Health - As Victims, Men Struggle for Rape Awareness

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• As Victims, Men Struggle for Rape Awareness
• Stem Cell Study May Show Advance
• Global Update: Abortion: Worldwide Rate Stopped Falling After 2003; Researchers Cite Scarcity of Contraception
• Disgust’s Evolutionary Role Is Irresistible to Researchers
• Vital Signs: Study Finds No Childhood Obesity Link to School Junk Food
• Vital Signs: Use of 3 or More In Vitro Embryos Is Too Risky, Study Concludes
• Vital Signs: Accident Risk Seen for Pedestrians Wearing Headphones
• China Reports 2nd Bird Flu Death in Month
• Chefs, Butlers and Marble Baths - Not Your Average Hospital Room
• Recipes for Health: Lunches to Take to Work — Recipes for Health
• Bird Flu Scientists Agree to Pause H5N1 Research
• As Specialists Debate Autism, Some Parents Watch Closely
• Administration Rules Insurers Must Cover Contraceptives
• A Nurse Need Never Forget
• A Bridge to Recovery on Campus
• New Definition of Autism May Exclude Many, Study Suggests
• Johnson & Johnson Settles Risperdal Claim in Texas
• Osteoporosis Is So Slow, Bone Density Retests Can Wait, Study Says
• Well: Helping Injured Dogs Walk Again
• A French Film Takes Issue With the Psychoanalytic Approach to Autism
• Afghanistan Polio Cases Rise After Years of Decline
• Paula Deen Says She Has Type 2 Diabetes
• Well: Obesity Rates Stall, But No Decline
• Well Blog: Gross! Yuck! Harnessing the Power of Disgust
• Well Blog: Omelet Recipes for Health
• Well Blog: Looking Inside the Twinkie
• Well Blog: Boosting Mental Fitness in Middle Age
• Well Blog: Doctor and Patient: Why Doctors Can't Predict Life Expectancy
• The New Old Age: The Alzheimer's Reading Room
• The New Old Age Blog: The Caregivers' Bookshelf: An Alzheimer's Classic
• The New Old Age Blog: Older Women and Bone Tests
• The New Old Age Blog: Ask the Elder Law Attorney: Disclosures and Loans
• Really?: The Claim: Excess Weight Raises the Risk of Acne
• Personal Health: Lifelines for People With Hearing Loss
• News Analysis: Hard Truths About Disclosure
• Opinionator: What We Give Up for Health Care
• Letters: Brain Trauma Lingers (1 Letter)
• Letters: When the Heart Hurts (1 Letter)
• Letters: Life After Bad Choices (1 Letter)
• Teenagers Sharing Passwords as Show of Affection

As Victims, Men Struggle for Rape Awareness Posted: 23 Jan 2012 12:25 PM PST Keith Smith was 14 when he was raped by a driver who picked him up after a hockey team meeting. He had hitchhiked home, which is why, for decades, he continued to blame himself for the assault. Enlarge This Image Michael Nagle for The New York Times NIGHTMARES Keith Smith "was waking up screaming" for years after his rape, he said. When the driver barreled past Hartley’s Pork Pies on the outskirts of Providence, R.I., where Mr. Smith had asked to be dropped off, and then past a firehouse, he knew something was wrong. “I tried to open the car door, but he had rigged the lock,” said Mr. Smith, of East Windsor, N.J., now 52. Still, he said, “I had no idea it was going to be a sexual assault.” Even today, years after the disclosure of the still-unfolding child abuse scandal in the Catholic Church and the arrest of a former Pennsylvania State University assistant football coach accused of sexually abusing boys, rape is widely thought of as a crime against women. Until just a few weeks ago, when the federal government expanded its definition of rape to include a wider range of sexual assaults, national crime statistics on rape included only assaults against women and girls committed by men under a narrow set of circumstances. Now they will also include male victims. While most experts agree women are raped far more often than men, 1.4 percent of men in a recent national survey said they had been raped at some point. The study, by the Centers for Disease Control and Prevention, found that when rape was defined as oral or anal penetration, one in 71 men said they had been raped or had been the target of attempted rape, usually by a man they knew. (The study did not include men in prison.) And one in 21 said they had been forced to penetrate an acquaintance or a partner, usually a woman; had been the victim of an attempt to force penetration; or had been made to receive oral sex. Other estimates have run even higher. A Department of Justice report found that 3 percent of men, or one in 33, had been raped. Some experts believe that one in six men have experienced unwanted sexual contact of some kind as minors. But for many men, the subject is so discomfiting that it is rarely discussed — virtually taboo, experts say, because of societal notions about masculinity and the idea that men are invulnerable and can take care of themselves. “We have a cultural blind spot about this,” said David Lisak, a clinical psychologist who has done research on interpersonal violence and sexual abuse and is a founding board member of 1 in 6, an organization that offers information and services to men who had unwanted or abusive sexual experiences as children. “We recognize that male children are being abused,” Dr. Lisak said, “but then when boys cross some kind of threshold somewhere in adolescence and become what we perceive to be men, we no longer want to think about it in this way.” Even when high-profile cases dominate the news, said Mai Fernandez, executive director of the National Center for Victims of Crime advocacy organization in Washington, “attention goes to the things we feel more comfortable talking about — such as whether Penn State had done enough, and what will happen to their football program — and not to the question, ‘What do we do to prevent boys from being sexually assaulted?’ ” In an interview with The Washington Post this month, Joe Paterno, the Penn State football coach who was fired after the abuse scandal erupted and who died of lung cancer on Sunday, said that when an assistant had told him about witnessing an inappropriate encounter between a young boy and Jerry Sandusky, the former assistant coach who is facing charges of sexual abuse, he had been confused and unsure how to proceed. Mr. Paterno said the assistant “didn’t want to get specific. And to be frank with you, I don’t know that it would have done any good, because I never heard of, of rape and a man.” Much of the research on the sexual assault of men has focused on prisons. But men are also raped outside of prison, usually by people they know, including acquaintances and intimate partners, but occasionally by complete strangers. They are raped as part of violent, drunken or drug-induced assaults; war crimes; interrogations; antigay bias crimes; and hazing rites for male clubs and organizations, like fraternities, and in the military. In one study of 3,337 military veterans applying for disability benefits for post-traumatic stress disorder, 6.5 percent of male combat veterans and 16.5 percent of noncombat veterans reported either in-service or post-service sexual assault. (The rates were far higher for female veterans, 69.0 percent and 86.6 percent respectively.) A Pentagon report released on Thursday found a 64 percent increase in sexual crimes in the Army since 2006, with rape, sexual assault and forcible sodomy the most frequent violent sex crimes committed last year; 95 percent of all victims were women. Some studies have reported that the risk of rape is greatest for men who are young, are living in poverty or homeless, or are disabled or mentally ill. The C.D.C. study found that one-quarter of men who had been raped were assaulted before they were 10 , usually by someone they knew. And young men raised by poor single mothers are especially vulnerable to male predators, said Dr. Zane Gates, an internist who cares for low-income patients on Medicaid at a community health center in Altoona, Pa. “You’re looking for a male figure in your life desperately, and you’ll give anything for that,” he said. 1 2 Next Page » This posting includes an audio/video/photo media file: Download Now

Stem Cell Study May Show Advance Posted: 23 Jan 2012 10:53 AM PST LOS ANGELES — A treatment for eye diseases that is derived from human embryonic stem cells might have improved the vision of two patients, bolstering the beleaguered field, researchers reported Monday. Enlarge This Image Dr. Steven D. Schwartz, a retina specialist at the University of California, Los Angeles, treated the two patients in the clinical trial. The report, published online in the medical journal The Lancet, is the first to describe the effect on patients of a therapy involving human embryonic stem cells. The paper comes two months after Geron Corporation, a stem cell industry pioneer, cast a pall over the field by abruptly halting the world’s first clinical trial based on embryonic stem cells — one aimed at treating spinal cord injury. Geron, which has not published results from the aborted trial, also said it would abandon the entire stem cell field. The results reported Monday could help lift some of that pall. They come from the second clinical trial involving the stem cells, using a therapy developed by the company Advanced Cell Technology to treat macular degeneration, a leading cause of blindness. “It’s a big step forward for regenerative medicine,” said Dr. Steven D. Schwartz, a retina specialist at the University of California, Los Angeles, who treated the two patients. Both patients, who were legally blind, told researchers that they had gains in eyesight that were meaningful for them. One said she could see colors better and was able to thread a needle and sew on a button for the first time in years. The other said she was able to navigate a shopping mall by herself. Still, it is hard to judge much from only two patients, especially when there was no control group given a placebo treatment. Indeed, Dr. Schwartz said that the improvement in vision of the woman who could go to the mall might have been a placebo effect, though he thought the improvement in the other patient did result from the implanted cells. Yet another reason to be cautious is that Advanced Cell Technology has had a reputation for publicizing its positive work, in part because it has often been on the brink of insolvency. The company’s stock was up 6 percent to 15 cents a share Monday. Advanced Cell’s desire for publicity — its scientists are co-authors of the paper — could be one reason that the paper was published after only two patients out of a planned 24 were treated. “It’s extremely unusual and it is contrary to my usual behavior,” Dr. Schwartz said of the early publication. But he said there was huge interest in the results. “I think it’s important for the field to have something positive,” he said. Human embryonic stem cells can theoretically be turned into any type of cell in the body. Researchers envision one day making replacement cells and tissues for damaged organs, treating a wide range of diseases. But the field has been controversial because the creation of the stem cells usually entails the destruction of human embryos. In this case, researchers at Advanced Cell Technology turned embryonic stem cells into retinal pigment epithelial cells. Those cells help support the light detectors in the eye. Deterioration of these retinal cells can lead to damage to the macula, the central part of the retina, and to loss of the straight-ahead vision necessary to recognize faces, watch television or read. Some 50,000 of the cells were implanted last July under the retinas in one eye of each woman in surgeries that took about 30 minutes. One woman, Sue Freeman, who is in her 70s, suffered from the dry form of age-related macular degeneration, one of the leading causes of severe vision loss in the elderly. The other, who asked that her name not be used to protect her privacy, was a 51-year-old graphic designer in Los Angeles with Stargardt’s macular dystrophy, which tends to occur in younger people. There are no approved drugs for either disease. One safety concern in using embryonic stem cells is that if any of the cells get into the body, they could form tumors. The researchers reported that this did not happen in the first four months after the surgery and that there were no obvious safety problems. The women were given low doses of drugs to suppress the body’s immune system and prevent them from rejecting the implanted cells, even though the eye is somewhat shielded from the immune system. Before the treatment, the woman with Stargardt’s was able to see the motion of a hand being waved in front of her but could not read any letters on an eye chart. Twelve weeks after the treatment, she was able to read five of the biggest letters on the eye chart with the treated eye, corresponding to 20/800 vision, according to the paper. “I kind of did have a day when I woke up and said there really is a difference here,” the woman said in an interview in late October, about three months after the surgery. “I want my other eye done.” Ms. Freeman, who lives in Laguna Beach, Calif., went from being able to read 21 letters on an eye chart before treatment to 28 letters six weeks after treatment, an improvement to 20/320 from 20/500 vision, according to the paper. However, vision in her untreated eye also improved somewhat, and Dr. Schwartz said that after a while he could not detect any evidence in her eye of the implanted cells, possibly because she stopped taking the drug to suppress her immune system, owing to side effects. That is why, he said, he thought the effect might have been a placebo effect. The trial is now continuing and expanding beyond U.C.L.A., and using gradually higher doses of cells. A patient with Stargardt’s was implanted in London on Friday. This posting includes an audio/video/photo media file: Download Now

Global Update: Abortion: Worldwide Rate Stopped Falling After 2003; Researchers Cite Scarcity of Contraception Posted: 23 Jan 2012 12:41 PM PST The world’s abortion rate, which began declining steadily in the 1990s, has stopped falling, according to a new study. The study, published online last week in The Lancet, was done by the World Health Organization and the Guttmacher Institute in New York, which studies sexuality and reproductive health. Globally, abortions fell from 35 per 1,000 women in 1995 to 29 per 1,000 by 2003. After that, the rate essentially leveled off. The study blamed a decline in access to birth control. “When contraception rates are high, abortion rates are low,” Gilda Sedgh, a senior research associate at the institute and the lead author of the new study, said in an interview. Birth control may have declined as the fight against AIDS, malaria and other diseases diverted dollars from it, she added. The United States is the biggest donor toward birth control in poor countries, but those funds leveled off as the Bush administration poured money into AIDS drugs, mosquito nets and other health measures. European donors “tried to fill the void but couldn’t,” Dr. Sedgh said. Paradoxically, countries where abortion is illegal often have more abortions, the study found. For example, abortion rates are far higher in Africa and Latin America — where abortions are illegal or heavily restricted — than in the United States and Western Europe. But in South Africa, where they are legal, the abortion rate is the continent’s lowest. After South Africa liberalized its abortion law in 1997, Dr. Sedgh said, maternal deaths from unsafe abortions fell by 90 percent.

Disgust’s Evolutionary Role Is Irresistible to Researchers Posted: 23 Jan 2012 12:50 PM PST Disgust is the Cinderella of emotions. While fear, sadness and anger, its nasty, flashy sisters, have drawn the rapt attention of psychologists, poor disgust has been hidden away in a corner, left to muck around in the ashes. Enlarge This Image Ron Barrett Well Share your thoughts on this column at the Well blog. Go to Well » How Does Your Disgust Rate? Take the researchers' survey and figure out how your disgust compares. Related Reading List: Some Recent Books on Disgust (January 24, 2012) RSS Feed Get Science News From The New York Times » Enlarge This Image Srinivass The character 'laddu lingam' in a skit to promote handwashing with soap in rural Andhra Pradesh, India.  No longer. Disgust is having its moment in the light as researchers find that it does more than cause that sick feeling in the stomach. It protects human beings from disease and parasites, and affects almost every aspect of human relations, from romance to politics. In several new books and a steady stream of research papers, scientists are exploring the evolution of disgust and its role in attitudes toward food, sexuality and other people. Paul Rozin, a psychologist who is an emeritus professor at the University of Pennsylvania and a pioneer of modern disgust research, began researching it with a few collaborators in the 1980s, when disgust was far from the mainstream. “It was always the other emotion,” he said. “Now it’s hot.” It still won’t wear glass slippers, which may be just as well, given the stuff it has to walk through. Nonetheless, its reach takes disgust beyond the realms of rot and excrement. Speaking last week from a conference on disgust in Germany, Valerie Curtis, a self-described “disgustologist” from the London School of Hygiene and Tropical Medicine, described her favorite emotion as “incredibly important.” She continued: “It’s in our everyday life. It determines our hygiene behaviors. It determines how close we get to people. It determines who we’re going to kiss, who we’re going to mate with, who we’re going to sit next to. It determines the people that we shun, and that is something that we do a lot of.” It begins early, she said: “Kids in the playground accuse other kids of having cooties. And it works, and people feel shame when disgust is turned on them.” Some studies have suggested that political conservatives are more prone to disgust than liberals are. And it is clear that what people find disgusting they often find immoral, too. It adds to the popularity of disgust as a subject of basic research that it is easier to elicit in an ethical manner than anger or fear. You don’t have to insult someone or make anyone afraid for his or her life — a bad smell will do the trick. And disgust has been relatively easy to locate in the brain, where it frequents the insula, the amygdala and other regions. “It is becoming a model emotion,” said Jonathan Haidt of the University of Virginia, a disgust pioneer with Dr. Rozin. And the research may have practical benefits, including clues to obsessive compulsive disorder, some aspects of which — like excessive hand washing — look like disgust gone wild. Conversely, some researchers are trying to inspire more disgust at dirt and germs to promote hand washing and improve public health. Dr. Curtis is involved in efforts in Africa, India and England to explore what she calls “the power of trying to gross people out.” One slogan that appeared to be effective in England in getting people to wash their hands before leaving a bathroom was “Don’t bring the toilet with you.” Disgust was not completely ignored in the past. Charles Darwin tackled the subject in “The Expression of the Emotions in Man and Animals.” He described the face of disgust, documented by Guillaume-Benjamin Duchenne in his classic study of facial expressions in 1862, as if one were expelling some horrible-tasting substance from the mouth. “I never saw disgust more plainly expressed,” Darwin wrote, “than on the face of one of my infants at five months, when, for the first time, some cold water, and again a month afterwards, when a piece of ripe cherry was put into his mouth.” His book did not contain an image of the infant, but fortunately YouTube has numerous videos of babies tasting lemons. Human beings are complex, of course, as evidenced by the behavior of parents who give their babies lemons and record their distress on video, and the lemon face is not exactly that of adult disgust. It is, however, generally accepted that disgust evolved partly to avoid putting bad things in the mouth, an idea already put forth when Dr. Rozin tackled disgust. He and his colleagues developed the idea that disgust was then elaborated by cultural evolution to include other forms, one of them based in a dislike for reminders of the animal nature of humans. Sex, death, feces and bad food all smacked of animality. There are many variations in how scientists now view disgust, but one new approach by evolutionary psychologists was captured in a December special issue of The Philosophical Transactions of the Royal Society B, “Disease Avoidance: From Animals to Culture,” and in a conference on “The Evolution of Disgust” this month in Bielefeld, Germany, where many of the same scientists appeared. 1 2 Next Page » This posting includes an audio/video/photo media file: Download Now

Vital Signs: Study Finds No Childhood Obesity Link to School Junk Food Posted: 23 Jan 2012 11:29 AM PST In the fight against childhood obesity, communities all over the country are banning the sale of sweets and salty snacks in public schools. But a new study suggests that the strategy may be ineffective. Related More Vital Signs Columns Researchers at Pennsylvania State University tracked the body mass indexes of 19,450 students from fifth through eighth grade. In fifth grade, 59 percent of the children attended a school where candy, snacks or sugar-sweetened beverages were sold. By eighth grade, 86 percent did so. The researchers compared children’s weight in schools where junk food was sold and in schools where it was banned. The scientists also evaluated eighth graders who moved into schools that sold junk food with those who did not, and children who never attended a school that sold snacks with those who did. And they compared children who always attended schools with snacks with those who moved out of such schools. No matter how the researchers looked at the data, they could find no correlation at all between obesity and attending a school where sweets and salty snacks were available. “Food preferences are established early in life,” said Jennifer Van Hook, the lead author and a professor of sociology and demography at Penn State. “This problem of childhood obesity cannot be placed solely in the hands of schools.” The study appeared in the January issue of the journal Sociology of Education.

Vital Signs: Use of 3 or More In Vitro Embryos Is Too Risky, Study Concludes Posted: 23 Jan 2012 11:30 AM PST About 40 percent of in vitro fertilizations in the United States involve the transfer of three or more embryos, and more than 20 percent of pregnancies from IVF procedures result in multiple births. The health risks and expenses of these pregnancies are enormous. Related More Vital Signs Columns Now a British study, published online Jan. 12 in The Lancet, has found that the number of live births does not increase with the transfer of more than two embryos, but that the risk of harm does. Researchers looked at 124,148 IVF procedures that resulted in 33,514 live births. Among all women, the transfer of two embryos resulted in more live births than the transfer of one. But in those under age 40, transferring three embryos produced a lower rate of live birth than transferring two. In older women, transferring three embryos instead of two made no difference in the rate. The transfer of three or more embryos in any age group, however, was associated with a significantly higher risk of complications, including preterm birth and low birth weight. Scott M. Nelson, an author of the study and the chairman of obstetrics at the University of Glasgow, said the United States was one of the few countries in which more than two embryos may still routinely be transferred. “The study clearly shows that transferring three or more is not beneficial,” he said.

Vital Signs: Accident Risk Seen for Pedestrians Wearing Headphones Posted: 23 Jan 2012 11:34 AM PST Walking around with an iPod or an MP3 player plugged into your ears may seem harmless, but a new study suggests that the habit has its dangers. Related More Vital Signs Columns After examining statistics from the National Electronic Injury Surveillance System and other databases, researchers at the University of Maryland found 116 accidents from 2004 to 2011 in which pedestrians wearing headphones or ear buds were injured by vehicles. More than half the accidents involved trains, and there were 81 deaths and 24 cases with life-threatening injuries. More than a third of those injured or killed were younger than 18, and two-thirds were under 30. “I’m not suggesting that pedestrians wearing headphones be pulled over,” said Dr. Richard Lichenstein, the lead author of the study and an associate professor of pediatrics at the University of Maryland. “But wearing them at the gym is different from using them wherever you’re walking around. You’re distracted, and you can’t hear the surrounding environment.” The study, published online last week in Injury Prevention, has some major limitations. It relies in part on news accounts, in which severe accidents may be overly represented while nonfatal cases are underreported. And the study is retrospective, so conclusions about causation and correlation are impossible to establish.

China Reports 2nd Bird Flu Death in Month Posted: 23 Jan 2012 10:37 AM PST BEIJING — A man died in southern China on Sunday from the H5N1 bird flu virus, the Health Ministry reported. It was China’s second such death in less than a month. Connect With Us on Twitter Follow @nytimesworld for international breaking news and headlines. The latest victim, an unidentified 39-year-old, fell ill on Jan. 6 and was admitted to a hospital in Guizhou Province the same day, the Health Ministry said in a statement reported by Xinhua, the official news agency. A 39-year-old bus driver in Shenzhen, a city in Guangdong Province near Hong Kong, died of the disease on Dec. 31. Both deaths were notable because neither victim reported any contact with birds in the month preceding his illness. The virus is known to spread through contact with infected birds, eggs or bird feces, but experts said a pandemic could occur were it to mutate into a form that was more easily spread. In the latest case, the victim “did not report obvious exposure history to poultry before the onset of symptoms,” according to the Hong Kong bulletin. But Chinese authorities, who are monitoring 71 people known to have been in contact with the victim, have found no other evidence of flu, the ministry reported. People who were in contact with the Shenzhen victim also have remained symptom-free, leading some experts to conclude that neither case involved transmission among humans. Worldwide, bird flu has killed 343 of the 582 people who are known to have been infected, according to the World Health Organization, including 28 of the 42 infected Chinese victims. With the world’s largest poultry population, and close contact between birds and people in rural areas, China is regarded as a major breeding ground for the disease. Vietnam has reported 60 deaths, including that of an 18-year-old duck farmer last week. A victim in Indonesia also recently died.

Chefs, Butlers and Marble Baths - Not Your Average Hospital Room Posted: 23 Jan 2012 09:34 AM PST The feverish patient had spent hours in a crowded emergency room. When she opened her eyes in her Manhattan hospital room last winter, she recalled later, she wondered if she could be hallucinating: “This is like the Four Seasons — where am I?” Follow @NYTMetro Connect with @NYTMetro on Twitter for New York breaking news and headlines. Enlarge This Image NewYork-Presbyterian Hospital/Weill Cornell Medical Center A menu available to patients in Greenberg 14 South, the luxury wing of NewYork-Presbyterian/Weill Cornell hospital. The bed linens were by Frette, Italian purveyors of high-thread-count sheets to popes and princes. The bathroom gleamed with polished marble. Huge windows displayed panoramic East River views. And in the hush of her $2,400 suite, a man in a black vest and tie proffered an elaborate menu and told her, “I’ll be your butler.” It was Greenberg 14 South, the elite wing on the new penthouse floor of NewYork-Presbyterian/Weill Cornell hospital. Pampering and décor to rival a grand hotel, if not a Downton Abbey, have long been the hallmark of such “amenities units,” often hidden behind closed doors at New York’s premier hospitals. But the phenomenon is escalating here and around the country, health care design specialists say, part of an international competition for wealthy patients willing to pay extra, even as the federal government cuts back hospital reimbursement in pursuit of a more universal and affordable American medical system. “It’s not just competing on medical grounds and specialties, but competing for customers who can go just about anywhere,” said Helen K. Cohen, a specialist in health facilities at the international architectural firm HOK, which recently designed luxury hospital floors in Singapore and London and renovated NewYork-Presbyterian’s elite offerings in the McKeen Pavilion in Washington Heights. “These kinds of patients, they’re paying cash — they’re the best kind of patient to have,” she added. “Theoretically, it trickles down.” A waterfall, a grand piano and the image of a giant orchid grace the soaring ninth floor atrium of McKeen, leading to refurbished rooms that, like those in the hospital’s East 68th Street penthouse, cost patients $1,000 to $1,500 a day, and can be combined. That fee is on top of whatever base rate insurance pays to the hospital, or the roughly $4,500 a day that foreigners are charged, according to the hospital’s international services department. But in the age of Occupy Wall Street, catering to the rich can be trickier than ever, noted Avani Parikh, who worked for NewYork-Presbyterian as in-house project leader when the 14th floor was undertaken. She pointed to the recent ruckus at Lenox Hill Hospital, where parents with newborns in the intensive-care unit complained that security guards had restricted their movements and papered over hospital security cameras in their zeal to please Jay-Z (real name Shawn Carter) and Beyoncé Knowles, whose daughter was born on Jan. 7 in a new “executive suite.” Many American hospitals offer a V.I.P. amenities floor with a dedicated chef and lavish services, from Johns Hopkins Hospital in Baltimore to Cedars-Sinai Medical Center in Los Angeles, which promises “the ultimate in pampering” in its $3,784 maternity suites. The rise of medical tourism to glittering hospitals in places like Singapore and Thailand has turned coddling and elegance into marketing necessities, designers say. The spotlight on luxury accommodations comes at an awkward time for many urban hospitals, now lobbying against cuts in Washington and highlighting their role as nonprofit teaching institutions that serve the poor. Indeed, NewYork-Presbyterian, which once opposed amenities units, would not answer questions about its shift, and declined a reporter’s request for a tour. In Greenberg, where the visitors’ lounge seems to hang over the East River in a glass prow and Ciao Bella gelato is available on demand, the patient who likened her suite to the Four Seasons was not paying for it. She did not want to be identified because her wealthy boss, who picked up the bill, would not want publicity. During a reporter’s unofficial visits to both units this month, however, some people enjoying the perks expressed uneasiness about those priced out. In space-starved New York, many regular hospital rooms are still double-occupancy, though singles are now the national standard for infection control and quicker recovery. 1 2 Next Page »

Recipes for Health: Lunches to Take to Work — Recipes for Health Posted: 23 Jan 2012 09:29 AM PST Many people who have chimed in on the Recipes for Health page on Facebook have requested recipes for lunches they can take to work and eat at a desk. Although I work at home, my lunch requirements are probably similar to those of many of you who work in an office. I don’t like to eat complex dishes with strong flavors like raw garlic or onion at midday, because I don’t want those flavors lingering when I get back to work. I want a lunch that’s light and simple, enjoyable but not distracting. It usually includes protein and a vegetable of some kind, often a complex carbohydrate like whole-grain bread or a grain. I don’t spend much time preparing it because I’ve made it ahead (salad, wraps, something I’ve tested for this column that fits the bill), or because it’s as simple as cottage cheese and avocado with a corn tortilla or two, heated over the gas burner so that it has a nice charred taste. Recipes for Health Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. See All Recipes for Health » Visit Recipes for Health on Facebook. I so enjoyed working on these recipes, as they provided me with great lunches all week long. They’ve kept all week in the refrigerator, and they don’t require refrigeration during those few hours between the time to get you work and the time you eat your lunch, though all of them will taste fresher if they have been in the fridge. Tuna, Chickpeas and Broccoli Salad With Yogurt Dressing This is inspired by one of my favorite Italian combinations, tuna and beans. It’s a salad that keeps well in the refrigerator and one that I love to have on hand. The broccoli will not retain its pretty green color once in contact with the acid in the dressing, so for best results keep the broccoli separate, along with a tablespoon of the dressing. Just before you want to eat, toss in the broccoli and extra dressing; or eat the broccoli separately with the dressing. 1 can water-packed light tuna, drained 1/2 can chickpeas, (3/4 cup) drained and rinsed 1 stalk celery, cut in small (1/4-inch) dice 1/2 red bell pepper, cut in small (1/4-inch) dice 2 tablespoons chopped fresh parsley (optional) 1 tablespoon chopped fresh chives (optional) 1 broccoli crown, steamed for 4 to 5 minutes and broken into florets 1 1/2 tablespoons fresh lemon juice 1/2 tablespoon vinegar (red wine, sherry or white wine) Salt to taste 1 teaspoon Dijon mustard 1 tablespoon extra virgin olive oil 1/4 cup plain low-fat yogurt 1. In a medium bowl, mix together the tuna, chickpeas, celery, bell pepper, parsley and chives. Keep the broccoli separate. 2. In a small bowl or measuring cup, mix together the lemon juice, vinegar, salt, and Dijon mustard. Whisk in the olive oil and yogurt, and toss with the tuna and chickpea mixture. Refrigerate in a bowl or in containers until ready to take to work or eat. Add the broccoli just before serving. Yield: 2 1/2 servings. Advance preparation: This keeps for 3 or 4 days in the refrigerator. Nutritional information per serving: 240 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 4 grams monounsaturated fat; 22 milligrams cholesterol; 19 grams carbohydrates; 5 grams dietary fiber; 492 milligrams sodium (does not include salt to taste); 24 grams protein   Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

Bird Flu Scientists Agree to Pause H5N1 Research Posted: 23 Jan 2012 07:49 AM PST The scientists who altered a deadly flu virus to make it more contagious have agreed to suspend their research for 60 days to give other international experts time to discuss the work and determine how it can proceed without putting the world at risk of a potentially catastrophic pandemic. Enlarge This Image Ron Fouchier The small black bodies are H5N1 viruses produced by an infected human cell, at left. H5N1 is a contagious strain of bird flu. RSS Feed Get Science News From The New York Times » Enlarge This Image Dirk-Jan Visser for The New York Times Ron Fouchier, of the Netherlands research team. Suspensions of biomedical research are almost unheard of; the only other one in the United States was a moratorium from 1974 to 1976 on some types of recombinant DNA research, because of safety concerns. A letter explaining the flu decision is being published in two scientific journals, Science and Nature, which also plan to publish reports on the research, but in a redacted form, omitting details that would let other researchers copy the experiments. The letter is signed by the scientists who produced the new, more contagious form of the flu virus, as well as by more than 30 other leading flu researchers. “We recognize that we and the rest of the scientific community need to clearly explain the benefits of this important research and the measures taken to minimize its possible risks,” the letter states. At an international meeting next month in Geneva, participants selected by the World Health Organization will consider what to do next. Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said the gathering would “address some of these difficult issues on an international scale instead of something restricted to the United States government.” The scientists say their work has important public health benefits, but they acknowledge that it has sparked intense public fears that the deadly virus could accidentally leak out of a laboratory, or be stolen by terrorists, and result in a devastating pandemic. A national biosecurity panel in the United States has already taken the unusual step of asking the scientists to keep part of their data secret to prevent others from reproducing their work. Scientists are split regarding the research, with some praising it as important and urging that it be published, and others saying the experiments are so dangerous that they should never have been done. The experiments involve a type of bird flu virus known as H5N1, which rarely infects people but is highly deadly when it does. The work, paid for by the National Institutes of Health, was done by two separate research teams, at Erasmus Medical Center in Rotterdam, the Netherlands, and at the University of Wisconsin, Madison. Ron Fouchier, a virologist who conducted the research at Erasmus Medical Center, explained why he and his colleagues decided to pause the research. “It is unfortunate that we need to take this step to help stop the controversy in the United States,” he said. “I think if this were communicated better in the United States it might not have been needed to do this. In the Netherlands we have been very proactive in communicating to the press, politicians and public, and here we do not have such a heated debate.” Dr. Fauci said that he had never seen the scientific world so polarized, and that led him to urge the researchers to show good faith and flexibility by declaring the moratorium themselves. A concern “looming in the background,” he said, was that biosecurity experts might overreact and impose excessive restrictions on the research. “I think it’s important research that needs to go forward,” Dr. Fauci said. “I think we need to get greater input on the conditions in which it goes forward.” Dr. Fauci and others who support the research say it may help explain how flu viruses that start out in animals adapt to humans and become transmissible, and therefore able to cause pandemics. That information, the researchers say, could help them recognize viruses on the way to developing pandemic potential. Richard H. Ebright, a molecular biologist at Rutgers, is among those who oppose the research because of its risks, and doubts that it could be used to predict pandemics. He said that a moratorium was a good idea, but that this one did not go far enough. He said that the letter did not acknowledge the need for improved “biosafety, biosecurity and oversight,” and that in any case, 60 days would not be enough time to put the needed safeguards in place. The letter noted a “perceived fear” among the public, Dr. Ebright said, and seemed to suggest that the debate would cool down if people would just let the researchers explain that they had done the experiments safely. Dr. Ebright said experiments with this virus should be done only in laboratories with the highest biosafety rating, BSL4, not in the “enhanced BSL3” in which the work was actually done. Dr. Fouchier disagreed. He also said that his center did not have BSL4 labs. Dr. Fauci said various expert groups, including the Centers for Disease Control and Prevention, had determined that enhanced BSL3 was good enough for bird flu research. Since 1997, when the H5N1 virus was first identified, about 600 people have been infected, and more than half died — an extraordinarily high death rate. The saving grace of H5N1 is that when people do become infected — nearly always from contact with birds — they almost never transmit the disease to other people. But the virus has persisted in the environment, infecting millions of birds, and scientists have warned that if it mutates to become more contagious in people, disaster could ensue. But what mutations would make the virus more easily transmissible? And how hard, or easy, would it be for those mutations to occur? Hoping to answer those questions, some researchers began experimenting with bird flu, working with ferrets, which are considered the best model for studying flu, because they contract it and get sick in much the same way that people do. Recently, the teams in Rotterdam and Madison announced that they had produced a form of H5N1 with mutations that allowed it to “go airborne,” meaning that it spread through the air from one ferret to another. Presumably, though not certainly, the virus could spread in the same way among people. Dr. Fouchier said he was surprised by how easy it was to change the virus into the very form that the world has been dreading. Now, scientists around the world will have to grapple with what to do with Dr. Fouchier’s creation. This posting includes an audio/video/photo media file: Download Now

As Specialists Debate Autism, Some Parents Watch Closely Posted: 20 Jan 2012 09:50 PM PST A debate among medical professionals over how to define autism has spilled over into the public domain, stirring anger and fear among many parents and advocates of those with the neurological disorder, even as some argue that the diagnosis has been too loosely applied. Enlarge This Image Jessica Kourkounis for The New York Times Amanda Forman's 5-year-old son was given a diagnosis of a mild form of autism. This led to therapy that she said has helped him. Multimedia Graphic Redefining Autism Related New Definition of Autism Will Exclude Many, Study Suggests (January 20, 2012) Autism, Grown Up: Navigating Love and Autism (December 26, 2011) Autism, Grown Up: Autistic and Seeking a Place in an Adult World (September 18, 2011) Health Guide: Autism Connect With Us on Twitter Follow @NYTNational for breaking news and headlines. Twitter List: Reporters and Editors A study reported on Thursday found that proposed revisions to the American Psychiatric Association’s definition would exclude about three-quarters of those now diagnosed with milder forms of autism called Asperger syndrome or “pervasive developmental disorder, not otherwise specified,” also known as P.D.D.-N.O.S. These are people who have difficulties with social interaction but do not share the most severe impairments of children with classic autism. “He was right on the border, they told me when he got the diagnosis; that’s what scares me,” said Amanda Forman of Flourtown, Pa., whose 5-year-old son was diagnosed two years ago with P.D.D.-N.O.S. After receiving play therapy, occupational therapy and 17 hours a week of behavioral therapy, the boy, who was once unresponsive to other children and engaged in self-destructive behavior, may enter a mainstream kindergarten class next year, his mother said. “What if he has to be re-evaluated? If the criteria were stricter, he might not get these services that have been helping him so much.” The proposed revisions, which would take effect in 2013, are likely to have practical implications for those who would once have qualified for services that experts say can improve an individual’s abilities to socialize, learn and ultimately live independently. But they have also ignited a broad discussion over the value of a diagnosis for behavior differences, and how to fairly apportion services at a time when resources are shrinking. The Diagnostic and Statistical Manual, now under revision, is the standard reference for mental disorders, driving research, treatment and insurance decisions. Since 1994, when recognition of Asperger syndrome was first included as an autism-spectrum disorder, diagnosis of the condition has surged. Over the last decade, the number of 6- to 21-year-olds with autism in public schools has quadrupled, according to the Department of Education. Such students may get private school placement, a classroom aide or curriculum adaptations. In recent years, 29 states have passed laws requiring insurance companies to provide behavioral therapies and other forms of care to people with an autism diagnosis. “We have to make sure not everybody who is a little odd gets a diagnosis of autism or Asperger disorder,” said Dr. David J. Kupfer, a professor of psychiatry at the University of Pittsburgh and chairman of the task force making the revisions, which are still subject to change. “It involves a use of treatment resources. It becomes a cost issue.” But some autism advocates argue that acknowledging the neurological basis for socially odd behaviors has benefits beyond eligibility for services, promoting cultural tolerance and a degree of self-understanding that may be lost without it. “Having a diagnosis helps people understand why we process thoughts and emotions differently and make positive changes,” said Michael John Carley, director of the Global and Regional Asperger Syndrome Partnership, which urged members to call the psychiatric association to complain. “Sadly, we may be heading back to the days when our differences are seen through the lens of character deficits rather than in the context of brain wiring.” Even within the medical community, the number of people who would not be eligible for an autism diagnosis under the new criteria is a matter of dispute. Some may fall under a new category, “social and communication disorder,” though it is not clear what kind of aid, if any, they would be eligible for as a result. Catherine Lord, the director of the Institute for Brain Development at NewYork-Presbyterian Hospital, and a member of the committee overseeing the revisions, said that the goal was to ensure that autism was not used as a “fallback diagnosis” for children whose primary trait might be, for instance, an intellectual disability or aggression. 1 2 Next Page »

Administration Rules Insurers Must Cover Contraceptives Posted: 20 Jan 2012 10:24 PM PST WASHINGTON — The Obama administration said Friday that most health insurance plans must cover contraceptives for women free of charge, and it rejected a broad exemption sought by the Roman Catholic Church for insurance provided to employees of Catholic hospitals, colleges and charities. Related Beliefs: Many Evangelicals See Something to Admire in Candidates' Broods (January 21, 2012) Federal officials said they would give such church-affiliated organizations one additional year — until Aug. 1, 2013 — to comply with the requirement. Most other employers and insurers must comply by this Aug. 1. Leaders of the Roman Catholic Church had personally appealed to President Obama to grant the broad exemption. He made the final decision on the issue after hearing from them, as well as from family planning advocates, scientific experts and members of Congress, administration officials said. The rule takes a big step to remove cost as a barrier to birth control, a longtime goal of advocates for women’s rights and experts on women’s health. In announcing details of the final rule on Friday, Kathleen Sebelius, the secretary of health and human services, said it “strikes the appropriate balance between respecting religious freedom and increasing access to important preventive services.” “Scientists have abundant evidence that birth control has significant health benefits for women,” Ms. Sebelius said, and “it is documented to significantly reduce health costs.” Catholic bishops issued a statement saying they would fight the “edict” from the government. “In effect, the president is saying we have a year to figure out how to violate our consciences,” said Archbishop Timothy M. Dolan of New York, the president of the United States Conference of Catholic Bishops. In an interview, Archbishop Dolan, who is to become a cardinal next month, said, “We’re unable to live with this.” Other opponents of the rule said they would seek legislation to block it and might challenge it in court as well. The rule includes an exemption for certain “religious employers,” including houses of worship. But church groups said the exemption was so narrow that it was almost meaningless. A religious employer cannot qualify for the exemption if it employs or serves large numbers of people of a different faith, as many Catholic hospitals, universities and social service agencies do. Ms. Sebelius said the one-year grace period would be available to certain “nonprofit employers who, based on religious beliefs, do not currently provide contraceptive coverage in their insurance plan.” The extra time will allow them to “adapt to the new rule,” Ms. Sebelius said. Chris Jacobs, a health policy analyst for Senate Republicans, said, “This decision looks suspiciously like yet another political stunt designed to delay the controversy by a year, until after the president’s re-election campaign.” Senator Orrin G. Hatch, Republican of Utah, said the transition period was pointless. “The problem is not that religious institutions do not have enough time to comply,” Mr. Hatch said. “It’s that they are forced to comply at all. Unfortunately, the administration has shown a complete lack of regard for our constitutional commitment to religious liberty.” The National Association of Evangelicals said that as a result of the White House decision, “Employers with religious objections to contraception will be forced to pay for services and procedures they believe are morally wrong.” The Becket Fund for Religious Liberty, a nonprofit law firm, has filed lawsuits challenging an earlier version of the rule in federal courts on behalf of a Catholic college connected to a monastery in North Carolina and an evangelical university in Colorado. The 2010 health care law says insurers must cover “preventive health services” and cannot charge for them. The new rule interprets this mandate. It requires coverage of the full range of contraceptive methods approved by the Food and Drug Administration. Among the drugs and devices that must be covered are emergency contraceptives including pills known as ella and Plan B. The rule also requires coverage of sterilization procedures for women without co-payments or deductibles. The issue forced Mr. Obama to weigh competing claims of Catholic leaders and advocates for women’s rights. 1 2 Next Page » Laurie Goodstein contributed reporting from New York.

A Nurse Need Never Forget Posted: 20 Jan 2012 02:00 PM PST THESE days, when a nursing student at the University of Iowa fields a question about a drug, “the answer is often, ‘I don’t know, but give me a few seconds,’ and she pulls out her phone,” according to Joann Eland, an associate professor there. Enlarge This Image Viktor Koen Related Education Life Preview: What You (Really) Need to Know (January 22, 2012) In just a few years, technology has revolutionized what it means to go to nursing school, in ways more basic — and less obvious to the patient — than learning how to use the latest medical equipment. Nursing schools use increasingly sophisticated mannequins to provide realistic but risk-free experience; in the online world Second Life, students’ avatars visit digital clinics to assess digital patients. But the most profound recent change is a move away from the profession’s dependence on committing vast amounts of information to memory. It is not that nurses need to know less, educators say, but that the amount of essential data has exploded. “There are too many drugs now, too many interactions, too many tests, to memorize everything you would need to memorize,” says Ms. Eland, a specialist in uses of technology. “We can’t rely nearly as much as we used to on the staff knowing the right dose or the right timing.” Five years ago, most American hospital wards still did not have electronic patient records, or Internet connections. Now, many provide that access with computers not just at a central nurse’s station but also at the patient’s bedside. The latest transition is to smartphones and tablet computers, which have become mandatory at some nursing schools. “We have a certain set of apps that we want nursing students to have on their handheld devices — a book of lab tests, a database of drugs, even nursing textbooks,” says Helen R. Connors, executive director of the Kansas University Center for Health Informatics. Visiting alumni, she says, are shocked to see students not carrying physical textbooks to class. But technology carries risks as well. So much data is available that students can get overwhelmed, and educators say that a growing part of their work is teaching how to retrieve information quickly and separate what is credible, relevant and up-to-date from what is not. (Hint: look for the seal of approval of Health on the Net.) They also worry that students rely too much on digital tools at the expense of patient interaction and learning.“There’s a danger that having that technology at the point of care at the bedside creates a misperception that students don’t need to know their stuff,” says Jennifer Elison, chairwoman of the nursing department at Carroll College in Helena, Mont. “I get worried when I hear about nursing programs that want to replace the person-to-person clinical experience with increased hours with simulation,” she says. “We hear sometimes that it feels to patients that the computers are more important than they are.” Then there’s the patient privacy issue in the era of blogging, Facebook and Twitter. How to properly use social media has become standard in the curriculum, thanks in part to what is known in nursing circles as “the placenta incident.” Four nursing students at a community college in Kansas posted Facebook photos of themselves with a human placenta. The students were expelled in 2010, and later reinstated, but the episode showed how murky the boundaries of privacy and professionalism can be. The National Council of State Boards of Nursing recently published guidelines on social media. “That is the new hot issue now,” Ms. Elison says. “That’s been hard, because this is a generation that immediately hits that send button.”

A Bridge to Recovery on Campus Posted: 20 Jan 2012 02:00 PM PST IN their undergrad uniforms of fleece and sweats, a clutch of Rutgers students gathered on the worn red couches of their dorm’s common room and told their stories. A good-looking, fun-loving 23-year-old named Greg described arriving at college freshman year with a daily pot-smoking habit and a close relationship with alcohol. He soon followed the lead of his alcoholic father and was binge drinking (five drinks or more in a row). “It was pretty scary,” he said. Enlarge This Image Marcus Yam for The New York Times For his self-diagnosed anxiety and depression, he secretly began taking Klonopin, which he bought from another student. By sophomore year, he was taking six a day. And when it ran out, he wound up in a hospital to manage withdrawal, followed by nine months of rehab. Unlike the other students on the couch, Devin Fox, 26, gave permission to use his surname because of his career choice. He is pursuing a graduate degree in social work, hoping to work at a policy level in the mental illness field. Mr. Fox had been so despondent over his addiction to methamphetamine that he tried to overdose. Like Greg, he is now three years clean. The students live in one of two recovery dorms tucked away in anonymity on the sprawling New Brunswick, N.J., campus. In 1988, Rutgers started what is believed to be the first residential recovery program on a college campus, according to Lisa Laitman, director of its Alcohol and Other Drug Assistance Program. She helped create the program after seeing students struggle to abstain as dorm-mates partied. Back then, there was little talk about helping students transition to college after treatment for their drug and alcohol problems. Even in 2002, when the nonprofit Association of Recovery Schools was formed, only four colleges joined. But over the past several years recovery programs have been popping up at colleges, large and small, public and private. Now there are more than 20 programs, with more in the pipeline. Texas Tech University has used some $900,000 in federal grants to help campuses build programs. Case Western Reserve and Augsburg College, like Rutgers, provide separate housing. William Paterson University groups recovering students in substance-free housing, where drugs and alcohol aren’t welcome. Texas Tech puts its first-year students on their own floor. New this fall, students at the University of Michigan could choose a recovery room from the residential life drop-down menu to live with a like-minded roommate. “There’s a big difference between a substance-free and a recovery option,” explains Mary Jo Desprez, the program director. “A recovery room is for students who are actively pursuing staying sober.” Until recently, public policy focused on prevention and treatment. “We never talked about recovery as a kind of separate entity — it was almost like treatment was the end in and by itself,” says R. Gil Kerlikowske, director of the White House’s Office of National Drug Control Policy, which is joining with the Department of Education to urge colleges to consider recovery programs. And, no wonder. Research shows that young people are among the most vulnerable to addiction. Though pleasure-seeking, risk-taking parts of their brain are in full throttle, areas that control judgment, emotion and impulse aren’t fully developed until the mid-20s. “You’ve got the accelerator without the brakes,” says Dr. Robert L. DuPont, first director of the National Institute on Drug Abuse and author of “The Selfish Brain: Learning From Addiction.” Genetics, peer pressure and psychological disorders up the ante. And the earlier people start to drink or take drugs, the more likely they are to become addicted. A Texas Tech survey of college students in five recovery programs found that the average age of addiction was 15. Recovery program directors say many of their students had both an alcohol and drug habit, with marijuana dependency increasingly common. Studies have found that 17 percent of college students report smoking marijuana at least once a month; 8 percent use other illicit drugs, including pharmaceuticals like Adderall, Vicodin and OxyContin without a prescription; and 42 percent binge drink, a rate fairly constant over the past decade. The social fabric of college can be harrowing for students who are trying to shake addictions. After rehab, some don’t return to school, or they live at home while continuing their studies. Students living on campus often face relapse triggers — old drinking and drugging buddies; stress over exams, finances and social lives — without a supportive environment. “It’s simply a recipe for failure,” says Dr. Jon Morgenstern, director of addiction treatment in the Department of Psychiatry at Columbia University Medical Center, which recently collaborated with Hazelden, a nonprofit addiction agency, to establish a recovery residence in the TriBeCa area of Manhattan for college students. 1 2 3 Next Page » Abigail Sullivan Moore is the co-author, with Barbara K. Hofer, of "The iConnected Parent: Staying Close to Your Kids in College (and Beyond) While Letting Them Grow Up."

New Definition of Autism May Exclude Many, Study Suggests Posted: 20 Jan 2012 10:17 AM PST Proposed changes in the definition of autism would sharply reduce the skyrocketing rate at which the disorder is diagnosed and might make it harder for many people who would no longer meet the criteria to get health, educational and social services, a new analysis suggests. Readers' Questions: Redefining Autism James C. McPartland, an assistant professor in the Child Study Center at Yale University, is answering your questions about this possible new definition of autism. Multimedia DOCUMENT: How the Definition of Autism May Change Graphic Redefining Autism Interactive Feature Patient Voices: Autism Related Health Guide: Autism Autism, Grown Up: Navigating Love and Autism (December 26, 2011) Autism, Grown Up: Autistic and Seeking a Place in an Adult World (September 18, 2011) The definition is now being reassessed by an expert panel appointed by the American Psychiatric Association, which is completing work on the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, the first major revision in 17 years. The D.S.M., as the manual is known, is the standard reference for mental disorders, driving research, treatment and insurance decisions. Most experts expect that the new manual will narrow the criteria for autism; the question is how sharply. The results of the new analysis are preliminary, but they offer the most drastic estimate of how tightening the criteria for autism could affect the rate of diagnosis. For years, many experts have privately contended that the vagueness of the current criteria for autism and related disorders like Asperger syndrome was contributing to the increase in the rate of diagnoses — which has ballooned to one child in 100, according to some estimates. The psychiatrists’ association is wrestling with one of the most agonizing questions in mental health — where to draw the line between unusual and abnormal — and its decisions are sure to be wrenching for some families. At a time when school budgets for special education are stretched, the new diagnosis could herald more pitched battles. Tens of thousands of people receive state-backed services to help offset the disorders’ disabling effects, which include sometimes severe learning and social problems, and the diagnosis is in many ways central to their lives. Close networks of parents have bonded over common experiences with children; and the children, too, may grow to find a sense of their own identity in their struggle with the disorder. The proposed changes would probably exclude people with a diagnosis who were higher functioning. “I’m very concerned about the change in diagnosis, because I wonder if my daughter would even qualify,” said Mary Meyer of Ramsey, N.J. A diagnosis of Asperger syndrome was crucial to helping her daughter, who is 37, gain access to services that have helped tremendously. “She’s on disability, which is partly based on the Asperger’s; and I’m hoping to get her into supportive housing, which also depends on her diagnosis.” The new analysis, presented Thursday at a meeting of the Icelandic Medical Association, opens a debate about just how many people the proposed diagnosis would affect. The changes would narrow the diagnosis so much that it could effectively end the autism surge, said Dr. Fred R. Volkmar, director of the Child Study Center at the Yale School of Medicine and an author of the new analysis of the proposal. “We would nip it in the bud.” Experts working for the Psychiatric Association on the manual’s new definition — a group from which Dr. Volkmar resigned early on — strongly disagree about the proposed changes’ impact. “I don’t know how they’re getting those numbers,” Catherine Lord, a member of the task force working on the diagnosis, said about Dr. Volkmar’s report. Previous projections have concluded that far fewer people would be excluded under the change, said Dr. Lord, director of the Institute for Brain Development, a joint project of NewYork-Presbyterian Hospital, Weill Medical College of Cornell University, Columbia University Medical Center and the New York Center for Autism. Disagreement about the effect of the new definition will almost certainly increase scrutiny of the finer points of the psychiatric association’s changes to the manual. The revisions are about 90 percent complete and will be final by December, according to Dr. David J. Kupfer, a professor of psychiatry at the University of Pittsburgh and chairman of the task force making the revisions. At least a million children and adults have a diagnosis of autism or a related disorder, like Asperger syndrome or “pervasive developmental disorder, not otherwise specified,” also known as P.D.D.-N.O.S. People with Asperger’s or P.D.D.-N.O.S. endure some of the same social struggles as those with autism but do not meet the definition for the full-blown version. The proposed change would consolidate all three diagnoses under one category, autism spectrum disorder, eliminating Asperger syndrome and P.D.D.-N.O.S. from the manual. Under the current criteria, a person can qualify for the diagnosis by exhibiting 6 or more of 12 behaviors; under the proposed definition, the person would have to exhibit 3 deficits in social interaction and communication and at least 2 repetitive behaviors, a much narrower menu. Dr. Kupfer said the changes were an attempt to clarify these variations and put them under one name. Some advocates have been concerned about the proposed changes. “Our fear is that we are going to take a big step backward,” said Lori Shery, president of the Asperger Syndrome Education Network. “If clinicians say, ‘These kids don’t fit the criteria for an autism spectrum diagnosis,’ they are not going to get the supports and services they need, and they’re going to experience failure.” 1 2 Next Page » Amy Harmon contributed reporting.

Johnson & Johnson Settles Risperdal Claim in Texas Posted: 20 Jan 2012 11:47 AM PST Johnson & Johnson said on Thursday that it would pay $158 million to settle a Texas lawsuit accusing the drug maker of improperly marketing its Risperdal antipsychotic drug to state residents on the Medicaid health program for the poor, including children. Related Times Topic: Johnson & Johnson Add to Portfolio Johnson & Johnson Go to your Portfolio » The lawsuit accuses the company of pushing Risperdal as “appropriate and safe to treat a broad range of symptoms in populations and disease states for which it had no F.D.A.-approved indication, including in the child and adolescent population.” The settlement fully resolves all Risperdal-related claims in Texas, the company said. The agreement applies only to the state of Texas and does not involve other state or federal Risperdal litigation. The deal settles claims brought by Texas in 2004 and involves allegations of Medicaid overpayments from 1994 to 2008, according to a statement from the company’s Janssen Pharmaceuticals unit. “Johnson & Johnson’s scheme to profit from the Medicaid program by overstating the safety and effectiveness of an expensive drug and improperly influencing officials ended up costing taxpayers millions of dollars,” Texas’s attorney general, Greg Abbott, said in a statement. The settlement will be paid to the original plaintiff, his lawyers, the State of Texas and the federal government, which provides Medicaid reimbursements, the company said. The complaint against Johnson & Johnson and several of its units filed in federal court in Texas accused company representatives of targeting “every level of the Texas Medicaid Program with misrepresentations about the safety, superiority, efficacy, appropriate uses and cost effectiveness of Risperdal.” Johnson & Johnson had previously said it was in discussions with the federal government over its Risperdal inquiries. The company is in various stages of litigation with several other states.

Osteoporosis Is So Slow, Bone Density Retests Can Wait, Study Says Posted: 19 Jan 2012 11:37 PM PST Bone loss and osteoporosis develop so slowly in most women whose bones test normal at age 65 that many can safely wait as long as 15 years before having a second bone density test, researchers report in a new study. Enlarge This Image Michael Nagle for The New York Times Dr. Ethel S. Siris, director of the Toni Stabile Osteoporosis Center, stands in front of a bone density scanner at the Columbia University Medical Center New York-Presbyterian Hospital. New Old Age Share your thoughts on this column at the New Old Age blog. Go to New Old Age » Related Health Guide: Osteoporosis The study, published in Thursday’s issue of The New England Journal of Medicine, is part of a broad rethinking of how to diagnose and treat the potentially debilitating bone disease that can lead to broken hips and collapsing spines. A class of drugs, bisphosphonates, which includes Fosamax, has been found to prevent fractures in people with osteoporosis. But medical experts no longer recommend the medicines to prevent osteoporosis itself. They no longer want women to take them indefinitely, and no longer consider bone density measurements the sole defining factor in deciding if a woman needs to be treated. Now, with the new study, researchers are asking whether frequent bone density measurements even make sense for the majority of older women whose bone density is not near a danger zone on initial tests, recommended at age 65. “Bone density testing has been oversold,” said Steven Cummings, the study’s principal investigator and an emeritus professor of medical epidemiology and biostatistics at the University of California, San Francisco. The study followed nearly 5,000 women ages 67 and older for more than a decade. The women had a bone density test when they entered the study and did not have osteoporosis. (In a separate national study by the Centers for Disease Control and Prevention, about 70 percent of women over age 65 did not have osteoporosis.) The researchers report that fewer than 1 percent of women with normal bone density when they entered the study, and fewer than 5 percent with mildly low bone density, developed osteoporosis in the ensuing 15 years. But of those with substantially low bone density at the study’s start, close to the cutoff point for osteoporosis of fewer than 2.5 standard deviations from the reference level, 10 percent progressed to osteoporosis in about a year. Dr. Margaret Gourlay, the study’s lead author and a family practice specialist and osteoporosis researcher at the University of North Carolina, said she and her colleagues were surprised by how slowly osteoporosis progressed in women. Medicare pays for a bone density test every two years and many doctors have assumed that is the ideal interval, although national guidelines recommend them only at “regular intervals.” “I think this will change the way doctors think about screening,” Dr. Gourlay said. The results, said Joan A. McGowan, director of the division of musculoskeletal diseases at the National Institute of Arthritis and Musculoskeletal and Skin Diseases, “provide telling evidence that you are not going to fall off a cliff if you have normal bone density in your 60s or early 70s, that you are not going to have osteoporosis in the next five years unless something else happens.” For example, said Dr. McGowan, who was not involved in the study, a woman who had to take high doses of corticosteroids for another medical condition would lose bone rapidly. But the findings “cover most normal women,” she said. Bone density screening took off after Fosamax, the first bisphosphonate, was approved at the end of 1995. For the first time, doctors had a specific treatment that had been shown to prevent fractures in people with osteoporosis. For years doctors were overly enthusiastic, prescribing it for women whose bone density was lower than normal but not in a danger zone, keeping women on the drug indefinitely. They even gave a name, osteopenia, to lower than normal bone density, although it was not clear it had real clinical significance. Now, osteoporosis experts consider osteopenia to be a risk factor, not a disease, and its importance varies depending on a patient’s age, said Dr. Ethel S. Siris, an osteoporosis researcher at Columbia University who was not involved in the study. Doctors are more likely to prescribe bisphosphonates for older patients and recommend against them for most younger postmenopausal women with osteopenia. The experts also generally recommend that most people on bisphosphonates take them for just five years at a time, followed by a drug holiday of undetermined length. The idea is to reduce the risk of rare but serious side effects, including unusual thighbone fractures and loss of bone in the jaw. A risk calculator, FRAX, can help determine whether treatment is recommended. It assesses a combination of risk factors: whether a parent has had a hip fracture, the age of the patient, steroid use, bone density at the hip, and whether the person has broken a bone after age 50, an especially important indicator. Nearly half who break a hip already had already broken another bone, Dr. Siris said. “If you are an older individual, a man or a woman, who already broke a major bone — spine, hip, shoulder, or pelvis or wrist — take it very seriously and get treated,” she said. “If you have relatively good bone density then you are not at risk now.”

Well: Helping Injured Dogs Walk Again Posted: 19 Jan 2012 11:51 AM PST

A French Film Takes Issue With the Psychoanalytic Approach to Autism Posted: 20 Jan 2012 02:50 AM PST PARIS — “Le Mur,” or “The Wall,” a small documentary film about autism released online last year, might normally not have attracted much attention. But an effort by French psychoanalysts to keep it from public eyes has helped to make it into a minor cause and shone a spotlight on the way children in France are treated for mental health problems. The documentary, the first film by Sophie Robert, follows two autistic boys: Guillaume, who has been treated with the behavioral, or “American,” approach; and Julien, who has been kept in an asylum for six years and treated with psychoanalysis. Guillaume, though challenged, is functioning at a high level in school. Julien is essentially silent, locked out of society. Since Sept. 8, when the film first became available on the Web, it and Ms. Robert, 44, have been the targets of criticism from both the analysts who appear in the film and from within the country’s psychoanalytic establishment. Three of the psychoanalysts whom Ms. Robert interviewed for the film have sued her, claiming she misrepresented them in the 52-minute documentary, which has not yet been screened in cinemas or on television. On Jan. 26, a court in the northern city of Lille will decide whether Ms. Robert must remove their interviews from the documentary if she wishes to keep screening it. The plaintiffs are also seeking damages of €300,000, or $384,000. The lawsuit might be futile, since the film is widely available on the Web (with English subtitles), having been viewed on YouTube more than 16,000 times. (Ms. Robert argues that the plaintiffs, all of whom appear in the film, signed detailed releases.) Ms. Robert is planning to screen the film in Philadelphia at an autism conference on Jan. 27, the day after the court is to rule. If she wins, a local channel in the north of France, Weo, has agreed to screen it, as has Télévision Suisse Romande, a Swiss channel. The film makes no pretense of objectivity, juxtaposing interviews with psychoanalysts with scathing criticism of the field’s precepts. Ms. Robert, 44, describes herself as an anthropologist and said she once wanted to be a psychoanalyst herself. “I would have never imagined what I discovered,” she said of her first few interviews for the film. “Then I thought, wow, what I hear is just crazy.” Christian Charrière-Bournazel, the lawyer for the three plaintiffs — Esthela Solano Suárez, Éric Laurent et Alexandre Stevens — did not respond to requests for comment. But in court filings, Mr. Charrière-Bournazel said the film had been edited to make his clients look absurd. Ms. Robert, he said, presented the project to the analysts as a documentary, though “it was in reality a polemical enterprise meant to ridicule psychoanalysis in favor of the behavioral treatments that are so fashionable in the United States.” “The film is unfair,” Élisabeth Roudinesco, a French historian of psychoanalysis at the University of Paris VII, said. “It is fanatically anti-psychoanalysis. But I don’t think she’s manipulated the film to make them look ridiculous; rather, I think she chose to talk with very dogmatic psychoanalysts who come across as ridiculous.” Professor Roudinesco said the French psychoanalysis community was actually quite divided by the question of autism, with some “fanatics who believe that autism is caused by a frigid, cold mother. But you don’t attack an entire discipline of medicine because of a scandal involving a few practitioners.” “Even if it is proved someday that autism is a genetic malady,” she asked, “why abandon the idea that the talking cure could help the patient?” The idea that children with autism spectrum disorder should be treated with the “talking cure” employed in psychoanalysis may sound outdated to some viewers, since many medical scientists believe that underlying physiological problems are at least partly responsible for the disorder. In the United States, the National Institutes of Health recommends that it be treated with behavioral and other therapies. Ms. Robert said the version of psychoanalysis that is most prevalent in France, particularly the post-Freudian school championed by Jacques Lacan, takes it as a given that autism and other mental health problems are caused by children’s relationship with their mothers, or by “maternal madness.” “Sometimes, when the mother is depressed, in utero, I mean when she is pregnant or at birth, sometimes the child can be autistic,” an analyst tells the camera in one scene. Another explains that autistic children “are sick of language — autism is a way of defending themselves from language.” To the question of what an autistic child can expect to gain from psychoanalysis, yet another analyst responds, “The pleasure of taking interest in a soap bubble. I can’t answer anything else.” 1 2 Next Page »

Afghanistan Polio Cases Rise After Years of Decline Posted: 18 Jan 2012 12:40 PM PST KABUL, Afghanistan — It has often been called the polio cease-fire. Related Times Topic: Afghanistan Health Guide: Poliomyelitis Connect With Us on Twitter Follow @nytimesworld for international breaking news and headlines. In a country where insurgents have for years attacked and killed people working for the government or the international community, a small army of vaccination teams connected to both has, year after year, fanned out through some of Afghanistan’s most dangerous areas, quietly and mostly safely. Appointed by the government, paid for by international agencies and given free passage by the Taliban in one of the last three countries in the world where polio is endemic, the Global Polio Eradication Initiative’s 65,000 volunteers and workers had seemed to have nearly wiped out the disease — until recently. After years of steady decline, only 25 polio cases were reported in the country in 2010, prompting one international health care official to declare that “the Afghans are heroes.” Then last year, the number tripled to 76, the Afghan Ministry of Public Health said. While the total remains small, polio is highly contagious, and health experts say that each detected case is an indicator of hundreds of “silent” ones, mainly children with mild infections who become carriers. Health workers are alarmed at the reversal of what has been a local and worldwide trend — particularly since some of the cases erupted far outside the disease’s traditional areas in Afghanistan. “This is a national tragedy to end up with a major polio outbreak, especially with all the effort they have put into it,” said Dr. Bruce Aylward, the polio coordinator for the World Health Organization. “It increases the risk to neighboring countries and is both a local and national, and international, concern.” President Hamid Karzai, in a statement, in effect blamed the Taliban. “Those who stand in the way of vaccination are the true enemies of our children’s future,” he said, calling on “the armed opposition to allow the vaccination teams to help save children against the lifetime paralysis.” Health care officials said they had experienced no change in the militants’ tolerance for the vaccination efforts, and the Taliban reacted indignantly. “It is not for Karzai to ask us to attack or not to attack someone,” said the Taliban’s southern Afghanistan spokesman, Qari Yousaf Ahmadi. Mr. Ahmadi said there had been no change in Taliban policy toward polio vaccination teams. “We have never attacked medical teams, as long as they coordinate with us when they enter areas under our control,” he said. After decades of worldwide immunization efforts, polio is now considered endemic only to Afghanistan and neighboring Pakistan, where cases also increased drastically last year, and in northern Nigeria. India, long a center of the disease, last week celebrated its first full year with no new cases, the World Health Organization reported. “It has been a huge achievement,” Vidhya Ganesh, Unicef’s deputy representative in Afghanistan, said of the worldwide effort. Unicef and the World Health Organization oversee the $32 million eradication campaign in Afghanistan. “If polio were to be eradicated, it would be only the second disease ever,” she said. The last case of smallpox, the first human disease believed to be successfully eradicated, was diagnosed in 1977. Ahmad Azadi, a spokesman for the World Health Organization here, said, “At only 25 cases, you could almost smell the victory.” Peter Crowley, Unicef’s country representative in Afghanistan, said security was a factor in the rising number of cases, “but it is not the only factor.” In Afghanistan, polio has traditionally been concentrated in the Pashtun belt across southern Afghanistan — some of the most dangerous areas of conflict in the country. Last year, however, cases also emerged in northern, central and eastern parts of Afghanistan, apparently spread by travelers or refugees from endemic areas in Pakistan. One of Pakistan’s major polio areas is the Pashtun tribal region contiguous with Afghanistan’s. Just as a porous, rugged border has allowed the infiltration of insurgents, it has also provided pathways for the spread of polio. New polio cases in Pakistan rose to 192 in 2011 from 80 in 2010, said Muhammed Taufiq Mashal, the director general of preventive medicine in the Afghan Ministry of Public Health. He blames much of the polio increase on infiltration from Pakistan, which World Health Organization scientists say is confirmed by gene sequencing of the virus in victims. While some extremist Muslim leaders in Pakistan and Nigeria have denounced vaccination programs as a Western conspiracy, that has not been the case with the Taliban. Many polio vaccination teams carry a letter bearing the signature of the Taliban leader, Mullah Muhammad Omar, approving of their work. Those who saw Mr. Karzai’s statement as politicizing the issue were sharply critical. “I was very shocked when I read the president’s statement,” said an international health official, who spoke on the condition of anonymity because of his agency’s rules about criticizing a host country’s government. “Politicizing this issue is alarming. Health is not a political thing.” A Western official speaking anonymously said, “The reason polio vaccination teams have been able to operate is because they’re allowed to operate.” Naqibullah Faieq, who leads the health committee in the Afghan Parliament, said, “This health issue is nonpolitical, nonmilitary.” He added, “We want both the government and the Taliban to not use the issue of vaccination in their speeches.” The World Health Organization is expected this week to declare increases in polio cases a “global public health emergency,” Dr. Aylward said. He said that the eradication program in Afghanistan remained effective, and that authorities on all sides seemed determined to make it work. Still, he said, “anytime you see a three-fold increase in an epidemic-prone disease, you’ve got to be concerned about it.” Donald G. McNeil Jr. contributed reporting from New York, and Sharifullah Sahak from Kabul.

Paula Deen Says She Has Type 2 Diabetes Posted: 21 Jan 2012 07:58 PM PST FOR 10 years, wielding slabs of cream cheese and mounds of mayonnaise, Paula Deen has become television’s self-crowned queen of Southern cuisine and one of the country’s most popular chefs, with an empire built on layers of gooey butter cake, fried chicken and sheer force of personality. Enlarge This Image Alberto E. Rodriguez/Getty Images Paula Deen in January 2011.  Related Times Talk Excerpt: Kim Severson Interviews Paula Deen Diner's Journal: Which Paula Deen Recipe Tops Them All? (January 17, 2012) From Phobia to Fame: A Southern Cook's Memoir (February 28, 2007) Health Guide: Diabetes, Type 2 Related in Opinion Op-Ed Columnist: Of Mouselike Bites and Marathons (January 22, 2012) Op-Ed Columnist: Unsavory Culinary Elitism (August 25, 2011) On Tuesday, she suddenly unveiled a new career for herself: herald of a healthy life. In an interview on the “Today” show on NBC, she revealed — as has long been rumored — that she has Type 2 diabetes, a diagnosis that she said she received three years ago. In an interview with The New York Times, she said the delay in announcing it had been part of a necessary personal journey. “I wanted to wait until I had something to bring to the table,” she said. Now, Ms. Deen, 64, has brought to her own table a multiplatform endorsement deal with Novo Nordisk, the Danish pharmaceutical company that makes Victoza, a noninsulin injectable diabetes medication that she began promoting on Tuesday morning. She and her sons, Jamie and Bobby (who do not have diabetes), are all being paid to spearhead the company’s upbeat new public-relations campaign, “Diabetes in a New Light,” which advocates using the drug along with eating lighter foods and increasing physical activity. All the same, Ms. Deen said she would not change her own lifestyle or cooking style drastically, other than to reduce portion sizes of unhealthful foods. “I’ve always preached moderation,” she said. “I don’t blame myself.” Bobby Deen, who was at his mother’s side throughout the day, has a new healthful-cooking show, “Not My Mama’s Meals,” that began last month. Through a spokeswoman, the Food Network said that that it did not know of Ms. Deen’s illness before last week. Ms. Deen’s announcement, delivered with the liveliness of the head cheerleader she was back in 1965, testified to her savvy as an up-from-the-roots businesswoman, turning a setback into a fresh opportunity with a series of news media appearances that played out through the day. Andrew Essex, head of the New York marketing agency Droga5, which advises candidates and companies on branding, said Ms. Deen’s bid for transformation was ambitious. “There’s no question that she was the face of a certain kind of egregious indulgence,” he said. “If she can now become the face of healthy living, it will be a Gatsby-esque turnaround.” Her revelation also adds a fresh story line to a roiling national debate about obesity, with elements of celebrity, schadenfreude and the current popular favorite, class warfare. And it comes as the Food Network prepares next week to broadcast “Fat Chef,” a new reality show that illustrates the difficulty many cooks have in managing the temptations and nutritional pitfalls of the job. Thousands of Ms. Deen’s fans tweeted their support and posted messages of sympathy on her Facebook wall Tuesday. But many others questioned her motives in concealing the condition for so long, or said they spotted hypocrisy in her decision to profit from an illness that they believe she had abetted. On Facebook, Dolly Furst of Pennsylvania posted: “Sorry Paula. I think you hid the disease because the network thought people would dump your show.” Katherine Pietrycha wrote: “These deals don’t get done overnight. I think she’s known for quite some time she’s had this, and in the meantime, has been pushing recipes filled with sugar and fat.” A chorus of “told you sos” sprang up on the blogosphere. “No wonder she has diabetes,” tweeted Jennifer Eure, who lives in Franklin, Va., during “Paula’s Home Cooking” on Monday as Ms. Deen discussed what kind of breadsticks to pair with bacon cheese fries. More than 25 million Americans, or about 8.3 percent of the population, are believed to have diabetes, most of it Type 2 or “adult onset” diabetes. Like those other cases, Ms. Deen’s illness was probably caused by any of a number of forces, including excess weight, high blood pressure, lack of exercise and high blood levels of sugar, fat and cholesterol. But unlike her fellow patients, Ms. Deen is now enduring an epic public scolding because of her cooking and eating habits. Heredity, according to the American Diabetes Association, always plays some part. “You can’t just eat your way to Type 2 diabetes,” said Geralyn Spollett, the group’s director of education. But, Ms. Spollett added, Southern cooking, as often practiced, can be particularly hazardous to those predisposed to the disease. “There’s no denying that Paula’s food has a lot of what we call the deadly triangle: fat, sugar and salt,” she said. Ms. Deen would not say what she thought had caused her illness. But she said she takes the drug she is promoting, Victoza. 1 2 Next Page »

Well: Obesity Rates Stall, But No Decline Posted: 17 Jan 2012 01:44 PM PST

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Really?: The Claim: Excess Weight Raises the Risk of Acne Posted: 23 Jan 2012 08:04 AM PST

Personal Health: Lifelines for People With Hearing Loss Posted: 16 Jan 2012 11:29 AM PST

News Analysis: Hard Truths About Disclosure Posted: 23 Jan 2012 11:18 AM PST IN New York and a growing number of American cities, diners are encountering sanitary grades in restaurants’ windows — A, B or C. That system is an example of helpful disclosure, researchers say: information that is simple and comprehensible, important to recipients and easily acted upon. I recently chose between outwardly identical Japanese noodle shops on East Ninth Street in Manhattan based on the system, walking into the A rather than the B. Enlarge This Image Jennifer Daniel Related News U.S. to Force Drug Firms to Report Money Paid to Doctors (January 17, 2012) Enlarge This Image Jennifer Daniel But as greater disclosure has become the go-to solution for a wide range of problems — from unethical campaign financing to rising corporate carbon emissions — it has often delivered lackluster results, researchers say. Just last week, the Obama administration announced plans to require drug companies to disclose a wide variety of payments and gifts to doctors, from speaking fees to the purchase of breakfasts for office staffs, in the hope of reducing commercial influence on prescribing practices. President Obama has promised to run the most open, transparent administration in history. But is more disclosure the solution? If recent history serves as a guide, disclosure laws — meant to elucidate — do not necessarily lead to greater transparency or prevent the things they were meant to deter. Every holder of a subprime mortgage that is now underwater once signed an elaborate disclosure statement required by the Truth in Lending Act describing precisely the risky terms of their loan. Likewise, “super PACs” in the presidential campaign are technically compliant with financial disclosure laws, but have so far proved successful at hiding many of the sources of their money. Everyone agrees that openness is a virtue in a democracy. So what is going wrong? One fundamental problem is that disclosure requirements merely get information onto the table, but themselves demand no further action. According to political theory, disclosure is both a citizen’s right and a tool to ensure good government and consumer protection, because it provides information that leads to informed decisions. Instead, disclosure has often become an endpoint in the chain of responsibility, an act of compliance with the letter of the law rather than the spirit of transparency. “In the beginning, disclosure was a means to an end, and now it’s often an end in itself,” said Kevin P. Weinfurt, professor of psychiatry and behavioral science at Duke University. “People think, ‘If we’ve disclosed we’ve fulfilled our responsibilities.’ ” Indeed, disclosure has taken on the gestalt of confession: Dump the information and be absolved of further moral or legal responsibility. How did car-crazy cities like Los Angeles and Phoenix earn an A+ in a study by the Roberts Environmental Center at Claremont McKenna College? By being superb at disclosing, not controlling, emissions. Clyde Wilcox, a political scientist at Georgetown University, said: “Disclosure by itself is not the solution to any problem. It’s a path to earn trust. But just saying things is not enough, unless you also do something.” Part of the problem is that the goals of disclosure are often unclear, said Dr. Weinfurt, who has studied disclosure in medicine. “We want the information, but often no one knows exactly what to do with the information once they get it.” For example, how should one respond to the government disclosure letters sent to homes in the United States with information about local water quality, containing lists of chemical compounds in parts per million? And what was the appropriate reaction to the Homeland Security Department’s recently abandoned program to disclose risk assessments with color-coded warnings at airports ranging from safe green to “severe” red? Unlike the restaurant-grading system, such threat-level disclosure “is ineffective because there’s no way to act on it,” said Archon Fung, co-founder of the Transparency Policy Project at the Harvard Kennedy School. Many disclosure programs today cloud rather than clarify a particular situation. As disclosure statements have become more numerous and more complicated, “consumers just ignore them or don’t understand what they say,” said Jeff Sovern, an expert in consumer law at St. John’s University. To illustrate how few people actually read its terms and conditions disclosure, the online retailer Gamestation, on April Fools’ Day 2010, replaced the usual text with what it called an “immortal soul clause,” which read: “By placing an order via this Web site on the first day of the fourth month of the year 2010 anno Domini, you agree to grant us a non-transferable option to claim, for now and forever more, your immortal soul.” Eager to get on with their online purchase, 88 percent of customers clicked the box to sell their souls. (The 12 percent who opted out were rewarded with a cash credit for their diligence.) 1 2 Next Page » Elisabeth Rosenthal is a reporter and blogger on environmental issues for The New York Times. This posting includes an audio/video/photo media file: Download Now

Opinionator: What We Give Up for Health Care Posted: 21 Jan 2012 02:41 PM PST

Letters: Brain Trauma Lingers (1 Letter) Posted: 16 Jan 2012 09:32 PM PST To the Editor: “When Injuries to the Brain Tear at Hearts” (Jan. 10) graphically illustrates both the devastating consequences of severe brain injuries and the limited prospects for recovery, but it ignores a very important point. As a matter of elementary rationality, fairness and sensitivity to all concerned, family members should think long and hard before authorizing heroic measures to save the lives of people who have had the misfortune to suffer such injuries. It is often better to let a person go than to consign him to a miserable existence as someone very different from who he was before the catastrophe. John S. Koppel Bethesda, Md.

Letters: When the Heart Hurts (1 Letter) Posted: 16 Jan 2012 09:32 PM PST To the Editor: Having survived broken heart syndrome (“The Claim: Grief Can Cause a Heart Attack,” Really?, Jan. 10), I think it is limiting not to include the death of a relationship as a main cause. Death, loss (including job loss), separation and bereavement come in many forms that can trigger stress hormones. Syndrome survivors may discover that there were no blockages in our arteries, no need for a stent or angioplasty, and often no medications are prescribed. Medical researchers have little long-range data on broken heart syndrome, also called Takotsubo cardiomyopathy. More research dollars, please. Judith Bin-Nun Los Angeles

Letters: Life After Bad Choices (1 Letter) Posted: 16 Jan 2012 09:32 PM PST To the Editor: Re “Advice From Life’s Graying Edge on Finishing With No Regrets” (Personal Health, Jan. 10): I think that Jane Brody should write a column on finishing life with regrets. The obvious issue with her article is that everyone noted made the right decisions and enjoyed a comfortable life. The advice you want is from Americans Who Made Stupid Decisions Early On. Charlton Holland Oakland, Calif.

Teenagers Sharing Passwords as Show of Affection Posted: 18 Jan 2012 09:27 AM PST

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