Health - Well: Is a Well-Rested Doctor a Better Doctor?

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• Well: Is a Well-Rested Doctor a Better Doctor?
• Disabled, but Looking for Work
• Virginia Lawmakers Limit Insurers’ Abortion Coverage
• Vital Signs: Patterns: Fewer Women Dying of Lung Cancer
• Baruch Blumberg, Who Discovered and Tackled Hepatitis B, Dies at 85
• W. H. Prusoff, Who Developed AIDS Drug, Is Dead at 90
• Recipes for Health: Grapefruit Ice
• Well: Estrogen Lowers Breast Cancer and Heart Risk in Some
• Vital Signs: Risks: Focus on Heart Deaths in Student-Athletes
• Well: A Comedic TV Talent Turns the Tables on Oprah
• Economic Scene: Generational Divide Colors Debate Over Medicare’s Future
• Senate Passes Change to Health Law
• Inquiry Into Payments by Device Maker
• U.S. Sees Array of New Threats at Japan’s Nuclear Plant
• Radiation Is Everywhere, but How to Rate Harm?
• Patient Voices: Obscure, and Often Devastating
• Well: The Truth About Sex and Exercise
• Well: Back to Work and Life, With a Fresh Perspective
• The New Old Age: A Common Infection, Commonly Overtreated
• The New Old Age: Soothing Those With Dementia
• Prescriptions: Privatizing Medicare
• Prescriptions: Kaiser Opens Clinic in Washington
• Overstimulated (1 Letter)
• Crisis Saddles Village With Unwanted Notoriety
• News Analysis: Drugs’ Cost and Safety Fuel a Fight
• G.O.P. Blueprint Would Remake Health Policy
• Mandi Schwartz, Athlete at Center of Marrow Drive, Dies at 23
• Vital Signs: Patterns: Long Hours May Add to Heart Trouble
• Recipes for Health: Pear and Red Wine Sorbet
• Recipes for Health: Caramelized Honey-Baked Pears

Well: Is a Well-Rested Doctor a Better Doctor? Posted: 07 Apr 2011 04:00 AM PDT

Disabled, but Looking for Work Posted: 07 Apr 2011 08:36 AM PDT BATESVILLE, Ark. — Christopher Howard suffers from herniated discs in his back, knee problems and hepatitis C. As a result, Social Security sends him $574 every month and will until he reaches retirement age — unless he can find a job. Enlarge This Image Jacob Slaton for The New York Times Christopher Howard, 36, with his wife, Darlene. “I would feel better if I worked and made my own money,” he said. Economix Moving From Disability Benefits to Jobs A study finds the earnings ceiling for those receiving disability checks from Social Security creates a “powerful disincentive to work.” Post a Comment Multimedia Graphic Disability Benefits and Recipients Add to Portfolio McDonald's Corp Go to your Portfolio » Enlarge This Image Jacob Slaton for The New York Times Christopher Howard and his wife live on his $574 a month disability check from Social Security. He is confident he will find a job. Though he has been collecting disability checks for three years, Mr. Howard, who is just 36, desperately wants to work, recalling dredging for gravel rather fondly and repairing cell towers less fondly. “It makes me feel like I am doing something,” said Mr. Howard, a burly man with a honey-colored goatee. “Instead of just being a bum, pretty much.” Programs intended to steer people with more moderate disabilities back into jobs have managed to take only a small sliver of beneficiaries off the Social Security rolls. Yet, at a time when employers are struggling to create spots for the 13.5 million people actively looking for jobs, helping people like Mr. Howard find employment — or keeping them working in the first place — is becoming increasingly important to the nation’s fiscal health. For the last five years, Social Security has paid out more in benefits to disabled workers than it has taken in from payroll taxes. Government actuaries forecast that the disability trust fund will run out of money by 2018. About 8.2 million people collected disabled worker benefits totaling $115 billion last year, up from 5 million a decade earlier. About one in 21 Americans from age 25 to 64 receive the benefit, according to an analysis of Social Security data by Prof. Mark G. Duggan, an economist at the University of Maryland, compared with one in 30 a little over a decade ago. In Mr. Howard’s home state of Arkansas, the figure is one in 12, among the highest in the nation. Along with monthly checks that are based on the worker’s earnings history, beneficiaries generally qualify for Medicare — otherwise reserved for those over 65 — two years after being admitted to the disability rolls. There are several reasons for the increase in beneficiaries. Baby boomers are hitting the age when health starts to deteriorate, and more people are claiming back and other muscular-skeletal ailments and mental illnesses than claimed those as disabilities a generation ago. Lawyers who solicit clients on television and on the Internet probably play a role. And administrative law judges say pressure to process cases sometimes leads to more disability claims being accepted. But given the difficult job market, some economists say they believe that an increasing number of people rely on disability benefits as a kind of shadow safety net. The program was designed to help workers who are “permanently and totally disabled,” and administration officials say that it is an important lifeline for many people who simply cannot work at all. But Social Security officials can take into consideration a claimant’s age, skills and ability to retrain when determining eligibility. So one question is: How many of these beneficiaries could work, given the right services and workplace accommodations? Social Security officials say relatively few. Nicole Maestas, an economist at the Rand Corporation, has examined Social Security data with fellow economist Kathleen J. Mullen, and concluded that in the absence of benefits, about 18 percent of recipients could work and earn at least $12,000 a year, the threshold at which benefits are suspended. Other economists say that even among those denied benefits, a majority fail to go back to work, in part because of medical problems and a lack of marketable skills. “In an atmosphere in which there is a concern about fiscal problems, it’s always easy to point the finger at groups and say, ‘These people should be working,’ ” said Prof. John Bound, an economist at the University of Michigan, “exaggerating the degree to which the disability insurance program is broken.” Even if claimants have more ambiguous medical cases, once they are granted disability benefits, they generally continue to collect. Of the 567,395 medical reviews conducted on beneficiaries in 2009, Social Security expects less than 1 percent to leave because of improved health. The benefits have no expiration date, like the current 99-week limit for collecting unemployment. And because many people spend years appealing denials and building their medical case before being granted benefits, their skills often atrophy and gaps open on their résumés, making it more difficult for them to get back to work. Beneficiaries, who also fear losing health care coverage, may view their checks as birds in the hand. “Even if you’re taking just $800 or $900 a month, that’s better than nothing,” said Bruce Growick, an associate professor of rehabilitation services at Ohio State University. Shortly after Mr. Howard’s benefit checks started arriving, he received a four-by-six-inch card from Social Security informing him of services to help him return to work. Confused by the bureaucratic language and fearing the loss of medical coverage, he discarded it. When he called the local office, he said a staff member did not seem to know what his rights were or what help was available. “I thought it is just better to get what we are getting,” he said. 1 2 Next Page »

Virginia Lawmakers Limit Insurers’ Abortion Coverage Posted: 06 Apr 2011 10:08 PM PDT RICHMOND, Va. — Lawmakers in Virginia approved an amendment Wednesday that would ban private insurance plans from covering abortions if they participate in a state health care exchange under President Obama’s new health care law. Related Times Topics: Health Care Reform | Abortion The amendment, proposed by Gov. Bob McDonnell and passed by both the State House and Senate on Wednesday, states that no insurance plan sold as part of the state health care exchange could cover abortion except in cases of rape, incest and danger to the mother’s life. It is part of a bill that would take the first step toward setting up such an exchange, which was mandated by the new health care bill, to provide coverage for certain segments of the population, including low-income people. The bill, which passed last month, is an effort to remain compliant with the federal law, despite a suit the state has filed that challenges the law’s constitutionality. Virginia joins at least seven other states that have passed bans on coverage of abortion in state health care exchanges, a pattern that abortion advocates say threatens to erode abortion coverage. The Guttmacher Institute, a research organization, estimates that more than 80 percent of private insurance plans now provide abortion coverage. Coverage for low-income women has long been restricted under the 1977 Hyde Amendment, which prohibits certain federal funds from paying for abortion. Some states choose to pay for it themselves. “This affects a much broader segment of women,” said Tarina Keene, executive director of Naral Pro-Choice Virginia. “What is next?” State officials argue that the overwhelming majority of people who would potentially take part in the exchange — estimated to be just under a tenth of the population — would be receiving federal subsidies and already are subject to limitations under the Hyde Amendment. But a smaller contingent of middle- and upper-income earners who receive no federal or state subsidies will also be able to buy private plans in the exchanges, and those people will be limited as well, according to a spokeswoman for the governor. The reason, she said, is that the exchange itself will be paid for with government dollars, an argument that abortion rights advocates reject. “Since when are we telling people they cannot spend their own money on something private insurance companies offer?” said Mary Margaret Whipple, a Democratic state senator. “This goes farther than we’ve ever gone before.” Abortion opponents also point out that the federal law spells out that any state may elect to prohibit abortion coverage in plans in state exchanges if it chooses. Governor McDonnell, an abortion opponent, recently signed a bill that imposes heightened requirements on abortion clinics, which abortion rights advocates say would effectively shutter about two-thirds of the clinics in the state. His support of the anti-abortion measures comes as he is talked about as a potential Republican vice-presidential candidate, and political observers say he could be trying to burnish his image among conservatives. “He has gotten a reputation for being too nice a guy, too moderate,” said Larry J. Sabato, director of the Center for Politics at the University of Virginia. “This allows him to re-assert his social conservative credentials.”

Vital Signs: Patterns: Fewer Women Dying of Lung Cancer Posted: 06 Apr 2011 10:14 PM PDT Death rates from lung cancer have begun to decline for the first time among women in the United States, falling almost 1 percent a year from 2003 to 2007, according to a new report by cancer researchers. Related More Vital Signs Columns Health Guide: Lung Cancer For several decades, death rates had been increasing among women with lung cancer. The drop in death rates reflects declines in smoking that occurred among women many years ago, analysts said. “This is really good news,” said Betsy A. Kohler, executive director of the North American Association of Central Cancer Registries, which produces the annual national report on cancer with the American Cancer Society, the Centers for Disease Control and Prevention and the National Cancer Institute. “We expected this trend would happen in women because we saw the pattern in men, and women picked up smoking cigarettes a little later.” The researchers analyzed five-year trends because they are more accurate than year-to-year changes in mortality. Lung cancer death rates for women dropped by 0.9 percent a year on average from 2003 to 2007. The absolute death rate from lung cancer dropped to 39.98 per 100,000 women in 2007 from 41.24 per 100,000 women in 2003. The incidence of lung cancer among women has been dropping since 1998, but the disease is still the leading cause of cancer death in both men and women. This posting includes an audio/video/photo media file: Download Now

Baruch Blumberg, Who Discovered and Tackled Hepatitis B, Dies at 85 Posted: 06 Apr 2011 09:20 PM PDT Dr. Baruch S. Blumberg, the Nobel Prize-winning biochemist and medical anthropologist who discovered the hepatitis B virus, showed that it could cause liver cancer and then helped develop a powerful vaccine to fight it, saving millions of lives, died Tuesday in Moffett Field, Calif. He was 85 and lived in Philadelphia. His family said he died, apparently of a heart attack, shortly after giving a keynote speech at a NASA conference at the Ames Research Center in Moffett Field, which is in the San Francisco Bay area. Dr. Blumberg had long been associated with a NASA project to hunt for micro-organisms in space. Dr. Blumberg’s prize-winning virology and epidemiology work began in the 1960s at the Fox Chase Cancer Center in Philadelphia and took him and his colleagues on field trips around the world, from Japan to Africa. The work led to the discovery of the hepatitis B virus in 1967, the first test for hepatitis B in the blood supply and the development in 1969 of the hepatitis B vaccine — the first “cancer vaccine.” Dr. Irving Millman, a colleague at the research center, was its co-creator. Dr. Blumberg’s discoveries have been compared to those of Jonas Salk, the developer of the polio vaccine. He shared the Nobel Prize in Physiology or Medicine in 1976 with D. Carleton Gajdusek for their work on the origins and spread of infectious viral diseases. (Dr. Gajdusek had discovered the cause of the kuru, or “trembling disease,” prevalent in New Guinea.) Almost 20 years later, after decades of hepatitis B-related studies and a global search for medicinal plants to treat hepatic infections, Dr. Blumberg began what he called his second career. In 1999 he became the founding director of the National Aeronautics and Space Administration’s Astrobiology Institute. The institute’s mission was to oversee research teams in the development of life-detecting devices for planetary rovers and asteroid fly-bys, and to scrutinize life forms in “extreme” environments on Earth, like the ocean bottom and the geothermal cauldrons that produce geysers. He joined several expeditions himself. To these seemingly disparate endeavors — investigating disease-causing organisms and postulating alien or primordial life forms — Dr. Blumberg contributed a broadened understanding of the evolutionary phenomenon called polymorphism, in which a species can adapt to an environment through changes in appearances and functions. From his base in Philadelphia, Dr. Blumberg began investigating viruses with a study of yellow jaundice, so named because of the characteristic vivid yellowing of the eyes and skin. As early as 1940, medical researchers had determined that there were two different forms of virus-induced jaundice, one that is transmitted as an intestinal infection, and the other spread mainly by blood transfusions. Scientific field trips to pinpoint the agent responsible for blood-borne jaundice were conducted by Dr. Blumberg and his colleagues in the Philippines, India, Japan, Canada, Scandinavia, Australia and Africa. Ultimately it was blood serum from an infected Australian aborigine that yielded the so-called Australian antigen, a protein found on the surface of the hepatitis B virus. After he and Dr. Millman developed the hepatitis vaccine, they struggled to interest a pharmaceutical company to help develop and produce it. “Vaccines are not an attractive product for pharmaceutical companies in that they are often used once or only a few times and they ordinarily do not generate as much income as a medication for a chronic disease that must be used for many years,” Dr. Blumberg wrote in an autobiographical essay for the Nobel committee. Moreover, he said, the medical research community in the early 1970s remained skeptical about the claim that a virus had been identified and a vaccine developed. Ultimately he and Dr. Millman signed an agreement with Merck & Company, whose vaccine laboratories were near Philadelphia. Dr. Blumberg’s discoveries are credited with saving millions of patients from ever developing liver cancer. But in his scientific autobiography, “Hepatitis B: The Hunt for a Killer Virus” (Princeton University Press, 2002), he observed ruefully that hepatic disease was still killing 1.5 million people a year worldwide — despite the widespread availability of the vaccines he helped develop — and that 350 million were chronically infected. Still, he was hopeful. “Life — and death — are full of surprises,” he wrote, “and while it may be tempting fate to be too optimistic, it appears likely that within the next few decades this virus will be effectively controlled.” (There is still no vaccine for the blood-borne hepatitis C, one of the five known hepatitis viruses.) Dr. Blumberg’s traced his fascination with inherited variations in susceptibility to disease to the volunteer service he did during medical school at an isolated mining town in northern Surinam, where he delivered babies, performed clinical services and undertook the first malaria survey done in that region. He was particularly interested in the sugar plantation workers who had been imported from several continents. “Hindus from India, Javanese, Africans (including the Djukas, descendants of rebelled slaves who resided in autonomous kingdoms in the interior), Chinese, and a smattering of Jews descended from 17th century migrants to the country from Brazil, lived side by side,” Dr. Blumberg wrote in his Nobel essay. “Their responses to the many infectious agents in the environment were very different.” He wrote his first scientific paper based on these studies and would revisit the tropics repeatedly. “Nature operates in bold and dramatic manner in the tropics,” he wrote. By the late 1990s Dr. Blumberg was immersed in astrobiology, as NASA called the new science. Appointed by the NASA administrator, Dan Goldin, to lead the Astrobiology Institute, Dr. Blumberg and his team were asked to address three profound questions: How does life begin and evolve? Does life exist elsewhere in the universe? And what is life’s future on Earth and beyond? 1 2 Next Page » Daniel E. Slotnik contributed reporting.

W. H. Prusoff, Who Developed AIDS Drug, Is Dead at 90 Posted: 06 Apr 2011 09:20 PM PDT William H. Prusoff, a pharmacologist at the Yale School of Medicine who, with a colleague, developed an effective component in the first generation of drug cocktails used to treat AIDS, died on Sunday in New Haven. He was 90 and lived in Branford, Conn. Enlarge This Image George Ruhe for The New York Times William H. Prusoff worked at the Yale School of Medicine. The death was confirmed by his son, Alvin. Dr. Prusoff spent most of his long career studying molecular derivatives of thymidine, a building block of DNA. His work led him to develop two important antiviral drugs. In the early 1950s, he synthesized idoxuridine, a successful treatment for infant keratitis. The condition, an inflammation of the cornea caused by the herpes simplex virus, was the leading infectious cause of blindness. Idoxuridine disrupted the virus’s ability to reproduce. This was an important breakthrough. At the time, it was believed that antiviral agents powerful enough to be effective would be too toxic for human use and that those safe for use would be too weak to counteract a virus. Idoxuridine overturned medical dogma and, after winning approval by the Food and Drug Administration, became the first clinically used antiviral drug. For this reason, Dr. Prusoff is sometimes called the father of antiviral chemotherapy. In the mid-1980s, as the AIDS epidemic spread, Dr. Prusoff and a Yale colleague, Tai-shun Lin, began looking at thymidine derivatives that had been developed to treat cancer but discarded when they proved ineffective. One of these was stavudine, also known as d4T, a molecular cousin of the first AIDS drug, AZT. Both had been synthesized in the 1960s by Dr. Jerome P. Horwitz at the Michigan Cancer Foundation, now the Karmanos Cancer Institute, in Detroit. Dr. Prusoff and Dr. Lin resynthesized the molecule and found in laboratory tests that it short-circuited the viral enzyme in H.I.V., causing it to produce short, incomplete pieces of DNA rather than complete strands. Yale took out a patent in the doctors’ names and licensed it to Bristol-Myers Squibb for development. In 1992, it became the first drug to be tested under the F.D.A.’s parallel-track policy, which allowed patients with life-threatening illnesses to obtain drugs undergoing clinical trials. After F.D.A. approval, stavudine was brought to market in pill form in 1994 and sold under the brand name Zerit. It joined three other drugs, known as nucleoside analogs, approved for treating H.I.V.: zidovudine (AZT), didanosine (ddI) and zalcitabine (ddC). Eventually, these were joined by a new generation of drugs known as protease inhibitors. Because of its potential side effects, notably numbness, burning sensations and loss of fat in the feet, legs or hands, the drug is now used primarily in poor countries, where it is cheap and widely available. Stavudine earned tens of millions of dollars for Yale each year — more than the total amount for all its other licensed medicines combined. It also made millions for Dr. Prusoff, who became a vocal supporter of a campaign initiated by Doctors Without Borders to persuade Bristol-Meyers to lower the drug’s price in sub-Saharan Africa, where AIDS was rampant. In March 2001, the company announced that it was reducing the price of the drug in Africa to 15 cents for a daily dose, from $2.23, and removing barriers to the sale of generic equivalents there. “We weren’t doing this to make money,” Dr. Prusoff told the Yale School of Medicine Chronicle. “We were interested in developing a compound that would be a benefit to society.” William Herman Prusoff, known as Bill, was born on June 25, 1920, in Brooklyn. His parents, Jewish immigrants from Russia, ran a small grocery. He earned a degree in chemistry from the University of Miami in 1941. Rejected by the Army because of his poor vision, he spent World War II inspecting fuses at a munitions factory in Memphis and, as a health inspector, checking the water supply and the kitchens in Miami Beach hotels where pilots were billeted. Urged by his parents, he applied to medical school, without success. He later enjoyed recalling that Yale deemed him so unqualified that it refunded his application fee in a gesture of pity. Instead, he earned a doctorate in chemistry from Columbia in 1949 and then taught pharmacology in Cleveland at Western Reserve University (now Case Western Reserve) before joining the pharmacology department at Yale in 1953. Dr. Prusoff used some of his patent money to create the William H. Prusoff Foundation, which supported numerous programs, including the Yale Initiative for the Interdisciplinary Study of Anti-Semitism. He also endowed lectureships in virology and pharmacology at Yale and several scientific prizes. In addition to his son, Alvin, of Fairfield, Conn., he is survived by a daughter, Laura, of Ortahisar, Turkey, and three grandchildren.

Recipes for Health: Grapefruit Ice Posted: 07 Apr 2011 12:00 AM PDT Grapefruit translates beautifully into an icy sorbet. Be sure to allow this to soften in the refrigerator for 20 minutes before serving. Recipes for Health Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. See All Recipes for Health » Visit Recipes for Health on Facebook. Related Recipes for Health: Desserts for the Conscientious (April 4, 2011) Recipes for Health: Winter Strawberry Gelato (April 5, 2011) Recipes for Health: Caramelized Honey-Baked Pears (April 6, 2011) Recipes for Health: Pear and Red Wine Sorbet (April 8, 2011) 2/3 cup sugar, preferably organic fair-trade sugar 1 cup water Zest of 1 grapefruit 1 tablespoon fresh lemon juice 3 1/2 cups strained fresh grapefruit juice (4 large grapefruit) 1. Combine the sugar, water and grapefruit zest in a saucepan, and bring to a boil. Stir to dissolve the sugar. Reduce the heat, and simmer for 10 minutes until slightly thickened. Remove from the heat, and allow to cool. Strain. 2. Combine the syrup with the lemon juice and grapefruit juice. Chill a 1-quart container or six serving dishes. Freeze the mixture in an ice cream maker, following the manufacturer’s instructions. Transfer to the container or the serving dishes, and place in the freezer for at least two hours. Before serving, allow to soften in the refrigerator for 20 to 30 minutes. Yield: One quart, serving six. Advance preparation: The sorbet will keep, well covered, in the freezer for two weeks. Nutritional information per serving: 144 calories; 0 grams saturated fat; 0 grams polyunsaturated fat; 0 grams monounsaturated fat; 0 milligrams cholesterol; 36 grams carbohydrates; 0 grams dietary fiber; 3 milligrams sodium; 1 gram protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Well: Estrogen Lowers Breast Cancer and Heart Risk in Some Posted: 06 Apr 2011 07:47 AM PDT

Vital Signs: Risks: Focus on Heart Deaths in Student-Athletes Posted: 06 Apr 2011 10:03 PM PDT Recent sudden cardiac deaths among high school athletes — including the death in March of a 16-year-old Michigan basketball player who had just scored a game-winning shot — have renewed questions about how common the risk is and whether athletes should be screened more carefully. Related More Vital Signs Columns A new study, published last week in the journal Circulation, offers a partial answer, finding that there is one sudden cardiac death for every 43,770 National Collegiate Athletic Association student-athletes each year. Earlier estimates, which relied almost exclusively on news reports for information, had put the number as low as 1 in 300,000. The new study — which drew information from N.C.A.A. databases and insurance claims, as well as from news reports — examined sudden deaths from 2004 to 2008 among N.C.A.A. student-athletes ages 17 to 23. The study found that certain students were at higher risk than others, including black athletes and Division I basketball players. The incidence of sudden cardiac death among black athletes was one in 18,000, possibly because of a higher prevalence of hypertrophic cardiomyopathy, a leading cause of sudden cardiac death, in this population. Dr. Kimberly G. Harmon, a sports physician affiliated with the University of Washington in Seattle and the study’s lead author, said athletes could be screened with electrocardiograms, a relatively inexpensive test that can detect cardiac abnormalities. “Everyone else in the world does ECG screening as part of their sports screening,” she said.

Well: A Comedic TV Talent Turns the Tables on Oprah Posted: 05 Apr 2011 09:58 PM PDT

Economic Scene: Generational Divide Colors Debate Over Medicare’s Future Posted: 05 Apr 2011 11:32 PM PDT The Republican budget released on Tuesday is a daring one in many ways. Above all, it would replace the current Medicare with a system of private health insurance plans subsidized by the government. Whether you like or loathe that idea, it would undeniably reduce Medicare’s long-term funding gap — which is by far the biggest source of looming federal deficits. Enlarge This Image Joshua Roberts/Bloomberg News The Republican budget written by Representative Paul Ryan asks for a whole lot of sacrifice from everyone under the age of 55 and little from everyone 55 and over. Multimedia Graphic Reaping More in Benefits Than Paying in Taxes Related Economix: Estimating Medicare Taxes Versus Benefits (April 5, 2011) Related in Opinion Editorial: The Budget Battles: Republicans Maneuver Toward a Shutdown (April 6, 2011) Editorial: The Budget Battles: Prosperity for Whom? (April 6, 2011) Editorial: The Budget Battles: The Threat to Medicaid and Medicare (April 6, 2011) Room For Debate Can Private Insurers Fix Medicare? The Republican budget proposal aims to replace traditional Medicare with private health plans. Will this reduce costs? Yet there is at least one big way in which the plan isn’t daring at all. It asks for a whole lot of sacrifice from everyone under the age of 55 and little from everyone 55 and over. Representative Paul Ryan, the Wisconsin Republican who wrote the plan, calls the budget deficit an “existential threat” to the United States. Then he absolves more than one-third of all adults from responsibility in dealing with that threat. This decision doesn’t make him unique in Washington. There is nearly a bipartisan consensus that any cuts to Medicare and Social Security should spare the baby boomers and the elderly. And, certainly, retirees or people on the verge of retirement shouldn’t have their benefits changed radically. But the consensus, like Mr. Ryan’s plan, goes too far. The reason is partly political. Older people vote in larger numbers than younger adults. Children, of course, can’t vote at all. But beyond politics, Washington’s age bias depends on a basic misunderstanding of the budget — namely, that older people have already paid for their Medicare benefits. They haven’t. For most Americans, Medicare resembles a giant welfare program. They receive far more in government benefits than they ever pay in taxes and premiums. The gap for a typical household runs to several hundreds of thousands of dollars. The Ryan plan would let anyone who turns 65 before 2022 continue to be part of this hugely popular welfare program. In fact, Mr. Ryan would scrap the common-sense attempts to slow costs in last year’s health bill, like the baby steps to base Medicare coverage decisions more on medical evidence. If you’re 55 or older, you get the same old Medicare, with its same soaring budget. If you’re under 55, you are excluded. You will instead receive a government subsidy to buy private insurance, and the subsidy will probably not keep pace with future increases in health costs. Beside violating basic notions of fairness, the grandfather clause has the potential to slow economic growth. Many of today’s 55- and 60-year-olds are going to be on Medicare for a long time. If the program doesn’t change, they will run up trillions of dollars in medical bills. That money won’t be available for education, early child care, scientific research or high-tech infrastructure — all of which can lift growth. The United States already has a “particularly strong age bias” in its government spending, Julia B. Isaacs of the Brookings Institution noted in a recent analysis of affluent countries’ budgets. In the years ahead, spending on the elderly has the potential to rise higher still and to crowd out spending on the young. Eugene Steuerle, a former Treasury official in both Democratic and Republican administrations, says simply, “We have a budget for a declining nation.” Mr. Steuerle — along with his Urban Institute colleague Stephanie Rennane — has done some of the most careful work comparing Medicare taxes and benefits. They added up all the taxes people at different points on the income spectrum would pay over their working lives and then translated these amounts into a single sum, expressed in today’s dollars. Mr. Steuerle and Ms. Rennane likewise added up the value of Medicare benefits (net of premiums) that men and women could expect to receive. Their results show that no cohort of Americans, with the possible exception of the very affluent, pays enough Medicare taxes and premiums to cover their costs. The gap is growing over time, too. Two married 66-year-olds with roughly average earnings over their lives will end up paying about $110,000 in dedicated Medicare taxes through the payroll tax, including the portion their employers pay. They can expect to receive about $340,000 in benefits. Two average-earning 56-year-olds will pay about $140,000 and get back about $430,000 in benefits. Why? By law, Medicare taxes cover mainly hospital bills, not doctors’ bills or the cost of drugs. These costs instead must be covered by the general government revenue, but there isn’t enough of that revenue. Instead, the government is running deficits — which is to say, it’s borrowing money from individuals and foreign governments and promising that future taxpayers will pay it back. Who are these future taxpayers who will kindly cover Medicare’s shortfall? The same ones who, under the Ryan plan, won’t have Medicare for themselves. A fairer, more fiscally conservative plan would not postpone dealing with Medicare. It would leave in place the cost control measures in the health reform bill and go even further to reward the quality of care rather than the volume. Obviously, these steps would run some risk of restricting good treatments, too. But, remember, we’re facing “an existential threat.” We can’t limit ourselves to solutions without risks. Next, the federal government would raise taxes. As countries have grown richer over time, they have historically paid higher taxes — to cover the costs of a strong military, good schools, comfortable retirements and other luxuries that the free market doesn’t provide. Affluent Americans, in particular, can afford higher taxes. They have received far larger raises in recent decades than any other income group, and their tax rates have fallen far more. Yet Mr. Ryan would reduce them further. Some health economists believe that a combination of higher taxes and more Medicare cost controls can solve the problem. Mr. Ryan does not. And his skepticism is healthy. To him, the only way to reduce Medicare’s cost growth is to stop shielding people from the consequences of their decisions. If they want almost limitless medical treatments, they won’t be able to foist the bill on taxpayers, as they do now. They will instead have to buy a generous insurance plan, partly with their own money. The resulting market forces, Mr. Ryan argues, will eventually bring down costs and leave most people better off. He may well be right that a solution along these lines is ultimately where health care needs to go. But it would be a lot easier to trust in the merits of his plan if he weren’t so busy promising 75 million Americans that they will never have to be a part of it. E-mail: leonhardt@nytimes.com; twitter.com/DLeonhardt This posting includes an audio/video/photo media file: Download Now

Senate Passes Change to Health Law Posted: 05 Apr 2011 09:57 PM PDT WASHINGTON (AP) — Congress sent the White House its first rollback of the new health care law on Tuesday, a bipartisan repeal of a tax reporting requirement that was widely unpopular with businesses. Related Times Topic: Health Care Reform The Senate voted 87 to 12 to repeal a requirement that would have forced businesses to file tax forms for every vendor selling them more than $600 in goods each year, starting in 2012. The requirement was unrelated to health care, but it would have been used to generate revenue to pay for part of the law. President Obama supports the change, which was approved by the House in early March. Republicans hope the bill is the first of many measures that will ultimately result in the dismantling of the entire health care law. Democrats say it is part of inevitable revisions needed to improve the measure. The filing requirement was projected to raise nearly $25 billion over a decade by ensuring that vendors paid their taxes. Under the new bill, the money will be made up by changing repayment requirements under another part of the law that, starting in 2014, will provide tax credits to low- and middle-income families to help pay premiums.

Inquiry Into Payments by Device Maker Posted: 05 Apr 2011 09:13 PM PDT Nevada state officials have begun an investigation to determine if payments to cardiologists there by a little-known heart device company were legitimate consulting fees or inducements to the doctors for using its products. Enlarge This Image Isaac Brekken for The New York Times At University Medical Center of Southern Nevada, Biotronik devices were favored by doctors who had taken consulting fees. Gov. Brian Sandoval on Monday asked state health officials to look into whether the dealings between the doctors and a company called Biotronik had involved improper billing practices or patient safety issues, according to a spokeswoman, Mary-Sarah Kinner. The inquiry follows a report on Sunday in The New York Times that heart device specialists at a Las Vegas practice started using Biotronik implants in nearly all their patients in 2008 after company documents showed they became consultants to the device maker, getting up to $5,000 a month in fees. Last year, at one Las Vegas hospital where the cardiologists practiced, University Medical Center of Southern Nevada, 95 percent of the patients, or 250 of the 263 people who got a pacemaker or defibrillator, got a Biotronik device. Before becoming Biotronik consultants, those doctors, who belong to a practice called Nevada Heart and Vascular, apparently rarely, if ever, used its devices. Several experts on medical ethics said on Tuesday that the ties between the cardiologists, Biotronik and a distributor for the device maker called Western Medical raised both ethical and legal questions. “It is giving off a reeking aroma of conflict of interest,” said Arthur Caplan, a professor of bioethics and philosophy at the University of Pennsylvania in Philadelphia. Ms. Kinner, the spokeswoman for Governor Sandoval, said he had asked officials of several state agencies to review the situation. A formal report has yet to be issued though no irregularities were found in a review of the services for which the doctors had billed, Ms. Kinner said. The state’s Board of Medical Examiners, which licenses physicians, is also reviewing the issue, she added. Under federal law, anyone who gives or receives something of value to induce the use of a drug or a medical device paid for by a taxpayer-financed program like Medicare can face criminal or civil charges. In the case of the medical device industry, kickbacks to doctors have been disguised as consulting fees or payments for other services. Biotronik has confirmed that federal investigators were examining its sales and marketing practices, though a company lawyer has declined to elaborate, other than to say he understood the inquiry was civil in nature. He said the company paid reasonable consulting fees for legitimate services. Nationwide, Biotronik accounts for just over 5 percent of the market for heart implants, according to industry estimates. In a statement Monday, Dr. William H. Resh, the managing partner of Nevada Heart and Vascular, said his group had turned to Biotronik because its devices were cost-effective and less prone than those of competitors to recalls. “When you are dealing with a person’s heart, it is important not only to know that you are using a quality product, but also a product that you have a good familiarity with,” Dr. Resh said. Dr. Resh did not respond to written questions about why he and his partners, given his concerns about recalls, had once frequently used devices made by Guidant, a company that recalled tens of thousands of devices in 2005 and 2006. For example, in 2007, University Medical Center data shows, over 85 percent of those patients who got a heart device there got one marketed by Boston Scientific, a company which just a short time earlier had acquired the troubled implant business of Guidant. Dr. Resh and his associates had a contract with the facility to perform those implants. A spokeswoman for one Las Vegas-area health care facility that does not have a contract with Biotronik, St. Rose Dominican Hospitals, said in response to a reporter’s inquiry that Dr. Resh’s group did do implants there using heart devices made by either Boston Scientific or another manufacturer, Medtronic. But that spokeswoman, Jennifer McDonnell, said that the volume of implants performed by his group had declined since 2008, the time when those cardiologists became Biotronik consultants. In a statement, University Medical Center said that Biotronik devices had performed very well and that patients had benefited since the facility adopted their use. The hospital first started using the devices in mid-2008, when it changed its contracting policies. The Times article focused on ties between a device industry sales official in Las Vegas named Caesar Fonte and Dr. Resh and his colleagues. Prior to mid-2008, when Mr. Fonte was at Guidant and later Boston Scientific after it acquired Guidant, he worked with the Las Vegas cardiologists who were then paid consultants to those companies. At that time, they largely used the devices Mr. Fonte represented. But in mid-2008, Mr. Fonte quit Boston Scientific to start his own company called Western Medical that distributed Biotronik implants and other medical products. Virtually overnight, Dr. Resh and his partners became Biotronik consultants and shifted much of their business to it. Dr. Resh, his colleagues and Biotronik declined to disclose how much the physicians had received in payments since mid-2008. For its part, Western Medical received a commission fee of 25 percent from Biotronik on each sale; in one month alone, the company sold $1 million worth of devices in Las Vegas. Mr. Fonte declined earlier to be interviewed. Dr. Resh did not respond Tuesday to an e-mail asking if he and Mr. Fonte had entered into any business arrangements or investments together. Speaking generally, Ann S. Brandt, an executive with HealthCare Appraisers, a firm based in Florida that evaluates physician consulting agreements, said the types of events in the Las Vegas case failed what she called the “sniff test.” “When you see a whole lot of people making a lot of money, it has to be looked at,” said Ms. Brandt.

U.S. Sees Array of New Threats at Japan’s Nuclear Plant Posted: 06 Apr 2011 11:18 AM PDT United States government engineers sent to help with the crisis in Japan are warning that the troubled nuclear plant there is facing a wide array of fresh threats that could persist indefinitely, and that in some cases are expected to increase as a result of the very measures being taken to keep the plant stable, according to a confidential assessment prepared by the Nuclear Regulatory Commission. Enlarge This Image Reuters Workers at the Fukushima Daiichi nuclear station are dealing with new challenges. Multimedia Interactive Feature Japan Earthquake and Tsunami Multimedia Related Company Says Radioactive Water Leak at Japan Plant Is Plugged (April 6, 2011) Crisis Saddles Village With Unwanted Notoriety (April 6, 2011) Radiation Errors Erode Confidence in Power Company (April 6, 2011) Among the new threats that were cited in the assessment, dated March 26, are the mounting stresses placed on the containment structures as they fill with radioactive cooling water, making them more vulnerable to rupture in one of the aftershocks rattling the site after the earthquake and tsunami of March 11. The document also cites the possibility of explosions inside the containment structures due to the release of hydrogen and oxygen from seawater pumped into the reactors, and offers new details on how semimolten fuel rods and salt buildup are impeding the flow of fresh water meant to cool the nuclear cores. In recent days, workers have grappled with several side effects of the emergency measures taken to keep nuclear fuel at the plant from overheating, including leaks of radioactive water at the site and radiation burns to workers who step into the water. The assessment, as well as interviews with officials familiar with it, points to a new panoply of complex challenges that water creates for the safety of workers and the recovery and long-term stability of the reactors. While the assessment does not speculate on the likelihood of new explosions or damage from an aftershock, either could lead to a breach of the containment structures in one or more of the crippled reactors, the last barriers that prevent a much more serious release of radiation from the nuclear core. If the fuel continues to heat and melt because of ineffective cooling, some nuclear experts say, that could also leave a radioactive mass that could stay molten for an extended period. The document, which was obtained by The New York Times, provides a more detailed technical assessment than Japanese officials have provided of the conundrum facing the Japanese as they struggle to prevent more fuel from melting at the Fukushima Daiichi plant. But it appears to rely largely on data shared with American experts by the Japanese. Among other problems, the document raises new questions about whether pouring water on nuclear fuel in the absence of functioning cooling systems can be sustained indefinitely. Experts have said the Japanese need to continue to keep the fuel cool for many months until the plant can be stabilized, but there is growing awareness that the risks of pumping water on the fuel present a whole new category of challenges that the nuclear industry is only beginning to comprehend. The document also suggests that fragments or particles of nuclear fuel from spent fuel pools above the reactors were blown “up to one mile from the units,” and that pieces of highly radioactive material fell between two units and had to be “bulldozed over,” presumably to protect workers at the site. The ejection of nuclear material, which may have occurred during one of the earlier hydrogen explosions, may indicate more extensive damage to the extremely radioactive pools than previously disclosed. David A. Lochbaum, a nuclear engineer who worked on the kinds of General Electric reactors used in Japan and now directs the nuclear safety project at the Union of Concerned Scientists, said that the welter of problems revealed in the document at three separate reactors made a successful outcome even more uncertain. “I thought they were, not out of the woods, but at least at the edge of the woods,” said Mr. Lochbaum, who was not involved in preparing the document. “This paints a very different picture, and suggests that things are a lot worse. They could still have more damage in a big way if some of these things don’t work out for them.” The steps recommended by the nuclear commission include injecting nitrogen, an inert gas, into the containment structures in an attempt to purge them of hydrogen and oxygen, which could combine to produce explosions. On Wednesday, the Tokyo Electric Power Company, which owns the plant, said it was preparing to take such a step and to inject nitrogen into one of the reactor containment vessels. The document also recommends that engineers continue adding boron to cooling water to help prevent the cores from restarting the nuclear reaction, a process known as criticality. Even so, the engineers who prepared the document do not believe that a resumption of criticality is an immediate likelihood, Neil Wilmshurst, vice president of the nuclear sector at the Electric Power Research Institute, said when contacted about the document. “I have seen no data to suggest that there is criticality ongoing,” said Mr. Wilmshurst, who was involved in the assessment. The document was prepared for the commission’s Reactor Safety Team, which is assisting the Japanese government and the Tokyo Electric Power Company. It says it is based on the “most recent available data” from numerous Japanese and American organizations, including the electric power company, the Japan Atomic Industrial Forum, the United States Department of Energy, General Electric and the Electric Power Research Institute, an independent, nonprofit group. 1 2 Next Page » Henry Fountain contributed reporting from New York, and Matthew L. Wald from Washington.

Radiation Is Everywhere, but How to Rate Harm? Posted: 04 Apr 2011 07:40 PM PDT Since the first reports last month of damage to nuclear reactors at the Fukushima Daiichi power plant, the lingering question has been whether drifting plumes of radioactive elements from the plant will harm people in Japan or other parts of the world. For many people, the biggest fear is cancer. Related Measuring Radioactive Elements and Their Effects on Human Cells (April 5, 2011) Certain levels of radiation exposure are known to increase the risk of cancer, but scientists disagree about the effects of very low doses of the sort that may have occurred so far in Japan. Some researchers say it is reasonable to use data from high doses to calculate the risk of smaller and smaller doses. They argue that any exposure to radiation raises the risk of cancer, though probably by only a small amount in the case of small doses. But others say that estimating risk for doses near zero is nonsensical, and some believe there is a threshold dose, or limit below which there is no risk from exposure. Dr. John Boice, for example, a professor of medicine at Vanderbilt University who studies radiation effects in humans, warns that risk calculations based on tiny doses are themselves risky. He argues that there is little data on doses below about 10 rem, but that some risk estimates nonetheless go down to a tenth of a rem or less. (He is also the scientific director of the International Epidemiology Institute in Rockville, Md., a private group that studies radiation with grants from government and industry.) “I can take a low dose, multiply it by a million people and estimate a risk,” Dr. Boice said, but he said professional groups like the Health Physics Society discourage it. “We say, don’t do that. Don’t multiply a tiny dose by millions and say there will be thousands of deaths. It’s inappropriate, misleading and alarmist. You’ve gone orders of magnitude below where we have proof of any effects at all.” But Dr. David Brenner, director of the Center for Radiological Research at Columbia University, is among those who believe there is no threshold. Radiation damages DNA, he says, and just one damaged cell can become the seed of a cancer, though it takes decades to develop. He is studying the possibility that in terms of causing cancer, low doses of radiation might be more dangerous than calculations based on high doses would predict. Current estimates by government agencies for risks from low doses rely on extrapolation from higher doses. In the United States, most government agencies use a unit called the rem to measure radiation doses. (Europe and Asia use the unit millisievert, which equals 0.1 rem.) According to the Environmental Protection Agency, people receive 0.3 rem per year from natural background radiation. If 10,000 people are each exposed to 1 rem, in small doses over a lifetime (above the natural background exposure), according to the agency, the radiation will cause five or six excess deaths from cancer. In a group that size, about 2,000 would normally die from cancers not caused by radiation, so the extra dose would raise the total to 2,005 or 2,006. So far only minute amounts of radioactivity from the Japanese reactors have been detected in the United States, in milk on both the East and West Coasts, and in rainfall in Massachusetts. American officials say instruments can detect levels so vanishingly small — far below the natural background level of radiation — that they pose no threat. In parts of Japan, radioactivity has been detected at various times in milk, meat, vegetables and tap water, on the ground and in the sea around the power plant. Levels in tap water in certain areas have sometimes been high enough for authorities to tell people to drink bottled water, and the Japanese government has banned the shipment of milk and produce from some prefectures. Milk from those regions has been found to contain radioactive iodine, which accumulates in the thyroid gland and can cause cancer, especially in children. Levels in the milk have exceeded those considered a cause for concern in the United States. A quarter mile from the Fukushima plant (residents have been evacuated from a 12-mile zone around the plant) radiation levels of 0.1 rem per hour have been measured, and researchers agree that four days of such exposure would increase a person’s risk of cancer. But some would argue that an even shorter exposure would raise the risk. Many of today’s risk estimates are based on a study of 200,000 people who survived the atomic bombing of Hiroshima and Nagasaki in August 1945. More than 40 percent are still alive. The research has been going on for 63 years, and an article reviewing its findings was published in March in the journal Disaster Medicine and Public Health Preparedness. So far, it is uncertain how relevant the results from bomb survivors are to members of the public in Japan who may have been exposed to radiation from the reactors. “One concern is trying to find out what dose these people actually received” from the Fukushima reactors, said Dr. Evan B. Douple, the first author of the article on the bomb survivors and the associate chief of research at the Radiation Effects Research Foundation in Hiroshima, which studies the survivors and is paid for by the governments of Japan and the United States. It is the successor to the Atomic Bomb Casualty Commission, which was created in 1947. Dr. Douple said the method of exposure was also different: The bomb survivors received their entire doses all at once to the full body, but exposure from the reactors may be gradual. 1 2 Next Page »

Patient Voices: Obscure, and Often Devastating Posted: 05 Apr 2011 08:23 AM PDT It is classified as a rare disease, but the chronic condition called Charcot-Marie-Tooth is one of the most common inherited nerve-related disorders, with an estimated 150,000 patients in the United States. It can be devastating to patients and their families, with crippling effects on balance and the ability to walk and grasp objects. Nor does it help that few people have heard of it, unless they are directly affected. Well Share your thoughts on this column at the Well blog. Go to Well » Multimedia Interactive Feature Patient Voices: Charcot-Marie-Tooth Disease Related Health Guide: Charcot-Marie-Tooth Disease Enlarge This Image Ryan Collerd for The New York Times Bernadette Scarduzio Enlarge This Image Michael Nagle for The New York Times Nicholas Zappola “It’s like the hidden secret,” said Allison Moore, chief executive of the Hereditary Neuropathy Foundation, who has the disease. “And when you mention, ‘I have C.M.T.,’ people look at you like you have three heads.” The disease — named for Jean-Martin Charcot, Pierre Marie and Howard Henry Tooth, the researchers who first described it in 1886 — is actually a group of neurodegenerative conditions that gradually degrade the nerves in the feet, legs, arms and hands, usually starting in childhood. There is no medical treatment, though orthopedic braces and corrective surgery can help. On nytimes.com/health, six patients describe life with C.M.T. Here are three.    Bernadette Scarduzio, 31 Drexel Hill, Pa. To have a disease that’s not well known is scary, and you feel like you’re not a part of the world. I’ve told people that I have multiple sclerosis before, because I know it’s like M.S., and I felt stupid saying I have this disease that no knows of. I felt weird. I want to be the face for this disease, and I want everyone to know that’s what I have. The people that are hiding, I need them to come out and say, ‘Yes, I have this disease.’ I know the name is silly, and it’s a family disease, and it sucks, but that’s the only way were going to get a cure for C.M.T.   Joseph Torello, 29 Queens As an actor with C.M.T., the most nerve-racking part of the audition is walking to the center of the room. It’s not the singing; it’s not the dance callback; it’s not the reading; it’s that walk. Everything is based on looks, and that’s why it’s so nerve-racking and so easy to get into your head when you have something like this. It’s hard enough to get a job, but to have one more hurdle in your way of that job is tough.   Nicholas Zappola, 18 Sag Harbor, N.Y. At first I was nervous and scared because you’re diagnosed with a disease that you have no idea about, but I knew I wasn’t alone, and I knew that I could talk to my family members that have it. I walk with a limp. I am in pain constantly, but I don’t let it get to me. You do suffer, but if you strengthen yourself, you can overcome just about anything. I feel like a stronger-hearted person than most of my friends because I have the capability of going through all this  —  keeping a strong mind and helping other people out  — and it makes me feel good.

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Overstimulated (1 Letter) Posted: 04 Apr 2011 08:00 PM PDT Overstimulated To the Editor: Re “A Century Later, Jury’s Still Out on Caffeine Limits” (March 29): The real problem isn’t so much the moderate amount of caffeine in popular energy drinks; rather, it’s the ubiquity of caffeinated products on the market today. We need to do a better job educating the public to all the sources of caffeine within arm’s reach. And if you’re a New Yorker who prefers egg creams to soft drinks, know that chocolate contains a sister compound (theobromine). Go with the vanilla if you’re watching your caffeine intake. Mark A. Maddaloni Closter, N.J.

Crisis Saddles Village With Unwanted Notoriety Posted: 05 Apr 2011 10:40 PM PDT IITATE, Japan — The mayor sprang into action the moment he heard that scientists from the International Atomic Energy Agency were in the village hall’s parking lot. He rushed outside to confront the group, three Europeans and a Japanese, who wore surgical masks and cloth booties as they waved around a Geiger counter. Enlarge This Image Ko Sasaki for The New York Times Mayor Norio Kanno of Iidate, Japan, confronting a scientist seeking to perform tests for the International Atomic Energy Agency. Related Company Says Radioactive Water Leak at Japan Plant Is Plugged (April 6, 2011) Radiation Errors Erode Confidence in Power Company (April 6, 2011) Times Topic: Japan â€" Earthquake, Tsunami and Nuclear Crisis (2011) The New York Times Residents of Iidate blame winds and geology for the radiation's path. “Who gave you permission to come here?” the mayor, Norio Kanno, yelled at the four, chasing them into a van with the markings of the atomic energy agency, or I.A.E.A., the Vienna-based nuclear watchdog. “You are causing trouble for us!” Such public confrontations are rare in rural northern Japan, which has borne last month’s deadly earthquake, tsunami and nuclear crisis with stoic reserve. But fear and frustration are on the rise in this small farming community, which has gained unwanted notoriety as Japan’s radiation village. Iitate (pronounced EE-tah-tay) has felt itself under siege since the damaged Fukushima Daiichi Nuclear Power Station showered the village with far higher levels of radiation than neighboring communities. Although Iitate’s inland location helped it escape the earthquake and tsunami with little damage, villagers blame an unfortunate combination of winds and the shapes of the mountains for channeling radioactive fallout from the plant, 25 miles to the southeast. According to the village’s own measurements, the amount of airborne radiation was 6.75 microsieverts on Sunday, down from the levels of more than 10 two weeks ago, but still more than 100 times normal radiation levels, the village said. The Japanese government says that is not high enough to pose a health risk. But on Monday a Japanese university team advised all pregnant women and young children to leave the village. Since the nuclear crisis began, about half of Iitate’s 6,200 residents have fled of their own accord, though a few have returned to their homes as the plant has appeared to avoid a full-scale meltdown. Those who remained say a lack of clear guidance from the national government, and the sometimes contradictory assessments of the danger levels by outside experts like the atomic energy agency have left them confused and scared about the fate of their village. “If our soil has been contaminated, then agriculture here is dead. Iitate will become one big abandoned field,” said Kenichi Hasegawa, who like many farmers in this dairy-producing region lives in a wooden, tile-roofed farmhouse overlooking long sheds filled with cows. Mr. Hasegawa, 58, said radiation worries had already forced him to throw away 11 tons of milk, worth about $12,000, by pouring it into a hole he dug in a field. He said if the nuclear crisis continued, as many experts predict it will, he would be bankrupted in two or three months. Yet he said he was determined to stay on this 62-acre farm, nestled in a gently winding valley between rocky hills. He said fears of radiation had prompted him to send many in his family, including his 2-year-old granddaughter, to the relative safety of suburban Tokyo. He cast his decision to stay as not just devotion to the land where he grew up and a reluctance to abandon his cows, but also an act of defiance against the powerful government and corporate elite, whose hubris he blames for the crisis. “The country, the prefecture, Tokyo Electric — for years, they all told us that the nuclear plants were ‘Safe, safe, safe,’ ” he said, angrily. “I will stay here until the Self-Defense Forces drag me away by my arm,” he added, referring to Japan’s military. In fact soldiers are stationed nearby, just in case Iitate must be evacuated, village officials say. That appeared to be a real possibility just a few days ago, when the International Atomic Energy Agency announced that Iitate’s levels of radioactive iodine had exceeded one of its criteria for evacuation. But then Iitate seemed to get a reprieve over the weekend, when the agency said radiation had fallen below evacuation levels. Yet instead of relief, the apparent reversal stirred outrage. Mayor Kanno explained the parking lot clash by saying that he was fed up with contradictory information about the radiation risks. He said he had also harangued a delegation from Tokyo Electric, the utility that runs the stricken plant, when it visited several days ago to apologize. 1 2 Next Page »

News Analysis: Drugs’ Cost and Safety Fuel a Fight Posted: 04 Apr 2011 08:10 PM PDT After weeks of controversy, federal health officials announced last week that they would not stop pharmacies from making a cheaper alternative to a costly drug given to prevent premature birth. And separately, they investigated the deaths of nine Alabama hospital patients who received a nutritional supplement contaminated with bacteria. The two events seemed unrelated, but both revolved around a century-old struggle between pharmacists and the government over who is best equipped to safeguard the nation’s drug supply. And both raise questions about what price the country is willing to pay for that protection. It is the drug industry equivalent of the battle between food trucks and restaurants. The Alabama supplement was made by a so-called compounding pharmacy, a company that makes medicinal concoctions that are not otherwise available, like a liquid form of a drug sold only as a pill. But while the compounds are supposed to be made specially for individuals, some compounding pharmacies operate in a legal gray area, making large batches of medicines and selling them widely. Even though many patients over the years have died after taking these medicines, the F.D.A. does not subject compounding pharmacies to the strict controls that are routine for drug manufacturers. The battle over the pregnancy drug, 17P, goes back at least to 2003, when demand soared after a landmark study confirmed its effectiveness in preventing premature births. First approved by the Food and Drug Administration in 1956, it was manufactured by Bristol-Myers Squibb until 2000; now the only makers are compounding pharmacies, which charge $10 to $20 per injection — $200 to $400 for the drug’s 20-week course. There is no evidence that present supplies of 17P are unsafe, but the F.D.A. is always eager for crucial injectable medicines to be made under consistent and verifiable controls. Applying for manufacturing approval can be expensive, and companies generally go through it only if they can be assured of a high price and exclusive rights. Since it was decades old, 17P had no patent protection. But a law called the Orphan Drug Act does provide seven years of exclusive sales rights to manufacturers who win F.D.A. approval for drugs that affect fewer than 200,000 people. On Feb. 3, the F.D.A. approved an application from KV Pharmaceutical, a specialty-drug manufacturer based in St. Louis, and gave the company its exclusive orphan license. KV named the drug Makena. The March of Dimes, which has long been dedicated to preventing premature births (and has received more than $1 million in donations from KV and its partners), cheered the announcement. Then KV announced that the price for Makena would be $1,500 per injection, or $30,000 for an entire course. And the company sent letters to compounding pharmacies warning that they could run afoul of the F.D.A. if they continued to sell competing versions. Last week, in the face of protests from outraged obstetricians, women’s advocates and lawmakers, the agency issued a statement asserting that KV’s letters were incorrect and that “at this time and under this unique situation, F.D.A. does not intend to take enforcement action.” On Friday, KV announced that it would slash its price for Makena, to $690 per dose. It defended the price by pointing out that the F.D.A. had insisted it conduct a long and expensive clinical trial. But the controversy did not end. “This company took advantage of the system,” said Dr. Alan Fleischman, medical director for the March of Dimes. Mary Dunkle, a spokeswoman for the National Organization for Rare Disorders, said the Makena controversy should not be “used to undermine the Orphan Drug Act, which we consider one of the most important pieces of legislation ever enacted.” Dr. Janet Woodcock, director of the F.D.A.’s center for drug evaluation and research, said the incentives built into the legislation were crucial for its success. The F.D.A. is still eager for KV to complete its confirmatory clinical trial. “There is a price that society has to pay for having a quality drugs,” she said. “But that price should be reasonable,” she said.

G.O.P. Blueprint Would Remake Health Policy Posted: 05 Apr 2011 10:47 AM PDT WASHINGTON — The proposal to be unveiled by House Republicans on Tuesday to rein in the long-term costs of Medicaid and Medicare represents a fundamental rethinking of how the two programs work, an ambitious effort by conservatives to address the nation’s fiscal challenges, and a huge political risk. Related Obama Invites Republicans to Meet on Budget (April 5, 2011) Related in Opinion David Brooks: Moment of Truth (April 5, 2011) Room For Debate Can Private Insurers Fix Medicare? The Republican budget proposal aims to replace traditional Medicare with private health plans. Will this reduce costs? House Republican aides said the budget blueprint to be issued by the chairman of the Budget Committee, Representative Paul D. Ryan of Wisconsin, would slice more than $5 trillion from projected federal spending in the coming decade. Health care accounts for much of the savings. But while saving large sums for the federal government, the proposals on Medicaid and Medicare could shift some costs to beneficiaries and to the states. Under the proposal, Medicaid would be transformed into a block grant, with a lump sum of federal money given to the states to care for low-income people. States would be given more discretion over use of the money than they have under the current federal-state partnership. For future Medicare beneficiaries — people now under 55 — Mr. Ryan’s proposal calls for the federal government to contribute a specified amount of money toward the premium for private health coverage. Under the traditional Medicare program, the government reimburses doctors and hospitals directly. Although many House Republicans see a need to revamp Social Security, too, they are not expected to press this week for comprehensive or specific changes in that program. Democrats signaled that they would fight the health proposals, and the clash could well become a defining issue for both parties in the 2012 elections. Republicans say the health care proposals would help the federal government predict and control its costs under Medicaid and Medicare, which insure more than 100 million people and account for more than one-fifth of the federal budget. But if, as many economists predict, health costs continue to rise at a rapid clip, beneficiaries of these programs would be at risk for more of the costs. Mr. Ryan said his Medicare proposal was similar to one he advanced in November with Alice M. Rivlin, a budget director in the Clinton administration. Analyzing that plan, the Congressional Budget Office said, “Federal payments would tend to grow more slowly under the proposal than projected costs per enrollee under current law.” As a result, the budget office said, “enrollees’ spending for health care — and the uncertainty surrounding that spending — would increase.” Medicaid and Medicare are now open-ended entitlements. Anyone who meets the eligibility criteria is entitled to benefits defined in detail by federal law. The federal government and the states must pay the additional cost if more people become eligible for Medicaid, as happened in the recent recession. Likewise, Medicare bears the cost if doctors perform more numerous, more complex and expensive tests and procedures. Some of those additional costs are passed on to beneficiaries in the form of higher premiums. Republicans say they are taking the initiative on Medicaid and Medicare because President Obama has done nothing to put the programs on a solid fiscal footing. In his 2012 budget, Mr. Obama did not propose significant savings in Medicaid or Medicare, even though he and many fiscal experts say the programs are unsustainable in their current form. Mr. Ryan and fellow House Republicans are wading into tricky waters, where many other politicians have run aground. But with the nation’s fiscal problems looming larger, Republicans say the politics of the issue have shifted. They expect to receive credit from the public for trying to hold down the deficit and the debt. “We have a moral obligation to the country to do this,” Mr. Ryan said in an interview last week. Representative Jan Schakowsky, a Democrat and a former executive director of the Illinois State Council of Senior Citizens, said she was incensed by such claims. “Mr. Ryan and the Republicans are declaring war on entitlements — and war on the elderly and the poor,” Ms. Schakowsky said. “Beneficiaries will end up paying more.” About half of Medicaid recipients are children. Nearly two-thirds of the money spent on Medicaid benefits is for low-income people who are 65 and older or disabled. The government shutdown in 1995-96 stemmed, in part, from a conflict between President Bill Clinton and Congressional Republicans over what he described as “devastating cuts” in Medicaid and Medicare. In his veto message in December 1995, Mr. Clinton listed 82 “objectionable provisions” of the Republicans’ budget bill. He complained that it “converts Medicaid into a block grant with drastically less spending.” The Congressional Budget Office recently estimated that a Medicaid block grant, of the type proposed by Mr. Ryan and Ms. Rivlin, could save $180 billion over 10 years. House Republicans could save an additional $434 billion by eliminating the expansion in Medicaid eligibility scheduled to take place in 2014 under the new health care law. Mr. Ryan said he was not cutting Medicaid and Medicare, but rather slowing their growth rate. In addition, he insists he is not trying to convert Medicare to a voucher program because the money would be paid to insurance companies and health plans, not directly to beneficiaries. If health costs for a group of patients exceeded the federal payment in a given year, the insurer would have to absorb the cost. Finally, Mr. Ryan says his proposal is equitable because Medicare would pay less on behalf of higher-income beneficiaries, and they would pay more of the cost of their health coverage. But high-income Medicare beneficiaries already pay higher premiums, with an annual surcharge of more than $3,800 in premiums for some of the most affluent ones this year. What Mr. Ryan and his committee plan to do this week is to approve a budget resolution, setting goals for spending and revenues. If approved by the House and the Senate in the same form, such a resolution would bind Congress in its deliberations, but it would not be presented to the president and would not become law. There is almost no chance the Democratic-controlled Senate would adopt a resolution along the lines Mr. Ryan is proposing, although his counterpart in the Senate, Kent Conrad, Democrat of North Dakota, the chairman of the Senate Budget Committee, is working on a bipartisan plan to address entitlement spending as part of a broader package to reduce the budget deficit. The budget resolution typically assumes changes in federal programs like Medicaid and Medicare. But those assumptions do not bind the House committees with power over those programs, which could choose to save the same amounts in other ways.

Mandi Schwartz, Athlete at Center of Marrow Drive, Dies at 23 Posted: 04 Apr 2011 11:00 PM PDT Mandi Schwartz, the Yale hockey player whose struggle with leukemia inspired thousands of people to volunteer to be bone marrow donors, died Sunday in Regina, Saskatchewan. She was 23. Enlarge This Image Sam Rubin/Yale University, via Bloomberg News Mandi Schwartz in 2010. Related At Yale, a Fight to Help a Teammate Off the Ice (June 13, 2010) If it happens on ice and it involves hitting and scoring, The Times's Slap Shot blog is on it. Go to the Slap Shot Blog The university confirmed her death. Little more than two years ago, Schwartz was a stalwart on the Yale women’s hockey team, earning ice time in 73 straight games as a forward. But in the fall of 2008, during her junior year, her teammates noticed that the usually hard-working Schwartz seemed to be chronically tired and struggling to keep pace on the ice. Schwartz learned she had leukemia that December and left the team to receive treatment. Last January, with her cancer in remission, she returned to Yale and started practicing again with her teammates. “The hope of coming back kept me going,” Schwartz told The Yale Daily News at the time. “I knew I could fight through it, and everyone around me was telling me that I could do it, so I didn’t really have a choice to think otherwise.” But last April, she learned that her cancer had returned, prompting her teammates and friends to mount a widely publicized worldwide search for a bone marrow donor. No perfect match for Schwartz was found, but donors for at least five other people were discovered. The efforts were not without obstacles. In July, Yale cut ties with the man who had been spearheading the search, Tedd Collins IV. Collins founded two charities to help leukemia patients after his daughter, a Yale medical student, died of the disease. The university’s decision came after The New York Times reported that Collins was the subject of a federal fraud investigation, and Connecticut’s attorney general started an inquiry into his charities. In September, at a hospital in Seattle, Schwartz received what her doctors hoped would be a life-saving stem-cell transplant. The procedure used umbilical cord blood, an alternative when a perfect bone marrow donor match cannot be located. In December, with her cancer in remission, Schwartz returned to the ice for the first time since her transplant. But a few days later, a biopsy showed that her cancer had returned, and she stopped aggressive treatment shortly after. Mandi Jocelyn Schwartz was born Feb. 3, 1988, in Yorkton, Saskatchewan, the daughter of Rick and Carol Schwartz. Before coming to Yale, she was the captain of the Athol Murray College of Notre Dame hockey team in Wilcox, Saskatchewan. Her brother Jaden, a freshman forward for Colorado College, was a first-round draft pick of the St. Louis Blues last year. In addition to him and her parents, Schwartz is survived by another brother, Rylan, a sophomore forward for Colorado College.

Vital Signs: Patterns: Long Hours May Add to Heart Trouble Posted: 04 Apr 2011 09:49 PM PDT When assessing a patient’s risk for heart disease, doctors take into account such factors as age, cholesterol and smoking status. A new study suggests an additional measure: long working hours. Related Health Guide: Heart Attack More Vital Signs Columns People who worked 11 hours or more per day were far more likely to develop heart trouble over a 12-year period, compared with similar subjects who worked seven to eight hours a day, the new study found. It was published Monday in Annals of Internal Medicine. In the early 1990s, British researchers examined 7,095 adults aged 39 to 62, including 2,109 women, and used the information to score each subject’s risk for coronary heart disease. About 10 percent reported long workdays. Over 12.3 years of follow-up on average, 29 participants died of heart disease and 163 suffered nonfatal heart attacks. Those who had reported working 10 or more hours a day were not at significantly greater risk than those who had worked less. But those subjects who had been working 11 or more hours a day were 66 percent more likely to have a heart attack or to die of one, the researchers found. Mika Kivimaki, the paper’s lead author and a professor of social epidemiology at University College London, said it was not clear whether long working days were causing the increased risk or were simply a marker that could be used to predict risk. But it is possible, he said, “the chronic experience of stress often associated with working long hours adversely affects metabolic processes,” or leads to depression and sleep problems.

Recipes for Health: Pear and Red Wine Sorbet Posted: 06 Apr 2011 10:53 AM PDT This has a beguiling flavor and a wonderful ruby color. You’ll simmer away most of the alcohol in the red wine, but the phytonutrients in the red pigments will still be present. Recipes for Health Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. See All Recipes for Health » Visit Recipes for Health on Facebook. Related Recipes for Health: Desserts for the Conscientious (April 4, 2011) Recipes for Health: Winter Strawberry Gelato (April 5, 2011) Recipes for Health: Caramelized Honey-Baked Pears (April 6, 2011) Recipes for Health: Grapefruit Ice (April 7, 2011) 2 1/2 pounds ripe pears (4 medium to large pears, like Bartlett pears) 1/2 cup sugar, preferably organic fair-trade 1 1/2 cups red wine 1 1/2 cups water 1 2- or 3-inch cinnamon stick 1/2 teaspoon vanilla extract Pinch of freshly ground black pepper 2 tablespoons fresh lemon juice 1. Peel, core and quarter the pears. Place them in a medium saucepan with the sugar, red wine, water, cinnamon stick and vanilla extract. Bring to a boil, reduce the heat and simmer, uncovered, until the pears are soft and translucent. This will take 15 to 20 minutes if the pears are ripe and soft to begin with, or about 30 minutes if they’re somewhat hard. Add the pepper. 2. Using tongs, remove the pears to a bowl. Remove the cinnamon stick from the poaching liquid, and discard. Turn up the heat, and reduce until the mixture has the consistency of a thin syrup. (This step may be unnecessary, depending on how long you cooked the pears and how juicy they were.) 3. Place the pears, in batches, in a blender, or place all of them in a food processor fitted with the steel blade. Purée until smooth. Slowly add the poaching liquid and the lemon juice, and blend together. Transfer to a bowl, and chill. Meanwhile, place a 1-quart container in the freezer. 4. Freeze in an ice cream maker following the manufacturer’s instructions. Transfer to the chilled container, and freeze for at least two hours before serving. If frozen solid, allow to soften in the refrigerator for 15 to 30 minutes. Yield: One quart, serving six. Advance preparation: This will keep for a couple of weeks in the freezer. Nutritional information per serving: 218 calories; 0 grams saturated fat; 0 grams polyunsaturated fat; 0 grams monounsaturated fat; 0 milligrams cholesterol; 46 grams carbohydrates; 5 grams dietary fiber; 6 milligrams sodium; 1 gram protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Recipes for Health: Caramelized Honey-Baked Pears Posted: 05 Apr 2011 11:50 PM PDT The flavor of cloves infuses these pears and their tawny syrup during their long stay in the oven. Two hours is a long time, but it’s worth it: the pears are transformed, and the syrup, which is not very sweet, is caramelized. The pears will be intact, but they’re so soft you can eat them with a spoon. They also make a nice breakfast with yogurt. Recipes for Health Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. See All Recipes for Health » Visit Recipes for Health on Facebook. Related Recipes for Health: Desserts for the Conscientious (April 4, 2011) Recipes for Health: Winter Strawberry Gelato (April 5, 2011) Recipes for Health: Grapefruit Ice (April 7, 2011) Recipes for Health: Pear and Red Wine Sorbet (April 8, 2011) 6 ripe but firm pears 2 tablespoons honey 1/4 cup raw brown (turbinado) sugar or regular brown sugar, preferably organic fair-trade, tightly packed 12 cloves 1. Preheat the oven to 400 degrees. Butter a baking dish. Cut a small cone from the bottom of each pear with a paring knife, and place a teaspoon of honey inside. Peel a strip of skin away from the top of each pear, just below the stem, but leave the stems intact. Then place the pears bottom side down in the baking dish. Sprinkle the brown sugar over the pears. Pour in water until it reaches 1/3 of the way up the side of the pears, and place the cloves in the water. 2. Set the baking dish on a sheet pan, place in the oven and bake for 15 minutes. Then turn down the heat to 350 degrees and bake for two hours more, basting every 15 minutes with the liquid in the pan. From time to time, lay down the pears down in the liquid so they are thoroughly moistened and cook evenly. After two hours their skins should be shriveled and caramelized. 3. Remove the pears from the oven, transfer to a platter or bowls and allow to cool. Place the liquid in the baking dish in a saucepan, and reduce to a syrup. Pour over the pears, and serve or chill and serve cold. Yield: Six servings. Advance preparation: These will keep for three or four days in the refrigerator. Nutritional information per serving: 155 calories; 0 grams saturated fat; 0 grams polyunsaturated fat; 0 grams monounsaturated fat; 0 milligrams cholesterol; 41 grams carbohydrates; 6 grams dietary fiber; 5 milligrams sodium; 1 gram protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

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