Monday, March 28, 2011

Health - Pretty Patterns That Camouflage a Poison

Health - Pretty Patterns That Camouflage a Poison

Pretty Patterns That Camouflage a Poison

Posted: 28 Mar 2011 11:52 AM PDT

When Dr. Gerald F. O’Malley began work last summer in the department of emergency medicine at Jefferson Medical College in Philadelphia, he took a walk around nearby Chinatown and noticed the variety of elaborately adorned pottery for sale.

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From a previous posting in Colorado, he knew that colorful Mexican ceramics were a significant source of lead contamination. He wondered if the same held true with the pottery in Philadelphia’s Chinatown.

The answer, he and a group of researchers has found, is yes. While the ceramics’ sources are not yet known — and neither is the extent of their distribution — the contamination that Dr. O’Malley and his group found in the cooking and eating utensils appeared to be severe enough to cause health problems.

“What we’ve demonstrated is that there’s a problem in Philadelphia’s Chinatown,” Dr. O’Malley said. “We’ve conclusively shown that. If it’s happening in Philadelphia, it’s happening in other Chinatowns in other cities.”

To do the research, Dr. O’Malley, 48, enlisted four medical students and a colleague, Dr. Thomas J. Gilmore, a second-year resident at Jefferson, to buy pottery samples and test them. They wound up with a collection sold at 32 locations, with 87 pieces bought in Chinatown and 49 in nearby neighborhoods.

Using a screening device commonly used for paint, the researchers examined each piece for lead content. More than a quarter of the samples tested positive.

Then Dr. O’Malley’s team performed additional laboratory tests on 25 of the pieces to confirm the findings, establish the degree of contamination and determine if the lead is leachable — that is, if it could be ingested along with food. Three plates and two spoons were found to be leaching lead in quantities that far exceeded the limits set by the Food and Drug Administration. One of the plates leached lead at more than 145 parts per million. The agency’s limit is 2 parts per million.

Dr. O’Malley and his group have sent their data to the F.D.A., and Michael E. Kashtock, a consumer safety officer at the agency, confirmed that he had received the information.

“We collect our own samples and do our own testing,” Dr. Kashtock said. “We have to have complete confidence that the test results we have are fully defensible if any kind of administrative proceeding arises. We’re in the process of following up.”

Dr. Gilmore said the agency had been “very open and helpful, and I fully expect them to do the right thing.”

He emphasized that the stores were not at fault. “The vendors should have the assurance that they’re buying from sources who are in compliance,” he said. “The vendors are getting bad press here, but we want them to be helped by this, not hurt. I’m hoping that the F.D.A. will do a formal investigation and in the end track this to the source.”

Dr. O’Malley has his own plans for follow-up. He will ask patients to bring their utensils to his clinic for testing. If they come up positive for lead, he will test the patients’ blood levels.

“As far as I know,” he said, “there’s no study that’s looked at whether there’s a correlation between eating utensils and elevated lead levels in blood.”

The American Academy of Pediatrics generally recommends that children be tested twice for lead before age 2, with some variations depending on local conditions. Dr. O’Malley said he was concerned that he was working with a population that was not being screened at all.

“If you have 4- or 5-year-old kids eating with these utensils, or a pregnant woman, they’re ingesting lead with them,” he said. “No one’s really looking at these patients.”

A Century Later, Jury’s Still Out on Caffeine Limits

Posted: 28 Mar 2011 12:19 PM PDT

The latest skirmish in the caffeine wars — this one involving the high levels of caffeine in so-called energy drinks, especially those consumed by children — recalls one of the earliest.

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PRECEDENT The 1885 label of a drink made by the inventor of Coca-Cola.

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It happened a century ago this month, in a courtroom in Chattanooga, Tenn. The trial grabbed headlines for weeks and produced scientific research that holds up to this day — yet generated no federal limits for caffeine in foods and beverages.

Those levels remain virtually unregulated today. As two researchers recently wrote in The Journal of the American Medical Association, nonalcoholic energy drinks “might pose just as great a threat to individual and public health and safety” as alcoholic ones, and “more research that can guide actions of regulatory agencies is needed.”

Nobody used the term “energy drink” in 1911, but the drink that was on trial in Chattanooga contained as much caffeine as a modern Red Bull — 80 milligrams per serving.

The drink was Coca-Cola. Harvey Washington Wiley, the “crusading chemist” who led the Bureau of Chemistry in the United States Department of Agriculture, had brought a lawsuit against the Coca-Cola Company, accusing it of adulterating the drink by adding a harmful ingredient: caffeine. (Current levels of caffeine in a Coke are much lower.)

Preparing its defense, the company found a gap in the existing research on caffeine. “When their scientists took a look at the data, they had all of these animal studies, and didn’t really have the human data they needed,” said Ludy T. Benjamin Jr., a professor of psychology at Texas A & M University who has studied the trial. “So they were looking for someone to come up with some human data, and in a hurry.”

Coca-Cola hired a Barnard College psychology instructor named Harry Levi Hollingworth. He mustered 16 subjects aged 19 to 39, including occasional, moderate and regular caffeine users, along with abstainers. In a Manhattan apartment rented for the research, he tested their mental and motor skills under varying levels of caffeine use and abstinence. They took caffeine capsules and placebos — double blinded, so neither they nor the researcher knew which was which — and “soda fountain” drinks with and without caffeine. The trial looming, Hollingworth did it all in just 40 days.

The subjects kept good notes. On Feb. 22, a regular user was caffeine-free: “Felt like a ‘bone head’ all day. My head was dull more than usual.” On Feb. 25, an abstainer was dosed with four grains of caffeine (260 milligrams, the approximate equivalent of a 12-ounce cup of Starbucks coffee): “Gradual rise of spirits till 4:00. Then a period of exuberance, of good feeling. Fanciful ideas rampant.”

Hollingworth found that moderate doses of caffeine stimulated his subjects’ performance on an array of tests, though some slept poorly after the highest doses. His appearance on March 27, 1911, was a high point in a four-week trial dominated by anecdotal, contradictory or sloppy testimony.

“His testimony was by far the most interesting and technical of any yet introduced,” The Chattanooga Daily Times reported. But the jury never issued a verdict based on the science, because a week later the judge granted Coca-Cola’s motion to dismiss. (After years of appeals, the case was settled with a no-contest plea.)

Hollingworth compiled his studies in a 1912 book that used a contemporary spelling for the substance: “The Influence of Caffein on Mental and Motor Efficiency.” An editorial in The Journal of the American Medical Association that year welcomed the research: “It is gratifying to have the effects on the human system of a drug like caffeine so investigated by rigorous scientific tests at the hands of capable investigators; only in this way will there be provided an adequate basis for correct conclusions as to the possible dangers of the use of caffeine-containing beverages.”

Writing in the same journal last month, the two researchers, Amelia Arria of the University of Maryland and Dr. Mary Claire O’Brien of Wake Forest University cited concerns about energy drinks’ effects on sleep, blood pressure and patterns of addiction, and their use in cocktails. “More research is needed in particular to guide the decision making of regulatory agencies related to placing a scientifically validated upper limit on the amount of caffeine a manufacturer can include in a single serving of any beverage,” they wrote.

Because the Chattanooga case was dismissed, the jury issued no verdict on the larger questions argued in the courtroom: How much caffeine is too much? Is it different when added to soft drinks than as a natural constituent of coffee? Is it habit-forming? Should it be marketed to youths? And how should the federal government regulate it?

Facing a new generation of beverages with higher caffeine concentrations, larger sizes and more complex formulas than the Coca-Cola of 1911, Americans are debating the same questions today. “I don’t know if Hollingworth would be surprised,” Dr. Benjamin said, “but I’ll bet he’d be amused about it.”

Books: Defending Vaccination Once Again, With Feeling

Posted: 28 Mar 2011 12:26 PM PDT

Does the reading public really need yet one more rundown of the repeatedly debunked claims linking childhood vaccinations and autism? The positions of those who uphold vaccine safety and those who assail it have at this point thoroughly saturated the news media; what more is there to say?

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Or so I thought before opening Seth Mnookin’s new book. Barely a dozen pages in, I began to reconsider, and by the end I had completely changed my mind: Mr. Mnookin’s passionate defense of vaccination may be just what the public needs, in equal parts because of what it says and because of who is saying it.

Mr. Mnookin is no expert in the field — at least he wasn’t when he entered the fray. Neither a doctor nor a scientist, he has no vested interest in upholding the medical status quo (thus avoiding an accusation regularly flung at vaccine proponents). He hails instead from what might be called, sadly enough, exactly the opposite demographic: he is young and hip, got a good liberal arts education, lives in an upscale enclave and works in another, as a contributing editor of Vanity Fair. He is the father of a young child.

And it is people of precisely this description who are slowly picking apart the safety net that protected their own childhoods, prompted by a well-intentioned mixture of arrogance, ignorance and confusion.

It is not that these parents buy into some of the more lurid accusations out there, like the one floated by a British doctor that all pediatric vaccinations cause some degree of neurologic damage. It is more that the parents are alarmed by the hubbub and prefer to play it safe — but wind up defining “safe” in exactly the wrong way. In some communities nonvaccination rates have hit the double digits — well into the danger zone.

Expert opinion seems to have oddly little influence over these parents, but perhaps an analysis by a peer, rather than an expert, will change some minds. It certainly doesn’t hurt that Mr. Mnookin has put it all together in a readable narrative encompassing celebrity high jinks worthy of Vanity Fair at its snarkiest.

But those come at the end. Mr. Mnookin doggedly begins at the very beginning, with the first vaccine consisting of fresh smallpox pus. Subsequent vaccines were refined, first with the use of less dangerous germs and then with noninfectious germ fragments. The first great triumph of mass vaccination, the Salk polio vaccine, made its debut in 1954, promptly followed by the first great vaccine-associated disaster: a sloppily made batch that paralyzed several dozen children in California.

One shudders to think of the fallout from such an event today, but back in the ’50s parents were still familiar with the toll of childhood diseases, and vaccine momentum barely stumbled. Now, Mr. Mnookin reflects, cases of vaccine-preventable disease have become so uncommon that in 2003 one desperately ill infant (too young to be vaccinated) managed to cough the unmistakable “whoop” of whooping cough in the faces of dozens of baffled medical professionals before the disease was correctly diagnosed — too late to save her life.

Autism, meanwhile, was first named during World War II, and since then rates have skyrocketed. The first to claim a vaccine-autism link was a British physician named Andrew Wakefield, in a small study published in 1998. Dr. Wakefield ultimately lost his medical license for a variety of misbehaviors, and this flagship study, under investigation for years, was formally discredited several months ago.

Dr. Wakefield held that measles virus from the measles-mumps-rubella vaccine spread through the intestinal tracts of vulnerable children and then caused brain damage. Meanwhile, separate speculation focused on the mercury-based preservative thimerosal (used not in the M.M.R. but in other vaccines up until 2003); the idea here was that toxic mercury levels damaged the brain. Neither notion has stood up to careful analysis, and studies have repeatedly failed to confirm any clear association between these vaccinations and autism.

Mr. Mnookin traces out all these separate threads (with the footnotes of a true scholar), even venturing away from the tangle long enough to explain how scientists are trained to think about causation and how profoundly this measured approach is bound to infuriate a distraught parent with a suddenly altered child.

But he really hits his stride when he turns to the social history of autism advocacy; his section on the actress Jenny McCarthy is a tour de force. To promote her 2007 book describing the purported vaccine-induced autism of her young son and his subsequent cure, Ms. McCarthy staged a media blitz, a medical tent show writ large. Blond and charismatic, she waved away the science, energized the people who wanted to believe her message (the not inconsiderable “I feel, therefore it is” segment of our society, as Mr. Mnookin puts it) and managed to do quite nicely for herself as well, netting a deal with Oprah Winfrey’s production company.

I suspect that it was never among Mr. Mnookin’s goals in life to become the de facto sparring partner of such an individual, but this book sealed his fate, and he has acquitted himself nobly. Parents who want to play it safe, but are not altogether sure how, should turn with relief to this reasoned, logical and comprehensive analysis of the facts.

Scientist at Work: Countering Radiation Fears With Just the Facts

Posted: 28 Mar 2011 12:30 PM PDT

As soon as David J. Brenner heard about the undersea earthquake and subsequent tsunami that devastated northern Japan on March 11, he checked a map of the region’s nuclear power plants. One, because of its coastal location and reactor design, looked particularly vulnerable: Fukushima Daiichi. He hoped he was wrong.

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Béatrice de Géa for The New York Times

Dr. David J. Brenner focuses on developing mechanistic models for the effects of ionizing radiation on living systems.

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Less than a day later, ominous reports of failed cooling systems and radiation leaks at that plant began to emerge. Dr. Brenner, director of the Center for Radiological Research at Columbia University — the oldest and largest such center in the world — found himself called on repeatedly to explain what was happening with the failed reactors and to assess the radiation risk to public health, both in Japan and around the world.

Dr. Brenner, 57, a native of Liverpool, England, is a physicist who has spent his career studying the effects of radiation on human health. He has published research showing that CT scans increase the cancer risk in children, and he recently testified before Congress, saying that the widespread use of whole-body X-ray scanners at airports would produce 100 extra cases of cancer each year in the United States.

He thinks CT scanners and the people who use them need more regulation to make sure the scans are medically needed and the doses of radiation as low as possible. He believes that even low doses increase the risk of cancer, and that there is no “safe” level or threshold below which the risk does not rise — even if that risk cannot be measured statistically.

But for all his concern about potential harm from radiation, he does not foresee a public health disaster resulting from the crisis at Fukushima Daiichi.

From the start, he has spoken with a scientist’s caution, respect for facts and numbers, and keen appreciation of how much is simply not known or, at this point, even knowable. The situation changes constantly, and the path to the truth can be dicey, twisting through parties with passionate agendas for or against nuclear power, information meted out by government and industry, and public fears of radiation that many scientists consider wildly exaggerated.

How to explain the facts without scaring people needlessly? How to reassure without seeming to sugar-coat or patronize? The last thing people want, Dr. Brenner said, is a guy like him in a white coat on TV smugly telling them everything is fine.

“People are very worried, which is not surprising,” he said. “We want people to be able to make some kind of realistic assessment.”

In the week or so after the earthquake, he did about 30 interviews with reporters, he said, “some good, some dreadful.”

Some interviewers tried to push him to say the danger was much greater than he believed it to be. He resisted, and canceled one appearance when he realized that the host group had a strong anti-nuclear agenda.

“I try to keep my political views separate from my academic life,” he said.

Asked whether he was for or against nuclear power, he paused, then said, “I think there is a role for safe nuclear power.”

From the beginning of the troubles at Fukushima Daiichi, he has said that the Japanese plant is not, and will not become, Chernobyl. The Soviet reactor, which had no real containment structure, blew up in 1986 and spewed its contents far and wide. The Japanese reactors, though damaged, do have containment vessels, and the government acted quickly to evacuate people from the areas around the plant.

But he thinks the events in Japan should be a call to action for the United States. “This country and Japan have a fleet of aging nuclear reactors,” he said.

Early on, Dr. Brenner said that Fukushima Daiichi would probably turn out to be similar to the 1979 Three Mile Island accident in the United States, which has never been found to have effects on public health. As conditions deteriorated at the Japanese plant, he said he thought the outcome would be somewhat worse than that at Three Mile Island, but not much worse.

But he expects cases of radiation sickness among the workers at the contaminated plant, and, he added, “I fear there will be fatalities.”

He said it was possible that there would be some cases of thyroid cancer — probably too few to prove a connection statistically — years from now among people exposed as children to milk, water or produce contaminated with radioactive iodine.

So far, it seems unlikely that the accident will create a vast uninhabitable zone in Japan like the one that Chernobyl left in what is now Ukraine, Dr. Brenner said. Extensive fallout of radioactive cesium occurred at Chernobyl, and it takes many years to decay to safe levels. That kind of fallout has not occurred in Japan.

Delving Into the Minds of Dictators

Posted: 28 Mar 2011 11:04 AM PDT

He is a delusional narcissist who will fight until his last breath. Or an impulsive showman who will hop the next flight out of town when cornered. Or maybe he’s a psychopath, a coldly calculating strategist — crazy, like a desert fox.

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Col. Muammar el-Qaddafi, the Libyan leader, sounds very certain, if not always coherent. More Photos »

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The endgame in Libya is likely to turn in large part on the instincts of Col. Muammar el-Qaddafi, and any insight into those instincts would be enormously valuable to policy makers. Journalists have formed their impressions from anecdotes, or from his actions in the past; others have seized on his recent tirades about Al Qaeda and President Obama.

But at least one group has tried to construct a profile based on scientific methods, and its conclusions are the ones most likely to affect American policy. For decades, analysts at the Central Intelligence Agency and the Department of Defense have compiled psychological assessments of hostile leaders like Colonel Qaddafi, Kim Jong-il of North Korea and President Hugo Chávez of Venezuela, as well as allies, potential successors and other prominent officials. (Many foreign governments do the same, of course.)

Diplomats, military strategists and even presidents have drawn on those profiles to inform their decisions — in some cases to their benefit, in other cases at a cost.

The political profile “is perhaps most important in cases where you have a leader who dominates the society, who can act virtually without constraint,” said Dr. Jerrold Post, a psychiatrist who directs the political psychology program at George Washington University and founded the C.I.A. branch that does behavioral analysis. “And that has been the case here, with Qaddafi and Libya.”

The official dossiers are classified. But the methods are well known. Civilian psychologists have developed many of the techniques, drawing mostly on public information about a given leader: speeches, writings, biographical facts, observable behavior. The resulting forecasts suggest that “at-a-distance profiling,” as it is known, is still more an art than a science. So in a crisis like the one in Libya, it is crucial to know the assessments’ potential value and real limitations.

“Expert profilers are better at predicting behavior than a blindfolded chimpanzee, all right, but the difference is not as large as you’d hope it would be,” said Philip Tetlock, a psychologist at the Wharton School of the University of Pennsylvania and the author of “Expert Political Judgment: How Good Is It? How Can We Know?” (Princeton University, 2006), who has done profiling of his own. “There’s no secret sauce, and my impression is that often the process can be rushed,” as a leader suddenly becomes a person of intense interest.

The method with the longest track record is modeled on clinical case studies, the psychobiographies that therapists create when making a diagnosis, citing influences going back to the sandbox. The first one on record, commissioned in the early 1940s by the Office of Strategic Services, the predecessor to the C.I.A., was of Adolf Hitler; in it, the Harvard personality specialist Henry A. Murray speculated freely and luridly about Hitler’s “infinite self-abasement,” “homosexual panic” and Oedipal tendencies.

Analysts still use this clinical-case approach but now ground it far more firmly in biographical facts than on Freudian speculation or personal opinion. In a profile of Colonel Qaddafi for Foreign Policy magazine, Dr. Post concludes that the dictator, while usually rational, is prone to delusional thinking when under pressure — “and right now, he is under the most stress he has been under since taking over the leadership of Libya.”

At his core, Colonel Qaddafi sees himself as the ultimate outsider, the Muslim warrior fighting impossible odds, Dr. Post argues, and he “is indeed prepared to go down in flames.”

Characterizations of this type have been invaluable in the past. In preparation for the Camp David peace negotiations between Israel and Egypt, the C.I.A. provided President Jimmy Carter with profiles of both nations’ leaders, Menachem Begin and Anwar el-Sadat. In his memoir “Keeping Faith,” Mr. Carter credited the profiles with giving him crucial insights that helped close a peace deal.

The brief on the Egyptian president, “Sadat’s Nobel Prize Complex,” noted that Sadat “sees himself as a grand strategist and will make tactical concessions if he is persuaded his overall goals will be achieved,” and added, “His self-confidence has permitted him to make bold initiatives, often overriding his advisers’ objections.”

Yet the assessments can also be misleading, even embarrassing. Profiles of President Saddam Hussein of Iraq that circulated in the early 1990s suggested that he was ultimately a pragmatist who would give in under pressure. And in 1993, the C.I.A. reportedly provided lawmakers with a brief alleging that the Haitian leader Jean-Bertrand Aristide had a history of mental illness, including manic depression.

Mr. Aristide furiously denied it, and the report was soon discredited. In a 1994 review of the episode in Foreign Policy, Thomas Omestad wrote that the profile was “light on facts and heavy on speculation; it came closer to character assassination than character analysis.”

Intelligence specialists have learned to hedge their bets over the years, supplementing case histories with “content analysis” techniques, which look for patterns in a leader’s comments or writings. For instance, a software program developed by a researcher at Syracuse University, Margaret Hermann, counts the relative frequency of certain words (like “I,” “me,” “mine”) and links those to leadership traits.

A technique used by David G. Winter, a professor of psychology at the University of Michigan, draws on similar sources to judge leaders’ motives, in particular their need for power, achievement and affiliation. The sentence “We can certainly wipe them out” reflects a high power orientation; the comment “After dinner, we sat around chatting and laughing together” rings of affiliation.

“Combine high power and high affiliation, the person is likely to reach out, whereas power and low affiliation tend to predict aggression,” said Dr. Winter, who has profiled Presidents Richard M. Nixon and Bill Clinton, among many others. “That’s the idea, though of course you can’t predict anything with certainty.”

At least one group of political profilers has incorporated that flaw itself — uncertainty — into its forecasts. Peter Suedfeld, a psychologist at the University of British Columbia who has worked with Dr. Tetlock, sifts through a leader’s words to rate a quality called integrative complexity. This is a measure of how certain people are, how confident in their judgments, whether they have considered any opposing points of view.

In a series of studies, the researchers have compared communications leading up to the outbreaks of World War I and the Korean War with those that led to a peaceful resolution, like the 1962 Cuban missile crisis. And the higher the level of acknowledged uncertainty, the less likely the leader is to pursue war, Dr. Suedfeld said.

He has not yet analyzed Colonel Qaddafi’s comments, but it doesn’t take an expert to observe that the Libyan leader sounds very certain, if not always coherent.

What is missing amid all this number crunching and modeling is any sense of which methods are most useful when. In an exhaustive review of intelligence analysis published this month, a prominent panel of social scientists strongly agreed: psychological profiling and other methods intelligence analysts use to predict behavior are sorely in need of rigorous testing.

And new ideas. In an unusual move, the Office of the Director of National Intelligence, which commissioned the report, has sponsored a kind of competition (http://goodjudgment.info), inviting people to test their own forecasting techniques, to improve intelligence analysis.

Given the challenge of predicting what leaders like Colonel Qaddafi might do, think of it as a plea for help.

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States Weigh Fighting Meth With Drug Prescriptions

Posted: 28 Mar 2011 11:40 AM PDT

NASHVILLE — Faced with a surging methamphetamine problem, a number of states are weighing contentious bills this spring that would require a doctor’s prescription for popular decongestants like Sudafed.

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Items seized from a suspected meth producer in a bust by the 19th Judicial District Drug Task Force in Clarksville, Tennessee, on March 22, 2011.

The drugs contain pseudoephedrine, the crucial ingredient in methamphetamine, and the police say past efforts to keep them out of the hands of meth cooks have failed. Here in Tennessee, the police seized nearly 2,100 meth labs last year — a 45 percent increase over 2009 and more than any other state.

“It’s a no-brainer,” said Thomas N. Farmer, director of the Tennessee Methamphetamine Task Force, who is pushing for a prescription-only law along with most other law enforcement officials here. “This has got to be the next step.”

But the proposals have met with stiff resistance from drugmakers and pharmacy groups, who say the measures would place an undue burden on cold and allergy sufferers. They are promoting other bills that would help the police monitor pseudoephedrine sales with interstate electronic tracking.

“We can’t change lives just to stop these weirdo people,” said Joy Krieger, executive director of the St. Louis chapter of the Asthma and Allergy Foundation of America, who is fighting a prescription-only bill in Missouri.

Officials like Mr. Farmer say drug companies are fighting the measures only because they want to protect the profits they reap from over-the-counter pseudoephedrine sales, estimated at more than $550 million a year. But the industry’s argument to legislators — that law-abiding citizens should not have to pay for a doctor’s visit for a mere stuffy nose — has proved potent. Prescription-only bills were defeated or failed to make it to a vote this month in Arkansas, Kansas, Kentucky and West Virginia after heavy lobbying by the Consumer Healthcare Products Association, a trade group representing makers of over-the-counter drugs. Similar bills are still alive in Alabama, Missouri, Nevada, Tennessee, Oklahoma and several other states.

Two states, Oregon and Mississippi, already require prescriptions for pseudoephedrine; law enforcement officials there say meth lab seizures have plummeted since the laws were passed. In Mississippi, which adopted a prescription-only law last year, the authorities say meth lab seizures have dropped by nearly 70 percent.

Marshall Fisher, director of the Mississippi Bureau of Narcotics, said that from July through February, 203 meth labs were seized there, down from 607 from July 2009 through February 2010. The prescription requirement, he said, has stymied “smurfers,” people who buy the drug at multiple stores, in small enough amounts to evade detection.

“Yes, I do think it’s inconvenient,” Mr. Fisher said of the law. “But I don’t have the resources to constantly be chasing around a bunch of smurfers and addicts out there.”

He added that while opponents of Mississippi’s law predicted a public outcry after it took effect, “it hasn’t occurred.”

Pseudoephedrine was a controlled substance until 1976, when the Food and Drug Administration allowed it to be sold over the counter. Sales of over-the-counter pseudoephedrine drugs now exceed $550 million a year, said Elizabeth Funderburk, a spokeswoman for the Consumer Healthcare Products Association, in an e-mail.

The rise in meth lab seizures, concentrated in the South and Midwest, comes five years after Congress passed a series of restrictions that initially seemed to curb production. They required pharmacies to keep pseudoephedrine drugs behind sales counters, set daily and monthly limits on how much each customer could buy, and required pharmacists to keep a log of sales.

Meth labs have spread again partly due to smurfing, the police say; another reason is a new, easier way of making meth with household chemicals in a two-liter bottle. Jesse Reynolds, director of the 19th Judicial District Drug Task Force in Clarksville, Tenn., said undercover agents often spot carloads of smurfers leaving drugstores there.

“We’ll follow them from pharmacy to pharmacy to pharmacy,” Mr. Reynolds said. “They’ll make a big circle around town.”

Methamphetamine, a highly addictive stimulant, produces an initial rush when smoked or injected and generally makes users hyper-energetic. Chronic abuse can lead to aggression, delusions, rotten teeth and brain damage. Instead of prescription-only bills, the Consumer Healthcare Products Association is calling for an interstate electronic tracking system for pseudoephedrine purchases. Unlike the current logbooks that pharmacies use, tracking could identify people who exceed purchase limits in real time, according to the group.

“It seems to me that we need to try tracking before putting people to all the trouble of a doctor’s visit,” said State Senator Mae Beavers, a Republican sponsoring a tracking bill that has more momentum in Tennessee than the prescription-only proposal. “It’s the easiest thing we can do right now.”

But law enforcement officials said tracking had not stopped the spread of meth labs in states like Kentucky and Oklahoma, and could not stop smurfers who buy less than the legal limit or use fake IDs.

“Those are the two things that completely evade and eviscerate the electronic tracking systems,” said Rob Bovett, the district attorney in Lincoln County, Ore., who said meth lab seizures in his state had dropped by 96 percent since its prescription-only law took effect in 2006, and arrests involving meth by 32 percent.

Ms. Funderburk said meth lab seizures had dropped throughout the West, not just in Oregon, and that smurfing rings were not a proven trend.

“We have seen no evidence or hard data that smurfing rings actually exist,” she said. “We only hear anecdotes.”

Opponents also said prescription-only laws would not stop drug traffickers from importing vast amounts of Mexican methamphetamine; Mr. Bovett said demand for that product had dropped, though, because Mexico banned pseudoephedrine in 2009 and the meth produced there is now less potent.

Law enforcement officials like to point out that dozens of cold and allergy treatments do not contain pseudoephedrine, and thus would not be affected by prescription-only laws. But for people like Harriet Mabry, who lives in Clarksville and battles year-round allergies, pseudoephedrine drugs work best.

Ms. Mabry said she disliked the monthly limits imposed by the current law and thought a prescription might simplify things at the pharmacy counter.

“It’s very irritating,” she said of the limits and the requirement to show identification whenever she buys Zyrtec-D. “I’m 77 years old with a head full of white hair, so they should look at me and know I’m not making meth.”

Philadelphia School Battles Students’ Bad Eating Habits, on Campus and Off

Posted: 28 Mar 2011 06:34 AM PDT

PHILADELPHIA — Tatyana Gray bolted from her house and headed toward her elementary school. But when she reached the corner store where she usually gets her morning snack of chips or a sweet drink, she encountered a protective phalanx of parents with bright-colored safety vests and walkie-talkies.

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Battling Over Childrens’ Diets

The scourge the parents were combating was neither the drugs nor the violence that plagues this North Philadelphia neighborhood. It was bad eating habits.

“Candy!” said one of the parents, McKinley Harris, peering into a small bag one child carried out of the store. “That’s not food.”

The parents standing guard outside the Oxford Food Shop are foot soldiers in a national battle over the diets of children that has taken on new fervor. With 20 percent of the nation’s children obese, the United States Department of Agriculture has proposed new standards for federally subsidized school meals that call for more balanced meals and, for the first time, a limit on calories. The current standard specifies only a minimum calorie count, which some schools meet by adding sweet foods.

Earlier this year, when Michelle Obama, as part of her campaign against childhood obesity, announced that Wal-Mart would reduce salt and sugar in its packaged foods, she said, “We’re beginning to see the ripple effects on the choices folks are making about how they feed their kids.”

But this effort is up against an array of powerful forces, from economics to biology, all of which are playing out in Philadelphia, where the obesity rate is among the nation’s highest. At the intersection of North 28th and West Oxford Streets, the Oxford Food Shop and the William D. Kelley School are in a tug of war over the cravings of kids.

Amelia Brown, the principal of the kindergarten through eighth grade school, said that deplorable diets caused headaches and stomachaches that undermine academic achievement, and that older students showed a steady progression of flab. So inside the school, the nutrition bug is rampant.

The gym teacher, Beverly Griffin, teaches healthy eating using a toy model of the federal food pyramid and rewritten children’s songs. “And on his farm he had some carrots,” Tatyana, a first grader, belted out one recent morning, skipping around the gym with her classmates.

Like schools throughout the nation, Kelley has expelled soda and sweet snacks. Instead of high-calorie fruit juices, the school nurse, Wendy Fine, said, “I push water.”

The Agriculture Department wants to change the content of federally subsidized school meals — 33 million lunches and 9 million breakfasts a day — by the fall of 2012. Beyond the calorie cap, the new standards would emphasize whole grains, vegetables and fruits and set tighter limits on sodium and fats.

“This will mean a huge shift in school meals,” said Margo G. Wootan, the director of nutrition policy at the Center for Science in the Public Interest, a consumer advocacy group.

Fernando Gallard, a spokesman for the Philadelphia School District, said schools were meeting the new federal meal proposals by using more dark green and orange vegetables, as well as fruits, whole grains and legumes.

The food industry is defending products by focusing on their mineral and vitamin content. The National Potato Council, for example, is warning against cutting starch, saying children need potatoes’ potassium and fiber.

Some companies are adjusting their recipes, although hardly drastically. After Philadelphia schools stopped buying the sugary products of the local bakery icon Tastykake, the company created a 190-calorie muffin, reducing sugar enough to move it below flour on the list of ingredients. The new formulation, which uses whole grains, got Tastykake muffins back on the school breakfast menu and classified as bread. “It is sweet,” said Autumn R. Bayles, a company senior vice president. “Sugar is just not the first ingredient.”

To match the efforts inside the school, one of Ms. Brown’s first acts as principal last August was to ask owners of nearby corner stores to stop selling to students in the morning.

There was a reason for this. While research suggests that as little as an extra 200 calories a day can make an adult overweight, a recent study led by Gary D. Foster, the director of the Center for Obesity Research and Education at Temple University, found that children were getting 360 calories a day from chips, candy and sugary drinks — all for an average of $1.06.

Gladys Tejada, who owns the Oxford shop, said, “It’s a good thing, what they’re trying to do, but I can’t control who comes in.”

Nor can she control what they buy. “They like it sweet,” she said. “They like it cheap.”

Since 2001, a Philadelphia organization called Food Trust has worked to get corner stores to offer healthier foods, including fresh fruit, vegetables and water, as well as products with reduced sugar, salt and fat. But just 507 of the city’s estimated 2,500 corner stores have signed on.

Vital Signs: Regimens: Drug Is Seen to Limit Progression to Diabetes

Posted: 28 Mar 2011 08:40 AM PDT

People at high risk of developing diabetes may be able to ward off the disease by taking the drug pioglitazone, a new study suggests, but critics say the potential side effects of the medication may outweigh the benefits for those who are still disease-free.

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Pioglitazone, sold under the brand name Actos, belongs to the same class of drugs as the diabetes medication rosiglitazone, sold as Avandia, which was found to increase the risk of heart attack in patients taking it. Rosiglitazone was taken off the market in Europe, and its use is greatly restricted in the United States.

Pioglitazone is believed to be safer than rosiglitazone, but it has been linked to an increased risk of congestive heart failure, and the Food and Drug Administration is investigating a possible link to bladder cancer.

In the new study, a team led by researchers at the University of Texas Health Science Center in San Antonio followed patients who had elevated blood sugar levels but had not yet progressed to diabetes, tracking them for just over two years on average. Those who took pioglitazone daily were significantly less likely to develop the disease than a similar group given a placebo, the team found.

The annual average incidence of progression to diabetes was 7.6 percent for the placebo group and 2.1 percent for those taking pioglitazone, representing a 72 percent reduction in risk, the researchers said.

Dr. Ralph A. DeFronzo, chief of the diabetes division at the health science center and senior author of the study, called the results “astounding.”

Patients taking the drug gained weight, however, and experienced fluid retention. Critics said it was not clear whether the drug prevented diabetes or simply lowered elevated blood sugar, and some suggested that a better alternative would be for people at risk to exercise and eat a healthier diet.

“The F.D.A. has never approved any drug to prevent diabetes,” said Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, who first raised questions about the safety of rosiglitazone. “There’s a reason for skepticism, because we don’t know whether these drugs are really preventing diabetes or just masking it.”

The study was published on Thursday in The New England Journal of Medicine. It was financed in part by Takeda Pharmaceuticals, maker of pioglitazone.

Vital Signs: Risks: Wealthier Women Get More Melanoma, Study Finds

Posted: 28 Mar 2011 07:50 AM PDT

Rates of melanoma among young white women have more than doubled in the past three decades, and wealthier, more educated women appear to be at greatest risk. Experts aren’t sure why, but a new study suggests that these women may be at increased risk because they are spending more leisure time outdoors.

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Researchers at the Cancer Prevention Institute of California studied 3,842 cases of melanoma in 3,800 white women younger than 40 who received the diagnosis between 1988 and 1992 and between 1998 and 2002, incorporating census data and ultraviolet radiation exposure measures from the National Oceanic and Atmospheric Administration.

The analysis, published in Archives of Dermatology, was limited to invasive cancers. Melanoma rates increased significantly during the study periods only among higher-income women, the researchers found. Women from the highest-income areas were nearly six times as likely to have malignant melanoma as those in the poorest areas.

“We think this has to do with cultural preferences in higher-income groups for tanning, having the time to tan and the means to pay for tanning beds, and sun exposure on vacations in the middle of winter,” said Christina A. Clarke, senior author of the paper.

Vital Signs: Prognosis: Study Finds Troubles With Gastric Band Surgery

Posted: 28 Mar 2011 07:20 AM PDT

More than a decade after having gastric band surgery for weight loss, patients at a university hospital in Belgium had lost just 43 percent of their excess weight on average, a new study reports. In nearly half of the patients, the bands had been removed because of medical complications.

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Although the study included just 82 of 151 patients who had laparoscopic gastric band surgery at the hospital from 1994 to 1997, it is believed to be the first to track the outcomes over a long period. The report was published last week in Archives of Surgery.

The bands eroded in almost one in three patients, the researchers found. Sixty percent had undergone additional surgery, including 17 percent who went on to have gastric bypass. Researchers concluded that the adjustable gastric band surgery, which is growing in popularity in the United States, “appears to result in relatively poor long-term outcomes.”

The results “are worse than we expected,” said Dr. Jacques Himpens, of the European School of Laparoscopic Surgery and St. Pierre University Hospital in Brussels, lead author of the new study. Dr. Himpens advised those considering gastric band surgery not to “nourish exaggerated expectations,” adding that anyone who has had the procedure should see a care provider on a regular basis and be vigilant for signs of infection or band erosion.

Recipes for Health: A Versatile Vegetable for a Chilly Spring

Posted: 28 Mar 2011 09:58 AM PDT

Spring vegetables aren’t here quiet yet — and if the weather doesn’t improve soon, they may not arrive for a while. Until then, there’s a fine alternative: Swiss chard.

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.

This leafy green, hearty enough to withstand the cold but more delicate in flavor than kale and collards, has been finding its way into all sorts of comforting dishes in my kitchen, from pastas to soups to stir-fries. It’s the most versatile of greens, and an excellent source of calcium and potassium, vitamin C, vitamin A and beta-carotene.

Some of you have asked why I blanch greens before using them in dishes. I find it’s the most efficient way to wilt them quickly and evenly, and they aren’t boiled so long -- just a minute or two — that the nutrients are depleted. But lately I’ve also been steaming chard, and I find this works well, too. I use the basket of my pasta pot, placing it above an inch of water in the pot.

Orecchiette With Swiss Chard, Red Peppers and Goat Cheese

When making this easy pasta, be sure to cut the sweet bell peppers into very small dice; that way, they’ll lodge in the hollows of the orecchiette, along with the chard and goat cheese.

3/4 pound Swiss chard (1 bunch), stemmed and washed in two changes of water

1 tablespoon extra virgin olive oil

2 red bell peppers, cut in small dice

Pinch of red pepper flakes (optional)

1 to 2 garlic cloves (to taste), minced

Salt and freshly ground pepper

1 teaspoon chopped fresh marjoram

3/4 pound orecchiette

2 ounces goat cheese, crumbled (1/2 cup)

1. Begin heating a large pot of water while you stem and wash the chard. Fill a bowl with ice water. When the water in the pot comes to a boil, salt generously and add the chard. Blanch the chard leaves for one to two minutes until tender. Using a skimmer or a slotted spoon, transfer the chard to a bowl of ice water, then drain and squeeze out excess water. Chop medium-fine. Keep the pot of water at a simmer.

2. Heat 1 tablespoon of the olive oil over medium heat in a large, heavy skillet, and add the bell peppers and the red pepper flakes. Cook, stirring often, until tender, five to eight minutes. Add the garlic and salt to taste, and stir for half a minute. Then stir in the chopped chard and the marjoram. Stir together for a few seconds, then turn the heat to very low.

3. Bring the water in the pasta pot back to a boil, and add the orecchiette. Cook al dente, following the timing instructions on the package. Add about 1/2 cup of the pasta water to the pan with the chard and peppers. Stir in the goat cheese. Drain the pasta, transfer to the pan and toss with the chard, pepper and goat cheese mixture. Serve hot.

Yield: Serves four.

Advance preparation: You can make this through Step 2 several hours before cooking the pasta. The pepper and chard mixture can be stored in the refrigerator for a couple of days and reheated.

Nutritional information per serving: 445 calories; 4 grams saturated fat; 1 gram polyunsaturated fat; 4 grams monounsaturated fat; 15 milligrams cholesterol; 71 grams carbohydrates; 5 grams dietary fiber; 239 milligrams sodium (does not include salt to taste); 17 grams protein

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

Well: Can Cavities Be Contagious?

Posted: 28 Mar 2011 12:30 PM PDT

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Personal Health: Finding a Balm for Frequent Nosebleeds

Posted: 28 Mar 2011 12:16 PM PDT

Nosebleeds, like noses, come in varied forms, and the number of sufferers is growing as the population ages. Millions of them rejoice at this time of year, when the most frequent cause — winter’s dry, heated indoor air — begins to yield to the warm, moist air of spring.

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Four years ago Charles Kingson, a New Yorker in his 70s, experienced a frightening series of nosebleeds that initially proved hard to control. Eventually Mr. Kingson found a doctor who stopped the bleeding, and he has since learned how to prevent it from recurring.

But Mr. Kingson also found that several of his friends also were similarly plagued, and none knew why — or what to do about it.

Nosebleeds most often afflict older adults and young children. Among the young, Dr. Alan Lipkin, an otolaryngologist in Denver, told me, “digital and other manipulation” is the usual cause. Translation: nose-picking or putting foreign objects in the nose, behaviors that most parents are eager to discourage.

Of course, some adults also engage in “digital manipulation,” especially when winter dryness turns nasal mucus into irritating crusts that can impair breathing. And nosebleeds in young children may be caused by nasal dryness, as they often are in older adults.

Among both adults and children, however, there are many other causes worth knowing about. And while most nosebleeds can be self-treated or prevented with simple home remedies, frequent nosebleeds should never be taken lightly. They can be a sign of a more serious problem, like leukemia, a nasal tumor or a blood clotting disorder, and should be brought to a doctor’s attention.

Two Major Types

Most often, nosebleeds originate in the front of the nose, where many small blood vessels near the surface of the nasal septum (the tissue that divides the two nostrils) warm the air you inhale. These so-called anterior nosebleeds are annoying, and they can be frequent and frightening, on occasion producing several ounces of blood.

But anterior nosebleeds are rarely dangerous. Of greater concern are the severe, potentially dangerous nosebleeds that originate in larger blood vessels far back in the nose. So-called posterior nosebleeds are relatively uncommon, and home remedies are ineffective. They require prompt medical attention and more involved treatment, perhaps under anesthesia in a hospital.

Here are some common causes:

• Medications that “thin” the blood, like warfarin (Coumadin); clopidogral bisulfate (Plavix); nonsteroidal anti-inflammatory drugs, or Nsaids, like ibuprofen and naproxen; and aspirin, including “baby” aspirin that many older adults take to help prevent heart disease and colon cancer.

• Topical medications that irritate the nasal passages, like corticosteroid and antihistamine sprays, and overuse of decongestant nasal sprays.

• Allergies and their consequences — frequent sneezing and overly aggressive nose blowing.

• Upper respiratory infections involving the nose or sinuses.

• Nasal trauma from a direct or indirect blow to the nose, including a broken nose.

• A deviated septum, which can impede breathing through one nostril and overwork the other.

• Abrupt changes in air pressure.

• High blood pressure and atherosclerosis, which are more common with age, can be a contributing factor in adults.

• Other disorders, like liver or kidney disease, chronic abuse of alcohol and sniffing cocaine, also can result in nosebleeds.

In most cases, nosebleeds affect only one nostril, though if the problem is severe, blood can sometimes come from both nostrils (or even from an eye). Seek medical care if you experience repeated nosebleeds, bleed heavily or bruise easily; if you take medication or have an underlying disease that can interfere with blood clotting; if you vomit blood, become dizzy or faint; if you have trouble breathing or your heart races; or if your nosebleed is accompanied by a rash or fever.

Prevention and Treatment

Moistening the air you breathe and staying well hydrated, especially during the winter months, is a good place to start.

Mr. Kingson’s otolaryngologist suggested that he use a cold-mist vaporizer in the bedroom, take hot showers and drink lots of water, as often as every 15 minutes.

Nosebleed sufferers might also consider using absorbent cotton or gauze to coat the interior of the nostrils with a gel or petroleum jelly, Dr. Lipkin said. Nasal saline sprays are also helpful.

Avoid forceful nose blowing, and do not try to clear the nose with an object like a Q-tip. To keep undue pressure from building up in nasal vessels, children and adults should be taught to sneeze with their mouths open. To control nose-picking in children, keep their fingernails cut short.

If you must take a medication that can cause bleeding, ask your doctor whether a lower dose or different drug might be used. For pain control, try acetaminophen (Tylenol and many generics) instead of an Nsaid, but be sure not to exceed the recommended daily dose.

Most minor nosebleeds can be easily controlled at home. Do not lie down. Sit upright, and bend forward slightly from the hips to keep blood from running down the back of the throat. Swallowing blood can cause vomiting.

Placing your thumb and index finger on the soft part of the nose, just below the bony bridge, pinch the nostrils closed for 10 minutes without interruption, Dr. Lipkin recommended. Do not stuff anything into the nostril, but short-term use of a decongestant nasal spray may help constrict the culprit vessel, he said.

To keep the bleeding from restarting, do not blow your nose soon afterward. Do not bend over, and avoid strenuous activity and heavy lifting for a few hours.

If self-treatment is not effective and bleeding continues for more than 20 minutes, or if a nosebleed resulted from an injury to the face, see a doctor. Something else might be wrong, perhaps a fracture.

Medical treatment of challenging nosebleeds may require cauterizing the bleeding vessel with a chemical like silver nitrate or with a laser beam. Nasal packing, which is what ultimately stopped Mr. Kingson’s nosebleeds, may be used to apply pressure to the bleeding vessel and promote clotting.

If the problem involves a posterior vessel, hospitalization and sedation or anesthesia may be necessary. Posterior nasal packings are left in for two or three days, and should be removed only by a professional.

If that procedure doesn’t work, surgery or arterial blockage may be needed.

Really?: The Claim: Dental Cavities Can Be Contagious.

Posted: 28 Mar 2011 09:26 AM PDT

THE FACTS

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Christoph Niemann

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Everyone knows you can catch a cold or the flu. But can you catch a cavity?

Researchers have found that not only is it possible, but it occurs all the time.

While candy and sugar get all the blame, cavities are caused primarily by bacteria that cling to teeth and feast on particles of food from your last meal. One of the byproducts they create is acid, which destroys teeth.

Just as a cold virus can be passed from one person to the next, so can these cavity-causing bacteria. One of the most common is Streptococcus mutans. Infants and children are particularly vulnerable to it, and studies have shown that most pick it up from their caregivers — for example, when a mother tastes a child’s food to make sure it’s not too hot, said Dr. Margaret Mitchell, a cosmetic dentist in Chicago.

A number of studies have also shown that transmission can occur between couples, too. Dr. Mitchell has seen it in her own practice.

“In one instance, a patient in her 40s who had never had a cavity suddenly developed two cavities and was starting to get some gum disease,” she said. She learned the woman had started dating a man who hadn’t been to a dentist in 18 years and had gum disease.

To reduce the risk, Dr. Mitchell recommends frequent flossing and brushing, and chewing sugar-free gum, which promotes saliva and washes away plaque and bacteria.

THE BOTTOM LINE

Cavities can be transmitted from one person to another.

 

The New Old Age: A Place to Connect

Posted: 28 Mar 2011 09:50 AM PDT

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Prescriptions: This Week's Health Industry News

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Buffett and Gates Prod India’s Wealthy to Be More Philanthropic

Posted: 24 Mar 2011 10:20 PM PDT

NEW DELHI — India is behind only the United States and China in its number of billionaires. But by global standards, its charitable giving is miserly.

A few wealthy American philanthropists — Bill and Melinda Gates and Warren E. Buffett — are hoping to change that, one rich Indian at a time.

The three Americans met behind closed doors with about 70 of India’s wealthiest people Thursday afternoon at the Taj Majal hotel here, for a “giving discussion” meant to start gently preaching the gospel of philanthropy.

“It is not a case where we passed around a tin cup or had a signup list,” Mr. Gates said at a crowded news conference afterward. “Anything these people do will be their choice.”

None of the attendees Thursday, which included many of India’s top business families, pledged immediately to give away most of their fortunes, as the Gateses and Mr. Buffett have done.

But Mr. Buffett predicted that the meeting would eventually have an effect.

“I would be almost certain” that philanthropy increases in India over the next decade, Mr. Buffett said at the news conference. “The people in that room drew strength and conviction from hearing others talk,” he said. While India is home to more than 50 billionaires, the level of philanthropic giving is far lower than in the developed world.

Although nearly every major company or prominent business executive has a pet charity or donates to a cause, the overall portion of income given away is low.

The discrepancy can be glaring in India, which has the most poor people in the world. About 40 percent of its 1.2 billion people live below the World Bank’s poverty line of $1.25 a day, and there are staggering rates of malnutrition and preventable diseases.

“Philanthropy in India so far has been what we call feel-good philanthropy, instead of outcome or results-based philanthropy,” said Parth J. Shah, the president of the Centre for Civil Society, a New Delhi research organization. People give money to temples, or establish schools or hospitals, he said, but they tend not to focus on the impact of what they have set up or how that impact could be multiplied.

Charitable donations in India make up about 0.6 percent of the country’s gross domestic product, well below the 2.2 percent in the United States, according to a study by Bain management consultants. And government and foreign contributors make up the majority of donations in India, with individuals and charities donating just 10 percent of the total, according to Bain.

Still, the Bain report showed that India gave more as a percentage of its G.D.P. than Brazil (0.3 percent) or China (0.1 percent).

Bill and Melinda Gates and Mr. Buffett introduced the Giving Pledge last year in the United States, and 59 wealthy American families have since promised to give half or more of their wealth to philanthropic activities.

In September, Mr. Gates and Mr. Buffett held an event with China’s richest to encourage donations, to a lukewarm reception. Only about two-thirds of the invitees attended. Preparations for Thursday’s meeting seemed intended to lower expectations. The event was named the “Giving Discussion,” the guest list was closely guarded, and a press release afterward said that Mr. Buffett and the Gateses had “stressed that India would find its own unique approach” to charity.

“In neither China nor India were we coming asking people to make any kind of commitment,” Mr. Gates said during the news conference.

Many Indian billionaires have not been big givers partly because the country does not have large, well-run foundations and charities that could absorb hundreds of millions or billions of dollars in donations, said Jayant Sinha. He heads the India office of Omidyar Network, a philanthropic investment firm set up by Pierre Omidyar, the French-born Iranian-American founder of eBay.

Some of India’s richest men like Azim Premji, chairman of the technology company Wipro, have set up their own foundations. Mr. Premji recently gave his nonprofit organization shares in Wipro worth $2 billion to start a university and to help government-run schools in rural towns and villages. Shiv Nadar, a founder of another company, HCL Technologies, has also started an education-focused foundation.

“There are now some good examples of where people have put their money to very effective purposes, but they have had to work hard on the professionalization and the institutionalization of their philanthropic arms,” Mr. Sinha said. “There is no point giving it away if you can’t apply it well.”

Furthermore, Mr. Sinha said, many of India’s billionaires have earned their wealth relatively recently and are still actively managing businesses. That helps explain why many have not yet begun to give much away or establish robust philanthropic organizations.

For that matter, it was only after Mr. Gates stepped back from the day-to-day running of Microsoft that he and his wife became global philanthropists.

Older and more established Indian business families have focused more intently on philanthropy. Companies that are part of India’s largest conglomerate, the Tata Group, for instance, are partly owned by charitable trusts started by the Tata family. The trusts use the dividends they earn from Tata companies to support charities and social programs across the country.

An earlier generation of the Tata family also founded several of India’s most prestigious universities, including the Indian Institute of Science in Bangalore and Tata Institute of Fundamental Research in Mumbai.

But many of those institutions were established several decades, or even a century, ago, and the current generation of wealthy Indians has not matched the ambition of those earlier efforts, experts say.

Bill and Melinda Gates and Mr. Buffett have been criticized by other billionaires for their charitable impulses. On Thursday, for example, Mr. Buffett shrugged off one such critic, fielding a question about the telecommunications billionaire Carlos Slim Helú’s widely reported remark that creating jobs was more important than playing Santa Claus.

“You can create jobs and be Santa Claus at the same time,” Mr. Buffett said, laughing. “I mean, he employs 12 elves.”

Turning serious, he said, “When I give away my Berkshire Hathaway shares, they have no utility to me and great utility to others, and Berkshire Hathaway has all the money to invest that it has had before.”

Heather Timmons reported from New Delhi and Vikas Bajaj from Mumbai, India.

Lessons for Albany on Malpractice Limits

Posted: 24 Mar 2011 09:20 PM PDT

ALBANY — As New York lawmakers strive to complete the state budget by April 1, one of the most contentious battles involves whether to include a cap on medical malpractice payments that Gov. Andrew M. Cuomo has proposed with the support of the state’s hospital industry.

The measure would limit damages paid by doctors and hospitals for pain and suffering to $250,000, a ceiling that hospitals predict would reduce their insurance premiums by one-fourth and give them the savings necessary to blunt the pain of the sharp cuts in Medicaid spending that Mr. Cuomo has also proposed.

But other states that have similar caps in place offer cautionary evidence about the big savings for health care providers that such limits are believed to produce.

In 1975, California lawmakers approved a $250,000 cap on so-called noneconomic damages in cases of medical mistakes, which has since become a model for similar proposals. At least 35 states now have at least some limits on malpractice damages.

The California law has also been the focus of long-running debate over who benefits from caps — doctors or insurers — and whether the measures inflict unintended negative consequences upon victims of medical errors, including plaintiffs’ inability to find lawyers to take their cases.

In the early years after California enacted its cap, doctors did not see the cost of their insurance policies plummet. From 1976 to 1986, the total paid in premiums increased 176 percent, according to the National Association of Insurance Commissioners. (Nationally, premiums rose 221 percent.)

“I don’t think the doctors even believe that this saves them money,” said Jamie Court, the president of Consumer Watchdog, a California group that lobbies for insurance reform. “But what they know is this limits their legal accountability, and that’s more important for them.”

Supporters of tort changes say the years of legal challenges against California’s cap explain why insurers did not immediately reduce their rates. Over all, they say, states that have malpractice caps eventually see fewer claims, smaller average malpractice losses for doctors and, in turn, lower premiums.

California and three other states that had $250,000 caps in place in 1991 saw premiums increase 28 percent in the following decade, compared with a 48 percent increase in other states, according the Physician Insurers Association of America.

The trade association’s president, Lawrence E. Smarr, said that capping noneconomic damages “clearly does work” in reducing costs.

“Because it is a competitive marketplace, rates will go down,” Mr. Smarr said, “both because the insurers can afford to lower their rates and because you’ll have increased competition.”

Researchers have found that, generally speaking, limiting noneconomic damages in malpractice cases has the effect of slowing the rate of growth in premiums. But they have not found the huge savings that officials in New York are predicting.

A 2004 study by Kenneth E. Thorpe, a professor of health policy at Emory University found that caps had the effect of reducing premium rates on a per-physician basis by 13 percent, while a study published in 2005 found that limiting damages produced a 6 percent decrease in premium costs in the short term.

“Without question, it’s not a game-changer,” said an author of the 2005 study, W. Kip Viscusi, an economist at Vanderbilt University.

A committee appointed by Mr. Cuomo to find Medicaid cuts cited just one piece of cost-savings evidence: a 2004 report commissioned by a group of malpractice insurers that said a $250,000 cap would reduce malpractice costs for New York hospitals and doctors by 24 percent.

Kenneth E. Raske, the president of the Greater New York Hospital Association, said the savings would allow the state’s hospitals to live within the rate reductions and across-the-board spending cap that the Medicaid committee also proposed.

“If you have limited resources,” Mr. Raske said, “you have to go at those factors that are driving costs up, and divert those resources into patient care for everybody.”

Regulating Hits to Head Tests N.H.L. Tradition

Posted: 26 Mar 2011 10:39 PM PDT

The debate in the N.H.L. over how to curb concussions is only the latest example of tensions between liberal and traditional forces that have shaped hockey since its beginnings in 19th-century Canada.

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Montreal's former star Ken Dryden has urged the N.H.L. to ban all hits to the head.

The extremes in the current standoff include general managers, sponsors and fans who favor a ban on hits to the head and their old-school counterparts who see such a drastic rule change as potentially robbing the league of its rugged appeal just when its popularity is growing.

“The nature of the game is always being changed, but the rules, regulations, understandings and mythologies don’t change,” Ken Dryden, the Hall of Fame goalie from the Montreal Canadiens, said in describing the traditionalist impulse.

“That’s when you get into trouble,” he added, “when you don’t recognize the immense changes on one side, and don’t have the corresponding changes that make sense to the different game that evolves.”

Dryden broke his long silence on hockey matters this month, joining the team sponsors Air Canada and Via Rail, and the team owners Mario Lemieux of Pittsburgh and Geoff Molson of Montreal in urging the league’s general managers to recommend a prohibition of all hits to the head. The International Ice Hockey Federation, the N.C.A.A. and the Ontario Hockey League — all feeder organizations to the N.H.L. — have bans.

At their recent annual meeting, the general managers took a middle path, calling instead for stricter enforcement of boarding and charging rules, and for harsher fines and suspensions. In 2010, the league imposed a partial ban, outlawing blindside hits to the head and those that deliberately target the head. According to league statistics, 14 percent of concussions sustained by N.H.L. players were the result of legal checks to the head, meaning ones delivered from straight ahead.

Still, the N.H.L. remains bound by an ethos of toughness, an arena where fighting is tolerated and even encouraged as rough justice, and where playing through concussions and gruesome lacerations are marks of courage.

A leading voice among traditionalists is Toronto Maple Leafs General Manager Brian Burke, who has spoken often about the need to preserve “the fabric of our game.”

Recently, Burke said: “We want that hit in our game. What’s distinctive about our game from anywhere else in the world is the amount of body contact. So we have to try to take out the more dangerous hits and make it safer for the players, but keep hitting in the game.”

The calls for change grew in volume in response to increased speed in the sport, a result of stricter rules against obstruction adopted after the 2004-5 lockout. That change undoubtedly made the game more exciting, but some of the spectacular collisions that followed led to more concussions. And it happened just as scientific evidence was emerging of the long-term damage caused by brain trauma.

Charting a middle course between rock ’em, sock ’em hockey and greater player safety has long been characteristic of the N.H.L., which has one of the most comprehensive concussion-evaluation and postconcussion return-to-play standards in professional sports. Only in 2009 did the N.F.L. adopt hockey’s protocol.

The N.H.L. policy, in place since 1997, was strengthened this month. Now, a player suspected of having a concussion is taken from the rink to a quiet room and evaluated for 15 minutes by a team doctor. The move was praised by several general managers, including Pittsburgh’s Ray Shero, Carolina’s Jim Rutherford and Buffalo’s Darcy Regier.

“It’s a step in the right direction,” said Shero, who sustained a concussion as a college player and who this season has dealt with concussions to his star player, Sidney Crosby, and his 15-year-old son, Chris.

But traditionalists were not pleased.

“This is an overreaction, a knee-jerk reaction,” one general manager told The Calgary Sun, saying the 15-minute examination period was too long. “This is what doctors told the league is best to do, but we’re the ones to have to put the thing in practice and it doesn’t make sense.”

Dryden, a member of Parliament from Toronto since 2004, said a pattern of resistance to change followed by change was a recurring theme in hockey.

“At one point, one of the prides of hockey is this is a game when you stay on the ice the whole time, like soccer,” he said. “It’s not real hockey if you have substitutions. But substitutions were allowed.

“Then it wasn’t real hockey if you can pass the puck forward — that’s like cheating — instead of skating it forward like an individual. And then it’s not real hockey if you use helmets or goalie masks. And so on and so on.”

To many, there is a sense of inevitability regarding the eventual adoption of a ban on head contact. A poll of Canadian hockey fans by MacLean’s magazine revealed this month that 83 percent support the outlawing of all checks to the head. (And if there is doubt that Canadian fans have gone soft, only 13 percent would outlaw fighting.)Dryden said, however, that today’s traditionalists were unable to conceive of hockey as being hockey if hits to the head were banned. But the faster game has made hockey so dangerous, he said, that change is necessary.

In a Brazilian Town, a Rogue Gene and a Boom in Twins

Posted: 25 Mar 2011 05:45 AM PDT

SANTIAGO, Chile — For years, so many twins have been born in the small southern Brazilian town of Cândido Godói that residents wonder whether something mysterious lurks in the water, or even if Josef Mengele, the Nazi physician known as the Angel of Death, conducted experiments on the women there.

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André Vieira for The New York Times

Tânia Moelmann, in 2009, with her 3-month-old twins, Kiara, left, and Yasmin, in the Brazilian village of São Pedro in Cândido Godói.

But a group of scientists now says it can rule out such long-rumored possibilities. Ursula Matte, a geneticist in Porto Alegre, Brazil, said a series of DNA tests conducted on about 30 families since 2009 found that a specific gene in the population of Cândido Godói appears more frequently in mothers of twins than in those without. The phenomenon is compounded by a high level of inbreeding among the population, which is composed almost entirely of German-speaking immigrants, she said.

“We analyzed six genes and found one gene that confirms, in this population, a predisposition to the birth of twins,” Dr. Matte said.

She was the first scientist to document, in a study published in the 1990s, that the rate of twin births in the town was unusually high. It was especially high in São Pedro, a village of about 350 residents that is part of Cândido Godói. Dr. Matte found that from 1990 to 1994, 10 percent of the births in São Pedro were twins, compared with less than 1 percent for Brazil as a whole.

The high concentration of twins has stirred outlandish theories. Residents say Mengele moved around southern Brazil in the 1960s, posing as a veterinarian, at about the time the twin births were thought to have really taken off. An Argentine journalist suggested in a 2008 book that Mengele conducted experiments on women in Cândido Godói that resulted in a baby boom of twins, many of whom have blond hair and light-colored eyes.

Mengele, who died in Brazil in 1979, was notorious for his often-deadly experiments on twins at Auschwitz, ostensibly in an effort to produce a master Aryan race for Hitler.

But the study led by Dr. Matte analyzed 6,615 baptism certificates dating back 80 years in the predominantly Roman Catholic town and found that the twins phenomenon existed in the 1930s, “long before Mengele’s period,” she said.

“In the initial stages of our research we immediately disproved any involvement with Mengele,” Dr. Matte said.

Her team of 20 researchers also analyzed the town’s water supply — residents believe a mysterious mineral may be responsible for the high rate of twin births — and uncovered no abnormalities.

While studying the baptism certificates, the scientists confirmed that the highest concentration of twins has been in São Pedro, with 33 pairs out of 436 births from 1959 to 2008, all living in a one-and-a-half-square-mile area.

In São Pedro, they concluded their research by analyzing last names and conducting genetic tests on women. “With a small population of about 80 families, it was a challenge to find women that did not have twins within a first-degree relation,” Dr. Matte said.

The scientists believe that a small number of immigrant families living in São Pedro may have brought the variant gene to the region. “This does not mean that it is a universal gene,” Dr. Matte said. “If I take twins from New Zealand and test them, it will probably generate a different result.”

Dr. Matte has yet to publish the results of her findings but was set to present them in Cândido Godói on Friday.

“The entire city supports this study, and they have great hopes of finding out why they have so many twins, and to better understand what is behind their story,” said Daniela Junzvier, the culture coordinator at the mayor’s office.

Alexei Barrionuevo reported from Santiago, Chile, and Myrna Domit from São Paulo, Brazil.
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