe. “I had this illusion, like most people do, that the F.D.A. wouldn’t allow this to happen,” she said. “I definitely feel like a lab rat now.” The manufacturer, Xoft, which was bought in December by iCad, intended the shield to be used with its portable radiation device, the Axxent Electronic Brachytherapy System. The president of iCad, Ken Ferry, said his company bought Xoft because the idea of giving radiation treatment during surgery seemed so promising. A study published last summer showed good results from a different radiation machine using the same technique. Mr. Ferry said he thought the procedure might eventually be used to treat half of the 270,000 women a year in the United States who develop breast cancer. “We think the growth of the procedure will be dramatic over the next three years,” Mr. Ferry said. “That’s what really drove us to acquire the company.” But iCad also acquired the tungsten problem, which became apparent only a week or two after the deal was closed. 1 2 Next Page » This posting includes an audio/video/photo media file: Download Now

Rear-Facing Car Seats Advised at Least to Age of 2 Posted: 21 Mar 2011 07:50 PM PDT Toddlers are usually switched from rear-facing to forward-facing car seats right after their first birthday — an event many parents may celebrate as a kind of milestone. Enlarge This Image The Children's Hospital of Philadelphia NEW RECOMMENDATION A study found that children under 2 are 75 percent less likely to suffer severe or fatal injuries in a crash if they face backward. But in a new policy statement, the nation’s leading pediatricians’ group says that is a year too soon. The advice from the American Academy of Pediatrics, issued Monday, is based primarily on a 2007 University of Virginia study finding that children under 2 are 75 percent less likely to suffer severe or fatal injuries in a crash if they are facing the rear. “A baby’s head is relatively large in proportion to the rest of his body, and the bones of his neck are structurally immature,” said the statement’s lead author, Dr. Dennis R. Durbin, scientific co-director of the Center for Injury Research and Prevention at the Children’s Hospital of Philadelphia. “If he’s rear-facing, his entire body is better supported by the shell of the car seat. When he’s forward-facing, his shoulders and trunk may be well restrained, but in a violent crash, his head and neck can fly forward.” The new policy statement also advises that older children should ride in a belt-positioning booster seat until they are 4 feet 9 inches tall, and 8 to 12 years old. A booster seat allows the vehicle’s lap and shoulder seat belt to fit properly, meaning the lap portion of the belt fits low across the hips and pelvis, and the shoulder portion fits across the middle of the shoulder and chest. “Our recommendations are meant to help parents move away from gospel-held notions that are based on a child’s age,” Dr. Durbin said. “We want them to recognize that with each transition they make, from rear-facing to forward-facing, to booster seats, there is a decline in the safety of their child. That’s why we are urging parents to delay these transitions for as long as possible.” Safety advocates applaud the new policy, but say the transition from rear- to forward-facing is usually the one that parents are least willing to delay. “People cheer when they turn their kid around at one year, but hopefully some day they’ll cheer at how long they were able to keep their child rear-facing,” said Debbi Baer, a labor and delivery nurse in Baltimore who has been a car safety advocate for children for more than 30 years. The academy’s previous policy, from 2002, said it was safest for infants and toddlers to ride facing the rear, and cited 12 months and 20 pounds as the minimum requirements for turning the car seat forward. But Ms. Baer, a certified child passenger safety technician, said parents tended to take that as a hard and fast rule. “A lot of parents consider turning the car seat around as another developmental milestone that shows how brilliant and advanced their child is,” she said, “and they don’t realize that it’s making their child less safe.” Ms. Baer says the evidence from other countries is compelling: Sweden, for instance, where children face the rear until age 4, has the world’s lowest highway fatality rate for children under 6. Seven years ago, Ed Weissberg and his wife, Edda, of Baltimore, took Ms. Baer’s advice, and say it saved their daughter Renana’s life. The couple and their three children were traveling north on Interstate 95 when they were broadsided by a car that had had a blowout. Their minivan flipped into the air, sailed over three lanes of traffic and landed on the shoulder, upside down. “The E.M.T.’s told me later that as soon as they saw our car, they were ready to take out our bodies,” said Mr. Weissberg, who now lives in Israel with his family. Instead, they found the entire family nearly unscathed, with all three children suspended upside down, still securely strapped in their car seats. “People thought we were crazy for keeping our 2-year-old rear-facing, but if she had been facing forward, she wouldn’t be alive today,” he said. Dr. Alisa Baer, a pediatrician at Morgan Stanley Children’s Hospital in New York (and Debbi Baer’s daughter), said Renana Weissberg’s case was far from unique. “It’s a horrible term,” she said, “but E.M.T.’s call the rear-facing seat ‘the orphan seat’ because in a bad car accident, that child is often the only one who survives.” Until recently, most car seats that could be turned to face the rear did not accommodate children weighing more than 20 pounds. Today, however, the limits are closer to 30 to 35 pounds, and a few go to 45 pounds. Dr. Baer said she felt so strongly that if a parent wants to install a forward-facing seat for a child younger than 2, “I tell them, ‘If you really want to make a stupid decision for your child, you can do it, but I’m not going to help you.’ ” She noted that parents often told her that their 2-year-olds would be uncomfortable with their legs squashed against the back of the seat, and that they might be more likely to break their legs in a crash. Neither is true, she said. “I always reassure parents that just because it looks uncomfortable to you doesn’t mean that it is for a child,” said Dr. Baer.

A Panel Decides Washington State’s Health Care Costs Posted: 21 Mar 2011 10:10 PM PDT SEATTLE — The health care board was in session, and Deryk Lamb was pleading for them to continue paying for the spinal injections he receives to dull the pain from a workplace injury. Enlarge This Image Stuart Isett for The New York Times Deryk Lamb, right, was injured at work and seeks pain relief. Add to Portfolio Medtronic Inc Go to your Portfolio » Enlarge This Image Stuart Isett for The New York Times The American Pain Foundation organized a rally to support patients during a Health Technology Assessment meeting.  “My life would be a living hell without these injections,” said Mr. Lamb, a 44-year-old carpenter from Lake Stevens, Wash., who was crushed between two trucks in 1996. “I don’t deserve to be sentenced by a committee to a life of agony.” Mr. Lamb was testifying on Friday before Washington State’s Health Technology Assessment committee. The committee has authority under state law to determine which medical devices and procedures Washington will cover for state employees, Medicaid patients and injured workers, about 750,000 people in all. While all states, private insurers and the federal Medicare program decide what to cover, this state’s program is attracting nationwide attention, in part because its process is public and open. That provides a living laboratory of the complexities of applying evidence-based medicine, something that is becoming more common as a way to rein in health care costs. “This kind of scrutiny is increasingly the norm, rather than the exception,” said Dan Mendelson, chief executive of Avalere Health, a consulting firm that follows state and federal health programs. Washington State’s effort, he said, was “unique in the size and breadth of it.” The program is also drawing attention because it explicitly considers the cost of treatments in making its decisions, akin to Britain’s National Institute for Health and Clinical Excellence. That similarity alone has made the Washington program the target of criticism from opponents of the new federal health care legislation. Last Friday, The Wall Street Journal’s editorial board, a longtime opponent of the federal law, called Washington State’s process a harbinger of limitation of choice that it said would result from the national health care overhaul, which includes undertaking efforts to compare the effectiveness of different therapies. Criticism is also coming from doctors and manufacturers hurt by the decisions. An editorial in one medical journal in the pain-control field equated one of the committee’s decisions to waterboarding and other forms of torture, showing a photograph of a chair with numerous metal blades protruding from it. Medical device manufacturers are lobbying for changes in the program. “I think there is evidence that other states look at what they do,” said Rob Clark, senior director for state government affairs at Medtronic, who attended Friday’s meeting. Before that meeting, the committee, created by a 2006 law that had bipartisan support, had ruled on 21 devices or procedures, rejecting coverage for about half of them, including arthroscopic knee surgery and calcium scoring for cardiac disease. Virtual colonoscopy was rejected explicitly because it cost more than conventional colonoscopy. The other procedures, including routine ultrasound in pregnancy and hip resurfacing, were accepted, although the board set conditions on which type of patients would qualify. The decisions made so far were expected to save the state $31.8 million annually, of several billions spent on health care. But at a time when the state’s Medicaid program has eliminated most vision and dental benefits for adults, every bit helps, program officials said. Leah Hole-Curry, director of the program, defended its actions, saying they did not amount to rationing of health care. “Rationing is where you know you need something and without it you are going to suffer but there’s not enough to go around,” she offered as a definition. In this case, she said, the program denied coverage for procedures that have simply not been shown to work. “It’s still pretty astounding that we have individuals who say we don’t want you to look at scientific evidence in deciding how to spend taxpayer dollars,” she said. Until recently, at least, the program had not generated much controversy within the state. “The decisions have been pretty balanced and we have not had a lot of apprehension among our members,” said Dr. Dean Martz, president of the Washington State Medical Association, which represents 9,000 doctors. But Friday’s meeting, held in a conference room one level above the ticket counters at Seattle-Tacoma International Airport, raised concerns among local and national medical experts. First was a review of home blood glucose testing for children with insulin-dependent diabetes. An assessment of clinical trials prepared by a company called Spectrum Research — the “evidence vendor” in the program’s parlance — found virtually no proof that testing more than five times a day improved health. But diabetes organizations and experts testified that this was because it would be unethical to do a trial in which some children were not allowed to test themselves frequently. “Don’t mix up evidence-based medicine with ignorance-based medicine,” Dr. Irl B. Hirsch, a professor at the University of Washington, who is a consultant for various companies, told the committee. Melinda Woods said her 14-year-old son needed to check his glucose at meal times, snack times, when playing sports and in the middle of the night. “Right there you are looking at seven or eight checks a day,” she said. The committee — seven doctors, a nurse, a speech pathologist, a chiropractor and a naturopathic physician — voted unanimously to cover finger prick tests with no daily limit. It voted to cover continuous glucose monitors mainly for children considered most at risk of a dangerous incident of low blood sugar. 1 2 Next Page »

G. A. Marlatt, Advocate of Shift in Treating Addicts, Dies at 69 Posted: 21 Mar 2011 08:50 PM PDT G. Alan Marlatt, a psychologist who challenged the longstanding belief that substance addiction is incurable and that it can be controlled only by abstinence, died March 14 at his vacation home in Stanwood, Wash. He was 69 and lived in Seattle. Enlarge This Image University of Washington G. Alan Marlatt The cause was kidney failure, said his wife, Kitty Moore. For 30 years, Dr. Marlatt was director of the Addictive Behaviors Research Center, an arm of the University of Washington in Seattle that nurtured a movement among therapists holding that addiction treatment should take a more moderated approach than is common in traditional 12-step programs calling for complete abstinence, like that of Alcoholics Anonymous. Dr. Marlatt was perhaps the leading proponent of the approach, called “harm reduction.” His data demonstrated that reducing an addict’s level of alcohol use can lead directly to reduced troubles at home and at work. He maintained that while addicts may not be able to stop using a substance immediately, individualized counseling — a “meet them where they are” approach, as the movement calls it — can bring about changes in their “life conditions” and eventually lead to abstinence. Through his research, much of it involving students on campus, Dr. Marlatt also identified factors that can predict a relapse, among them negative emotions, conflicts with others and recurring thoughts that the substance will make the addict feel better. “Alan found that these high-risk situations can be planned for, and that by being taught appropriate coping responses the person can learn to avoid relapse,” said Mary Larimer, who worked with Dr. Marlatt for 27 years and is now associate director of the research center. “Prior to Alan’s work there was a perception that relapse was an inevitable part of the disease of addiction, primarily triggered by biological processes.” In his book “Relapse Prevention” (1985, revised in 2005), considered a seminal work in the field, Dr. Marlatt drew a distinction between a lapse and a full relapse. He postulated that a lapse can be seen as a warning sign, not as failure, and that the addict can get back on track through counseling. While his approach has gained many adherents, it has also been the subject of debate. “Alcoholism causes brain damage, and Marlatt never considered that in his analyses,” said Irving Maltzman, an emeritus professor of psychology at the University of California, Los Angeles, who specialized in alcoholism. “I support complete abstinence.” But Marc Schuckit, a professor of psychiatry at the University of California, San Diego, and an expert in genetic factors contributing to alcohol and drug dependence, saw value in both approaches. “Where Alan and I differed was where the problems with alcohol get really serious,” Dr. Schuckit said. “I agree that abstinence isn’t always essential for people who drink more than may be healthy for them, but who don’t have serious problems. However, when somebody meets criteria for alcohol dependence, I read the data as saying it is very unlikely they will ever be able to go back to controlled drinking.” Frederick Rotgers, president of the Society of Addiction Psychology, said Dr. Marlatt’s work was “the foundation for much of the psychological research in treatment today,” having “shifted it toward a more humane and respectful approach.” Gordon Alan Marlatt was born in Vancouver, British Columbia, on Nov. 26, 1941, to Vera and Sholto Marlatt, a Royal Canadian Air Force flight officer who died in a plane crash in England during World War II. Besides his wife, he is survived by a son, Kit; a stepson, Colin; two stepdaughters, Charlotte and Melanie; a half-brother, Robert; a grandson; and two stepgranddaughters. His three previous marriages ended in divorce. Dr. Marlatt received a bachelor’s degree in psychology from the University of British Columbia in 1964 and a Ph.D. in clinical psychology from Indiana University four years later. After teaching at the University of British Columbia and the University of Wisconsin, he joined the University of Washington faculty in 1972. In recent years, Dr. Marlatt took a lead role in efforts to deal with alcohol abuse on college campuses. He developed a counseling program called Basics — Brief Alcohol Screening and Intervention for College Students — that uses so-called harm-reduction techniques. It is now in place at more than 1,800 colleges.

Global Update: Bangladesh Bans Sale of Palm Sap After an Unusually Lethal Oubreak Posted: 21 Mar 2011 09:39 PM PDT Bangladesh is suffering an outbreak of deadly Nipah virus, causing the government to adopt an unusual prevention tactic: a ban on the sale of fresh palm sap. The virus, carried by bats, was identified only in 1999.  It causes dangerous brain inflammation in humans and is infectious. The Bangladeshi outbreak is unusually lethal, killing 35 of the 40 people known to have been infected. The first known outbreak of Nipah virus was in Malaysia, where most victims raised or butchered pigs that were the source of infection. The pigs are believed to have rooted beneath bat colonies in trees, eating food contaminated by droppings. But the Bangladesh outbreak happened without a swine vector. Bangladeshis like drinking date palm sap, which is gathered “in a way similar to maple syrup collection,” said Dr. Jonathan H. Epstein, a veterinarian with the EcoHealth Alliance, which is helping Bangladesh track the virus.  Gatherers called gachis climb high into the trees, shave the bark with machetes and hang clay pots on the trunks to collect the sap at night. Large fruit bats called Indian flying foxes are attracted and lap up the running sap, sometimes fouling the pots with their saliva, urine or feces. Many people in the tropics leave palm sap to ferment into wine — and fermentation might kill the virus.  But most Bangladeshis are Muslim, and do not drink alcohol, Dr. Epstein said. The government health agency is also trying to persuade the gachis to put what he called “bamboo skirts” over the mouths of their collecting jars. “The gachis like them,” he said. “They keep the stuff pure, so they can sell it for more.”

First Mention: In Vitro Fertilization, 1974 Posted: 21 Mar 2011 08:10 PM PDT When The New York Times first mentioned in vitro fertilization, the paper might have been reporting on a casually uttered lie. Associated Press MEDICAL MILESTONE Louise Brown, born July 25, 1978, was the first test-tube baby. The article appeared on July 16, 1974. A British physician, Dr. Douglas Bevis, gave a presentation on embryo implantation, work that had been going on in animals for some time. After his talk, during a question-and-answer session, he said that three test-tube human babies had already been born, and that he had “learned about the births through exchanges with colleagues in ‘chit-chat.’ ” The remark was greeted with disbelief. Fertilizing an egg in a test tube (actually, the less evocative petri dish) had been accomplished with animals, but no one knew of any human egg that had been fertilized artificially and successfully implanted in a woman, much less any baby born from the procedure. Dr. Bevis offered few details, either to colleagues or to reporters. The next day, The Times printed an article with the headline “Doctors Dubious on Births Report,” and three days later another one reported that Dr. Bevis was giving up research into embryo implants because he was “ ‘sickened’ by the publicity given to his announcement.” That September The Times Magazine published “The Embryo Sweepstakes,” an article that suggested Dr. Bevis’s claims might be fraudulent; it also described the work of two British doctors, Patrick C. Steptoe and Robert G. Edwards, who did seem close to achieving the feat. Dr. Bevis, who died in 1994, never spoke about the issue again. Except for a few incidental mentions, some of which confused in vitro conception and artificial insemination, the subject disappeared from The Times until July 15, 1978, when the paper reported on Page 45 that “the first authenticated birth of a baby whose embryo derived from fertilization and culturing in a laboratory, expected soon in Britain, will open the way for a new era in the control of human reproduction.” The article described in some detail the procedures that Dr. Steptoe and Dr. Edwards had used with Lesley and John Brown (who was misidentified as Gilbert Brown) that would lead to the birth of their daughter, Louise, the first test-tube baby. The Times reported Louise’s birth on July 26, 1978, and the birth of the first American test-tube baby, Elizabeth Carr, three years later. Dr. Steptoe died in 1988. On Oct. 5, 2010, a front-page article began, “The Nobel Prize in Physiology or Medicine has been awarded this year to Robert G. Edwards, an English biologist who with a physician colleague, Dr. Patrick Steptoe, developed the in vitro fertilization procedure for treating human infertility.” There are about four million in vitro babies alive worldwide, and 58,000 are born each year in the United States.    NICHOLAS BAKALAR

Observatory: For the Brain, a Race To Recall the Details Posted: 21 Mar 2011 07:40 PM PDT It is always a challenge to remember a new computer password after an old one has expired, or to memorize a new phone number. Enlarge This Image Chris Gash Related Observatory: Canine Genetic Wrinkle Has Human Potential (March 22, 2011) Observatory: Older Elephant Matriarchs Keep the Lions at Bay (March 22, 2011) More Observatory Columns RSS Feed Get Science News From The New York Times » That is because the brain is competing to recall old memories and new ones that are associated with the same thing, researchers from Yale and Stanford report in Proceedings of the National Academy of Sciences. Brice Kuhl, a psychologist at Yale, and his colleagues found that when the brain is cluttered with similar events, the difficulty in recalling just one of them is visible through the brain-scanning technology known as functional magnetic resonance imaging. The researchers provided subjects with words that had both face associations and scene associations. When they ran a scan and asked the subjects to recall the association they had most recently seen, blood flowed in parts of the brain that are used to recall faces and scenes. Most people regularly encounter this competition. “I park in a garage every day at work, and I park in a different space every day, depending on availability,” Dr. Kuhl said. “And I very often walk to where I parked the day before. It’s not that I totally forgot where I parked, it’s just that I still remember yesterday’s spot.” This posting includes an audio/video/photo media file: Download Now

Observatory: Canine Genetic Wrinkle Has Human Potential Posted: 21 Mar 2011 07:40 PM PDT Shar-peis are an ancient Chinese dog breed characterized by two singular traits: thick, wrinkly skin and frequent bouts of fever. Researchers now say that the same gene mutation is responsible for both the wrinkles and the fever. Related Observatory: Older Elephant Matriarchs Keep the Lions at Bay (March 22, 2011) Observatory: For the Brain, a Race To Recall the Details (March 22, 2011) More Observatory Columns RSS Feed Get Science News From The New York Times » “All shar-pei dogs have this mutation that causes the wrinkles, but the more copies they have, the higher the risk to have this fever,” said Mia Olsson, a doctoral student at Uppsala University in Sweden who worked on the study. The research appears in the journal PLoS Genetics. It was already known that the wrinkles were a result of excess production of a substance called hyaluronic acid distributed throughout the dogs’ skin. That excess is likely caused by to the overactivation of a gene called hyaluronan synthase 2. Dogs that carry multiple mutations of the gene seem predisposed to periodic fever, Ms. Olsson and her colleagues reported. Although the fever is short-lived, it can be intense and frequent, and cause inflammation. With more information, breeders might be able to avoid breeding shar-peis that have duplications of the gene mutation, Ms. Olsson said. The research was conducted with the help of breeders in the United States, Sweden and Spain. “Our highest priority right now is to see if there’s some way to create some kind of test or tool to reduce the number of dogs with the fevers,” she said. The fever closely resembles certain periodic fevers that humans inherit, and studying the mutation in the dogs could help human geneticists develop treatments. The most common periodic fever among humans is known as familial Mediterranean fever. It tends to affect people of Mediterranean and Middle Eastern descent, and there is no cure. This posting includes an audio/video/photo media file: Download Now

Recipes for Health: Frittata With Grated Zucchini, Goat Cheese and Dill Posted: 22 Mar 2011 12:34 PM PDT Goat cheese adds creaminess and rich flavor to this delicate frittata. 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 Better Way to Serve Eggs (March 21, 2011) 2 tablespoons extra virgin olive oil 1 pound zucchini, grated (about 4 cups) 2 garlic cloves, minced Salt and freshly ground pepper to taste 8 eggs 2 ounces goat cheese, crumbled (about 1/2 cup) 1/4 cup chopped fresh dill 1. Heat 1 tablespoon of the oil over medium heat in a 10-inch heavy nonstick skillet. Add the zucchini. Cook, stirring, until the zucchini begins to wilt, about two minutes. Stir in the garlic. Cook for another minute or until the zucchini has just wilted — it should still be bright green. Season to taste with salt and pepper, and remove from the heat. 2. Beat the eggs in a large bowl with the goat cheese. Add salt and pepper, and stir in the zucchini and the dill. 3. Clean and dry the pan, and return to the burner, set on medium-high. Heat the remaining tablespoon of olive oil in the skillet. Drop a bit of egg into the pan; if it sizzles and cooks at once, the pan is ready. Pour in the egg mixture. Tilt the pan to distribute the eggs and filling evenly over the surface. Shake the pan gently, tilting it slightly with one hand while lifting up the edges of the frittata with the spatula in your other hand, to let the eggs run underneath during the first few minutes of cooking. 4. Turn the heat to low, cover and cook 10 minutes, shaking the pan gently every once in a while. From time to time, remove the lid, tilt the pan and loosen the bottom of the frittata with a wooden spatula so that it doesn’t burn. The bottom should have a golden color. The eggs should be just about set; cook a few minutes longer if they’re not. 5. Meanwhile, heat the broiler. Uncover the pan and place under the broiler, not too close to the heat, for one to three minutes, watching very carefully to make sure the top doesn’t burn (at most, it should brown very slightly and puff under the broiler). Remove from the heat, and shake the pan to make sure the frittata isn’t sticking. Allow it to cool for at least five minutes and for as long as 15 minutes. Loosen the edges with a wooden or plastic spatula. Carefully slide from the pan onto a large round platter. Cut into wedges or into smaller bite-size diamonds. Serve hot, warm, at room temperature or cold. Yield: Six servings. Note: For four servings, use the same recipe but reduce the number of eggs to six. Advance preparation: In Mediterranean countries, flat omelets are served at room temperature, which makes them perfect do-ahead dishes. They’ll keep in the refrigerator for a few days, and they make terrific lunchbox fare. They do not reheat well. Nutritional information per serving: 192 calories; 5 grams saturated fat; 2 grams polyunsaturated fat; 7 grams monounsaturated fat; 258 milligrams cholesterol; 3 grams carbohydrates; 1 gram dietary fiber; 134 milligrams sodium (does not include salt to taste); 12 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

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Personal Health: A Guide to Smarter, Safer Antibiotic Use Posted: 21 Mar 2011 08:10 PM PDT Antibiotics are important drugs, perhaps the most important. In a world beset with “an unprecedented wave of new and old infections,” as one expert recently wrote, it is critically important that antibiotics work well when people need them. Enlarge This Image Yvetta Fedorova Related More Personal Health Columns But antibiotics are frequently misused — overprescribed or incorrectly taken by patients, and recklessly fed to farm animals. As a result, lifesaving antibacterial drugs lose effectiveness faster than new ones are developed to replace them. Each year, 100,000 people in the United States die from hospital-acquired infections that are resistant to antibiotics, according to the Infectious Diseases Society of America. These concerns led Dr. Zelalem Temesgen, an infectious disease specialist at the Mayo Clinic in Rochester, Minn., to create a 15-part “Symposium on Antimicrobial Therapy,” published in February in The Mayo Clinic Proceedings. The series is intended in part to help practicing physicians know when and how antibiotics should be used — and, equally important, when they should not. Improving how antibiotics are prescribed can do more than curb resistance. It can save lives and money by reducing adverse drug reactions and eliminating or shortening hospital stays, Dr. Temesgen said. The first installment in the series, based on guidelines developed by the infectious diseases society and published with Dr. Temesgen’s introduction, was devoted to helping doctors practice better medicine. It also can help patients better understand how and when antibiotics work best, and it can arm them with the right questions when an antibiotic prescription is being considered. Patient-Tailored Therapy The report, prepared by three infectious disease specialists — Surbhi Leekha, now at the University of Maryland, and Drs. Christine L. Terrell and Randall S. Edson, both at the Mayo Clinic — urged doctors to avoid a “one size fits all” approach to antibiotics. Rather, they said, many individual factors must be taken into account to ensure the right drug and the right dose are prescribed for each patient. It is often up to the patient to make sure the prescribing physician is aware of these influential factors. They include: Kidney and liver function. The kidneys and liver eliminate drugs from the body. If the organs are not working well, toxic levels can accumulate in the bloodstream. Age. Considering a new antibiotic? This is no time lie about your age. “Patients at both extremes of age handle drugs differently, primarily due to differences in body size and kidney function,” the experts wrote. A face-lift and hair coloring may disguise your geriatric status, but they will not help your kidneys process drugs as well as they did in your youth. In some cases, in young, otherwise healthy patients, higher drug doses may be needed to be sure that therapeutic levels are maintained. Pregnancy and nursing. Some antibiotics given to a pregnant or lactating woman can adversely affect her baby, and it is critically important to tell the prescribing doctor if you are pregnant (or might be pregnant) or nursing. The risk of drug-induced birth defects is highest in the first three months of pregnancy; during the last three months, drugs are eliminated from the body more quickly, and higher doses may be needed to maintain a therapeutic blood level. Drug allergy or intolerance. Make sure the doctor knows if you have ever had a bad reaction to an antibiotic. But — and this is important — neither you nor your doctor should assume you are allergic to, for example, penicillin because you once developed a rash while taking it. The rash could have been caused by the illness or something else entirely. When an allergy is suspected, a skin test should be performed to confirm it so that the ideal antibiotic treatment is not mistakenly ruled out in the future. “It has been shown that only 10 percent to 20 percent of patients reporting a history of penicillin allergy were truly allergic when assessed by skin testing,” the experts wrote. In an interview, Dr. Edson said it is possible to rapidly desensitize a patient to a needed antibiotic by administering progressively larger oral doses of the drug. Recent antibiotic use. Tell the doctor if you recently took an antibiotic. If you develop a bacterial illness within three months of antibiotic therapy, you may have a drug-resistant infection that requires use of an alternate class of medication. Genetic characteristics. Some people are born with factors that make them especially vulnerable to bad reactions from certain antibiotics. For example, in those with a condition known as G6PD deficiency, which is most common among blacks, certain antibiotics can lead to the destruction of red blood cells. Patients who could be at risk should be tested for G6PD deficiency beforehand. The Value of a Culture When patients arrive at the doctor’s office with an inflamed throat, deep cough, high fever or unrelenting sinus pain, more often than not they are given prescriptions for antibiotics. The experts noted that it is sometimes reasonable to treat an infection without first getting a culture of the responsible organism — like when the patient’s symptoms are typical of a known bacterial infection. “Doctors do have to exercise clinical judgment in many cases,” Dr. Edson said. For example, he and his co-authors wrote, “Cellulitis is most frequently assumed to be caused by streptococci or staphylococci, and antibacterial treatment can be administered in the absence of a positive culture.” Likewise, they added, community-acquired pneumonia (that is, pneumonia that develops somewhere other than a hospital) can be treated with an antibiotic without patients first receiving a diagnostic test. But all too often, the cause of a patient’s symptoms is not bacterial and may not even be an infection. In these cases, taking an antibiotic will do no good and may even be harmful. Possible nonbacterial causes include a viral infection (which will not respond to an antibiotic), a connective tissue disorder or an allergy, Dr. Edson said. He and his co-authors emphasized the importance of getting a laboratory to identify the responsible organism when the likely cause of symptoms is not apparent or when patients have a serious or life-threatening infection, require long-term antibiotic therapy or fail to benefit from the drug chosen initially. Sometimes a culture will indicate the need to administer two antibiotics simultaneously — for example, when the infectious organism produces an enzyme that inactivates what would otherwise be the most effective antibacterial drug. The experts also urged that if patients were first treated with a broad-spectrum antibiotic (one that attacks a number of different bacteria), doctors should consider switching to a narrow-spectrum drug that targets the specific cause once it is identified through a laboratory culture. This could reduce the risk of other bacteria becoming resistant to the broad-spectrum drug.

Really?: The Claim: Eating Flaxseed Can Help Relieve Hot Flashes Posted: 21 Mar 2011 10:31 PM PDT THE FACTS Enlarge This Image Christoph Niemann Well Share your thoughts on this column at the Well blog. Go to Well » Related More Really? Columns With so many questions surrounding hormone replacement therapy, alternative remedies for hot flashes have become increasingly popular. But few if any have solid scientific weight behind them, and flaxseed supplements appear to be no exception. Flaxseed contains lignans, estrogenlike compounds that in theory might ease hot flashes just as hormone therapy does. High in fiber, omega-3 fatty acids and other nutrients, the seeds are often ground up and sold in powder form for easier digestion. In one study at the Mayo Clinic, researchers looked at the effectiveness of flaxseed by recruiting a group of 30 women who had been having more than a dozen hot flashes per week and were not taking estrogen. For the first week, the women were simply told to keep diaries detailing their hot flashes and quality of life. Then, they were given ground flaxseed and told to mix two tablespoons into juice, yogurt or fruit twice a day for six weeks. At the end of the study, the women reported a drop in the frequency and intensity of their hot flashes. But many experienced bloating and other gastrointestinal side effects. Researchers at the University of Calgary studied what happened when women experiencing hot flashes began eating foods with large amounts of ground flaxseed, soy flour or a placebo. After 16 weeks, they found that neither flaxseed nor soy had any significant effect on their symptoms. THE BOTTOM LINE Studies have not borne out the effectiveness of flaxseed to ease hot flashes. scitimes@nytimes.com

Q & A: Behind the Mask Posted: 21 Mar 2011 09:20 PM PDT Q. Does wearing surgical masks reduce the spread of illnesses? Enlarge This Image Victoria Roberts Related More Q & A Columns RSS Feed Get Science News From The New York Times » A. Sometimes. “Several studies have shown that masks can reduce the amount of infectious particles shed into the air while coughing, talking and breathing when someone has an infection of the respiratory tract,” said David P. Calfee, chief hospital epidemiologist at NewYork-Presbyterian/Weill Cornell Medical Center. But he called masks only one component of respiratory hygiene, which also includes covering the mouth and nose when coughing or sneezing; frequent hand-washing; and keeping three feet away from others when possible. While the evidence does suggest that a mask may protect others from the wearer, can a mask protect the wearer? Dr. Calfee says it depends on what you are trying to protect yourself against. Masks prevent larger respiratory droplets from reaching the mucous membranes, and so have long been used by people caring for patients with infectious diseases transmitted by large droplets, including influenza and whooping cough. But the smaller airborne particles associated with certain diseases, like tuberculosis and measles, can pass through or around masks. A few studies have shown lower infection rates among household contacts of people with respiratory virus infections when using masks, Dr. Calfee said. But some studies found that most people could not wear a mask for long periods. So even if it is proved effective, a mask may not be very practical. 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

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Recipes for Health: A Better Way to Serve Eggs Posted: 22 Mar 2011 12:35 PM PDT I teach a class in knife skills for home cooks in Los Angeles. The students aren’t expected to wield their blades like Top Chefs, but my fellow instructor, Clifford A. Wright, and I do have them chop, slice, mince and dice often enough to become comfortable in front of a cutting board. 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. At the end of the class, we usually end up with several pounds of chopped vegetables on hand. A few weeks ago, after dividing up the spoils, my onions, peppers, carrots, zucchini and leeks found their way into frittatas. These flat omelets, which can be eaten hot or cold and pack well in a lunchbox, are a perfect destination for all sorts of vegetables. If you avoid eggs because you think they’re bad for you, you should reconsider. It was never clear that dietary cholesterol had a significant impact on heart health; saturated fat in the diet is thought to be a bigger culprit (how big is also a matter of dispute these days). The government’s new dietary guidelines acknowledge as much, advising that eating an egg every day will not affect blood cholesterol or cardiovascular health. Try to find eggs that are not produced en masse by caged chickens. Healthier cage-free chickens produce yellower, more flavorful eggs, and your frittatas will be better for using them. Onion and Thyme Frittata This recipe is an adaptation of a Provençal frittata that agricultural workers traditionally carried to the fields for the midmorning repast. The French call it the “harvest omelet.” 3 cups finely chopped onion (slightly more than 1 pound onions) 1 tablespoon red wine vinegar or sherry vinegar 3 tablespoons extra virgin olive oil Salt to taste 2 garlic cloves, minced 1 tablespoon fresh thyme leaves 8 eggs Salt and freshly ground pepper 2 tablespoons low-fat milk 1. Place the chopped onions in a bowl, cover with water and add the vinegar. Soak for one hour or longer. Drain, rinse and dry on paper towels. (Note: This step is optional, but the onions will be milder if you do it.) 2. Heat 2 tablespoons of the oil over medium heat in a 10-inch heavy nonstick skillet. Add the onions. Cook, stirring often, until tender, about five minutes. Add a generous pinch of salt, the garlic and the thyme. Continue to cook, stirring often, until the onions are lightly colored but not browned, about five more minutes. Remove from the heat, and allow to cool slightly. 3. Beat the eggs in a large bowl. Stir in the salt (about 1/2 teaspoon), pepper, milk and onions. Clean and dry the pan. Return to the burner, and set on medium-high. Heat the remaining tablespoon of olive oil in the skillet. Drop a bit of egg into the pan; if it sizzles and cooks at once, the pan is ready. Pour in the egg mixture. Tilt the pan to distribute the eggs and filling evenly over the surface. Shake the pan gently, tilting it slightly with one hand while lifting up the edges of the frittata with the spatula in your other hand, to let the eggs run underneath during the first few minutes of cooking. 4. Turn the heat down to low, cover and cook 10 minutes, shaking the pan gently every once in a while. From time to time, remove the lid, tilt the pan and loosen the bottom of the frittata with a wooden spatula so that it doesn’t burn. It should turn a golden color. The eggs should be just about set; cook a few minutes longer if they’re not. 5. Meanwhile, heat the broiler. Uncover the pan, and place it under the broiler, not too close to the heat, for one to three minutes. Watch very carefully to make sure the top doesn’t burn (at most, it should brown very slightly and puff under the broiler). Remove from the heat, and shake the pan to make sure the frittata isn’t sticking. Allow it to cool for at least five minutes and for as long as 15 minutes. Loosen the edges with a wooden or plastic spatula. Carefully slide from the pan onto a large round platter. Cut into wedges or into smaller bite-size diamonds. Serve hot, warm, at room temperature or cold. Yield: Six servings. Note: For four servings, use the same recipe but reduce the number of eggs to six. Advance preparation: In Mediterranean countries, flat omelets are served at room temperature, which makes them perfect do-ahead dishes. They’ll keep in the refrigerator for a few days, and they make terrific lunchbox fare. They do not reheat well. Nutritional information per serving: 191 calories; 3 grams saturated fat; 2 grams polyunsaturated fat; 7 grams monounsaturated fat; 248 milligrams cholesterol; 9 grams carbohydrates; 1 gram dietary fiber; 101 milligrams sodium (does not include salt to taste); 10 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

S.D. Requires Visit to Pregnancy Center Before Abortion Posted: 22 Mar 2011 11:00 AM PDT The sign out front of the old abortion center advertises free pregnancy tests, information about abortion and testing for sexually transmitted diseases, but it has been years since Planned Parenthood occupied this building in Sioux Falls, S.D. Related Times Topic: Abortion Instead, it is home to the Alpha Center, one of a growing number of organizations dedicated to encouraging women to bring their babies to term. As the choice of location and the vaguely worded sign might suggest, these centers have often used confusion as a way to draw in women seeking abortions so they can try to change their minds. Now such visits will be obligatory in South Dakota. A law signed by Gov. Dennis Daugaard on Tuesday makes the state the first to require women who are seeking abortions to first attend a consultation at one of these centers, to learn what assistance is available “to help the mother keep and care for her child.” The legislation, which passed easily in a state Legislature where Republicans outnumber Democrats by more than 3 to 1, also establishes the nation’s longest waiting period — three days — after an initial visit with an abortion provider before the procedure can be done. It makes no exceptions for cases of rape or incest. Many states require counseling from doctors or other clinic staff members before an abortion to cover topics like health risks. What makes the new South Dakota law different is that the mandated counseling will come from people whose central qualification is that they are opposed to abortion. “I think everyone agrees with the goal of reducing abortion by encouraging consideration of other alternatives,” Mr. Daugaard, a Republican, said in a statement Tuesday. The law has provoked vehement opposition from supporters of abortion rights, both locally and nationally, who describe the requirements as unconstitutional obstacles for women seeking to have an abortion. Planned Parenthood said it would challenge the law in court, which is scheduled to take effect July 1. Peggy Gibson, a Democratic state representative who voted against the measure, said the law amounted to “government intrusion into people’s medical decisions.” “South Dakota women should not need to submit to an in-person lecture from an unqualified, noncertified, faith-based counselor or volunteer at an antichoice crisis pregnancy center,” Ms. Gibson said. In statehouses around the country, Republicans have used their success in the midterm elections in November to push bills aimed at reducing abortions. More than half the states have introduced such legislation, including restricting health insurance coverage for abortion, requiring women to receive an ultrasound before an abortion, and banning abortion after 20 weeks, said Elizabeth Nash, who tracks abortion legislation for the Guttmacher Institute, a research organization. The South Dakota legislation, known as HB 1217, is the most far-reaching of the bills to become law, Ms. Nash said. Despite an abortion rate that is among the lowest in the nation, the state has become a battleground over the issue in recent years, with the Legislature passing a number of laws aimed at curbing abortions, some of which have been overturned by the courts and by voters in two ballot referendums. Those laws that remain are already restrictive by national standards. The state, for example, requires a one-day waiting period as well as some counseling from clinic staff, mandating that women be told that an abortion “will terminate the life of a whole, separate, unique living human being.” Requiring visits to “pregnancy help” centers is a significant tactical shift among opponents of abortion. Such centers — both secular and religiously affiliated — are eligible to provide counseling services under the law as long as their main mission is to “educate, counsel and otherwise assist women to help them maintain their relationship with their unborn children.” “There’s greater assurance that a woman considering an abortion is going to be fully informed about all the risks and about all the options,” said Roger Hunt, a Republican legislator who wrote the bill. “That’s not being done at the current time.” The law appears likely to escalate the tensions between abortion providers and the “pregnancy help” centers, which often operate in close proximity and are listed alongside each other in the phonebook under abortion. Each side regularly accuses the other of manipulating and coercing women. Leslee Unruh, the founder of the Alpha Center and a leader of antiabortion efforts, said that counseling sessions at her clinic would ensure that women were not being pressured into a decision by a boyfriend, husband or parents. The center already provides counseling sessions to women who regret the decision to have an abortion. She was dismissive of any opposition to the law, saying that women remained free to have an abortion if they chose to. “What are they so afraid of?” Ms. Unruh asked. “That women might change their minds?” The nearby Planned Parenthood clinic is the sole provider of nonemergency abortions in the state and has found no local doctors willing to perform them, so doctors are flown in each week from Minnesota. Patients often have to drive hours across the state to seek an abortion, so under the new law they would need to make several trips or find a place to stay for the three-day waiting period. Sarah Stoesz, president of the local Planned Parenthood chapter, said that the clinic was careful to ensure that patients were making the decision themselves, sometimes turning away a woman who appeared to be making the decision under pressure. In contrast, she said, employees at the “pregnancy help” centers have a record of providing misinformation about the physical and psychological risks associated with the procedure and use tactics like displaying graphic photos or quoting scripture in order to influence a woman’s decision. “They’re not licensed, they’re not regulated, they’re not accredited and they’re openly ideological,” Ms. Stoesz said. “The idea that they are being legally mandated to be coerced by people who aren’t even medical professionals — not that they should be coerced by anyone — is really beyond the pale.”

Trial to Open in Lawsuit Connected to Hospital Deaths After Katrina Posted: 20 Mar 2011 10:30 PM PDT A jury trial set to open on Monday will weigh whether one of America’s largest health care corporations should be held accountable for deaths and injuries at a New Orleans hospital marooned by floodwaters after Hurricane Katrina. Enlarge This Image Brad Loper/The Dallas Morning News, via Associated Press Patients awaited evacuation at Memorial Medical Center following Katrina. A high death rate after the storm raised many questions. Related The Deadly Choices at Memorial (August 30, 2009) Times Topic: Hurricane Katrina Enlarge This Image Brad Loper/The Dallas Morning News, via Associated Press Moving patients to the helipad at Memorial Medical Center after Hurricane Katrina. The class-action suit is expected to highlight desperate e-mail exchanges, not previously made public, between the hospital and its corporate parent. “Are you telling us we are on our own and you cannot help?” Sandra Cordray, a communications manager at Memorial Medical Center, which sheltered some 1,800 people, wrote to officials at the Tenet Healthcare Corporation’s Dallas headquarters after begging them for supplies and an airlift. The suit, brought on behalf of people who were at the hospital during the disaster, alleges that insufficiencies in Memorial’s backup electrical system and failed plans for patient care and evacuation, among other factors, caused personal injury and death. The complaint also focuses attention on the lack of comprehensive emergency preparedness requirements for the nation’s hospitals. Proposed regulations aimed at addressing “systemic gaps” identified after Katrina were scheduled for release by the federal Centers for Medicare and Medicaid Services in January, but have been delayed. President Obama’s budget proposal trims spending on a national hospital preparedness program by $42 million, or about 10 percent from current levels. The bodies of 45 patients were discovered at Memorial Medical Center after the August 2005 storm, far more than at any other hospital, and some doctors subsequently acknowledged that they had injected patients with drugs to hasten their deaths. No criminal charges were brought. Last year, a relative of a patient who died filed a civil claim of euthanasia against a Memorial doctor. It was dismissed and is on appeal. Staff members at Memorial said they did their best in the face of inhuman conditions. “The doctors didn’t create that environment. The hospital created that environment,” said Joseph M. Bruno, one of the lead lawyers for the class-action plaintiffs. He said no physicians had opted out of the class and some might testify at the trial in New Orleans. The hospital and Tenet deny the allegations. “We are confident that in the end, the evidence will show that Memorial Medical Center and its staff and physicians acted heroically in the face of such a tragic situation,” Rick Black, Tenet’s director of communications, said in a statement. Lawyers for Tenet and Memorial have lined up experts to testify that the city’s failed levees, a chaotic government response and the huge hurricane are what created the deadly environment. Plaintiffs’ lawyers have moved to exclude all such evidence from consideration, arguing that it is irrelevant to the duty the hospital had to its patients. One issue almost certain to figure in the trial is the extent to which executives at Memorial and other hospitals understood the possible dangers of flooding. It has been previously reported that Memorial did not act on a 2004 recommendation to move components of its electrical system above the ground floor. New documents raise questions about whether design, maintenance or other factors led to the total failure of backup power after the floodwaters rose. Even before all power was lost, Memorial’s air-conditioning shut down, by design. American hospitals are required to maintain emergency power systems, but they do not have to support air-conditioning or heating. According to employees, temperatures inside Memorial soon rose to over 100 degrees, threatening older patients in particular. Among them was 70-year-old Leon Preston, an amputee who died at Memorial and whose family’s case is part of the lawsuit. Memorial’s hurricane plan assumed that backup power would function for at least three days, but the system failed in less than two. At least some hospital employees were aware that the system would be at risk in a flood. Memorial’s director of plant operations learned from the Army Corps of Engineers in 2004 that the hospital could be surrounded by 12 to 15 feet of water after a major hurricane. The director, Eric Yancovich, who also served as safety officer, recommended raising basement and ground-level emergency power transfer switches and the pumps that supplied most of the hospital with medical air and vacuum suction — needed by patients with respiratory problems. A partial bid for the electrical work came to more than a quarter of a million dollars. “Due to the lack of capital, I don’t anticipate anything being approved right now,” Mr. Yancovich concluded in a memo to his supervisor. “I’ll keep it on file for future consideration.” Given these vulnerabilities, the hospital should have warned patients and visitors away before the hurricane, according to Mr. Bruno, the plaintiffs’ lawyer. “Fundamentally, they could have told their patients: ‘It’s not safe for you. Go.’ ” 1 2 Next Page » Sheri Fink, a physician, is a contributor to ProPublica, the independent nonprofit investigative organization. More material can be found at ProPublica.org.

Health Law Waivers Draw Kudos, and Criticism Posted: 21 Mar 2011 11:20 AM PDT WASHINGTON — Obama administration officials say they were expecting praise from critics of the new health care law when they offered to exempt selected employers and labor unions from a requirement to provide at least $750,000 in coverage to each person in their health insurance plans this year. Enlarge This Image Doug Mills/The New York Times President Obama after speaking about health care to a joint session of Congress in 2009. Multimedia Interactive Feature A History of Overhauling Health Care Related Times Topic: Health Care Reform Instead, Republicans have seized on the waivers as just more evidence that the law is fundamentally flawed because, they say, it requires so many exceptions. To date, for example, the administration has relaxed the $750,000 standard for more than 1,000 health plans covering 2.6 million people. The waivers have become a flash point as supporters and opponents try to shape public perceptions of the law, the Affordable Care Act, signed by President Obama last March 23. Administration officials, labor unions and consumer advocates plan to celebrate the first anniversary with a week of events highlighting benefits of the law to consumers. But Senator Michael B. Enzi of Wyoming, the senior Republican on the Senate health committee, asked, “If the law is so good, why are so many waivers needed?” Waivers are usually seen as a way to deal with exceptional circumstances in which the enforcement of a law or policy might cause hardship. But with the new health care law, exceptions like these have become increasingly common. They provide wiggle room in a law originally thought to be strict and demanding. Maine has just won a three-year reprieve from a provision of the law stipulating that insurers selling coverage to individuals and families must spend at least 80 percent of premium revenues on medical care and efforts to improve it. The White House had described this as one of the law’s most beneficial provisions, guaranteeing that consumers would get “more value for your dollars.” The Obama administration lowered the requirement to 65 percent for Maine, after finding “a reasonable likelihood” that the tougher standard would drive one big carrier out of the market for individuals, leaving thousands without insurance. Five other states — Florida, Georgia, Kentucky, Nevada and New Hampshire — have requested similar waivers, and at least a dozen other states are considering whether to apply. President Obama recently embraced legislation that would let states opt out of the law’s most contentious provisions, including a requirement for most Americans to carry insurance, if the states come up with alternatives that cover at least as many people. And Representative Mike Rogers, Republican of Michigan, has introduced a bill that would allow people to seek exemptions from major provisions of the law if they could show they would be harmed. Under the law and rules issued by the administration, health plans this year must generally provide at least $750,000 in annual coverage for essential benefits like hospital care, doctors’ services and prescription drugs. The government may grant a one-year exemption from the requirement if it is shown that compliance would cause a significant increase in premiums or a significant decrease in access to benefits. Such waivers have gone to entities as diverse as the Waffle House and Ruby Tuesday, health plans run by Aetna and Cigna, and labor unions representing Teamsters, electrical workers, plumbers, carpenters and food and commercial workers. Administration officials said the waivers showed a pragmatic, flexible approach to carrying out the law. Without the waivers, said Kathleen Sebelius, the secretary of health and human services, many employers would have increased premiums, and some would have dropped coverage altogether. Edmund F. Haislmaier, a health policy expert at the conservative Heritage Foundation, said the waivers “result in unequal application of the law and create a temptation to engage in political favoritism.” Republicans like Representative Darrell Issa of California said that in granting waivers, the administration had favored political allies, including labor unions. Tom Leibfried, a lobbyist for the A.F.L.-C.I.O., said: “This is just union bashing. The numbers do not show a pro-union bias.” Mr. Leibfried said some union health plans had a legitimate need for waivers because they had annual coverage limits lower than $750,000. If they had to increase coverage to that level, he said, they would incur significant new costs. But, Mr. Leibfried said, the main source of financing for such health plans — employer contributions — will not immediately increase because they are set by collective bargaining agreements, which are typically in effect for several years. Steven B. Larsen, director of the federal Center for Consumer Information and Insurance Oversight, which carries out many of the health law’s provisions, said the waivers provided a “bridge to 2014,” when more affordable insurance options should be available. He denied that unions had received “special treatment.” Indeed, he said, the center has granted waivers to 94 percent of all applicants. 1 2 Next Page »

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