Wednesday, June 15, 2011

Health - Lead Poisoning in China: The Hidden Scourge

Health - Lead Poisoning in China: The Hidden Scourge

Lead Poisoning in China: The Hidden Scourge

Posted: 15 Jun 2011 05:01 AM PDT

MENGXI VILLAGE, China — On a chilly evening early last month, a mob of more than 200 people gathered in this tiny eastern China village at the entrance to the Zhejiang Haijiu Battery Factory, a maker of lead-acid batteries for motorcycles and electric bikes. They shouldered through an outer brick wall, swept into the factory office and, in an outpouring of pure fury, smashed the cabinets, desks and computers inside.

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Sim Chi Yin for the New York Times

Han Tiantian, 3, of Mengxi Village, China, has more than four times China's allowable blood lead level. Her mother, Wen Yuni, and father, Han Zongyuan, have both worked in a battery factory.

News had spread that workers and villagers had been poisoned by lead emissions from the factory, which had operated for six years despite flagrant environmental violations. But the truth was even worse: 233 adults and 99 children were ultimately found to have concentrations of lead in their blood, up to seven times the level deemed safe by the Chinese government.

One of them was 3-year-old Han Tiantian, who lived just across the road from the plant. Her father, Han Zongyuan, a factory worker, said he learned in March that she had absorbed enough lead to irreversibly diminish her intellectual capacity and harm her nervous system.

“At the moment I heard the doctor say that, my heart was shattered,” Mr. Han said in an interview last week. “We wanted this child to have everything. That’s why we worked this hard. That’s why we poisoned ourselves at this factory. Now it turns out the child is poisoned too. I have no words to describe how I feel.”

Such scenes of heartbreak and anger have been repeated across China in recent months with the discovery of case after case of mass lead poisoning — together with instances in which local governments tried to cover them up.

In the past two and a half years, thousands of workers, villagers and children in at least 9 of mainland China’s 31 province-level regions have been found to be suffering from toxic levels of lead exposure, mostly caused by pollution from battery factories and metal smelters. The cases underscore a pattern of government neglect seen in industry after industry as China strives for headlong growth with only embryonic safeguards.

Chasing the political dividends of economic development, local officials regularly overlook environmental contamination, worker safety and dangers to public health until forced to confront them by episodes like the Haijiu factory riot.

A report by Human Rights Watch released Wednesday states that some local officials have reacted to mass poisonings by arbitrarily limiting lead testing, withholding and possibly manipulating test results, denying proper treatment to children and adults and trying to silence parents and activists.

“What we are trying to underscore is how little has been done to address the massive impact of lead pollution in China,” Joe Amon, the organization’s health and human rights director, said in an interview. “It really has affected a whole generation of kids.”

In more developed nations, where lead pollution has been tightly regulated for decades, a pattern of lead poisoning like China’s would most likely be deemed a public-health emergency.

High levels can damage the brain, kidney, liver, nerves and stomach and, in extreme cases, cause death. Children are particularly susceptible because they absorb lead more easily than adults.

“No blood lead level has been found to be safe for a child,” Dr. Mary Jean Brown, chief of the lead poisoning prevention branch of the Centers for Disease Control and Prevention, said in an interview last week.

Here, Chinese leaders have acknowledged that lead contamination is a grave issue and have raised the priority of reducing heavy-metal pollution in the government’s latest five-year plan, presented in March. But despite efforts to step up enforcement, including suspending production last month at a number of battery factories, the government’s response remains faltering.

At a meeting last month of China’s State Council, after yet another disclosure of mass poisoning, Prime Minister Wen Jiabao scolded Environmental Minister Zhou Shengxian for the lack of progress, according to an individual with high-level government ties who spoke on the condition of anonymity.

The government has not ordered a nationwide survey of children’s blood lead levels, so the number of children who are at risk is purely a matter of guesswork. Mass poisonings like that at the Haijiu factory typically come to light only after suspicious parents seek hospital tests, then alert neighbors or co-workers to the alarming results.

Chiyin Sim contributed reporting from Mengxi and Jonathan Ansfield contributed reporting from Beijing. Mia Li, Shao Heng and Adam Century contributed research from Beijing.

States Brace for End of Extra Payments for Medicaid

Posted: 15 Jun 2011 11:00 AM PDT

WASHINGTON — Faced with a deepening recession two years ago, the Obama administration injected billions of dollars into Medicaid, the nation’s low-income health program. The money runs out at the end of this month, and benefits are being cut for millions of people, even though unemployment has increased.

From New Jersey to California, state officials are bracing for the end to more than $90 billion in federal largess specifically designated for Medicaid. To hold down costs, states are cutting Medicaid payments to doctors and hospitals, limiting benefits for Medicaid recipients, reducing the scope of covered services, requiring beneficiaries to pay larger co-payments and expanding the use of managed care.

As a result, costs can be expected to rise in other parts of the health care system. Cuts in Medicaid payments to doctors, for example, make it less likely that they will accept Medicaid patients and more likely that people will turn to hospital emergency rooms for care. Hospitals and other health care providers often try to make up for the loss of Medicaid revenue by increasing charges to other patients, including those with private insurance, experts say.

Neither the White House nor Congress has tried to extend the extra federal financing for Medicaid, even though the number of beneficiaries is higher now than when Congress approved the aid as part of an economic recovery package in February 2009.

The Congressional Budget Office estimates that federal Medicaid spending will decline in 2012 for only the second time in the 46-year history of the program. But states say they will have to have to spend more on Medicaid as they struggle to make up for the loss of federal money.

State officials say they are resigned to the loss of the extra federal matching payments, given the climate in Congress, where deficit reduction is a paramount goal.

“We all see the reality of what’s going on in Congress,” said Mark W. Rupp, director of the Washington office of Gov. Christine Gregoire of Washington State, a Democrat who is chairwoman of the National Governors Association. “It’s more about cutting than spending. Why put a lot of effort into something that did not seem likely to have a positive outcome? It would have been fairly futile.”

Although Medicaid provides health insurance to one in five Americans at some point in a year, it is more vulnerable to cuts than Medicare and Social Security, which have broader political support.

“Medicaid is very much on the chopping block,” said Senator John D. Rockefeller IV, Democrat of West Virginia and chairman of the Senate Finance Subcommittee on Health Care. “Seniors vote. But if you are poor and disabled, you might not vote, and if you are a child, you do not vote — that’s a lot of Medicaid’s population. They don’t have money to do lobbying.”

Medicaid is financed jointly by the federal government and the states, with the federal government paying a larger share in poorer states like Mississippi and West Virginia and a smaller share in higher-income states like New York and Connecticut.

The aid ending next month increased the federal share of Medicaid spending in all states, with additional help for states where unemployment rates had risen sharply. The extra aid was scheduled to expire last December, but Congress extended it for six months at the urging of the White House and state officials.

The additional money pushed the average federal share of Medicaid spending nationwide to 67 percent. It will revert to 57 percent next month. The cutback in federal Medicaid money has put pressure on states to cut the budget for other programs, including education and social services.

Toby J. Douglas, director of the California Department of Health Care Services, said the federal Medicaid cut was causing “very consequential reductions in health care and other public programs.”

California is cutting Medicaid payments to doctors and many other providers by 10 percent; has established new co-payments for drugs, doctors’ services and hospital care; and will limit beneficiaries to seven doctor’s office visits a year unless a doctor certifies a need for more.

Johnson & Johnson to Stop Making Heart Stents

Posted: 15 Jun 2011 01:30 PM PDT

Johnson and Johnson announced on Wednesday that it would stop manufacturing drug-coated heart stents by the end of the year, abandoning an intensely competitive $4 billion market after a series of setbacks for the company and rising concerns about the use of stents in some patients.

The company is expecting to take a $500 million to $600 million restructuring charge this quarter and to trim 900 to 1,000 jobs this year.

The announcement by J.& J. and its subsidiary Cordis, long expected by some analysts because of a dwindling market share, opens up more sales possibilities for three competitors.

The use of heart stents is being challenged as unnecessary for some patients. Stents are tiny devices inserted through blood vessels to keep arteries open in the heart. But research in recent years has suggested that stents are overused by doctors and that drugs may be a cheaper, safer and more effective way for many patients to avoid heart attacks or strokes.

The emerging concerns, the recession and pricing pressures have caused a fall-off in stent sales. The worldwide market for coronary stents dropped to $4.2 billion last year, from $5.3 billion in 2006, according to the investment house Leerink Swann.

Cordis’s sales of drug-coated heart stents fell to $627 million globally last year, from $2.6 billion in 2006. By the end of the year, Cordis will stop manufacturing its Cypher stent — the first drug-coated stent to be approved by the Food and Drug Administration in 2003 — and stop researching a new one called the Nevo stent, the company said in a statement Wednesday.

Seth Fischer, worldwide chairman of Cordis, said the decision was prompted by “changing dynamics” and price pressures in an increasingly competitive market.

“There’s no question that our market share has declined in the last several years as competitors have joined the market,” he said in a telephone interview. “We felt that we could turn our attention toward other potential areas that would enhance cardiovascular health for patients.”

Mr. Fischer also said J.& J.’s losses in patent cases, including an appellate court decision last week, had a significant effect. “Unlicensed competition” has eroded its pricing, sales and market share, he said.

Cordis will cut 900 to 1,000 positions by closing its Cypher stent manufacturing facility in San Germán, Puerto Rico, and its Nevo stent plant in Cashel, Ireland, and trimming research, sales and marketing, a company spokeswoman, Sandra Pound, said in a telephone interview.

J.& J., based in New Brunswick, N.J., has suffered a series of consumer product recalls largely because of manufacturing problems. The decision to get out of the stent market also appeared to hurt the company in the eyes of investors. The stock price dipped by 1.4 percent to $66.16 on Wednesday.

J.& J.’s departure should help the market leaders, Boston Scientific and Medtronic, which are each introducing new drug-eluting stents in mid-2012, according to an investor note from Barclays Capital.

Boston Scientific stock rose 2.8 percent to $6.93, while Medtronic declined by nearly 1.25 percent, to $37.92. Abbott Laboratories, which also sells heart stents in the United States, held even in the stock market.

J.& J. held about 15 percent of the worldwide market share in drug-eluting stents. Barclays said that share was expected to drop to 10 percent this year and 7 percent in 2012.

Leerink Swann, in an investor note, said J.& J.’s withdrawal was long expected and would both help other stent-makers and help J.& J. focus on more profitable areas.

Dr. James J. Rahal, 77, Virus Expert, Dies

Posted: 15 Jun 2011 07:33 AM PDT

Dr. James J. Rahal, an infectious-disease specialist who raised early alarms about the rise of drug-resistant bacteria in hospitals, and who emerged as a leading expert in the treatment of West Nile virus after the Queens community where he worked became the epicenter of a deadly outbreak in 1999, died on Saturday in Manhattan. He was 77.

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Dr. James J. Rahal

The cause was a rare disorder called Rosai-Dorfman disease, said his wife, Barbara Britton.

Dr. Rahal (pronounced rah-HALL), a professor of medicine at the Weill Medical College of Cornell University and director of the infectious-diseases division at New York Hospital Medical Center of Queens, in Flushing, was known both as a widely published researcher and as a hands-on physician who asked and answered a lot of questions in treating patients in one of the most ethnically diverse communities in the world.

The two roles fused naturally in Dr. Rahal’s approach to his work, said Dr. Sherwood Gorbach, a professor of medicine at Tufts University and editor of Clinical Infectious Diseases, the journal in which Dr. Rahal published many of his articles. “He had an ability to see the patient in front of him, and at the same time to see that individual as part of a larger whole,” Dr. Gorbach said.

In the infectious-disease world, he added, that larger whole includes not only other humans, but also the whole living web of animals, insects, viruses, fungi and microbes through which a patient passes on the way to a hospital emergency room. “Jim had an extra perception, an intuitive way of recognizing patterns,” Dr. Gorbach said.

Dr. Rahal was among the first to publish articles raising concerns about the drug-resistant strains of bacteria he began seeing in the early 1990s at New York Hospital Medical Center of Queens, where he worked. The problem was emerging throughout the country, partly as a result of overuse and misuse of some of the workhorse antibiotics developed after World War II.

“But he was talking about it at conferences and publishing papers documenting it before it was widely understood as the serious problem that it was,” said Dr. Louis Rice, chairman of medicine at the Alpert Medical School of Brown University and a specialist in the field.

In spring and summer 1999, Dr. Rahal found himself absorbed in the puzzle of an unidentified virus that was sending dozens of people a day into the emergency room at the hospital. Some arrived with fevers and body aches, but others had developed infections of the brain like meningitis and encephalitis. Seven people died and hundreds more were sickened in the New York area during the outbreak.

The Centers for Disease Control identified the cause as West Nile virus, an infectious disease of African origin that had never before spread in the Western Hemisphere, and Dr. Rahal’s work led to the development of the first effective treatment for it, using interferon. The treatment received provisional approval by the Food and Drug Administration in 2002 and a patent in 2005.

James Joseph Rahal Jr. was born on Oct. 14, 1933, in Boston, the oldest of three children. His father was a dentist. His mother, the former Najla Maloof, and father were both children of Lebanese Syrian immigrants.

James Jr. graduated from Harvard University and Tufts Medical School and trained in the infectious-disease field in New York and Boston before settling in New York in 1969 as an assistant professor of medicine at the New York University School of Medicine. In 1988, he became a professor at Cornell and head of infectious diseases at Booth Memorial Hospital, which later became New York Hospital Medical Center of Queens, where he remained until his illness forced him to take a leave of absence last year.

Besides his wife, he is survived by three children, James J. Rahal III of Pearl River, N.Y., Susan Rahal Chapman of Reno, Nev., and Linda Rahal of Washington; three granddaughters; a brother, Joseph Rahal of South Boston; and a sister, Joyce Rahal Sarrouf, of Belmont, Mass.

Dr. Rahal’s reputation for kindness and his interest in the lives of other people meant he was often being called “a nice guy,” an appellation he had mixed feelings about, said his colleague, Dr. Sorana Segal-Maurer, who succeeded Dr. Rahal as the acting director of infectious diseases. “It got to be a sort of joke with him,” she added. “He gave a speech accepting an award not too long ago, and told the people in the audience that the next person who called him a nice guy he was going to punch in the face.”

Well: When Warming Up for Exercise, Less May Be More

Posted: 15 Jun 2011 08:07 AM PDT

The New Old Age: A Dose of Confusion

Posted: 15 Jun 2011 09:20 AM PDT

Recipes for Health: Fresh Fava Bean and Shrimp Risotto

Posted: 13 Jun 2011 01:13 PM PDT

This luxurious risotto is a cinch to make. Use the plumpest, juiciest shrimp you can find.

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 pounds fava beans, shelled and skinned

1 pound medium shrimp, in the shell (large shrimp wil work, but not giant ones)

1 quart chicken stock, vegetable stock or water

Salt to taste

2 tablespoons extra virgin olive oil, or 1 tablespoon unsalted butter and 1 tablespoon extra virgin olive oil

1/2 cup finely chopped onion or leek

1 1/2 cups arborio or carnaroli rice

2 large garlic cloves, green shoots removed, minced

1/2 cup dry white wine

2 tablespoons chopped fresh flat-leaf parsley

Freshly ground pepper to taste

1. Prepare the fava beans, and set aside.

2. Shell the shrimp and de-vein if necessary. Retain the shells. Salt the shrimp lightly, and set aside in a bowl (in the refrigerator, if you won’t be making and serving the risotto right away). Rinse the shells, and combine them with five cups water in a medium saucepan. Bring to a boil, skim off foam, reduce the heat to low and simmer partially covered for 30 minutes. Strain and add to the chicken stock or water. Taste and add enough salt to make a well-seasoned broth. Bring to a simmer in a saucepan.

3. Heat the oil over medium heat in a large nonstick frying pan or a large, wide saucepan. Add the onion (or leek). Cook, stirring, until it softens, three to five minutes. Add the rice and the garlic. Cook, stirring, until the grains of rice are separate and beginning to crackle.

4. Stir in the wine, and cook, stirring, over medium heat. The wine should bubble but not too quickly. When it has just about evaporated, stir in a ladleful or two of the simmering stock, just enough to cover the rice. The stock should bubble slowly. Cook, stirring often, until it is almost absorbed. Add another couple of ladles of the stock. Continue to cook for 20 minutes, stirring not too fast and not too slowly, and adding more stock whenever the rice is almost dry.

5. Taste a bit of the rice. It should be slightly al dente. Stir in more stock to cover, and add the favas and the shrimp. Cook, stirring, for another five to 10 minutes until the shrimp are pink and cooked through but still moist (this will depend on the size of the shrimp) and the favas are bright. Stir in the parsley and another small ladle of stock. Remove from the heat, add pepper, stir for a few seconds and serve.

Yield: Serves four generously.

Advance preparation: The broth can be made several hours before you wish to cook the risotto. You can make the risotto halfway through Step 3 several hours ahead. Spread in the pan in a thin layer, and allow to cool. Shortly before serving, add a ladleful of stock to the rice, bring back to a simmer and proceed with the recipe.

Nutritional information per serving: 559 calories; 1 gram saturated fat; 2 grams polyunsaturated fat; 5 grams monounsaturated fats; 125 milligrams cholesterol; 83 grams carbohydrates; 11 grams dietary fiber; 682 grams sodium (does not include salt to taste); 31 grams protein

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

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