Tuesday, August 23, 2011

Health - Malaria Gets the Foil-in-a-Microwave Treatment

Health - Malaria Gets the Foil-in-a-Microwave Treatment

Malaria Gets the Foil-in-a-Microwave Treatment

Posted: 22 Aug 2011 12:48 PM PDT

What wacky idea has the Bill and Melinda Gates Foundation put $1 million into now?

A plan to treat malaria by sticking the patient into a microwave.

O.K., not the whole patient. Probably just an arm or a leg. And not just any microwave oven, but one set at very low power and with the frequency of its electromagnetic field tuned very precisely.

“You can’t do this with a kitchen microwave,” said Dr. José A. Stoute, a Penn State microbiologist and one of the two inventors of the concept. Other than that, the process is simple: Open special microwave, insert limb, repeat daily.

Dr. Stoute and his co-inventor, Carmenza Spadafora of the Institute for Advanced Scientific Studies in Panama, were originally given $100,000 by the Gates Foundation after writing a two-page proposal suggesting microwaves could safely kill malaria parasites in the blood. Dr. Spadafora proved the idea worked in a petri dish. The new $1 million is to see if it works in mice.

“There’s a lot of data on mice exposed to microwaves, so we think we’ll be able to stay well below their level of safety,” Dr. Stoute said, in a tone probably less reassuring to mice than to men.

The idea, he said, is based on the fact that malaria parasites invade red blood cells and eat the hemoglobin inside them. Hemoglobin contains iron — and, as any bozo who’s ever tried to heat up a sandwich wrapped in tinfoil knows, it’s a bad idea to microwave metal.

Of course, the red cells containing parasites are floating along in arteries right next to healthy red cells, so whatever damage the microwave does to the parasites cannot be visited on the healthy cells, too.

And that, Dr. Stoute said, is where a crucial difference comes in: When a malaria parasite digests hemoglobin, it converts the iron into an inert crystalline pigment called hemozoin. The parasite must do that because free iron will tear oxygen atoms off things the parasite wants intact, like its cell membrane. The hemozoin crystals, packed with concentrated iron, are pushed into the parasite’s food vacuole — the empty space where a rudimentary creature that does not have a gut dumps its waste products. Drifting into an electromagnetic field with a vacuole full of hemozoin is about as brainy as stepping into a microwave with a stomach full of nails. But parasites don’t have brains, either.

Dr. Stoute and Dr. Spadafora have shown that they can fine-tune a custom-built microwave so that only the parasites are damaged. Their theory is that the heated-up hemozoin swells the vacuoles till they pop, unleashing an acid bath on the parasite’s innards.

The microwave is built from commercially available parts, but puts out less than one-thousandth the power of a kitchen model.

The idea, Dr. Stoute said, evolved as he and Dr. Spadafora were tossing around proposals that might land them a Gates grant. Malaria parasites inevitably become resistant to every new drug, so the foundation is interested in new ways to kill them.

Dr. Stoute kept nixing Dr. Spadafora’s ideas, he recalled. “She finally said, ‘What do you want — a magic ray?’ And I remembered reading a study about using microwaves on cancer cells after tagging them with iron. I thought, ‘Parasites come with their own iron. Why don’t we try this?’ ”

Even if the approach works in mice, all sorts of problems will have to be worked out before it is tested on humans, Dr. Stoute said. Hot spots like those that a microwave creates in liquids must be avoided. And any patient will undoubtedly need treatments for several days in a row, because the parasites hide in the brain, liver and spleen — and microwaving the head or abdomen is probably a bad idea.

“But eventually they have to come back out into the blood,” he said, “and that’s when we’ll get them.”

Dr. Stoute has not discussed his idea widely, but one person he told was Dr. Gray Heppner, the former chief of malaria vaccine development at the Walter Reed Army Institute of Research.

“I think it’s a long shot, but I think it’s a brilliant idea,” Dr. Heppner said. “Microwaves are not ionizing radiation. They cause heat. If he can get them to cause very local heat, there’s an exquisite differential susceptibility that might make it possible. And if anyone can carry this off, it’s José.”

Dr. Heppner, a retired colonel, said Dr. Stoute did “brilliant jobs” running a hospital in the Persian Gulf war and a malaria research project in Kenya.

Stephen Ward, the first Gates Foundation official to see the grant application, said his initial reaction was: “This is an absolutely crazy idea.”

“But once you understand the underlying biology,” he added, “it’s a crazy idea that just might work.”

A different grant applicant, he said, had proposed a malaria test using hemozoin, which helped him better understand the key role the crystal plays in malaria. Another advantage, said Dr. David Brandling-Bennett, head of the foundation’s malaria strategy team, was that if the technology works, it may be practical to use in poor countries.

“We want things that, in theory, are low in cost and make reasonable power demands, that might even run on batteries or solar power,” he said. “We wouldn’t be interested if it was expensive and usable only in a tertiary hospital in the first world, like an M.R.I.”

He could imagine many future uses, he said. The simplest would be a microwave that could be used on bags of donated blood if malaria tests were not available. And his wildest vision was an airport scanner that would cure malaria as immigrants walked through it — and do it so harmlessly that there would not even be a need to test them first.

A Conversation With Daniel Lieberman: Born, and Evolved, to Run

Posted: 22 Aug 2011 11:29 AM PDT

Among his academic peers, Daniel Lieberman, 47, is known as a “hoof and mouth” man.

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HOOF AND MOUTH MAN Daniel Lieberman studies how the human head and foot have evolved over the millenniums.

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That’s because Dr. Lieberman, an evolutionary biology professor at Harvard, spends his time studying how the human head and foot have evolved over the millenniums. In January, Harvard University Press published his treatise, “The Evolution of the Human Head.”

We spoke in a Cambridge hotel room for three hours last winter and then again on the telephone in June. An edited and condensed version of the two conversations follows.

Q. Why heads?

A. Our heads are what make our species interesting. If you were to meet a Neanderthal or a Homo erectus, you’d see that they are the same as us — except from the neck up. We’re different in our noses, ears, teeth, how we swallow and chew. When you think about what makes us human, it’s our big brains, complex thought and language. We speak with our heads, breathe and smell with our heads. So understanding how we got these heads is vital for knowing who we are and what we are doing on this planet.

Q. Are there any practical benefits to your research?

A. There are. A majority of the undergraduates who register for my evolutionary anatomy and physiology class here at Harvard are pre-medical students. Learning this will help them become better doctors. Many of the conditions they’ll be treating are rooted in the mismatch between the world we live in today and the Paleolithic bodies we’ve inherited.

For example, impacted wisdom teeth and malocclusions are very recent problems. They arise because we now process our food so much that we chew with little force. These interactions affect how our faces grow, which causes previously unknown dental problems. Hunter-gatherers — who live in ways similar to our ancestors — don’t have impacted wisdom teeth or cavities. There are many other conditions rooted in the mismatch — fallen arches, osteoporosis, cancer, myopia, diabetes and back trouble. So understanding evolutionary biology will definitely help my students when they become orthopedists, orthodontists and craniofacial surgeons.

Q. Your other specialty is the evolution of the foot. Why this emphasis on the farthest points of our bodies?

A. Actually, I’m interested in the entire body. However, I got into feet because of my interest in heads. Some years ago, I was doing an experiment where I put pigs on treadmills. The goal was to learn how running stressed the bones in the head. One day, a colleague, Dennis Bramble, walked into the lab, watched what was going on, and declared, “You know, that pig can’t hold its head still!”

This was my “eureka!” moment. I’d observed pigs on treadmills for hundreds of hours and had never thought about this. So Dennis and I started talking about how, when these pigs ran, their heads bobbed every which way and how running humans are really adept at stabilizing their heads. We realized that there were special features in the human neck that enable us to keep our heads still. That gives us an evolutionary advantage because it helps us avoid falls and injuries. And this seemed like evidence of natural section in our ability to run, an important factor in how we became hunters rather than just foragers and got access to richer foods, which fueled the evolution of our big brains.

So I got interested in how we developed these stable heads. I’m a runner myself. It’s always interesting to study one’s passion. By 2004, we’d found enough evidence to publish a paper in Nature where we declared, “Humans were born to run.” We cited the many dozens of adaptations in the human body that had made us into superlative endurance runners, even compared to dogs and horses.

Before bows and arrows and before horses were tamed, we did “persistence hunting” where we ran kudu, wildebeest and zebra into exhaustion. These animals can’t pant when they gallop. They overheat. People would find a big animal and chase it till it collapsed. You need no technology to do this, just the ability to run long distances, which all of us have.

You can see proof of this capability every November when 45,000 people run for many hours through the streets of New York.

Q. People with bad backs often blame evolution for their pain. They say, “My back aches because man was not meant to walk on two feet.” Are they right?

A. If that were true, natural selection would have its toll and we’d be extinct. What is more likely is that many people sit in chairs all day, get no exercise, and thus have weak backs. We did not evolve to sit in chairs all day.

Q. In your lab, you study the phenomenon of barefoot running. How did that become part of your portfolio?

A. About a year after the Nature paper came out, I gave a public lecture where this bearded guy, with only socks and duct tape on his feet, came up to me and said, “I don’t like to wear shoes when I run — how come?” He’d become a barefoot runner because his feet hurt in shoes. The man was “Barefoot Jeffrey,” a Harvard grad who owned a bicycle shop in Jamaica Plains. What a great question!

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The New Old Age Blog: Shared Meals, and Lives

Posted: 22 Aug 2011 12:21 PM PDT

Preaching a Healthy Diet in the Deep-Fried Delta

Posted: 22 Aug 2011 04:41 AM PDT

HERNANDO, Miss. — Not much seems out of place in the Mississippi Delta, where everything appears to be as it always has been, only more so as the years go by. But here in the fellowship hall of a little Baptist church on a country road is an astonishing sight: a plate of fresh fruit.

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At Oak Hill Baptist Church in Hernando, Miss., and at a number of other churches, healthful food has replaced fried fare. More Photos »

“You get used to it,” said Arelia Robertson, who has been attending the church for almost eight decades.

Despite a dirge of grim health statistics, an epidemic of diabetes and heart disease and campaigns by heath agencies and organizations, the Delta diet, a heavenly smorgasbord of things fried, salted and boiled with pork, has persisted.

It has persisted because it tastes good, but also because it has been passed down through generations and sustained through such cultural mainstays as the church fellowship dinner. But if the church helped get everybody into this mess, it may be the church that helps get everybody out.

For over a decade from his pulpit here at Oak Hill Baptist in North Mississippi, the Rev. Michael O. Minor has waged war against obesity and bad health. In the Delta this may seem akin to waging war against humidity, but Mr. Minor has the air of the salesman he once was, and the animated persistence to match.

Years into his war, he is beginning to claim victories.

The National Baptist Convention, which represents some seven million people in nearly 10,000 churches, is ramping up a far-reaching health campaign devised by Mr. Minor, which aims to have a “health ambassador” in every member church by September 2012. The goals of the program, the most ambitious of its kind, will be demanding but concrete, said the Rev. George W. Waddles Sr., the president of the convention’s Congress of Christian Education.

The signs of change in the Delta may be most noticeable because they are the most hard-fought.

A sign in the kitchen of First Baptist Church in Clarksdale declares it a “No Fry Zone.” Bel Mount Missionary Baptist Church in the sleepy hamlet of Marks just had its first Taste Test Sunday, where the women of the church put out a spread of healthier foods, like sugar-free apple pie, to convince members that healthy cuisine does not have to taste like old tires.

Carved out of the fields behind Seek Well Baptist Church in the tiny town of Lula is a new community garden. The pastor, the Rev. Kevin Wiley, is even thinking about becoming a vegetarian, a sort of person he says he has never met in the Delta.

Many pastors tell the same story: They started worrying about their own health, but were motivated to push their congregations by the campaign that began in Mr. Minor’s church.

“I’m not going to say it has to be done by the church,” Mr. Wiley said. “But it has to be done by people within the community. How long is an outsider going to stay in Lula, Mississippi?”

Certainly, others have been trying to help.

Mississippi finds itself on the wrong end of just about every list of health indicators. It is first among states in percentage of children who are obese, according to the Kaiser Family Foundation. It is first in rates of heart disease, second in the number of adults with diabetes, second in adult obesity, near last in the percentage of adults who participate in physical activity, near last in fruit and vegetable consumption and dead last in life expectancy.

On almost all these scales, the Delta is the worst part of Mississippi. The state has fought this by putting healthier meals in schools, working with mayors to create parks and farmers’ markets and paying for public awareness campaigns.

But the solution is not just a matter of telling people to live healthier, said Victor D. Sutton, director of preventive health for the Mississippi State Department of Health. The Delta is one of the poorest areas of the country, and its problems are deep and varied. The church is part of that whole equation.

“It’s not going to be the answer,” he said, “but it’s going to be one of the answers.”

Mr. Minor was born in the Delta but left for Harvard and a stint selling cars in Boston. He returned to Memphis and in the middle 1990s became the pastor at Oak Hill outside Hernando, about an hour south of Memphis.

If Mr. Minor had never left, he probably would never have noticed it. But he saw it immediately when he returned.

“There were a lot of people not only in this church, but in churches that we fellowship with, that were ...” he searched for the right phrase, “of good size.”

When he began preaching his health gospel right from the start, he was met not by outright resistance — that would have been rude — but by a polite disregard. This is the way people have always cooked here, church members said, and they ignored him.

Trade Commission Challenges a Hospital Merger

Posted: 21 Aug 2011 10:40 PM PDT

WASHINGTON — Obama administration officials have been roaming the country, talking up their vision of a future in which doctors and hospitals team up to provide better care at lower cost. But a starkly different picture is unfolding this summer in a courtroom here, where lawyers from the Federal Trade Commission have been challenging a hospital merger in Toledo, Ohio.

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The Toledo Hospital, the flagship institution of ProMedica, which now operates four hospitals in Lucas County, Ohio.

The lawyers have put the transaction under a virtual microscope, taking hundreds of hours of testimony intended to show that the merger would stifle competition and drive up health care costs. In the process, they are scrutinizing details of the Toledo health care market that might seem more appropriate for investigation by state legislators or county commissioners.

Executives from the ProMedica Health System of Toledo and St. Luke’s Hospital in Maumee, a suburb, say their merger, which was consummated last August, will allow them to collaborate and provide care that is “more efficient and cost-effective” — an overarching goal of the new health care law espoused in scores of speeches by President Obama and administration officials.

The trial here, before the chief administrative law judge of the Federal Trade Commission, has implications far beyond Toledo. It illustrates the risks that arise when competing health care providers try to collaborate, as they are racing to do all over the country, in part because of incentives built into the new health law.

Federal officials are seeing a wave of mergers, consolidations and joint ventures in the health care industry. More and more hospitals are buying up medical practices that competed with one another. Groups of doctors, with the same or different specialties, are merging their practices.

Patricia M. Wagner of Epstein Becker Green, one of the nation’s largest health care law firms, estimates that “50 percent to 60 percent of physicians and hospitals are exploring ways” to team up. The health care law encourages such alliances and joint ventures but provides no exemption from antitrust law, which bans mergers that may substantially “lessen competition.”

Matthew J. Reilly, a senior lawyer at the trade commission, and his team of 14 lawyers have been hammering away at the Ohio merger for more than two months. Armed with thousands of confidential e-mails and dozens of depositions, Mr. Reilly said the merger would increase ProMedica’s market share and “bargaining leverage,” so it could force health insurance plans to pay higher rates to St. Luke’s and to ProMedica’s other hospitals.

St. Luke’s chose to join ProMedica even though it concluded that the affiliation could “stick it to employers, that is, to continue forcing high rates on employers and insurance companies,” according to an internal document unearthed by the commission.

“Soon after the acquisition was consummated,” Mr. Reilly said, “ProMedica approached certain health plans to obtain higher reimbursement rates.” The higher rates, he said, are typically passed on to consumers in the form of higher premiums, co-payments and other costs.

Numerous witnesses, including insurance executives and employers, have testified that Toledo has some of the highest health care costs in Ohio. In addition, they say that ProMedica’s rates are among the highest in the Toledo area, while St. Luke’s is a low-cost, high-quality provider. The government’s goal is to undo the merger and restore the competition that existed when St. Luke’s was independent.

In March, a federal district judge in Toledo issued a preliminary injunction blocking ProMedica and St. Luke’s from continuing to carry out their consolidation until the trade commission could hold a full administrative trial on the merits of the case. The judge, David A. Katz, said the injunction was needed because otherwise ProMedica would be free to carry out “its plans to increase hospital rates, terminate employees at St. Luke’s and eliminate important clinical services” there.

ProMedica, which has 11 hospitals in Ohio and Michigan and annual revenue of $1.7 billion, has described itself to a credit rating agency as having “market dominance” in the Toledo area. It owns and operates one of the largest commercial health plans in Lucas County, which includes Toledo, and is the largest employer of doctors there. For all these reasons, ProMedica says, it is “uniquely positioned for health care reform.”

Randy Oostra, the president of ProMedica, said the merger would benefit patients in many ways. “We could coordinate care,” Mr. Oostra said. “We could improve quality at St. Luke’s by adopting electronic health records and using clinical protocols to standardize the delivery of care. But the F.T.C. has stopped us in our tracks.”

ProMedica said it came to the rescue of St. Luke’s by promising to invest $35 million in the hospital, which it said was losing money and could not have survived on its own. One problem, Mr. Oostra said, was that prices charged to commercially insured patients at St. Luke’s were too low — “substantially below market rates” and, he said, below the cost of providing services.

The trade commission says it is investigating at least a dozen cases in which competing groups of doctors are linking up with one another or with hospitals under a single corporate umbrella.

“Such arrangements have the potential to generate cost savings and quality benefits for patients,” said Richard A. Feinstein, director of the Bureau of Competition at the F.T.C. “However, in some cases, the arrangements can create highly concentrated markets that may harm consumers through higher prices or lower quality of care.”

A study issued last week by the Center for Studying Health System Change, a nonpartisan research institute, said hospital employment of doctors was growing rapidly, “driven largely by hospitals’ quest to increase market share and revenue.”

The commission expressed “serious concerns” about plans by a hospital in Spokane, Wash., to acquire two competing groups of cardiologists. And it has challenged the merger of two hospitals in Albany, Ga.

For all practical purposes, the commission said, the Georgia transaction is “a merger to monopoly” because the hospitals, Phoebe Putney Health System and Palmyra Park, are the only two competing hospitals in the Albany area.

The Toledo case focuses on the market for inpatient hospital care and inpatient obstetrical services in Lucas County, where ProMedica has four hospitals, including St. Luke’s.

The government says the merger will enhance ProMedica’s dominant position in the county, increasing its share of the market for general inpatient hospital services to 58 percent, from 47 percent, and raising its share of inpatient obstetrical services to 80 percent, from 71 percent.

Jeffrey C. Kuhn, general counsel for ProMedica, insisted that his hospitals could not simply sharply increase prices. “If ProMedica charges too much,” Mr. Kuhn said, “health plans and employers can shift to other hospitals in the area, which have excess capacity.”

N.Y. Still Pursues Case Against Whistle-Blower

Posted: 21 Aug 2011 10:23 PM PDT

ALBANY — The Cuomo administration is continuing to pursue a two-year-old disciplinary case against Jeffrey Monsour, a state employee at the Office for People With Developmental Disabilities who has been an outspoken critic of the agency’s management.

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Mr. Monsour, 50, a direct-care worker, is accused of getting into an argument with a co-worker in front of a resident in 2009. The state is seeking a four-week suspension, a penalty that exceeds those imposed on many employees who committed acts of abuse or neglect against developmentally disabled people.

Mr. Monsour has long been a gadfly within the office, which runs more than 1,000 group homes and institutions. Over the years, he has filed many Freedom of Information requests examining its practices, annoying agency officials, and he sees the case being brought against him as their latest attempt at retribution.

The case highlights the agency’s haphazard approach to discipline.

Mr. Monsour was written about by The New York Times in March; that article told of a state worker who, while being investigated by the police in a case of sexual assault against a severely disabled resident, returned to his job without penalty, despite witness testimony and DNA evidence implicating the employee. That worker was eventually convicted of endangering an incompetent person, a charge stemming from the assault case, and was jailed. Another worker described in the article racked up multiple offenses, including twice punching residents in the face, before losing his job.

This year, Gov. Andrew M. Cuomo forced out the agency’s commissioner, installing Courtney Burke, a policy expert, in the position, and he has asked Clarence J. Sundram, a former regulator, to lead a broad review of the agency’s practices. Seeking to add predictability to the disciplinary system, the administration recently negotiated a plan with the Civil Service Employees Association to create a matrix of punishments for various offenses.

But it has continued to pursue the case against Mr. Monsour.

Last month, after prodding by The Times and Mr. Monsour’s lawyer, the administration took the unusual step of turning over nearly 200 pages of transcripts from Mr. Monsour’s arbitration proceedings, offering a rare window into a continuing disciplinary case involving a state employee.

According to the documents, the argument, which was between Mr. Monsour and his co-worker Meghan Hotte, took place in 2009 at a group home in Lake George. Both Mr. Monsour and Ms. Hotte provided the residents with primary care, and the home they were working in at the time lacked a permanent supervisor to issue assignments, a point of tension that set off the argument.

Included among the documents is the testimony of the resident who witnessed the argument and who was well-spoken enough to testify.

The resident described being upset by the argument, blamed both workers and was taken to the hospital for a psychological evaluation the next day. But the resident also considered Mr. Monsour a friend and said Ms. Hotte was cursing during the argument while Mr. Monsour was not. The resident also said Ms. Hotte was yelling more loudly.

Ms. Hotte has had disciplinary problems before. The Office for People With Developmental Disabilities previously fired her for time and attendance violations; she was subsequently rehired.

The agency has since said it would move to stop rehiring employees who had been fired.

Mr. Monsour, an employee since 1999, has no prior disciplinary offenses on his record.

“I did everything I could that day to resolve the situation as fast as I could,” Mr. Monsour said in an interview, adding that he had asked his supervisors to issue assignments to avoid a problem.

“Nobody would be getting into trouble if management was out doing their job,” he said. “That’s their job, to make assignments.”

Ms. Burke, the new commissioner, declined to be interviewed.

Travis Proulx, a spokesman, said the agency was “not permitted to compromise the rights or privacy of any employee in arbitration by commenting on a case that is ongoing.”

A woman who answered the phone at Ms. Hotte’s house said Ms. Hotte would not comment. The agency sought a four-week suspension for Ms. Hotte but settled for a one-week suspension with the possibility of a second week if she were to commit another, similar offense.

Mr. Monsour has paid $800 so far to cover arbitration costs. He has forgone the representation of his union during arbitration and is being represented pro bono by Robert W. Sadowski, a former federal prosecutor.

Mr. Sadowski called the case “a colossal waste of the taxpayers’ money.”

“The system is so obviously broken,” he said. “The resources could be used in a far more beneficial way than retaliating against someone who is only trying to do the right thing.”

Mr. Monsour’s clashes with agency management go back to 2004, when he said he refused to falsify fire evacuation records. Since then, he has had a number of run-ins with officials.

In an evaluation in 2007, he was described as “not a team player” because he called 911 to seek outside help after a resident wandered off and ran through traffic. The agency later redacted the reference.

That year, he was questioned at length after he allowed a resident to share a small amount of eggplant Parmesan with his elderly mother, who was visiting the resident at his state-run home.

“They haven’t been able to discipline me thus far because I haven’t done anything wrong, but they’ve made several attempts,” Mr. Monsour said. “It’s retaliation.”

Media Cache: Hazards Lurk Between TV and Sofa

Posted: 22 Aug 2011 05:59 AM PDT

PARIS — Once, while watching a late-night rerun of “Big Brother 17,” or maybe it was “Big Brother 7,” a nearly finished pint of Häagen-Dazs on my lap, I wondered: Is this shortening my life?

Now, thanks to a study by researchers in Australia, I know that the answer is yes. Watching television may indeed be hazardous to one’s health.

The report, published last week in The British Journal of Sports Medicine, says that every hour of television, after the age of 25, shortens the viewer’s life expectancy by 22 minutes. Adults who watch six hours a day may be cutting almost five years off their lives — almost as much as if they were lifelong smokers.

If the data are confirmed and show “a causal association, TV viewing is a public health problem comparable in size to established behavioral risk factors,” the researchers wrote.

The big problem with television watching, the researchers say, is its sedentary nature. People do not tend to watch television while running marathons. They do it from the sofa.

The data were adjusted to reflect differences in the subjects’ age, waist circumference, alcohol intake and other factors.

Yet I was left wondering: What about differences in the kinds of programming? Is reality television more or less lethal than the news, for example? If I spend my time watching “Jersey Shore,” am I more likely to die of skin cancer?

If I keep the TV tuned to Arté, the French-German cultural channel, for hours on end, am I more likely to succumb to a nasty case of ennui?

Plenty of fodder, in other words, for future studies. More at 11.

Inciting violence Television may kill, but other media are not without their hazards. Last week, two British men were sentenced to four years in prison each after being found guilty of inciting violence via Facebook. These were among the most severe punishments yet in connection with the rioting and looting in London and other British cities this month.

Never mind that neither of the men had actually succeeded in starting a riot or in carting away any loot. The only people who appear to have answered their call to hit the streets of Northwich and Warrington were the police officers who arrested them.

Four years in prison is a long time — as long as Britons convicted of manslaughter typically get, experts pointed out.

Prime Minister David Cameron has called on the courts to send a “tough message” to anyone involved in the riots. He has made social networks a particular target of his ire, saying he is looking at ways “to stop people communicating via these Web sites and services when we know they are plotting violence, disorder and criminality.”

Mr. Cameron’s enthusiasm for curbs on social media could cause problems with the Liberal Democrats, partners with the prime minister’s Conservative Party in the British governing coalition. Some Liberal Democratic lawmakers said last week that they intended to call for legislation to block any new restrictions.

Yet Mr. Cameron is not without supporters. Xinhua, the state-run Chinese news agency, for example, endorsed what it called Britain’s “U-turn,” saying it made a welcome change from China’s being hectored about censorship.

“We may wonder why Western leaders, on the one hand, tend to indiscriminately accuse other nations of monitoring, but on the other take for granted their steps to monitor and control the Internet,” Xinhua said. “For the benefit of the general public, proper Web monitoring is legitimate and necessary.”

We are guessing the British measures will stop short of the approach in China, where a Google search for, say, “Tiananmen Square protests” is likely to result in a so-called 404 error. Still, the sentences handed down to the would-be Facebook rioters suggest that a considered response is not the order of the day.

Concussion Suit Seeks Better Health Monitoring

Posted: 20 Aug 2011 10:30 PM PDT

As the attention paid to head injuries in the N.F.L. has increased in recent years, much of the emphasis has been on the plight of retired players, many of whom are now facing a number of serious ailments.

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Jim McMahon is a plaintiff in a suit seeking damages and changes in how injuries are handled.

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A new lawsuit, however, is seeking to expand the focus. In what could become the first concussion-related class action against the N.F.L., a group of former players — including two players who retired within the past two years — is seeking monetary damages for injured players as well as changes in the medical monitoring of players, an action experts say may push boundaries in both law and science.

The inclusion in the filing of Joseph E. Thomas, 30, and Michael Furrey, 34, is important, according to the group’s lawyer, Larry Coben, because it highlights the issue of monitoring. Coben said that while the new collective bargaining agreement between the league and the players contained significant improvements in how concussions were analyzed and treated, the provisions did not go far enough in identifying injuries to current players.

Specifically, Coben cited the use of blood tests as a way to diagnose concussions, saying the United States military has already begun using the technique and contending that such tests would increase player safety in the N.F.L.

Coben also asserted that the N.F.L. should be using testing procedures that examine genetic markers for indications of whether a player may be more at risk for developing chronic traumatic encephalopathy later in life.

“Modern technology is advancing,” Coben said in a telephone interview. “We need to get past just using doctors on the sideline and in the locker rooms to see if a player has been hurt.”

Medical experts questioned the validity of Coben’s claims — specifically the readiness for widespread use of blood testing or genetic marking in the field of head injuries — but the larger issue, at least presently, is the likelihood that this group of players could be certified to bring a class-action lawsuit.

Coben won a $12 million product liability judgment in 2000 arguing on behalf of a former high school player who was paralyzed during a tackle. But Samuel Issacharoff, a professor of law at New York University, said this latest case had “a series of complex layers.”

Essentially, Issacharoff said, there are three potential classes within the group of players (and their spouses) named in the lawsuit: The younger players, like Thomas and Furrey, both of whom recently retired, who are symbolic of the need to seek changes in the monitoring of current players; the middle-age retirees like the former Chicago Bears quarterback Jim McMahon, who turns 52 on Sunday, who are seeking changes in the monitoring of retired players so as to identify (and treat) potential brain-related conditions as early as possible; and the older players, such as Ray Easterling, 61, the named plaintiff in the lawsuit and a former defensive back in the 1970s.

The last group, Issacharoff said, is almost impossible to certify as a class because injuries (and thus damages) are not uniform; everyone has a different level of pain and suffering, making it hard to display uniformity in a class.

The middle group would have the same problem if it sought damages for injuries, Issacharoff said, but would most likely succeed in being certified as a class if it sought changes in the monitoring of retired players.

And the first group, the younger players, is virtually certain to be certified, according to Issacharoff , because it is seeking “injunctive relief,” or a legally mandated change in action.

“So, the lawsuit as it is filed is really a series of classes,” Issacharoff said. “Some of them possible as certified classes, some of them not.”

An N.F.L. spokesman, Greg Aiello, said that the league was unaware of this specific lawsuit but “will contest any claims of this kind.”

Beyond the legal issues, there is also significant debate in the medical and scientific communities over the current viability of some of the procedures cited by Coben.

Dr. Robert Stern, co-director of the Center for the Study of Traumatic Encephalopathy at Boston University, said that although research was being conducted on chronic traumatic encephalopathy, “There is no good evidence available at this point to indicate that a specific gene or genetic marker puts people at greater risk for C.T.E.”

As Farmers’ Markets Go Mainstream, Some Fear a Glut

Posted: 22 Aug 2011 01:05 PM PDT

FLORENCE, Mass. — John Spineti started selling plump tomatoes and shiny squash at farmers’ markets in the early 1970s and saw his profits boom as markets became more popular. But just as farmers’ markets have become mainstream, Mr. Spineti said business has gone bust.

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Farmers in pockets of the country say the number of farmers’ markets has outstripped demand, a consequence of a clamor for markets that are closer to customers and communities that want multiple markets.

Some farmers say small new markets have lured away loyal customers and cut into profits. Other farmers say they must add markets to their weekly rotation to earn the same money they did a few years ago, reducing their time in the field and adding employee hours.

“It’s a small pie — it’s too hard to cut it,” said Mr. Spineti, who owns Twin Oak Farms in nearby Agawam. Mr. Spineti, who was selling vegetables and small fig trees, his farm’s specialty, at the Wednesday market here, said his profits were down by a third to a half over the last few years.

Nationwide, the number of farmers’ markets has jumped to 7,175 as of Aug. 5; of those, 1,043 were established this year, according to the federal Agriculture Department. In 2005, there were 4,093 markets across the country.

Here in the Pioneer Valley of Massachusetts, where hand-painted signs for fresh vegetables dot winding roads and eating local has long been a way of life, some farmers and market managers are uttering something once unfathomable: there are too many farmers’ markets.

This summer there are 23 farmers’ markets in the area, which encompasses the Connecticut River Valley, according to the Federation of Massachusetts Farmers Markets.

At the Wednesday farmers’ market in Florence, shoppers perused plum peppers, freshly cut sunflowers, jars of homemade pickles and fragrant bunches of basil, rushing them into cars before a midafternoon thunderstorm.

Rick Wysk, who spent the morning pulling beets out of the eight acres he tills at River Bend Farm in nearby Hadley, says his business at farmers’ markets is half what it was five years ago.

“You have a certain amount of demand, and the more you spread out the demand, you’re making less,” said Mr. Wysk, who has been selling at markets for 13 years. He believes his business is further hurt by additional markets that opened this year in Northampton and Springfield.

“We’re Western Mass. We’re not New York City. We’re not Boston,” Mr. Wysk said. “We’ve got people, but not the population in the bigger markets.”

More densely populated areas, however, seem to be where the problem is most acute. In Seattle, farmers have spent the last few years jumping from new market to new market. In San Francisco, there are simply “too many farmers’ markets,” said Brigitte Moran, the executive director of the Marin Markets in San Rafael, Calif.

“We have this mentality of, oh, we have a Starbucks on every corner,” Ms. Moran said. “So why can’t we have a farmers’ market? The difference is these farmers actually have to grow it and drive it to the market.”

Dale Davis, the owner of Stony Hill Gardens and Farm Market in Chester, N.J., cut three New Jersey markets this year because sales were down and the extra travel crimped his profit, and he blames a spate of new suburban markets.

“You send out these guys with fuel and they’re picking and loading,” Mr. Davis said in a telephone interview while selling squash and other vegetables at the Hoboken Farmers’ Market, “and you can’t end up on the long end for too long.”

Stacy Miller, executive director of the Farmers’ Market Coalition, a nonprofit organization that supports farmers’ markets, said that the growth had been a boon to most communities and that many places still lacked markets that connect residents with fresh, healthful food.

But, she acknowledges, some markets are saturated. One reason is that more community groups want to open farmers’ markets without doing “sufficient planning to ensure the demand is keeping up with the supply,” Ms. Miller said.

U.S. Scrambling to Ease Shortage of Vital Medicine

Posted: 19 Aug 2011 10:30 PM PDT

WASHINGTON — Federal officials and lawmakers, along with the drug industry and doctors’ groups, are rushing to find remedies for critical shortages of drugs to treat a number of life-threatening illnesses, including bacterial infection and several forms of cancer.

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The proposed solutions, which include a national stockpile of cancer medicines and a nonprofit company that will import drugs and eventually make them, are still in the early or planning stages. But the sense of alarm is widespread.

“These shortages are just killing us,” said Dr. Michael Link, president of the American Society of Clinical Oncology, the nation’s largest alliance of cancer doctors. “These drugs save lives, and it’s unconscionable that medicines that cost a couple of bucks a vial are unavailable.”

So far this year, at least 180 drugs that are crucial for treating childhood leukemia, breast and colon cancer, infections and other diseases have been declared in short supply — a record number.

Prices for some have risen as much as twentyfold, and clinical trials for some experimental cures have been delayed because the studies must also offer older medicines that cannot be reliably provided.

On Wednesday, Dianne Nomikos, 65, went to M. D. Anderson Cancer Center in Houston for a 9 a.m. appointment to receive Doxil, a vital medicine for her ovarian cancer. She was told to go home and wait until new supplies arrived.

“My life is in jeopardy,” she said through tears in a telephone interview. “Without the drug, who knows what’s going to happen to me?”

The Obama administration is considering creating a government stockpile of crucial cancer medicines. The Centers for Disease Control and Prevention already stockpile antibiotics, antidotes and other drugs needed in the event of a terrorist attack or earthquake.

Under one plan, the government would store the dry ingredients for cancer drugs and, in the face of a shortage, distribute them to hospitals, where pharmacists could mix them into injectable compounds.

Dr. Richard Schilsky, a professor of medicine at the University of Chicago, said the number of cancers diagnosed in a year was easy to predict. “So we ought to be able to make a pretty good estimate of the grams required to treat every patient in the country in any given year,” he said.

Legislation proposed in both the House and the Senate would give the Food and Drug Administration the power to demand that drug makers give early warnings of possible supply disruptions. Senator Amy Klobuchar, Democrat of Minnesota, said the idea behind the bipartisan bill came after she found that the agency had prevented 38 shortages last year after getting early alerts of problems at drug makers.

“I can’t say the drug companies are excited” about the proposed legislation, she said in an interview. “But we need to give the F.D.A. more time.”

A group of leading oncologists has started a not-for-profit drug company that it hopes will soon be able to import supplies of some of the missing medicines. The company will eventually manufacture the drugs itself, according to Dr. George Tidmarsh, a pediatric oncologist and biotechnology entrepreneur who will lead it.

“We have a meeting with the F.D.A. next week,” Dr. Tidmarsh said. “This unfolding tragedy must stop, and right now.”

More than half the recent shortages have resulted because government or company inspectors found problems like microbial contamination that can be lethal on injection. Others have occurred because of capacity problems at drug plants or lack of interest because of low profits, according to the F.D.A.

Doxil, the cancer drug Ms. Nomikos needs, is made by Johnson & Johnson. Monica Neufang, a company spokeswoman, said, “Our third-party manufacturer has had some manufacturing issues related to capacity.”

Heather Bresch, president of the generic drug giant Mylan, says the shortages grow out of a sweeping consolidation of the generic drug industry into a few behemoths that compete only on price and have foreign plants that are rarely inspected.

“The race to the bottom has led to an increase of products coming from plants in China and India that may have uncertain supply and may have never been inspected,” Ms. Bresch said. “If the F.D.A. was required to inspect foreign drug plants at the same rate it does domestic ones, we might not have so many of these shortages.”

Ms. Bresch has helped to broker an agreement that would require the industry to pay $299 million a year for increased inspections of foreign drug plants, a deal that must be approved by Congress and one she says will prevent some shortages.

Top government officials have held a blizzard of meetings in recent weeks to tackle the shortage issue, and more are expected over the next month — including a public advisory meeting at the F.D.A. and hearings in Congress.

Antibacterial Chemical Raises Safety Issues

Posted: 22 Aug 2011 08:16 AM PDT

The maker of Dial Complete hand soap says that it kills more germs than any other brand. But is it safe?

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Fred R. Conrad/The New York Times

Triclosan stands out on the label of Dial Complete.

That question has federal regulators, consumer advocates and soap manufacturers locked in a battle over the active ingredient in Dial Complete and many other antibacterial soaps, a chemical known as triclosan.

The Food and Drug Administration is reviewing the safety of the chemical, which was created more than 40 years ago as a surgical scrub for hospitals. Triclosan is now in a range of consumer products, including soaps, kitchen cutting boards and even a best-selling toothpaste, Colgate Total. It is so prevalent that a survey by the Centers for Disease Control and Prevention found the chemical present in the urine of 75 percent of Americans over the age of 5.

Several studies have shown that triclosan may alter hormone regulation in laboratory animals or cause antibiotic resistance, and some consumer groups and members of Congress want it banned in antiseptic products like hand soap. The F.D.A. has already said that soap with triclosan is no more effective than washing with ordinary soap and water, a finding that manufacturers dispute.

The F.D.A. was to announce the results of its review several months ago, but now says the timing is uncertain and unlikely until next year. The Environmental Protection Agency is also looking into the safety of triclosan.

The outcome of the federal inquiries poses a significant risk to the makers of antimicrobial and antibacterial hand soaps, which represent about half of the $750 million market for liquid hand soaps in the United States, according to the market research firm Kline & Company.

Many of those soaps use triclosan as the active ingredient and say so on the label. Dial Complete is the fifth-best-selling liquid hand soap in the nation, according to data collected from most major stores (except for Wal-Mart) by SymphonyIRI Group, a Chicago-based market research firm.

Richard Theiler, senior vice president for research and development at Henkel, the German-based manufacturer of Dial Complete, said there was no real evidence showing that triclosan was dangerous for humans. He also said that several recent studies had proved the effectiveness of triclosan in killing germs, and that those studies had been submitted to the federal regulators.

“It has been used now in products safely for decades,” Mr. Theiler said.

But as consumer groups have campaigned against triclosan, some consumer product manufacturers have removed it and substituted less controversial ingredients. Reckitt Benckiser removed triclosan from three face washes, for instance. And citing “changing consumer preferences,” Colgate-Palmolive replaced triclosan with lactic acid in Palmolive Antibacterial Dish Liquid, and its Softsoap liquid hand soap has been reformulated without the chemical.

Colgate, however, continues to use triclosan in its Colgate Total toothpaste because it has been proved to fight gingivitis, a claim approved by the F.D.A.

“The safety and efficacy of Colgate Total toothpaste is fully supported by over 70 clinical studies in over 10,000 patients,” the company said in a statement.

Scientists have raised concerns about triclosan for decades. Last year, Representative Edward J. Markey, Democrat from Massachusetts, pressured the F.D.A. to write regulations for antiseptic products like hand soap, including the use of triclosan. The process of creating regulations was started more than three decades ago, but has been repeatedly delayed. In the meantime, Mr. Markey has called for a ban on triclosan in hand soaps, in products that come in contact with food and in products marketed to children.

The concern is based on recent studies about the possible health impacts of triclosan, which the F.D.A. said, in a Feb. 23, 2010, letter to Mr. Markey, “raise valid concerns about the effect of repetitive daily human exposure to these antiseptic ingredients.”

Several have shown that triclosan disrupts the thyroid hormone in frogs and rats, while others have shown that triclosan alters the sex hormones of laboratory animals. Others studies have shown that triclosan can cause some bacteria to become resistant to antibiotics.

Brian Sansoni, spokesman for the American Cleaning Institute, said the evidence against triclosan was hardly convincing and that the chemical had been used safely in consumer products and in hospitals for decades. He said there was no evidence that triclosan caused antibiotic resistance.

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Longer Lives for Obese Mice, With Hope for Humans of All Sizes

Posted: 19 Aug 2011 10:48 AM PDT

Sustaining the flickering hope that human aging might somehow be decelerated, researchers have found they can substantially extend the average life span of obese mice with a specially designed drug.

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The drug, SRT-1720, protects the mice from the usual diseases of obesity by reducing the amount of fat in the liver and increasing sensitivity to insulin. These and other positive health effects enable the obese mice to live 44 percent longer, on average, than obese mice that did not receive the drug, according to a team of researchers led by Rafael de Cabo, a gerontologist at the National Institute on Aging.

Drugs closely related to SRT-1720 are now undergoing clinical trials in humans.

The findings “demonstrate for the first time the feasibility of designing novel molecules that are safe and effective in promoting longevity and preventing multiple age-related diseases in mammals,” Dr. de Cabo and colleagues write in Thursday’s issue of the new journal Scientific Reports. Their conclusion supports claims that had been thrown in doubt by an earlier study that was critical of SRT-1720.

A drug that makes it cost-free to be obese may seem more a moral hazard than an incentive to good health. But the rationale behind the research is somewhat different: the researchers are trying to capture the benefits that allow mice on very low-calorie diets to live longer. It just so happens that such benefits are much easier to demonstrate in mice under physiological stress like obesity than in normal mice.

“The drugs could be used as a preventative to stave off diseases, but I don’t think they will ever be an excuse to abuse your body,” said David Sinclair, a biologist at Harvard Medical School and co-chairman of the scientific advisory board of Sirtris, which developed SRT-1720.

The company, a small pharmaceutical concern in Cambridge, Mass., designed SRT-1720 and a set of similar drugs to mimic resveratrol — the trace ingredient of red wine that is thought to activate protective proteins called sirtuins.

The sirtuins help bring about the 30 percent extension of life span enjoyed by mice and rats that are kept on very low-calorie diets. Since few people can keep to such an unappetizing diet, researchers hoped that doses of resveratrol might secure a painless path to significantly greater health and longevity.

But large doses of resveratrol are required to show any effect, so chemical mimics like SRT-1720 were developed to activate sirtuin at much lower doses.

Sirtuins have proved to be highly interesting proteins, but the goal of extending life span was set back last year when extensive trials of resveratrol showed it did not prolong mice’s lives, although it seemed to do them no harm. Another blow came in 2009, when biologists at Pfizer reported that SRT-1720 and other resveratrol mimics did not activate sirtuins and did not have any beneficial effects in fat mice.

The report by Dr. de Cabo and his colleagues may do much to rescue SRT-1720 from this shadow. They found that SRT-1720 offered substantial benefits to the fat mice, with no signs of toxicity. Unlike the Pfizer study, which was short term, they followed large groups of mice for over three years.

“This is good evidence that this compound has a positive effect on the physiology of the obese animal, and that is definitely promising for humans,” said Jan Vijg, an expert on aging at the Albert Einstein College of Medicine in the Bronx.

Dr. de Cabo and his team “make a reasonable case” that the compound works by activating sirtuins, although they have not proved it, Dr. Vijg said.

In one sense it does not much matter how the drug obtains its effects, as long as it works. But the credibility of SRT-1720 and its cousins also rests on their design as sirtuin activators.

Despite the positive new results with SRT-1720, Sirtris is not putting it into clinical trials because the company believes another of its resveratrol mimics, SRT-2104, is more promising. That drug “is more suitable for human consumption,” said Dr. Sinclair, a co-author of Dr. de Cabo’s report.

“Questions were raised about the molecules and if they are working the way we said they were,” Dr. Sinclair said. “But with this paper, the weight of evidence is shifting back in favor of the premise that we can tweak the aging pathway with drugs.”

Obese mice are a standard research tool, but experts differ as to how relevant they are to humans. “They’ve poisoned the mice with this high-fat diet that makes them very sick indeed, and with SRT-1720 they can reverse some portion of that illness,” said Dr. Richard A. Miller, an expert on aging mice at the University of Michigan.

Dr. Miller said the finding “looks like something people should pay a lot of attention to,” but added that the study would have been even more interesting if it had shown an effect on normal mice.

Dr. de Cabo and his team included normal, untreated lean mice in their study as a control group for the treated and untreated fat mice. The treated fat mice lived longer than the untreated ones, but died long before the normal mice. Although the treated fat mice lived significantly longer on average, there was little difference between their maximum life span and that of the untreated mice. The drug, in other words, helped the fat mice enjoy more of their available life span without increasing the span itself.

The researchers’ findings would be more significant if they had showed that SRT-1720 prolonged the lives of normal mice. Dr. Sinclair said that this leg of the study had been started at the same time, but that the treated normal mice were taking longer to die and could not be reported with the others. Dr. de Cabo said the results were “encouraging” but could not be discussed until they were published early next year. But Dr. Vijg noted that since the drug did not extend the maximum life span of fat mice, it would be surprising if it did so with lean mice.

Some researchers say that too much attention has been given to resveratrol and its sirtuin-activating mimics, and that other compounds like the antibiotic rapamycin may be even more promising. But the sirtuins “are worth a lot of attention even though some of the early claims have proved hard to reproduce,” Dr. Miller said.

Because of the uncertainty about several earlier findings, the sirtuin field has become polarized. “Some people are strongly in support, and others are convinced there’s nothing there,” said Brian Kennedy, president of the Buck Institute for Research on Aging. He described himself as standing in the middle, but hopeful that the sirtuins would turn out to be “key modulators of aging.”

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Well Blog: What a Cow Taught Me About Running

Posted: 17 Aug 2011 09:01 PM PDT

Exhibition Review: Darkness Visible, and Palpable

Posted: 19 Aug 2011 01:30 PM PDT

In the land of the blind — as you learn in the exhibition “Dialog in the Dark,” which opens on Saturday at the South Street Seaport — the one-eyed man hasn’t a chance.

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Members of a tour group at “Dialog in the Dark” at the South Street Seaport Exhibition Center, preparing for the start of the tour.

The genius of this presentation — more a form of participatory theater than an exhibition — is that for the hour or so it takes to make your way through its mysteries, you really are blind.

It isn’t that you get some idea of what it’s like to be blind, or that you approximate the condition of blindness, or that you are metaphorically blind. No. For most of your visit here, you can see absolutely nothing — not your hand in front of your face, not the legs of the person you keep bumping into, not the fountain of water you hear, not the unhusked corn on the supermarket shelves you handle, not the stairs that drop you into the cacophonous roar of what seems to be the New York City subway system.

You swing your cane in an arc on the ground in front of you — from 11 o’clock to 1 o’clock, as taught in an introductory video — and that provides the main warning of what lies ahead. There is also the stumbling conversation of the other blind novitiates, but we are all really dependent on the voice of our guide, Romeo Edmead, a vigorous, charming man, completely unruffled by the tumult we find around us. He is not only comfortable navigating the slopes and turns of the path, but also able, from the very start, to locate and name us as we grope and blunder in pitch darkness. He was blinded by glaucoma at 2, but here it is we who are the infants.

To see things through another person’s eyes in this case means not seeing anything at all. We are meant to try to “see” those scenes most familiar to us — a fountain in Central Park, the Fairway supermarket, the subway, Times Square with its traffic and street vendors, a cafe — the way a blind person would. We never for a minute think we really are in those various settings, but aspects of them — the feel of gravel underfoot, the sound of an approaching train, the scent of coffee, or the shelves stocked with goods that can be distinguished only through smell and touch — are here.

The exhibition is a bit like the antigravity simulators used by astronauts, only here we are really training for the re-entry, for returning to the sunlit city with expanded awareness of a world without sight. For an hour we have to revise our assumptions. Don’t bend at the waist, we are told, if we want to feel something: we would risk banging our heads on invisible obstacles. Instead bend at the knees.

More than just habits are transformed. Usually, when we see something, we see it in advance: we know we can approach it; we can assess it as we move forward. Sight helps shape our sense of the future.

Here we have a different experience of time. Sounds help us anticipate, but in this strange, darkened space, even voices seem to float, positionless, in a void. We don’t know what is about to happen; we aren’t sure where we have been; and it is a problem finding out just where we are. No wonder horror movies rely on darkness: Anything can take shape in front of our eyes, and we would hardly know it. The world becomes immaterial in one respect but all too solid with dangers in another.

We are actually making our way through carefully constructed paths in galleries at the Seaport’s exhibition center that have been thoroughly vetted to minimize danger. Two tours (usually 10 visitors apiece) run through nearly identical courses. They each begin with a group’s being ushered into a preview room and learning from a video about blindness and the experience ahead. The blind guide sits in silence.

Then the lights dim — all cameras, phones and light-emitting watch dials must be checked — and we are in a world that only the blind find familiar. Ultimately the guide’s voice becomes our touchstone and his arm an invaluable aid in negotiating unexpected steps. He is alert to each of our sounds and as patient with our inabilities to make our way in his world as his instructors must have once been in teaching him how to navigate ours. And the worlds, of course, are one and the same.

The experience is so intense and the method so simple that it is surprising how unique and fresh it feels. And yes, it has been done before, since 1988, with great success. A version of this show has been presented in 35 countries, with five permanent exhibitions in Brazil, Israel and Italy and two in Germany. As many as six million people have experienced it.

The idea was developed by Andreas Heinecke, a German journalist and filmmaker who in 1986 had to design a rehabilitation program for a newly blinded colleague. Mr. Heinecke was awakened to the difficulties of the blind and to the subtle denigration and fear that often greeted them. A version of this show, developed a few years later, was one response. He didn’t just want to provide insight into blindness. His goal was more didactic, deliberately placing those who might feel somewhat superior in a position where they were dependent on those who were apparently inferior. He has said that he wants visitors to reach an understanding of the “other.”

In some of Mr. Heinecke’s literature, it can sound like a form of social work: “The exhibition encourages teamwork, trust and understanding and allows visitors to gain a greater appreciation of the power of communication and the abilities of others.” And in a profile prepared when he was awarded an Ashoka Fellowship in 2005 as a “social entrepreneur,” we learn that he has been interested in expanding his project beyond blindness, creating experiences that deal with “old age, migration, exile and crime and punishment.”

In a 2008 talk at a TED conference, he explained that he was also influenced by his discovery that he was born to a Jewish mother, whose family was murdered in Nazi camps, and a German father, whose relatives were Nazi loyalists. Why, he wondered, did the Germans fail to transcend their stereotypes and hatreds?

The risk in this approach is that it will sweep all of human life and suffering into a vast empathetic net that slights differences and detail — which are, after all, at the heart of empathy. This approach also has its limits; getting too deeply absorbed in the world of the “other” can overly soften perceptions of some crimes; it can also replace notions of individual responsibility with something more indulgent.

But these are complicated issues. And it is a tribute to the power of this show that never once do we crash into a pointed message-making machine or bang against any pedagogical edges. Mr. Heinecke and his company, Dialogue Social Enterprise, have created an exhibition that really does draw on the best possibilities of human understanding, formed by social interaction in unsettling conditions.

The New York version, like the one in Atlanta — which opened in 2008 and is still operating — is organized by Premier Exhibitions (which is also presenting the “Bodies” show in the same building). Judging by Mr. Edmead, the company has hired talented blind guides (16 so far). At the end of the tour he sits with visitors in a mock cafe that gradually slides from darkness into light, answering questions about being blind in a visual world.

If anything, the tour was too short, but it seemed to justify the initial quotation on the wall from the German Jewish philosopher Martin Buber: “The only way to learn is through encounter.” Buber cherished the notion of dialogue — hence the exhibition’s title — and while it isn’t the only way to learn, in this case the result is an eye-opener.

“Dialog in the Dark” opens on Saturday at the South Street Seaport Exhibition Center, 11 Fulton Street, at Front Street, Lower Manhattan; dialognyc.com.

Black Scientists Less Likely to Win Federal Research Grants, Study Reports

Posted: 18 Aug 2011 10:36 PM PDT

A research grant application from a black scientist to the National Institutes of Health is markedly less likely to win approval than one from a white scientist, a new study reported on Thursday.

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Jennifer S. Altman for The New York Times

Dr. Francis S. Collins of the National Institutes of Health, which commissioned the report, said that he would act on its findings.

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Even when the researchers made statistical adjustments to ensure they were comparing apples to apples — that is, scientists at similar institutions with similar academic track records — the disparity persisted. A black scientist was one-third less likely than a white counterpart to get a research project financed, the study found.

“It is striking and very disconcerting,” said Donna K. Ginther, a professor of economics at the University of Kansas who led the study. “It was very unexpected to find this big of a gap that couldn’t be explained.”

The findings are being published in Friday’s issue of the journal Science.

At the N.I.H., which commissioned the study, top officials said they would follow up to figure out the causes of the disparity and take steps to fix it.

“This situation is not acceptable,” said Dr. Francis S. Collins, the director of the N.I.H., a federal medical research agency. “This is not one of those reports that we will look at and then put aside.”

The researchers said they did not know whether the panels that reviewed the grant applications were discriminating against black applicants, whether applications from black researchers were somehow weaker, or whether a combination of factors was at play.

In the study, Dr. Ginther and her colleagues looked at 83,000 grant applications from 2000 to 2006. For every 100 applications submitted by white scientists, 29 were awarded grants. For every 100 applications from black scientists, 16 were financed.

After the apples-to-apples statistical adjustments, the gap narrowed but still existed.

The medical research community has long struggled to recruit more minority scientists. For example, about 2.9 percent of full-time medical school faculty members are black, Dr. Collins said; according to census figures, blacks make up 12.6 percent of the population. But the study now shows that the few blacks who do enter research are not on an even playing field.

“It indicates to us that we have not only failed to recruit the best and brightest minds from all of the groups that need to come and join us,” Dr. Collins said, “but for those who have come and joined us, there is an inequity in their ability to achieve funding from the N.I.H.”

Members of other races and ethnic groups, including Hispanics, do not appear to run into the same difficulties. Asians were somewhat less successful, but the gap disappeared when foreign-born scientists — who may have difficulty with English in writing successful grants — were excluded.

Earlier studies have found that women have largely the same level of success as men in obtaining N.I.H. grants.

The grant applications are reviewed in a two-step process. In the first, an application is assigned to a committee consisting of 10 to 40 people, largely drawn from researchers outside the N.I.H. For each application, three committee members review it in detail and assign a tentative score, and then the full committee discusses the top 50 percent of the applications before assigning a final numerical score to each.

The study found that once final numerical scores were assigned, the second review treated scientists of all groups equally based on the scores.

On the grant applications, researchers are asked to identify their race and ethnicity, but that information is not passed along to the review committees. Still, because the applications are not judged anonymously, the reviewers may know the applicant, and often race is not difficult to infer from the name or academic details. For example, a person who attended a historically black university is likely to be black.

Dr. Otis W. Brawley, who is the chief medical officer at the American Cancer Society and is black, said the cause was not overt racism. “It’s not that they’re out to deny blacks funding,” said Dr. Brawley, who worked as an administrator at the National Cancer Institute, part of the N.I.H., in the 1990s.

Rather, it is more likely an unconscious bias, he said, with the reviewers more likely to give the benefit of the doubt to someone they are familiar with, and with black researchers tending to keep a low profile in the scientific world.

Dr. Collins agreed. “Even today, in 2011, in our society, there is still an unconscious, insidious form of bias that subtly influences people’s opinions,” he said. “I think that may be very disturbing for people in the scientific community to contemplate, but I think we have to take that as one of the possibilities and investigate it and see if that is in fact still happening.”

The institutes have put together a task force to follow up on the Science study. For example, it plans to perform an experiment to review some grants by two committees; one will use the current review process, while the other will review the applications with the names and institutions of the applicants removed.

The institutes will also recruit more young researchers to serve on the review committees. That experience could give them a better understanding of how to write a successful application for their own research.

Dr. Raynard S. Kington, a co-author of the Science study who helped put it together when he was the N.I.H.’s deputy director in 2008, lauded Dr. Collins and other officials there for taking the issue seriously.

“There are those who have said, ‘I don’t understand what the problem is, why do we need to do anything?’ ” said Dr. Kington, who is black and is now president of Grinnell College in Iowa.

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Recipes for Health: Pan-Cooked Summer Squash With Tomatoes and Basil

Posted: 18 Aug 2011 11:20 PM PDT

This Provençal summer dish is delightful as a starter or as a side dish with fish, chicken or cooked grains.

Recipes for Health

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

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2 tablespoons extra virgin olive oil

1 1/2 pounds medium or small zucchini or other summer squash, thinly sliced or diced (depending on what shape squash you use)

2 garlic cloves, minced

1 pound ripe tomatoes, grated on the large holes of a box grater, or peeled, seeded and diced

Salt and freshly ground pepper

1 to 2 tablespoons chopped or slivered fresh basil (to taste)

1. Heat 1 tablespoon of the olive oil over medium-high heat in a wide, heavy skillet. Add the zucchini. Cook, stirring or shaking the pan, until the zucchini is lightly seared and beginning to soften, three to five minutes. Remove from the pan, and set aside.

2. Add the remaining olive oil to the pan, then the garlic. Cook, stirring, just until fragrant -- less than 30 seconds. Stir in the tomatoes. Cook, stirring, until the tomatoes have begun to cook down, about five minutes. Return the zucchini to the pan, add salt and pepper to taste, and reduce the heat to medium. Cook, stirring often, until the zucchini is tender and translucent and the tomatoes have cooked down to a fragrant sauce. Stir in the basil, and taste and adjust seasonings. Remove from the heat and serve hot, or allow to cool and serve at room temperature.

Yield: Serves four to six.

Advance preparation: You can make this a day or two ahead of time. Keep refrigerated, and reheat gently on top of the stove. The dish is also good cold, doused with a little lemon juice.

Nutritional information per serving (four servings): 111 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 0 milligrams cholesterol; 10 grams carbohydrates; 3 grams dietary fiber; 20 milligrams sodium (does not include salt to taste), 3 grams protein

Nutritional information per serving (six servings): 74 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 3 grams monounsaturated fat; 0 milligrams cholesterol; 7 grams carbohydrates; 2 grams dietary fiber; 13 milligrams sodium (does not include salt to taste), 2 grams protein

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

Advertising: A Feminine Approach to Incontinence

Posted: 17 Aug 2011 09:50 PM PDT

A PRINT ad for Poise Hourglass, a new line of bladder protection products from Kimberly-Clark, features the bare back of a woman facing away from the camera, her supple torso assuming the shape of an apostrophe.

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Kimberly-Clark's ad for Poise Hourglass bladder protection products emphasizes a woman's shape.

“You,” says the type that stretches across her back. “The inspiration for our new shape.”

Being more tapered in their midsections than other pads, Poise Hourglass promises a better fit for some women. They are “shaped to fit your body better,” the ad continues, “because they are the only line of pads designed to fit a woman’s curves.”

Kimberly-Clark estimates one in three women over 18 experience at least occasional instances of light bladder incontinence. So the company wants women to perceive Poise as more of a feminine care product than something for the elderly.

The ad, by Ogilvy & Mather Worldwide in New York, part of WPP, will appear in the September issues of magazines including Better Homes & Gardens, Ladies’ Home Journal and Woman’s Day. The ad also will appear in Weight Watchers magazine, since heavier women may be particularly drawn to the line, said Joe Kuester, the senior brand manager at Poise.

“Women that have a higher B.M.I. probably relate to this product better than other products,” said Mr. Kuester, referring to the body-mass index.

More than 20 percent of women using bladder protection pads report having had the pads leak, said Mr. Kuester, adding that the cause often is a pad bunching up while worn, and that is more likely with heavyset users.

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Still, Mr. Kuester said that in consumer testing, many slender women also preferred the pad — partly for aesthetic reasons. In what the brand says is a first for the category, the pads, which have primarily been plain white, are printed with pastel floral patterns, as is the box.

“Traditionally these have been very square, very white — with some blue to convey their absorbent nature,” Mr. Kuester said. “We’re building a great deal of feminine details into this product so women can feel like this is not an institutional product, that, ‘I can have a feminine care product designed for me that makes me feel feminine.’ ”

Nancy Muller, executive director of the National Association For Continence, a nonprofit educational and advocacy group, lauded the Poise Hourglass approach.

“It’s brilliant in the sense that when women are leaking urine from their bladders they can feel very uncomfortable, very unclean, and they certainly don’t feel sexy,” Ms. Muller said. “What Kimberly-Clark is trying to achieve here is that you can still feel feminine, you can still feel like a woman and every bit as pretty.”

While the brand, which coined the term “light bladder leakage” as a less stigmatizing alternative to “incontinence,” pitches the product to all women over 18, the primary target is women aged 45 to 55.

In what the brand also says will be a first, end-of-aisle displays at retailers including Wal-Mart and Walgreens will include an actual Poise Hourglass pad that is reinforced with foam core to hold its shape.

“This is a category that doesn’t get a lot of in-store support, but retailers have been supportive because of our marketing spend,” Mr. Kuester said. He described the advertising effort, which along with print will include online advertising, as a multimillion-dollar campaign, and as the biggest to date for Poise, but declined to provide the exact cost. Poise spent $12.8 million on advertising in 2010, according to the Kantar Media unit of WPP.

The American market for adult incontinence pads and disposable garments is surging, mainly because of aging baby boomers. Euromonitor International estimated annual sales at $1.3 billion in 2010, up from $971 million in 2005.

Kimberly-Clark dominates the category, with its more substantial Depend line accounting for 31 percent of the market and Poise with 25 percent, according to data for the 52 weeks ending July 10 from the SymphonyIRI Group, whose totals do not include Wal-Mart. Sales for Poise were up 6.9 percent for the period.

An online campaign last year for Poise featured Whoopi Goldberg, the actress and co-host of “The View,” depicting historical figures including Helen of Troy and Joan of Arc suffering from weak bladders.

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Consumer shame about the issue may be one of the biggest challenges for the industry, with the trade publication Nonwovens Industry summing it up this way in a recent headline: “Incontinence, an embarrassment of riches.”

Writing in the Euromonitor Global Market Research blog in 2010, Rob Walker, an analyst based in London, said both in America and internationally, “the biggest challenge for the industry is that vast numbers of sufferers are too embarrassed to raise the problem of incontinence with their health practitioner, or worse, even buy available products at a retail outlet.”

To address that, Mr. Walker added, “the commercial opportunity here is for the big international hygiene players to humanize (or even Viagra-ize) incontinence, making products as accessible, consumer-friendly and embarrassment-free as, for example, women’s sanitary protection.”

Asked to review the new Poise Hourglass design and advertisement, Mr. Walker, in a telephone interview from London, said that he thought the brand was on track.

“If Kimberly-Clark can bring in an incontinence product geared to women and present it within the feminine care category, it makes a lot of sense,” Mr. Walker said. “It’s about breaking down barriers, and it’s taking out that whole geriatric vibe from incontinence.”

Proposal Would Aid Deciphering of Benefits

Posted: 17 Aug 2011 10:20 PM PDT

WASHINGTON — The Obama administration proposed new rules on Wednesday that would require health insurance companies and employers to provide information to policyholders and employees describing health benefits, coverage and costs in plain English.

Kathleen Sebelius, the secretary of health and human services, said the new “summary of benefits and coverage” would make it easier for consumers to shop for insurance and compare plans.

The new forms, scheduled to be available next year, set disclosure standards for private health plans covering 180 million people.

Groups like Consumers Union said the new document could be a boon to consumers as they struggle to decipher the details of health insurance, which comes in a mind-boggling variety of configurations.

The White House compared the new information to the “nutrition facts” labels found on many packaged foods. Lynn Quincy, a health policy analyst at Consumers Union, likened the new document to the standard disclosure of information about credit cards and home mortgages.

Insurers said they supported the goal of the new rule, to educate consumers about their choices. But Robert E. Zirkelbach, a spokesman for America’s Health Insurance Plans, a trade group, said compliance could be expensive for insurers.

Employers choose many different benefit packages for their employees, Mr. Zirkelbach said, so insurers “could be required to create tens of thousands of different versions of this new document.”

The administration estimated that it would cost insurers and employers $50 million a year to compile and disseminate the required information.

As part of the new form, insurers and employers would have to itemize the costs that would be incurred by consumers needing certain services. These “coverage examples” would show how insurers cover the cost of having a baby, treating breast cancer and managing diabetes.

The government would specify the services and billing codes to be used in calculating costs in each case.

Kathryn Wilber, a lawyer at the American Benefits Council, a trade group for large employers, said, “Many of our members have been providing information about benefits and coverage in a very effective way.” But Ms. Wilber said, “The coverage examples are very new, and we do not have experience with them.”

In the summary of benefits and coverage, insurers must answer questions like these: “What is the premium? What is the overall deductible? Is there an out-of-pocket limit on my expenses? Is there an overall annual limit on what the insurer pays? Does this plan use a network of providers? Do I need a referral to see a specialist?”

Insurers must also provide subscribers with a glossary offering standard, government-approved definitions of more than 40 terms commonly used in health insurance coverage, like “deductible” and “co-payment.”

Insurers and employers are subject to civil fines up to $1,000 for each policyholder or employee to whom they fail to send the required disclosure form.

Under the new health care law, insurers and employers are supposed to provide the required information to consumers and employees by March 23, 2012. Insurers and employers said they would probably need more time because the administration was late in issuing the proposed rule.

The rule largely follows recommendations from the National Association of Insurance Commissioners.

Prof. Timothy S. Jost, an expert on health law at Washington and Lee University, said the proposed rule “could have done much more to facilitate comparison shopping.”

But the administration said the rule would still be helpful because “many consumers do not understand how health insurance works” and insurance contracts are often full of jargon.

The public has until Oct. 21 to file comments on the proposed rule.

Cuts in Health Care May Undermine Role in Labor Market

Posted: 18 Aug 2011 11:00 PM PDT

Even during months of stubborn unemployment, the health care industry has provided a solid underpinning, reliably adding jobs in an otherwise dismal environment.

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Stephen McGee for The New York Times

The emergency room team at the University of Michigan Hospital in Ann Arbor.

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Health Care Job Growth
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Stephen McGee for The New York Times

Kimberley Wallaker is a nurse at the University of Michigan Hospital. Though administrators have no current plans to reduce staff, in the future they hope to deliver care with fewer people.

For example, hospitals, nursing homes and the like added about 430,000 jobs during the recession, as the country shed 7.5 million jobs. With the latest government reports showing a meager overall gain of 117,000 jobs in July, health care remained a significant contributor with an additional 31,000 jobs for the month, a tad higher than an average monthly addition of 25,000 health jobs in the last year. Hospitals, which had a slight decline in June, added 14,000 jobs in July.

While few experts can predict how the stock market’s gyrations and government cutbacks this month will affect the health industry, several health industry analysts warn that the sector is showing signs of economic sluggishness that has long kept other business sectors beleaguered.

The situation has led many in the health industry to caution that it cannot be relied upon to keep hiring workers. “It’s not realistic to believe that we’re going to continue to generate job growth when you’re speaking about Medicare and Medicaid reductions in the hundreds of billions of dollars over the next few years,” said Daniel Sisto, president of the Healthcare Association of New York, which represents the state’s hospitals and health systems.

Companies that rely on government spending have been bracing for deeper reductions, and President Obama recently alluded to another round of belt-tightening from one of the industry’s bedrock payers — Medicare.

Signs of a gloomier outlook have been surfacing in various spots, from a slowing in new construction plans to falling share prices of nursing home companies to announced layoffs among hospital support staff.“Nobody is sure what will happen,” said Alan M. Garber, a physician and health policy expert at Stanford. The cuts in government programs like Medicare and Medicaid, and pressure to reduce costs, are thwarting health care employers in trying to meet the rising demand for their services.

“The health care industry is facing greater uncertainty than in any time in memory,” Dr. Garber said.

Yet even though economists and other experts still predict increasing demand for health care as the population ages, with an accompanying demand for job growth, health care officials and executives cite a daunting cascade of recent events as reasons to reassess any expansions.

They point to Congress’ intent to reduce spending, economically depressed states struggling to deal with a rash of cuts in Medicaid programs and the continued uncertainty of financial costs that will be imposed by the federal health care law, including contradictory lower court decisions about the constitutionality of various provisions.

A survey by the Conference Board, a business research group, found that help-wanted ads for health care providers and technicians fell by 61,200 listings in July.

In Florida, for example, health care led the state in job gains during the recession — it was the only industry that did not lose jobs during that time. But since September of last year, the leisure and hospitality industry has been adding more jobs, according to a state economist.

The Palo Alto Medical Foundation, a large physician group in Northern California that employs 5,500 people, including 1,000 doctors, says it has no plans to add many more people in the near future. “Really our focus these days is to do more with the assets we have,” said Cecilia Montalvo, the vice president for strategic development for the medical group.

Hospitals also appear to be slowing the pace of building, as projects begun before the recession started are now being completed. The volume of tax-exempt debt for hospitals in the first half of the year has fallen by nearly half from a year ago, said David Johnson, a managing director at BMO Capital Markets. “We’re overinvested in hospitals and hospital beds,” he said.

The University of Michigan Health System, for example, is adding some 560 jobs as a result of new children’s and women’s hospitals it plans to open soon and an expansion of its emergency department. But Doug Strong, who heads the system’s hospitals, said his overall goal is to shrink his work force in future years as he tries to make the system more efficient, though their are no current plans to reduce the system’s staff.

Tom Torok contributed reporting.

Schools Restore Fresh Cooking to the Cafeteria

Posted: 17 Aug 2011 09:40 AM PDT

GREELEY, Colo. — The idea of making school lunches better and healthier has gathered steam in many parts of the nation in recent years, but not equally for every child. Schools with money and involved parents concerned about obesity and nutrition charged ahead, while poor and struggling districts, overwhelmed by hard times, mostly did not.

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Kevin Moloney for The New York Times

George Coates III, who trained at the Culinary Institute of America, has become the Greeley district's first executive chef.

This midsize city in northern Colorado, where 60 percent of the 19,500 students qualify for free or reduced-price meals, is trying to break the mold. When classes start on Thursday, the district will make a great leap forward — and at the same time back to the way it was done a generation ago — in cooking meals from scratch.

Factory food took over most American schools in a rolling, greasy wave of chicken nuggets and pre-prepped everything over the last few decades. Now, real ingredients and spices like cumin and garlic — and in a modern twist, fiber-laden carrots snuck in where children do not expect them, like pasta sauce — are making their return to the cafeteria tray.

Getting ready for that counterrevolution here in Greeley involved a weeklong boot camp to relearn forgotten arts like kitchen math — projecting ingredients to scale when making, say, 300 pans of lasagna, which cooks were doing this week — and to brush up on safe cooking temperatures for meat.

“It shows it’s not just for the elite,” said Jeremy West, the nutrition services director for Weld County District 6.

Colorado, which has been the least obese state in the nation since federal health measurements of American girth began, is a leader in the back-to-scratch movement. Of the 100 or so districts nationally that have worked with Cook for America, a group that trains school cooks in healthier lunch-ways and ran Greeley’s boot camp, more than half are in Colorado, including schools in the largest districts in Denver, Colorado Springs and Boulder.

Nutrition experts say that many school systems around the nation, however much they might want to improve the food they serve, have been profoundly distracted by years of budget cuts and constriction. Many face structural problems, too. Some newer schools have tiny kitchens designed for only reheating premade meals, while some older schools have outdated electrical wiring that cannot handle modern equipment. Many districts, and their lawyers, have also grown fearful of handling and cooking raw meat, as food-borne illnesses like E. coli have made headlines.

“A lot of schools are looking to prepare more items from scratch, and starting to prepare more, but there are tremendous hurdles,” said Diane Pratt-Heavner, a spokeswoman for the School Nutrition Association, a nonprofit membership organization of school nutrition professionals.

Greeley’s schools will be cooking from scratch about 75 percent of the time on the opening day, with a goal of reaching 100 percent by this time next year, when ovens and dough mixers for whole wheat pizza crust will be up and running. But already, the number of ingredients in an average meal — not to mention the ones that sound like they came from chemistry class — is plummeting.

Consider the bean burrito: last year, in arriving from the factory wrapped in cellophane, each one had more than 35 ingredients, including things like potassium citrate and zinc oxide. This year: 12, including real cheddar cheese. Italian salad dressing went from 19 ingredients to 9, with sodium reduced by almost three-fourths and sugar — the fourth ingredient in the factory blend — eliminated entirely.

Statistics showing obesity rates growing faster here in Weld County than in surrounding areas gave the project impetus with district administrators, Mr. West said. The argument was then cinched by the numbers, which showed that going back to scratch would not cost more at all, but could in fact save the district money in the long run.

From the Colorado Health Foundation, a nonprofit group that has helped districts all over the state return to healthy cooking, Greeley got $273,000 in grants, which helped defray much of the $360,000 for construction and new equipment.

Equally crucial was the fact that the district still had a huge central kitchen space that was partly intact from the old days, including a bank of giant ovens that for some reason were never ripped out in the 1980s when cooking from scratch faded. That sharply reduced transition and projected operating costs. Even with 10 new hires in the core kitchen, Mr. West said, 10 net food service jobs were eliminated, since many lunch workers in individual schools were no longer needed.

“The biggest myth is that it costs more money,” said Kate Adamick, a food consultant based in New York and co-founder of Cook for America. She said federal reimbursement rules could actually give poorer school systems some advantages in shifting back to scratch, especially for meat, which many districts buy with deep discounts. Cooking the meat themselves, rather than paying a processor, can drastically reduce total costs, she said.

Meanwhile, the district’s first executive chef, George Coates III, who trained at the Culinary Institute of America and worked in high-end restaurants in Arizona and elsewhere, is plotting a food revolution. Mr. Coates, known in the kitchen as Chef Boomer, said he envisioned good food not just taking over the schools here in Greeley, but also eventually filtering back into homes, reconnecting parents with cooking through a system of recipe sharing — especially if, as he hopes, children go home and talk about the good food they are getting on his watch.

And he has a trick or two up his white sleeves. Take macaroni and cheese, for example. It will still be a staple on the new menu and will still have that bright, strange yellow color that children have become accustomed to, but it will not be artificial. “No natural cheese is that color,” he said.

Greeley’s version will be colored by turmeric, a spice associated with Indian cooking. “Adds a really interesting, subtle flavor, too,” Mr. Coates said.

Elida Martinez is among the kitchen workers who saw the full circle of change over her 32 years at the district. She sees now, she said, that the old days of cooking from scratch were not perfect. Dessert, often gooey, was offered every day, for example, and there was not a lot of fussing over sodium or fat. The new menu plan makes dessert a special occasion.

“We’re going to teach children how to eat again,” she said.

Some things, though, are going back the way they were. A recipe box from the old days was found, tucked away in an office, maybe even saved with hopes of this moment. Chef Boomer said his chili recipe, with a tweak here and there, would be pretty close.

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Personal Health: In Decline, Stillbirths Continue to Devastate

Posted: 18 Aug 2011 03:24 PM PDT

I had been in active labor for 12 hours when my obstetrician said he would have to do a Caesarean because Twin A was stuck and neither twin could emerge naturally. Terrified of losing either baby, I responded, “I don’t care if I cough them up, just get them out alive!”

Yvetta Fedorova

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Which, thankfully, he did — almost 42 years ago.

Alas, not every woman is so lucky. Even with the highly advanced technology now available to monitor the unborn, each year 27,000 fetuses that pass the 20th week of gestation and 13,000 that reach the 28th week or beyond are born dead. One in every 200 pregnant women who gets to 22 weeks of gestation will have a stillborn baby.

It often is a devastating experience. “As soon as they learn they are pregnant, most women consider their unborn baby their child, and for many a stillbirth is like the death of a child,” said Dr. Robert Goldenberg, an obstetrician-gynecologist at Drexel University College of Medicine.

Though stillbirths have declined sharply since the 1940s, they remain very much with us, and not just among women who are poor or poorly educated or lack access to good medical care. Even under the best of circumstances, sometimes babies just don’t make it.

And, as Dr. Zoe Mullan and Dr. Richard Horton wrote recently in the British medical journal The Lancet, “The grief of a stillbirth is unlike any other form of grief: the months of excitement and expectation, planning, eager questions and the drama of labor — all magnifying the devastating incomprehension of giving birth to a baby bearing no signs of life.”

With financing primarily from the Bill and Melinda Gates Foundation, the journal has published online a major series of reports on the global problem of stillbirths, more than 2.6 million of which occur each year. Though all but 2 percent take place in low- and middle-income countries, “stillbirths also continue to blight wealthy nations, with around one in every 320 babies stillborn in high-income countries,” Lancet editors noted.

Yet society does little to acknowledge these losses, and friends and relatives tend to avoid talking about them.

Calling stillbirth “one of the last taboos — the death of a baby before birth somehow considered not to count,” Janet Scott of the Stillbirth and Neonatal Death Charity in London wrote that “in high-income countries, although infant mortality rates have dropped, stillbirth rates have not changed in more than a decade.”

Many Known Causes

Adding to parental devastation is the usual mystery of why a stillbirth occurred. In only about 40 percent of stillbirths is there an explanation, according to Dr. Goldenberg, an author of the Lancet series.

Yet, he said in an interview, “when a careful autopsy is performed of both the baby and placenta and the baby’s chromosomes are examined, we can find an explanation 80 to 85 percent of the time.”

Dr. Goldenberg added, “Many of the tests that could clarify why a baby died are not done because the doctor and family feel badly, because the parents believe the baby has suffered enough and don’t want it disturbed any further, or because the hospital gets no extra payment for an autopsy.”

Still, there are a number of known causes, some of which have increased in recent years. In the Lancet report, Australian and British researchers listed maternal overweight and obesity as the most important preventable risk factor in high-income countries, accounting for up to 18 percent of stillbirths. Second and third, the authors wrote, are maternal age over 35 and smoking during pregnancy, the latter being more common among the poor.

Women over 35 face a 65 percent increase in the odds of a stillbirth, compared with younger women. And, the researchers noted, “the number of women delaying childbearing is rising, which is leading to a growing proportion” of women over 35 having their first babies. First babies themselves are more likely to be stillborn.

In vitro fertilization resulting in multiple pregnancies is yet another factor that has become more common in recent years. “Without question,” Dr. Goldenberg said, “twins and triplets have much higher rates of stillbirth.” To reduce the risk, he strongly recommended that, when attempting an in vitro pregnancy, only one embryo be implanted.

While being overweight is in itself a risk factor for stillbirth, Dr. Goldenberg said it also increased the risk of two other causes, gestational diabetes and pre-eclampsia (high blood pressure brought on by pregnancy). Women with diabetes or high blood pressure before becoming pregnant are also at higher risk for stillbirth, especially if their conditions are poorly controlled.

Another potentially preventable cause is infection, especially untreated periodontal disease, which should be corrected before a woman becomes pregnant, Dr. Goldenberg suggested. Studies thus far have not shown a clear benefit of periodontal treatment during pregnancy. Still, when a blood-borne infection from any cause is diagnosed, treatment with antibiotics may reduce the chances of a stillbirth.

Balancing the Risks

If a pregnancy goes well past term, defined as 40 weeks for a singleton and 38 weeks for twins, the risk of stillbirth rises. The Lancet authors recommended that women who are still pregnant after 41 weeks undergo induced labor.

Of course, this means a woman’s due date must be accurately determined, usually by a “dating” ultrasound exam early in pregnancy. Some causes of stillbirth — like placental abnormalities and fetal growth retardation — are not preventable but can be monitored and, if necessary, “treated” with early delivery to save the infant. Low-dose aspirin can reduce the risk associated with some placental problems.

“In the United States, growth-retarded babies don’t have to die,” Dr. Goldenberg said. Monitoring factors like fetal movements and blood flow through the placenta can show which babies are in trouble and should be delivered early.

“We have to balance the risk of prematurity with the risk of stillbirth,” he said.

His own first grandchild was born early this way. At 28 weeks gestation, the baby’s mother developed pre-eclampsia and the baby’s growth was retarded. The pregnancy was monitored closely for four more weeks, when it was decided that an early delivery was safer than risking stillbirth. Now 16 months old, Dr. Goldenberg’s granddaughter is “just wonderful,” he said.

Unfortunately, many women in this country lack access to the kind of care his daughter-in-law received. As a result of medical inequities, the risk of stillbirth is nearly twice as high among African-American women as among white and Hispanic women, the Lancet report stated. Rural women, too, are at a relative disadvantage compared with urban women.

Dr. Goldenberg said that if the new health care law gets more women into care early in pregnancy, there should be a positive effect on stillbirth, which currently occurs 10 times as often as sudden infant death syndrome in the United States.

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Posted: 16 Aug 2011 08:55 AM PDT

Opinion: I Won’t Have the Stomach for This

Posted: 14 Aug 2011 02:48 PM PDT

Anna Stoessinger is a writer who works in advertising.

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Eleanor Davis

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I AM a ravenous, ungraceful eater. I have been compared to a dog and a wolf, and have not infrequently been reminded to chew. I am always the first to finish what’s on my plate, and ever since I was a child at my mother’s table, have perfected the art of stealthily helping myself to seconds before anyone else has even touched fork to frog leg. My husband and I have been known to spend our rent money on the tasting menu at Jean Georges, our savings on caviar or wagyu tartare. We plan our vacations around food — the province of China known for its chicken feet, the village in Turkey that grows the sweetest figs, the town in northwest France with the very best raclette.

So it was a jarring experience when, a few months ago, at 36 years old, I learned I had stomach cancer.

I had only mild symptoms at first: a slight pain below the breastbone when I swallowed, discomfort that felt like nerves or indigestion. Two doctors told me it was nothing. “Take some Prilosec,” they said, which made sense. We had just returned from a trip to Italy. In Florence, we had eaten mounds of roast duck, crostini and rich fish stews; maybe I just had heartburn. But the feeling lingered, and the hypochondriac in me went to the gastroenterologist.

It was a tumor. We got the call early on Friday morning. My husband and I were still in bed, and it took more than a moment to register. At my age, I am not supposed to have stomach cancer. In the United States, it’s a disease that most commonly afflicts older, Asian men, and I am none of these. I have also parted with all my vices, save the occasional sugar binge. But after years of worrying that I might have cancer, years of, “Can you look at this? Is this a lump? What’s this right here? No, here,” I actually did.

I had only one thought about the possibility of death: the fear that I would have to part from my husband a half-century too soon. We had just married in October. We had just moved into a cottage in Connecticut. We had just discovered the simple pleasures of a happy routine. A calendar on the fridge. Roast chicken with leeks for dinner. Losing our life together was what death meant to me, and that, I think, is love.

Thankfully, my doctors assured me that death was a remote possibility. But I wasn’t getting off easily; there were things to lose. First, with three rounds of intense chemotherapy, I lost my appetite. But that was only temporary. Then my surgeon told me that I needed a total gastrectomy — I would have part of my esophagus and all of my stomach permanently removed.

With nothing but a small intestine left to digest food, my gastronomic future would hold only small, frequent meals, consumed slowly and deliberately, without my characteristic gusto. Without abandon. Without — there would be a lot of without.

“You can live without a stomach,” my doctor told me. I have often thought about what I could live without, if I had to: a savings account, an extra bedroom, the new Prada suede platform pump in burgundy. But a stomach never entered my mind. And food? It was so much more. As a little girl, sharing food with my mother was a solace, a joy, and a way of communicating. Sharing it with my husband has been as intimate as anything I’ve experienced. We fell in love one taste at a time: roadside cheeseburgers, bonito with ginger sauce, hazelnut gelato. After the first bite had lingered on our tongues, we’d say to each other: Wait for it. And then: Did you get that? The smoke? The spice? The texture? We always did.

And so, with just 10 days left with my trusted stomach, we set out to capture all that food meant — all the memories it conjured, all the happiness it brought. We were determined to eat as much and as well as possible. We made lists. What categories of food needed attention? Which meals did we want to recreate? We went from lowbrow to high, and everywhere in between. Peanut butter and jelly doughnuts, ginger ice cream, sashimi, grilled porterhouse, wild blueberries. We came up with a plan. Travel options were limited (health, timing), but we would go from Connecticut to Maine to New Brunswick, and finish in New York City three days before my surgery.

On the road, we ate candy in the car like kids. Then, at the White Barn Inn near Kennebunkport, Me., we ate a foie gras and fig torchon, which was velvety, buttery and dusted with pistachios; we ate butter-poached smoked lobster, the summery steam wafting up from the meat; and we tasted scallops with passion fruit coulis, thinly sliced disks of silky pleasure in a sweet, tangy sauce.

MY mother made scallops like nobody else. Perfectly seared and turned in butter. Simple and divine. And she served them at her hugely popular, often impromptu, dinner parties. Watching her cook was what I imagined it was like to watch Jackson Pollock paint. She hurled salt and spices. Spun sugar like a sculptor. Emptied a bottle of rosemary onto a leg of lamb, massaged it with butter into the meat, and turned out a masterpiece. I surged with pride when the first guests arrived and remarked on the wonderful smells sailing out of the kitchen, to whose creation I alone had been witness.

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Personal Health: Doctors Hone Message on Kidney Disease

Posted: 22 Aug 2011 01:20 PM PDT

A patient with early-stage kidney disease provided a recent wake-up call for Dr. Joseph Vassalotti, a leading kidney specialist. After explaining the diagnosis in great detail, the doctor asked his patient to repeat what he had heard in his own words.

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With a rather bored look on his face, the man said, “Kidney disease, yada yada yada yada.”

Dr. Vassalotti, a nephrologist at Mount Sinai Medical Center in New York and chief medical officer of the National Kidney Foundation, was stunned. It was hardly the first time he had explained kidney disease to one of his patients, and he thought he knew how to help them recognize its seriousness and to motivate them to do what they could to forestall the day when their kidneys failed and dialysis or a transplant would be the only option for survival.

“I learned a lot from this patient,” Dr. Vassalotti told me. “Clearly my explanation was not pitched correctly to fit his level of understanding and his attitude toward his health."

Twenty-six million Americans have chronic kidney disease, which has a number of causes — most often diabetes and high blood pressure. As the kidneys begin to fail, the body’s waste products build up in the bloodstream, leading to anemia, nerve damage, heart disease and other ailments.

As with heart disease and diabetes, avoiding these complications depends heavily on how well patients care for themselves. But the disease is symptomless, at least in the early stages, and many patients fail to appreciate that they are gradually heading toward a precipice.

The medical profession has been trying harder in recent years to communicate better with patients, but clearly there are serious impediments. Doctors are grappling with shortage of time and lack of training on how best to get needed information and advice across in terms that patients can hear and understand.

Too often, doctors speak in medicalese, a foreign language to their patients. Or they may be reluctant to place all the cards on the table, concerned that patients may become so fearful they fail to hear important information. Unlike Dr. Vassalotti, some doctors never ask patients what they understood.

Medicare now reimburses for educating patients with relatively advanced kidney disease, but not for those in the early stages.

Many Careless Patients

Communication is a two-way street, however, and patients with chronic kidney disease also are contributing to its failure in several ways.

Many lack health literacy. Unable to understand even simplified medical terms, they may misinterpret what a doctor tells them or forget it entirely.

They may be too intimidated to ask questions or request a clarification. They may regard all medical matters to be the doctor’s purview. Or they may be fatalists who assume whatever will be, will be.

What kidney patients do, and don’t do, can make a huge difference in the quality and length of their lives. Whether they follow through on medical advice depends heavily on what they know about their disease and what can make matters better or worse, Dr. Vassalotti said in an interview.

In a study published in March in The American Journal of Kidney Disease, a research team at Vanderbilt University Medical Center in Nashville uncovered serious knowledge gaps among 401 patients with various stages of the disease.

The team, headed by Dr. Kerri L. Cavanaugh, a nephrologist, pointed out that within the general population, most people with kidney disease don’t know they have it. And among those who do know, a previous study of 676 patients with moderate to advanced kidney disease had found that more than a third knew little or nothing about it and nearly half knew nothing about treatment options should their kidneys fail completely.

Participants in the Vanderbilt study were being treated at the university’s nephrology clinic for chronic kidney disease. They ranged in age from 46 to 68; 53 percent were men, 83 percent were white and 94 percent had completed high school or higher. More than half had seen a nephrologist at least three times in the past year, and 17 percent had attended a kidney education session.

When asked whether they had chronic kidney disease, however, more than a third answered “no.” The 28-question survey revealed that only about one in five knew that protein in the urine was a sign of poor kidney function and that kidney disease often progresses without causing any symptoms.

Only two in five knew that controlling blood sugar is important in kidney disease, although more than 90 percent knew it is important to control blood pressure.

The usual lack of symptoms as kidney disease progresses is especially critical for patients to understand, because many fail to seek medical care or follow medical recommendations when they feel well.

Dr. Julie Anne Wright, an author of the Vanderbilt study, said that it “highlights the need for providers to ensure that communication is not only delivered but understood by all parties involved.”

What to Remember

Here is what everyone with chronic kidney disease and those at increased risk of developing it should know.

¶ There are four main risk factors for kidney disease: diabetes, high blood pressure, age over 60, and a family history of the disease. Anyone with these risk factors should have a test of kidney function at least once a year, Dr. Vassalotti said. Members of certain ethnic groups are also at higher than average risk: African-Americans, Hispanics, Pacific Islanders and Native Americans.

¶ Two simple, relatively inexpensive tests, easily done during a routine doctor visit, can detect declining kidney function: a blood test called eGFR (for estimated glomerular filtration rate, a measure of kidney function) and urine albumin, which shows whether the kidneys are spilling protein.

¶ Early detection can delay progression to kidney failure, when dialysis or transplant is the only option. Good control of blood sugar, blood pressure, cholesterol levels and body weight can delay the loss of kidney function. Not smoking and getting regular physical activity and sleep are also important.

¶ Certain drugs and dyes are toxic to the kidneys and should be avoided by people with kidney disease. The drugs include painkillers like acetaminophen, aspirin and ibuprofen; laxatives and antacids that contain magnesium and aluminum (Mylanta and Milk of Magnesia); ulcer drugs like Tagamet and Zantac; decongestants like Sudafed; enemas that contain phosphorus (Fleet); and Alka-Seltzer, which is high in salt. Contrast dyes used for certain tests, like angiograms and some M.R.I.’s, can also be harmful to kidney patients.

¶ When kidney disease progresses, patients can develop symptoms like changes in urination; swelling in the legs, ankles, feet, hands or face; fatigue; skin rashes and itching; a metallic taste in the mouth; nausea and vomiting; shortness of breath; feeling cold even when it is warm; dizziness and trouble concentrating; and back or leg pain. If any of these occur, they should be brought to a doctor’s attention without delay.

Essay: Pathogens May Change, but the Fear Is the Same

Posted: 15 Aug 2011 11:25 PM PDT

In “House on Fire: The Fight to Eradicate Smallpox,” Dr. William H. Foege, one of the conquerors of the virus, describes a grotesque moment in the war: The last victim in Benin, in West Africa, is visited by several “fetisheurs” — witch doctors — seeking to harvest his scabs.

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ERADICATED Red Cross workers in Brooklyn lined up for smallpox vaccinations in 1947. The disease finally disappeared because of changes in inoculation strategy.

For a fee, fetisheurs performed inoculations, a medical practice common in Africa for centuries. Into a small cut in the arm of a healthy person, they would rub in a victim’s powdered scabs. (The inoculee had about a 2 percent risk of dying, but a typical African epidemic was about 25 percent lethal.)

But when business was slow, fetisheurs would drum some up by starting outbreaks. Coating thorn branches with a paste of scabs and tucking them in doorways to scratch passers-by would do the trick.

One is reminded of a conspiracy theory that still haunts another fatal disease, AIDS: the notion that a top-secret cure exists but is kept suppressed by pharmaceutical companies because there is more profit in drugs taken for life.

To a doctor, all epidemics are objectively different. Viruses are not bacteria are not parasites. Transmission by sex is not transmission by sneeze or mosquito. But to the mortals they mow down, all epidemics are emotionally alike — an onslaught of fear, awe, repulsion, stigma, denial, rage and blame — and doctors would be foolish to forget that.

Three works circulating now — Dr. Foege’s book, Larry Kramer’s autobiographical play “The Normal Heart” and a movie, “Life, Above All,” set in South Africa — remind us how fragile life looks when the miasma is still swirling around our nostrils.

That is, before our fear ebbs and we tumble back into indifference, as we have about swine flu, SARS and even AIDS.

One of the first things we forget is epidemics’ power to alter history.

Many Americans know AIDS killed Rock Hudson, Arthur Ashe, Freddie Mercury and Rudolf Nureyev. Sad deaths, but not earth-shaking.

Most probably do not know that, as he delivered his Gettysburg Address in 1863, Abraham Lincoln was just coming down with smallpox, which in the next week nearly killed him in midwar.

Or that George Washington’s most important tactical decision may have been to inoculate his army in 1777, knowing his British foes, already protected, might prevail if an epidemic in Boston kept spreading. Two years earlier, American troops weakened by the pox had lost the Battle of Quebec.

The autobiographical work by Dr. Foege, a former director of the Centers for Disease Control and Prevention and now an adviser to the Bill and Melinda Gates Foundation, describes the last days of the only human disease ever eradicated.

The others are about AIDS, first detected in 1981, the year after smallpox died. It has now killed more than 30 million people, and the toll grows yearly — except in the minds of average middle-class heterosexual white Americans, a group that has lost its fear of the disease, according to a recent survey by the Kaiser Family Foundation.

A revival of “The Normal Heart,” by Mr. Kramer, an early AIDS activist, is now on a national tour. It opens in Greenwich Village in 1981, as it dawns on a few American doctors that something mysterious and terrible is afoot. The play is really a vehicle for Mr. Kramer’s anger, a series of tirades by his stand-in, whose message is that gay men should stop defining their struggle for equal rights chiefly as the right to have promiscuous sex. It makes him unpopular, but as medical advice it is sound: Avoid vectors of fatal illnesses, no matter how cute they are.

“Life, Above All,” by contrast, is set in rural South Africa in 2010. It opens with a 12-year-old girl meeting an older man. Once you realize he is kindly, you are horrified to grasp why she is there: Her mother, paralyzed by grief, has sent her to buy a coffin for her baby sister.

The word “AIDS” is almost never said aloud in the film. Instead there are sidelong accusations, the bluntest being the baby’s drunken father snarling at his wife, “You poisoned her with your milk.”

Like “The Normal Heart,” it exploits the shock value of symptoms American doctors rarely see anymore: the purple blooms of Kaposi’s sarcoma, the white foam of oral thrush, the meningitis stare.

Everyone dies miserably, pushed down holes or abandoned under trees. One scene recalls an event I covered in 1998: the death of Gugu Dlamini, a South African woman beaten to death by her neighbors for admitting on a Zulu radio station on World AIDS Day that she was infected.

However, unlike Mr. Kramer’s play, it takes place in a time when AIDS tests and antiretroviral drugs are available, even in the small town where it is set. People ought to be embracing hope, but stigma and fatalism force them to die rather than get tested.

Personal Best: Perks of Cross-Training May End Before Finish Line

Posted: 15 Aug 2011 08:46 PM PDT

The question has occurred to many endurance athletes, and it seems so basic: Will cross-training — doing a second sport, or lifting weights on days when you aren’t running or cycling or swimming — improve your performance in your primary sport?

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And at first glance, the answer might seem to be an obvious no. If you want to be a better runner, you have to run — regularly, consistently, and with a training plan that forces you to gradually increase your distance and speed. If you want to be a better cyclist, you have to ride and train according to the same principles. Same goes for swimming or any other endurance sport.

But there also is a body of opinion that says cross-training is necessary and important if you want to improve your performance and avoid injury.

The science, though, is not nearly so definitive. And the answer as to what, if anything, cross-training can accomplish depends on your goal.

The American Orthopedic Society for Sports Medicine encourages cross-training, saying that it can provide a “ ‘total body tune-up,’ something you won’t get if you concentrate on just one type of activity,” and that “you may experience fewer overuse injuries.”

The American College of Sports Medicine’s guidelines for most Americans advise doing some of everything: exercises that increase your heart rate, weight lifting, stretching and balance exercises.

But the purpose of its recommendations is overall health, not performance. If that is your goal, researchers say, it is not so clear that cross-training in an alternate sport will help.

Hirofumi Tanaka, an exercise physiologist at the University of Texas in Austin, came to that conclusion more than a decade ago in a review of published papers. Studies comparing athletes, both trained and untrained, had found that only one factor mattered if performance was the goal: training in that sport.

Since then, he said, there have been numerous small studies, asking the same question and coming to the same conclusion. For example, two subsequent recent studies — one involving moderately fit runners and the other trained runners — found that adding cycling to a running program did not improve running performance.

The results make sense, Dr. Tanaka said. Each sport uses highly specific muscles and nerves. Using an elliptical cross-trainer may feel as if it is exercising your running muscles, but it is not giving you the same kind of training that running does. Nor does it train the muscles you need for cycling.

“You can maintain your cardiovascular capacity by cross-training, but it is extremely difficult to maintain your performance when you rely on cross-training,” Dr. Tanaka said. “This is because you are violating the principle of the specificity of training.”

Anyone who has been injured and forced to do an alternate sport knows this already. If you cannot run and end up substituting workouts on a bicycle for running, almost invariably you will end up losing running speed and endurance.

But if an alternate sport doesn’t help endurance athletes, resistance training might. It’s a bit counterintuitive — if you are training for an endurance sport like running, your workouts increase your ability to perform the same motion over and over again but do not markedly increase your muscle strength.

Lifting weights is just the opposite — you do a few repetitions with the goal of increasing muscle strength and size. Yet in a review of published studies, Dr. Tanaka found that resistance training improved endurance in running and cycling. The effect occurred both in experienced athletes and in novices.

A more recent study of experienced runners by a group of Norwegian researchers confirmed that weight lifting could increase performance. One group did half squats with heavy weights three times a week while continuing a running program. The other group just ran. Those who did the squats improved their running efficiency and improved the length of time they could run before exhaustion set in.

Similar studies also have found the effect in cyclists, but not in swimmers, Dr. Tanaka said. Swimmers do get faster, however, when they try a very specific type of resistance training, done while in the water, that concentrates on the movements they use in their strokes.

It is not known why weight lifting would improve performance, but investigators speculate that it may train supporting muscle fibers in the legs, allowing runners or cyclists to use them to augment muscles that get tired.

In swimmers, the investigators say, the research suggests that mastery of the highly technical swimming stroke is the most important factor in performance and endurance. Upper-body strength plays at best a minor role.

But even when cross-training doesn’t improve performance, might it prevent injuries? It’s a difficult question to answer, because it is not easy to do the necessary studies.

Dr. Willem van Mechelen, head of public and occupational health at VU University Medical Center in Amsterdam, looked at data on injuries in runners and tried to tease out the factors that were linked to them. And he concluded that the only way to prevent running injuries is not to run.

The harder you run and the longer your running distances, the more likely you are to get injured. And, he wrote, among the factors “significantly not associated with running injuries” is “participation in other sports.”

Unless cross-training means you simply do less of your primary sport, then, don’t expect it to protect you from injuries.

U.S. Rejects Mayor’s Plan to Ban Use of Food Stamps to Buy Soda

Posted: 19 Aug 2011 10:20 PM PDT

Federal officials on Friday rejected Mayor Michael R. Bloomberg’s proposal to bar New York City’s food stamp users from buying soda and other sugary drinks with them.

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The decision derailed one of the mayor’s big ideas to fight obesity and poor nutrition in the city. Mr. Bloomberg and the city’s health commissioner, Dr. Thomas A. Farley, were quick to criticize the ruling by the United States Department of Agriculture as a disservice to low-income residents.

Dr. Farley, who said he was “very upset” by the decision, said that it “ really calls into question how serious the U.S.D.A. is about addressing the nation’s most serious nutritional problem.”

In October, city and state officials proposed a two-year experiment to see if the prohibition would reduce obesity among people who buy their groceries with food stamps. Dr. Farley said that about 57 percent of adults in the city and 40 percent of the children in its public schools were overweight or obese, and that obesity was especially rampant in low-income neighborhoods. Limiting consumption of sodas and other drinks with high sugar content, he argued, could help reverse that trend.

But in a letter to a New York State official, an administrator of the food stamp program in Washington said the city’s proposed experiment would have been “too large and complex” to implement and evaluate.

Jessica Shahin, an associate administrator in the Agriculture Department, wrote that the waiver the city sought was denied because of the logistical difficulty of sorting out which beverages could or could not be purchased with food stamps and because it would be hard to gauge how effective the step was in reducing obesity. As an alternative, Ms. Shahin suggested the federal government could work with the city on other efforts to encourage consumers to make “healthy choices.”

Tom Vilsack, the secretary of agriculture, said in a statement that the department “has a longstanding tradition of supporting and promoting incentive-based solutions that are better-suited for the working families, elderly and other low-income individuals” who rely on food stamps than restrictions are. “We are confident that we can solve the problem of obesity and promote good nutrition and health for all Americans and stand ready to work with New York City to achieve these goals.”

The city’s proposal was part of Mr. Bloomberg’s campaign to make the city a healthier place, which has included banning smoking indoors and in public parks, barring restaurants from cooking with trans fats and requiring them to inform customers about calorie counts. The mayor was not pleased with the rejection.

“We think our innovative pilot would have done more to protect people from the crippling effects of preventable illnesses like diabetes and obesity than anything else being proposed elsewhere in this country — and at little or no cost to taxpayers,” Mr. Bloomberg said in a statement. “We’re disappointed that the federal government didn’t agree, and sorry that families and children may suffer from their unwillingness to explore our proposal. New York City will continue to pursue new and unconventional ways to combat the health problems that hurt New Yorkers and Americans from coast to coast.”

The decision was a victory for the soft-drink industry, which had lobbied against the proposal, and for advocates for the poor and underfed, who had argued that the government should not stigmatize them by taking away their right to shop like other consumers. The food-selling industry also contended that it would be too complicated for stores to have to program their registers differently in the city than elsewhere.

“It was a big deal not to start breaking up the programs,” said Jennifer Hatcher, senior vice president for government relations at the Food Marketing Institute in Washington.

The disappointment of Mr. Bloomberg and Dr. Farley was matched by the thrill in the voice of Joel Berg, the executive director of the New York City Coalition Against Hunger, who cheered the federal government for “deciding not to micromanage” the lives of poor people.

“The whole attempt was misguided and unworkable,” Mr. Berg said. “This proposal was based on the false assumption that poor people were somehow ignorant or culturally deficient.”

The decision was the second in seven years in which the Agriculture Department rejected such a proposed ban. In 2004, it denied a request by officials in Minnesota to prevent food stamp recipients from buying junk food.

The Agriculture Department questioned the merits of that plan, which focused on candy and soda, among other foods, and said it would “perpetuate the myth” that food stamp users made poor shopping decisions.

Mr. Berg and other advocates for the poor and underfed said that New York City’s proposal would have had a similar effect. Instead of restricting the dietary choices of low-income residents, he said, city officials should reconsider how to increase the purchasing power of low-income residents so that they can buy food that is more nutritious.

“If healthier food is made affordable and accessible,” he said, “low-income people will line up to get it.”

Medicaid Pays Less Than Medicare for Many Prescription Drugs, U.S. Report Finds

Posted: 15 Aug 2011 10:10 PM PDT

WASHINGTON — Medicaid gets much deeper discounts on many prescription drugs than Medicare, in part because Medicaid discounts are set by law whereas Medicare prices are negotiated by private insurers and drug companies, federal investigators said Monday in a new report.

The report, from the inspector general of the Department of Health and Human Services, could be used by lawmakers trying to cut drug prices as Congress looks for ways to rein in the cost of Medicare under the new deficit-reduction law.

Under existing law, the Congressional Budget Office estimates that the cost of Medicare’s outpatient drug benefit will increase an average of nearly 10 percent a year, to $175 billion in 2021, from $68 billion this year.

Medicaid and Medicare receive discounts in the form of rebates, which are paid by drug manufacturers when their products are dispensed to people enrolled in the programs.

The inspector general, Daniel R. Levinson, found that rebates reduced spending on 100 widely used brand name drugs by 19 percent in Medicare and by 45 percent in Medicaid. After taking account of the rebates, Mr. Levinson said, Medicaid paid significantly less than Medicare for the same drugs.

Federal law specifies how the discount, or rebate, is calculated under Medicaid, the program for low-income people. The minimum rebate for a brand-name drug was increased last year to 23 percent of the average price that manufacturers receive for sales of the product to retail pharmacies.

Drug companies must pay additional rebates to Medicaid if a drug’s price rises faster than general inflation, measured by the Consumer Price Index. The inspector general said these added rebates accounted for slightly more than half of all rebates paid to Medicaid on the top 100 drugs. Prices for many of these drugs have been rising at a brisk pace.

“The inflation-based additional rebate is the primary reason Medicaid rebates are substantially higher” than Medicare rebates, Mr. Levinson said.

“Manufacturers for virtually all brand name drugs under review paid inflation-based rebates” to Medicaid because their prices rose faster than inflation, the report said.

For 68 of the 100 brand-name drugs examined in the study, the Medicaid rebate was at least twice as large as the rebate paid to Medicare.

About 30 million older Americans and people with disabilities receive drug coverage through Part D of Medicare. More than 50 million low-income people have drug coverage through Medicaid.

When Congress added a prescription drug benefit to Medicare in 2003, it prohibited the government from negotiating drug prices on behalf of Medicare beneficiaries and stipulated that outpatient drug coverage should be provided entirely through private insurers like UnitedHealth and Humana, under contract with Medicare.

Insurers have aggressively negotiated with pharmaceutical companies, so Medicare’s prescription drug program has cost the government less than originally predicted. But the private insurers have not obtained discounts or rebates as large as those secured by Medicaid, the inspector general said.

The study comparing Medicare and Medicaid was required by the new health care law.

Drug companies oppose the type of discounts required by Medicaid, seeing them as government price controls. Drug makers say they prefer Medicare’s market-oriented approach, in which discounts are negotiated by drug plans and manufacturers.

Two Democrats, Representative Henry A. Waxman of California and Senator John D. Rockefeller IV of West Virginia, recently introduced bills that would require drug manufacturers to pay the higher Medicaid rebates for drugs provided to Medicare beneficiaries who are also eligible for Medicaid. President Obama’s deficit-reduction commission has endorsed the proposal, saying it could save $49 billion over 10 years.

The Texas Tribune: Center Typifies New Face of Pregnancy Services

Posted: 15 Aug 2011 09:06 AM PDT

Nearly 180,000 Texas women and men are likely to lose access to birth control and preventative examinations next month because the Legislature recently slashed financing for family planning services by two-thirds.

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But socially conservative lawmakers succeeded in their efforts to increase money for a small state program, Alternatives to Abortion Services, more ideologically aligned with their politics. Lawmakers added $300,000 to the program’s budget for each of the coming two fiscal years, bringing it to $8.3 million for 2012 and for 2013.

The Texas Health and Human Services Commission allocates money from Alternatives to Abortion Services via the Texas Pregnancy Care Network, a nonprofit agency. Formed in 2006, the network oversees 47 providers, including 26 pregnancy centers (out of more than 100 in the state), social services, adoption agencies and maternity homes, and says that more than 1,500 women seek its services each month. One of those crisis pregnancy resource centers, Austin LifeCare, several miles north of the Capitol, has offered free services to pregnant women for 27 years, including counseling, diapers, clothing and classes like parenting and personal finance. Obstetricians and nurses donate their time to offer ultrasounds and pregnancy tests, the only medical services performed on the premises.

Austin LifeCare’s executive director, Pam Cobern, said it was supported by more than 40 churches and received about 3 percent of its budget, or $45,000, from the state.

Austin LifeCare is still learning to operate under the network’s guidelines, which say that “misleading a woman in crisis pregnancy about the scope of available services is neither compassionate or caring.” The state reviews phone protocols and advertisements. Graphic images are not allowed to be shown. Nonspiritual counseling must be offered. Ms. Cobern said women who come to Austin LifeCare were told that they had three options: parenting, adoption or abortion. However, she said, the center’s policy is to refer women to community health clinics that are not affiliated with Planned Parenthood or other abortion providers.

Asked about the huge cut in family planning money while anti-abortion organizations received an increase, Ms. Cobern said: “There’s certainly a need for family planning. I’m not sure that organizations that have political agendas should be providing them.”

State Representative Sid Miller, Republican of Stephenville, agrees. He voted with other lawmakers to cut financing for family planning for the next two years to $37.9 million from $111.5 million, calling it a “direct attack” on Planned Parenthood, which has been the second-largest recipient of such money. Planned Parenthood has legally separated its nonabortion health clinics so it can receive state aid. No taxpayer money is used to finance abortions.

“I think we’re trying to shut down abortions in Texas, and doing that through cutting off the purse strings,” Mr. Miller said.

The interim chief executive of Planned Parenthood of the Texas Capital Region, Sarah Wheat, noted that her agency’s offerings went well beyond abortion and included such medical services as prenatal care, access to birth control, Pap smears and screenings for sexually transmitted diseases, diabetes and cervical and breast cancer.

“This is basic women’s health care that has been funded for generations,” Ms. Wheat said, “and one of the reasons it’s been funded is because it works.”

ttan@texastribune.org

Fritz Bach, Who Aided Transplant Survival, Dies at 77

Posted: 18 Aug 2011 11:01 PM PDT

Dr. Fritz H. Bach, a physician and medical researcher who helped develop techniques to improve people’s chances of surviving organ and bone marrow transplants, died Sunday at his home in Manchester-by-the-Sea, Mass. He was 77.

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Dr. Fritz H. Bach

The cause was cardiac arrest, his son Peter said.

In a transplant, a major worry is that the body will reject the new organ. So the goal is to find as compatible a donor as possible. A kidney transplant between identical twins in 1954 had proved to work, but most people needing transplants do not have twins.

Dr. Bach’s seminal contribution was to develop a process for systematically mixing cells from the patient with cells from potential donors until a donor is found whose cells do not react adversely with those of the patient. The technique provides a measure of how compatible the tissues from the two bodies are likely to be. The more likely, the less the possibility of rejection.

In the 1960s, Dr. Bach applied his approach to bone marrow, which contains the stem cells that produce the body’s blood cells.

In the 1950s, scientists had succeeded in transplanting bone marrow into people whose own marrow had been ravaged by nuclear radiation or cancer-killing chemicals. By the late 1960s, doctors were beginning to try transplants on different kinds of patients. Dr. Bach’s techniques made it possible to determine in advance that antibodies from the donor and the patient would not fight to the death.

His primary procedure was used twice in 1968. The first use was when Dr. Robert A. Good, considered the father of immunology, saved the life of a 5-month-old boy who had been born with a bone marrow defect. Then Dr. Bach led a team that operated on a 2-year-old boy who bled constantly and suffered repeated infections. In both cases, bone marrow from a sister was used for the transplant.

In 1975, Dr. Bach announced a way to speed up his process of analysis to hours, rather than days. That made it applicable to transplants of cadaver kidneys, which must be used within 48 hours. Adding to the efficiency of his technique, he described how infection-fighting white blood cells could be classified and frozen for use in screening many potential donors. His work on the compatibility of donors paved the way for experiments that led to the identification of the Major Histocompatibility Complex, a large gene family whose molecules play an important role in the immune system.

Fritz Heinz Bach was born into a Jewish family in Vienna on April 5, 1934. After Nazis and their sympathizers attacked Jews in planned riots called Kristallnacht, or Night of broken glass, in November 1938, Fritz and his older brother fled to England. They were among nearly 10,000 mainly Jewish children rescued by the British and put in the care of British families. They later reunited with their family in Bath, England. An American soldier sponsored their emigration to the United States, and they settled in Burlington, Vt.

Dr. Bach graduated from Harvard in 1955 with a degree in physical science. He studied medicine at Washington University in St. Louis and Harvard Medical School, from which he received an M.D. in 1960. He taught and did research at the University of Wisconsin, the University of Minnesota and the Columbia and Harvard medical schools. He published more than 800 scientific papers.

Dr. Bach was married twice, to Marilyn Lee Brenner and Jeanne Elizabeth Gose. Survivors include his six children, David, Peter, Wendy, Kathryn, Erika and Dana, all of whom have his last name; and four grandchildren.

In recent years, Dr. Bach was concerned with transplanting pig organs to humans as a way to alleviate a persistent shortage in organs to transplant. He worried that swine tissue could unleash new diseases in humans, and did scientific research on ways to stop this. He advised proceeding, but methodically, and involving the public — not just experts — in making decisions about literally mixing species.

Dr. Bach’s many awards included the Peter Medawar Award of the Transplantation Society. His life came full circle in 2004 when the University of Vienna, where he had started a laboratory and was training young scientists, gave him an honorary doctorate.

In recent years he found evidence that carbon monoxide, inhaled at very low concentrations, could help damaged arteries. He was also working to find ways for people to tolerate transplants without having to take medication for the rest of their lives.

He treasured a photo taken of him early in his career, in which he is shown delivering a lecture on a new genetic hypothesis he had constructed. It turned out to be completely wrong.

Cancer’s Secrets Come Into Sharper Focus

Posted: 16 Aug 2011 09:30 AM PDT

For the last decade cancer research has been guided by a common vision of how a single cell, outcompeting its neighbors, evolves into a malignant tumor.

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This week: A disease with a mind of its own, looking for the oldest forms of life on Earth, and is it a boy or a girl?

Bryce Vickmark for The New York Times

NETHERWORLD Elinor Ng Eaton cloned DNA at the Whitehead Institute in Cambridge, Mass. Researchers are finding clues that pseudogenes lurking within "junk" DNA might play a role in cancer.

Through a series of random mutations, genes that encourage cellular division are pushed into overdrive, while genes that normally send growth-restraining signals are taken offline.

With the accelerator floored and the brake lines cut, the cell and its progeny are free to rapidly multiply. More mutations accumulate, allowing the cancer cells to elude other safeguards and to invade neighboring tissue and metastasize.

These basic principles — laid out 11 years ago in a landmark paper, “The Hallmarks of Cancer,” by Douglas Hanahan and Robert A. Weinberg, and revisited in a follow-up article this year — still serve as the reigning paradigm, a kind of Big Bang theory for the field.

But recent discoveries have been complicating the picture with tangles of new detail. Cancer appears to be even more willful and calculating than previously imagined.

Most DNA, for example, was long considered junk — a netherworld of detritus that had no important role in cancer or anything else. Only about 2 percent of the human genome carries the code for making enzymes and other proteins, the cogs and scaffolding of the machinery that a cancer cell turns to its own devices.

These days “junk” DNA is referred to more respectfully as “noncoding” DNA, and researchers are finding clues that “pseudogenes” lurking within this dark region may play a role in cancer.

“We’ve been obsessively focusing our attention on 2 percent of the genome,” said Dr. Pier Paolo Pandolfi, a professor of medicine and pathology at Harvard Medical School. This spring, at the annual meeting of the American Association for Cancer Research in Orlando, Fla., he described a new “biological dimension” in which signals coming from both regions of the genome participate in the delicate balance between normal cellular behavior and malignancy.

As they look beyond the genome, cancer researchers are also awakening to the fact that some 90 percent of the protein-encoding cells in our body are microbes. We evolved with them in a symbiotic relationship, which raises the question of just who is occupying whom.

“We are massively outnumbered,” said Jeremy K. Nicholson, chairman of biological chemistry and head of the department of surgery and cancer at Imperial College London. Altogether, he said, 99 percent of the functional genes in the body are microbial.

In Orlando, he and other researchers described how genes in this microbiome — exchanging messages with genes inside human cells — may be involved with cancers of the colon, stomach, esophagus and other organs.

These shifts in perspective, occurring throughout cellular biology, can seem as dizzying as what happened in cosmology with the discovery that dark matter and dark energy make up most of the universe: Background suddenly becomes foreground and issues once thought settled are up in the air. In cosmology the Big Bang theory emerged from the confusion in a stronger but more convoluted form. The same may be happening with the science of cancer.

Exotic Players

According to the central dogma of molecular biology, information encoded in the DNA of the genome is copied by messenger RNA and then carried to subcellular structures called ribosomes, where the instructions are used to assemble proteins. Lurking behind the scenes, snippets called microRNAs once seemed like little more than molecular noise. But they have been appearing with increasing prominence in theories about cancer.

By binding to a gene’s messenger RNA, microRNA can prevent the instructions from reaching their target — essentially silencing the gene — and may also modulate the signal in other ways. One presentation after another at the Orlando meeting explored how microRNAs are involved in the fine-tuning that distinguishes a healthy cell from a malignant one.

Ratcheting the complexity a notch higher, Dr. Pandolfi, the Harvard Medical School researcher, laid out an elaborate theory involving microRNAs and pseudogenes. For every pseudogene there is a regular, protein-encoding gene. (Both are believed to be derived from a common ancestral gene, the pseudogene shunted aside in the evolutionary past when it became dysfunctional.) While normal genes express their will by sending signals of messenger RNA, the damaged pseudogenes either are mute or speak in gibberish.

Vital Signs: Regimens: Soothing Melodies for Cancer Patients

Posted: 15 Aug 2011 11:26 PM PDT

Listening to music may reduce anxiety and pain in cancer patients, new research suggests.

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Researchers at Drexel University pooled data from randomized trials of both music medicine, in which recordings simply are played for patients, and music therapy, in which trained therapists use music to assess and treat patients. In all, they looked at 30 studies with a total of 1,891 participants. The study was published in the August issue of The Cochrane Reviews.

There was not enough data to determine whether music medicine or music therapy was more effective, but the researchers did find that either technique can reduce anxiety and pain, and improve mood and quality of life, in people with cancer.

Listening to music also was linked to some beneficial physiological changes, including small reductions in heart rate, respiratory rate and blood pressure. The number of trials that tested music’s effect on distress, body image and immunological function was too small to draw any conclusions, the researchers concluded.

Five small trials tested the effect of music on depression, and none found it useful.

The authors caution that the quality of the evidence is not high, largely because it is difficult or impossible to conduct strictly controlled trials of music therapy.

“Music is something we use every day,” said Joke Bradt, the lead author and an associate professor of creative arts therapies at Drexel, “and its powers can be used in a very targeted way with cancer patients.”

Vital Statistics: Watch Your Step While Washing Up

Posted: 15 Aug 2011 09:20 PM PDT

The smallest room in the house can be a dangerous place.

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According to the Centers for Disease Control and Prevention, every year about 235,000 people over age 15 visit emergency rooms because of injuries suffered in the bathroom, and almost 14 percent are hospitalized.

More than a third of the injuries happen while bathing or showering. More than 14 percent occur while using the toilet.

Injuries increase with age, peaking after 85, the researchers found. But injuries around the tub or shower are proportionately most common among those ages 15 to 24 and least common among those over 85. People over 85 suffer more than half of their injuries near the toilet.

Fainting is not a common cause of injury, but it occurred most often in the 15-to-24 age group. Alcohol use may be a factor, the researchers suggested, but there is no data to prove it.

The bathroom injury rate for women was 72 percent higher than for men, the analysis found. Studies have shown that women are at higher risk than men for injuries in falls, and the authors speculate that the disparity might also be attributed to differences in physical activity, lower-body strength, bone mass or even more willingness to seek treatment.

The most hazardous activities for all ages are bathing, showering and getting out of the tub or shower. (Only 2.2 percent of injuries occur while getting into the tub or shower, but 9.8 percent occur while getting out.) Injuries in or near the bathtub or shower account for more than two-thirds of emergency room visits.

“Injuries getting on and off the toilet are quite high in people 65 and older,” said Judy A. Stevens, an epidemiologist with the C.D.C. and the lead author of the report. “Having grab bars by the toilet would be helpful for people in their older years, and everyone would benefit from having grab bars both inside the tub or shower and where you get in and out.”

The analysis appeared in the June 10 issue of the Morbidity and Mortality Weekly Report. NICHOLAS BAKALAR

Recipes for Health: Cumin-Scented Summer Squash Salad

Posted: 18 Aug 2011 12:40 AM PDT

The summer squash is lightly steamed in this North African salad.

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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1 pound zucchini or other summer squash, thinly sliced or cut in 1/2-inch dice

3 tablespoons freshly squeezed lemon juice

1 garlic clove, minced or puréed

3/4 to 1 teaspoon cumin seeds, lightly toasted and ground

Salt and freshly ground pepper

1/4 cup extra virgin olive oil

2 tablespoons chopped cilantro

1. Steam the squash for three to five minutes until just tender. Remove from the heat.

2. Mix together the lemon juice, garlic, cumin, salt, pepper and olive oil. Toss with the squash. You can serve this warm, in which case add the cilantro and serve. Alternately, refrigerate until shortly before serving. Toss with the cilantro and serve.

Yield: Serves four.

Advance preparation: This will keep for a day or two in the refrigerator, but the colors and flavors will be less vivid.

Nutritional information per serving: 144 calories; 2 grams saturated fat; 2 grams polyunsaturated fat; 10 grams monounsaturated fat; 0 milligrams cholesterol; 5 grams carbohydrates; 1 gram dietary fiber; 10 milligrams sodium (does not include salt to taste), 2 grams protein

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

Recipes for Health: Marinated Zucchini Salad

Posted: 17 Aug 2011 12:10 AM PDT

Raw zucchini can be a dull ingredient, but when it’s very thinly sliced it marinates beautifully, especially in lemon juice. I like to use a mixture of green and yellow squash here. Assemble this dish at least four hours before you wish to serve it, so that the squash has time to soften and soak up the lemony marinade.

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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1 pound medium or small zucchini, preferably a mix of green and yellow

Salt to taste

3 tablespoons freshly squeezed lemon juice

1 garlic clove, crushed

3 tablespoons extra virgin olive oil

2 tablespoons finely chopped parsley, mint, chives, dill or a combination

1. Slice the squash as thinly as you can. Sprinkle with salt, preferably kosher salt, and let sit for 15 to 30 minutes. Rinse and drain on paper towels.

2. Mix together the lemon juice, garlic and olive oil. Toss with the zucchini. Season with salt and pepper. Cover and refrigerate for four to six hours.

3. Remove from the refrigerator, and remove the garlic clove. Add the fresh herbs, and toss together. Taste, adjust seasoning and serve.

Yield: Serves four.

Advance preparation: This dish will keep for a day or two, but it is best served just after the herbs are added. The lemony zucchini will lose its flavor over time.

Nutritional information per serving: 113 calories; 2 grams saturated fat; 1 gram polyunsaturated fat; 7 grams monounsaturated fat; 0 milligrams cholesterol; 5 grams carbohydrates; 1 gram dietary fiber; 11 milligrams sodium (does not include salt to taste), 2 grams protein

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

Recipes for Health: Shells With Summer Squash, Corn, Beans and Tomato

Posted: 16 Aug 2011 11:42 AM PDT

You can use canned beans for this dish, but if you happen to have cooked pintos or borlottis in broth, use the broth for the pasta sauce.

Recipes for Health

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

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2 tablespoons extra virgin olive oil

1/2 pound summer squash, diced (1/2 to 3/4 inch)

Salt to taste

2 garlic cloves, minced

1 pound tomatoes, grated on the large holes of a box grater, or peeled, seeded and diced

Pinch of sugar

Kernels from 1 ear sweet corn

1 1/2 cups cooked pintos or borlotti beans, with 3/4 to 1 cup of their broth or, if using canned beans, 1/2 to 3/4 cup water

2 tablespoons slivered basil leaves

Freshly ground pepper

3/4 pound medium pasta shells

1 to 2 ounces Parmesan or pecorino Romano, grated (optional)

1. Begin heating a large pot of water for the pasta.

2. Meanwhile, heat the olive oil over medium-high heat in a wide, heavy skillet. Add the summer squash. Cook, stirring, until the squash begins to color, three to five minutes. Season with salt, and add the garlic. Stir until fragrant, just a few seconds, and add the tomatoes and a pinch of sugar. Cook, stirring often, until the tomatoes have cooked down and smell fragrant, five to eight minutes. Stir in the corn, beans and bean broth or water, and season to taste with salt and pepper. Turn the heat to medium-low, and simmer for five minutes. Stir in the basil, and keep warm.

3. When the water comes to a boil, salt generously and add the pasta. Boil, following the timing directions on the package but checking a minute before the indicated time. When the pasta is cooked al dente, remove 1/2 cup of the cooking water, then drain the pasta and toss with the vegetables and beans. If the vegetable and bean mixture seems dry, moisten with pasta water to taste. Add the cheese, toss again and serve.

Yield: Serves four.

Advance preparation: You can make this recipe through Step 2 several hours before you cook the pasta, but don’t add the basil. Add it when you toss the mixture with the pasta.

Nutritional information per serving: 521 calories; 1 gram saturated fat; 2 gram polyunsaturated fat; 5 grams monounsaturated fat; 0 milligrams cholesterol; 92 grams carbohydrates; 11 gram dietary fiber; 17 milligrams sodium (does not include salt to taste), 20 grams protein

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

Recipes for Health: Summer Squash, With a Lighter Touch

Posted: 16 Aug 2011 11:10 AM PDT

Recently, I asked for recipe requests on the Recipes for Health Facebook page. There were many for squash, and no surprise: In August, home-delivered produce baskets are filled with pattypans, green and yellow zucchini, yellow crookneck squash and sturdy ronds de Nice.

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.

They don’t have to be made into cheesy gratins, of course. With the exception of one pasta that you could serve with grated cheese or not, this week I focused on light starter and side dishes that require no dairy.

Spicy Grilled Zucchini

This mildly spicy dish from southern Italy can serve as an appetizer or side. Cut the zucchini on the diagonal into long, thin slices, or cut it lengthwise.

1 pound zucchini, cut on the diagonal or lengthwise in thin slices

2 tablespoons extra virgin olive oil, as needed

Salt and freshly ground pepper

1/2 teaspoon red pepper flakes (more to taste)

1 tablespoon slivered fresh mint or basil

1 lemon, cut in half

1. Prepare a medium-hot grill. Season the zucchini with salt and pepper, and toss with the olive oil. Grill on each side until the slices are tender and there are light marks on the sides. Transfer to a platter, and sprinkle with the red pepper flaks and the herbs. Douse with lemon juice if desired, and serve.

Yield: Serves four.

Advance preparation: You can serve this at room temperature. It will hold for an hour or two. Don’t douse with lemon juice or sprinkle on the herbs until just before serving.

Nutritional information per serving: 81 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 0 milligrams cholesterol; 4 grams carbohydrates; 1 gram dietary fiber; 10 milligrams sodium (does not include salt to taste), 1 gram protein

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

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