Health - Well: Keeping Score on How You Take Your Medicine

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• Well: Keeping Score on How You Take Your Medicine
• On View: Spoonfuls of Medicine, Marketed for Centuries
• The Champions: Support Is Mutual for Senator and Utah Industry
• Once Rare, Infection by Tick Bites Spreads
• Recalls of Imported Foods Are Flawed, a Government Audit Reports
• Health Law in a Swirl of Forecasts
• Vital Signs: Hazards: A Pacemaker Is Found to Carry Risk
• Vital Signs: Pregnancy: Weight-Loss Surgery May Affect Fertility
• National Briefing | NORTHWEST: Oregon: Millions of Gallons of Water Disposed Of
• Well: A New Worry About Tick Bites
• Well: Debating the 10 Percent Rule for Runners
• Personal Health: Explaining Sunscreen and the New Rules
• Well: Pets Can Raise a Child’s Risk of Developing Allergies
• Letters: Preventing Addiction (2 Letters)
• Letters: Switching Doctors (1 Letter)
• U.S. Releases Graphic Images to Deter Smokers
• Recipes for Health: Lasagna With Asparagus and Chives

Well: Keeping Score on How You Take Your Medicine Posted: 20 Jun 2011 02:23 PM PDT

On View: Spoonfuls of Medicine, Marketed for Centuries Posted: 21 Jun 2011 09:05 AM PDT Everyone knows you can’t buy health, but that has never stopped anyone from trying to sell it to you. As a small, gorgeous and fiercely funny exhibition of posters at the Philadelphia Museum of Art makes clear, the marketing of this particular noncommodity is an enduring art in every sense of the word. Multimedia Slide Show Historical Health Advertisements The basic gambit has probably not changed since the Stone Age: a concerned stranger presents you with a vision of the future, starring either a happier, better you with the use of a certain product, or a sadder-but-wiser, considerably more miserable you without it. For centuries all was word of mouth, but with the birth of the modern poster in the late 19th century the visions suddenly became visual, flowering in large and colorful profusion all over the world. Early adopters straddled the Atlantic. In the United States they included Prof. P. H. van der Weyde, M.D., inventor of the genuine German Electro Galvanic Belt for ailments including liver, stomach and kidney diseases (“beware of imitations”), and M. K. Paine, a pharmacist in Windsor, Vt., who compounded Green Mountain Balm of Gilead from the resins of local evergreens. In France, the famous Dr. Guillaume Dupuytren, having devised an operation for a hand condition that still bears his name, moved on to the presumably more lucrative problem of baldness before he died in 1835. His hair-strengthening pomade was still going strong in the 1860s, celebrated in respectful neoclassical style against a hot pink background. The familiar verbal effluvia of the patent medicine industry clutter some early posters. The Green Mountain balm is “universally acknowledged to be the best Plaster ever known,” with an entire paragraph in small print enumerating its target ills, from pain and internal inflammation through lameness, boils and corns. Dr. Trikos, purveyor of an eponymous lotion for irritations of the skin and baldness, summarized it all eloquently: “I have cured myself, I have cured my friends, and I wish to cure all who suffer.” The words eventually fell away, though, and the images took center stage, helped along by some of the best-known poster artists of the time. Jules Chéret, the master of Belle Époque poster art, dispatched two of his vivacious gauze-clad young women to the cause of Vin Mariani, the wine that refreshes body and brain and restores health and vivacity. Each demoiselle gaily pours herself a glass; for neither, clearly, is it her first. Leonetto Cappiello, the Italian-born French artist called “father of modern advertising,” created an ecstatic senior citizen dancing in dressing gown and slippers after Uricure repaired his joints. Drinking buddies every bit as unforgettable as the glorious Parisiennes were sketched by an anonymous Hungarian artist, but here the tall guy in charge of the bottle has a black robe and a skull’s head, while his small, flushed companion in baggy work clothes and a large droopy mustache is clearly headed for trouble. (A temperance philanthropy was behind that one.) Skulls are deployed elsewhere to make dire points about syphilis, while a gigantic black spider does the honors for TB. But the star of the show may be the single image intended neither to cajole nor to terrify but to educate and amuse. The five-volume anatomy and physiology textbook that the German physician Fritz Kahn brought out in the 1920s was illustrated with a poster-size folding color plate depicting “Man as Industrial Palace,” a work that combines the Lilliputian charms of “Where’s Waldo?,” Willy Wonka’s factory, the world’s best dollhouse and a really good pinball game. Up in the chambers of the brain, two groups of tiny men in suits and ties deliberate around small conference tables: they are, of course, Will and Reason. Nearby a lone fellow in shirtsleeves and headphones operates a telegraph: he is Hearing, while the photographer one cubicle over is Sight. Gears move particles of food along the alimentary tract, aided by tiny workers with rakes and cauldrons of digestive enzymes. Down in Bone Marrow a solitary artisan stamps out red blood cells. It is an image begging to be animated, and the contemporary German designer Henning M. Lederer has done just that, in a short film looping alongside the actual lithograph. There is no need to travel to Philadelphia for this particular pleasure, though; Mr. Lederer’s utterly irresistible creation is online at http://www.vimeo.com/6505158. Any immersion in medical history is likely to produce a stereotyped set of reflections on the remarkably short lifespan of most good medical advice and the remarkably enduring nature of the motivations behind it. Altruism and the hard sell have always been intertwined. In fact, William H. Helfand, a retired Merck executive and collector of medical memorabilia whose many donations to the museum include the 50-odd items in the show, goes on record in the catalog ruefully acknowledging patent medicine salesmen as his “figurative ancestors.” The bold images on display here prompt one more reflection. As our technical understanding of health becomes ever more pixilated in dull shades of gray, muted by risk and benefit and by statistical slicing and dicing, the giant assertions splashed over these gallery walls are more appealing than ever. Just tell me what to do, they say. Give me something that will work. No doctor today can do either one, not without a lot of disclaimers, but that doesn’t mean anyone has stopped asking. “Health for Sale: Posters From the William H. Helfand Collection” is at the Philadelphia Museum of Art through July 31.

The Champions: Support Is Mutual for Senator and Utah Industry Posted: 21 Jun 2011 09:56 AM PDT SALT LAKE CITY — A drive along mountain-lined Interstate 15 here shows why Senator Orrin G. Hatch is considered a hero in this region nicknamed the Silicon Valley of the nutritional supplement industry. The Champions A 'Natural Ally' Articles in this series will look at members of Congress and their advocacy for favorite industries or causes. Multimedia Document Orrin Hatch: An Industry Champion Blogs The Caucus The latest on President Obama, the new Congress and other news from Washington and around the nation. Join the discussion. FiveThirtyEight: Nate Silver's Political Calculus More Politics News Enlarge This Image Douglas C. Pizac/Associated Press A glass of Xango juice, which contains slightly more antioxidants than cranberry juice. In the town of Lehi is the sprawling headquarters of Xango, where company officials praised Mr. Hatch, a Utah Republican, late last year for helping their exotic fruit juice business “operate without excessive intrusion” from Washington. Up in Sandy, Utah, is 4 Life Research, whose top executives donated to Mr. Hatch’s last re-election campaign after federal regulators charged the company with making exaggerated claims about pills that it says helps the immune system. And nearby in West Salem, assembly-line workers at Neways fill thousands of bottles a day for a product line that includes Youthinol, a steroid-based hormone that professional sports leagues pushed to ban until Mr. Hatch blocked them. “Senator Hatch — he’s our natural ally,” said Marc S. Ullman, a lawyer for several supplement companies. Mr. Hatch, who credits a daily regimen of nutritional supplements for his vigor at 77, has spent his career in Washington helping the $25-billion-a-year industry thrive. He was the chief author of a federal law enacted 17 years ago that allows companies to make general health claims about their products, but exempts them from federal reviews of their safety or effectiveness before they go to market. During the Obama administration, Mr. Hatch has repeatedly intervened with his colleagues in Congress and federal regulators in Washington to fight proposed rules that industry officials consider objectionable. While Congress is often stalled or bitterly divided in addressing some of the nation’s most pressing problems, like the economy and immigration, legislative champions like Mr. Hatch are often remarkably successful in delivering for niche industries or parochial programs. It is not unusual, of course, for lawmakers to fight for local interests, but Mr. Hatch’s alliances are particularly strong and mutually beneficial. Mr. Hatch has been rewarded with hundreds of thousands of dollars in campaign contributions, political loyalty and corporate sponsorship of his favorite causes back home. His family and friends have benefited, too, from links to the supplement industry. His son Scott Hatch, is a longtime industry lobbyist in Washington, as are at least five of the senator’s former aides. Mr. Hatch’s grandson and son-in-law increase revenue at their chiropractic clinic near here by selling herbal and nutritional treatments, including $35 “thyroid dysfunction” injections and a weight-loss product, “Slim and Sassy Metabolic Blend.” And Mr. Hatch’s former law partner owns Pharmics, a small nutritional supplement company in Salt Lake City. But many public health experts argue that in his advocacy, Mr. Hatch has hindered regulators from preventing dangerous products from being put on the market, including supplements that are illegally spiked with steroids or other unapproved drugs. They also say he is the person in Washington most responsible for the proliferation of products that make exaggerated claims about health benefits. Just in the last two years, 2,292 serious illnesses, including 33 that were fatal, were reported by consumers of supposedly harmless nutritional supplements, federal records show. (These “severe adverse reaction” reports do not necessarily mean the supplements caused the illnesses, just that the consumers became ill after taking them.) And some of Mr. Hatch’s most important supporters in Utah have faced repeated accusations of falsely claiming their products can treat almost everything, including cancer and heart disease. “Orrin Hatch certainly has a right to fight for his constituents,” said Steven Novella, a clinical neurologist at the Yale School of Medicine who was a co-founder of a Web site that tracks claims by the supplement industry. “But the consequences are we have an effectively unregulated market for these products, a Wild West, and people are being abused by slick marketing, and as a result taking things that are worthless or in some cases not even safe.” Mr. Hatch rejects such accusations, noting that he has repeatedly demanded that federal regulators step up enforcement of existing laws, and even worked to expand their powers. “No relationships have or will ever have any impact on my policy positions,” Mr. Hatch said in a written statement. “Supplements are healthy and safe, and they are a major industry in my home state of Utah.” The depth of his industry support could be put to a test over the coming year, as Mr. Hatch prepares for what could be a tough re-election fight if Representative Jason Chaffetz, a Republican, mounts a primary challenge. Mr. Chaffetz, a former executive at a Utah company that sells anti-aging and skin care products, is also an industry ally. Several executives, though, say they cannot imagine turning their back on Mr. Hatch. “Some folks get elected, go to Washington, forget where they came from,” John F. Gay, chief executive of an industry trade association, said last year in introducing Mr. Hatch at an industry convention in Las Vegas. “Others get elected, go to Washington, and use the knowledge they have gained, the relationships they’ve built, the power they have developed over the years of incumbency to help the folks who got them there. That is the type of person that Senator Hatch is.” Hatch to the Rescue 1 2 3 Next Page » Kitty Bennett contributed research.

Once Rare, Infection by Tick Bites Spreads Posted: 20 Jun 2011 11:00 PM PDT A potentially devastating infection caused by tick bites has gained a foothold in the Lower Hudson Valley and in coastal areas of the Northeast, government researchers have found. The condition, called babesiosis, is a malaria-like illness that results from infection with Babesia microti, a parasite that lives in red blood cells and is carried by deer ticks. Though far less common than Lyme disease, babesiosis can be fatal, particularly in people with compromised immune systems. Because there is no widely used screening test for babesiosis, its spread poses a particular threat to the blood supply, scientists said. “We are very worried about it and are doing everything in our power to address this,” said Sanjai Kumar, chief of the laboratory of emerging pathogens at the Food and Drug Administration. According to a recent report by the Centers for Disease Control and Prevention, there were six cases of babesiosis in the Lower Hudson Valley in 2001 and 119 cases in 2008, a 20-fold increase. In areas where Lyme disease is endemic, like coastal Rhode Island, Massachusetts, Connecticut and Long Island, babesiosis also is becoming very common, said Dr. Peter Krause, senior research scientist at the Yale School of Public Health. In one study of residents of Block Island, R.I., Dr. Krause found babesiosis to be just 25 percent less common than Lyme disease. Babesiosis also is spreading slowly into other regions where it did not exist before, like the Upper Midwest, said Dr. Krause. Many people who are infected with the parasite have no symptoms at all, while others experience mild to moderate flu-like symptoms that may last for a few days or as long as six months. “But some people get so sick that they wind up hospitalized, put into an intensive care unit, or even dying,” said Dr. Gary Wormser, chief of infectious diseases at Westchester Medical Center in New York. In states that track the disease, there are an estimated 1,000 reported cases a year, said Dr. Krause, but he and other experts believe this represents a fraction of the people who are infected. In the Block Island study, researchers tested about 70 percent of the islanders and found that about one quarter of adults and half of children who were infected had no symptoms and were therefore not reported. Even people with mild to moderate symptoms may never see a physician. Even if they do, the condition may not be accurately diagnosed. Experts fear that many undiagnosed patients may be donating blood. Currently, blood banks do not screen for Babesia because the Food and Drug Administration has not licensed a test for this purpose. The only way to screen a patient is by using a questionnaire, which simply asks blood donors if they are infected. Babesiosis already is the most frequently reported infection transmitted through transfusion in the United States, responsible for at least 12 deaths.  In New York City, six transfusion-associated cases of babesiosis were reported in 2009. Infection by this route can be serious: One study found approximately 30 percent of people who were infected by a transfusion died. Between 1999 and 2007, several infants in Rhode Island developed babesiosis following blood transfusions. The Rhode Island Blood Center has become the first in the country to use an experimental new test to screen blood for the parasite. Experts urge blood transfusion patients and their doctors to be aware of symptoms of babesiosis, which can occur up to nine weeks after a transfusion. The symptoms can be vague (there is no tell-tale rash as there may be with Lyme disease) and include fever, sweats, chills, headache, fatigue, and muscle aches and pains. In people who also have Lyme disease, doctors might suspect babesiosis if the symptoms are particularly severe or the antibiotics are not working, said Dr. Krause. A diagnosis can be confirmed through blood testing. Infants and adults over age 50 are more likely to get moderate to severe symptoms if infected. People at increased risk of complications include patients with compromised immune systems (such as people receiving immunosuppressants), those who’ve had their spleens removed, and those with lymphoma or H.I.V. or who are being treated for cancer. If not caught and treated early, babesiosis can lead to such complications as kidney, lung or heart failure. The infection can be treated with antimicrobial medications, but people with serious complications are less responsive to the drugs. Why the parasite is spreading and why it’s spreading more slowly than Lyme disease are not well understood. One theory is that Babesia may be carried primarily in mice, which don’t tend to travel far afield. The bacterium causing Lyme disease, Borrelia burgdorferi, can be carried by birds.

Recalls of Imported Foods Are Flawed, a Government Audit Reports Posted: 21 Jun 2011 03:52 AM PDT Government food officials are often sloppy and inattentive in their efforts to ensure that contaminated foods from abroad are withdrawn promptly and completely from the nation’s food supply, according to government investigators. In an audit of 17 recalls, investigators found that the Food and Drug Administration often failed to follow its own rules in removing dangerous imported foods from the market, according to Daniel R. Levinson, inspector general of the Department of Health and Human Services. The products included cantaloupes from Honduras contaminated with salmonella, frozen mussel meat from New Zealand infected with listeria and frozen fish from Korea that contained the bacterium that causes botulism. In one case, more than three months passed from the time the F.D.A. became aware of the contamination to the time a recall was initiated. In another case, the lag was nearly a month. In 13 of the 17 cases, the companies that supplied the tainted goods failed to provide accurate or complete information to their customers so that the products could be withdrawn completely, the audit found. In a response to the audit, David Dorsey, the F.D.A.’s acting deputy commissioner for policy, planning and budget, said that the landmark food safety law signed in January by President Obama would fix some of these problems. For instance, the law for the first time gave the F.D.A. the authority to order companies to withdraw foods suspected of being contaminated. Until this year, the F.D.A. could only ask manufacturers to withdraw suspect foods. The F.D.A. is studying other ways to improve food recalls, and one possible solution would be to hire contractors to do the work, Mr. Dorsey wrote. From July 1, 2007, through June 30, 2008, the F.D.A. oversaw 40 recalls of imported foods that were so contaminated that the agency deemed them to be an imminent threat. Auditors examined 17 of these recalls, which included seven for salmonella, five for listeria, four for Clostridium botulinum and one for high lead levels. The investigation found that the government had not followed up with any vigor to ensure that contaminated food imports were withdrawn from the food chain completely. In 14 of the 17 cases, the F.D.A. failed to conduct inspections or obtain complete information about the contaminated products. In five of the cases, the F.D.A. never conducted an audit to make sure the recalls had been conducted at all. In 12 of the cases, the agency’s audit of the recalls was belated and incomplete. And in 13 of the 17 recalls, the agency never witnessed the disposal of the contaminated foods or obtained the required documentation to show that the products had been thrown out. Audits of the F.D.A.’s oversight of the nation’s food system routinely find the agency’s efforts wanting, in part, the agency says, because its budget for such activities has long been inadequate. And although the new food safety law gave the agency extra supervisory powers, it is not clear how much it will be able to do, given that House Republicans have proposed cutting its budget for protective measures. On Monday, the F.D.A. released a report suggesting ways to cope with an increasing flood of imported foods, drugs and medical devices. The report recommended that the F.D.A. cooperate with regulators in other countries to ensure safety.

Health Law in a Swirl of Forecasts Posted: 20 Jun 2011 09:30 PM PDT The debate over the effects of the federal health care law on employer-provided insurance has been intensifying in recent weeks, with controversial polls and consultants contradicting one another about whether employees will benefit or lose coverage by 2014. Enlarge This Image Andrew Harrer/Bloomberg News Douglas Holtz-Eakin headed a group of 105 economists opposed to the Affordable Care Act. After nearly two weeks of widespread queries and criticisms, McKinsey & Company, the management consulting firm, posted on Monday the questionnaire and methodology of an online survey it had released that was denounced by the White House and others for contending that nearly a third of employers would definitely or probably drop coverage for employees when provisions of the health care law took effect in 2014. The White House responded on Monday night. “As we learn more, it’s become clear that this one flawed study from McKinsey is truly an outlier,” Nancy-Ann DeParle, an assistant to the president and deputy chief of staff, said in a blog post. The White House initially pointed to forecasts by the Congressional Budget Office and other experts whose estimates were much smaller in terms of whether employees would lose some or all coverage. For example, an Urban Institute study to be released on Tuesday suggests that employees in small businesses may receive more coverage, not less. McKinsey also came under fire for not providing access to the survey’s authors, and for not publishing the questions, the types of employers taking part or the survey methodology. In posting “details regarding the survey” on its Web site Monday, McKinsey acknowledged that its survey was “not comparable” to the studies by the budget office, Urban Institute or others using economic modeling. Rather, it surveyed business owners using an online panel. McKinsey said it paid for the survey by Ipsos, a French marketing firm, “to capture the attitudes of employers,” large and small. In addition, McKinsey seemed to be trying to address the criticisms by the White House and others, asserting that its report was not intended to be predictive. McKinsey’s explanations did not satisfy Senator Max Baucus, chairman of the Senate Finance Committee, and several from the House who have inquired. “This report is filled with cherry-picked facts and slanted questions,” he said in a statement. “It did not provide employers with enough information for them to make honest choices and fair evaluations. Rather than correct the major deficiencies in their report, McKinsey has chosen to again stand by their faulty analysis and misguided conclusions.” Several other reports have focused on small businesses, the group having the hardest time dealing with rising medical costs. The latest, issued on Tuesday, is by the Urban Institute, a Washington research center. Its study, based on analysis of Census Bureau and Department of Health and Human Services surveys, estimates that employer coverage will increase modestly for workers and their dependents in firms with 50 or fewer employees. By contrast, Douglas Holtz-Eakin, who was an economic and health policy adviser to Senator John McCain’s presidential campaign, predicts that more than 35 million people will lose employer insurance. “We figured they would all end up in the exchanges,” the state-sponsored insurance agencies to be set up under the new law, he said in a telephone interview. Over all, including all employers, analyses by a number of widely cited researchers predicted little or no change in employer-sponsored insurance in 2014. They include the Congressional Budget Office, RAND, Lewin Associates and Mercer. John Arensmeyer, a small business advocate who supports the law, the Affordable Care Act, calls it “a big step in the right direction.” But he said a poll by his group, Small Business Majority, found that more than half of respondents did not know what was in the law. “Once they learn about tax credits and the exchanges option, they are more inclined to participate,” Mr. Arensmeyer said. Linda J. Blumberg, an Urban Institute researcher, said, “Contrary to a lot of statements that have been made in the press and elsewhere, the impact of the law on small employers is going to be positive in great degree.” Mr. Holtz-Eakin headed a group of 105 economists who filed a brief supporting the lawsuit by Republican officials from 26 states seeking to have the Affordable Care Act overturned. But Dr. Blumberg said Virginia and other states with Republican governors were working to set up the exchanges. Republicans prefer state exchanges to the probability of a federal version if they do not act. Four states, West Virginia, Maryland, California and Colorado, recently passed laws to establish exchanges, and similar bills have been adopted by one house in a number of other states, she said. “There is a division between what the attorneys general are doing and what governors’ offices are doing,” she said. Gerry Harkins, who owns a small construction company in Atlanta and is a spokesman for the National Federation of Independent Business, said he would try to “figure out a way to game the system.” “This whole plan is really slanted toward large employers,” he said. Firms with 10 and fewer workers also should benefit. “The burden falls in the middle.” His company, Southern Pan Services, had 1,200 employees before the economic crisis. It now has “under 100,” he said. He is considering splitting his company into two units to get under 50 employees each and reduce the $3,000 penalty, for each worker, he will face for his current health plan, which is entirely paid for by employees. Joseph R. Antos, a health policy expert at the American Enterprise Institute, criticizes the health law. He says it has “too much central direction and not enough appreciation for our fiscal situation.” But Mr. Antos said large employers, who cover the majority of American workers, would probably wait several years after 2014 to see how the new system worked before deciding what to do. Those with union contracts will take much longer, he said. He said the many variables in the law made predictions difficult. “Whatever you assume, is what you get out of it,” he said.

Vital Signs: Hazards: A Pacemaker Is Found to Carry Risk Posted: 20 Jun 2011 11:30 PM PDT A special type of pacemaker fails to help almost half of the heart patients who get it, and now researchers believe they know why. Related More Vital Signs Columns The implantable device, called a biventricular pacemaker, is designed to correct the irregularity in contractions of the heart’s ventricles that sometimes occurs in people with heart failure. The pacemaker is generally used in patients for whom medication has been ineffective. More than 50,000 are implanted each year. Medical guidelines suggest that the pacemakers be used in patients with a delay of 0.12 seconds or more in QRS duration, a particular heart rhythm abnormality that appears on an electrocardiogram. Researchers writing online last week in The Archives of Internal Medicine reviewed five randomized controlled trials of the device, involving 5,813 patients. They found that the treatment was effective only for those with a QRS delay of 0.15 seconds or more, leaving 40 percent of the patients treated with no benefit at all. The pacemakers are expensive — getting one can cost $70,000 or more — and the lead author, Dr. Ilke Sipahi, an assistant professor of medicine at Case Western Reserve, said that implantation has significant risks. “If you’re not going to benefit,” he said, “taking the risk is not worth it.” NICHOLAS BAKALAR

Vital Signs: Pregnancy: Weight-Loss Surgery May Affect Fertility Posted: 20 Jun 2011 11:30 PM PDT Weight loss surgery may have helped restore fertility in a handful of extremely obese women who were unable to have children because of a hormonal imbalance caused by polycystic ovarian syndrome, according to a report presented at a recent medical conference. Related More Vital Signs Columns Researchers reviewed the medical records of 566 extremely obese women who underwent gastric bypass surgery over a period of nine years, including 31 patients who had been diagnosed with PCOS prior to surgery. Some of the women with PCOS did not want to have children, and some were post-menopausal. But all six of these patients who wanted children had managed to conceive within three years of having gastric bypass surgery, the researchers found. All of them had lost significant amounts of weight. Dr. Mohammad Jamal, an author of the study and clinical assistant professor of surgery at the University of Iowa Hospitals and Clinics in Iowa City, said it was premature to recommend the surgery to obese women with PCOS. But bariatric surgery often improves blood sugar levels and can reduce resistance to insulin, which studies have linked to PCOS, he noted. The findings were presented last week at a meeting of the American Society for Metabolic & Bariatric Surgery in Orlando, Fla.

National Briefing | NORTHWEST: Oregon: Millions of Gallons of Water Disposed Of Posted: 20 Jun 2011 10:30 PM PDT Portland is disposing of eight million gallons of drinking water because a man was caught on camera urinating in a reservoir. Water from the city’s five open-air reservoirs goes directly to customers. A city official said he did not want to serve water with urine in it. Critics call that an overreaction, saying animals routinely defecate and urinate in the reservoirs and sometimes die in them. Health officials say that urine is sterile in healthy people and that the urine was so diluted it posed little health risk. Officials say it will cost the system’s customers less than $8,000 to treat it as sewage. The 21-year-old man caught on camera has not been charged.

Well: A New Worry About Tick Bites Posted: 21 Jun 2011 12:38 PM PDT

Well: Debating the 10 Percent Rule for Runners Posted: 21 Jun 2011 11:38 AM PDT

Personal Health: Explaining Sunscreen and the New Rules Posted: 20 Jun 2011 11:00 PM PDT Attention, sun lovers (and yes, that includes all who think they are adequately protected against the sun’s damaging rays): Nearly four years after announcing its intention to improve the labeling of sunscreens, the Food and Drug Administration has finally issued new rules that should help reduce the confusion that currently prevails when consumers confront the aisle-long array of products in most pharmacies. Enlarge This Image Yvetta Fedorova Related F.D.A. Unveils New Rules About Sunscreen Claims (June 15, 2011) More Personal Health Columns But these rules will not take effect for another year (and for small manufacturers, two years). Meanwhile, everyone needs to know what to do now about preventing painful sunburns, disfiguring and deadly skin cancers and premature skin aging. How high an SPF should one choose? Is SPF 60 really that much better than SPF 30? What does “broad spectrum” mean? Are all sunscreen ingredients equally effective? And equally safe? And perhaps the most frightening question: Why has the incidence of melanoma, the deadliest of skin cancers, doubled since sunscreens (as opposed to tanning lotions) became popular? No better time to get the answers to these questions than now, the week of the summer solstice. Even if it is not sunny where you are, the ultraviolet rays hitting your skin will be their most intense. Rating Sunscreens First, some facts about sun and current sunscreen labels. There are two kinds of solar rays: short ones called UVB that cause burning and skin cancer and long ones called UVA that cause skin cancer and wrinkling. SPF ratings — the letters stand for sun protection factor — reflect only the extent of protection against UVB. The higher the rating, the longer one can stay in the sun before burning. But there are two important caveats. First, SPF ratings are based on a rather thick application of sunscreen, not the amount consumers normally use, which is most often a quarter to a half the amount applied in manufacturers’ tests. An adult in a bathing suit should apply about three tablespoons of lotion every two hours, experts say. Second, above an SPF of 30, which can block 97 percent of UVB (if used in testing amounts), effectiveness increases by only 1 or 2 percent. In the way that sunscreens are used in the real world, then, a product with an SPF of 30 actually provides the protection of SPF 2.3 to 5.5, and one rated SPF 50 provides the protection of SPF 2.7 to 7.1, according to a report published this month in Drug and Therapeutics Bulletin. UVA, which represents more than 95 percent of solar radiation reaching the earth, does not figure in SPF ratings. The phrase “broad spectrum” is meant to indicate protection against UVA, but there is no numerical rating for product effectiveness. Under the new rules, products labeled “broad spectrum” will have to provide equal protection against UVB and UVA, and only products with an SPF of 15 or higher will be allowed to claim protection against skin cancer and premature skin aging. Meanwhile, dermatologists suggest choosing only products that are labeled “broad spectrum” and have an SPF rating of 30 to 50. There is no evidence that anything higher than 50 is any better. Apply the sunscreen just before exposure, and reapply it two hours later — it loses effectiveness over time. And even if the label claims the sunscreen is water resistant, be sure to reapply it after swimming or sweating heavily. The rise in melanoma has led to fears that sunscreens may actually cause this deadly cancer. But other explanations are more likely. By allowing people to stay in the sun longer, sunscreens have greatly increased exposure to UVA radiation. And many, if not most, victims of melanoma were damaged long before sunscreens became popular. A history of sunburn is a major risk factor for this cancer; five sunburns per decade raise the risk by about threefold. Another reason for the increase in diagnoses: skin cancer screening and detection have improved greatly in recent decades. With regard to ingredients, many dermatologists recommend products with micronized titanium or zinc oxide as the most effective sun blockers that leave no white residue on the skin. There is some concern, based on animal studies, that the most popular ingredient in sunscreens, oxybenzone, may disrupt natural hormones, but the scientific evidence is scant. Another chemical, retinyl palmitate, sometimes listed among the inactive ingredients, has been linked to skin cancers in animal studies. Because it is converted into a compound that can cause birth defects, it should be avoided by women who are pregnant or likely to become pregnant. However, although more studies of these possible risks should be done, Consumer Reports concluded that “the proven benefits of sunscreen outweigh any potential risks.” Finally, don’t be fooled by price. In tests of 22 sunscreens, Consumer Reports found nine to be effective against UVB and UVA and ranked three as “Best Buys”: Up & Up Sport SPF spray (88 cents an ounce) at Target; No-Ad With Aloe and Vitamin E SPF 45 lotion (59 cents); and Equate Baby SPF 50 lotion (63 cents). The organization said La Roche-Posay Anthelios SPF 40 cream, at $18.82 an ounce, scored well below these three in effectiveness. Although it may be tempting to try to kill two birds at once with a combination sunscreen and insect repellent, the Centers for Disease Control and Prevention does not recommend this. Multiple applications could result in an overdose of the repellent. Seek Other Protection The best advice to prevent UV damage is to stay out of the midday sun altogether and to cover up with clothing, a hat and umbrella during the rest of the day even if it is cloudy. Clouds do not block damaging rays. Keep in mind that ultraviolet radiation is reflected off sand and water, intensifying exposure even if you are protected by an umbrella from above. Ordinary clothing provides a good sun shield when dry (the tighter the weave, the better) but little or no protection when wet. Special sun-protective clothing is costly but works well wet or dry; it is a wise investment for children who tend to stay in or around water for hours. Caps with a neck flap are especially helpful for sports enthusiasts. And no matter how well covered up you are, don’t forget to apply sunscreen to your face, ears, neck and hands. Also, keep in mind that some sun exposure is necessary to maintain a healthful level of vitamin D. Dermatologists suggest, for light-skinned people, that exposing one’s hands, arms, face or back to nonburning doses of sunlight for 15 minutes two or three times a week from April to September should result in adequate vitamin D synthesis. Dark-skinned people need longer exposure. This posting includes an audio/video/photo media file: Download Now

Well: Pets Can Raise a Child’s Risk of Developing Allergies Posted: 21 Jun 2011 10:43 AM PDT

Letters: Preventing Addiction (2 Letters) Posted: 20 Jun 2011 10:40 PM PDT To the Editor: RSS Feed Get Science News From The New York Times » The headline “A General in the Drug War” (Profiles in Science, June 14) misstates Dr. Nora D. Volkow’s mission. The war on drugs targets people who possess, use or sell illicit drugs, and locks them up in prison. In contrast, Dr. Volkow and her agency, the National Institute on Drug Abuse, are devoted to uncovering knowledge on addiction as an illness and finding evidence-based methods to help people recover and return to full productivity. Some confusion is understandable, because the federal government is responsible both for criminalizing people who use drugs and for finding ways to heal people with the disease of addiction. Carolyn Davis Washington ♦ To the Editor: The experience of pain specialists over decades has convinced us that long-term opioid therapy is beneficial for a minority of patients with common causes of chronic pain and for a large majority of those with pain due to serious illness. Undertreated pain is a serious public health problem, and access to opioid medicines must be preserved even as society deals with the serious public-health problem of rising prescription drug abuse. To do so, we must understand that opioid addiction, overdose and abuse are separate but related problems. The compulsive use that characterizes addiction may or may not be involved in the overdose deaths of recreational drug users or the misuse of a drug prescribed by a poorly trained physician. When two public health problems of such complexity coexist, aggressive action for one problem must acknowledge the complexity and avoid actions that unintentionally worsen the other. Russell K. Portenoy, M.D. New York Science Times welcomes letters from readers. Those submitted for publication must include the writer’s name, address and telephone number. E-mail should be sent to scitimes@nytimes.com. Send letters to Science Editor, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018. This posting includes an audio/video/photo media file: Download Now

Letters: Switching Doctors (1 Letter) Posted: 20 Jun 2011 10:42 PM PDT To the Editor: Re “A Graduation That May Carry Unnecessary Risk” (18 and Under, June 14): It’s true that age 18 is too late for getting doctors and parents to consider how to transition children with chronic illnesses and disabilities into adult health care. But often these young people need more than a good doctor to help them make that transition smoothly; they need a good lawyer, too, to ensure continuity of critical support services within a rapid and inflexible timeframe. Young people with disabilities age out of childhood Supplemental Security Income benefits at age 18. Many states will remove them from Medicaid at age 19, and some children are phased out of various state health support programs or special education services starting at age 21. As a new attorney working with a medical-legal partnership on legal issues for youth with chronic medical needs, I appreciate it when I meet a physician who engages families on all facets of planning ahead for the transition years. Purvi P. Patel Chicago Science Times welcomes letters from readers. Those submitted for publication must include the writer’s name, address and telephone number. E-mail should be sent to scitimes@nytimes.com. Send letters to Science Editor, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018.

U.S. Releases Graphic Images to Deter Smokers Posted: 21 Jun 2011 12:31 PM PDT Federal health officials on Tuesday released their final selection of nine graphic warning labels to cover the top half of cigarette packages beginning next year, over the opposition of tobacco manufacturers. Enlarge This Image U.S. Food and Drug Administration, via Associated Press The warnings cover the top half of cigarette packages. In the first major change to warning labels in more than a quarter-century, the graphic images will include photographs of horribly damaged teeth and lungs and a man exhaling smoke through a tracheotomy opening in his neck. The Department of Health and Human Services selected nine color images among 36 proposed to accompany larger text warnings. Health advocacy groups praised the government plan in the hope that images would shock and deter new smokers and scare existing smokers into quitting. The images are to cover the upper half of the front and back of cigarette packages produced after September 2012, as well as 20 percent of cigarette advertisements. “These labels are frank, honest and powerful depictions of the health risks of smoking and they will help encourage smokers to quit, and prevent children from smoking,” Kathleen Sebelius, the secretary of health and human services, said in a statement Tuesday. The four leading tobacco companies were all threatening legal action, saying the images would unfairly hurt their property and free-speech rights by obscuring their brand names in retail displays, demonizing the companies and stigmatizing smokers. The government won one case last year in a federal court in Kentucky on its overall ability to require larger warning labels with images; the specific images released on Tuesday are likely to stir further legal action. The Kentucky case is before the United States Court of Appeals for the Sixth Circuit. The new labels were required under landmark antismoking legislation giving the Food and Drug Administration power to regulate, but not ban, tobacco products. The Family Smoking Prevention and Tobacco Control Act required F.D.A. action on the graphic warning labels by Wednesday, the two-year anniversary of President Obama’s signing it into law. The United States was the first nation to require a health warning on cigarette packages more than 25 years ago, but since then, at least 39 other nations including Canada and many in Europe have imposed more eye-catching warnings, including graphic photographs. “This is a critical moment for the United States to move forward in this area,” F.D.A. Commissioner Margaret A. Hamburg said in an interview. “The trends in smoking really support the need for more action now. For four decades, there was a steady decline in smoking, but five to seven years ago we leveled off at about the 20 percent level of adult and youth smoking in this country.”    Lawrence R. Deyton, director of the F.D.A. Center for Tobacco Products, said the government estimates — based on other countries’ experience — that the new warning labels will prompt an additional 213,000 Americans to quit smoking next year. “We are pleased with the images they picked,” said Nancy Brown, chief executive of the American Heart Association. “They strongly depict the adverse consequences of smoking. They will get people’s attention. And they will certainly be much more memorable than the current warning labels.”    Gregory N. Connolly, a professor and tobacco expert at the Harvard School of Public Health, also praised the strength of the pictorial warnings, but he said the F.D.A. needed to take tougher action against cigarettes.   “What’s on the pack is important, but if you really want to cut smoking rates, you’ve got to get inside the pack and deal with ingredients like menthol and nicotine,” Dr. Connolly said.   The nine images chosen in the United States include some that are among the most graphic of the 36 draft images. But they also include some of the less vivid, including a cartoon depiction of a baby rather than a photo in the draft set that showed a mother blowing smoke at a baby. The images to appear on cigarette packs on a rotating basis also include one of a man proudly wearing a T-shirt that says: “I QUIT.” All of the packs will also contain a toll-free telephone number for smoking cessation services. The F.D.A. has already proposed nine different text warnings that will be paired with the photographs, including, “Warning: Cigarettes cause cancer” and “Warning: Quitting smoking now greatly reduces serious risks to your health.” The government surveyed 18,000 Americans of all ages to determine which of the 36 proposed labels would be most effective to deter smoking. The F.D.A. can revise the selection of color photographs in the future. A few smokers randomly surveyed on New York sidewalks were unswayed by the images. Khariton Popilevsky, 46, a pawnbroker, shrugged and said, “Telling me things we already know. I’ll still be smoking.” Hayley Sapp, 28, a paralegal, said, “There are lots of other high risks out there, you know. Obesity is huge.” Saiful Islam, 34, a convenience store clerk, said higher prices would cut sales a lot more than the images on cigarette packs. A submission to the F.D.A. by R. J. Reynolds, Lorillard and Commonwealth Brands, the second, third and fourth largest cigarette makers, said the “nonfactual and controversial images” were “intended to elicit loathing, disgust, and repulsion” about a legal product. Those companies and a few others filed suit in Kentucky in August 2009 over several provisions of the law. United States District Judge Joseph H. McKinley Jr. ruled that the companies could be forced to put graphic warning labels on the packages, but said they could not be forced to limit marketing materials to black text on a white background, saying that was too broad an intrusion on commercial free speech.   Gregg Perry, a spokesman for Lorillard Tobacco, said on Tuesday that the company was reviewing the graphics and would not comment at this time. A spokeswoman for R.J. Reynolds repeated its earlier opposition to thegraphic labels.  Altria said it would not comment. Altria, the parent company of Philip Morris, the only major tobacco company to support the overall F.D.A. legislation, said in a letter earlier this year that the graphic warning provision was an unconstitutional part of the law “added in a last-minute amendment.” The rate of smoking in America has been cut roughly in half, to about 20 percent, from 42 percent in 1965, but health officials say progress has stalled. Smoking remains the leading cause of preventable death, killing 443,000 Americans a year, according to the Centers for Disease Control and Prevention. Each day, an estimated 4,000 youths try their first cigarette and 1,000 a day will become regular smokers, the government says. This posting includes an audio/video/photo media file: Download Now

Recipes for Health: Lasagna With Asparagus and Chives Posted: 20 Jun 2011 12:45 PM PDT Lasagna doesn’t always have to be assembled and baked; it can be thrown together quickly, like a regular pasta dish. Use no-boil lasagna noodles for this deconstructed lasagna. Despite the name, they do require boiling here, but they will be lighter than regular lasagna noodles. Recipes for Health Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. See All Recipes for Health » Visit Recipes for Health on Facebook. Related Recipes for Health: Asparagus With an Italian Twist (June 20, 2011) Recipes for Health: Asparagus With Anchovies and Capers (June 21, 2011) Recipes for Health: Asparagus Rolled in Herb Crêpes (June 23, 2011) Recipes for Health: Asparagus With Gremolata, Lemon and Olive Oil (June 24, 2011) 1 pound asparagus, trimmed 1/2 cup ricotta 1 garlic clove, finely minced or (preferably) pureed 2 tablespoons chopped chives or a combination of chives and slivered basil 1/2 pound no-boil lasagna noodles 1/4 cup (1 ounce) freshly grated Parmesan or pecorino romano (or a combination) 1. Bring a large pot of water to a rolling boil, salt generously and add the asparagus. Meanwhile, fill a bowl with cold water. Boil thin stalks for three minutes, thicker stalks for four to six minutes until tender. Using tongs, remove the asparagus from the pot and transfer to the bowl of cold water. Drain and cut on the diagonal into 3/4-inch lengths. 2. Add the lasagna noodles to the boiling water, and boil until cooked al dente -- firm to the bite. Meanwhile, place the ricotta in a large pasta bowl, and stir in the garlic. When the noodles are done, remove 1/2 cup of the pasta water, and add to the bowl with the ricotta. Mix together well, and add the asparagus, fresh herbs and Parmesan or pecorino to the bowl. Drain the lasagna, and toss with the ricotta mixture. Serve at once. Yield: Serves four. Advance preparation: You can make this through Step 1 several hours ahead of serving, then cook the pasta just beforehand. Nutritional information per serving (four servings): 323 calories; 4 grams saturated fat; 1 gram polyunsaturated fat; 2 grams monounsaturated fat; 22 milligrams cholesterol; 48 grams carbohydrates; 5 grams dietary fiber; 135 milligrams sodium (does not include salt to taste); 17 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

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