Wednesday, April 13, 2011

Health - Rabbis Sound an Alarm Over Eating Disorders

Health - Rabbis Sound an Alarm Over Eating Disorders

Rabbis Sound an Alarm Over Eating Disorders

Posted: 12 Apr 2011 12:02 PM PDT

In the large and growing Orthodox Jewish communities around New York and elsewhere, rabbinic leaders are sounding an alarm about an unexpected problem: a wave of anorexia and other eating disorders among teenage girls.

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Alex di Suvero for The New York Times

EXPERT Rabbi Dovid Goldwasser of Brooklyn counsels women all over the world on eating disorders.

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Ken Blaze for The New York Times

RECOVERED Naomi Feigenbaum, at home in Beachwood, Ohio, dealt with anorexia.

While no one knows whether such disorders are more prevalent among Orthodox Jews than in society at large, they may be more baffling to outsiders. Orthodox women are famously expected to dress modestly, yet matchmakers feel no qualms in asking about a prospective bride’s dress size — and her mother’s — and the preferred answer is 0 to 4, extra small.

Rabbis say the problem is especially hard to treat because of the shame that has long surrounded mental illness among Orthodox Jews.

“There is an amazing stigma attached to eating disorders — this is the real problem,” said Rabbi Saul Zucker, educational director for the Union of Orthodox Jewish Congregations of America, or O.U., the organization that issues the all-important kashrut stamp for food. “But hiding it is not going to make it go away. If we don’t confront it, it’s going to get worse.”

Referring to the high risk of death from heart problems and suicide in patients with anorexia, he said: “This isn’t a luxury type of disease, where, O.K., someone is a little underweight. People die.”

As a teenager, Naomi Feigenbaum developed bizarre eating habits that had nothing to do with Jewish dietary laws: Cocoa Puffs and milk in the morning, when she figured she had all day to burn off the calories, and nothing but Crystal Light and chewing gum the rest of the day.

At the kosher dinner table in her home near Cleveland, she said she would start arguments with her parents so she could stomp off and avoid eating. She lost weight so rapidly in high school that she used safety pins to cinch her long skirts around her waist.

By the time her rabbi came to visit her, she was emaciated. He told her that she must attend a treatment program that met on Saturday, the Jewish day of rest, even if she had to violate religious rules by riding in a car to get there. She could even eat food that wasn’t kosher.

“That’s when I realized it was a matter of life and death,” Ms. Feigenbaum said in an interview. “My rabbi does not take Jewish law lightly. But he told me the Jewish laws are things God wanted us to live by, not die by, and that saving a life takes precedence over all of them.”

Now 24, she has written a memoir, “One Life” (Jessica Kingsley Publishers, 2009), about her recovery from anorexia after treatment at the Florida branch of the Renfrew Center, the nationwide eating-disorders clinic.

There is little research to indicate how many women are in a similar position. Israeli studies consistently find high rates of disordered eating among Jewish adolescents but not Arab ones, and Israel’s rate of dieting is among the highest in the world — more than one woman in four — though obesity rates are relatively low.

Data about American Jews is limited, but two small studies have reported high rates of disordered eating in certain communities. One of those, a 1996 study of an Orthodox high school in Brooklyn, found 1 in 19 girls had an eating disorder — about 50 percent higher than in the general population at the time. The 1996 study was done with the agreement that it would not be published. The other study, done in 2008, looked at 868 Jewish and non-Jewish high school students in Toronto and found that 25 percent of the Jewish girls suffered from eating disorders that merited treatment, compared with 18 percent of the non-Jewish girls.

Demand for treatment programs that accommodate Orthodox teenagers prompted the Renfrew Center to start offering kosher food at its clinics in Philadelphia, New York, Dallas and Florida, while a new residential facility catering to young women from the United States opened last year in Jerusalem. It is not affiliated with Renfrew.

Relief Resources, a mental health referral agency that serves Orthodox communities, runs an eating disorders hot line, and last year the O.U. teamed with a social worker to make “Hungry to be Heard,” a documentary about eating disorders among the Orthodox.

Most of the young women interviewed for this article said they did not blame the culture for their health problems and said they derived support from their religious faith. But they spoke openly about the enormous pressure they feel to marry young and immediately start families , and the challenges of balancing professional careers with the imperative to be consummate homemakers who prepare elaborate Sabbath meals.

Experts say that eating disorders usually emerge during adolescence and other times of transition. And in large Orthodox families, the girls are often expected to help care for their younger siblings, leaving them little time to pursue their own interests. Experts suspect that anorexia may provide a way to stall adult responsibilities by literally stopping the biological clock: the drastic weight loss can halt menstruation.

Young Orthodox women are also expected to conform to a rigorous code of conduct, with few outlets for rebellion. They are expected to be chaste until marriage and do not date until they start looking for a husband. Even gossip is considered a sin.

Once matchmaking starts, they may be expected to choose a life partner after only a brief courtship. Known mental illness in a family can affect the chances of a successful match, not just for the individual but for siblings as well, so young women may well avoid psychiatric treatment.

Well: A Couple's Knot, Tied Tighter by Dual Diagnoses

Posted: 12 Apr 2011 12:10 PM PDT

Recipes for Health: Rice Bowl With Spinach and Smoked Trout

Posted: 12 Apr 2011 11:18 AM PDT

If you have just a few good condiments on hand, you can make a great, simple meal in minutes by adding cooked rice.

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

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3/4 cup cooked sprouted brown rice

Soy sauce to taste (optional)

1 to 2 teaspoons lemon-scented olive oil, to taste

1 cup spinach leaves, or a mixture of spinach and arugula, tightly packed

Zest of 1/8 lemon

1 ounce smoked trout

1 lemon wedge

1 sprig cilantro, chopped

1/2 to 1 teaspoon toasted sesame seeds, to taste

1. Season the cooked sprouted brown rice to taste with soy sauce, and place in a large, wide bowl.

2. Stalk the salad greens and cut crosswise into thin strips (chiffonade). Alternatively, place the greens in a bowl and cut into small pieces with scissors. Toss with the lemon oil and pile over the rice, or toss with the rice. Break up the smoked trout, and place on top of the spinach. Squeeze on a few drops of lemon juice and top with the cilantro. Scatter on the lemon zest, sprinkle on the sesame seeds and serve.

Variation: You can also toss all of the ingredients together and serve.

Yield: Serves one.

Advance preparation: The cooked sprouted brown rice will keep for three or four days in the refrigerator.

Nutritional information per serving: 262 calories; 1 gram saturated fat; 2 grams polyunsaturated fat; 5 grams monounsaturated fat; 12 milligrams cholesterol; 36 grams carbohydrates; 3 grams dietary fiber; 219 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."

Screening Prostates at Any Age

Posted: 12 Apr 2011 11:22 AM PDT

When, if ever, are people just too old to benefit from cancer screening?

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 Dr. Scott E. Eggener is studying why older patients are still getting prostate exams when their life expectancy is ten years or less.            

The question keeps arising and has never been satisfactorily answered. Now it has come up again, in the context of a provocative new study on the popular P.S.A. test for prostate cancer. The paper, published in The Journal of Clinical Oncology, finds that men in their 70s are being screened at nearly twice the rate of men in their 50s — and men ages 80 to 85 are being screened as often as those 30 years younger.

“That is mind-boggling,” said the lead author, Dr. Scott E. Eggener, a University of Chicago urologist. “What we were hoping was that young, healthy men who were most likely to benefit would be screened at higher rates and that screening would tail off in older men.”

The American Cancer Society and the American Urological Society discourage screening for men whose life expectancy is 10 years or less. The cancer is so slow-growing that it can take that long for screening to show a benefit.

The United States Preventive Services Task Force recently concluded that screening should stop at 75. Dr. Mary Barton, scientific director for the group, said “it is more than just a lack of data” that led to that conclusion. “What data we do have for this group suggests it is a net-harm situation,” she added.

But although 80-year-olds are much more likely than 50-year-olds to have chronic illnesses and a limited life expectancy, age should not be the deciding factor, Dr. Eggener said. “Health condition and life expectancy are far more important,” he said. “There are 50-year-olds that shouldn’t be screened and 70-year-olds that may benefit from it.”

The new study only included national data through 2005, the most recent year they were available, but, said Dr. Durado Brooks, director of prostate and colorectal cancers for the American Cancer Society, “there is no reason to believe it has changed significantly since 2005.” Doctors said there are several reasons screening seems to continue indefinitely as men age. They range from patient demands to malpractice fears to financial incentives and doctors’ own lack of understanding of the risks and benefits of screening.

“There are a lot of pressures,“ said Dr. Gerald L. Andriole, a urologic surgeon at Washington University. “It is not all pure data that is promoting aggressive screening.” Dr. Andriole is directing a National Cancer Institute study of 76,000 men that failed to find a screening benefit after 10 years. The men were aged 55 to 74 when the study began. P.S.A. screening is controversial at any age. Screening proponents say the cancer institute study was flawed and point to a European study of 162,000 men aged 55 to 69 that showed a 20 percent drop in the prostate cancer death rate with screening.

Screening critics say the European study was flawed and add that there is a logical reason it has been hard to show a screening benefit.

They note that prostate cancer is a common cancer, found in most men’s prostates on autopsy, although often the men had no idea they had it. The cancer can be lethal, but it usually grows so slowly that men die with it, not because of it.

For most men, screening only has harms because it leads to biopsies and treatments with unpleasant side effects. And, they say, it might not help cure many deadly prostate cancers because those cancers may have already spread outside the prostate, microscopically seeding other organs, long before a P.S.A. test indicates a possible problem.

A positive P.S.A. test usually leads to a biopsy and then, if cancer is found, to a decision about whether to treat it. Nearly all men opt for treatment, which includes surgery to remove the prostate or radiation to destroy the cancer. Side effects can include impotence and incontinence.

Even younger men should weigh the harms of screening, says Dr. Lisa Schwartz of Dartmouth Medical School. “You also have the potential to wreck their lives,” she said.

One reason treatment is the most common choice is that it is hard to know if a cancer is lethal. Pathologists can distinguish between cancers that look particularly aggressive and those that do not, but there is a real possibility that even if tissue obtained at a biopsy has only less aggressive tumor cells, more aggressive cells might still be lurking in the prostate.

But even with this uncertainty, prostate cancer specialists say, most men who are treated would not have died of prostate cancer, and that is especially true for elderly men, in particular those who are frail and have a limited life expectancy. Yet changing medical practice can be difficult.

“Anytime a practice becomes ingrained, it is difficult to eradicate,” says Dr. Brooks. “It is harder to get rid of an aberrant behavior than to adopt a new one.”

Dr. Andriole said the very concept of not screening is difficult.

“It is the hardest thing in the world not to look for a cancer and not to treat it,” he says. And doctors, he added, have many inducements to screen. They often are afraid they could be sued if they do not screen and a man is found to have a lethal cancer. And there are financial incentives.

“Urologists make money by finding ways to biopsy men and administer treatments,” Dr. Andriole said. Screening, he added, “is promoted by hospitals and industry.” And, he added, “many patients demand it.”

Dr. Brooks of the cancer society says he travels the country and talks to primary care doctors about screening, and has learned that many have misconceptions about the test’s benefits.

“They often don’t appreciate the downside of screening,” Dr. Brooks said, “and they don’t appreciate the delay in benefit.” In addition, Dr. Brooks said, primary care doctors often “overestimate the likelihood that early detection of prostate cancer will lead to survival benefits.”

Added to that, Dr. Brooks said, is the length of time it takes to discuss the pros and cons of screening with patients. Often it is easier to just order the test.

Dr. Bruce Roth, a professor of medicine at Washington University in St. Louis, said that ideally, a doctor should take a man’s overall health into account and not just go by age in ordering P.S.A. tests. But if a man has been screened year after year, it can be hard to suggest he stop because he may not live much longer.

Some men say the cautions just do not apply to them.

J. Allen Wheeler, who is 82 and lives in Portland, Ore., said he had his most recent P.S.A. test in January. His doctor orders it routinely, he says, adding, “In all honestly, it’s part of my physical.” His doctor “just does it — that’s the understanding between us.”

Mr. Wheeler, who says his health is “fairly good,” said he could not foresee a time when he would stop having the test. He would like to know if he has cancer, he says, although he may decide not to be treated.

A 75-year-old Connecticut man said he had the test because he was healthy and wanted to stay that way.

“I think I am going to live to be 100,” he said, asking that his name be withheld to protect his privacy. A recent P.S.A. test found a small cancer, and he does not want to take a chance that it will grow slowly and not cause him problems.

“I am thinking seriously of having the whole thing taken out,” he says. “Hasta la vista.”

18 and Under: A Tonsil Remedy Is Fitted for a New Century

Posted: 12 Apr 2011 11:24 AM PDT

The Tonsil Hospital is no more.

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BYGONE ERA The Tonsil Hospital opened in Manhattan in 1921 to treat the poor.

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It opened on East 62nd Street in February 1921, its mission to remove the tonsils and adenoids of poor children on the East Side of Manhattan, thereby preventing sore throats and streptococcal infections and all their serious consequences in an era without antibiotics. Parents saw scarlet fever, named for its red, sandpapery rash, as a frightening and dangerous childhood illness; rheumatic fever, which sometimes followed strep, could seriously damage the heart.

But times have changed. Built on studies of throat infections and tonsillectomies, new guidelines from the American Academy of Otolaryngology, issued in January, suggest tonsillectomy for recurrent sore throats only if frequent or severe.

At the same time, the academy now recommends that the operation be considered for children who have trouble breathing while they sleep.

The new guidelines reflect changes in clinical practice, and attempt to bring scientific evidence to bear on an operation at times popular to the point of ubiquity.

In the era of the Tonsil Hospital, pretty much all children got tonsillectomies. Consider “Cheaper by the Dozen”: The 1948 memoir about two efficiency experts and their 12 children happens to contain the single funniest tonsillectomy chapter in literature (granted, competition is limited).

Six of the children undergo tonsillectomies, performed by a doctor in an operating room rigged in the family home in Montclair, N.J. The father of the family still has his tonsils, and the doctor is “rewarded” for his cooperation by being allowed to remove them, too.

Leaving aside all the family dynamics, the chapter is notable for the matter-of-fact assumption that sooner or later, all tonsils need to be removed. And even after antibiotics were available, many if not most tonsils continued to be removed, through the 1950s and ’60s.

“It was the single most common operation in the United States,” said Dr. Ellen Wald, a specialist in pediatric infectious disease who is chairwoman of the pediatrics department at the University of Wisconsin School of Medicine and Public Health.

But which children really benefited from these operations, and which did not? “When I was in practice and first began to question this issue and was faced with the question of ‘Should my child have a tonsillectomy or not?,’ I never knew the right answer,” said Dr. Jack L. Paradise, professor emeritus of pediatrics at the University of Pittsburgh School of Medicine.

Dr. Paradise and his colleagues tried to provide an answer in a study, published in 1984, that looked at children with many well-documented episodes of throat infection (seven or more in the preceding year, for example). Those who got tonsillectomies had fewer infections in the first couple of years after surgery than those who didn’t, the researchers found. But the children who didn’t have surgery also had fewer and fewer infections as they got older.

Tonsillectomies were a reasonable option for children with severe, recurrent throat infections, Dr. Paradise concluded. But so was watchful waiting.

Later, Dr. Paradise studied children with fewer infections and concluded that the benefit of tonsillectomy was too “modest” to justify the risk, the pain and the cost of surgery in those children.

These days, many doctors are less likely to move to tonsillectomy for a smaller series of run-of-the-mill sore throats. I try to explain to parents that their children will grow out of these infections, and taking out their tonsils won’t necessarily do very much to expedite that process.

Yet at the same time, doctors are more willing to consider that children may need the operation if their tonsils obstruct the throat enough to affect breathing while they sleep.

Dr. Richard M. Rosenfeld, one of the authors of the new tonsillectomy guidelines and a professor of otolaryngology at SUNY Downstate Medical Center in Brooklyn, suggests that back when most children had their tonsils out, it was perhaps less common to see these sleep problems — what with all the tonsillectomies, there was “nobody breathing with a golf ball in the mouth.”

Now that more children are growing up with their tonsils intact, he said, “we created this new disease, sleep-disordered breathing.”

Some behavioral issues, including some attention problems, can be traced to a lack of deep, restful sleep. A child suffering from obstructive sleep apnea will not simply grow out of it, said Dr. Kasey Li, a surgeon at Stanford University. Even if the tonsils do become less problematic at puberty, as sometimes happens, the child’s development will have been affected.

For problems short of obstructive sleep apnea, “the advice to parents is, if you’re even the least bit unsure, don’t do it — it’s an elective surgery, don’t worry about it, you can always re-address it,” Dr. Rosenfeld said. “There’s very little harm to some watchful waiting till things sort themselves out.”

Parents should also know that in a significant number of children, the breathing problems — and everything that follows from disordered sleep — may persist even after the operation and need further treatment.

So the tonsillectomy, once routine, now requires a nuanced diagnosis. It may improve quality of life for some children, but there are limits to what it can accomplish — with sleep issues and behavior problems, and with recurrent infections.

It’s a far cry from where we were in the first half of the 20th century, when philanthropists provided poor children with a dedicated facility for tonsil removal. The Tonsil Hospital closed in 1946.

“I’m on the Upper East Side at Cornell New York hospital, 10 blocks from where the original hospital was," said Dr. Edward McCoul, an otolaryngologist who wrote about the hospital last year in a medical journal. “I ask around, and basically no one I’ve mentioned it to has ever heard of it.”

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Essay: Is This the Poster Food for a Radiation Menace?

Posted: 12 Apr 2011 11:27 AM PDT

One of the many endearing things about my husband is that he has five Geiger counters.

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Harry Campbell

I didn’t have much use for them until I started writing about radiation from the damaged nuclear reactors at the Fukushima Daiichi power plant in Japan. Recently, one of my interviews took a turn for the weird. I asked a scientist about possible health effects from radioactive materials leaking out of the plant, and he started talking about bananas.

“Why, we ingest radioactive material every day,” he said in a tone of wonderment. “Bananas are a most potent source.”

They contain a naturally occurring form of radioactive potassium, more than other fruit, he explained.

“It stays in our body, in our muscles,” he said. “Every second, our bodies — yours and mine — are irradiating.”

Brazil nuts are even hotter than bananas, he added, sounding almost gleeful. “The radium content is off the wall!”

I tried to steer the interview back to nuclear reactors, and for a few minutes it seemed to work. He said unnecessary exposures to radiation should be avoided.

But then he said: “I love bananas. I will not give them up.”

A few days later, I tried another expert, halfway across the country from the first. I asked about radioactive iodine and cesium being found in some Japanese milk and produce.

He said there wasn’t much risk, but it would probably still be better not to eat the food. Then he said, “I just had a banana for lunch.”

Uh oh, I thought, here comes the banana speech again. Is there a script circulating out there in radiation land, “How to Calm the Public With Bananas”?

“Bananas are radioactive,” he went on soothingly. “Everything is radioactive, including the food we eat and, for many people in this country, the water we drink. There is a point at which we say there’s no more than Mother Nature out there.”

Is there a point at which we say the urge to reassure people might get in the way of straight answers? A point at which, for instance, a reporter might think that if one more person brings up bananas, she herself will melt down, or, with all due respect, giggle.

I know the experts were just trying to put the invisible menace of radiation into perspective. But it did feel like a Wizard-of-Oz effort to distract the audience from the real questions: Pay no attention to those fuel rods behind the curtain!

When I told Peter Sandman about the banana speech, he laughed. Dr. Sandman is a risk communication expert based in Princeton, N.J., who has spent much of his long career advising scientists to avoid doing things like answering in bananas when the question is milk.

“The right comparison is the food they’re talking about,” Dr. Sandman said. “You can say: ‘The average amount is X. Now we’re seeing Y.’ ”

“It’s very bad risk communication to communicate in ways that make people feel as if you think they’re stupid,” he said.

He said he had worked with nuclear scientists who were irritated by the public’s ignorance about radiation, but were also proud to be recognized as experts. Pride plus irritation, he said, can be a recipe for pronouncements that come off as pompous and condescending. Mix in an agenda — whether it’s the urge to reassure people, or to stir them up — and the message can really backfire.

“People smell it,” Dr. Sandman said. “And they don’t trust you.”

That’s where the Geiger counters come in handy. Just how radioactive are bananas?

My husband, who teaches high school chemistry, took a banana to school and tested it with one of the Geiger counters he keeps in his classroom. He put the probe near the banana, then against the skin, then poked into the fruit — two five-minute runs at each spot. He did multiple runs to test the background radiation in the classroom. For good measure, he even tested an apple, an orange and a granola bar. The banana was not so hot. Not hot at all, in fact, no more counts per minute than the other stuff, or the background. He ate the banana.

I’m not saying the experts were wrong. But my husband staunchly defends the sensitivity of his Geiger counter. Maybe it was an odd banana. It doesn’t matter now.

Vexing Rise in Oblique Injuries, and Little Explanation

Posted: 12 Apr 2011 09:32 AM PDT

Nearly everyone has four of them — broad flat muscles, known as obliques, that attach the rib cage and the pelvis on each side of the body and, until recently, have not really been part of the sports lexicon.

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Anatomical Drawing, iStock Images; Baseball Player, Chris O'Meara/Associated Press. Illustration by Sam Manchester/The New York Times

Among those afflicted by oblique injuries has been Tampa Bay’s Evan Longoria.

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Stan Conte, the Dodgers' head trainer, has analyzed core injuries in baseball since 1991.

But now they are. The muscles are particularly important to baseball players, who use them to rotate their bodies as hard as possible to throw a ball and swing a bat, and increasingly those muscles are being injured and putting players like Tampa Bay’s Evan Longoria on the disabled list.

Why this is happening is not really clear, but happening it is. The Los Angeles Dodgers’ head trainer, Stan Conte, was so intrigued that he stayed up through the night last week going line by line through a list he has assembled of the roughly 7,000 players who have gone on the disabled list since 1991.

“I had to do that because those injuries weren’t always called obliques,” said Conte, who has spent several years trying to build mathematical formulas to predict the physical problems that players may encounter. “Until the late 1990s, they were called rib cage injuries or abdominal injuries or lower chest injuries. As M.R.I. technology got better, the diagnosis became more particular and we began to see them called oblique injuries.”

For continuity, Conte then grouped everything — what used to be called rib cage or abdominal injuries two decades ago but are now called an oblique — under the term “core injuries.”

And what he found was that four players had gone on the D.L. with core, or oblique, injuries at this point a year ago. But in 2011, the total is already 14 — 12 players at the start of the season and 2 more since then. It is a small sample, Conte acknowledged, but he said it was significant nonetheless because the increase was in contrast to the general pattern since 1991.

That pattern, Conte said, showed that the number of oblique injuries had risen slightly in the last two decades. But over the last eight years, Conte said, the number had actually remained flat, leading to an obvious question: Why is there such a big increase this year?

“One theory I have is that players are transferring more quickly from the off-season to spring training games and to more competitive regular-season games, and the muscles aren’t holding up to the increased strain and force the players are putting on them in competition,” Conte said in a telephone interview.

Conte said that for some players, there might be a shorter period of time between when they report to spring training and when they actually start playing exhibition games. In fact, since 1991 a third of all oblique injuries have occurred in April. (Spring training injuries are counted under an April heading because the disabled list is not used before the season starts). The number decreases throughout the season, with just 1 percent of oblique injuries occurring in September.

Yankees center fielder Curtis Granderson was among four Yankees who injured their obliques during spring training this year.

“One of the first questions I was asked was whether I was taking more or less batting practice,” Granderson said. “I felt like I had been doing about the same amount from last year to this year.”

Granderson, who injured his oblique toward the end of spring training but started in center field for the Yankees on opening day, said that a player who might be swinging more might be more likely to injure his oblique.

“But I didn’t feel like anything I was doing was anything drastically different to anything I was doing before,” he said. “I had the same warm-up I was doing before, nothing that gave a sign that hey, it’s a little sore or anything like that. It was literally one swing. It was a funny swing, it was an out-in-front swing where I swung and didn’t square it up.”

Last season, pitchers who injured their obliques and went on the disabled list typically took about 43 days before returning to play compared with 31 days for position players.

Another theory in baseball for the rise of oblique injuries is that players are putting too much emphasis on strengthening their abdominal muscles.

“Personally I don’t think that’s true because I can’t imagine a stronger, more flexible, muscle that has more endurance being a bad thing,” Conte said. He noted that “nobody did these exercises” back in 1991 and that the number of injuries then was similar to the numbers in recent years, although 2011 is clearly different.

Yankees Manager Joe Girardi, who watched one player after another sustain oblique injuries this spring, said the whole thing remained a mystery to him.

“We’ve had two appendectomies, which I wouldn’t have really bet on,” he said referring to Adam Dunn of the Chicago White Sox and Matt Holliday of the St. Louis Cardinals, both of whom underwent that procedure earlier this month.

As for the oblique injuries, Girardi said, “I can’t really tell you why it’s happened.”

“Players are strong now and they take swings,” he said. But why that might lead to more oblique injuries, Girardi was not willing to say. “It used to be the hammy,” he said of the hamstring pulls that once dominated injury discussions. And no one, Girardi said, seemed to know why that was the case, either.

Dan Graziano contributed reporting, and Ben Shpigel contributed reporting from Boston.

Global Update: A Vaccine for the Very Young Takes Aim at Bacterial Diseases

Posted: 11 Apr 2011 09:31 PM PDT

With help from international donors, Congo introduced a new vaccine this month in an effort to save more of its babies from pneumococcal disease.

The donors and the country’s health minister, Dr. Victor Makwenge Kaput, acknowledged that the success will be hard to achieve. Congo is one of Africa’s largest and poorest countries. Vast stretches lack not just electricity and refrigeration, but paved roads. It has the world’s second-highest rate of infant mortality (after Chad). Its eastern provinces are convulsed by fighting that mixes local tribal hostilities, rival Hutu and Tutsi militias from Rwanda, warlord armies and efforts to control areas containing diamonds and other minerals.

The pneumococcus bacterium, which can cause fatal pneumonia, meningitis or sepsis, kills about 500,000 children under the age of 5 each year worldwide; more than 125,000 of them are in Congo, according to a 2004 study by Unicef, which found that only malaria killed more Congolese youngsters. At first, the new vaccine (given at a health center in Rwanda, above) is being rolled out only in the capital, Kinshasa, and it will be extended to just two of the Congo’s 11 provinces.

In the last six months, pneumococcal vaccine has been introduced in Guyana, Kenya, Mali, Nicaragua, Sierra Leone and Yemen, through the Global Alliance for Vaccines Initiative, which has received more than $2 billion from Britain, Canada, Italy, Norway, Russia and the Bill & Melinda Gates Foundation. The alliance is seeking another $4 billion to reach more countries with this vaccine and a rotavirus vaccine against diarrhea.

Republican Medicare Plan Could Shape 2012 Races

Posted: 12 Apr 2011 12:05 PM PDT

WASHINGTON — Just four months into their new majority, House Republicans face a potentially defining Medicare vote this week that is sure to become a centerpiece of Democratic efforts to recapture the House in 2012 and spill into the presidential and Senate campaigns as well.

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Representative Steve Israel, Democrat of New York, called a coming vote “the moment of truth” for some House Republicans.

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Newt Gingrich, a Republican weighing a presidential run, says he supports his party's Medicare overhaul plan and budget.

Republicans acknowledge that the vote is risky, and party strategists have warned House leaders about the dangers, aides said. But Republicans are calculating that the political ground has shifted, making the public, concerned about the mounting national debt, receptive to proposals to rein in costs by reshaping the program.

Newt Gingrich, a former House speaker exploring a bid for the Republican presidential nomination, said proposing a major overhaul of entitlement programs was not as politically fraught as it might have been a decade ago. But he said Republicans must be vigilant in defending their actions and mindful that Democrats were poised to attack.

“I think it is a dangerous political exercise,” Mr. Gingrich said in an interview Monday. “This is not something that Republicans can afford to handle lightly.”

Democrats are preparing to try to brand Republicans as proponents of dismantling the Medicare system if they vote for the party’s budget, which advocates converting the program from one where the government is the insurer into one where the government subsidizes retirees in private insurance plans.

Republicans say that without such changes, Medicare will not be financially sustainable in the long run as the population ages and medical costs continue to rise.

The House is scheduled to vote on the Republican budget, developed by Representative Paul D. Ryan, Republican of Wisconsin and the chairman of the Budget Committee, by the end of the week.

Representative Steve Israel, the New York Democrat leading his party’s House campaign operation, called the budget vote “the moment of truth” for House Republicans in 14 Democratic-leaning districts that backed John Kerry for president in 2004 and 61 that went for Barack Obama in 2008.

“We are going to use the budget to prove to Americans that every time Republicans choose to protect oil company profits while privatizing Medicare for seniors, seniors will chose Democrats,” Mr. Israel said.

He and other party strategists say they believe the Republican stance on Medicare could be particularly persuasive against incumbents in states like Florida, Illinois, Michigan, New York, Ohio and Pennsylvania. It could carry extra potency, they say, because Republicans hit Democrats hard in the 2010 midterms on cutting Medicare as part of the new health law and Democrats now intend to turn that message back on them.

President Obama is expected to enter the debate over entitlement spending in a speech on Wednesday and could offer his own views on how to control Medicare costs. But he is expected to go nowhere near as far as Republicans did in the Ryan budget.

Republicans say the willingness of the White House to talk about entitlement changes could reinforce the Republican claim that steps need to be taken to preserve Medicare, limiting the ability of Democrats to attack and making the debate mainly about what the steps should be.

Democrats are looking to the budget vote to reshape the election landscape much as President George W. Bush’s proposal to overhaul Social Security did in 2006, particularly among older voters and independents who deserted Democrats in 2010.

A fund-raising e-mail sent Monday by the Democratic Congressional Campaign Committee warned recipients that the Ryan budget would “end Medicare as we know it and force seniors to clip coupons if they need to see a doctor.” It added, “Meanwhile, the wealthy would receive another tax cut.”

Republicans say Democrats are exaggerating the impact of any vote. They say their party has a credible response that the budget preserves Medicare for future retirees since it could collapse under runaway costs if left unchanged. Americans now 55 or older would still be covered under the existing program.

“If there is one thing we can understand from Democrats right now it is that they are willing to stop at nothing to scare America’s seniors,” said Paul Lindsay, a spokesman for the National Republican Congressional Committee. “It demonstrates their unwillingness to tell the American people the truth when it comes to the looming debt crisis facing this country.”

Some first-term House Republicans who could be on the front lines do not seem overly anxious about the budget vote, saying that is what they came to Washington to do.

Jennifer Steinhauer contributed reporting.

Japan Nuclear Disaster Put on Par With Chernobyl

Posted: 11 Apr 2011 10:35 PM PDT

TOKYO — Japan has decided to raise its assessment of the accident at the crippled Fukushima Daiichi nuclear power plant to the worst rating on an international scale, putting the disaster on par with the 1986 Chernobyl explosion, the Japanese nuclear regulatory agency said on Tuesday.

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Officials, monks, military officers and other emergency workers observed a moment of silence on Monday in Natori, Japan.

The decision to raise the alert level to 7 from 5 on the scale amounts to an admission that the accident at the nuclear facility, brought on by the March 11 earthquake and tsunami, is likely to have substantial and long-lasting consequences for health and for the environment. Some in the nuclear industry have been saying for weeks that the accident released large amounts of radiation, but Japanese officials had played down this possibility.

The new estimates by Japanese authorities suggest that the total amount of radioactive materials released so far is equal to about 10 percent of that released in the Chernobyl accident, said Hidehiko Nishiyama, deputy director general of Japan’s nuclear regulator, the Nuclear and Industrial Safety Agency.

Mr. Nishiyama stressed that unlike at Chernobyl, where the reactor itself exploded and fire fanned the release of radioactive material, the containments at the four troubled reactors at Fukushima remained intact over all.

But at a separate news conference, an official from the plant’s operator, Tokyo Electric and Power, said, “The radiation leak has not stopped completely and our concern is that it could eventually exceed Chernobyl.”

On the International Nuclear Event Scale, a Level 7 nuclear accident involves “widespread health and environmental effects” and the “external release of a significant fraction of the reactor core inventory.” The scale, which was developed by the International Atomic Energy Agency and countries that use nuclear energy, leaves it to the nuclear agency of the country where the accident occurs to calculate a rating based on complicated criteria.

Japan’s previous rating of 5 placed the Fukushima accident at the same level as the Three Mile Island accident in Pennsylvania in 1979. Level 7 has been applied only to the disaster at Chernobyl, in the former Soviet Union.

“This is an admission by the Japanese government that the amount of radiation released into the environment has reached a new order of magnitude,” said Tetsuo Iguchi, a professor in the department of quantum engineering at Nagoya University. “The fact that we have now confirmed the world’s second-ever level 7 accident will have huge consequences for the global nuclear industry. It shows that current safety standards are woefully inadequate.”

Mr. Nishiyama said “tens of thousands of terabecquerels” of radiation per hour have been released from the plant. (The measurement refers to how much radioactive material was emitted, not the dose absorbed by living things.) The scale of the radiation leak has since dropped to under one terabecquerel per hour, the Kyodo news agency said, citing government officials.

.

The announcement came as Japan was preparing to urge more residents around the crippled nuclear plant to evacuate, because of concerns over long-term exposure to radiation.

Also on Monday, tens of thousands of people bowed their heads in silence at 2:46 p.m., exactly one month since the 9.0-magnitude earthquake and ensuing tsunami brought widespread destruction to Japan’s northeast coast.

The mourning was punctuated by another strong aftershock near Japan’s Pacific coast, which briefly set off a tsunami warning, killed a 16-year-old girl and knocked out cooling at the severely damaged Fukushima Daiichi power station for almost an hour, underscoring the vulnerability of the plant’s reactors to continuing seismic activity.

On Tuesday morning, there was another strong aftershock, which shook Tokyo.

The authorities have already ordered people living within a 12-mile radius of the plant to evacuate, and recommended that people remain indoors or avoid an area within a radius of 18 miles.

The government’s decision to expand the zone came in response to radiation readings that would be worrisome over months in certain communities beyond those areas, underscoring how difficult it has been to predict the ways radiation spreads from the damaged plant.

Unlike the previous definitions of the areas to be evacuated, this time the government designated specific communities that should be evacuated, instead of a radius expressed in miles.

Moshe Komata and Kantaro Suzuki contributed reporting.

Medtronic Bone-Growth Product Scrutinized

Posted: 11 Apr 2011 11:10 PM PDT

One of Medtronic’s most profitable divisions — selling bone growth products used in spinal fusion procedures — faces growing pressure amid a widening criminal investigation into the company’s marketing of one product and a rejection by federal regulators of another one.

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A spinal implant that contains Medtronic's Infuse, a bioengineered bone growth product.

Recently, the Food and Drug Administration turned down the company’s application to sell a new spinal fusion device that is essentially a high-strength version of an approved one called Infuse. An agency review of clinical studies raised questions about a higher rate of cancers in patients treated with the new product, which is called Amplify, compared with those who did not get it.

Meanwhile, a long-running investigation by the Justice Department into the marketing of Infuse is apparently widening. In recent years, a number of physicians were contacted by prosecutors in connection with that inquiry, but just a few weeks ago, another doctor said he had also been contacted by Justice Department officials. He asked not to be identified because the inquiry is under way.

Prosecutors have also sought records from United States Army researchers involved in studies of Infuse, a bioengineered bone growth product that has also been used to treat severely wounded American soldiers, according to people who have been contacted as part of the inquiry.

Medtronic has said it plans to discuss the rejection of Amplify with regulators to try to allay their concerns, and the company has not been charged with any wrongdoing in the criminal inquiry. But the developments could pose significant future problems for Medtronic, a medical device giant whose other products include heart pacemakers and defibrillators.

A Wall Street analyst, Larry Biegelsen of Wells Fargo Securities, said Infuse accounts for the vast majority of Medtronic’s sales of biologic products, which he projected would reach $897 million in the company’s current fiscal year.

Mr. Biegelsen said the continuing federal investigation of Infuse, along with the F.D.A.’s rejection of Amplify, could lead to a slowdown of Infuse sales over the next year. He estimated that off-label use by doctors of the bone-growth protein made up 70 to 80 percent of Infuse sales.

The extent of the federal criminal inquiry involving Infuse is not clear. But the doctor who was recently contacted by Justice Department officials also said that it was his understanding that prosecutors had contacted other physicians in recent months.

One military surgeon testified before a federal grand jury in Boston investigating the Infuse issue about a year ago, said people with knowledge of the inquiry who also requested anonymity because it was continuing.

Army officials have also provided the Justice Department with the results of a military investigation into the experimental use of Infuse on dozens of soldiers at Walter Reed Army Medical Center in Washington, said Col. Norvell V. Coots, commander of the Walter Reed Health Care System. The Army’s 2008 report on that investigation found that a former military doctor, Dr. Timothy R. Kuklo, had overstated Infuse’s benefit in a medical journal study that examined its use in the treatment of solders whose shin bones had been severely shattered by explosive devices in Iraq.

Dr. Kuklo, who became a Medtronic consultant, also forged the signatures of that study’s co-authors in a journal submittal, the Army said. Medtronic later broke its ties to him, and the medical journal that published the article retracted it.

Medtronic has previously disclosed both the existence of a federal inquiry into its marketing of Infuse as well as the Justice Department’s interest into research it underwrote at Walter Reed.

In response to an inquiry from The New York Times, the company released a statement noting its previous disclosures. It declined to say whether federal officials were examining specific issues like company-sponsored research.

“Medtronic does not comment on what precise topics the government may or may not be examining at any point in the investigation,” the company said.

Henry J. Dane, who represented Dr. Kuklo in the Walter Reed investigation, said the Justice Department had subpoenaed the doctor’s records. Mr. Dane said he understood that prosecutors had also sought records from academic researchers and doctors outside the military who worked on other studies about Infuse that had been financed by Medtronic.

“He’s far from the only one,” to get a subpoena, said Mr. Dane, referring to Dr. Kuklo.

Mr. Dane said that a lawyer in Boston, Thomas C. Frongillo, has represented Dr. Kuklo and other physicians contacted by the Justice Department in the Infuse investigation. Reached by telephone, Mr. Frongillo declined comment. Several academic researchers involved in Medtronic-financed studies about Infuse did not respond to inquiries or declined to comment.

A spokeswoman for the United States attorney’s office in Boston, Christina DiIorio-Sterling, cited Justice Department policy in declining to confirm or deny the existence of an investigation.

In 2002, the Food and Drug Administration approved the use of Infuse for a certain type of spinal fusion procedure, in which problem spinal vertebrae are joined in an effort to stop severe back pain. Doctors are free to use an approved product in any way they choose, and many surgeons began using Infuse for other types of spinal fusion operations.

Some of the doctors who performed research studies into such so-called off-label uses of Infuse received millions of dollars in consulting fees from Medtronic, Congressional investigations have found.

In 2008, the F.D.A. issued a warning about the use of bone-growth proteins like Infuse in one off-label fusion procedure used to treat neck pain, citing reports of life-threatening injuries.

Obstacles Seen in Poor Areas for New Farmers’ Markets

Posted: 12 Apr 2011 10:48 AM PDT

For years, the Bloomberg administration has labored to improve the eating habits of New Yorkers, banning trans fats from restaurants, urging food purveyors to use less salt and creating special zoning to encourage fresh-food supermarkets to open in produce-poor neighborhoods.

But the city still puts roadblocks in the way of community groups seeking to open farmers’ markets in low-income neighborhoods, says a report to be released on Tuesday by the Manhattan borough president, Scott M. Stringer. Those efforts face excessive fees, confusing rules and a lack of coordination among agencies, the report says.

“Instead of all the red tape, we should roll out the red carpet, because every time one of these farmers’ markets succeeds, you end up serving a community that has no access to this produce,” said Mr. Stringer, considered a likely mayoral candidate in 2013. “I think sometimes the job of the city government is to get out of the way and let things happen organically, no pun intended.”

The city has its own Greenmarket program run by GrowNYC, a nonprofit group that works out of the mayor’s office and operates seasonal and year-round markets throughout the city, partly through a contract with the parks department. While those markets have cropped up in poorer areas in recent years, they have tended to flourish in more affluent neighborhoods in or close to Manhattan.

By contrast, most of the community-based markets are clustered in low-income neighborhoods where officials and even farmers were not convinced they could succeed. GrowNYC markets generally charge higher vendor fees and require that growers be present at the stand, a condition the community markets, operating in less tested areas, cannot always meet.

“When we asked to have a farmers’ market, we were told that farmers don’t want to come to the Bronx because it’s dangerous, or poor people can’t afford organic products,” said Karen Washington of La Familia Verde, a community garden organization active in Crotona, East Tremont and West Farms in the Bronx that started its markets with the help of Just Food, which promotes local and urban agriculture and coordinates 17 markets in the city. “But instead of listening to the naysayers, we figured: since we grow it, we know our community; let’s form our own farmers’ market.”

According to the report, the demand is clear: the city’s 60 community markets took in almost $500,000 in government nutrition coupons in 2009 and 2010.

But organizers must follow different permitting processes depending on where they seek to operate — in, say, a community garden or a park or on a street corner — and the income level of the area. Fees, which must be paid in advance of the selling season, can exceed $1,600 annually, a level that can strain the resources of a small organization. And even after the permits are obtained, vendors can have parking problems, since their permits are not always recognized by city ticket agents.

Mr. Stringer’s report recommends creating a single entity to oversee the markets, a uniform application process, a guide to operations and standard procedures for parking. It also suggests eliminating some fees.

Responding to the issues raised by the report, Mayor Michael R. Bloomberg’s office did not acknowledge a problem and had little to say about whether change could be on the way. Asked why the process was so complicated and if the city could do anything to make it easier, a spokeswoman said in an e-mail, “New Yorkers who apply for a street permit to hold a farmers’ market receive a detailed outline of all the necessary steps to make the process as clear as possible.” A follow-up question about those applying for permits for other locations — like parks or community gardens — went unanswered.

The executive director of GrowNYC, Marcel Van Ooyen, acknowledged that the system was complex. “It’s just complicated to work through New York City in anything you do; you have multiple agencies” involved in the regulations, he said, adding that his group had routinely tried to help others negotiate the bureaucracy. He said he was considering creating an online tutorial for anyone thinking about starting a market, to provide all the information in one place.

Hospital Care at Life’s End: A Disparity

Posted: 12 Apr 2011 08:20 AM PDT

At the end of life, people with chronic diseases like cancer get more aggressive medical care in the New York area than anyplace else in the country, continuing a trend going back decades, according to a report released on Monday by researchers at Dartmouth College.

The study, which looked at federal data from 2007, the most recent year available, found that 46 percent of chronically ill patients in the Manhattan hospital region, which also covers most of Brooklyn and Staten Island, were being treated at hospitals when they died, as opposed to dying at home or in hospices or nursing homes. That rate was the highest in the country.

The region covering Long Island and Queens was second, with 42 percent; the Bronx region was third, at 40 percent; and the New Brunswick, N.J., region was fourth, at 39 percent. Nationally, 28 percent of hospitals’ chronic patients were being treated at hospitals when they died.

Dr. Elliott S. Fisher, a co-author of the new study, said that some of the disparity might be driven by financial incentives for keeping patients in New York-area hospitals while neglecting the true wishes of the patients. “Surveys show quite clearly that Americans don’t want to spend their last days in intensive-care units,” Dr. Fisher said. “What they want is to avoid suffering, to be with their families, to be mentally aware.”

His colleague Dr. David C. Goodman, a professor of pediatrics and health policy at Dartmouth Medical School, said that Medicare generally paid better for hospital-based care, including procedures and specialists, than for palliative care or community-based medical services.

Dr. Gary Kalkut, chief medical officer of Montefiore Medical Center in the Bronx, said that the study did not consider the complex factors that determine how long a patient stays in the hospital. “If someone doesn’t have a home, it’s hard to send them home,” he said. He said that studies, including ones by Dartmouth doctors, had shown that black and Hispanic patients were more likely to prefer dying in the hospital than in hospice care.

He denied that federal financing provided an incentive to offer more aggressive care, saying that Montefiore had one of the lowest rates of intensive care use for terminally ill cancer patients in the country.

The study also found that the use of hospice care was increasing in New York and across the country. Hospice care focuses on the quality of the life still remaining to the patient, rather than on curing diseases.

At the five academic medical centers in the New York City area, the average number of days patients spent in hospice care, either at home or in an institution, rose to 10.1 days in 2007 from 5.4 days in 2003.

“End-of-life care in the U.S. is changing fairly rapidly,” Dr. Goodman said Monday. Patients, he said, “are spending less time in the hospital and receiving more hospice care over all.”

Well: Eating Disorders Among Orthodox Jews

Posted: 12 Apr 2011 09:45 AM PDT

Well: When Should Men Stop P.S.A. Testing?

Posted: 12 Apr 2011 09:48 AM PDT

Well: Taking Out Tonsils Less Often

Posted: 12 Apr 2011 09:49 AM PDT

Well: Depressed About Allergies?

Posted: 12 Apr 2011 09:50 AM PDT

Well: Lessons From the Hormone Studies

Posted: 12 Apr 2011 09:51 AM PDT

Personal Health: Keeping Eyes on Distracted Driving’s Toll

Posted: 11 Apr 2011 09:37 PM PDT

While driving a car, have you ever:

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• Reprogrammed your GPS device?

• Retrieved something you or a child dropped?

• Searched for a particular CD?

• Put on makeup or shaved?

• Struggled to open a package of nuts or chips?

Perhaps you never have texted or talked on a cellphone while operating a motor vehicle. But if you engaged in any of the above activities, you are just as guilty of distracted driving as if you had.

It’s easy to become complacent. Maybe you’re a good driver, and you’ve gotten away with such actions for years. Maybe you managed to avert a near-accident when your attention returned to the road in the nick of time. But one of these days, your luck may run out and you, or someone you hit, could be maimed for life or dead.

“Driving while distracted is roughly equivalent to driving drunk,” Dr. Amy N. Ship, an internist at Harvard Medical School, wrote last year in a commentary in The New England Journal of Medicine. “Any activity that distracts a driver visually or cognitively increases the risk of an accident. None of them is safe.”

Following widespread publicity about the hazards of distracted driving, including a Pulitzer-prize winning series in this newspaper, medical groups are working hard to make patients more aware of the problem. The most recent effort was started last week by the American Academy of Orthopaedic Surgeons and the Orthopaedic Trauma Association, whose “Decide to Drive” campaign calls attention to the increasing number of distractions engaged in by multitasking drivers and the resulting toll on people’s lives.

“We take care of a lot of people injured in car accidents, and distracted driving is a substantial contributor to these accidents,” Dr. Daniel Berry, president of the academy, said in an interview. “If we could get rid of this part of our practice, it would be a great service to the people we care for.”

Orthopedists would do very well, thank you, without the business generated by the 307,369 crashes that have occurred so far this year, according to estimates from the National Safety Council, involving drivers talking on cellphones or texting.

Last year Aaron Brookens of Beloit, Wis., then 19, was driving home at 75 miles an hour after spending a weekend with his girlfriend when he decided to send her a text message — and wound up pinned under a semi. The toll: two broken femurs, a broken kneecap and ankle, nerve damage to both legs, and a lacerated spleen, kidney and liver.

Numerous operations and a lengthy rehab later, Mr. Brookens knows he’s lucky to be alive. “No one thinks it will happen to them,” he said on Wednesday at a news conference convened by the orthopedists. He now realizes that “deciding to drive” is always the best option, and he wants others to learn from his mistake.

“We don’t expect our campaign to change everyone’s behavior overnight,” Dr. Berry said. “It took a lot of years to get the message across about using seat belts or driving drunk. We’re adding our voice to those of others — the more jungle drums, the better.”

Among those beating the drums are the parents of Eric Okerblom, a 19-year-old college student who was struck by a car and killed in 2009 while cycling near his home in Santa Maria, Calif.; the driver, a teenager, was traveling 60 m.p.h. while texting on her cellphone. His father, Bob Okerblom, is now on a cross-country bike ride, blogging along the way in order to spread the word about distracted driving.

Last November, the transportation secretary, Ray LaHood, introduced a Web site called “Faces of Distracted Driving” (distraction.gov/faces) that explores the cost these behaviors inflict on families and communities. “Distracted driving has become a deadly epidemic on America’s roads,” said Mr. LaHood, who urges bans on drivers texting and using phones or other devices.

At the news briefing, Dr. Andrew Pollak, president of the trauma association, said: “It isn’t just cellphones. It’s anything that takes our attention from the task of driving.”

David L. Strickland, administrator of the National Highway Traffic Safety Administration, added: “No one does multitasking well.”

The orthopedists’ campaign will try to raise the national consciousness and change future driving behavior by taking their message to schoolchildren, especially those in grades 5 through 8, who may discourage their parents and siblings from driving distracted and refrain themselves when they become drivers.

Statistics and Studies

Really?: Allergies Can Increase the Risk of Depression

Posted: 12 Apr 2011 11:42 AM PDT

THE FACTS

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Christoph Niemann

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Spring always brings a rash of sneezing, sniffling and stuffy noses. But can seasonal allergies be psychologically harmful?

A wave of emerging research suggests that may be the case. While there’s no firm evidence that allergies cause depression, large studies show that allergy sufferers do seem to be at higher risk of depression.

Severe allergies can bring sleeplessness, headaches, fatigue and a general feeling of physical depletion, all of which can worsen mood. Studies have found that allergic reactions release compounds in the body called cytokines, which play a role in inflammation and may reduce levels of the hormone serotonin, which helps maintain feelings of well-being. And it’s well known that some common allergy medications, like corticosteroids, can cause anxiety and mood swings.

Several large studies have found that the risk of depression in people with severe allergies is about twice that of those without allergies. In 2008, researchers at the University of Maryland reported that this link may help explain a widely established — but poorly understood — increase in suicides during the spring every year. Analyzing medical records, the authors found that in some patients, changes in allergy symptoms during low- and high-pollen seasons corresponded to changes in their depression and anxiety scores.

A Finnish population study in 2003 found a link between allergies and depression; however, women were much more likely to be affected. In 2000, a study of twins in Finland also showed a shared risk for depression and allergies, a result of genetic influences, the authors wrote.

THE BOTTOM LINE

Severe seasonal allergies may be a risk factor for depression.

ANAHAD O’CONNOR

scitimes@nytimes.com

The New Old Age: Care for Elderly Diabetics

Posted: 11 Apr 2011 01:55 PM PDT

Prescriptions: A New Public-Private Partnership for Patients

Posted: 12 Apr 2011 12:36 PM PDT

Prescriptions: This Week's Health Industry News

Posted: 11 Apr 2011 06:56 AM PDT

Letters: Threats Big and Small (2 Letters)

Posted: 11 Apr 2011 09:20 PM PDT

Threats Big and Small

To the Editor:

Denise Grady’s article “Radiation Is Everywhere, but How to Rate Harm?” (April 5) is excellent as far as it goes. But missing from her analysis is any mention of the radioisotope polonium 210 — the most lethal component of tobacco and surely the most destructive ionizing radiation to which world populations are ordinarily exposed. Inhaled and circulating to every tissue and cell, it emits alpha particles and is a powerful toxin. Nuclear plants deserve careful control, but action must be taken to stop the sale of cigarettes.

R. T. Ravenholt, M.D.

Seattle

To the Editor:

Denise Grady is correct that “scientists disagree about the effects of very low doses of radiation.” But she does not mention that the committee on the Biological Effects of Ionizing Radiation and the International Commission on Radiological Protection maintain that there is no threshold beneath which radiation has no effect. Some experts claim that the lower the dose, the higher the risk, because when the cell attempts to repair itself, mutations result. This was the conclusion Dr. Alice Stewart came to when she discovered, in the 1950s, that a fetal X-ray doubles the risk of a childhood cancer. Her findings were dismissed, because the radiation exposure was a fraction of the dose “known” to be safe. But she was right.

Gayle Greene

El Cerrito, Calif.

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: Prescription for Parity (1 Letter)

Posted: 11 Apr 2011 09:20 PM PDT

Prescription for Parity

To the Editor:

Re “Illness More Prevalent Among Older Gay Adults” (Vital Signs, April 5): Health disparities among older gay people are the direct result of disparities in equality. There is no question about the cost of discrimination to the human body: increased stressors lead to increase in illness. The remedies are clear. To begin with, let’s put an end to institutionalized discrimination. Repeal laws like the Defense of Marriage Act. Lift the bans on same-sex marriage. Make it illegal to discriminate based on sexual identity, sexual orientation or gender expression in employment, housing, accommodation and credit. Our health care system can’t afford it.

Roberta Sklar

New York

 

Science Times welcomes letters from readers. Those submitted for publication must include the writer’s name, address and telephone number. E-mail should be sent to scitimes@nytimes.com. Send letters to Science Editor, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018.

Japan Rates Disaster as Chernobyl-Scale

Posted: 12 Apr 2011 12:50 PM PDT

This article is by Keith Bradsher, Hiroko Tabuchi and Andrew Pollack.

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A center for evacuees at the Big Palette Fukushima sports arena in Koriyama, Japan, on Tuesday.

TOKYO — Japanese officials struggled through the day on Tuesday to explain why it had taken them a month to disclose large-scale releases of radioactive material in mid-March at a crippled nuclear power plant, as the government and an electric utility disagreed on the extent of continuing problems there.

The government announced Tuesday morning that it had raised its rating of the severity of the accident at the Fukushima Daiichi Nuclear Power Station to 7, the worst on an international scale, from 5. Officials said that the reactor had released one-tenth as much radioactive material as the Chernobyl accident in 1986, but still qualified as a 7 according to a complex formula devised by the International Atomic Energy Agency.

Japan’s new assessment was based largely on computer models showing very heavy emissions of radioactive iodine and cesium from March 14 to 16, just after the earthquake and tsunami rendered the plant’s emergency cooling system inoperative. The nearly monthlong delay in acknowledging the extent of these emissions is a fresh example of confused data and analysis from the Japanese, and put the authorities on the defensive about whether they have delayed or blocked the release of information to avoid alarming the public.

Seiji Shiroya, a commissioner of Japan’s Nuclear Safety Commission, an independent government panel that oversees the country’s nuclear industry, said that the government had delayed releasing data on the extent of the radiation releases because of concern that the margins of error were large in initial computer models. But he also suggested a public policy reason for having kept quiet.

“Some foreigners fled the country even when there appeared to be little risk,” he said. “If we immediately decided to label the situation as Level 7, we could have triggered a panicked reaction.”

The Japanese media, which has a reputation for passivity but has become more aggressive in response to public unhappiness about the nuclear accident, questioned government leaders through the day about what the government knew about the accident and when it knew it.

Prime Minister Naoto Kan gave a nationally televised speech and press conference in the early evening to call for national rebuilding, but ended up defending his government’s handling of information about the accident.

“What I can say for the information I obtained — of course the government is very large, so I don’t have all the information — is that no information was ever suppressed or hidden after the accident,” he said. “There are various ways of looking at this, and I know there are opinions saying that information could have been disclosed faster. However, as the head of the government, I never hid any information because it was inconvenient for us.”

Junichi Matsumoto, a senior nuclear power executive from the plant’s operator, Tokyo Electric Power Company, fanned public fears about radiation when he said at a separate press conference on Tuesday morning that the radiation release from Daiichi could, in time, surpass levels seen in 1986.

“The radiation leak has not stopped completely and our concern is that it could eventually exceed Chernobyl,” Mr. Matsumoto said.

But Hidehiko Nishiyama, deputy director general of Japan’s nuclear regulator, the Nuclear and Industrial Safety Agency, said in an interview on Tuesday evening that he did not know how the company came up with its estimate. “I cannot understand their position,” he said.

He speculated that Tokyo Electric was being “prudent and thinking about the worst-case scenario,” adding, “I think they don’t want to be seen as optimistic.”

Mr. Nishiyama said that his agency did not expect another big escape of radiation from Daiichi, saying that “almost all” the material that is going to escape has already come out. He said that the rate of radiation release had peaked in the early days after the March 11 earthquake, and that the rate of radiation had dropped by 90 percent since then.

The peak release in emissions of radioactive particles took place following hydrogen explosions at three reactors, as technicians desperately tried to pump in seawater to keep the uranium fuel rods cool, and bled radioactive gas from the reactors in order to make room for the seawater.

Mr. Nishiyama took pains to say — and other nuclear experts agree — that the Japanese accident poses fewer health risks than Chernobyl.

Democrat in Missouri to Oppose Health Care Law

Posted: 12 Apr 2011 08:10 AM PDT

KANSAS CITY, Mo. — Missouri’s Democratic attorney general broke with his party on Monday and urged a federal judge to invalidate the central provision of the new health care law.

Chris Koster

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The filing of the brief by Attorney General Chris Koster, a onetime Republican state legislator who switched to the Democratic Party in 2007, underscores the act’s political tenuousness in a critical Midwestern swing state.

Mr. Koster’s action followed months of pressure from state Republicans that he join attorneys general from other states who are challenging the constitutionality of the law.

Rather than join the litigation, however, Mr. Koster chose to file a “friend of the court” brief in the United States Court of Appeals for the 11th Circuit, in Atlanta, which is reviewing one of five challenges to the act that have moved into the midlevel appellate courts.

Three lower court judges have upheld the law, while two have ruled that its central provision — the requirement that most Americans obtain health insurance — is unconstitutional.

The 11th Circuit is hearing a case filed in Pensacola, Fla., by Republican governors and attorneys general from 26 states. The federal district judge in that case, Roger Vinson, decreed that the entire health care act should be invalidated, but stayed his ruling until the Supreme Court settled the matter.

In Missouri, a ballot referendum aimed at nullifying the law was approved by nearly three to one last year, and the legislature recently passed resolutions urging Mr. Koster to join the legal challenges. The state’s lieutenant governor, a Republican, filed a lawsuit last year seeking to block the law.

In a letter to the Republican leaders of the legislature announcing his decision to oppose the law, Mr. Koster acknowledged that the legislative resolutions, though nonbinding, were “impactful, as they give voice to the political will of Missourians.”

Although he supports an expansion of health coverage, he wrote, his duty is “to the law, and not to a political outcome.”

Though Mr. Koster has been slow to weigh in, he did not mince words, arguing in the court brief that Congress had overstepped its authority by mandating that individuals buy health insurance, which he called “a substantial blow to federalism and personal freedom.”

“If Congress can force activity under the Commerce Clause, then it could force individuals to receive vaccinations or annual checkups, undergo mammogram or prostate exams or maintain a specific body mass,” he wrote.

He asked that the mandate be stripped from the law, and that the rest of it be allowed to remain in effect.

His central argument echoed those made by plaintiffs in a number of the lawsuits, but it was noteworthy coming from a Democrat. The only Democratic state official who has joined the litigation as a plaintiff, Attorney General Buddy Caldwell of Louisiana, switched to the Republican Party in February.

For Mr. Koster, who was elected in 2008, the decision to oppose his party on such a high-profile issue reflects the political challenges for Missouri Democrats in the coming election cycle.

Though this state has long been viewed as a political bellwether, the politics of the electorate have grown more conservative in recent years, and Barack Obama narrowly lost the state in 2008.

Mr. Koster, who is up for re-election next year along with the state’s two top Democrats, Gov. Jay Nixon and Senator Claire McCaskill, has already faced questions about his political loyalties.

Known as a Republican moderate, he became a Democrat just months before announcing his candidacy for attorney general, succeeding despite criticism of the move from both parties, including being pinned with the nickname Koster the Imposter.

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Physicist Reviews Nuclear Meltdowns

Posted: 11 Apr 2011 10:34 PM PDT

WASHINGTON — The three partial Japanese nuclear meltdowns bring the worldwide total to a dozen accidents with reactor core damage since the first one in 1957, and nuclear reactors worldwide are suffering such accidents about eight times more frequently than the United States’ safety goal, an American physicist said.

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Thomas B. Cochran, a Natural Resources Defense Council scientist, looked at 12 accidents — four in the United States, two in France, one each in Scotland, East Germany and Ukraine, and the three in Japan.

He excluded one accident, SL-1, an experimental United States Army reactor that was being tested 50 years ago as a remote power source for radar in the Canadian Arctic to watch for a Soviet nuclear attack. Among the dozen reactors, it was the only one not connected to the power grid.

The earliest meltdown on his list occurred at a reactor being tested at the federal government’s Santa Susana Field Laboratory, near Los Angeles, in 1957. Also on the list are Enrico Fermi Unit 1, near Detroit, in 1966; Three Mile Island, in 1979; and Chernobyl, in Ukraine, in 1986.

Given that in the history of nuclear energy, 582 reactors have operated for a total of 14,400 years (counting each year of operation by one reactor as a reactor-year), a core-damage accident has happened once every 1,309 years of operation. With 439 reactors now operating worldwide, the rate would yield an accident an average of once every three calendar years.

One variable is that some of the accidents were at types of reactors that are no longer commercially operated.

In contrast, the Nuclear Regulatory Commission has set a goal of no more than one accident per 10,000 years of collective operation. A corollary goal was that no more than one in 10 of those should result in significant off-site releases of radioactive material.

The commission’s position is that all American reactors operating today meet that goal, but the conclusion is reached by calculating the probability of various failures and not by actual experience.

Mr. Cochran is scheduled to testify about his calculations before the Senate Environment and Public Works Committee on Tuesday. The Natural Resources Defense Council has called for a moratorium on new reactor licensing in the United States and on extensions for some plants.

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A New Push to Let H.I.V. Patients Accept Organs That Are Infected

Posted: 11 Apr 2011 12:07 PM PDT

David Aldridge of Los Angeles had a kidney transplant in 2006, but he will soon need another. Like many people living with H.I.V., he suffers from kidney damage, either from the virus or from the life-saving medications that keep it at bay.

Until recently, such patients did not receive transplants at all because doctors worried that their health was too compromised. Now they can get transplants, but organ-donor waiting lists are long. And for Mr. Aldridge, 45, and other H.I.V. patients, a potential source of kidneys and livers is off limits, because it is illegal to transplant organs from donors who test positive for the virus — even to others who test positive.

But federal health officials and other experts are calling for repeal of the provision that bans such transplants, a 23-year-old amendment to the National Organ Transplant Act.

“The clock is ticking more quickly for those who are H.I.V.-positive,” said Dr. Dorry Segev, transplant surgery director of clinical research at Johns Hopkins and a co-author of a new study indicating that 500 to 600 H.I.V.-infected livers and kidneys would become available each year if the law were changed. “We have a huge organ shortage. Every H.I.V.-infected one we use is a new organ that takes one more person off the list.”

The ban on transplanting organs from people with the virus that causes AIDS was passed at the height of the AIDS scare in 1988, when infection with the virus was considered a death sentence. But now many people with H.I.V. are living long enough to suffer kidney and liver problems, adding to the demand for organs.

This has led some health authorities to say that H.I.V.-infected organs should be available for transplant, primarily for patients infected with the virus but also potentially for some who are not.

The federal Centers for Disease Control and Prevention and other health agencies are about to issue new guidelines that will encourage a first step: research involving transplanting H.I.V.-positive organs into H.I.V.-positive people. That would require the transplant ban to be lifted.

“We would like to see as many safe transplants occurring as possible, and there’s no reason why H.I.V.-positive recipients shouldn’t get transplants and that H.I.V.-positive donors can’t be used,” said Dr. Matthew Kuehnert, who directs the C.D.C.’s Office of Blood, Organ and Other Tissue Safety.

“I could see someone saying: ‘That’s horrible. Why would you want to transplant H.I.V.?’ ”he said. “They don’t understand. Anyone who understands transplant today, in the current era, understands the need.”

The H.I.V. Medicine Association, a professional group, just issued a similar statement, calling for “changing federal law on H.I.V.-infected organ donation.” Its chairwoman, Dr. Kathleen Squires, said her organization and other medical groups would lobby Congress this year.

Until recent years, H.I.V.-positive patients were not given transplants because of concerns that the virus could destabilize transplanted organs or that the immunosuppressive drugs used in transplants might make the virus more dangerous.

But a large clinical trial found that results in H.I.V.-positive recipients are “just as good as H.I.V.-negative patients, more or less,” said the study’s leader, Dr. Peter Stock, a transplant surgeon at University of California, San Francisco. “Our kidney patients do slightly worse than the general population of transplant patients, but better than kidney transplant patients over 65.”

Last year, at least 179 H.I.V-positive people received kidneys or livers, up from 9 in 2000.

Allowing H.I.V.-positive organs to be used would create an additional supply when some 110,000 Americans are awaiting transplants. They often wait years, and sometimes are too sick when organs become available to benefit from them.

There are concerns, even among some supporters of changing the law.

“People I know in the gay community are very split on it,” said Michael Bauer, 45, of Iowa City, who became H.I.V.-positive two years ago and will probably need a liver transplant in coming years. “There’s the concept that having an H.I.V-positive donor could actually be more damaging. You could have a donor who has a tougher strain of H.I.V.”

Doctors say this and other risks could probably be managed by screening out the sickest donors and recipients. And for patients like Mr. Bauer, the risks may be worth it.

“I can get slapped on a list for a healthy liver, but there’s a whole slew of people ahead of me,” he said. “I don’t want to be excluded from options.”

Others fear that H.I.V.-infected organs could be transplanted by mistake. While extremely rare, such errors have occurred.

In Chicago in 2007, four recipients were infected by organs from a single dead donor; the body had tested negative, but the test was administered too early, before the virus could be detected. In 2009 a kidney recipient in New York was infected from a living donor, who tested negative, then had unprotected sex and became infected in the 79 days before the transplant. That case prompted the federal disease centers to issue stricter testing recommendations this year, and Dr. Kuehnert said the new guidelines would address ways to make transplants even safer.

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Recipes for Health: Thai-Style Sprouted Rice and Herb Salad

Posted: 11 Apr 2011 02:10 PM PDT

This is inspired by a recipe in “Seductions of Rice,” by Naomi Duguid and Jeffrey Alford. The traditional dressing is made with four times as much fish sauce, which I’ve revised here to keep the sodium levels more manageable. I find any amount of fish sauce makes a dish hard to resist.

Recipes for Health

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

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4 cups cooked sprouted brown rice

2 tablespoons fresh lime juice

1 1/2 cups tightly packed, coarsely chopped watercress leaves, baby spinach, arugula or a mix

1 1/2 cups edamame

1 sweet red bell pepper, cut in thin 2-inch-long strips

2 tablespoons finely chopped mint

1/4 cup tightly packed fresh Asian or sweet basil leaves, or tarragon, coarsely chopped

1 cup loosely packed chopped cilantro

1 shallot, cut in thin rings, soaked for five minutes in cold water, drained and rinsed; or 1/4 cup finely sliced scallion (optional)

1 teaspoon finely minced lemon grass from the tender inner part of the stalk

1 bird or serrano chili, minced

Leaf lettuce for serving

For the dressing:

2 tablespoons Thai fish sauce

1/3 cup water

1 teaspoon brown sugar, turbinado sugar or dark agave nectar

1/2 teaspoon minced lemon grass, from the tender inner part of the stalk

1 garlic clove, minced

1/4 to 1/2 teaspoon crumbled dried red chili

2 tablespoons canola oil

3 tablespoons fresh lime juice

1. Combine all of the salad ingredients in a large bowl.

2. Combine the fish sauce and water in a small saucepan. Add the sugar, lemon grass, garlic and chili flakes, and bring to a boil. Lower the heat, and simmer for five minutes, stirring occasionally. Make sure the liquid does not boil down. Transfer to a bowl or measuring cup, and whisk in the canola oil and lime juice. Toss with the salad.

3. Line a platter with lettuce leaves, top with the salad and serve.

Yield: Serves six to eight.

Advance preparation: You can combine all of the salad ingredients several hours before serving and refrigerate. Toss with the dressing just before serving.

Nutritional information per serving (six servings): 208 calories; 0 grams saturated fat; 1 gram polyunsaturated fat; 3 grams monounsaturated fat; 0 milligrams cholesterol; 31 grams carbohydrates; 3 grams dietary fiber; 397 milligrams sodium (does not include salt to taste); 6 grams protein

Nutritional information per serving (eight servings): 156 calories; 0 grams saturated fat; 1 gram polyunsaturated fat; 2 grams monounsaturated fat; 0 milligrams cholesterol; 23 grams carbohydrates; 3 grams dietary fiber; 298 milligrams sodium (does not include salt to taste); 4 grams protein

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

Recipes for Health: Brown Rice, but Better

Posted: 12 Apr 2011 09:48 AM PDT

Sprouts are hardly news — I was learning to cook around the time that alfalfa sprouts began to appear in green salads and veggie sandwiches. But until recently I’d never heard of sprouted brown rice.

Recipes for Health

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

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These sprouts aren’t like the ones you put on a sandwich. Sprouted brown rice looks and feels like regular brown rice, and it must cooked for the same amount of time. But once cooked, it’s sweeter and more delicate than ordinary brown rice, and a little less chewy.

Sprouting any grain increases its nutritional value by making its nutrients more bio-available, among them calcium. But it’s the flavor and texture of this new sprout that have gotten me hooked. If you’ve been hard pressed to get your family to embrace brown rice, this may be the way to go.

Sprouted Brown Rice Bowl With Carrot and Hijiki

Julienne carrots with hijiki seaweed is a traditional Japanese combination. Here I’ve added some tofu to bulk up the protein. Hijiki is an excellent source of iodine, vitamin K, folate and magnesium; the seaweed is soaked and simmered before cooking with the carrot and aromatics.

1/2 ounce (about 1/2 cup) dried hijiki

1 tablespoon soy sauce, preferably tamari (more to taste)

2 teaspoons mirin

1 tablespoon peanut oil or canola oil

1/2 pound firm tofu, cut in 1/2-by-1-inch dominoes

1 tablespoon plus 1 teaspoon shredded or minced ginger

1/2 pound (2 large) carrots, cut in 2- or 3-inch long julienne

Salt to taste (optional)

1 1/2 tablespoons toasted sesame seeds

3 cups cooked sprouted brown rice

1 tablespoon dark sesame oil

1. Place the hijiki in a medium bowl, and cover with water. Soak 15 minutes, and drain. Place in a medium saucepan, and add just enough water to cover, along with 2 teaspoons of the soy sauce. Bring to a boil, reduce the heat and simmer 15 minutes. Drain.

2. Combine the remaining soy sauce and mirin in a small bowl, and place within reach of your wok or pan. Heat a 14-inch flat-bottomed wok or 12-inch steel skillet over high heat until a drop of water quickly evaporates from the pan. Swirl in the peanut or canola oil by adding it to the sides of the pan and then tilting the pan side to side. Add the tofu and stir-fry until lightly colored, one to two minutes. Add the ginger, and stir-fry for no more than 10 seconds.

3. Add the carrots, and stir-fry for one minute until they begin to soften. Add the hijiki, soy sauce and mirin. Continue to stir-fry for another two to three minutes until the carrots are crisp-tender. Stir in the sesame oil and rice, and toss together for a minute or two, pressing the rice into the sides of the wok before scooping and stirring. Transfer to a platter, sprinkle with sesame seeds and serve.

Yield: Serves three to four.

Advance preparation: This is a last minute stir-fry; however, you can prepare the hijiki through Step 1 several hours or even a day before you make the dish. Cooked sprouted brown rice will keep for three or four days in the refrigerator.

Nutritional information per serving (three servings): 444 calories; 2 grams saturated fat; 7 grams polyunsaturated fat; 6 grams monounsaturated fat; 0 milligrams cholesterol; 61 grams carbohydrates; 9 grams dietary fiber; 447 milligrams sodium (does not include salt to taste); 13 grams protein

Nutritional information per serving (four servings): 333 calories; 2 grams saturated fat; 5 grams polyunsaturated fat; 4 grams monounsaturated fat; 0 milligrams cholesterol; 46 grams carbohydrates; 7 grams dietary fiber; 335 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."

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