Health - Bacteria Divide People Into 3 Types, Scientists Say

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• Bacteria Divide People Into 3 Types, Scientists Say
• Consults: College-Bound and Living With Autism
• The New Old Age: A Mother’s Nighttime Rage
• In Online Games, a Path to Young Consumers
• Medical Experts Dispute a Hospital’s Claims on Heart Device Data
• Vibrators Carry the Conversation
• Ohio County Losing Its Young to Painkillers’ Grip
• Personal Best: For an Exercise Afterburn, Intensity May Be the Key
• Mind: Come On, I Thought I Knew That!
• Well: New Lessons to Pave a Road to Safety
• Recipes for Health: ‘Bouillabaisse’ of Fresh Peas With Poached Eggs
• Alfred Freedman, a Leader in Psychiatry, Dies at 94
• Obama Panel to Curb Medicare Finds Foes in Both Parties
• J.&J. Profit Tops Estimates on Prescription Drug Sales
• U.S. Engineers Cite Lengthy Cleanup in Japan
• Drug That Stops Bleeding Shows Off-Label Dangers
• Vegan Promoter Uses Photos of Meat and Dairy Items, and Fury Follows
• Global Update: Syria: Fighting the Fungi That Threaten Wheat
• Well: Pesticide Exposure in Womb Affects I.Q.
• Well: Think Like a Doctor: A Litany of Symptoms Solved!
• Well: Think Like a Doctor: A Litany of Symptoms
• Well: Are Gawky Adolescents More Injury Prone?
• Well: Side Sleeping to Reduce Snoring
• Magazine Preview: The Crash and Burn of an Autism Guru
• Personal Health: The Nose May Not Know What It’s Missing
• Really?: The Claim: To Reduce Snoring, Try Sleeping on Your Side
• The New Old Age: Remaking Alzheimer's: A Few Questions
• The New Old Age: Alzheimer's, Redefined
• The New Old Age: 'Ask Medicare' 2.0
• Prescriptions: UnitedHealth Group Reports Strong Earnings
• Prescriptions: This Week's Health Industry News
• Letters: Sick, but Not Alone (1 Letter)
• Letters: Glowing With Health (1 Letter)
• Letters: The Hearts of Athletes (1 Letter)
• Administration Wants Tighter Painkiller Rules
• Allan Blakeney, Pioneer of Canadian Health Care, Dies at 85
• Lack of Success Terminates Study in Africa of AIDS Prevention in Women
• Guidelines Allow Earlier Definition of Alzheimer’s
• Vital Signs: Exercise: Fewer Healthy Habits for Young Mothers
• Recipes for Health: Ribollita
• Recipes for Health: Apple-Spice Breakfast Soup
• Recipes for Health: Majorcan Bread and Vegetable Soup
• Recipes for Health: A Bowlful of Our Daily Bread

Bacteria Divide People Into 3 Types, Scientists Say Posted: 21 Apr 2011 04:40 AM PDT In the early 1900s, scientists discovered that each person belonged to one of four blood types. Now they have discovered a new way to classify humanity: by bacteria. Each human being is host to thousands of different species of microbes. Yet a group of scientists now report just three distinct ecosystems in the guts of people they have studied. Enlarge This Image Photo Researchers Gut microbes help digest food and synthesize vitamins. RSS Feed Get Science News From The New York Times » Blood type, meet bug type. “It’s an important advance,” said Rob Knight, a biologist at the University of Colorado, who was not involved in the research. “It’s the first indication that human gut ecosystems may fall into distinct types.” The researchers, led by Peer Bork of the European Molecular Biology Laboratory in Heidelberg, Germany, found no link between what they called enterotypes and the ethnic background of the European, American and Japanese subjects they studied. Nor could they find a connection to sex, weight, health or age. They are now exploring other explanations. One possibility is that the guts, or intestines, of infants are randomly colonized by different pioneering species of microbes. The microbes alter the gut so that only certain species can follow them. Whatever the cause of the different enterotypes, they may end up having discrete effects on people’s health. Gut microbes aid in food digestion and synthesize vitamins, using enzymes our own cells cannot make. Dr. Bork and his colleagues have found that each of the types makes a unique balance of these enzymes. Enterotype 1 produces more enzymes for making vitamin B7 (also known as biotin), for example, and Enterotype 2 more enzymes for vitamin B1 (thiamine). The discovery of the blood types A, B, AB and O had a major effect on how doctors practice medicine. They could limit the chances that a patient’s body would reject a blood transfusion by making sure the donated blood was of a matching type. The discovery of enterotypes could someday lead to medical applications of its own, but they would be far down the road. “Some things are pretty obvious already,” Dr. Bork said. Doctors might be able to tailor diets or drug prescriptions to suit people’s enterotypes, for example. Or, he speculated, doctors might be able to use enterotypes to find alternatives to antibiotics, which are becoming increasingly ineffective. Instead of trying to wipe out disease-causing bacteria that have disrupted the ecological balance of the gut, they could try to provide reinforcements for the good bacteria. “You’d try to restore the type you had before,” he said. Dr. Bork notes that more testing is necessary. Researchers will need to search for enterotypes in people from African, Chinese and other ethnic origins. He also notes that so far, all the subjects come from industrial nations, and thus eat similar foods. “This is a shortcoming,” he said. “We don’t have remote villages.” The discovery of enterotypes follows on years of work mapping the diversity of microbes in the human body — the human microbiome, as it is known. The difficulty of the task has been staggering. Each person shelters about 100 trillion microbes. (For comparison, the human body is made up of only around 10 trillion cells.) But scientists cannot rear a vast majority of these bacteria in their labs to identify them and learn their characteristics. As genetics developed, scientists learned how to study the microbiome by analyzing its DNA. Scientists extracted DNA fragments from people’s skin, saliva and stool. They learned how to recognize and discard human DNA, so that they were left with genes from the microbiome. They searched through the remaining DNA for all the variants of a specific gene and compared them with known species. In some cases, the variants proved to be from familiar bacteria, like E. coli. In other cases, the gene belonged to a species new to science. These studies offered glimpses of a diversity akin to a rain forest’s. Different regions of the body were home to different combinations of species. From one person to another, scientists found more tremendous variety. Many of the species that lived in one person’s mouth, for example, were missing from another’s. Scientists wondered if deeper studies would reveal a unity to human microbiomes. Over the past few years, researchers have identified the genomes — the complete catalog of genes — of hundreds of microbe species that live in humans. Now they can compare any gene they find with these reference genomes. They can identify the gene’s function, and identify which genus of bacteria the microbe belongs to. And by tallying all the genes they find, the scientists can estimate how abundant each type of bacteria is. In the recent work, Dr. Bork and his team carried out an analysis of the gut microbes in 22 people from Denmark, France, Italy and Spain. Some of their subjects were healthy, while others were obese or suffered from intestinal disorders like Crohn’s disease. Dr. Bork and his colleagues searched for fragments of DNA corresponding to the genomes of 1,511 different species of bacteria. The researchers combined their results with previous studies of 13 Japanese individuals and 4 Americans. The scientists then searched for patterns. “We didn’t have any hypothesis,” Dr. Bork said. “Anything that came out would be new.” Still, Dr. Bork was startled by the result of the study: all the microbiomes fell neatly into three distinct groups. And, as Dr. Bork and his colleagues reported on Wednesday in the journal Nature, each of the three enterotypes was composed of a different balance of species. People with type 1, for example, had high levels of bacteria called Bacteroides. In type 2, on the other hand, Bacteroides were relatively rare, while the genus Prevotella was unusually common. “You can cut the data in lots of different ways, and you still get these three clusters,” Dr. Bork said. Dr. Bork and his colleagues found confirmation of the three enterotypes when they turned to other microbiome surveys, and the groups continue to hold up now that they have expanded their own study to 400 people. This posting includes an audio/video/photo media file: Download Now

Consults: College-Bound and Living With Autism Posted: 21 Apr 2011 08:28 AM PDT

The New Old Age: A Mother’s Nighttime Rage Posted: 20 Apr 2011 10:35 AM PDT

In Online Games, a Path to Young Consumers Posted: 21 Apr 2011 10:05 AM PDT HESPERIA, Calif. — Deep into one of her favorite computer games, Lesly Lopez, 10, moves her mouse to click on a cartoon bee. She drags and drops it into an empty panel, creating her own comic strip. Enlarge This Image J. Emilio Flores for The New York Times Lesley Lopez, 10, creates comics on the Honey Nut Cheerios Web site, and pesters her mother to buy sugary cereals. More Photos » Ask a Question About Marketing Online to Children What should parents know about online marketing to children? Should food companies face tougher regulations when communicating with children online? The Pulitzer Prize-winning reporter Matt Richtel will respond to readers' questions. Multimedia Slide Show Online Playgrounds With a Message Related Bits Blog: McDonald's Makes Subtle Play for Children Online (April 20, 2011) Add to Portfolio McDonald's Corporation Coca-Cola Company Apple Incorporated Unilever N.V comScore Inc General Mills Inc PepsiCo Inc Go to your Portfolio » Lesly likes this online game so much that she plays twice a week, often e-mailing her creations to friends. “I always send them to my cousin in Los Angeles,” she said. But this is not just a game — it is also advertising. Create a Comic, as it is called, was created by General Mills to help it sell Honey Nut Cheerios to children. Like many marketers, General Mills and other food companies are rewriting the rules for reaching children in the Internet age. These companies, often selling sugar cereals and junk food, are using multimedia games, online quizzes and cellphone apps to build deep ties with young consumers. And children like Lesly are sharing their messages through e-mail and social networks, effectively acting as marketers. When these tactics revolve around food, and blur the line between advertising and entertainment, they are a source of intensifying concern for nutrition experts and children’s advocates — and are attracting scrutiny from regulators. The Federal Trade Commission has undertaken a study of food marketing to children, due out this summer, while the White House Task Force on Childhood Obesity has said one reason so many children are overweight is the way junk food is marketed. Critics say the ads, from major companies like Unilever and Post Foods, let marketers engage children in a way they cannot on television, where rules limit commercial time during children’s programming. With hundreds of thousands of visits monthly to many of these sites, the ads are becoming part of children’s daily digital journeys, often flying under the radar of parents and policy makers, the critics argue. “Food marketers have tried to reach children since the age of the carnival barker, but they’ve never had so much access to them and never been able to bypass parents so successfully,” said Susan Linn, a psychiatry instructor at Harvard Medical School and director of the Campaign for a Commercial-Free Childhood, an advocacy coalition. Ms. Linn and others point to many studies that show the link between junk-food marketing and poor diets, which are implicated in childhood obesity. Food industry representatives call the criticism unfair and say they have become less aggressive in marketing to children in the Internet era, not more so. Since 2006, 17 major corporations — including General Mills, McDonald’s, Pepsi, Coca-Cola and Burger King — have taken a voluntary pledge to reduce marketing of their least nutritious brands to children, an effort they updated last year to include marketing on mobile devices. The pledge says the companies, if they choose to market to children, will only advertise food choices that are “better for you,” said Elaine D. Kolish, director of the Children’s Food and Beverage Advertising Initiative, an arm of the Better Business Bureau that oversees the pledge. “Compliance is excellent,” she said of the pledge. She noted that in recent months, companies had shut down several child-centric sites, including General Mills’s popular virtual world Millsberry, while other sites have been changed to focus on adults, like those of Kellogg’s Pop Tarts and Pepsi’s Cap’n Crunch. And she said General Mills and Post Foods had cut or pledged to cut the amount of sugar in some cereals. Only rarely do these major companies violate their pledges, she said: “It’s pretty darn infrequent and it’s not willful.” Nutrition experts say that the voluntary pledges are fraught with loopholes, and that “better for you” is a relative term that allows companies to keep marketing unhealthful options. Whatever criticism they may invite, the companies have good financial reason to pitch to children. James McNeal, a former marketing professor at Texas A&M University, estimates conservatively that children influence more than $100 billion in food and beverage purchases each year, and well over half of all cold cereal purchases. Children “have power over spending in the household, they have power over the grandparents, they have power over the babysitters, and on and on and on,” said Professor McNeal, who has researched family behavior for decades and consulted for major companies on marketing to children. “All of that is finally being recognized and acknowledged.” Some parents, like Lesly Lopez’s mother, Toribia Huerta, 26, say the online marketing is subverting their efforts to improve their children’s diets. Ms. Huerta said Lesly and her younger siblings pester her for sugary cereals they see in the games and for snacks like Baby Bottle Pops, a candy with a game site that the girl also visits often. “They ask me for it constantly. They’re hard to resist when they whine,” Ms. Huerta said, speaking in Spanish through a translator. She blames her daughter’s love of sugar for her dental problems, including many cavities. But Ms. Huerta also said the food sites seemed fun and safe: “They look like good games for her age.” Games for Goods 1 2 Next Page » Joshua Brustein contributed reporting from New York. This posting includes an audio/video/photo media file: Download Now

Medical Experts Dispute a Hospital’s Claims on Heart Device Data Posted: 20 Apr 2011 10:12 PM PDT Several medical experts have disputed the basis for a Las Vegas hospital’s claim that patients benefited when cardiologists there switched to heart devices made by a company that paid it consulting fees, saying data to support that claim did not exist. Add to Portfolio Boston Scientific Corporation Go to your Portfolio » This month, University Medical Center of Southern Nevada said in a statement, “results to date show significantly improved outcomes for our cardiac patients” who got heart implants made by a little-known company, Biotronik. The statement was attributed to Kathleen Silver, the chief executive of the hospital. Ms. Silver issued that statement after an article in The New York Times reported that cardiologists there switched in 2008 to using Biotronik devices after that company started paying them thousands of dollars in consulting fees. A hospital spokeswoman later said in response to a reporter’s question that Ms. Silver’s comments were based on data drawn from a national registry of heart patients who received an implanted defibrillator. University Medical Center also provided The Times with limited data from that registry that it said backed its contention. But several experts knowledgeable about that defibrillator database said in separate interviews that it did not track how device recipients fared after they left a hospital. As a result, it cannot and does not provide data to hospitals or manufacturers about the long-term performance of any company’s device. It also does not produce data that can be used to compare the performance of competing implants made by different companies. “To saying that we are doing better is a bridge too far for the data they have,” said Dr. Jeptha Curtis, an assistant professor of medicine at Yale, who has worked on research studies involving registry data. Told of the experts’ assessments, Danita Cohen, the spokeswoman for the Las Vegas hospital, responded in writing by stating, “By way of clarification, U.M.C. did not intend to say that our better outcomes can be attributed to a particular device.” She added that the hospital’s remarks about “improving patient outcomes” were intended to mean that its use of the defibrillator database was helping it monitor its performance. The hospital’s disputed claims may intensify scrutiny of the ties between the Las Vegas physicians, Biotronik and a company called Western Medical that acts as the company’s sales representative in Nevada and several other states. Those ties are currently under review by state officials in Nevada. The Justice Department started a separate investigation last year into Biotronik’s sales and marketing practices. The Times article focused on relationships between a device industry sales official named Caesar Fonte and cardiologists at a Las Vegas practice, Nevada Heart and Vascular. Before 2008, when Mr. Fonte worked at Boston Scientific, a defibrillator producer, the same cardiologists were paid consultants to that company and almost exclusively used its devices, hospital data shows. Then in 2008, Mr. Fonte quit Boston Scientific and started Western Medical, the Biotronik distributor. The implant specialists at Nevada Heart and Vascular then became paid consultants to Biotronik and switched to using its devices in nearly all patients. Both Biotronik, the physicians and Mr. Fonte have rejected any suggestion that the consulting fees were inducements to get them to use the company’s devices. The defibrillator database is part of the National Cardiovascular Data Registry, a project run by the American College of Cardiology Foundation, in conjunction with a professional medical group, the Heart Rhythm Society. It is often referred to as the ICD registry, which is short for implantable cardioverter-defibrillator, the device’s formal name. In 2004, Medicare mandated the creation of a national ICD registry as a condition for approving payments for defibrillators for a new class of patients, for whom evidence of a benefit was equivocal. Implant makers, who have realized vastly added sales from the Medicare ruling, supported the registry for one year then cut back financing. Its is now underwritten by hospitals, but limited financing has restricted the data it can collect. Essentially, during a procedure to implant a defibrillator, information is collected about areas like a patient’s heart function and other medical conditions. If an existing defibrillator is being replaced by a new one, a hospital can also indicate one of several reasons why such a replacement is being performed. The information from the national ICD registry provided by University Medical Center to The Times reflected data from two of those device replacement fields. It showed that for a four-year period between 2007 and 2010, no device had been replaced at University Medical Center because it had been recalled or because it had malfunctioned. Earlier, when providing the data, Ms. Cohen, the hospital spokeswoman, said that its results were “highly significant” when compared with the national average for such replacement reasons. The hospital added that Biotronik has not issued any recent device recalls. Experts like Dr. Curtis said, however, that the hospital’s data was effectively meaningless because there was no way of knowing from it whether a device being replaced at U.M.C. had been initially implanted there, or whether devices implanted at U.M.C. were later replaced elsewhere. “If they are thinking that no news is good news from the registry, then they are misunderstanding what function the registry is performing,” said another registry expert at Yale, Dr. Harlan Krumholz. The national ICD registry does report back to hospitals about in-hospital complication rates related to device implantation procedures so they can compare it with the national average. Asked for its complication rate, U.M.C. declined to release it. This posting includes an audio/video/photo media file: Download Now

Vibrators Carry the Conversation Posted: 21 Apr 2011 09:32 AM PDT TOOTHPASTE? Check. Tampons? Check. Vibrator? Check! Enlarge This Image Tina Fineberg for The New York Times Enlarge This Image Tina Fineberg for The New York Times Various personal massage devices line the shelves of a Duane Reade store in New York. For years, vibrators were bought quietly in sex shops, and later online, arriving in discreet unmarked packages. They were rarely discussed, other than perhaps during a late-night girl-talk session fueled by many glasses of pinot grigio. But now you can find them advertised on MTV and boldly displayed at Duane Reade, Walgreens and other mainstream drugstores, mere steps from the Bengay and Dr. Scholl’s. The newest model on the shelves is the Tri-Phoria ($39.99), created by the condom company Trojan after a study the company conducted in 2008 in partnership with the Center for Sexual Health Promotion at Indiana University revealed that over half of American women had used vibrators, and of that group, nearly 80 percent had shared them with their partners. James Daniels, vice president for marketing at Trojan, said: “The idea really came from consumers. They kept telling us vibrators, vibrators. And we just laughed. And then we realized they were serious.” The Tri-Phoria joins the A:Muse Personal Pleasure Massager by LifeStyles, which arrived in stores in January, and the Allure, by Durex, which made its over-the-counter debut in 2008; both models are $19.99. Alan Cheung, senior brand manager for Durex, said that sales of the company’s vibrating products are up 60 percent over the last six months, compared with the same period last year. “Consumers are definitely not shy about this kind of purchase in the retail environment,” he said. This comes as no surprise to Rachel Venning, a founder of Babeland, a chain of sex-toy stores that opened a store in family-friendly Park Slope, Brooklyn, in 2008 to nary a ripple of protest. “I know women will buy them at Duane Reade, and as a lifelong cheerleader for sexual empowerment I’m thrilled at this development,” Ms. Venning said. “It’s one more step in the evolution of vibrators to just another consumer product, unburdened of its freight of shame, sexual defect and sluttiness.” Liz Canner, who directed the 2009 documentary “Orgasm Inc.,” agrees. Her film confronted pharmaceutical companies that suggested women were dysfunctional, and therefore needed some sort of medicinal or therapeutic help, if they could not climax during sex. “It’s easier in a repressed culture to have a disorder than go to a sex store and get a vibrator,” Ms. Canner said in a recent interview. “Vibrators have been shown to enhance sexual pleasure for over 100 years now. Why not partake?” Vibrators made occasional cultural cameos in the 1990s, with scenes in films like “She’s the One” and “Slums of Beverly Hills.” But it wasn’t until an episode of HBO’s “Sex and the City” —called “The Turtle and the Hare,” featuring an actual device called the Rabbit Pearl — that the vibrator truly emerged from the nightstand drawer. “ ‘Sex and the City’ did as much for women’s sexual comfort as really anything has done in the past couple of decades,” said Dr. Laura Berman of “In the Bedroom with Dr. Laura Berman,” on OWN: Oprah Winfrey Network. Dr. Berman, a prominent sex and relationship expert, also has a line of sex toys (drlauraberman.com), which she said grossed $5 million in 2010, up from $100,000 in 2005. After one appearance on “Oprah” that focused on adult women who had problems climaxing, one of her top-selling products, the Aphrodite, “was back-ordered forever,” she said. And in 2006 she sparked a national debate when she encouraged mothers to buy vibrators for their teenage daughters. “If she gets hot and bothered on a date,” Dr. Berman said about the daughter, “she can go home and self-stimulate, instead of getting pregnant.” (Of course, a plastic battery-powered device is not needed for self-stimulation, but there is no market potential in that idea.) Assessing the vibrator’s current ubiquity, Dr. Berman said, “Women are getting less and less caught up on an unrealistic and puritanical vision of what a good girl is. When they can embrace their self-stimulation, they can take ownership of their sexuality.” Men interviewed proclaimed themselves not only unthreatened by the addition of accessories to their partners’ sex lives, but downright enthusiastic. Jeremy, 31, a content strategist in the entertainment business who lives in New York and wanted his last name omitted for privacy, said, “From my perspective, a woman who has thoroughly explored her own body, both alone and with or without whichever toys she finds interesting, makes for a significantly better lover.” Kate, 29, a programming coordinator in New York who has been Jeremy’s girlfriend for a year and a half, calls herself “an evangelist for vibrators.” In college, she recalled seeing a Hello Kitty-themed one. “I wanted it just because it was kitschy and cool,” she said. “I thought it was so ridiculous that I ended up doing a bit more research and started to take it seriously.” Kate, a devoted Babeland customer, said that at one point she asked her friends to pool their money and buy her a fancy vibrator for her birthday, which she promised to review for them. And when Lou, 44, who lives on Long Island and has been married to Sarah, 47, for 20 years, was found to have prostate cancer, he used a make-your-own vibrator kit to make a mold of himself for his wife before having surgery. “It never entered my mind that, oh, my God, this was bad,” he said. Carol Queen, who is the curator of the Antique Vibrator Museum and a staff sexologist for Good Vibrations, a sex-toy retailer since 1977 that bills itself as the “original clean well-lit place to buy vibrators,” attributes more-honest discussions about sex and pleasure to fear of H.I.V./AIDS in the early 1990s, which led to frank discussions about condoms. She also mentioned a shift in published erotica at that time. 1 2 Next Page »

Ohio County Losing Its Young to Painkillers’ Grip Posted: 20 Apr 2011 12:02 PM PDT PORTSMOUTH, Ohio — This industrial town was once known for its shoes and its steel. But after decades of decline it has made a name for itself for a different reason: it is home to some of the highest rates of prescription drug overdoses in the state, and growing numbers of younger victims. Multimedia Photographs Prescription Drug Abuse in Appalachia Related Administration Wants Tighter Painkiller Rules (April 20, 2011) Their pictures hang in the front window of an empty department store, a makeshift memorial to more than two dozen lives. The youngest was still in high school. Nearly 1 in 10 babies born last year in this Appalachian county tested positive for drugs. In January, police caught several junior high school students, including a seventh grader, with painkillers. Stepping Stone House, a residential rehabilitation clinic for women, takes patients as young as 18. In Ohio, fatal overdoses more than quadrupled in the last decade, and by 2007 had surpassed car crashes as the leading cause of accidental death, according to the Department of Health. The problem is so severe that Gov. John R. Kasich announced $36 million in new spending on it this month, an unusual step in this era of budget austerity. And on Tuesday, the Obama administration announced plans to fight prescription drug addiction nationally, noting that it was now killing more people than crack cocaine in the 1980s and heroin in the 1970s combined. The pattern playing out here bears an eerie resemblance to some blighted cities of the 1980s: a generation of young people who were raised by their grandparents because their parents were addicts, and now they are addicts themselves. “We’re raising third and fourth generations of prescription drug abusers now,” said Chief Charles Horner of the Portsmouth police, who often notes that more people died from overdoses in Ohio in 2008 and 2009 than in the World Trade Center attack in 2001. “We should all be outraged,” Chief Horner said. “It should be a No. 1 priority.” Scioto County (pronounced sy-OH-tuh), of which Portsmouth is the seat, has made it one, bringing what had been a very private problem out into the public. A coroner and a pharmacist are among its state lawmakers, and a bill in the state legislature would more strictly regulate pain clinics where drugs are dispensed. The most popular drug among addicts here is the painkiller OxyContin. The county’s efforts got the attention of political leaders in the state, including Governor Kasich, who declared the county a pilot project for combating addiction. The problem is so bad that a storage company with business in the county recently complained to Chief Horner that it was having trouble finding enough job candidates who could pass drug tests. “Around here, everyone has a kid who’s addicted,” said Lisa Roberts, a nurse who works for the Portsmouth Health Department. “It doesn’t matter if you’re a police chief, a judge or a Baptist preacher. It’s kind of like a rite of passage.” About 10 years ago, when OxyContin first hurtled through the pretty hollow just north of town where the Mannering family lives, the two youngest children were still in high school. Their parents tried to protect them, pleading with neighbors who were selling the drug to stop. By mid-decade, they counted 11 houses on their country road that were dealing the drug (including a woman in her 70s called Granny), and their two youngest children, Nina and Chad, were addicted. A vast majority of young people, officials said, get the drugs indirectly from dealers and other users who have access to prescriptions. Nina and Chad’s father, Ed Mannering, said he caught a 74-year-old friend selling the pills from his front door. The sales were a supplement, the man said sheepishly, to his Social Security check. “You drive down the road here, and you think, ‘All these nice houses, no one’s doing any of that stuff,’ ” said Judy Mannering, Nina and Chad’s mother. “But they are. Oh, they are.” Nina Mannering tried to quit, her mother said. She had a small daughter to care for. She was in a counseling program for a few months, but was told to leave when her boyfriend brought her pills. At one point, Ms. Mannering counted the number of schoolmates in four graduating classes who had died from overdoses, her mother recalled. The total was 16. “It’s like being in the middle of a tornado,” said Ed Hughes, director of the Counseling Center, a network of rehabilitation and drug counseling clinics in the county. “It was moving so fast that families were caught totally off guard. They had no idea what they were dealing with.” 1 2 Next Page »

Personal Best: For an Exercise Afterburn, Intensity May Be the Key Posted: 18 Apr 2011 06:50 PM PDT Depending on whom you ask, the answer to this question is either one of the great myths of exercise or one of the great unappreciated truths: Is there an afterburn effect from a workout? Related More Personal Best Columns Whether the metabolism speeds up for hours after exercise an old question, first studied a century ago, and over the years, study after study has been carried out, with decidedly mixed results. Some investigators found no post-exercise effect. Others reported effects so small they were almost unnoticeable — one found male triathletes burned just 12 to 30 extra calories after a workout. Others found as many as 700 additional calories were burned after a long and exhausting exercise session. The latest sally comes in a recent paper in the journal Medicine & Science in Sports & Exercise. Its lead author, Amy A. Knab of Appalachian State University, says it trumps studies that preceded it because of its careful design. And its results are good news — sort of. Dr. Knab and her colleagues recruited 10 men, ages 22 to 33, who agreed to spend two periods of 24 hours each in a metabolic chamber, a small room that measures the calories people burn while they are inside. The men were not all athletes, but they did have to be able to ride a bike vigorously. On the first visit to the chamber, the subjects had to stay perfectly still, sitting in a chair and moving only to eat meals, which were sent in through an air lock. In the afternoon, they were permitted a two-minute stretch every hour. Bedtime was 10:30 p.m. At 6:30 the next morning, the subjects were awakened and allowed to leave. They burned, on average, 2,400 calories on this totally sedentary day. The second visit to the chamber came two days later. Everything was the same, with one exception. At 11 a.m., the subjects rode a stationary bicycle at a high intensity for 45 minutes. The exercise itself burned about 420 calories, Dr. Knab and her colleagues reported. But what was most interesting was the calories burned afterward. Over the next 14 hours, the men burned an extra 190 calories, increasing the total calories burned by 37 percent. “We were surprised,” Dr. Knab said. She thought there might be extra calories burned, but she did not expect so many, nor did she expect the effect to last so long. She suspects one reason she saw such a pronounced effect was that the exercise was so intense. The subjects had had to cycle at 70 percent of their so-called VO2 max, the maximum amount of oxygen a person’s body can take in during exercise — an effort that made them breathe too heavily to carry on a conversation. And they had to keep it up for 45 minutes. A different study, also using a metabolic chamber, tested the effects of moderate exercise and found no afterburn. Those subjects exercised at 50 percent of their VO2 max, a level that still allows conversation. Claude Bouchard, a scientist at the Pennington Biomedical Research Center in Baton Rouge, La., along with other researchers, investigated the exercise effect with conventional methods using a mouthpiece and nose clip or a ventilated hood to determine oxygen used and carbon dioxide exhaled. From those measures, researchers can calculate calories burned. They find, he says, that when studies are done properly (many are not), extra calories are burned in the hours after exercise — but only if subjects exercise at least as hard and long as Dr. Knab’s subjects. And if they exercise even harder, they burn even more calories afterward. A recent book that Dr. Bouchard and a colleague edited notes two studies that found this effect. The researchers found that if subjects ran at 70 percent of their VO2 max or cycled at 75 percent of it, they could burn 300 to 700 extra calories after the exercise was over, though 700 calories was unusual. It is not clear why extra calories should be burned after a bout of intense exercise, Dr. Bouchard says. Part of the effect may be due to post-exercise energy metabolism: the body starts using more fat and less carbohydrate after a hard exercise session. Several hormones that are released during exercise remain elevated in the blood afterward, increasing metabolism. And extra calories may be burned when the body replenishes glycogen, the sugar stored in muscles. But for the most part, the effect remains a mystery. Whatever the cause, researchers say, the extra calories burned after exercise can help people lose weight. Unfortunately, those who may have the most to lose may have the hardest time doing the sort of exercise that gives them a calorie-burning bonus. The usual guideline for general health is 30 minutes of moderate exercise most days of the week. That’s doable for most people and should increase heart health, even if it provides no calorie bonus. But that sort of moderate exercise, Dr. Bouchard said, “is what we recommend — that’s the target.”

Mind: Come On, I Thought I Knew That! Posted: 18 Apr 2011 09:40 PM PDT Trick question: Is it easier to remember a new fact if it appears in normal type, like this, or in big, bold letters, like this? Enlarge This Image Margaret Riegel Enlarge This Image The answer is neither. Font size has no effect on memory, even though most people assume that bigger is better. But font style does. New research finds that people retain significantly more material — whether science, history or language — when they study it in a font that is not only unfamiliar but also hard to read. Psychologists have long known that people’s instincts about how well they’ve learned a subject are often way off. The feel of a study session can be a poor reflection of its nutritional value: Concepts that seem perfectly clear become fuzzy at exam time, and those that are hard to grasp somehow click into place when it counts. In recent years, researchers have begun to clarify why this is so, and in some cases how to correct for it. The findings are especially relevant nowadays, experts say. “So much of the learning that we do now is unsupervised, on our own,” said Robert A. Bjork, a psychologist at the University of California, Los Angeles, “that it’s crucial to be able to monitor that learning accurately; that is, to know how well we know what we know, so that we avoid fooling ourselves.” Mistakes in judging what we know — in metacognition, as it’s known — are partly rooted in simple biases. For instance, most people assume when studying that newly learned facts will long be remembered and that further practice won’t make much difference. These beliefs are subconscious and automatic, studies find, even though people know better when they stop to think about it. Yet overconfidence also develops as a result of the brain’s natural tendency to find shortcuts — and to quickly forget that it used them. In a recent report in the journal PNAS, researchers at Harvard and Duke had college students take what they thought was an I.Q. test. Some got an answer key with the test “to check their answers afterward,” and others did not. To no one’s surprise, those who got the key peeked at it and did better on the test, on average, than those without it. But after grading their tests, both groups of students predicted how well they would do on a hypothetical longer test without the answer key. Those who had seen the key expected a far higher score on the future test than did those who hadn’t. “The finding was that people who use an answer key when taking a test see their score as a sign of their innate ability, selectively forgetting that the key helped them achieve the score,” said the lead author, Zoe Chance, a doctoral student in marketing at Harvard Business School. Without the answers handy, those confident students did no better on an actual second test than the others. Anyone who has ever peeked at the answers at the back of the physics or chemistry textbook already suspects this. It’s one thing to study a solution when the problem itself is totally unfamiliar, requiring techniques that haven’t yet been learned. It is another to scan the answers when problems are familiar but difficult. Those problem sets go more smoothly, confidence goes up, the temptation to take a study break grows stronger. These sensations reflect more than simple self-deception. Even hints or answers that are not consciously remembered alter how the brain processes a problem or question, making the experience very different from an unaided exam question. In a 1996 study, researchers at Macalester College and New York University had subjects solve 60 anagrams and rate how difficult each one would be for others to solve. One group of participants had already seen the answers to half of the puzzles in an earlier phase of the study, scattered like so many detective-novel clues in a long list of random words. As a result, they solved those anagrams faster and rated them as significantly easier to solve than the other half — without consciously remembering having seen the answers. “Studying something in the presence of an answer, whether it’s conscious or not, influences how you interpret the question,” Dr. Bjork said. “You don’t appreciate all of the other things that would have come to mind if the answer weren’t there. “Let’s say you’re studying capitals and you see that Australia’s is Canberra. O.K., that seems easy enough. But when the exam question appears, you think: ‘Uh oh, was it Sydney? Melbourne? Adelaide?’ ” That’s why some experts are leery of students’ increasing use of online sites like Cramster, Course Hero, Koofers and others that offer summaries, step-by-step problem solving and copies of previous exams. The extra help may provide a valuable supplement to a difficult or crowded course, but it could also leave students with a false sense of mastery. 1 2 Next Page »

Well: New Lessons to Pave a Road to Safety Posted: 20 Apr 2011 04:03 PM PDT

Recipes for Health: ‘Bouillabaisse’ of Fresh Peas With Poached Eggs Posted: 21 Apr 2011 12:20 AM PDT In the Provence region of France, it is a peasant tradition to make “poor man’s bouillabaisse” with vegetables. For this soup, only fresh peas will work — don’t try it with frozen. Recipes for Health Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. See All Recipes for Health » Visit Recipes for Health on Facebook. Related Recipes for Health: A Bowlful of Our Daily Bread (April 18, 2011) Recipes for Health: Majorcan Bread and Vegetable Soup (April 19, 2011) Recipes for Health: Apple-Spice Breakfast Soup (April 20, 2011) Recipes for Health: Ribollita (April 22, 2011) 2 tablespoons olive oil 1 medium onion, chopped 3/4 pound fingerling potatoes or Yukon golds, scrubbed and sliced 4 large garlic cloves, minced 4 cups freshly shelled peas (about 4 1/2 pounds) Generous pinch of saffron 1 1/2 quarts water or chicken stock Salt and freshly ground pepper 4 to 5 eggs 3 tablespoons chopped fresh parsley, or a mixture of parsley, tarragon and chives 4 to 5 thick slices country bread, toasted and rubbed with a cut clove of garlic 1. In a heavy soup pot, heat the olive oil over medium heat, and add the onion. Cook, stirring, until tender, about five minutes, and add the potatoes and garlic. Cook, stirring, until the garlic begins to smell fragrant, about one minute. Add the water, saffron and salt to taste. Bring to a boil, reduce the heat, cover and simmer 15 minutes. Add the peas, cover and simmer another 15 minutes or until the vegetables are tender and the broth is sweet. Taste, adjust salt and add pepper. 2. One by one, break each egg into a teacup, then tip into the soup. Poach the eggs for four minutes until just set. Place a crouton in each bowl and, using a skimmer or a slotted spoon, scoop out a poached egg and place it on top. Stir the herbs into the soup, then ladle the soup into the bowls and serve. Variation: Omit the eggs and sprinkle each crouton with Parmesan cheese. Yield: Serves four to five. Advance preparation: You can have the peas shelled and ready hours ahead of time, but the soup is best served right away. You could also poach the eggs ahead of serving, keeping them in the refrigerator in a bowl of water. Drain and dry on paper towels before serving. Nutritional information per serving (four servings): 399 calories; 3 grams saturated fat; 2 grams polyunsaturated fat; 7 grams monounsaturated fat; 186 milligrams cholesterol; 54 grams carbohydrates; 11 grams dietary fiber; 254 milligrams sodium (does not include salt to taste); 18 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Alfred Freedman, a Leader in Psychiatry, Dies at 94 Posted: 20 Apr 2011 09:40 PM PDT Dr. Alfred M. Freedman, a psychiatrist and social reformer who led the American Psychiatric Association in 1973 when, overturning a century-old policy, it declared that homosexuality was not a mental illness, died on Sunday in Manhattan. He was 94. Enlarge This Image New York Medical College Alfred M. Freedman The cause was complications of surgery to treat a fractured hip, his son Dan said. In 1972, with pressure mounting from gay rights groups and from an increasing number of psychiatrists to destigmatize homosexuality, Dr. Freedman was elected president of the association, which he later described as a conservative “old boys’ club.” Its 20,000 members were deeply divided about its policy on homosexuality, which its Diagnostic and Statistical Manual of Mental Disorders II classified as a “sexual deviation” in the same class as fetishism, voyeurism, pedophilia and exhibitionism. Well known as the chairman of the department of psychiatry at New York Medical College and a strong proponent of community-oriented psychiatric and social services, Dr. Freedman was approached by a group of young reformers, the Committee of Concerned Psychiatrists, who persuaded him to run as a petition candidate for the presidency of the psychiatric association. Dr. Freedman, much to his surprise, won what may have been the first contested election in the organization’s history — by 3 votes out of more than 9,000 cast. Immediately on taking office, he threw his support behind a resolution, drafted by Robert L. Spitzer of Columbia University, to remove homosexuality from the list of mental disorders. On Dec. 15, 1973, the board of trustees, many of them newly elected younger psychiatrists, voted 13 to 0, with two abstentions, in favor of the resolution, which stated that “by itself, homosexuality does not meet the criteria for being a psychiatric disorder.” It went on: “We will no longer insist on a label of sickness for individuals who insist that they are well and demonstrate no generalized impairment in social effectiveness.” The board stopped short of declaring homosexuality “a normal variant of human sexuality,” as the association’s task force on nomenclature had recommended. The recently formed National Gay Task Force (now the National Gay and Lesbian Task Force) hailed the resolution as “the greatest gay victory,” one that removed “the cornerstone of oppression for one-tenth of our population.” Among other things, the resolution helped reassure gay men and women in need of treatment for mental problems that doctors would not have any authorization to try to change their sexual orientation, or to identify homosexuality as the root cause of their difficulties. An equally important companion resolution condemned discrimination against gays in such areas as housing and employment. In addition, it called on local, state and federal lawmakers to pass legislation guaranteeing gay citizens the same protections as other Americans, and to repeal all criminal statutes penalizing sex between consenting adults. The resolution served as a model for professional and religious organizations that took similar positions in the years to come. “It was a huge victory for a movement that in 1973 was young, small, very underfunded and had not yet had this kind of political validation,” said Sue Hyde, who organizes the annual conference of the National Gay and Lesbian Task Force. “It is the single most important event in the history of what would become the lesbian, gay, bisexual and transgender movement.” In a 2007 interview Dr. Freedman said, “I felt at the time that that decision was the most important thing we accomplished.” Alfred Mordecai Freedman was born on Jan. 7, 1917, in Albany. He won scholarships to study at Cornell, where he earned a bachelor’s degree in 1937. He earned a medical degree from the University of Minnesota in 1941 but cut short his internship at Harlem Hospital to enlist in the Army Air Corps. During World War II he served as a laboratory officer in Miami and chief of laboratories at the Air Corps hospital in Gulfport, Miss. He left the corps with the rank of major. After doing research on neuropsychology with Harold E. Himwich at Edgewood Arsenal in Maryland, he became interested in the development of human cognition. He underwent training in general and child psychiatry and began a residency at Bellevue Hospital in Manhattan, where he became a senior child psychiatrist. He was the chief psychiatrist in the pediatrics department at the Downstate College of Medicine of the State University of New York for five years before becoming the first full-time chairman of the department of psychiatry at New York Medical College, then in East Harlem and now in Valhalla, N.Y. In his 30 years at the college he built the department into an important teaching institution with a large residency program. He greatly expanded the psychiatric services offered at nearby Metropolitan Hospital, which is affiliated with the school and where he was director of psychiatry. To address social problems in East Harlem, Dr. Freedman created a treatment program for adult drug addicts at the hospital in 1959 and the next year established a similar program for adolescents. These were among the earliest drug addiction programs to be conducted by a medical school and to be based in a general hospital. He also founded a division of social and community psychiatry at the school to serve neighborhood residents. With Harold I. Kaplan, he edited “Comprehensive Textbook of Psychiatry,” which became adopted as a standard text on its publication in 1967 and is now in its ninth edition. During his one-year term as president of the American Psychiatric Association, Dr. Freedman made the misuse of psychiatry in the Soviet Union one of the organization’s main issues. He challenged the Soviet government to answer charges that it routinely held political dissidents in psychiatric hospitals, and he led a delegation of American psychiatrists to the Soviet Union to visit mental hospitals and confer with Soviet psychiatrists. After retiring from New York Medical College, Dr. Freedman turned his attention to the role that psychiatry played in death penalty cases. With his colleague Abraham L. Halpern, he lobbied the American Medical Association to enforce the provision in its code of ethics barring physicians from taking part in executions, and he campaigned against the practice of using psychopharmacologic drugs on psychotic death-row prisoners so that they could be declared competent to be executed. In addition to his son Dan, of Silver Spring, Md., he is survived by his wife, Marcia; another son, Paul, of Pelham, N.Y.; and three grandchildren.

Obama Panel to Curb Medicare Finds Foes in Both Parties Posted: 21 Apr 2011 09:33 AM PDT WASHINGTON — Democrats and Republicans are joining to oppose one of the most important features of President Obama’s new deficit reduction plan, a powerful independent board that could make sweeping cuts in the growth of Medicare spending. Enlarge This Image Philip Scott Andrews/The New York Times Representative Paul D. Ryan, Republican of Wisconsin, said expanding the board would put limitations on providers. Blogs The Caucus The latest on President Obama, the new Congress and other news from Washington and around the nation. Join the discussion. FiveThirtyEight: Nate Silver's Political Calculus More Politics News Philip Scott Andrews/The New York Times Representative Allyson Y. Schwartz, Democrat of Pennsylvania, opposes the board. Mr. Obama wants to expand the power of the 15-member panel, which was created by the new health care law, to rein in Medicare costs. But not only do Republicans and some Democrats oppose increasing the power of the board, they also want to eliminate it altogether. Opponents fear that the panel, known as the Independent Payment Advisory Board, would usurp Congressional spending power over one of the government’s most important and expensive social programs. Under the law, spending cuts recommended by the presidentially appointed panel would take effect automatically unless Congress voted to block or change them. In general, federal courts could not review actions to carry out the board’s recommendations. The impact of the board’s decisions could be magnified because private insurers often use Medicare rates as a guide or a benchmark in paying doctors, hospitals and other providers. Last week, in his speech on deficit reduction, Mr. Obama said he wanted to beef up the board’s cost-cutting powers in unspecified ways should the growth of Medicare spending exceed certain goals. Supporters say the board will be able to make tough decisions because it will be largely insulated from legislative politics. Lawmakers do not agree. Representative Paul D. Ryan, Republican of Wisconsin and chairman of the House Budget Committee, called it “a rationing board” and said Congress should not “delegate Medicare decision-making to 15 people appointed by the president.” He said Mr. Obama’s proposal would allow the board to “impose more price controls and more limitations on providers, which will end up cutting services to seniors.” Senator John Cornyn, a Texas Republican who introduced a bill last month to repeal the Medicare board, said the president’s proposal “punts difficult decisions on health spending to an unelected, unaccountable board of bureaucrats.” Representative Allyson Y. Schwartz, a Pennsylvania Democrat prominent on health care issues, said: “It’s our constitutional duty, as members of Congress, to take responsibility for Medicare and not turn decisions over to a board. Abdicating this responsibility, whether to insurance companies or to an unelected commission, undermines our ability to represent our constituents, including seniors and the disabled.” Ms. Schwartz signed up on Friday as co-sponsor of a bill to repeal the board. The purpose of the panel, according to the health care law, is to reduce the rate of growth in Medicare spending per beneficiary. The law sets annual goals — “target growth rates” — for Medicare spending below the average of the last 15 years. Board members will be subject to Senate confirmation — no easy feat in the current political climate. Terms are six years. Members can serve no more than two full consecutive terms. The White House has yet to submit any nominations for the board. “Why have legislators?” asked Representative Pete Stark of California, the senior Democrat on the Ways and Means Subcommittee on Health. In some ways, Mr. Stark said, expanding the power of the board could be as bad as giving vouchers to Medicare beneficiaries to buy private insurance. “In theory at least, you could set the vouchers at an adequate level,” he said. “But, in its effort to limit the growth of Medicare spending, the board is likely to set inadequate payment rates for health care providers, which could endanger patient care.” Representative Shelley Berkley, Democrat of Nevada, said she wanted to repeal the Medicare board. “I have great faith that this administration can put together a strong, independent and knowledgeable board,” Ms. Berkley said, but she said she had less confidence in future administrations. Mark Parkinson, president of the American Health Care Association, which represents nursing homes, said his members disliked the board because it would allow Congress and the president to “subcontract out difficult decisions.” Still, the idea of a more potent Medicare board could be a live option if the White House insisted on it in budget negotiations with Congress. Mr. Obama said last week that he would “reduce wasteful subsidies and erroneous payments,” cut spending on prescription drugs and take other steps to save $500 billion in Medicare and Medicaid by 2023. “But if we’re wrong and Medicare costs rise faster than we expect,” he said, the Medicare board would have “the authority to make additional savings by further improving Medicare.” The president’s proposal would set stricter goals for Medicare spending and establish some type of automatic cost-cutting device as an “enforcement mechanism,” but Mr. Obama did not say exactly how it would work. Kathleen Sebelius, the secretary of health and human services, described the board as a backstop to “ensure that health costs are reduced.” The board might not have to take action if the president’s other proposals slow the growth of Medicare spending, she said. The board grew out of proposals by Mr. Obama and Senator John D. Rockefeller IV, Democrat of West Virginia. “Medicare payment policy should be determined by experts, using evidence, not by the undue influence of special interests,” Mr. Rockefeller said. AARP, the American Medical Association and the American Hospital Association voiced concern about the president’s latest proposal. “Relying on arbitrary spending targets is not a good way to make health policy, especially when decisions may be left to the unelected and unaccountable,” said A. Barry Rand, chief executive of AARP, the lobby for older Americans. Under the law, the board cannot make recommendations to “ration health care,” raise revenues or increase beneficiaries’ premiums, deductibles or co-payments. This increases the likelihood that the board will try to save money by trimming Medicare payments to health care providers.

J.&J. Profit Tops Estimates on Prescription Drug Sales Posted: 20 Apr 2011 10:01 AM PDT Johnson & Johnson posted better-than-expected quarterly earnings on Tuesday, as rebounding sales of prescription drugs overshadowed declining revenue from over-the-counter medicines that have been plagued by recalls. Add to Portfolio Novartis AG Thomson Reuters Corp Abbott Laboratories Johnson & Johnson (JNJ) Go to your Portfolio » The drug maker also increased its profit estimate for 2011, citing the positive effects on overseas sales of a weaker dollar. Its shares climbed $2.23, or 3.7 percent, to close at $62.69. Earnings totaled $3.48 billion, or $1.25 a share, in the first quarter, down from $4.53 billion, or $1.62 a share, a year ago, when it had substantial tax gains. Excluding special items, including litigation expenses and the cost of recalling hip replacement products, Johnson & Johnson earned $1.35 a share. That topped the average forecast of $1.26 a share among analysts polled by Thomson Reuters. Revenue rose 3.5 percent to $16.17 billion, above Wall Street expectations of $15.84 billion. The Swiss drug maker Novartis also reported better-than-expected results for its first quarter on Tuesday. Its sales rose 14 percent, helped by demand for the company’s new Gilenya pill to treat multiple sclerosis. At Johnson & Johnson, global sales of prescription drugs rose 7.5 percent, to $6.1 billion, with contributions from older and newer medicines. Sales of Concerta, used to treat attention deficit disorder, rose 10 percent, to $362 million, while sales of the antibiotic Levaquin rose 17 percent, to $434 million. Revenue from the company’s biggest-selling drug, the arthritis treatment Remicade, increased 8.3 percent to $1.29 billion, despite competition from rival biotech drugs like Humira from Abbott Laboratories. Simponi, a newer arthritis treatment, posted sales of $95 million. Johnson & Johnson last week settled a two-year dispute with Merck that allowed Merck to continue selling Remicade and Simponi overseas, but in fewer markets. Earnings this year are now expected to total $4.90 to $5 a share, up from a previous view of $4.80 to $4.90, the company said. Dominic J. Caruso, the chief financial officer, told investors in a conference call that most of the increase was because of the weakening dollar, which raised the value of sales in overseas markets. Johnson & Johnson has recalled more than 300 million packages of Tylenol and other over-the-counter medicines in the last 16 months after regulators cited faulty procedures and other quality-control lapses at three factories. It is fixing the problems under supervision of the government. Mr. Caruso said the 2011 forecast would have been higher if not for plant upgrades and related factors, which weighed down the outlook by 12 cents a share, twice the company’s earlier estimate. In its earnings statement, Johnson & Johnson did not make any reference to recent reports that it was negotiating to acquire the Swiss medical devices maker Synthes for about $20 billion, which would make it the biggest deal in the company’s history. Synthes on Monday confirmed that it was in merger talks.

U.S. Engineers Cite Lengthy Cleanup in Japan Posted: 19 Apr 2011 10:53 PM PDT Veterans of the Three Mile Island cleanup said that a much larger task faced the Japanese engineers who are trying contain and secure the damaged Fukushima Daiichi reactors. And Three Mile Island took 14 years. Multimedia Interactive Feature Japan Earthquake and Tsunami Multimedia Related Water Pumping Begins at Japan Nuclear Reactor (April 20, 2011) Toyota Plans to Reduce Production for 6 Weeks (April 20, 2011) Times Topic: Japan â€" Earthquake, Tsunami and Nuclear Crisis (2011) Lake Barrett, the senior Nuclear Regulatory Commission engineer at Three Mile Island during the early phases of the cleanup said by comparison, “it was a walk in the park compared to what they’ve got.” The Fukushima Daiichi reactors are similar to those in Pennsylvania — “the cores are probably really similar, partially melted,” Mr. Barrett said — but engineers pointed out several key differences in the aftermath of the accidents. In Japan, four separate reactors are damaged, and fixing each one is complicated by the presence of its leaking neighbors. It will also require a major infusion of equipment to replace parts far from the reactor’s core, like pumps and switchgear that were destroyed by the tsunami. In the short term, weather is a factor: according to engineers who managed the American cleanup, which ran from 1979 to 1993, Tokyo Electric Power has only a few weeks to patch up the three smashed secondary containments before the coming rainy season, when downpours could wash more contamination into the environment. And the company will have to carefully watch that the number of workers with the necessary skills do not burn out under the size of the task, or absorb so much radiation that they have to quit. Still, Mr. Barrett and others say that the mess at Fukushima Daiichi can be contained, cleaned up and even securely wrapped up for long-term disposal. The plant may benefit from past experience, because it is the second major accident worldwide in a big water-cooled reactor, they say. The first task, they agree, is to fill the reactors and the spent fuel pool with water that can be pumped out again, cooled and then returned to the reactors. That would sharply reduce the possibility of generating new hydrogen and new explosions, and would go a long way toward declaring that the plants were stable, a point that the N.R.C. observed recently that Fukushima Daiichi had not reached. Right now the reactors are in “feed and bleed” mode, adding clean water and cooling the fuel by letting that water boil off or dribble out, but such bleeding allows radiation leakage. “Whatever you bleed is letting cesium out,” said Mr. Barrett, referring to the radioactive isotope. Cooling with recirculating water could end releases of radioactive materials, but will require new pumps and possibly new piping, experts said. Before that new equipment can be installed, engineers will have to clean up the water in the basements of the reactor buildings, the turbine buildings and other structures. At Three Mile Island, water in the reactor building and the primary auxiliary building gave radiation doses as high as 1,000 rem an hour, said Ronald L. Freemerman, a Bechtel engineer who was the project manager of the cleanup. That meant a worker would hit the N.R.C.’s annual limit in about a minute. The water can be pumped through filters that will strain out the radioactive elements. Engineers from Three Mile Island laid out the three next steps: First, decontaminate the walls and floors, to hold down the potential radiation dose. “They have to economize on how they expose these people,” Mr. Freemerman said, or the company will run out of trained workers. Second, rebuild the secondary containments of units 1, 2 and 4, and fix or replace the heavy cranes just beneath their ceilings. That would allow workers to defuel the reactor. That step alone took five years at Three Mile Island, where no buildings had to be rebuilt. Third, peek inside the reactor vessel and figure out what tools will be needed to remove the wrecked fuel in the core. Three Mile Island was a surprise, Mr. Freemerman said, because so much of the core had melted and flowed beneath a support made of five plates of thick steel. Another veteran of the cleanup, Michael McGough, said only then did they realize they would need new remote-controlled tools to cut through the metal, to get to the material below. Mr. McGough’s technicians worked from a trailer outside the containment vessel, manipulating a cutting tool that was operating under about 40 feet of water. They also used long-handled picks and scoops to break apart the fused mass of ceramic fuel pellets and metal. “Basically we dug our way down through that debris until we got everything removed,” Mr. McGough said. At Three Mile Island, technicians then painstakingly loaded debris into shielded casks, under water to shield themselves from radiation, and then brought the casks to the surface. Eventually about 150 tons of radioactive rubble was shipped to an Energy Department laboratory in Idaho Springs, Idaho, where it still sits, waiting, as all used American fuel does, for a final resting place. Japan may have another option if the wrecked core isn’t too thoroughly mixed with other materials. It already has a reprocessing plant, where old fuel is chopped up, dissolved in acid, and then sorted, with its plutonium being removed, and the uranium sorted out for possible re-use. But that process is likely years away.

Drug That Stops Bleeding Shows Off-Label Dangers Posted: 19 Apr 2011 12:03 PM PDT A powerful, costly drug approved in 1999 for a small group of patients who may bleed uncontrollably during surgery is now used in a host of other surgical situations, sometimes with serious negative effects, two new studies report. Multimedia Graphic Using a Powerful Clotting Drug The studies present a cautionary tale, researchers say, that makes clear the pitfalls of a common medical practice — using new drugs in situations in which they have never been rigorously tested. The drug, sold as NovoSeven, was approved for people who lack a gene to make a particular blood-clotting protein called Factor VIIa and for certain people with hemophilia who can’t tolerate another drug that can stop bleeding. The drug, which is Factor VIIa, is made by baby hamster kidney cells that have the gene for Factor VIIa added to them. The baby hamster cells secrete the protein into a solution containing newborn calf serum, and the protein is then extracted from that solution and purified. It takes a year to produce — most of that time, nine to 10 months, is devoted to testing the drug for purity and safety. The drug costs $10,000 a dose, but can be a lifesaver for these patients. It is also used for other patients, according to the new studies, in The Annals of Internal Medicine. In fact, the small group for whom it was approved accounts for only 3 percent of the 18,000 times a year the drug is used in hospitals. Ninety-seven percent of the time when it is used in hospitals, it is given to patients with other reasons for bleeding, including having heart surgery or a hemorrhagic stroke, in which bleeding in the brain causes damage. For such patients, one of the papers concluded, the drug not only fails to improve survival, it increases the likelihood of a blood clot in the heart or brain, resulting in a heart attack or the kind of stroke in which blood flow to a part of the brain is blocked. The drug is also used in trauma surgery, and in that use as well it fails to show improved survival. In trauma patients who receive the drug, however, there do not appear to be more clots than would otherwise occur. “It’s scary,” said Dr. Jerry Avorn, a professor of medicine at Brigham and Women’s Hospital in Boston who wrote an editorial commenting on the studies. “This is a powerful drug, and we don’t fully understand it,” said Dr. Veronica Yank of Stanford, an author on both papers. In heart surgery, the researchers report, one out of every 20 people given Factor VIIa would be expected to have a serious clot in the heart or brain. When the drug is used to control bleeding in or around the brain, as in patients suffering from hemorrhagic stroke, one out of 17 patients would get a dangerous clot at the higher dose that is often used and one out of 33 would get a clot in situations where doctors used a lower dose. The clots, said Dr. Yank, can occur anywhere in the body, obstructing blood vessels. “Some patients got more than one clot,” she added. Doctors say they give the drug because they can see an immediate effect: The bleeding stops. “It’s very dramatic,” said Dr. Mark Gladwin, chief of pulmonary and critical care medicine at the University of Pittsburgh Medical Center. And so, he added, “there is a very compelling motivation to use it.” And the doctors who use the drug during surgery may not see a longer-term effect — clotting — which can occur days later. And they would have no way of knowing if the drug saves lives in the long run. Dr. Gladwin pointed out that doctors routinely administer drugs for unapproved uses. Companies cannot promote drugs for such uses, but doctors are free to prescribe them. Novo Nordisk, the maker of the Factor VIIa drug, says that it does not promote unapproved uses and that it worked with the Food and Drug Administration to include warnings against such uses on the drug’s label. As for the high cost, insurers pay for Factor VIIa as part of the general cost of treating hospitalized patients, so the drug may not be specifically identified. “Typically, the health plan would not know that it was used,” said Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an industry group. Payment for Factor VIIa “would be part of a global payment,” she said. Trauma surgeons were among the most enthusiastic early adopters of Factor VIIa, but they were also among the first to curtail use. “I have used it, and virtually every trauma surgeon in the world who has access to it has used it,” said Dr. Ernest Moore, chief of surgery at Denver Health, an affiliate of the University of Colorado. Many doctors got interested when they saw a paper, about a decade ago, describing an Israeli soldier who had a gunshot wound to the abdomen, got Factor VIIa, and was saved from what it seemed would have been certain death. In addition, research studies indicated that Factor VIIa was important in initiating clotting, giving credibility to the report. As trauma surgeons began using the drug, Dr. Moore said, they had “the unforgettable experience of seeing people who were bleeding to death suddenly stop bleeding.” And, he added, “there is no question that in the right circumstances it can be a miracle treatment.” But trauma surgeons’ unbridled enthusiasm for Factor VIIa was tempered recently when studies began to show no survival benefit. He is using it less often now, as are many other trauma surgeons, Dr. Moore said. It is not clear that other medical specialties had a similar awakening, but some institutions, like the University of Pittsburgh Medical Center, have taken steps to control the drug’s use. The Pittsburgh hospital began requiring that doctors who wanted to use Factor VIIa get permission from a hematology consultant. The one exception was patients who were bleeding into the brain, taking a blood thinner and about to have emergency neurosurgery. The consultants often refuse permission, said Dr. Franklin Bontempo, director of the coagulation laboratory at the University of Pittsburgh Medical Center. Some doctors want to use it for routine bleeding in trauma patients or in patients having liver transplants. That is unnecessary, they often are told. Others call because a patient is bleeding into the lungs, coughing up blood, and the doctor is, quite understandably, worried, wanting to give Factor VIIa to make the bleeding stop. In that situation, Dr. Bontempo said, the hematologist will suggest other methods. “Often that takes care of the problem,” he said. The lesson in the story of Factor VIIa, Dr. Yank said, is that anecdotal reports, even ones citing results as powerful as bleeding cessation, can be misleading. Using a drug for an unapproved use can be risky. A single measurement of outcomes can miss the big picture of risks and benefits. And the risk-benefit picture for the approved use may be quite different from what occurs when the drug is used in other situations “You may be correct in assuming the drug has the same benefits,” Dr. Yank said, “but then again, you may not.”

Vegan Promoter Uses Photos of Meat and Dairy Items, and Fury Follows Posted: 19 Apr 2011 12:18 PM PDT VegNews, a “vegetarian lifestyle” magazine and Web site based in San Francisco, is eating a little crow. Enlarge This Image On its Web site, Veg News has shown food containing meat, and irate vegans are venting their fury on blogs, Facebook and other online forums. Related Diner’s Journal Blog: Meat Discovered in Meatless Magazine (April 14, 2011) A blog about energy and the environment. Go to Blog » The publication is reeling after revelations last week that its editorial staff regularly used images of meat and dairy-filled foods to accompany vegan-themed articles and recipes. The gastronomical subterfuge was revealed in an April 13 post by Quarrygirl.com, a vegan blog, which found that images of conventional foods from a free online stock-photo service were identical to images accompanying supposedly vegan dishes in the magazine and on its Web site. In one case, an ordinary slab of grilled ribs was made to appear meatless after the bones were digitally airbrushed out of the picture. In other instances, images of hamburgers, hot dogs, macaroni and cheese and ice cream were featured so as to appear meat and dairy-free. Irate vegans took to blogs, Twitter, Facebook and other online forums to vent their fury. Angry at being taken in by the images, one reader commented on the magazine’s Web site how awful it felt “to have craved any of the foods featured here, because now I feel I was craving animals.” Other commenters criticized the editors as contributing to public perceptions of vegan food as bland and unappealing. “Any omnivore who catches wind of this will be left with the impression that vegan food must turn out so unappetizing that even the leading vegan magazine will not show legitimate photos of it,” a commenter said. VegNews has 210,000 subscribers to its bimonthly magazine and receives more than one million monthly online visitors to its Web properties. In an interview, Joseph Connelly, VegNews’s publisher, apologized for using nonvegan images and said the practice would be discontinued. An earlier statement by the magazine acknowledged using stock images of meat and dairy but said it was necessary for budgetary reasons and would continue. “We were shellshocked by the response,” Mr. Connelly said. “We underestimated our responsibility, and we’re taking steps to correct it.” “I do want to apologize to the vegetarian and vegan community for our oversight,” he added. “We’re going to make an effort to publish nothing but vegan photography.” Mr. Connelly rejected an earlier statement that using the stock images was necessary to maintain the magazine’s quality. “I don’t think quality will suffer,” he said. “We may have to work a little harder.” He said he hoped the magazine’s readership would “stand up and help us” in providing vegan photography. A writer for Quarrygirl.com, who declined to be identified by name, said in an e-mail message that the magazine’s change of heart was “good news” but that its initial response revealed a “chasm of empathy between them and their readership.” “The way they have handled this so far has lost them a lot of friends,” she said. The bloggers at Quarrygirl.com, based in Hollywood, added that they would be returning an award they had received in 2009 from VegNews for an investigative article that uncovered nonvegan ingredients’ being served regularly at vegan restaurants in the Los Angeles area.

Global Update: Syria: Fighting the Fungi That Threaten Wheat Posted: 18 Apr 2011 07:00 PM PDT Fungi that attack wheat are growing as a threat to the hungry inhabitants of poor countries. At a conference this week in Aleppo, Syria, scientists will be planning a counteroffensive. The unusual venue was chosen both because Syria has been hit hard by “yellow rust” fungus and because Aleppo is home to the International Center for Agricultural Research in the Dry Areas. The center was built in 1977 because the area has the right climate for research and because Aleppo is in the heart of the so-called Fertile Crescent, where agriculture began 10,000 years ago. The fungi have damaged wheat grown in a broad ribbon of dry climate from Morocco to northern India, where as much as 60 percent of the crop has been lost, said Mahmoud Solh, the center’s director. The prevailing theory is that wetter winters caused by climate change are helping the fungi persist until new crops are planted. Rich countries can afford fungicides and new resistant varieties of wheat; poor ones cannot. Food prices are being driven up by other factors, including summer fires and farmers growing crops for ethanol instead of food. Before his death in 2009, Norman E. Borlaug, the plant biologist who won the 1970 Nobel Peace Prize partly for his role in creating more vigorous varieties of wheat, called one particular fungus — known as Ug99 for its 1999 discovery in Uganda — “a looming catastrophe,” even more dangerous than the strain that destroyed 20 percent of American wheat in the 1950s. Since then, Ug99 has been joined by other fungal strains, like stem rust, above.

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Magazine Preview: The Crash and Burn of an Autism Guru Posted: 21 Apr 2011 12:38 PM PDT As people streamed into Graceview Baptist Church in Tomball, Tex., early one Saturday morning in January, two armed guards stood prominently just inside the doorway of the sanctuary. Their eyes scanned the room and returned with some frequency to a man sitting near the aisle, whom they had been hired to protect. Post a Comment Share your thoughts on the Motherlode blog. Enlarge This Image Eva Vermandel for The New York Times Andrew Wakefield The man, Andrew Wakefield, dressed in a blazer and jeans and peering through reading glasses, had a mild professorial air. He tapped at a laptop as the room filled with people who came to hear him speak; he looked both industrious and remote. Broad-shouldered and fair at 54, he still has the presence of the person he once was: a conventional winner, the captain of his medical school’s rugby team, the head boy at the private school he attended in England. Wakefield was a high-profile but controversial figure in gastroenterology research at the Royal Free Hospital in London when, in 1998, he upended his career path — and more significant, the best-laid plans of public-health officials — by announcing at a press conference that he had concerns about the safety of the measles-mumps-rubella vaccine (M.M.R.) and its relationship to the onset of autism. Although Wakefield did not claim to have proved that the M.M.R. vaccine (typically given to children at 12 to 15 months) caused autism, his concerns, not his caveats, ricocheted around the world. His belief, based on a paper he wrote about 12 children, is that the three vaccines, given together, can alter a child’s immune system, allowing the measles virus in the vaccine to infiltrate the intestines; certain proteins, escaping from the intestines, could then reach and harm neurons in the brain. Few theories have drawn so much attention and, in turn, so much refutation: a 2003 paper in The Archives of Pediatrics and Adolescent Medicine, which reviewed a dozen epidemiological studies, concluded that there was no evidence of an association between autism and M.M.R., and studies in peer-reviewed journals since have come to the same conclusion. In Britain, the General Medical Council revoked Wakefield’s medical license after a lengthy hearing, citing numerous ethical violations that tainted his work, like failing to disclose financing from lawyers who were mounting a case against vaccine manufacturers. The Lancet, which published the original Wakefield paper, retracted it. In a series that ran early this year, The British Medical Journal concluded that the research was not just unethically financed but also “fraudulent” (that timelines were misrepresented, for example, to suggest direct culpability of the vaccine). Andrew Wakefield has become one of the most reviled doctors of his generation, blamed directly and indirectly, depending on the accuser, for irresponsibly starting a panic with tragic repercussions: vaccination rates so low that childhood diseases once all but eradicated here — whooping cough and measles, among them — have re-emerged, endangering young lives. And yet here he was in Texas, post-career-apocalypse, calmly discussing his work, and a crowd of around 250 people showed up to listen. As people walked into the lobby of the church in Tomball, they passed by a whiteboard with a message that asked attendees to express their thoughts to Wakefield. Many complied with lavish thanks: “We stand by you!” and “Thank you for the many sacrifices you have made for the cause!” When he finally took the podium, the audience members, mostly parents of autistic children, stood and applauded wildly. In his presentation, Wakefield sounded impatient but righteous. He used enough scientific terms — “ataxic,” “histopathological review” and “vaccine excipients” — that those parents who did not feel cowed might have been flattered by his assumption of their scientific fluency. He also tried to defend himself against a few of the charges laid out in The British Medical Journal — offering defenses that did not hold up before the journal’s panel of editors but were perhaps enough to assure an audience of his fans that he did, in fact, have defenses. Some part of Wakefield’s cult status is surely because of his personal charisma, and he spoke with great rhetorical flair. He took off his glasses and put them back on like a gifted actor maximizing a prop. “What happens to me doesn’t matter,” he said at one point. “What happens to these children does matter.” After the talk, a line of visitors snaked down the length of the lobby, his followers waiting to have Wakefield sign a book he wrote about his experience and convictions, “Callous Disregard.” “All right, love?” he said, handing the book back to one mother. “Of course,” he said when asked for a photo. A pregnant woman in the lobby told me she was there trying to educate herself. Another woman, with tears in her eyes, blamed herself for not working harder to obtain a separate measles vaccine for her possibly autistic child. Michelle Guppy, the coordinator of the Houston Autism Disability Network and the organizer of the Tomball event, said she believed her own autistic son benefited greatly from one aspect of Wakefield’s work: his conviction that untreated gastrointestinal problems could be behind some of autism’s symptoms. It was Guppy, it turned out, who thought to hire the armed guards “to make the statement,” she said, “that this is neutral ground, and it’s going to be civil.” Guppy, a mother of two who was elegantly dressed for the occasion, made no pretense of neutrality herself. She narrowed her eyes when she learned that a writer from The New York Times was there to write about Wakefield. “Be nice to him,” she said, “or we will hurt you.” 1 2 3 4 5 Next Page » Susan Dominus (susan.dominus@nytimes.com) is a staff writer for the magazine. Her most recent article was about the young-adult novelist Suzanne Collins. Editor: Lauren Kern (l.kern-MagGroup@nytimes.com). To post a comment, go to the Motherlode blog.

Personal Health: The Nose May Not Know What It’s Missing Posted: 19 Apr 2011 11:59 AM PDT Dr. Ronald DeVere, a neurologist in Austin, Tex., was baffled. In 1995, after recovering from a viral infection, something happened to his sense of smell. Fresh milk smelled sour, the dirty dog pen smelled good, and other odors couldn’t be detected at all. Enlarge This Image Yvetta Fedorova Related More Personal Health Columns After weeks passed without improvement, he consulted experts at the University of Pennsylvania Smell and Taste Center, one of 11 such clinics now scattered around the country. Tests there showed that as a result of his illness, he’d lost 70 percent of his ability to smell. In the years since, Dr. DeVere has recovered much of his ability to smell and taste. But the experience inspired him to open his own clinic for smell and taste disorders and, most recently, to write a book, “Navigating Smell and Taste Disorders” (Demos Health), about this poorly understood and often unrecognized problem. In an interview, Dr. DeVere said he hoped the book would help not only patients with smell and taste disorders but also their physicians, most of whom know little about these problems, he said, and often tell sufferers that “nothing can be done — you’ll have to live with it.” The book was written with his sister-in-law, Marjorie Calvert, an accomplished cook who provided a food preparation guide and dozens of recipes — some contributed by patients — that can help restore dining pleasure to those affected. Taste is mostly a result of odor detection, so the recipes emphasize spice, texture and temperature, sensations that remain unimpaired even when smell malfunctions. You’ve no doubt experienced a temporary disruption in smell and taste while suffering from a cold or sinus infection. Try to imagine your life if the problem lasted indefinitely and you could no longer enjoy the flavor of an orange or chocolate or taste the difference between chicken and steak. But smell and taste disorders can affect more than the ability to “smell the roses” in life and toenjoy food. Also affected is the ability to detect and correct unpleasant smells, like body odor or a dirty diaper in need of changing. For people like professional cooks and firefighters, the problem can force an occupational switch. Most important, smell disorders can be downright dangerous for those who cannot detect the odor of smoke, burning or spoiled food, natural gas or other noxious aromas. An Underrecognized Problem While reliable statistics are hard to come by, several million Americans are thought to suffer from the major smell disorders: hyposmia, a reduced ability to detect certain odors; anosmia, an inability to detect any odors at all; or dysosmia, in which pleasant odors can smell foul or vice versa. Most people who think they have a taste disorder, usually because food has lost its flavor, turn out to have a smell problem, according to Richard M. Costanzo, a neurophysiologist at Virginia Commonwealth University. The smell disorders clinic there receives regular inquiries from distressed patients; one of them said his inability to taste food flavors was “a very life-altering experience, and most normal people cannot understand the impact it has on one’s life.” There are many common causes. In addition to viral infections like colds and flu, they include disorders of the nose (for example, polyps) or sinuses; injuries to the nose or head; medications like blood pressure drugs, antibiotics, cholesterol-lowering drugs, antidepressants and cancer chemotherapy; radiation therapy of the head and neck; exposure to toxins like formaldehyde and pesticides; smoking and alcohol abuse; diseases of the thyroid, kidneys, liver or pancreas; and neurological disorders like Parkinson’s disease, Lewy body disease, multiple sclerosis and various kinds of dementia. Half of all people with diabetes have a diminished sense of smell and taste, and 90 percent of those with Alzheimer’s disease have impaired smell capacity, Dr. DeVere said. By far the leading cause — and the one least often recognized — is advancing age. Whereas only 1 percent to 2 percent of young people are affected, a quarter of those over 55 and nearly two-thirds of those over 80 have a diminished sense of smell. But unlike vision or hearing loss, which is often apparent to others, if not to the afflicted person, a loss of smell sensitivity with age is often undetected because it occurs gradually. The result can be a diminished interest in food and gradual weight loss, or a tendency to over-season foods with salt or sugar, which may impair control of high blood pressure or diabetes, common problems in the elderly. Limited Treatments Depending on the cause of a smell disorder, therapeutic possibilities include treatment with nasal decongestants, antihistamines, or antibiotics; surgery to remove nasal polyps; use of a nasal saline solution; correction of hormonal or nutrient deficiencies; and stopping smoking. Dr. DeVere said that over time smell disorders may gradually diminish in intensity, as his did. Nonetheless, Dr. Costanzo said: “We have to be fair to patients. There’s no magic bullet. Some smell problems are treatable, most are not.” Especially challenging are those that result from head injuries, whether minor or severe, that disrupt the function of the body’s smell receptors — olfactory nerve cells that lie outside the brain. These cells pick up odor molecules high in the nose and transmit scent messages to the brain’s olfactory bulb, he explained. A head blow can injure or tear olfactory nerves. Damaged olfactory nerve cells can regenerate, but don’t always reconnect properly in the brain. Dr. Costanzo and colleagues are working on grafts and transplants that may one day overcome current treatment limitations. Staying Safe While everyone should have working smoke detectors in their homes, a person with a smell disorder should also have a detector for natural gas or propane, lest a leak go undetected and result in an explosion. Perishable foods should be dated and kept refrigerated, and discarded when they expire. It may be wise for a person with normal olfactory function to check these foods before someone with an impaired sense of smell eats them. Make sure all cleaning and garden products are properly labeled and stored separately from foods. When cooking or baking, check periodically to make sure nothing is burning, and set a timer to ring when the food will be done. Since you can’t rely on a “sniff test,” be sure to bathe and launder clothes regularly. Use underarm deodorant, and go easy with cologne. Regularly check diapers for visual signs that a change is needed. For more information, consult the Web site of the National Institute on Deafness and Other Communication Disorders at www.nidcd.nih.gov/health/smelltaste.

Really?: The Claim: To Reduce Snoring, Try Sleeping on Your Side Posted: 18 Apr 2011 06:50 PM PDT THE FACTS Enlarge This Image Christoph Niemann Well Share your thoughts on this column at the Well blog. Go to Well » Related Health Guide: Snoring More Really? Columns Chronic snoring can be more than a noisy nuisance. Up to three-quarters of nightly snorers also have sleep apnea, which causes breathing interruptions throughout the night. Sleep apnea raises the risk of heart disease, stroke and high blood pressure. Snorers looking for a cure are often told to sleep on their sides, not on their backs, so that the base of the tongue will not collapse into the back of the throat, narrowing the airway and obstructing breathing. But for some snorers, changing sleep position may not make much of a difference. Scientists say there are two types of snorers: those who snore only when they sleep on their backs, and those who do it regardless of their position. After sleep researchers in Israel examined more than 2,000 sleep apnea patients, for example, they found that 54 percent were “positional,” meaning they snored only when asleep on their backs. The rest were “nonpositional.” Other studies have shown that weight plays a major role. In one large study, published in 1997, patients who snored or had breathing abnormalities only while sleeping on their backs were typically thinner, while their nonpositional counterparts usually were heavier. The latter group, wrote the authors, consequently suffered worse sleep and more daytime fatigue. But that study also found that patients who were overweight saw reductions in the severity of their apnea when they lost weight. According to the National Sleep Foundation, in people who are overweight, slimming down is generally the best way to cure sleep apnea and end snoring for good. THE BOTTOM LINE Sleeping on your side can help reduce snoring, though in people who are overweight, it may not make much difference without weight loss. ANAHAD O’CONNOR scitimes@nytimes.com

The New Old Age: Remaking Alzheimer's: A Few Questions Posted: 21 Apr 2011 11:41 AM PDT

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Prescriptions: UnitedHealth Group Reports Strong Earnings Posted: 21 Apr 2011 10:27 AM PDT

Prescriptions: This Week's Health Industry News Posted: 18 Apr 2011 09:21 AM PDT

Letters: Sick, but Not Alone (1 Letter) Posted: 18 Apr 2011 09:50 PM PDT To the Editor: It was no surprise to me that married cancer patients have higher survival rates than similar patients who are separated or widowed (“A Couple’s Knot, Tied Tighter by Dual Diagnoses,” Well, April 12). I was diagnosed with breast cancer in 2000. While I have no doubt that the aggressive chemotherapy I received was a necessary condition for my survival, I am also certain that without the constant nurturing that I received from my husband, it would not have been sufficient. His presence, his advocacy for me with the doctors and his unwavering belief that I would survive were constants throughout my treatment. Even when only one member of a couple is sick, both are involved in the treatment and the journey to survive. Carol G. Feldman Boston Science Times welcomes letters from readers. Those submitted for publication must include the writer’s name, address and telephone number. E-mail should be sent to scitimes@nytimes.com. Send letters to Science Editor, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018.

Letters: Glowing With Health (1 Letter) Posted: 18 Apr 2011 09:50 PM PDT To the Editor: Re “Is This the Poster Food for a Radiation Menace?” (April 12): Bananas do contain natural potassium, which includes the naturally radioactive isotope potassium-40. The same is true of the human body. What physicists miss, but no biologist would, is that potassium in the human body is homeostatically regulated, so regardless of how many bananas you eat, the amount of potassium-40 in your body is constant. Therefore, your radiation dose is constant regardless of your banana intake. What biologists miss, on the other hand, is that a Geiger counter is a poor instrument with which to detect potassium-40 in bananas (or in people, for that matter). Put any person under a sensitive gamma-spectrum analyzer, and the gamma energy peak from their potassium-40 will be readily apparent. This also works for bananas. Richard Poeton Bennington, Vt. Science Times welcomes letters from readers. Those submitted for publication must include the writer’s name, address and telephone number. E-mail should be sent to scitimes@nytimes.com. Send letters to Science Editor, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018.

Letters: The Hearts of Athletes (1 Letter) Posted: 18 Apr 2011 09:50 PM PDT To the Editor: Re “Focus on Heart Deaths in Student-Athletes” (Vital Signs, April 12): Physicals that rely on stethoscope, personal and family history do not adequately identify many whose lives are at risk for sudden cardiac arrest. Most athletes who die on the field have experienced no symptoms prior to their death. Communities should insist on automated external defibrillators (A.E.D.’s), CPR/A.E.D. training and emergency response plans wherever youth play. We have the tools and technology available to save young lives. We should be using them, or live with the fact that kids will continue to die while we debate whether they’re worth saving. Michele Snyder Northbrook, Ill. Science Times welcomes letters from readers. Those submitted for publication must include the writer’s name, address and telephone number. E-mail should be sent to scitimes@nytimes.com. Send letters to Science Editor, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018.

Administration Wants Tighter Painkiller Rules Posted: 19 Apr 2011 11:50 PM PDT The Obama administration said on Tuesday that it would seek legislation requiring doctors to undergo training before being permitted to prescribe powerful painkillers like OxyContin, the most aggressive step taken by federal officials to control both the use and abuse of the drugs. Enlarge This Image Robert F. Bukaty/Associated Press The prescription drugs Dilaudid, left, and OxyContin, center and right, are two of the medicines likely to be affected by a proposal to require doctors to undergo training to prescribe painkillers. Related Ohio County Losing Its Young to Painkillers’ Grip (April 20, 2011) In the last decade, the abuse of pain medications like OxyContin has remained at epidemic levels, and medical experts have expressed concern that the legitimate use of the drugs may also pose patient risks. For years, the question of whether doctors should be trained as a condition of prescribing such medications has been fiercely debated. Proponents of the training argue that it would help doctors better identify patients who would benefit from treatment with long-acting narcotics, and help them unmask patients feigning pain to get drugs they then abuse. Opponents say a training requirement will reduce the number of doctors prescribing pain drugs and hamper patient care. Such a measure would probably entail Congressional approval of an amendment to the Controlled Substances Act to require that doctors undergo training as a condition of the renewal of licenses issued by the Drug Enforcement Administration for the prescription of narcotics. The law now gives the D.E.A. the authority to approve prescription licenses if a doctor merely shows an active license to practice medicine. Federal officials announced the legislative initiative on Tuesday along with outlining other measures they hope will reduce prescription drug abuse. “The White House is absolutely committed to legislation that will make prescriber education mandatory,” R. Gil Kerlikowske, President Obama’s top drug policy adviser, said in an interview. “Of all the things we’re proposing, this is certainly the one that’s got a real bright light behind it.” Mr. Kerlikowske said his office had already approached several lawmakers about the legislation and intended to help draft it. He acknowledged that it was unclear when a bill would be submitted but said he hoped backers in Congress would do so by year’s end. Any proposal is likely to be fought by drug makers, some doctors and patient groups, who have argued that doctor training should be voluntary, not mandatory. In addition, proposed legislation would most likely encounter opposition among some lawmakers who have already mounted campaigns against what they consider to be the overregulation of the health care industry. Among the drugs that would most probably fall under a stricter licensing measure are OxyContin, fentanyl, hydromorphone and methadone. They are considered critical to pain treatment. But they also have been associated in recent years with a national epidemic of prescription drug abuse and addiction and thousands of overdose-related deaths. OxyContin is the brand name for a long-acting form drug oxycodone. Dilaudid is the brand name for hydromorphone. The administration’s move comes after a panel of experts assembled by the Food and Drug Administration overwhelmingly rejected last year its proposal that physician training be voluntary. Those experts said that mandatory training was needed. The F.D.A. has long argued that only Congress has the authority to mandate physician training as a condition of prescribing narcotics. That is because the legal distribution of the drugs is regulated by the Controlled Substances Act of 1970, and the licensing of doctors to prescribe them is overseen by the D.E.A., not the F.D.A. In a related development, the F.D.A. released new regulations on Tuesday that would require the makers of long-acting or extended release painkillers to provide training to doctors but would not require doctors to take such courses. This proposal is similar to the one rejected as too weak in last year’s debate. Dr. Janet Woodcock, who heads the F.D.A. Center for Drug Evaluation and Research, indicated that the new agency rules were effectively a placeholder until legislation was passed or were to be used if a relevant bill failed. In response to a reporter’s question, she said officials of the F.D.A., the D.E.A. and other federal agencies had agreed on the mandatory training requirement. Mr. Kerlikowske, the White House drug czar, said he had sought input from doctors, medical schools and representatives of the pharmaceutical industry, which he said would pay for the training. The training would focus on opioid painkillers like OxyContin because they were the most widely abused and dangerous class of drugs prescribed by doctors, he said. “That’s where, right now, the impetus and the public concern is,” he said. “You don’t want to be accused of overreaching.” During the F.D.A. review, some drug makers strenuously opposed mandatory physician training. But an executive of Covidien, which sells the painkiller fentanyl, said his company supported such a requirement. “The proposed amendment to the Controlled Substances Act giving authority to the D.E.A. to require prescriber training would be a valuable measure,” said that executive, Dr. Herbert Neuman. A spokeswoman for the maker of OxyContin, Purdue Pharma, said it also supported the approach. “The D.E.A. process to authenticate training would seem to be the best way to gain compliance,” that spokeswoman, Libby Holman, stated in an e-mail. About 600,000 doctors, dentists and physician assistants are licensed by the D.E.A. to prescribe controlled substances, according to Mr. Kerlikowske’s office. “They don’t get a lot of information in their training about pain management, about addiction, about tolerance and dependence,” he said. Several other pending Congressional bills are aimed at prescription drug abuse. One of them, submitted by Representative Mary Bono Mack, Republican of California, would direct the F.D.A. to limit the approval of OxyContin and other controlled-released forms of oxycodone to the treatment of severe pain.

Allan Blakeney, Pioneer of Canadian Health Care, Dies at 85 Posted: 19 Apr 2011 10:00 PM PDT Allan Blakeney, the health minister of the Canadian province of Saskatchewan who helped start North America’s first tax-financed universal health care system in 1962, and was later the province’s premier, died Saturday at his home in Saskatoon. He was 85. United Press International Allan Blakeney in 1974. The Saskatchewan government said the cause was liver cancer. In 1946, the government of Tommy Douglas, then Saskatchewan’s premier, enacted universal insurance coverage for hospitalization. Mr. Douglas’s successor, Woodrow Lloyd expanded the program in 1962 to include the costs of medical care provided by doctors. Nine out of 10 doctors responded by going on strike, people demonstrated in support of the doctors and newspapers editorialized in their favor. Mr. Blakeney, as the health minister in Mr. Lloyd’s government, became the main negotiator with the physicians. He succeeded in keeping the new system — partly by emphasizing its lower cost — but compromised to give doctors the right to charge fees for services, rather than going on salary. Mr. Blakeney later called the brouhaha the “the greatest social conflict I was involved in.” By 1966, universal medical coverage had been extended to all Canadians. Opposition to the plan in Saskatchewan, however, helped the Liberal Party defeat Mr. Lloyd’s government in 1964. Mr. Blakeney remained a member of the provincial legislature and practiced law. But by 1970, he had become leader of the provincial New Democratic Party, and he led it to victory the next year. As Saskatchewan’s premier, a post he held until 1982, he put into effect a flurry of programs he called a New Deal for People. These included a dental program for children, a prescription drug program, subsidized housing, home care and a guaranteed income supplement for the elderly poor. He helped pass a law to allow the government to purchase land from older farmers, so it in turn could rent the land to their children, making it financially feasible for them to stay on the family homestead. Mr. Blakeney aggressively increased the fees charged by the province for mining potash, a component of fertilizer. After foreign producers, largely American, refused to pay, Mr. Blakeney’s government seized the mines of companies producing more than 40 percent of the province’s potash, paying what it said was a fair market price. Both the companies and the United States government protested, but the action stood. Mr. Blakeney also became a force on the national scene during the discussions over Canada’s new Constitution in the early 1980s. He successfully argued for more power for provincial legislatures. Allan Emrys Blakeney was born on Sept. 7, 1925, in Bridgewater, Nova Scotia, and grew up dreaming of being a sea captain. He earned a law degree from Dalhousie University in Halifax, then studied at Oxford as a Rhodes scholar, earning a bachelor’s degree in politics, philosophy and economics. He worked as a civil servant in the Saskatchewan government until he was elected to the provincial legislature in 1960. In addition to being provincial health minister, he was also minister of education and treasurer. He ran unsuccessfully to return to the premier’s job in 1986, then retired from politics two years later. Mr. Blakeney’s first wife, the former Molly Schwartz, died in 1957. His survivors include his wife, the former Anne Gorham, and four children. Mr. Blakeney watched the United States’ debate on health care, which resulted in the Affordable Health Care for America Act of 2009, with keen interest. He called the American law “a painfully small step.”

Lack of Success Terminates Study in Africa of AIDS Prevention in Women Posted: 18 Apr 2011 11:00 PM PDT In an unexpected setback for a new form of AIDS prevention, scientists on Monday halted a study in Africa intended to find out whether a daily antiretroviral pill can prevent women from becoming infected with the AIDS virus. Related Health Guide: AIDS Early data showed no evidence that the pill was working. Women taking the medication, Truvada, were just as likely as those taking a placebo to become infected, according to an independent panel that analyzed the results after the study had enrolled about half the 4,000 women researchers had hoped to enlist. Of the 1,900 women taking Truvada or a placebo, 28 in each group had become infected as of last week, according to FHI, formerly Family Health International, the nonprofit group that was conducting the study in South Africa, Kenya and Tanzania. “It’s surprising, disappointing and frustrating,” said Mitchell Warren, executive director of AVAC, an advocacy group for AIDS prevention in New York. “But there’s a strong rationale for continuing other trials in women in hopes of obtaining better results in the future.” Two other studies of what is called “pre-exposure prophylaxis” in women are still under way in Africa. The results are expected over the next two years. The inconclusive results of the latest trial are a surprise to many experts. A study published last November found that Truvada protected gay men against infection. Men who took their pills faithfully were shown to have better than 90 percent protection, a result hailed as a breakthrough for AIDS prevention. And results published last summer from a trial in South Africa showed that a vaginal gel containing tenofovir, one of the two antiretroviral drugs in Truvada, reduced the chances of infection by 54 percent in the women who used it faithfully before and after sex. Because the current study — known as FEM-PReP on the list of catchy acronyms scientists use to distinguish many similar trials from one another — was stopped early and abruptly, many questions about it remain. One is whether there was any difference in how often the women given Truvada and those given a placebo actually took their pills. More women taking Truvada complained of unpleasant side effects, and therefore a greater number might have failed to adhere to the program. The researchers asked the women every month how often they took their pills, but preferred to confirm those answers through blood samples. The samples are in storage and have not yet been analyzed. After that is done, “we might be able to get a better handle on the adherence,” said Dr. Timothy Mastro, vice president for health and development sciences of FHI. Any woman who became pregnant was removed from the study, because Truvada has not been proved safe for pregnant women; for unknown reasons, more women taking the medication became pregnant, which may also have skewed the early results. Another question is how much Truvada infused the walls of the vagina, where the initial infection takes place. According to Dr. Robert M. Grant, a California AIDS researcher who led the study of Truvada in gay men, other research has shown that vaginal gels are as much as 100 times more effective than pills at getting protective antiretroviral drugs into the vaginal walls. Pills and gels are about equally effective in getting them into rectal tissue, he said.

Guidelines Allow Earlier Definition of Alzheimer’s Posted: 19 Apr 2011 12:50 AM PDT For the first time in 27 years, the definition of Alzheimer’s disease is being recast in new medical guidelines that reflect fast-mounting evidence that it begins ravaging the brain years before the symptoms of dementia. Related Stages of Alzheimer’s Disease (April 19, 2011) The guidelines, to be issued Tuesday by the National Institute on Aging and the Alzheimer’s Association, divide the disease into three stages: a phase when dementia has developed, a middle phase in which mild problems emerge but daily functions can still be performed, and the most recently discovered phase, in which no symptoms are evident but changes are brewing in the brain. “We’re redefining Alzheimer’s disease and looking at this in a different way than had ever been done,” said Creighton Phelps, director of the National Institute on Aging’s Alzheimer’s Disease Centers Program. “I think we’re going to start to identify it earlier and earlier.” The drive to diagnose Alzheimer’s before it has progressed into profound dementia is also reflected in a bill introduced in Congress this month, which would create specific Medicare cost codes for Alzheimer’s diagnosis, including steps involving discussions between the patient’s doctor and caregivers, a recognition that keeping family members well-informed can result in better planning and care. “Early diagnosis is really the key to this,” said Representative Edward J. Markey, Democrat of Massachusetts and a sponsor of the bill. “Oftentimes family members notice the symptoms in their loved ones, but it’s only years later that they get diagnosed or understand what resources are available.” The most striking addition to the guidelines concerns methods that assess brain changes involved in Alzheimer’s, including brain scans and tests of cerebral spinal fluid. Such methods measure what are called biomarkers, physiological indicators that someone is likely to develop dementia eventually, just as cholesterol and blood pressure are biomarkers of impending heart disease. For now, the guidelines specify that Alzheimer’s biomarkers — including abnormal levels of the proteins amyloid and tau, and shrinkage of certain brain areas — should not yet be put into widespread use, but used only with patients enrolled in clinical trials. That is because scientists cannot yet standardize the results of the tests, or know “what measure is truly abnormal and what measure is not,” said Marilyn Albert, director of the Johns Hopkins Alzheimer’s Disease Research Center, and a leader of one working group that developed the new guidelines. As many as a third of people with amyloid plaques in their brains, for example, have not developed Alzheimer’s symptoms by the time they die. The guidelines also urge caution because there is currently no drug known to halt or significantly delay the onset of symptoms, so people told they are likely to get Alzheimer’s have no effective medication to take. “We don’t have enough information about what to tell people,” said Dr. Steven DeKosky, dean of the University of Virginia medical school, who participated in one of the working groups. “Until you can tell a clinician, ‘If you do this test you have X amount of reliability and to do that will make a difference in the life of your patient’ — until then, it remains in the lab.” But the guidelines reflect a sense in the medical community that the moment when science will have more specific knowledge about biomarkers is not that far off. They are intended to encourage more research so that drugs can be developed to attack early brain changes and to identify people who might benefit from such drugs when they become available. The goal, said William Thies, chief medical and scientific officer for the Alzheimer’s Association, is “extending the range of our ability to investigate this disease and eventually find the treatment that is going to be so necessary to avoid the epidemic of Alzheimer’s disease that we see facing us over the next 40 years.” In the short term, the biggest impact is likely to be seen with people who fall into the middle phase, those with mild cognitive impairment linked to Alzheimer’s. Experts say there are at least as many people experiencing this phase as the 5.4 million people estimated to have Alzheimer’s dementia. And they expect others to now ask their doctors if they are showing signs of mild impairment, which include experiencing some difficulty or inefficiency with memory, attention or other mental faculties, while still being able to function independently. Dr. Albert said that if patients with symptoms of mild cognitive impairment wanted to “increase the certainty” of the diagnosis by getting a brain scan or spinal fluid test, they should obtain such tests in a research trial so they have a better chance of getting accurate results. The guidelines also clarify diagnosis criteria for people with dementia symptoms, distinguishing Alzheimer’s from other dementias, including vascular, fronto-temporal and Lewy body. And they note that the earliest symptom of Alzheimer’s dementia is not always memory loss, but could be mood changes or problems with language, spatial perception or reasoning. Dr. Pierre Tariot, director of the Banner Alzheimer’s Institute in Phoenix, who was not involved in drafting the guidelines, called them “a step in the right direction” that he hoped would not be “misconstrued” as a sign that biomarker tests are further along than they are. He added, “The notion that Alzheimer’s disease is a continuum that has an extensive pre-symptomatic phase is a very important message to get out.” Dr. Phelps said it would hardly be the last word from the medical community on Alzheimer’s. “We’re not drawing a line and saying this is it,” Dr. Phelps said. “What we’re saying is this is the best of our knowledge and we’re not going to wait 27 years to revisit these again.”

Vital Signs: Exercise: Fewer Healthy Habits for Young Mothers Posted: 18 Apr 2011 10:22 PM PDT Many women adopt healthier lifestyles when they become pregnant, but a new study suggests that young mothers of small children exercise less than other women their age and don’t eat as well. Well Share your thoughts on this column at the Well blog. Go to Well » Related More Vital Signs Columns The report, published April 11 in the journal Pediatrics, drew data from a study called Project EAT on a diverse group of 838 women and 682 men from Minneapolis and St. Paul who were 25 years old on average. The young mothers in this group consumed more calories — eating more saturated fat and drinking more sweetened beverages — and got about an hour less of moderate to vigorous physical activity each week than similar childless women, who were active for three hours a week on average, the researchers found. The mothers were also more likely to be overweight than other women their age, but researchers said that may have been because many had recently given birth. The young fathers got five hours a week of physical activity, compared with almost seven for childless men their age. While they exercised less, their diets were not significantly different and they weren’t heavier. “The take-home message is that this is a time when new parents are at high risk for behaviors that could set them on a negative long-term trajectory for their health, and we need to figure out how to support them,” said Jerica M. Berge, assistant professor of family medicine and community health at the University of Minnesota and the paper’s lead author.

Recipes for Health: Ribollita Posted: 19 Apr 2011 09:10 AM PDT In Tuscany region of Italy, the way to transform leftover bean and vegetable soup into the ultimate comfort food is to reheat the soup with dry or toasted bread, then blend it into a thick, comforting pap. This is called ribollita, which means “reboiled.” Recipes for Health Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. See All Recipes for Health » Visit Recipes for Health on Facebook. Related Recipes for Health: A Bowlful of Our Daily Bread (April 18, 2011) Recipes for Health: Majorcan Bread and Vegetable Soup (April 19, 2011) Recipes for Health: Apple-Spice Breakfast Soup (April 20, 2011) Recipes for Health: ‘Bouillabaisse’ of Fresh Peas With Poached Eggs (April 21, 2011) 6 ounces (1 scant cup) white or borlotti beans, soaked, if desired, for four hours and then drained 1 onion, cut in half 3 large garlic cloves, 1 crushed, the rest minced Salt to taste 3 tablespoons extra virgin olive oil 1 large carrot, diced 1 celery rib, diced Pinch of red chili flakes 1/4 Savoy or green cabbage, cored and shredded (2 cups shredded) 1 14-ounce can chopped or puréed tomatoes, with juice 3/4 pound (1 bunch) Swiss chard, kale or a mixture, stemmed, cleaned and chopped or cut in chiffonade (3 cups chopped greens) A bouquet garni made with a bay leaf, a few sprigs each thyme and parsley, and a Parmesan rind 6 thick slices country bread, preferably whole-grain (about 6 ounces) 1. Place the beans in a medium saucepan, and add 4 cups water, the halved onion and crushed garlic clove. Bring to a boil. Reduce the heat, add salt to taste, cover and simmer 1 hour. Remove the onion halves. Taste and adjust seasonings. 2. Heat 2 tablespoons of the oil in a heavy soup pot, and add the chopped onion, carrots and celery. Cook, stirring often, until the onion is tender, about five minutes. Add the garlic and chili flakes, and stir together for 30 seconds to a minute until fragrant. Add the cabbage. Cook, stirring, until the cabbage wilts, three to five minutes. Add the tomatoes. Cook, stirring, until the tomatoes cook down and smell fragrant, five to 10 minutes. Season to taste with salt. 3. Stir in the beans and their liquid, add the bouquet garni and another 2 cups of water, and bring to a boil. Reduce the heat, cover and simmer 30 minutes or until the beans are tender. Taste and adjust seasonings. Add the greens, raise the heat and simmer covered for another 15 minutes. The greens should be falling apart in the soup. Remove the bouquet garni. 4. Meanwhile, preheat the oven to 300 degrees. Place the bread on the rack, and toast until dry but not browned, about 15 to 20 minutes. Break up into pieces. Remove about 1 cup of the beans and vegetables from the soup. Bring the remaining soup to a simmer, and add the bread. Submerge in the soup, and remove the soup from the heat. Let stand for 20 minutes until the bread is soft. Blend, using a hand immersion blender or the pulse action of a food processor. Return to the pot, add the beans and vegetables you set aside, and heat through. The ribollita should have the consistency of oatmeal. Dilute with water as necessary. Taste and adjust salt and pepper. Spoon the ribollita into bowls or onto soup plates, drizzle olive oil over each bowl and serve. Note: You can make ribollita with 5 to 6 cups of any type of leftover minestrone using the bread proportions above. Yield: Serves four to six. Advance preparation: Ribollita will stiffen up considerably if you make it too far in advance. If you do so, thin it out as desired with water or stock and adjust salt. Nutritional information per serving (four servings): 407 calories; 2 grams saturated fat; 1 gram polyunsaturated fat; 7 grams monounsaturated fat; 0 milligrams cholesterol; 63 grams carbohydrates; 17 grams dietary fiber; 610 milligrams sodium (does not include salt to taste); 16 grams protein Nutritional information per serving (six servings): 271 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 0 milligrams cholesterol; 42 grams carbohydrates; 11 grams dietary fiber; 407 milligrams sodium (does not include salt to taste); 10 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Recipes for Health: Apple-Spice Breakfast Soup Posted: 20 Apr 2011 12:20 AM PDT Years ago, when I lived in Austin, Tex., I had a little business selling hot cups of soup to vendors and shoppers on the “Drag” in front of the University of Texas. This soup was always a favorite on a chilly day. It’s sweet and spicy, and although you can serve it at lunch or dinner, I prefer it for breakfast, with more yogurt stirred in. Use whole-grain sandwich bread if you can. Recipes for Health Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. See All Recipes for Health » Visit Recipes for Health on Facebook. Related Recipes for Health: A Bowlful of Our Daily Bread (April 18, 2011) Recipes for Health: Majorcan Bread and Vegetable Soup (April 19, 2011) Recipes for Health: ‘Bouillabaisse’ of Fresh Peas With Poached Eggs (April 21, 2011) Recipes for Health: Ribollita (April 22, 2011) 1 1/2 quarts water 4 large tart apples, like Pink Lady, unpeeled, cored and diced (about 2 1/2 pounds) 2/3 cup dark or golden raisins 1 teaspoon freshly grated nutmeg 1 1/2 teaspoons ground cinnamon 1/4 teaspoon ground cloves 1/2 teaspoon ground allspice Pinch of salt 1/4 cup honey 4 slices whole-wheat or multigrain bread (about 6 ounces), diced (3 cups tightly packed) 2 tablespoons fresh lemon juice 1/2 to 1 cup plain yogurt, to taste, plus additional for garnish Thin lemon slices for garnish 1. Combine the water, apples, raisins, spices, salt and honey in a large soup pot. Bring to a boil, reduce the heat and stir in the bread. Cover and simmer one hour. The bread will fall apart and thicken the soup. 2. Remove from the heat, and stir in the lemon juice and yogurt. Serve hot or warm, or chill and serve cold. Garnish each serving with a dollop of yogurt and a thin slice of lemon. Yield: Serves six to eight. Advance preparation: This soup will keep for a few days in the refrigerator. Nutritional information per serving (six servings): 251 calories; 0 grams saturated fat; 0 grams polyunsaturated fat; 0 grams monounsaturated fat; 0 milligrams cholesterol; 62 grams carbohydrates; 7 grams dietary fiber; 161 milligrams sodium (does not include salt to taste); 4 grams protein Nutritional information per serving (eight servings): 189 calories; 0 grams saturated fat; 0 grams polyunsaturated fat; 0 grams monounsaturated fat; 0 milligrams cholesterol; 47 grams carbohydrates; 5 grams dietary fiber; 121 milligrams sodium (does not include salt to taste); 3 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Recipes for Health: Majorcan Bread and Vegetable Soup Posted: 19 Apr 2011 08:59 AM PDT This thick soup is traditionally made with day-old bread, which soaks up much of the broth. Add a poached egg if you want an even more substantial meal. Recipes for Health Each week this series will present recipes around a particular type of produce or a pantry item. This is food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and a pleasure to eat. See previous recipes » Related Recipes for Health: A Bowlful of Our Daily Bread (April 18, 2011) Recipes for Health: Apple-Spice Breakfast Soup (April 20, 2011) Recipes for Health: ‘Bouillabaisse’ of Fresh Peas With Poached Eggs (April 21, 2011) Recipes for Health: Ribollita (April 22, 2011) 3 tablespoons extra virgin olive oil 1 bunch scallions, white and light green parts only, chopped 1 small onion, chopped 4 garlic cloves, minced, plus 1 additional clove, cut in half 1 green pepper, cored, seeded and finely chopped 2 tablespoons minced parsley 1 (14-ounce) can chopped tomatoes with juice 3/4 pound green cabbage, coarsely chopped Salt and freshly ground pepper to taste 5 cups water or vegetable stock 1/2 pound spinach or Swiss chard, stemmed, washed and coarsely chopped 12 slices country bread (about 1/2 pound), stale or lightly toasted 1. Heat 2 tablespoons of the oil over medium heat in a large ovenproof casserole. Add the scallions and onion. When they begin to soften, after about three minutes, stir in the minced garlic, green pepper and parsley. Stir together for a minute or two, then cover and turn heat to low. Cook for 15 minutes, stirring occasionally. Add the tomatoes, turn heat to medium-high and cook, stirring often, for five minutes. Add the cabbage, salt to taste and pepper. Cover, turn heat to low and cook slowly for 15 minutes. Add the water or stock, bring to a boil, reduce the heat, cover and simmer for 15 minutes. Stir in the spinach or chard, and bring back to a simmer. Cover and simmer for five to 10 minutes until the greens are very tender and the broth is fragrant. Taste and adjust seasonings. 2. Preheat the oven to 450 degrees. Rub both sides of the bread with a cut clove of garlic. Place a layer of bread slices in a large earthenware casserole, and ladle on soup to cover. Make another layer of bread, and ladle on more soup to cover. Repeat with the remaining bread, and add the remaining soup. Drizzle with the remaining olive oil, transfer to the oven and bake 10 minutes, uncovered. Serve hot or warm. Yield: Serves six. Advance preparation: The dish can be done through Step 1 three days before serving and kept in the refrigerator. Nutritional information per serving: 216 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 0 milligrams cholesterol; 32 grams carbohydrates; 6 grams dietary fiber; 371 milligrams sodium (does not include salt to taste); 5 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Recipes for Health: A Bowlful of Our Daily Bread Posted: 19 Apr 2011 08:59 AM PDT Soups thickened with fresh or stale bread are ubiquitous throughout the Mediterranean — indeed, wherever bread is a staple. The simplest are made with thick, toasted slices of bread, sometimes rubbed with garlic, arranged in wide bowls and covered with soup. They can be topped with poached eggs for a satisfying meal. Recipes for Health Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. See All Recipes for Health » Visit Recipes for Health on Facebook. Related Recipes for Health: Majorcan Bread and Vegetable Soup (April 19, 2011) Recipes for Health: Apple-Spice Breakfast Soup (April 20, 2011) Recipes for Health: ‘Bouillabaisse’ of Fresh Peas With Poached Eggs (April 21, 2011) Recipes for Health: Ribollita (April 22, 2011) Other bread soups are thick, paplike dishes: chunks of bread are added to the soup and simmered until they break down, thickening the broth. The most famous Italian versions are pappa al pomodoro and ribollita, which is usually made with leftover bean and vegetable soup that is reheated and blended with bread. Portugal has an array of bread soups called açordas, too, but the Mediterranean region isn’t the only place to look for them. In Scandinavia, you’ll find soups made with dark bread and beer, as well as one of my favorites, a sweet apple spice soup thickened with whole-grain bread. Although some bread soups are very simple mixtures of bread and broth, the ones I love most are packed with produce. And while the traditional versions of the Mediterranean soups are made with white bread, there’s no reason not to use whole-grain breads in these recipes. I don’t recommend sourdough, however, because the flavor is too strong. Those of you celebrating Passover will be saving these recipes for another time, of course. But here’s an alternative perfect for this week: my favorite matzo balls. Tuscan Bread and Tomato Soup Called pappa al pomodoro, this humble mixture of bread, tomatoes, garlic and basil has a luxurious flavor. Although the soup is traditionally made with unsalted Tuscan bread, it works beautifully with any country bread. 3 tablespoons extra virgin olive oil 1 small onion, chopped 4 garlic cloves, minced 1 (28-ounce) can chopped tomatoes, with juice 2 tablespoons tomato paste Pinch of sugar Pinch of red chili flakes Salt and freshly ground pepper 4 cups water 1 pound stale country bread, crusts removed, cut into cubes (about 7 cups) 2 to 3 tablespoons slivered fresh basil 1. Heat 2 tablespoons of the oil in a large, heavy soup pot over medium-low heat. Add the onion, and cook, stirring, until tender, about five minutes. Meanwhile, pulse the tomatoes in a food processor fitted with the steel blade until coarsely blended. 2. Add the garlic to the pot. Cook, stirring, for about a minute until fragrant. Add the tomatoes, tomato paste, sugar, red chili flakes, and salt and pepper. Cook, stirring occasionally, until the tomatoes have cooked down, about 10 minutes. 3. Stir the bread cubes into the tomatoes. Add the water, half the basil and salt to taste. Increase the heat, and simmer, stirring and mashing the bread, for about 10 minutes until the soup is thick, like pap. Stir in the remaining basil, and taste and adjust the seasonings. Serve hot, warm or room temperature with the remaining olive oil drizzled over each serving. Yield: Serves six to eight. Advance preparation: This soup can be made a day ahead and will be even more flavorful the second day. I reheat mine in a microwave. Nutritional information per serving (six servings): 258 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 0 milligrams cholesterol; 41 grams carbohydrates; 4 grams dietary fiber; 594 milligrams sodium (does not include salt to taste); 6 grams protein Nutritional information per serving (eight servings): 193 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 4 grams monounsaturated fat; 0 milligrams cholesterol; 31 grams carbohydrates; 3 grams dietary fiber; 446 milligrams sodium (does not include salt to taste); 5 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

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