Health - In Fighting Anorexia, Recovery Is Elusive |
- In Fighting Anorexia, Recovery Is Elusive
- Well: Gym Class: AntiGravity Yoga
- Essay: If Only All We Wanted Was Expert Advice
- Hippo, Warts and Other Thugs of the Genetic Realm
- Regulator Will Treat E-Cigarettes Like Tobacco
- Bill Cook, Medical Device Maker, Dies at 80
- Recipes for Health: Pigeon Peas With Mango
- Well: What Annoys You?
- Letters: A Drug’s Many Uses (2 Letters)
- Letters: Asleep at the Wheel (1 Letter)
- After School in Brooklyn, West African Girls Share Memories of a Painful Ritual
- Recipes for Health: Mango, Orange and Ginger Smoothie
| In Fighting Anorexia, Recovery Is Elusive Posted: 25 Apr 2011 09:05 PM PDT Dr. Suzanne Dooley-Hash believes that she will never fully recover from the anorexia that has plagued her since she was 15 years old. Brendan Smialowski for The New York TimesKathleen MacDonald, a policy assistant at the Eating Disorders Coalition in Washington, had an eating disorder for 16 years, but considers herself fully recovered. MultimediaFor many years, she did not take laxatives constantly to lose weight, as she did in the mid-1980s, and her health was “relatively O.K.” Thoughts about her weight did not occupy every second of every minute of every day. But in 2005 she relapsed, losing one-third of her body weight in six months. She took off 19 months from her job as an emergency room physician at the University of Michigan Medical School in Ann Arbor to devote herself to getting her life back in order. Like many patients with eating disorders, however, she is not sure what recovery means. “Does it mean ‘functional?’ ” asked Dr. Dooley-Hash, 45. “I’m a physician at a really high-powered institution, and I’ve published in well-respected journals — I’m functional. I don’t think functionality is necessarily a good measure.” Dr. Dooley-Hash is not alone in her confusion. Most medical experts agree that a third of people with the disorder will remain chronically ill, a third will die of their disorder, and a third will recover — with one significant caveat. There is surprisingly little agreement as to what “recovery” means for people with anorexia. Indeed, just a handful of studies on long-term recovery rates have been conducted over the last decade or so, and different parameters were used in each one. “Without consistency, it’s hard to compare across studies,” said Dr. Michael Strober, a professor of eating disorders and psychiatry at the University of California, Los Angeles. “You just have to know how recovery is defined in each study to have a balanced interpretation.” It is difficult to define recovery from an illness that has both physical and mental dimensions. If, for example, a patient reaches “normal weight” — which researchers define as either 85 or 95 percent of a person’s ideal weight — and starts menstruating again, she would be considered to have recovered in most studies. But what if she still weighs herself daily, monitors her calories with a vengeance and obsesses about food and the size of her ankles? Or, as is often the case, moves from anorexia to bulimia or binge-eating disorder? “About 50 percent of people with anorexia will be able to reach and maintain a normal weight, but most of them are very preoccupied with the calorie content of food,” said Dr. Katharine Halmi, professor of psychiatry at Weill Cornell Medical College in New York City. Still, she added: “Many people who’ve never had anorexia watch their diet carefully. So the big issue is, how do you define recovery? Maintaining a normal weight, recurrence of menstruation is easy to document. Mental status is a different problem.” With that in mind, many with anorexia prefer to view recovery as many alcoholics do — the disease may be in remission, but the potential for relapse always lurks in the background. “Some people find comfort in saying ‘recovering’ so they don’t have to be responsible for being recovered, which means ‘I will never relapse,’ ” said Aimee Liu, 57, author of “Restoring Our Bodies, Reclaiming Our Lives.” Others, she said, liken their eating disorder to managing a chronic illness like diabetes, requiring constant vigilance. “I say to patients, ‘This is your Achilles’ heel,’ ” said Dr. Daniel Le Grange, an associate professor of psychiatry at the University of Chicago and director of the eating disorders program at the University of Chicago Medical Center. “If you have another crisis, you’re predisposed to resorting to starvation as your way of managing that issue. It would be foolish of us as clinicians not to prepare our patients that they should be on the lookout for a recurrence.” Most doctors believe recovery from anorexia is rarely absolute and more often occurs by degrees. While patients may get better, aspects of their disease will continue to nag at them. “The literature suggests you can have physical recovery from the weight loss, but the cognitive symptoms might not continue to get better,” said Dr. Kamryn T. Eddy, a psychologist at Massachusetts General Hospital. “They definitely do improve, but one of the things we wonder is, how well does one have to be to be ‘recovered’? And how well does one actually get?” In the absence of expert consensus, patients and caregivers have come up with their own definitions of recovery. Harriet Brown, author of the recently released “Brave Girl Eating,” a memoir of her 14-year-old daughter’s bout with anorexia, defines it as “absolutely ordinary relations with food.” And what exactly is ordinary? “That thinking about food does not consume large quantities of your time and energy,” she said in an interview. “You enjoy food, you don’t undereat or overeat often, you don’t meet any of the diagnostic criteria for anorexia. Your weight is in a healthy range for you. And most of all, you’re able to live life in a way that’s not completely organized around food and eating.” For Ms. Liu, recovery is a “full restoration of nutritional, physical, emotional and psychological health.” But in a telephone conversation, Ms. Liu, who was actively anorexic from age 13 to 20, acknowledged that without good treatment many people spend years in what she called the “half life” of anorexia. “They recover nutritionally and suspend the behaviors of starving, bingeing and purging,” said Ms. Liu, who suffered a relapse 11 years ago. “But the self-criticism, self-abuse, perfectionism, judgmentalism and restrictive mind-set persist.” Still, both doctors and patients emphasize the importance of believing that full recovery is an option. Kathleen MacDonald, a policy assistant at the Eating Disorders Coalition in Washington, was anorexic and then bulimic for 16 years, but considers herself fully recovered since 2004. “People always said once you have an eating disorder, you’re always going to have an eating disorder,” she said. “I tell people, ‘There was a time in your life when you didn’t have an eating disorder, and if that’s possible, anything is.’ ” For Dr. Dooley-Hash, the future feels a little murkier. “I feel like I can’t ever be off guard,” she said. “The next time I’m overwhelmed and stressed, my first instinct is going to go back to restricting. I think I would be naïve to think it would ever not be a part of my life.” |
| Well: Gym Class: AntiGravity Yoga Posted: 26 Apr 2011 09:50 AM PDT |
| Essay: If Only All We Wanted Was Expert Advice Posted: 26 Apr 2011 11:27 AM PDT I have a dishwasher problem that’s lasted several years. Here are the symptoms: every fourth or fifth wash, the dishes come out much dirtier than when I put them in. You can see little black flecks of something when you hold a glass against the light. My theory is that the problem lies in the pipes downstream from the dishwasher — once in a while, perhaps something makes the dirty dishwater kick back and mess up the dishes. Several plumbers have come over to examine my situation. They listen to my story and hear my explanation, an account that to me, a nonplumber, makes perfect sense. Then they look at me like I am crazy — not a little crazy but completely nuts — and tell me to either buy a new dishwasher (tried it already: didn’t work) or else wash my dishes more thoroughly before loading the dishwasher (vide above: done, no luck). Then they tighten something or loosen something, nod sympathetically to my wife, and head for the door — fast — leaving me with flecks on the glasses and mounting disappointment. But, hey, what do they know? During the latest round, I realized how similar these exchanges are to those I sometimes have with patients. Patient concerns obviously are of a scope and scale completely different from those of my appliances; yet the patients too have a problem, a problem that is clearly defined to them, a problem they have spent hours, days, weeks, perhaps years mulling over. They understand their situation exactly and unflinchingly. Most have tried this and that to assess its impact on their condition: they eat less or differently; they exercise more or change sports; they sleep in the other room for a week or two; they try their child’s medicine given years ago for something possibly similar. They are little Pasteurs pursuing a solution in the lab of their own body, adhering to the scientific method with admirable rigor. And yet often I dismiss their ideas with the same careless flick of the wrist I have come to expect from the latest in my long line of plumbers and dishwasher subspecialists. Like the plumber, I’ve heard that one before, whatever the complaint; I’ve previously spent time and wasted patient hope chasing the same false lead down a dead-end path. I hope I have learned from my missteps, gained in wisdom, tempered my own eagerness to order test after test. I am the one with more experience at this, right? Isn’t that the point? Many patients sense my reluctance to consider their theories. One recently asked me to evaluate him because of a sense of deepening fatigue without fever or weight loss; might it be an infection? I explained that I had tried many times through the years to diagnose infection in patients with his specific set of complaints but had never turned up an answer. In my judgment, the “million dollar work-up” was a waste of his time and money. After I finished, we stared at each other in awkward silence. I had broken his heart a little, and I too was demoralized. It is not enjoyable to trample hope. It seems to me that what we have here is a basic problem with our attitude toward experts. The calculation ought to be simple: we all seek people who know more about a situation than we do exactly because they know more than we do. Of course, we always want experts. And when we find them, we ought to trust them, right? Instead, however, we dismiss them when they aren’t whistling our tune. We suddenly become more expert at the very thing we thought they were expert at. After all, patients come to see me in a major research hospital, the ultimate house of science, a temple to the rational mind built on a foundation of countless sharp-edged logical observations made by experts from Hippocrates right up to the doctors and researchers published in this week’s New England Journal of Medicine. I am the somber keeper of this great tradition, the translator of the randomized double-blinded placebo-controlled studies conducted by thousands of researchers on hundreds of thousands of patients. I have the facts. Ah, but there’s the rub. When matters of personal health (or home appliances) are at stake, we want a lot more than expertise from our experts. The rational world suddenly loses its appeal; dull, steady scientific observation seems only dull and steady. We want some pixie dust, a little magic, an eccentric genius who can see through the usual mumbo-jumbo to the core of the problem (paging Dr. House). But until our prince comes, we are left with the most basic, bare-bones determination: do we trust this guy or not? And this decision, rather than following along a perfectly manicured line of reasoning and evidence, relies on that least scientific of all human inclinations — the simple leap of faith. |
| Hippo, Warts and Other Thugs of the Genetic Realm Posted: 25 Apr 2011 10:12 PM PDT If you should ever have a heart attack, Hippo, Warts, Merlin, Yorkie, Scalloped, Shaggy, Frizzled, Dishevelled and Mob-as-tumor-suppressor may have a lot to do with why you don’t get better in a hurry. GROWTH SWITCH The Hippo gene restraints the proliferation of heart cells in mice, left. Knock it out, and a heart grows to two and a half times bigger. These are not characters from a Damon Runyon story but a crew of genes that work together to switch other genes on and off. A team of biologists led by James F. Martin and Todd Heallen of the Texas A&M System Health Science Center has now found that these genes block the heart from growing new heart muscle cells, at least in mice. Knock out Hippo, for example, and the mouse’s heart grows two and a half times bigger than usual, they report in Science. This and other advances, including the discovery this year that infant mice can regenerate their hearts for the first seven days after birth, is evoking considerable interest among researchers trying to develop new treatments for heart attacks. The findings “will mark a renaissance of interest in the genetics of cardiac muscle growth control because of the potential therapeutic applications,” said Michael D. Schneider, a heart biology expert at Imperial College in London. The reason that heart attacks are so serious is that when a large number of heart muscle cells die, they are not replaced. Yet the heart does slowly generate new muscle cells during a person’s lifetime, showing that a growth program is in place. It is firmly repressed, however, presumably to avert the danger of cancer. Surgeons have tried injecting stem cells of all kinds into stricken hearts, but despite many clinical trials, there is little evidence that the cells do much good. This setback has led to renewed interest in trying to unlock the heart cells’ inherent growth program. Dr. Martin started with the Hippo gene because it is known to regulate the size of a fruit fly’s organs. Fruit fly biologists are often the first to recognize new genes and to work out what they do. The names they confer on genes are colorful and often grotesque because they are inspired by what happens to the fly when you knock out a specific gene from its genome. If you delete the Hippo gene, the fruit fly grows an enormous head with folded skin around the neck. Hence Hippo. By engineering a mouse in which Hippo was deleted just in the heart, Dr. Martin’s team showed that the chain of genes in which Hippo acts serves as at least one of the natural restraints on the proliferation of heart muscle cells. Zebra fish can regenerate the tip of the heart when it is cut off. Researchers have recently found the fish can even replace the scar tissue that forms when muscle cells die, which is often a problem for failing human hearts. The finding that infant mice can also regenerate the heart means that mammals, perhaps including people, may also have this ability, even though it is lost in adults. If the mouse and zebra fish have some natural way of escaping the Hippo gene’s clamp on heart cell growth, it is possible that some drug could be developed that would close down the Hippo pathway in people for a few days after a heart attack, allowing the heart muscle cells to enjoy a much-needed spurt of proliferation. Dr. Martin said his next step would be to grow adult mice with a disabled Hippo gene and see if they recover faster after a heart attack. He also plans to see if human heart muscle cells grown in a laboratory dish proliferate better if the Hippo pathway is disrupted. In fruit flies, an organ can produce more cells only if two gene promoters, called Yorkie and Armadillo, get to penetrate the cell’s nucleus and switch on the suites of genes required for the cells to grow and divide. But when Hippo is active neither Yorkie nor Armadillo can do its work. The signal that activates Hippo in the fly is called Dachsous, which must first trigger a receptor protein called Fat in the cell’s surface. But receptors like Fat can respond to many different signals. So it is not yet clear that the mouse or human counterparts to Dachsous and Fat are the triggers for the effect Dr. Martin’s team has seen, Dr. Schneider said. If the human counterparts are identified, then a drug that blocked them, switching off Hippo, might let heart muscle cells regenerate themselves, leading to a novel and fundamental treatment for heart attacks. But Hippo, Warts, Merlin and crew would not be part of the story. When mouse researchers look for the counterparts of fruit fly genes in mice, they give them new and duller names. Human geneticists are even more fearful that colorful gene names will create an aura of frivolity that discourages serious grant money. “They ruin it,” Dr. Martin said. The gene that fly biologists call Ménage-à-trois 1 is called MAT 1 by human geneticists. The poetically named Son-of-Sevenless in flies is the prosaic SOS 1 in people. As for Hippo, mouse researchers have already decolorized it to MST 1. |
| Regulator Will Treat E-Cigarettes Like Tobacco Posted: 25 Apr 2011 09:40 PM PDT The Food and Drug Administration said Monday that it planned to regulate smokeless electronic cigarettes as tobacco products and would not try to regulate them under stricter rules for drug-delivery devices. The agency said in a letter to interested parties that it intended to propose rule changes to treat e-cigarettes the same as traditional cigarettes and other tobacco products. The news is considered a victory for makers and distributors of electronic cigarette devices, which continue to gain popularity worldwide. E-cigarettes are plastic and metal devices that heat a liquid nicotine solution in a disposable cartridge, creating vapor that the user inhales. A tiny light on the tip even glows like a real cigarette. Users and distributors say e-cigarettes address both the nicotine addiction and the behavioral aspects of smoking — the holding of the cigarette, the puffing, seeing the smoke come out and the hand motion — without the more than 4,000 chemicals found in cigarettes. First marketed overseas in 2002, e-cigarettes were not readily available in the United States until late 2006. Now, the industry has grown to several million users worldwide from thousands in 2006. And the number of users increases by tens of thousands every week. No timeline has been set on the proposed rule changes. The F.D.A. said e-cigarettes could still be regulated as drugs or drug-delivery devices if they were marketed as a stop-smoking aid or for other so-called therapeutic purposes. Nearly 46 million Americans smoke cigarettes. About 40 percent try to quit each year, according to the Centers for Disease Control and Prevention. But unlike nicotine patches or gums, e-cigarettes have operated in a legal gray area. The F.D.A. lost a court case last year after trying to treat e-cigarettes as drug-delivery devices, rather than as tobacco products, because e-cigarettes heat nicotine extracted from tobacco. The agency had until Monday to appeal to the Supreme Court. In December, a federal appeals court ruled that electronic cigarettes should be regulated as tobacco products by the F.D.A. rather than as drug-delivery devices, which have more stringent requirements like expensive clinical trials to prove the products are safe and effective as an aid to stop smoking. Some sellers of e-cigarettes sued the F.D.A. in 2009 after the agency told customs officials to refuse entry of shipments into the United States. A federal judge ruled that the F.D.A. was not permitted to stop the shipments, saying the agency had overstepped its authority. |
| Bill Cook, Medical Device Maker, Dies at 80 Posted: 26 Apr 2011 07:38 AM PDT Bill Cook’s first business venture — selling shot glasses with pictures of nude women on the bottom — flopped. But that did not stop him from developing a sprawling company that has made thousands of medical devices, including heart stents, urological equipment and living-tissue transplants. Chris Howell/Cook Medical, via Business WireBill Cook in the rotunda of his company's headquarters Along the way he amassed a $3.1 billion fortune, making him the 101st richest American in 2011, according to Forbes magazine. And yet he lived a modest life. He and his wife, Gayle, continued to live in the three-bedroom home they bought in 1967, having moved there from an apartment where they had used a spare bedroom to make a new sort of catheter. The catheter and other Cook products “supported the many innovative new minimally invasive therapies that have profoundly revolutionized medicine,” the Society of Interventional Radiology said last week. The group was responding to Mr. Cook’s death at age 80 at his Bloomington, Ind., home on April 15. The cause was congestive heart failure, his privately held conglomerate, said. Mr. Cook was not widely known outside Indiana, where he sprinkled many millions in gifts. Certainly his products — used to treat conditions from heart attacks to incontinence — were not household names. But he built a 42-company empire with annual sales of $1.7 billion that spanned four continents and employed 10,000 people. He started work every day at 5 a.m.; liked chatting with old friends in barbershops and luncheonettes and, four years ago, finally built a garage. Until then he had been scraping the snow and ice off his windshield himself. Though he was a billionaire, he had no driver. Mr. Cook fit no obvious category. He sometimes drove the bus that took his friend, the singer John Mellencamp, on tour. He and his wife led in the restoration of many Indiana buildings, including 40 on the National Register of Historic Places. He built a casino in French Lick, Ind., in the shape of a boat to comply with a law allowing only riverboat gambling. A moat encircles it. His was certainly the only medical supply company ever to produce a Broadway show, “Blast!” in 2001. The show grew out of his long sponsorship of a champion local drum and bugle corps. (He drove the bus.) “Blast!,” an exuberant tribute to brass and percussion by Hoosier musicians, won Tony and Emmy awards (the Emmy for a televised production on PBS). In 1989, Mr. Cook’s wife was kidnapped while grocery shopping and held for a day. The kidnapper was captured while making ransom demands and served 12 years in prison. Mr. Cook blamed Forbes for the incident, saying it would not have happened if the magazine had not published his name as one of the richest 400 Americans. William Alfred Cook was born on Jan. 27, 1931, in Mattoon, Ill., and grew up in Canton, Ill., where he played three sports, sang in the choir and played in piano competitions. After earning a biology degree from Northwestern University, failing at his shot-glass brainstorm and serving in the Army, he became the catalog editor for a hospital supply firm, where he liked imagining new products. One was disposable hypodermic needles. In 1957 he married Gayle Karch, who survives him, along with their son, Carl, and a granddaughter. The next year, he started a company in Chicago, MPL Inc., to make hypodermic needles. It became the nation’s third-largest needle maker. He moved to Bloomington after being waylaid there in a blizzard and liking it. In 1963, he and his wife started what became the Cook Group. They invested $1,500 in a blowtorch, soldering iron and plastic tubing to make catheters in their apartment. Mr. Cook wore a tie and coat as a means of self-discipline. Their first sale: two catheters at $7.50 each. At a medical trade show in 1964, Mr. Cook was using a Bunsen burner to demonstrate making catheters from plastic tubing when a man wandered by to ask if he could borrow the equipment, as the exhibit was closing for the day. He was Dr. Charles T. Dotter, who developed angioplasty, the technique of mechanically widening an obstructed blood vessel. He returned the next morning with 15 exquisitely made catheters, and Mr. Cook promptly sold them for $10 apiece. They went on to form a mutually beneficial association in many projects over the years. Mr. Cook, like many billionaires, had luck. A local jeweler asked if he would hire his 17-year-old son, Thomas Osborne, who was not good in school but who was handy. Sure, Mr. Cook said. The young man soon made a prototype machine to wind wire used to guide a catheter. “His name’s on almost every patent,” Mr. Cook said of Mr. Osborne, who went on to make a career at Cook. “The kid was just destined.” In 1993, Mr. Cook’s company was the first in the United States to sell coronary stents, as the tube inserted into a blood vessel is called. A more recent product line is tissue made from a pig’s small intestine to treat wounds. Not everything Mr. Cook touched turned golden. In 1991, he bought the money-losing Manchester United basketball team in Britain for almost nothing. He was offered United’s soccer team as part of the deal, for a price under $25 million, but he said no. It is now worth $1.86 billion. This posting includes an audio/video/photo media file: Download Now |
| Recipes for Health: Pigeon Peas With Mango Posted: 26 Apr 2011 11:45 AM PDT This dish is based on a recipe from “660 Curries,” by Raghavan Iyer. I’ve given you the option of using cayenne and sesame seeds instead of Mr. Raghavan’s garam masala, but I encourage you to make the spice mix if you can. You can find pigeon peas and curry leaves in Indian markets. Pigeon peas resemble split yellow peas in color and flavor.  Recipes for HealthMartha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat.
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1 heaped cup skinned yellow pigeon peas (toovar or toor dal), preferably the un-oily variety, picked over for stones 1 medium ripe mango, peeled, seeded and chopped 1/2 teaspoon cayenne plus 1 teaspoon ground toasted sesame seeds, or 2 tablespoons Maharashtran sesame-flavored garam masala (see below) Salt to taste 1/2 teaspoon ground turmeric 10 to 12 curry leaves 2 tablespoons ghee (clarified butter) or canola oil 2 teaspoons cumin seeds 1/4 cup finely chopped cilantro 1. Place the pigeon peas in a medium, heavy saucepan. Cover with 1 inch of water, and roll around the peas. The water will cloud. Drain through a strainer, and return to the pot. Repeat several times until the water is no longer very cloudy when you cover the peas. Drain and return to the pot, then add 3 cups water and bring to a boil over medium-high heat. Skim off and discard any foam. Stir the peas, reduce the heat to medium-low, cover and simmer, stirring from time to time, for 10 minutes. The peas will be partly tender. 2. Add the mango, the garam masala or the cayenne, salt, turmeric, curry leaves and 1 cup water. Bring back to a boil, then reduce the heat again to medium-low. Cover and simmer 20 minutes, stirring occasionally, or until the peas are tender and falling apart. 3. While the peas are simmering, heat the ghee or oil in a small, heavy skillet over medium-high heat. Add the cumin seeds. When they begin to sizzle, turn a reddish brown and smell nutty, remove from the heat. Add the cilantro, and stir until the sizzling stops. 4. When the pigeon peas and mango are very tender, remove the curry leaves and mash the mixture with the back of your spoon. Scrape in the seasoned ghee or oil, and stir together. Cover and simmer five minutes until the flavors are nicely blended. Taste, adjust salt and serve. Note: For the garam masala, in a small, heavy skillet over medium-high heat combine 2 tablespoons skinned raw peanuts; 1 tablespoon white sesame seeds; 1 1/2 teaspoons coriander seeds; 1/2 teaspoon cumin seeds; 4 to 5 dried red Thai chilies, cayenne chilies or arbol chilies; 1/8 teaspoon freshly grated nutmeg or nutmeg shavings; and 1 blade of mace. Stir until the peanuts are lightly colored in spots and the sesame seeds are a honey-brown color. Immediately transfer to a plate or bowl to cool completely. Add 2 tablespoons shredded dried unsweetened coconut to the pan, and stir just until almond brown, about 15 seconds. Transfer to the plate or bowl with the spices and nuts. Allow to cool completely. Blend in a spice mill, pulsing the mixture so that the sesame seeds and peanuts don’t heat and grind to butter. Transfer to a jar, and store in a cool, dry place. Yield: Four servings. Advance preparation: You can keep this in the refrigerator for two or three days. It will stiffen up. Thin out with water if desired. Nutritional information per serving: 296 calories; 5 grams saturated fat; 1 gram polyunsaturated fat; 0 grams monounsaturated fat; 20 milligrams cholesterol; 44 grams carbohydrates; 9 grams dietary fiber; 12 milligrams sodium; 12 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health." |
| Posted: 26 Apr 2011 05:36 AM PDT |
| Letters: A Drug’s Many Uses (2 Letters) Posted: 25 Apr 2011 09:00 PM PDT To the Editor: In “Drug That Stops Bleeding Shows Off-Label Dangers” (April 19), Gina Kolata presented a balanced view of a complicated topic. We believe, however, that her story missed a key part of the statement we provided to her: A majority of NovoSeven is used in the outpatient setting and for the product’s approved indications. This was stated in the final report by the federal Agency for Healthcare Research and Quality, but was a missing element in the articles she referenced in The Annals of Internal Medicine. Without this important clarifying statement, the reader is led to believe that the majority of NovoSeven use is off-label. That is simply not true. Robert Gut, M.D., Ph.D. Princeton, N.J. The writer is executive director of clinical development and medical affairs, biopharmaceuticals, at Novo Nordisk. ♦ To the Editor: In your otherwise excellent article on Factor VIIa, I am concerned about the suggestion that it is useful for patients on blood thinners with brain bleeding. A recent study in the medical journal Blood showed that despite making laboratory values normal, Factor VIIa had no effect on reversing the coagulation derangements caused by the blood thinner. This very important article has led our hospital and many others to not rely exclusively on Factor VIIa for blood-thinner reversal. Thomas DeLoughery, M.D. Portland, Ore. The writer is a professor of medicine, pathology and pediatrics at Oregon Health & Science University. This posting includes an audio/video/photo media file: Download Now |
| Letters: Asleep at the Wheel (1 Letter) Posted: 25 Apr 2011 09:06 PM PDT To the Editor: Re “New Lessons to Pave a Road to Safety” (Well, April 19): It was heartening to see an article addressing teenage safety. It was not as encouraging to read the narrow — and misleading — information about how to handle teenage driving safety as it relates to sleep. The advice to parents to restrict their teenager’s driving to school if their child happens to get only five or six hours of sleep misses the point. Adolescents who start school at 7 or 8 rarely get the nine-plus hours of sleep they require to drive safely, to perform optimally in academics and athletics, and for that matter to maintain optimal mood. Let’s all wake up to the realities of teenage biology and support sleep education and later school start times. Eileen Moran Van Rheenen Atherton, Calif. |
| After School in Brooklyn, West African Girls Share Memories of a Painful Ritual Posted: 26 Apr 2011 06:42 AM PDT In a high school classroom in Brooklyn with walls adorned with algebra problems, a 15-year-old girl born in the West African nation of Guinea was talking recently with her friends, after the school day had ended. In order to view this feature, you must download the latest version of flash player here. Béatrice de Géa for The New York TimesZeinab Eyega is executive director of the Sauti Yetu Center for African Women, which campaigns against genital cutting. Béatrice de Géa for The New York TimesMariama Diallo, a social worker at Sanctuary for Families, works with girls who have experienced genital cutting. The small group — all the students had roots in West Africa — was there not to discuss quadratic equations, but something much more personal. The 15-year-old was sharing the memory of the day back in her homeland when a neighbor duped her into going to a hospital. There, she was tied down, and restrained, and subjected to genital cutting. She was 8 at the time, and had to be hospitalized for the bleeding. “I got sick,” the girl said. “I was about to die.” After she had healed, a celebration was held in her honor. Now a high school sophomore, the girl belongs to a group of young West Africans who all share the experience of having been subjected to genital cutting, a procedure that is sometimes called circumcision and that opponents refer to as female genital mutilation. The issue has largely been considered a foreign human rights concern but is starting to pose a bigger challenge here with an increase in the number of immigrants from countries in Africa and elsewhere where the practice is most common. A conference on Wednesday at Harlem Hospital, hosted by the hospital and by the Sauti Yetu Center for African Women and Families, a group based in the Bronx that works to end female genital cutting, will focus on the physical and emotional needs of women in the United States who have experienced it. Female genital cutting was banned in the United States in 1996. Some parents send daughters overseas to have it done; other girls are cut by relatives without their parents’ knowledge while on vacation abroad. A 19-year-old woman from Guinea whose genitals were cut before she moved to the United States said her 13-year-old sister was 6 when their parents arranged for her to undergo the procedure while visiting their homeland. “Since she was there, they did it for her,” said the 19-year-old, who lives in Brooklyn. Like all of the young women interviewed for this article, she asked not to be identified, saying that she did not want to be publicly associated with an intimate and controversial procedure. In some families, parents oppose female genital cutting, but the decision about whether or not to have it done is not always theirs to make. Many elders in West African communities hold great social authority and do not seek parental permission to have it done to a girl. The 15-year-old from Guinea was cut without the consent of her mother, who was living in the United States while her daughter was being raised in Africa by the girl’s paternal grandmother — who also was not consulted. Female genital cutting is controversial even in countries where it is performed, and opponents have lobbied their governments for decades to outlaw the practice. Campaigns to end the practice have made strides in countries like Senegal and Burkina Faso. The practice can cause a variety of medical problems, including extensive bleeding, infection, painful menstruation and complications during childbirth. Some women are leery of seeking medical care because they fear their doctors’ reaction. “It bothers me a lot when I go to doctor visits, how they don’t understand,” said an 18-year-old woman from Guinea whose genitals were cut and who lives in the Bronx. “The look in their face tells you that they are shocked or confused.” Female genital cutting is practiced in more than two dozen African countries and parts of Asia and the Middle East, and the World Health Organization estimates that up to 140 million women have undergone it. Female genital cutting refers to a range of procedures performed without a medical purpose. They range from clitoridectomy, the removal of part or all of the clitoris, to infibulation, in which all the outer genitalia are removed and the vagina is sealed, often with stitches, except for a small opening. Despite the risks and the controversy, the cutting is, in many places, grounded in strongly held beliefs about cleanliness, chastity and coming of age. “This is not done with ill intent,” said Zeinab Eyega, the executive director of Sauti Yetu. “This is actually done to embrace the child, to bring the child into the fold of the community.” Nonetheless, Ms. Eyega said the practice was dangerous and needed to be stopped. Whatever the arguments over the practice, the experience often leaves indelible memories. “That day was the worst day of my life,” said a 16-year-old high school sophomore in the Bronx. She said she was cut at her grandmother’s house in Guinea when she was 4. One 17-year-old from the Bronx who was cut at an aunt’s house in Ivory Coast learned of the medical risks by watching a television report about a girl who had been cut and could not have children. “It made me feel angry, because maybe that can happen to me,” said the 17-year-old, who has been in the United States for eight months. “And it make me feel like my aunt lied to me, but I feel like she doesn’t know, too. She just taught me the way they taught her, too.” Sauti Yetu and other organizations run peer support groups for African high school students and provide counseling for women who have been cut. Some opponents of the practice are also pressing for federal legislation to make it a crime to deliberately take or send a girl overseas to be cut. “It’s not preventing people from going for vacation,” said Mariama Diallo, a social worker with Sanctuary for Families, a Manhattan nonprofit group that opposes genital cutting. “But the girls will feel protected.” But Ms. Eyega said such a law would discourage women from reporting the procedure or seeking help, out of fear of causing legal trouble for their families. The bill is sponsored by Representatives Joseph Crowley, Democrat of Queens, and Mary Bono Mack, Republican of California. Nevada and Georgia, as well as several European countries, have adopted similar laws. More than anything else, girls and young women who have been cut seem to want to be accepted in their new homeland. The 19-year-old from Brooklyn, who was cut in Guinea, said, “They shouldn’t think Africans are weird just because of that.” |
| Recipes for Health: Mango, Orange and Ginger Smoothie Posted: 25 Apr 2011 01:54 PM PDT Ginger combines very well with mango and contributes a host of antioxidant and anti-inflammatory phytochemicals. Recipes for HealthEach 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. Related
1 cup orange juice 1/2 large mango 1 1/4 teaspoons ginger juice (see note below) 4 ice cubes Optional: 1/2 ripe banana (about 2 ounces peeled banana) 1. Combine the orange juice, mango, ginger juice and ice cubes in a blender. Blend until frothy and smooth. If you want a thicker drink, add the banana. Serve right away for the best flavor. Note: To make the ginger juice, grate about 2 teaspoons ginger. Place on a piece of cheesecloth. Gather together the edges of the cheesecloth, hold over a bowl and twist to squeeze out the juice. Yield: One large serving or two small servings. Advance preparation: This is best served right away. Nutritional information per serving: 201 calories; 0 grams saturated fat; 0 grams polyunsaturated fat; 0 grams monounsaturated fat; 0 milligrams cholesterol; 48 grams carbohydrates; 3 grams dietary fiber; 4 milligrams sodium; 3 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health." |
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