Thursday, April 28, 2011

Health - Armadillos Can Transmit Leprosy to Humans, Federal Researchers Confirm

Health - Armadillos Can Transmit Leprosy to Humans, Federal Researchers Confirm

Armadillos Can Transmit Leprosy to Humans, Federal Researchers Confirm

Posted: 28 Apr 2011 07:57 AM PDT

Armadillos have never been among the cuddly creatures routinely included in petting zoos, but on Wednesday federal researchers offered a compelling reason to avoid contact with the armored animals altogether: They are a source of leprosy infections in humans.

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Julio Viard

Few armadillos live long enough in the wild to be seriously affected by the infection.

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Using genetic sequencing machines, researchers were able to confirm that about a third of the leprosy cases that arise each year in the United States almost certainly result from contact with infected armadillos. The cases are concentrated in Louisiana and Texas, where some people hunt, skin and eat armadillos.

Leprosy, also known as Hansen’s disease, is an ancient scourge that has largely disappeared, but each year about 150 to 250 people in the United States and 250,000 in the world contract the illness. As long as the disease is identified relatively quickly, treatment with antibiotics — a one- to two-year regimen with three different drugs — offers an effective cure. But every year dozens of people in the United States do not recognize their skin lesions for what they are early enough and suffer lifelong nerve damage as a result.

Part of the problem is that doctors sometimes fail to consider leprosy in patients who have not traveled to parts of the world where the disease is endemic, like India, Brazil, Africa, the Philippines and other islands in the Western Pacific. Two-thirds of leprosy patients in the United States are people who have either lived or worked in such places before coming down with the illness.

But in a given year, about 50 to 80 people who have symptoms consistent with leprosy tell their doctors that they have not traveled to such areas or had any contact with someone with a leprosy infection. And in these patients, doctors may mistakenly dismiss consideration of a leprosy infection.

“These patients have always been a puzzle,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases.

Now researchers are hoping that their study leads doctors to ask one more question of patients who have skin lesions that are numb in the center: Any armadillos in your life?

Leprosy now joins a host of other infectious diseases — including flu, H.I.V./AIDS and SARS — that are known to have jumped from animals to humans. Flu is thought to have first crossed to humans from migratory waterfowl several hundred years ago. H.I.V./AIDS first crossed from a chimpanzee about 90 years ago.

Dr. Fauci said that about 70 percent of new emerging infectious diseases were known to have animal origins.

But one of the interesting aspects of leprosy is that transmission seems to have gone in both directions. Leprosy was not present in the New World before Christopher Columbus, and armadillos are indigenous only to the New World.

“So armadillos had to have acquired it from humans sometime in the last 400 to 500 years,” said Dr. Richard W. Truman, a researcher at the National Hansen’s Disease Program in Baton Rouge, La., and an author of the armadillo study, which was published Wednesday in The New England Journal of Medicine.

Some studies have shown that as many as 20 percent of armadillos in some areas are infected with leprosy.

Armadillos now range from Colorado to North Carolina and have a similar habitat to opossums. Few armadillos live long enough in the wild to be seriously affected by the infection, Dr. Truman said, but those in laboratories suffer many of the same problems as humans and eventually die of liver and kidney failure.

The microbe that causes leprosy, Mycobacterium leprae, is a fragile one. It does not grow in laboratory petri dishes, and survives only a week or two in moist soil. Indeed, the only animals in which it is known to flourish are humans and armadillos, and researchers have long used armadillos to grow the disease, although its presence in armadillos predates such research. Because of this, researchers have speculated that some share of human leprosy cases reported in the United States and other parts of the Americas resulted from contact with armadillos, but there has not been definitive proof until this study.

The fragility of the leprosy bacterium suggests that infections result from something more than casual contact with an armadillo, Dr. Truman said.

“The important thing is that people should be discouraged from consuming armadillo flesh or handling it,” Dr. Truman said.

Skin Deep: Allergies Can Be Natural, Too

Posted: 27 Apr 2011 09:20 PM PDT

WENONAH MADISON-SAUER, 36, co-owner of a farm and take-out restaurant on Martha’s Vineyard, tries to be eco-conscious about not just food but also cosmetics. For her firstborn son, Waylon, she used biodynamic calendula-based products anointed by NaTrue, an international third-party certifier of natural and organic skincare and cosmetics. But her second, Amos, now 2 1/2, is gooped up with Hydrolatum, a creamy petroleum-derived, non-organic cream that comes in a large plastic tub. Amos has food allergies, which have resulted in atopic dermatitis and eczema. Much of what he is allergic to (tree nuts, peanuts, seeds and coconut) is found — in oil form as emollients — in organic products.

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Robert Caplin for The New York Times

Dr. Xiu-Min Li of Mount Sinai has been studying Chinese herbal therapy for food allergies and eczema.

“I didn’t want to use Hydrolatum,” Ms. Madison-Sauer said, but “it’s the only thing that locks in moisture and protects him against certain things touching his skin. It seals him.”

While most skincare and hair care is filled with potential allergy triggers, it turns out that organic versions are, to green parents’ dismay, among the worst offenders. “Generally the more expensive organic products have more allergens; they’re in their purest form,” said Lisa Borden, 39, a Toronto-based mother whose 8-year-old daughter is allergic to peanuts, nuts and kiwi. Dr. Hauschka, one popular certified natural line celebrated for its purity, is chockablock with potential irritants: its products contain organic almond, sunflower, peanut, macadamia and argan oils.

This could be worrisome (however needlessly) in a lip balm. “Allergy from ingested tree nuts is a Type I anaphylaxis-type allergy, which can be life threatening,” said Dr. Maryann Mikhail, an attending dermatologist at Beth Israel Medical Center in New York. More common is a Type IV, contact allergy — not “life-threatening,” Dr. Mikhail said, though it can cause “horrible eczema.” Getting advice on what cosmetics are safe can be a game of hot potato: brands from Dr. Hauschka to the dermatologist’s office staple Cetaphil all urge consumers to talk to their health care providers, while many doctors tell their patients to check with manufacturers. Dr. Amy Wechsler, a dermatologist on the Upper East Side of Manhattan whose daughter is allergic to salmon (and formerly to eggs), has called companies herself and suggests patients read all labels, since allergens pop up in unexpected places.

But labels with long chemical names can be hard to decipher. Labeling laws in the United States are more relaxed than those in Europe and Canada, which mandate clearer warnings of potential allergens. Online message boards like the Allergic Living Talking Allergies Forum offer commiseration and the latest news on companies that have reformulated products with no warning (the newish fragrance-free version of Burt’s Bees baby shampoo contains sweet almond oil, the perfumed one does not), but there’s no go-to database of safe cosmetics for people with food allergies. “You cannot begin to provide that list; everyone has different allergens,” said Robyn McCord O’Brien, author, with Rachel Kranz, of “The Unhealthy Truth: How Our Food Is Making Us Sick — and What We Can Do About It” (Crown Archetype, 2009).

Since most products have multiple ingredients, tracking down a culprit can be tough. The red bumps covering Amos might be caused by nut oil, or fragrance — natural or synthetic — or even laundry detergent enzymes; all are proven irritants. “People are always touching him with an allergen,” Ms. Madison-Sauer said. “He has a rash every day and I don’t always necessarily know what caused it.”

More confusing, someone with a nut allergy won’t necessarily be allergic to a nut oil in a product. It’s the protein in the nut that causes an allergic response, and some manufacturers say they remove the protein from the oil. This can involve chemicals or heat — an important distinction for a consumer interested in a natural product. Cetaphil’s spokeswoman called the method it uses to process the sweet almond and macadamia nut oils in its moisturizing cream and lotion “proprietary information.” Weleda, maker of Ms. Madison-Sauer’s preferred calendula baby-care line, says its oils are heated above 400 degrees and filtered, making them risk-free. “That said, we suggest that if you have a severe reaction to almonds, it may be best to not use the products for your utmost mental, emotional and physical well-being,” said Jennifer Barckley, Weleda North America’s director of corporate communications and education.

Dr. Wechsler, who is also a psychiatrist, said that “there is a big psychological thing to being someone who is tree-nut allergic rubbing almond oil on their skin,” adding: “I have not had any patients who have anaphylaxed from a topical cream. I think we can make ourselves a little bit crazy. The goal is not to pass on the craziness to the kid.”

But Dr. Xiu-Min Li, a professor of pediatrics, allergy and immunobiology at Mount Sinai Medical Center, who sells carefully blended herbal creams, tea and bath products, said, “Paranoia on the parents’ part is understandable,” adding, “There is a potential problem if the product contains nonrefined nut oil or isn’t reliable.”

Wary of steroids to treat reactions, some organic-minded families throw up their hands and use nothing at all or rely on one-ingredient food-grade certified organic oils (though Ms. Madison-Sauer said olive oil wasn’t moisturizing enough). Ms. Borden praises coconut and sesame oils. Dr. Wechsler suggests safflower oil. “If you couldn’t eat it, don’t rub it on your skin,” Ms. O’Brien said. “Skin is your largest organ. If you wouldn’t rub it on your heart, kidney or lungs, then you might not want it on your largest organ either.”

The Man Who Made Working Out Cool

Posted: 28 Apr 2011 09:03 AM PDT

ON a recent Thursday night, the 38,000-square-foot David Barton Gym on Astor Place was throbbing to the Scorpions’ “Rock You Like a Hurricane.” Up the white-plaster staircase, candles flickered in the virgin springwood-paneled yoga room. Down below, a line of porcelain doll heads grinned over the moodily lighted lobby as lithe young things churned past the reception desk, designer gym bags in tow.

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Scott Morgan/Patrick McMullan

Working out with a D.J. at a David Barton gym in 1997.

In the center of the lobby, presiding over it all, was David Barton himself. In his 20 years as the bodybuilder-in-chief to downtown celebrities and partygoers, he has morphed into a kind of self-created cartoon superhero.

At 5 feet 5 inches tall, Mr. Barton is so hugely, broadly muscled that he appears almost cube-shaped. His thatch of brown hair was spiked and shellacked, his ample, exposed biceps tanned a blood-orange. He wore a chain dripping with silver fake razor blades, a tie-dyed sweatshirt revealing his bulging pectoral cleavage and stacked-heel boots that put him at eye-level with his female employees.

“We call this Victorian punk,” Mr. Barton, 46, said of the décor in his raspy, staccato, Mickey Rourke voice, his right biceps spasming, as it constantly does. “It’s like some punk rockers took over an old East Village church and made it cool.”

Few things at a David Barton gym look uncool. Since Mr. Barton opened his first gym in Chelsea in 1991, he estimates that he has grossed $230 million with six fitness centers in New York, Miami Beach, Chicago and elsewhere that feel more like nightclubs (noirish lighting, live D.J.’s, spalike locker rooms) than workaday gyms.

But recently, Mr. Barton has “failed out” — bodybuilder jargon for not finishing a workout set. In December, he confirmed news reports that he was separating from Susanne Bartsch, the nightclub promoter and his wife of 15 years. In January, two former trainers filed a harassment suit alleging that managers called them anti-lesbian names and made offensive jokes about sex toys. Then a month later, the company announced it was filing for Chapter 11 bankruptcy protection and partnering with Meridian Sports Club, a group of mid-priced gyms in California, to help restructure $65 million in debt.

“I don’t know how to answer,” Mr. Barton said, when asked about his current state of mind. It was a remarkable admission for a hard-driving, self-promoting man who, as a 20-something personal trainer, built a fitness empire with “a pillowcase full of money.” Added Mr. Barton: “Nobody ever said this business was going to be a cakewalk.”

DAVID BARTON grew up in Queens and New Jersey, the son of a Shell executive and a United Nations secretary, but he made his mark in Chelsea, where he still lives and works.

His first gym, in the unlovely basement of a 1970s apartment building on West 15th Street, was an instant hit among the neighborhood’s burgeoning gay populace. It featured a relentless house-music track, lush spotlighting and wall-to-wall mirrors that seemed to magnify a culture of muscle worship.

“I’d never worked out before, and that gym pretty much changed my life,” said Amanda Lepore, the transsexual party hostess whose surgically enhanced body Mr. Barton has featured in ads. Mr. Barton would let Ms. Lepore and other downtown club figures work out free in exchange for the buzz. “David showed me that I could sculpt my body with weights,” Ms. Lepore said, “which is better than plastic surgery, because you can control it more.”

Other clubs followed on the Upper East Side and in other cities, including Miami Beach, where the opening of the David Barton gym in the Delano hotel in 1995 helped brand that hotel as one of South Beach’s hot spots and where, later, its move to the Gansevoort South was seen as something of a coup for that hotel. Toned down somewhat from the flamboyant Chelsea original, the subsequent locations still succeeded in defining an entirely new kind of gym experience, one that felt as much like hitting a glitzy party as logging an everyday workout.

“David Barton created the prototype of the gym-as-nightclub that has been widely imitated,” said Taylor Hamilton, a senior analyst covering sports and fitness for IBISWorld, a market research company. “They’re probably the highest cachet gyms in the U.S. other than Equinox.”

In 2004, Mr. Barton fulfilled a dream to move his Chelsea flagship to a higher-profile site: the former McBurney YMCA, a century-old landmark on West 23rd Street. It became his most nightclubby gym, with the weight room swathed in theatrical shadows, D.J.’s pumping dance music at night and a fiber-optic light show in the steam room.

With Deal, J.&J. Tries to Change Discussion

Posted: 27 Apr 2011 09:43 PM PDT

In announcing on Wednesday Johnson & Johnson’s biggest acquisition ever, on the eve of its annual shareholder meeting, the company’s chief executive tried to pivot from a year of manufacturing lapses, product recalls and a disappointing share price.

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Joshua Prezant/Bloomberg News

William C. Weldon, chief executive of J.&J., said that buying Synthes would help create openings in emerging markets.

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The $21.3 billion deal for Synthes, a Swiss-American medical device maker, would make Johnson & Johnson the largest player in the market for surgical tools and implants to treat trauma patients, and would make it a more powerful competitor in the $37 billion worldwide market for orthopedic medical devices.

Synthes is a leading maker of screws, plates and surgical tools used to stabilize traumatic injuries. The deal is a move aimed at appealing to investors who have been troubled by Johnson & Johnson’s failure to quickly resolve significant and apparently systemic problems in the company’s consumer products division, which have tarnished once-golden brands like Tylenol.

Johnson & Johnson’s chief executive, William C. Weldon, championed the new deal in an interview on Wednesday, citing what he hoped would be cooperation between the company’s existing orthopedic and spinal implant division, DePuy, and Synthes. “We’ve got the opportunity to create the most innovative and comprehensive orthopedic business in the world,” Mr. Weldon said.

Trauma products are more profitable and less vulnerable than other kinds of medical devices to changes in broad economic trends, he said. The combination of Johnson & Johnson’s global presence and Synthes’s products, he said, created a new opening in emerging markets for the combined company.

Many Wall Street analysts praised the deal, even as some groused that it would not immediately add to earnings.

“J.& J. will be able to offer hospitals an inescapable breadth and depth of products that will offer one-stop shopping in reconstructive implants and trauma repair,” said Rick Wise, an analyst at Leerink Swann. “You are going to have to do business with J.& J.”

Johnson & Johnson is offering 159 Swiss francs (about $181) a share for Synthes — of which 55.65 francs is cash and 103.35 francs is Johnson & Johnson common stock. Derrick Sung, an analyst at Sanford C. Bernstein, said some investors were disappointed that the company was not planning to make use of its stockpile of foreign cash for the deal.

“It’s dilutive, at least for the first year,” he said. “There was an expectation that it would be accretive in the first year.”

At the annual shareholder meeting on Thursday, some investors are expected to raise concerns about Mr. Weldon’s management and his compensation. “I don’t think they would have done the deal if they didn’t need a distraction,” said Erik Gordon, an assistant business professor at the University of Michigan who has been a frequent critic of Mr. Weldon’s leadership.

The company stands at a crossroads as Mr. Weldon nears the end of his tenure. Even as Johnson & Johnson plans to use the Synthes acquisition to improve its position in the device sector and its performance, the company must still resolve major manufacturing problems in its consumer division and work to regain consumer trust. During a conference call with investors on Wednesday morning, some analysts asked whether the company was equipped to handle both a substantial acquisition and significant remediation.

Some investors fault a lack of management oversight for major problems, like last year’s manufacturing lapses at the company’s McNeil Consumer Healthcare unit, which was responsible for the recalls of nearly 300 million items in 2010, including for popular brands like Motrin and Rolaids. McNeil closed its Fort Washington, Pa., manufacturing plant to overhaul it, and is now operating under a consent decree with federal regulators.

Johnson & Johnson bought Pfizer’s consumer business, including brands like Listerine, for $16.6 billion in 2006, and some analysts have speculated that the unwieldy acquisition, along with cost-cutting measures, may have contributed to the problems that developed at McNeil.

In Florida, H.M.O.’s Would Treat Medicaid Patients

Posted: 28 Apr 2011 10:40 AM PDT

DAVIE, Fla. — A crucial experiment in the future of Medicaid is playing out in Florida, where both houses of the Legislature are vying to find ways to drastically cut costs, manage care and reduce waste and fraud.

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Maggie Steber for The New York Times

Vicki Ahern, with her son Keith, opted out of an H.M.O. pilot program.

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Gary Coronado/The Palm Beach Post, via Associated Press

Gov. Rick Scott is urging cuts in Medicaid costs.

The cuts and changes being sought by the Republican-led Legislature and encouraged by the new Republican governor, Rick Scott, a wealthy former hospital company executive, are deeper than those in many other states.

In the past 11 years, the cost of Medicaid in Florida has grown to $21 billion from $9 billion and amounts to a third of the state budget. The federal government pays more than half the tab.

“There is a consensus that the Medicaid system is irretrievably broken,” said State Senator Joe Negron, a Republican who took the lead in writing the Senate bill, which is expected to come to a vote before the legislative session ends a week from Friday. The House approved its bill this month. The changes could go into effect as early as next year.

“I’ve never seen something where we are spending $21 billion and nobody is happy,” Mr. Negron said. “We were not going to kick the can down the road another year.”

Relying loosely on a five-year-old pilot program to shift care to H.M.O.’s, Florida lawmakers are poised to scrap the traditional model in which the state pays doctors for each service they perform. Instead, almost all of Florida’s Medicaid recipients would be funneled into state-authorized, for-profit H.M.O.’s or networks run by hospitals or doctors. H.M.O.’s or networks would also manage the long-term care of the elderly, shifting them away from nursing homes and leading to an expansion of in-home care. Lawmakers who support the bill say the state needs this flexibility in curtailing the exploding cost of Medicaid.

The Florida legislation is being closely watched by other states as they tackle the rapid growth of enrollment and the cost of care. Because Florida has three million Medicaid patients and a high number of uninsured people, a swift jump into managed care would be significant. And while many states use managed care for Medicaid users in one form or other, the Florida proposals stand out because they would set possible limits on services, giving the state and H.M.O.’s the right to deny some benefits that are now offered to patients. This would require federal permission.

“If Florida adopts this method of looking at managed care, other states will definitely look at that, and this is a tool we can use,” said Michael W. Garner, the president of the Florida Association of Health Plans, which lobbies for H.M.O.’s. “The toolbox is pretty empty right now.”

But there is concern across the state that the emerging proposals will not only reduce available health care for millions, but also leave the most vulnerable — the disabled, the elderly and those with serious chronic illnesses — at risk. An April study of the pilot program by Georgetown University raised doubts about patient services and cost efficiency, saying there was too little data. For some, the proposals hold a fearful prospect.

Vicki Ahern, 40, a single mother in Davie, Fla., who is her son’s full-time caregiver, spent several years trying to cobble together a network of medical specialists across several counties to help her son, Keith, 16, grapple with muscular dystrophy, spinal injuries and debilitating pain.

Then, suddenly, the network crumbled. With 10 days’ notice, Ms. Ahern said, Keith was shuttled into the pilot project, which transferred Medicaid patients in five counties to H.M.O.’s and hospital- or doctor-run networks. The counties are Baker, Clay, Duval and Nassau in the northeast and Broward in the south.

The participating H.M.O.’s in Broward County, where the Aherns live, listed none of Keith’s doctors or therapists; they offered few specialists and fewer services. The one rheumatologist who proved helpful dropped out of the program because of low reimbursement rates and frustrations with the bureaucracy.

“I started panicking and considered moving out of state, but we couldn’t,” Ms. Ahern said. “I was very angry because I knew he wasn’t going to get his services. If you have a chronic disability or are medically fragile, then forget it.”

After several months in the pilot program, Ms. Ahern discovered she could opt out, a long bureaucratic process, and she did.

The two bills now in play in Tallahassee are modeled in large part on the pilot program. It allowed the state to provide a set amount of money for managed-care companies to more efficiently serve each Medicaid patient, who include low-income children and pregnant women, the developmentally disabled and others.

The bills vary: the House version would send the developmentally disabled to managed care; the Senate’s would not. The Senate is pushing block grants, which would restrict financing further by creating a cap on the Medicaid budget each year; the House version does not.

The proposed changes worry health care advocates and Medicaid patients, who say that the for-profit nature of H.M.O.’s makes it difficult to care for the neediest.

The pilot program appears to have been far from successful, according to the Georgetown report: H.M.O.’s fled because of low reimbursement rates. Among those leaving was WellCare, which left 55 percent of Duval County’s Medicaid patients in limbo. The company was later accused of cherry-picking Medicaid patients to maximize profits, and five of its former executives were indicted on fraud charges.

Patients were shuffled from H.M.O. to H.M.O. and reported difficulty gaining access to services. In other cases, doctors listed in the network stopped accepting Medicaid patients. Supporters of the bills say that the rates would be adjusted to increase H.M.O. participation and that oversight would be bolstered.

Lawmakers are also planning steep budget cuts in the Medicaid program to tackle the state’s yawning deficits. This would make the shift even more burdensome, Democrats say.

“It can’t work,” said Representative Elaine J. Schwartz, a Democrat, who held community meetings on the program in Broward County. “It undermines the basic purpose of Medicaid, which is to provide services. If the private sector could have made money on Medicaid, they would have. With this plan, we are basically handing them $20 billion. Two groups of people will suffer: the patients because they are bamboozled and the taxpayer who is not getting their money’s worth.”

Joan Alker of the Center for Children and Families at Georgetown, who co-wrote the April report, said that so far there was no solid evidence of how much the pilot program had saved or whether the savings came from denying services. Florida pays among the lowest rates in the country for each Medicaid patient, ranking 43rd, making Medicaid less expensive than private insurance, Ms. Alker said.

Mr. Negron said he envisioned $1 billion in savings from his proposal in its first year and perhaps $4 billion in subsequent years.

“One of my guiding principles,” he said, “is that our friends and neighbors on Medicaid should not receive fewer benefits than their counterparts, but they shouldn’t have a more generous benefit either.”

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Recipes for Health: Shrimp and Mango Tacos

Posted: 28 Apr 2011 12:06 PM PDT

This sweet and pungent combination of mango, shrimp, chilies and cumin is as quick to put together as a stir-fry. Indeed, if you don’t have corn tortillas on hand, serve the shrimp with rice.

Recipes for Health

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

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2 tablespoons canola oil

1 pound medium or small shrimp, peeled and deveined

2 garlic cloves, sliced

2 teaspoons cumin seeds, lightly toasted and ground

2 Serrano or bird chilies, or 1 large jalapeño, minced

1 large mango, peeled, seeded and finely chopped

1/4 cup chopped cilantro

4 to 5 tablespoons lime juice

8 corn tortillas

1. Heat a large, heavy skillet or wok over medium-high heat, and add the canola oil. When the oil is hot, add the shrimp, salt to taste and the garlic. Sauté, stirring or shaking the pan, until the shrimp begins to color, about two minutes. Add the cumin, and continue to cook until the shrimp is pink and opaque, about three minutes. Add the chilies, mango and cilantro, and stir together for one minute. Stir in the lime juice, and remove from the heat. Taste and adjust seasonings.

2. Wrap the tortillas in a heavy kitchen towel, and place in a steamer basket over 1 inch of boiling water. Cover the pot, and steam for one minute. Turn off the heat, and allow to sit for 15 minutes without uncovering. Alternatively, wrap the tortillas in a towel, and heat in the microwave for one minute.

Warm the shrimp briefly in the pan. Place 2 tortillas on each plate, top with the shrimp, fold over the tortillas and serve with rice.

Yield: Serves four.

Advance preparation: This is best served right after you cook the shrimp and mango.

Nutritional information per serving: 268 calories; 1 gram saturated fat; 3 grams polyunsaturated fat; 5 grams monounsaturated fat; 159 milligrams cholesterol; 28 grams carbohydrates; 3 grams dietary fiber; 763 milligrams sodium; 1 gram protein

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

Technology Advances; Humans Supersize

Posted: 27 Apr 2011 02:37 PM PDT

For nearly three decades, the Nobel Prize-winning economist Robert W. Fogel and a small clutch of colleagues have assiduously researched what the size and shape of the human body say about economic and social changes throughout history, and vice versa. Their research has spawned not only a new branch of historical study but also a provocative theory that technology has sped human evolution in an unprecedented way during the past century.

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Sally Ryan for The New York Times

Robert W. Fogel

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The Growing American

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Next month Cambridge University Press will publish the capstone of this inquiry, “The Changing Body: Health, Nutrition, and Human Development in the Western World Since 1700,” just a few weeks shy of Mr. Fogel’s 85th birthday. The book, which sums up the work of dozens of researchers on one of the most ambitious projects undertaken in economic history, is sure to renew debates over Mr. Fogel’s groundbreaking theories about what some regard as the most significant development in humanity’s long history.

Mr. Fogel and his co-authors, Roderick Floud, Bernard Harris and Sok Chul Hong, maintain that “in most if not quite all parts of the world, the size, shape and longevity of the human body have changed more substantially, and much more rapidly, during the past three centuries than over many previous millennia.” What’s more, they write, this alteration has come about within a time frame that is “minutely short by the standards of Darwinian evolution.”

“The rate of technological and human physiological change in the 20th century has been remarkable,” Mr. Fogel said in an telephone interview from Chicago, where he is the director of the Center for Population Economics at the University of Chicago’s business school. “Beyond that, a synergy between the improved technology and physiology is more than the simple addition of the two.”

This “technophysio evolution,” powered by advances in food production and public health, has so outpaced traditional evolution, the authors argue, that people today stand apart not just from every other species, but from all previous generations of Homo sapiens as well.

 “I don’t know that there is a bigger story in human history than the improvements in health, which include height, weight, disability and longevity,” said Samuel H. Preston, one of the world’s leading demographers and a sociologist at the University of Pennsylvania. Without the 20th century’s improvements in nutrition, sanitation and medicine, only half of the current American population would be alive today, he said.

To take just a few examples, the average adult man in 1850 in America stood about 5 feet 7 inches and weighed about 146 pounds; someone born then was expected to live until about 45. In the 1980s the typical man in his early 30s was about 5 feet 10 inches tall, weighed about 174 pounds and was likely to pass his 75th birthday.

Across the Atlantic, at the time of the French Revolution, a 30-something Frenchman weighed about 110 pounds, compared with 170 pounds now. And in Norway an average 22-year-old man was about 5 ½ inches taller at the end of the 20th century (5 feet 10.7 inches) than in the middle of the 18th century (5 feet 5.2 inches).

Mr. Fogel and his colleagues’ great achievement was to figure out a way to measure some of that gain in body size, Mr. Preston said. Much of the evidence — childhood growth, mortality, adult living standards, labor productivity, food and manufacturing output — was available, but no one had put it all together in this way before. Over the years Mr. Fogel and his colleagues have pored over a monumental amount of raw data to piece together the health records of thousands of people in different countries. When he won the Nobel in economics in 1993, the Swedish committee stated it was “for having renewed research in economic history by applying economic theory and quantitative methods in order to explain economic and institutional change.”

“The Changing Body” is full of statistical tables and graphs that include the heights of girls in Croatia and Germany; the caloric energy derived from potatoes, fish and wine; and the average annual allowance of grains and meat for widows in Middlesex County, Mass., from 1654 to 1799 — a testament to both the staggering accumulation of information and the collaborative nature of the enterprise. 

Justices’ Debate Turns to Privacy for Doctors

Posted: 26 Apr 2011 10:17 PM PDT

WASHINGTON — A somewhat esoteric Supreme Court case on Tuesday about data mining by drug companies turned into a debate over a fundamental First Amendment principle that has much engaged the justices lately: What role may the government play in regulating the marketplace of ideas?

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In assessing the Vermont law at issue Tuesday (Sorrell v. IMS Health, No. 10-779), which bars some but not all uses of prescription drug data, several justices indicated that they viewed government efforts to alter the mix of available information as constitutionally problematic.

That principle animated last term’s decision in Citizens United, which struck down part of a federal law regulating speech about politics by corporations and unions. The tenor of Tuesday’s arguments suggested that a majority of the justices had similar concerns about the Vermont law, which regulates the use of information collected about doctors by records kept by pharmacies.

The case is not about patients’ privacy rights, as individual information about them is meant to be stripped from the data. Rather, the Vermont law restricts tailored efforts to market drugs to doctors aided by databases showing what medicines they have been prescribing.

The state law forbids the sale of prescription data to market drugs and bars drug companies from using the data to market drugs, unless the prescribing doctor consents. But other uses of the same data are allowed, including ones by law enforcement, insurance companies and journalists. And drug companies remain free to market their drugs in a more indiscriminate fashion, without knowing the prescribing habits of individual doctors.

Bridget C. Asay, an assistant state attorney general defending the law, tried to frame it as one meant to protect doctors’ privacy. But the argument gained little traction, and several justices noted that the law permitted uses that seemed to invade doctors’ privacy as much as the forbidden ones, and in any event doctors remain free to decline to meet with marketers.

Some of the justices also seemed concerned about what the law meant to achieve, as reflected in legislative findings justifying the law.

There is, the state Legislature said, a “massive imbalance in information presented to doctors” and “the marketplace for ideas on medicine safety and effectiveness is frequently one-sided.” The point of the law, several justices suggested, was therefore to protect doctors from hearing from drug marketers that might suggest more expensive drugs even as the state pushed cheaper generic drugs.

“You want to lower your health care costs, not by direct regulation, but by restricting the flow of information to the doctors,” Chief Justice John G. Roberts Jr. told Ms. Asay. “To use a pejorative word,” he went on, the state is “censoring what they can hear to make sure they don’t have full information.”

The chief justice’s two most senior colleagues, Justices Antonin Scalia and Anthony M. Kennedy, forcefully made similar points. The three justices sit at the center of the Supreme Court bench and at times they seemed a juggernaut bearing down on Ms. Asay.

Other members of the court were also skeptical about the way Vermont had chosen to regulate the distribution of prescription data.

Justice Ruth Bader Ginsburg said the state “is interested in promoting the sale of generic drugs and correspondingly to reduce the sale of brand-name drugs.” But she said that goal ran up against a basic First Amendment problem.

“You can’t lower the decibel level of one speaker,” she said, “so that another speaker, in this case the generics, can be heard better.”

Thomas C. Goldstein, a lawyer for several data mining companies challenging the law, said that sort of government manipulation of information is impermissible.

“The way the First Amendment works in the marketplace of ideas that so upsets Vermont is that both sides get to tell their story,” he said. “The thing that is supposed to be biased here is that the drug companies have too much money. That is not a basis for restricting speech.”

New Hampshire and Maine have laws similar to the one in Vermont, and those have been upheld by the federal appeals court in Boston. The Vermont law at issue in Tuesday’s case was struck down last year by a divided panel of the federal appeals court in New York.

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Recipes for Health: Red Coconut Rice Pudding With Mango

Posted: 27 Apr 2011 08:44 AM PDT

This dish is inspired by a classic Thai sweet made with sticky rice. The red Bhutanese rice has a very nice chewy texture, and the pudding has a light purple-red hue.

Recipes for Health

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

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3/4 cup red Bhutanese rice

1 1/2 cups water

1/4 teaspoon salt

1 cup milk (can use 2 percent) or rice beverage

1 cup unsweetened low-fat coconut milk

Seeds from 1 split vanilla bean, or 1 teaspoon vanilla extract

1/2 cup raw brown sugar, preferably fair-trade organic

1/2 teaspoon rose water (optional)

1 ripe mango, peeled, seeded and cut in thin slices

Fresh lime juice

1. Combine the rice, water and salt in a saucepan, and bring to a boil. Reduce the heat, cover and simmer 30 minutes or until all of the water is absorbed.

2. Add the milk, coconut milk, vanilla and sugar to the rice, and stir together. Bring to a boil while stirring. Reduce the heat and simmer uncovered, stirring often, for 10 to 20 minutes until creamy. Stir in the rose water.

3. Scrape into a bowl or into individual serving dishes, and allow to cool. Serve warm, if you prefer. If serving chilled, cover and cool for at least two hours before serving. Spoon into wide serving bowls or plates, and arrange slices of mango atop or alongside each serving. Squeeze a little lime juice over the mango slices, and serve.

Yield: Serves four.

Advance preparation: This will keep for a couple of days in the refrigerator, but it will stiffen up as the rice absorbs more liquid. Add more coconut milk or regular milk, if desired.

Nutritional information per serving: 346 calories; 3 grams saturated fat 0 grams polyunsaturated fat; 0 grams monounsaturated fat; 5 milligrams cholesterol; 71 grams carbohydrates; 3 grams dietary fiber; 207 milligrams sodium; 6 grams protein

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

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