Monday, April 25, 2011

Health - Books: All About the Invidious Irritants That Irk Individuals

Health - Books: All About the Invidious Irritants That Irk Individuals

Books: All About the Invidious Irritants That Irk Individuals

Posted: 25 Apr 2011 12:00 PM PDT

If there’s anything I can’t stand, it’s somebody kicking the back of my chair. That, and the public clipping of fingernails. And loud gum chewing. Oh yes, and the neighbors’ muffled stereo, and people who are habitually late, and there are actually 20 or 30 other little problems I have with the world at large. But now on to you.

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Ron Barrett

You get every bit as annoyed as I do by car alarms that never stop, fingernails screeching down blackboards, and a fly buzzing around your head. The prolonged whining of a child, your own or somebody else’s, drives you crazy.

In other words, some annoyances are particular to the individual, some are universal to the species, and some, like the fly, appear to torture all mammals. If ever there was a subject for scientists to pursue for clues to why we are who we are, this is the one.

And yet, as Joe Palca and Flora Lichtman make clear in their immensely entertaining survey, there are still more questions than answers in both the study of what annoys people and the closely related discipline of what makes people annoying.

Mr. Palca and Ms. Lichtman — he is a science correspondent for National Public Radio and she an editor for the network’s “Science Friday” program — skitter all over the map in pursuit of their subject, and at first their progress seems peculiarly random, like one of those robotic vacuums. But in the end they do indeed cover every part of the terrain: from physics and psychology to aesthetics, genetics and even treatment for the miserably, terminally annoyed.

Formulating a good working definition of annoyance is a persistent challenge for researchers. One calls it the weakest form of anger, simply diluted rage. Others cite overtones of disgust (a persistently belching dinner guest), dislike (a concert of atonal music) and even panic (that visceral “get me out of here” reaction to the fingernail on the board).

Still, a few constants emerge. An annoyance is unpleasant. It follows a pattern, but unpredictably so. It will definitely end at some point, but you don’t know when. Finally, it is neither harmful nor dangerous in itself, but it often channels something that is.

In sum, it barges into your brain and takes over. If it is a sound, it occupies enough of your attention to interfere with other thoughts. If it is a situation, it keeps you from where you want to be (the recipe calls for two eggs and you have only one). And if it is a person who is late (again!), it manages to do both.

Because so many annoyances are auditory, sounds are particularly well studied. Sometimes the context creates the problem, like the “halfalogue” of an overheard cellphone conversation: Our brains can tune out a whole conversation but seem programmed to pay attention to half. Sometimes the annoyance is the sound itself. One research group found that midrange frequencies, somewhere between a boom and a shriek, annoyed people more than either extreme. Reaction to sound may be cultural, but then again it may not be: Even members of an isolated African tribe appeared bothered by dissonant music.

Sometimes sound is meant by nature to annoy, like a baby’s wail. One researcher suggested that the fingernail on the blackboard bothers us because our primitive midbrain hears in it a primate’s warning cry.

And sometimes the problem lies more in the ear than the sound. People with perfect pitch report they are routinely driven insane by nebulous halftones that don’t fit into their ordered brains.

Mr. Palca and Ms. Lichtman have a lot of fun with the other large repository of annoyances: our fellow humans. Is there a prototype for the innately annoying person, that car alarm on two legs? Needless to say, there are many.

There are the people who display “uncouth habits, inconsiderate acts and intrusive behaviors” — we are annoyed by those who violate our social norms. Then there are the infinite variations on the unfortunate personality. First on a list of traits that tend to annoy others, interestingly, is that of being constantly annoyed. Then come arrogant and picky.

What about your own personal irritant, the spouse who was so enchanting during courtship and is exactly the opposite now? Studies show that precisely those traits that once attracted often begin to repel. Once he was cool; now he is cold. Once she was adoring; now she smothers. Here the problem seems to be a matter of dose.

People who are annoyed to the point of irritable and beyond might head for a medical evaluation; some neurologic diseases start like this well before other symptoms surface. For these patients antidepressants often work miracles.

For other sufferers, alas, there are few quick fixes. And so when you begin to kick my chair, I could try to pretend that I am Japanese, for it seems that the Asian ideal of subjugation of the self to the group makes for less annoyance with one’s neighbor. I could try to change my expectation that when peacefully seated I will not be jiggled like a fishing line, for it seems that among laboratory monkeys thwarted expectations are a prime source of annoyance. Or I can just turn around and glare at you and tell you to cut it out. Then I will be happy. And you will be annoyed.

Cases Without Borders: Without His Mother’s Milk, a Haitian Boy Is Lost

Posted: 25 Apr 2011 12:44 PM PDT

PORT-AU-PRINCE, Haiti — I had just sat down after spending most of the morning and the early afternoon in the outpatient clinic at Bernard Mevs hospital here when one of the surgeons came in and said: “You’re a pediatrician, right? There’s a kid at the front gate who’s pretty sick.”

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I got up and walked over to the hospital entrance. Because the emergency room had only two beds, and the hospital itself had limited resources, patients were sent through triage at the gate, and only those who could be treated were brought in. The others were turned away to seek care elsewhere.

Arriving at the gate, I could already smell the sharp odor of diarrhea. A young woman was holding a baby wrapped in a stained and tattered blanket. From the interpreter, I learned this was a 5-month-old boy with watery yellow diarrhea, vomiting and a decrease in oral intake during the previous four days.

Opening the blanket and looking at him, I was amazed that he was still alive. His chest looked like a chicken breast picked clean of meat. His mucus membranes were pasty dry, his eyes and fontanel were sunken and his skin hung off his arms and legs as if it were three sizes too large. At 5 months he weighed less than four and a half pounds.

The gastroenteritis, it turned out, was only what had tipped him over. On further questioning we learned that his mother had stopped nursing shortly after he was born because her “milk was bad,” and had been bottle-feeding him with watered-down 7Up soda.

Because he was so dehydrated, his veins had collapsed and the nurses in the emergency room weren’t able to place an intravenous line to give him fluids. It was clear that I’d have to insert a thick needle directly into his shinbone to deliver sterile saline solution with a syringe, an ounce at a time.

Never having done this before (though I had practiced on a raw chicken leg), I was nervous about the procedure. The only needle available was longer than his leg was thick, and I was afraid I would push it through and pin him to the mattress.

He hardly whimpered as the needle entered the tibial cavity with a crunch. We gave him the fluids and admitted him to the pediatric ward, but had no way of measuring his electrolytes. He continued to have severe diarrhea and died several hours after being admitted. While gastroenteritis can be fatal in otherwise healthy infants, his extreme malnutrition had made him more vulnerable, and we were unable to save him.

The Haitian belief in “bad milk” — “lèt gate,” in Creole — is well described by Paul Farmer in his book “Partner to the Poor” (University of California, 2010). It is one of the main reasons for the premature stopping of breast-feeding in Haiti, often with deadly consequences for the infant deprived of safe and dependable nourishment.

That same week, one of the nurses in our group was able to prevent something similar from happening to another infant for whom we were caring. Born a few hours before we arrived, and several weeks before his due date, he, too, weighed less than four and a half pounds.

He was placed in an incubator and given antibiotics, and he seemed to be doing well except for one thing: His mother refused to nurse him, or even to express milk to feed him by bottle. Denise, the nurse who cared for him the week we were there, could not understand why the mother refused so adamantly to feed her son.

She pressed the mother every time she saw her, explaining the advantages of breast milk over formula, until finally the mother explained that a previous child of hers had died in infancy, and that a houngan (voodoo priest) had told her that her milk was no good and that she must never nurse any subsequent babies or else they, too, would suffer a similar fate.

Each day Denise pleaded with her to try to nurse. On the third day, the maternal grandmother came to visit and had a long conversation with Denise, asking whether her daughter’s milk was somehow tainted. Denise assured her it was not.

The next day the mother agreed to try nursing her son. He had difficulty latching on, and she expressed a small amount into a bottle, which he eagerly gulped down.

The following morning she returned, nervous about how he had fared. Once she saw that he was fine, she unbuttoned her blouse and again tried to nurse, this time with better success. Over the next few days she continued to nurse him until she no longer needed to express into a bottle, and looked much more relaxed and in better spirits than she had since he was born.

The difference between breast milk and calorically depleted drinks, or formula prepared from water potentially contaminated with organisms that cause diseases like cholera, can be a matter of life or death. And so encouraging this young mother to give her son the sustenance he needed was a potentially lifesaving intervention, achieved through patience, education and the building of trust.

While it may not sound like much, the sad truth is that in Haiti all of these are hard to come by and remain very much in need.

Dr. Dennis Rosen is a pediatric pulmonologist at Children’s Hospital Boston and an instructor at Harvard Medical School.

Study of Vision Tackles a Philosophy Riddle

Posted: 25 Apr 2011 11:27 AM PDT

If a blind person were suddenly able to see, would he be able to recognize by sight the shape of an object he previously knew only by touch? Presented with a cube and a globe, could he tell which was which just by looking?

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Pause for a moment and think of the answer. Then read on.

The question goes to the heart of a problem in the philosophy of mind: Is there an innate conception of space common to both sight and touch, or do we learn that relationship only through experience? Research published online April 10 in the journal Nature Neuroscience may have finally answered the question, which has vexed philosophers and scientists for more than 300 years.

William Molyneux, an Irish politician and scientist, first raised the issue in a letter to John Locke in 1688. Locke took up what came to be known as Molyneux’s problem in “An Essay Concerning Human Understanding,” published a few years later.

Locke’s answer was no. “He would not be able with certainty to say which was the globe, which the cube, whilst he only saw them,” he wrote, “though he could unerringly name them by his touch.” For Locke, the connection between the senses was learned.

Dozens of philosophers have since considered the problem, among them George Berkeley, Gottfried Leibniz, Voltaire, Diderot, Adam Smith and William James. And some efforts have been made to answer the question experimentally, beginning in the early 18th century with studies of patients whose congenital cataracts had been removed in adulthood and continuing recently in observations of newborns.

But according to the authors of the new experiment, the studies have been inadequate, never establishing how well the patient could see afterward, or failing to test soon enough after surgery so that the subject was still completely inexperienced with vision.

The new research appears to show definitively that Locke was right. The brain cannot immediately make sense of what the eyes are taking in, and the blind man given the ability to see cannot distinguish the two objects. But he can very quickly learn to do so.

Working with a group that provides medical treatment to the blind and visually impaired in resource-poor countries, the researchers tested five subjects from rural northern India, four boys and a girl ages 8 to 17. A all had been blind since birth, one with a disorder of the cornea, and the others with cataracts. Before their operations they could perceive light, and two could discern its direction, but none could see objects. Afterward, they all had vision measured at 20/160 or better, good enough to distinguish objects and carry out the tasks of daily living.

The children were tested within 48 hours of their operations. The researchers placed 20 small objects similar to Lego blocks on a table where they could be seen, but not touched. Then they had the children feel identical blocks under the table where they were invisible, and try to match them with those they could see. The average performance in matching one object with another by either touch or sight alone was high, close to 100 percent. Yet when they were asked to match an object they had felt with an object seen, the average number of correct answers dropped to barely better than chance.

But improvement was rapid. A co-author of the study, Yuri Ostrovsky, a postdoctoral fellow at M.I.T., said one child was proficient in less than a week. Within three months, the average number of right answers in matching an object seen with one touched was above 80 percent.

The lead author, Pawan Sinha, a professor of vision and computational neuroscience at M.I.T., believes that answering the philosophical question is not the only benefit.

“This paper strengthens the case that cross-modal learning is possible despite years of deprivation,” Dr. Sinha said. “That’s very important from a clinical perspective because it argues for making a treatment available to all, irrespective of age. Children beyond 6 or 7 are not beyond the correctable age. The brain retains its plasticity well into late childhood and even into adulthood.”

Global Update: Height: Very Poor Women Are Shrinking, as Are Their Chances at a Better Life

Posted: 25 Apr 2011 01:15 PM PDT

The average height of very poor women in some developing countries has shrunk in recent decades, according to a new study by Harvard researchers.

Height is a reliable indicator of childhood nutrition, disease and poverty. Average heights have declined among women in 14 African countries, the study found, and stagnated in 21 more in Africa and South America. That suggests, the authors said, that poor women born in the last two decades, especially in Africa, are worse off than their mothers or grandmothers born after World War II.

“It’s a sobering picture,” said S. V. Subramanian, a professor at the Harvard School of Public Health and lead author. “It tells you the world is not getting to be a better place for women of lower socioeconomic status. For them, it’s getting worse.”

The study, published last week in the online journal PLoS One, analyzed data on 365,000 adult women in 54 poor and middle-income countries from the hundreds of huge Demographic and Health Surveys paid for largely by American foreign aid.

Only women ages 25 to 49 were included to avoid counting those young and growing, or old and shrinking. Women from Senegal and Chad were the tallest, while those from Guatemala and Bangladesh were the shortest.

The study found that the richest 20 percent of women in all the countries surveyed have grown. Those born in the 1940s averaged 5 feet 1 1/2 inches; those born in the 1980s averaged 5-foot-2.

Those in the poorest 20 percent averaged 5-foot-1, no matter what decade they were born in. Guatemala and Honduras had the biggest gaps in height between rich and poor women; Uganda and Ethiopia (above, where women sorted coffee) had the smallest.

Vital Statistics: For a Sex Survey, Privacy Goes a Long Way

Posted: 25 Apr 2011 11:45 AM PDT

It is not easy to ask people about their sex lives, and getting honest answers may be even harder. But there are ways to do it. One good method is to have a computer ask the questions, while the interviewee listens through earphones and enters the answers on the screen — without the intervention, or even the presence, of another human.

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Last month the Centers for Disease Control and Prevention published a report on sexual behavior that used this technique with laptops to gather data on Americans’ sexual behavior, attraction and identity by age, marital status, education and race. Anjani Chandra, the lead author, said the process was developed to assure total anonymity for the respondents.

Dr. Chandra, a demographer with the agency, explained: “The computer tells the interviewees what key to press to lock away the responses. When they return the laptop to the interviewers, they can’t get in. It’s transmitted to a central place where the data processing happens without names or addresses. We get a file that can’t be linked back to the person.”

The researchers got a 75 percent response rate, very high for a household survey, when they interviewed more than 13,000 people ages 15 to 44 from 2006 to 2008.

They found a large reduction in sexual activity among young adults ages 15 to 24. According to the survey, about 29 percent of women and 27 percent of men had not had sexual contact with the opposite sex. This was a sharp increase from 2002, when about 23 percent of young adults had never had sex.

Among men and women older than 25, about 99 percent had had vaginal intercourse. About 90 percent of men and 89 percent of women had had heterosexual oral sex, and 44 percent of men and 36 percent of women had had anal sex with an opposite-sex partner.

Forty-year-old virgins were rare: In the 40-to-44 age group, only 1 percent of men and even fewer women had never had relations with the opposite sex. But in the 15-to-19-year-old group, 43 percent of males and 48 percent of females reported never having an opposite-sex partner.

Over all, about 13 percent of women and 5 percent of men reported same-sex sexual behavior.   

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Vital Signs: Prognosis: Testosterone and Prostate Cancer

Posted: 25 Apr 2011 09:41 AM PDT

Doctors have long held that men with prostate cancer should not be given testosterone because the hormone might fuel tumor growth. But a small study adds to evidence that the fear may be overblown, at least in patients without evidence of recurrent or metastatic disease.

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Researchers studied 13 men with scores of 6 or 7 on the 10-point Gleason scale, indicating mildly to moderately aggressive prostate cancer. They all initially chose watchful waiting rather than treatment for their cancers. All the men had low testosterone.

The men received testosterone therapy for an average of two and a half years, and had periodic prostate biopsies. None of their cancers progressed or spread to other organs. One subject whose score had increased to 7 from 6 had his prostate removed, but the final pathological exam found no aggressive disease.

The authors acknowledge that the study, published in the April issue The Journal of Urology, was small and retrospective. Still, it is the first to use biopsies to monitor the effects of testosterone in men with untreated, localized prostate cancer.

The lead author, Dr. Abraham Morgentaler, an associate clinical professor of surgery at Harvard, said that the findings of this and other recent studies suggest that the risks of testosterone therapy may have been exaggerated.

Vital Signs: Risks: Television Time and Children’s Eyes

Posted: 25 Apr 2011 08:07 AM PDT

Children who spend more time in front of television and computer screens and less in outdoor physical activity have narrower blood vessels in their eyes, a new study has found.

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In adults, constricted blood vessels in the eyes have been linked to an increased risk of cardiovascular disease.

Scientists in Australia studied 1,492 6-year-olds randomly selected from 34 schools in Sydney. The children’s parents completed questionnaires asking how much time their children spent in physical activities and how much time they spent in front of a TV or computer. Then the researchers examined the children’s eyes.

After adjusting for a variety of health factors, they found that blood vessels in the eyes of children who watched the most TV were slightly smaller in diameter than those in children who watched the least amount.

The results for physical activity were similar: the eyes of children who exercised the least had the narrowest blood vessels. The reason is unclear.

“We don’t know what it means in children,” said Dr. Paul Mitchell, a professor of ophthalmology at the University of Sydney and lead author of the study. “We have to follow them for much longer.”

The study was published on Thursday in the journal Arteriosclerosis, Thrombosis and Vascular Biology.

Vital Signs: Childbirth: More Labor Interventions, Same Outcomes

Posted: 25 Apr 2011 08:09 AM PDT

Hospitals vary considerably in the frequency with which they induce labor and perform Caesarean sections. But a new study finds that these differences do not seem to affect how newborns fare in these facilities.

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Dr. J. Christopher Glantz, a professor of obstetrics at the University of Rochester, reviewed records of almost 30,000 births from 10 upstate New York community hospitals without specialized neonatal intensive care units. Some hospitals relied heavily on induced labor and Caesarean sections, while others performed the procedures much less often.

Dr. Glantz measured neonatal outcomes in three ways: whether a child was moved to an intensive care hospital, whether a child needed immediate assisted ventilation and whether a child received a low Apgar score.

He found no difference in outcomes for babies born in the hospitals with the highest rates of these procedures and those with the lowest. The result suggests that routine reliance on the procedures does little to improve outcomes for infants, he said.

“I’m not saying that no interventions should be the goal,” Dr. Glantz said. “But when you see the difference in rates of these interventions with no difference in outcome, it leads me to believe that we can get by with fewer of them.” Dr. Glantz acknowledged that the study, in the April issue of The Journal of Maternal-Fetal and Neonatal Medicine, was retrospective and could not control for all confounding factors.

Recipes for Health: The ‘King of Fruits’ Commands Respect

Posted: 25 Apr 2011 12:38 PM PDT

Why don’t Americans eat more mangoes? Often called the “king of fruits” elsewhere in the world, the mango is not high in calories, and it is an excellent source of beta-carotene, vitamin A and potassium. Now is the time to get acquainted with them: although they’re in season from January to August, mangoes peak in May and June.

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.

A ripe mango gives a bit when pressed, and its fragrance should be heady and sweet, particularly at the stem end. But if you can find only hard, green mangos, bring them home anyway — they will ripen at room temperature in a few days time. Put them in a paper bag with an apple to speed the process along.

To dice a mango, cut down the broad side of the fruit, slightly off center, from the stem end to the tip end. The knife should slide down against the flat side of the pit. Repeat on the other side, cutting as close to the pit as possible. Cut the flesh from the sides of the pit, following the curve of the pit.

Lay each half on your cutting surface and score with the tip of your knife in a crosshatch pattern, down to -- but not through -- the skin. Lift the mango half, and press on the skin with your thumbs to turn it inside out. Little squares of mango will pop out on the other side, and you can easily cut them away from the skin.

If you want to peel the mango before cutting, slice off a small piece of the end, stand the mango upright and peel down the sides using a paring knife, between the skin and the flesh, as you would a pineapple.

Strawberries in a Mango Sea

One summer I lived in Cuernavaca, Mexico, and I would gather mangos from the ground in a park where they dropped, ripe, all day long. If I had had a food processor or a blender, I would have made this every day.

2 large or 4 smaller ripe mangos

3 tablespoons fresh lime juice

2 tablespoons sugar

2 pints ripe, sweet strawberries, hulled and quartered

Fresh mint leaves for garnish

1. Peel and pit the mangos: cut down the broad side of the fruit from stem end to tip end, slightly off center, with the knife following the edge of the pit. Cut down the other side of the fruit in the same way. Cut the flesh from the sides of the pit, cutting as close to the pit as possible. Lay each half, skin side down, on your cutting surface and score with the tip of your knife in a crosshatch pattern, down to -- but not through -- the skin. Lift each mango half, and press on the skin with your thumbs to turn the half inside out. Slice the cubes away from the skin. Repeat with the other half. Cut the strips from the sides away from the skin. Discard the skins.

2. Place the mango in a food processor fitted with the steel blade. Add half the lime juice and 2 teaspoons of the sugar. Puree until smooth. Scrape into a bowl, and set aside. You should have about 2 cups puree.

3. Toss the strawberries with the remaining lime juice and sugar, and let sit for 15 to 30 minutes, in or out of the refrigerator.

4. Spoon about 1/4 cup of mango puree onto each dessert plate or into wide dessert bowls. Place a spoonful of strawberries, with juice, in the middle. Garnish with mint and serve.

Yield: Serves eight.

Advance preparation: The mango puree will keep for a day in the refrigerator.

Nutritional information per serving: 80 calories; 0 grams saturated fat; 0 grams polyunsaturated fat; 0 grams monounsaturated fat; 0 milligrams cholesterol; 20 grams carbohydrates; 3 grams dietary fiber; 2 milligrams sodium; 1 gram protein

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

Doctors INC.: Family Physician Can’t Give Away Solo Practice

Posted: 25 Apr 2011 11:48 AM PDT

CROFTON, Md. — “So there we are, miles from shore, fishing since 11 o’clock at night, and we haven’t gotten one single bite until finally we gaff one that’s about this big.”

A Wrenching Transition

Articles in this series are examining recent shifts in medical care.

Are You a Doctor?

Share your insights on the changing medical profession with The New York Times and the Public Insight Network from American Public Media.

Tell us your story.

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A Profession in Transition

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Brendan Smialowski for The New York Times

Dr. Sroka examined John Dennstaedt, a patient of his for 10 years.

Dr. Ronald Sroka held his hands about three feet apart, and John Mayer — fishing buddy and patient — smiled from the examination table. Dr. Sroka shook his head, glanced at a wall clock and quickly put his stethoscope to his ears.

“All right, deep breaths,” Dr. Sroka said. It was only 10 a.m., but Dr. Sroka was already behind schedule, with patients backed up in the waiting room like planes waiting to take off at La Guardia Airport. Too many stories; too little time.

“Talking too much is the kind of thing that gets me behind,” Dr. Sroka said with a shrug. “But it’s the only part of the job I like.”

A former president of the Maryland State Medical Society, Dr. Sroka has practiced family medicine for 32 years in a small, red-brick building just six miles from his childhood home, treating fishing buddies, neighbors and even his elementary school principal much the way doctors have practiced medicine for centuries. He likes to chat, but with costs going up and reimbursements down, that extra time has hurt his income. So Dr. Sroka, 62, thought about retiring.

He tried to sell his once highly profitable practice. No luck. He tried giving it away. No luck.

Dr. Sroka’s fate is emblematic of a transformation in American medicine. He once provided for nearly all of his patients’ medical needs — stitching up the injured, directing care for the hospitalized and keeping vigil for the dying. But doctors like him are increasingly being replaced by teams of rotating doctors and nurses who do not know their patients nearly as well. A centuries-old intimacy between doctor and patient is being lost, and patients who visit the doctor are often kept guessing about who will appear in the white coat.

The share of solo practices among members of the American Academy of Family Physicians fell to 18 percent by 2008 from 44 percent in 1986. And census figures show that in 2007, just 28 percent of doctors described themselves as self-employed, compared with 58 percent in 1970. Many of the provisions of the new health care law are likely to accelerate these trends.

“There’s not going to be any of us left,” Dr. Sroka said.

Indeed, younger doctors — half of whom are now women — are refusing to take over these small practices. They want better lifestyles, shorter work days, and weekends free of the beepers, cellphones and patient emergencies that have long defined doctors’ lives. Weighed down with debt, they want regular paychecks instead of shopkeeper risks. And even if they wanted such practices, banks — attuned to the growing uncertainties — are far less likely to lend the money needed.

For patients, the transition away from small private practices is not all bad. While larger practices tend to be less intimate, the care offered tends to be better — with more preventive services, better cardiac advice and fewer unnecessary tests. And the new policies that may finally put Dr. Sroka out of business are almost universally embraced — including wholesale adoption of electronic medical records and bundled payments from the federal Medicare program that encourage coordinated care.

“Those of us who think about medical errors and cost have no nostalgia — in fact, we have outright disdain — for the single practitioner like Marcus Welby,” David J. Rothman, president of the Institute on Medicine as a Profession at Columbia University, said of the 1970s TV doctor.

Dr. Sroka has not taken a sick day in 32 years. After his latest partner left in September, he was unable for five months to schedule any time off until another local doctor volunteered to cover for him. His income and patients depend upon his daily presence. This resiliency is part of a tough-minded medical culture — forged in round-the-clock residency shifts, constant on-call schedules, and workplaces in which revered doctors made decisions and staff members followed orders — that is fast disappearing.

Had he left a decade ago, Dr. Sroka might have been able to persuade a doctor to pay $500,000 or more for his roster of 4,000 patients. That he cannot give his practice away results not only from the unattractiveness of its inflexible schedule but also because large group practices can negotiate higher fees from insurers, which translates into more money for doctors.

Building Relationships

Handsome, silver-haired and likable, Dr. Sroka is indeed a modern-day Marcus Welby, his idol. He holds ailing patients’ hands, pats their thickening bellies, and has a talent for diagnosing and explaining complex health problems.

Many of his patients adore him.

One of them, Alicia Beall, 53, came in for a consultation after a pain in her foot grew worrisome. She has been seeing Dr. Sroka for 30 years, and he quickly guessed that she was suffering plantar fasciitis, a painful inflammation.

“So take off your shoe,” Dr. Sroka said. She did, and Dr. Sroka lifted her foot.

“If it’s plantar fasciitis, it’s usually right there,” Dr. Sroka said and pressed his thumb into her heel.

“Ow! Don’t do that,” Ms. Beall said and smacked him with a magazine. They both laughed.

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For Many Chinese, New Wealth and a Fresh Face

Posted: 25 Apr 2011 10:54 AM PDT

BEIJING — Even in a blue-striped hospital bathrobe, her face wiped clean of makeup and marked with purple lines by her surgeon, the young woman who called herself Devil embodied an image of beauty widely admired in China: large, luminous eyes, a delicate nose and softly sculpted cheekbones.

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Sim Chi Yin for The New York Times

Chen Xiaomeng, 25, is pleased with her new eyelids. "Cosmetic surgery is now accepted in practically every household," she said.

But her jaw line? Too square for her liking. So the 22-year-old television reporter recently traveled from a coastal province to a private hospital in downtown Beijing to have it reshaped — for about $6,000. Her boyfriend, a 29-year-old businessman wearing designer eyeglasses, picked up the bill.

“I am not nervous at all,” said Devil (the English first name she chose for herself, and the only one she would reveal) as she awaited surgery at Evercare Aikang hospital in downtown Beijing. “I will look more sophisticated and exquisite.”

The breathtaking pace of transformation for upwardly mobile Chinese — from bicycles to cars, village to city, housebound holidays to ski vacations — now extends to faces. In just a decade, cosmetic and plastic surgery has become the fourth most popular way to spend discretionary income in China, according to Ma Xiaowei, China’s vice health minister. Only houses, cars and travel rank higher, he said.

No official figures exist, but the International Society of Aesthetic Plastic Surgery estimated in 2009 that China ranked third, behind the United States and Brazil, with more than two million operations annually. And the number of operations is doubling every year, Mr. Ma said at a conference organized by the Health Ministry in November.

“We must recognize that plastic and cosmetic surgery has now become a common service, aimed at the masses,” he said.

Face-lifts and wrinkle-removal treatments are in vogue, just as in the West. But at Evercare, which runs a chain of cosmetic-surgery hospitals in China, two-fifths of patients are in their 20s, said Li Bin, the general manager and one of the founders.

Nationally, the most requested surgeries have nothing to do with age: The No. 1 operation is designed to make eyes appear larger by adding a crease in the eyelid, forming what is called a double eyelid, said Zhao Zhenmin, secretary general of the government-run Chinese Association of Plastics and Aesthetics.

The second most popular operation raises the bridge of the nose to make it more prominent — the opposite of the typical nose job in the West. Third is the reshaping of the jaw to make it narrower and longer, he said.

The youthful patients include job applicants hoping to enhance their prospects in the work force, teenagers who received cosmetic surgery as a high school graduation present and even middle school students, most of whom want eye jobs, surgeons say.

China’s regulatory system, by all accounts, has not kept up. At the conference in Beijing in November, Mr. Ma, the vice health minister, said the situation “can even be called neglect.”

Out of 11 clinics and hospitals offering cosmetic or plastic surgery that were inspected late last year, he said, fewer than half met national standards. Employees lacked professional credentials, he said; equipment and materials were subpar. Beauty parlors are flagrant violators, illegally administering Botox injections and performing eyelid surgery.

Mr. Ma likened the industry to a medical “disaster zone,” with frequent accidents. His point was underscored when a 24-year-old former contestant on the Chinese reality show “Super Girl” died after her windpipe filled with blood during an operation to reshape her jaw in Hubei Province.

Health officials demanded an inquiry. But Mr. Zhao, who also serves as the vice director of Beijing’s government-run Plastic and Cosmetic Surgery Hospital, said it was impossible to gather evidence because the body was quickly cremated — a common practice in China when hospitals privately settle malpractice claims.

“Personally speaking, I think this is pretty despicable,” he said. “We need to get to the bottom of such cases in order to protect people in the future.”

The shortcomings of China’s medical system are hardly limited to cosmetic and plastic surgery. But the industry now generates an estimated $2.3 billion in revenue, and the government has begun to take note. Officials say new regulations will probably be issued this year.

One implicit goal is to halt the flow of Chinese patients to better-established hospitals in South Korea. Mr. Ma estimates that Chinese make up 30 percent of cosmetic surgery patients in Seoul.

For now, many beauty salons, like one downtown Beijing branch of a major chain, are capitalizing on the lack of oversight. One recent afternoon, a 62-year-old woman in a white coat who described herself as an internist said she could summon a doctor who could give a visitor double eyelids in 20 minutes about $180, a fraction of the standard hospital fee.

“Immediately you will look different,” she said.

Shi Da, Li Bibo, Zhang Jing and Jonathan Kaiman contributed research.

A Fight Over How Drugs Are Pitched

Posted: 25 Apr 2011 09:59 AM PDT

Before pharmaceutical company marketers call on a doctor, they do their homework. These salespeople typically pore over electronic profiles bought from data brokers, dossiers that detail the brands and amounts of drugs a particular doctor has prescribed. It is a marketing practice that some health care professionals have come to hate.

“It’s very powerful data and it’s easy to understand why drug companies want it,” said Dr. Norman S. Ward, a family physician in Burlington, Vt. “If they know the prescribing patterns of physicians, it could be very powerful information in trying to sway their behavior — like, why are you prescribing a lot of my competitor’s drug and not mine?”

Marketing to doctors using prescription records bearing their names is an increasingly contentious practice, with three states, Maine, New Hampshire and Vermont, in the vanguard of enacting laws to limit the uses of a doctor’s prescription records for marketing.

On Tuesday, the Supreme Court will hear arguments in a case, Sorrell v. IMS Health, that tests whether Vermont’s prescription confidentiality law violates the free speech protections of the First Amendment.

The case is being closely watched not only by drug makers and data collection firms, but also by health regulators, doctors and consumer advocates who say the decision will have profound implications for doctors’ control over their prescription histories, and for information privacy, medical decision-making and health care costs.

Vermont’s attorney general, William H. Sorrell, petitioned the court to review the case after three leading data collection firms including IMS Health, a health information company, and the Pharmaceutical Research and Manufacturers of America, a drug industry trade group, challenged the state statute. Although the federal district court in Vermont originally upheld the law, an appellate court reversed the decision last November.

The federal government, the attorneys general of several dozen states, AARP, professional medical associations, privacy groups and the New England Journal of Medicine have filed briefs in support of Vermont’s law. The National Association of Chain Drugstores, the Association of National Advertisers and news organizations like Bloomberg and The Associated Press have filed briefs aligning themselves with the data firms.

The concern over marketing based on doctor-specific prescription records revolves around the argument that it makes commercial use of private health treatment decisions — initiated in nonpublic consultations between doctor and patient, and completed in government-regulated transactions with pharmacists.

The data has become more available because pharmacies, which are required by law to collect and maintain detailed files about each prescription filled, can sell records containing a doctor’s name and address, along with the amount of the drug prescribed, to data brokers. (The records are shorn of patient names and certain other personal details covered by the Health Insurance Portability and Accountability Act, known as H.I.P.A.A., the federal legislation governing a patient’s privacy.) Data brokers in turn aggregate the records for use in medical research and marketing.

Drug makers spent about $6.3 billion on marketing visits to doctors in 2009, the last year that such figures were available, according to IMS Health. Access to a doctor’s prescription history, drug makers say, helps ensure that information about the latest prescription drug options quickly reaches specialists who treat particular conditions.

But some federal regulators and medical societies argue that drug makers are simply mining the data to identify and go after the doctors who would be most likely to prescribe the latest, most expensive brand-name medicines — driving up health care costs and exposing patients to newer drugs whose side effects may not yet be fully known.

Vermont enacted its prescription confidentiality law with the idea that drug makers do not have an inherent right to a doctor’s identifiable prescription information for use in marketing because the data originated in highly government-regulated, nonpublic health care transactions, said Mr. Sorrell, the Vermont attorney general.

“Does ‘Ajax Incorporated’ have a constitutional unfettered right to the data for commercial purposes,” Mr. Sorrell said, “or is it legitimate to give the doctor who is writing the prescription a say over whether that information should be used for marketing?”

Although the state law does not inhibit pharmaceutical sales representatives from marketing to doctors in their offices, he said, it does give doctors the right to consent before their prescribing information may be sold and used for marketing. If a doctor does not agree, he said, pharmacies must remove or encrypt the doctor’s name, just as they do for patients, before they sell this type of record for promotional use.

Even if the Supreme Court were to find that the law infringes on free speech, Mr. Sorrell added, the justices could still uphold the law on the grounds that the state has a legitimate interest in containing the higher medical costs and safety risks that can be associated with the newest drugs.

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City Issues Rule to Ban Dirtiest Oils at Buildings

Posted: 21 Apr 2011 09:20 PM PDT

Buildings in New York City will be required to phase out using the most-polluting grades of heating oil under a new regulation that is expected to improve air quality significantly and make black smoke billowing from smokestacks a thing of the past.

The new rule, announced on Thursday by Mayor Michael R. Bloomberg as part of an update to his environmental agenda, known as PlaNYC, affects about 10,000 buildings that burn the dirtiest types of heating oil: No. 6, the cheapest oil pumped into aging boilers; and No. 4, another heavy oil that is only slightly less noxious.

Only 1 percent of buildings in the city burn the dirty oil, officials said, but are responsible for more than 85 percent of all the soot pollution from buildings.

Soot pollution can irritate the lungs, worsen conditions like asthma and increase the risks of heart attacks and premature death.

In a report released on Thursday, the city’s health department said air pollution from the fine particles emitted by the dirty-oil buildings, as well as other sources in the city, caused more than 3,000 deaths, 2,000 hospital admissions for lung and heart conditions and about 6,000 emergency room visits for asthma annually.

Aside from the city’s efforts to curb smoking, Mr. Bloomberg said the heating oil regulations were “the single biggest step that we’ve taken to save lives.”

Under the new rule, by 2015, existing boilers must switch from No. 6 oil to a low-sulfur version of the No. 4 heating oil or to an equivalent cleaner fuel. Any newly installed boiler would have to burn an even less polluting grade — low-sulfur No. 2 oil — or natural gas or an equivalent low-emission fuel, which would in effect eventually phase out No. 4 oil.

Boilers not replaced by 2030 would need to be modified to meet the new regulations.

Building owners said the biggest challenge in making the conversion was cost, particularly for smaller buildings in these tough economic times.

In a statement, the Real Estate Board of New York said it would work with the Bloomberg administration “to identify and implement ways to achieve those goals in an expeditious and sensible manner.”

The organization has previously noted that compliance costs will be borne by tenants in the form of higher rents or maintenance charges.

It will cost about $10,000 or less to convert boilers to use No. 4 oil — and much more to switch to No. 2 oil or natural gas. City officials said buildings that demonstrated a severe financial hardship could seek an extended schedule for complying.

More than 200 public schools are among the buildings that must make the switch.

The phase-out, when fully in effect, will reduce the amount of fine particles emitted by heating buildings by at least 63 percent and lower the overall concentration of fine particles in the city’s air from all sources by 5 percent.

“The health benefits will be dramatic,” said Andy Darrell, the New York regional director for the Environmental Defense Fund, a national environmental group that will work with the city to educate building owners about the conversions.

In an address on the eve of Earth Day, Mr. Bloomberg presented the first update to PlaNYC, which calls for such revisions every four years.

Speaking at Harlem Stage, a performing arts site inside Harlem’s Gatehouse, to an audience of city officials, environmental groups and others who helped update the plan, the mayor also announced the start of a new nonprofit corporation, the New York City Energy Efficiency Corporation, that will use $37 million in federal money to make loans to building owners for energy-efficiency upgrades.

Japanese Revisit Nuclear Zone While They Can

Posted: 22 Apr 2011 05:50 AM PDT

OKUMA, Japan — Residents who lived near the damaged Fukushima Daiichi nuclear power plant flocked to the area on Thursday ahead of a midnight evacuation deadline imposed by the government.

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Michiko Koyama, whose house is near the Fukushima Daiichi nuclear plant, returned home with her husband, Nobuo, to retrieve their belongings.
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While they were greeted by the buckling roads and collapsed houses familiar to many Japanese in the wake of the earthquake and tsunami that wrought such destruction here on March 11, they faced the added burden that dangerous radiation levels from the Daiichi plant might mean they were saying goodbye to their homes for months or years. Some worried they would never return.

In Okuma and nearby towns inside the 12-mile zone around the plant declared off limits by the government, those who returned encountered a ghost town where traffic lights did not function and abandoned dogs lolled in the empty streets.

At a family farm in nearby Tomioka, cows had the run of the place, eating the lettuce in the garden and roaming through the front yard. At a farm in Namie, the scene was grisly: about 40 cows, chained to their posts, lay dead, side by side, in two adjacent barns. Another dead cow was sprawled across the road, blood oozing from its mouth. A few live cows sat serenely nearby, as if nothing had happened.

In Futaba, a town next to the plant, several signs stretching across the empty streets extolled the virtues of atomic energy. “Nuclear power is energy for a brighter future,” read one. Another said, “The correct understanding of nuclear power leads to a better life.”

And at the gate of the Fukushima Daiichi plant itself, workers in white suits and masks turned away an unauthorized car while photographing its license plate. On a board behind the workers someone had written, “Don’t give up.”

The crippled reactors themselves, and the undoubtedly frenzied work going on there, were obscured by hills, some with cherry trees in full blossom.

While the government ordered an evacuation of the area shortly after the nuclear emergency began, it has not enforced the edict until now, and residents have been slipping back into the zone to retrieve their belongings.

Radiation levels around the plant have fallen sharply since the days just after the accident, clearing the way for returnees. A reporter who roamed through various parts of the evacuation zone for five hours on Thursday had a total exposure of about 50 microsieverts, about the same as one would experience on a round-trip flight between New York and Los Angeles.

With the government now enforcing the evacuation order, there is the question of whether those who have ignored  it until now will leave. The government says 78,200 people lived within the 12-mile radius of the plant before the earthquake. A police spokesman in Fukushima Prefecture, where the plant is located, said spot checks on 3,378 addresses in the past three weeks found people at 63 of them.

An additional 62,400 people live 12 to 18 miles from the plant. They were urged to evacuate or to remain indoors.

Tadanori and Eiko Watanabe, who live in that outer zone, about 17 miles from the power plant, have done neither. While worried about radiation, they refused to abandon their 16 beef cows. “Our cows are like our family, and we can’t leave them here,” said Ms. Watanabe, as she and her husband carted away manure in wheelbarrows.

Most of their neighbors have long since left, and their houses are dark. “Especially at night it’s scary,” Ms. Watanabe said, adding that she and her husband passed the time watching television. Ms. Watanabe said that if she were ordered to evacuate, rather than just urged to do so, she would obey. “We’re looking for a place we can go with the cows,” she said.

Kiyoshi Abe, a farmer in Minamisoma who lives about eight miles from the nuclear plant, said he was the only one in his neighborhood not to evacuate. “I’m amazed the Japanese are so obedient,” he said by telephone.

But Mr. Abe, who is 83, said that at his age, “I don’t care about a little bit of radiation.” He also has cancer, which he said might worsen if he had to move.

Ken Ijichi contributed reporting from Okuma, Japan, and Yasuko Kamiizumi from Tokyo.

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Personal Health: Thyroid Fears Aside, That X-Ray’s Worth It

Posted: 25 Apr 2011 11:20 AM PDT

It doesn’t take much to scare people when it comes to cancer, especially when the cause, unlike smoking, seems beyond one’s control.

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So I was not surprised by a stream of panicked e-mails I received after a television show in which the popular Dr. Mehmet Oz called thyroid cancer “the fastest-growing cancer in women” and cited the harmful effects of radiation from sources like dental X-rays and mammograms.

Dr. Oz warned that people who have more than five X-rays a year have a fourfold greater risk of developing this cancer, and recommended the use of a lead thyroid shield when getting dental X-rays or mammograms. One of his guests on the program, Dr. Carolyn Runowicz, a gynecological cancer specialist, said she would not get dental X-rays if the only reason was to check her teeth.

Thyroid cancer is much on people’s minds, particularly because of the nuclear reactor accident in Japan. After all, it has only two known causes: a rare genetic condition and exposure to large doses of radiation, especially during childhood.

The effects of radiation are cumulative, so in theory frequent exposure to even low doses could add up to a cancer risk. So what are the facts about radiation and the thyroid, and how concerned should you be about an annual mammogram or dental X-rays every few years?

Here are a few things to remember:

¶Thyroid cancer is relatively rare, accounting for about 3 percent of all cancers in women, 1 percent in men and 1.4 percent in children.

¶Diagnoses of thyroid cancer have increased sharply in recent decades. Between 1980 and 2007, the incidence rose to 17 per 100,000 from 6 per 100,000 each year, and to 5.8 per 100,000 from 2.5 per 100,000 men each year. The number of diagnoses in women nearly doubled from 2000 to 2008.

¶Yet the death rate from this disease has not increased, and more than 97 percent of patients survive.

Dr. Otis W. Brawley, chief medical officer of the American Cancer Society, said the stable death rate despite a rising incidence strongly suggests that most of the thyroid cancers now being diagnosed would never have become a health threat.

“Our technology has gotten so good that we are finding cancers today that even 15 years ago would not have been diagnosed,” Dr. Brawley said in an interview. “We’re finding and treating cancers that would never have killed anyone.”

Advances in Diagnostics

In a study describing a 140 percent increase in thyroid cancers diagnoses from 1973 to 2002, published in The Journal of the American Medical Association in 2006, researchers at the Veterans Affairs medical center in White River Junction, Vt., also concluded that the rise was the result of “increased diagnostic scrutiny.”

They noted that if there were a true increase in thyroid cancer, the rise would be reflected in patients at every stage of the disease. But in their study, 87 percent of the increase was attributable to diagnoses of small papillary thyroid cancers, many of which would never have caused any problem.

The fact that thyroid cancer increased in all age groups from 2000 to 2008, Dr. Brawley said, “is more consistent with the introduction of new diagnostic technology than with any cause like mammography.” If mammography were a factor in the rise of thyroid cancer, he added, you’d expect to see a greater rise in women older than 50 than in women ages 20 to 40.

Dr. Leonard Wartofsky, a thyroid cancer specialist at Washington Hospital Center in the District of Columbia, said in an interview, “The doses associated with mammography have been well studied and well calibrated. As long as it is done with modern equipment, women should not be concerned. That degree of radiation is not consequential.”

The higher rates of thyroid cancer found in women could also reflect the fact that many are checked annually by gynecologists, who routinely examine the thyroid region for possible enlargement, Dr. Brawley suggested.

With regard to dental X-rays, he noted that the amount of radiation exposure associated with them has decreased considerably in the last 20 years, which is inconsistent with a rise in thyroid cancer diagnoses.

Radiation Risks

To be sure, exposure to high doses of radiation, especially in childhood, raises the risk of cancer, and thyroid cancer in particular. Well before this risk was recognized, radiation was widely used to treat benign conditions like enlarged tonsils and adenoids, acne and ringworm of the scalp.

Thyroid cancers afflicted many who were exposed as children, or even prenatally, to large amounts of radiation when Americans dropped atomic bombs in Japan in 1945 and when the Chernobyl accident occurred in 1986.

While very large doses of radiation destroy the thyroid, moderately high doses — like those that are used to treat Hodgkin’s disease or tumors of the head and neck — can cause genetic mutations that develop into cancer.

But what of lower doses? Studies of the relationship between frequent dental X-rays and thyroid cancer have been conflicting, and in some the methodology has been suspect. (Some reports, including a frightening one from Kuwait, relied on people’s ability to remember the X-rays they received.)

But the best study of diagnostic X-ray exams, conducted in Sweden, where precise medical records are kept, found no connection to thyroid cancer.

Other factors linked to an increased risk of thyroid cancer include consumption of nitrates in public water supplies (from fertilizer runoff) and certain vegetables, and goiter caused by insufficient iodine in the diet.

Playing It Safe

There’s no harm in asking a mammographer to use a lead thyroid collar, and a lead apron should cover the front of the neck during dental X-rays. Still, some internal radiation scatter will occur, Dr. Brawley said.

Dr. Wartofsky suggested that women worried about the radiation from a mammogram could have an M.R.I. or ultrasound exam instead. But check first on insurance coverage for these alternatives.

For dental checkups, find a dentist who uses digital X-rays, which deliver much less radiation. “We’ve said for years that the amount of radiation from dental X-rays is not enough to cause cancer,” Dr. Wartofsky said.

And don’t let irrational fear get the better of you: It is simply not possible to detect all dental decay without X-rays, and missing hidden decay could result in the need for a root canal or extraction of the tooth.

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Really: The Claim: Ginger Can Help Reduce Morning Sickness

Posted: 25 Apr 2011 11:50 AM PDT

THE FACTS

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Ginger has a long history as a cure for upset stomachs. One of its active compounds, 6-gingerol, is known to help relax gastrointestinal muscles, and research has shown that ginger pills and fresh ginger root can ease seasickness and other forms of queasiness.

But when researchers recently analyzed the data on ginger as a treatment for nausea in early pregnancy, the results were not convincing.

The analysis was carried out in 2010 and published in the Cochrane Database of Systematic Reviews. In it, researchers pooled data from randomized trials of ginger and other common remedies for morning sickness, focusing on studies involving women in their first 20 weeks of pregnancy, when vomiting is most common.

The scientists found that while ginger appeared to be helpful in some instances, over all the evidence of its effectiveness was “limited and not consistent.” Some women reported experiencing heartburn. There was no explanation as to why ginger appeared so effective against nausea caused by other conditions — like chemotherapy treatment — but less so in early pregnancy.

The study also reviewed the data on vitamin B6 supplements and morning sickness, which were not convincing, and looked at acupuncture, which the researchers said “showed no significant benefit to women in pregnancy.”

The researchers concluded that while there wasn’t very strong evidence for any of the studied treatments, women who wished to try one anyway should do so in consultation with their doctors.

THE BOTTOM LINE

Ginger is helpful as a treatment against nausea, but as a balm for morning sickness, the jury is still out.

ANAHAD O’CONNOR

scitimes@nytimes.com

The New Old Age: Suing Nursing Homes

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Maybe Just Drunk Enough to Remember

Posted: 23 Apr 2011 05:48 PM PDT

Drunken recollections, especially in rape trials, rarely play well to jurors. In a society that can be quick to turn a skeptical eye toward women who say they were raped — she was scantily dressed, she’s promiscuous, she’s just angry at him — prosecutors of sex crimes say one of their biggest obstacles in the courtroom is alcohol.

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A rape trial in Manhattan is the latest example. The accuser, who completed her testimony Monday, admitted that she was so drunk on the night in question that she could not remember most of what happened, even the cab ride home. Yet she provided a vivid description of the moment she said she was raped by the police officer who escorted her up to her apartment.

Can someone be that drunk, yet remember specific details of an event?

According to scientists, it’s possible. But it is also possible that any memory of a drunken episode is colored by suggestion or outside information.

When drunk, people sometimes pass out; they become unconscious. Or they could black out — a condition in which they’re conscious but not storing memories.

Blackouts tend to start at blood alcohol levels of at least 0.15 percent, about twice the legal limit for driving, especially when a person hits that level quickly. When alcohol floods the hippocampus — a brain region that records our lives as they unfold — neurons stop talking to each other and capturing memories, said Aaron White, a researcher with the National Institute on Alcohol Abuse and Alcoholism.

When the hippocampus is off, no matter how hard one tries, a memory will not be recalled because it will not have been recorded in the first place, Dr. White said.

Yet a person in that condition can still be conscious and “interacting with people, talking, driving a car, having sex, engaging in all kinds of complex behavior,” said Kim Fromme, a psychology professor at the University of Texas at Austin who has researched alcohol-induced blackouts.

The woman who testified last week seemed to be experiencing what researchers call a fragmentary blackout, a phenomenon well recognized in neuropsychology. In those cases, the neurons tend to flicker, allowing the brain to capture scenes here and there, according to Dr. White.

But the brain does not necessarily favor one event over another. In other words, it’s not true that after a drunken night we tend to recall the exceptional over the mundane.

“There does not appear to be an association between the emotional salience of an event and whether it will be recorded,” Dr. White said. During a blackout, he added, “a person is just as likely to remember brushing their teeth as being assaulted.”

The recollection of an incident during a drunken blackout can also be influenced.

“An individual can’t remember something, but they keep being asked: ‘What about this? What about that?’ ” Dr. Fromme said. “You have to be cautious about memories becoming contaminated by people’s questioning. People can then take that information you’ve given them and create a false memory that’s not actually true.”

Some research suggests, however, that traumatic memories, when they are captured, can stick with more detail than even something that is pleasant.

A person may, for instance, remember clearly how the food at his or her wedding tasted. Yet if someone were to force food down that person’s mouth, that would produce a more vivid memory, said David Lisak, a psychology professor at the University of Massachusetts in Boston.

“The brain is really affected by the neurochemicals that are circulating in it” during traumatic events, he said. “The memories tend to be sensory fragments, vivid smells, vivid images, vivid physical sensations, body sensations.”

Scientists still do not know whether some people are predisposed to blackouts. One study found that people with a history of blackouts may experience them at a blood alcohol level of 0.08 percent.

Researchers performed memory tests on people while they were sober, and again while they were at 0.08 percent. Using magnetic-resonance imaging, the researchers found that individuals who were having blackouts had less activity in the frontal areas associated with memory, decision making and attention, said Reagan Wetherill, a postdoctoral fellow at the University of California at San Diego’s School of Medicine who conducted the research.

Researchers remain unclear about exactly which cues tend to help people recall memory, and why.

There may be one seemingly radical, but still unproven, method for jogging the memories of people who have blacked out: get them drunk again.

Studies of a theory called state-dependent learning have suggested that some people who witnessed an event while they were drunk were better able to recall the details later when they were brought back to the same level of drunkenness, said Seema L. Clifasefi, a research scientist at the University of Washington’s Addictive Behaviors Research Center.

“In essence, the state of being intoxicated may serve as an internal memory cue and allow access to information that may not be readily available under a sober state,” she wrote in an e-mail.

Beyond the fact that the science is not yet solid, Dr. Clifasefi acknowledged that applying this theory in court might be a stretch.

“Would getting people intoxicated to recall details of an event fly with our current legal system or is it really feasible?” she wrote. “Probably not!!”

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